IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hands. | |
COUNTY OF SAN MATEO | |
By: | |
President, Board of Supervisors, San Mateo County | |
Date: | |
ATTEST: | |
By: | |
Clerk of Said Board | |
Youth and Family Enrichment Services (YFES) | |
Contractor’s Signature | |
Michael Garb, Chief Executive Officer | |
Date: | |
Long Form Agreement/Non Business Associate v 6/28/06 |
EXHIBIT “A” |
SERVICES |
In consideration of the payments set forth in Exhibit “B,” Contractor shall provide the following services: |
I. Description of Services to be Performed by the Contractor |
Contractor shall provide a minimum of six thousand (6,000) hours of mental health and substance abuse treatment services to individuals, hereinafter referred to as “program participants,” who are committed to or who are being considered for commitment to the Margaret J. Kemp Camp (Camp Kemp), over the course of this two-year agreement. This figure includes an adjustment to reduce services for the period of November 1, 2008 through June 30, 2009 due to lower projected population at Camp Kemp. Program participants may be residing at Camp Kemp, at San Mateo County’s Juvenile Hall, or in the community. Program participants shall be adolescent girls presenting with a current charge or disposition who have multiple risk factors and significant substance abuse, behavior and/or mental health issues. |
All payments under this Agreement must directly support services specified in this Agreement. |
A. Assessment/Case Planning Contractor shall provide comprehensive assessment and case planning for all program participants who are in the intake phase of admission to Camp Kemp (“30-day assessment period”). Contractor shall provide a total minimum of one thousand (1,000) hours of this service during the term of the Agreement. Assessment services shall include administration of the Relationship Satisfaction Scale, the Self-Defeating Belief Scale, the Stressful Life Experiences Screening, the Post-Traumatic Stress Disorder Screening, the CRAFFT Alcohol and Other Drug Screening, the Burns Anxiety Inventory, and the Burns Depression Checklist. Contractor shall submit a psychological report to the Probation Department’s Director of Camps and to the Juvenile Court within twenty-one (21) days of a program participant’s commitment. The report shall be in the format provided by the Probation Department. |
B. Individual Counseling Contractor shall provide assigned program participants with a minimum of one (1) hour of individual counseling/therapy per week. Contractor shall provide a total minimum of two thousand one hundred (2,100) hours of this service during the term of this Agreement. |
C. Group Counseling Contractor shall provide assigned program participants with one youth group counseling/therapy session per week and family counseling as appropriate, based on youth needs assessments. Contractor shall provide a total minimum of six hundred (600) hours of these services during the term of the Agreement. |
D. Multi-Family Group Education/Counseling Contractor shall provide Multi-Family group counseling and education such that all program participants and their families (if applicable) receive a total of 16 sessions. Contractor shall provide a total minimum of one hundred and sixty-seven (167) hours of this service during the term of this Agreement. |
E. Additional Counseling/Collateral Contacts Contractor shall provide a total minimum of two thousand one hundred thirty-three (2,133) hours of additional service during the term of the Agreement. These services shall be determined by the immediate needs of the program or participants, but may include: • Additional individual, group, or Multi-Family Group counseling sessions; • Family therapy; • Referral of program participants and families to other resources and services; • Collaboration with other Camp Kemp treatment and service providers, including attendance at weekly case conferences with the San Mateo County Mental Health Services and Rape Trauma Services; • Participation in case conferences, weekly Camp Kemp staff meetings, GIRLS Program Steering Committee meetings, and other collaborative meetings; • Case consultation and transition planning with community treatment providers; and • Documentation of delivered services, including preparation of time-keeping records. Contractor shall be prepared to account for the type of collateral services delivered during the term of this Agreement. |
II. Quality of Services to be Performed by the Contractor |
A. Contractor shall ensure that program participants are involved in setting their goals and monitoring their progress. |
B. Contractor shall maintain sufficiently-detailed case notes in accordance with generally-accepted standards in the mental health field. |
