Staff Report - Grant Award from State of California - Department of Aging - California Community Program for Alzheimer’s Services and Supports Grant — Sacramento City Council, November 29, 2022

City of Sacramento
City Council - 5PM Report
915 I Street Sacramento, CA 95814
www.cityofsacramento.org
File ID: 2022-01886 11/29/2022 Consent Item 18.

Grant Award from State of California - Department of Aging - California Community Program for Alzheimer’s Services and Supports (CalCOMPASS) Grant File ID: 2022-01886
Location: Citywide
Recommendation: Adopt a Resolution authorizing the City Manager of City Manager’s designee to:
1) establish the CalCOMPASS Grant project (G19090910) (Fund 2702) to implement the project in the Triple R Adult Day Program; and 2) establish the revenue and expenditure budgets in the amount of $350,000 in the CalCOMPASS Grant Project (G19090910) (Fund 2702) to implement the grant award.

Contact: Stephanie Wilson, Recreation Superintendent, (916) 808-1591 [email protected]; Daina Stiles, Administrative Officer, (916) 808-2347, [email protected]; Youth Parks and Community Enrichment.

Presenter: None
Attachments:
1-Description/Analysis
2-Resolution
3-Agreement
Description/Analysis
Issue Detail: The California Department of Aging (CDA) is administering a competitive grant program with one-time funding of $4.5 million for a California Community Program for Alzheimer’s Services and Support (CalCOMPASS). CalCOMPASS is a 13-month pilot project to meet the needs of diverse older adults and families in a community setting through the provision of dementia care services, provided at licensed Adult Day Programs and Adult Day Health Care Centers, to address the health and wellbeing of older adults and their caregivers, prevent or delay institutionalization and advance health equity.

On August 16, 2022, the Youth, Parks and Community Enrichment (YPCE) Department - Triple R Adult Day Program - received City Council approval to submit a grant application for the State of

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File ID: 2022-01886 11/29/2022 Consent Item 18.

California CalCOMPASS in the amount of $350,000 (Resolution 2022-0269). The same resolution authorized the City Manager or the City Manager’s designee to execute a grant agreement accepting any grant funds awarded. On October 10, 2022, the City received notice of intent to award from CDA.

A copy of the executed grant agreement is attached as Attachment 3.

The Triple R Adult Day Program will provide person-centered care and support services for individuals and families experiencing dementia and serve as a model program for the State. Funding will allow for expansion of the number of participants being served through the program and will provide services to prevent and delay institutionalization of individuals due to high care needs. Staff of the program will provide intensive case management services to support caregivers’ health and wellbeing through education and a network of community resources. This partnership with the State of California will provide the State with access to what they consider model dementia care programs.

Their aim is to use the information they glean from working with us this year through what they are calling a "learning lab" to recommend future state funding that allows people experiencing dementia to continue living in the community.

Policy Considerations: Funding for this project would enhance recreational opportunities, ensure continuity of integral community services, and is consistent with the City’s strategic plan to achieve sustainability and enhance livability.

Economic Impacts: Not applicable.

Environmental Considerations:

California Environmental Quality Act (CEQA): Under the California Environmental Quality Act (CEQA), continuing administrative activities, such as what is recommended in this report do not constitute a “project” (CEQA Guidelines section 15378(b)(2).) Sustainability: The project has been reviewed for consistency with the goals, policies, and targets of the City’s Sustainability Master Plan (SMP) and the 2035 General Plan. The Project will advance the goals, policies, and targets of these plans by improving the health of residents through access to a diverse mix of wellness and recreation activities.

Commission/Committee Action: None.

Rationale for Recommendation: The Triple R Adult Day Program provides a critical segment of services to older adults experiencing Alzheimer’s and dementia. Individuals experiencing dementia can require ongoing support with activities of daily living such as bathing and eating, as well as experience impacts in mood and behavior. Caregivers of individuals experiencing Alzheimer’s and other forms of dementia also face challenges in daily care and require ongoing support. In addition, Alzheimer’s and dementia disproportionately impact women, ethnic minorities, and individuals with disabilities. As Alzheimer’s and dementia are the cause of death in 1 in 3 older adults (California Taskforce on Alzheimer’s Prevention & Preparedness Report, 2020), it is vital to ensure the City’s communities have continued access to a critical resource like the Triple R Adult Day Program. The recommended project meets all grant criteria and maximizes competitiveness based on the following criteria:

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File ID: 2022-01886 11/29/2022 Consent Item 18.
· is one of a small group of eligible service providers · has specific experience and capacity for required grant program elements such as ongoing provision of caregiver support, provides services to participants with moderate to advanced stages of dementia, etc.
· meets the grant goals to leverage partnerships toward integrating models of support, demonstrate experience with recognized models of care and best practices and facilitate collaborative relationships with local and regional stakeholders.

Financial Considerations: YPCE will be receiving the CalCOMPASS funding in the amount of $350,000 to implement the project in the Triple R Adult Day Program. The grant provides State funds for the implementation of program services and supports.

YPCE will establish the revenue and expenditure budgets in the amount of $350,000 in the CalCOMPASS Grant Project (G19090910) (Fund 2702) to implement the grant award.

Local Business Enterprise (LBE): Not applicable.

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RESOLUTION NO. 2022-
Adopted by Sacramento City Council
November 29, 2022
Grant Award from State of California – Department of Aging -CalCOMPASS Grant

BACKGROUND:

A. The California Department of Aging (CDA) is administering a competitive grant program with one-time funding of $4.5 million for a California Community Program for Alzheimer’s Services and Support (CalCOMPASS).

B. CalCOMPASS is a 13-month pilot project to meet the needs of diverse older adults and families in community setting through the provision of dementia care services, provided at licensed Adult Day Programs and Adult Day Health Care Centers, to address the health and wellbeing of older adults and their caregivers, prevent or delay institutionalization, and advance health equity.

C. The Youth, Parks & Community Enrichment (YPCE) Department – Triple R Adult Day Program – received City Council approval on August 16, 2022 (Resolution 2022-0269) to apply for the State of California CalCOMPASS in the Amount of $350,000, and to execute any grant agreement.

D. YPCE’s Triple R Adult Day Program will provide person-centered care and support services for individuals and families experiencing dementia and serve as a model program for the State pilot program.

E. On October 10, 2022, the City received notice of intent to award from CDA and the City Manager’s Office has executed the grant agreement accepting $350,000 in funding.

BASED ON THE FACTS SET FORTH IN THE BACKGROUND, THE CITY COUNCIL RESOLVES AS FOLLOWS:

Section 1. The City Manager or the City Manager designee is authorized to establish the CalCOMPASS Grant project (G19090910) to be used in implementing the project objectives.

Section 2. The City Manager or the City Manager designee is authorized to establish the revenue and expenditure budgets in the amount of $350,000 in the CalCOMPASS Grant Project: (G19090910) (Fund 2702) to implement the grant award.

2. The term of this Agreement is:

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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EXHIBIT A

SCOPE OF WORK

1. CONTRACTED PARTIES:

City of Sacramento dba Triple R Program, hereafter referred to as Contractor, agrees to help facilitate and create a dementia care model that is financially sustainable and sets a standard for dementia care in the full field of licensed Adult Day Programs (ADP) and Adult Day Health Care (ADHC) Centers (as defined in Section 5) to the Department of Aging (CDA), pursuant to the terms and conditions of the Agreement.

2. SERVICE LOCATIONS:

The services shall be performed at the program site or meeting site, or remotely when appropriate and agreed to by CDA. Locations will be coordinated by the Project Representatives.

3. SERVICE HOURS:

The services shall be provided on an as needed basis, based on regular program hours.

4. PROJECT COORDINATORS:

A. The project coordinators during the term of this Agreement shall be:

Department of Aging City of Sacramento dba Triple R
Program
Section/Unit: Health at Home Branch
Attention: Michelle Johnston Hector Barron
Title: Program Director,
Dementia Initiatives
Assistant City Manager

Address: 2880 Gateway Oaks Drive
Suite 200
Sacramento, CA 95833
915 I Street
Sacramento, CA 95814
Phone: (916) 898-9539 (916) 808-1040
Email: [email protected] [email protected] DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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B. Direct all Agreement inquiries to:

Department of Aging City of Sacramento dba
Triple R Program
Section/Unit: Health at Home Branch
Attention: Shawntel Bush Stephanie Wilson
Title: Chief Recreation Superintendent
Address: 2880 Gateway Oaks Drive
Suite 200
Sacramento, CA 95833
915 I Street
Sacramento, CA 95814
Phone: (916) 751-0189
Email: [email protected] [email protected] Either party may make changes to the contact names or information above by giving written notice to the other party. Said changes shall not require an amendment to this Agreement.

5. AMENDMENTS
The parties reserve the right to amend this Agreement to clarify terms or add language or other items to accomplish the work, if necessary. Additionally, the parties reserve the right to amend this Agreement for additional funding and/or time as needed. This right to amend is in addition to the right to amend for other reasons contained in this Agreement or noted in the solicitation that resulted in this Agreement, if applicable. Any amendment shall be in writing and signed by both parties.

6. CONTRACTOR’S RESPONSIBILITIES
A. Contractor and its sub-contractors shall procure and keep in full force and effect during the term of this Agreement all permits, registrations and licenses necessary to accomplish the work specified in this Agreement and shall give all notices necessary and incident to the lawful prosecution of the work. Contractor shall provide proof of any such license(s) permits(s), and certificate(s) upon request by the CDA. Contractor agrees that failure by itself or its sub-contractors to provide evidence of licensing, permits, or certifications shall constitute a material breach for which the CDA may terminate this Agreement with cause.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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B. Contractor shall provide services as outlined in this Agreement. Contractor shall be responsible to fulfill the requirements of the Agreement and shall incur expenses at its own risk and invest enough time and capital to fulfill the obligations as contained herein.

C. Contractor and its sub-contractors shall keep informed of, observe, comply with, and cause all its agents and employees to observe and to comply with all prevailing Federal, State, and local laws, and rules and regulations made pursuant to said Federal, State, and local laws, which in any way affect the conduct of the work of this Agreement. If any conflict arises between provisions of the plans and specifications and any such law above referred to, then the Contractor shall immediately notify the state in writing.

D. The CDA may terminate the Agreement pursuant to section 7 of Exhibit C if the Contractor or its sub-contractors fails to comply with a federal, state, or local law and the noncompliance, based on the facts and circumstances, would constitute a material breach of this Agreement under California law.

7. CAL-COMPASS PROGRAM OVERVIEW
In 1980, AB 2975 established the Older Californians Act (OCA). The 1980 OCA established the California Department of Aging (CDA) as the single state agency responsible for administering the Older Americans Act (OAA) within California. It also defined the duties and functions of CDA as well as the state's 33 Area Agencies on Aging (AAAs). In 1996, the Legislature amended the OCA via the Mello-Granlund Act (AB 2800). AB 2800 expanded upon the 1980 OCA by establishing new programs and making structural changes to service delivery. One such change was the establishment of state-funded programs and services for older adults and adults with disabilities through community-based services. Some of these programs and services include but are not limited to the following: access services, nutrition services, legal services, support services, health promotion and disease prevention, and caregiver support services. AB 2800 also established community-based services that were not included in the OAA but funded by the State’s general fund and/or Medi-Cal (i.e., the State’s Medicaid program). The Alzheimer’s Day Care Resource Center (ADCRC) program is one such program and provided access to specialized day care resource centers for individuals with Alzheimer’s disease and other dementia-related disorders as well as support to their families and caregivers.

While the authorizing language remains in statute, budget cuts during the 2008 Great Recession eliminated funding for the ADCRC program.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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CDA has been granted one-time funds that will help facilitate and create a dementia care model that is financially sustainable and sets a standard for dementia care in the full field of licensed Adult Day Programs (ADP) and Adult Day Health Care (ADHC) Centers, thereby uplifting dementia-capable services statewide. This investment also supports principles of equity and access to care in the community setting by using enhanced person-centered principles to support people at any stage of dementia.

CDA, in partnership with Contractors, will create a modernized approach to the ADCRC principles and best practices for Alzheimer’s and dementia in community care settings. CDA is administering a time limited program that will leverage one- time funds to design and implement a modernized Alzheimer’s community care model. California’s Community Program for Alzheimer’s Services and Support (Cal- COMPASS) will serve as a learning laboratory through which to further develop ADCRC best practices in diverse communities and where there is a great need for educating and supporting caregivers. The Contractors, along with CDA team members, and the evaluation contractor will help shape the model, collect participant data, and further develop best practices.

