To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Jan Cobaleda-Kegler, 707-565-5157
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Agreements for Murphy Conservatee Facilities
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute agreements subject to review and approval as to form by counsel, for behavioral health long-term care services for conserved clients with the following entities:
i. 7th Avenue Center LLC, in an amount not to exceed $876,000 with a term ending June 30, 2026.
ii. Inspire Behavioral Health, in an amount not to exceed $1,104,796 with a term ending June 30, 2026.
iii. New Generations dba Windsor Care of Sacramento, in an amount not to exceed $1,078,425 with a term ending June 30, 2026.
B) Authorize the Director of Health Services, or designee to execute modifications to the agreements in order to address changes in service needs, payment or reimbursement methodologies, subject to available funding as well as review and approval by County Counsel.
C) Adopt a Resolution authorizing budgetary adjustments to the fiscal year 2025-2026 adopted budget, increasing appropriations in the amount of $1,529,611 to program funds available to support behavioral health long-term care services for conserved clients at the facilities outlined in this item.
(4/5th Vote Required)
end
Executive Summary:
The Department of Health Services (hereinafter, “DHS” or “the Department”) is requesting Board approval to execute agreements with 7th Avenue Center LLC, Inspire Behavioral Health, and New Generations dba Windsor Care of Sacramento to provide behavioral health long-term care (LTC) services for conserved clients. Following the results of California Fourth Appellate District Court decision in late 2024, Murphy Conservatees who have been found incompetent to stand trial are no longer allowed to wait indefinitely in law enforcement custody for placements at California Department of State Hospitals. As a result, Sonoma Superior Courts are faced with potentially having to release these individuals from custody if appropriate placement is not found under statutory guidelines. As a result of this emergency need to find placements for these Conservatees, Sonoma Superior Courts have ordered DHS to research and contract with LTC providers who will accept these clients.
In addition, the Department is requesting Fiscal Year 2025-2026 appropriations in the amount of $1,529,611 to fund the proposed agreements, utilizing Measure O and Intergovernmental Transfer (IGT) funds to support client placements.
Discussion:
On December 9, 2024, the State of California Superior Court issued a decision stating that the State of California can no longer allow Lanterman-Petris-Short (LPS) Murphy Conservatees to wait indefinitely in law enforcement custody for placements at Department of California State Hospitals. Murphy Conservatees are those individuals who have been arrested on felony criminal charges and have been returned from the Department of State Hospitals and found incompetent to stand trial. These individuals have, as a result of a mental health condition, concurrently been found to meet criteria for grave disability as listed under Welfare and Institutions Code 5150. Murphy Conservatees require a highly specialized level of care in a locked facility to ensure community safety due to determination of dangerousness.
Sonoma Superior Courts are now faced with potentially having to release these individuals from custody if placement is not found under statutory guidelines. The Sonoma Superior Courts have ordered DHS to research and contract with Long-Term Care (LTC) providers who will accept LPS Murphy Conservatee clients. The County is required by the California LPS Act to provide appropriate placement for Conservatees.
Contractors provide licensed care through a Skilled Nursing Facility, Skilled Nursing Facility with Special Treatment Program or Mental Health Rehabilitation Center. These types of facilities are referred to as Long-Term Care (LTC) facilities. LTC facilities provide treatment services in a locked setting for adults with serious mental illness who are conserved and require a higher level of care to remain safe while working toward recovery. Basic services provided by such facilities are regulated by their applicable California Code of Regulations, which define the scope and responsibility of such facility-based services. Contracts with these providers will be for a special level of care, referred to as Murphy Conserved. Clients are placed in these facilities following clinical review, approval by the County Conservator’s office, and at the discretion of the facility.
Sonoma County does not own or operate long-term care facilities and must contract with external providers to deliver these services. Fewer than ten facilities in the State of California serve clients at this level of care, and DHS is pursuing a Single Source Waiver to contract with providers willing to accept Sonoma County clients. This request comes amid statewide demand for limited long-term care resources, as counties across California face the same mandates.
All three service providers will offer the same level of care. The agreement usage will be dictated by the facility’s bed availability to serve clients. The contract amounts were calculated using each provider’s cost for an estimated four clients, who may spend 365 days at the facility. Under these agreements, the County will provide supplemental funding through Measure O fund balance and Intergovernmental Transfer revenues to provide augmented services to support the level of care designed to meet the special needs of mentally disabled adults who have severe psychiatric illnesses and/or concurrent medical complications and whose adaptive functioning is so impaired that it prevents the individual from receiving treatment and care in the community in a less restrictive environment.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
None
Fiscal Summary
|
Expenditures |
FY 25-26 Adopted |
FY26-27 Projected |
FY27-28 Projected |
|
Budgeted Expenses |
$1,529,610 |
|
|
|
Additional Appropriation Requested |
$1,529,611 |
|
|
|
Total Expenditures |
$3,059,221 |
|
|
|
Funding Sources |
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|
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|
General Fund/WA GF |
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State/Federal |
$1,529,610 |
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Fees/Other |
$1,529,611 |
|
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Use of Fund Balance |
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General Fund Contingencies |
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Total Sources |
$3,059,221 |
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Narrative Explanation of Fiscal Impacts:
Approval of this item will authorize a total of $3,059,221 for the execution of three Murphy Conservatee contracts, funded through Measure O and Intergovernmental Transfers (IGT). This action includes $1,529,611 increase in appropriations to the FY 2025-2026 Adopted Budget from Measure O fund balance. The remaining $1,529,610, already included in the adopted budget, is funded through IGT.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Sample Agreement
Related Items “On File” with the Clerk of the Board:
N/A