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Home My WebLink AboutITEM NO. 2 PART 2 24 c. In the event of an unplanned or administrative discharge, the discharge summary may be available to the Guest within a reasonable time frame or at their request and contain all available information. d. A discharge summary includes: i. Admitting diagnosis, and disposition. ii. Allergies. iii. Discharge medication list. iv. Follow up instruction list. v. Any specialty care and/or primary care follow up appointments schedule. vi. Patient education/after care instructions. vii. List of pending procedures or labs that require follow up. viii. Communicable disease alerts. ix. Behavioral alerts. x. Any pain management plan. A.Any follow-up actions needed as a result of health insurance applications or other benefits initiated while at the medical respite program. xii. Contact information for treating providers and assigned long-term case managers. xiii. Exit placement. e. For Guests returning to the hospital, a clinical summary is generated to describe the reason for return. f. Adequate protocols are in place for transferring Guest information (or access to e-record) to appropriate community providers to meet HIPAA compliance and other state and federal guidelines. Standard 7: Medical respite care personnel are equipped to address the needs of people experiencing homelessness. I. The Center will establish a training plan to equip employees, volunteers, contractors, and affiliated staff with direct Guest contact,with necessary skills to maintain a safe and quality-oriented environment. Training topics should include: a. Health information privacy and HIPAA regulations. b. Trauma-informed care. c. De-escalation and conflict resolution. d. Non-discrimination, cultural humility, and non-stigmatizing language. e. Diversity, Equity, and Inclusion and/or Antiracism. �F CalOptirria Health 25 f. Sexual harassment. g. Bloodborne pathogen exposure. h. Incident reporting. i. Timely and complete documentation of clinical care. Additional training topics may include: j. social determinants of health and adverse childhood experiences (ACEs) k. Drivers/causes of homelessness. I. Harm Reduction m. Interprofessional collaboration n. Health topics related to the specific patient population represented in the program. 2. Staff will have access to adequate equipment to complete their job function and roles. 3. Self-audits and/or peer reviews will be conducted at least annually. 4. The Center will implement explicit procedures to remove bias and discrimination, including: a. Embedding principles of Diversity, Equity, and Inclusion in hiring and compensation practices, training, personnel reviews and audits, and volunteer recruitment. b. Procedures to address and respond to episodes of or concerns of bias and discrimination in the workplace. c. When possible, Staff will be representative of the Guest population (throughout the hierarchy) and feel valued and included in the workplace. S. Staff employed by the Center will have written job descriptions and meet the qualifications required by such job descriptions. 6. The credentials of licensed and certified professionals (employed, contracted, and volunteer)will be Verified. 7. Written procedures will be in place to screen volunteers to ensure patient safety. All clinical volunteers will be credentialed per programs' credentialing process for their relevant scope of practice. 8. Performance reviews will be conducted annually for all employees pursuant to written human resource policies. For clinical staff, the performance review includes an evaluation of the quality of clinical care provided. �F CalOptirria Health 26 Standard 8. Medical respite care is driven by quality improvement. 1. The Center will establish and annually update a quality improvement (QI) plan. The QI plan will include essential information on how the program will implement and monitor high quality clinical and enabling services. The QI plan should include the following: a. A systematic process with identified leadership, accountability, and dedicated resources, and includes stakeholders such as direct staff and consumers. i. A continuous adaptive, flexible, and responsive process to changes in the community or shifts needs of the patient population. b. Use of data and objective measures to determine progress toward relevant, evidence-based benchmarks and outcomes. i. Outcomes should include both quantitative and qualitative data, including Guest satisfaction and feedback surveys. ii. Metrics and outcomes used should be race-conscious to identify potential disparities in populations referred, care, and outcomes. c. Data collected is reported and analyzed to determine if goals are met and outcomes are improved. d. Clearly define methods to evaluate improvements and goals including: i. Frequency of data collection, review, and reporting. ii. How services were improved. iii. How improvements addressed identified problems. e. Developing an action plan to improve outcomes. i. Program improvements may reflect environmental/facility updates or adding in new interventions, supports, and services. ii. Provide staff training to adjust services to address needs and changes identified. 2. Center will establish a framework for service delivery that is based on the QI plan findings and outcomes. To illustrate areas of impact, the outcomes should reflect health and social outcomes. a. Program establishes outcomes that are focused on the health needs of clients and the clinical care provided by the program. This may include: i. Assessment of and coordination of health screenings. ii. Care planning before client's discharge. iii. Guest's report of self-improvement. iv. Connection to primary care, connection to specialty care including mental health and substance use disorder (SUD) treatment as appropriate. 'F CalOptirria Health 27 v. Decreased emergency use. b. The Center will establish outcomes that focus on coordination of care for a complex population who may otherwise face barriers in navigating and engaging support. These social outcomes may include: i. Enabling services (i.e., connection to insurance). ii. Linkages to social support, coordination of care to mental health services and SUD treatment. iii. Client readiness for transition and placement at discharge. c. Every Guest has an opportunity to complete an experience of care survey prior to discharge or as part of discharge process, include forms/surveys and individual interviews. d. The Center will have a written patient grievance policy and procedure. i. The Center will incorporate a process to immediately respond to grievances. ii. Grievances should also be reviewed at structured intervals to identify programmatic improvements. 3. The Center will implement procedures to protect patient information in all data collection processes. a. Data will be kept in a secure location and meets regulatory guidelines for information security. b. Data that is shared with outside organizations will be de-identified so that no patient is identifiable based on information shared, or information is aggregated so that no one person can be identified by data sharing. c. Data will only be collected and/or reported to meet guidelines or established metrics. Sensitive and personal data is only collected and shared with consent of the patient or for mandatory reporting guidelines as stipulated by the local health department. 4. The Center will have a written plan and signed contract for any data and information sharing capacities with hospitals, health systems, and continuums of care (CoC). a. The Center will meet the guidelines for data collection and reporting. S. Outcomes shared by the program will accurately reflect the data collected and can be concluded by information available and will be calculated by appropriate and qualified individuals. �F CalOptirria Health 28 SECURITY POLICIES 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. Actively participate in city and county-wide community events and attend meetings of the local Neighborhood Associations and Chamber of Commerce. a 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. C Sponsor special events such as community resource fairs,which will include the community and neighbors. Neighborhood Engagement Team 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. �F CalOptirria Health 29 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 follow a strict no loitering policy that will ensure: 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. A bicycle rack will be provided in a secured, outdoor area for guests to utilize. and not be parked in the surrounding neighborhood. from site. Abandoned property, shopping carts and other "blight." Securitv Plan CalOptima Health will follow policies and procedures 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. The Safety and Security team consists of the Safety and Security Manager and 15 Guest Safety Associates. The front entrance will be staffed with the receptionist and at least one member of the Safety and Security team. 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. 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. 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 from the opening of the center. Install and keep in good working order visible surveillance cameras both inside and outside the facility, covering all public areas. �F CalOptirria Health 30 Monitor Security Cameras 24/7 by security personnel. 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 fob 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. Prohibit guests from bringing weapons or objects which can be used as weapons into the center. 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 Gender and sexual orientation affirming care. Health Equity and Social Determinants of Health CPR and First Aid Food Handling • Fire drill and disaster evacuation procedures Rounding Program 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. Employees will be trained to look for signs of medical distress, behaviors commensurate with alcohol and drug use and presence of weapons. This rounding protocol helps ensure all Guests are cared for the facility is kept safe. �F CalOptirr'ia Health 31 Alcohol and Drug Protocol 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 above) 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 Weapons Protocol 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. Curfew Following the policy at the Village of Hope, there will be a curfew of I0:00pm. 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. CalOptima Health will make every effort to ensure Guests are not discharged to the street. Guests in the Recuperative Care/Post Hospitalization Program will be allowed to have visitors between the hours of 9am 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. Guest with Vehicles On very rare occasions,one of the Guests in the Recuperative Care/Post Hospitalization programs may 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. 'F CalOptirria Health 32 Partnership with Tustin Police Department 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 Living Center that requires Police intervention. Additionally, CalOptima will make available requested CCTV footage in consult with CalOptima's legal team. r' ,)ntact Informatior* 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 A designated phone number and contact information will be established and posted 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 5pm Monday- Friday 8am to 5pm 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 a 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. The Director of the PACE Program will be on site M-F 8:30am-5:OOpm. The program is closed on weekends. RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM A designated phone number and contact information will be established and posted 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 a 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 �F CalOptirria Health 33 Community Living Center of Tustin is fully committed to providing an appropriate customer service response to all inquiries. 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 1 1:30am- 8:00pm. There will be a "Manager on Duty" during all hours outside of these hours; a manager is on duty 24/7. 'F CalOptirria Health 34 Frequently Asked Questions (FAQ) I. Will the facility function as 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. 2. Will 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 Cio 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. 3. Will services (recuperative or PACE) 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. 4. 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 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. S. Can homeless individuals register themselves into the recuperative care and post-hospitalization housing programs? Homeless individuals are not able to register themselves for the Recuperative Care Program/Post Hospitalization Program. The only way for an unhoused Older Adult 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. 6. 1 would like to learn more about a typical PACE participants experience at the center. Can you share an example? �F CalOptirria Health 35 Yes. Please find this example in Appendix B. 7. Can you give me some specific information about the PACE shuttles? Yes. Information about the PACE shuttle schedule, size and third-party vendor can be found in Appendix C. 8. If a Guest needs additional medical care, what hospital partners would accept these guests? 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. 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. 9. Where is the BeWell Regional Campus is located, and what are 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. 10. 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. Cal Optima Health does not currently provide Recuperative Care services in Orange County. 11. 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. CalOptima Health 36 12.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 CaIAIM 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. 13.What is the funding mechanism behind the program - on what basis are funds allocated from CaIAIM to the center? Are there any other funding sources outside of CaIAIM? All funding for the program is provided by CalOptima Health through the CaIAIM program which is funded by the State of California. No other funding sources outside of CalOptima Health will be required. 14. Can you show me on the floor plans where the following areas in the building will be located: PACE versus Recuperative Care/Post Hospitalization areas, entrances to both programs, the intake department, and Guest storage areas within the semi-private rooms and any additional storage? Please see floor plans in Appendix D with all the above areas identified. I S.Will the PACE areas of the building be used outside of the regular PACE operating hours? No.These areas will be locked and inaccessible for use outside of the regular PACE operating hours. 16.Will there be any new fencing around the perimeter of the property or building and how will access to and from the buildings, common outdoor areas and underground parking be secured and controlled? The perimeters of the building are already enclosed which provides privacy as well as security. 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. 17.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. CalOptima Health 37 18.Will beds be designated for emergency shelter while the intake/screening/insurance process occurs? No. The Community Living Center is not an emergency shelter. The intake/screening and insurance processes occur prior to the Guest being approved for admission. 19. 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. 20.What constitutes morning, evening, and night shifts in the Recuperative Care/Post Hospitalization Program? Morning Shift: 7:OOam- 3:30pm Afternoon Shift: 3:OOpm- 11:30pm Night Shift: I I:00am to 7:30pm 21. Can you specify the number of employees by expertise (i.e., therapists, social workers, recreation, etc.) for PACE? Nurses:10 Medial Assistants: 6 Therapists:12 Social Workers:8 Receptionists: 2 Dietician: 3 Activity Personnel: 3 Home Care: 4 Medical Director: I Medical Records: 5 Transportation: 2 AdministrationA Remote: 10 GOMM CalOptima Health Appendix A 38 Shelter List 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 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 �F CalOptirria Health Appendix B 39 PAcr 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 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 MOT 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 �F CalOptirr'ia Health Appendix B 40 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. �F CalOptirria Health Appendix C 41 Shuttle Information 1. What are the dimensions and seating capacity of the shuttle vans? 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. 2. What is the name of the third-party company that 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: 12800 Center Court Drive South, Suite 120 Cerritos, CA 90703 3. What are the shuttle arrival schedules? How many shuttles arrive/depart per hour? Where would they load/unload on-site? Shuttles arrive and depart between the hours of 8am 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 Site Plan in Appendix D). 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. 4. 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 (identified in question #2 above) 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 (identified in question #2 above)when not in use. CalOptima Health Appendix D 42 --_-----mow;u ----_-- F CalOptima Shuttle Loading and Unloading Area I Shuttle Staging o Km i cl I CMG I I C I r t, Y a1 w r o� I Y _ � !1 1 nY If1Y+w+� I 1 I I I I u I CalOptima Health I Appendix D 43 VZZ6 V-') 111113fil f — AV 311W I W991 is vq�l 0) l 92V 1 o =m ' J—ij < 40 vc- O 7 o LA PN. IJU /� YI CalOptima Health Appendix D 44 c OBZT6 VO'Nugm 3AV 311SANN 991 N vudok 1 5,vv i b' -- -- Ht173H W1tdofQi'd� 17 Al 4 e r - .IJ f d. 'I f1i .f J{� Fs I CalOptima Health Appendix D 45 1S VIRJOA 1581?I I r 4 I I � � I - � o u _ i n}i ` ' 1 J CalOptima Health Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 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. Operations and Security 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 Appendix D 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. Answered in FAQ #16 II. REGARDING PROJECT DESCRIPTION AND USE: a. Define "Community Living Center." Answered on Page 3 and FAQ # 11 b. Define eligibility criteria for the recuperative care program and short-term post- hospitalization housing. Answered on Page 5-6 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. Answered on Pages 5-6 Older adult is defined on Page 3 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." Answered in FAQ #1 1 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 e. Clarify if the site will provide housing to homeless individuals who do not need medical assistance or rehabilitation services. Please see FAQ #2 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. Please see FAQ #3 f. Clarify any differences between the recuperative care vs. short-term post- hospitalization program. Answered on Page 4 i. Is there a difference in services provided, eligibility criteria, room locations within the center, etc.? Answered on Page 4 ii. Is there a fixed number of beds available for the recuperative care program vs. the short-term post-hospitalization housing program? Answered on Page FW 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? Answered on page 4 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? Answered on Page 6 g. What is expected of recuperative care/short-term housing participants in their role as care recipients? Answered on page 13 i. Will there be a curfew? If so, how will this be implemented or monitored? Answered on page 30 ii. Will there be a no drug or alcohol use policy? If so, how will it be enforced? Answered on page 29 h. Is there a visitor policy for recuperative care/short-term housing recipients? Answered on page 30 2 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 i. What is CalOptima's or CaIAIM's affiliation with the County of Orange Continuum Care, Coordinated Entry System, etc.? Answered in FAQ # 12 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? Answered in FAQ #13 k. Are Tustin community organizations, such as Families Together of Orange County, partnered with the center? Answered in FAQ # 17 III. 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 counted as sheltered or unsheltered. If they are counted as homeless individuals, to what cities are they to be assigned? Answered in FAQ # 4 IV. INTAKE AND DISCHARGE a. PACE: i. Clarify if other homeless individuals (not recuperative patients) can access the PACE center and its services. Answered on page 5 ii.Clarify and provide a map for the CalOptima PACE Service Area. Answered on page 5 iii. Define the "financial criteria" for PACE participants. Answered on page 5 iv. Provide a Code of Conduct with expectations for PACE participants. Answered on page 11-14 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? Answered on page 6 3 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 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. Answered on page 6 iii. Define or provide information related to behavior expectations and Code of Conduct for recuperative care/post-hospitalization housing recipients. Answered on page 14-15 iv. Clarify if homeless individuals can register themselves into the recuperative care and post-hospitalization housing programs. Answered in FAQ # 5 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. Answered on pages 5-7 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. Answered on page 10 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? Answered on page 6 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? Answered on page 15 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. Answered on page 7 4 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 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? Answered on page 31 ii. What personnel are on the Neighborhood Engagement Team? How often do they meet, and what happens after they identify an issue? Answered on page 27 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? Answered on page 28 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. Provided in pages 27-31 iii. Define the protocol for ensuring guests do not use illegal drugs. Answered on page 29 iv. Define the protocol for ensuring guests are unable to bring weapons into the center. Ex. will there be bag checks, metal detectors, etc.? Answered on page 30 v. Elaborate on the rounding program that will monitor guests throughout the day. What does this entail? Answered on page 29 5 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 vi. What staff will have portable communication devices? Will this be implemented from the beginning of the center's opening? Answered on page 28 vii. What personnel will staff the front entrances? Answered on page 28 City follow-up Questions to Responses to Questions dated January 3, 2023 1. Clarify who are the hospital partners that would accept guests needing additional medical care. Answered in FAQ #8 2. Clarify where the BeWell Regional Campus is located, and how the terms of the partnership between them and CalOptima. Answered in FAQ #9 3. Clarify who are partnering county and city shelters - what organizations operate these shelters and what cities are they located in? Answered in Appendix A 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? Answered on page 3C City follow-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? Answered in Appendix C 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. Answered in Appendix C 3. Specify which third-party company provides shuttle services, and what city/location the vans are stored when not in use. Answered in Appendix C 4. Elaborate on van arrival schedules. How many shuttles arrive/depart per hour?Where would they load/unload on-site? Answered in Appendix C 6 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 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? Provided in Appendix D 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. Indicated on floor plans in Appendixes B and D 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? Answered on page 3C 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.). Answered in FAQ # 20 and 21 9. Please specify the full breadth of services provided to PACE participants and participants of the recuperative care/short-term housing programs. Answered on pages 3-4 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. Answered on page 6 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. Answered on page 8 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? Answered on page 8 o Will beds be designated for emergency shelter while the intake/screening/insurance process occurs? Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 Answered in FAQ # 18 4. Specify where the intake department will be located. Specified on the floor plan in Appendix D 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? Answered on page 10 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 pages 15-26 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." Specified in Appendix D and page 16 8. How many rooms are anticipated to be made available for guests with pets? How large of pets and what kind would be permitted? Answered in FAQ # 19 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? Answered on page 9 City follow-up Questions to Responses to Questions dated 1-18-23 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 Answered in FAQ # 10 City Questions dated 12-22-22 1. Where are guests are taken when involuntarily discharged from the PACE and Recuperative Care programs? Answered on page 10 8 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 2. Security camera locations and willingness to share surveillance footage with the Tustin Police Department? Answered on page 28 and 30 City Question 1-10-23 1. How many shuttles will you have for the facility, what are their sizes, and will they be stored overnight on-site? Answered in Appendix C 2. What are the shuttle arrival schedules? Are they staggered? Answered in Appendix C 3. What are the hours of PACE hours of operation? Answered on page 4. 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? Answered on page 30. 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? Answered in FAQ # 21 Citys Questions 1-12-23 1. How do prospective guests apply for the program? Are they only to be referred by hospitals? Certain partner organizations? Answered on page 6 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. Answered on page 10 3. Does the proposed recuperative care program follow the NIMRC Standards for Medical Respite Care Programs? Answered on pages 15-26 4. What is the policy regarding storage of guest belongings? Where do they store belongings when part of the program? Answered on page 16 9 Request for Additional Information January 26, 2023 Conditional Use Permit 2022-0019 5. What is the pet policy? Can guests bring pets with them? Answered in FAQ # 19 6. Can guests voluntarily disenroll from the recuperative care program prior to being placed in permanent housing? What is the protocol in this scenario? Answered on page 9 7. What is the protocol once guests exceed the 6-month term for post-hospitalization housing? Answered on page 4 Citys Question 1-17-23 1. Can you confirm if CalOptima provides recuperative care services elsewhere in the county? I know CalOptima partners with other agencies who provide similar services, like the Illumination Foundation, but is CalOptima an operator? Answered in FAQ # 10 10 COMMUNITY LIVING FACILITY OF TUSTI N _ f C A \ All I Operations and Security Plan 14851 Yorba Ave Tustin CA 92780 alOptim Health 1 CONTENTS ExecutiveSummary .....................................................................................................2 Operations Plan Program and Scope of Services................................................................................... 3 EligibilityCriteria.............................................................................................................6 Intake and Admission Process......................................................................................8 Discharge...................................................................................................................... 11 Codeof Conduct............................................................................................................14 LocalPriority Policy ..........................................................................................19 National Institute for Medical Respite Care Standards.....................................20 Security Policies- GoodNeighbor Policy ......................................................................................32 Loitering ..........................................................................................................33 SecurityPlan .................................................................................................................33 ContactInformation .........................................................................................37 Frequently Asked Questions.................................................................................................39 Appendixes AppendixA. Shelter List...............................................................................................49 Appendix B. PACE only and PACE and RCC/STPH Walkthrough Description .......50 Appendix C. Shuttle Information................................................................................53 AppendixD. Floor Plans...............................................................................................55 Appendix E Program Comparisons.............................................................................59 Appendix F: Recuperative Care/Short-Term Post Hospitalization Comparison...60 Appendix G: CalAIM Information................................................................................61 Appendix H: List of Housing Partners .......................................................................67 Appendix I: List of Service Partner Types..................................................................68 Appendix J: Administrative Organizational Chart ...................................................69 0, 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 CaIAIM, 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, Tustin community members receiving priority at this facility. Overall, the recuperative care center will serve 119 unhoused older adults working toward a permanent housing placement (The number of beds in the original CUP). The PACE center will serve up to 500 individuals from both the community and the recuperative care center. Am ■ CalOptima 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. Vrogram 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. CalOptima Health 4 • 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 • 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 CalOptima Health 5 The PACE program will be open Monday thru Friday, 7:30am to 5:00pm. RECUPERATIVE CARE/POST-HOSPITLAIZATION 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. • Medication management • 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. Recuperative care does not provide any direct medical services, only medical oversight, and management. Should a Guest need direct medical care, they will be referred the PACE clinic or the clinic of their choice. At times a Guest will have a medical issue that requires the assistance of a licensed home health agency. Should this be the case, the program nurse will arrange these services. Medical services that may be provided by a licensed home health agency include Wound Care and IV Antibiotics. The Short Term-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. CalOptima Health 6 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 income criteria (low or extremely low income) CalOptima Health's PACE program can provide services throughout Orange County. Our defined PACE Service Area 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 en94: 99ze4 906r9 a463+ .... .. eSaaa Rwerside s]bs ,'�q s9xr 9069P°B�' 9zez: 9+Tba 9a5o5 szs9a Moreno V """`l0]2�B6� 942d2 9aW5 9162] 9daW ga 92553 7646a�4634]+'S��tl 90T96 m 94638�' 99tl]5 9]986 4Pitli 9]eT9 995ab 9211 25 1 9W4r 94895�11 90]�T4]_9p4a�1a3�2B�9}�2tlT9 l 5 m'0 mY'90YIG 9QT 9962,�424 92ga1 gp5 9289T 42b46 9]a11 928.61 �3 a25Q1 4469T T fiReeS b3�A3a69 9ti00 �{'eJ9 428 %nf4i lbz4595e��ss seas a�sozx9 946e4 Paz stasia aza� nxe 89a1flT846 9YBds 91�$/4 �Te�99 azs]o •4 saTLrlseJ�e,:i�P .99rw vrss3 8Ma] 9rToa azT95�z .. ©z 59s93 9zc5s Sratn�ro,5h3s92Te2 9z6Ts � 9aee1 9' sm3Zibral sw ,.mTsaru�2ur 9zrae sn�'2eTq sxbm 9z BMgB 42814 9]bT8 935]2�SIT Huntl4&UV4 9zalz s291a , 928M 92689 92688 92580 916aa 926 "'as3 22666622 1T"�9i63T p�szs9`��szsrs 9a 59a gy �YGST 9Y89M89gq'n 111711 62651 9re9a 92%2 Mum 9�T5 9M29 926T3 92'! 92624 g 92a55 92 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 individuals, outside of those residing in the Community Living Center, will be eligible to enroll in the PACE program. C%I CalOptima Health 7 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. CalOptima Health 8 CalOptima Health is the pD1 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. 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 that 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. 0 CalOptima Health 9 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 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. Medical condition is confirmed through a review hospital discharge paperwork and other medical records provided by the hospitals. 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 CalOptima Health 10 The program will utilize a bed reservation system.All guests will arrive to the program by hospital contracted and provided transportation (UberHealth 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, the Department can contact the Center and an evaluation team consisting of a nurse, social worker and intake coordinator will deploy to the location of the identified unhoused individual and engage with the individual to assess eligibly. If the individual meets eligibility criteria and is willing to enroll in the program, transportation will be arranged by CalOptima Health. CalOptima Health staff will stay with the individual until the transportation arrives and then follow that transportation vehicle to the Center. CalOptima Health will designate key points of contact in order for Tustin Police Department and OCFA to have timely access. Tustin Police and Tustin Shelters will be the oo Police Department and Shelters in the County able to refer Guests to the Community Living Center as this is not a requirement of the program, but rather an additional opportunity offered to the City of Tustin only. Development of a Housing and Care Plan Within 7 days of your admission into the Recuperative Care Center, each Guest will be asked to create an individualized Housing and Medical Care Plan along with their Nurse and Social Worker that will outline both the Guest's medical care and housing goals. Each Guest will be encouraged to participate fully in this process. Medical Care Plan: The nurse will meet with each Guest within 7 days of admission and create with them their medical care plan that will include goals that are individualized to each Guests medical condition. This could include (but not be limited to) follow up medical appointments, medication management, health education, and self-care. This plan will be reviewed by the nurse monthly with each Guest and modified as needed. Housing Plan: The Social Worker will meet with each Guest withing 7 days of admission and create with them their Housing plan that identifies barriers, includes short and long term measurable goals for each issue, establishes the approach to meet the each goal. This includes: • Determining the housing options that are appropriate for each Guest based on their medical condition and financial resources. • Identifying the appropriate permanent housing options • Assisting to secure identified housing including the completion of housing applications. 0, CalOptima Health 11 • Assisting with benefits advocacy, including assistance with obtaining identification (e.g., Social Security Card, birth certificate, prior rental history). • Assist with SSI eligibility and supporting the SSI application process. • Identify and secure available resources to assist with subsidized rent (e.g. HUD Vouchers or other assistance programs) • Identify and secure resources that cover expenses such as security deposit, moving costs, adaptive aids, environmental modifications, and other one-time expenses. • Landlord education and engagement • Ensuring that the living environment is safe and ready for move-in • Communicating and advocating on behalf of the Guest with landlords. • Assisting in arranging for and supporting the details of the move Which of these services above provided will be based on the individualized assessment of needs that are included in the Housing Plan. This plan will be reviewed by the Social Worker monthly with each Guest and modified as needed. 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. es CalOptima Health 12 • 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 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 decides they would like to leave the program prior to identifying permanent housing and it is not due to family reunification, es CalOptima Health 13 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 that leaves the program to permanent housing will receive housing tenancy services, Housing Tenancy Services are provided as a Medi-Cal benefit through CalOptima Health to assist Guests of the Recuperative Care/Post-Hospitalization program that have identified and secured permanent housing to maintain that housing long-term. These services include having an assigned case manager conduct monthly check meetings for at least one year after recuperative guests are placed into permanent housing. Services provided in the monthly meeting include but are not limited to: • 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 • Continuing assistance with lease compliance Involuntary Discharge 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. CalOptima Health 14 • 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 or non-medical transportation 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 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. Code 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. CalOptima Health 15 • 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 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 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. 0, CalOptima Health 16 • 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. • 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. 0, CalOptima Health 17 • 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 agree to and abide by the following Guidelines and Code of Conduct. 0, CalOptima Health 18 • 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 Housing and 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 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. 0, CalOptima Health 19 Therefore, we recommend you keep all your belongings inside of your room and utilize your personal locker for all 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. • Please observe our Curfew of 10:00pm. We understand that at times it will be necessary for you to return after I0:00pm. 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. Local Priority Policy Priority will be given to residents of the City of Tustin for both the Recuperative Care and PACE Programs. Local priority is defined as prioritizing anyone who has residency ties to the City of Tustin (verified by, but not limited to family connections, verified former Tustin residence, high school affiliation, etc.). This policy will be implemented during the intake process as residency will be determined at this point. This will be monitored by the intake team and an annual report provided to the designated City of Tustin representative/department. There is no predetermined number of beds/spaces designated for the City of Tustin. CalOptima Health 20 National Institute for Medical Respite 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". 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. 5. 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. 0 CalOptima Health 21 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. 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. 0, CalOptima Health 22 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. 5. 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 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). CalOptima Health 23 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. 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. Standard 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. 0, CalOptima Health 24 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. 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. 5. 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. 0, CalOptima Health 25 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. 1. 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: 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. CalOptima Health 26 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. Developing a housing plan with the Guest and 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. 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 r 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. CalOptima Health 27 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. CalOptima Health 28 c. In the event of an unplanned or administrative discharge, the discharge summary may be available to the Guest within a reasonable time frame or at their request and contain all available information. d. A discharge summary includes: i. Admitting diagnosis, and disposition. ii. Allergies. iii. Discharge medication list. iv. Follow up instruction list. v. Any specialty care and/or primary care follow up appointments schedule. vi. Patient education/after care instructions. vii. List of pending procedures or labs that require follow up. viii. Communicable disease alerts. ix. Behavioral alerts. x. Any pain management plan. A. Any follow-up actions needed as a result of health insurance applications or other benefits initiated while at the medical respite program. xii. Contact information for treating providers and assigned long-term case managers. xiii. Exit placement. e. For Guests returning to the hospital, a clinical summary is generated to describe the reason for return. f. Adequate protocols are in place for transferring Guest information (or access to e-record) to appropriate community providers to meet HIPAA compliance and other state and federal guidelines. Standard 7: Medical respite care personnel are equipped to address the needs of people experiencing homelessness. 1. The Center will establish a training plan to equip employees, volunteers, contractors, and affiliated staff with direct Guest contact, with necessary skills to maintain a safe and quality- oriented environment. Training topics should include: a. Health information privacy and HIPAA regulations. b. Trauma-informed care. c. De-escalation and conflict resolution. CalOptima Health 29 d. Non-discrimination, cultural humility, and non-stigmatizing language. e. Diversity, Equity, and Inclusion and/or Antiracism. f. Sexual harassment. g. Bloodborne pathogen exposure. h. Incident reporting. i. Timely and complete documentation of clinical care. Additional training topics may include: j. social determinants of health and adverse childhood experiences (ACES) k. Drivers/causes of homelessness. I. Harm Reduction m. Interprofessional collaboration n. Health topics related to the specific patient population represented in the program. 2. Staff will have access to adequate equipment to complete their job function and roles. 3. Self-audits and/or peer reviews will be conducted at least annually. 4. The Center will implement explicit procedures to remove bias and discrimination, including: a. Embedding principles of Diversity, Equity, and Inclusion in hiring and compensation practices, training, personnel reviews and audits, and volunteer recruitment. b. Procedures to address and respond to episodes of or concerns of bias and discrimination in the workplace. c., When possible, Staff will be representative of the Guest population (throughout the hierarchy) and feel valued and included in the workplace. 5. Staff employed by the Center will have written job descriptions and meet the qualifications required by such job descriptions. 6. The credentials of licensed and certified professionals (employed, contracted, and volunteer) will be Verified. 7. Written procedures will be in place to screen volunteers to ensure patient safety. All clinical volunteers will be credentialed per programs' credentialing process for their relevant scope of practice. 8. Performance reviews will be conducted annually for all employees pursuant to written human resource policies. For clinical staff, the performance review includes an evaluation of the quality of clinical care provided. 0, CalOptima Health 30 Standard 8. Medical respite care is driven by quality improvement. 1. The Center will establish and annually update a quality improvement (QI) plan. The QI plan will include essential information on how the program will implement and monitor high quality clinical and enabling services. The QI plan should include the following: a. A systematic process with identified leadership, accountability, and dedicated resources, and includes stakeholders such as direct staff and consumers. i. A continuous adaptive, flexible, and responsive process to changes in the community or shifts needs of the patient population. b. Use of data and objective measures to determine progress toward relevant, evidence- based benchmarks and outcomes. i. Outcomes should include both quantitative and qualitative data, including Guest satisfaction and feedback surveys. ii. Metrics and outcomes used should be race-conscious to identify potential disparities in populations referred, care, and outcomes. c. Data collected is reported and analyzed to determine if goals are met and outcomes are improved. d. Clearly define methods to evaluate improvements and goals including: i. Frequency of data collection, review, and reporting. ii. How services were improved. iii. How improvements addressed identified problems. e. Developing an action plan to improve outcomes. i. Program improvements may reflect environmental/facility updates or adding in new interventions, supports, and services. ii. Provide staff training to adjust services to address needs and changes identified. 2. Center will establish a framework for service delivery that is based on the QI plan findings and outcomes. To illustrate areas of impact, the outcomes should reflect health and social outcomes. a. Program establishes outcomes that are focused on the health needs of clients and the clinical care provided by the program. This may include: i. Assessment of and coordination of health screenings. ii. Care planning before client's discharge. iii. Guest's report of self-improvement. CalOptima Health 31 iv. Connection to primary care, connection to specialty care including mental health and substance use disorder (SUD) treatment as appropriate. v. Decreased emergency use. b. The Center will establish outcomes that focus on coordination of care for a complex population who may otherwise face barriers in navigating and engaging support. These social outcomes may include: i. Enabling services (i.e., connection to insurance). ii. Linkages to social support, coordination of care to mental health services and SUD treatment. iii. Client readiness for transition and placement at discharge. c. Every Guest has an opportunity to complete an experience of care survey prior to discharge or as part of discharge process, include forms/surveys and individual interviews. d. The Center will have a written patient grievance policy and procedure. i. The Center will incorporate a process to immediately respond to grievances. ii. Grievances should also be reviewed at structured intervals to identify programmatic improvements. 3. The Center will implement procedures to protect patient information in all data collection processes. a. Data will be kept in a secure location and meets regulatory guidelines for information security. b. Data that is shared with outside organizations will be de-identified so that no patient is identifiable. based on information shared, or information is aggregated so that no one person can be identified by data sharing. c. Data will only be collected and/or reported to meet guidelines or established metrics. Sensitive and personal data is only collected and shared with consent of the patient or for mandatory reporting guidelines as stipulated by the local health department. 4. The Center will have a written plan and signed contract for any data and information sharing capacities with hospitals, health systems, and continuums of care (CoC). a. The Center will meet the guidelines for data collection and reporting. 5. Outcomes shared by the program will accurately reflect the data collected and can be concluded by information available and will be calculated by appropriate and qualified individuals. CalOptima Health 32 SECURITY POLICIES 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, as determined necessary by each stakeholder group. 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. • 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. To be collaborative with the community, CalOptima will determine the frequency of these team meetings in accordance with what the group determines is necessary. • Sponsor special events such as community resource fairs, which will include the community and neighbors. Neighborhood Engagement Team • 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 0 CalOptima Health 33 the entire team. To be collaborative with the community, CalOptima will determine the frequency of these team meetings in accordance with what the Team determines is necessary. Issues identified will be given immediate attention and a plan will be developed to ensure the issue is resolved. 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. Loitering will be monitored, prevented, and discouraged by the Safety and Security team. Therefore, the Center will follow a strict no loitering policy that will ensure: • 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 UberHealth 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. • A bicycle rack will be provided in a secured, outdoor area for Guests to utilize. • and not be parked in the surrounding neighborhood. from site. • Abandoned property, shopping carts and other "blight." CalOptima Health will follow policies and procedures 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. Security will be provided 24 hours a day, 365 days per year with 24/7 monitoring of approximately 40 cameras (both inside and outside the building) by the Safety and Security team. This team consists of the Safety and Security Manager and 24 Guest Safety Associates. The front entrance will be staffed with the receptionist and at least one member of the Safety and Security team. The Community Living Center will implement a "Dispersed Security System." This will ensure all staff are trained and responsible in all areas outlined in the security plan. The building will be divided into 5 "pods" of roughly 25 beds in each pod. Each pod will be staffed with its own Social 0, CalOptima Health 34 Worker and Nurse, and a Guest Safety Associate 24 hours a day, one for each of the three shifts (Shift 1: 07:00am- 15:30pm, Shift 2: 15:00pm-23:30pm, Shift 3: 23:00pm-07:30am). 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. • 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 from the opening of the center. • Install and keep in good working order visible surveillance cameras both inside and outside the facility, covering all public areas. • Monitor Security Cameras 24/7 by security personnel. • 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 fob 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. • Prohibit guests from bringing weapons or objects which can be used as weapons into the center. 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 CalOptima Health 35 • Supporting and caring for Individuals with Substance use disorders. • Supporting and caring for Individuals with Mental Health diagnosis • Gender and sexual orientation affirming care. • Health Equity and Social Determinants of Health • CPR and First Aid • Food Handling • Fire drill and disaster evacuation procedures Rounding Program 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 Safety Associates, Environmental Services, Security Personnel, Food Service and Administration. Employees will be trained to look for signs of medical distress, behaviors commensurate with alcohol and drug use and presence of weapons. This rounding protocol helps ensure all Guests are cared for the facility is kept safe. Guest Safety Associate's rounding occur throughout the day and night that includes taking a nightly census. This rounding census information combined with the sign out sheets (see Sign In and Out protocol below) at reception ensure all Guests are back in the building by curfew and accounted for overnight. Alcohol and Drug Protocol 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 and additionally if suspected to have drugs and/or Alcohol. All staff will be trained to identify behaviors commensurate with drug use to ensure the safety of all Guests. The consistent Rounding Program (detailed above) will provide consistent monitoring of the facility to ensure illegal drug use does not occur. Finally, should a Guest be literally observed using drugs or alcohol, it will be disposed of, and the Guest will be reminded of the policy they agreed to upon admission. Staff will engage with the Guest using their professional skills, as well the motivational interviewing, trauma informed care, and other techniques learned through the ongoing annual training provided to all employees. Should a Guest return to the facility intoxicated, the situation will be assessed by the LVN Manager on site, and if necessary, the guest will be transferred to the BeWell Sobering Center. Should a guest need to be reminded of the no alcohol and drug policy a second time for any reason, they will be disenrolled from the program. CalOptima Health 36 Weapons Protocol Weapons will not be allowed at the Community Living Center. All Guests bags will be checked upon admission and additionally if suspected to have weapons or items that present a threat to others. 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. Curfew 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 I0:00pm who have not made arrangements for a post-curfew return will be counseled by their social worker and encouraged to arrive before curfew. The Safety and Security Manager will provide a report to the Director the names of Guests that violate the curfew, who is then responsible for determining and implementing any resulting actions. CalOptima Health will make every effort to ensure Guests are not discharged to the street. If a Guest does not return from Curfew by morning, their Social Worker will attempt to reach them by phone (if the Guest has a phone) to encourage the Gust to return. Should the Guest be unreachable, their bed will be held for 48 hours. If the Guest returns after that time, the Social Worker will assist the Guest with locating a shelter option. Visitors Guests in the Recuperative Care/Post-Hospitalization Program will be allowed to have visitors between the hours of 9am 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. All Guests must sign in and out at reception. Based on previous experience, we anticipate fewer than five Guest visitors per week. Sign In and Out Protocol Guests will be required to sign in and out of the building each time they leave and return to the building. The receptionist will have access to emergency information for each guest that includes a picture. This will help clarify the identity of Guests staying at the Tustin Living Center from those visiting. Guest with Vehicles CalOptima Health 37 On very rare occasions, one of the Guests in the Recuperative Care/Post Hospitalization programs may 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. Partnership with Tustin Police Department 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 Living Center that requires Police intervention. Additionally, CalOptima will make available requested CCTV footage in consult with CalOptima's legal team. 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 A designated phone number and contact information will be established and posted 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 5pm Monday-Friday 8am to 5pm 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. The Director of the PACE Program will be on site M-F 8:30am-5:00pm. The program is closed on weekends. CalOptima Health 38 RECUPERATIVE CARE/POST HOSPITALIZATION PROGRAM A designated phone number and contact information will be established and posted 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. 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. CalOptima Health will be the entity responsible for the overall oversight of the project and Kelly Bruno- Nelson, Executive Director of Medi-Cal and Ca1AIM will be the person the City can contact once the facility is operational. CalOptima Health is required to issue an RFP to identify the PACE clinic provider. Once confirmed, this provider will also be under the oversight/direction of Kelly Bruno-Nelson. CalOptima Health 39 FREQUENTLY ASKED QUESTIONS (FAQ) I. Will the facility function as 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. 2. Will the site 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. 3. Will services (recuperative or PACE) 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. 4. 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 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. According to the Office of Care Coordination, only individuals residing a dwelling self-designated as an "Emergency Shelter" are counted towards the Point in Time Count. The Community Living Center is not a shelter; therefore, Guests will not be counted towards the Point in Time Count. V11", CalOptima Health 40 5. Can homeless individuals register themselves into the recuperative care and post- hospitalization housing programs? Homeless individuals are not able to register themselves for the Recuperative Care Program/Post-Hospitalization Program. The only way for an unhoused Older Adult 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. 6. 1 would like to learn more about a typical PACE only participants experience at the center as well as a recuperative care/short term post hospitalization Guest who is also a PACE participant. Can you share an example? Yes. Please find this example in Appendix B. 7. Can you give me some specific information about the PACE shuttles? Yes. Information about the PACE shuttle schedule, size and third-party vendor can be found in Appendix C. 8. If a Guest needs additional medical care, what hospital partners would accept these guests? 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. In the event the additional medical care does not constitute a 91 1 call, the Guest has can choose the hospital at which they would prefer to be admitted. 9. Where is the BeWell Regional Campus is located, and what are 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. 10. 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. CalOptima Health 41 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. Cal Optima Health does not currently provide Recuperative Care or short-term post hospitalization services and is not associated with any other like programs. 11. 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. 12. 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 CaIAIM currently serves on the Board of the County of Orange Continuum of Care. CalOptima Health has access to the Coordinated Entry System and HMIS as an organization (not connected to leadership) and plans to utilize these systems at the Community Living Center, having Social Workers enter eligible Guests into the systems. Qualifications to be entered into the systems are determined by the Office of Care Coordination. 13 What is the funding mechanism behind the program — on what basis are funds allocated from CaIAIM to the center? Are there any other funding sources outside of CaIAIM? Does the funding source require acceptance of all hospital referrals to the recuperative care/short-term post hospitalization program. If so, please identify each such funding source and identify the specific requirement(s). All funding for the program is provided by CalOptima Health through the CaIAIM program which is funded by the State of California. No other funding sources outside of CalOptima Health will be required. "Local Priority" as defined on page 15 of this manual and is consistent with the requirements of the project funding. The funding source does not require acceptance of all hospital referrals. CalOptima is able to determine eligibility and ensure the level of care is consistent with the program services offered. %A' CalOptima Health 42 14 Can you show me on the floor plans where the following areas in the building will be located: PACE versus Recuperative Care/Post Hospitalization areas, entrances to both programs, the intake department, and Guest storage areas within the semi-private rooms and any additional storage? Please see floor plans in Attachment D with all the above areas identified. 15 Will the PACE areas of the building be used outside of the regular PACE operating hours? No. These areas will be locked and inaccessible for use outside of the regular PACE operating hours. 16 Will there be any new fencing around the perimeter of the property or building and how will access to and from the buildings, common outdoor areas and underground parking be secured and controlled? The perimeters of the building are already enclosed which provides privacy as well as security. 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. Security will be provided 24 hours a day, 365 days per year with 24/7 monitoring of approximately 40 cameras (both inside and outside the building) by the Safety and Security team. This team consists of the Safety and Security Manager and 24 Guest Safety Associates. The front entrance will be staffed with the receptionist and at least one member of the Safety and Security team. Underground parking is secured with an automatic gate which will be secured and controlled with key card access. 17 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. 18 Will beds be designated for emergency shelter while the intake/screening/insurance process occurs? CalOptima Health 43 No. The Community Living Center is not an emergency shelter. The intake/screening and insurance processes occur prior to the Guest being approved for admission. 19 Will pets be allowed at the Tustin Community Living Center? No. 20 What constitutes morning, evening, and night shifts in the Recuperative Care/Post Hospitalization Program? Morning Shift: 07:00am- 15:30pm Afternoon Shift: 15:00pm- 23:30pm Night Shift: 23:00am to 07:30pm 21 Can you specify the number of employees by expertise (i.e., therapists, social workers, recreation, etc.) for PACE? PACE Director: I Assistant Director: I Operations Manager: I Nursing Manager: I Nurses:9 Medial Assistants: 6 Therapists:12 Social Worker Manager: I Social Workers: 7 Receptionists: 2 Dietician: 3 Activity Personnel: 3 Home Care: 4 Medical Director: I Medical Records: 5 Transportation: 2 Remote: 10 Overall Site Director: I CalOptima Health 44 22. Can you provide a summary of staffing, including quantity, by position, title, and number for Recuperative Care/Short-term Post Hospitalization? Director: I Assistant Director: I Operations Manager: I Nursing Manager: I Nurses: 7 Safety and Security Manager: I Guest Safety Associates: 24 Overnight/Mid shift Managers: 4 Receptionist: I Intake/Admissions: 3 Social Services Manager: I Social Service Coordinators: 6 Kitchen Manager: I Kitchen Staff. 5 Environmental Services Manager: I Environmental Services Staff: 5 Maintenance Manager: I Community Initiatives Liaison: I Volunteer Manager: 1 23. Please clarify how the recuperative care/short-term post hospitalization program differs from each of the following: emergency shelter. navigation center transitional housing, and homeless shelter. Please see comparison chart in Attachment E. 24. Provide a comparison chart that describes the differences between recuperative care program and short-term post hospitalization care program. Please see comparison chart in Attachment F. CalOptima Health 45 25. Will guests be required to sign lease or occupancy agreements. No. 26. Provide data and statistics related to the success rate for placement of individuals into permanent housing after completion of stay. If none available for CalOptima, please specify in writing why, and provide alternative data for other recuperative care facilities (i.e. Illumination Foundation facility in Fullerton). There are no sites that follow the guaranteed permanent housing assistance model of care that is being proposed. 100% of Guests that are accepted into the Center will receive assistance identifying and securing permanent housing.. It is our hope that each individual, with the help of their social worker, will identify and secure housing within a year. However, if no housing is identified, then the individual will be allowed to stay. 27. The applicant verbally stated the interior floor plan would not change; however, the submitted plans indicate demolition of walls which implies that tenant improvements are planned. Please provide a scope of work that is consistent with the plans submitted. Revise and resubmit plans as needed. The plans originally submitted reflect the tenant improvements planned for the building. 28. During the site visit, CalOptima indicated there would be rooms with single beds, but none are shown on the floor plan. Please clarify which is correct and revise and resubmit floor plans as needed. CalOptima intended to indicate that the room could be used for single occupancy in case of the need for isolation. However, the room would remain a double occupancy room and would be able to be used as such when an isolation room is not needed. Therefore, the plans are correct as submitted. 29. Provide a parking summary for all employees and anticipated guests and demonstrate that required parking can be provided on-site. Please see Appendix J 30. Once guests' medical needs have been met (i.e., they have healed from their injury or illness and/or are medically stable), what funding sources will be used to finance their continued occupancy at the recuperative care/short-term post hospitalization program? CalOptima is the only funding source for these programs and will fund the entirety of each Guest's stay, regardless of length. 31. Will guests be permitted to utilize the Project more than once in their lifetime? If so, what are the policies regarding returning guests? Since all Guests are allowed to remain at the facility until permanently housed, it is not expected that a Guest would return. However, it is possible a previous Guest could be %A' CalOptima Health 46 hospitalized due to a medical condition that falls within the medical criteria of the program. In these occurrences, CalOptima will assess the possibility of readmission on a case-by-case basis. 32. Please describe the applicant's proposed community engagement program during the entitlement process. Cal Optima's Leadership will make itself available to answer any questions directly from individual Tustin residents. Additionally, a website specific to the project containing all the information in this Operations and Security Manual as well as contact information will launch once a planning commission hearing date is confirmed. Additionally, CalOptima Heath will conduct quarterly community meetings during the time between the approval of the CUP and the opening of the building to directly address any questions from the community. Once the building is open, a full time community liaison will be employed to address community concerns and promote community engagement. 33. Can you provide a separate narrative that explains the association between CalOptima and CaIAIM? Please see Appendix G 34. Can you provide a list of partners (i.e., service providers such as non-profit organizations) that will potentially provide housing to Guests post-hospitalization? Can you clarify if such partnerships are currently in place by existing contracts/agreements? A list of 25 housing providers are listed in Appendix H. CalOptima Health currently holds contacts with all those identified with a * (20 of the 25) 35. Can you provide a list of partner types (i.e., service providers such as non-profit organizations) that will potentially provide services to Guests? Can you clarify if such partnerships are currently in place by existing contracts/agreements, or other means? A list of 22 service providers are listed in Appendix 1 36. 1 understand that CalOptima Health is the only Medi-Cal Health Plan in Orange County and therefore all; Guests admitted to the recuperative care/short term post hospitalization program will be CalOptima Health members. What happens if another Medi-Cal Health Plan starts operating in Orange County? It is difficult for CalOptima Health to predict if another Medi-Cal Health Plan will ever provide services in Orange County. However, we can confirm that regardless of this possibility, only CalOptima Health members will be eligible for enrollment into all programs of the Tustin Community Living Center. 37. What is the Building Occupancy Type proposed for Recuperative Care and PACE sections of the building? Will any State or regulatory agency be required to approve floor plan modifications, and/or building/site improvements? 0, CalOptima Health 47 No state or regulatory agencies are required to approve the floor plan modifications, and/or building site improvements. Proposed occupancy types are as follows: Building I (14185 Yorba Str) - Construction Type : type 11, fully rated, Proposed Occupancy: R2.1 & B Building 2 (165 N Myrtle Str) - Construction Type : type V, I hour rated, Proposed Occupancy R2.1 38. Can you provide a queuing plan with shuttle turning radius to demonstrate that the shuttles can load and unload on-site without causing conflicts to building entries/exits, no queuing off-site onto street, not impeding on drive-aisles, and not impeding on-site circulation? A queuing plan is now included as an amendment to the Plan Set. No more than three shuttles will be on site at any given time. 39. Can you provide a parking summary for all employees and anticipated visitors and demonstrate that required parking can be provided on-site. A parking summary is not included as an amendment to the Plan Set. The summary illustrates that existing underground parking provides ample parking for the facility use. 40. Can you provide an Administration Organizational Chart? Please see Appendix J CalOptima Health 48 APPENDIXES CalOptima Health Appendix A 49 Shelter List 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 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 CalOptima Health Appendix 13.1 50 PACE Only 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 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: CalOptima Health Appendix 13.2 51 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. Recuperative Care /Short-Term Post Hospitalization Guest who is also a PAC' Participant Walkthrough Description A Recuperative Care/Short-Term Post Hospitalization Guest will be escorted from their room to the PACE Center by a Guest Safety Associate 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 the Guest Safety Associate will 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 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. The PACE receptionist will contact Recuperative Care/Short Term Post Hospitalization receptionist to notify the participant is ready, and the Guest Safety Associate will then escort the participant back to their room. 0 CalOptima Health Appendix B.3 52 Rehab Experience: Some of our participants are arriving to the center only for their skilled MOT services. In these cases, the participant is escorted to the PACE center by the Guest Safety Associate, and 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 PACE receptionist will contact Recuperative Care/Short Term Post Hospitalization receptionist to notify the participant is ready, and the Guest Safety Associate will then escort the participant back to their room. 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 participant is escorted to the PACE center by the Guest Safety Associate, who are then guided to the reception area for Clinic 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 PACE receptionist will contact Recuperative Care/Short Term Post Hospitalization receptionist to notify the participant is ready, and the Guest Safety Associate will then escort the participant back to their room. 0, CalOptima Health Appendix C.1 53 Shuttle Information I. What are the dimensions and seating capacity of the shuttle vans? 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. 2. What is the name of the third-party company that 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: 12800 Center Court Drive South, Suite 120 Cerritos, CA 90703 3. What are the shuttle arrival schedules? How many shuttles arrive/depart per hour? Where would they load/unload on-site? Shuttles arrive and depart between the hours of 8am and 4pm. On average 5 shuttles will arrive and depart each hour. There is no concentration of shuttle arrivals at the end of the day as most of the PACE participants will be coming from the Recuperative Care/Short-term Post Hospitalization program and will be walking to the PACE program. 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. We do not anticipate that there will ever be more than 3 shuttles at the site at a time. 4. 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 (identified in question #2 above) 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 (identified in question #2 above) when not in use. 5. The below schedule demonstrates that while there are nine vans in circulation, no more than 3 vans will be on site at one time. Morning and late afternoon drop off times are longer due to Am CalOptima Health Appendix C.2 54 multiple people being on the van versus the mid-afternoon arrivals that will be for individual's arriving for doctor appointments. PACE Shuttle Schedule Y.an S 'Y`An Van Van 4 Van 5 % k K % K. K x K K K K Van 6 % % K x x I K x K K Y'an 7 x x, x % K x x x x. x x W x Yin a x x, x % x x x x x. I x x I Yin 9 TotIVans 3 3 3 3 3 3 31377 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 313131 3 3 CalOptima Health Appendix D.1 55 CalOptima M l I Shuttle Loading and Unloading Area { shuttle staging a.� pr' I f I al O . m 4 T� tl c) 17 C� Loading area for ...., 1 deliveries { i 0 I I CalOptima Health Appendix D.2 56 OVLZ6 VO'NIIS(Ii EAV 31INAW 99 1 v is V�INOA �39111 I;Lu 6- O t2 fjt iu F Ur V tu CalOptima Health Appendix D.3 57 OSLZ6 VO'NI1Sf11 — —ea — — — 9AV3IISAW991 N *" 8 1S v9?JOA l S8Y l HIIv3H VWIIJOIVO N 4 ` _ 1 L h' 3 3 �I u T i � h nC ti13n nh F�I �y,pgp _ V In ! ;; 'M1 � �y py„ry I--1• d -I . � CL I S I 3 - s t.7 I CalOptima Health Appendix D.4 58 c C sE _ ® � 3AV 3UdAW 991 —— mw%m� 'S 15 V'9 ]OA l98tr l 0 H11V3H VWILJO1d:) d Ze Ell I1 I _ I iM1 ➢ ti,ti7 Ci _r • i t E 71 I i. I I CalOptima Health Appendix E 59 Program Comparisons Recuperative Emergency Navigation Transitional Homeless Care/STPH Shelter Center Housing Shelter Walk up/Drop-in emergency services available Emergency shelter beds available X Limited length of stay in beds X Individuals must leave during the X day Programmatic goal to Connection X X X X Individuals to Permanent Housing Medical eligibility necessary X X X X For admission Able to assist individuals with X X X X Mobility issues ------------------ ADA Facility/Semiprivate rooms X X X X with individual restrooms Medical services available on site X X X X Covered by Medi-Cal Insurance X X X X Social Worker to develop a housing X X X X Plan for each individual PACE/Medical Services on site X X X X Individual can remain until X X X X Permanently housed Funded by Med-CaL X X X X 0 CalOptima Health Appendix F 60 /r Recuperative Care and Short-Term Post Hospitalization Program Comparisons ........................................................................... Recuperative Short-Term Care Post Hospitalizati on Residential Care for individuals who no longer require X X hospitalization but need additional time to heal Development of a Care plan and ongoing monitoring of medical and X X behavioral health conditions by an interdisciplinary team Coordination of on-going medical and social services appointments X X -Development of a housing plan and support in accessing benefits X X and housing Development of a Medical plan, including education and monitoring. X X Trauma-Informed Care rations (1 to 25) X X Utilization of best practices including harm reduction, motivational X X interviewing and housing first. Access to all PACE programs and services X X Access to Day Habilitation groups and programs X X Access to behavioral health and substance use groups and programs X X Semi-Private rooms with private restroom and shower X X Access to all facility amenities including beauty salon, store, gym, X X Cybercafe, mailroom, and outdoor courtyards Meals Provided three times a day X X Maximum Length of Stay until A 90 Days permanently housed Referral Source as required by Funding to be eligible: Individuals Individuals exiting a hospital exiting or at risk of recuperative hospitalization care or hospitals 0 CalOptima Health Appendix G.1 61 iD 1 1 C ,6sFi os ry ,� r W s. =c Ar"11111 'Roo State of California—Health and Human Services Agency Department of Health Care Services GAVIN NEWSOM GOVERNOR California Advancing and Innovating Medi-Cal (CaIAIM) High Level Summary The Department of Health Care Services (DHCS) has developed a framework for the upcoming waiver renewals that encompasses broader delivery system, program and payment reform across the Medi-Cal program, called CaIAIM: California Advancing and Innovating Medi-Cal. CaIAIM advances several key priorities of the Administration by leveraging Medicaid as a tool to help address many of the complex challenges facing California's most vulnerable residents, such as homelessness, insufficient behavioral health care access, children with complex medical conditions, the growing number of justice-involved populations who have significant clinical needs, and the growing aging population. This proposal recognizes the opportunity to provide for non-clinical interventions focused on a whole- person care approach via Medi-Cal that target social determinants of health and reduce health disparities and inequities. Furthermore, the broader system, program, and payment reforms included in CaIAIM allow the state to take a population health, person-centered approach to providing services and puts the focus on improving outcomes for all Californians. Attaining such goals will have significant impact on an individual's health and quality of life, and through iterative system transformation, ultimately reduce the per-capita cost over time. DHCS intends to work with the Administration, Legislature and our other partners on these proposals and recognizes the important need to discuss these issues and their prioritization within the state budget process. These are initial proposals whose implementation will ultimately depend on whether funding is available. Background and Overview V!III CalOptima Health Appendix G.2 62 Medi-Cal has significantly expanded and changed over the last ten years, most predominantly because of changes brought by the Affordable Care Act and various federal regulations as well as state-level statutory and policy changes. During this time, the DHCS has also undertaken many initiatives and embarked on innovative demonstration projects to improve the beneficiary experience. In particular, DHCS has increased the number of beneficiaries receiving the majority of their physical health care through Medi-Cal managed care plans. These plans are able to offer more complete care coordination and care management than is possible through a fee-for-service system. They can also provide a broader array of services aimed at stabilizing and supporting the lives of Medi-Cal beneficiaries. Depending on the needs of the beneficiary, some may need to access six or more separate delivery systems (managed care, fee-for-service, mental health, substance use disorder, dental, developmental, In Home Supportive Services, etc.). As one would expect, need for care coordination increases with greater system fragmentation, greater clinical complexity, and/or decreased patient capacity for coordinating their own care. Therefore, in order to meet the behavioral, developmental, physical, and oral health needs of all members in an integrated, patient centered, whole person fashion, DHCS is seeking to integrate our delivery systems and align funding, data reporting, quality and infrastructure to mobilize and incentivize towards common goals. To achieve such outcome, CalAIM proposals offer the solutions to ensure the stability of Medi-Cal program and allows the critical successes of waiver demonstrations such as Whole Person Care, the Coordinated Care Initiative, public hospital system delivery transformation, and the coordination and delivery of quality care to continue and be expanded to all Medi-Cal enrollees. CalAIM seeks to build upon past successes and improve the entire continuum of care across Medi-Cal, ensuring the system more appropriately manages patients over time through a comprehensive array of health and social services spanning all levels of intensity of care, from birth to end of life. To do this, we must change the expectations for our managed care and behavioral health systems. Holding our delivery system partners accountable for a set of programmatic and administrative expectations is no longer enough. We must provide a wider array of services and supports for complex, high need patients whose health outcomes are in part driven by unmet social needs and make system changes necessary to close the gap in transitions between delivery systems, opportunities for appropriate step- down care and mitigate social determinants of health, all hindering the ability to improve health outcomes and morbidity. Key Goals CalAIM has three primary goals: AMRak V!l!ll CalOptima Health Appendix G.3 63 • Identify and manage member risk and need through Whole Person Care Approaches and addressing Social Determinants of Health. • Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and • Improve quality outcomes and drive delivery system transformation through value based initiatives, modernization of systems and payment reform. The reforms of CalAIM are comprehensive and critical to the success of the delivery system transformation necessary to improve the quality of life for Medi- Cal members as well as longterm cost savings/avoidance that will not be possible to achieve absent these initiatives. Furthermore, these reforms are interdependent and build off one another; without one, the others are not either possible or powerful. Below is an overview of the various proposals and recommendations that make up CaIAIM. Identify and Manage Member Risk and Need through Whole Person Care Approaches and Addressing Social Determinants of Health • Require plans to submit local population health management plans. • Implement new statewide enhanced care management benefit. • Implement in lieu of services (e.g., housing navigation/supporting services, Recuperative care, respite, sobering center, etc.). • Implement incentive payments to drive plans and providers to invest in the necessary infrastructure, build appropriate enhanced care management and in lieu of services capacity statewide. • Evaluate participation in Institutions for Mental Disease Serious Mental Illness/Serious Emotional Disturbance Section 1115 Expenditure Waiver. • Require screening and enrollment for Medi-Cal prior to release from county jail. • Pilot full integration of physical health, behavioral health, and oral health under One contracted entity in a county or region. • Develop a long-term plan for improving health outcomes and delivery of health care for foster care children and youth. Moving Medi-Cal to a More Consistent and Seamless System by Reducing Complexity and Increasing Flexibility Managed Care • Standardize managed care enrollment statewide • Standardize managed care benefits statewide • Transition to statewide managed long-term services and supports • Require Medi-Cal managed care plans be National Committee for Quality CalOptima Health Appendix G.4 64 Assurance accredited. • Implement annual Medi-Cal health plan open enrollment • Implement regional rates for Medi-Cal managed care plans Behavioral Health • Behavioral health payment reform • Revisions to behavioral health inpatient and outpatient medical necessity criteria for children and adults • Administrative behavioral health integration statewide • Regional contracting •Substance use disorder managed care program renewal and policy improvements Dental • New benefit: Caries Risk Assessment Bundle and Silver Diamine Fluoride for young children • Pay for Performance for adult and children preventive services and continuity of care through a Dental Home County Based Services • Enhance oversight and monitoring of Medi-Cal Eligibility • Enhance oversight and monitoring of California Children's Services and the Child Health and Disability Prevention program • Improving beneficiary contract and demographic information For detailed descriptions of the CalAIM proposals please refer to the full CalAIM document located on of the DHCS website. CalAIM aligns with and advances several key priorities of the Administration. At its core, CalAIM recognizes the impact of Medi-Cal on the lives of its beneficiaries well beyond just accessing health services in traditional delivery settings. CalAIM establishes a foundation where investments and programs within Medicaid can easily integrate, complement, and catalyze the Administration's plan to impact the State's homelessness crisis, support reforms of our justice systems for youth and adults who have significant health issues, build a platform for vastly more integrated systems of care and move toward a level of standardization and streamlined administration required as we explore single payer principles through the Healthy California for All Commission. Furthermore, CalAIM will advance a number of existing Medi-Cal efforts such as Whole Person Care and the Health Homes Program, the prescription drug Executive Order, improving screenings for kids, proliferating the use of value-based payments across our system, including in behavioral health and long-term care. CalAIM will also support the ongoing CalOptima Health Appendix G.5 65 need to increase oversight and monitoring of all county-based services including specialty mental health and substance use disorder services, Medi-Cal eligibility, and other key children's programs currently administered by our county partners. Below is an overview of the impact CaIAIM could have on certain populations, if enacted and funded as proposed: Health for All: In addition to focusing on preventive and wellness services, CaIAIM will identify patients with high and emerging risk/need and improve the entire continuum of care across Medi-Cal, ensuring the system more appropriately manages patients over time, through a comprehensive array of health and social services spanning all levels of intensity of care, from birth and early childhood to end of life. High Utilizers (top 5%): It is well documented that the highest utilizers represent a majority of the costs in Medi-Cal. CaIAIM proposes enhanced care management and in lieu of services benefits (such as housing transitions, respite, and sobering centers) that address the clinical and non-clinical needs of high-cost Medi-Cal beneficiaries, through a collaborative and interdisciplinary whole person care approach to providing intensive and comprehensive care management services to improve health and mitigate social determinants of health. Behavioral Health: CaIAIM's behavioral health proposals would initiate a fundamental shift in how Californians (adults and children) will access specialty mental health and substance use disorder services. It aligns the financing structure of behavioral health with that of physical health, which provides financial flexibility to innovate, and enter into value- based payment arrangements that improve quality and access to care. Similarly, the reforms in CaIAIM simplify administration of, eligibility for, and access to integrated behavioral health care. Vulnerable Children: CaIAIM would provide access to enhanced care management for medically complex children to ensure they get their physical, behavioral, developmental, and oral health needs met. It aims to identify innovative solutions for providing low barrier, comprehensive care for children and youth in foster care and furthers the efforts already underway to improve preventive services for children including identifying the complex impacts of trauma, toxic stress, and adverse childhood experiences by, among other things, a reexamination of the existing behavioral health medical necessity definition. Homelessness and Housing: The addition of in lieu of services would build capacity to clinically linked housing continuum via in lieu of services for our home appendix less population, including housing transitions/navigation services, housing deposits, housing CalOptima Health Appendix G.6 66 tenancy, and sustaining services, short-term post hospitalization housing, recuperative care for inpatient transitions and day habilitation programs. Justice Involved: The Medi-Cal pre-release application mandate, enhanced care management and in lieu of services would provide the opportunity to better coordinate medical, behavioral health and non-clinical social services for justice-involved individuals prior to and upon release from county jails. These efforts will support scaling of diversion and reentry efforts aimed at keeping some of the most acute and vulnerable individuals with serious medical or behavioral health conditions out of jail/prison and in their communities, further aligning with other state hospital efforts to better support care for felon's incompetent to stand trial and other forensic state-responsible populations. Aging Population: In lieu of services would allow the state to build infrastructure over time to provide Managed Long-Term Services and Supports (MLTSS) statewide by 2026. MLTSS will provide appropriate services and infrastructure for home and community- based services to meet the needs of aging beneficiaries and individuals at risk of institutionalization and should be a critical component on the State's Master Plan on Aging. V!III CalOptima Health Appendix H 67 List of Housing Partners The following is a list of some partner service providers that will assist in providing housing for Guests upon discharge from the Tustin Community Living Center. This is not an exhaustive list as service providers organizations and partnerships continue to evolve. . American Family Housing* 2. Mercy House* 3. Volunteers of America* 4. PATH* S. Jamboree Housing* 6. Orange County Rescue Mission 7. Illumination Foundation* 8. Lutheran Social Services* 9. Friendship Shelter* 10.Families Forward I.Salvation Army* 12.Grandma's House of Hope* 13.United Way* 14.Pathways to Independence S.CAP OC* 16.Orange County Housing Authority 17.Chrysalis* 18.Latino Health Access* 19.Share Our Selves 20.Pathways of Hope* 21.Family Assistance Ministries* 22.Leading Purpose* 23.Wise Place* 24.00APICA* 25.Dale Macintosh* *Existing Contracts 0 CalOptima Health