CDA will engage an independent evaluator for this project to work with CDA and the Cal-COMPASS contractors. The evaluation may include an assessment of the implementation process, identification of lessons learned and best practices, early outcomes, and/or recommendations for further scaling and sustainability.

A. CAL-COMPASS GOALS
1) Create an opportunity to further distinguish California as a hub of expertise for Alzheimer’s and dementia-capable community-based services. 2) Leverage CDA’s partnerships across multiple agencies, departments, and stakeholders to integrate a model for Alzheimer’s and dementia supports into the Master Plan for Aging, California Advancing and Innovating Medi-Cal (CalAIM) and other initiatives.
3) Demonstrated practices that aid in the development of a Cal-COMPASS learning laboratory to accelerate knowledge and skill building for Alzheimer’s and dementia-capable programs and best practices.
4) Utilize cross-departmental expertise of ADPs and ADHCs that have specializations in Alzheimer’s and dementia care to implement proven best practices and the testing of latest research, person-centered concepts, and non-pharmacological interventions.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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5) Create a statewide learning community with a sustained focus and strong links to the Department of Health Care Services’ (DHCS) efforts with CalAIM and the new Office of Medicare Innovation and Integration, helping to achieve the goal of community living for those with Alzheimer’s and dementia and support of their caregivers who are facing challenges due to disease stages, symptoms, and/or circumstances.
6) Foster connections with the state’s existing infrastructure and resources, which may include AAAs, Aging and Disability Resource Connections (ADRC), Caregiver Resource Centers, Independent Living Centers, and the work of the California Department of Public Health and its California Alzheimer’s Disease Centers and Healthy Brain Initiative counties. 7) Create a direct link and consistent approach to the Medicaid Home and Community Based Services Spending Plan’s investments in workforce development and training that can be used to build Alzheimer’s and dementia-capable expertise among clinical and non-clinical care providers. 8) Gather and maintain data and evaluate outcomes for similarly identified individuals.
9) Enable common standards of practice to be defined, monitored, and evaluated via uniform assessment measures and use for outcomes research and continuous quality improvement.
10) Facilitate collaborative relationships with local partners, including, but not limited to AAAs, ADRCs, and experienced stakeholders. Leverage these relationships to build and expand future funding and certification for Alzheimer’s and dementia-capable programs that will be critically needed as the number of people living with Alzheimer’s, including people with Down syndrome, increases exponentially.

8. CAL-COMPASS OUTCOMES
1) Develop start-up and staff training manuals.
2) Implement tested and valid common evaluation and screening tools. 3) Create a replicable and scalable dementia-care services model. 4) Establish demographic and related descriptive statistics. 5) Gather, review, and analyze data to support positive person-centered outcomes.
6) Allow for shared technology and telehealth services.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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7) Develop training for the community and providers to keep people out of Nursing Facilities, Hospitals and Emergency Departments.

9. CAL-COMPASS OPERATIONS
A. Contractors (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) are responsible for:
1) Maintaining licensing status with the State of California and operating in accordance with all applicable federal and state laws, rules, regulations, and policies.
2) Complying with all processes, reporting, and procedures required by CDA. 3) Providing a program and services to meet the special care needs of, and address the behavioral problems of, participants.
4) Providing adequate and appropriate staffing to meet the nursing, psychosocial, and recreational needs of participants.
5) Providing physical facilities that include the safeguards necessary to protect the participants’ safety.
6) Providing a program for assisting individuals who cannot afford the entire cost of the program. This may include, but need not be limited to, utilizing additional funding sources to provide supplemental aid, and allowing family members to participate as volunteers at the applicant’s facility. 7) Maintaining family and caregiver support groups.
8) Providing or arranging transportation to and from the facility for participants. 9) Concentrating on participants in the moderate to severe ranges of disability. 10) Providing or arranging for a meal for participants. 11) Serving as model centers available to other service providers for onsite training in the care of these participants.
12) Maintaining a systematic means of capturing and reporting all required community-based services program data.
13) Establishing contact with local educational programs, such as nursing and gerontology programs, to provide onsite training.
14) Providing services to assist family members, including counseling and referrals to other resources.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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15) Conducting community outreach activities and providing educational and informational materials to the community.
16) Committing to assist with the development and use of common Cal- COMPASS elements to further the goal of refining and designing a person- centered, equitable, and evidenced-informed approach to Alzheimer’s and dementia services which include but are not limited to:
a) Enrollment and disenrollment processes
b) Diagnostic requirements (how to support the participant in getting an accurate diagnosis and subsequent planning)
c) Tools selected for common use, including evaluating engagement in activities
d) Training curriculum
e) Tiers of service with dementia-specific criteria
f) Required practices
g) Best practices
h) Equity and access standards and approaches
i) Community education framework
j) Support group requirements
k) Learning Community framework that meets the needs of diverse programs and communities
l) Coordination with ADRCs, Alzheimer's and other Associations m) Coordination with CalAIM and DHCS
n) Evaluation component
17) Notifying CDA at the beginning of this Agreement of key personnel who will provide services as part of Cal-COMPASS and will notify CDA as soon as feasible of any key personnel changes.
18) Notifying CDA in writing of any proposal to make major changes to Cal- COMPASS, implementation strategy, key personnel, or timetable and will obtain CDA's written approval before making any such changes.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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19) Providing availability to continual care for people in moderate to severe stages of disease.
20) Actively participating in the Cal-COMPASS learning community to help develop best practices and support for caregiving families and individuals living alone in the community.
21) Ensuring ongoing engagement with community and state partners. 22) Serving as a hub for creating community awareness around prevention, early intervention and clinical best practices around diagnosis and treatment. 23) Holding regular meetings, participating in Cal-COMPASS conference calls, and providing data and quarterly reports to CDA as required and requested. 24) Maintaining complete books and records of revenues and expenditures for Cal-COMPASS and making them available to CDA for inspection at reasonable times as deemed necessary by CDA.

B. CDA is responsible for and shall incorporate the following components into Cal- COMPASS:
1) Provide staff support to coordinate work on Cal-COMPASS, Contractors (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement), and others.
2) Create and maintain a resource library on the CDA website drawing upon the assistance provided by Cal-COMPASS sites.
3) Provide Contractors (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) with guidance and technical assistance regarding Cal-COMPASS reporting requirements and data collection processes.
4) Monitor and conduct an evaluation of operations under Cal-COMPASS. This may include a visit from CDA staff and/or advisors to observe Contractor’s (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) implementation of the program, discuss the program with Contractor’s (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) personnel, and review financial and other records and materials connected with the activities financed by this Agreement (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 3 of this Agreement).

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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10. REPORTING REQUIREMENTS AND DISBURSEMENT SCHEDULE
A. Contractor shall submit the following reports, in a format and manner acceptable to CDA:

Report Report Period Report
Deadline
Report Type
1st Report November 1 – Dec. 31,
2022
Jan. 31, 2023 Interim & Expenditure
Reports
2nd Report Jan. 1 - March 31,
2023
April 28, 2023 Interim & Expenditure
Reports
3rd Report April 1 - June 30, 2023 July 31, 2023 Interim & Expenditure Reports
4th Report July 1 - Sept. 30, 2023 Oct. 31, 2023 Interim & Expenditure Reports
Final
Report
Oct. 1 – Dec. 31, 2023 December 31,
2023
FINAL Program
Report & Fiscal
Closeout Reports
B. The final report shall be comprehensive and include:
1) A summary of the program goals and objectives.
2) Accomplishments toward achieving those goals and objectives. 3) Issues encountered and how the issues were resolved.

C. Quarterly Status Reports
1) Reports are a snapshot of each quarter and shall include an overview of significant developments during the report period, identified problems, and solutions. The report narrative should be concise and informative. The subject areas to be addressed are:
a) Progress towards implementing the Cal-COMPASS goals and achieving site-specific program goals and objectives, including any program or service improvements made possible through Cal-COMPASS funding. b) Summary of organization’s participation in Cal-COMPASS learning community, including any best practices that can inform the model. c) Issues/challenges encountered and plans/progress to address them. d) Summaries of outcomes data related to program components or participants, if available
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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e) Monthly participant count
f) Fiscal Reporting – Expenditure data and receivables by budget category D. Contractor shall submit Ad Hoc Reports as may be required by CDA to help develop the Cal-COMPASS model. Common program elements for reporting purposes may include but not be limited to:
a) Eligibility criteria, including qualifying symptoms and diagnoses b) Enrollment and disenrollment processes
c) Diagnostic requirements (how to support the participant in getting an accurate diagnosis and subsequent planning)
d) Tools selected for common use, including evaluating engagement in activities
e) Training curriculum
f) Tiers of service with dementia-specific criteria
g) Required practices
h) Best practices
i) Equity and access standards and approaches
j) Community education framework
k) Support group requirements
l) Learning Community framework that meets the needs of diverse programs and communities
m) Coordination with ADRCs, Alzheimer's and other Associations n) Coordination with CalAIM and the DHCS
o) Evaluation component
E. Fiscal closeout reports
(1) As part of the closeout procedures for this contract, Contractor shall submit a closeout package which must include the following documents:
(a) Final accounting reconciliation
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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(b) Closeout budget
(c) Fiscal summary report for the State
F. Contractor, at its discretion, may at any time prepare and submit reports and correspondence to CDA summarizing any issues and/or concerns.

11. TERMINATION OBLIGATIONS SPECIFIC TO THIS AGREEMENT
A. CONTRACT PERIOD
The Contract period will commence as of November 1, 2022, through December 31, 2023. Contractors (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) must submit a final report by the end of the contract term, December 31, 2023. Work on the program ends with the submission of the final report.

B. AGREEMENT TERMINATION BY CDA
CDA may terminate this Agreement by providing a thirty (30) day written notification to Contractor. Upon such termination, Contractor and any Sub- Contractors will return any funds (including interest accrued) not expended or committed for the purposes of the program prior to the termination to CDA within forty-five (45) calendar days.

C. TERMINATION BY CONTRACTOR
Contractor, and Sub-Contractor may terminate the agreement with a thirty (30) day written notice to CDA if the continuation of the Agreement creates a financially unsustainable burden for Contractor. Contractor shall provide written notification of termination to CDA with an explanation of the financial information causing the termination. Upon such termination, Contractor, and Sub-Contractor will return any funds, (including interest accrued) not expended or committed for the purposes of the program prior to the termination, to CDA within forty-five (45) calendar days of the date of the termination.

After CDA’s Notice of Termination or Contractor’s, and Sub-Contractor’s Notice of Intent to Terminate, Contractor shall immediately proceed with the following obligations, as applicable, regardless of any delay in determining or adjusting any funds due under this clause.

Contractor shall:
1) Take immediate steps to ensure the health and safety of ADP/ADHC Participants managed by Contractor. Contractor agrees to refer ADP/ADHC Participants to other local resources.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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2) Maintain staff to provide services to Participants during transition. 3) Deliver updated Participant records to the subsequent ADP/ADHC Providers as directed by CDA.
4) With assistance from CDA, develop a written Transition Plan, to locate alternative services for each Participant through another ADP/ADHC site or community agency in accordance with this Agreement.
5) Contractor shall submit a transition plan to CDA within fifteen (15) business days of delivery of the written Notice to Terminate the Contract. The Transition Plan must be approved by CDA and shall, at a minimum, include the following:
a) A current Participant count identifying Participant information upon request.
b) A description of how Participants will be notified about the change in their ADP/ADHC Provider.
c) A plan to communicate with other ADP/ADHC sites, local agencies and advocacy organizations that can assist in locating alternative services for Participants.
d) A plan to inform community referral sources of the pending termination of this Agreement and what alternatives, if any, exist for future referrals. e) A plan to evaluate the health and safety of Participants to assure appropriate placement.
f) A plan to transfer confidential Participant records to a new ADP/ADHC Provider.
g) A plan to maintain adequate staff to provide continued care to ADP/ADHC Participants through the term of the Agreement.
h) Contractor shall implement the Transition Plan as approved by CDA. CDA will monitor the progress in carrying out all elements of the Transition Plan.
(1) Be responsible for providing all necessary Participant services until termination or expiration of the Agreement.
(2) Submit a full accounting and closeout of Contractor’s existing budget.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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D. CONFIDENTIALITY
Contractor will maintain the confidentiality of all Protected Health Information (PHI) and/or Personal Identifying Information (PII) (as defined in Exhibit F of this Agreement) provided to CDA and will not disclose it to any other party without prior written consent of CDA.

