(1) Enhanced Behavioral Support Home (EBSH) - Adolescents

Announcementof RequestforProposals(RFP):

(1) Enhanced Behavioral Support Home (EBSH) - Adolescents

Fiscal Year2016-2017

Deadline Extended to May 12, 2017 at 4pm

SummaryofProject

TheWestsideRegionalCenter(WRC) is solicitingproposalsforthefollowingCommunityPlacementPlan(CPP)contractedservice(s):

PostingDate: May 2017

ServiceType:One (1)Enhanced Behavioral Supports Home (EBSH)for male/femaleadolescentswiththree(3)beds.

Start-upAvailable: Upto$225,000

Start-up funds canonlybeusedfor non-recurringcosts associatedwithinitiallyestablishingaservice,whichmayincludeadministrativecomponents,licensing,householdfurnishingsandsupplies,personnelrecruitmentandtrainingexpenses,generalequipment,andothercostsasdescribedpercontract.Start-upfundsarenotintendedtocover100%ofthedevelopmentcosts.

Location: Tobedetermined.

DevelopmentTimeline:TheprogramshouldbereadytoprovideservicesnolaterthanFebruary 2018.

SERVICEDESCRIPTION

Westside Regional Center is seeking a provider to develop anEnhanced Behavior Supports Home (EBSH) intended to serve a maximum of three (3) residents each of whom require 24-hour non-medical in a homelike setting care due to excessive behavioral impairments. These homes exceed the minimum requirements of level 4I facilities. Such homes will haveadditional staffing, supervision, consultation, and shall employ enhanced characteristics, such as delayed egress devices and/or secured perimeters, to address challenging behaviors.

Each resident will have their own bedroom. The home will provide services to adolescents between the ages of 11 – 17 with significant behavioral challenges, severe self-care deficits, risk of elopement, and/or SIB with possible dual-diagnosed with mental health diagnosis or substance abuse issues, may currently or historically face forensic complications, and will primarily be transitioning to communityplacement from a developmental center, institute for mental disease, or acute crisis facility. Each resident of the home will have an individual behavior supports plan documenting the individual's behavioral needs and the supports and services to be provided to address those needs. The provider is required by law to have a Board Certified Behavior Analyst (BCBA) or qualified behavior modification professional on-staff or contract for monthly observation and treatment recommendations of the residents, at least four of which per year are to be unannounced. Residents will receive support from the regional center and the clients' rights advocate.

The service provider will be required to obtain a license as an Adult Residential Facility (ARF) from the California Department of Social Services' Community Care Licensing division and will be answerable to allapplicable statutes and regulations, including those currently under development upon their publishing.

ThehomewillbeownedandrenovatedbyaNon-ProfitHousingOrganization(NPO)thatwilldeveloptheproperty,underaseparategrantprocess,to thespecificationsofthisregionalcenter.ThesuccessfulapplicantforthisCPPgrantwillleasethepropertyfromtheNPO.Thestart-upfundsidentified in this RFP are solelyfortheuse of theservice provider for activitiesintegral to the establishmentofthelicensedhome,e.g.licensing,householdfurnishingsandsupplies,andpersonnelrecruitment,development,training,transitionplanning,meetings,travelrelatedtoconsumervisits,etc.

APPLICABLE OR RELEVANT STATUES AND REGULATIONS: California Welfare & InstitutionsCodeChapter6,Article3.6(§4684.80- §4684.87)andArticle6(§4695-§4695.2);Title 17 CaliforniaCodeofRegulations(§56001–§56067);andallotherapplicablefederalandCaliforniastatutesandregulations,includingthosenotyetpromulgated.

Please see attached EBSH Regulations PDF document.

Potentialprovidersmusthavepriordemonstrableexperienceincluding:

•Supportingchildrenandadolescentswithdevelopmentaldisabilitieswithco-occurringmentalhealth

diagnoses, the courts, and/or Community Placement Program;

•OwningoroperatingaLevel4AdultResidentialFacility(ARF),SmallResidentialFacility(SRF),

Children’sResidentialFacility(CRF)orprovidingsupportedlivingservices;

•Workingwithsocialservicecommunitybasedagenciesandresources;

•Workingwithchildrenandadolescentsincrisis,requiringhospitalization,oratriskoffrequent

hospitalization;

•Workingwithandarrangingservicesforchildrenandadolescentsincludingwithschools,school

districts,families,mentalhealthsystemsandproviders,behavioralsupports,andpotentiallythe

criminaljusticesystem;

•Successfullyproviding24/7care,supportandsupervision.

