uses 1, 1.1, (a), (i), (1) numbering scheme for leases...

City and County of San Francisco

Request for Proposals #715 for

DAAS Nutrition Programs

Date issued: January 5, 2017Pre-proposal conference: 9:00 a.m., January 13, 2017Proposal due: 12:00 p.m., February 17, 2017

Request for Proposals #715 for DAAS Nutrition Programs

TABLE OF CONTENTS

Page

I. Introduction and Schedule........................................................1

II. Scope of Work..........................................................................7

III. Submission Requirements....................................................12

IV. Minimum Qualifications and Selection Criteria......................16

V. Pre-proposal conference and Contract award...........................18

VI. Terms and Conditions for Receipt of Proposals......................18

VII. Contract Requirements........................................................21

VIII. Protest Procedures...........................................................22

IX. Standard Forms.....................................................................1

X. San Francisco Human Services Agency RFP Letter of Intent.......3

XI. San Francisco Human Services Agency Page Number Form......5

XII. San Francisco Human Services Agency Budget Forms and Instructions...................................................................................7

XIII. Needs Assessment – Nutrition Services..............................................8

P-590 (1-15) i January 2017

RFP #715 for DAAS Nutrition Programs

I. Introduction and Schedule

A. GeneralThe San Francisco Human Services Agency (SF-HSA) announces its intent to seek proposals from organizations or individuals interested in contracting to provide nutrition services to seniors and adults with disabilities.

The grant agreement shall have a tentative term from July 1, 2017 to June 30, 2020. In addition, the City shall have the option to extend the term for a period of one year, for a total of four years, subject to annual availability of funds, annual satisfactory contractor performance, and need. SF-HSA has the sole, absolute discretion to exercise this option, and reserves the right to enter into grants of a shorter duration.

The source of funding for these services includes federal, state, and local funds. Payment for all services provided in accordance with provisions under this grant shall be contingent upon the availability of funds. The City shall not be required to provide any definite units of services, nor does the City guarantee any minimum amount of funding for these services.

B. ScheduleThe anticipated schedule for this procurement is:

Proposal Phase Date RFP is issued by the City January 5, 2017

Pre-proposal conference January 13, 2017 @9:00AM

Deadline for submission of written questionsor requests for clarification January 18, 2017 @2:00PM

Deadline for submission of Letters of Intent February 17, 2017 @12:00PM

Proposals due February 17, 2017 @12:00PM

Dates and times subject to change

C. Grant AmountIn consideration of the multitudinous nutrition needs across San Francisco’s 11 Supervisor districts and ethnically diverse population, this RFP has tailored its funding based on the existing nutrition service array and evolving community needs (see Section XIII for the 2016 DAAS Needs Assessment). SFHSA will award funding for each nutrition program type by Supervisor district and/or cuisine, whichever applicable. Proposals for any funding category will only compete against proposals applying for the same category.

The following table provides the estimated amount of funds available annually for each service, first by overall program and then individual program by either supervisor district and/or cuisine type:

Service Total Annual Funding Amount

ENP Congregate Meals $5,780,772

ENP Congregate CHAMPSS $540,000

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AWD Congregate Meals $479,321

ENP Home-Delivered Meals $7,689,760AWD Home-Delivered Meals $1,349,005Emergency Home-Delivered Meals $140,000

Home-Delivered Groceries $728,177Total $16,707,036

ENP Congregate Meals Funding CategoriesD1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11

American $82,767 $190,199 $240,206 $46,754 $909,547 $42,079 $494,019 $45,891 $129,959 $154,106American-Latino $76,071 $242,571American- Southern $353,825 $91,739Chinese $156,716 $628,047 $152,308 $237,636 $81,296 $116,303 $78,225Japanese $458,584Kosher $122,223Russian $215,060Samoan-Hawaiian $27,164American-Breakfast $9,930 $194,509Nutrition Compliance costs for Meal Providers (NCQA) $73,933Citywide Nutrition Compliance costs for Service Expansion (NCQA) $129,105

ENP Congregate CHAMPSS Funding Categories (Meals & Nutrition Compliance)D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11

Chinese and American $209,412 $261,765 $68,823

AWD Congregate Meals Funding CategoriesD1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11

American $7,580 $24,952 $77,217 $5,000 $120,921 $10,657 $5,491American-Latino $12,893 $24,620American-Southern $52,527 $35,417Chinese $5,000 $14,511 $5,000 $5,000Russian $5,415

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Expansion ($67,120) X X X

ENP Home-Delivered Meals & Nutrition Compliance Funding CategoriesCuisine Type

American $6,167,627American-Latino $231,196Chinese $533,336Japanese $261,777Kosher $86,502Russian $247,592Total All Cuisines $7,528,030 ($6,702,760Meals + $825,270 NCQA) Citywide HDM Nutrition Education and Counseling, includes Service Expansion (NCQA) $161,730

AWD Home-Delivered Meals Funding CategoriesCuisine Type

American $953,005Latino $50,000Chinese $50,000Citywide Intake & Initial Assessments (NCQA) $206,000Annual Reassessments for American Meals (NCQA) $90,000

Emergency Home-Delivered Meals Funding Category$140,000

Home-Delivered Groceries Funding CategoriesD1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 Citywide

HDG Partnership

Program $14,328 $11,410 $3,273 $8,636 $12,339 $3,273 $8,636 $340,249HDG Food Networking

Program $144,966 $20,072 $83,634 $77,361

D. Definitions General

CA-GetCare A web-based application that provides specific functionalities for contracted agencies to use to perform consumer intake/assessment/enrollment, record service objectives, run reports, etc.

CARBON Contract Administration, Reporting and Billing Online system administered by the City.

CRFC California Retail Food Code, a uniform statewide health and sanitation standard for food facilities, found in Section 113700 et seq., California Health and Safety Code.

City

Controller

City and County of San Francisco, a municipal corporation.

Controller of the City and County of San Francisco, or designated agent.

Coordination Activities that involve the active participation of the agency staff to include

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liaison with both OOA and non-OOA funded agencies and organizations for the purpose of avoiding duplication, improving services, resolving problems related to service delivery, and addressing the service needs of the eligible service population.

DAAS Department of Aging and Adult Services

Disability A condition attributable to mental or physical impairment, or a combination of mental and physical impairments including hearing and visual impairments, that results in substantial functional limitations in one (1) or more of the following areas of major life activity: a) Self-care: Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL), especially grocery shopping and meal preparation and have no safe, healthy alternative for meals; b) Capacity for independent living and self-direction; c) Cognitive functioning, and emotional adjustment.

Frail An individual is determined to be functionally impaired because the individual either: (a) Is unable to perform at least two activities of daily living, including bathing, toileting, dressing, feeding, breathing, transferring and mobility and associated tasks, without substantial human assistance, including verbal reminding, physical cueing or supervision. (b) Due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to others.

Grantee Contractor awarded grant

HSA Human Services Agency, also SFHSA

OCM Office of Contract Management, San Francisco Human Services Agency.

OOA Office on the Aging

Low Income Having income at or below 200% of the federal poverty line defined by the federal Bureau of the Census and published annually by the U.S. Department of Health and Human Services.

Minority An ethnic person of color who is any of the following:

a) Black – a person having origins in any of the Black racial groups of Africa, b) Hispanic – a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish or Portuguese culture or origin regardless of race, c) Asian/Pacific Islander – a person whose origins are from India, Pakistan or Bangladesh, Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, or the United States Territories of the Pacific including the Northern Marianas, d) American Indian/Alaskan Native – an American Indian, Eskimo, Aleut, or Native Hawaiian. Source: California Code of Regulation Sec. 7130.

California Department of Aging DefinitionsADL Activities of Daily Living: the basic tasks of everyday life including eating,

bathing, dressing, toileting, and transferring (i.e., getting in and out of a bed or chair).

IADL Instrumental Activities of Daily Living: Activities related to independent living and include preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone.

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Program Requirements

Title III program requirements found in the Older Americans Act (OAA 42 USC Section 3001-3058), Code of Federal Regulations (45 CFR XIII, 1321); Title 22, California Code of Regulations (CCR), Section 7000 et seq.; California Retail Food Code; California Department of Aging Program Memoranda.

Program Income Revenue generated by the Contractor or subcontractor from contract-supported activities. Program income is:

a) Voluntary contributions received from a participant or responsible party as a result of services.

b) Income from usage or rental fees of real or personal property acquired with grant funds or funds provided under this Agreement.

c) Royalties received on patents and copyrights from contract-supported activities.

d) Proceeds from sale of items fabricated under a contract agreement.

Program income is to be used to increase the service level or facilitate access to service.

Eligible Service Population

Eligible service population for Title IIIC programs means individuals 60 years of age or older, with emphasis on those in economic and social need with particular attention to low income minority individuals and older individuals residing in rural areas. [OAA, Section 305 (a)(2)(E)][Title 22, CCR, Sections 7125, 7127, 7130, and 7135].

Elderly Nutrition Program (ENP) Menu Requirements

Meals shall comply with the current Dietary Guidelines for Americans, published by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture; and shall provide to each participating older individual: (a) A minimum of one-third of the Dietary Reference Intakes (DRIs) as established by the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, if the project provides one meal per day; (b) At least two-thirds of the DRIs for the provision of 2 meals per day; (c) At least 100% of the DRIs if the project provides 3 meals per day; and (d) Fractions of meals or snacks may not be counted even when such snacks cumulatively equal one-third of the DRIs.

HACCP Hazard Analysis of Critical Control Points. A prevention-based food safety system focusing on time and temperature control at different crucial food service system points.

Menu Analysis A detailed nutritional analysis approved by a registered dietitian: (a) When utilizing computerized menu analysis, meals shall be analyzed on a weekly basis for a minimum of 2 weeks of the 5-week cycle menu. (b) Each average meal (a weekly average) shall meet no less than one-third of the DRI for males 51+ for all calculated nutrients. (c) At a minimum, values must be determined for calories, protein, fat (total, saturated and trans fat), fiber, calcium, magnesium, sodium, potassium, vitamins A, C, D and B12. Nutrients that do not meet the requirements should be the focus of future menu revisions and/or nutrition education.

Nutrition Risk Screening

Each participant receiving congregate or HDM nutrition service is required to be screened annually for his or her nutritional status using the nutrition risk screening tool on CAGetCare. The screening may be done on a one-on-one

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basis or in a group setting.

.

RD/RDN Registered Dietitian/Registered Dietitian Nutritionist. An individual who is registered by the Commission on Dietetic Registration and qualified as specified in Sections 2585 and 2586, California Business and Professions Code.

Title 22 Regulations

Refers to Barclay’s official California Cod of Regulations. Title 22 Social Security, Division 1.8. California Department of Aging. Chapter 4 (1) Title III Programs – program and service provider requirements. Article 5. Title III C- Elderly Nutrition Program.

web link: http://www.aging.ca.gov/ProgramsProviders/AAA/Nutrition/Code_of_Regulations/

Congregate Nutrition: (Title III C1)

Nutrition services for older individuals in a congregate setting. Services include meals, nutrition and health promotion education, nutrition risk screening, and opportunities for socialization.

Nutrition Education

The service provider dietitian or consulting dietitian shall approve the nutrition education plans, activities, and materials. The nutrition education for congregate sites is defined as demonstrations, audiovisual presentations, lectures, or small group discussions. Nutrition education services shall be provided by a dietitian or by personnel trained or approved by the dietitian. Dietetic students, interns, or technicians may provide nutrition education under the close supervision of a qualified dietitian. Coordination with community resource is encouraged. Nutrition education services shall be based on the needs of the participants as determined by annual needs assessment and evaluation of service impact. The nutrition education activities shall be provided at least four times a year and documented. One unit is defined as one nutrition education presentation provided to one participant.

Nutrition Counseling

To provide congregate or HDM program participants individual dietary evaluation counseling to those screened at high nutrition risk, and/or to those receiving modified/therapeutic diets as prescribed by the physicians or deemed necessary by a Registered Dietitian. This service must be performed by a Registered Dietitian (R.D.) who is covered by professional liability insurance.

Home-Delivered Meal (HDM) DefinitionsHDM: Title III C2

Nutrition services provided to homebound individuals age 60 and above including meals, nutrition and health promotion education, and nutrition risk screening. Each Meal shall provide one-third (1/3) of the Dietary Reference Intakes (DRI) and comply with the current Dietary Guidelines for Americans.

HDM Comprehensive Assessment

The assessment covers physiological, socioeconomic, and psychological factors including acute or chronic disease, syndromes or conditions, limited functional ability and family/support system, which contribute to an individual’s need for meals and other related services.

HDM Intake An initial determination of HDM eligibility, which may be accomplished by telephone or in person using an intake form approved by the OOA.

Nutrition To provide regularly scheduled activity which comply with the requirements of

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http://www.aging.ca.gov/ProgramsProviders/AAA/Nutrition/Code_of_Regulations/

http://www.aging.ca.gov/ProgramsProviders/AAA/Nutrition/Code_of_Regulations/


Education the Office on the Aging’s Nutrition Education policy, and which are planned, approved and coordinated by a qualified dietitian or nutritionist. Nutrition education for HDM may be shared with individuals in written form or in person.

E. Target PopulationThis grant funding is intended to serve seniors age 60 and over and/or adults age 18-59 with disabilities who reside in the City and County of San Francisco with one or more of the following target priorities:

1. Minority populationsa. Minority population can be defined by race, ethnic status, religion, sexual orientation, and gender status (Refer to Definition for details)

2. Low-income3. Limited English proficiency4. Frail

II. Scope of Work

The Scope of Work is to be used as a general guide and is not intended to be a complete list of all work necessary to complete the project. Contractors should use this description when designing their proposed programs. However, contractors may suggest modifications and/or additions that will, in their estimation, make the program more feasible or effective. The description below outlines the key program elements and services the selected vendor(s) will provide.

