HomeMy WebLinkAboutITEM NO. 2 PART 3 Appendix 1 68
List of Service Partner Types
The following is a list of types of service providers that will assist in providing services for our
Guests while at the Tustin Community Living Center. This is not an exhaustive list as
organizations and partnerships continue to evolve. These partnerships are not contractual.
. Orange County Social Service Agency
2. Orange County Health Care Agency
3. Rapid Rehousing Assistance
4. Section 8
S. Assisted Living for Older Adults
6. Sober Living Homes
7. Affordable Rental Unit Assistance
8. Domestic Violence Resource Organizations
9. Credit Counseling
10.Tenant Readiness Education
1 1.Personal Finance Counseling
12.General Relief/CaIWORKS/SSI/SDI
13.Transportation
14.Legal Assistance
S.Addiction/Substance Use Disorder Support Groups
16.Mental Health Counseling
17.Aging/Older Adult Support Groups
18.Employment Support
19.Immigration/Naturalization Assistance
20.Outpatient Substance Abuse Treatment/Counseling
21.CalFresh
22.Older Adult Congregate Meals
0
CalOptima Health
Appendix
Administrative Organizational
Executive Director,
CaIAIM/Medi-Cal
Kelly Bruno-Nelson
Director
Tustin Community Living
Center
Director
Director
RCC/STPH Clinic Pr
PACE
Assistant Director Medical Director
RCC/STPH PACE PA
erations Manager Nursing Manager Nursing Man Operations Manager
RCC/STPH � RCC/STPH Maki
PACE
Safety and Secu' ��
Cal
cial Service Manger
Manager RCC/STPH Social Service Manger
RCC/STPH I �y RCC/STPH
Kitchen Mana olunteer Manage
RCC/STPH RCC/STPH
nmental S
ernight/Mid-shift
Manager Managers
RCC/STPH �� RCC/STPH �
aintenance Manage
RCC/STPH
• •
CalOptima's Responses to the City's Incomplete Letter dated March 10, 2023
EXHIBIT A
COMMENTS AND CORRECTIONS
CUP 2022-0019
CALOPTIMA RECUPERATIVE CARE/SHORT-TERM POST HOSPITALIZATION
HOUSING SERVING THE HOMELESS AND PACE FACILITY LOCATED AT 165
MYRTLE AVENUE AND 14851 YORBA STREET
On January 26, 2023, the Community Development Department transmitted via email a list of
questions and comments seeking clarification regarding the operations plan and security
measures associated with the application request for Conditional Use Permit (CUP) application
2022-0019 (Project). Responses to those questions/comments were submitted by the applicant
on February 6th and 10th, 2023. The documents submitted consisted of an "annotated plan floor
plan" and a document entitled "Community Living Center of Tustin-Operations and Security Plan"
(Plan). In addition, on February 23,2023, staff toured a PACE facility in Garden Grove operated by
the applicant and the proposed location at 165 Myrtle Avenue and 14851 Yorba Street.
City's Questions 3-10-23
1. The above narrative does not address how the Alcohol and Drug Protocol will be
implemented, and as such, the following questions remain unanswered:
• How will guests be made aware of the drug and alcohol policy?
Please see original answer in Security Policies section, subsection Security Plan,
second subsection Alcohol and Drug Protocol.
• Will guests sign and agree to a code of conduct prior to admittance that clearly
advises them of their responsibilities and expressly consents to searches of their
belongings?
Original answer in Operations Plan section, subsection Code of Conduct
• Is there a draft Guest Code of Conduct that can be provided as an attachment?
Original answer in Operations Plan section, subsection Code of Conduct.
• Confirm guests will not be required to sign lease or occupancy agreements.
Guests are not requested to sign a lease or occupancy agreement. Please see
new FAQ #25
• In addition to when a guest is admitted to the facility, will guests' belongings be
subject to search in the event that facility staff observes, or has reason to believe,
that a guest is in violation of the protocol?
Original answer in Operations Plan section, subsection Code of Conduct, second
subsection Recuperative Care/Post Hospitalization and updated answer in
Page 1 of 19
Security Policies section, subsection Security Plan, second subsections Alcohol
and Drug Protocol and Weapons Protocol.
• What constitutes "observed using drugs or alcohol?"
Updated answer in Security Policies section, subsection Security Plan, second
subsections Alcohol and Drug Protocol.
• Does that include a guest who returns to the facility intoxicated after consuming
drugs and/or alcohol at an offsite location?
Updated answer in Security Policies section, subsection Security Plan, second
subsections Alcohol and Drug Protocol.
• If so, how will staff/security engage with the guest?
Updated answer in Security Policies section, subsection Security Plan, second
subsections Alcohol and Drug Protocol.
• Are the consequences the same?
Updated answer in Security Policies section, subsection Security Plan, second
subsections Alcohol and Drug Protocol.
• What training will staff receive to identify signs of an intoxicated guest?
Original answer in Security Policies section, subsection Security Plan.
• Is training required on a recurring basis?
Original answer on in Security Policies section, subsection Security Plan
2. 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.
Answered in new FAQ #23 and new Appendix F
MONITORING OF CLIENTS
3. Coordinated Entry System (page 36). The Plan states: "Kelly Bruno-Nelson,
CalOptima Health's Executive Director of Medi-Cal and CalAIM currently serves
on the Board of the County of Orange Continuum of Care. CalOptima Health has
access [emphasis added] to the Coordinated Entry System and plans to utilize this
system at the Community Living Center." Please specify if the proposed operation
would incorporate the use of the CES into its day-to-day operations, and if so:
a. How will CES be utilized?
Updated answer in FAQ #12
b. What are the qualifications/requirements the applicant must meet to utilize
CES?
Updated answer in FAQ #12
Page 2 of 19
c. If applicant's leadership changes, will the applicant continue to have access
to CES? If not, what will be used instead of CES?
Updated answer in FAQ #12
4. Specify if applicant will enter clients into the Homeless Management Information
System (HMIS). Explain why or why not?
Updated answer in FAQ #12
5. Elaborate on the "Interdisciplinary team/guest services" mentioned on pages 8, 21,
and 30. Specifically, elaborate on how the applicant will ensure that the
posthospitalization clients will be supported to ensure that they transition to transitional
or permanent housing.
Answer in Operations Plan section, subsection Intake/ Admission Process, second
subsection Recuperative Care/Post Hospitalization Program, third subsection
Development of a Housing and Care Plan
a. Identify the services the applicant will provide to assist guests to identify and
apply for housing, obtain benefits and connect with available resources.
Answer in Operations Plan section, subsection Intake/ Admission Process,
second subsection Recuperative Care/Post Hospitalization Program, third
subsection Development of a Housing and Care Plan
6. Provide a list of partners (i.e., service providers such as non-profit organizations)
that will potentially provide housing to clients post-hospitalization. Clarify if such
partnerships are currently in place by existing contracts/agreements, or other
means. Specify in detail that applicant's method for identifying permanent housing.
Answered in FAQ # 34, Appendix H and Operations Plan section, subsection Intake/
Admission Process, second subsection Recuperative Care/Post Hospitalization
Program, third subsection Development of a Housing and Care Plan
7. Provide a list of partners (i.e., service providers such as non-profit organizations)
that will potentially provide services to guests. Clarify if such partnerships are
currently in place by existing contracts/agreements, or other means.
Answered in FAQ # 35 and Appendix 1
8. 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).
Answered in FAQ #26
9. Identify applicant's procedures and processes for handling "missing adult reports"
and state whether such individuals would be classified as "at-risk".
Answered in Security Policies section, subsection Security Plan, second subsection
Curfew.
Page 3 of 19
OPERATIONS
10. Remove references to the "Village of Hope" operation and revise to specify how
the proposed operation will be implemented for the proposed use.
Completed
11. Define "local preference" and description of how the policy will be implemented,
monitored and reported to the City of Tustin.
Answered in Operations Plan section, subsection Local Priority Policy
a. Identify all funding sources utilized by the applicant for the Project and
confirm that the `local preference' is consistent with the requirements for all
Project funding.
Please see updated answered in FAQ #13
b. If Tustin Police and Tustin Shelters are allowed to refer guests, will
CalOptima also be required to accept guests from other police departments
and/or shelters?
Answered in Operations Plan section, subsection Intake/Admission Process,
second subsection Recuperative Care/Post Hospitalization Program.
12. Provide a comparison chart that describes the differences between recuperative
care program and short-term post hospitalization care program.
Answered in new FAQ # 24 and new Appendix F
13.Confirm whether any funding source for the Project requires acceptance of 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).
Answered in updated FAQ #13
14.Confirm whether any funding source for the Project requires hospital referrals for
each guest to qualify for the recuperative care/short-term post hospitalization
program. If so, please identify each such funding source and identify the specific
requirement(s).
Answered in Appendix F
15. Provide a typical daily itinerary for (1) PACE only client and (2) a Recuperative
Care/Short-Term Post Hospitalization client that is also a PACE client.
Answered in Appendix B updated to include both itineraries.
16. Provide a list of medical care services that are provided to guests in the
recuperative care/short-term post hospitalization program.
Answered in Operations Plan section, subsection Program Scope of Services, second
subsection Recuperative Care/Post Hospitalization Program.
Page 4 of 19
17. Provide a list of other recuperative care/short-term post hospitalization program
facilities associated with and/or operated by CalOptima and explain CalOptima's role
at each such facility.
Originally answer in FAQ #10
FLOOR PLAN
18.Confirm the proposed quantity and location(s) of all primary points of access to the
facility from Yorba Street. During the tour of the project site, CalOptima verbally
indicated that there will a single point of entry to the facility facing Yorba Street
(covered entry); however, the floor plan shows two (2) independent entrances, one
that is the covered entry and the other identified as the "PACE Entrance" shown
on Sheet A2.1 b.
There is one single point of entry for each program as shown on Sheet A2.1 b
19.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.
Answered in new FAQ #27
20. 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.
Answered in new FAQ #28
SUBMITTED NARRATIVE OPERATOR INFORMATION
21. Recuperative/Post-hospitalization:
a. Provide a list of other locations operated by CalOptima for Recuperative and/or
Post-hospitalization.
See original answer in FAQ #10
b. Provide a list of other recuperative and/or post-hospitalization facilities in
Orange County and, if none, other locations.
Answered in new FAQ #26
22. It is our understanding that CalOptima has a project that combines a medical clinic
with affordable housing. Please clarify how the recuperative care/short-term post
hospitalization program functions either similarly or differently from such facility.
This is not accurate. CalOptima does not have a project as described above.
23. Provide the name of the entity that will be responsible for the day-to-day operation
of the facility and the name of a person that will be the City contact once the facility
is operational. If CalOptima, then please confirm that information in writing. If
Page 5 of 19
services will be outsourced to other providers, please identify the providers.
Please provide a chart that describes which, if any, operational responsibilities that
will not be contracted to another entity or party.
Answered in Appendix 1
24. Please provide a summary of staffing, including quantity by position title and
number, listed separately for (1) Recuperative/Short-Term Housing and (2) PACE
separately. Supplement this information with an organizational chart to
demonstrate the responsible parties for the various areas that comprise the
proposed operations.
Originally FAQ #21 and additional FAQ #22 and Appendix 1
25. Provide a justification for the number of beds proposed.
Answered in Executive Summary
26. Provide a separate narrative that explains the association between CalOptima and
CaIAIM?
Answered in new FAQ # 33 and new Appendix G
27. Provide clarification regarding the statement that guests will not be counted
towards the Point in Time Count in light of the requirement that guests must be
homeless to participate in the recuperative care/short-term post hospitalization
program and, upon such participation, would be "sheltered".
Answered in updated answer in FAQ #4
Site Tour Follow-up Questions
28.City staff was informed that no pets would be allowed at site for recuperative
care/short-term post hospitalization program clients; however, Page 37 of the Plan
states pets would be allowed in up to ten (10) rooms. Please clarify. If pets are
allowed, please be specific as to the size of pets, number of pets, and identify any
boarding or keeping areas for pets in the site and floor plans.
Answered in updated answer in FAQ #19
29.City staff was informed that clients in recuperative housing can leave and are not
on "lock down."
• Please provide procedures that the applicant will implement to ensure clients are
accounted for overnight.
Answered in Security Policies section, subsection Security Plan, second
subsection Rounding Program.
• In addition, please clarify how staff identifies registered clients from visitors.
Answered in Security Policies section, subsection Security Plan, second
subsection Sign in and Out Protocol.
Page 6 of 19
• Please also identify how loitering at or near the exterior of the Project will be
monitored and prevented or discouraged.
Answered in Security Policies section, subsection Loitering.
• Be specific on the responsible party for monitoring and specify consequences for
violating the curfew and who will be responsible for implementing those
consequences.
Answered in Security Policies section, subsection Security Plan, second
subsection Curfew.
ON-SITE CIRCULATION
30. 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.
Addressed in revised Sheet A1.1 of the plan set.
31. Label and indicate any loading areas for laundry and/or cafeteria food service
deliveries, and any other vendors that may deliver to the site as part of the day-today
operations.
Answered in Appendix D.1
PROJECT DATA
32. Provide a parking summary for all employees and anticipated guests and
demonstrate that required parking can be provided on-site.
Addressed in the Project Data section of Sheet A0.1 of the plan set.
33. Project Data — Sheet A0.1 (i.e., units vs. beds)
a) Revise "Total number of units" to "Total number of rooms". Project does not
include an independent kitchen for each room; therefore, these are not
considered "units".
No answer required.
34.Specify the Building Occupancy Type proposed for the recuperative care and
PACE sections of the buildings. Indicate whether any State or other regulatory
agency would be required to review and approve floor plan modifications,
building/site improvements?
Answered in new FAQ #37 and on revised Sheet A0.1 of the plan set.
GUEST SCREENING/REQUIREMENTS
35. How will guests' medical qualification to participate in the recuperative
care/short term post hospitalization program be determined and by whom?
Page 7 of 19
Answered in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization
• What are the criteria?
Answered in Operations Plan section, subsection Eligibility Criteria. Second
subsection Recuperative Care/Post Hospitalization.
36.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?
Answered in new FAQ #30
37.Will guests be permitted to utilize the Project more than once in their lifetime? If
so, what are the policies regarding returning guests?
Answered in new FAQ # 31
38. Page 8 of the Plan states that Cal-Optima 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?
Answered in new FAQ #Question #36
COMMUNITY ENGAGEMENT
39. Please describe the applicant's proposed community engagement program during
the entitlement process.
Answered in new FAQ #32
40. Please provide additional detail regarding the applicant's good neighbor policy and
procedures after entitlement.
Answered in Security Policies Section, subsection Good Neighbor Policy
ZONING
41.The proposed site has a combined zoning designation of Public Institution,
Professional and Specific Plan 9. The City reserves the right to revisit the zoning
of the Project based on the information received from the applicant as it affects the
proper land use determination and categorization of the Project. If determined to
be necessary, approval of a Zone Change (ZC) and General Plan Amendment
(GPA) by the Planning Commission and the City Council may be required.
No answer required.
Page 8 of 19
CalOptima's February 10, 2023 Responses to City's Request for Additional Information
dated January 26, 2023.
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.
Answered in Appendix L)
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.
The perimeters of the building are already enclosed which provides privacy as well as
security. No additional fencing is being proposed. 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. More detail can be found in
FAQ #16
II. REGARDING PROJECT DESCRIPTION AND USE:
a. Define "Community Living Center."
Answered in Operations Plan section and FAQ # 11
b. Define eligibility criteria for the recuperative care program and short-term post-
hospitalization housing.
Answered in Eligibility Criteria section
C. There has been conflicting information provided in the submittal.
Page 9 of 19
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 in Eligibility Criteria section
Older adult is defined in Operations Plan section
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 and a new Table clarifying the differences between programs has
been provided in Appendix E.
e. Clarify if the site will provide housing to homeless individuals who do not need
medical assistance or rehabilitation services.
Answered in 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.
Answered in FAQ #3
f. Clarify any differences between the recuperative care vs. short-term post-
hospitalization program.
Answered in the Operations Plan section, subsection Program Scope of Services,
second subsection Recuperative Care/Post Hospitalization Program and a Table
depicting program comparisons can be found in Appendix F.
i. Is there a difference in services provided, eligibility criteria, room locations within
the center, etc.?
Answered on Page 5 and the Table in Appendix F.
ii. Is there a fixed number of beds available for the recuperative care program vs.
the short-term post-hospitalization housing program?
Answered in the Operations Plan section, subsection Program Scope of Services,
second subsection Recuperative Care/Post Hospitalization
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 in the Operations Plan section, subsection Program Scope of Services,
second subsection Recuperative Care/Post Hospitalization
and the Table in Appendix F
Page 10 of 19
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 in the Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization
g. What is expected of recuperative care/short-term housing participants in their role
as care recipients?
Answered in Operations Plan section, subsection Code of Conduct, second
subsection Recuperative Care/Post Hospitalization Program.
i. Will there be a curfew? If so, how will this be implemented or monitored?
Our Code of Conduct Policy will request Guests observe a 10:OOpm curfew. Our
Security Policies addresses how Guests will be monitored for compliance with
policies and rules.
ii. Will there be a no drug or alcohol use policy? If so, how will it be enforced?
Answered in Security Policy Section, subsection Security Plan, second subsection
Alcohol and Drug Protocol.
h. Is there a visitor policy for recuperative care/short-term housing recipients?
Yes, this was preciously addressed. The visitor policy can be found in the Security
Policy Section, subsection Security Plan, second subsection Visitors.
i. What is CalOptima's or CaIAIM's affiliation with the County of Orange Continuum
Care, Coordinated Entry System, etc.?
The relationship has been clarified 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?
Additional information has been added to FAQ #13
k. Are Tustin community organizations, such as Families Together of Orange County,
partnered with the center?
This was previously addressed. We anticipate to partner with local qualified
service providers but these organizations will need to respond to a formal Request
for Proposals (RFP). Please refer to 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?
Page 11 of 19
This was previously addressed in FAQ # 4. Guests are not counted in the Point in
Time Count.
IV. INTAKE AND DISCHARGE
a. PACE:
i. Clarify if other homeless individuals (not recuperative patients) can access the
PACE center and its services.
Answered in Operations Plan section, subsection Eligibility Criteria, second
subsection PACE program.
ii.Clarify and provide a map for the CalOptima PACE Service Area.
Answered in Operations Plan section, subsection Eligibility Criteria, second
subsection PACE program.
iii. Define the "financial criteria" for PACE participants.
Answered in Operations Plan section, subsection Eligibility Criteria, second
subsection PACE program.
iv. Provide a Code of Conduct with expectations for PACE participants.
Answered in Operations Plan section, subsection Code of Conduct, second
subsection PACE program
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 in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization Program
ii. The Operation Plan states guests are patients discharged from hospitals. Clarify
what hospitals guests will be received from. Provide a list of participating hospitals,
if any.
Answered in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization Program
iii. Define or provide information related to behavior expectations and Code of
Conduct for recuperative care/post-hospitalization housing recipients.
Answered in Operations Plan section, subsection Code of Conduct, second
subsection Recuperative Care/Post Hospitalization Program
iv. Clarify if homeless individuals can register themselves into the recuperative care
and post-hospitalization housing programs.
Page 12 of 19
Homeless registration was previously addressed in FAQ # 5. No homeless
individuals are able to register themselves for recuperative care/post
hospitalization.
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 in the Operations Plan Section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization.
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 in Operations Plan section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Involuntary discharge.
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 In Operations Plan section, subsection Intake/Admission Process,
second subsection Recuperative Care/Post Hospitalization
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 in Operations Plan section, subsection Local Priority Policy.
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 in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization Program
V. SECURITY
b. Loitering
Page 13 of 19
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 in Security Policies Section, subsection Contact Information
ii. What personnel are on the Neighborhood Engagement Team? How often do they
meet, and what happens after they identify an issue?
Answered in Securities Policies section, subsection Good Neighborhood Policy,
second subsection Neighborhood Engagement Team
c. 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 in Security Policies section, subsection Security Plan.
ii. Provide a detailed Security Management Plan for review and approval. The
Security Management Plan shall include security measures to minimize impact to
adjacent residential and non-residential uses from potential noise, pedestrian and
vehicular activities (i.e. noise from ambulance, Fire trucks, loitering, etc.). The
Security Management Plan shall also include measures to address loitering, illegal
drugs/narcotic activities, illegal activities, security cameras, security alarms,
procedures for calling Tustin Police Department regarding observed or reported
crime, security measures during non-operating hours, training protocols for all
employees and security personnel, and an after-hours single point of contact for
the Police Department prior to the commencement of the proposed use.
Answered in Security Policies Section, subsection Security Plan.
iii. Define the protocol for ensuring guests do not use illegal drugs.
Answered on page 37
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 in Security Policies Section, subsection Security Plan, second
subsection Weapons Protocol.
v. Elaborate on the rounding program that will monitor guests throughout the day.
What does this entail?
Answered in Security Policies Section, subsection Security Plan, second
subsection Rounding Program.
vi. What staff will have portable communication devices? Will this be implemented
from the beginning of the center's opening?
Answered in Security Policies Section, subsection Security Plan.
Page 14 of 19
vii. What personnel will staff the front entrances?
Answered in Security Policies Section, subsection Security Plan
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?
5. Answered in Security Policies Section, subsection Security Plan, second
subsection Partnerships with Tustin Police Department
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.
