COMPLETED BOARD ORDER�2��W28
Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No: A-11196
a. Approve and authorize the Director of Health to sign a Mental Health
Services Agreement with Davis Guest Home, Inc., for services to adults
with severe psychiatric disabilities, in the annual amount of $277,127 for
Fiscal Year 2008-09 and $248,127 for FY 2009-10 and FY 2010-11 for a
total agreement amount of $773,381; and
b. Authorize the Director of Health to sign up to three 3) future amendments
to this Mental Health Services Agreement where the amendments do not
exceed ten percent 10%) of the original contract amount, and do not
significantly change the scope of work.
Upon motion of Supervisor Salinas, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby:
a. Approved and authorized the Director of Health to sign a Mental Health Services Agreement
with Davis Guest Home, Inc., for services to adults with severe psychiatric disabilities, in the
annual amount of $277,127 for Fiscal Year 2008-09 and $248,127 for FY 2009-10 and FY
2010-11 for a total agreement amount of $773,381; and
b. Authorized the Director of Health to sign up to three 3) future amendments to this Mental
Health Services Agreement where the amendments do not exceed ten percent 10%) of the
original contract amount, and do not significantly change the scope of work.
PASSED AND ADOPTED this 24th day of June, 2008, by the following vote, to wit:
AYES: Supervisors Armenta, Calcagno, Salinas, Mettee-McCutchon, Potter
NOES: None
ABSENT: None
I, Annette D'Adamo, Interim Clerk of the Board of Supervisors of the County of Monterey, State of California,
hereby certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and
entered in the minutes thereof of Minute Book 74 for the meeting on June 24, 2008.
Dated: June 26, 2008
Annette D'Adamo, Interim Clerk of the Board of Supervisors
County of Monterey, State of California
Deputy
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EXECUTED AGREEMENTX���� �COUNTY OF MONTEREY
MENTAL HEALTH SERVICES AGREEEMENT
Contract Number: A-11196
COUNTY Department Contract Representative:
Len Foster
Director of Health
1270 Natividad Road, Salinas, CA 93906
THIS CONTRACT is made and entered into by and between the COUNTY OF MONTEREY, a
political subdivision of the State of California hereinafter referred to as COUNTY", and DAVIS
GUEST HOME, INC. hereinafter referred to as CONTRACTOR."
RECITALS
WHEREAS, COUNTY desires to enter into an Agreement whereby CONTRACTOR will
provide community mental health services in accordance with the requirements of the Bronzan-
McCorquodale Act California Welfare and Institutions Code sections 5600 et seq.), Part 2.5 of
Division 5 of the California Welfare and Institutions Code, and Titles 9 and 22 of the California
Code of Regulations; and
WHEREAS, CONTRACTOR is able to furnish such services under the terms and
conditions of this Agreement and in accordance with applicable law, including all federal and
state rules and regulations pertaining to the provision of Medi-Cal services.
NOW, THEREFORE, IT IS HEREBY AGREED AS FOLLOWS:
1. SERVICES TO BE PROVIDED
CONTRACTOR shall provide the services set forth in this Agreement, including the
program services detailed in Exhibit A, to the recipient population and to the COUNTY,
in compliance with the terms of this Agreement. These services can be summarized as
follows: community-based living that provides a normalizing experience for adults with
severe psychiatric disabilities.
II. EXHIBITS
The following exhibits are attached and incorporated by reference as a part of this
Agreement:
EXHIBIT A: PROGRAM DESCRIPTION
EXHIBIT B: PAYMENT PROVISIONS
EXHIBIT C: CONFIDENTIALITY OF PATIENT INFORMATION
EXHIBIT D: ASSURANCE OF COMPLIANCE WITH SECTION 504 OF THE
REHABILITATION ACT OF 1973, AS AMENDED
EXHIBIT E: MONTHLY SERVICE LEVEL REPORT
Davis Guest Home, Inc.
FY 08/09 FY 10/11
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EXECUTED AGREEMENTX���� �EXHIBIT F: PROVIDER INVOICE
EXHIBIT G: SCHEDULE OF RATES
EXHIBIT H: PRIOR AUTHORIZATION FOR ADMISSION FORM
EXHIBIT I: BUSINESS ASSOCIATE AGREEMENT
III. PAYMENT BY COUNTY
A Payment shall be made pursuant to the terms and conditions set forth in Exhibit B
attached hereto and by this reference made a part hereof.
B CONTRACTOR shall hold harmless the State of California and any recipients of
services in the event COUNTY does not reimburse CONTRACTOR for services
performed under this Agreement.
IV. TERM AND TERMINATION
A Term. This Agreement shall be effective July 1, 2008 and shall remain in effect
until June 30, 2011.
B Termination without Cause. Either party may terminate this Agreement at any
time by serving thirty 30) days written notice upon the other party. The notice
shall state the effective date of and the reason for the termination.
C Termination with Cause. COUNTY may cancel and terminate this Agreement for
good cause immediately upon written notice to CONTRACTOR. Good cause"
includes, but is not limited to, failure of CONTRACTOR to perform a material
requirement of the Agreement. Good cause" shall also include
CONTRACTOR's failure to implement corrective action in a timely fashion
pursuant to section IX of this Agreement.
D Reduction and/or Termination of Government Funding. Notwithstanding any
other provision of this Agreement, if the state or federal government terminates or
reduces its funding to the COUNTY for services that are to be provided under this
Agreement, then COUNTY may, after consultation with the CONTRACTOR,
elect to terminate this Agreement by giving written notice of termination to
CONTRACTOR effective immediately or on such other date as COUNTY
specifies in the notice. Alternatively, it is mutually agreed that the Agreement
shall be amended to reflect any reduction in funding.
E Survival of Obligations after Termination. Upon termination of this Agreement,
COUNTY will no longer refer clients to the CONTRACTOR under this
Agreement, and the rights and duties of the parties shall be terminated, except that
the following obligations shall survive termination:
1. CONTRACTOR shall, pursuant to this Agreement and upon approval of
the Behavioral Health Director, continue treatment of clients then
receiving care from CONTRACTOR until completion of treatment or until
continuation of the client's care by another provider can be arranged by
COUNTY;
Davis Guest Home, Inc. 2
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EXECUTED AGREEMENTX���� �2. COUNTY shall arrange for such transfer of treatment no later than sixty
60) days after Agreement termination if the clients' treatment is not by
then completed;
3. COUNTY, any payer, and CONTRACTOR will continue to remain
obligated under this Agreement with regard to payment for services
rendered prior to termination or required to be rendered after termination
as provided above, except that COUNTY's post-termination payment
obligations shall not exceed ten percent 10%) of the maximum amount
payable to the CONTRACTOR under this Agreement as specified in
Exhibit B;
4. CONTRACTOR will continue to remain obligated with respect to the
confidentiality and auditing requirements of this Agreement.
V. COMPLIANCE WITH APPLICABLE LAW AND TERMS OF GRANT
A Compliance with Law. In providing services under this Agreement,
CONTRACTOR shall comply with all applicable laws, regulations, and
administrative requirements adopted by federal, state, and local governments
including, but not limited to, Welfare and Institutions Code, Divisions 5, 6, and 9;
California Code of Regulations, Titles 9 and 22; any Short-Doyle and Short-
Doyle/Medi-Cal policies as identified in Department of Mental Health letters and
in the Cost Reporting/Data Collection CR/DC) Manual. In addition, if
CONTRACTOR is providing Medi-Cal services pursuant to this Agreement,
CONTRACTOR shall comply with Title XIX of the Social Security Act, and all
other applicable federal laws, regulations and guidelines pertaining to federally
funded mental health programs, including all requirements necessary for
Medicaid/Medi-Cal reimbursement for mental health treatment services.
B Compliance with Terms of State and/or Federal Grants. If this Agreement is
funded with monies received by the COUNTY pursuant to contract(s) with the
state and/or federal government in which the COUNTY is the grantee,
CONTRACTOR will comply with all provisions of said contract(s), to the extent
applicable to CONTRACTOR as a subgrantee under said contract(s), and said
provisions shall be deemed a part of this Agreement as if fully set forth herein.
Upon request, COUNTY will deliver a copy of said contract(s) to
CONTRACTOR at no cost to CONTRACTOR.
