Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
03 PC REPORT CUP 2024-0018 SPECIALTY HOSPITAL
AGENDA REPORT ITEM 93 MEETING DATE: FEBRUARY 11 , 2025 TO: PLANNING COMMISSION FROM: COMMUNITY DEVELOPMENT DEPARTMENT SUBJECT: CONDITIONAL USE PERMIT 2024-0018 (14851 YORBA STREET AND 165 NORTH MYRTLE AVENUE) — CONTINUED FROM THE JANUARY 28, 2025 PLANNING COMMISSION MEETING. APPLICANT: PROPERTY OWNER: ROBERT MOONEY GARY NGUYEN LIFE GENERATIONS HEALTHCARE, LLC YORBA MYRTLE, LLC 6 HUTTON CENTRE DRIVE, SUITE 400 13800 ARIZONA STREET, SUITE 200 SANTA ANA, CA 92707 WESTMINISTER, CA 92683 LOCATION: 14851 YORBA STREET AND 165 NORTH MYRTLE AVENUE (APN: 402-302-14) GENERAL PLAN: PUBLIC/INSTITUTIONAL (PI) ZONING: PUBLIC AND INSTITUTIONAL (P&I) DISTRICT, PROFESSIONAL (Pr) DISTRICT, AND SPECIFIC PLAN NO. 9 (SP9-YORBA SPECIFIC PLAN) ENVIRONMENTAL: THIS PROJECT IS CATEGORICALLY EXEMPT (CLASS 1) PURSUANT TO SECTION 15301 OF THE CALIFORNIA ENVIRONMENTAL QUALITY ACT REQUEST: A REQUEST TO ESTABLISH A SKILLED NURSING FACILITY (SPECIALTY HOSPITAL) WITHIN EXISTING AND VACANT MEDICAL BUILDINGS RECOMMENDATION: That the Planning Commission approve Resolution No. 4519 approving CUP 2024-0018, for the establishment and operation of a Skilled Nursing Facility (SNF) licensed through the California Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 2 APPROVAL AUTHORITY: The project location is within the Public and Institutional (P&I)zoning district, and pursuant to Tustin City Code (TCC) 9245b, Hospitals are conditionally permitted uses. Pursuant to TCC 9291c, the Planning Commission has the authority to review and act on CUPs. BACKGROUND AND DISCUSSION: At the January 28, 2025 Planning Commission meeting, Planning Staff requested a continuance of the subject project, and the Planning Commission motioned to approve the continuance to the February 11, 2025 Planning Commission meeting. The continuance was requested because information relative to Special Treatment Programs was not included in the applicant's submittal information and was not analyzed by Staff. The continuance allowed Staff to review the operational characteristics of Special Treatment Programs and determine that these programs are consistent with, and considered, SNFs. Staff has since incorporated the analysis of the Special Treatment Programs into the Staff Report and modified the associated Conditions of Approval accordingly. Site and Surrounding Properties The project site is located south of the intersection of Irvine Boulevard and Yorba Street (Figure 1, Page 3). Adjacent properties to the east are developed with single-family homes that have been re-purposed into office buildings, while the adjacent property to the north is developed with a more typical multi-tenant office building. The adjacent property to the south (along the east side of Myrtle Avenue) is developed with a multi-family apartment community. The property along the west side of Myrtle Avenue is developed with a medical dialysis center. Figure 1 — Aerial View f It of � � �� 5--( �� �f� Y ,I --` i eia San[a Ana + ,t 1 Office Re •et r _Irvine Blvd _ SU jet Office office Property v o } . Opwntown Ct nnmercial Core rP" First Street - Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 3 The subject property is a 2.27-acre campus, developed with two buildings connected by an enclosed corridor (Figure 2). The northerly two-story building (14851 Yorba Street) is approximately 56,000 square feet, was built in 1991 , and was formerly used as a rehabilitation hospital. The southerly one-story building (165 N. Myrtle Avenue) is approximately 17,000 square feet, was built in 1971, and was formerly used as a SNF. A shared outdoor courtyard is located between both buildings. The site was previously occupied by Encompass Health Rehabilitation Hospital, providing acute care and rehabilitation services, until the site was vacated in May 2022. Figure 2 — Site Plan — n0 oq _ 2 Story Building / I L El 0 0 0 1 Story Building ' > I. \ L cauNr �l mT.�NUMeEH CF eE�. It§ The existing medical campus provides a total of 165 parking spaces. An underground, two- level parking structure, accessed through Myrtle Avenue, provides 159 parking spaces. A surface parking lot, accessible through Yorba Street, provides an additional six parking spaces. Tenant improvements are needed to prepare the buildings for the proposed use and would be submitted to the City for review and permitting by the Building Division. Project Description Skilled Nursing Facility Life Generations Healthcare provides various skilled nursing and adult residential health services in convalescent hospitals since 1998. Life Generation Healthcare has over 3,500 licensed beds in 31 facilities throughout California and Nevada (Attachment D - Letter of Operations). Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 4 Life Generations Healthcare is proposing a skilled nursing and supportive care facility for 121 patients, including 24-hour inpatient care (dietary, pharmaceutical services and activity programs) within the existing buildings located at 14851 Yorba Street and 165 N. Myrtle Avenue. The project site was previously approved and built as a hospital-related use (SNF and rehabilitation facility), and the application currently being proposed essentially reactivates the site with a hospital-like use by using the same floor plan and updating the interior and exterior of the buildings. The proposed services are described as follows and elaborated upon in Attachment D: • The facility will operate 24-hours a day, 365 days a year and a reception desk will be staffed during "normal business hours" that are considered 9:00 a.m. to 5:30 p.m., daily. • The facility will provide services commensurate with SNFs and include, but not limited to the following: o Room and board; o Nursing care (skilled observation and assessment); o Respiratory care; o Physical, speech, and occupational therapies; o Catheterizations; o Wound care; o Intravenous (IV) fluids; o IV, intramuscular and subcutaneous medications; o Pain control; o Feedings such as parenteral nutrition; o Ventilator care; o Medication management (as ordered by the patient's physician); o Vaccine administration; and, o Ancillary Special Treatment Program. The 56,000 square foot, two-story building at 14851 Yorba Street would contain the main entrance and reception area, shared occupancy patient rooms, administrative offices, and other operational support areas. Operational support areas include: administrative offices, dining areas, therapy rooms, kitchen, medical offices, and exam rooms. Figures 3 and 4 (Page 6) provide the floor plans for these areas. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 5 Figure 3— Proposed/Existing 1ST Floor Plan, 14851 Yorba Street k fit *F !! f 4� .moo ..,..,.._.-, •----• •--- `� i _— ..�.� i Offices —� Medical/Dining Srvcs. ,� II � ❑ Patient Rooms a .J., rr !i wrrvn "C VA ul 1 Figure 4— Proposed/Existing 2ND Floor Plan, 14851 Yorba _ L _ -- r �•"L - - T °:�� N `� — � n f n n NX ,TT— , N 3 r The 17,000 square foot, one-story building at 165 N. Myrtle Avenue is proposed to contain 27 shared occupancy patient rooms in addition to staff office areas and operational support facilities, surrounding a centralized outdoor courtyard. Operational support facilities include, but are not limited to therapy rooms, offices, lounge and dining areas, employee areas, restrooms, and more (Figure 5, Page 7). Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 6 Figure 5 - Proposed 15t Floor Plan, 165 N. Myrtle Avenue P�:.Ya leaf y . 3'r�e rapt' H- 1I. .1�Pft0 61rft V`4R lfRf"'.1M ITT P.R }Ar1 R,7OMTIENT T1ENT pTIN1LJPFrEil-9 Iq� -1^I— Tf ICa. Coa�u I � vn aat RGerr, _ .,.. Wd :. xarrevr .. • EFice I I Irnxagc 1'C,in � Oin_ny R:xm 1Cal A 1 Tl�mpyT71 . AAA PATIEWT R60kM ` �� F.\-IEH- ?Ai1IFtiT Yp1�1I F E 1 13 C.:1}xr k.A F, P ly I 4 h ftOvM ROOA1 p�l R '.I" PhT11EHr 5i]IIpJI � IL I. R;xil 13 _I, �IF'' L PATIENT �M-ENl F,i-IEIi- Ls'f f W {F[F Raw 0_ F. Special Treatment Program (STP) Article 4 of Chapter 3 of Division 5 of Title 22 of California Code of Regulations identifies Special Treatment services that can be provided in part to, or as a SNF. STPs are skilled nursing services "that provide programs to serve patients who have chronic psychiatric impairment and whose adaptive functioning is moderately impaired. Special treatment program services are those therapeutic services, including prevocational preparation and prerelease planning, provided to mentally disordered persons having special needs in one or more of the following general areas: self-help skills, behavior adjustment, interpersonal relationships." (CCR Sec. 72443) A significant number of patients in SNFs have one or more behavioral health challenges along with their medical acuity necessitating skilled nursing. Recognizing co-morbidities exist for many patients, California Department of Health Care Services (DHCS) has authorized SNFs to include in their rehabilitation programs certified mental health programs called "Special Treatment Programs" ("STP"). These programs allow SNFs to wholistically treat patients to expedite recovery. As such, in addition to the restorative, cardiac, orthopedic, stroke recover, and wound care and rehabilitation services (including physical therapy, occupational therapy, speech therapy, etc.), STPs also offer individual and group therapy sessions, psychiatric and psychological services and clinics, along with a full-time licensed program director dedicated to administering the STP to the patients. Although the applicant has not committed to establishing a STP at the project site, if they proceed, they will need to obtain State licensure to offer STP services. The STP will be licensed and supervised by both CDPH and DHCS. If the applicant proceeds with STP services, approximately 30 beds will be set aside for patients with behavioral health. Typically, people