This has been previously addressed in Appendix C
4. Elaborate on van arrival schedules. How many shuttles arrive/depart per hour?Where
would they load/unload on-site?
Anticipated shuttle operation can be found in Appendix C.
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?
Page 15 of 19
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 in Security Policies Section, subsection Security Plan, second subsection
Guest with Vehicles
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.).
The hours have been previously addressed in FAQ #20. Staffing levels by expertise
has been updated and is found in FAQ #21
9. Please specify the full breadth of services provided to PACE participants and
participants of the recuperative care/short-term housing programs.
Answered in Operations Plan section, subsection Program Scope of Services, second
subsection PACE Program.
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 in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization.
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 in Operations Plan section, subsection Intake/Admission Process, second
subsection Recuperative Care/Post Hospitalization.
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 in Operations Plan section, subsection Intake/Admission Process, second
subsection Recuperative Care/Post Hospitalization.
Page 16 of 19
o Will beds be designated for emergency shelter while the
intake/screening/insurance process occurs?
No. Previously answered in FAQ # 16
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 in Operations Plan section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Housing tenancy Services.
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.
Answered in Operations Plan section, subsection National Institute for Medical
Respite Care Standards.
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."
Answered in Appendix D.
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 amended FAQ # 19. Previously identified limited accommodations for
pets. This policy has been revised that no pets will be allowed.
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 in Operations Plan section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Voluntary Discharge.
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
Page 17 of 19
1. Where are guests are taken when involuntarily discharged from the PACE and
Recuperative Care programs?
Answered in Operations Plan section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Involuntary Discharge.
2. Security camera locations and willingness to share surveillance footage with the
Tustin Police Department?
Answered in Security Polices section, subsection Security Plan and second
subsection partnership with Tustin Police Department
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 in Operations Plan section, subsection Program Scope of Services, second
subsection PACE Program.
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 in Security Policies section, subsection Security Plan, second subsection
Guest with Vehicles.
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?
This was previously addressed in FAQ # 21
City's 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 in Operations Plan section, subsection Eligibility Criteria, second
subsection Recuperative Care/Post Hospitalization.
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 in Operations Plan section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Housing Tenancy Services.
Page 18 of 19
3. Does the proposed recuperative care program follow the NIMRC Standards for
Medical Respite Care Programs?
Answered in Operations Plan Section, subsection National Institute for Medical
Respite Care Standards.
4. What is the policy regarding storage of guest belongings? Where do they store
belongings when part of the program?
Answered in Operations Plan Section, subsection National Institute for Medical
Respite Care Standards, subsection Standard 1-Medical Respite Program Provides
Sage and Quality Accommodations.
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 in Operations section, subsection Discharge, second subsection
Recuperative Care/Post Hospitalization, third subsection Voluntary Discharge.
7. What is the protocol once guests exceed the 6-month term for post-hospitalization
housing?
Answered in Operations Plan section, subsection Program Scope of Services, second
subsection Recuperative Care/Post Hospitalization Program.
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
Page 19 of 19
CA L O P TI MA HEALTH
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ATTACHMENT D
APPLICANT'S (CALOPTIMA) LETTER
DATED OCTOBER 7, 2022
CalOptime Health
A PL3blic Agency
a 505 City Parkway west
Health orange, CA 92858
,gym`; ry U 714-24E-8400
f- ' TTY; 711
Q calaptima-arg
October 7, 2022
Justina Wlllkor-n, Community Development Director
City of Tustin
300 Centennial Way
Tustin, CA 92780
RE: Detailed Project Narrative for CalOptima Health's Conditional Use Permit application at
14851 Yorba Street and 165 N Myrtle Avenue
Dear Ms, Wiilkom:
CalOptima Health is a county-organized health system that provides publicly funded health care
coverage for low-income children, adults, seniors, and people with disabilities in Orange County,
California. CalOptima Health's mission is to serve member health with excellence and dignity,
respecting the value and needs of each person. Cal Optima Health serves more than 911,000 local
members with a network of more than 10,600 primary care doctors and specialists and 41 acute
and rehab hospitals.
This year the California Department of Health Care Services (DHCS) launched CalAIM (California
Advancing and Innovating Medi-Cal) to expand its Medi-Cal program beyond traditional
healthcare to cover a variety of community support services that enable more comprehensive
care for the whole person, These services include medically tailored meals, personal care, and
other services that address individuals' social determinants of health. CalOptima Health
recognizes that health outcomes are greatly influenced by social factors and its members overall
experiences. With that in mind, CalOptima Health has committed to offering all 14 community
supports made reimbursable through CaIAIM and expanding its provider network to reach
members across the county.