E. INDEPENDENT AGREEMENTS
CDA and Contractor are entering into an independent Agreement about one another, and nothing in this Agreement will be construed to create an employment, joint employment, partnership, joint venture, agency, or any other kind of relationship between them. In no event will Contractor or its employees, or agents, if any, be considered employees of CDA. Contractor will not have, nor will Contractor claim or imply that Contractor has, any authority to enter any obligation on behalf of, or binding upon, CDA. Contractor will be solely responsible for all taxes, withholdings, and other statutory or contractual obligations of any sort, regarding persons retained by it to perform the program, including, but not limited to, workers' compensation insurance, and employee pension, health, welfare, or other fringe benefit plans.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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F. INDEMNIFICATION
Contractor agrees to indemnify, defend and save harmless the State of California, CDA and its officers, employees and agents, from any and all claims, losses, and liabilities accruing or resulting to any and all contractors, sub- contractors, suppliers, laborers and any other person, firm, or corporation furnishing or supplying work services, materials, or supplies in connection with the performance of this Agreement, and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Contractor in the performance of this Agreement.

G. DISSEMINATION AND PUBLICITY
CDA, along with other Cal-COMPASS partners, will oversee dissemination of the results of the program and any related publicity activities. CDA will provide appropriate acknowledgment of Contractor if any material resulting from Cal- COMPASS is published whether in print or electronic form. Contractor is encouraged to collaborate with the CDA Communications team on any promotions. Contractor will not issue a press release or any other publication regarding the program or the resulting published material without the prior review and approval of the content of such proposed publication by CDA.

H. BUSINESS ASSOCIATE
While providing technical assistance to Contractor, CDA anticipates it will receive PHI regarding Contractor's beneficiaries. As such, CDA and Contractor (as defined in Exhibit D, Section 1 Definitions, Section A, Subsection 2 of this Agreement) will comply with the obligations as set forth in Exhibit F of this Agreement.

I. NOTICES
All notices required or permitted under this Agreement will be sufficient if sent electronically to [email protected]; or hand-delivered; or mailed to the party involved at its respective address set forth below, by certified or registered mail, return receipt requested; or sent by a nationally recognized overnight courier service, addressed to the appropriate party as follows:

If to CDA:

California Department of Aging
Attn: Cal-COMPASS / Michelle Johnston
2880 Gateway Oaks Drive, Suite 200
Sacramento, CA 95833
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 CA Department of Aging City of Sacramento dba Triple R Program Agreement #: CC-2223-03
Exhibit A – Scope of Work

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If to Contractor:

City of Sacramento, dba Triple R Program
ATTN: Mario Lara
915 I Street
Sacramento, CA 95814
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit A, Attachment 1 – Contractor’s Proposal

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EXHIBIT A, ATTACHMENT 1
CONTRACTOR’S PROPOSA L NARRATIVE

1. OPERATIONAL EXPERIENCE
The City of Sacramento’s Triple R program is licensed as an Adult Day Social Model Program (ADP) with Department of Social Services, Community Care Licensing, and remains in good standing since 1996 (26 years). This program is one of the few city- operated ADPs in California, and as ADPs are not eligible for MediCal reimbursement, this funding is an integral support of program services and capacity building.

Connecting socially, feeling a part of the community, and sensing joy are critical experiences throughout the lifespan. Recognizing that older adults with dementia were at risk of being left out of this life experience, the City of Sacramento opened its first state-licensed social model adult day program (ADP) 26 years ago as a public/private partnership with the Del Oro Caregiver Resource Center. From the beginning, a priority was placed on providing individualized, person-centered care for the older adult with dementia and quality respite, education, and resources for the caregiver. Triple-R, which stands for Recreation, Respite and Resources, has made strategic advancements, and expanded over the years, but has never lost focus on providing a safe environment that supports the physical and cognitive health of seniors with dementia and allows for vital community connection.

More than 90% of participants at Triple-R have some form of dementia, usually Alzheimer’s Disease, but including other forms such as frontotemporal dementia, Lewy Bodies dementia, vascular dementia, or late-stage Parkinson’s Disease.

Severity ranges from early stage to severe dementia and we also provide care for early-onset dementia. In the early stages of the program, Triple-R provided service to up to 35 individuals, five days a week at the Hart Senior Center in downtown Sacramento. One of the first program changes was to expand hours of operation after recognizing the need for caregivers to utilize day care services to maintain their careers while providing care for their loved one. To accommodate this, Triple-R hours of operation were expanded to 7:30am-6:00pm in 1996 and continued until the pandemic in 2020.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit A, Attachment 1 – Contractor’s Proposal

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In 1999, Triple-R was designated by the State of California as the Alzheimer’s Day Care Resource Center (ADCRC) for Sacramento County. ADCRC status enabled funding opportunities for staff and partnerships, including the state's Multi-Service Senior Program (MSSP), a program that supports Triple-R's services to very low- income, physically vulnerable seniors. With continued support through partnerships with Del Oro and MSSP, as well as local grant funding, the program has maintained an accessible fee-structure with sliding scale scholarships provided to approximately 30% of participating families. ADCRC funding also allowed an increase of staffing of 4:1 participant to staff ratio, which created increased capacity for care of people in later stages of dementia with higher personal care and behavioral needs. Higher levels of personal care services allow individuals to remain in a community environment for a longer period and maintaining important social connections to others. Becoming an ADCRC program also increased capacity to provide focused and relevant dementia care training for staff to support program activities and provide individualized caregiver support.

In 2002, the city opened a second Triple-R location in partnership with ACC (then known as Asian Community Center), a senior-focused nonprofit organization in Sacramento. The City Sought to provide a broader range of services tailored to vulnerable and marginalized communities experiencing higher risks for caregiver burnout, including outreach to Hispanic/Latino, African American, and Asian American communities. The Hart Senior Center had established outreach and engagement with various underserved communities, Asian American communities were not utilizing services at similar rates. Culturally, Asian-American caregivers were reluctant to reach out for assistance beyond their families due to an innate sense of duty to provide care for their loved one and were statistically at higher risk for depression and burnout than their caregiving counterparts. Through the city’s partnership with ACC, Triple-R was able to provide culturally appropriate services through activities, food, and language (including staff speaking multiple languages such as Cantonese, Mandarin, Japanese, Tagalog, and Hmong). In 2019, after outgrowing the location at ACC, Triple-R moved into a larger facility in South Land Park and continues to partner with ACC through food and transportation service at the new location.

In 2005, the city opened a third Triple-R site concurrent with an afterschool program for children on the Woodlake Elementary School campus in North Sacramento, providing an opportunity for intergenerational programming. Initially opened for older adults in all stages of dementia, the focus of the program was refined in 2014 with a grant from the Brookdale Foundation to serve older adults with early-stage memory loss. This allowed newly diagnosed older adults, including those who can still drive to the program themselves, the ability to bond with others sharing a similar life experience in a positive and supportive environment.

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In March 2020, Triple-R served approximately 85 participants daily across three locations, providing 11,000 days of respite per year. The program had to pivot to remote services quickly once onsite programs closed due to the COVID pandemic.

Within two days of closing, staff began providing online activities for participants with dementia through Zoom five days a week, including caregiver support groups. In addition to online services, Triple-R provided phone check-ins and quarterly delivery of supplies.

In June 2021, Triple-R resumed in-person service in a modified capacity, integrating public safety measures that included but were not limited to, masking and maintaining six-foot distancing between all staff and participants, increased ventilation on the program floor and shorter program hours. This allowed caregivers access to respite services after over a year of providing 24/7 care to their loved ones in isolation.

2. PARTICIPANTS WITH COGNITIVE IMPAIRMENT & EXPERIENCE ASSISTING

CAREGIVERS
For the past 26 years, Triple-R has specialized in dementia care and approximately 90% of participants have some form of dementia. Triple-R provides services on a continuum of care, providing support for early-stage memory loss at Club Refresh (provided on an elementary school campus) to advanced dementia at Midtown and South Sacramento locations with a 4:1 patient to staff ratio to provide individualized and personal care at the requisite levels for advanced dementia.

Supporting caregiver health and well-being is a priority for Triple-R. 85% of caregivers report they feel an improvement of their own health after enrolling in the program, due to the respite and support through regular communication with Triple- R staff, educational workshops, and social activities. Triple-R offers regular caregiver education classes with topics ranging from improving communication with someone who has dementia, acquiring assistance with legal and financial matters, and addressing difficult issues related to dementia care including wandering, anxiety, and combativeness. Also offered is a monthly Caregiver Café support group where caregivers can share tips and get support from others living a similar experience.

Triple-R also provides grief support groups for people who have recently lost a loved one and, after years of providing care, are struggling to move into a new chapter of their life that does not involve caregiving.

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Providing social activities that facilitate caregivers’ creative or social expressions, while being around people who understand their caregiving experience is a critical service provided through Triple-R. During the pandemic, caregivers met weekly with staff online to talk about their love of nature—a nature theme was picked for each week: stars, flowers, birds— giving caregivers an opportunity to share their knowledge of each topic. Through the weekly Zoom meetings, caregivers shared memories and experiences, as well as discussing emotions, personal conflicts, and working through challenges related to caregiving, particularly in the context of the pandemic. Since the return of in-person services, staff coordinate meetings and events for caregivers, including film screenings. These facilitated social connection points create shared and positive experiences, new bonds, and support networks amongst caregivers.

3. TRAINING
Triple-R staff include a Program Director, three Program Coordinators, two Program Developers, certified as Dementia Capable Specialists through the Crisis Prevention Institute, and Recreation Aides, who receive both experiential and classroom dementia care training. Classes are developed by leadership of the Triple-R program and reflect current research on dementia communication models. Triple-R University classes include Dementia 101 (stages of Alzheimer’s Disease, process of diagnosis, and health risks related to caregiving), Difficult Dementia Behavior/Communication, Dementia 201 (neurological and biological impacts of dementia, and related behaviors that individuals with dementia may exhibit) and Mobility Training (taught by a Registered Nurse). Triple-R also hosts an annual training inviting experts in dementia care such as the Alzheimer’s Association, Del Oro Caregiver Resource Center, and California State University Gerontology Department to provide cutting edge information about dementia communication and caregiver support. Triple-R staff have been invited to speak at multiple conferences, including California Association for Adult Day Program (CAADS), Northern California/Northern Nevada Alzheimer’s Association, and Del Oro Caregiver Resource Center conferences.

Triple-R has also been invited to speak on topics such as marketing, site expansion and staff training.

A longstanding relationship with the California State University, Sacramento Gerontology Department provides up to 30 internships per year offering students an immersive work experience with older adults with dementia in an adult day program environment.

Triple-R works closely with multiple organizations to provide on-going caregiver education classes. The Program Director is a member of Caregiver Education Committees for both Northern California/Northern Nevada Alzheimer’s Association and CAADS (Triple-R Program Director chaired the CAADS Education Committee for three years).

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4. MULTIDISCIPLINARY TEAM FOR DEMENTIA CAPABLE SERVICES Triple-R leadership includes a program director/administrator for three adult day program sites specializing in dementia care working in the field for over 20 years as well as a Program Coordinator with 18 years of experience with a Master’s degree in Marriage and Family Counseling providing operational oversight and staff training. A Program Supervisor and Program Coordinator in Older Adults Services each hold a degree in Gerontology and assist with the organizing, planning and development of caregiver support and resources. A Program Coordinator at each Triple-R site provides daily oversight for the program, supervises Recreation Aides, and provides daily contact for caregivers. Recreation Aides work on the program floor to provide organized activities as well as personalized care based on an individual’s care plan.

Recreation Aides and Program Coordinators trained as Dementia Capable Specialists provide care for people with dementia in early to advanced stages and have been trained to provide compassionate, person-centered care for people displaying behaviors related to dementia such as wandering, anxiety, combativeness, and depression.