VI. LICENSURE AND STAFFING REQUIREMENTS
A Licensure and Certification. CONTRACTOR shall furnish qualified professional
personnel as prescribed by Title 9 of the California Code of Regulations, the
Business and Professions Code, the Welfare and Institutions Code, and all other
applicable law for the type of services rendered under this Agreement. All
personnel providing services pursuant to this Agreement shall be fully licensed in
accordance with all applicable law and shall remain in good professional standing
throughout the entire duration of this Agreement. CONTRACTOR shall comply
with all COUNTY and state certification and licensing requirements and shall
ensure that all services delivered by staff are within their scope of licensure and
Davis Guest Home, Inc. 3
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EXECUTED AGREEMENTX���� �practice.
B Staffing. CONTRACTOR shall ensure that all personnel, including any
subcontractors performing services under this Agreement, receive appropriate
training and supervision. CONTRACTOR shall also maintain appropriate levels
of staffing at all times when performing services under this Agreement.
VII. PATIENT RIGHTS
A CONTRACTOR shall comply with all applicable patients' rights laws including,
but not limited to, the requirements set forth in Welfare and Institutions Code,
Division 5, Part 1. sections 5325 et seq., and California Code of Regulations, Title
9, Division 1, Chapter 4, Article 6 sections 860 et seq.).
B As a condition of reimbursement under this Agreement, CONTRACTOR shall
ensure that all recipients of services under this Agreement shall receive the same
level of services as other patients served by CONTRACTOR. CONTRACTOR
shall ensure that recipients of services under this Agreement are not discriminated
against in any manner including, but not limited to, admissions practices,
evaluation, treatment, access to programs and or activities, placement in special
wings or rooms, and the provision of special or separate meals.
VIII. MAINTENANCE AND CONFIDENTIALITY OF PATIENT INFORMATION
A CONTRACTOR shall maintain clinical records for each recipient of service in
compliance with all state and federal requirements. Such records shall include a
description of all services provided by the CONTRACTOR in sufficient detail to
make possible an evaluation of services, and all data necessary to prepare reports
to the State, including treatment plans, records of client interviews, and progress
notes. CONTRACTOR shall retain clinical records for a minimum of seven 7)
years and, in the case of minors, for at least one year after the minor has reached
the age of majority, but for a period of no less than seven years.
B CONTRACTOR shall comply with the confidentiality requirements set forth in
Exhibit C and incorporated by reference as if fully set forth herein.
IX. CONTRACT MONITORING AND QUALITY CONTROL
A The State Department of Mental Health, COUNTY, and other appropriate state
and federal agencies shall have the right to inspect and evaluate the quality,
appropriateness and timelines of services performed under this Agreement.
B The Behavioral Health Director shall assign a Contract Monitor to ensure
compliance with the terms and conditions of this Agreement. The Contract
Monitor and CONTRACTOR shall meet at intervals deemed appropriate by
COUNTY. In addition, the Contract Monitor shall review at regular intervals all
statistical reports, financial records, clinical records, and other documents
concerning services provided under this Agreement. In addition, CONTRACTOR
shall at all times cooperate with the COUNTY's Quality Improvement QI) Plan.
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EXECUTED AGREEMENTX���� �C CONTRACTOR shall conduct reviews at regular intervals of the quality and
utilization of services for all recipients of service under this Agreement.
CONTRACTOR shall furnish all required data and reports in compliance with
State Department of Mental Health Client and Service Information System CSI).
Units of time reporting, as stipulated in the Cost Reporting/Data Collection
CR/DC) manual, are subject to special review and audit.
D If the COUNTY discovers any practice, procedure, or policy of the
CONTRACTOR which deviates from the requirements of this Agreement,
violates federal or state law, threatens the success of the program carried on
pursuant to this Agreement, jeopardizes the fiscal integrity of such program, or
compromises the health or safety of recipients of service, the COUNTY may
require corrective action, withhold payment in whole or in part, or terminate this
Agreement immediately. If COUNTY notifies CONTRACTOR that corrective
action is required, CONTRACTOR shall initiate and correct any and all
discrepancies, violations or deficiencies to the satisfaction of the COUNTY
within thirty 30) days, unless the COUNTY notifies the CONTRACTOR that it
is necessary to make corrections at an earlier date in order to protect the health
and safety of recipients of service.
E If CONTRACTOR is an in-patient facility, CONTRACTOR shall submit its
patient admissions and length of stay requests for utilization review through
existing hospital systems or professional standards review organizations.
X. REPORTS OF DEATH, INJURY, DAMAGE, OR ABUSE
A Reports of Death, Injury, or Damage. If death, serious personal injury, or
substantial property damage occur in connection with the performance of this
Agreement, CONTRACTOR shall immediately notify the Behavioral Health
Director by telephone. In addition, CONTRACTOR shall promptly submit to
COUNTY a written report including: 1) the name and address of the
injured/deceased person; 2) the time and location of the incident; 3) the names
and addresses of CONTRACTOR's employees or agents who were involved with
the incident; 3) the names of COUNTY employees, if any, involved with the
incident; and 4) a detailed description of the incident.
B Child Abuse Reporting. CONTRACTOR shall ensure that all known or suspected
instances of child abuse or neglect are promptly reported to proper authorities as
required by the Child Abuse and Neglect Reporting Act, Penal Code sections
11164 et seq. CONTRACTOR shall require that all of its employees, consultants,
and agents performing services under this Agreement who are mandated reporters
under the Act sign statements indicating that they know of and will comply with
the Act's reporting requirements.
C Elder Abuse Reporting. CONTRACTOR shall ensure that all known or suspected
instances of abuse or neglect of elderly people 65 years of age or older and
dependent adults age 18 or older are promptly reported to proper authorities as
required by the Elder Abuse and Dependent Adult Protection Act Welfare and
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EXECUTED AGREEMENTX���� �Institutions Code sections 15600 Code et seq.). CONTRACTOR shall require
that all of its employees, consultants, and agents performing services under this
Agreement who are mandated reporters under the Act sign statements indicating
that they know of and will comply with the Act's reporting requirements.
XI. INDEMNIFICATION
A CONTRACTOR shall indemnify, defend, and save harmless the COUNTY, its
officers, agents, and employees, to the extent permitted by applicable law, from
and against any and all claims, liabilities, and losses whatsoever including but
not limited to damages, court costs, and attorneys' fees) occurring or resulting to
any and all persons, firms, or corporations furnishing or supplying work, services,
materials, or supplies in connection with the performance of this Agreement, and
from any and all claims, liabilities, and losses occurring or resulting to any
person, firm, or corporation for damage, injury, or death arising out of or
connected with the CONTRACTOR's performance of this Agreement, unless
such claims, liabilities, or losses arise out of the sole negligence or willful
misconduct of COUNTY. CONTRACTOR's performance" includes
CONTRACTOR's action or inaction and the action or inaction of
CONTRACTOR's officers, employees, agents, and subcontractors.
XII. INSURANCE
Without limiting CONTRACTOR's duty to indemnify, CONTRACTOR shall maintain
in effect throughout the term of this Agreement a policy or policies of insurance with the
following minimum limits of liability:
A Commercial general liability including, but not limited to, premises, personal
injuries, products, and completed operations, with a combined single limit of not
less than one million dollars $1,000,000) per occurrence; and
B Automobile liability covering all motor vehicles, including owned, leased, non-
owned, and hired vehicles used in providing services under this Agreement, with
a combined single limit of not less than one million dollars $1,000,000) per
occurrence; and
C Workers' Compensation Insurance, if CONTRACTOR employs others in the
performance of this Agreement, in accordance with California Labor Code section
3700 and with Employer's Liability limits not less than one million dollars
$1,000,000) each person, one million dollars $1,000,000) each accident and one
million dollars $1,000,000) each disease; and
D Professional liability insurance in the amount of not less than one million dollars
$1,000,000) per claim and two million dollars $2,000,000) in the aggregate, to
cover liability for malpractice or errors or omissions made in the course of
rendering professional services. If professional liability insurance is written on a
claims-made" basis rather than an occurrence basis, CONTRACTOR shall, upon
the expiration or earlier termination of this Agreement, obtain extended reporting
Davis Guest Home, Inc. 6
FY 08/09 FY 10/11
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ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
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AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
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3)-U012
FUTURE-U012
AMENDMENTS-U012
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HEALTH-U012
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AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
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AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
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OF-U012
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EXECUTED AGREEMENTX���� �coverage tail coverage") with the same liability limits. Any such tail coverage
shall continue for at least five 5) years following the expiration or earlier
termination of this Agreement.
E General Insurance Requirements.
1. All insurance required by this Agreement shall be with a company
acceptable to the COUNTY and issued and executed by an admitted
insurer authorized to transact insurance business in the State of California.