Respondents selected through this procurement process will be expected to provide the Nutrition Services listed below. A site visit to review the proposed sites/requests may be conducted as part of the evaluation process. Selected respondents will also be expected to meet service objectives and outcome measures. A sample of the service objectives and outcomes is included in this section of the RFP. Final service objectives, outcome measures, and units of service will be developed and agreed upon during the grant negotiation process.

Respondents should state in measurable, quantifiable terms the service and outcome objectives they will achieve in providing these services. The major purpose of objectives is to measure quantity, quality, and impact of services. Both quantitative and qualitative analysis shall be applied to measure program efficiency and effectiveness.

A. Description of Services – Congregate MealsClient Eligibility: ENP consumers include individuals age 60 and older, their spouse regardless of age,

disabled individuals age 18-59 who reside in facilities where there is a certified congregate site, disabled individuals age 18-59 who accompany their family members or caregivers age 60 and older to attend the congregate site, and individuals who serve as volunteers at the site regardless of age.

Eligible Adults with Disabilities consumers include individuals age 18-59 with a disability.

Minimum Program Requirements: To provide meals to eligible individuals at certified congregate sites, which have

sufficient staff or trained volunteer responsible for the day-to-day operation. Sites requesting OOA funding for site manager/coordinator must show a demonstrated need for serving an average of 25 meals or more per day.

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To operate the food service in accordance with the most recent CRFC and local regulations.

Meals served must meet menu requirements, and be ready to be served as a hot or cold (e.g. sandwich, salad, etc.) meal, as appropriate for the target population.

Meal sites serving less than 25 meals a day to Adults with Disabilities with must be an ENP approved site.

Meals shall be served in environmentally sound containers that are either reusable, or biodegradable, compostable or recyclable.

The meal shall be culturally appropriate to the target population(s) served. Meals shall be reported at client level (e.g., tracking and reporting the meals served to

each participant enrolled in the program). Enroll program participants and enter all necessary data into CaGetCare in a timely

basis. To administer nutrition risk screening to all program participants annually and

coordinate with appropriate service agencies for intervention, if needed. To make arrangements for the availability of meals to participants during a major

disaster where feasible and appropriate.

Nutrition Compliance-Quality Assurance Services for Congregate Meals: Kitchen and Site Monitoring: To provide quarterly monitoring of the food production

facilities and meal sites to ensure that they comply with CRFC, CDA and DAAS nutrition program requirements.

In-Service Training: To provide at least quarterly food service in-service training to staff and volunteers with at least two topics on food safety and sanitation and one on elder abuse reporting.

Nutrition Education: To provide nutrition education by a registered dietitian or qualified nutritionist at least four times a year that complies with DAAS-OOA Policy Memo 27 to program participants on food safety and health promotion topics of interest to the participants.

Nutrition Counseling (Optional): To provide nutrition counseling to program participants screened at high nutrition risk and/or to those on modified diets, either in person or by phone.

Menu Planning: A Registered Dietitian who will assist nutrition provider in developing menu cycle that complies with DAAS menu requirements, assist provider with nutrient analysis, review and approve agency's menus and menu substitutions for compliance.

Service Objectives for Congregate Meals: Number of unduplicated consumers served (ENP & Adults with Disabilities): One

unit is one consumer receiving at least three (3) meals at a congregate site during the course of a fiscal year.

Number of meals provided (ENP & Adults with Disabilities): One unit is one complete meal served to one consumer.

Number of nutrition education units provided: One unit is one presentation conducted at one congregate site to one consumer.

Number of nutrition counseling (Optional): One unit is one hour of individual counseling. This service is for the provider’s interested in DAAS’ expansion to provide this service citywide

Outcome Objectives for Congregate Meals:

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1. Based on the DAAS annual consumer satisfaction survey, with sample size of at least the average daily number of program clients, 85% of clients will report being satisfied (rate as “Excellent or Good”) with the meal quality.

2. Based on the DAAS annual consumer satisfaction survey, with sample size of at least the average daily number of program clients, 75% of clients will report that meal service helps maintain their independence.

3. To increase consumption of fruits, vegetables or milk products among program clients. There will be at least 65% improvement in the nutrition risk screening question “I eat few fruits or vegetables or milk products” compared to the participant’s previous screening.

4. At least 65% of clients assessed with high nutrition risk will be connected with additional resources.

5. Using the DAAS-adopted screening questions, at least 65% of clients assessed with high risk of loneliness will be connected with additional resources.

B. Description of Services – Home-Delivered MealsClient Eligibility: Eligible ENP consumers include seniors residing in San Francisco, age 60 or above

who are homebound by reason of illness, incapacitating disability, isolation, lack of support network, and have no safe, healthy alternative for meals. An eligible HDM participant’s spouse/partner, regardless of age, resides in the home of the homebound senior if it is in the senior’s best interest.

Adults with Disabilities: Eligible consumers include individuals residing in San Francisco age 18-59 with a disability who are unable to access congregate meals or other food on a regular basis by reason of illness, incapacitating disability, isolation, or lack of support network, and have no safe, healthy alternative for meals.

Criteria for Emergency HDM: Seniors or adults with disabilities who are eligible for HDM, who are low income and approved by DAAS Integrated Intake to qualify for Emergency HDM.

Minimum Program Requirements: To deliver meals to the homes of eligible individuals. To operate the food service in accordance with the most recent CRFC and local

regulations. Meals served must meet ENP menu requirements, and ready to serve as hot, chilled and/or frozen meal, as appropriate for the target population.

Meals served to HDM- Adults with Disabilities must be by an ENP approved meal provider. The meal provider must communicate on a timely basis with the HDM-AWD Assessment provider regarding the client’s status, service needs, etc.

Meals shall be served in environmentally sound containers that are reusable, biodegradable, compostable, or recyclable.

The meal shall be culturally appropriate to the target population(s) served. One meal a day per client. Two meals a day per client will be considered if need is

well-documented and justified. Meals shall be reported at consumer level (e.g., tracking and reporting the meals

served to each participant enrolled in the program). Enroll program participants and enter all necessary data into CaGetCare in a timely

basis. To comply with OOA Policy Memo #17 (HDM Intake and Priority Policy and

Procedures)

Additional Program Requirements for Emergency HDM:

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To provide meals as regular or modified, hot, chilled or frozen meals seven days a week, at 2 meals per consumer a day. The type of meal provided will be based on assessment of the consumer’s needs. The meals must meet ENP meal requirements.

Ability to deliver meals citywide to eligible participants. To provide meals within 2-5 days of approved meal request.

Nutrition Compliance-Quality Assurance Services for HDM Only: Kitchen and Route Monitoring: To provide quarterly monitoring of the food

production facilities and meal delivery routes to ensure that they comply with CRFC, CDA and DAAS nutrition program requirements.

In-Service Training: To provide at least quarterly food service in-service training to staff and volunteers with at least two topics on food safety and sanitation and one on elder abuse reporting.

Nutrition Education: To provide nutrition education at least four times a year by a registered dietitian or qualified nutritionist at least four times a year that complies with DAAS-OOA Policy Memo 27 to program participants on food safety and health promotion topics of interest to the participants.

Nutrition Counseling (Optional): To provide nutrition counseling to program participants screened at high nutrition risk and/or to those on modified diets, either in person or by phone.

Menu Planning: A Registered Dietitian who will assist nutrition provider in developing menu cycle that complies with DAAS menu requirements, assist provider with nutrient analysis, review and approve agency's menus and menu substitutions for compliance.

To conduct an annual comprehensive eligibility assessment in the home of the program participant at least once a year, and quarterly reassessment of the participant, to ensure compliance with DAAS-OOA Policy Memo #17, Home-Delivered Meal Intake & Priority Policy & Procedures.

Nutrition Compliance-Quality Assurance Services for HDM- Adults with Disabilities Only. With exception of reassessment service, DAAS intends to award one contractor who can provide these services citywide:To conduct screening, intakes and referrals to clients requesting HDM for Adults with Disabilities service, and make appropriate referrals to HDM providers or other community-based organizations for service to the participant. Initial Intake and Comprehensive Assessment: To conduct an initial comprehensive

eligibility assessment in the home of all the program participants served by the HDM- Adults with Disabilities meal providers to ensure that the participant meets eligibility requirements.

Reassessment: At least every 6 months, reassessment shall be conducted and an annual comprehensive reassessment shall be conducted in the participant’s home to ensure that the person continues to meet eligibility requirements. Optional: HDM service provider may propose to offer this service.

Other Related Service: Referring and assigning appropriate consumers to the participating HDM service providers, maintaining and prioritizing a waiting list according to OOA requirements and coordinating regular meetings with the participating HDM service providers. Grantee shall meet with HDM providers on a quarterly basis and follow-up on participants, discuss any issues, and provide technical assistance as needed.

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Service Objectives for Home-Delivered Meals: Number of unduplicated consumers served (ENP & Adults with Disabilities): One

unit is one consumer receiving at least three (3) meals at his or her home during the course of a fiscal year.

Number of meals provided (ENP & Adults with Disabilities): One unit is one complete meal delivered.

Number of home-delivered meal assessment (ENP & AWD): One unit is one comprehensive (initial or annual) assessment of the consumer at his/her home, and documenting all of the required participant information.

Number of nutrition education units provided (ENP & AWD): One unit is one set of materials delivered to one consumer.

Number of hours of nutrition counseling (ENP& AWD): One unit is one hour of individual counseling. This service is required for providers offering modified diets and for the provider interested in DAAS’ expansion to provide this service citywide to participants screened at high nutrition risk.

Outcome Objectives for Home-Delivered Meals:1. Based on the DAAS annual consumer satisfaction survey, with sample size of at

least the average daily number of program clients, 85% of clients will report being satisfied (rate as “Excellent or Good”) with the meal quality.

2. Based on the DAAS annual consumer satisfaction survey, with sample size of at least the average daily number of program clients, 75% of clients will report that meal service helps maintain their independence.

3. To increase consumption of fruits, vegetables or milk products among program clients. There will be at least 65% improvement in the nutrition risk screening question “I eat few fruits or vegetables or milk products” compared to the participant’s previous screening.

4. At least 65% of clients assessed with high nutrition risk will be connected with additional resources.

5. Using the DAAS-adopted screening questions, at least 65% of clients assessed with high risk of loneliness will be connected with additional resources.

C. Description of Services – Home-Delivered GroceriesClient Eligibility: Home-Delivered Groceries:

o Frail seniors or adults with disabilities who live in San Francisco and with limited mobility that prevents them from accessing food pantry sites, and

o At or below 200% Federal Poverty level with a demonstrated need for supplemental groceries due to isolation, lack of support network, poor nutrition, and/or other reasons, and

o Has capacity or help to store and handle delivered groceries.

Minimum Program Requirements: Have staff that will train, coordinate, and oversee volunteers. Operate the food handling and packaging in accordance with the most recent CRFC

and local regulations. Form an agreement with the San Francisco-Marin Food Bank or other organizations

to provide the food supplies or grocery bags for distribution to program participants.

Additional requirement for Home-Delivered Groceries:

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Deliver supplemental food/groceries to the homes of eligible individuals on a bi-monthly or weekly basis by trained and culturally sensitive volunteers.

Service Objectives for Home-Delivered Groceries: Number of unduplicated consumers served (Senior & Adults with Disabilities): One

unit is one consumer receiving a grocery bag at a pantry site or his or her home during the course of a fiscal year.

Number of grocery bags provided/delivered: One unit is one bag of groceries delivered to the consumer.

Number of Intakes/Reassessments: One unit is one comprehensive (initial or annual) assessment of the consumer, and documenting all of the required consumer information. The consumers shall be reassessed at least on an annual basis to ensure that they meet program eligibility. NOTE: Initial intake and referrals may be from the community, e.g. DAAS Integrated Intake, 211, DAAS Grantee, etc.

Number of Activity Scheduling Hours (Optional): One unit is one hour of scheduled activity sponsored or organized by the Grantee. Activities may include educational presentations, workshops, trainings, cultural/social events, exercise classes, etc., that bring people together for education or wellness purposes, and help consumers maintain/enhance their level of functioning.

Number of Social Service Hours (Optional): One unit is one hour of providing one-on-one assistance to consumers to enable them to resolve problems. Assistance may include information and referral, forms/application completion, home visits, medical escort services, and emotional support by phone or in person.

Number of Enhanced Outreach Hours (Optional): One unit is one hour of formal outreach efforts to support outreach efforts for the program, e.g. conducting outreach at a community fair, hours spent developing public service announcements, social media marketing, etc. Volunteer Recruitment and Development (Optional):

o Number of Volunteer(Optional)s: One unit is one volunteer (recruited, trained, with 6-month commitment)

o Number of Volunteer Hours(Optional): One unit is one hour reported work by volunteer

o Number of Trainings (Optional): One unit is one session of training The HDG program model relies heavily on the volunteers that take the time to become trained and assigned to work with specific HDG recipients. Conduct outreach to draw volunteers who will undergo training and will commit to volunteer for at least a six (6) month period.

Outcome Objectives for Home-Delivered Groceries: Based on DAAS Annual Consumer Satisfaction Surveys with sample size of at

least 25% of enrolled clients: 75% of the participants will indicate that they feel healthier as result of participating in the program.

85% of clients will report being satisfied (rate as “Excellent or Good”) with the food quality.

75% of clients will report that meal service helps maintain their independence.

III. Submission Requirements

A. Time and Place for Submission of ProposalsProposals must be received by 12:00 p.m., on February 17, 2017. Postmarks will not be considered in judging the timeliness of submissions. Proposals may be delivered in person and left with any Contract Manager with the Human Services Agency, Office of Contract Management at 1650 Mission Street, Suite 300, San Francisco, or mailed to:

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Justin Chan #GB23Office of Contract ManagementSan Francisco Human Services Agency1650 Mission Street, Suite 300San Francisco, CA 9410

Proposers shall submit four (4) hard copies and one (1) electronic pdf copy of the proposal to the above location. The electronic version of the application is submitted to: [email protected]. Both the hard copies and the electronic pdf copy must be received prior to the deadline to be considered a timely submission. Proposals that are submitted by fax will not be accepted. Late submissions will absolutely NOT be considered. Please take every measure to ensure that both the electronic and hard copies are delivered by the deadline stated in section III, item A.