C. Contractor shall collaborate and communicate with Probation Department staff and other treatment providers as appropriate. |
D. Contractor shall be prepared to report on the progress and status of program participants at all meetings and case conferences. |
III. Adherence to Best Practices/Compliance with Laws and Regulations | |
A. Contractor’s services shall be consistent with the State of California Alcohol and Drug Program (ADP) Certification Standards (http://www.adp.ca.gov/Licensing/pdf/Final_Regulations.pdf). | |
B. Contractor shall be fully compliant with Center for Substance Abuse Treatment’s Treatment Improvement Protocol 9: Assessment and Treatment of Patients with Co-existing Mental Illness and Alcohol and Other Drug Abuse (http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.27486). | |
C. Contractor shall possess and maintain the appropriate licensure and/or certification required to provide the services described in Exhibit A, Part I (Description of Services) above. | |
D. If County discovers any practice, procedure, or policy of the Contractor which, in the judgment of the Chief Probation Officer, fails to meet the standard set forth in the Agreement or otherwise threatens the success of the program carried on pursuant to this Agreement, or which jeopardizes the fiscal integrity of said program, County shall give Contractor 15 days written notice during which time the discrepancy or discrepancies shall be corrected to the satisfaction of the County. At the expiration of the 15-day period, if County is satisfied that the discrepancy has been corrected, County shall notify Contractor in writing of satisfactory resolution of the discrepancy. In the event the discrepancy is not resolved, County shall give the Contractor written notice that the corrective action is unsatisfactory and this Agreement shall be deemed terminated, and an effective date of termination shall be stated. No additional notice and no hearing shall be necessary. In the event of termination, all finished or unfinished documents, reports, and other materials (collectively referred to as “materials”) prepared by the Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. In such event, County shall reimburse Contractor for the value of satisfactory services performed for the benefit of residents of San Mateo County up to the date the notice is served to Contractor that the County is terminating the contract. | |
E. All services to be performed by the Contractor pursuant to this Agreement shall be performed in accordance with all applicable Federal, State, County, and Municipal laws, ordinances, and regulations, including but not limited to appropriate licensure regulations, provisions pertaining to confidentiality of records, and applicable quality assurance regulations. | |
F. Contractor agrees to fully comply with the Child Abuse and Neglect Reporting Act, California Penal Code 11164 et. seq. Contractor shall ensure that all known or suspected instances of child abuse or neglect are reported to an agency (police department, sheriff’s department, county probation department if designated by the County to receive mandated reports, or the County welfare department) described in California Penal Code Section 11165.9. This responsibility shall include: | |
1. A requirement that all employees, consultants, or agents performing services under this contract who are required by the California Penal Code to report child abuse or neglect, sign a statement that he or she knows of the reporting requirement and will comply with it; | |
2. Establishing procedures to ensure reporting even when employees, consultants, or agents who are not required to report child abuse under the California Penal Code gain knowledge of, or reasonably suspect that a child has been a victim of abuse or neglect; and | |
3. Contractor warrants that its employees, subcontractors, assignees, volunteers, and any other persons who, while providing services under this Agreement, who have supervisory or disciplinary power over any person under his or her care or over any minor, have been fingerprinted in order to determine whether they have a criminal history which would compromise the safety of minors with whom Contractor’s employees, subcontractors, assignees, volunteers have contact (see California Penal Code 11105.3). Contractor further warrants that said employees, subcontractors, assignees, volunteers, and other persons have been cleared by Contractor to perform the services described in this Agreement. All fingerprinting services shall be at Contractor’s sole expense. | |
IV. Data Collection/Reporting to be Performed by the Contractor |
|