Unless otherwise specified by this Agreement, all such insurance shall be
written on an occurrence basis, or, if the policy is not written on an
occurrence basis, such policy with the coverage required herein shall
continue in effect for a period of three 3) years following the date
CONTRACTOR completes its performance of services under this
Agreement.
2. Each liability policy shall provide that the COUNTY shall be given notice
in writing at least thirty 30) days in advance of any endorsed reduction in
coverage or limit, cancellation, or intended non-renewal thereof. Each
policy shall provide identical coverage for CONTRACTOR and additional
insureds with respect to claims arising from each subcontractor, if any,
performing work under this Agreement, or be accompanied by a certificate
of insurance showing each subcontractor has identical insurance coverage
to the above requirements.
3. Commercial general liability and automobile liability policies shall
provide an endorsement naming the County of Monterey, its officers,
agents, and employees as Additional Insureds and shall further provide
that such insurance is primary insurance to any insurance or self-insurance
maintained by the COUNTY and that the insurance of the Additional
Insureds shall not be called upon to contribute to a loss covered by the
CONTRACTOR's insurance.
4. Prior to the execution of this Agreement by the COUNTY,
CONTRACTOR shall file certificates of insurance with the County's
Contract Administrator and County's Contracts/Purchasing Division,
showing that CONTRACTOR has in effect the insurance required by this
Agreement. The CONTRACTOR shall file a new or amended certificate
of insurance within five 5) calendar days after any change is made in any
insurance policy which would alter the information on the certificate then
on file. Acceptance or approval of insurance shall in no way modify or
change the indemnification clauses in the Agreement, which shall continue
in full force and effect.
5. CONTRACTOR shall at all times during the term of this Agreement
maintain in force the insurance coverage required under this Agreement
Davis Guest Home, Inc. 7
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39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
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11905-U05
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DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
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DIRECTOR-U012
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HEALTH-U012
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TO-U012
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AMENDMENTS-U012
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CONTRACT-U012
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CHANGE-U012
SCOPE-U012
OF-U012
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EXECUTED AGREEMENTX���� �and shall send, without demand by COUNTY, annual certificates to
County's Contract Administrator and County's Contract/Purchasing
Division. If the certificate is not received by the expiration date,
COUNTY shall notify CONTRACTOR and CONTRACTOR shall have
five 5) calendar days to send in the certificate, evidencing no lapse in
coverage during the interim. Failure by CONTRACTOR to maintain such
insurance is a default of this Agreement which entitles COUNTY, at its
sole discretion, to terminate this Agreement immediately.
XIII. ANNUAL COST REPORT
A Submission of Year-End Cost Report. For each fiscal year or portion thereof that
this Agreement is in effect, CONTRACTOR shall provide to the COUNTY one
1) original and one 1) copy of an annual cost report within ninety 90) days
following the close of each fiscal year. Such reports shall be prepared in
accordance with generally accepted accounting principles, cost report forms, and
instructions provided by the COUNTY.
B Submission of Cost Report Upon Early Termination. If this Agreement is
terminated or canceled prior to June 30th of any year, CONTRACTOR shall
prepare a cost report for the Agreement period which ends on the termination or
cancellation date, and shall submit two 2) copies of that report to the COUNTY
within sixty 60) days after the termination or cancellation date.
XIV. ACCESS TO AND AUDIT OF RECORDS
A Maintenance of Records. CONTRACTOR shall maintain records indicating the
nature and extent of all services performed and all payments received under this
Agreement for a period of five 5) years after completion of all services pursuant
to this Agreement or until all disputes, claims, litigation, or audits have been
resolved, whichever occurs later. CONTRACTOR shall maintain such records in
a form comporting with generally accepted standards and applicable law.
Government Code sec. 8546.7 makes any expenditure of public funds over
$10,000 subject to the examination and audit of the State Auditor for a period of
three 3) years after final payment under the Agreement.
B Right to Inspect Records. The COUNTY, State Department of Mental Health, the
Comptroller General of the United States, the U.S. Department of Health and
Human Services, and other authorized federal and state agencies shall have the
right to inspect any and all books, records, and facilities maintained by
CONTRACTOR during normal business hours to evaluate the use of funds and
the cost, quality, appropriateness, and timeliness of services.
C Overpayment. If the results of any audit show that the funds paid to
CONTRACTOR under this Agreement exceeded the amount due, then
CONTRACTOR shall pay the excess amount to COUNTY in cash not later than
sixty 60) days after the final audit settlement, or at COUNTY'S election,
Davis Guest Home, Inc. 8
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39655-U01
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FO64075-U03
MG69409-U03
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ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
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HEALTH-U012
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AGREEMENT-U012
AMENDMENTS-U012
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EXCEED-U012
TEN-U012
PERCENT-U012
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OF-U012
ORIGINAL-U012
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AMOUNT,-U012
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SIGNIFICANTLY-U012
CHANGE-U012
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OF-U012
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EXECUTED AGREEMENTX���� �COUNTY may recover the excess or any portion of it by offsets made by
COUNTY against any payment owed to CONTRACTOR under this or any other
Agreement.
D Responsibility for Audit Exceptions. Any and all audit exceptions by COUNTY
or any state or federal agency resulting from an audit of CONTRACTOR's
performance of this Agreement, or actions by CONTRACTOR, its officers,
agents, and employees shall be the sole responsibility of the CONTRACTOR.
E Availability of Records for Grievances and Complaints by Recipients of Service.
CONTRACTOR shall ensure the availability of records for the prompt handling
of grievances or complaints filed by recipients of services. Release of records
shall be subject to the confidentiality provisions set forth in this Agreement.
F Reports. CONTRACTOR shall prepare any reports and furnish all information
required for reports to be prepared by the COUNTY as may be required by the
State of California or applicable law.
XV. NON-DISCRIMINATION
A Non-discrimination. During the performance of this Agreement, CONTRACTOR
shall not unlawfully discriminate against any person because of race, religion,
color, national origin, ancestry, mental or physical handicap, medical condition,
marital status, age over 40), sex, or sexual preference, either in
CONTRACTOR's employment practices or in the furnishing of services to
recipients. CONTRACTOR shall insure that the evaluation and treatment of its
employees and applicants for employment and all persons receiving and
requesting services are free of such discrimination. The provision of services
primarily or exclusively to such target population as may be designated in this
Agreement shall not be deemed to be unlawful discrimination. In addition,
CONTRACTOR's facility access for the disabled shall comply with section 504
of the Rehabilitation Act of 1973, as amended 29 U.S.C. 794).
B Discrimination defined. The term discrimination," as used in this Agreement, is
the same term that is used in Monterey County Code, Chapter 2.80 Procedures
for Investigation and Resolution of Discrimination Complaints"); it means the
illegal denial of equal employment opportunity, harassment including sexual
harassment and violent harassment), disparate treatment, favoritism, subjection to
unfair or unequal working conditions, and/or discriminatory practice by any
Monterey County official, employee or agent, due to an individual's race, color,
ethnic group, national origin, ancestry, religious creed, sex, sexual preference,
age, veteran's status, cancer-related medical condition, physical handicap
including AIDS) or disability. The term also includes any act of retaliation.
C Application of Monterey County Code Chapter 2.80. The provisions of Monterey
County Code Chapter 2.80 apply to activities conducted pursuant to this
Agreement. CONTRACTOR and its officers and employees, in their actions
under this Agreement, are agents of the COUNTY within the meaning of Chapter
2.80 and are responsible for ensuring that their workplace and the services that
Davis Guest Home, Inc. 9
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ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
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$773,381;-U012
B.-U012
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HEALTH-U012
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OF-U012
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OF-U012
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EXECUTED AGREEMENTX����
�they provide are free of discrimination, as required by Chapter 2.80. Complaints
of discrimination made by recipients of services against CONTRACTOR may be
pursued using the procedures established by Chapter 2.80. CONTRACTOR shall
establish and follow its own written procedures for prompt and fair resolution of
discrimination complaints made against CONTRACTOR by its own employees
and agents, and shall provide a copy of such procedures to COUNTY on demand
by COUNTY.