5. UTILIZE TECHNOLOGY AS STANDARD SUPPORT FOR STAFF,

PARTICIPANTS AND CAREGIVERS
Triple-R uses technology to add convenience for caregivers and to provide a more personalized experience for the participants. In the program, Triple-R participants can listen to their favorite music through playlists on an Apple iPad or enjoy virtual reality experiences with Oculus googles. Air tags are added to the nametags of participants who are at risk of wandering. For caregivers, everyone can choose how they want to stay in touch with Triple-R staff and a majority choose text messaging.

This allows for quick response between staff and caregivers as well as the ability to share in positive moments in the program through pictures and videos. During the pandemic, Triple-R offered activities for people with all stages of dementia (BINGO, armchair travel, chair exercises, etc.). This programming continues and includes livestreaming exercise classes from the center. In addition to in-person caregiver education and support, a monthly online caregiver support group called Caregiver Café is also offered.

6. POPULATION READINESS CRITERIA
As a designated ADCRC, Triple- uses a person-centered care approach to dementia care and communication as an integral foundation of adult day services. Losing ADCRC funding curtailed the ability to provide expanded services to more people.

However, Triple-R continues to provide services at ADCRC standards for those we serve including maintaining a 1:4 staff ratio, providing intensive support for the caregivers, and offering choice to participants in the program.

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As Triple-R expanded over the years, a conscious effort was made to create a continuum of care that would allow a family to enroll a loved one with early-stage dementia and to use adult day services throughout the progression of the disease through to advanced care. This is reflected through the opening of a program site on an elementary school campus, integration of intergenerational activities, and a focus on services for people with early-stage dementia. This allowed participants with early-stage dementia to bond as a group and emotionally support each other. When personal care or dementia communication needs exceed the services provided at the early-stage memory loss program, participants may move to another Triple-R site that supports care for moderate to advanced dementia. Staff are purposely scheduled to provide support across all sites to allow a familiar face for someone who moves to a new site. Additionally, staff try to move two or more participants at the same time when a move to moderate services is necessary, to ensure friendships started at Club Refresh can be maintained at the new site.

The City’s Older Adult Services Division has a vision that people with dementia feel as welcome throughout their community as they do in the adult day program. To that end, the city launched a Dementia Friendly Sacramento initiative in 2018. In collaboration with California State University, Sacramento (CSUS), a curriculum was derived from Triple-R University materials for use by retail businesses, to train staff on provision of compassionate and appropriate customer service for elderly, frail, and/or disoriented individuals. The training packet includes the curriculum as well as a laminated info sheet detailing dementia communication tips, for easy reference near a store register or desk. The curriculum was created as a 15-minute training, to ensure appropriate and relevant information could be shared in a digestible format for retail employees. A CSUS Gerontology intern provided the trainings. Retailers were provided stickers to self-identify as dementia-friendly businesses upon completion of the training. In a follow-up with participants three months after receiving training, over 60% of 30 retail establishments continued to regularly use the info sheet and more than 70% of retailers utilized the “dementia-friendly business” sticker. When asked what part of the training was most helpful, most retailers said the tips for communicating with someone who appeared confused was most helpful. The trainings were suspended in 2020 due to the pandemic but will be offered again in Fall 2022.

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7. CONNECTION TO LOCAL RESOURCES
Since its inception, Triple-R has prioritized networking and collaboration within the older adult services network in Sacramento. Triple-R started as a public/private partnership with the Del Oro Caregiver Resource Center. For 26 years, Del Oro CRC and Triple-R have worked together to provide respite care for caregivers taking care of loved ones with moderate to severe dementia and experiencing caregiver burden. Triple-R works with MSSP to provide dementia care services to low-income, MediCal eligible older adults and ACC for transportation, meals, and outreach. In addition, the Hart Senior Center provides resource and referral services for transportation and housing as well as access to the Health Insurance Counseling and Advocacy (HICAP) Program, Tax preparation assistance for caregivers, and consultations with Pucci Pharmacy.

8. RELIABLE DATA, NEED FOR DEMENTIA SUPPORT, ANALYSIS OF GAPS

THAT EXIST
Triple-R relies on annual data collected from the Alzheimer’s Association as well as the local Area Agency on Aging to identify gaps for dementia support in the community. Additionally, Triple-R conducts an annual survey of caregivers using Triple-R services to determine what type of respite and other supportive services are of most value to them and how to further support them in their caregiving journey.

9. LEADERSHIP CRITERIA
A. OPERATIONAL LEADERSHIP AT EXECUTIVE & STAFF LEVELS
Program Director, Stephanie Wilson, has over 20 years of experience providing dementia care services at Triple-R. Hired in 2002 to oversee the Triple-R site located at the Hart Senior Center, she expanded the program to two additional sites. The additional sites provide special services for underrepresented populations (early-stage and early-onset memory loss) as well as culturally appropriate dementia care services. Ms. Wilson is a frequent speaker at local and statewide conferences on standards of care for dementia care services and has served at different times and in multiple executive capacities on the Board of Directors for the California Association for Adult Day Services (CAADS) and its sister organization, Alliance for Leadership and Education (ALE) since 2002.

Additional information about Triple-R leadership can be found in the section describing our multidisciplinary staffing.

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B. COMMITMENT TO DEMENT IA AND CAREGIVING BE ST PRACTICES AND

ETHICAL STANDARDS OF CARE
Triple-R is committed to dementia and caregiving best practices and ethical standards of care as witnessed by our designation as an Adult Day Care Resource Center (ADCRC). Triple-R is also an active member of CAADS which conveys ethical standards of practice for ADPs/ADHCs. Please reference the Operational Experience section for more information on the program’s best practice models for dementia and caregiving.

10. EQUITY CRITERIA
A. ABILITY AND EFFORTS TO REFLECT AND RESPO ND TO LANGUAGE,

RACE, ETHNICITY, CUL TURAL DIVERSITY, SEX UAL ORIENTATION AND

GENDER IDENTITY REPRESENTED IN THEIR COMMUNITIES
Sacramento is recognized as one of the most diverse cities in California. As mentioned in the operational experience section, Triple-R recognizes the value of reflecting the diversity of our community. Triple-R has embraced opportunities such as collaborating with the Asian Community Center to provide culturally appropriate dementia care services for caregivers. Triple-R staff are fluent in multiple languages including Spanish, Japanese, Cantonese, Mandarin, Vietnamese, Tagalog, Hmong, and American Sign Language. Language accessibility resources and referrals are utilized for participants whose primary language is not spoken by a staff member. Current participation demographics reflect 46% Caucasian, 34% Asian, 12% Black/African American and 8% Hispanic/Latino participants. Though statistics on gender identity or sexual orientation are not collected through the program, the program espouses an inclusive, inviting environment and provides culturally relevant services to the LGBT community.

B. UNDERREPRESENTED
Early-Stage and Early On-set Dementia: As mentioned in the operational experience section, Triple-R operates an intergenerational program for people with early-stage memory loss located on an elementary school campus. While people diagnosed with early-onset dementia tend to progress to more advanced stages of the disease faster than someone who has dementia later in life, they still need the support of peers that understand their situation when they are first diagnosed.

Living Home Alone: The City of Sacramento’s Caring Neighborhood Program aims to strengthen neighborhood connections and promote community support to a growing elderly population who wish to live at home without an aide. Triple-R staff provide education and support for people living at home alone with dementia.

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11. PROJECT GOALS
The City of Sacramento proposes to use Cal-COMPASS funds to:

A. PROJECT GOAL #1: PROVIDE ADULT DAY SERVICES FOR ADULTS AGED 50 AND OVER IN EARLY, MIDDLE, AND LATE STAGES OF DEMENTIA The city will provide adult day care for older adults experiencing dementia at three locations in Sacramento for up to 90 people per day. Services provided will include a 4:1 participant to staff ratio with personal care assistance and congregate activities. One site, Club Refresh, located on an elementary school campus in Sacramento, will provide care for people with early-stage memory loss with the opportunity for intergenerational activities with the schoolchildren. Full- time staff at all three sites are Dementia Capable Specialists trained through the Crisis Intervention Institute. The full-time staff trains and supervises the part-time staff.

B. PROJECT GOAL #2 DEMENTIA CAREGIVER EDUCATION AND SUPPORT Most family caregivers who seek Triple-R services express a desire to keep their loved one at home and to delay or avoid institutionalization for their loved one.

Triple-R is committed to helping caregivers fulfil this wish. Respite is an important aspect of sustainability for caregivers; staying healthy and rested are often neglected aspects of self-care. The largest factor in caregiver support is education on successful dementia communication and providing emotional support services for self-care. For caregivers utilizing Triple-R services, the city will provide individualized caregiver support through quarterly one-on-one sessions with a Program Coordinator to discuss how to integrate dementia communication practices as used in the program and teach caregivers the skills used by staff in the adult day program to provide consistency for the participant both at home and in the program.

Triple-R is also committed to being a resource for caregivers regardless of their participation in adult day services. Working with other community organizations such as the Alzheimer’s Association and Del Oro Caregiver Resource Center, Triple-R will provide monthly caregiver education classes, either online or in- person – depending on public health safety considerations and personal preferences. Monthly sessions will be open to the public and 1-3 hours in duration depending on the topic. Topics such as ambiguous grief, self- compassion for the caregiver, life after caregiving, and COVID safety and precautions will be taught by Triple-R staff. Triple-R staff will teach or work in collaboration with partner organizations to provide education on dementia communication (especially for seniors with moderate to advanced dementia), how to deal with difficult dementia situations, stages of dementia, legal and financial considerations as a caregiver, and how to mitigate caregiver depression and burnout.

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C. PROJECT GOAL #3: CRE ATE AND PRODUCE PROF ESSIONAL TRAINING VIDEOS ON DEMENTIA CARE FOR ADULT DAY PROGRAM STAFF.

The city will create and produce at least two professional videos to use when training adult day program staff on dementia care. Educational video topics will cover effective dementia communication techniques for people in middle to late- stage dementia as well as an overview of how dementia affects communication and mobility with tips for assisting participants. Triple-R has provided training to other programs’ adult day program staff in the past and is known as a resource for adult day programs for staff training. The videos would be accessible through our website to be used by other adult day programs.

D. PROJECT GOAL #4: COL LABORATION AND LEARN ING LAB WITH CAL -

COMPASS PROVIDERS
1) The city will work in collaboration with other Cal-COMPASS providers to develop best practice standards and to learn from each other.

We are eager to share our long and deep experience serving people living with dementia and their caregivers with others and to learn from other programs. The new experience Triple-R gains from providing adult day services for older adults with Down Syndrome and dementia as well as hosting educational opportunities for both caregivers and staff working at ADP/ADHC’s will be shared with the learning community and contribute to emerging best practices for this population.
2) Cal-COMPASS Project Goals
Create an opportunity to further distinguish California as a hub of expertise for Alzheimer’s and dementia-capable community-based services. a) Triple-R works closely with other adult day programs throughout the state as a member of CAADS. Leadership staff is often tapped to sit on member panels to share expertise on a variety of topics including pandemic response, infection control, emergency response and standards for policies and procedures. Triple-R leadership is a member of CAADS vision team and has participated in various webinars to share best practices.

Leverage CDA’s partnerships across multiple agencies, departments, and stakeholders to integrate a model for Alzheimer’s and dementia supports into the Master Plan for Aging, California Advancing and Innovating Medi- Cal (CalAIM) and other initiatives.

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b) As an ADCRC-accredited program, Triple-R recognizes the value of integration of a dementia care model throughout the older adult services support system and welcomes the ability to work with others to integrate thoughtful and appropriate responses to dementia care across the spectrum of services.

Demonstrate practices that aid in the development of a Cal-COMPASS learning laboratory to accelerate knowledge and skill building for Alzheimer’s and dementia-capable programs and best practices. c) Triple-R has consistently embraced innovation in dementia care services and a willingness to work with others to define and enrich standards of care. Triple-R comes to the learning laboratory with a demonstrated history of providing early-stage, intergenerational, culturally appropriate dementia care and has the knowledge and skills developed from ADCRC experience.