Contractor shall submit quarterly reports and invoices documenting the services delivered in that time period according to the schedule below: • Quarter 1 (covering the period July 1, 2007-September 30, 2007) – due October 31, 2008 • Quarter 2 (covering the period October 1, 2007-December 31, 2007) – due January 31, 2008 • Quarter 3 (covering the period January 1, 2008-March 31, 2008) – due April 30, 2008 • Quarter 4 (covering the period April 1, 2008-June 30, 2008) – due July 15, 2008 • Quarter 5 (covering the period July 1, 2008-September 30, 2008) – due October 31, 2008 • Quarter 6 (covering the period September 1, 2008-December 31, 2008) – due January 31, 2009 • Quarter 7 (covering the period January 1, 2009-March 31, 2009) – due April 30, 2009 • Quarter 8 (covering the period April 1, 2009-June 30, 2009) – due July 15, 2009 | |
Contractor’s reports shall follow the format contained in Attachment D, Report and Invoice Format. | |
EXHIBIT “B” |
PAYMENTS AND RATES |
In consideration of the services provided by Contractor in Exhibit “A,” County shall pay Contractor based on the following fee schedule: |
In full consideration of the services provided by Contractor pursuant to this Agreement, and subject to the provisions, County shall pay Contractor in the manner described below. County shall pay Contractor no more than the maximum Agreement obligation of ONE HUNDRED EIGHTY ONE THOUSAND EIGHTY DOLLARS ($181,080.) over the term of this twenty-four (24) month Agreement, July 1, 2007 through June 30, 2009. |
The monthly rate of payments shall be: For the period July 1, 2007-June 30, 2008 -- $9,000/month |
1. Contractor shall bill on or before 30 days after quarter end for prior quarter’s services, except for June invoices, which must be received by the San Mateo County Probation Department no later than the immediate following July 15. |
2. All invoices must include an invoice number and reference the Agreement number before submission for payment. Reports and invoices are to be sent to: San Mateo County Probation Department Margaret J. Kemp Camp Attention: Glenda Miller, Director 222 Paul Scannell Drive San Mateo, CA 94402. |
3. The County shall not be obligated to pay Contractor for services covered by any invoice received more than 120 days after the date Contractor renders the services, or more than 90 days after this Agreement terminates, whichever is earlier. |
4. In the event Contractor claims or receives payment from County for a service, reimbursement for which is later disallowed by County or the State of California, or the United States Government, then Contractor shall promptly refund the disallowed amount to County upon request, or at its option, County may offset the amount disallowed from any payment due or become due to Contractor under this Agreement or any other agreement. |
5. Payments for services provided are contingent upon the availability of County, State, Federal, foundation, or other funding. In the event the State or the Federal government does not appropriate the necessary funds as part of either or both of their budgets, the County shall not be liable for any payment whatsoever; including but not limited to, payments that are based on County funds. The County may terminate this Agreement for unavailability of County, State, Federal, foundation, or other funding. |
ATTACHMENT B
CHILD ABUSE PREVENTION, REPORTING, AND FINGERPRINTING REQUIREMENTS
Contractor agrees to ensure that all known or suspected instances of child abuse or neglect are reported to a child protective agency. Contractor agrees to fully comply with the Child Abuse and Neglect Reporting Act, California Penal Code Section 11164 et seq. Contractor will ensure that all known or suspected instances of child abuse or neglect are reported to an agency (police department, sheriff’s department, County probation department if designated by the County to receive mandated reports, or the County welfare department) described in Penal Code Section 11165.9. This responsibility shall include:
A. A requirement that all employees, consultants, or agents performing services under this contract who are required by Penal Code Section 11166(a), to report child abuse or neglect, sign a statement that he or she knows of the reporting requirement and will comply with it.
B. Establishing procedures to ensure reporting even when employees, consultants, or agents who are not required to report child abuse under penal Code Section 11166(a), gain knowledge of, or reasonably suspect that a child has been a victim of abuse or neglect.
C. Contractor agrees that each applicant for employment or a volunteer position at Contractor’s program who will have a supervisory or disciplinary power over a minor or any person under his or her care will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of such minor(s) or person(s) under his or her care. (Penal Code Section 11105.3(a), as amended in 1990 by AB 2617). All fingerprinting will be at Contractor’s expense.
