HomeMy WebLinkAboutMINUTES - 11121980 - Residential Care Placement CONTRA COSTA COUNTY HEALTH SERVICES
To: Marsha Covarrubis Date: November 10, 1980
Clerk of the Board
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From: Darlyn Gerber Subject: Residential Care
Contracts and Grants Specialist Placement Agreements
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The Emergency Residential Care Placement Agreement 424-086-15 for
Willie Mae Williams (dba Sanford Family Care Home) which was approved by
the Board on June 17, 1980, will not be executed.
The Mental Health Division has notified me that this facility is no longer
operating.
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RECEIVED
o V /x', 1980
J. R. OLSSON
LE OARD OF SUP RVISORS
N S CO-
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In the Board of Supervisors
of
Contra Costa County, State of California
June 17 19 80
In the Matter of
Emergency Residential Care Placement
Agreements Under the County's
Continuing Care (Short-Doyle Opt-Out)
Program for FY 1980-81
The Board having considered the recommendation of the Director, Health
Services Department, regarding the continuation of the County's Continuing Care
(Short-Doyle Opt-Out) Program in FY 1980-81 and the use of standard form Emergency
Residential Care Placement Agreements with 32 residential care facility operators
under said program, IT IS BY THE BOARD ORDERED that:
1. The Director, Health Services Department, or his designee
(Ronald N. Levinson, Ph.D.), is AUTHORIZED to execute, on behalf of the County,
standard form Emergency Residential Care Placement Agreements, effective on
July 1, 1980, for FY 1980-81 with the 32 licensed residential care facility
operators specified in the attached "FY 1980-81 Residential Care Facility,
Operator Listing," to provide emergency residential care for potentially
eligible SSI/SSP applicants under the County's FY 1980-81 Continuing Care
(Short-Doyle Opt-Out) Program;
2. The payment of up to $12 per day per client to said facility
operators is AUTHORIZED under said Agreements for such emergency residential
care in FY 1980-81, subject to the budgetary limitations set forth in the
County Mental Health Services/Short-Doyle Budget; and.
3. , The payment of up to $47 per month for incidental expenses and
personal needs in FY 1980-81 is AUTHORIZED to such clients who are enrolled in
the County's, Continuing Care (Short-Doyle Opt-Out) Program and are placed for
emergency residential care under said Agreements, subject to the budgetary
limitations set forth in the County Mental Health Services/Short-Doyle Budget.
PASSED BY THE BOARD on June 17 , 1980.
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1 hereby certify that the foregoing is a true and correct copy of an order entered on the
minutes of said Board of Supervisors on the date aforesaid.
Orig: Health Services Dept. Witness my hand and the Seal of the Board of
Attn: Contracts & Grants Unit Supervisors
cc: County Administrator affixed this 17th day of June 19 80
Auditor-Controller
Facility Operators
J. R. OLSSON, Clerk
By Deputy Clerk
R. Fluhrer
RJP:dg
H-24 3/79 15M
FY 1980-81 RESIDENTIAL CARE FACILITY OPERATOR LISTING
(Attachment to 6%17/80 Board Order)
Number Residential Care Facility Operator
24-086-3 Eleanor Cohen (dba Cohen Family Home, Richmond)
24-086-4 Annie Darnell (dba Darnell Board and Care Home, Richmond)
24-086-6 Loreca Felts (dba Felts Board and Care Home, Richmond)
24-086-7 Ruby Jackson (dba Jackson's Home for the Aged, Richmond)
24-086-8 Faye Johnson (dba Johnson's Board and Care Home, Concord)
24-086-12 Phoenix Programs, Inc. (Concord)
24-086-15 Willie Mae Williams (dba Sanford Family Care Home, Richmond)
24-086-21 Jeffie Brown (dba Brown's Home, Pittsburg)
24-086-22 Elijah and Birdie Lee Cole (dba Cole Family Home, Richmond)
24-086-25 Edward and Corrine DeBacker (dba DeBacker Care Home, Concord)
24-086-32 Elva Garcia (dba Garcia Residential Care Home, Richmond)
24-086-34 Dorothy Galyes (dba Gayles Residential Care Homes, #1 and #2, San Pablo) '
24-086-44 Ruth Lawton (dba Lawton Family Home, Richmond)
24-086-45 Carole Moore (dba Lone Tree Home, Brentwood)