Utilize cross-departmental expertise of ADPs and ADHCs that have specializations in Alzheimer’s and dementia care to implement proven best practices and the testing of latest research, person-centered concepts, and non-pharmacological interventions.
d) As a social model program, Triple-R is committed to finding solutions to complicated dementia situations through non-pharmacological solutions and has always worked with other ADP/ADHC programs to educate ourselves on the latest research and to share best practices. An example of some best practices Triple-R may contribute includes use of dementia care mapping techniques, originally outlined by Dr. Tom Kitwood as a way of providing person-centered care for a person with dementia. Triple-R staff assess non-verbal signals of distress or agitation from a participant using dementia care mapping techniques and intervene before the feelings progress into escalated behaviors.

Create a statewide learning community with a sustained focus and strong links to the DHCS’ efforts with CalAIM and the new Office of Medicare Innovation and Integration, helping to achieve the goal of community living for those with Alzheimer’s and dementia and support of their caregivers who are facing challenges due to disease stages, symptoms, and/or circumstances.

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e) Triple-R’s strengths in this area will be providing expertise about how to assist older adults and their caregivers to maintain caregiver health while keeping their loved one with dementia at home by providing caregiver respite and education on dementia communication. As outlined in organizational experience, it is the goal of Triple-R to provide services that allow an older adult with dementia to not only continue to live in their own community, but to thrive and have purpose. Triple-R leadership has worked together with other ADP/ADHC’s throughout the state through CAADS to implement best practices that achieve this goal of community living. Exploring opportunities for historically non-MediCal models through CalAim and Medicare innovative models is promising and reflects a critical access and equity issue for middle income families.

Foster connections with the state’s existing infrastructure and resources, which may include Area Agencies on Aging, Aging and Disability Resource Connections, Caregiver Resource Centers, Independent Living Centers, and the work of the California Department of Public Health and its 10 California Alzheimer’s Disease Centers and six Healthy Brain Initiative counties.
f) Triple-R maintains good relationships with Del Oro Caregiver Resource Center and Alta California Regional Center as well as our local Area Agency on Aging and welcomes new collaborative opportunities to improve the lives of people living with dementia.

Create a direct link and consistent approach to the Medicaid Home and Community Based Services Spending Plan’s investments in workforce development and training that can be used to build Alzheimer’s and dementia-capable expertise among clinical and non-clinical care providers.
g) Triple-R has 30 years of experience to share in providing non-clinical, person-centered care for people across all stages of dementia and welcomes innovations in workforce development to train a new generation of employees in this important work. Triple-R has worked with local colleges for 30 years providing training and experience to individuals training to become clinical providers such as occupational therapy, speech therapy and social work.

Gather and maintain data to evaluate outcomes for similarly identified individuals.

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h) As a program of the City of Sacramento, Triple-R has the staffing and knowledge to gather and maintain data and to share that data with other groups. If a specific database is identified to gather data for this project, Triple-R has the capacity to develop program infrastructure and software as necessary.

Enable common standards of practice to be defined, monitored, and evaluated via uniform assessment measures and use for outcomes research and continuous quality improvement.
i) Triple-R currently works with other ADP/ADHC programs to identify uniform assessment measures through CAADS work groups and is interested in further developing these assessment measures and supporting their use in adult day services. We have a demonstrated willingness to partner with researchers such as Dr. Tina Sadarangani who is focusing her work on adult day services and its impact on dementia outcomes.

Facilitate collaborative relationships with local partners, including, but not limited to Area Agencies on Aging, ADCRC, and experienced stakeholders. Leverage these relationships to build and expand future funding and certification for Alzheimer’s and dementia-capable programs that will be critically needed as the number of people living with Alzheimer’s, including people with Down’s syndrome, increases exponentially.
j) Triple-R has been a leader in advocating for funding and certification options based on standards of care and has long-standing relationships with local partners. Triple-R has a vested interest in developing a wider range of collaborative partnerships and capacity building across service providers and stakeholders to ensure appropriate standards of care and services are integrated and accessible to communities experiencing Alzheimer’s and dementia-related diseases.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit B – Budget Detail, Payment Information, and Closeout

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EXHIBIT B

BUDGET DETAIL, PAYME NT INFORMATION, AND CLOSEOUT

1. CAL-COMPASS PROGRAM BUDGET
A. Contractor will complete work on the program in accordance with the budget set forth in this Agreement. The payments are intended to cover all fees and expenses associated with the program, and no further payment will be made under this Agreement unless agreed to in advance in writing by the parties. If Contractors expend greater than the award amount, they shall do so using their own funding for the overage.

2. FUNDS
A. EXPENDITURE OF FUNDS
1) The Contractors shall expend all funds received hereunder in accordance with this Agreement.

3. BUDGET AND BUDGET REVISION
A. The Contractor shall be compensated for expenses only as itemized in the approved Budget except for line-item budget transfers as noted in this Exhibit and shall not be entitled to payment for these expenses until this Agreement is approved and executed by CDA. The approved Budget is hereby incorporated by reference into this Agreement as a part of Exhibit B.

B. The Contractor shall submit electronically a budget revision thirty (30) calendar days after receiving an amended Budget Display with changes in funding levels, unless otherwise instructed by CDA.

C. The Contractor shall submit a revised budget to CDA when a line-item budget transfer exceeds ten percent (10%) of the total budget.

D. Budget revisions may be submitted as necessary, but no later than sixty (60) days prior to the ending date of the contract.

4. DEFAULT PROVISIONS
A. The State, without limiting any rights which it may otherwise have, may, at its discretion and upon written notice to the Contractors, withhold further payments under this Agreement, and/or demand immediate repayment of the balance of any advance payment hereunder, upon occurrence of any one of the following events:
1) Termination or suspension of this Agreement
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit B – Budget Detail, Payment Information, and Closeout

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2) A finding by the State that the Contractor:
a) Has failed to observe any of the conditions of these provisions, or has failed to comply with any material provisions of this Agreement or b) Has failed to make progress, or is in such unsatisfactory financial condition, as to endanger performance of this Agreement

5. PAYMENT INFORMATION
A. The Contractor shall submit monthly expenditures in an electronic format, utilizing the CDA online Local Finance Reporting System, no later than the last business day of each month unless otherwise specified by CDA, reporting costs and funding for the month prior.

B. Payments will be made to reimburse monthly expenditures reported. CDA shall process and approve reported expenditures that are based upon actual, not estimated expenditures.

C. CDA shall notify the Contractor of any disputed expenditures. The Contractor shall submit timely expenditures to CDA. Late expenditures may lead to a delay in payment until the following month.

D. Upon written request by CDA, Contractor shall submit additional documentation or justification to support the reported expenditure.

6. NO GUARANTEE OF WORK
The State does not expressly or by implication agree that the actual amount of work will correspond with this Agreement’s total dollar amount; and reserves the right to omit portions of the work as may be deemed necessary or advisable by the State.

The total amount on this Agreement is an estimate and is not a guarantee of business and is subject to change depending on need for services. The State makes no guarantee, expressed, or implied for actual number of hours to be used.

However, the actual budget listed in this Agreement shall be binding for the term of this Agreement

1. BUDGET CONTINGENCY CLAUSE
A. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State or offer an agreement amendment to Contractor to reflect the reduced amount.

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2. PROMPT PAYMENT CLAUSE:

Payment will be made in accordance with, and within the time specified in, Government Code section 927, et seq.

3. BUDGET DETAIL:

A. At the sole discretion of the CDA and for the purposes of accounting, the CDA may adjust the total proposed expenditure for each fiscal year as needed. In no event will this change the contract price for the services rendered.

B. Contractor must submit all invoices within a reasonable time but, no later than 30 calendar days from the date that services were provided. If Contractor fails to provide invoices within 30 calendar days from the date that services are rendered, the CDA may elect to reject the invoices for payment as untimely and Contractor will be deemed to have waived any right to payment of the late invoices.

4. TRAVEL REIMBURSEMENT
A. Any reimbursement for authorized travel and per diem shall be at rates not to exceed those amounts paid by the State in accordance with the California Department of Human Resources’ (CalHR) rules and regulations. 3) IN STATE:

Mileage/Per Diem (meals and incidentals)/Lodging
https://www.calhr.ca.gov/employees/pages/travel-reimbursements.aspx 4) OUT OF STATE:
http://hrmanual.calhr.ca.gov/Home/ManualItem/1/2201
B. This is not to be construed as limiting the Contractor from paying any differences in costs from funds other than those provided by CDA, between the CalHR rates and any rates the Contractor is obligated to pay under other contractual agreements. No travel outside the state of California shall be reimbursed unless prior written authorization is obtained from the State. [SCM 3.17.2.A(4)] C. The Contractor agrees to include these requirements in all contracts it enters with sub-contractors to provide services pursuant to this Agreement.

D. CDA reserves the right to refuse payment to the Contractor or disallow costs for any travel expenditure, as determined by CDA to be out of compliance with this Agreement; unrelated or inappropriate to contract activities; when adequate supporting documentation is not presented; or where prior approval was required but was either not requested or not granted.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit B, Attachment 1 – Budget Display

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EXHIBIT B, ATTACHMENT 1

BUDGET DISPLAY

Cal-COMPASS
Budget Display
City of Sacramento - Triple R Program
November 1, 2022 through December 31, 2023
Program Fund Type Project Number Baseline Adjustment TOTAL Community
Based
Adult
Services
Older Adults'
Recovery and
Resilience Fund -
Home and
Community Based
Services
HDCL $350,000 $0 $350,000
Notes
Can utilize up to 10% of the funding for Administration.

Expenditures must be reported in closeout by December 31, 2023 DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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EXHIBIT D

SPECIAL TERMS AND CO NDITIONS

1. DEFINITIONS
A. GENERAL DEFINITIONS
1) “Agreement” or “Contract” means the Standard Agreement (Std. 213); Exhibits A, B, D, E, and F; the approved Budget as identified in Exhibit B; amendments; and any other Addendums, Appendices, or documents incorporated by reference, unless otherwise provided for in this section. 2) "Contractor" means the entity contracting directly with the California Department of Aging under this Agreement.
3) “Dementia Care Management” a model of collaborative care, on the treatment and care of people with dementia and their caregivers.
4) “State” means the State of California.
5) “California Department of Aging” (CDA) and the “Department” are used interchangeably.
6) “Confidential information” means all information disclosed by a party to the other party, whether orally or in writing, that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure.
7) “Sub-Contractor” means the legal entity that receives funds from the Contractor to carry out part of a federal award identified in this Agreement. 8) “Sub-Contract” means any form of legal agreement between the Contractor and the Sub-Contractor, including an agreement that the Contractor considers a contract, including vendor type Agreements for providing goods or services under this Agreement.
9) “CFR” means Code of Federal Regulations.
10) “USC” means United States Code.
11) “CCR” means California Code of Regulations.
12) “Cal. Gov. Code” means California Government Code.
13) “Cal. Civ. Code” means California Civil Code.
14) “Participant” means any individual participating in the ADP/ADHC program.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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15) “Party” and “Parties” means an entity or the entities, respectively, executing this Agreement.
16) “Allocation” means the process of assigning a cost, or a group of costs, to one or more cost objective(s), in reasonable proportion to the benefit provided or other equitable relationship. The process may entail assigning a cost(s) directly to a final cost objective or through one or more intermediate cost objectives (2 CFR 200.4).
17) “Disallowed costs” means those charges determined to be unallowable, in accordance with the applicable Federal statutes, regulations, or the terms and conditions. (2 CFR 200.31 and 45 CFR 75.2).

2. ASSURANCES
A. LAW, POLICY AND PROCEDURE, LICENSES, AND CERTIFICATES Contractor agrees to administer this Agreement and require Sub-Contractors to administer their sub-contracts in accordance with this Agreement and with all applicable local, State, and federal laws and regulations including, but not limited to, discrimination, occupational safety, and to fire, safety, health, and sanitation regulations, directives, and guidelines related to this Agreement and to resolve all issues using good administrative practices and sound judgment. Contractor and its Sub-Contractors shall keep current and in effect all licenses, permits, notices, and certificates that are required by law.

B. SUB-CONTRACTS
The Contractor shall require language in all sub-contracts to require all sub- contractors to comply with all applicable State and federal laws.

C. NONDISCRIMINATION
Contractor shall comply with all federal and State statutes, regulations, and laws or other authorities relating to nondiscrimination and shall comply with the following:
1) Equal Access to Federally Funded Benefits, Programs and Activities.