D. The fingerprinting process set forth in subparagraph 9.C above will be completed and the results of the process will be obtained before any of the Contractor’s employees, subcontractors, assignees or volunteers are assigned or permitted to work at the program. Alternatively, the Contractor may set a hire date prior to obtaining fingerprinting results contingent on the applicant certifying that: (1) his or her employment application truthfully and completely discloses whether he or she has ever been convicted of a felony or misdemeanor or been on parole or probation, and (2) that the applicant understands that a background check will be conducted, and that he or she will be dismissed from employment immediately if he or she has failed to provide information regarding convictions, has provided incomplete information regarding convictions, has or omitted information regarding convictions, or if the fingerprinting results reveal any conviction incompatible with this employment.
E. Contractor will maintain, and make available to County upon request, a written fingerprint certification required by subparagraph 9.C. above, for each applicant for employment or a volunteer position at the program for whom fingerprinting is required pursuant to subparagraph 9.C. above. Such certification shall state that the individual has been fingerprinted, that the process has disclosed no criminal history on the part of the individual, which would compromise the safety of persons with whom that individual has contact. Fingerprint information received from Department of Justice (DOJ) will be retained or disposed of pursuant to DOJ directive.
ATTACHMENT C
FINGERPRINTING CERTIFICATION FORM
Agreement with San Mateo County
Contractor agrees that its employees and/or its subcontractors, assignees and volunteers who, during the course of performing services under this agreement, have contact with children will be fingerprinted in order to determine whether they have a criminal history which would compromise the safety of children with whom contractors employees, assignees and subcontractors or volunteers have contact.
Name
Title
Signature
Date
ATTACHMENT D
REPORT AND INVOICE FORMAT
(On agency letterhead)
YOUTH AND FAMILY ENRICHMENT SERVICES
AGREEMENT #[insert Agreement number from contract]
REPORT
[Insert time period, e.g., “July 1, 2007-September 30, 2007”]
NARRATIVE
1. Significant Achievements
2. Staffing Changes
3. Topic Areas/Issues Addressed in Group Counseling
4. Topic areas/Issues Addressed in Multi-Family Groups
5. Agendas from Group Counseling, Multi-Family Groups, or Educational Sessions (Attachment)
YOUTH AND FAMILY ENRICHMENT SERVICES
AGREEMENT #[insert Agreement number from contract]
INVOICE #[insert YFES invoice number]
[Insert time period, e.g., “July 1, 2007-September 30, 2007”]
Service |
Units Delivered |
Hours Delivered |
||
Assessment/Case Planning |
[XXX] |
|||
Individual Counseling |
[XXX] |
|||
Group Counseling |
[XXX] |
|||
Multi-Family Group Education/Counseling |
[XXX] |
|||
Additional Counseling/Collateral Contacts |
[XXX] |
|||
TOTAL DELIVERABLES |
[XXX] |
|||
TOTAL DUE |
$XX,XXX |
Invoice prepared by: ______________________________
Phone: ___________________________
Date: _____________________
ATTACHMENT I
The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto.
The Contractor(s) gives/give this assurance in consideration of for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s).
The Contractor(s): (Check a or b)
_ a. Employs fewer than 15 persons.
_ b. Employs 15 or more persons and, pursuant to section 84.7(a) of the regulation (45 C.F.R. 84.7(a)), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulation:
_____________________________________________________
Name of 504 Person - Type or Print
Youth and Family Enrichment Services______________________
Name of Contractor(s) - Type or Print
610 Elm Street, Suite 212_________________________________
Street Address or P.O. Box
San Carlos, CA 94070 _________________________________
City, State, Zip Code
I certify that the above information is complete and correct to the best of my knowledge.
_____________________________________________________
Signature
_____________________________________________________
Title of Authorized Official
_____________________________________________________
Date
* Exception: DHHS regulations state that: "If a recipient with fewer than 15 employees finds that, after consultation with a disabled person seeking its services, there is no method of complying with (the facility accessibility regulations) other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible."