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HomeMy WebLinkAboutITEM NO. 2 PART 1 f lrc, AGENDA REPORT ITEM #2 MEETING DATE: JUNE 26, 2023 TO: PLANNING COMMISSION FROM: COMMUNITY DEVELOPMENT DEPARTMENT SUBJECT: APPEAL FROM COMMUNITY DEVELOPMENT DIRECTOR'S USE DETERMINATION (UD 2023-0002) APPLICANT: PROPERTY OWNER: KELLY BRUNO-NELSON DAVID TANG EXECUTIVE DIRECTOR CALAIM, YORBA MYRTLE LLC CALOPTIMA HEALTH 16027 BROOKHURST STREET„ STE 641 505 CITY PARKWAY WEST FOUNTAIN VALLEY, CA 92708 ORANGE, CA 92868 PROJECT SITE: 14851 YORBA STREET AND 165 NORTH MYRTLE AVENUE (APN: 402-302-14) ZONING: PUBLIC AND INSTITUTIONAL (P&I) DISTRICT, PROFESSIONAL (Pr) DISTRICT, AND SPECIFIC PLAN NO. 9 (SP9-YORBA SPECIFIC PLAN) GENERAL PLAN: PUBLIC/INSTITUTIONAL (PI) ENVIRONMENTAL THIS APPEAL IS CATEGORICALLY EXEMPT (CLASS 1) REVIEW: PURSUANT TO SECTION 15301 OF THE CALIFORNIA ENVIRONMENTAL QUALITY ACT REQUEST: On April 27, 2023, the applicant submitted an appeal of the Community Development Director's Use Determination (UD) 2023-0002 (Attachment G). The applicant's appeal is as follows: That the proposed project should be considered one (1) integrated use and characterized as "a `hospital' or 'similar' use to a hospital" and therefore a Conditionally permitted use on the project site. The applicant's appeal includes a statement that all aspects of the Use Determination are appealed, except for the determination that the PACE aspect of the project is a conditionally permitted use under the site's zoning district and general plan land use designation. Planning Commission June 26, 2023 Appeal of CDD's Use Determination Page 2 RECOMMENDATION: That the Planning Commission adopt Resolution No. 4477 denying the appeal and upholding the Community Development Director's Use Determination (UD 2023-0002). REVIEW AUTHORITY: Tustin City Code (TCC) Section 9298b authorizes the Community Development Director to determine, in cases of ambiguity, whether or not the use of any land or structure in any district is similar in character to the particular uses or plans allowed in the district. Per TCC 9298f, any decision of the Community Development Director may be appealed to the Planning Commission at a public hearing in accordance with procedures described in TCC Section 9294. The public hearing shall be de novo and the Planning Commission may approve, approve with conditions, or disapprove the matter, in accordance with TCC, or remand the matter to the Community Development Director or the Zoning Administrator for further proceedings in accordance with directions of the Planning Commission. On June 26, 2023, the Planning Commission will consider the appeals of a Reasonable Accommodation request and the UD 2023-0002 request and, depending upon the outcome of their considerations, the proposed project may or may not be determined to be an allowable use in the zone. Any decision of the Planning Commission may be appealed to the City Council by any person. All appeals shall be filed within ten (10) calendar days of the date of the decision. BACKGROUND On October 17,2022, the applicant filed a request fora Conditional Use Permit(CUP)2022- 0019 (Attachment C) to allow the operation of the proposed land uses as defined in their application and listed below: • Recuperative Care: A "short-term housing [program] inclusive of comprehensive care management and housing navigation services paired with traditional medical oversight from trained professionals over an up-to-90-day stay" (Attachment D, CalOptima October 7, 2022 letter); this program is only available to unhoused individuals (CalOptima Operations and Security Plan submitted March 27, 2023 (Attachment E, "Ops, Plan", p. 39). • Post-Hospitalization Housing: A program that "provides Guests additional time to receive medical support and permanent housing assistance immediately after the Recuperative Care Program[t]here is no difference in the services provided, eligibility criteria, or room location" as compared to Recuperative Care (Ops. Plan pp. 5, 7); Planning Commission June 26, 2023 Appeal of UD 2023-0002 Page 3 this program is only available to unhoused individuals (Attachment E, "Ops. Plan", p. 39); and • Program of All-Inclusive Care for the Elderly(PACE): A program that"enable[es] older adults to remain living in the community and out of institutions" by providing services that include "on-site medical care, a day-activity center, transportation, rehabilitation therapies, meals, homecare, medications, medical equipment, and coverage for hospital and long-term care." (Attachment E, "Ops. Plan", p. 2.) On April 19, 2023, the Community Development Director issued a Use Determination, referenced as "UD 2023-0002" (Attachment F) pursuant to TCC Section 9298b, as follows: • The Community Development Director determined that the proposed Recuperative Care and Post-Hospitalization Housing uses are not similar in character to other uses conditionally permitted in the P&I District; therefore, they are not permitted in the P&I District, nor are they permitted in the Pr or SP9 districts. The operational characteristics of the proposed Recuperative Care and Post-Hospitalization Housing components are similar in character to residential uses such as extended care facilities or supportive housing, setting the proposed land uses apart from uses that are conditionally permitted in the P&I District. Additionally, the P&I District does not explicitly list Recuperative Care or Post-Hospitalization Housing as permitted land uses; and • The Community Development Director determined that the operational characteristics of the proposed PACE use is similar to a hospital use. Hospital uses are conditionally permitted uses in the P&I District. As such, the PACE use can be allowed with the review and approval of a CUP by the Planning Commission. Site and Surrounding Properties The project site is located south of the intersection of Irvine Boulevard and Yorba Street (Figure 1). The subject property is a 2.27-acre campus, developed with two (2) buildings connected by an enclosed corridor. The northerly two-story building (14851 Yorba Street) is approximately 56,000 square feet, was built in 1991, and was formerly used as an acute care medical rehabilitation hospital. The southerly one-story building (165 North Myrtle Avenue) is approximately 17,000 square feet, was built in 1971, and was formerly used as a skilled nursing facility. Together the buildings were authorized for neurological or convalescent care facility (CUP 88-01). A shared outdoor courtyard is located between the buildings. The site was previously occupied by Encompass Health Rehabilitation Hospital, providing acute care medical rehabilitation services, until the site was vacated in May 2022. The 2.27-acre campus provides a total of 159 parking spaces. An underground parking structure, accessed through Myrtle Avenue, provides 149 parking spaces. A surface parking lot accessible through Yorba Street provides an additional ten (10) parking spaces. Planning Commission ,dune 26, 2023 Appeal of LID 2023-0002 Page 4 Adjacent properties to the east are developed with single-family homes that have been repurposed into office buildings, while the adjacent property to the north is developed with a multi-tenant office building. The adjacent property to the south (along the east side of Myrtle Avenue) is developed with a multi-family apartment community. The property along the west side of Myrtle Avenue is developed with a medical dialysis center. CITY OF TUSTIN LIMIT SINGLE FAMILY f� RESIDENTIAL SUBJECT SITE HELEN ESTOCI( ELEMENTARY ^ SCHOOL AwF6t01k4t . CFRCE +, t a t ti SERVICE STATIt]N C � P r O pkOFESSIONALOFFICES IRVINE BLVD I' = �u FIRST ST. AMR o'4 1 } E YVLT4FA.IlILY j ( - 1 d PEL'.TENTIAL �' (((jjj rr }.i4LE F$19LY RE}IflEiri'aLL CITY OF SANTA ANA I! CITY OF TUSTIN f 300 0 Feet • Source:ESRI,City of Tustin M Figure 1 - Site and Surrounding Uses Planning Commission June 26, 2023 Appeal of UD 2023-0002 Page 5 ANALYSIS UD 2023-0002 Most recently, on March 28, 2023, CalOptima representatives submitted supplemental materials augmenting the original CUP 2022-0019 application submittals filed on February 6, 2023. The application, including plans and documents, is a proposal to establish a hybrid two-pronged program: a Recuperative Care/Post-Hospitalization Housing use to serve the unhoused and a Program of All-Inclusive Care for the Elderly(PACE) use at the site located at 14851 Yorba Street and 165 North Myrtle Ave and is generally comprised of a two- building project site with 73,180 square feet of programmable space. The application materials indicated that all uses are intended to serve those individuals who are 55 years and older. The subject property has a combined zoning designation of Public and Institutional (P&I) District, Professional (Pr) District and Specific Plan No. 9 (SP9 - Yorba Street Specific Plan). The existing buildings located at 14851 Yorba Street and 165 North Myrtle Avenue are located within the Public and Institutional zoning district (P&I); the front parking lot at 14851 Yorba Street is located within the Professional Office zoning district(Pr) and Specific Plan No. 9 (SP-9 — Yorba Street Specific Plan) and the entire Property has a Public and Institutional (P/1) General Plan land use designation. • The purpose of Professional District is to identify properties that are authorized for professional offices. • The purpose of the Yorba Street Specific Plan is to encourage orderly development and lot consolidation, and to preserve and protect the public health, safety, and welfare of the area. • The purpose of the P&I District is to identify properties within the City that are used or authorized for public, quasi-public, and institutional uses distinct from the standard classifications of residential, commercial, and industrial. The P&I District, as described in TCC 9245(b), does not permit any land uses by right, and instead, conditionally permits uses such as libraries, places of worship, schools, and hospitals a or other uses determined to be similar—subject to obtaining a CUP. Recuperative Care and Post-Hospitalization Housing The operational characteristics of the proposed Recuperative Care and Post-Hospitalization Housing components include, but are not limited to the following: • Duration of stay(average anticipated length of stay will be one (1) year); • Interim Housing until permanent housing can be identified and secured (all guests will be allowed to stay indefinitely); • Medical oversight only (no direct medical services provided); • Limited assistance with Instrumental Activities of Daily Living (ADL) and/or Activities Planning Commission Juno 26, 2023 Appeal of UD 2023-0002 Page 6 of Daily Living (guest must able to complete ADLs independently i.e. transfer from toilet to wheelchair, use of durable medical equipment without assistance, and ambulate at least 20 feet prior to hospital discharged); • Coordination and connection to health services, transportation to post discharge services, case management, access to benefits and resources; • Able to self-administer medication; • Continent of both bladder and bowels (if diapers are used, Guest must change and maintain hygiene completely Independently); • Medically and psychiatrically stable; • Alert and oriented; • Access to PACE limited to PACE hours of operation (no 24-hour medical assistance); and, • Meals will be provided on site. Guests admitted to the Recuperative Care program must be discharged from Orange County Hospital or referred by the Tustin Police Department or a Tustin shelter. Based on the review of all of CalOptima's submittal documents and the above required criteria for admission, the Recuperative Care and Post-Hospitalization Housing components of the proposed project are not similar to a hospital as the appeal request has characterized. The Recuperative Care and Post-Hospitalization Housing are not similar to hospital for the following reasons: • Guests must be able to complete activities of daily living (not typical in a hospital or rehabilitation hospital setting); • No direct medical services (not typical in hospital or rehabilitation hospital setting); • Guests can stay indefinitely and post any medical needs (not typical in hospital or rehabilitation hospital setting); • No skilled nursing; • Guest must be able to self-administer medication (not typical in hospital or rehabilitation hospital setting); • Guest must be continent of both bladder and bowels and if diapers are used, Guest must change and maintain hygiene completely independently (not typical in hospital or rehabilitation hospital setting); • Guest must be alert and oriented and medically and psychiatrically stable (not typical in hospital or rehabilitation hospital setting); and • Guest will not be admitted if the above criteria are not met at time of admission. Staff also researched the definition and/or description of Recuperative Care. The California Department of Health Care Services describes Recuperative Care as: "short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to i i Planning Commission June 26, 2023 Appeal of UD 2023-0002 Page 7 continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing. At a minimum, the service will include interim housing with a bed and meals and ongoing monitoring of the individual's ongoing medical or behavioral health condition (e.g., monitoring of vital signs, assessments, wound care, medication monitoring). Based on individual needs, the service may also include..." additional services. "Recuperative Care is primarily used for those individuals who are experiencing homelessness or those with unstable living situations who are too ill or frail to recover from an illness (physical or behavioral health) or injury in their usual living environment; but are not otherwise III enough to be in a hospital. Accordingly, in accordance with TCC 9298b, the UD 2023-0002 was issued on April 19, 2023 by the Community Development Director determining that the proposed Recuperative Care and Post-Hospitalization Housing uses are similar in character to residential uses such as extended care facilities or supportive housing, setting the proposed land uses apart from uses that are conditionally permitted in the P&I District. Those operational characteristics are not similar in character to other uses conditionally permitted in the district; therefore, they are not permitted in the P&I District, nor are they permitted in the Pr or SP9 districts. PACE The P&I District does not explicitly list PACE as a permitted land use, nor is it explicitly prohibited. However, based on the information provided in the application documents, including the most recent submittal on March 28, 2023, PACE would offer medical services similar to hospital uses that include, but are not limited to the following: • Routine physicals and preventative health evaluations and care; • Kidney dialysis; • X-ray services; • Laboratory procedures; • Physical, occupational and speech therapy; • Nutritional counseling; • Psychiatric services; • Outpatient surgical and mental health services; etc. In accordance with TCC 9298b, the Community Development Director has determined that the operational characteristics of the proposed PACE use is consistent with a hospital use. Hospital uses are conditionally permitted uses in the P&I District. As such, the PACE use can be allowed with the review and approval of a CUP by the Planning Commission. The City has treated the PACE portion of the proposed Project identically to the previously existing acute care medical rehabilitation facility at the Property. Planning Commission June 26, 2023 Appeal of UD 2023-0002 Page 8 Appeal Consideration The applicant's appeal requests that the Planning Commission reconsider the Community Development Director's UD 2023-0002 and consider the entire proposed project as a single "Hospital Use" subject to a CUP, in order to avoid discrimination on the basis of alleged disability of CalOptima's intended guests. Staff believes that to do so would be improper based upon the documentation provided by CalOptima regarding the operational characteristics of the Recuperative Care and Post- Hospitalization Housing component of the Project and CalOptima's own characterization of the Project as a "two-pronged program: a Recuperative Care and Post-Hospitalization program and a PACE program" and as "two programs ... designed to provide services consecutively." (Attachment E, Ops. Plan pp. 2, 5.). In addition, CalOptima has indicated that the Recuperative Care and Post-Hospitalization Housing does not provide medical services(medical oversight only); however, their services include connection of guests to on-going medical and behavioral health services. If desired by guests (guests have the option to use medical clinics of their choice); guests may, but not required to, utilize PACE services during the limited hours only (when PACE is open to the public). Hence, the Recuperative Care and Post-Hospitalization Housing operates independently of the PACE program and they are not a single integrated hospital use. Furthermore, the City cannot process an entitlement request that includes a use that is not permitted in the zone or TCC (i.e. Recuperative Care/Post-Hospitalization Housing). Nevertheless, City staff has provided a pathway for a fair hearing with regard to the Recuperative Care and Post-Hospitalization program as set forth in the email dated June 1, 2023 from Irma Huitron, Assistant Director- Planning to the applicant(Attachment H). The email describes the process and 'next steps'by which CalOptima may apply for a concurrent Specific Plan Amendment, zone change and Conditional Use Permit, as follows: "In accordance with Tustin City Code (TCC) 9295, the applicant may submit a Specific Plan Amendment of Specific Plan No. 9 (SP 9)to request that the entire project site (referenced as 14851 Yorba Street and 165 N. Myrtle Avenue) be incorporated and added to SP 9, request that the SP 9 be amended to authorize the proposed use, combination of Recuperative Care and Post-Hospitalization Housing, and "Program of All-inclusive Care for the Elderly(PACE)"), be listed as a conditionally permitted uses in the SP 9 district, and a zone change removing the P&I and Pr zoning designations from the project site. The applicant may request that a CUP application for the proposed use be processed concurrently with the Specific Plan amendment and Zone Change request." Planning Commission June 26, 2023 Appeal of UD 2023-0002 Page 9 Public Notice and Comments Public notice for the June 26, 2023 public hearing, was published in the Orange County Register on June 15, 2023. The public notice was mailed to property owners within 300 feet of the project site on June 15, 2023. Additionally, on June 15, 2023, public notice was emailed or mailed to other interested parties that requested to be included in all public notices relative to the proposed project. The public notice was also posted on the site on June 15, 2023. As of the preparation of this report, staff had received one (1) public comment related to this appeal (Attachment 1). CONCLUSION Based on the reasons included in this staff report, staff recommends that the Planning Commission deny the appeal and uphold the Community Development Director's UD 2023- 0002 by approving Resolution No. 4477 which includes the required findings pursuant to TCC 9298b. The Planning Commission would also find that the appeal is Categorically Exempt pursuant to Section 15301 (Class 1) of the California Environmental Quality Act (CEQA). /L`I Ra mond Rarragan , Irma Huitron Principal Plannbr Assistant Community Development Director— Planning J 06Va L. 1NiIIkom Community Development Director Attachments: A. Location (Radius) Map B. Land Use Fact Sheet C. Application (CUP 2022-0019) filed on October 17, 2022 and subsequent supplemental materials D. Applicant's (CalOptima) letter dated October 7, 2022 E. Applicant's (CalOptima) Operations and Security Plan ("Ops Plan") submitted March 28, 2023 F. Community Development Director's UD 2023-0002 dated April 19, 2023 G. Applicant's Appeal of UD 2023-0002 dated April 27, 2023 H. City Email to Applicant regarding pathway to process the proposed uses dated June 1, 2023 I. Public Comments J. Resolution No. 4477 Denying Applicant's Appeal of UD 2023-0002 ATTACHMENT A LOCATION (RADIUS) MAP Radius Map 14851 Yorba Street and 165 North Myrtle Avenue f N Li 0 ft. Subject Property -- - 300 Q- -07 a _ f F r� r r+ 300 ft,500 ft,and 1000 ft Radius ATTACHMENT B LAND USE FACT SHEET LAND USE APPLICATION FACT SHEET 1. LAND USE APPLICATION NUMBER(S): APPEAL OF UD DETERMINATION (UD) 2023-0002; APPEAL OF DENIAL OF REASONABLE ACCOMODATION REQUEST 2. LOCATION: 165 NORTH MYRTLE AVENUE & 14851 YORBA STREET 3. APN: 401-302-14 4. PREVIOUS OR CONCURRENT APPLICATIONS RELATING TO THIS PROPERTY: PENDING: CONDITIONAL USE PERMIT (CUP 2022-0019) PRIOR: UP 69-328; UP 72-396; CUP 83-14; GPA 844B; ORD. 934/935; PM 87-412; CUP 88-01/DR 88-10; AMENDMENT TO CUP 88-01/DR 88-10 VIA PC RESO. 2748 AND 2750; UD 2023-0002 5. SURROUNDING LAND USES: NORTH: OFFICE EAST: OFFICE SOUTH: MULTI-FAMILY APARTMENTS WEST: 5-FREEWAY 6. SURROUNDING ZONING DESIGNATION: NORTH: PR (PROFESSIONAL) EAST: SP 9 (YORBA STREET SPECIFIC PLAN) SOUTH: PR, SP 9, AND R3 (MULTI-FAMILY WEST: N/A RESIDENTIAL) 7. SURROUNDING GENERAL PLAN DESIGNATION: NORTH: PO (PROFESSIONAL OFFICE) EAST: PO SOUTH: HDR (HIGH DENSITY WEST: N/A RESIDENTIAL)AND PO 8. SITE LAND USE EXISTING PROPOSED A. GENERAL PLAN: PUBLIC & INSTITUTIONAL N/A B. ZONING*: P&I, PR, AND SP-9 N/A DEVELOPMENT FACTS: 9. LOT AREA: 2.235 ACRES 10. BUILDING AREA: 73,180 SF TOTAL EXISTING PROPOSED 11. PARKING: 155 PARKING STALLS N/A 12. BUILDING HEIGHT: TWO STORIES N/A 13. DEVELOPMENT STANDARDS: ANY DEVELOPMENT WOULD BE SUBJECT TO DEVELOPMENT STANDARDS SETFORTH BY THE ZONE(S). *SEE ZONING MAP ON NEXT PAGE ZONING MAP 1� I 4 H9 Ham Wock C' 8chn�o' ri "�alrok:+ems: 1 Z'VINEELVD. Pubic&lnsbWbc lal tiPl&I . o1'Ed ard;,f�arai5trtet5p3[afieFl SF'-9f201'PS •a"'8� - i •;�F Ate+ W 1 9P 1r `I �I 3C{7'9i1`ra• Zoning FI 0 rd _ I PC Rn - f FU Pi PH 19791 E.Men SC .yam N I ..i io Q R3 I o I I I I I i 1z ''a I � ATTACHMENT C APPLICATION (CUP 2022-0019� FILED ON OCTOBER 17, 2022 AND SUBSEQUENT SUPPLEMENTAL MATERIALS CalOptima Health A PUblic Agenry 505 City Parkway west Calu" pt-ima Health Orange, CA 92868 "0 Via' 714-246-8400 rTY: 7l1 calaptima.org October 7, 2022 Justina Willkom, Community Development Director City of Tustin 300 Centennial Way Tustin, CA 92780 RE: Detailed Project Narrative for Caloptima Health's Conditional Use Permit application at 14851 Yorba Street and 165 N Myrtle Avenue Dear Ms. Willkom: CalOptima Health is a county-organized health system that provides publicly funded health care coverage for low-Income children, adults, seniors, and people with disabilities in Orange County, California. CalOptima Health's mission is to serve member health with excellence and dignity, respecting the value and needs of each person, CalOptima Health serves more than 911,000 local members with a network of more than 10,600 primary care doctors and specialists and 41 acute and rehab hospitals. This year the California Department of Health Care Services (DHCS) Launched CalAIM (California Advancing and Innovating Medi-Cal) to expand its Medi-Cal program beyond traditional healthcare to cover a variety of community support services that enable more comprehensive care for the whole person, These services include medically tailored meals, personal care, and other services that address individuals" social determinants of health. CalOptima Health recognizes that health outcomes are greatly influenced by social factors and its member's overall experiences. With that in mind, CalOptima Health has committed to offering all 14 community supports made reimbursable through CalAIM and expanding its provider network to reach members across the county. Community supports address some of the challenges faced by the most vulnerable populations in our neighborhoods, including those experiencing homelessness, aging, children with complex care needs, and those involved with the justice system. By providing more comprehensive social support for our members and partnering with more community-based providers, we can meet members where they are and help them on their path to better health. At the beginning of the year, CalOptima Health began offering the first four community supports, Including Recuperative Care. Recuperative Care (also known as Medical Respite) is short-term housing for individuals experiencing homelessness who are healing from an injury or illness and could benefit from medical oversight while completing their recovery. As part of Ca10ptima Health's strategy for providing this critical community service to Its members experiencing homelessness, we are partnering with community providers that operate recuperative care facilities. We are also planning the renovation of the subject property to house a hybrid program for recuperative care and PACE (Program of AII-Inclusive Care for the Elderly.) This Tustin-based facility will focus on service to older adults living in the community and those transitioning from living on the streets to a permanent home. Bringing Supportive Services to the Community Recuperative care services will be the foundation of this holistic care site in Tustin. Recuperative care is short-term housing inclusive of comprehensive care management and housing navigation services paired with traditional medical oversight from trained professionals over an up-to-90- day stay. Guests of this program have daily interaction with medical professionals and receive medication education to ensure they continue to heal after their hospitalization,The care management and housing navigation services provided help members to become "housing ready" with the necessary documents that enable access to housing. Guests also receive referrals to job training, substance use disorder services,and any other community supports that prepare there to make a permanent move home. This site will also provide another CalAIM-funded community support: Short Term Post- Hospitalization Housing. This service functions similarly to the recuperative care program but offers a more extended stay of up to six months.It is anticipated that guests of the recuperative care program will frequently transition into post-hospitalization housing until they can move into their permanent homes. Finally, a portion of the building will be dedicated to Cal©ptima Health's PACE (Program of all Inclusive Care for the Elderly) program. PACE is a home and community-based service that provides medical services and supports everyday living needs for specific older individuals, most. of whom are eligible for benefits under both Medicare and Medicaid. Individuals accessing these services will live both onsite and within the broader Tustin area. PACE offers complete health care and social supportwithin one program, enabling older adults to remain living in the community and out of institutions. PACE provides a wide range of services, including on-site medical care,a day-activity center, transportation, rehabilitation therapies, meals, home care, medications, medical equipment,and hospital and long-term care coverage. At the core of these programs are multidisciplinary teams who treat guests and assess and plan j for healthcare and social needs to maintain health. All program guests receive individualized care plans and services, and referrals designed to address their health and wellness challenges. i i 2 CalOptima's History of PACE Services CaiOptlma Health has provided PACE services t❑ the Orange County cornMUnity since October 2009.Through its location in Garden Grove, CalOptima Health serves 435 individuals, who have an average age of 72, have multiple chronic conditions, and need help with 4-5 activities of daily living.They receive care in their own homes and on-site at the PACE center. Exceptional outcomes have been demonstrated through CalOptima Health's PACE Program, indicating lower nursing home admissions, shorter hospital stays, lower mortality rates, and better self-reported health and duality of life. Serving our Aging Neighbors CalOptima Health is proposing to provide these services to Orange County residents, with Tustin community members receiving priority at this facility. Overall,the facility will house 119 individuals.The average daily occupancy rate is expected to be 751yo. The facility will serve older adults, many of whom were previously experiencing homelessness but are working toward a permanent h❑using placement.Typically, these individuals have multiple chronic conditions and need help with activities of daily living. To be eligible for PACE, individuals must be at least 55 years of age, reside in Orange County, meet California's skilled nursing facility requirements,and be abie to live safely in the community with proper support. Bringing Employment Opportunities &A Spotlight on Innovative Services This facility will be staffed around the clock and will bring various skilled job opportunities to the community. Physicians, registered nurses, and licensed therapists will be retained, In addition to lower-level medical care professionals,administrators, housekeeping, personal care attendants, and guest services associates responsible for ensuring a secure experience for all stakeholders. CalOptlma Health employment will likely track closely t❑ recognized industry standards for similar care facilities. We would anticipate a ratio of 1 direct caregiver (including RNs, LPN/LVNs, and NAs)to 5 residents on the day shift, 1 t❑ 10 for evenings, and 1 to 15 for nights in addition to 1 Director of Nursing (DON) and 1 Assistant DON.The pr❑posed 119-bed facility at 100% occupancy would require 24-25 employees on day shift, 1 z-13 employees ❑n evening shift and 8-9 employees❑n night shift. Very few programs across the state focus ❑n the aging population at the intersection of medical care and homelessness. CalOptima Health is designing a state-of-the-art facility that will provide exceptional services to the residents of Orange County. Beyond that, it will serve as an example of best practices in homeless services, focusing on our aging neighbors, the fastest growing subset of the homeless population, Cordial! , Kelly Brun❑-Nelson Executive Director Medi-Cal/CalAIM 3 . s CALOPTIMA HEALTH ry PROGRAM OF ALL—INCLUSIVE CARE(PACE CAMPUS) AND d"I' 'aa°d ( _ i cansl�r q GI Fun l RECUPERATIVE CARE FACILITY ManagememI F .} ehmabi I,uyr ra t u m 14851 YORBA ST&165 MYRTLE AVE, TUSTIN,CA 92780 PROJECT DATA P�a.o ienP.waxorruss.ova � SQQ0, w Qol��Q PROJECT DIRECTORY SHEET INDEX 0 r U C :Z 00 NPuw —aV i' fl 4 s VICINITY MAP p �� SITE Fn 'THE P oE oaM ,�' A0.1 — — Integra led cans tr uct�on a man.agomanf II iasla�na[�111Iy N otum I 6 P Ex�a. „a=,roRaAa.REE. EMA�N -I ® I I ——- J W N oho oho m� Ex�a.� ,s=MrR.�A�EN�E EMA�N I N o { 0m'� I U o ' Ia�RrA�ErAR�No No I aEoa��N, I rora�N�meEa of eEoe Ns fl E SITE PLAN � 77""" A1.1 --�--- ;.� leC�8 loll o c11 n ir uclion mgn.a 90 m arnl otum o�.000a � ®0 �E ® Q �Ea > {!J N > rwrmi S m LLJ 0, �Mo �o�� CL FIRST FLOOR PLAN - FL001 PL. j A2.is N lln I eg rated g a CQ 5 l,uct,o. 3 n a 9 0 rn 9 In I LI J-,�) Iw,t ai.a b It It IR .21=1 u m f LU I'D ,17 C) IF CL CL EC Ei 3 ® 3 o I A 111 11 11 11 11 11 El El El 1701, 700 FIRST FLOOR PLAN N 77- --------- (D FL001 PL. j A2.1b N I e g U I a d "In s tr uction m g na go m URI u m T,T Q LAI --------- L j 0, c,Lu 002 CL 000,011 El'I El El fl SECONDFLOORPLAN 710NI FLOOl PL. j A2.2 Maldonado, Jorge From: Douglas Dumhart <douglas.dumhart@gmail.com> Sent: Tuesday, October 18, 2022 4:34 PM To: Maldonado, Jorge Subject: Re: (CUP-2022-0019) CalOptima, OCFA Review Jorge: Thank you for the update. Appreciate the heads-up on OCFA PR 204 review. We will get a check and prints prepared and complete the Service Request form. Should have that in a couple days. I also inquired with CalOptima about how the PACE participants access the facility. They inform me that: Most PACE participants do not drive themselves; they use CalOptima's transportations services. Out of 430 registrants at the Garden Grove PACE Center, there is only one that drives. No one walks/takes the OCTA bus. The Garden Grove PACE facility reports that their vans do an estimate of 150 trips a day that include, outside appts, clinic appts (at the PACE site), rehab appts, and day center. Pre-covid they had on average 100 participants for day center attendance only. The average stay is 6-8 hours. Their day center has two shifts: am/pm each 4 hours, but many participants stay for both shifts due to supervision and family working. Respectfully submitted, Douglas D. Dumhart 3-D Advisors, LLC 949-421-9119 On Tue, Oct 18, 2022 at 4:14 PM Maldonado,Jorge<JMaldonado@tustinca.org>wrote: Hi Douglas, It was great talking with you yesterday.The plans have been routed for review and staff is scheduled to have a roundtable discussion on November 3. 1 wanted to confirm if plans had also been submitted to OCFA for their Development Plan Site Review? If not, we would need to coordinate that right away. Please stop by City Hall to obtain and fill out their application form. The attached PDF shows what it looks like, but OCFA needs the physical copy completed as it is in triplicate. Please bring two full-size sets of plans with you and a check made payable to the Orange County Fire Authority in the amount of$538. OCFA has regular pick-ups at City Hall so we can submit it on your behalf. We can reuse the USB you had provided for the City submittal. 1 Let me know if a particular time works best for you. I will be in the office tomorrow and Thursday but can give a heads up to staff working on Friday. Best, JORGE MALDONADO I Associate Planner City of Tustin I Community Development Department 300 Centennial Way I Tustin, CA 92780 imaldonado@tustinca.org z Maldonado, Jorge From: Douglas Dumhart <douglas.dumhart@gmail.com> Sent: Tuesday, October 18, 2022 5:40 PM To: Maldonado, Jorge Subject: Re: (CUP-2022-0019) CalOptima, OCFA Review Jorge: I believe that is the intent. Both Community Living and PACE entrances oriented to Yorba Street. Myrtle and First is not a signalized intersection. Yorba and Irvine Blvd is a fourway signalized intersection. Much safer. ILI aasprvaievaY ll�F>M io�`Naw .• ` •. r :ySt 4b43{aTHLT ::. d 1 �' P.4litti6_i911M ur+ven P _li II wwua,�nww �ffm:k � lGR.F?l3Pt1 ,ar��awnee*.crania ,.r Respectfully submitted, Douglas D. Dumhart 3-11)Advisors, LLC 949-421-9119 On Tue, Oct 18, 2022 at 5:19 PM Maldonado,Jorge<JMaldonado@tustinca.org>wrote: Also meant to ask, does the applicant anticipate funneling most of their PACE trips through the Myrtle Avenue entrance or Yorba Street? Jorge 1 From: Maldonado,Jorge Sent:Tuesday, October 18, 2022 5:10 PM To: Douglas Dumhart<douglas.dumhart@gmail.com> Subject: RE: (CUP-2022-0019) CalOptima, OCFA Review Through the City, thanks for asking. Best, JORGE MALDONADO I Associate Planner City of Tustin I Community Development Department 300 Centennial Way I Tustin, CA 92780 amaldonado@tustinca.org From: Douglas Dumhart<douglas.dumhart@gmail.com> Sent:Tuesday, October 18, 2022 4:53 PM To: Maldonado,Jorge <JMaldonado@tustinca.org> Subject: Re: (CUP-2022-0019) CalOptima, OCFA Review Jorge: You are right, it's PR105. Do you want us to route the PR105 application through the City of Tustin or submit directly to OCFA? Every City has a different preference. Respectfully submitted, Douglas D. Dumhart 3-11)Advisors, LLC 949-421-9119 2 On Tue, Oct 18, 2022 at 4:39 PM Maldonado,Jorge<JMaldonado@tustinca.org>wrote: Hi Douglas, Thank you for this information, I'll make sure the other reviewers receive it. Regarding OCFA, I believe this would be a PR 105 submittal unless you've been advised otherwise by OCFA. It may be best to discuss directly with them at 714- 573-6100. Best, JORGE MALDONADO I Associate Planner City of Tustin I Community Development Department 300 Centennial Way I Tustin, CA 92780 amaldonado@tustinca.org From: Douglas Dumhart<douglas.dumhart@gmail.com> Sent:Tuesday, October 18, 2022 4:34 PM To: Maldonado,Jorge <JMaldonado@tustinca.org> Subject: Re: (CUP-2022-0019) CalOptima, OCFA Review Jorge: Thank you for the update. Appreciate the heads-up on OCFA PR 204 review. We will get a check and prints prepared and complete the Service Request form. Should have that in a couple days. I also inquired with CalOptima about how the PACE participants access the facility. They inform me that: 3 Most PACE participants do not drive themselves; they use CalOptima's transportations services. Out of 430 registrants at the Garden Grove PACE Center, there is only one that drives. No one walks/takes the OCTA bus. The Garden Grove PACE facility reports that their vans do an estimate of 150 trips a day that include, outside appts, clinic appts (at the PACE site), rehab appts, and day center. Pre-covid they had on average 100 participants for day center attendance only. The average stay is 6-8 hours. Their day center has two shifts: am/pm each 4 hours, but many participants stay for both shifts due to supervision and family working. Respectfully submitted, Douglas D. Dumhart 3-D Advisors, LLC 949-421-9119 On Tue, Oct 18, 2022 at 4:14 PM Maldonado,Jorge<JMaldonado@tustinca.org>wrote: Hi Douglas, It was great talking with you yesterday.The plans have been routed for review and staff is scheduled to have a roundtable discussion on November 3. I wanted to confirm if plans had also been submitted to OCFA for their Development Plan Site Review? If not, we would need to coordinate that right away. Please stop by City Hall to obtain and fill out their application form. The attached PDF shows what it looks like, but OCFA needs the physical copy completed as it is in triplicate. Please bring two full-size sets of plans with you and a 4 check made payable to the Orange County Fire Authority in the amount of$538. OCFA has regular pick-ups at City Hall so we can submit it on your behalf. We can reuse the USB you had provided for the City submittal. Let me know if a particular time works best for you. I will be in the office tomorrow and Thursday but can give a heads up to staff working on Friday. Best, JORGE MALDONADO I Associate Planner City of Tustin I Community Development Department 300 Centennial Way I Tustin, CA 92780 imaldonado@tustinca.org 5 COMMUNITY LIVING FACILITY OF TUSTIN HUI V P Y �u 0 • r I 1+ �y Operations and Security Plan 1111 Yorba Ave Tustin CA 90000 CalOptima Health 1 CONTENTS ExecutiveSummary ........................................................................................................ 2 Operations Plan Intakeand Discharge ............................................................................................. 3 Residentsof Tustin................................................................................................. 6 Security Policies GoodNeighbor Policy ........................................................................................... 6 Loitering ............................................................................................................... 7 SecurityPolicy ..................................................................................................................7 ContactInformation ....................................................................................................... 9 0 CalOptima HeAth Executive Summary 2 In January 2022, California expanded its Medi-Cal program beyond traditional healthcare to cover a variety of community supportive services that enable more comprehensive care for the whole person. Entitled CalAIM, this expansion includes services that address the social determinants of health and commensurate challenges faced by the most vulnerable populations in our neighborhoods including those experiencing homelessness and the aging. As part of CalOptima Health's strategy for providing these critical community service to unhoused and aging members, we are planning the renovation of a Tustin-based building to house a hybrid two-pronged program: a Recuperative Care and Post-Hospitalization program and a PACE program (Program of All-inclusive Care for the Elderly). There are very few programs across the state that focus on the aging population at the intersection of medical care and homelessness. CalOptima Health is designing a state-of-the-art facility in the city of Tustin that will stand as an example of best practice in homeless services by focusing on the fastest growing subset of the homeless population, our aging neighbors. The Recuperative care and Post-Hospitalization program will be the foundation of this wholistic care site, providing unhoused older adults who are healing from an injury or illness with vital medical oversight services from trained healthcare professionals. Guests will have daily interaction with medical professions as well as care management and housing navigation services, job training, substance use disorder services, and any other community supports that prepare them to make a permanent move home. All guests will be welcome to stay in the program until permanent housing is identified and secured. In addition, a portion of the building will be dedicated to CalOptima Health's PACE program which provides all-inclusive care for older adults, enabling them to remain living in the community and out of institutions. The PACE program will provide a wide range of services to its members including on-site medical care, a day-activity center, transportation, rehabilitation therapies, meals, homecare, medications, medical equipment, and coverage for hospital and long-term care. CalOptima Health has been providing PACE services to the Orange County community since October 2009, currently serving 435 older adults at its Garden Grove location. CalOptima Health will provide these ` Y services to Orange County residents, , with Tustin community members receiving priority at this facility. Overall, the recuperative care center will serve 1 19 unhoused older adults working toward a permanent housing placement. The PACE center will serve up to 500 individuals from both the community 40 and the recuperative care center, with a a maximum daily census of 200. 0 CalOptima Health 3 Intake It is the goal of the Community Living Center of Tustin to create an environment of dignity, healing, acceptance and health. Therefore, all guests of the Center will be involved in the development of their personal plan of care, and willing to participate in its execution. Additionally, all guests will be expected to follow program guidelines and maintain appropriate behavior throughout their stay, respecting other guests, visitors and center staff. PACE PROGRAM The PACE program is open to all eligible individuals living both at the Recuperative Care/Post Hospitalization program as well as the surrounding Tustin Community. A referral to the PACE program may come from any source and may be taken by any PACE staff member, by phone, or otherwise. The PACE program enrollment and intake process will include four(4) stages: I. Initial eligibility determination. 2. Home visit and Level of Care (LOC) tool submission to DHCS. 3. Completion and submission of PACE LOC tool an if approved. 4. Enrollment Conference. To be eligible for the PACE program, an individual must be: • Fifty-five (55) years of age or older. • Live in the defined CalOptima PACE Service Area. • Meet the nursing facility eligibility criteria as defined by Title 22 California • Be able to live safely in the community with assistance • Meet financial criteria. If the individual meets the eligibility requirements, the PACE Enrollment Coordinator and Registered Nurse will schedule a home visit to determine the remaining eligibility criteria. During the home visit, PACE program staff shall conduct an environmental assessment and evaluate home and community safety issues, including stairs, clutter, neighborhood crime, accessibility, bath or shower, toilet, telephone, food, neighborhood services, public transportation, religious services, and shopping. If the Guest is determined PACE eligible, the PACE LOC tool is submitted to DHCS for approval. Upon approval, staff will contact the prospective enrollee to inform them of the State's determination, set up an enrollment conference and arrange transportation for those not in the Recuperative Care/Post Hospitalization program. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM After being discharged from a hospital, many older adults experiencing homelessness often still need medical support and stability for their healing journey. CalOptima's Recuperative Care and 0 CalOptima Health 4 Post-hospitalization program will provide quality care to our older adult neighbors experiencing homelessness, recognizing everyone is worthy of a dignified experience on their path to health and home. The program will utilize a bed reservation system. Prior to acceptance into the program, all potential guests will be prescreened by the intake department for eligibility and medical appropriateness. All Guests will arrive to the program by uber, taxi, ambulance, or non-medical transportation. Upon arrival, each new Guest will receive a Welcome Orientation from center staff to help ensure each has the tools and information necessary to promote a successful and productive stay at the center. This Welcome Orientation will include: • Review of the program guidelines, schedules, programs, and behavior expectations • Initial Nursing and Social Services assessment • Tour of the Center and key program locations • Introduction to key staff and roommate Guests of the Recuperative Care/Post Hospitalization Center will be allowed to remain until permanent housing is identified and secured, ensuring housing stability from the moment of admission. Discharge The Community Living Center is committed to providing services to the older adult unhoused and frail elderly populations. Therefore, staff will exhaust all possible options to remedy a situation before proceeding with an involuntary discharge. PACE PROGRAM All involuntary disenrollment's require prior approval of the Department of Health Care Services (DHCS) and require twenty (20) calendar days advance notice to Guests. An involuntary disenrollment will occur under the following circumstances: • The Guest moves, or is out of the Service Area, for more than thirty (30) consecutive calendar days • Guest engages in disruptive, or threatening, behavior that jeopardizes his or her own health or safety, or the health or safety of others. • Guest's caregiver or family member engages in disruptive, or threatening, behavior that jeopardizes his or her own health or safety, or the health or safety of others. • The PACE program contract with the Centers for Medicare & Medicaid Services (CMS) and DHCS is not renewed or is terminated, or the PACE program is unable to offer healthcare services due to the loss of state licenses, or contracts with outside providers. • The Guest no longer meets the California nursing facility Level of Care requirements. 0 CalOptima Health 5 The PACE program shall make every effort to resolve areas of conflict or jeopardy through negotiation and open communication among the team and the Guest before requesting an involuntary disenrollment. If CalOptima Health PACE staff exhausts all possible and feasible options to remedy the situation and those efforts to resolve the situation are unsuccessful, the PACE program may pursue an involuntary disenrollment. A Participant may voluntarily disenroll from CalOptima PACE without cause, at any time. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM The Recuperative Care/Post Hospitalization program will have a balanced approach to program exits and readmission policies. Consideration will be given to maintaining a safe and successful center, the safety of our Guests, volunteers, staff, and surrounding neighborhood as well as demonstrate compassion towards the unhoused older adults who face increasingly vulnerable situations if forced to exit from the center into places not suitable for human habitation. When service is terminated, either voluntarily or involuntarily, employees of the Recuperative Care/Post Hospitalization center will adhere to the following orderly and respectful process: Voluntary Discharge: Permanent Housing or higher level of Care When a Guest has successfully achieved their goals and is ready to move into a permanent housing setting, the following steps are employed to ensure an orderly and comprehensive discharge: • Nursing and Social Services to conduct an exit conference and review Guest's discharge/aftercare plan • Guest is provided with all medications if applicable • Guest is provided with appropriate referrals where external after care is required • Staff will assist Guest in packing all personal property • Transportation is arranged and a warm hand-off to the permanent housing location is arranged Involuntary Discharge In some cases, if a Guest is not successful in following the programmatic and/or behavioral guidelines of the program, they will be discharged on an involuntary basis When this occurs, the procedures to ensure an orderly and comprehensive discharge will be: • Center Manager signs off on the decision to ask a guest to leave. • Guest is informed of reason for discharge and a discharge location is identified • Guest is given appropriate resources/services prior to leaving the program. • Transportation to discharge location is arranged All discharges will occur between the hours of 9am and 7pm. 0 CalOptima Health 6 T i .J r .;T ... +rF, ... �r Residents of the City of Tustin All residents of Orange County who meet eligibility requirements are welcome in both the Recuperative Care/Post Hospitalization and PACE programs of the Community Living Center. However, priority will be given in both programs to residents of the City of Tustin. When demand exceeds the facility approved capacity a waiting list will be created. Tustin residents on the waiting list will receive priority access when space becomes available.A Tustin resident is defined as somebody having lived within the City corporate boundary for a period of more than 31 days within the last 12 months. Good Neighbor Policy Successful operations of the Community Living Center of Tustin will be for the public good and to move the homeless continuum of care system forward. This will require partnerships with various stakeholders, service providers, community groups and government organizations. Both programs of the Community Living Center of Tustin are committed to communicating with all these stakeholders on a regular and ongoing basis. The programs will operate in a manner to eliminate neighborhood impacts and ensure a safe and clean community within immediate proximity of the center. In addition, it is the goal of the center to foster strong community engagement that supports the long-term success of the Community Living Center of Tustin. As part of the implementation of the Good Neighbor Policy, CalOptima Health will: • Communicate and coordinate regularly with neighbor residents, local businesses, and other vested stakeholders. • Communicate and coordinate regularly with local police and fire departments and work collaboratively to minimize the impact on the departments. • Communicate and coordinate regularly with the City of Tustin, The County of Orange and other community service providers. 0 CalOptima Health 7 • Actively participate in city and county-wide community events and attend meetings of the local Neighborhood Associations and Chamber of Commerce. • Lead a neighborhood engagement team, comprised of both staff and community volunteers, to promote cleanliness, engage with neighbors, and enhance the safety and cleanliness of the immediate vicinity. • Sponsor special events such as community resource fairs,which will include the community and neighbors. 414 r .. Loitering The Community Living Center of Tustin is committed to being a good neighbor and ensuring the center will have not a negative optical impact on the community. Therefore, the Center will implement the following measures to discourage loitering: • A designated waiting area for guest departures will be established and clearly delineated. • Guests will not be allowed to loiter in front of the building or in the surrounding neighborhood. • A bed reservation system will be utilized; no walk-ins will be accepted. • All guests will arrive by taxi or non-medical transportation at the front of the building, utilizing designated admission parking spaces. • Guest vehicles will be parked in a designated location in the underground parking structure, eliminating unauthorized parking in the surrounding neighborhood • Shuttle bus drivers and employees will be trained to "watch" the neighborhood for PACE guests and spot and report any observed loitering to Manager on Duty (MOD) • Security personnel to sweep the immediate vicinity one (1) hour after PACE Center closure. • A bicycle rack will be provided in a secured, outdoor area for guests to utilize. • Neighborhood Engagement Team will monitor the neighborhood to control issues of abandoned property, shopping carts and other "blight" 0 CalOptima Health 8 Security Plan CalOptima Health will follow policies and procedures in both the Recuperative Care/Post Hospitalization and PACE programs that promote the utmost of safety for our guests, staff, volunteers, and the community and will strive to provide an atmosphere that promotes community, stays alert for signs of conflict and addresses behaviors before they escalate. As part of the implementation of the security plan, CalOptima Health will: • Provide security personnel on site 24 hours a day, 365 days per year • Prohibit guests from bringing weapons or objects which can be used as weapons into the center. • Implement a rounding program will be implemented that includes security personnel, nursing, social services, environmental services, food service and administration, ensuring each guest is engaged and monitored a minimum of 4 times per day. • Ensure all staff will have communication with each other via portable electronic equipment. • Install and keep in good working order surveillance cameras both inside and outside the facility. • Install and keep in good working order security lighting both inside and outside the facility, including but not limited to entrances and parking lots. • Install and keep in good working order an electronic gate for the entrance to the underground parking. • Install and keep in good working order a security key fab system for all exterior doors and offices. • Install and keep in good working order an intercom system and emergency response system • Ensure all guests enter the Community Living Center through the front entrance, utilize a coordinated sign in/out process, and identification as a resident will be verified. The Community Living Center of Tustin will be staffed to provide the safest, most dignified environment for all guests. All staff will be easily identifiable and will wear CalOptima Health approved shirts and name tags. In addition, all staff will engage in a year-round training program that will include topics including but not limited to: • Trauma-Informed Care • Motivational Interviewing • Cultural Humility and Implicit Bias • HIPPA Compliance • Promoting Safety and de-escalation • Supporting and caring for Individuals with Substance use disorders • Supporting and caring for Individuals with Mental Health diagnosis 0 CalOptima Health 9 • Gender and sexual orientation affirming care • Health Equity and Social Determinants of Health • CPR and First Aid, and AED • Food Handling • Fire drill and disaster evacuation procedures Contact Information Upon opening, the Community Living Center of Tustin will have the following in place to ensure effective and consistent communication and contact the public: PACE PROGRAM An on-site Point of Contact and a Corporate Point of Contact will be established, and phone numbers posted both at the facility and on the program's website. This website will also include "Frequently Asked Questions" to help provide instant answers to community questions and concerns. In addition, a receptionist will be on duty 8am to Spm Monday-Friday 8am to Spm to respond to public inquiries. During off hours, the community will be able to leave a message and receive a response during business hours the following day. Program brochures will be available on site as well as disseminated during community events. Media guidelines will be created, and a team designated to handle all media requests as well as ensure the public is regularly updated on the progress and success of the program. Visits by members of the community and tours of the program will be available by scheduling an appointment with the receptionist. The PACE Program of the Community Living Center of Tustin is fully committed to providing an appropriate customer service response to all inquiries. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM An on-site Point of Contact and a Corporate Point of Contact will be established, and phone numbers posted both at the facility and on the program's website. This website will also include "Frequently Asked Questions" to help provide instant answers to community questions and concerns. In addition, a receptionist will be on duty every day from 8am to 8pm to respond to public inquiries. During off hours, the community will be able to leave a message and receive a response during business hours the following day. Program brochures will be available on site as well as disseminated during community events. Media guidelines will be created, and a team designated to handle all media requests as well as ensure the public is regularly updated on the progress and success of the program. Visits by members of the community and tours of the program will be available by scheduling an appointment with the receptionist The Residential Program of the Community Living Center of Tustin is fully committed to providing an appropriate customer service response to all inquiries. 0 CalOptima Health CalCptima Health A Public Agency AVWO ' ""• 5G5 City Parkway West IT- a l 4 i a Health Orange, 46 92868 V 7 t 4-246-840D `J' TTY: 71,1 caloptime.org January 3,2023 Jorge Maldonado Planning Division, CDD, City of Tustin 300 Centennial Way Tustin, CA 92780 Dear Mr. Maldonado, Thank you for reviewing Cal Optima Health's Operation and Security Plan for the Community Living Facility in Tustin, Please see below responses to the two questions outlined in your email received December 22,2002. Where guests are taken when involuntarily discharged from the PACE and Recuperative Care programs? It is the policy of CalOptima Health to ensure that all guests in both the PACE and Recuperative Care programs have a safe discharge plan, and that no one is discharged directly to the street voluntarily or involuntarily. In the unfortunate event a guest must be discharged involuntarily, the following options will be available: • Hospital partners will assist with Recuperative Care Guests needing additional immediate medical care. • BeWell Regional Campus will assist with Recuperative Care Guests needing additional immediate behavioral health care.. • Tustin Police Department will assist with Recuperative Care Guests who are involved in criminal activity, • Partnering County and City shelters will assist with Recuperative Care Guests who are inappropriate for the center. • PACE Guests do not live at the center and therefore all involuntary discharges would be to the Guest's home. • Family members open to reunification. Security camera locations and willingness to share surveillance footage with the Tustin Police Department? Ensuring the safety of our Tustin neighbors; employees and guests of our Community Living Center is of highest importance to CalOptitna Health. Therefore, the security plan includes visible cameras located both inside and outside building, covering all public areas. These cameras will be monitored 24/7 security personnel, It is anticipated that a minimum of 30 cameras will be needed, the locations of which will be finalized as the building plans are developed. CalOptima Health sees the Tustin Police Department as a partner in the services we provide to the communities we serve. In the spirit of that vested partnership we expect to share resources for the safety Of our guests, employees, and neighbors. CalOptima will nfiake available requested CCTV footage in consult with CalCptima's legal team. Thank you For the opportunity to share our responses to your questions. We look forward to the scheduled Planning Commission meeting scheduled for January 24`h and our continued work together on this important project. Sincerely, lue Kelly Bruno-Nelson Executive Director, Medi-Cal & CalAIM CalOptima Health CalOptirna Health, A Public Agency CalOptima responses to Jorge Maldonado's January 10, 2023 follow up questions. 1. How many shuttles will you have for the facility, what are their sizes, and will they be stored overnight on-site? Current plans are to utilize the PACE shuttles already in operation at our Garden Grove site. We currently operate 17 shuttles. These shuttles are commercially sized (similar to Access shuttles). CalOptima currently contacts with an outside company to operate these shuttles, and they are stored at this outside company's location. 2. What are the shuttle arrival schedules? Are they staggered? Arrival and departures are staggered during regular business hours of 7:30am to 5:OOpm, Monday thru Friday. 3. What are the hours of PACE hours of operation? PACE will be open between 7:30am and 5:OOpm Monday thru Friday. 4. Operations and Safety Plan for the Recuperative Care states "All guests will arrive to the program by uber, taxi, ambulance, or non-medical transportation." Will any Recuperative Care guests arrive by their own vehicle? We do not anticipate recuperative guests arriving by their own vehicle as the population to be served does not generally own a vehicle. In the rare occasion this was to occur, guests would park their vehicles securely and out of site in the underground parking at the facility. 5. The Detailed Project Narrative identifies the anticipated number of employees for the Recuperative Care component by shifts. How many employees will there be for the PACE component of the campus? The PACE program will have approximately 75 employees but maximum at any one time would be approximately 50. Responses to City's January 12, 2023 follow-up questions: 1 . How do prospective guests apply for the program? Are they only to be referred by hospitals? Certain partner organizations? Most guests will be referred by local hospitals and must meet all eligibility criteria in order to be admitted. We are also looking forward to working with the local police and fire department to also identify individuals who may be living on the street that could be eligible. Our intake department will do a full intake of these individuals to ensure eligibility criteria is met prior to admittance. No one is admitted without being screened through our intake department. 2. Does the program involve a follow-up meeting with guests after they have been placed in permanent housing and successfully recovered? If so, please describe. Each individual that leaves our program will receive "housing tenancy services", a community support offered through CaIAIM. This service offers ongoing support to individuals newly housed to ensure they remain housed. These services are offered for up to a year after recuperative guests are placed into permanent housing. 3. Does the proposed recuperative care program follow the NIMRC Standards for Medical Respite Care Programs? Yes- these are the policies created by the national healthcare for the homeless counsel that are referenced in our security and operations manual. 4. What is the policy regarding storage of guest belongings? Where do they store belongings when part of the program? As most Guests arrive directly from the hospital, they do not have many belongings with them. Each Guest will be staying in semi-private rooms that will be equipped with dressers, closets, additional storage and a personal locker. Therefore, each guest will store their belongings in their own room. For guests with additional items, on site storage will be available. 5. What is the pet policy? Can guests bring pets with them? Space permitting, the facility plans to have a limited number of rooms available for guests with pets. 6. Can guests voluntarily disenroll from the recuperative care program prior to being placed in permanent housing? What is the protocol in this scenario? Typically, if Guest decides to leave the program prior to being placed in permanent housing, it is to pursue housing through a family reunification opportunity either local or out of state. In the rare event, that a guest decides, they would like to leave the program prior to identifying permanent housing, arrangements will be made for the guest with a local shelter. 7. What is the protocol once guests exceed the 6-month term for post-hospitalization housing? If the program has not identified permanent housing for a guest prior to the six- month post hospitalization period, the guest will be allowed to remain in the program until permanent housing is identified. 46 CALoP - N TIMA". f 1 TH PROGRAM OF ALL-INCLUSIVE CARE(PACE CAMPUS) AND RECUPERATIVE CARE FACILITY msn.pnment � to'ina6lllly Motu m 14851 YORBAST&165 MYRTLE AVE,TUS71V.CA92780 PROJECT DATA -1014 MW � � w 'PROJECTUIRF,CTo1 SHEET INpEJ[ yr VICINITY MAP .L.LL-L 5ITE i I 1 .. 41 I`AO.1 i s� /C t4C�1 11 rl'7 6 x r_Y Qed U-'ado Hum u �aw� r Lilll�Ll�1.1.11 4MPON (D ^^ A1.1 t. w 4 Y �ae. a� ni Li rip --- Jo ii 77 - r I ��.- LI LLI I LI LLLI II` r LLI Ia la i.l LLLI PACE � III� lilllli ��a n1e. s -I-�vSpi'�t��ia. an FlREr FLO�W PLM _ - A2.lb I I I a, foam 30-,m a° VJI.i IJLILLI I1IL1VIIiiILI � I��IICII�III CIO FiQORP4Al1 fl 'ti]] A2.F L .. _ ----------. -- .. • i "9� I "IY .. ti - W, ALUATETS w 0 U^ LV LLV LLI Ia.I I 1 PffJApff a-ho(od'd pit.- i 'i ZA FIRST FLOOR PLLA � A2.1a RECI MI) 2�z3 Request for Additional Information FEB 6 January 26, 2023 Conditional Use Permit 2022-0019 COMMUNM DEVELOPMENT BY; The Community Development Department is requesting clarification on information provided regarding Conditional Use Permit (CUP) application 2022-0019. Please see the questions and comments below which are organized by the document they reference. Please consolidate the responses to these questions with the responses and operation plan previously provided such that all information is submitted in one document. Also, to expedite our review, please provide separate documents under a different cover for (1) Operations Plan and Manual and (2) Security Plan. O erations and Securit Plan dated 12-15-2022 I. FLOOR PLAN AND SITE PLAN: a. Identify on the floor plans the areas used for PACE vs. recuperative care vs, post- hospitalization housing. Consider shading or outlining these areas in different colors. Identify what entrances will be used for specific programs. Please see floor plans in Attachment A with areas and entrances identified. b. Clarify if any new fencing is proposed around the perimeter of the property or building, and how access to and from the buildings, common outdoor areas, and underground parking is otherwise secured and controlled. No additional fencing is being proposed. Each exterior door of the facility will be equipped with security "key card" access. Common outdoor areas are secured and accessible from inside the building and with key access where any exterior fences exist. Underground parking is secured with an automatic gate which will be secured and controlled with key card access. II. REGARDING PROJECT DESCRIPTION AND USE: a. Define "Community Living Center," Community Living Center is the term used to describe the entirety of the campus buildings being proposed for the location at 14851 Yorba Street and 165 Myrtle Avenue. More specifically, the Community Living Center refers to this facility that will provide recuperative beds and post hospitalization beds to unhoused older adults, defined as 55 years or older, and a PACE center for Guests to access. b. Define eligibility criteria for the recuperative care program and short-term post- hospitalization housing. Any Guest being considered for admittance into the Community Living Center's Recuperative Care program must meet the following eligibility guidelines and criteria: 1 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Able to complete all Activities of Daily Living (ADLs) independently or with minimal assistance. For Guests with wheelchairs and/or Durable Medical Equipment (DME), Guests must be able to: Use DME device safety and understand proper use and handling. (i.e., transfers from toilet to wheelchair) Use DME without assistance (no Care Giver Assistance required) Ambulate at least 20 ft prior to hospital or facility discharge (with or without DME) • Able to self-administer medication with staff oversight • Continent of both bladder and bowels (if diapers are used, patient must change and maintain hygiene completely independently) • Medically and psychiatrically stable at discharge. • Alert and oriented (Name, place, date and situation) • Not a danger to self or others (not suicidal or violent) Exclusion Criteria: • Unable to complete ADLs, personal care, or medication administration • Incontinent of bladder and/or bowel • Significant Cognitive impairment, suicidal, or danger to self or others. • Active Tuberculosis/C-DIFF/MRSA of Sputum • Stage 3 or higher decubitus ulcers • Unstable medically and/or psychiatrically • Patients actively detoxing (will need to be stabilize prior to being referred) Guests admitted into the Post-Hospitalization program will be transferred directly from the Recuperative Care program. C. There has been conflicting information provided in the submittal. i. Some narrative identifies clients are low and extremely low-income individuals with no defined age; other narrative identifies clients as unhoused older adults. Clarify if patients are limited to unhoused older adults or any individuals that are low or extremely low income. Define older adults. The Recuperative Care/Post Hospitalization Program is only available to Older Adults, aged 55 and over, who are unhoused. Any individual who does not meet the minimal age requirement will not be admitted into the facility. 2 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 Guests admitted into the PACE program may be inclusive of both Guests living at the Community Living Center as well as community members who are low and extremely low income, or current CaiOptima Health members, who also meet the additional PACE eligibility requirements outlined in the operations manual, only if capacity allows. Similarly, CalOptima Health's current PACE program in Garden Grove, all Guests are low income and Medi-Cal recipients. d. Clarify if the facility is going to function as a Navigation Center for all homeless individuals or limited to registered patients only. Clarify the differences, if any, between the proposed use and a "navigation center." The Community Living Center is not a Navigation Center, The Community Living Center, is a Recuperative Care/Post-Hospitalization Program that will utilize a bed reservation system and only be available to Older Adults, 55 years or older, who meet the medical criteria. e. Clarify if the site will provide housing to homeless individuals who do not need medical assistance or rehabilitation services. The Community Living Center will not provide housing to individuals who do not need medical assistance or rehabilitation services. The only individuals who are eligible for the Community Living Center are Older Adults, 55 years or older, who are unhoused and meet the medical criteria. i. Confirm if services (recuperative or PACE) would be provided to families that are experiencing homelessness and/or meet income eligibility requirements, but who are not otherwise elderly or in need of medical care. Both the Recuperative Care/Post Hospitalization and PACE Programs will provide services only to individuals; the center does not serve families. f. Clarify any differences between the recuperative care vs. short-term post- hospitalization program. i. Is there a difference in services provided, eligibility criteria, room locations within the center, etc.? Post Hospitalization program is designed to provide Guests additional time to receive medical support and permanent housing assistance immediately after the Recuperative Care Program. These two programs are designed to provide services consecutively. There is no difference between the services provided, eligibility criteria, or room location within the center. ii. Is there a fixed number of beds available for the recuperative care program vs. the short-term post-hospitalization housing program? 3 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 No. iii. Are the 6 months of post-hospitalization housing in addition to the initial 90-day term of the recuperative program (so 9 months total)? Is there a time limit after the 6 months? How much longer can they stay? Yes, the 6 months of the Post-Hospitalization Program is in addition to the initial 90-day term of the Recuperative Care Program. However, ALL guests will be allowed to stay until permanent housing is identified and secured, ensuring housing stability from the moment of admission. We anticipate the average length of stay will be 1 year. iv. Explain how insurance companies handle situations where guests exceed the 6- month term for post-hospitalization housing. Are guests automatically approved? How often is this anticipated to happen? All Guests will be Medi-Cal recipients or Medi-Cal eligible. CalOptima Health is the o�/y Medi-Cal Health Plan in Orange County so therefore all Guests admitted to the Recuperative Care/Post Hospitalization Program will be CalOptima. Health members. Cal Optima Health's claims department already processes approvals for recuperative care bed days and post-hospitalization bed days. All authorizations will be handled in accordance with current claims practices, and will be automatically approved until Guests are medically stable and have identified and secured permanent housing. g. What is expected of recuperative care/short-term housing participants in their role as care recipients? Within 7 days of admission to the Community Living Center, a care plan will be created with each Guest, in coordination with the interdisciplinary care team(Nurse and Social Worker). Each Guest will be expected to participate in their plan of care. i. Will there be a curfew? If so, how will this be implemented or monitored? Following the policy at the Village of Hope, there will be a curfew of 10.00pm. The Community Living Center will not allow loitering. Guest waiting for coordinated transportation will do so inside the building. Guests arriving after 10;00pm who have not made arrangements for a post-curfew return will be counseled and encouraged to arrive before curfew. CaiOptima Health will make every effort to ensure Guests are not discharged to the street. 4 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 ii. Will there be a no drug or alcohol use policy? If so, how will it be enforced? Drug and alcohol use will not be permitted at the Community Living Center. Guests will be made aware of this policy at the time of admission during the Guest Orientation process. All staff will be trained to report any observed drug use by Guests. Should a Guest be observed using drugs or alcohol, they will be reminded of the policy they agreed to upon admission. Should a Guest need to be reminded a second time, they will be disenrolled from the program. h. Is there a visitor policy for recuperative care/short-term housing recipients? Guests in the Recuperative Care/Post-Hospitalization Program will be allowed to have visitors between the hours of gam and 5pm. All visits will be pre-coordinated and occur in designated, public areas of the Center. All visitors will park in the underground parking lot that already exists and be escorted by security into the building. Based on previous experience, we anticipate fewer than five Guest visitors per week. i. What is CalOptima's or CaIAIM's affiliation with the County of Orange Continuum Care, Coordinated Entry System, etc.? Kelly Bruno-Nelson, CalOptima Health's Executive Director of Medi-Cal and CalAIM currently serves on the Board of the County of Orange Continuum of Care. CalOptima Health has access to the Coordinated Entry System and plans to utilize this system at the Community Living Center. j. Clarify the funding mechanism behind the program — on what basis are funds allocated from CalAIM to the center? Are there any other funding sources outside of CaIAIM? All funding for the program is provided by CalOptima Health through the CalAIM program which is funded by the State of California. No other funding sources outside of CalOptima Health will be required. k. Are Tustin community organizations, such as Families Together of Orange County, partnered with the center? An RFP will be released to identify the partner organization to operate the medical services associated with both the Recuperative Care/Post-Hospitalization and PACE Programs. We anticipate that Families Together Orange County will apply to this RFP. Ill. GENERAL.. a. Will guests in the recuperative care or short-term post-hospitalization housing programs be counted towards the Point in Time Count? Please clarify how guests are 5 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 counted as sheltered or unsheltered. If they are counted as homeless individuals, to what cities are they to be assigned? The Point in Time Survey counts sheltered and unsheltered homeless individuals. The Community Living Center is not a shelter, therefore Guests will not be counted towards the Point in Time Count. IV. INTAKE AND DISCHARGE a. PACE: i. Clarify if other homeless individuals (not recuperative patients) can access the PACE center and its services. No unhoused individuals, outside of those residing in the Community Living Center, will be eligible to enroll in the PACE program. ii. Clarify and provide a map for the Caloptima PACE Service Area. Calaptima Health's PACE program is able to provide services throughout Orange County and includes the following zip codes:. 90620 92602 92624 92649 92672 92694 92801 92832 92866 90621 92603 92625 92651 92673 92701 92802 92833 92867 90623 92604 92626 92653 92675 92703 92804 92835 92868 90630 92606 92627 92655 92676 92704 92805 92840 92869 90631 92610 92629 92656 92677 92705 92806 92841 92870 90638 92612 92630 92657 92679 92706 92807 92843 92886 90680 92614 92637 92660 92683 92707 92808 92844 92887 90720 92617 92646 92661 92688 92708 92821 92845 90740 92618 92647 92662 92691 92780 92823 92861 90743 92620 92648 92663 92692 92782 92831 92865 1 taamr aCTW '!p1"° upl —11 Tolra YTIam KiiuCfSltiP �AW. 1!�MT 90 0 Offlt !fall 11TOi Y]Y5} pya 111W Morom V. f5tlRL9AT<blmT�v�P nIa � Ym}]y iP.T] 1Jiaq b1f1 ams Iwa w os�T, ttm lT°3-` r'�a'3xe3da a9Tlrc ax°�' parr rr+o! ylei 1mTac {raat W � aAT�}t y. !901 WW.. 9:1p+.' 9Tlmi - M1Fl %}DI Taa fmfl] Y11 ]G ✓�PratllmlfJfd} Y1aa'P t1a11. 4411Y1T !1a Wil1 StlYt fi¢/:A �a a}}TMOI YfNI1 WtIGP iTa 9a Y.aia At�n 9i1;Plyyiy llala 1.P 11Vl fjl'.11"1^"4 WT°0 110 1— OV. 9P11/laT1V soaps ��oYiat °z}a 543ffuTot'uhi�;rill� loua. SyTu.errili101 s,!"a aria 'HunllrRy'4!#}�i Er�p+r. !x' �! aura e}s.,r"Tsar W2 oxrs 1261. 1.li. .. !Tear 1�0 °' 4a>r aresiEatll uax arx} g dal ��>re'1/111 VIE4NFO !e Y! Sea. Y1fA1 at 1iT MEOfll a15/i alYrT ✓ Y''wTa PAT faY I.YT/ Y3dTj IWal Y q U Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 iii. Define the "financial criteria" for PACE participants. There are no financial criteria for PACE. Community members who are low or extremely low income, or CalOptima Health Members, are able to participate in PACE should they meet all other requirements. iv. Provide a Code of Conduct with expectations for PACE participants. The PACE program is licensed and monitored by the Department of Health Services. Therefore, program guidelines, requirements and expectations are determined by the State of California. Below is the "Patient Rights and Responsibilities" policy approved by the State of California that includes conduct expectations. All Guests have the right to: • Receive your health care in an accessible manner and in a safe, clean environment. • Be free from harm.. Harm includes physical or mental abuse, neglect, excessive medications, physical punishment or being placed by yourself against your will, as well as any physical or chemical restraint used on you for discipline or convenience of staff that you do not need to treat your medical symptoms or prevent injury. • Be free from hazardous procedures, • Receive treatment and rehabilitation services designed to promote your functional ability to the optimal level and to encourage your independence. • Receive care from professionally trained staff that has the education and experience to carry out the services for which they are responsible. • Participate in a program of services and activities that promote positive attitudes on usefulness and capabilities and are designed to encourage learning, growth and awareness of constructive ways to develop your interests and talents. • Self-determination within the day care setting, including the opportunity to: 1. Participate in developing a plan for services. 2. Decide whether or not to participate in any given activity. 3. Be involved to the extent possible in program planning and operation. • Be cared about in an atmosphere of sincere interest and concern in which needed support and services are provided. • Be ensured of auditory and visual privacy during all health care examinations and treatment visits. • Be encouraged and assisted to exercise your rights in CalOptima PACE. 7 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Receive assistance, if you need it, to use the Medicare and Medi-Cal complaint and appeal processes, and your civil and other legal rights, • Be encouraged and helped in talking to CalOptima PACE staff about voicing complaints and recommending changes in policies and services to CalOptima PACE staff and to chosen outside representatives. There will be no restraint, interference, coercion, discrimination or reprisal by staff if this occurs. • Use a telephone while at the CalOptima PACE Center, make and receive confidential calls and/or have such calls made, if necessary. • Not have to do work or services for CalOptima PACE. • To receive competent, considerate, respectful care from staff and contractors without regard to race, national/ethnic origin, religion, age, sex, sexual orientation, mental or physical disability, or source of payment for your health care. • Have someone help you if you have a language or communication barrier in order that you can understand all information provided you. • Have someone interpret all information given to you into your preferred language in a culturally competent manner, if your first language is not English and you cannot speak English well enough to understand the information being given to you. • Have the Enrollment Agreement discussed fully and explained to you in a manner you understand. • Receive marketing materials and CalOptima PACE Rights in English and any other frequently used language in your community. You can also receive these materials in braille or in an audio format, if necessary, • Receive a written copy of your rights from CalOptima PACE. CalOptima PACE will post these rights in a public place in the CalOptima PACE Center where it is easy to read them. • Be fully informed, in writing, of the services offered by CalOptima PACE, • Review, with assistance if needed, the results of the most recent review of CalOptima PACE. • Have a copy of CalOptima PACE's non-proprietary clinical and administrative policies and procedures from the PACE Director. Requests are to be submitted in writing. • To choose a health care provider within the CalOptima PACE network and to receive quality health care. • Women have the right to get services from a qualified women's health care specialist for routine or preventive women's health care services. s Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • To reasonable and timely access to specialists as indicated by your health condition and consistent with current clinical practice guidelines. • To receive emergency services when and where you need them without CalOptima PACE approval. • To fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. • Have all treatment options explained to you in a language you understand, be fully informed of your health and functional status and how well you are doing, and make health care decisions. • Be informed of all treatment prescribed by the IDT prior to being treated, when and how services will be provided, and the names and functions of people providing your care. • Refuse treatment or medications. If you choose not to receive treatment, you must be told how this will affect your health. • Be assured that decisions regarding your care will be made in an ethical manner. • Be assured that you and your family will be educated about an illness affecting you so that you can help yourself, and your family can understand your illness and help you. • Receive information on advance directives and have CalOptima PACE help you create an advance directive. • Participate in making and carrying out your plan of care, which will be designed to promote your functional ability to the highest level and encourage your independence. • Appeal any treatment decision made by CalOptima PACE or our contractors through our appeals process and request a State Hearing. • Receive necessary care across all care settings, up to and including placement in a long-term care facility when the PACE organization can no longer maintain you safely in the community through the support of PACE services. • Be given advance notice, in writing, of any plan to move you to another treatment setting, and the reason you are being moved. You have the right to: • Talk with health care providers in private and have your personal health care information kept private as protected under state and federal laws. 9 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Review and receive copies of your medical records and request amendments to those records. • Be assured that all information contained in your health record will be held in confidence, including information contained in any automated data bank. • Be assured of confidentiality when accessing sensitive services, such as sexually transmitted disease (STD) and HIV testing. • A full explanation of the complaint and appeals process. • Assistance to exercise civil, legal and participant rights, Including the CalOptima. PACE grievance process, the Medi-Cal State Hearing process and the Medicare and Medi-Cal appeals processes. b. Recuperative Care: i. Define and clarify Recuperative Care and Post Hospitalization service areas. Can any person throughout the county receive services if they meet eligibility criteria? The Recuperative Care/Post-Hospitalization Program will prioritize eligible Older Adults that are unhoused from the City of Tustin. Older Adults who are unhoused from Orange County, either discharged from a hospital or referred from a shelter in the City of Tustin and meet eligibility requirements are also eligible to receive services in the Recuperative Care/Post-Hospitalization Program. ii. The Operation Plan states guests are patients discharged from hospitals. Clarify what hospitals guests will be received from. Provide a list of participating hospitals, if any. All hospitals in Orange County will be able to refer potential Guests to the Recuperative Care/Post Hospitalization Program. Once medical eligibility is confirmed, priority will be given to those with ties to Tustin. iii. Define or provide information related to behavior expectations and Code of Conduct for recuperative care/post-hospitalization housing recipients. To ensure all Guests have a safe and pleasant stay, CalOptima Health asks each Guest to abide by the following Guidelines and Code of Conduct. • Please keep common areas neat and clean for all to enjoy by cleaning up after yourself, • Keep your room organized and free from unnecessary clutter. • Weapons of any kind are not permitted in The Community Living Center. 10 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • We will respect your privacy. However, we will search your belongings upon entry into the Community Living Center and additionally if we suspect you have weapons, property that belongs to others, or items that present a threat to others. • We ask that you treat Guests, staff and visitors with respect. Behavior that is deemed to be threatening to the safety of others will be reviewed for potential early discharge. • Guests are only permitted in their assigned rooms. We ask that you do riot enter other Guests' rooms. • We strongly encourage you to take your medications as prescribed by your physician. However, if you choose not to, please do not flush or throw them away. Our medical coordinator is happy to discuss with you any questions you may have about your medications. • For everyone's safety, please do not share your medications with anyone. • Please utilize the available sharps containers in the nursing office and in your restroom for all needle disposal. • Drug and alcohol use is not permitted at the Community Living Center, Should you choose to use drugs or alcohol at the Center, you will be discharged. • Three meals will be provided daily in the dining room. Cooking inside of your room is not allowed. For your convenience, microwaves are located in the "Grab and Go" areas. • Healthy snacks are always available in designated "Grab and Go" areas. In addition, a snack cart will make rounds daily. • You may have visitors while staying at the Community Living Center between the hours of gam and 5pm. All visits must take place in designated visiting areas. 24-hour prior arrangements with your Social Worker must be made for visits to be approved. • While we expect all guests to be respectful of each other's property, theft does sometimes occur. We are not responsible for any lost or stolen property, including medication. Therefore, we recommend you keep all of your belongings inside of your room and utilize your personal locker for all of your valuables, including medication. • We encourage you to keep your medicine in your room. However, we can also store your medication for you in the nurse's office if that is something you prefer. • Quiet hours are observed from 10:00 p.m. to 7:00 a.m. As a courtesy to everyone, we ask that you keep noise levels at a minimum during this time. 11 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Please observe our Curfew of 10:00pm. We understand that at times it will be necessary for you to return after 10:00pm. Please make arrangements with your Social Worker for these occurrences. • It is our hope that all Guests will secure Permanent Housing prior to discharge from the Community Living Center. However, if discharge does occur prior (and is not due to a hospitalization), we will hold your personal items for up to 72 hours after your discharge. • If at any point during your stay with us you are unsatisfied with the care you are provided, you may notify administration by filing a grievance report. These are available at the lobby front desk. • Staff will knock and with permission, enter your room six times throughout the day and night as they check in with you to ensure your wellbeing. We ask that you answer the door each time you hear a knock on the door. If for some reason you do not answer, staff will enter the room to ensure your safety. During those visits, please let staff know how they can assist you and support your recovery. iv. Clarify if homeless individuals can register themselves into the recuperative care and post-hospitalization housing programs. Homeless individuals are not able to register themselves forthe Recuperative Care Program/Post-Hospitalization Program. The only way for an unhoused ©lderAdult to obtain a bed in the Community Living Center is through a direct referral from a hospital, Tustin law enforcement, or a shelter within the City of Tustin. v. Clarify eligibility requirements for the recuperative care and post-hospitalization housing programs, such as individuals needing to have injuries, be referred by hospitals, etc. Any Guest being considered for admittance into the Community Living Center's Recuperative Care Program must meet the following eligibility guidelines and criteria: Able to complete all Activities of Daily Living (ADLs) independently or with minimal assistance. For Guests with wheelchairs and/or DME guest must be able to: Use DME device safety and understand proper use and handling. (i.e., transfers from toilet to wheelchair) Use DIME without assistance (no Care Giver Assistance required) Ambulate at least 20 ft prior to hospital or facility discharge (with or without DME) 12 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Able to self-administer medication with staff oversight • Continent of both bladder and bowels (if diapers are used, patient must change and maintain hygiene completely independently) • Medically and psychiatrically stable at discharge. • Alert and oriented (Name, place, date and situation) • Not a danger to self or others (not suicidal or violent) Exclusion Criteria: • Unable to complete ADLs, personal care, or medication administration • Incontinent of bladder and/or bowel • Significant Cognitive impairment, suicidal, or danger to self or others. • Active Tuberculosis/C-DIFF/MRSA of Sputum • Stage 3 or higher decubitus ulcers • Unstable medically and/or psychiatrically • Patients actively detoxing (will need to be stabilize prior to being referred vi. For involuntary discharge, please identify potential discharge locations. Will guests be discharged to locations based upon their last known residences? If guests are from other cities (not Tustin) where will they be discharged? Does CalOptima have any cooperative agreement(s) with other shelters, affordable housing providers, non-profit organizations, etc. that will accept discharged individuals? Please describe the mechanism to allow guests to be discharged to the specific locations. CalOptima Health will follow the same policy and procedures of the Tustin Temporary Emergency Shelter when it comes to involuntary discharges to ensure that all guests in all programs at the Community Living Center have a safe discharge plan. No Guests who is involuntarily discharged will be discharged to the streets of Tustin. In the unfortunate event a Guest must be discharged involuntarily, the following options will be available through our community partners: • Hospital partners will assist with Recuperative Care Guests needing additional immediate medical care. • BeWell Regional Campus will assist with Recuperative Care Guests needing additional immediate behavioral health care. • Tustin Police Department will assist with Recuperative Care Guests who are involved in criminal activity. • Partnering County and City shelters will assist with Recuperative Care Guests who are inappropriate for the center. 13 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • PACE Guests do not live at the center and therefore all involuntary discharges would be to the Guest's home. • Family members open to reunification. • If none of these options are available, CalOptima Health will contract with UberHealth to provide transportation to a location based upon their last known residence. vii. Can other shelters refer individuals to the program? If yes, how do you determine if guests are eligible? Do they need to be referred by a medical professionals or hospitals? Most Guests will be referred by Orange County hospitals and Tustin law enforcement. If capacity allows, only a Tustin shelter may refer a potential Guest to the Recuperative Care/Post-Hospitalization Program if the Guest meets the medical criteria for the program. The same intake and screening process will be implemented to ensure the potential Guest meets all eligibility requirements. viii. The program will provide preference for individuals that have ties to Tustin. How will this be provided? Is there a minimum number of beds set aside for Tustin individuals? The Community Living Center will give local preference to the City of Tustin. The number of beds is currently not predetermined. C. Post Hospitalization: i. Clarify eligibility for the Post Hospitalization Housing Program. The narrative includes "quality care to older adult neighbors experiencing homelessness." Clarify if this program is limited to guests "terming out" of the recuperative care program only. If not, please clarify where guests originate from and how they are admitted to the program.. The Post Hospitalization Program is designed to provide Guests terming out of the Recuperative Care program additional time to receive medical support and secure permanent housing immediately after the Recuperative Care Program. These two programs are designed to provide services consecutively. V. SECURITY a. Loitering i. How many Managers on Duty will be present on-site? What are their weekday and weekends hours of availability? Are they available after regular business hours? If not, who is the point of contact at the center after hours? 14 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 The Director of the PACE Program will be on site M-F 8:30am-5:00pm. The program is closed on weekends. The Director of the Recuperative Care/Post Hospitalization Program will be on site Monday thru Friday 8:30am- 5:00pm. The Assistant Director will be on site Wednesday thru Sunday 11:30am-8:00pm. There will be a "Manager on Duty" during all hours outside of these hours; a Manager is on duty 24/7. ii. What personnel are on the Neighborhood Engagement Team? How often do they meet, and what happens after they identify an issue? The Neighborhood Engagement Team will be led by the Community Living Center's Community Engagement Manager and will be comprised of additional Community Living Center staff as well as community volunteers. The Community Engagement Manager will work to identify and engage these community volunteers and coordinate a meeting schedule that accommodates the entire team. This team will meet weekly or as often as the team determines necessary. Issues identified will be given immediate attention and a plan will be developed to ensure the issue is resolved. b. Security Plan i. How many security personnel will be on-site during regular business hours (daytime) and after hours (nighttime)? What certifications, if any, would they have as security personnel? The Safety and Security team consists of the Safety and Security Manager and 15 Guest Safety Associates. It should be noted that The Community Living Center will follow the same security policies and procedures as the Village of Hope and implement a "Dispersed Security System". This will ensure all staff are trained and responsible in all areas outlined in the security plan. ii. Provide a detailed Security Management Plan for review and approval. The Security Management Plan shall include security measures to minimize impact to adjacent residential and non-residential uses from potential noise, pedestrian and vehicular activities (i.e. noise from ambulance, Fire trucks, loitering, etc.). The Security Management Plan shall also include measures to address loitering, illegal drugs/narcotic activities, illegal activities, security cameras, security alarms, procedures for calling Tustin Police Department regarding observed or reported crime, security measures during non-operating hours, training protocols for all employees and security personnel, and an after-hours single point of contact for the Police Department prior to the commencement of the proposed use. 15 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 iii. Define the protocol for ensuring guests do not use illegal drugs. Guests will be made aware that drugs and alcohol are not permitted at the Community Living Center and educated on this policy during the Guest Orientation process that occurs upon admission. Guest belongings will be scanned upon admission. All staff will be trained to identify behaviors commensurate with drug use to ensure the safety of all Guests. The consistent Rounding Program (detailed below) will provide consistent monitoring of the facility to ensure illegal drug use does not occur. Finally, should a Guest be observed using drugs or alcohol, they will be reminded of the policy they agreed to upon admission. Should a guest need to be reminded a second time, they will be disenrolled from the program. iv. Define the protocol for ensuring guests are unable to bring weapons into the center. Ex. will there be bag checks, metal detectors, etc.? Weapons will not be allowed at the Community Living Center. CalOptima Health will implement the policy in place at the Village of Hope: All Guests bags will be checked upon entry to the facility. A metal detector wand will be available as well. Additionally, experience has shown that consistent rounding is the best way to ensure Guests remain safe and that weapons are not in the center. Staff are trained to scan rooms when doing rounding and to report any weapons they may see to the Safety and Security Manager. v. Elaborate on the rounding program that will monitor guests throughout the day, What does this entail? The Guests in the Recuperative Care/Post-Hospitalization Program will require medical oversight to ensure they heal from any and all medical conditions that prompted their admittance into the program, Therefore, a consistent rounding Protocol is important. Each Guest will be checked on at minimum, 6 times per day by members of the interdisciplinary team (Nursing and Social Services) in addition to Guest Services, Environmental Services, Security Personnel, Food Service and Administration. This rounding protocol helps ensure all Guests are safe and cared for as well as allows consistent monitoring of activities in the facility. vi. What staff will have portable communication devices? Will this be implemented from the beginning of the center's opening? All staff will have portable communication devices. This will be implemented from the beginning of the center's opening. vii. What personnel will staff the front entrances? 16 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 The front entrance will be staffed with the receptionist and at least one member of the Safety and Security team. City follow-up Questions to Res oases to Questions dated January 3 2023 1 , Clarify who are the hospital partners that would accept guests needing additional medical care. In the event the additional medical care does not constitute a 911 call, the Guest has can choose the hospital at which they would prefer to be admitted. In the event of a 911 call, the paramedics will make the determination based on proximity to the Community Living Center as well as available beds. 2. Clarify where the BeWell Regional Campus is located, and how the terms of the partnership between them and CalOptima. The BeWell campus is located at 265 S. Anita Drive, Orange, California 92868, BeWell OC is a comprehensive mental health facility that provides coordinated, compassionate mental health care and addiction treatment to all Orange County residents. CalOptima Health has both a contractual partnership with BeWell for Sobering Center services as well as a collaborative partnership for Street Medicine. 3. Clarify who are partnering county and city shelters - what organizations operate these shelters and what cities are they located in? CalOptima Health will partner with all City and County shelter providers in Orange County to ensure that maximum discharge options are available for those Guests who require discharge to a shelter. This will ensure, when possible, that the shelter chosen for discharge is located in the city where the Guest has previous residency ties. Anaheim Anaheim Emergency Shelter Bridges at Kraemer Grandma's House of Hope La Mesa Emergency Shelter Buena Park Buena Park Navigation Center Costa Mesa Costa Mesa Bridge Shelter Fullerton Fullerton Illumination Foundation Center Huntington Beach Huntington Beach Navigation Center 17 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 Laguna Beach Friendship Shelter ASL Placentia Placentia Navigation Center Santa Ana Carnegie WISEPlace Yale Navigation Center Tustin The Village of Hope Tustin Temporary Emergency Shelter Tustin Veteran's Outpost 4. Expand on how Tustin PD would be a partner. What type of services are anticipated to be needed based on other recuperative care and short-term post-hospitalization housing facilities? The Tustin Police Department will be a key partner in the services we provide to the communities we serve for referrals. In the spirit of that vested partnership we expect to share resources for the safety of our Guests, Employees, and Neighbors. It is our hope that we would rarely need to rely on the Tustin Police Department for any occurrence at the Community hiving Center that requires Police intervention. Based on past experience, this is the only service that will be needed. Additionally, CalOptima will make available requested CCTV footage in consult with CalOptima's legal team. City :)Ilow-up Questions to Responses to Questions dated January 10 2023 1. Regarding the use of shuttles for PACE participants, please elaborate on future plans assuming maximum capacity at the center. Are shuttles anticipated to be parked on- site at any point in the future? Plans are to utilize the PACE shuttles already in operation at our Garden Grove site. We currently operate 17 shuttles. CalOptima Health currently contracts with an outside company to operate these shuttles, and shuttles are stored at this outside company's location. No shuttles are anticipated to be parked on-site at the Community Living Center. Following the shuttle drop off, the shuttle will be parked at the designated location in question #3, when not in use. 2. Specify the dimensions and seating capacity of the shuttle vans, and provide a site plan showing the loading and parking/idling areas for the shuttles. The shuttles are 219 Inches in length, 81.3 inches in width without mirrors, 97.4 inches in width with mirrors, and 100.8 inches in height. Each shuttle has a seating capacity of 6-10, dependent on number of wheelchairs. 18 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 3. Specify which third-party company provides shuttle services, and what city/location the vans are stored when not in use. The third-party vendor for our shuttle service is Secure Transportation. All shuttles are stored at their location at: 12300 Center Court drive South, Suite 120 Cerritos, CA 90703 4. Elaborate on van arrival schedules. How many shuttles arrive/depart per hour? Where would they load/unload on-site? Shuttles arrive and depart between the hours of Sam and 4pm. On average 5 shuttles will arrive and depart each hour except for the 4pm hour where there will be an average of 10-15 shuttles. It should be noted that these shuttles arrive throughout the hour, ensuring Guests do not need to wait, and drop off and pick up is quick and smooth. The shuttles will load and unload in front of the PACE center (identified on the floor plan in Attachment A.). These shuttles will not be parked at the facility and only used to transport individuals who are using the PACE program who are not Guests staying at the Community Living Center. 5. Provide a floor plan showing what parts of the building will be open for PACE activities during PACE hours of operation (7:30 a.m. to 5.00 p.m., Monday through Friday). What will these areas be used for outside of regular PACE operating hours? The floor plans provided (in Attachment A) identify the parts of the building that will be open for PACE activities during the PACE hours of operation. These areas will be locked and inaccessible for use outside of the regular PACE operating hours. 6. Indicate where the PACE receptionist will be sitting and provide a written walkthrough description of a typical PACE participant experience at the center, starting from when they check in. PACE receptionist location is identified on the attached floor plans (in Attachment A). Walkthrough Description A PACE participant is picked up by one our drivers and brought to the PACE location to receive their day center activities, skilled rehab services, or medical care. Day Center Experience: Upon arrival to the PACE location our drivers escort our participants to our reception area. The receptionist will check the daily schedule to ensure we are guiding the participant to the correct area. If our participants are here for day center activities, they will be escorted to the day floor by the receptionist or personal care aides (PCA), they will ensure the participant is wearing their name badge. The participants are then escorted to table and chair, where they will engage in activities for the day. They get to enjoy snack time with our PCA, receive daily news, work on creative arts, engage 19 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 in Bingo, exercise, and stretch with the rehab team, enjoy some relaxation time, and participate in our social sunshine group. PACE participants also receive a nutritional meal, which is medically tailored to meet their needs, while they are at the center. Some examples of our meals include Chicken fajitas, Persian Tamarind Cod, Canh Bap Cai, Fish tacos, and California turkey burger. Our day center participants may also have an appointment with their clinic provider, if they do our expert staff will guide them to the clinic reception area, where they will check-in and be escorted to the exam room. Once the day concludes all the services were complete for the day, our staff escorts the participant to reception for check-out, and our drivers guide the participants on to the shuttle. They are then taken home for the day. Rehab Experience: Some of our participants are arriving to the center only for their skilled PT/OT services. In these cases, the participants arrive to the PACE center, checks-in with receptionist. Our rehab staff is alerted that the participant has arrived. The participant is then escorted to the rehab area. The participants meet with their assigned therapist, to engage in the skilled services. The participant also has an opportunity to ask questions related to the treatment (i.e., progress, modifications, or areas of concern). Once the therapy service has concluded the participant is escorted to reception area for check- out. The driver then escorts the participant into the shuttle and drives the participant back home. Clinic Experience: Some of our participants arrive to the center only for their medical care and see one of our providers. In these cases, the participants arrive with one of our drivers, who are then guided to the reception area for check-in, the receptionist will confirm the appointment and inform the clinic staff of participants arrival. The participant will then be escorted to wait in the clinic reception area for their appointment and clinic check in. The participant will then be escorted to an exam room for the clinic appointment, where the medical needs will be addressed. Once the visit is complete and all medical testing is done, the participant will be escorted to the reception area for check-out. The driver will then guide the participant to the shuttle and be driven home. 7. Specify how recuperative care recipients arriving by their own vehicle would know where to park underground. How would they gain access to the parking structure? Will stalls be dedicated for this purpose? If so, how many? It should be noted that based on the population served and past experience managing like programs, it is on a very rare occasion that a Guest will have a vehicle. For those rare events, there will be designated parking in the underground parking lot. An estimated two spots will be designated for these rare occasions. Guests will access this parking with assistance from the receptionist or security personnel. 8. Specify approximate shift times. What constitutes morning, evening, and night shift? For PACE: specify the number of employees by expertise (i.e. therapists, social workers, recreation, etc.). 20 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 Morning Shift: 7:00am- 3:30pm Afternoon Shift: 3:00pm- 11 :30pm Night Shift: 11:00am to 7:30pm PACE Employees by Expertise: Nurses:10 Medial Assistants: 6 Therapists:12 Social Workers:8 Receptionists: 2 Dietician: 3 Activity Personnel: 3 Home Care: 4 Medical Director: 1 Medical Records: 5 Transportation: 2 Administration:4 Remote: 10 9. Please specify the full breadth of services provided to PACE participants and participants of the recuperative care/short-term housing programs. PACE services include the following: • Primary care clinic visits (with the CalOptima PACE physician, nurse practitioner and/or nurse). If applicable. • Routine physicals, and preventive health evaluations and care (including pap smears, mammograms, immunizations, and all generally accepted cancer screening tests). • Sensitive services, which are services related to sexually transmitted diseases and HIV testing. • Consultation with medical specialists. When medically indicated, our PCP will initiate a referral to a specialist. Referrals will be processed in a timely manner and urgent requests will be expedited, • Kidney dialysis • Outpatient surgical services • Outpatient mental health • Medical social services/case management • Health education and counseling • Rehabilitation therapy (physical, occupational and speech) 21 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Personal care • Recreational therapy • Social and cultural activities (intergenerational, if applicable) • Nutritional counseling and meals if medically needed • Transportation, including escort (transportation provided for PACE-related services, requests are managed by PACE staff and the transport team). • Ambulance service • X-rays • Laboratory procedures • Emergency coverage anywhere in the United States and its territories. • Durable medical equipment • Prosthetic and orthotic appliances • Routine podiatry • Prescribed drugs and medicines • Vision care (prescription eyeglasses, corrective lenses after cataract surgery). • Hearing exams and hearing aids • Dental care • Diagnosis and treatment of male erectile dysfunction • Mastectomy, lumpectomy, lymph node dissection, prosthetic devices, and reconstructive surgery. • Necessary materials, supplies and services for the management of diabetes mellitus. • Home Care or Personal care (e.g,, grooming, dressing, assistance in using the bathroom) or Homemaker/chore services o Rehabilitation maintenance or Evaluation of home environment • Home Health or Skilled nursing services or Physician visits (at discretion of physician) or Medical social services or Home health aide service Hospital Inpatient Care • General medical and nursing services • Psychiatric services • Prescribed drugs, medicines and biologicals • Diagnostic or therapeutic items and services 22 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Laboratory tests, X-rays and other diagnostic procedures • Medical/surgical, intensive care, coronary care unit, as necessary • Dressings, casts, supplies • Operating room and recovery room • Oxygen and anesthesia • Organ and bone marrow transplants (non-experimental and non- investigative) • Use of appliances, such as a wheelchair Recuperative Care/Post Hospitalization Services include the following: • Ongoing monitoring of medical and behavioral health conditions, medical oversight and 24 hour on-call medical support • Limited assistance with Instrumental Activities of Daily Living and/or Activities of Daily Living • Coordination of transportation to post-discharge appointments • Connection to ongoing medical and behavioral health services • Support in accessing benefits. • Support in accessing culturally appropriate community resources • Support in accessing permanent housing • Case Management and the development of an individualized care plan • Meals • Interim Housing until Permanent Housing can be identified and secured. City follow-up Questions to Responses to Questions dated January 12 2023 1. Specify which local hospitals would be referring patients to the recuperative care program. Define local hospitals. All hospitals in Orange County will be able to refer potential Guests to the Recuperative Care/Post Hospitalization program. Once medical eligibility is confirmed, priority will be given to those with ties to Tustin. 2. Elaborate on how you would work with Tustin PD and the OC Fire Authority to identify individuals that may be eligible for the recuperative care program. If possible, provide examples of how you accomplish this with other cities. Please see below for this process. 23 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 3. Please explain how the center would process potential recuperative care recipients who are living on the street and not referred by a hospital (i.e, referred by Tustin PD, OCFA, etc.). How are these individuals evaluated for eligibility for the recuperative care program? What if they are not injured or do not require rehabilitation? What defines injured individuals or individuals that need recuperative care? Should the Tustin Police Department orthe OCFA identify and make CalOptima Health aware of an individual living on the street in Tustin that may qualify as a Guest of the Community Living Center, an evaluation team consisting of a nurse, social worker and intake coordinator will engage with the individual and assess eligibly. If the individual meets eligibility criteria and is willing to enroll in the program, transportation will be arranged and the individual transported to the center. CalOptima Health will designate key points of contact in order for Tustin Police Department and OCFA to have timely access. Will beds be designated for emergency shelter while the intake/screening/insurance process occurs? No. The Community Living Center is not an emergency shelter. 4. Specify where the intake department will be located. Intake department location is identified on the floor plans. Please see Attachment A for both the Recuperative Care and Post/Hospitalization site plans and PACE. 5, Please elaborate on the "housing tenancy services" that will be offered to successful program participants. Is this part of PACE, or one of the recuperative care programs? Both? Housing Tenancy Services are provided as a Medi-Cal benefit through CalOptima Health. The State of California has allowed this benefit to be available through CalAIM, generally, and in this case to assist Guests of the Recuperative Care/Post- Hospitalization program that have identified and secured permanent housing to maintain that housing long-term. Services include; • Creating a housing support plan • Early identification/intervention for behaviors that may jeopardize housing • Education on tenant and landlord rights/responsibilities and coaching on maintaining relationships with landlords/property managers • Working with landlord/case manager to address issues that could impact housing • Assistance to resolve landlord/neighbor disputes to reduce eviction risk 24 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 • Assistance with benefits, housing recertification, and resources to prevent eviction • Health and safety visits • independent living and life skills training • Continuing assistance with lease compliance 6. Please incorporate into the operations plan, with a high level of specificity, the year/version of the NIMRC standards for medical respite care programs to be used, and explain how they apply to the recuperative care and short-term post- hospitalization housing programs being proposed. Please see updated Operations and Security Plan in Attachment B. 7. On the floor plan, specify the size of guest storage areas and their locations. Identify storage within the semi-private bedrooms in addition to storage locations for "guests with additional items." Each semiprivate room will be equipped with two nightstand/lockers (one for each guest), a four drawer dresser (shared) and closet (shared). Additionally, each bed will be equipped with under bed additional storage (one for each guest). A sample of this is identified on the floor plans.. An additional storage area is also identified on the floor plans. It should be noted that the majority of the Guests admitted into the Recuperative Care/Post Hospitalization program will be coming directly from the hospital and therefore have very little, if any belongings. 8. How many rooms are anticipated to be made available for guests with pets? How large of pets and what kind would be permitted? CalOptima Health anticipates making 10 rooms available for guests with small pets. 9. Please specify who will make arrangements with local shelters for recuperative care recipients that choose to leave the program prior to securing permanent housing. What shelters does this include, and how long does this process take? Each Guest in the Recuperative Care/Post Hospitalization Program will be assigned their own Social Worker upon admission. This Social Worker will be responsible for making arrangements for the Guests discharge. Since residency for each Guest is identified at intake, efforts will be made to discharge the Guest to a shelter within that city. If the Guest does not have residency in a city with a shelter, the County shelter system will be accessed. The Social Worker will arrange a warm handoff to the shelter identified for the discharge. 25 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 It should be noted that based on previous experience and the high-quality design of the proposed building, it is highly unlikely that Guests enrolled in the Recuperative Care/Post Hospitalization Program will choose to leave prior to permanent housing being identified and secured. Guests will not be discharged to the City of Tustin unless that this the city of origin. City follow-up Questions to Responses to Questions dated 1-18 23 1. Does CalOptima have experience providing recuperative care or short-term post- hospitalization housing in another County or state? Please elaborate on the experience of facility administrators, medical care providers, and the staff that will be operating the day-to-day operations. The Tustin endeavor is being spearheaded by Executive Director of Medi-Cal/CaIAIM Kelly Bruno-Nelson, whose previous experience building, operating, and financing recuperative care will serve as the operational foundation and model for CalOptima. In addition, CalOptima Health plans to recruit additional medical and administrative staff with experience working with the older adult and unhoused populations, as well as those with experience in recuperative care facilities. 26 COMMUNITY LIVING CENTER OF TUSTI N ..44uk x'a J i i 3 �' LL a, II ,� M � J"� 1 Operations and Security Plan r 14851 Yorba Street and 165 N. Myrtle Avenue alVealth ptim H Tustin, CA 92780 Health 1 CONTENTS ExecutiveSummary ...........................................................................................................2 Operations Plan Program and Scope of Services ....................................................................................... 3 EligibilityCriteria ................................................................................................................ 5 Intake and Admission Process ...................................................................................7 Discharge ............................................................................................................................. 8 Codeof Conduct ............................................................................................................... 11 Local Preference Policy............................................................................................15 National Institute for Medical Respite Care Standards ................................................15 Security Policies GoodNeighbor Policy .............................................................................................27 Loitering .................................................................................................................27 SecurityPlan .......................................................................................................................28 Contact Information................................................................................................30 Frequently Asked Questions ......................................................................................................32 AppendixA. Shelter List ..............................................................................................................38 Appendix B. PACE Walkthrough Description .........................................................................39 Appendix C. Shuttle Information .............................................................................................41 AppendixD. Floor Plans ........................................................................................................42 GOMM CalOptima Health Executive Summary 2 In January 2022, California expanded its Medi-Cal program beyond traditional healthcare to cover a variety of community supportive services that enable more comprehensive care for the whole person. Entitled CalAIM, this expansion includes services that address the social determinants of health and commensurate challenges faced by the most vulnerable populations in our neighborhoods including those experiencing homelessness and the aging. As part of CalOptima Health's strategy for providing these critical community service to unhoused and aging members, we are planning the renovation of a Tustin-based building to house a hybrid two-pronged program: a Recuperative Care and Post-Hospitalization program and a PACE program (Program of All-inclusive Care for the Elderly). There are very few programs across the state that focus on the aging population at the intersection of medical care and homelessness. CalOptima Health is designing a state-of-the-art facility in the city of Tustin that will stand as an example of best practice in homeless services by focusing on the fastest growing subset of the homeless population, our aging neighbors. The Recuperative Care and Post Hospitalization program will be the foundation of this wholistic care site, providing unhoused older adults who are healing from an injury or illness with vital medical oversight services from trained healthcare professionals. Guests will have daily interaction with medical professions as well as care management and housing navigation services, job training, substance use disorder services, and any other community supports that prepare them to make a permanent move home. All guests will be welcome to stay in the program until permanent housing is identified and secured. In addition, a portion of the building will be dedicated to CalOptima Health's PACE program which provides all-inclusive care for older adults, enabling them to remain living in the community and out of institutions. The PACE program will provide a wide range of services to its members including on-site medical care, a day-activity center,transportation, rehabilitation therapies, meals, homecare, medications, medical equipment, and coverage for hospital and long-term care. CalOptima Health has been providing PACE services to the Orange County community since October 2009, currently serving 435 older adults at its Garden Grove location. CalOptima Health will provide these services to Orange County residents, �� with Tustin community members " ' , receiving priority at this facility. Overall, the recuperative care center will serve ` r:e. 1 19 unhoused older adults working s � toward a permanent housing placement. 41. The PACE center will serve up to 500 x w individuals from both the community L r and the recuperative care center. , �F CalOptirria Health 3 OPERATIONS PLAN The following manual contains information for both the Recuperative Care/Post Hospitalization and PACE programmatic components of the Community Living Center of Tustin. Community Living Center is the term used to describe the entirety of the campus buildings being proposed for the location at 14851 Yorba Street and 165 Myrtle Avenue. More specifically, the Community Living Center refers to this facility that will provide recuperative beds and post hospitalization beds to unhoused older adults, defined as 55 years or older, and a PACE center for Guests to access. Policies and practices are combined when they concur and separated when different for each program. rrogram Scope of Services PACE PROGRAM PACE services include the following: • Primary care clinic visits (with the CalOptima PACE physician, nurse practitioner and/or nurse). If applicable. Routine physicals, and preventive health evaluations and care (including pap smears, mammograms, immunizations, and all generally accepted cancer screening tests). Sensitive services,which are services related to sexually transmitted diseases and HIV testing. Consultation with medical specialists. When medically indicated, our PCP will initiate a referral to a specialist. Referrals will be processed in a timely manner and urgent requests will be expedited. Kidney dialysis Outpatient surgical services Outpatient mental health Medical social services/case management Health education and counseling Rehabilitation therapy (physical, occupational and speech) Personal care Recreational therapy Social and cultural activities (intergenerational, if applicable) • Nutritional counseling and meals if medically needed. Transportation, including escort (transportation provided for PACE-related services, requests are managed by PACE staff and the transport team). Ambulance service X-rays Laboratory procedures Emergency coverage anywhere in the United States and its territories. Durable medical equipment �F CalOptirria Health 4 Prosthetic and orthotic appliances Routine podiatry Prescribed drugs and medicines Vision care (prescription eyeglasses, corrective lenses after cataract surgery). Hearing exams and hearing aids Dental care Diagnosis and treatment of male erectile dysfunction Mastectomy, lumpectomy, lymph node dissection, prosthetic devices, and reconstructive surgery. Necessary materials, supplies and services for the management of diabetes mellitus. Home Care or Personal care (e.g., grooming, dressing, assistance in using the bathroom) or Homemaker/chore services o Rehabilitation maintenance or Evaluation of home environment Home Health or Skilled nursing services or Physician visits (at discretion of physician) or Medical social services or Home Health aide service Hospital Inpatient Care General medical and nursing services Psychiatric services Prescribed drugs, medicines, and biologicals Diagnostic or therapeutic items and services Laboratory tests, X-rays, and other diagnostic procedures Medical/surgical, intensive care, coronary care unit, as necessary Dressings, casts, supplies Operating room and recovery room Oxygen and anesthesia Organ and bone marrow transplants (non-experimental and non-investigative) Use of appliances, such as a wheelchair The PACE program will be open Monday thru Friday, 7:30am to 5:OOpm. RECUPERATIVE CARE/POST-HOSPITLIZATION PROGRAM Recuperative Care/Post Hospitalization Services include the following: Ongoing monitoring of medical and behavioral health conditions, medical oversight and 24 hour on- call medical support. Limited assistance with Instrumental Activities of Daily Living and/or Activities of Daily Living Coordination of transportation to post-discharge appointments Connection to ongoing medical and behavioral health services Support in accessing benefits. Support in accessing culturally appropriate community resources. Support in accessing permanent housing. 'F CalOptirria Health 5 Case Management and the development of an individualized care plan Meals Interim Housing until Permanent Housing can be identified and secured. Post Hospitalization program is designed to provide Guests additional time to receive medical support and permanent housing assistance immediately after the Recuperative Care Program. These two programs are designed to provide services consecutively. There is no difference between the services provided, eligibility criteria, or room location within the center.ALL guests will be allowed to stay until permanent housing is identified and secured, ensuring housing stability from the moment of admission. We anticipate the average length of stay will be I year. Eligibility Criteria PACE PROGRAM To be eligible for the PACE program, an individual must be: • Fifty-five (55) years of age or older. Live in the defined CalOptima PACE Service Area. Meet the nursing facility eligibility criteria as defined by Title 22 California. Be able to live safely in the community with assistance. Enrolled in CalOptima Health or meet 10-criteria (low or extremely low income). CalOptima Health's PACE program is able to provide services throughout Orange County. Our defined PACE Service Area includes the following zip codes: 90620 92602 92624 92649 92672 92694 ��°77'°°' �°Pe° w °�'1— 0iz08 �2eB° 925py u' "5'de 1 -^"4ev9 x7 seta awas 50e 9s e°s Pr1C1fP.92551 59 92l21 b2 e23 92801 92832 92866 90621 92603 92625 9D2,� 22 P", 98Q=° �3er9 s2e9e 026� 925e6 GW"4�A4X1 9B2W °3.•.'g�2S 83�28.92�65''§2eT0 97ll 11'. 9FdT4 121192551 9265 192673 9270 192802 92833 92867 „7 m0°59e2'1 ���'. 1 92NT 92869 g2e°3 925°3 90623 92604 92626 92653 92675 92703 , m=2/5 �°8°' a ;$*1a45�14-52e6r 93A8 92es, 92804 92835 92868 90630 92606 92627 :'.° ''�„�1755�"°'° 9a22° '° ° �28Q2 92eF] 92869 Q,e 9Q8 MABQt Q2813 92�,¢#p 926y6 92920 L0790S�C1W5P"',W2IF1 4256�1�91 §2]tl5 921052�2 929�6 9: 92655 92676 92704 92805 92840 92869 9P23_k131 WIN 9]43y M55 SFVZ FTV1§,r W21e2 92013 90631 92610 92629 92656 92677 92705 '°" °�" 921Qes22° �2e� °' Nuntl 3L?4 diia76w e2e1° sseTa ad7szser 92806 92841 92870 90638 92612 92630 � ' 9�,2 OZA `]2822' 93812 42830 92689 9255° 92657 92679 92706 92807 92843 92886 90680 92614 92637 92660 92683 92707 62Qx2�d5r 92808 92844 92887 90720 92617 92646 9%51 92­ 92562 Mum 428F2 �2= I 92661 92688 92708 92821 92845 90740 92618 92647 92662 92691 92780 92823 elk 92824 92861 90743 92620 92648 92663 92692 9292 92782 92831 92865 92 ANAILL rMIS °N CalOptima Health 6 Guests admitted into the PACE program may be inclusive of both Guests living at the Community Living Center as well as community members who meet the PACE eligibility criteria outlined above. No unhoused older adults, outside of those residing in the Community Living Center,will be eligible to enroll in the PACE program. RECUPERATIVE CARE/POST-HOSPITLAIZATION PROGRAM Any Guest admitted into the Community Living Center's Recuperative Care program must meet the following criteria: 55 years of age or older and unhoused Discharged from an Orange County Hospital or referred by Tustin PD or Tustin shelter In need of medical assistance and/or medical oversight A CalOptima Health Member Able to complete all Activities of Daily Living (ADLs) independently or with minimal assistance. For Guests with wheelchairs and/or Durable Medical Equipment (DME), Guests must be able to: ■ Use DME device safety and understand proper use and handling (i.e., transfers from toilet to wheelchair) ■ Use DME without assistance (no Care Giver Assistance required) ■ Ambulate at least 20 ft prior to hospital or facility discharge (with or without DME) Able to self-administer medication with staff oversight Continent of both bladder and bowels (if diapers are used, patient must change and maintain hygiene completely independently) Medically and psychiatrically stable at discharge Alert and oriented (Name, place, date, and situation) Not a danger to self or others (not suicidal or violent) Exclusion Criteria: Unable to complete ADLs, personal care, or medication administration Incontinent of bladder and/or bowel Significant Cognitive impairment, suicidal, or danger to self or others Active Tuberculosis/C-DIFF/MRSA of Sputum Stage 3 or higher decubitus ulcers Unstable medically and/or psychiatrically Patients actively detoxing (will need to be stabilize prior to being referred) Referred from a hospital outside of Orange County Referred from a shelter outside of Tustin Does not have medical need. �F CalOptirria Health 7 CalOptima Health is the on/yMedi-Cal Health Plan in Orange County so therefore all Guests admitted to the Recuperative Care/Post Hospitalization Program will be CalOptima Health members. All authorizations will be handled in accordance with current claims practices and will be automatically approved until Guests are medically stable and have identified and secured permanent housing. Most Guests will be referred by Orange County hospitals and Tustin law enforcement. All hospitals in Orange County will be able to refer potential Guests to the Recuperative Care/Post Hospitalization program. Once medical eligibility is confirmed, the Program will prioritize eligible older adults who are unhoused from the City of Tustin. If capacity allows, a Tustin shelter may refer a potential Guest to the Recuperative Care/Post Hospitalization Program if the Guest meets the medical criteria for the program. The same intake and screening process will be implemented to ensure the potential Guest meets all eligibility requirements. The Post Hospitalization Program is designed to provide Guests terming out of the Recuperative Care program additional time to receive medical support and secure permanent housing immediately after the Recuperative Care Program. These two programs are designed to provide services consecutively. Therefore, all Guests admitted into the Post Hospitalization program will be transferred directly from the Recuperative Care program. Only Guests previously in the Recuperative Care Program are eligible for the Post-Hospitalization Program. There is no fixed number of beds available for the recuperative care program versus the Short-Term Post Hospitalization program. Intake/Admission Process PACE PROGRAM The PACE program is open to all eligible individuals living both at the Recuperative Care/Post Hospitalization program as well as the surrounding Tustin Community. Once determined eligible for the PACE program, the intake process will include four(4) stages: I. Initial eligibility determination. 2. Home visit and Level of Care (LOC) tool submission to DHCS. 3. Completion and submission of PACE LOC tool an if approved. 4. Enrollment Conference. Once it is determined the individual meets the eligibility requirements of age and place of residence in the Service Area, the PACE Enrollment Coordinator and Registered Nurse will schedule a home visit to confirm the eligibility criteria. During the home visit, PACE program staff shall conduct an �F CalOptirria Health 8 environmental assessment and evaluate home and community safety issues, including stairs, clutter, neighborhood crime, accessibility, bath or shower, toilet, telephone, food, neighborhood services, public transportation, religious services, and shopping. Next, the PACE LOC tool is submitted to DHCS for approval. Upon approval, staff will contact the new Guest to inform them of the State's determination and set up an enrollment conference to take place at the PACE center. During this enrollment conference, Guests will meet their Interdisciplinary Team, learn about the programs and services available to them, get a tour of the facility and review the Code of Conduct. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM The Recuperative Care/Post Hospitalization Program is open to eligible older adults who are unhoused, have a medical need and are being discharged from an Orange County Hospital or referred by Tustin PD or Tustin shelter. The intake process includes the following: I. Hospital contacts the program's intake team and makes a referral. 2. Intake team confirms medical condition, residency, and overall appropriateness for the program. 3. If determined eligible, arrangements are made for transportation from the Hospital to the Program. Upon arrival, each new Guest will receive a Welcome Orientation from center staff to help ensure each has the tools and information necessary to promote a successful and productive stay at the center. This Welcome Orientation will include Review of the shelter guidelines and code of conduct, schedules, programs, and behavior expectations Initial Nursing and Social Services assessment Tour of the Center and key program locations Introduction to key staff and roommate The program will utilize a bed reservation system. All guests will arrive through pre-coordinated transportation such as uber, taxi, ambulance, or non-medical transportation. Should the Tustin Police Department or the OCFA identify and make CalOptima Health aware of an individual living on the street in Tustin that may qualify as a Guest of the Community Living Center, an evaluation team consisting of a nurse, social worker and intake coordinator will engage with the individual and assess eligibly. If the individual meets eligibility criteria and is willing to enroll in the program, transportation will be arranged and the individual transported to the center. CalOptima �F CalOptirria Health 9 Health will designate key points of contact in order for Tustin Police Department and OCFA to have timely access. Discharge The Community Living Center is committed to providing services to the older adult unhoused and frail elderly populations. Therefore, staff will exhaust all possible options to remedy a situation before proceeding with an involuntary discharge. PACE PROGRAM All involuntary disenrollment's require prior approval of the Department of Health Care Services (DHCS) and require twenty(20) calendar days advance notice to Guests.An involuntary disenrollment will occur under the following circumstances: The Guest moves, or is out of the Service Area, for more than thirty (30) consecutive calendar days. Guest engages in disruptive, or threatening, behavior that jeopardizes his or her own health or safety, or the health or safety of others. Guest's caregiver or family member engages in disruptive, or threatening, behavior that jeopardizes his or her own health or safety, or the health or safety of others. The PACE program contract with the Centers for Medicare & Medicaid Services (CMS) and DHCS is not renewed or is terminated, or the PACE program is unable to offer healthcare services due to the loss of state licenses, or contracts with outside providers. The Guest no longer meets the California nursing facility Level of Care requirements. The PACE program shall make every effort to resolve areas of conflict or jeopardy through negotiation and open communication among the team and the Guest before requesting an involuntary disenrollment. If CalOptima Health PACE staff exhausts all possible and feasible options to remedy the situation and those efforts to resolve the situation are unsuccessful, the PACE program may pursue an involuntary disenrollment. A Participant may voluntarily disenroll from CalOptima PACE without cause, at any time. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM The Recuperative Care/Post Hospitalization program will have a balanced approach to program exits and readmission policies. Consideration will be given to maintaining a safe and successful center, the safety of our Guests, volunteers, staff, and surrounding neighborhood as well as demonstrate compassion towards the unhoused older adults who face increasingly vulnerable situations if forced to exit from the center into places not suitable for human habitation. When service is terminated, either �F CalOptirria Health 10 voluntarily or involuntarily, employees of the Recuperative Care/Post Hospitalization center will follow the following orderly and respectful process: Voluntary Discharge: Permanent Housing or higher level of Care When a Guest has successfully achieved their goals and is ready to move into a permanent housing setting, the following steps are followed to ensure an orderly and comprehensive discharge: Nursing and Social Services to conduct an exit conference and review Guest's discharge/aftercare plan Guest is provided with all medications if applicable. Guest is provided with appropriate referrals where external after care is required. Staff will assist Guest in packing all personal property. Transportation is arranged and a warm hand-off to the permanent housing location is arranged. In the rare occasion a Guest decides to leave the program prior to being placed in permanent housing, it is most likely to pursue housing through a family reunification opportunity either locally or out of state. In the even rarer event, a Guest may decide to leave the program prior early and not reunify with family, arrangements will be made for the Guest with a local shelter. The Guest's Social Worker will make these arrangements within 24 hours of discharge being requested. Housing Tenancy Services Everyone who leaves the program to permanent housing will receive Housing Tenancy Services (services). These services are provided as a Medi-Cal benefit through CalOptima Health to assist Guests of the Recuperative Care/Post Hospitalization program who have identified and secured permanent housing. The goal of the services is to help maintain that housing long-term. These services are offered for up to a year after recuperative guests are placed into permanent housing. Services include: Creating a housing support plan Early identification/intervention for behaviors that may jeopardize housing. Education on tenant and landlord rights/responsibilities and coaching on maintaining relationships with landlords/property managers. Working with landlord/case manager to address issues that could impact housing. Assistance to resolve landlord/neighbor disputes to reduce eviction risk. Assistance with benefits, housing recertification, and resources to prevent eviction. Health and safety visits Independent living and life skills training �F CalOptirria Health 11 Continuing assistance with lease compliance Involuntary Discharge CalOptima Health will follow the same policy and procedures of the Tustin Temporary Emergency Shelter when it comes to involuntary discharges to ensure that all guests have a safe discharge plan. No Guests who are involuntarily discharged will be discharged to the streets of Tustin. In the unfortunate event a Guest must be discharged involuntarily, the following options will be available through our community partners: Hospital partners will assist with Recuperative Care Guests needing additional immediate medical care. BeWell Regional Campus will assist with Recuperative Care Guests needing additional immediate behavioral health care. Tustin Police Department will assist with Recuperative Care Guests who are involved in criminal activity. Partnering County and City shelters will assist with Recuperative Care Guests who are inappropriate for the center. If residency is established, a shelter will be chosen commensurate with residency. A list of shelters can be found in Appendix A. PACE Guests do not live at the center and therefore all involuntary discharges would be to the Guest's home. Family members open to reunification. If none of these options are available, CalOptima Health will contract with UberHealth to provide transportation to a location based upon their last known residence or location. All discharges will occur between the hours of 9am and 7pm. Each Guest in the Recuperative Care/Post Hospitalization Program will be assigned their own Social Worker upon admission. Should a Guest be discharged involuntarily or choose to leave the program prior to permanent housing being identified and secured, this Social Worker will be responsible for making arrangements for the Guests discharge to a shelter. Since residency for each Guest is identified at intake, efforts will be made to discharge the Guest to a shelter within that city. If the Guest does not have residency in a city with a shelter, the County shelter system will be accessed. The Social Worker will arrange a warm handoff to the shelter identified for the discharge. It should be noted that based on previous experience and the high-quality design of the proposed building, it is highly unlikely that Guests enrolled in the Recuperative Care/Post Hospitalization �F CalOptirria Health 12 Program will choose to leave prior to permanent housing being identified and secured. Guests will not be discharged to the City of Tustin unless that this the city of origin. Cvui:.- of Conduct PACE PROGRAM The PACE program is licensed and monitored by the Department of Health Services. Therefore, program guidelines, requirements and expectations are determined by the State of California. Below is the "Patient Rights and Responsibilities" policy approved by the State of California that includes conduct expectations. All Guests have the right to: Receive your health care in an accessible manner and in a safe, clean environment. Be free from harm. Harm includes physical or mental abuse, neglect, excessive medications, physical punishment or being placed by yourself against your will, as well as any physical or chemical restraint used on you for discipline or convenience of staff that you do not need to treat your medical symptoms or prevent injury. Be free from hazardous procedures. Receive treatment and rehabilitation services designed to promote your functional ability to the optimal level and to encourage your independence. Receive care from professionally trained staff that has the education and experience to carry out the services for which they are responsible. Participate in a program of services and activities that promote positive attitudes on usefulness and capabilities and are designed to encourage learning, growth, and awareness of constructive ways to develop your interests and talents. Self-determination within the day care setting, including the opportunity to: I. Participate in developing a plan for services. 2. Decide whether to participate in any given activity. 3. Be involved to the extent possible in program planning and operation. Be cared about in an atmosphere of sincere interest and concern in which needed support and services are provided. Be ensured of auditory and visual privacy during all health care examinations and treatment visits. Be encouraged and assisted to exercise your rights in CalOptima PACE. Receive assistance, if you need it,to use the Medicare and Medi-Cal complaint and appeal processes, and your civil and other legal rights. Be encouraged and helped in talking to CalOptima PACE staff about voicing complaints and recommending changes in policies and services to CalOptima PACE staff and to choose outside �F CalOptirria Health 13 representatives. There will be no restraint, interference, coercion, discrimination, or reprisal by staff if this occurs. Use a telephone while at the CalOptima PACE Center, make and receive confidential calls and/or have such calls made, if necessary. Not have to do work or services for CalOptima PACE. To receive competent, considerate, respectful care from staff and contractors without regard to race, national/ethnic origin, religion, age, sex, sexual orientation, mental or physical disability, or source of payment for your health care. Have someone help you if you have a language or communication barrier in order that you can understand all information provided you. Have someone interpret all information given to you into your preferred language in a culturally competent manner, if your first language is not English and you cannot speak English well enough to understand the information being given to you. Have the Enrollment Agreement discussed fully and explained to you in a manner you understand. Receive marketing materials and CalOptima PACE Rights in English and any other frequently used language in your community. You can also receive these materials in braille or in an audio format, if necessary. Receive a written copy of your rights from CalOptima PACE. CalOptima PACE will post these rights in a public place in the CalOptima PACE Center where it is easy to read them. Be fully informed, in writing, of the services offered by CalOptima PACE. Review, with assistance if needed, the results of the most recent review of CalOptima PACE. Have a copy of CalOptima PACE's non-proprietary clinical and administrative policies and procedures from the PACE Director. Requests are to be submitted in writing. To choose a health care provider within the CalOptima PACE network and to receive quality health care. Women have the right to get services from a qualified women's health care specialist for routine or preventive women's health care services. To reasonable and timely access to specialists as indicated by your health condition and consistent with current clinical practice guidelines. To receive emergency services when and where you need them without CalOptima PACE approval. To fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you,you have the right to choose that person to act on your behalf. �F CalOptirria Health 14 Have all treatment options explained to you in a language you understand, be fully informed of your health and functional status and how well you are doing and make health care decisions. Be informed of all treatment prescribed by the IDT prior to being treated, when and how services will be provided, and the names and functions of people providing your care. Refuse treatment or medications. If you choose not to receive treatment, you must be told how this will affect your health. Be assured that decisions regarding your care will be made in an ethical manner. Be assured that you and your family will be educated about an illness affecting you so that you can help yourself, and your family can understand your illness and help you. Receive information on advance directives and have CalOptima PACE help you create an advance directive. Participate in making and carrying out your plan of care, which will be designed to promote your functional ability to the highest level and encourage your independence. Appeal any treatment decision made by CalOptima PACE or our contractors through our appeals process and request a State Hearing. Receive necessary care across all care settings, up to and including placement in a long-term care facility when the PACE organization can no longer maintain you safely in the community through the support of PACE services. Be given advance notice, in writing, of any plan to move you to another treatment setting, and the reason you are being moved. You have the right to: Talk with health care providers in private and have your personal health care information kept private as protected under state and federal laws. Review and receive copies of your medical records and request amendments to those records. Be assured that all information contained in your health record will be held in confidence, including information contained in any automated data bank. Be assured of confidentiality when accessing sensitive services, such as sexually transmitted disease (STD) and HIV testing. A full explanation of the complaint and appeals process. Assistance to exercise civil, legal, and participant rights, including the CalOptima PACE grievance process, the Medi-Cal State Hearing process and the Medicare and Medi-Cal appeals processes. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM To ensure all Guests have a safe and pleasant stay, CalOptima Health asks each Guest to abide by the following Guidelines and Code of Conduct. �F CalOptirria Health 15 Please keep common areas neat and clean for all to enjoy by cleaning up after yourself, Keep your room organized and free from unnecessary clutter. Weapons of any kind are not permitted in The Community Living Center. We will respect your privacy. However, we will search your belongings upon entry into the Community Living Center and additionally if we suspect you have weapons, property that belongs to others, or items that present a threat to others. We ask that you treat Guests, staff, and visitors with respect. Behavior that is deemed to be threatening to the safety of others will be reviewed for potential early discharge. Within 7 days of your admission, you will be asked to create an individualized care plan along with your Nurse and Social Worker that will plan both your care and housing goals. We encourage to participate fully in this process; we are excited to help you as you move forward in your health and housing journey. Guests are only permitted in their assigned rooms. We ask that you do not enter other Guests' rooms. We strongly encourage you to take your medications as prescribed by your physician. However, if you choose not to, please do not flush or throw them away. Our medical coordinator is happy to discuss with you any questions you may have about your medications. For everyone's safety, please do not share your medications with anyone. Please utilize the available sharps containers in the nursing office and in your restroom for all needle disposals. Drug and alcohol use is not permitted at the Community Living Center. Should you choose to use drugs or alcohol at the Center, you will be discharged. Three meals will be provided daily in the dining room. Cooking inside of your room is not allowed. For your convenience, microwaves are located in the "Grab and Go" areas. Healthy snacks are always available in designated "Grab and Go" areas. In addition, a snack cart will make rounds daily. You may have visitors while staying at the Community Living Center between the hours of 9am and Spm. All visits must take place in designated visiting areas. 24-hour prior arrangements with your Social Worker must be made for visits to be approved. While we expect all guests to be respectful of each other's property, theft does sometimes occur. We are not responsible for any lost or stolen property, including medication. Therefore, we recommend you keep all your belongings inside of your room and utilize your personal locker for all your valuables, including medication. �F CalOptirria Health 16 We encourage you to keep your medicine in your room. However, we can also store your medication for you in the nurse's office if that is something you prefer. Quiet hours are observed from 10:00 p.m. to 7:00 a.m. As a courtesy to everyone, we ask that you keep noise levels at a minimum during this time. Please observe our Curfew of 10:00pm. We understand that at times it will be necessary for you to return after 10:00pm. Please make arrangements with your Social Worker for these occurrences. It is our hope that all Guests will secure Permanent Housing prior to discharge from the Community Living Center. However, if discharge does occur prior (and is not due to a hospitalization), we will hold your personal items for up to 72 hours after your discharge. If at any point during your stay with us you are unsatisfied with the care you are provided,you may notify administration by filing a grievance report. These are available at the lobby front desk. Staff will knock and with permission, enter your room six times throughout the day and night as they check in with you to ensure your wellbeing. We ask that you answer the door each time you hear a knock on the door. If for some reason you do not answer, staff will enter the room to ensure your safety. During those visits, please let staff know how they can assist you and support your recovery. ' -)cal Preferenor� Policy Priority will be given to residents of the City of Tustin for both the Recuperative Care and PACE Programs. Residency is determined during the intake process. There is no predetermined number of beds/spaces designated for the City of Tustin. National Institute for Medical Resnite Care The Standards for Medical Respite Care developed by the National Institute for Medical Respite Care serve as a framework to help medical respite care programs operate safely, effectively, and seamlessly with local health care systems, and to promote program development and growth. Each of the Standards includes descriptive criteria, which guides programs in determining whether they have met the Standard. These criteria are used to inform and support development of program policies, procedures, and practices and help to ensure that care delivered is high-quality and person-centered. The Community Living Center will strive to achieve the highest level of quality by ensuring compliance with the 2021 Standards for Medical Respite Programs. For the purposes of the standards below, The Community Living Center will be referred to as "The Center". �F CalOptirria Health 17 Standard 1: Medical Respite Program Provides Safe and Quality Accommodations. 1. A bed is available to each Guest for 24 hours a day while admitted to the program. 2. Onsite showering and laundering facilities will be available to Guests to ensure access and ability to maintain hygiene. 3. Clean linens will be provided. 4. The Center is accessible and usable to people who have disabilities, including but not limited to mobility impairments and other physical disabilities. S. The Center will provide access to secured storage for personal belongings and medications. Each Guest will stay in semi-private rooms that will be equipped with dressers, closets, additional storage, and a personal locker. Therefore, each guest will store their belongings in their own room. For guests with additional items, on site storage will be available. 6. Three meals per day will be provided and food services meet applicable public health department guidelines for food handling. Guests will be provided education on dietary recommendations, based on diet available both at the Center and at the anticipated post-respite disposition. Food services will be culturally appropriate. 7.All staff will be trained to provide first aid and basic life support services and communicate to outside emergency assistance. 8. The Center will have 24-hour on-call medical support for nonemergency medical and behavioral health inquiries when clinical staff is not on site and Guests will have knowledge and access to on-call medical support information. 9. The Center will have written policies and procedures for responding to life-threatening emergencies. 10. The Center will be compliant with local and/or state fire safety standards governing the facility. 11. The Center will have a written code of Guest conduct that describes program policies including potential causes for early discharge and this document is shared with and acknowledged by the Guest at admission. 12. The Center will have policies and staff trainings to address safety, which include: a. The handling of alcohol, illegal drugs, and unauthorized prescription drugs found on site. b. The handling of weapons brought into the facility. c. Strategies to maximize client and staff safety. d. Trauma-informed de-escalation. e. Appropriate staff response to threatening behavior or violence. i. Guest's opportunity to receive support or debrief after incidents, ii. Threatening behavior clearly defined and based on observable actions. �F CalOptirria Health 18 f. Visitors policy. g. Procedure for managing, reporting, and responding to incidents. Standard 2: Medical Respite Program Provides Quality Environmental Services. 1. The Center will have a written policy and procedure for safe storage, disposal, and handling of biomedical and pharmaceutical waste, including expired or unused medications and needles. 2. The Center will follow state regulations for the storage, handling, security, and disposal of patient medications. 3. The Center will have a written protocol for preventing and managing exposure to bodily fluids and other biohazards. 4. The Center will have written protocols in place to promote infection control and the management of communicable diseases in alignment with local health department and Centers for Disease Control (CDC) guidelines and include: a. Process for screening communicable diseases at admission and/or if Guests presents with symptoms while within the Center. b. Process for isolating Guests with communicable diseases within Center or referring the Guest to an appropriate facility where isolation precautions can be implemented. c. Process for access and use of personal protective equipment (PPE) for staff and Guests, including what PPE should be used based on diagnosis and/or positive screen. S. The Center will follow applicable reporting requirements of communicable diseases for local and state health departments. 6. The Center's premises and equipment will be cleaned and disinfected according to policies and procedures or manufacturers' instructions to prevent, minimize, and control infection or illness, according to CDC and local health department guidelines. 7. A pest control program will be implemented and documented. Standard 3: Medical Respite Program Manages Timely and Safe Care Transitions to Medical Respite from Acute Care, Specialty Care, and/or Community Settings. I. The Center will maintain policies and procedures for screening and management of referrals, which include: a. Written admission criteria. Admission criteria and screening processes: i. Are equitable: Within the context and restrictions of site/program location and scope of �F CalOptirria Health 19 services, do not screen out or bias against particular groups, optimizes access for underrepresented, historically marginalized groups, and reflect the various identities within populations of people experiencing homelessness. ii. Strive to offer low-barrier access to services. b. Description of the program services will be available to Guests being referred, follow health literacy guidelines, and include: i. Description of program facility and staffing. ii. Services offered. iii. Equitable access and availability for all groups. iv. Parameters guiding length of stay. v. Discharge planning. vi. Program participation expectations vii. Program expectations regarding substance use. viii. Weapons management. ix. Management of personal possessions. x. Are available in the Guest's preferred language (when possible). c. Collection of pertinent referral information: i. Point of Contact and phone number for referrals. ii. Confirmation that the Guest is agreeable to transitioning to the Center. iii. Clinical summary, including medication list. iv. Screening for known active risks for suicidal, homicidal, or assaultive behavior. d. Review for clinical appropriateness. Each referral will be reviewed as an individual new case, even if the person has previously been referred or admitted to the program. e. Assessment of the Guest's psychosocial needs and ability to be met by current program support. f. Referral process such as including referral decision time and return communication. g. HIPAA-compliant communication and adherence to local and state privacy laws. 2. The Center will maintain standards for admitting practices which include: a. Each admitted Guest will have a designated referring medical provider (such as the hospital physician or primary care provider) when possible b. The Guest will be introduced and oriented to the program and staff. c. Admission agreements will be reviewed and signed by the admitting Guest. �F CalOptirria Health 20 d. The Center will screen for possession of weapons and partners for safe storage to ensure safety of patient and the other patients in program. e. Medication information will be gathered, verified, and coordinated. f. The Guest is transported safely and in a timely manner. h. The Center will provide naloxone kits in conjunction with Guest education on decreasing risk for and the management of overdoses, when indicated. tandard 4: Medical Respite Program Administers High Quality Post-Acute Clinical Care. 1. Care provided to Guest will reflect trauma-informed care practices. 2. Each guest will develop an individualized care plan within 7 days of admission that includes: a. Identification of Guest goals and priorities and specifying treatments and plans to support goals. b. Focus on optimizing medication adherence, which may include medication education or identification and provision of supports and adaptations for taking medications. c. Screening for and treating communicable diseases such as HIV, tuberculosis, syphilis, hepatitis, and sexually transmitted infections. d. Offering indicated immunizations to include, at minimum, influenza vaccination, COVID 19 vaccination, and/or other age-appropriate vaccinations. e. Screening for social determinants of health (SDOH). f. Discharge planning g. Screening for and supporting Guest's obtainment of disability or other benefits, if applicable. h. Connection to long-term medical, behavioral health and case management services, as is applicable. 3. Appropriate Center staff will conduct a baseline assessment of each Guest to determine factors that will influence care, treatment, and services using standardized and non-standardized. measures. For each Guest, the baseline assessment will include: a. The Guest's understanding and knowledge of their health status. b. Current diagnoses, pertinent history, medication history (including allergies and sensitivities), current medications, and current treatments. c. Medication reconciliation. d. Gender identity and sexual orientation. e. Physical and mental health status. f. Behavioral health needs, including substance use and screening for suicidal and homicidal ideation. g. Active symptoms. 'F CalOptirria Health 21 h. Fall risk. i. Overdose risks. j. Immunization status. k. Cultural needs and considerations. 4. Clinical encounters will be conducted based on individualized care plans or changes in Guest conditions to ensure current acuity is being supported. S. Program and affiliated staff involved in direct Guest care will be trained in and services provided reflect avoidance of stigmatizing language, and services provided reflect avoidance of stigmatizing language. a. Center will have a written procedure for managing discriminatory behavior that might arise at the Center among staff and patients. 6. Clinical and affiliated staff will be trained in the administration of naloxone. 7.A medical record will be maintained for each Guest and its content, maintenance, and confidentiality meet the requirements set forth in federal and state laws and regulations. 8. Guests will receive at least four wellness checks every 24 hours by medical respite or program- affiliated staff(clinical or non-clinical). a. Affiliated staff roles and responsibilities will be formally documented and communicated. b. Center staff will report notable changes in the Guest's condition or notable incidents to staff members working the oncoming shift. c. Staff will communicate changes in patient's condition or patient concerns to the designated medical provider, when indicated. 9. Services will be provided to the patient in an interdisciplinary, collaborative manner. 10. Guest will have access and actionable support for offsite medical appointments and telemedicine. Standard 5: Medical Respite program Assists in Health Care Coordination, provides Wrap- Around Services, and Facilitates Access to Comprehensive Support Services. I. A plan for care coordination and related needs will be established with the Guest, including: a. Guest goals and priorities. b. Identification of available care coordination supports within the Center. c. Identification of community supports and services to address identified goals and priorities. 2. The Center will designate staff to coordinate health care. Care coordination activities include: �F CalOptirria health 22 a. Supporting the Guest in developing self-management goals. b. Identify barriers to accessing health care and related services outside of the Center. c. Helping Guests navigate health systems and establish an ongoing relationship with primary care providers/patient-centered medical homes. d. Coordinating and/or providing transportation to and from medical appointments and support. services. e. Facilitating Guest follow up for medical appointments and accompanying the Guest to medical appointments, when necessary, to aid Guest in addressing their conditions/symptoms and advocating for preferences for care; f. Ensuring communication occurs between Center and outside providers to follow up on any changes in Guest care plans. g. Providing access to local phone service during the Center stay. h. Making referrals and coordinating follow-up to substance use and/or mental health programs, as needed. i. Referral placed for long-term case management, when appropriate and available. j. Connection to and engagement with community health workers and peer support services, as indicated. 3. The Center staff will provide wraparound services as appropriate, and may include: a. Facilitating and securing permanent housing, b. Identifying culturally appropriate community resources to address basic needs and provide a safe space for drop-in services, as indicated. c. Submitting applications for SSI/SSDI, food stamps, Med-iCal, and/or other federal/state benefit programs. d. Referrals to legal clinics as indicated. e. Providing access to available social support groups, including onsite peer groups, health education, and outside support groups (e.g., cancer support, addiction support, religious and spiritual groups). f. Facilitating family/caregiver or support system interaction at the direction and preference of the Guest. Standard 6: Medical Respite Program Facilitates Safe and Appropriate Care Transitions out of Medical Respite Care. 1. The Guest will be engaged in the discharge planning process, including: a. Identifying discharge indicators and timeline. CalOptima Health 23 b. Guest will be informed of the discharge policy and procedures. c. Guests will be provided with options for placement after discharge from the medical respite program. 2. The Center will maintain clear policies for discharging Guests back into the community. These include: a. A written discharge policy. i. The policy specifies the personnel authorized to make discharge decisions. ii. Discharge policies will be reviewed to ensure equitable transitions and discharge practices. b. Guests will be given a minimum of 24 hours' notice prior to being discharged from the program. (Exceptions for discharges determined by admissions, discharge, and program safety policies); c. The Center will respect the Guest's self-determination in the event the Guest requesting to be discharged from the program. Planned and standard discharge procedures are followed. d. The Center will have a policy that addresses non-routine discharge, including but not limited to death and leaving against medical advice (AMA) or absent without official leave (AWOL). e. Storage of Guest's belongings after discharge from the Center, including length of time belongings will be stored and how belongings may be accessed (including both planned and unplanned discharges). 3. Center will maintain standards for discharging procedures: a. Discharge will be based on Guest's care plan being met, availability of discharge placement, and the patient's view of program stay and assessment of goals completion. b. In a planned discharge, a discharge summary will be made available to the Guest and the Guest is given an opportunity to discuss information listed. The discharge instructions will be written to be easily understood by the Guest and will include the following: i. Written medication list and medication refill information (i.e., pharmacy). ii. Medical problem list, allergies, indications of a worsening condition, and how to respond. iii. Instructions for accessing relevant resources in the community(e.g., shelters,day centers, transportation). iv. List of follow-up appointments and contact information for medical providers. v. Special medical instructions (e.g., weight bearing limitations, dietary precautions, wound orders). vi. List of follow-up appointments and contact information for community case management and related resources, and where to follow up regarding pending applications. �F CalOptirria Health