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24-086-46 Albert Marrero (dba Marrero's Care Home, Richmond)
24-086-50 Beatrice Oakley (dba Beatrice Oakley Board and Care Home, Richmond)
24-086-56 Lizzie Townsend (dba Townsend Board and Care Home, Richmond)
24-086-57 Clara Tutor (dba Tutor Home, Brentwood)
24-086-58 Verna Altes (dba Verna V. Altes Residential Care Homes,
#1 and #2, Brentwood)
24-086-59 Vivian Rhine (dba Viv's Residential Care Home, Richmond)
24-086-60 Oneata Williams (dba Williams' Board and Care, E1 Cerrito)
24-086-61 Annie B. Williams (dba Annie Williams Residential Care Home
I for Adults, Richmond)
24-086-62 Hu land and JoNell Barnett (dba Jo's Board and Care Home, Richmond)
24-086-66 Ivy L. Cook (dba Cook Board and Care Home, Pinole)
24-086-67 Vernoy E. and Eleanor C. Jones (dba Jones Family Care Home, Richmond)
24-086-69 Mable L. Dyer (dba Dyer Family Care Home, Richmond)
24-086-72 General and Sara Lee (dba Lee's Boarding Home, Richmond)
24-086-73 Lester and Minnie Cannon (dba Cannon's Board and Care Home, Richmond)
24-086-74 Lillie Maria Goldsby (dba *faria's Evanual Boarding Home, Richmond)
24-086-75 Lillie and Irma Hagans (dba Hagans' Boarding Home, Richmond)
24-086-77 Rito and Barbara Rodarte (dba Rodarte's Board and Care Home, #1 and #2,
and Rodarte's Rest Home, Pittsburg)
24-086-78 Ruby L. Roberts (dba Roberts Residential Care Home, Richmond)
RESIDENTIAL CARE PLACEMENT AGREEMENT
Agreement Identification. Number 24-086-15 (3)
Department: Health Services (Mental Health Programs)
Subject: FY 1979-80 Continuing Care (Short-Doyle OPT-OUT) Program
(Emergency Residential Care for Potential SSI/SSP Eligible Clients)
Parties. The County of Contra Costa, California (County) , for its Department named
above, and the following named Operator of a licensed residential care (non-medical)
facility mutually agree and promise as follows:
Facility Operator: MRS. WILLIE MAE WILLIAMS (dba Sanford Family Care Home)
Capacity: Self-employed individual
Facility License Number: 070202577 License'Expiration Date: 5/20/80
Licensed Name and Address of Facility(ies): Sanford Family Care Home
218 Sanford Avenue
Richmond, CA 94806
Term. The effective date of this Agreement is July 1, 1979 , and it
terminates June 30, 1980, unless sooner terminated as provided herein.
Termination. This Agreement may be terminated by either party, at its sole
discretion, upon fifteen-day advance written notice thereof to the other, or
cancelled immediately by written mutual consent.
County Obligations. In consideration of the Facility Operator' s provision of
services as described herein, County shall make monthly payments , as determined
below, to Facility Operator upon its submission of a properly documented, and
Department approved, County Demand Form D-15.
a. Payment Amount.
(1) County' s payment to Facility Operator shall not exceed $10 per day
per client. Payment shall be determined by the client's aid status as follows:
(a) If the client is not receiving income or aid of any kind,
County' s payment shall be the full $10 per day;
If the client is receiving income or aid of any sort,
F
� •._ County's payment shall be reduced accordingly. As
1 L_ �✓ s V determined by the Continuing Care Unit of County's
ental Health program, the amount due to the Facility
i ! 1979 DPerator for the care of a client in any calendar month
/ hall be reduced by all income or aid received by the
J. R. L2SERVISOR:;
lient during such month, except for payments not
r_ COAR F xceeding $40 per month made by County to the client
U. or incidential expenses and personal needs, if any.
(2) In determining the number of days for which payment is to be made,
the following shall be included: l
(a) All days comprising the client's actual length of stay in the
facility, including the first and last day of his stay; and
(b) iThe number of days which fall short of the fourteen-day prior
notice, which the Facility Operator requires be given by a
client who intends to leave said facility. (This provision
does not apply if the client's leaving is at the Facility
Operator' s request or is determined to be in the best interest
, of the client by the Continuing Care Office.)
I
b. Payment Limitation. Payments hereunder are limited to funds available
therefor from the County Short-Doyle budget for fiscal year 1979-80.
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Facility Operator's Obligations. The Facility Operator shall provide twenty-four
our emergency residential care and supervision as specified in the state regulations
under which the Facility is licensed, for eligible continuing care clients referred
by the County' s Continuing Care Office.
The Facility Operator warrants that he is specially trained, experienced, expert,
and competent to perform such services.
The Facility Operator shall orally notify the Continuing Care Office, in advance,
of the date of any Facility-required client discharge.
Amendments. This Agreement may be amended in order to change the facility name(s)
or address(es) or to change the payment rates (as authorized by the State of
California) by a written document executed by the Facility Operator and the County
Board of Supervisors or, after Board approval, by its designee.
Independent Contractor's Status. This Agreement is by and between two independent
contractors and does not create and shall not be construed to create the relationship
of agent, servant, employee, partnership, joint venture, or association.
Indemnification. The Facility Operator shall defend, save harmless, and indemnify
the County and its officers, agents, and employees from all liabilities and claims
for damages for death, sickness or injury to persons or property, including without
limitation, all consequential damages, from any cause whatsoever arising from or
connected with the operations or the services of the Facility Operator hereunder,
resulting from the conduct, negligent or otherwise, of the Facility Operator, its
agents or employees. County assumes no liability for injury or damages arising
from acts of clients placed with the Facility Operator hereunder.
Legal Authority. This Agreement is entered into under and subject to the following
legal authorities:
California Welfare h Institutions Code 410053.8 and 45650 et seq.;
California Government Code 426227 and 431000.
Signatures. These signatures attest the parties' agreement hereto:
COUNTY'OF CONTRA COSTA, A IFORNIA RESIDENTIAL CARE FACILITY OPERATOR
BY �
Y-4 �/' BY C i1 D .� O w l / i/0 • Oi • �+
Des 'gn
Self-employed individual(s) Owner
Official Capac' ty Designate Official Capacity
Date: �� Z /J 72 WILLIE MAE WILLIAMS
f� Print or Type Name of Facility Operator
Date: �.�✓�/�"'L 7—
(Form approved by County Counsel) Standard Form
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In bile Boar d of Superyisors
of
Contra C051CI County, Skate , of Cali;ornia
July 3 . 19 79
In the Matt--r of
Residential Care Under the
County' s . Continuing Care (S-D
Opt-Out) Program .for FY 1979-80
The Boar& having considered the _recommendation of the Director of the
Health Services Department regarding the continuation of the County' s
Continuing Care (Short-Doyle OPT-OUT) Progra**r in FY 1979-80 and the
use of standard form Residential Care Placement Agreements with. twenty-n
residential care facility operators under said program, IT IS BY THE
BOARD ORDERED that:
1. The Director, Health Services Department, or his designee
n (Charles L. Pollack, M.D. , Assistant Health Services Director, or
Ronald N. Levinson, Ph.D. , Continuing Care Services Director) is
AUTHORIZED to execute, on behalf of. the County, standard form
Residential Care Placement Agreements, effective on July -"1, ,1979,
for FY 1979-80 with the 29 licensed residential care facility
operators specified in the attached "FY 1979-80 Residential Care
Facility Operator Listing, " under the County' s FY 1979-80
Continuing Care (Short-Doyle OPT-OUT) Program, upon approval
of such Agreements as to legal form by the Office of the County
Counsel;
2. The payment of up to $10 per day per client to said residential
carelfacility operators is AUTHORIZED for such residential care
under said Agreements in FY 1979-80, subject to the budgetary
limitations set forth in the County Mental Health Services/
Short-Doyle Budget, and
3. The payment of up to $40 per month is AUTHORIZED to eligible
clients who are enrolled in the County' s Continuing Care (Short-
Doyle OPT-OUT) Program and are placed for residential care under
said Agreements for incidental expenses and personal needs in
FY 1979-80, subject to the budgetary limitations set forth in
the County Mental Health Services/Short-Doyle Budget.
PASSED BY THE BOARD on Jaly 3, 1979.
I hereby ceeify that the foregoing is a true and correct copy o`r an orarr entered on thsr
minutes of said Board of Supervisors on the date aforesaid.
Orig: Health Services Dept. Witness my hand and the Seal of fihe Board of
cc: County Administrator Supervisors
(Contracts Unit) anxed this Mrd day of July
19 79
County Auditor Controller
J.' R. OLSSON, Clerk
Sy ,: r h , Deputy Clerk
R. J� lu_ e-
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FY 1979-80 RESIDENTIAL CARE F_1CILITi OPERATOR LlsTI?IG
(Attachment to 7/3/79 Board .Order)
24-OS6-1 Mrs. Osia Blake (dba Osia Blake Family Home, Richmond)
24-036-3 Mrs. Eleanor Cohen (dba Cohen Family Home, Richmond)'
24-036-4 Mrs. Annie Darnell (dba Darnell Board & Care ?Lome, Richmond)
24-086-5 Mrs. Bessie. Davis (dba Davis Care Home, Richmond)
24-086-6 Mrs. Loreca Felts (dba Felts Board & Care Home, Richmond)
24-086"7 Mrs. Ruby Jackson (dba Jackson's Home for th.e Abed, Richmond)
-; 24-086-8 Mrs. Faye Johnson (dba Johason's Board & Care Rome, Concord)
24-036-9 ' Mrs. Hildegarde Jones (dba Hildagz_de Jones' Family Home,. Concord)
24-036-12, Phoenix Programs, Iac: (Concord)
24-086-15 Mrs. Willie Mae Williams (dba Sanford Fa±ily Care Home, Richmond)
24-086-20 Mrs. Edna Bell (dba Bell Board and Care Homes, `1 & T,2, Richmond)
24-086-21 Mrs. Jeffie Brown (dba Broom's Home, Pittsburg)
". 24-086-23 Mrs. Beulah Cook (dba Cook's Guest Homes, .,'.`1 & ;=2, Pittsburg)
" 24-086-25 Edward and Corrine DeBadcer (dba D=Backer Care Home,- Coacord)
24-086-32 Mrs. Elva Garcia (dba Garcia Residential Care Home, Richmond)`
24-0&6-34 Mrs. Dorothy Gayles (dba Gayles Residential Care Homes,., ZIP Z & r2, San Pal
24-086-44 Mrs. Ruth Lawton (dba Lawton Family Home, Richmond)
24-036-45 Mrs. .Carole Moore (dba Lone Tree Home, Brentwood)
24-086-47 Mrs_' Hilda McCree (dba McCree's Family Home, Richmond)
24-086-50 Mrs.. Beatrice Oakley (dba Beatrice Oakley Board and Care Home, Richmond
24-086-52 Mrs. Dorothy Merton (Baltzell) Campbell
_(dba Restview Board and Care Home, Antioch)
24-036-56 Mrs. Lizzie Townsend (dba Townsend BBoard and Care Home, Richmond)
�, 24-086-58 Mrs. Verna Altes (dba Verna V. Altes Residential Care Homes, Brentwood)
24-086-59 Mrs. Vivian Rhine (dba Viv' s Residential Care ''Home, Richmond)
24-086-61 Mrs. Annie B. Williams
(dba Annie Williams Residential Care Home for Adults, Richmond)
24-086-66 Ivy L. Cook (dba Cook Board and Care Home, Pinole)
24-086-67 Vernoy E. abed Eleanor C. Jones (dba Jones Family Care come, Richmond)
24-OS6-72 General and Sara Lee (dba Lee's Boardio Home, Richmond)
24-086-73 Lester and Minnie Cannon (dba Cannon's Board and Care Rome, Richmond)
EMERGENCY RESIDENTIAL CARE PLACEMENT AGREEMENT
Agreement Identification. Number 24-086-15 (2)
Department: Medical Services - Mental Health
Subject: Mental Health Program--Continuing Care Services
(Emergency Residential Care for Potential SSI/SSP Eligible Clients)
Parties. The County of Contra Costa, California (County) , for its Department named
above, and the following named Operator of a licensed residential care (non-medical)
facility mutually agree and promise as follows:
Facility Operator: Mrs. Willie Mae Williams (dba Sanford Family Care Home)
Capacity: Self-employed individual
Licensed Name and Address of Facility(ies) : 218 Sanford Avenue
Richmond, California 94801
Term. The effective date of this Agreement is January 1, 1979 , and it
terminates June 30, 1979, unless sooner terminated as provided herein.