Community supports address some of the challenges faced by the most vulnerable populations
in our neighborhoods, including those experiencing homelessness, aging, children with complex
care needs, and those involved with the justice system. By providing more comprehensive social
support for our members and partnering with more community-based providers, we can meet
members where they are and help them on their path to better health. At the beginning of the
year, CalOptima Health began offering the first four community supports, including Recuperative
Care. Recuperative Care {also known as Medical Respite) is short-term housing for individuals
experiencing homelessness who are healing from an injury or illness and could benefit from
medical oversight while completing their recovery.
I
I
As part of CalOptima Health's strategy for providing this critical community service to its
members experiencing homelessness, we are partnering with community providers that operate
recuperative care facilities. We are also planning the renovation of the subject property to house
a hybrid program for recuperative care and PACE (Program of All-Inclusive Care for the Elderly.)
This Tustin-based facility will focus on service to older adults living in the community and those
transitioning from living on the streets to a permanent home.
Bringing Supportive Services to the Community
Recuperative care services will be the foundation of this holistic care site in Tustin. Recuperative
care is short-term housing inclusive of comprehensive care management and housing navigation
services paired with traditional medical oversight from trained professionals over an up-to-90-
day stay. Guests of this program have daily interaction with medical professionals and receive
medication education to ensure they continue to heal after their hospitalization. The care
management and housing navigation services provided help members to become "housing
ready" with the necessary documents that enable access to housing. Guests also receive referrals
to job training, substance use disorder services, and any other community supports that prepare
them to make a permanent move home.
This site will also provide another CalAIM-funded community support: Short Term Post-
Hospitalization Housing. This service functions similarly to the recuperative care program but
offers a more extended stay of up to six months. It is anticipated that guests of the recuperative
care program will frequently transition into post-hospitalization housing until they can move into
their permanent homes.
i
Finally, a portion of the building will be dedicated to CalOptima Health's PACE (Program of all
Inclusive Care for the Elderly) program. PACE is a home and community-based service that
provides medical services and supports everyday living needs for specific older individuals, most
of whom are eligible for benefits under both Medicare and Medicaid. Individuals accessing these
services will live both onsite and within the broader Tustin area. PACE offers complete health care
and social support within one program, enabling older adults to remain living in the community
and out of institutions. PACE provides a wide range of services, including on-site medical care, a
day-activity center, transportation, rehabilitation therapies, meals, home care, medications,
medical equipment, and hospital and long-term care coverage.
At the core of these programs are multidisciplinary teams who treat guests and assess and plan
for healthcare and social needs to maintain health. All program guests receive individualized care j
plans and services, and referrals designed to address their health and wellness challenges.
i
i
2
i
CalOptima's History of PACE Services j
CalOptima Health has provided PACE services to the Orange County community since October
2009.Through its location in Garden Grove, CalOptima Health serves 435 individuals, who have
an average age of 72, have multiple chronic conditions, and need help with 4-5 activities of daily
living. They receive care in their own homes and on-site at the PACE center. Exceptional
outcomes have been demonstrated through CalOptima Health's PACE Program, indicating lower
nursing home admissions, shorter hospital stays, lower mortality rates, and better self-reported
health and quality of life.
Serving our Aging Neighbors
i
CalOptima Health is proposing to provide these services to Orange County residents, with Tustin
community members receiving priority at this facility. Overall, the facility will house 119
individuals. The average daily occupancy rate is expected to be 75%. The facility will serve older
adults, many of whom were previously experiencing homelessness but are working toward a
permanent housing placement. Typically, these individuals have multiple chronic conditions and
need help with activities of daily living. To be eligible for PACE, individuals must be at least 55
years of age, reside in Orange County, meet California's skilled nursing facility requirements, and
be able to live safely in the community with proper support.
Bringing Employment Opportunities &A Spotlight on Innovative Services
i
This facility will be staffed around the clock and will bring various skilled job opportunities to the
community. Physicians, registered nurses, and licensed therapists will be retained, in addition to
lower-level medical care professionals, administrators, housekeeping, personal care attendants, j
and guest services associates responsible for ensuring a secure experience for all stakeholders.