Aprovidermustbeabletoworkcollaborativelywithothersinamulti-agency,interdisciplinaryconfiguration(e.g.otherregionalcenters,mentalhealthsystems,schooldistricts,etc.)forthesuccessfulsupportoftheindividual.

GENERALREQUIREMENTS

•Facilitywill be licensed as an Adult Residential FacilitybyCommunityCareLicensing(CCL)priorto

vendorizationbyWRC;

•Facilitywillsupport3permanentadolescentresidents;

•24-hour non-medical care;

•ProgrammustmeetallapplicableTitle17andTitle22regulations;

•FacilitymustmeetapplicableAmericanswithDisabilitiesActs(ADA)standards;

•Shall exceed minimum requirements for level 4I facility as defined by law;

•Individual rates shall include staffing, consultants, food costs and incidentals incurred on a per resident

basis;

• Facility rates shall include the lease and constant operation;

• Behavior (BCBA) support plan within one week of admission;

• Monitoring required by regional center qualified behavior modification professional at least monthly, four

of which are unannounced;

• Vendoring regional center and each client’s regional center shall have joint responsibility for monitoring

and evaluating the services provided;

• Monthly Case management and quarterly quality assurance visits, at minimum is required;

• Administratormusthaveaminimumof2yearsfull-timeexperienceinalicensedresidentialfacility

(preferablyaLevel4ARForSRF)forpersonswithdevelopmentaldisabilities,mentalhealth,and

forensic backgrounds. Administratorand Licenseemust bothpossessa current ARFAdministrator

Certificate;

•Administrator must have completed DSP I and DSP II;

A group home administrator must fit under (A) or (B) or (C) or (D)

(A)Have a master’s degree in a behavioral science from an accredited college or university,

plus aminimum of one year of employment as a social worker, as defined in Section

80001s.(4), in anagency serving children or in a group residential program for children;

(B) Have a bachelor’s degree from an accredited college or university, plus at least one year

ofadministrative experience or supervisory experience over social work, child care, and/or

support staff providing direct services to children in an agency or in a community care

facility with a licensedcapacity of seven or more;

(C) Have completed at least two years at an accredited college or university, plus at least

two yearsadministrative experience or supervisory experience over social work, child care,

and/or supportstaff providing direct services to children in an agency or in a community

care facility with a licensedcapacity of seven or more;

(D) Have completed high school, or equivalent, plus at least three years administrative

experienceor supervisory experience over social work, child care, and/or support staff

providing direct servicesto children in an agency or in a community care facility with a

licensed capacity of seven or more;

•DirectSupportProfessionals(DSP)mustspeakthelanguageof thepeopletheysupport;

•Perspective provider must hire and retain direct care staff trained in non-violent crisis

prevention/interventioninaccordancewithTitle17regulations;

•ApplicantsmustidentifyalltypesofconsultantstheyproposetoutilizeandmustincludeaBCBA;

•Applicants mustdemonstratefiscalresponsibilitybysubmitting2completefiscalyearsandcurrent

yeartodatefinancialstatementsthatdetailallcurrentandfixedassetsandcurrentandlong-term

liabilities;Theapplicantmustdocumentavailablecreditlineandprovidenecessaryinformationfor

verification;

•Adherence to forthcoming DSS regulations to address, at minimum, staffing structure, staff

qualification, and training;

•Health and Safety §1667.64 requires a minimum of 16 hours of emergency intervention training,

including positive behavioral supports and techniques for all staff;

•Health and Safety §1567.65 (f) DSS determines that urgent action is necessary to protect a consumer

residing in an EBSH, it shall notify DDS. DDS may request that the regional center or centers take

action within 24 hours, which may include, as appropriate, the removal of a consumer from the home or

obtaining additional services.

DeadlineforSubmission:ProposalsmustbereceivedatWestsideRegionalCenterby4:00p.m.onFriday,May 5, 2017.

Applicationsthataresubmittedafterthedeadlineorthatareincomplete,orproposalsthatdonotmeetthebasicrequirementswillbedisqualified.Noproposals willbereturned.

ThisRFPdoesnotcommitWRCtoprocureorcontractforservicesorsupports.WRCmayelecttofundall,part,ornoneoftheproject,dependingonfundingavailabilityasapprovedbytheDepartmentofDevelopmentalServicesandthequalityoftheproposalsreceived.

It is anticipated that a negotiated rate that exceeds the typical Level 4-I ARM rate will be required in order to meet the actual costs of providing individual bedrooms, other specialized consultant and staff, salaries, staff ratios and consultant hours that are needed to provide quality support services for people with complex mental health and behavior challenges. The rate of reimbursement for ongoing services is negotiable but shall not exceed the level of median rates as required by California statute. WRC will negotiate rates based on the DDS statewide median rate methodology for this project.

APPLICANTQUALIFICATIONS

Thefollowingqualificationswillbesoughtinapotentialproviderandwillbeassessedby evaluatinganapplicant’sproposal,andresponsestointerviewquestions,ifapplicable.Forfinalists,assessmentofthesequalificationswillalsoincludethecollectionandevaluationofadditionalinformationutilizing,butnotlimitedto,theevaluationprocedureslistedbelow:

QualificationsSoughtinaProvider / EvaluationProcedures
Applicant has a proven history of financial
responsibility,stabilityandsoundness. / Allfinalistswill be required to submitaFinancial Statement
formandattachbusinessandfinancialrecordstosubstantiatethefinalist’sadequateworkingcapital.Forfinalistswithoutbusinessrecords,twoyearsoftaxreturnswillberequestedandreviewed.
ConferwithAccountingDepartmentandFiscalMonitoratWRCandtheCommunityServicesandAccountingDepartmentsatotherregionalcentersasapplicable.
Applicanthasaprovenhistorydemonstratingtheabilitytoprovidedirectsupervisionorservices/supportstopersonswithdevelopmentaldisabilitiesorspecialneeds. / ConferwithClientServicesandCommunityServicesstaffatWRC,andotherregionalcentersasapplicable.
Complete unannounced visit(s) to existing programs,homesorservicesowned/operatedbytheapplicant.
Applicanthasprovencredentials,licenses,trainingand/or skills requiredand/or preferredfortheproposedprojectorservice. / Completereferencechecktosubstantiatesubmittedresume(s)includingapplicabledegrees,credentials,licensesorcertificates,anddescriptionsofstaffqualificationsincludingspecializedtrainingandskills.
Applicanthasaprovenhistoryofpositiveworkingrelationshipswiththecommunityandapplicablegovernmentagencies.Ifapplicantis acurrentvendor, applicantmustbe ingoodstandingwiththeregionalcenterandlicensingagencies. / ConferwithClientServicesandCommunityServicesstaffatWRC,andotherregionalcentersasapplicable.
Conferwithlicensing agencies(e.g., Dept.ofPublicHealthorCommunityCareLicensing),asapplicable.
Applicanthasaprovenhistoryintheareaofprojectdevelopment,includingtheabilitytocompleteprojects,meetprojecttimelinesandmanageaprojectofthissizeandscope. / ConferwithCommunityServicesstaffatWRCandotherregionalcentersasapplicable,regardingapplicant’strackrecordonmanagingandcompletingprojectsandmeetingprojecttimelines.
Applicanthastheadministrativecapacitytocompletetheprojectand/orimplementtheserviceinatimelyfashion. / Confirmthenumberofprograms/projectsapplicantcurrentlyoperatesand/orhasindevelopment,andensurethattheapplicant’sadministrativecapacityisnotoverstretchedorthattheapplicanthascompetingorconflictingresponsibilitieswithservicesvendoredorindevelopmentwithotherregionalcenters.

Both not-for-profit and proprietary organizations are eligible to apply. Employees of regional centers are not eligible to apply. Applicants must disclose any potential conflicts of interest per Title 17, Section 54500. Applicants, including members of governing boards, must be in good standing in regards to all services vendored with any regional center.

ThesuccessfulapplicantwillworkwithWRCtodeveloparatewhichwillincludeallorsomeoftheitemslistedbelow;

(1)ApresetsalaryrangeforDirectSupportProfessional(DSPs);

(2)DirectSupportProfessionals whohavecompletedDSPIandDSPII.

(3)Servicesinclude24-hour-a-dayonsitesupport;

(4)1,2, or more awakenightstaff;

(5)Administratorordesigneeon-call24/7;

(6)Administratorworkingaminimumof20hoursper week;

Preferencewillbegiventoapplicants whohaveoridentifyanadministrator whohas:

a)Bachelordegreeorhigherinarelatedfield

b)Atleasttwoyearsofworkhistoryasanadministratorinahomethatprovidedmentalhealthtreatmentand/orsupport,substanceabusepreventionand/ortreatment,behavioralsupport,andcourtorforensicsupporttochildrenandadolescentswithdevelopmentaldisabilitieswhohaveresidedinastatedevelopmentalcenter,orareatriskofsuchplacement.

c)DemonstratedunderstandingoftheIPPprocessandthelegalrightsof peoplewithdevelopmentaldisabilitiesinCalifornia;

d)Demonstratedthe abilityto workwiththeDepartmentof Social Services,CommunityCareLicensingDivisionandknowledgeofallTitle22and17regulations;

e)HasacurrentAdministratorCertification;

f)HassuccessfullycompletedDSPIandDSPIIcertification;

g)Is,orwillbe,aCPICertifiedinstructor;

h)HascompletedorcompletesaWRC(orotherRC,uponWRCapproval)residentialorientation;

i)HascompletedorwillcompleteDr.TomPomeranz’sUniversalEnhancementCourse.