admitted to a SNF/STP for solely a behavioral health condition is rare because there are other facility types that are less specialized with the health acuity part of Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 7 the SNF that could treat a patient who did not have a co-existing health condition. In rare occurrences, the facility may provide a special placement for individuals that only require STP; however, the majority of patients who will require the STP will also need medical SNF services. DISCUSSION: California Code of Regulations, Title 22, Division 5 establishes the State's authorization for licensing and certification of health facilities, clinics, home health agencies, including hospitals. Chapter 3 of Division 5 establishes licensing requirements for skilled nursing facilities and defines skilled nursing facilities as "...a health facility or a distinct part of a hospital which provides continuous skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. It provides 24-hour inpatient care and, as a minimum, includes physician, skilled nursing, dietary, pharmaceutical services and an activity program." (CCR Sec. 72103). The previous tenant of the site, Encompass Health Rehabilitation Hospital, provided acute care and rehabilitation services, and was licensed as a "specialty hospital". A Specialty Hospital is defined as "...a hospital which provides special services either rehabilitation, maternity, or dentistry, and which meets all the requirements for a general acute care hospital, except that it is not required to provide surgical or anesthesia services." Although the proposed use and the previous rehabilitation hospital are classified under distinct classifications, they are both considered hospital-like uses that are conditionally permitted in the P&I zone. Furthermore, as stated above, a portion of the site was previously used as a SNF. To ensure the facility is operated as SNF, Conditional of Approval No. 2.3 states that a change of license type to a use other than a SNF, pursuant to California Code of Regulations, Title 22, Division 5 is not allowed, and the approval of CUP 2024-0018 does not allow the establishment of short-term housing uses such as Recuperative Care or Post- Hospitalization Housing. Proposals for the establishment of housing-related uses may be subject to a new CUP and legislative actions such as a zone change or a specific plan amendment. Operation The applicant's wholly owned subsidiary will obtain a license for the facility from the Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5. As required by law, the proposed use will provide skilled nursing and supportive care, including 24-hour inpatient care and, as a minimum, physician skilled nursing, dietary, and pharmaceutical services and an activity program. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 8 The applicant has various contracts with hospitals throughout the region, such as the following: • St Joseph Health (Providence Health System) • Hoag Hospital • OC Global Medical Center • University California Irvine Medical Center • St. Jude Medical Center (Providence Health System). The contract hospitals refer patients to the facility for skilled nursing services for patients who no longer require acute care but require an environment with medical and social services for individuals whose care needs cannot be met at home or in a residential care setting. The applicant's patients are referred from their private and public partners in need of Skilled Nursing services, including those with needs of Physical Therapy, Occupational Therapy, Speech Therapy, Orthopedic Rehabilitation, Stroke, Pulmonary, or Cardiac Rehabilitation, Spinal Cord Rehabilitation, IV therapy or tube feeding and, in some instances, behavioral health services. The applicant also specializes in orthopedic care after surgeries such as knee and hip replacements. Wound care is also a focus of their facilities. As with all SNFs, Department of Healthcare Access and Information (HCAI) (formerly OSHPD) monitors the construction, renovation, and seismic safety of California's hospitals and SNFs. As such, Tustin's Building Division will not review construction plans or issue permits for construction activity under the DHCAI jurisdiction. City-issued building permits will be required for improvements not under DHCAI's jurisdiction. The operation of the proposed project will be monitored by DHCS and CDPH, therefore, staff has included Conditions of Approval to ensure that the establishment, maintenance or operation of the proposed use will not, under the circumstances of the particular case, be detrimental to the health, safety, morals, comfort and general welfare of the persons residing or working in the neighborhood of such proposed use, or whether it will be injurious or detrimental to property and improvements in the neighborhood or the general welfare of the City. Special Treatment Program (STP) As stated earlier in this report, the applicant has not committed to establishing a STP at the project site; however, if they proceed, they will need to obtain State Iicensure to offer STP services. The STP will be licensed and supervised by CDPH and DHCS. Additional security would be included in the STP-designated portion for the safety and peace of mind of the patients both in the STP portion of the facility, and the rest of the SNF. Additional information relative to security measures can be found in the Security section on Page 12. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 9 The applicant has over 26 years of experience providing SNF services and seven years operating STPs. The closest facility operated by the applicant is the Newport Nursing and Rehabilitation Center located at 1555 Superior Avenue in Newport Beach. htti)s://Iifegen.net/locations/newi)ort-nursing-rehabilitation-centerw. The facility is an established SNF, and the applicant is in the process of adding STP certification. The STP is currently under construction and a Certificate of Occupancy is anticipated in early February 2025. The Newport Beach facility is a 61-bed facility and when the STP is completed, the facility will provide 31 SNF beds and 30 STP beds, increasing to a total of 61 beds. Newport Beach did not require zoning clearances or entitlements for the establishment of the new STP within the existing SNF because SNFs are permitted by right in the zone where the facility is located. Patient Intake and Discharge and Stay Duration The patient intake and discharge process take approximately one hour. During intake, the patient will be transported by ambulance to the proposed facility from one of the partner hospitals. The ambulance will park in a designated parking stall in the surface parking lot fronting Yorba Street, and the patient will be brought into the building where the staff will continue their intake process, consistent with State guidelines. Patient intake can take place at any time of day but typically occurs during normal business hours (9:00 a.m. to 5:30 p.m.). Upon successful recovery, staff will conduct the discharge process within the facility consistent with State guidelines. Upon completion of the discharge process, the patient will be transported by ambulance from the designated parking stall in the surface parking lot on Yorba Street to their destination. Patient discharge typically takes place during regular business hours (9:00 a.m. to 5:30 p.m.). Condition of Approval No. 2.7, would require a designated parking stall for intake and discharge purposes in the surface parking lot fronting Yorba Street (Figure 6). Pursuant to the applicant, patients stay an average of 60 days; however, typical care is concluded in approximately 21 days. In severe cases, patients could stay as long as 18 months. In the case that the patient's prognosis is terminal, most prefer to return home with hospice, or they are returned to the hospital for more immediate care. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 10 Figure 6 — General Location of Intake/Discharge Parking Stall Intake/Discharge Parking Stall . M Building Entrance A . Staffing The facility will be staffed 24 hours a day with skilled medical personnel, such as registered nurses (RN) and licensed therapists, as well as administration, housekeeping, activity and dietary service associates responsible for ensuring a safe experience for the patients. Table 1 below illustrates the total number of staff per shift. At 100% capacity, the proposed 121- bed facility would require 35 employees during the A.M. shift, 34 employees on P.M. shift, 15 employees on Night shift, including one security guard, and 19 employees during regular business hours. The applicant Letter of Operations provides details regarding the staffed positions (Attachment D). TABLE I R OF EMPLOYEES Shift No. of Employees A.M. Hours 7:00 a.m. to 3:00 .m. 35* P.M. Hours (3:00 p.m. to 11:00 p.m.) 34* Night Hours (11:00 p.m. to 7:00 a.m.) 15 (w/Security) During Business Hours 8:00 a.m. to 5:00 .m. 19 *Five additional staff members may be added if STP is established. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 11 Security The facility will be a locked complex with 24-hour security. The site will be secured by a locking system at all exterior gates leading into the facility. The Tustin Police Department has reviewed the project and established Conditions of Approval requiring security measures, such as cameras and a "Knox box" to provide an override access for immediate first responders. The applicant plans on providing security personnel during the night shift, when there is a lower number of staff at the facility. Security for the STP would include camera systems throughout the exterior and common areas, with state-of-the-art tracking and remote phone access. All gates would be equipped with delayed egress tied back to the fire systems and opened with key