REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 18, 2025
FROM
GEORGINA YOSHIOKA, Director, Department of Behavioral Health
SUBJECT
Title
Contracts for Skilled Nursing Facilities
End
RECOMMENDATION(S)
Recommendation
Approve contracts with the following agencies, including a non-standard term, for Skilled Nursing Facilities, in the total aggregate amount not to exceed $11,864,050, for the contract period of July 1, 2025, through June 30, 2030:
1. Alvarado Care Center
2. Community Care on Palm Riverside, LLC
3. Crestwood Behavioral Health, Inc.
4. Foothill Heights Care Center, LLC
5. Helios Healthcare, LLC
6. Maple Healthcare Center LLC
7. Windsor Terrace Healthcare, LLC DBA Windsor Terrace Healthcare Center
8. RG Legacy II LLC- Pasadena Nursing Center
9. Rosemead Healthcare Center
10. Studebaker Healthcare Center
11. Unique Adult Day Healthcare, Inc.
12. United Convalescent Facilities, INC
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
Approval of this item will not impact Discretionary General Funding (Net County Cost). The estimated total aggregate amount not to exceed $11,864,050 for Skilled Nursing Facilities (SNF) is funded by 1991 Realignment funds. Adequate appropriation and revenue have been included in the Department of Behavioral Health’s (DBH) 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
DBH is responsible for providing mental health and substance use disorder (SUD) services to county residents experiencing severe mental illness and/or SUD. SNFs are required to provide 24-hour skilled nursing care, as well as related or rehabilitative services. The typical SNF resident is a person who is chronically ill or recuperating from an illness/surgery and needs regular nursing care and additional health related services. Residents in SNFs are under the care of their personal Physician or the facilities’ Medical Director. Each resident must have an individual plan of care developed by the Physician, resident (or his/her representative), and facility staff. These facilities provide a protective environment with medical and social services to individuals whose care needs cannot be met at home or in a residential care setting.
SNFs provide custodial care; dietary, social, pharmaceutical, and recreational therapy services; specialized units for dementia residents; administration of medications; and Activities of Daily Living (bathing, dressing, grooming and transferring). SNFs may also provide ancillary services such as physical, occupational, and speech therapies. Through the provision of these services, DBH will be able to transition appropriate clients from State Hospitals, acute hospitals, and other locked levels of care to SNFs and provide services at a lower overall cost, both financially and subjectively. This process will shorten lengths of stay in a higher level of care and benefit clients whose needs require a locked setting for psychiatric and medical care. Placement of clients will be less costly to the County than other options for similar treatment options.
In 2022-23, SNFs served a total of 40 clients amongst eight facilities. Approval of this item will allow DBH to pool available SNF funding into an aggregate amount to allow for increased flexibility in placing individuals in the most appropriate and available contracted facility to meet their needs. Due to the varying costs between facilities and levels of individual care, the number of beds available for the aggregated funds will vary. The total cost of SNF services will not exceed $11,864,050 for the period of July 1, 2025, through June 30, 2030.
The contract with Crestwood Behavioral Health, Inc. includes the following non-standard term:
Crestwood Behavioral Health, Inc., will not indemnify the County for any claims for any cause and is limited to its obligations under the contract and the indemnification does not apply regardless of fault or the County’s negligence.
• The County standard contract general indemnity provision requires the contractor to indemnify, defend, and hold the County harmless from third-party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: Crestwood Behavioral Health, Inc.’s indemnity obligation is more limited compared to the standard County general indemnity obligation. In the event a claim arises that falls outside the scope of Crestwood Behavioral Health, Inc.'s limited indemnity obligation, the County could be financially responsible for the defense of the claim and any resulting judgment/settlement.
DBH will implement mechanisms to regularly review 1) client service data and progress, conduct site visits and annual monitoring to ensure performance and compliance standards of the contract(s) are met; 2) applicable claims data and claims for reimbursement to ensure fidelity and accuracy of service billing and optimization of Medi-Cal reimbursement in alignment with Contract terms and Department of Health Care Services billing requirements; and 3) provider invoices administratively and programmatically to ensure client and/or bed counts are accurate prior to payment processing.
PROCUREMENT
On November 22, 2024, the County Administrative Office approved and authorized the release of Request for Proposals (RFP) No. DBHE24-ADMN-5540 through the Electronic Procurement Network (ePro), to solicit interested and qualified organizations and agencies to provide SNF services. The RFP was publicly advertised in local newspapers and sent through direct mailings to more than 600 community-based organizations, service providers, and other interested parties.
A bidder’s conference was held on January 8, 2025. Thirteen proposals were received in response to the RFP by the established deadline. All 13 proposals, received from the agencies listed below, met the minimum requirements and continued through the evaluation process:
|
Agency |
City and State |
|
Alvarado Care Center |
Los Angeles, CA |
|
Community Care on Palm Riverside, LLC |
Pasadena, CA |
|
Crestwood Behavioral Health, Inc. |
Sacramento, CA |
|
Foothill Heights Care Center, LLC |
Pasadena, CA |
|
Helios Healthcare, LLC |
Sacramento, CA |
|
Maple Healthcare Center LLC |
Pasadena, CA |
|
Windsor Terrace Healthcare, LLC DBA Windsor Terrace Healthcare Center |
Los Angeles, CA |
|
Pamoja Advanced Nursing Practice, Inc. |
Anaheim, CA |
|
RG Legacy II LLC- Pasadena Nursing Center |
Pasadena, CA |
|
Rosemead Healthcare Center |
Los Angeles, CA |
|
Studebaker Healthcare Center |
Norwalk, CA |
|
Unique Adult Day Healthcare, Inc. |
Hesperia, CA |
|
United Convalescent Facilities, INC |
Pasadena, CA |
The evaluation committee comprised of five individuals from the Office of the Public Guardian, San Bernardino County Superior Court, Human Services, and DBH, which evaluated the proposals based on the criteria referenced in the RFP. The evaluation criteria included, but were not limited to: ability to serve the target population, ability to provide required services as specified in the RFP, ability to service the necessary number of unduplicated participants, readiness to provide services, experience, staffing levels and qualifications, appropriateness of facility (in Geographic Service Option/area, proximity to mass transit, facility layout, laundry/shower facilities, etc.), and the ability to measure outcomes.
Based on the evaluation criteria, the committee determined that all the agencies above were recommended for award. However, after being selected, Pamoja Advanced Nursing Practice, Inc., provided an updated Fee Schedule, which negatively impacted the cost associated with their services, resulting in the ending of negotiations. Award and denial letters were sent to all responsible and responsive proposers on March 19, 2025. No protests were received within the allowable period.
The Purchasing department supports this competitive procurement based on the formal solicitation described above.
REVIEW BY OTHERS
This item has been reviewed by Behavioral Health (Lisa Rivas-Ordaz, Contracts Supervisor, 383-3940) on May 8, 2025; County Counsel (Dawn Martin, Deputy County Counsel, 387-5455) on May 22, 2025; Risk Management (Gregory Ustaszewski, Staff Analyst, 386-9008) on May 23, 2025; Purchasing (Jessica Barajas, Supervising Buyer, 387-2065) on May 22, 2025; Finance (Paul Garcia, Administrative Analyst, 386-8392) on May 30, 2025; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0332) on May 30, 2025.