D Compliance with Applicable Law. During the performance of this Agreement,
CONTRACTOR shall comply with all applicable federal, state and local laws and
regulations which prohibit discrimination including, but not limited to, the
following:
1. California Code of Regulations, Title 9, sections 526, 527;
2. California Fair Employment and Housing Act, Govt. Code sec. 12900 et
seq.), and the administrative regulations issued thereunder, Cal. Code of
Regulations, Title 2, secs. 7285 et seq.;
3. Govt. Code sees. 11135-11139.5 Title 2, Div. 3, Part 1, Chap. 1, Art. 9.5)
and any applicable administrative rules and regulations issued under these
sections;
4. Federal Civil Rights Acts of 1964 and 1991 see especially Title VI, 42
U.S.C. Sees. 2000(d) et seq.), as amended, and all administrative rules and
regulations issued thereunder see especially 45 C.F.R. Parts 80);
5. Sections 503 and 504 of the Rehabilitation Act of 1973, as amended 29
U.S.C. sec. 793 and 794); all requirements imposed by the applicable HHS
regulations 45 C.F.R. Part 84); and all guidelines and interpretations
issued pursuant thereto;
6. Americans with Disabilities Act of 1990, 42 U.S.C. sees. 12101 et seq.,
and 47 U.S.C. Sees. 225 and 611, and any federal regulations issued
pursuant thereto see 24 C.F.R. Chapter 1; 28 C.F.R. Parts 35 and 36; 29
C.F.R. Parts 1602, 1627, and 1630; and 36 C.F.R. Part 1191);
7. Unruh Civil Rights Act, Cal. Civil Code sec. 51 et seq.
8. Government Code section 12900 A-F) and California Code of
Regulations, Title 2, Division 4, Chapter 5.
In addition, the applicable regulations of the Fair Employment and Housing
Commission implementing Government Code section 12990 as set forth in
Chapter 5, Division 4 of Title 2 of the California Code of Regulations are
incorporated into this Agreement by reference and made a part hereof as if set
forth in full.
E Written Assurance. Upon request by COUNTY, CONTRACTOR will give any
written assurances of compliance with the Civil Rights Acts of 1964 and 1991, the
Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act
of 1990, as may be required by the federal government in connection with this
Davis Guest Home, Inc. 10
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EXECUTED-U02
AGREEMENT-U02
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FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
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DO71619-U03
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AMOUNT-U012
OF-U012
$277,127-U012
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2008-09-U012
$248,127-U012
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2009-10-U012
FY-U012
2010-11-U012
A-U012
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AMOUNT-U012
OF-U012
$773,381;-U012
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OF-U012
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EXECUTED AGREEMENTX����
�Agreement, pursuant to 45 C.F.R. sec. 80.4 or C.F.R. sec. 84.5 or other applicable
state or federal regulations.
F Written Statement of Non-discrimination Policies. CONTRACTOR shall
maintain a written statement of its non-discrimination policies. Such statement
shall be consistent with the terms of this Agreement and shall be available to
employees, recipients of services, and members of the public upon request.
G Notice to Labor Unions. CONTRACTOR shall give written notice of its
obligations under this section to labor organizations with which it has a collective
bargaining or other agreement.
H Access to Records by Government Agencies. CONTRACTOR shall permit
access by COUNTY and by representatives of the State Department of Fair
Employment and Housing and any state agency providing funds for this contract
upon reasonable notice at any time during normal business hours, but in no case
less than 24 hours' notice, to such of its books, records, accounts, facilities, and
other sources of information as the inspecting party may deem appropriate to
ascertain compliance with these nondiscrimination provisions.
I Binding on Subcontractors. The provisions above shall also apply to all
CONTRACTOR's subcontractors. CONTRACTOR shall include the non-
discrimination and compliance provisions above in all subcontracts to perform
work or provide services under this Agreement.
XVI. CULTURAL COMPETENCY AND LINGUISTIC ACCESSIBILITY
A CONTRACTOR shall provide services in a culturally competent manner to assure
access to services by all eligible individuals as required by Department of Mental
Health regulations and policies and other applicable laws. Cultural competency is
defined as a congruent set of practice skills, behaviors, attitudes, and policies that
enable staff to work effectively in cross-cultural situations. Specifically,
CONTRACTOR'S provision of services shall acknowledge the importance of
culture, adapt services to meet culturally unique needs, and promote congruent
skills, behaviors, attitudes, and policies enabling all persons providing services to
function effectively in cross-cultural situations.
B CONTRACTOR shall provide linguistically accessible services to assure access
to services by all eligible individuals as required by Department of Mental Health
regulations and policies and other applicable laws. Specifically, CONTRACTOR
shall provide services to eligible individuals in their primary language through
linguistically proficient staff or interpreters. Family members, friends, or
neighbors may be used as interpreters only in emergency situations.
C For the purposes of this Section, access is defined as the availability of medically
necessary mental health services in a manner that promotes, provides the
opportunity and facilitates their use.
Davis Guest Home, Inc. 11
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FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
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AMOUNT-U012
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$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
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TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
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EXECUTED AGREEMENTX����
�XVII. DRUG FREE WORKPLACE
CONTRACTOR shall submit to the COUNTY evidence of compliance with the
California Drug-Free Workplace Act of 1990, Government Code sections 8350 et seq.,
to provide a drug-free workplace by doing all of the following:
A Publishing a Statement notifying employees that the unlawful manufacture,
distribution, dispensation, possession, or use of a controlled substance is
prohibited in the person's or organization's workplace and specifying the actions
that will be taken against employees for violations of the prohibitions.
B Establishing a drug-free awareness program to inform employees about all of the
following:
1. The dangers of drug abuse in the workplace;
2. The person's or organization's policy of maintaining a drug-free
workplace;
3. Any available drug counseling, rehabilitation, and employees assistance
programs;
4. The penalties that may be imposed upon employees for drug abuse
violations;
5. Requiring that each employee engaged in the performance of the
Agreement or grant be given a copy of the company's drug-free policy
statement and that, as a condition of employment on the contract or grant,
the employee agrees to abide by the terms of the statement.
XVIII. INDEPENDENT CONTRACTOR
In the performance of work, duties, and obligations under this Agreement,
CONTRACTOR is at all times acting and performing as an independent contractor and
not as an employee of the COUNTY. No offer or obligation of permanent employment
with the COUNTY or particular COUNTY department or agency is intended in any
manner, and CONTRACTOR shall not become entitled by virtue of this Agreement to
receive from COUNTY any form of employee benefits including, but not limited to, sick
leave, vacation, retirement benefits, workers' compensation coverage, insurance or
disability benefits. CONTRACTOR shall be solely liable for and obligated to pay
directly all applicable taxes including, but not limited to, federal and state income taxes
and social security, arising out of CONTRACTOR's performance of this Agreement. In
connection therewith, CONTRACTOR shall defend, indemnify, and hold the COUNTY
harmless from any liability COUNTY may incur because of CONTRACTOR's failure to
pay such taxes.
XIX. SUBCONTRACTING
CONTRACTOR may not subcontract any services under this Agreement without
COUNTY's prior written authorization. At any time, COUNTY may require a complete
Davis Guest Home, Inc. 12
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FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
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DIRECTOR-U07
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HEALTH-U07
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SIGN-U07
A-U07
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SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
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FUTURE-U012
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TO-U012
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WORK.-U012
EXECUTED AGREEMENTX����
�listing of all subcontractors employed by the CONTRACTOR for the purpose of
fulfilling the terms of this Agreement. CONTRACTOR shall be legally responsible for
subcontractors' compliance with the terms and conditions of this Agreement and with
applicable law. All subcontracts shall be in writing and shall comply with all COUNTY
requirements, state requirements, and applicable law. In addition, CONTRACTOR shall
be legally responsible to COUNTY for the acts and omissions of any subcontractors and
persons either directly or indirectly employed by them.
XX. GENERAL PROVISIONS
A Amendment. This Agreement may be amended or modified only by an instrument
in writing signed by all the parties hereto.
B Waiver. Any waiver of any terms and conditions of this Agreement must be in
writing and signed by the parties hereto. A waiver of any of the terms and
conditions of this Agreement shall not be construed as a waiver of any other terms
or conditions in this Agreement.
C Assignment. This Agreement shall not be assigned by CONTRACTOR, either in
whole or in part, without the prior written consent of the COUNTY. Any
assignment without such consent shall automatically terminate this Agreement.
D Contractor. The term CONTRACTOR" as used in this Agreement includes
CONTRACTOR's officers, agents, and employees acting on CONTRACTOR's
behalf in the performance of this Agreement.
E Headings. The section and paragraph headings are for convenience only and shall
not be used to interpret the terms of this Agreement.
F Counterparts. This Agreement may be executed in two or more counterparts,
each of which shall be deemed an original, but all of which together shall
constitute one and the same Agreement.