cards. Patients and visitors will not be allowed in the courtyards or other outdoor areas without supervision. Visitors meet their loved ones in a designated area of the STP. TPD would require review of the security policies and procedures related to the STP prior to obtaining a Certificate of Occupancy (Condition of Approval No. 2.1). Parking and Circulation The applicant proposes to establish a hospital use providing skilled nursing for up to 121 patients. TCC 9263(g) requires one parking space per four beds for "extended care" uses, which includes services such as elderly care, SNFs, etc. This patient ratio results in a requirement of 31 parking spaces. The proposed facility would be staffed in four shifts (A.M., P.M., Night and Business Hours). The A.M. and P.M. shifts contain the most staffing with 35 and 34 total staff members, respectively, and the facility would be staffed with 19 employees during normal business hours. Although there would be an overlap at the end of one shift, and the beginning of the next, it is estimated that a maximum of 54 parking spaces would be required to allow for this brief occurrence. If the STP is established, an additional five parking spaces would be required. The property is supplied with 165 existing parking spaces — 159 spaces that are provided in an underground parking lot accessed via Myrtle Avenue, and six spaces provided on the surface parking lot fronting Yorba Street. As proposed, the maximum parking spaces required is 85 (90 with STP) spaces as shown in Table 2. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 12 TCC Parking Requirement Project Metric Total Parking 1 space for each 4 beds the facility is licensed to 121 Patients 31 Spaces Required accommodate 1 space for each employee 54 employees duringmaximum occupancy (largest shift+ business hours) 54 Spaces Required STP-related Staffing 5 Employees 5 Spaces Required Total Spaces Required 85 Spaces Required (90 with STP) Total Spaces Provided 165 Spaces Provided NOTICING AND PUBLIC COMMENTS: This item was noticed for a public hearing before the Planning Commission in the Tustin News, mailed to property owners within 300 feet of the project site, and posted to the project site on January 16, 2025. As of the preparation of this report, no public comments were received. ENVIRONMENTAL: The subject project is Categorically Exempt pursuant to California Environmental Quality Act (CEQA) Section 15301 (Class 1 — Existing Facilities). CONCLUSION: Based on this report and the findings and Conditions of approval contained herein, staff recommends that the Planning Commission adopt Resolution No. 4519 approving CUP 2024- 0018 to establish a Specialty Hospital use required to be licensed as a Skilled Nursing Facility through the California Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5. within the existing buildings located at 14851 Yorba Street and 165 N. Myrtle Avenue. Planning Commission Agenda Report CUP 2024-0018 February 11, 2025 Page 13 PREPARED BY: Raymb arr n Principal Planner APP ED BY: Jay stman Assistant Community Development Director J - &k:� u a L, Willkom Community Development Director Attachments: A. Location (Radius) Map B. Land Use Fact Sheet C. Proposed Site Plan and Floor Plans D. Applicants' Letter of Operation and Policies, dated October 25, 2024 E. Resolution No. 4519 a. Conditions of Approval ATTACHMENT A Radius Map 14851 Yorba Street and 165 N. Myrtle Avenue a N 0 ft. Subject Property I 300 P 2- �F. ss n; f r 300 ft,500 ft,and 1000 ft Radius ATTACHMENT B LAND USE APPLICATION FACT SHEET 1. LAND USE APPLICATION NUMBER(S): CONDITIONAL USE PERMIT (CUP 2024-0019) 2. LOCATION: 165 N. MYRTLE & 14851 YORBA STREET 3. APN: 401-302-14 4. PREVIOUS OR CONCURRENT APPLICATIONS RELATING TO THIS PROPERTY: UP 69-328; UP 72-396; CUP 83-14; GPA 84-4B; ORD. 934/935; PM 87-412; CUP 88- 01/DR 88-10; AMENDMENT TO CUP 88-01/DR 88-10 VIA PC RESO. 2748 AND 2750; U D-2023-0002 5. SURROUNDING LAND USES: NORTH: OFFICE EAST: OFFICE SOUTH: MULTIFAMILY APARTMENTS WEST: 5-FREEWAY 6. SURROUNDING ZONING DESIGNATION: NORTH: PR (PROFESSIONAL) EAST: SP 9 (YORBA STREET SPECIFIC PLAN) SOUTH: PR, SP 9, AND R3 (MULTIFAMILY WEST: N/A RESIDENTIAL) 7. SURROUNDING GENERAL PLAN DESIGNATION: NORTH: PO (PROFESSIONAL OFFICE) EAST: PO SOUTH: HDR (HIGH DENSITY WEST: N/A RESIDENTIAL)AND PO 8. SITE LAND USE EXISTING PROPOSED A. LAND USE: HOSPITAL SKILLED NURSING FACILITY B. GENERAL PLAN: PUBLIC & INSTITUTIONAL NO CHANGE C. ZONING: P&I, PR, AND SP-9 NO CHANGE DEVELOPMENT FACTS: 9. LOT AREA: 2.235 ACRES 10. BUILDING AREA: 73,180 SF (TWO STORY BLDG.)AND 17,000 (ONE STORY BLDG.) EXISTING PROPOSED 11. PARKING: 165 PARKING STALLS NO CHANGE 12. BUILDING HEIGHT: TWO AND ONE NO CHANGE 13. DEVELOPMENT STANDARDS: THE SITE IS AN EXISTING HOSPITAL FACILITY AND NO EXPANSION OF FLOOR AREA OR BUILDING FOOTPRINT IS PROPOSED. HOWEVER, THE PROPOSED PROJECT INCLUDES INTERIOR IMPROVEMENTS ADDRESSING A CHANGE OF OCCUPANCY. IF APPROVED, TI CONSTRUCTION DRAWINGS WILL BE REVIEWED THROUGH THE BUILDING PLAN CHECK PROCESS. ATTACHMENT C Ob V-DITCH Ls'3s..J 411 - e ssis wssr wrn ,xsv.. °fL c TWO—STORY HOSPITAL — _ a111 T �� _ ❑ - t C �� _� cw Vli... .�. � dlr� IT— n r..r e.oeeo;ec rw ,' {I: / /i�0 1 xr r - ❑ _ - (i�( _; l��r - �P,r�7 2 . h / •' )��'/ a �� . j�'c rr€�r .>< la:: �`�' n-['t's .r �e '-'s°� 1 a'^ � 7 �4 r% ----r � w �� t't,'s✓ ©_ £C r 'C; _ r, iJz Y 1Ge+�fEe1 dlGY. LFr; � �6 at � i . ONE—STORY HOSPITAL a h r r g w � x SCRIiCr t"-Zo' t = I _�srws ;e PARKING CALCULATION: EXISTING SURFACE PARKING 3 SPACES EXISTING FIRST FLOOR PARKING STRUCTURE 80 SPACES EXISTING SECOND FLOOR PARKING STRUCTURE 76 SPACES EXISTING HANDICAP SURFACE PARKING 3 SPACES EXISTING HANDICAP PARKING STRUCTURE 3 SPACES TOTAL: 165 SPACES OVERALL SITE PLAN £�— TUSTIN REHABILITATION HOSPITAL 14851 YORBA ST, TUSTIN CA 92780 TWO-STORY HOSPITAL YfrysFaai � i9ierapy PATIENT PATIENT PATIENT PATIENT PATIENT PATIENT PATIENT�PATJNT PATIENT, PATIENT ROOM_ROOM ROOM ROOM ROOM ROOM ROOM— R ROOM ROOM • EII ility TAmp pON - en Cast Room ftst S[A Y,;[7n PATIENT PATIENT PATIENT 1 Ih' n McC1 Faun ROOM ROOM ROOM yfpcKyn IFS•-� — - • UfEire Lounge Patio 4 Dining Fnan Physical Therapy S Lt:r oyc PATIENT ROOM {{{ PATIENT PATIENT PATIENT ��� £Cat ROOM ROOM ROOM [ "- Iti.lb RCJ(Tn Lallli[y 5peeCh PATIENT n * '� T11eY'apy ROOM PATIENT PATIENT PATIENT PATIENT PATIENT PATIENT PATIENT PATIENTET S t of E ROOM ROOM ROOM ROOM ROOM ROOM ROOM "ROOM DEVelcpmenl EXISTING FIRST FLOOR PLAN (SINGLE STORY TUSTIN REHABILITATION HOSPITAL 165 MYRTLE AVE, TUSTIN CA 92780 d P CONTROL ,x7 I TLT TLT I TLT TLT ! OFFICE Y OFFICE PATIENT i PATIENT f� PATIENT PATIENT PATI PATIENT ' - PATIENT PATIENT: �' PATIENT — ROOM ROOM ROOM R00)ul RM! ROOM ROOM HR U ' ROOM ROOMSAFTt OFFCETLT. TLT r T '.� T OFF CE HR {,4 OFFICE a. y /j,OFFICE I' OFFICE �v NURSES ' SUP SOILED CLEARI f ` JC { OFFICE ' JGI NURSES OFFICE OFFICE STATION _ ` it �� MECH �J STO T I LOUNGE TLT TLT TLT _ , ' �HYSICAL �j{� NOURI '!y TAT CHART OICT3 CHART oK THERAPY 4a�/�TLT��` TLT l TUB—I �F,I^TLT LTS f I RE Gil ROOM`1 f( '1 F ,� CONFERENCE EMPLOYEE EM PLOVEE t' ',1+ SrOR-` ROOM REC RDS NURSES OA PR it SS LOBBY LOCKERS. LOCKERS -� II i ' �,, I OFFICE OFFICE OFFIC� OFFICE LOBBY OFFICE � R ''4WOMENS � - OFFICE� 4 ,-.--• I�/ TLT , Ih I ASST OFFICE CLEAN 1 1F 4 i 1 bAOMIN LINEN/JI OFFICE 1+1 STA - TL OFFICE OIETITW ! OISHWASHER � DRESS. X-RAY ^� �' I� ADMITTING L l ¢ ..fWART V OFFICE PHARMACY LAB i <<`` - - JC �' TLT' I! i, �TyF \� MIN ` II� F�. f1 OFFICE STO CONTROL STA STAFFRKal AREA DOR ly OM ~CONTROL ' r-LS TILT -ROOM ELEC DRY KITCHEN SERVING DINING �TTJ _ — XJ2AV O � WARiNc RECEIPT� ..y LOBBY WA ji ) .� �I -� I WAITING STORAGE 1 11 OFFICE ONE-STORY HOSPITAL EXISTING FIRST FLOOR PLAN TUSTIN REHABILITATION HOSPITAL 14851 YORBA ST, TUSTIN CA 92780 _ ROOM TLT TLT ! TLT --��� r - TLT' TLT *al QUIET HYDRO- T IENT ,PATIENT PATIENT. PATIENT PATIENT PATIENT' PATIENT -!PATIENT PATIENT (PATIENT ROOM THERAPY OM r ROOM ROOM ROOM ROOM I ROOM, f ROOM -i ROOM ROOM �,�' PATIENT �I TLT TIFF TLT 4� TLT1 �!pFLEC 1 r + { ROOM f �y_x r , \ �I�TTLLT^�' ,,�I{ 7 -- -- � ----� NURSE STAT,OS STATION SUf�NOURISH r OFFICE $ �l r f BATH -i 71 L STAFF1\�/,{� STOR WORK LOUNGE ice\ ! �STOR �� DI I STOR �-+ h4 ROOM PLAY �� MEIN STOR EXAM STAFF BATH S VYERr _ _ r y ILI ISOLATION ,r / LW T�L.T_ � -} VESTIBULE( EAN/SORTED '�EXAM �� �'�l w- (CHART�� II I" , MECH l STAFF r SP M ROOM S JC SORi�j NJOFFICE\ I TL i i i V�`. TITER ,,�'} PSVCH I! OFOF CE 4� _ STAFF ' I PATIENT I ' PT/OT LOUNGE ` LOUNGE ¢ THERAPY T77 LT TLT NURSES �ISUP� OFFICE r STATION I I OFFICE SP �{ OR I� ILI THE THER iI OFFICE STOR .OFFICE } - •' _ F oB'. STOR — --- H TLT ! _TLT TLT 1 REP r RAP ' 11 ELEV PATIENT " PAT ENT! PATIENT -� PATIENTv PATIENT r PATIENT PATIENT] LOBBY ROOM ROOM ROOM _ ROOM 7' I ( DINING/REC H iI u ,_, ROOM ROOM ROOM i. - --}-�—{f" TLT TLT l TLTJ TLTU j KfFCHENi SUPE6VISOR EXISTING SECOND FLOOR PLAN TUSTIN REHABILITATION HOSPITAL 14851 YORBA ST, TUSTIN CA 92780 I I w, �-1-71 s F i ®® ,x^.. .✓ 11 I s. Qa a'F-rd jVtilr�L.Mi� 1 f n EXISTING LOWER LEVEL PARKING 1 FLOOR PLAN TUSTIN REHABILITATION HOSPITAL 14851 YORBA ST, TUSTIN CA 92780 � I i py r; �VwP 3N1 _ I I �a I � I � I ao ■ � � CQ O C7 � CQ ,• r, C� EXISTING LOWER LEVEL PARKING 2 FLOOR PLAN TUSTIN REHABILITATION HOSPITAL 14851 YORBA ST, TUSTIN CA 92780 ATTACHMENT D GENERATIONS HEALTHCARE Tustin City Community Development 300 Centennial Way Tustin, CA 92780 RBarragangtustinca.org AVallegtustinca.org October 25, 2024 RE: Life Generations Healthcare CUP Application—Letter of Operations Dear Sir or Madam: We respectfully submit this Letter of Operations in support of Life Generations Healthcare LLC's ("GHC") application for a Conditional Use Permit to utilize the property located at 14851 Yorba& 165 N. Myrtle, Tustin, California (the"Property") as a 121-bed Convalescent Hospital (the "Facility"). For years, the Property was