SuccessfulapplicantstothisRFPprojectmustadheretotheRFPwritingguidelinesoutlinedinthisRFPandcompleteeachattachmentenclosedinthisRFP.

Thecontractsfortheprojectwillrequireanagreementthatthegranteewillprovide,atminimum,120months(tenyears)ofcontinuousresidential care services,basedupon thedateofthe firstadmission.Failuretomeetthistermofservicewillrequiretheawardeetorepayaportionoftheoriginalstart-upgrant,i.e.,12monthsrepay90%oforiginalstart-upgrant;24monthsrepay80%oforiginalstart-upgrant;36monthsrepayat70%oforiginalstart-upgrant;48monthsrepayat60%oforiginalstart-upgrant;60monthsrepayat50%oforiginalstart-upgrant;72monthsrepayat40%oforiginalstart-upgrant;84monthsrepayat30%oforiginalstart-upgrant;96monthsrepayat20%oforiginalstart-upgrant;and108monthsrepayat10%oforiginalstartupgrant.

Theprovider isrequiredtokeepreceipts,cancelledchecks,andfinancial datafor3years fromdateofcontract.

PersonsidentifiedasmembersoftheCommunityPlacementPlanbyWestsideRegionalCenterhavepriorityconsiderationoveranyotherreferrals.

Applicantsmustadopta“no-reject”/nofailurepolicytowardadolescentsbeingsupportedandacommitmenttomodifyingsupportstoensurecontinuedstabilitywithoutrequestingadditionalfundingfromtheregionalcenter.ResponsestothisRFPmustcommunicateavisiondedicatedtoprovidinglong-termsupportsthatadapttotheneedsoftheindividual.MovingpeopletotheStateDevelopmentalCenterisnolongerconsideredaviablealternativeforoperatorsofCommunityCareFacilities. TheregionalcenterwillprovideataminimumquarterlymonitoringofCommunityPlacementPlanhomes.

APPLICANTELIGIBILITYANDRESTRICTIONS

Eligibility

Anyindividual,partnership,corporation,associationorprivate-for-profitornot-for-profitagencymaysubmitaproposal.

• Forpartnershipsubmissions,allpartnersshouldhavefullknowledgeofthecontentsoftheproposalsubmittedandmustdemonstratecommitmenttotheprojectduringstart-upaswellasongoingoperations.

• Applicants,including membersofthegoverningboard,mustbeingood standinginregardstoallservicesvendoredwithanyregionalcenter.

Ineligibility

Underthefollowingconditions,anindividualorentityisineligibletobearegionalcentervendor,andthereforemaynotsubmitaproposal.

1.Conflict-of-Interest:Anyindividualorentitythathasaconflict-of-interestasestablishedinDDSRegulations,Title17,Sections54314and54500etseq.,unlessawaiverispermittedandobtained,including:

• Regional center employees, board members, and their family members.

SELECTIONPROCEDURES

Allproposalsreceivedbythedeadlinewillundergoapreliminaryscreening.Lateorincompleteapplicationswillnotbeacceptedforreviewandrating.Any proposalmaybedisqualifiedifitdeviatesfromthesubmissioninstructionsintheRFP.

WRCwillseattheRFPSelectionCommittee.Theevaluationprocesswillincludeindividualcommitteememberevaluationandratingofeachproposal,followedbycommitteediscussionandrankingofproposals.

Proposalswillbereviewedandevaluatedfor:

• Completenessandresponsivenessoftheproposal;

• Relevantexperienceandqualificationsoftheapplicant;

• Reasonablenessoftimelineandcosttocompleteeachproject;

• Demonstratedfinancialresponsibility,stabilityandsoundnessoftheapplicant.

Proposalsmaybeeliminatedfromfurtherconsiderationduetoinconsistencywithstateandfederalguidelines,failuretofollowRFPinstructions,incompletedocuments,orfailuretosubmitrequireddocuments.