G Authority. Any individual executing this Agreement on behalf of an entity
represents and warrants hereby that he or she has the requisite authority to enter
into this Agreement on behalf of such entity and bind the entity to the terms and
conditions of the same.
H Integration. This Agreement, including the exhibits hereto, shall represent the
entire Agreement between the parties with respect to the subject matter hereof and
shall supersede all prior negotiations, representations, or agreements, either
written or oral, between the parties as of the effective date hereof.
I Governing Law. This Agreement shall be governed by and interpreted under the
laws of the State of California.
J Non-exclusive Agreement. This Agreement is non-exclusive and both parties
expressly reserve the right to contract with other entities for the same or similar
services.
K Construction of Agreement. The parties agree that each party has fully
Davis Guest Home, Inc. 13
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39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
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TO-U012
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3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
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AMENDMENTS-U012
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ORIGINAL-U012
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SIGNIFICANTLY-U012
CHANGE-U012
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OF-U012
WORK.-U012
EXECUTED AGREEMENTX���� �participated in the review and revision of this Agreement and that any rule of
construction to the effect that ambiguities are to be resolved against the drafting
party shall not apply in the interpretation of this Agreement or any amendment
hereto.
L Severability. In the event of changes in law that effect the provisions of this
Agreement, the parties agree to amend the affected provisions to conform to the
changes in the law retroactive to the effective date of such changes in law. The
parties further agree that the terms of this Agreement are severable and, in the
event of changes in law as described above, the unaffected provisions and
obligations of this Agreement will remain in full force and effect.
M Time is of the essence. Time is of the essence in each and all of the provisions of
this Agreement.
XXI. CONSERVATORSHIP STATUS
COUNTY agrees that in the event individuals placed with CONTRACTOR are no
longer conserved by COUNTY, the COUNTY will notify the CONTRACTOR as
to the change of status for the conservatee. COUNTY will continue case
management responsibility for any client whose Monterey County
conservatorship terminates while at CONTRACTOR'S facility. COUNTY
further agrees to work towards avoiding a non-conserved client leaving
CONTRACTOR'S facility and becoming a Stanislaus County permanent resident.
All efforts will be made to relocate such a client to Monterey County for
placement.
XXII. NOTICES AND DESIGNATED LIAISONS
Notices to the parties in connection with this Agreement may be given personally
or may be delivered by certified mail, return receipt requested, addressed to:
COUNTY OF MONTEREY
Wayne W. Clark
Behavioral Health Director
1270 Natividad Road
Salinas, CA 93906
831) 755-4509
CONTRACTOR
Lonny Davis
Davis Guest Home, Inc.
1878 East Hatch Road
Modesto, CA 95351
209) 538-1496
14
Davis Guest Home, Inc.
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39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
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AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
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DIRECTOR-U012
OF-U012
HEALTH-U012
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EXECUTED AGREEMENTX���� �IN WITNESS WHEREOF, the COUNTY and CONTRACTOR have executed this Agreement as
of the day and year written above.
COUNTY OF MONTEREY CONTRACTOR
DAVIS GUEST HOME, INC.
B 7--~
irector ealth or P rchasing u er 000) ntractor's siness Name
Date: By:
APPROVED AS O E AL FORM ignature Chair, President or Vice President) *
By:
County CounseT \j ame and Title Zf H
Date: 8 Date: Z o
APPROVED AS TO FISCAL PROVISIONS
By: B L
Auditor-Controller Signature of Secretary. Assistant Secretary, CFO, or Assistant
Treasurer) *
Date:- n C
APPg9 A,,t 1,(TO;INSU,RA NCE L ROVISIONS Name and Title
LNGIJAL:
By: 1 4/ a4 g
t Date:
o
Risk d g
5 Ok'
Date:
APPROVED AST ONTE
By:
Behavio al Health irector
Date:
*INSTRUCTIONS: If CONTRACTOR is a corporation, including limited liability and nonprofit corporations, the fidl legal name of
the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a partnership.
the name of the partnership shall be set forth above together with the signature of a partner who has authority to execute this
Agreement on behalf of the partnership. If CONTRACTOR is contracting in an individual capacity, the individual shall set forth
the name of the business. if any, and shall personally sign the Agreement.
Davis Guest Home, Inc. 15
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EXECUTED-U02
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MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
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DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
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WORK.-U012
EXECUTED AGREEMENTX���� �EXHIBIT A:
PROGRAM DESCRIPTION
1. IDENTIFICATION OF PROVIDER
Davis Guest Home, Inc.
1878 East Hatch Road
Modesto, CA 95351
11. CERTIFICATION/TYPE OF FACILITY LICENSE
The Monterey County Behavioral Health Division MCBHD) has developed a residential
care registry of Monterey County clients in the program. A facility must provide a
monthly list of clients they are providing extra assistance to be eligible for the registry.
The facility must show evidence of currently meeting all licensing requirements for
Community Care facilities authorized by the State Department of Social Services to
provide care and supervision to mentally disordered adults, as defined in Section 1502 of
the Health and Safety Code. The facility must retain ongoing licensure and be in full
compliance with licensing regulations. Any complaints received by the CONTRACTOR
pertaining to services performed pursuant to this Agreement must be referred to
MCBHD.
III. PROGRAM GOALS and OBJECTIVES
In order to receive a payment for the care of mentally ill clients who have been assessed
by the MCBHD, a residential care facility must be licensed by the State of California
Community Care Licensing and must provide services that will accomplish the following
goals and objectives:
Goal #1 For clients who require the management of behavioral problems, the
facility will provide a level of supervision and intensive interaction
that is consistent with the clients' needs as outlined in the client's
individualized care plan.
Objectives:
I a. The facility will participate with the case manager, the client and others in the
development of an individualized needs assessment and care plan for each client within
the first thirty 30) days of placement and retain a signed copy of the documented results
in a client chart that is retained in the facility.
1 b. The facility will work cooperatively with the staff and programs of the MCBHD
to accomplish each client's individualized treatment plan and will document significant
ongoing problems and/or progress.
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7/25/2008-U04
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MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
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EXECUTED AGREEMENTX���� �I c. The facility will attempt to reasonably manage those crisis situations so as to
avoid psychiatric hospitalization. The goal will be to reduce the client's need for acute
psychiatric services.
ld. The facility will work cooperatively with and provide information to the MCBHD
Case Manager to facilitate the evaluation of those clients deemed to require re-admission.
GOAL #2 The facility will assist the client to become more responsible to take
medications as prescribed by the treating physician.
Objectives:
2a. Facility staff will transport the client to, and/or will monitor, visits for psychiatric
treatment at MCBHD.
2b. Facility staff will attend scheduled medication evaluation and planning
appointments and will work with MCBHD staff when medications are changed.
2c. The facility will store and dispense medication in an approved and effective
manner, following State guidelines.
2d. The facility will maintain an updated record of the daily dispensing of medication,
recording changes in dosages and types and recording the effects of medication
administration.
GOAL #3 The facility will encourage the client to use treatment services and
develop continuing support systems.
Objectives:
3a. The facility will provide transportation for the client to attend services and
programs as outlined in each client's individual care plan.
3b. The facility will educate and encourage the client to use the services of the
MCBHD Adult Services Programs and other specialized services identified in each
client's individualized care plan.
3c. Facility staff will cooperate with the case manager and the staff of specialized
services identified in each client's individualized care plan.
3d. The facility will document in the client folder, the client's attendance at
community programs.
Davis Guest Home, Inc. 2
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FO21330-U03
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FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
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AUTHORIZE-U07
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HEALTH-U07
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HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
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OF-U012
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EXECUTED AGREEMENTX���� �GOAL #4 The facility will encourage the client's use of leisure time in a
constructive manner.
Objectives:
4a. The facility will post, on a monthly basis, information about programs, groups
and activities that are provided by community agencies for the general and specialized
needs and interests of the client.
4b. The facility will encourage the client to develop regular daily activities or
routines.
4c. The facility will post, on a monthly basis, the activities that the facility will
provide for the client to supplement those provided by community agencies.
4e. The facility will document in the client's folder the monthly activities attended by
the client.
GOAL #5 The facility will encourage the client to maintain an acceptable level of
personal hygiene and grooming, as well as physical and dental health.
Objectives:
5a. Facility staff will encourage, track, monitor, and reinforce the maintenance of an
acceptable level of personal hygiene and grooming by the client, as well as teach self-
care when needed.
5b. The facility will provide adequate supplies and materials to accomplish this goal.