Contractor shall ensure compliance with Title VI of the Civil Rights Act of 1964 [42 USC 2000d; 45 CFR 80 et seq.], which prohibits recipients of federal financial assistance from discriminating against persons based on race, color, religion, or national origin.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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2) Equal Access to State-Funded Benefits, Programs and Activities.

Contractor shall, unless exempted, ensure compliance with the requirements of Cal. Gov. Code § 11135 et seq., and 2 CCR § 11140 et seq., which prohibit recipients of state financial assistance from discriminating against persons based on race, national origin, ethnic group identification, religion, age, sex, sexual orientation, color, or disability. [22 CCR § 98323] 3) Contractor shall assure the State and the Department that Contractor complies with the Americans with Disabilities Act of 1990 (ADA), which prohibits discrimination based on disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. [42 USC 12101 et seq.]
4) Contractor agrees to include these requirements in all contracts it enters with sub-contractors to provide services pursuant to this Agreement.

D. STANDARDS OF WORK
Contractor agrees that the performance of work pursuant to the requirements of this Agreement shall conform to accepted professional standards.

E. CONFLICT OF INTEREST
1) The Contractors shall prevent employees, consultants, or members of governing bodies from using their positions for purposes including, but not limited to, the selection of Sub-Contractors, that are, or give the appearance of being, motivated by a desire for private gain for themselves or others, such as family, business, or other ties. If the State or the Department determines that a conflict of interest exists, any increase in costs associated with the conflict of interest may be disallowed by the State or the Department and such conflict may constitute grounds for termination of the Agreement. 2) This provision shall not be construed to prohibit employment of persons with whom the Contractor’s officers, agents, or employees have family, business, or other ties, so long as the employment of such persons does not result in a conflict of interest (real or perceived) or increased costs over those associated with the employment of any other equally qualified applicant, and such persons have successfully competed for employment with the other applicants on a merit basis.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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F. AGREEMENT AUTHORIZATION
1) If a public entity, Contractor shall submit to CDA a copy of an approved resolution, order, or motion by the Governing Board or appropriately delegated authority referencing this Agreement number authorizing execution of this Agreement.
2) If a private nonprofit entity, Contractor shall submit to CDA an authorization by the Board of Directors to execute this Agreement, referencing this Agreement number.
3) Documentation in the form of a resolution, order, or motion by the Governing Board or appropriately delegated authority is required for the original and each subsequent amendment to this Agreement. This requirement may also be met by a single resolution by Contractor’s Governing Board or appropriately delegated authority authorizing the Director or designee to execute the original and all subsequent amendments to this Agreement.

G. CONTRACTOR’S STAFF
1) Contractor shall maintain adequate staff to meet the obligations under this Agreement.
2) This staff shall be available to the State or the Department for training and meetings which the State or the Department may find necessary to carry out the objectives of this project.
3) Any failure by the Contractor to maintain good standing shall result in suspension or termination of this Agreement with CDA until satisfactory status is restored to the satisfaction of CDA. A person or organization in good standing is regarded as having complied with all explicit obligations, while not being subject to any form of sanction, suspension, or disciplinary censure.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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H. LOBBYING CERTIFICATION
By signing this Agreement, Contractor hereby certifies to the best of its knowledge and belief, that:
1) No federally appropriated funds have been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of any agency; a Member of Congress; an officer or employee of Congress; or an employee of a Member of Congress; in connection with the awarding of any federal contract; the making of any federal grant; the making of any federal loan; the entering into of any cooperative agreement; and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement (see 45 CFR 75.450).
2) If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the Contractor shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying, in accordance with its instructions.

3. SUB-CONTRACTS
A. Contractor is responsible for carrying out the terms of this Agreement, including the satisfaction, settlement, and resolution of all administrative, programmatic, and fiscal aspects of the program(s), including issues that arise out of any sub- contracts, and shall not delegate or contract these responsibilities to any other entity. This includes, but is not limited to, disputes, claims, protests of award, or other matters of a contractual nature. The Contractor’s decision is final, and the Sub-Contractor has no right of appeal to CDA.

B. Contractor shall, in the event any sub-contract is utilized by the Contractor for any portion of this Agreement, retain the prime responsibility for all the terms and conditions set forth, including but not limited to, the responsibility for preserving the State’s copyrights and rights in data and ensuring the keeping of access to, availability of, and retention of records of Sub-Contractors.

C. Contractor shall not obligate funds for this Agreement in any sub-contracts for services beyond the ending date of this Agreement.

D. Contractor shall have no authority to contract for, or on behalf of, or incur obligations on behalf of the State.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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E. Contractor shall maintain on file copies of sub-contracts, memorandums and/or Letters of Understanding which shall be made available for review at the request of CDA.

F. Contractor shall monitor the insurance requirements of its sub-contractors in accordance with this Agreement. (Exhibit D, Section 10, Insurance Requirements)
G. Contractor shall require language in all sub-contracts to require all sub- contractors to indemnify, defend, and save harmless the Contractor, its officers, agents, and employees from any and all claims and losses accruing to or resulting from any sub-contractors, suppliers, laborers, and any other person, firm, or corporation furnishing or supplying work services, materials, or supplies in connection with any activities performed for which funds from this Agreement were used and from any and all claims and losses accruing or resulting to any person, firm, or corporation who may be injured or damaged by the Sub- Contractor(s) in the performance of this Agreement.

H. Contractor shall ensure that the Sub-Contractor will complete all reporting and expenditure documents requested by CDA. These reporting and expenditure documents shall be sent to the Contractor in a timely manner and at intervals as determined by CDA.

I. Contractor shall, prior to the awarding of a new sub-contract to any for-profit entity, submit the following to CDA for review and approval:
1) The Request for Proposal or Invitation for Bid.
2) All bids or proposals received.
3) The proposal or bid evaluation documentation, along with the Contractor’s rationale for awarding the sub-contract to a for-profit entity. [22 CCR 7362] Where a program may be sub-contracted to a for-profit organization, the Contractor should include in its contract with the for-profit entity, a requirement for performance of a program-specific audit of the sub-contracted program by an independent audit firm.
4) Sub-contracts already in place through competitive bid do not need to be re- bid.

J. Contractor shall require all sub-contractors to maintain adequate staff to meet the Sub-Contractor’s Agreement with the Contractor. This staff shall be available to the State for training and meetings which the State may find necessary from time to time.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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K. If a private nonprofit, or for-profit, corporation, the Sub-Contractor shall be in good standing with the Secretary of State of California and shall maintain that status throughout the term of the Agreement.

L. Contractor shall refer to 2 CFR 200.330, Subpart D - Subrecipient and Contractor Determinations and 45 CFR 75.351, Subpart D - Subrecipient and Contractor Determinations in deciding if a sub-contractor relationship exists. If such a relationship exists, then the Contractor shall follow the procurement requirements in the applicable OMB Circular.

M. Contractor shall utilize procurement procedures as follows:
1) Contractor shall obtain new goods and services through open and competitive awards. Each Contractor shall have written policies and procedures, including application forms, for conducting an open and competitive process, and any protests resulting from the process.

4. GENERAL PROVISIONS
A. ASSIGNMENT
Neither Party will assign or delegate any part of this Agreement to any other person or entity without the express prior written consent of the other Party. The Parties acknowledge and agree that notwithstanding the foregoing, this Agreement will inure to the benefit of, and be binding upon, the respective successors and assigns of the respective parties.

B. SEVERABILITY
If any provision of this Agreement is determined to be void, illegal or otherwise unenforceable, that provision will be limited or eliminated to the minimum extent necessary so that this Agreement will remain enforceable and in full force and effect.

C. WAIVER
The failure of either Party to enforce its rights under this Agreement at any time for any period will not be construed as a waiver of such rights.

D. GOVERNING LAW
This Agreement has been executed and delivered in and will be governed by and construed in accordance with the substantive laws of the State of California.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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E. JURISDICTION, VENUE, FORUM
The parties hereto mutually consent and submit to the jurisdiction of any state or federal court of competent jurisdiction located in the County of Sacramento, State of California, in any action or proceeding arising out of or relating in any manner to this Agreement.

F. ENTIRE AGREEMENT
This Agreement, including all Appendices and Exhibits constitutes the entire Agreement and understanding of the parties and terminates and supersedes all prior agreements, arrangements, and understandings, both oral and written, express or implied, between the Parties concerning its subject matter.

5. AGREEMENT
A copy of this executed Agreement is on file and available for inspection at the California Department of Aging, 2880 Gateway Oaks, Suite 200, Sacramento, California 95833.

6. COMMENCEMENT OF WORK
Should Contractor or Sub-Contractor begin work in advance of receiving notice that this Agreement is approved, that work shall be considered as having been performed at risk as a volunteer and may not be reimbursed or compensated.

7. RECORDS
A. Contractor shall maintain complete records which shall include, but not be limited to, accounting records, contracts, agreements, a reconciliation of the “Financial Closeout Report” (CDA Closeout) to the audited financial statements, audit report, and general ledgers, and a summary worksheet identifying the results of performing an audit resolution of its Sub-Contractors. This includes Letters of Agreement, insurance documentation, memorandums and/or Letters of Understanding, Participant records and electronic files of its activities and expenditures hereunder in a form satisfactory to CDA. All records pertaining to this Agreement must be made available for inspection and audit by the Department, the State, or the duly authorized agents of either, at any time.

B. All such records, including confidential records, must be maintained, and made available by Contractor until an audit has occurred and an audit resolution has been issued or unless otherwise authorized in writing by CDA.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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C. If this Agreement is completely or partially terminated, the records relating to the work terminated shall be preserved and made available to the Department, the State, or the duly authorized agents of at any time. Contractor shall ensure that any Participant records remain the property of CDA upon termination of this Agreement and are returned to CDA.

D. In the event of any litigation, claim, negotiation, audit exception, or other action involving the records, all records relative to such action shall be maintained and made available until every action has been cleared to the satisfaction of CDA.

E. All records containing confidential information shall be handled in a confidential manner in accordance with the requirements for information integrity and security. After the authorized period has expired, confidential records shall be shredded and disposed of in a manner that will maintain confidentiality.

F. Adequate source documentation of each transaction shall be maintained relative to the allowability of expenditures reimbursed by the State or the Department under this Agreement. If the allowability of expenditures cannot be determined because records or documentation of the Contractor are nonexistent or inadequate, the expenditures will be questioned in the audit and may be disallowed by CDA during the audit resolution process.

8. MONITORING AND EVALUATION
A. Authorized representatives of the State or the Department shall have the right to monitor and evaluate Contractor’s performance pursuant to this Agreement. Said monitoring and evaluation may include, but is not limited to, administrative processes and data components. This shall include policies, procedures, and interviews of project staff and participants.

B. Contractor shall cooperate with the State and the Department in the monitoring and evaluation processes, which include, but are not limited to, making any administrative and program staff available during any scheduled process.

C. Contractor shall monitor contracts and sub-contracts to ensure compliance with laws, regulations, and the provisions of contracts that may have a direct and/or material effect on each of its CDA funded programs.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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9. AUDIT REQUIREMENTS
A. GENERAL
1) Any duly authorized representative of the State government, which includes but is not limited to the State Auditor, CDA Staff, and any entity selected by the State to perform inspections, shall have the right to monitor and audit Contractor and Sub-Contractors providing services under this Agreement through on-site inspections, audits, and other applicable means the State government, or its delegate, determines necessary. CDA will provide timely notice to Contractor if CDA is informed of an audit by an outside entity or State government entity affecting Contractor.
2) Contractor shall make available all reasonable information necessary to substantiate any expenditures under this Agreement are allowable and allocable, including, but not limited to books, documents, papers, and records.

Contractor shall agree to make such information available to the State, or any of their duly authorized representatives, including representatives of the entity selected by State to perform inspections, for examination, copying, or mechanical reproduction, on or off the premises of the appropriate entity upon a reasonable request.
3) All agreements entered by Contractor and Sub-Contractors with audit firms for purposes of conducting independent audits under this Agreement shall contain a clause permitting any duly authorized representative of the State government access to the supporting documentation of said audit firm(s). 4) Contractor shall cooperate with and participate in any audits which may be required by the State, including CDA fiscal and compliance audits. 5) CDA shall have access to all audit reports of Contractors and have the option to perform audits and/or additional work, as needed.
6) Contractor shall include in its contract with an independent auditor a clause permitting access by the State to the work papers of the independent auditor. 7) Audits which may be performed shall be, minimally, financial and compliance audits, and may include economy and efficiency and/or program results audits.