Termination. This Agreement may be terminated by either party, at its sole
discretion, upon fifteen-day advance written notice thereof to the other, or
cancelled immediately by written mutual consent.
County Obligations. In consideration of the Facility Operator's provision of
services as described herein, County shall make monthly payments, as determined
below, to Facility Operator upon its submission of a properly documented, and
Department approved, County Demand Form D-15.
a. Payment Amount.
(1) County's payment to Facility Operator shall not exceed $10 per day
per client. Payment shall be determined by the client's aid status as follows:
(a) If the client is not receiving income or aid of any kind,
County's payment shall be the full $10 per day;
(b) If the client is receiving income or aid of any sort,
County's payment shall be reduced accordingly. As
determined by the Continuing Care Unit of County's
Mental Health program, the amount due to the Facility
Operator for the care of a client in any calendar month
shall be reduced by all income or aid received by the
client during such month, except for payments not
exceeding $40 per month made by County to the client
for incidential expenses and personal needs, if any.
(2) In determining the number of days for which payment is to be made,
the following shall be included:
(a) All days comprising the client's actual length of stay in the
facility, including the first and last day of his stay; and
(b) The number of days which fall short of the fourteen-day prior
notice, which the Facility Operator requires be given by a
client who intends to leave said facility. (This provision
does not apply if the client's leaving is at the Facility
Operator's request or is determined to be in the best interest
of the client by the Continuing Care Office.)
b. Payment Limitation. Payments hereunder are limited to funds available
therefor from ,the County Short-Doyle budget for fiscal year 1978\79.
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a
Facility Operator' s Obligations. The Facility Operator shall provide twenty-four
hour emergency residential care and supervision as specified in the state regulations
under which the Facility is licensed, for eligible continuing care clients referred
by the County's Continuing Care Office.
The Facility Operator warrants that he is specially trained, experienced, expert,
and competent to perform such services.
The Facility Operator shall orally notify the Continuing Care Office, in advance,
of the date of any Facility-required client discharge.
Amendments. This Agreement may be amended in order to change the facility name(s)
or address(es) or to change the payment rates (as authorized by the State of
California) by a written document executed by the Facility Operator and the County
Board of Supervisors or, after Board approval, by its designee.
Independent Contractor's Status. This Agreement is by and between two independent
contractors and does not create and shall not be construed to create the relationship
of agent, servant, employee, partnership, joint venture, or association.
Indemnification. The Facility Operator shall defend, save harmless, and indemnify
the County and its officers, agents, and employees from all liabilities and claims
for damages for death, sickness or injury to persons or property, including without
limitation, all consequential damages, from any cause whatsoever arising from or
connected with the operations or the services of the Facility Operator hereunder,
resulting from the conduct, negligent or otherwise, of the Facility Operator, its
agents or employees. County assumes no liability for injury or damages arising
from acts of clients placed with the Facility Operator hereunder.
Legal Authority. This Agreement is entered into under and subject to the following
legal authorities:
California Welfare & Institutions Code 410053.8 and 45650 et seq. ;
Government Code 426227, 431000.
Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA, CALIFORNIA / RESIDENTIAL /CARE
7FACILITY
--,,OPERATOR
By h / BY
Designee
Self E�mloved Owner
Official Ca acity Designate Official Capacity
Date:
Name of Facility Operator
Date: ( _
(Form approved by County Counsel) Standard Form
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