5c. The facility will ensure that the client receives an annual medical evaluation and
dental check-up and will record the date and results of both in the client's folder.
5d. The facility will monitor to ensure that the client follows up on any established
plan to care for identified medical and dental problems and will record these actions in
the client's folder.
GOAL #6 The facility will provide services in a manner that reflects an
understanding of the specialized needs of the seriously mentally ill.
Objectives:
6a. The facility will ensure that all administrative staff and staff responsible for the
supervision of clients receive a minimum of twenty 20) hours of specialized training
approved by the MCBHD.
Davis Guest Home, Inc. 3
FY 08109 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
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EXECUTED AGREEMENTX���� �6b. The facility will document and maintain a record of each staff person's attendance
at approved training programs.
GOAL #7 The facility will allow the staff of the MCBHD access to the facility, to
the extent authorized by law.
Objective:
7a. The facility will work with the staff of the MCBHD to conduct client assessments,
monitor care, provide consultation, conduct record reviews and evaluate the results of the
services.
IV. TREATMENT SERVICES
The MCBHD will provide case management services to all clients. Clients who receive
services will be assessed and monitored by the MCBHD Case Management staff,
initially, and at least every ninety 90) days thereafter. A copy of the completed
assessment will be reviewed, scored and approved by the Unit Supervisor. The
Behavioral Health Program Manager must certify and approve the assessment for
admittance and continuance of the client in the supplemental rate program. This
procedure will be used to assist in the determination of the functional ability and
programmatic needs of the clients, and the appropriate placement in facilities providing
supplemental services. If there are more clients eligible for the program than funding
permits, eligible clients will be placed on a waiting list as vacancies permit.
Davis Guest Home, Inc. 4
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
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DO71619-U03
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11905-U05
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FY-U012
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$248,127-U012
FY-U012
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A-U012
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EXECUTED AGREEMENTX���� �EXHIBIT B:
PAYMENT PROVISIONS
1. PAYMENT TYPE
Negotiated Rate
H. PAYMENT CONDITIONS
A In order to receive any payment under this Agreement, CONTRACTOR shall
submit reports and claims in such form as may be required by the County of
Monterey's Behavioral Health Division. Specifically, CONTRACTOR shall
submit its claims on a form acceptable to COUNTY, Exhibit F, so as to reach the
Behavioral Health Division no later than the 30th day of the month following the
month of service. Upon termination of this Agreement, CONTRACTOR shall
submit its final claim for payment no later than thirty 30) days after the
completion of services.
A If CONTRACTOR fails to submit claims for services provided under the term of
this Agreement as described above, the COUNTY may, at its sole discretion, deny
payment for that month of service and disallow the claim.
B COUNTY shall review and certify CONTRACTOR's claim either in the
requested amount or in such other amount as COUNTY approves in conformity
with this Agreement, and shall then submit such certified claim to the COUNTY
Auditor. The Auditor shall pay the claim in the amount certified by the
COUNTY.
C If COUNTY certifies payment at a lesser amount than the amount requested,
COUNTY shall immediately notify the CONTRACTOR in writing of such
certification and shall specify the reason for it. If the CONTRACTOR desires to
contest the certification, the CONTRACTOR must submit a written notice of
protest to the COUNTY within twenty 20) days after the CONTRACTOR's
receipt of the COUNTY notice. The parties shall thereafter promptly meet to
review the dispute and resolve it on a mutually acceptable basis. No court action
may be taken on such a dispute until the parties have met and attempted to resolve
the dispute in person.
III. PAYMENT RATE
Services shall be paid at the daily rates outlined in Exhibit G and shall be subject to the
applicable cost report provisions of this Agreement.
Davis Guest Home, Inc.
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
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DO71619-U03
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$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
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AUTHORIZE-U012
DIRECTOR-U012
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TO-U012
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UP-U012
TO-U012
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AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
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EXECUTED AGREEMENTX���� �IV. MAXIMUM OBLIGATION OF COUNTY:
A. Subject to the limitations set forth herein, COUNTY shall pay to
CONTRACTOR during the term of this Agreement a maximum amount of
$773,381 for services rendered under this Agreement.
B. Maximum Annual Liability:
FISCAL YEAR MAXIMUM LIABILITY AMOUNT
July 1, 2008 to June 30, 2009 $277,127
July 1, 2009 to June 30, 2010 $248,127
July 1, 2010 to June 30, 2011 $248,127
TOTAL MAXIMUM LIABILITY $773,381
C. If, as of the date of signing this Agreement, CONTRACTOR has already
received payment from COUNTY for services rendered under this
Agreement, such amount shall be deemed to have been paid out under this
Agreement and shall be counted towards COUNTY's maximum liability
under this Agreement.
D. If for any reason this Agreement is canceled, COUNTY's maximum
liability shall be the total utilization to the date of cancellation not to
exceed the maximum amount listed above.
Davis Guest Home, Inc. 2
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
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7/25/2008-U04
BARAJASRM-U04
11905-U05
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$277,127-U012
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2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
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AMOUNT-U012
OF-U012
$773,381;-U012
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AUTHORIZE-U012
DIRECTOR-U012
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EXECUTED AGREEMENTX���� �EXHIBIT C:
CONFIDENTIALITY OF PATIENT INFORMATION
Confidentiality of Patient Information and Records. All patient information and records are confidential.
CONTRACTOR shall maintain the confidentiality of all patient records, including billings and computerized
records, in accordance with all state and federal law relating to confidentiality of patient records and patient
information, including but not limited to: Welfare and Institutions Code sections 5328 et seq., 14100.2, and
10850 et seq; Title 45 Code of Federal Regulations section 205.50, and Title 42, CFR, section 431.300 et seq.
Patient information" or confidential information" includes any patient/recipient of services identifying
information including, but not limited to: name, identifying numbers, symbol, fingerprint, photograph or voice
print. In addition, patient information" or confidential information" includes all information
CONTRACTOR has obtained about a patient/recipient of services whether or not a documentary record of such
information exists.
Use and Disclosure of Patient Information. Confidential information gained by CONTRACTOR from access
to records and from contact with patients/recipients of service and complainants shall be used by
CONTRACTOR only in connection with its performance under this Agreement. CONTRACTOR shall not
disclose patient records or information, including the identities of patients/recipients of service, without proper
consent to such disclosure or a court order requiring disclosure. In addition, CONTRACTOR shall obtain
COUNTY's authorization to such disclosure prior to any release of confidential information. The COUNTY,
through the Behavioral Health Director, shall have access to such confidential information.
Penalty for Unauthorized Disclosure. CONTRACTOR understands that disclosure of patient information in
violation of law may subject the party releasing the information to a minimum of $10,000 in civil damages, as
set forth in Welfare and Institutions Code Section 5330.
Duty to Warn. CONTRACTOR understands that persons providing services under this Agreement may, in
certain situations involving a patient or recipient of services who is a danger to himself or others, have a duty to
warn third parties of such danger and should consult supervisory staff and/or legal counsel about such duty to
warn as appropriate.
Dissemination of these Confidentiality Provisions. CONTRACTOR shall inform all its officers, employees,
agents, and subcontractors providing services hereunder of these provisions.
By my signature below, as the authorized representative of the CONTRACTOR named below, I certify
acceptance and understanding for myself and the CONTRACTOR of the above confidentiality provisions.
Business Name of Contractor
Signa re o Authorized Representative Name of Authorized Representative printed)
P-1 2k l 0I
Date Title of Authorized Representative
Davis Guest Home, Inc.
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
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11905-U05
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EXECUTED AGREEMENTX���� �EXHIBIT D:
ASSURANCE OF COMPLIANCE WITH
SECTION 504 OF THE REHABILITATION ACT OF 1973, AS AMENDED
CONTRACTOR hereby agrees that it will comply with: 1) Section 504 of the Rehabilitation Act of
1973, as amended 29. U.S.C. 794), 2) all requirements imposed by the applicable HHS Regulations
45 C.F.R. Part 84) and, 3) all guidelines and interpretations issued pursuant thereto.
Pursuant to Section 84.5(a) of the Regulation 45 C.F.R. 84.5a) CONTRACTOR gives this Assurance
in consideration of and for the purpose of obtaining any and all federal grants, loans, contracts except
procurement contracts and contracts of insurance or guaranty), property, discounts or other federal
financial assistance extended after the date of this Assurance, including payments or other assistance
made after such date on applications for federal financial assistance which will be extended in reliance
on the representations and agreements made in this Assurance. The United States will have the right
to enforce this Assurance through lawful means. This Assurance is binding on CONTRACTOR, its
successors, transferees and assignees. The person or persons whose signatures appear below are
authorized to sign this Assurance on behalf of CONTRACTOR.