CalOptima Health employment will likely track closely to recognized industry standards for
similar care facilities. We would anticipate a ratio of 1 direct caregiver (including RNs, LPN/LVNs,
and NAs) to 5 residents on the day shift, 1 to 10 for evenings, and 1 to 15 for nights in addition to
1 Director of Nursing (DON) and 1 Assistant DON. The proposed 119-bed facility at 100%
occupancy would require 24-26 employees on day shift, 12-13 employees on evening shift and 8-9 I
employees on night shift.
Very few programs across the state focus on the aging population at the intersection of medical
care and homelessness. CalOptima Health is designing a state-of-the-art facility that will provide
exceptional services to the residents of Orange County. Beyond that, it will serve as an example
of best practices in homeless services, focusing on our aging neighbors, the fastest growing
subset of the homeless population.
Cordially,
Kelly Bruno-Nelson
Executive Director Medi-Cal/CalAIM
3
ATTACHMENT E
APPLICANT'S (CALOPTIMA).
OPERATIONS & SECURITY PLAN ("OPS PLAN"�
SUBMITTED MARCH 28, 2023
COMMUNITY LIVING
FACILITY OF TUSTIN
w
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Operations and
Security Plan
14851 Yorba Ave Tustin CA 92780 ` al pti a 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: Administrative Organizational Chart ...................................................69
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.
■
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.
rrogram Scope of Services
PACE PROGRAM
PACE services include the following:
• Primary care clinic visits (with the CalOptima PACE physician, nurse practitioner and/or
nurse). If applicable.
• Routine physicals, and preventive health evaluations and care (including pap smears,
mammograms, immunizations, and all generally accepted cancer screening tests).
• Sensitive services, which are services related to sexually transmitted diseases and HIV testing.
• Consultation with medical specialists. When medically indicated, our PCP will initiate a
referral to a specialist. Referrals will be processed in a timely manner and urgent requests will
be expedited.
• Kidney dialysis
• Outpatient surgical services
• Outpatient mental health
• Medical social services/case management
• Health education and counseling
• Rehabilitation therapy (physical, occupational and speech)
• Personal care
• Recreational therapy
• Social and cultural activities (intergenerational, if applicable)
• Nutritional counseling and meals if medically needed.
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.
141111
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
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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.
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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.
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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.
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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
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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.
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• 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.
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• 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,
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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.
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• 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.
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• 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.
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• 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.
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• 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.
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• 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.
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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 I0:00pm. 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.
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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.
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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.
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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
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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
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• 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.
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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
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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.
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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.
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.
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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.
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?
14101
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.
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e
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
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?
e01m
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 1 (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]
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:
AM
it ■
.. 2
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.
■
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.
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
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
van x
bin 2 x K x x N x I
wan 3
Swan 4 I I N I N I N h N x K K
Van J 8 I K I N 8 M K k N x K K
'Jan 6 I I K I N I M K k K x K K
','an 7
ban 6
Y'an 9 % 8 8 8
Total Vans 3 3 3 3 3 3 3 3 3 3 3 3 31313 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
0
CalOptima Health
Appendix D.1 55
y F CalOptima
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CalOptima Health
Appendix D.2 56
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CalOptima Health
Appendix D.3 57
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CalOptima Health
Appendix D.4 58
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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
DHCS
' 4`F� of rye
wr~ a
a
a
State of California—Health and Human Services Agency °gFgR ,
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
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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:
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• 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
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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
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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
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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.
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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
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List of Service Partner Types
The following is a list of types of service providers that will assist in providing services for our
Guests while at the Tustin Community Living Center. This is not an exhaustive list as
organizations and partnerships continue to evolve. These partnerships are not contractual.
. Orange County Social Service Agency
2. Orange County Health Care Agency
3. Rapid Rehousing Assistance
4. Section 8
S. Assisted Living for Older Adults
6. Sober Living Homes
7. Affordable Rental Unit Assistance
8. Domestic Violence Resource Organizations
9. Credit Counseling
10.Tenant Readiness Education
1 1.Personal Finance Counseling
12.General Relief/CaIWORKS/SSI/SDI
13.Transportation
14.Legal Assistance
S.Addiction/Substance Use Disorder Support Groups
16.Mental Health Counseling
17.Aging/Older Adult Support Groups
18.Employment Support
19.Immigration/Naturalization Assistance
20.Outpatient Substance Abuse Treatment/Counseling
21.CalFresh
22.Older Adult Congregate Meals
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