Inadditiontoevaluatingthemeritoftheproposal,applicantswillbeevaluatedandselectedbasedonpreviousperformance,includingtimelycompletionofprojectsandahistoryofcooperativeworkwiththeregionalcenter.(PleaserefertothesectiontitledApplicantQualificationsfordetails)

Afterpreliminaryratingandrankingofproposals,visitswillbearrangedatanyexistingprogramsalreadyinoperation bythe applicantandtheninterviews maybescheduledwithfinalists,particularlyiftwoormoreproposalsarecloselyratedand/ormoreinformationisneeded.Referenceswillbecontactedforallfinalists.Allfinalistswillberequiredtocompleteandsubmitabudgetandfinancialstatement(s).(PleaseseesectiontitledApplicantQualificationsfordetails)

Thefinal recommendationofthe RFP SelectionCommitteewill be submittedforapproval bytheWRCExecutiveDirectorandis notsubjecttoappeal.Allapplicantswillreceive writtennotificationofWRC’sdecisionregardingtheirproposalandanannouncementoftheapplicantawardedtheprojectwillbepostedonthe Center’sweb site:

Additionalinformationmayberequiredfromtheselectedapplicantpriortotheawardingoftheproject.Anyinformationwithheldoromitted,orfailuretodiscloseanyhistoryofdeficienciesorclientabuse

shalldisqualifytheapplicantfromawardoftheprojectand/orcontract.

WRC reservestherightnottoselectanapplicantforprojectimplementationif,initsdetermination,noqualifiedapplicanthasappliedorissufficientlyresponsivetotheserviceneed.

Intheeventthatnoproposalisselected,WRCmayelecttoeithernotdeveloptheservicependingfurtheranalysisofalternativesto meettheexpressedneed,ortoissueanewRFPtoattempttoexpandthepoolofpotentialrespondents.

AdditionalRequirements

• DevelopmentofService Design:Theselectedapplicantwillberequiredtocompleteaservicedesignwithinthirty(30)daysofawardofthecontract.

• ProofofLiabilityInsurance:Theselectedapplicantwillberequiredtomaintaingeneralandprofessionalliabilityinsuranceforallworkperformedonbehalfofregionalcenterclientsandtheirfamiliesandtonametheregionalcenterasanadditionalinsuredonallsuchpolicies.

RESERVATIONOFRIGHTS

WRCreservestherighttorequestornegotiatechangesinaproposal,toacceptallor part ofaproposal,or torejectanyor allproposals.WRCmay,atoursoleandabsolutediscretion,selectnoproviderfortheseservicesif,initsdetermination,noapplicantissufficientlyresponsivetotheneed.WRCreservestherighttowithdrawthisRequestforProposal(RFP)and/oranyitemwithintheRFPatanytimewithoutnotice.WRCreservestherighttodisqualifyanyproposalwhichdoesnotadheretotheRFPguidelines.ThisRFPisbeingofferedatthediscretionofWRC.ItdoesnotcommitWRCtoawardanygrant.

COSTSFORPROPOSALSUBMISSION

ApplicantsrespondingtotheRFPshallbearallcostsassociatedwiththedevelopmentandsubmissionofaproposal.

SUBMISSIONINSTRUCTIONS

ProposalContentandServiceSummaryContentGuidelines

Pleaseincludeallinformationrequestedbelowandsubmitinthesameorderinyourdocumentation.Foradditionalguidanceinwritingyourservicesummary,pleaserefertoTitle17andTitle22regulations.Eachproposalmustbecomprisedof(6)completesetsofthefollowingcomponents:

Application/ProposalCoversheet–AttachmentA

TableofContents

ProfessionalResumesandReferences–AttachmentB

StatementofObligation–AttachmentCSampleFinancialStatement–AttachmentDBudgetSummary–AttachmentE

Mission,VisionandValueStatements:ProvideanyagencyMVVstatementsandhowtheseweredevelopedforyouragency.

BackgroundandExperience:Summarizeeducation,experience,andknowledgeofkeypersonnelinprovidingservicestothetargetpopulations.Describehowthedocumentededucation,knowledge,andexperiencewillbeagoodfitfordevelopingthisprogram.

Equity & Diversity Statement: Please see list below. Applicants will describe how they will:

• Provide a statement outlining applicant’sservices and supports plan to serve diverse populations, including but not limited to culturally and linguistically diverse populations. Promoting equity and diversity and according to NPOs program design. W&I code 4648.11
• Provide examples of applicant’s commitment to addressing the needs of those diverse populations.
• Provide any additional information that the applicant deems relevant to issues of equity and diversity.

DevelopmentExperience:Brieflysummarizeyourcurrentandpreviousdevelopmentofservicesandprograms.Highlightsimilaritiesbetweencurrentorpreviousprogram(s)developedandyourproposedprogramforthisRFP.

AgencyOutcomes:Describeanticipatedoutcomesofproposedserviceforpeopleresidinginthehomeandhowachievementofoutcomeswillbemeasured.