used for this purpose, and in fact, when the zoning of the Property was changed in 1984, it was changed explicitly to include this use. (See Attachment A, 1984 Zone Change Summary Analysis). GHC proposes to return the Property to its original use. GHC, through its wholly-owned subsidiaries, has been providing Skilled Nursing and Adult Residential Health Services in Convalescent Hospitals since 1998. We believe that caring for the sick, the elderly, and the infirm is a special and sacred stewardship. We currently have over 3,500 licensed beds in thirty-one facilities throughout California and Nevada, the majority of which are Convalescent Hospitals (i.e., "Skilled Nursing Facilities"'). Our facilities and staff have received numerous awards through the years, including the Bronze National Quality Award from the AHCA/NCAL. The Facility will be licensed by a wholly-owned GHC subsidiary through the California Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5. As required by law, the Facility will provide skilled nursing and supportive care, including 24-hour inpatient care and, as a minimum, physician, skilled nursing, dietary, and pharmaceutical services and an activity program. The Facility will be locked, with 24-hour lhttps://www.aging.ca.gov/Care Options/Skilled Nursing Facilities/#:—:text=A%20number%20of%20different%20 terms,In%20addition%2C%20SNFs%20provide: ("A number of different terms,including`convalescent hospitals,' are used to describe facilities that are formally referred to in California as skilled nursing facilities(SNFs).") 6 Hutton Centre Drive,Suite 400,Santa Ana,CA 92707 T.(714) 241-5600 1 F:(714) 241-8911 Doc ID: 7968480db75bfOdOf32f59f2lb8a9d6ffb27b5a7 GENERATIONS �If HEALTHCARE security, ensuring that the Facility's operations will not impact the members of the community. The Property has 166 available parking spaces (Tustin City Code only requires, at most, 44 spaces), so there will be no street or neighborhood parking burden caused by our operations. Our operational overview is as follows: A. Daily Operations 1. Operating Hours: The Facility will be operational 24-hours a day, 365 days a year. Our reception desk will be staffed from 9:00 a.m. — 5:30 p.m. ("normal business hours"). 2. Staff: The Facility will be staffed as follows: a. Registered Nurses/Licensed Vocational Nurses: AM shift—7; PM shift—7; Night shift— 5. b. Certified Nursing Assistants: AM Shift— 16, PM Shift— 16, Night shift— 8. c. Social Services: 3 employees, including 1 coordinator and 2 assistances, M-F during normal business hours. d. Maintenance Staff: 4 employees, including 1 director and 3 assistants. e. Housekeeping Staff: 7 employees, including one supervisor and 2 morning and 2 evening laundry staff, and 1 morning j anitor and 1 night j anitor. f. Laundry Staff: 9 employees, including 1 supervisor, and 8 assistants split between the morning and evening shifts. g. Dietary Staff. 14 employees including a dietary manager, 3 cooks, 6 dietary aids and five dishwashers, split between the morning and evening shifts. h. Activities Staff: 5 employes, including a fully time activities director, and four activities assistants during daytime hours. i. Business Office Staff: three full time employees during normal business hours. j. Admissions Staff: two full time employees, including a coordinator and an assistant during normal business hours. k. Medical Records Staff: three full time employees, including a supervisor and 2 assistants during normal business hours. 3. Services Provided: The Facility will provide its patients with the following services: a. Room and board; b. Nursing care (skilled observation and assessment); 6 Hutton Centre Drive,Suite 400,Santa Ana,CA 92707 T:(714) 241-5600 A F:(714) 241-8911 Doc ID: 7968480db75bfOdOf32f59f21b8a9d6ffb27b5a7 GENERATIONS �If HEALTHCARE c. Respiratory care; d. Physical therapy, speech therapy, and occupational therapy; e. Catheterizations; f. Wound care; g. Intravenous ("IV")fluids; h. IV, intramuscular and subcutaneous medications; i. Pain control; j. Feedings such as total parenteral nutrition ("TPN"), NG, GT or JT; k. Ventilator care; 1. Medication management(as ordered by the patients' physician(s)); m. Vaccine administration; and n. Related services. 4. Supplies Provided: The Facility will provide its patients with the following supplies: a. IV supplies (including pump, IV therapies, rate control device as needed,) b. Durable medical equipment as needed c. Ancillary supplies. 5. Quality Assurance and Quality Improvement: The Facility will maintain GHC's standard QA/QI program and have such program available for licensing administration upon request. 6. Monitoring and Reporting: The Facility will maintain GHC's standard monitoring and reporting programs and have such program available for licensing administration upon request. 