B. FormatPlease use recycled paper and bind the proposal with a binder clip, rubber band, or single staple, or submit it in a three-ring binder. Please do not bind your proposal with a spiral binding, glued binding, or anything similar. You may use tabs or other separators within the document. For word processing documents, text should be unjustified (i.e., with a ragged-right margin) using a double-spaced 12 point serif font (e.g., Times Roman, and not Arial), and page margins should be at least 1” on all sides (excluding headers and footers). Please note: “one page” equals one single-sided page, not double-sided. Printing double-sided pages is fine for the purposes of saving paper, but counts as two pages.

C. ContentOrganizations interested in responding to this RFP must submit the following information, in the order specified below. All proposals for funding must be developed using the format below. This is necessary so that all proposals can receive fair and equal evaluation. Proposals not following the required format will not be considered for funding. Information must be at a level of detail that enables effective evaluation and comparison between proposals by the Proposal Evaluation Panel. The Agency must ensure that the proposal addresses the Selection Criteria.

IMPORTANT: Respondents must submit SEPARATE proposals for each of the seven major program types (ENP Congregate, ENP CHAMPSS, AWD Congregate, ENP Home-Delivered, AWD Home-Delivered, Emergency Home-Delivered, Home-Delivered Groceries) listed in Section I.C. of this RFP.

Respondents must also apply for whatever amount of Nutrition Compliance and Quality Assurance (NCQA) funding that’s necessary for running the proposed program.

1. RFP Letter of Intent (use form provided in Section X) Submit the letter of intent signed by a person authorized to obligate the organization to perform the commitments contained in the proposal. Submission of this document will constitute a representation by the organization that the organization is willing and able to perform the commitments contained in the proposal.

2. Table of Contents Each proposal package should contain a complete table of contents showing page numbers. All pages in the package must be numbered consecutively, and major sections must be indexed.

3. Completed Page Number Form (refer to Section XI)

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Page number form will guide reviewers to the proposal page/s that responds to each section of the required submission content.

4. Minimum Qualifications – up to 3 pages All agencies submitting proposals for funding must provide a Minimum Qualifications Narrative describing in detail how the proposing agency meets each of the Minimum Qualifications. Any proposals failing to demonstrate these qualifications will be considered non-responsive and will not be eligible for proposal review or award of grant (refer to section IV, item A).

5. Organizational Capacity – up to 8 pages (not including charts and attachments) Description of your agency’s ability to deliver the services proposed in this RFP.Please address the following:

a) Describe your organization's history, purpose, and mission statement.b) Provide a summary of your organization’s experience implementing a service relevant to the

service described in this RFP for which you are seeking funding. c) Describe your organization’s experience in reaching and serving the proposed target

populations and areas described in this RFP for which you are seeking funding.d) Describe your organization’s experience in partnering with other funders to address needs of

the San Francisco older adult and adults with disabilities population. Explain how consumers will be effectively connected to other services besides the nutrition programs in this RFP. Describe your organization’s ability to successfully execute contracts and fulfill contracting obligations.

e) Describe your organization’s physical capacity to provide the proposed nutrition services. Physical capacity pertains to the organization’s access to and condition of necessary capital equipment including but not limited to kitchen facility, cookware, and meal transport vehicles.

f) Fill out the Disability Checklist (template found through the following link):

http://mission.sfgov.org/OCABidPublication/ReviewBids.aspx

6. Program Approach – up to 12 pages (not including charts and attachments) Description of your agency’s specific program approach to deliver the services proposed in this RFP.Please address the following:

a) Provide a summary of the proposed service. Include in the response how the proposed service aligns with DAAS’s most recent Needs Assessment and services requested in this RFP and include the following: a) goals and objectives of the proposed service; b) service areas/districts served; c) description of target population to be served; d) proposed number of service units.

Complete and submit the service Site Chart (template found through the following link):


Click on the “Consultants and Professional Services” link, and then the link for this RFP to find the budget forms.

For meal providers only: Describe how the agency will develop nutrition service programs and menus that are in compliance with OOA requirements. Include type of meal service model (regular congregate, CHAMPSS, etc.), type of meals (e.g. breakfast, lunch or dinner),

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type of diet (e.g. modified diets (diabetic, etc.) or ethnic cuisine (e.g. American, Chinese, Latino, etc.) to be served and sample menu for all proposed menu types.

Sample menu template found through the following link:


b) Describe the positions, duties, and full-time equivalent hours of paid staff and volunteers that will be involved in the delivery, management, and administration of the service proposed. Provide a copy of your organizational chart that shows where these paid and volunteer program personnel fit in your agency structure. Provide Job description for key positions, specifically executive director, program director, food service or program manager, nutritionist, data coordinator, etc.

Provide in-service training schedule for staff and volunteers.

c) Describe how the organization will gather and manage client and service data and comply with the reporting requirements. The description should include the agency’s policies and procedures to obtain client intake information, ensure the completeness and accuracy of gathering the required data elements, maintain privacy/ confidentiality of client records, track units of service provided, and handle and report data breach. Describe the agency’s procedure for ensuring timely submission of data and other administrative reports as requested by the DAAS, federal and state funders.

d) Describe your plan for monitoring and evaluating the program on a regular basis. What procedures/ systems are used to ensure food safety and/or program requirements? How frequently is the program monitored and by whom?

What is the agency’s strategy to successfully meet the program outcome measures outlined in this RFP?

How do consumers provide feedback and how often?

7. Fiscal Capacity (Budget and Justification) – up to 7 pages (not including budget templates) a) Describe the organization’s current accounting system, including the following: areas and

frequency of accounting for receivables and payables, payroll processing, financial statement preparation & internal/external auditing. Describe the agency’s procedures for ensuring timely submission of invoices and other fiscal reports as requested by the County.

b) Using the Program Budget Forms provided in this RFP, prepare a budget for the service proposed. Describe the budget’s individual expenses and calculations in the budget narrative. Include a narrative of the cost allocation plan for indirect costs.

Provide clear and specific descriptions of the following to demonstrate the Respondent’s ability to cover all costs of the service proposed: a) agency’s fundraising plan; b) source(s) of cash match and in-kind support to cover costs not covered by the grant.

The approved budget templates are located in the following link:


Further budget instructions are provided in Section XII. The SF Human Services Agency intends to award this grant to respondents that it considers will provide the best overall

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program services at a reasonable pricing structure. The SF Human Services Agency reserves the right to accept other than the lowest priced offer and to reject any proposals that are not responsive to this request.

IV. Minimum Qualifications and Selection Criteria

A. Minimum Qualifications Respondent must possess a minimum of 3 years of experience providing nutrition services to a

low-income population; and Respondent must possess a minimum of 3 years of experience serving the senior and/or adults

with disabilities populations; and Respondent must be a certified vendor with the City and County of San Francisco or declare their

ability to become a certified vendor (instructions on Section IX) following notice of intent to award; and

Respondent must declare their ability to comply with the City contracting requirements set forth in Section VII of this RFP.

B. Selection CriteriaThe proposals will be evaluated by a selection committee comprised of parties with expertise in the service areas identified in this RFP. The City intends to evaluate the proposals generally in accordance with the criteria itemized below.

Total Possible Points: 100Respondents must receive a minimum of 60% of the available points to be considered for award.

Organizational Capacity (30 points)1. Respondent has a well-established history of serving residents of San Francisco, including older

adults & adults with disabilities. Respondent’s mission, purpose, and goals are aligned with the priorities set forth in this RFP. (3 points)

2. Respondent demonstrates prior experience delivering the service proposed. Respondent shows successful implementation of the service sought in this RFP or a comparable program. (8 points)

3. Respondent has a clear understanding of the targeted populations or communities identified in the RFP. Respondent demonstrates experience reaching and serving the targeted populations and/or targeted area described in the RFP. The outreach plan is viable, timely, appropriate, and can be realistically implemented. (4 points)

4. Respondent provides culturally and linguistically competent services to a diverse population. (2 points)

5. Respondent demonstrates its capacity to serve consumers with disabilities including physical, sensory, and mental disabilities. Respondent satisfactorily completes the Disability Checklist. (2 points)

6. Respondent lists relevant partnerships; include length of time relationship has existed and the type of services provided. (2 points)

7. Respondent describes its systematic approach to effectively connect consumers to needed services through referrals or other internal means. (2 points)

8. Respondent has evidence/history of capacity to successfully execute contracts and fulfill contracting obligations based on performance as a contractor with other funding organizations. (2 points)

9. Respondent demonstrates physical capacity to provide the proposed services. Respondent demonstrates access to kitchen and/or meal transport equipment that is in suitable condition. (5 points)

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Program Approach (40 points)1. Respondent provided complete and concise response to the questions. Respondent is proposing to

implement an approach, intervention, or best practice that has proven successful. For promising innovative proposals, respondent indicates how success will be measured. (10 points)

2. Respondent sufficiently describes its specific program approach to deliver the services proposed and how this approach will appropriately address the needs and barriers of the target population? Respondent indicates how the congregate and HDM nutrition compliance requirements will be provided. Sample menu is completed. (5 points)

3. The Site Chart is completed accurately. The proposed units are realistic. Where applicable, there are signed or draft agreements with partners. (5 points)

4. Staff and volunteer positions, duties, and hours are appropriate and adequate to deliver, manage, and administer the nutrition program. (5 points)

5. Copy of organization chart provided. Program staff and volunteers are clearly identified on the organizational chart. Copy of key staff job description provided & resumes provided. (3 points)

6. In-service schedule provided and includes relevant training topics to meet OOA program standards. (2 points)

7. Respondent’s description of data management process and procedures are clear and complete. Respondent effectively explains how the contractual obligations will be monitored. (5 points)Respondent describes the following processes as instructed, and as appropriate:

Obtaining consumer information, intake Ensuring data accuracy, completeness Maintaining privacy, confidentiality Tracking units of service provided Handling and reporting data breach Ensuring timely submission of data and other administrative reports

8. Respondent has a clear plan for monitoring and evaluating the program that demonstrates clear methodology to measure both output and outcome of the service. If applicable, respondent describes their protocol and systems to comply with food safety. Respondent provides a description of their quality control system. Methods to evaluate the program compliance in all applicable areas are clear and reasonable. Respondent demonstrates understanding of the program outcome measures and provides a viable plan to successfully meet those outcome measures. Respondent explains the proposed model for consumers to offer input regarding program operations. (5 points)

Program Budget (30 points)1. Respondent’s accounting system is sound and describes the following as instructed (5 points):

Frequency of accounting for receivables and payables Payroll processing Financial statement preparation External/internal auditing Procedure for timely submission of invoices and other fiscal reports.

2. Budget is reasonable and reflects sound, adequate allocation of resources. Respondent has a clear plan to cover all costs of the program, including nutrition compliance requirements. (6 points)

3. The budget narrative is clear and provides pertinent information for understanding the proposed costs/budget. (5 points)

4. Meal rate is competitive with other proposals bidding for the same service area/s. (10 points)5. Budget meets or exceeds matching requirements. Respondent’s description of its fundraising plan

is clear and specific. It includes description of its source(s) of cash match and in-kind support is clear and specific. (4 points)

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V. Pre-proposal conference and Contract award

A. Pre-Proposal ConferenceProposers are encouraged to attend a pre-proposal conference on January 13, 2017, at 9:00 am to be held at 1650 Mission Street, Suite 400, San Francisco, CA 94103. All questions will be addressed at this conference and any available new information will be provided at that time. If you have further questions regarding the RFP, please contact the individual designated in Section VI.B. All questions addressed will also be posted on the City website along with the answers.

B. Contract AwardThe Human Services Agency will select a proposer with whom Agency staff shall commence contract negotiations. The selection of any proposal shall not imply acceptance by the City of all terms of the proposal, which may be subject to further negotiations and approvals before the City may be legally bound thereby. If a satisfactory contract cannot be negotiated in a reasonable time the Human Services Agency, in its sole discretion, may terminate negotiations with the highest ranked proposer and begin contract negotiations with the next highest ranked proposer.

C. Written QuestionsProposers are encouraged to submit written questions before the due date stated in Section I.B. to the individual designated in Section VI.B. All questions will be addressed and any available new information will be provided in writing via email to proposers. All written questions must be submitted on or prior to January 17, 2017 at 2:00PM.

VI. Terms and Conditions for Receipt of Proposals

A. Errors and Omissions in RFPProposers are responsible for reviewing all portions of this RFP. Proposers are to promptly notify the Department, in writing, if the proposer discovers any ambiguity, discrepancy, omission, or other error in the RFP. Any such notification should be directed to the Department promptly after discovery, but in no event later than five working days prior to the date for receipt of proposals. Modifications and clarifications will be made by addenda as provided below.

B. Inquiries Regarding RFPInquiries regarding the RFP and all oral notifications of intent to request written modification or clarification of the RFP, must be directed to:

Justin Chan 1650 Mission Street, Suite 300San Francisco, CA [email protected]

C. Objections to RFP TermsShould a proposer object on any ground to any provision or legal requirement set forth in this RFP, the proposer must, not more than ten calendar days after the RFP is issued, provide written notice to the Department setting forth with specificity the grounds for the objection. The failure of a proposer to object in the manner set forth in this paragraph shall constitute a complete and irrevocable waiver of any such objection.

D. Change Notices

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The Department may modify the RFP, prior to the proposal due date, by issuing Change Notices, which will be posted on the website. The proposer shall be responsible for ensuring that its proposal reflects any and all Change Notices issued by the Department prior to the proposal due date regardless of when the proposal is submitted. Therefore, the City recommends that the proposer consult the website frequently, including shortly before the proposal due date, to determine if the proposer has downloaded all Change Notices.

E. Term of ProposalSubmission of a proposal signifies that the proposed services and prices are valid for 120 calendar days from the proposal due date and that the quoted prices are genuine and not the result of collusion or any other anti-competitive activity.

F. Revision of ProposalA proposer may revise a proposal on the proposer’s own initiative at any time before the deadline for submission of proposals. The proposer must submit the revised proposal in the same manner as the original. A revised proposal must be received on or before the proposal due date.

In no case will a statement of intent to submit a revised proposal, or commencement of a revision process, extend the proposal due date for any proposer.At any time during the proposal evaluation process, the Department may require a proposer to provide oral or written clarification of its proposal. The Department reserves the right to make an award without further clarifications of proposals received.

G. Errors and Omissions in ProposalFailure by the Department to object to an error, omission, or deviation in the proposal will in no way modify the RFP or excuse the contractor from full compliance with the specifications of the RFP or any contract awarded pursuant to the RFP.

H. Financial ResponsibilityThe City accepts no financial responsibility for any costs incurred by a firm in responding to this RFP. Submissions of the RFP will become the property of the City and may be used by the City in any way deemed appropriate.

I. Proposer’s Obligations under the Campaign Reform OrdinanceProposers must comply with Section 1.126 of the S.F. Campaign and Governmental Conduct Code, which states:

No person who contracts with the City and County of San Francisco for the rendition of personal services, for the furnishing of any material, supplies or equipment to the City, or for selling any land or building to the City, whenever such transaction would require approval by a City elective officer, or the board on which that City elective officer serves, shall make any contribution to such an officer, or candidates for such an office, or committee controlled by such officer or candidate at any time between commencement of negotiations and the later of either (1) the termination of negotiations for such contract, or (2) three months have elapsed from the date the contract is approved by the City elective officer or the board on which that City elective officer serves.

If a proposer is negotiating for a contract that must be approved by an elected local officer or the board on which that officer serves, during the negotiation period the proposer is prohibited from making contributions to:

• the officer’s re-election campaign• a candidate for that officer’s office

P-590 (1-15) 19 of 23 January 2017


• a committee controlled by the officer or candidate.

The negotiation period begins with the first point of contact, either by telephone, in person, or in writing, when a contractor approaches any city officer or employee about a particular contract, or a city officer or employee initiates communication with a potential contractor about a contract. The negotiation period ends when a contract is awarded or not awarded to the contractor. Examples of initial contacts include: (1) a contractor contacts a city officer or employee to promote himself or herself as a candidate for a contract; and (2) a city officer or employee contacts a contractor to propose that the contractor apply for a contract. Inquiries for information about a particular contract, requests for documents relating to a Request for Proposal, and requests to be placed on a mailing list do not constitute negotiations.

Violation of Section 1.126 may result in the following criminal, civil, or administrative penalties:1. Criminal. Any person who knowingly or willfully violates section 1.126 is subject to a fine of up

to $5,000 and a jail term of not more than six months, or both.2. Civil. Any person who intentionally or negligently violates section 1.126 may be held liable in a

civil action brought by the civil prosecutor for an amount up to $5,000.3. Administrative. Any person who intentionally or negligently violates section 1.126 may be held

liable in an administrative proceeding before the Ethics Commission held pursuant to the Charter for an amount up to $5,000 for each violation.

For further information, proposers should contact the San Francisco Ethics Commission at (415) 581-2300.

J. Sunshine OrdinanceIn accordance with S.F. Administrative Code Section 67.24(e), contractors’ bids, responses to RFPs and all other records of communications between the City and persons or firms seeking contracts shall be open to inspection immediately after a contract has been awarded. Nothing in this provision requires the disclosure of a private person’s or organization’s net worth or other proprietary financial data submitted for qualification for a contract or other benefits until and unless that person or organization is awarded the contract or benefit. Information provided which is covered by this paragraph will be made available to the public upon request.

K. Public Access to Meetings and RecordsIf a proposer is a non-profit entity that receives a cumulative total per year of at least $250,000 in City funds or City-administered funds and is a non-profit organization as defined in Chapter 12L of the S.F. Administrative Code, the proposer must comply with Chapter 12L. The proposer must include in its proposal (1) a statement describing its efforts to comply with the Chapter 12L provisions regarding public access to proposer’s meetings and records, and (2) a summary of all complaints concerning the proposer’s compliance with Chapter 12L that were filed with the City in the last two years and deemed by the City to be substantiated. The summary shall also describe the disposition of each complaint. If no such complaints were filed, the proposer shall include a statement to that effect. Failure to comply with the reporting requirements of Chapter 12L or material misrepresentation in proposer’s Chapter 12L submissions shall be grounds for rejection of the proposal and/or termination of any subsequent Agreement reached on the basis of the proposal.

L. Reservations of Rights by the CityThe issuance of this RFP does not constitute an agreement by the City that any contract will actually be entered into by the City. The City expressly reserves the right at any time to:1. Waive or correct any defect or informality in any response, proposal, or proposal procedure;2. Reject any or all proposals;

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3. Reissue a Request for Proposals;4. Prior to submission deadline for proposals, modify all or any portion of the selection procedures,

including deadlines for accepting responses, the specifications or requirements for any materials, equipment or services to be provided under this RFP, or the requirements for contents or format of the proposals;

5. Procure any materials, equipment or services specified in this RFP by any other means; or6. Determine that no project will be pursued.

M. No WaiverNo waiver by the City of any provision of this RFP shall be implied from any failure by the City to recognize or take action on account of any failure by a proposer to observe any provision of this RFP.

N. Local Business Enterprise Goals and OutreachDue to county, federal and state funding for these services, LBE bid discounts will not be used in this RFP.

VII. Contract RequirementsA. Standard Contract Provisions

The successful proposer will be required to enter into a contract substantially in the form of the Agreement for Professional Services, attached hereto as Appendix C. Failure to timely execute the contract, or to furnish any and all insurance certificates and policy endorsement, surety bonds or other materials required in the contract, shall be deemed an abandonment of a contract offer. The City, in its sole discretion, may select another firm and may proceed against the original selectee for damages.

Proposers are urged to pay special attention to the requirements of Administrative Code Chapters 12B and 12C, Nondiscrimination in Contracts and Benefits; the Minimum Compensation Ordinance; the Health Care Accountability Ordinance; the First Source Hiring Program; and applicable conflict of interest laws, as set forth in paragraphs B, C, D, E and F below.

B. Nondiscrimination in Contracts and Benefits The successful proposer will be required to agree to comply fully with and be bound by the provisions of Chapters 12B and 12C of the San Francisco Administrative Code. Generally, Chapter 12B prohibits the City and County of San Francisco from entering into contracts or leases with any entity that discriminates in the provision of benefits between employees with domestic partners and employees with spouses, and/or between the domestic partners and spouses of employees. The Chapter 12C requires nondiscrimination in contracts in public accommodation. Additional information on Chapters 12B and 12C is available on the CMD’s website at www.sfCMD.org.

C. Minimum Compensation Ordinance (MCO)The successful proposer will be required to agree to comply fully with and be bound by the provisions of the Minimum Compensation Ordinance (MCO), as set forth in S.F. Administrative Code Chapter 12P. Generally, this Ordinance requires contractors to provide employees covered by the Ordinance who do work funded under the contract with hourly gross compensation and paid and unpaid time off that meet certain minimum requirements.

For the amount of hourly gross compensation currently required under the MCO, see www.sfgov.org/olse/mco. Note that this hourly rate may increase on January 1 of each year and that contractors will be required to pay any such increases to covered employees during the term of the contract. Additional information regarding the MCO is available on the web at www.sfgov.org/olse/mco.

P-590 (1-15) 21 of 23 January 2017

http://www.sfgov.org/olse/mco

http://www.sfCMD.org/


D. Health Care Accountability Ordinance (HCAO)The successful proposer will be required to agree to comply fully with and be bound by the provisions of the Health Care Accountability Ordinance (HCAO), as set forth in S.F. Administrative Code Chapter 12Q. Contractors should consult the San Francisco Administrative Code to determine their compliance obligations under this chapter. Additional information regarding the HCAO is available on the web at www.sfgov.org/olse/hcao.

E. First Source Hiring Program (FSHP)If the contract is for more than $50,000, then the First Source Hiring Program (Admin. Code Chapter 83) may apply. Generally, this ordinance requires contractors to notify the First Source Hiring Program of available entry-level jobs and provide the Workforce Development System with the first opportunity to refer qualified individuals for employment.Contractors should consult the San Francisco Administrative Code to determine their compliance obligations under this chapter. Additional information regarding the FSHP is available on the web at http://www.workforcedevelopmentsf.org/ and from the First Source Hiring Administrator, (415) 401-4960.

F. Conflicts of InterestThe successful proposer will be required to agree to comply fully with and be bound by the applicable provisions of state and local laws related to conflicts of interest, including Section 15.103 of the City's Charter, Article III, Chapter 2 of City’s Campaign and Governmental Conduct Code, and Section 87100 et seq. and Section 1090 et seq. of the Government Code of the State of California. The successful proposer will be required to acknowledge that it is familiar with these laws; certify that it does not know of any facts that constitute a violation of said provisions; and agree to immediately notify the City if it becomes aware of any such fact during the term of the Agreement.

Individuals who will perform work for the City on behalf of the successful proposer might be deemed consultants under state and local conflict of interest laws. If so, such individuals will be required to submit a Statement of Economic Interests, California Fair Political Practices Commission Form 700, to the City within ten calendar days of the City notifying the successful proposer that the City has selected the proposer.

VIII. Protest Procedures

A. Protest of Non-Responsiveness DeterminationWithin five working days of the City's issuance of a notice of non-responsiveness, any firm that has submitted a proposal and believes that the City has incorrectly determined that its proposal is non-responsive may submit a written notice of protest. Such notice of protest must be received by the City on or before the fifth working day following the City's issuance of the notice of non-responsiveness. The notice of protest must include a written statement specifying in detail each and every one of the grounds asserted for the protest. The protest must be signed by an individual authorized to represent the proposer, and must cite the law, rule, local ordinance, procedure or RFP provision on which the protest is based. In addition, the protestor must specify facts and evidence sufficient for the City to determine the validity of the protest.

B. Protest of Contract AwardWithin ten calendar days of the City's issuance of a notice of intent to award the contract, any firm that has submitted a responsive proposal and believes that the City has incorrectly selected another

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http://www.sfgov.org/olse/hcao


proposer for award may submit a written notice of protest. Such notice of protest must be received by the City on or before the tenth calendar day after the City's issuance of the notice of intent to award.

The notice of protest must include a written statement specifying in detail each and every one of the grounds asserted for the protest. The protest must be signed by an individual authorized to represent the proposer, and must cite the law, rule, local ordinance, procedure or RFP provision on which the protest is based. In addition, the protestor must specify facts and evidence sufficient for the City to determine the validity of the protest.

C. Delivery of ProtestsAll protests must be received by the due date. If a protest is mailed, the protestor bears the risk of non-delivery within the deadlines specified herein. Protests should be transmitted by a means that will objectively establish the date the City received the protest. Protests or notice of protests made orally (e.g., by telephone) will not be considered. Protests must be delivered to:

Executive DirectorHuman Services AgencyP.O. Box 7988San Francisco, CA 94120

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IX. Standard Forms

Before the City can award any contract to a contractor, that contractor must file three standard City forms (items 1-3 on the chart). Because many contractors have already completed these forms, and because some informational forms are rarely revised, the City has not included them in the RFP package. Instead, this Appendix describes the forms, where to find them on the Internet (see bottom of page 2), and where to file them. If a contractor cannot get the documents off the Internet, the contractor should call (415) 554-6248 or e-mail Purchasing ([email protected]) and Purchasing will fax, mail or e-mail them to the contractor.

If a contractor has already filled out items 1-3 (see note under item 3) on the chart, the contractor should not do so again unless the contractor’s answers have changed. To find out whether these forms have been submitted, the contractor should call Vendor File Support in the Controller’s Office at (415) 554-6702.

If a contractor would like to apply to be certified as a local business enterprise, it must submit item 4. To find out about item 4 and certification, the contractor should call Contract Monitoring Division at (415) 252-2500.

Item Form name and Internet location

Form Description Return the form to;For more info

1. Request for Taxpayer Identification Number and Certification

http://sfgsa.org/index.aspx?page=4762

www.irs.gov/pub/irs-fill/fw9.pdf

W-9 The City needs the contractor’s taxpayer ID number on this form. If a contractor has already done business with the City, this form is not necessary because the City already has the number.

Controller’s OfficeVendor File SupportCity Hall, Room 484San Francisco, CA 94102

(415) 554-6702

2. Business Tax Declaration


P-25 All contractors must sign this form to determine if they must register with the Tax Collector, even if not located in San Francisco. All businesses that qualify as “conducting business in San Francisco” must register with the Tax Collector

Controller’s OfficeVendor File SupportCity Hall, Room 484San Francisco, CA 94102

(415) 554-6702

3. S.F. Administrative Code Chapters 12B & 12C Declaration: Nondiscrimination in Contracts and Benefits


In Vendor Profile Application

CMD-12B-101

Contractors tell the City if their personnel policies meet the City’s requirements for nondiscrimination against protected classes of people, and in the provision of benefits between employees with spouses and employees with domestic partners. Form submission is not complete if it does not include the additional documentation asked for on the

Human Rights Comm.25 Van Ness, #800San Francisco, CA 94102-6059(415) 252-2500

P-590 (1-15) B-1 December 2016


Item Form name and Internet location

Form Description Return the form to;For more info

form. Other forms may be required, depending on the answers on this form. Contract-by-Contract Compliance status vendors must fill out an additional form for each contract.

4. CMD LBE Certification Application

http://www.sfgsa.org/index.aspx?page=6058

In Vendor Profile Application

Local businesses complete this form to be certified by CMD as LBEs. Certified LBEs receive a rating bonus pursuant to Chapter 14B when bidding on City contracts if applicable. To receive the bid discount, you must be certified by CMD by the proposal due date.

Contract Monitoring Unit30 Van Ness Avenue, Suite 200 San Francisco, CA 94102 Phone: (415) 581-2310

Where the forms are on the Internet

Office of Contract Administration

Homepage: www.sfgov.org/oca/Purchasing forms: Click on “Required Vendor Forms” under the “Information for

Vendors and Contractors” banner.

Contract Monitoring Division

CMD’s homepage: http://sfgsa.org/index.aspx?page=5365 Equal Benefits forms: http://sfgsa.org/index.aspx?page=5359LBE certification form: http://sfgsa.org/index.aspx?page=5364#Section%20V

P-590 (1-15) B-2 December 2016

http://sfgsa.org/index.aspx?page=5364#Section%20V




X. San Francisco Human Services Agency RFP Letter of Intent

NAME OF ORGANIZATION(S): __________________________________________

ADDRESS: __________________________________________

DIRECTOR: __________________________________________

PHONE/FAX#: __________________________________________

EMAIL: ___________________________________________

FEDERAL EMPLOYER #: __________________________________________

PROGRAM TYPE REQUESTED: [ ] ENP Congregate Meals[ ] ENP CHAMPSS[ ] AWD Congregate Meals[ ] ENP Home-Delivered Meals[ ] AWD Home-Delivered Meals[ ] Emergency Home-Delivered Meals[ ] Home-Delivered Groceries

FUNDING CATEGORIES REQUESTED (fill in all fields applicable to the program type)

Row Cuisine Type Supervisor District # Annual Amount1

23456789101112131415

P-590 (1-15) B-3 December 2016


I understand that the San Francisco Human Services Agency (SFHSA) reserves the right to modify the specifics of this application at the time of funding and/or during the contract negotiation; that a contract may be negotiated for a portion of the amount requested; and that there is no contract until a written contract has been signed by both parties and approved by all applicable City Agencies. Submission of a proposal signifies that the proposed services and prices are valid for 120 calendar days from the proposal due date and that the quoted prices are genuine and not the result of collusion or any other anti-competitive activity

Signature of authorized representative(s):

Name: ________________________ Title:__________________________

Signature:________________________ Date:__________________________

Name: ________________________ Title:__________________________

Signature:________________________ Date:__________________________

Submit an electronic and four (4) copies to:San Francisco Human Services AgencyOffice of Contract Management, Worker #GB23c/o Justin Chan1650 Mission Street, Suite 300San Francisco, CA [email protected]

P-590 (1-15) B-4 December 2016


XI. San Francisco Human Services Agency Page Number Form

This form is to assist the review panel in finding the information in the Proposal that corresponds to the evaluation criteria. For each item listed below, please list the page number(s) where the reviewer may find the answer(s) to the criteria.

Evaluation and Selection Criteria Page Number(s)

Minimum Qualifications

Respondent must possess a minimum of 3 years of experience providing nutrition services to a low-income population.

Respondent must possess a minimum of 3 years of experience serving the senior and/or adults with disabilities populations.

Respondent’s facility must have received a passing health score from the locally presiding Public Health Department within the last two years.

Respondent must be a certified vendor with the City and County of San Francisco or declare their ability to become a certified vendor (instructions on Section IX) following notice of intent to award.

Respondent must declare their ability to comply with the City contracting requirements set forth in Section VII of this RFP.

Organization Capacity (30 points)

1. Respondent has a well-established history of serving residents of San Francisco, including older adults & adults with disabilities. Respondent’s mission, purpose, and goals are aligned with the priorities set forth in this RFP. (3 points)

2. Respondent demonstrates prior experience delivering the service proposed. Respondent shows successful implementation of the service sought in this RFP or a comparable program. (8 points)

3. Respondent has a clear understanding of the targeted populations or communities identified in the RFP. Respondent demonstrates experience reaching and serving the targeted populations and/or targeted area described in the RFP. The outreach plan is viable, timely, appropriate, and can be realistically implemented. (4 points)

4. Respondent provides culturally and linguistically competent services to a diverse population. (2 points)

5. Respondent demonstrates its capacity to serve consumers with disabilities including physical, sensory, and mental disabilities. Respondent satisfactorily completes the Disability Checklist. (2 points)

6. Respondent lists relevant partnerships; include length of time relationship has existed and the type of services provided. (2 points)

7. Describes respondent’s systematic approach to effectively connect consumers to needed services through referrals or other internal means. (2 points)

8. Respondent has evidence/history of capacity to successfully execute contracts and fulfill contracting obligations based on performance as a contractor with other funding organizations. (2 points)

9. Respondent demonstrates physical capacity to provide the proposed services. Respondent demonstrates access to kitchen and/or meal transport equipment that is in suitable condition. (5 points)

P-590 (1-15) B-5 December 2016


Service Design and Program Approach (40 points)

1. Respondent provided complete and concise response to the questions. Respondent is proposing to implement an approach, intervention, or best practice that has proven successful. For promising innovative proposals, respondent indicates how success will be measured. (10 points)

2. Respondent sufficiently describes its specific program approach to deliver the services proposed and how this approach will appropriately address the needs and barriers of the target population. Respondent indicate how the congregate and HDM nutrition compliance requirements will be provided. Sample menu is completed. (5 points)

3. The Site Chart is completed accurately. The proposed units are realistic. Where applicable, there are signed or draft agreements with partners. (5 points)

4. Staff and volunteer positions, duties, and hours are appropriate and adequate to deliver, manage, and administer the nutrition program. (5 points)

5. Copy of organization chart provided. Program staff and volunteers are clearly identified on the organizational chart. Copy of key staff job description provided & resumes provided. (3 points)

6. In-service schedule provided and includes relevant training topics to meet OOA program standards. (2 points)

7. Respondent’s description of data management process and procedures are clear and complete. Respondent effectively explains how the contractual obligations will be monitored. (5 points)

8. Respondent has a clear plan for monitoring & evaluating the program that demonstrates clear methodology to measure both output and outcome of the service. If applicable, respondent describes their protocol & systems to comply with food safety. Respondent provides a description of their quality control system. Methods to evaluate the program compliance in all applicable areas are clear and reasonable. Respondent demonstrates understanding of the program outcome measures and provides a viable plan to successfully meet those outcome measures. Respondent explains the proposed model for consumers to offer input regarding program operations. (5 points)

Fiscal Capacity (30 points)

1. Respondent’s accounting system is sound and clearly describes their financial systems as requested. (5 points):

2. Budget is reasonable and reflects sound, adequate allocation of resources. Respondent has a clear plan to cover all costs of the program, including nutrition compliance requirements. (6 points)

3. The budget narrative is clear & provides pertinent information for understanding the proposed costs/budget. (5 points)

4. Meal rate is competitive with other proposals bidding for the same service area/s. (10 points)

5. Budget meets or exceeds matching requirements. Respondent’s description of its fundraising plan is clear and specific. It includes description of its source(s) of cash match and in-kind support is clear and specific. (4 points)

P-590 (1-15) B-6 December 2016


XII. San Francisco Human Services Agency Budget Forms and Instructions

Budgets should be submitted in the standard HSA format. Forms are available at:


Click on the “Consultants and Professional Services” link, and then the link for this RFP to find the forms.

The following spreadsheets are in Excel. There are 4 pages in the budget (in addition to the budget justification), as follows: Contract Budget Summary, Salaries and Benefits Detail, Operating Expense Detail, Capital Expenditure Detail.

Please note the Salaries and Benefits, Operating Expense and Capital Expenditure are direct costs and must be clearly and easily attributable to a specific program.

The Budget Justification is a narrative which provides the detailed information and calculations supporting the amount allocated for each budget line item. Please detail all mathematical computations for each line item. Show how the total dollar amount was derived, e.g., the annual salary for each position multiplied by the FTE, the number of square feet of office space to be utilized multiplied by the rate per square foot, the cost per month for insurance multiplied by the number of months in the contract term, etc. For the Salaries and Benefits section, list the position, a brief sentence of the position's responsibilities, the full-time equivalent (FTE), the percentage of FTE allocated to the activity, the salary per month, the salary per annum, and the mathematical computation used to arrive at the total dollar amount.

The Cost Allocation Plan is required. Respondents must follow the City’s cost allocation guidelines for nonprofit contractors, which largely follow those described by Generally Accepted Accounting Principles (GAAP) and in Federal OMB Circular A-122. The plan should include how indirect costs were calculated. No contract funds should be used for anyone that is lobbying.

If applicable, attach a separate detailed Subcontracting budget using the standard HSA format if there is a Subcontractor arrangement made under the terms of the contract. Provide a brief explanation of the subcontracting arrangement, as well as a budget breakdown. Please note, the total subcontractor budget amount should appear on the Operating Expense Detail sheet under the Subcontractor section.

Indirect rates are not allowable on subcontractor indirect expenditures, capital expenditures, aid payments, other direct voucher payments, or any stipend, subsidy or expense paid on behalf of a client (i.e, security deposit, rental payment assistance, transportation vouchers, etc.). These examples are not intended to be a comprehensive list. If an organization is uncertain whether indirect costs can be applied to a particular expense, it should consult with the HSA Contract Manager.

These guidelines provide general information. If further clarification or technical assistance is required, consult your HSA Office of Contract Management Contract Manager.

P-590 (1-15) B-7 December 2016



XIII.Needs Assessment – Nutrition ServicesDecember 2016

Over the last ten years, the percentage of the senior population age 60 and older that faces the threat of hunger has increased by 45% (Ziliak & Gunderson, 2015). An estimated 15.5% of seniors nationwide face the threat of hunger. In California, the percent of older adults facing the threat of hunger is slightly higher: 16.33%. California has the eleventh highest rate of senior food insecurity in the nation (United Health Foundation, 2015). Approximately 34% of households with an adult whose disability prevents labor force participation are food insecure (RTI, 2014).

Food insecurity is linked to poor health status (Stuff et al, 2004) and malnutrition (Lee & Frungilo, 2001). Malnutrition can lead to loss of weight and strength, greater susceptibility to disease, confusion, and disorientation (National Resource Center on Nutrition, Physical Activity, and Aging, 2015). Several of the most common diseases that affect older persons, including cardiovascular disease, diabetes, osteoporosis, and cancer, are all affected by diet (World Health Organization, 2015). A recent study found that over half of senior patients visiting the emergency room were malnourished or at risk of malnourishment (Pereira et al, 2015). Malnutrition is also associated with increased length of stay, discharge to higher level of residential care, and mortality risk in senior surgical patients (Charlton et al, 2012).

Income is a significant factor in food insecurity. In San Francisco, the cost of food is estimated to be 23% higher than the national average (Wallace, 2015). Individuals with limited financial resources may have to choose between paying for food and other necessities, such as rent and medication (Maher & Eliade, 2015). Low-income neighborhoods tend to lack full-service grocery stores, leaving residents to shop at small corner stores where fresh produce and healthy items are often limited and more expensive than less healthy alternatives (Beaulac et al, 2009). Due to their very low income level and ineligibility for CalFresh, California residents on Supplemental Security Income (SSI) are especially likely to benefit from alternate nutrition programs. In San Francisco, 17,046 adults between age 18 and 64, and 27,084 seniors age 65 and older receive SSI. Notably, San Francisco SSI recipients are much more likely to be seniors than elsewhere in the state; 60% compared to 43% statewide. However, it is also important to note that many individuals with income above the SSI and poverty line also face food insecurity and the threat of malnutrition. Approximately 30% of seniors with income between 100% and 200% of the federal poverty line are food insecure (Ziliak & Gunderson, 2015). A variety of medical, physical, and social factors also contribute to food insecurity and malnutrition. Disease can cause a decrease in appetite or poor absorption of nutrients. Dental issues may inhibit ability to eat, and aging is also associated with a loss of taste and smell, which can reduce enjoyment and interest in eating (Donini, Salvina & Canella, 2003). Individuals with functional impairment may be unable to shop for groceries or prepare meals. Seniors experiencing depression, anxiety, and dementia are also at risk for malnutrition. Lifestyle and social factors, including isolation/loneliness and knowledge of how to prepare nutritious meals, can also have a significant impact on nutrition status (Hickson, 2006). Research indicates that households that have low income, are minority, are socially isolated, or have physical or mental impairments are at increased risk for food insecurity and hunger (Hall & Brown, 2005).

P-590 (1-15) B-8 December 2016


Needs Assessment Recommendations

The needs assessment for this Request for Proposals solicitation has identified the recommendations listed below to better meet the needs of seniors and adults with disabilities (AWD) in need of nutrition support. Recommendations with funding implications specify the amount of newly available funding.

Congregate Meals for Seniors Expand service in District 3, including both generic American and Chinese cuisine.

Contracted service levels in District 3 are low compared to the distribution of the city’s low-income population. New funding: $52,240 each for American and Chinese cuisine.

Expand service in District 11, including both generic American and Chinese cuisine. Contracted service levels are low compared to the distribution of the city’s low-income population. New funding: $78,315 to begin providing Chinese cuisine and $24,420 to expand generic American-style cuisine.

Consider outreach strategies to increase participation from low-income white seniors who are 41% of low-income seniors living alone but only 12% of clients. New funding: Not applicable.

Congregate Meals for Adults with Disabilities Develop service in southwestern part of the city. There are currently no AWD congregate

meals funded in Districts 4, 7 or 11. While most of the AWD population lives closer to downtown, the 14% of adults with disabilities who live in the southwestern quadrant of the city are at risk of geographic isolation and may be unable to access existing service. DAAS should fund at least one site in this area – either a traditional site or offshoot of the restaurant-based CHAMPSS model. New funding: $67,120

Expand service in District 6 (and also develop better understanding of potential unmet need). DAAS should add meals in this area to better mirror need. Because funding for this program is limited and many non-DAAS affiliated agencies also provide nutrition services in this area, DAAS should develop a more comprehensive understanding of all nutrition services in the area to identify service gaps it is best suited to address before any major redirection of existing funding to this district. New funding for American cuisine: $72,509

Develop a site focused on serving adults with disabilities. In order to better serve younger adults with disabilities, DAAS should develop a site specifically for this population that is paired with appropriate and engaging activities. DAAS should carve out nutrition funding for this venture to be paired with community services funding in a separate solicitation. Note: $50,000 of nutrition funding will be integrated into a solicitation for a community hub for adults with disabilities (service to begin FY 17/18)

Establish a minimum funding level per site. DAAS currently funds a handful of sites that provide very minimal service for adults with disabilities. This approach restricts outreach,

P-590 (1-15) B-9 December 2016


risks having to turn clients away, and is administratively costly. Setting a minimum funding level per site will support more consistency and better serve the population. New funding: $15,815 across Districts 1, 5, 6, and 10.

Home-Delivered Meals for Seniors Increase funding to address waitlist. Senior HDM clients tend to stay enrolled, limiting the

availability of space for new clients. Despite significantly growth in the program budget and additional spaces for new clients, there continues to be a waitlist for HDM service. Any expansion should also prioritize providers able to serve large portions of the city – if not citywide – to maintain program flexibility. New funding available: $201,987 has been added to expand HDM service. This has been allocated based on expressed client preference and historic enrollment trends:

o American cuisine: $156,987o Chinese cuisine: $20,000o Japanese cuisine: $10,000o Latino cuisine: $5,000o Kosher cuisine: $5,000o Russian cuisine: $5,000

Work with community partners for targeted outreach to the Asian Pacific Islander (API) community in District 3. This population appears to be underrepresented among those currently enrolled. New funding: Not applicable.

Home-Delivered Meals for Adults with Disabilities Allocate funding for ethnic cuisine to provide culturally appropriate cuisine options.

Currently all meals are generic American cuisine but almost half of those most likely to need HDM are API and Latino. New funding: $50,000 for Latino cuisine and $50,000 for Chinese cuisine.

P-590 (1-15) B-10 December 2016


Seniors and Adults with Disabilities in San Francisco

Per the Administration on Aging, services should target those in greatest social and economic need, including low-income individuals, minority individuals, and those at risk of institutional care. This section provides a brief overview of these subpopulations of seniors and adults with disabilities (AWDs). The subsequent sections compare these profiles to FY 15/16 service to help identify areas with unmet need. The information in this section is intended to help community partners understand the client populations throughout the city and develop appropriately-targeted outreach strategies and service models. A map of supervisorial districts is available at the end of this assessment.

A brief methodology note: The Older Americans Act identifies age 60 as the age threshold for a senior. Wherever possible, this threshold is used for this analysis. However, census data that allows for analysis by location is primarily available at the age 65 threshold. Accordingly, two types of census data and two age thresholds were used for this needs assessment

Senior Population OverviewAs shown below, seniors are distributed relatively evenly throughout the city with District 3 (Chinatown, North Beach, Nob Hill) home to the largest contingent: 13,621 or 12% of city seniors. One in four seniors in this district has income below the federal poverty threshold – a measure of destitution in a city with a high cost of living like San Francisco. District 6 (Tenderloin, South of Market) has a smaller senior population but the second largest population of those in poverty – followed closely by District 5 (Western Addition, Haight).

P-590 (1-15) B-11 December 2016


Overall, 16,335 San Francisco seniors (16%) age 60 and older have income below the federal poverty threshold – annual income of $11,367 for a single senior. However, given the high cost of living in San Francisco, a more accurate estimate of persons with inadequate income to meet their needs includes those with income up to 200% of the poverty threshold. There are a total of 42,038 seniors aged 65 and older with income below this level. As shown to the right, seniors with income below 200% of the poverty threshold are most commonly API – 49% or 28,123 individuals. Whites are slightly underrepresented among those in poverty; they are 40% of the overall senior population and 30% of those with low-income.

The chart below provides the ethnicity of the senior population living in poverty below the federal poverty threshold by supervisorial district.1 The ethnic profile of those in poverty varies by district. For example, 81% of impoverished seniors living in District 3 are API. In District 9 (Mission, Bernal Heights), 42% of seniors in poverty are Latino.

1 Unfortunately, this data is not available at the 200% poverty threshold level.

P-590 (1-15) B-12 December 2016


Adults with Disabilities Population Overview

Unfortunately, census data by location for adults with disabilities is limited. This section draws on other formats of census data to provide a portrait of this population. The charts based on adults with disabilities age 18 to 64 represent 41,009 individuals.

There are 34,266 adults reporting disabilities in the census. As shown to the right, most of this population is low-income. Almost one in three – 10,557 people – are living in poverty below the federal poverty threshold. In a city like San Francisco with a soaring cost of living, including persons with income below 200% of this threshold provides a more accurate estimate of those likely struggling to make ends meet. There are an additional 7,110 individuals (21% of adults with disabilities) who have income in this range.

As shown below, adults with disabilities (AWDs) are concentrated in District 6 (Tenderloin, SOMA). Approximately 17% live in this area. District 5, District 10 (Bayview-Hunters Point, Visitacion Valley), and District 11 (Excelsior, OMI) also have larger AWD populations.

Low-income AWDs are most likely to live in District 6, which may be due to the availability of (historically) less expensive Single Room Occupancy (SRO) hotels. Approximately 54% of the AWDs living in District 6 have income below the poverty threshold. This population also tends to live in District 5, District 9 (Mission, Bernal Heights), and District 10.

P-590 (1-15) B-13 January 2017


The chart below provides the ethnicity of adults reporting disabilities by supervisorial district – this profile should inform outreach and targeting strategies for engaging this population in services.2 For example, in District 6, which has the largest AWD population and most in poverty, adults reporting disabilities are predominantly white (43%) and Latino (22%). In District 10, adults reporting disabilities tend to be African-American.

Though the chart above is not limited to persons with low income, the high rates of poverty in the population suggest the overall population demographics are likely similar to those in poverty. The below comparison confirms this. African-American adults reporting disabilities are overrepresented in the low-income population, while white and API are slightly underrepresented – but the general trends hold, suggesting that the above chart by supervisorial district can provide useful insight.

Congregate Meals

2 Notably, API adults appear to be underrepresented in the AWD population. Approximately 31% of San Francisco adults age 18 to 59 are API. However, only 18% of self-reported AWDs are API. While it may be the case that there is a lower prevalence of disability in this community, it may also be a result of cultural variation in how disability and the census questions are perceived.

P-590 (1-15) B-14 January 2017


Congregate meals provide nutrition services in communal settings at various community-based sites. In addition to the nutrition component, these programs offer seniors and adults with disabilities valuable opportunities for social engagement with peers and connection to additional resources that are often offered on-site (e.g., community service activities and social work staff).

Results from the 2013 National Survey of Older Americans Act Participants highlight the benefits of congregate meals. The positive impact of congregate meal programs is especially evident among low-income respondents and those living alone.

National Survey of Older Americans Act Participants (2013)

As a result of congregate meal program, respondents agree that…

All Respondents

Income Below

$20,000

Live Alone

Recipient eats healthier meals 75% 80% 76%Meal programs improve recipient's health 79% 82% 82%Recipient feels better 82% 90% 85%Recipient sees friends more 83% 84% 83%Recipient has increased social opportunities 56% 60% 62%Meals help recipients stay in own home 68% 78% 73%Meals represent at least half or more of recipient's total daily food 56% 68% 60%

Source: National OAA Participants Survey 2013. Accessed via AGID database (http://www.agid.acl.gov) on September 8, 2015.

In San Francisco, DAAS-funded congregate meals are provided in a variety of settings. Most commonly, the service is provided at community service sites or “senior centers.” This pairing of these services appears to support socialization beyond the meal experience; approximately 40% of congregate meal clients are also enrolled in at least one other on-site service (e.g., community services, SF Connected). DAAS also funds congregate meals as a standalone service at sites that serve the targeted populations, such as senior public housing developments. More recently, DAAS has expanded its congregate meals program through the Choosing Healthy Appetizing Meal Plan Solutions for Seniors (CHAMPSS) model, in which seniors can receive congregate meals from select restaurants. This model has primarily been used to expand service in areas of the city with few options for a traditional congregate meal site.

In FY 15/16, DAAS significantly expanded congregate meal service for seniors by funding: 893,000 congregate meals for up to 17,738 seniors at 51 sites throughout the city 49,452 congregate meals for up to 886 AWDs at 29 sites throughout the city

P-590 (1-15) B-15 January 2017


Congregate Meals for Seniors

Recommendations Expand Chinese and American-style meals in Districts 3 and 11. Consider expanding outreach to low-income white seniors.

Approximately 56,800 San Francisco residents are age 60 or older and have income below 200% of the federal poverty threshold (which equates to $22,734 annual income for a single senior). With 15,073 seniors served3 in FY 15/16, this leaves a difference of 42,000 individuals who may benefit from the service. The California Health Information Survey4 indicates 32% of San Francisco seniors below 200% poverty are food insecure (unable to afford enough food). This equates to 18,176 seniors – suggesting at least 3,023 individuals with unmet need.

Review: Location of Low-Income Seniors and Congregate Meal ServiceThe chart below compares the location of the low-income senior population with FY 15/16 contracted service levels to assess the accuracy of current targeting – the allocation of funding should mirror the distribution of the city’s low-income senior population. For the most part, current contract levels are relatively proportional. For example, District 1 has nine percent of low-income seniors and eight percent of OOA-funded meals.

In some districts, contracted service levels are higher than the low-income senior population in that area. These scenarios reflect nuance in the local population that are not captured by the poverty measure.5

Most importantly for DAAS, this comparison highlights the need for expanded service in 3Because congregate meal clients may enroll at multiple sites, the actual unduplicated client count served is typically lower than the sum of contracted service levels across all agencies and sites.4 UCLA Center for Health Policy Research. AskCHIS 2013-2014. Food security (ability to afford enough food) (San Francisco). Available at http://ask.chis.ucla.edu. Exported on November 13, 2016.

P-590 (1-15) B-16 January 2017

http://ask.chis.ucla.edu/


Districts 3 and 11 to appropriately reflect the distribution of the low-income senior population. Approximately 18% of the low income senior population lives in District 3 (Chinatown, Nob Hill). However, this district accounts for only 9% of contracted client enrollments and 13% of congregate meals. This is especially incongruous given that this district also has a disproportionately high share of households receiving Supplemental Security Income benefits and lacking cooking facilities. Similarly, District 11 (Excelsior, OMI) is home to 10% of low-income seniors but accounts for only 3% of anticipated enrollments and two percent of total meals. Current enrollment trends should inform expansion strategies to reach those most in need – please see information below.

District 3 – There were 1,298 seniors living in District 3 who were served congregate meals in FY 15/16. As shown below, the ethnic profile of these clients aligns with the low-income senior population in this area.

Almost all of the District 3 clients served at sites within the district were Asian-Pacific Islander (API). This trend likely reflects that 75% of meals were Chinese cuisine served at sites well-established within the API community where the majority of clients (75%) speak a primary language other than English.

White and African-American seniors living in District 3 were primarily visited sites serving generic American cuisine in Districts 2 and 6; some also went to District 5 for American-Southern meals. Latino seniors primarily went to Districts 8 and 9 for service at sites strongly rooted within the Latino community. These patterns underscore the importance of both cuisine and socialization/community for seniors in selecting a meal site. In expanding service in District 3, DAAS should fund both Chinese and generic American cuisine.

District 11 – In District 11, there were 1,160 seniors served congregate meals. Most – 75% – were served outside of the district. Aware of the need in this area, DAAS used FY 16/17 addback funding to add 8,010 meals in the district in the current year; while helpful, additional expansion is needed to better address need in this district.

As shown to the right, most District 11 residents enrolled in congregate meals

5 For example, District 6 is home to 14% of low-income seniors but offers 28% of funded meals. This district is home to 21% of the city’s households that are dependent on Supplemental Security Income and thus ineligible for nutrition support through CalFresh. Additionally, with many of the city’s Single Room Occupancy hotels in this district, District 6 households are more likely to lack adequate kitchen facilities to prepare meals (16% compared to 5% citywide). In District 8, a long-time congregate meal site located near the District 9 boundary focused primarily on serving the Latino senior population draws many clients from the Mission neighborhood – which also accounts for the slightly low contract levels in District 9.

P-590 (1-15) B-17 January 2017


were API. Approximately 35% of these API clients were served at the CHAMPSS sites in Districts 4 and 7, and 21% traveled to sites in Chinatown. These patterns suggest a desire for ethnic cuisine; currently, all congregate meals in District 11 are generic American cuisine. DAAS should add funding specifically for Chinese cuisine in this district – particularly given that District 11 seniors living in poverty are most commonly API (43%).

Latino and African-American seniors enrolled in congregate meals typically traveled to sites with strong connection to the ethnic communities. Latino seniors typically visited sites in neighboring Districts 8 and 9, while African-American seniors went to Districts 5 and 10. White and African-American seniors are underrepresented in served clients compared to the census records – both are 12% of seniors in poverty in District 11 but whites are only 3% and African-Americans only 5% of enrolled clients. DAAS should consider developing an outreach strategy with the local Aging and Disability Resource Center to publicize the local sites and potentially supplement funding for generic American cuisine to expand local opportunities for these clients.

Review: Ethnicity of Low-Income Seniors and Congregate Meal ClientsLooking more broadly at the entire program, the chart below compares the ethnicity of the FY 15/16 senior congregate meal clients with the low-income senior population (including those living alone). Most notably, white seniors are underrepresented in the enrolled clients: they are 41% of low-income seniors but only 12% of congregate meal clients. Many factors may contribute to this trend, such as differing cultural attitudes towards communal dining, level of awareness or program penetration within a community, and profile of the existing community at a particular site. Given that most of the congregate meals funded by DAAS are American-style cuisine suggests that simply adding more of these meals will not be enough. To increase enrollment of this group may require specific targeting or outreach.

P-590 (1-15) B-18 January 2017


Innovative Models for Congregate Meal ServiceDAAS is interested in developing new alternative models for congregate meal service, motivated in interest is motivated in part by the aging of the Baby Boomer generation. As the senior population grows, existing meal sites are at risk of reaching capacity and being unable to meet the demand, even with increased funding from DAAS. New retail space is increasingly expensive, making it challenging to establish new sites. Additionally, younger and more active seniors may prefer different models for service. DAAS encourages its community partners to explore innovative models that support nutritious meals at a reasonable cost point.

Most recently, DAAS has supported development of the Choosing Healthy Appetizing Meal Plan Solutions for Seniors or “CHAMPSS.” In this model, clients receive meals in a local restaurant using a prepaid meal card. CHAMPSS provides more flexibility and choice – clients can visit any time during the restaurants operating hours and select a meal from a dietitian-approved list. This model relies on a community-based organization to: identify an appropriate and interested restaurant that serves nutritious meals within a reasonable price range; manage client enrollment and the prepaid meal card system; and provide outreach, information, and referral services for clients since this model is not tied to a community service site like the typical traditional congregate meal site.

The initiative for this model was to expand service in parts of the city with limited space for traditional congregate meal sites. The two current sites are in Districts 4 and 7, which are primarily residential neighborhoods (e.g., Sunset, West of Twin Peaks). The chart below highlights how this model has allowed DAAS to increase service in these districts. The CHAMPSS model is also believed to appeal more to younger seniors who place strong value in choice and flexibility.

As noted earlier, DAAS is currently expanding District 11 service in FY 16/17. This will be accomplished by developing a new CHAMPSS site that will add 8,010 meals. As shown above, this growth has helped but further expansion is needed to address the need in this district.

P-590 (1-15) B-19 January 2017


Anticipated Service Levels Senior meal sites typically meet or even exceed contracted service levels (by leveraging outside funds), indicating there is a demand for the current level of service as allocated. DAAS wishes to avoid any significant disruption of service for those currently relying on congregate meals. The table below provides a sense of the baseline service levels DAAS expects to provide in each district through the current Request for Proposals solicitation.

Senior Congregate Meal ProgramBaseline Service Levels

Meal Site District Meal Cuisine #

Sites#

Meals#

ClientsD1 Lunch American 1 12,852 224

Chinese 1 23,709 360Russian 1 32,003 450

D2 Lunch American 3 29,534 430Kosher 1 18,215 850

D3^ Lunch American 2 29,192 323Breakfast American 1 3,000 35

Lunch Chinese 3 87,116 1,200D4 Lunch Chinese 1 23,042 380

CHAMPSS* Chinese & American 1 25,000 1,300D5 Lunch American 1 7,260 100

American-Southern 2 52,731 1,290Japanese 3 68,960 1,255

D6 Lunch American 6 193,997 2,916American-Latino 1 11,422 180

Chinese 3 35,951 720Breakfast American 1 6,000 100

D7 Lunch American 1 6,534 200Chinese 1 12,299 250

CHAMPSS* Chinese & American 1 32,000 1,800D8 Lunch American 4 76,711 2,126D9 Lunch American 1 7,126 250

American-Latino 2 36,422 949D10 Lunch American 2 20,180 240

American-Southern 2 15,103 535Chinese 1 11,295 300

Samoan-Hawaiian 1 4,218 35D11^ Lunch American 3 19,862 540

CHAMPSS* TBD 1 8,010 600Total 49 893,079 17,838

*CHAMPSS = Lunch or Dinner. ^ Additional funding has been made available for service expansion

P-590 (1-15) B-20 January 2017


Congregate Meals for Adults with Disabilities

Recommendations Develop service in southwestern part of the city. Expand service in District 6. Designate funding for a AWD community hub to be issued in a separate

solicitation paired with community activities. Establish minimum funding per site.

There are 17,667 adults aged 18 to 59 who report disabilities in the census and have income below 200% of the poverty threshold. According to the California Health Information Survey,6 67% of adults with disabilities at this income level are food insecure, which equates to 11,837 people. Current funding for congregate meals for adults with disabilities allowed meal providers to serve 598 clients last year.7 This service is entirely locally funded. Its existence reflects the city’s desire to support population not served by the Older Americans Act; few other Area Agencies on Aging in California provide this program.

Review: Ethnicity of Low-Income Adults with Disabilities and Congregate Meal ClientsThe chart below identifies the distribution of the lowest-income adults with disabilities (AWD) and contracted service levels for FY 15/16. In some districts, contracted service levels exceed the proportion of the AWD population. This is more a reflection of limited service rather than inappropriate targeting; a single site can heavily impact the distribution of service. For example, almost 30% of total AWD meals are funded in District 3 although this area has 10% of adults with disabilities living in poverty; this is driven by service at a supportive veterans housing site.

There is currently no AWD service in the southwest quadrant of the city in Districts 4 (Sunset), 7 (Sunset, Lake Merced), and 11 (Excelsior, OMI). While the standalone percentage of

6 UCLA Center for Health Policy Research. AskCHIS 2011-2014. Food security (ability to afford enough food) (San Francisco). Available at http://ask.chis.ucla.edu. Exported on November 13, 2016.7 Because congregate meal clients may enroll at multiple sites, the actual unduplicated client count served is typically lower than the sum of contracted service levels across agencies/sites.

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http://ask.chis.ucla.edu/


the AWD population in each of these districts is relatively low, a total of 14% of the AWD population lives in this part of the city and must travel a significant distance to receive meals. DAAS should dedicate funding for AWD congregate meal service in this area, perhaps by expanding the CHAMPSS program highlighted in the prior section of this assessment since there is limited space for traditional congregate meal sites in this part of the city.

The charts below provide the ethnic profiles of adults with disabilities in these districts. This information may be useful in developing local service and outreaching to these potential clients.

District 6 (Tenderloin, SOMA) also stands out as an area with potentially low service when comparing distribution of meals and the low-income population – particularly given that households in District 6 are more likely to receive Supplemental Security Income (and thus be ineligible for CalFresh) and less likely to have adequate cooking facilities. While it is known there are nutrition services funded outside of DAAS in this district, further research and service mapping should be conducted by DAAS to better understand the true unmet need in this area and identify specific gaps it is best suited to fill – particularly given that the program has relatively limited funding and there are parts of the city currently without any service. In the meantime, a moderate expansion of service would be appropriate.

More broadly, this new contract cycle offers a valuable opportunity to reflect on this program and consider strategies that may better address population needs, including increasing funding and also developing alternate service models that may be more appropriate for this population.

Unlike the senior meal program, the congregate meal program for adults with disabilities has never received a significant targeted funding increase. Instead, the program has grown piecemeal over the last several years as DAAS has been able to demarcate funding for this population. Consequently, contracted service levels for the AWD meal program constitute just five percent of all congregate meal clients and meals funded by DAAS – even though census data indicates

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adults with disabilities are 24% of the larger group of seniors and adults with disabilities with income below 200% of the poverty threshold. 8

In expanding congregate meal service for this population, DAAS should carefully consider the service model. As this program has developed over the years, DAAS has typically relied on existing partners willing to expand existing sites to include the younger population. As a result, all 29 sites that serve AWD congregate meals are primarily focused on seniors. At most of these sites, less than 10% of seats are designated for adults with disabilities. This can deter younger persons with disabilities from participating; these populations are at different stages of life and have different interests.

Enrollment trends corroborate this potential risk. As shown below, most of the AWD congregate meal clients served in FY 15/16 were aged 55 or older – likely persons biologically older than their chronological age who have become “seniors” at an earlier age.

DAAS is charged to serve adults with disabilities across the age range and should develop services predominantly focused on adults with disabilities. Prior experience has taught DAAS that meal sites co-located with activities tend to be the most successful at attracting a wide range of participants and encouraging community engagement. DAAS should consider alternative and innovative models that provide activities more appealing to the younger population than the typical senior-focused congregate meal/community services site pairing – and carve out nutrition funding to include in a separate solicitation to develop such a community services center for adults with disabilities in a separate solicitation. Based on the census profile of the low-income population, this AWD-specific effort should be located in either Districts 5, 6, or 10.

8 In addition to the disjointed growth of this program, there are understandable factors that have contributed to this discrepancy. The senior congregate meal program has a long history in the social services world and benefits from a strong advocacy network in San Francisco. There are also other resources available to help meet the need for nutrition support – in particular, CalFresh. As of September 2016, there were 22,919 CalFresh recipients between age 18 and 59 (the program does not collect information on disability). However, there are 16,626 adults aged 18 to 64 with disabilities who receive Supplemental Security Income benefits – all are ineligible for CalFresh and may benefit from nutrition support through a congregate meal program.

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Review: Ethnicity of Low-Income Adults with Disabilities and Congregate Meal ClientsThe chart below provides the ethnicity of adults with disabilities most likely to benefit from congregate meals in comparison to the profile of enrolled clients. DAAS may want to expand funding for generic American cuisine and Latino-style meals.

Innovative Models for Congregate Meal ServiceCurrently, congregate meal service for adults with disabilities is only provided in the traditional congregate meal setting. As noted above, this population may prefer alternate models, such as the restaurant-based CHAMPSS program. DAAS should consider opportunities to pilot new models of service for this population.

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Anticipated Service LevelsThe table below contains the contracted FY 15/16 service levels for congregate meals for adults with disabilities. DAAS plans to maintain existing service levels by cuisine and district to provide stability for current clients.

Congregate Meal Program for Adults with DisabilitiesBaseline Service Levels

Meal Site District

Meal Type

Cuisine # Sites

# Meals

# UDC

D1 Lunch American 1 1,190 5Chinese^ 1 35 2Russian 1 850 10

D2 Lunch American 3 3,917 69D3 Lunch American 2 12,122 60

Chinese 2 2,278 70D4^ n/a n/a 0 0 0D5 Lunch American^ 1 242 10

American-Southern 2 8,246 135D6^ Lunch American 3 6,208 146

American-Latino 1 2,024 69Chinese^ 2 350 11

D7^ n/a n/a 0 0 0D8 Lunch American 3 1,673 25D9 American-Latino 2 3,865 145D10 Lunch American 2 862 13

American-Southern 2 5,560 115Chinese^ 1 30 1

D11^ n/a n/a 0 0 0Total 29 49,452 886

^ Additional funding has been made available for service expansion

In addition to the AWD congregate meal service expansions recommended earlier in this section, DAAS should consider establishing a minimum funding and/or service threshold per site. As shown above, four existing sites have very limited service – serving two or fewer AWD clients per day (a result of the piecemeal growth of the program). Such limited availability puts these sites at increased risk of having to turn interested clients away and inhibits outreach activities to engage new clients. Still, this service is valued by the participating clients and should not be eliminated. By establishing a minimum funding and/or service level, DAAS can improve the viability and visibility of these sites.

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Home-Delivered Meals

Home-delivered meals (HDM) are intended to target frail, homebound or isolated individuals and, in certain cases, their caregivers and/or spouses. Like congregate meals, this service provides more than the nutritional component. The meal delivery also serves as a daily wellness check and opportunity for face-to-face contact and social engagement. HDM are often the first in-home service that an individual receives and can serve as an access point for connection to additional resources (Administration on Aging, 2015).

Home-delivered meals support well-being and can help prevent institutionalization (Shapiro & Taylor, 2002). A recent study suggests an association between increased state investment in community-based services (in particular, home-delivered meals) and proportionately fewer low-need nursing home residents (Thomas & Mor, 2013). Responses to the National Survey of Older Americans Act Participants also attest to the positive impact of this program.

National Survey of Older Americans Act Participants (2013)

As a result of home-delivered meal program, respondents agree that…

All Respondents

Income Below

$20,000

Live Alone

Recipient eats healthier meals 84% 85% 82%Meal programs improve recipient's health 83% 84% 84%Recipient feels better 90% 91% 91%Service helps recipient live independently 86% 86% 92%Recipient believes meals helps them stay in own home

92% 92% 92%

Meals represent at least half or more of recipient's total daily food

60% 61% 64%

Source: National OAA Participants Survey 2013. Accessed via AGID database (http://www.agid.acl.gov) on September 8, 2015.

DAAS currently funds a variety of meal types to fulfill client preferences for ethnic cuisine (e.g., Japanese, Kosher) and meet the needs of those with special diets (e.g., low-sodium). HDM providers that supply modified diet meals are also required to provide nutrition counseling if the client’s physician does not provide this service.

In FY 15/16, DAAS significantly expanded home-delivered meal service by funding: 1,472,570 non-emergency home-delivered meals to 4,095 seniors and 200,154 home-delivered meals to 505 adults with disabilities. 28,668 emergency home-delivered meals

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Home-Delivered Meals for Seniors

Recommendations Increase funding to address waitlist (with funding for all cuisine types). Work with community partners to outreach in the API community.

In San Francisco, there are 10,294 low-income seniors aged 60 and older who live alone and report self-care and/or independent living difficulties that may impede their ability to shop for groceries and prepare meals. As of FY 16/17, DAAS is funding service for 4,461 individuals, leaving 5,833 individuals with a potential unmet need for HDM. While a service gap persists, it is also important to recognize the significant expansion of this program in recent years. Since FY 13/14, the HDM program has added space for almost 900 additional seniors.

Review: Home-Delivered Meal Waitlist TrendsThe centralized HDM program provides critical insight into population needs and enrollment trends. Maintained by the DAAS Integrated Intake and Referral Unit, this waitlist captures all clients newly referred for service and is the best source of data for persons with a demonstrated need for HDM. Enrollment in HDM is driven by acuity; based on the intake assessment, a score is calculated that drives how clients are prioritized and who is enrolled.

In FY 15/16, DAAS received 1,374 requests for HDM service for seniors. The median wait time was 42 days and on average there were 275 clients waiting for service.9 The persistence of the waitlist suggests unmet need for this service. Once enrolled, HDM clients tend to stay enrolled; almost 70% of HDM senior clients in FY 15/16 were ongoing clients from the prior year. DAAS should consider increasing funding to support timely enrollment.

The chart below provides the location of clients referred over the last four years and those clients enrolled throughout FY 15/16 (this includes ongoing clients).

Overall, location trends have remained generally consistent, suggesting there have not been major shifts in where the most vulnerable seniors live in recent years. However, with the soaring cost of living and new developments displacing low-income populations in San Francisco, these

9 The waitlist length fluctuates throughout the year. As of December 2016, there were 150 clients waiting.

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trends may change over the upcoming contract cycle. DAAS should continue to incorporate flexibility into the HDM program so that meal providers can respond to any changes in population trends. Contracting with meal providers that serve large parts of the city (if not citywide) is one strategy to ensure the HDM program can be responsive to any changes in client location.

Most referrals (89%) in FY 15/16 did not indicate a cuisine preference – the client would accept the first meal available. The most common expressed preferences were for American (13%), Chinese (5%), and Japanese (4%) cuisines. These trends are generally consistent over time; DAAS should take these preference trends into account when allocating additional funding. These clients did not typically wait longer than those without an indicated preference.

Review: Location of Seniors and Home-Delivered Meal ClientsThough the waitlist is the key driver in HDM enrollment and best data source for clients with established need for HDM service, census data can help identify areas or populations that may benefit from increased outreach. The chart below compares the location of new HDM referrals and the FY 15/16 enrolled clients with the following census profiles: low-income seniors, seniors reporting independent living difficulty, and seniors living alone.10

While these are simply proxies for potential eligibility, enrollment trends appear relatively consistent with the location of persons most likely to need HDM. As with congregate meals, District 6 (Tenderloin, SOMA) has a higher proportion of new referrals and enrolled clients compared to census trends. However, this area has many of the city’s Single Room Occupancy (SRO) hotels that often lack adequate kitchen facilities to prepare meals. Service levels are

10 Unfortunately, census data available at the location-level does not permit integrating these indicators (e.g., to estimate number of low-income seniors living alone with disabilities by district). Still, reviewing these three indicators together provides a sense of the local senior population in each district.

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lowest in District 2 (Marina, Pacific Heights); this district has 12% of seniors living alone but much smaller percentages of the city’s low-income seniors and those with independent living difficulty. Seniors in this district are likely more able to purchase or prepare their own meals.

However, service levels in District 3 are lower than might be expected. This district has a disproportionately large share of the city’s low-income seniors (18%), those with independent living disabilities (16%), and those living alone (16%) – but only 9% of HDM clients. This district also houses many of the city’s SRO hotels, which often lack adequate kitchen facilities. It may be the case that these seniors are meeting their needs through other resources; 81% of the most low-income seniors in the district are API, and there is a strong community in Chinatown. SRO residents may have family nearby who provide support. Still, DAAS should consider coordinating with community-based organizations serving District 3 for targeted outreach – particularly the local Aging and Disability Resource Centers.

Review: Ethnicity of Low-Income Seniors and Home-Delivered Meal ClientsReview of HDM enrollment trends further highlights potential under enrollment of API seniors. Of those most likely to need HDM – seniors with low income who report disabilities that may impede ability to prepare meals and are living alone – approximately 31% are API. However, only 24% of HDM clients are API. Again, DAAS should work with the agencies that serve this population community to ensure that those in need are able to access this service.

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Anticipated Service LevelsThe table below contains the baseline contracted service levels that DAAS plans to maintain. These levels reflect the FY 16/17 budget to incorporate the $728,000 expansion in the current year. At minimum, providers must be able to serve in the districts identified below.

Senior Home-Delivered Meal Program - Baseline Levels Cuisine Type # Meals # Clients Supervisorial District Served

American^ 1,484,669 3,579 CitywideAmerican-Latino^ 31,913 167 D6, D9, D10, D11Chinese^ 65,054 350 D1, D3, D4, D6, D7Japanese^ 32,258 140 D1, D2, D4, D5Kosher^ 10,578 62 D1, D2, D3, D4, D5, D6, D7, D8, D9Russian^ 32,125 163 D1, D4, D5, D7

Total 1,656,597 4,461 .^ Additional funding has been made available to expand service in all cuisines

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Home-Delivered Meals for Adults with Disabilities

Recommendations Fund ethnic cuisine – specifically Chinese and Latino-style meals.

There are 4,521 adults aged 18 to 59 living alone who report self-care and/or independent living difficulties – those most likely to have difficulty shopping for groceries and preparing meals. In FY 15/16, DAAS funded meal providers to serve 505 adults with disabilities – which equates to 11% of funded clients for regular home-delivered meal service.

Like the AWD congregate meal program, HDM service for this population is entirely locally funded and reflects the city’s desire to support vulnerable persons with disabilities. The program has grown by over 200 seats since FY 12/13, when DAAS funded 295 seats.

Review: Home-Delivered Meal Waitlist TrendsReferrals for HDM service for adults with disabilities reached an all-time in FY 15/16. This likely is due in part to increased funding and coordination efforts among DAAS and providers that helped reduce the waitlist size and wait time. The median wait time for AWDs served last year was 15 days – a significant decrease over the median 78 day wait in FY 14/15.

As shown below, clients referred for service tend to live in District 6 (Tenderloin, SOMA), which has the highest poverty rates and many of the city’s SRO hotels. In prior years, a higher percentage of referrals came from District 10 (Bayview-Hunters Point) – although the FY 12/13 trends may be distorted by the low number of referrals that year – and District 9 (Mission, Bernal Heights).

*Citywide screening for eligibility: Prior to placement on the waitlist, AWD referrals must be assessed in person for eligibility. This service is provided through a contract with a community-based organization, which also processes the initial referrals (as does the DAAS Integrated Intake and Referral Unit). Enrolled clients must be assessed annually. As shown above, AWD referrals come in for persons living all over San Francisco. Accordingly, the agency contracted to provide this service must also serve citywide.

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Review: Location of Adults with Disabilities and Home-Delivered Meal ClientsWhile census data is unable to fully capture the nuanced eligibility criteria for HDM service, the population profiles can provide helpful context for thinking about current service levels. This is particularly important for a program like HDM for adults with disabilities. Because the scale of HDM service for the disabled adult population is limited, DAAS has primarily targeted outreach to social service and medical providers that work with vulnerable individuals, rather than conducting widespread outreach for the program. The chart on the following page can help identify areas that may benefit from targeted outreach.

Adults with disabilities are most likely to live in District 6. This trend is especially pronounced in the low-income population with 28% of this population (3,600 individuals) living in this area. While 50% of enrolled AWD HDM clients live in this district, it is important to bear in mind that is only 283 people individuals – given the scale of the program, the “over-representation” of District 6 residents isn’t necessarily inappropriate given the scale of this program.

The chart above does highlight potential underrepresentation of adults with disabilities in District 3 (Chinatown, Nob Hill), District 8 (Castro, Upper Market), and District 11 (Excelsior, OMI). DAAS should collaborate with community partners – including the local Aging and Disability Resource Centers – to discuss potential unmet need and how to refer eligible individuals.

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Review: Ethnicity of Adults with Disabilities and Home-Delivered Meal ClientsAWD HDM clients are primarily African-American or black (38%) and white (31%). This trend is generally consistent with the profile of those most likely to need HDM. Enrollment of API and Latino adults with disabilities is lower than might be expected.

The enrollment trends by ethnicity may be influenced by the cuisine available for adults with disabilities. During the economic recession and budget reductions several years ago, HDM providers serving ethnic cuisines switched to primarily frozen generic American style meals to reduce costs.

With funding levels restored (and surpassed), DAAS should reallocate a portion of funding for ethnic cuisine or identify additional funding to offer options that reflect the population’s diversity. Still, the majority of funds should remain allocated to generic American cuisine to preserve service for existing clients and align with overall population demographics. Providers with flexibility to serve hot, chilled, and/or frozen meals should be prioritized; depending on providers who only serve frozen meals limits the flexibility of this program, particularly given that persons in need of HDM may have functional impairments that impede meal reheating.

The current allocation is provided in the table below. DAAS plans to maintain the number of generic American-style meals.

AWD Home-Delivered Meal Program - Baseline Service Levels Meal Type # Meals # Clients Supervisorial District Served

American 200,154 505 CitywideTotal 200,154 505 .

^ Additional funding has been made available to provide Chinese- and Latino-style meals

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Emergency Home-Delivered Meals

The emergency home-delivered meal program provides immediate service to persons in dire need of nutrition support. The program goal is to serve all emergency requests within two to five days of referral.

This program is focused on supporting seniors and adults with disabilities who meet all of the following criteria:

Living alone or with a disabled partner Homebound One or more medical problems or terminally ill Isolated/lack of social support Lacking safe and healthy alternative for meals

Referrals from public agencies focused on protective services, such as the police department, fire department, and Adult Protective Services, may also be deemed eligible for emergency service. Many of those served emergency HDM have recently been discharged from a hospital or other institutional care.

In FY 15/16, this program served 316 individuals. As shown to the right, the majority of clients served lived in District 6 (Tenderloin, SOMA), but all supervisorial districts are represented.

For efficiency and prompt response to requests, DAAS prefers to have only one provider responsible for this service. The meal provider holding this contract is able to serve citywide in order to respond to client needs.

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Home-Delivered Groceries

DAAS values innovation and creativity to meet the changing needs of the diverse local population of seniors and adults with disabilities. The Home-Delivered Grocery (HDG) program is a newer service that has grown rapidly in recent years. A conceptual hybrid of the classic food pantry system and HDM service, the program is based on the understanding that many seniors and adults with disabilities would benefit from free groceries but are unable to wait in line or transport the heavy food bags home from a food pantry. HDG service providers bring the bag directly to the client’s home.

The HDG program is a collaboration of the San Francisco-Marin Food Bank (SFMFB) and community-based organizations (CBOs). The service included in this Request for Proposal solicitation is for the outreach, service coordination and delivery. The grocery bag cost is funded through a separate contract with the SFMFB that is currently mid-cycle; any respondent applying to participate in the HDG program must partner with the SFNFB for the grocery bag component.

The HDG program consists of several service models: HDG Partnership – A weekly supplemental grocery bag is coordinated and delivered to

the participant’s home. It relies on a variety of partnerships between the SFMFB and a variety of agencies that serve seniors and adults with disabilities. Current approaches include: existing food pantries utilizing volunteers and staff to package and deliver bags; community-based organizations picking up grocery bags from local food pantries and delivering to those in need; In-Home Supportive Services (IHSS) providers visiting local pantries to pick up bags for clients; and HDM providers delivering bags to persons ineligible for HDM and/or who would benefit from additional food in the home but are unable to pick it up.

HDG Food Networking Program – In this model, community-based organizations manage client outreach and are responsible for package and delivery of grocery bags (after a food delivery from SFMFB). Grocery bags are delivered weekly or bi-monthly. The program has a twofold purpose: in addition to the groceries, a core component of this model is reducing isolation through the provision of social activities and development of a supportive community network. Agencies may utilize volunteer networks or provide smalls stipends to “community connectors” to deliver grocery bags to their neighbors. Because of this extra support, this model has a higher cost per unit.

SRO Food Outreach Project – The original HDG model, this model first began in FY 09/10. It provides small food pantries in SROs in Chinatown; the food is supplied by SFMFB and supplemented with culturally appropriate cuisine, and volunteers are utilized to deliver bags to residents weekly. Note: This program is currently mid-contract and thus funding is not available in this Request for Proposals solicitation. It is included here as an example of an innovative program and to provide a comprehensive representation of current service levels in District 3.

Those likely to benefit from HDG are low-income individuals who may be homebound and/or unable to transport groceries home. Clients must have the capacity to store food (e.g., refrigerator) and ability to prepare meals (e.g., able to cook or receives assistance from family, friend, caregiver). Both seniors and AWDs are eligible for the service.

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This model is still under development and has not rolled out citywide in the same manner as congregate meals and HDM. Because the HDG program is relatively new and experienced a significant expansion in FY 16/17, ability to analyze current service levels is limited. Almost half of the HDG bags are delivered by citywide providers, inhibiting a forecast of clients by location. Prior to any significant expansion of this service in future years, DAAS should review enrollment trends to better understand need and identify areas for service expansion.

Anticipated Service LevelsGiven the significant program expansion in the current year, DAAS has based its baseline service for the new contract cycle on the current year service levels. The table below contains the total number of bags by service model and supervisorial district in the current year.

Home-Delivered Grocery Program - FY 16/17 Contracted Service Levels

District HDG Partnership Program

HDG Food Networking

Program

SRO Food Outreach Program

Total

D1 2,233 5,200 0 7,433D2 1,778 0 0 1,778D3 510 0 8,640 9,150D4 1,346 0 0 1,346D5 1,923 0 0 1,923D6 510 0 0 510D7 1,346 720 0 2,066D8 0 0 0 0D9 0 0 0 0D10 0 3,000 0 3,000D11 0 2,775 0 2,775Citywide 51,913 0 0 69,078

Total Bags 61,558 11,695 8,640 99,058Total Cost $394,944 $326,033 $28,180 $749,252

Average Cost $6.42 $27.88 $3.26 $7.56* SRO Food Project is mid-contract cycle and thus is not included in this RFP. It is included here to capture current service levels for HDG throughout the city.

Note: DAAS has identified an additional $7,106 available for the HDG program. This funding will be available through the HDG Partnership Program, which has the most citywide versatility and a relatively low cost per grocery bag that will maximize the use of this additional funding.

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Reference: Supervisorial District Map

Accessible online from the San Francisco Department of Elections at:http://www.sfgov2.org/ftp/uploadedfiles/elections/PrecinctServices/maps/SF_Neighborhoods_June_2014.pdf

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http://www.sfgov2.org/ftp/uploadedfiles/elections/PrecinctServices/maps/SF_Neighborhoods_June_2014.pdf

http://www.sfgov2.org/ftp/uploadedfiles/elections/PrecinctServices/maps/SF_Neighborhoods_June_2014.pdf

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