AssessmentandPerson-CenteredPlanning:Brieflydescribeyouragency’sapproachtotheperson-centeredplanningprocess.Discusshowindividualgoalsandobjectiveswillbedeterminedandprogressmeasured.

Administrative/ConsultantRoles:DescriberolesofLicensee,Administrator,additionalstaff,andproposedinvolvedconsultants.Providequalificationsofanycertifiedorlicensedstafforconsultants,includingaBCBA.Attachresumes.

MethodsandProcedures:Pleaseseelistbelow.Applicantswilldescribehowtheywill:

• Involveandplanforactivitiesleadingtothetransitionofadolescentsfromthecommunitythatmayotherwisebedifficulttoplace.

• Addressthepsychiatricandmentalhealthtreatmentneedsofresidents,aswellastherapeuticapproaches.Describehowadolescentswillbeassistedtolearnemotionalself-regulationskills,howstaffwillbetrainedtorecognize,document,andreportsymptomsofpsychiatricconditionsandmedicationeffectiveness.Describetheevidence-basedpsychotherapeuticapproachesthatwillbeimplemented.

• Addressthedevelopmentofpositivebehavioralsupportplansforresidents.

• Addresstheclosesupervisionneedsofproposedresidentswithanemphasisonmitigatingrisktotheindividual,thecommunity,andstaff.

• Teachsocialskilldevelopmenttoassistadolescents inlearningpro-socialbehaviorsasalternativestoself-injuriousbehavior,sexual/physicallyaggressionand/orassaultivebehaviors.

• Systemicallyaddressresidentmotivationissuesthroughtheuseofincentivesystemstopromotecooperationandparticipationinthetreatmentandeducationalaspectsoftheservices.

StaffRecruitmentandRetention:Describeyourplantorecruitandretainqualitystaff.Includethefollowing:

• Desiredcharacteristicsforallstaffpositions.

• Healthandcriminalbackgroundscreeningprocedures.

• Initialandongoingtraining,includingrequiredcertifications.Includeanyspecializedtrainingforprovidingbehaviorsupportandcrisisinterventiontoadolescentswhohavepotentiallydangerousbehaviors.

• Discusswhattypicalstaffturnoverisforyourorganization/agency.

• Provideinformationonsalarylevelsandbenefits.Directcarestaffmustbepaidatasetminimum.

• Attachanorganizationchartthatincludesthisprojectandmapsthesupervisoryhierarchy.

• Providejobdescriptionsandqualificationsfortheprimarystaffandconsultantpositions.

StaffingSchedule:Provideasampleone-weekstaffingscheduleincludingtheadministrativestaff,directsupportprofessionals,consultant(s),andprogrampreptime.

Transportation:Describehowtransportationwillbeprovidedforday/workservices,therapy andmedicalappointments,courtrequirements,orrecreationandotheractivities.

FinancialResources:Discusswhatfinancialresourcesyoubringtotheproject(e.g.lineofcredit,cashorfluidcapitalreserves,etc.).

ContinuousQualityImprovement(CQI):Describehowtheserviceagencywillusedata,suchasagencyoutcomes,stakeholdersatisfaction,orotherexistingdata(e.g.incidentreports,medicationlogs)toidentify serviceproblemspursuanttocorrectivechangessuchasrevisedstafftrainingcurriculums,stafftrainingprocedures(e.g.supervision,medicationmanagement,recruiting,etc.).Providersshalldescribethefeedbackloopbywhichproblemprocedureswillbeidentified,correctivethroughrevisedpractices,andfurthermonitoredtomeasuretheeffectivenessofthosechangesinagencypractice.

DevelopmentTeam:ProvidealistofmembersoftheproposedProjectDevelopmentTeamincludingthename,address,telephonenumbers,emailaddresses,andresumesfortheteammembers.Ata minimum,theteamshouldincludetheleadstaffwhowilldevelopheresponsetotheRFP,theprogramdesign,andtheindividualswiththeexpertisetohireskilledconsultantstoassisttheproviderindevelopingtheproject.

ImplementationPlan:Aproposedimplementationplanandtimelinefordevelopmentthatincludessequencedactivitiesnecessaryforoverallprojectcompletionwithidentifiedrealistictimeframesforthecompletionofeachactivity.Theplanmustspecificaprocessthatensurescompliancewithallstateandlocallicensingrequirements.

DS1891Applicant/VendorDisclosureStatement:Completeandincludethisdocument:

FormattingRequirements

Applicantsmustadheretothefollowingformattingrequirementswhensubmittingproposals:

Allsubmissionsmustbeonwhite,standardsize(8½”x11”)paper,single-sidedonly,inhard-copytoLourdes RuizatWestsideRegionalCenter.Addressprovidedbelow.