B. CDA FISCAL AND COMPLIANCE AUDITS
1) The CDA Audits Branch may perform fiscal and/or compliance audits of Contractors in accordance with Generally Accepted Government Auditing Standards (GAGAS) to ensure compliance with applicable laws, regulations, contracts, and agreement requirements.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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2) The CDA fiscal and compliance audits may include, but not be limited to, a review of:
a) Financial closeouts (See “Definitions, Closeout” 2 CFR 200.1 and 45 CFR

75.2)
b) Internal controls (2 CFR 200.303 and 45 CFR 75.303)
c) Allocation of expenditures (See “Definitions, Allocation” 2 CFR 200.1 and 45 CFR 75.2)
d) Allowability of expenditures (2 CFR 200.403 and 45 CFR 75.403) C. AUDIT REPORTING REQUIREMENTS (2 CFR 200 SUBPART F AND 45 CFR 75 SUBPART F)
1) Contractor Audit Reporting Requirements
a) A copy shall be submitted to the:

California Department of Aging
Attention: Audits Bureau
2880 Gateway Oaks, Suite 200
Sacramento, California 95833
b) The copy shall be submitted within thirty calendar (30) days after receipt of the Auditor’s report or nine (9) months after the end of the audit period, whichever occurs first, or unless a longer period is agreed to in advance by the parties of this Agreement.
c) For purposes of reporting, Contractor shall ensure that State-funded expenditures are displayed discretely in the audit report. 2) Contractor shall perform a reconciliation of the “Financial Closeout Report” to the audited financial statements, and general ledgers. The reconciliation shall be maintained and made available for CDA review.
3) Contract Resolution of Contractor’s Subrecipients
Contractor shall have the responsibility for resolving its contracts with Sub- Contractors to determine whether funds provided under this Agreement are expended in accordance with applicable laws, regulations, and provisions of contracts or agreements. Contractor shall, at a minimum, perform Contract resolution within fifteen (15) months of the “Financial Closeout Report.” 4) Contract resolution includes:

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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a) Reconciling expenditures reported to the Contractor to the amounts identified in the audit or other type of audit if the Sub-Contractors were not subject to the audit requirements. For a Sub-Contractor who was not required to obtain an audit and did not obtain another type of audit, the reconciliation of expenditures reported to CDA must be accomplished through performing alternative procedures (e.g., risk assessment [2 CFR 200.331 and 45 CFR 75.352], documented review of financial statements, and documented expense verification, including match, etc.). 5) Contractor shall prepare a summary worksheet of results from the contract resolutions performed of all sub-contractors. The summary worksheet shall include, but not be limited to, contract amounts; amounts resolved; amounts of match verified, resolution of variances; recovered amounts; whether an audit was relied upon or the Contractor performed an independent expense verification review (alternative procedures) of the Sub-Contractor in making a determination; whether audit findings were issued; and, if applicable, issuance date of the management letter; and any communication or follow-up performed to resolve the findings.

10. INSURANCE REQUIREMENTS
A. Prior to commencement of any work under this Agreement, Contractor shall provide for the term of this Agreement, the following insurance:
1) General liability of not less than $1,000,000 per occurrence for bodily injury and property damage combined. Higher limits may be required by the State in cases of higher than usual risks.
2) Automobile liability including non-owned auto liability, of not less than $1,000,000 for volunteers and paid employees providing services supported by this Agreement.
3) If applicable, or unless otherwise amended by future regulation, the Contractor and Sub-Contractors shall comply with the Public Utilities Commission General Order No. 115-F which requires higher levels of insurance for charter-party carriers of passengers and is based on seating capacity as follows:
a) $750,000 if seating capacity is under 8
b) $1,500,000 if seating capacity is 8 – 15
c) $5,000,000 if seating capacity is over 15
B. The insurance will be obtained from an insurance company acceptable to the Department of General Services (DGS), Office of Risk, and Insurance DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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Management (ORIM), or be provided through partial or total self-insurance acceptable to DGS.

C. Evidence of insurance shall be in a form and content acceptable to DGS ORIM.

D. Contractor shall notify the State within five (5) business days of any cancellation, non-renewal, or material change that affects required insurance coverage.

E. Insurance obtained through commercial carriers shall meet the following requirements:
1) The Certificate of Insurance shall provide the statement: “The Department of Aging, State of California, its officers, agents, and employees, are included as additional insureds, with respect to work performed for the State of California under this Agreement.” Professional liability coverage is exempt from this requirement.
2) CDA shall be named as the certificate holder and CDA’s address must be listed on the certificate.

F. The insurance provided herein shall be always in effect during the term of this Agreement. In the event the insurance coverage expires during the term of this Agreement, Contractor agrees to provide CDA a new Certificate of Insurance evidencing insurance coverage as provided herein for a period not less than the remaining Agreement term or for a period not less than one (1) year. Contractor shall provide the new Certificate of Insurance at least thirty (30) calendar days prior to the expiration date of the prior insurance coverage. In the event Contractor fails to keep always said insurance coverage in effect, CDA may, in addition to any other remedies it may have, terminate this Agreement.

G. Contractor shall require its Sub-Contractors under this Agreement, other than units of local government which are similarly self-insured, to maintain adequate insurance coverage for general liability, Worker’s Compensation liabilities, and if appropriate, auto liability including non-owned auto and professional liability, and further, Contractor shall require all its Sub-Contractors to hold the Contractor harmless. The Sub-Contractor’s Certificate of Insurance for general and auto liability shall also name Contractor, not the State, as the certificate holder and additional insured. Contractor shall maintain Certificates of Insurance for all its Sub-Contractors.

H. A copy of each appropriate Certificate of Insurance or letter of self-insurance, referencing this Agreement number shall be submitted to CDA with this Agreement.

I. Contractor shall be insured against liability for Worker’s Compensation or undertake self-insurance in accordance with the provisions of the California DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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Labor Code and Contractor affirms to comply with such provisions before commencing the performance of the work under this Agreement. [California Labor Code § 3700 et seq.]

11. DISSOLUTION OF ENTITY
Contractor shall notify CDA immediately of any intention to discontinue existence of the entity or to bring an action for dissolution.

12. AMENDMENTS, REVISIONS OR MODIFICATIONS
A. No amendment or variation of the terms of this Agreement shall be valid unless made in writing, signed, and approved by both parties. No oral understanding or agreement not incorporated in this Agreement is binding on any of the parties.

B. The State reserves the right to revise, waive, or modify the Agreement to reflect any restrictions, limitations, or conditions enacted by Congress or the Legislature or as directed by the Executive Branch of the State government.

13. INFORMATION INTEGRITY, AND SECURITY
A. INFORMATION ASSETS
Contractor, and its Sub-Contractors, shall have in place operational policies, procedures, and practices to protect State information assets, including those assets used to store or access Protected Health Information (PHI), Personal Identifying Information (PII), and any information protected under the Health Insurance Portability and Accountability Act (HIPAA) (i.e., public, confidential, sensitive and/or personal identifying information) as specified in the State Administrative Manual, 5300 to 5365.3; Cal. Gov. Code § 11019.9, DGS Management Memo 06-12; California Department of Finance Budget Letter 06-34; and CDA Program Memorandum 07-18 Protection of Information Assets and the Statewide Health Information Policy Manual.

Information assets may be in hard copy or electronic format and may include but is not limited to:
1) Reports
2) Notes
3) Forms
4) Computers, laptops, cellphones, printers, scanners
5) Networks (LAN, WAN, WIFI) servers, switches, routers DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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6) Storage media, hard drives, flash drives, cloud storage 7) Data, applications, databases
B. ENCRYPTION OF COMPUTING DEVICES
Contractor, and its Sub-Contractors, shall use 128-Bit encryption for data collected under this Agreement that is confidential, sensitive, and/or personal information including data stored on all computing devices (including but not limited to, workstations, servers, laptops, personal digital assistants, notebook computers and backup media) and/or portable electronic storage media (including but not limited to, discs, thumb/flash drives, portable hard drives, and backup media).

C. DISCLOSURE
1) Contractor, and its Sub-Contractors, shall ensure that all confidential, sensitive and/or Personal Identifying information (PII) is protected from inappropriate or unauthorized access or disclosure in accordance with applicable laws, regulations, and State policies.
2) Contractor, and its Sub-Contractors, shall protect from unauthorized disclosure all confidential, sensitive, and/or PII concerning persons receiving services pursuant to this Agreement, except for statistical information not identifying any participant.
3) “Personal Identifying information (PII)” shall include, but not be limited to name; identifying number; social security number; state driver’s license or state identification number; financial account numbers; any symbol or other identifying characteristic assigned to the individual, such as finger or voice print or a photograph; or any other information that would tend to identify an individual.
4) “Personal Health Information” is individually identifiable health information in any form, including physical records, electronic records, or spoken information. Demographic information may also be considered PHI when they are linked with health information.
5) Contractor, and its Sub-Contractors, shall not use confidential, sensitive and/or PII as described above for any purpose other than carrying out the obligations under this Agreement.
6) Contractor, and its Sub-Contractors, may share PHI and/or PII to perform the activities stated in Exhibit A of this Agreement only with prior written authorization from CDA.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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7) Participants may authorize the release of information to specific entities but shall not request or encourage any participant to give a blanket authorization or sign a blank release.

D. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Contractor, and its Sub-Contractors, agree to comply with the privacy and security requirements of HIPAA.

E. INFORMATION INTEGRITY AND SECURITY STATEMENT
Contractor shall sign and return an Information Integrity and Security Statement (CDA 1024) form with this Agreement. This is to ensure that Contractor is aware of, and agrees to comply with, its obligations to protect CDA information assets from unauthorized access and disclosure.

F. SECURITY INCIDENT REPORTING
A security incident occurs when CDA information assets are or reasonably believed to have been accessed, modified, destroyed, or disclosed without proper authorization, or are lost or stolen. Contractor, and its Sub-Contractors, must comply with CDA’s security incident reporting procedure.

G. SECURITY BREACH NOTIFICATIONS
Contractor, and its Sub-Contractors, shall provide all notices required by federal and/or State law in the event confidential, sensitive, and/or PII could have been breached in accordance with HIPAA, the Information Practices Act of 1977, and any other applicable federal or State authority.

H. SOFTWARE MAINTENANCE
Contractor, and its Sub-Contractors, shall apply security patches and upgrades in a timely manner and keep virus software up to date on all systems on which State data may be stored or accessed.

I. ELECTRONIC BACKUPS
Contractor, and its Sub-Contractors, shall ensure that all electronic information is protected by performing regular backups of files and databases and ensure the availability of information assets for continued business. Contractor shall ensure that all data, files, and backup files are encrypted.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit D – Special Terms and Conditions

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14. COPYRIGHTS AND RIGHTS IN DATA
A. COPYRIGHTS
Contractor certifies that it has appropriate systems and controls in place to ensure that State funds will not be used in the performance of this Agreement for the acquisition, operation, or maintenance of computer software in violation of copyright laws.

B. RIGHTS IN DATA
1) Contractor shall not publish or transfer any materials, as defined in paragraph 2 below, produced or resulting from activities supported by this Agreement without the express written consent of the Director of CDA. That consent shall be given, or the reasons for denial shall be given, and any conditions under which it is given or denied, within thirty (30) calendar days after the written request is received by CDA. CDA may request a copy of the material for review prior to approval of the request.
2) As used in this Agreement, the term “subject data” means writings, sound recordings, pictorial reproductions, drawings, designs or graphic representations, procedural manuals, forms, diagrams, workflow charts, equipment descriptions, data files and data processing or computer programs, and works of any similar nature (whether copyrighted or copyrightable) which are first produced or developed under this Agreement.

The term does not include financial reports, cost analyses and similar information incidental to agreement administration.
3) Subject only to other provisions of this Agreement, the State may use, duplicate, or disclose in any manner, and have or permit others to do so subject to State and federal law, all subject data delivered under this Agreement.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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EXHIBIT E

BUSINESS ASSOCIATE A DDENDUM

1. HIPAA
This Agreement has been determined to constitute a business associate relationship under the Health Insurance Portability and Accountability Act (HIPAA) and its implementing privacy and security regulations at 45 Code of Federal Regulations, Parts 160 and 164.