This Assurance obligates CONTRACTOR for the period during which federal financial assistance is
extended or, where the assistance is in the form of real or personal property, for the period provided
for in section 84.5(b) of the Regulations 45 C.F.R. 84.5b).
In addition, CONTRACTOR gives this assurance for the purpose of obtaining payment from the
COUNTY under this Agreement, regardless of the funding source. This assurance obligates the
CONTRACTOR during the entire term of this Agreement.
CONTRACTOR: Please check A or B)
A.
B.
K
Employs fewer than fifteen persons;
Employs fifteen or more persons, and pursuant to Section 84.7(a) of the Regulations
45 C.F.R. 84.7a), has designated the following person(s) to coordinate its efforts to
comply with the HHS regulations.
Contractor's Business Name
Name of Contractor's Designee L~ N 1 s
Title of Designee 0 WJ-j
Street Zia 7
City State Zip g 5 35
IRS Employer Identification Number t a c 3 G
I ce t Wait the above information is complete and correct to the best of my knowledge and belief.
By ZlZ9Jc'7
Con actor's Signature Date
Davis Guest Home, Inc.
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
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EXECUTED AGREEMENTX���� �EXHIBIT I
BUSINESS ASSOCIATE AGREEMENT
This Agreement is made effective the of 2008, by and between the COUNTY
OF MONTEREY, hereinafter referred to as Covered Entity", and DAVIS GUEST HOME,
INC., hereinafter referred to as Business Associate", individually, a Party" and collectively,
the Parties").
WITNESSETH:
WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, known as the Administrative Simplification
provisions," direct the Department of Health and Human Services to develop standards to protect
the security, confidentiality and integrity of health information; and
WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of
Health and Human Services has issued regulations modifying 45 CFR Parts 160 and 164 the
HIPAA Privacy Rule"); and
WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby
Business Associate will provide certain services to Covered Entity, and, pursuant to such
arrangement, Business Associate may be considered a business associate" of Covered Entity as
defined in the HIPAA Privacy Rule the agreement evidencing such arrangement is entitled
Mental Health Services Agreement, and is hereby referred to as the Arrangement
Agreement"); and
WHEREAS, Business Associate may have access to Protected Health Information as
defined below) in fulfilling its responsibilities under such arrangement;
THEREFORE, in consideration of the Parties' continuing obligations under the
Arrangement Agreement, compliance with the HIPAA Privacy Rule, and other good and
valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties
agree to the provisions of this Agreement in order to address the requirements of the HIPAA
Privacy Rule and to protect the interests of both Parties.
1.
DEFINITIONS
Except as otherwise defined herein, any and all capitalized terms in this Section shall have the
definitions set forth in the HIPAA Privacy Rule. In the event of an inconsistency between the
provisions of this Agreement and mandatory provisions of the HIPAA Privacy Rule, as
amended, the HIPAA Privacy Rule shall control. Where provisions of this Agreement are
different than those mandated in the HIPAA Privacy Rule, but are nonetheless permitted by the
HIPAA Privacy Rule, the provisions of this Agreement shall control.
The term Protected Health Information" means individually identifiable health information
including, without limitation, all information, data, documentation, and materials, including
without limitation, demographic, medical and financial information, that relates to the past,
Davis Guest Home, Inc.
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
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FY-U012
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FY-U012
2010-11-U012
A-U012
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AGREEMENT-U012
AMOUNT-U012
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B.-U012
AUTHORIZE-U012
DIRECTOR-U012
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HEALTH-U012
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THREE-U012
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FUTURE-U012
AMENDMENTS-U012
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HEALTH-U012
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AGREEMENT-U012
AMENDMENTS-U012
DO-U012
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CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
EXECUTED AGREEMENTX���� �present, or future physical or mental health or condition of an individual; the provision of health
care to an individual; or the past, present, or future payment for the provision of health care to an
individual; and that identifies the individual or with respect to which there is a reasonable basis
to believe the information can be used to identify the individual.
Business Associate acknowledges and agrees that all Protected Health Information that is created
or received by Covered Entity and disclosed or made available in any form, including paper
record, oral communication, audio recording, and electronic display by Covered Entity or its
operating units to Business Associate or is created or received by Business Associate on Covered
Entity's behalf shall be subject to this Agreement.
II. CONFIDENTIALITY REQUIREMENTS
a) Business Associate agrees:
i) to use or disclose any Protected Health Information solely: 1) for
meeting its obligations as set forth in any agreements between the Parties
evidencing their business relationship or 2) as required by applicable law, rule or
regulation, or by accrediting or credentialing organization to whom Covered
Entity is required to disclose such information or as otherwise permitted under
this Agreement, the Arrangement Agreement if consistent with this Agreement
and the HIPAA Privacy Rule), or the HIPAA Privacy Rule, and 3) as would be
permitted by the HIPAA Privacy Rule if such use or disclosure were made by
Covered Entity;
ii) at termination of this Agreement, the Arrangement Agreement or
any similar documentation of the business relationship of the Parties), or upon
request of Covered Entity, whichever occurs first, if feasible, Business Associate
will return or destroy all Protected Health Information received from or created or
received by Business Associate on behalf of Covered Entity that Business
Associate still maintains in any form and retain no copies of such information, or
if such return or destruction is not feasible, Business Associate will extend the
protections of this Agreement to the information and limit further uses and
disclosures to those purposes that make the return or destruction of the
information not feasible; and
iii) to ensure that its agents, including a subcontractor, to whom it provides
Protected Health Information received from or created by Business Associate on behalf
of Covered Entity, agrees to the same restrictions and conditions that apply to Business
Associate with respect to such information. In addition, Business Associate agrees to
take reasonable steps to ensure that its employees' actions or omissions do not cause
Business Associate to breach the terms of this Agreement.
b) Notwithstanding the prohibitions set forth in this Agreement, Business Associate
may use and disclose Protected Health Information as follows:
i) if necessary, for the proper management and administration of
Business Associate or to carry out the legal responsibilities of Business Associate,
provided that as to any such disclosure, the following requirements are met:
A) the disclosure is required by law; or
Davis Guest Home, Inc. 2
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
EXECUTED AGREEMENTX���� �B) Business Associate obtains reasonable assurances from the
person to whom the information is disclosed that it will be held
confidentially and used or further disclosed only as required by law or for
the purpose for which it was disclosed to the person, and the person
notifies Business Associate of any instances of which it is aware in which
the confidentiality of the information has been breached;
ii) for data aggregation services, if to be provided by Business
Associate for the health care operations of Covered Entity pursuant to any
agreements between the Parties evidencing their business relationship. For
purposes of this Agreement, data aggregation services means the combining of
Protected Health Information by Business Associate with the protected health
information received by Business Associate in its capacity as a business associate
of another covered entity, to permit data analyses that relate to the health care
operations of the respective covered entities.
c) Business Associate will implement appropriate safeguards to prevent use or
disclosure of Protected Health Information other than as permitted in this Agreement. The
Secretary of Health and Human Services shall have the right to audit Business Associate's
records and practices related to use and disclosure of Protected Health Information to ensure
Covered Entity's compliance with the terms of the HIPAA Privacy Rule. Business Associate
shall report to Covered Entity any use or disclosure of Protected Health Information which is not
in compliance with the terms of this Agreement of which it becomes aware. In addition,
Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known
to Business Associate of a use or disclosure of Protected Health Information by Business
Associate in violation of the requirements of this Agreement.
III. AVAILABILITY OF PHI
Business Associate agrees to make available Protected Health Information to the extent and in
the manner required by Section 164.524 of the HIPAA Privacy Rule. Business Associate agrees
to make Protected Health Information available for amendment and incorporate any amendments
to Protected Health Information in accordance with the requirements of Section 164.526 of the
HIPAA Privacy Rule. In addition, Business Associate agrees to make Protected Health
Information available for purposes of accounting of disclosures, as required by Section 164.528
of the HIPAA Privacy Rule.