All submissions must also include an electronic version sent to: .

Electronicsubmissionscannotexceed15megabytesperemail.MultipleemailsperRFPsubmissioncanandwillbeaccepted.An emailacknowledgementofeachsubmissionreceivedwillbesenttotheapplicant.

Attachments/Formsmustbetypewritten.Includeadditionalpagesasneeded. Allproposalsmustbecomplete,typewritten,collated,andpagenumbered.

Questionnairemustbetypewrittenin12-pointTimesNewRomanorArialfont.

The “Application/Proposal Coversheet” (see Attachment – A) must be the first page of theproposal.

TheproposalmustincludeaTableofContents.

Asapplicable,includeappendicesfordocuments,suchasresumes,certificates,curricula,schedules,lettersofrecommendation,lettersofsupportfromagencies,consultantsexpectedtoprovideprogramservices,etc.

FaxcopieswillNOTbeaccepted.DoNOTusehardcoverbinders.SubmissionswillNOTbereturned.

Noproposalswillbeacceptedafterthedeadline.

INQUIRIES/REQUESTFORASSISTANCE

All additional inquiriesregardingtheapplicationorrequesting technicalassistanceregardingthisRFPshouldbedirectedtoLourdes Ruiz.Technicalassistanceislimitedtoinformationontherequirementsforpreparationoftheapplicationpacket.Applicantsareexpectedtopreparethedocumentationthemselvesorretainsomeonetoprovidesuchassistance.Ifanapplicantchoosestoretainassistancefromanotherparty,theapplicantmustbeabletothoroughlyaddressallsectionsoftheproposalduringtheinterviewprocessand/ordemonstratethatthepartyassistingwiththeapplication willhaveacontinuingroleintheongoingoperationoftheprogram.

Inquiries/SubmittalContact: WestsideRegionalCenter

Attn:Lourdes Ruiz,QualityAssuranceSpecialist

5901GreenValleyCircle,Ste.320

CulverCity,CA90230(310)258-4284

Timeline

 / April 14, 2017 / Requestforproposalsrelease
 / May 12,2017,4:00PM / Deadlineforreceiptofproposals
 / May 15 – May 19,2017 / Evaluationofproposalsbyselectioncommittee
 / May 22 – May 26,2017 3,2017 / Programvisits,ifapplicable
 / May 30 – June 2,2017 / Interviewswithhighest-rankingapplicants,ifapplicable
 / June 2, 2017 / Noticeofselectionmailedtoapplicants
 / June 9,2017 / NotificationofprojectawardpostedonWRCwebsite
 / June 16,2017 / Start-upcontractsigned

Strictadherencetothedeadlinesabovewillbefollowed,tothebestoftheteam’sability.

APPLICATION/PROPOSALCOVERSHEET

Attachment–A

NameofApplicantorOrganizationSubmittingProposal
Nameofparentcorporation,ifapplicable
Applicant’smailingaddress
Contactpersonforproject
ContactphonenumberContactfax numberContacte-mailaddress
Authorof proposalorconsultantassistingwithproposalAuthor/consultantphonenumber
ListallRegionalCenters withwhichyouhavevendoredprogramsorservices
Reg.CenterNameof Program/ServiceTypeof Program/ServiceVendorNumber
ListallRegionalCenterswithwhichyouhaveprograms/servicesindevelopment
Reg.CenterTypeof Program/Servicein DevelopmentServiceStartDate

Applicationsubmittedby:

Signature(person mustbe authorizedtobind organization)Date

Attachment–B

PROFESSIONAL RESUMESANDREFERENCES

NameofApplicant/Organization:

Submitaprofessionalresumeforallstaffandconsultantsidentifiedorreferencedinapplication,includingindividualswhowillbeadministrator,ifknown.

Listallstaffand/orconsultantsforwhomaresumeisattached
NameJobTitle/TypeofConsultant

Listthreereferences,includingjobtitleandagencyaffiliation,whocanbecontactedinregardtoapplicant’squalifications,experienceandabilitytoimplementthisproposal.Referencesmustbeprofessionalinnature.Referencesfrommembersoftheapplicant’sgoverningboardand/orapplicant’sfamilymembersareexcludedfromconsideration.

Name:Phone: JobTitle:

AgencyAffiliation:

Name:Phone: JobTitle:

AgencyAffiliation:

Name:Phone: JobTitle:

AgencyAffiliation:

STATEMENTOF OBLIGATION

All applicants must complete this statement

1.Is theapplicantcurrently providingservices toindividuals with developmental disabilities?