2. AGREEMENT
The term “Agreement” as used in this Exhibit is and shall be construed to be consistent with the definition provided in Exhibit D, Section 1 Definitions, Section A, Subsection 1.

3. BUSINESS ASSOCIATE
CDA (Business Associate) may create, receive, maintain, transmit or aggregate certain information pursuant to the terms of this Agreement, some of which information may constitute Protected Health Information (PHI) and/or confidential information protected by Federal and/or state laws.

A. PROTECTED HEALTH INFORMATION
As used in this Agreement and unless otherwise stated, the term Protected Health Information (PHI) refers to and includes Personal Identifying Information (PII) and any information protected under the Health Insurance Portability and Accountability Act (HIPAA) (i.e., public, confidential, sensitive and/or personal identifying information) as specified in the State Administrative Manual, 5300 to 5365.3; Cal. Gov. Code § 11019.9, DGS Management Memo 06-12; California Department of Finance Budget Letter 06-34; and CDA Program Memorandum 07-18 Protection of Information Assets and the Statewide Health Information Policy Manual.

B. CONFIDENTIAL INFORMATION
As used in this Agreement, the term “confidential information” means all information disclosed by a party to the other party, whether orally or in writing, that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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4. TERMS
The terms used in this Agreement, but not otherwise defined, shall have the same meanings as those terms in HIPAA. Any reference to statutory or regulatory language shall be to such language as in effect or as amended.

5. PERMITTED USES AND DISCLOSURES OF PHI BY CONTRACTOR.

Except as otherwise indicated in this Agreement, Contractor may use or disclose PHI and/or PII, inclusive of de-identified data derived from such PHI and/or PII, only to perform functions, activities or services specified in this Agreement, provided that such use or disclosure would not violate HIPAA or other applicable laws.

A. SPECIFIC USE AND DISCLOSURE PROVISIONS.

Except as otherwise indicated in this Agreement, Contractor may use and disclose PHI if necessary for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor. Contractor may disclose PHI for this purpose if the disclosure is required by law, or the Contractor 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 purposes for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware that the confidentiality of the information has been breached.

6. COMPLIANCE WITH OTHER APPLICABLE LAWS
A. To the extent that other state and/or federal laws provide additional, stricter, and/or more protective (collectively, “more protective”) privacy and/or security protections to PHI or other confidential information covered under this Agreement beyond those provided through HIPAA, Contractor agrees:
1) To comply with the more protective privacy and security standards set forth in applicable state or federal laws to the extent such standards provide a greater degree of protection and security than HIPAA or are otherwise more favorable to the individuals whose information is concerned; and
2) To treat any violation of such additional and/or more protective standards as a breach or security incident, as appropriate, pursuant to Section 18 of this Agreement.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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3) Examples of laws that provide additional and/or stricter privacy protections to certain types of PHI and/or confidential information, as defined in Section 4. of this Agreement, include, but are not limited to the Information Practices Act, California Civil Code sections 1798-1798.78, Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, Welfare and Institutions Code section 5328, and California Health and Safety Code section 11845.5.

7. ADDITIONAL RESPONSIBILITIES OF BUSINESS ASSOCIATE CONTRACTOR A. NONDISCLOSURE.

Contractor shall not use or disclose PHI or other confidential information other than as permitted or required by this Agreement or as required by law.

B. SAFEGUARDS AND SECURITY.
1) Contractor shall use safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of PHI and other confidential data and comply, where applicable, with subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of the information other than as provided for by this Agreement. Such safeguards shall be based on applicable Federal Information Processing Standards (FIPS) Publication 199 protection levels.
2) Contractor shall, at a minimum, utilize an industry-recognized security framework when selecting and implementing its security controls, and shall maintain continuous compliance with its selected framework as it may be updated from time to time. Examples of industry-recognized security frameworks include but are not limited to
a) NIST SP 800-53 – National Institute of Standards and Technology Special Publication 800-53
b) FedRAMP – Federal Risk and Authorization Management Program c) PCI – PCI Security Standards Council
d) ISO/ESC 27002 – International Organization for Standardization / International Electrotechnical Commission standard 27002 e) IRS PUB 1075 – Internal Revenue Service Publication 1075 f) HITRUST CSF – HITRUST Common Security Framework
DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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3) Contractor shall employ FIPS 140-2 compliant encryption of PHI at rest and in motion unless Business Associate determines it is not reasonable and appropriate to do so based upon a risk assessment, and equivalent alternative measures are in place and documented as such. In addition, Business Associate shall maintain, at a minimum, the most current industry standards for transmission and storage of PHI and other confidential information.
a) Contractor shall apply security patches and upgrades, and keep virus software up to date, on all systems on which PHI and other confidential information may be used.
b) Contractor shall ensure that all members of its workforce with access to PHI and/or other confidential information sign a confidentiality statement prior to access to such data. The statement must be renewed annually. c) Contractor shall identify the security official who is responsible for the development and implementation of the policies and procedures required by 45 CFR Part 164, Subpart C.

C. CONTRACTOR’S AGENT.

Contractor shall ensure that any agents, sub-contractors, vendors, or others (collectively, “agents”) that use or disclose PHI and/or confidential information on behalf of Contractor agree to the same restrictions and conditions that apply to Business Associate with respect to such PHI and/or confidential information.

8. MITIGATION OF HARMFUL EFFECTS.

Contractor shall mitigate, to the extent practicable, any harmful effect that is known to Contractor of a use or disclosure of PHI and other confidential information in violation of the requirements of this Agreement.

9. ACCESS TO PHI.

Contractor shall make PHI available in accordance with 45 CFR section 164.524.

10. AMENDMENT OF PHI.

Contractor shall make PHI available for amendment and incorporate any amendments to protected health information in accordance with 45 CFR section 164.526.

11. ACCOUNTING FOR DISCLOSURES.

Contractor shall make available the information required to provide an accounting of disclosures in accordance with 45 CFR section 164.528.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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12. COMPLIANCE WITH CDA OBLIGATIONS.

To the extent Contractor is to carry out an obligation of DHCS under 45 CFR Part 164, Subpart E, comply with the requirements of the subpart that apply to CDA in the performance of such obligation.

13. BREACHES AND SECURITY INCIDENTS.

Contractor shall implement reasonable systems for the discovery and prompt reporting of any breach or security incident, and take the following steps:

A. NOTICE TO CDA.
1) Contractor shall notify CDA immediately upon the discovery of a suspected breach or security incident that involves confidential, sensitive, PII and/or PHI.

This notification will be provided by email upon discovery of the breach. If Contractor is unable to provide notification by email, then Business Associate shall provide notice by telephone to CDA.
2) Contractor shall notify CDA within 24 hours by email (or by telephone if Contractor is unable to email CDA) of the discovery of:
a) Unsecured PHI if the PHI is reasonably believed to have been accessed or acquired by an unauthorized person.
b) Any suspected security incident which risks unauthorized access to PHI and/or other confidential information.
c) Any intrusion or unauthorized access, use or disclosure of PHI in violation of this Agreement; or
d) Potential loss of confidential data affecting this Agreement. 3) Upon discovery of a breach or suspected security incident, intrusion, or unauthorized access, use or disclosure of PHI, Contractor shall take:
a) Prompt action to mitigate any risks or damages involved with the security incident or breach; and
b) Any action pertaining to such unauthorized disclosure required by applicable Federal and State law.

B. INVESTIGATION.

Contractor shall immediately investigate such security incident or confidential breach.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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C. NOTIFICATION OF INDIVIDUALS.

If the cause of a breach is attributable to Business Associate or its agents, Contractor shall notify individuals accordingly and shall pay all costs of such notifications, as well as all costs associated with the breach. The notifications shall comply with applicable federal and state law. CDA shall approve the time, manner, and content of any such notifications and their review and approval must be obtained before the notifications are made.

D. RESPONSIBILITY FOR REPORTING OF BREACHES TO ENTITIES OTHER THAN CDA.

If the cause of a breach of PHI is attributable to Business Associate or its sub-contractors, Business Associate is responsible for all required reporting of the breach as required by applicable federal and state law.

E. CDA CONTACT INFORMATION.

To direct communications to the above referenced CDA staff, the Contractor shall initiate contact as indicated here. CDA reserves the right to make changes to the contact information below by giving written notice to Contractor. These changes shall not require an amendment to this Agreement.

CDA Program Contract
Manager
CDA Privacy Office CDA Information
Security Office
Health at Home Branch
Michelle Johnston
Program Director, Dementia
Initiatives
2880 Gateway Oaks Drive,
Suite 200
Sacramento, CA 95833
(916) 898-9539
[email protected]

Privacy Office
c/o: Jeremy Avila
Department of Aging
2880 Gateway Oaks Drive,
Suite 200
Sacramento, CA 95833
Email: [email protected]
Telephone: (916) 445-4646
Information Security
Office
CDA Information
Security Office
2880 Gateway Oaks
Drive, Suite 200
Sacramento, CA
95833
Email:
[email protected]

14. RESPONSIBILITY OF CDA.

CDA agrees to not request the Contractor to use or disclose PHI in any manner that would not be permissible under HIPAA and/or other applicable federal and/or state law.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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15. AUDITS, INSPECTION AND ENFORCEMENT
A. FACILITIES INSPECTION
From time to time, CDA may inspect the facilities, systems, books, and records of Contractor to monitor compliance with this Agreement. Contractor shall promptly remedy any violation of this Agreement and shall certify the same to the CDA.

Whether or how CDA exercises this provision shall not in any respect relieve Contractor of its responsibility to comply with this Agreement.

B. AUDIT
If Contractor is the subject of an audit, compliance review, investigation or any proceeding that is related to the performance of its obligations pursuant to this Agreement or is the subject of any judicial or administrative proceeding alleging a violation of HIPAA, Contractor shall promptly notify CDA unless it is legally prohibited from doing so.

16. TERMINATION
A. TERMINATION FOR CAUSE.

Upon CDA’s knowledge of a violation of this Agreement by Contractor, CDA may in its discretion:

B. CURE OF VIOLATION
Provide an opportunity for Contractor to cure the violation and terminate this Agreement if Contractor does not do so within the time specified by CDA; or C. TERMINATION
Terminate this Agreement if Business Associate has violated a material term of this Agreement.

D. JUDICIAL OR ADMINISTRATIVE PROCEEDINGS.

CDA may terminate this Agreement if Contractor is found to have violated HIPAA, or stipulates or consents to any such conclusion, in any judicial or administrative proceeding.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

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17. MISCELLANEOUS PROVISIONS
A. DISCLAIMER.

CDA makes no warranty or representation that compliance by Contractor with this Agreement will satisfy the Contractor’s business needs or compliance obligations. Contractor is solely responsible for all decisions made by Contractor regarding the safeguarding of PHI and other confidential information.

B. AMENDMENT.
1) Conflicting Provisions
Any provision of this Agreement which conflicts with current or future applicable Federal or State laws is hereby amended to conform to the provisions of those laws. Such amendment of this Agreement shall be effective on the effective date of the laws necessitating it and shall be binding on the parties even though such amendment may not have been reduced to writing and formally agreed upon and executed by the parties. 2) Failure to make Amends
Failure by Contractor to take necessary actions required by amendments to this Agreement under Section 22.2.1 shall constitute a material violation of this Agreement.
3) Assistance in Litigation or Administrative Proceedings.

Business Associate shall make itself and its employees and agents available to CDA at no cost to CDA to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against CDA, its directors, officers and/or employees based upon claimed violation of HIPAA, which involve inactions or actions by the Business Associate. 4) No Third-Party Beneficiaries.

Nothing in this Agreement is intended to or shall confer, upon any third person any rights or remedies whatsoever.
5) Interpretation.

The terms and conditions in this Agreement shall be interpreted as broadly as necessary to implement and comply with HIPAA and other applicable laws.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031 California Department of Aging City of Sacramento dba Triple R Program Agreement#: CC-2223-03
Exhibit E – Business Associate Addendum

Page 9 of 9 ends

6) No Waiver of Obligations.

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.

DocuSign Envelope ID: E1A89F9C-C2EC-4AC2-AE61-749973DE8031

Sacramento City CouncilNovember 29, 2022

Sacramento City Council
November 29, 2022