IV. TERMINATION
Notwithstanding anything in this Agreement to the contrary, Covered Entity shall have the right
to terminate this Agreement and the Arrangement Agreement immediately if Covered Entity
determines that Business Associate has violated any material term of this Agreement. If Covered
Entity reasonably believes that Business Associate will violate a material term of this Agreement
and, where practicable, Covered Entity gives written notice to Business Associate of such belief
within a reasonable time after forming such belief, and Business Associate fails to provide
adequate written assurances to Covered Entity that it will not breach the cited term of this
Agreement within a reasonable period of time given the specific circumstances, but in any event,
Davis Guest Home, Inc. 3
FY 08/09 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
EXECUTED AGREEMENTX���� �before the threatened breach is to occur, then Covered Entity shall have the right to terminate this
Agreement and the Arrangement Agreement immediately.
V. MISCELLANEOUS
Except as expressly stated herein or the HIPAA Privacy Rule, the parties to this Agreement do
not intend to create any rights in any third parties. The obligations of Business Associate under
this Section shall survive the expiration, termination, or cancellation of this Agreement, the
Arrangement Agreement and/or the business relationship of the parties, and shall continue to
bind Business Associate, its agents, employees, contractors, successors, and assigns as set forth
herein.
This Agreement may be amended or modified only in a writing signed by the Parties. No Party
may assign its respective rights and obligations under this Agreement without the prior written
consent of the other Party. None of the provisions of this Agreement are intended to create, nor
will they be deemed to create any relationship between the Parties other than that of independent
parties contracting with each other solely for the purposes of effecting the provisions of this
Agreement and any other agreements between the Parties evidencing their business relationship.
This Agreement will be governed by the laws of the State of California. No change, waiver or
discharge of any liability or obligation hereunder on any one or more occasions shall be deemed
a waiver of performance of any continuing or other obligation, or shall prohibit enforcement of
any obligation, on any other occasion.
The parties agree that, in the event that any documentation of the arrangement pursuant to which
Business Associate provides services to Covered Entity contains provisions relating to the use or
disclosure of Protected Health Information which are more restrictive than the provisions of this
Agreement, the provisions of the more restrictive documentation will control. The provisions of
this Agreement are intended to establish the minimum requirements regarding Business
Associate's use and disclosure of Protected Health Information.
In the event that any provision of this Agreement is held by a court of competent jurisdiction to
be invalid or unenforceable, the remainder of the provisions of this Agreement will remain in full
force and effect. In addition, in the event a party believes in good faith that any provision of this
Agreement fails to comply with the then-current requirements of the HIPAA Privacy Rule, such
party shall notify the other party in writing. For a period of up to thirty days, the parties shall
address in good faith such concern and amend the terms of this Agreement, if necessary to bring
it into compliance. If, after such thirty-day period, the Agreement fails to comply with the
HIPAA Privacy Rule, then either party has the right to terminate upon written notice to the other
party.
Davis Guest Home, Inc. 4
FY 08109 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
EXECUTED AGREEMENTX���� �IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and
year written above.
COVERED ENTITY: BUSINESS ASSOCIATE:
COUNTY OF MONTEREY PARIS GUEST HOME, INC.
Title: Director of Health
Date:
Title: N 1 1 s
Date: 2 2
Davis Guest Home, Inc. 5
FY 08109 FY 10/11
BIB]
39655-U01
EXECUTED-U02
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO71619-U03
C7-U03
COUNTY-U03
CODE-U03
7/25/2008-U04
BARAJASRM-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
AMENDMENT NO. 1 TO MENTAL HEA��AMENDMENT NO. 1
TO MENTAL HEALTH SERVICES AGREEMENT NO. A-11196
BETWEEN
COUNTY OF MONTEREY AND DAVIS GUEST HOME, INC.
This Amendment No. 1 to Mental Health Services Agreement No. A-11196 is
made and entered into by and between the County of Monterey, hereinafter referred to as
COUNTY, and Davis Guest Homes, Inc., hereinafter referred to as CONTRACTOR).
Agreement is amended as follows:
1. Exhibit B, Section III. PAYMENT RATES, ESTIMATE NUMBER OF CLIENTS/DAYS
& PAYMENT AMOUNTS:
iscal Year
Board &Care
Service Rate
Per Day Estimated
# of
Clients
Per Day
Estimated
# of Days
Total
Contract
Amount
FY 2008-09 $68 10/8 365/150 $358,727
FY 2009-10 $75 18 365 $492,750
FY 2010-11 $75 18 365 $492,750
TOTAL $1,344,227
2. Exhibit B, Section IV. MAXIMUM OBLIGATION OF COUNTY:
A. Subject to the limitations set forth herein, COUNTY shall pay to
CONTRACTOR during the term of this Agreement a maximum
amount of $1,344,227 for services rendered under this Agreement.
B. Maximum Annual Liability:
FISCAL YEAR LIABILITY AMOUNT
July 1, 2008 to June 30, 2009 $ 358,727
July 1, 2009 to June 30, 2010 $ 492,750
July 1, 2010 to June 30, 2011 $ 492,750
MAXIMUM LIABILITY $ 1,344,227
2. All other terms and conditions of Agreement shall remain in full force and effect.
Davis Guest Home
FY 2008-09 thru FY 2010-11 1
BIB]
39955-U01
AMENDMENT-U02
NO.-U02
1-U02
TO-U02
MENTAL-U02
HEAL-U02
SERVICES-U02
AGREEMENT-U02
NO.-U02
A-11196-U02
BETWEEN-U02
COUNTY-U02
OF-U02
MONTERREY-U02
&-U02
DAVIS-U02
GUEST-U02
HOME,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO80136-U03
C5-U03
AGREEMENTS-U03
5/21/2009-U04
BOYDA-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012
AMENDMENT NO. 1 TO MENTAL HEA��IN WITNESS WHEREOF, County and CONTRACTOR have executed this Agreement as of the day
and year written below.
COUNTY OF MONTEREY
CONTRACTOR
DAVIS GUEST HOME, INC.
Conlcactor's Business Name*
l l t Q
Signature of Chair, President, or Vice-
President)*
*s Nti C9 7 P"s i s Name and Title
3~L4 ay
Signature of Secretary, st. Secretary,
CFO, Treasurer or Asst. Treasurer)*
*INSTRUCTIONS: If CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal
name of the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a
partnership, the name of the partnership shall be set forth above together with the signature of a partner who has authority to
execute this Agreement on behalf of the partnership. If CONTRACTOR is contracting in an individual capacity, the individual
shall set forth the name of the business, if any, and shall personally sign the Agreement.
Approval by County Counsel is required
AApproval by Auditor-Controller is required
3Approval by Risk Management is necessary only if changes are made in paragraph 8 or 9
Davis Guest Home
FY2008-09 thru FY2010-11
2-
BIB]
39955-U01
AMENDMENT-U02
NO.-U02
1-U02
TO-U02
MENTAL-U02
HEAL-U02
SERVICES-U02
AGREEMENT-U02
NO.-U02
A-11196-U02
BETWEEN-U02
COUNTY-U02
OF-U02
MONTERREY-U02
&-U02
DAVIS-U02
GUEST-U02
HOME,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO62956-U03
FO64075-U03
MG69409-U03
AS69434-U03
AS69436-U03
AI70336-U03
DO80136-U03
C5-U03
AGREEMENTS-U03
5/21/2009-U04
BOYDA-U04
11905-U05
7-U06
28.-U07
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
A-U07
MENTAL-U07
HEALTH-U07
SERVICES-U07
AGREEMENT-U07
DAVIS-U07
GUEST-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
6/12/2008-U011
HOME,-U012
INC.-U012
SERVICES-U012
TO-U012
ADULTS-U012
SEVERE-U012
PSYCHIATRIC-U012
DISABILITIES,-U012
IN-U012
ANNUAL-U012
AMOUNT-U012
OF-U012
$277,127-U012
FY-U012
2008-09-U012
$248,127-U012
FY-U012
2009-10-U012
FY-U012
2010-11-U012
A-U012
TOTAL-U012
AGREEMENT-U012
AMOUNT-U012
OF-U012
$773,381;-U012
B.-U012
AUTHORIZE-U012
DIRECTOR-U012
OF-U012
HEALTH-U012
TO-U012
SIGN-U012
UP-U012
TO-U012
THREE-U012
3)-U012
FUTURE-U012
AMENDMENTS-U012
TO-U012
MENTAL-U012
HEALTH-U012
SERVICES-U012
AGREEMENT-U012
AMENDMENTS-U012
DO-U012
EXCEED-U012
TEN-U012
PERCENT-U012
10%)-U012
OF-U012
ORIGINAL-U012
CONTRACT-U012
AMOUNT,-U012
DO-U012
SIGNIFICANTLY-U012
CHANGE-U012
SCOPE-U012
OF-U012
WORK.-U012