[ ] No[ ] Yes

Ifyes,indicatethe following:

Name: ______

Location: ______

Typeof Service: ______

Capacity: ______

2.Is theapplicant currently providing related services to individuals other than those with developmental disabilities?

[ ] No[ ] Yes

Ifyes,indicate the following:

Name: ______

Location: ______

Type of Service: ______

Capacity: ______

3.Is theapplicantcurrentlyreceivinggrant(s)/fundsfromany sourceto develop services for people with developmental disabilities?

[ ] No[ ] Yes

Ifyes,indicate the following:

Funding Source: ______

Scope of Grant Project: ______

4.Is the applicant currently applying grant(s)/funds from any source to develop services for Fiscal Year 2015 – 2016?

[ ] No[ ] Yes

If yes, indicate the following:

Funding Source: ______

Scope of Grant Project:______

5.Is the applicant planning toexpand existingservices (through a Letter of Intent and with orwithoutgrantfunds) fromasource otherthanWestside RegionalCenterduringFiscal Year2015-2016and/orfiscalyear2016–2017?

[ ] No[ ] Yes

Ifyes,provide details:

______

6.Has the applicant, any memberoftheapplicant’sorganization orstaffhasreceived a citationfromanyagencyforabuse(verbal,physical,sexualfiduciary,neglect)?

[ ] No[ ] Yes

Ifyes,explain in detail:

______

7.Has theapplicantoranymemberofthe applicant’sorganization received a Corrective Action Plan (CAP),Sanction,NoticeofImmediateDanger,oran“A”or“B”citation,or anyothercitationfromaregionalcenterorstate licensing agency?

[ ] No[ ] Yes

Ifyes, explain in detail:

______

8.Describe otherprofessional/businessobligationsheld bythe Licenseeand Administrator. Do not include services you propose to provide through this proposal.

Include the following:

Name: ______

Location: ______

Type of Service: ______

Time of commitment:______

Capacity: ______

Signature ofApplicantor Authorized RepresentativeDate

Attachment - D

Financial Statement

All respondents must complete this statement for last complete fiscal year

and current fiscal year to date

CURRENTASSETS
CashinBank
Accounts Receivable
NotesReceivable
EquipmentIVehicles
Inventory
Deposits/PrepaidExpenses
LifeInsurance(CashValue)
InvestmentSecurities (Stocks and Bonds)
TOTALCURRENTASSETS=
FIXEDASSETS
Buildingsand/orStructures
Real Estate Holdings
LongTerm Investments
PotentialJudgementsandLiens
TOTALFIXEDASSETS=
TOTALCURRENTANDFIXEDASSETS=
CURRENTLIABILITIES
AccountsPayable
NotesPayable (Current Portion)
TaxesPayable
TOTALCURRENTLIABILITIES=
LONGTERMLIABILITIES
NotesIContracts
RealEstateMortgages
TOTALLONGTERMLIABILITIES=
TOTALCURRENTANDLONGTERMLIABILITIES=
Equity=
TOTALLIABILITESANDEQUITY=
OTHERINCOME-RevenuefromotherSources
Wages/Revenue or Other Sources (Specify)
LINEOFCREDIT
AmountAvailable (specify)

Attachment – E

BUDGET SUMMARY

Name of Applicant Organization: ______

Date:______

Submit budget projections using estimates that are both reasonable and realistic uses of funds.
Care and Services / Start-up Expense
1. / Food
2. / Household Supplies
3. / Personal Supplies
4. / Program Equip/Recreation
5. / Total Board & Supply (add lines 1-4)
Physical Plant / Start-up Expense
6. / Lease/Insurance (first 6 months or until the home is licensed)
7. / Utilities (gas, electric, water, phone/media)
8. / Vehicle Lease
9. / Vehicle Maintenance/Gas/Insurance
10. / Furnishings/Maintenance
11. / Total Physical Plant (add Lines 6-10)
General Administration / Start-up Expense
12. / Admin Overhead
13. / Office Supplies/Equipment/phone
14. / Insurance(s)
15. / Other-CCL fees
16. / Staff recruitment
17. / Training & Staff Development
18. / Total Gen. Administration (add lines 12-17)
Staffing / Start-up Expense
19. / Salary – Administrator
20. / Direct Staffing (first 6 months or until the 1st person moves in)
21. / Program Consultants
22. / Employee Benefits (first 6 months or until the 1st person moves in)
23. / Payroll Taxes
24. / Worker’s Compensation (first 6 months or until the 1st person moves in.
25. / Total Staffing Expenses (add lines 19-24)
26. / Total Start-up Expenses (add lines 5,11,18 & 25) / $
27. / Total Mo. Rate Per Person (divide Line 26 by 3)