7. Compliance: The Facility will maintain all requirements for Medicare and Medi-Cal program compliance, including records, prompt payment, continuation of benefits as required, audit and inspection rights, accountability and delegation standards, exclusion and sanction compliance; certification of medical data; and compliance with all other relevant laws. B. Relationship with Patients 1. Subject to applicable law, GHC practitioners freely communicate with patients (or his/her authorized representative) about the patient's treatment options (including medication treatment options). 6 Hutton Centre Drive,Suite 400,Santa Ana,CA 92707 T:(714) 241-5600 A F:(714) 241-8911 Doc ID: 7968480db75bfOdOf32f59f21b8a9d6ffb27b5a7 GENERATIONS Zlf HEALTHCARE 2. Information about healthcare service and treatment options (including the option of no treatment) must be provided to patients in a culturally competent manner, and with appropriate access to language assistance, as required by applicable law. 3. GHC shall ensure that patients with disabilities are able to communicate with health care professionals in making decisions regarding treatment options. C. Admission and Discharge Procedures 1. The Facility will follow GHC's Administrative Policies for admissions. These include: Admission Agreement; Admission Criteria; Admission Notes; Admission Orientation; Admission Policies, and other documents regarding special circumstances. Our over-arching policy on admissions is that the Facility admits only patients whose medical and nursing care needs can be met. A sample of our admission policies are attached as Attachment B. 2. The Facility will follow GHC's Administrative Policies for discharges. When a patient's discharge is anticipated, a discharge summary and post-discharge plan is developed to assist the patient with discharge. A sample of our discharge policies are attached as Attachment C. D. Disaster and Emergency Preparedness and Response 1. The Facility will follow GHC's Administrative Policies for Disaster and Emergency Preparedness. This includes conducting a thorough hazard vulnerability analysis to help determine what events or incidents may negatively impact the Facility's operations, and then formulate an Emergency Management Plan. A copy of GHC's operational procedures for emergency preparedness are available upon request. 2. The Facility will follow GHC's Administrative Policies for Disaster and Emergency Response, including activation of the Facility's Emergency Management Plan. A copy of GHC's operational procedures for emergency response are available upon request. 6 Hutton Centre Drive,Suite 400,Santa Ana,CA 92707 T:(714) 241-5600 A F:(714) 241-8911 Doc ID: 7968480db75bfOdOf32f59f21b8a9d6ffb27b5a7 r GENERATIONS HEALTHCARE E. Food and Nutrition Services 1. The Facility will follow GHC's Policy and Procedure Manual for: Nutritional Assessments and Care Planning; Nutrition and Hydration Support; Food and Nutrition Services; Staffing; Safety; and Recordkeeping and Documentation. (See Attachment D). Please let us know if you need any further details regarding our proposed operations. Sincerely, 7�6/MaJ A Y�Aila Thomas Jurbala Director of Business Development 6 Hutton Centre Drive,Suite 400,Santa Ana,CA 92707 T:(714) 241-5600 A F:(714) 241-8911 Doc ID: 7968480db75bfOdOf32f59f21b8a9d6ffb27b5a7 Attachment A PUBLIC HEARING NO. 2 10-15-84 AGENDA/- -,s- •h a+� ,� DATE: October 15, 1984 - � Inter . Com TO: HONORABLE MAYOR AND CITY COUNCIL MEMBERS FROM: COMMUNITY DEVELOPMENT_ DEPART14ENT SUBJECT: GPA 84-4b BACKGROUND: Section 65302 of the California Government Code states that a city' s General Plan and zoning must be consistant. Recently, a property owner requested that the current zoning designation on his property be changed to reflect the existing land use designation. As a part of this request, the Council directed staff to review the city's land use map and identify any inconsistencies. Staff has reviewed the land use and zoning maps and presented a report to Council outlined each inconsistency. Council accepted this report and directed staff to advertise a public hearing before the Planning Commission. The Planning Commission considered these amendments in a public hearing on September 24, 1984. Staff recommended that the Planning Commission approve a resolution recommending that these amendments be adopted by the -City Council , and the Planning Commission accepted this recommendation. The resolution of approval has been enclosed for your review. In addition, the staff report from the September 24th meeting has also been included. DISCUSSION• The only purpose for these proposed land use element changes is to bring the land use and zoning maps into conformance. They will result in no change from the existing use or zoning with the exception of 165 N. Myrtle and 14851 Yorba. In that case, both the zoning and land use must be changed to bring this property into conformance with the existing use of the land. RECOMMENDED ACTION: Staff recommends that the City Council accept the recommendation of the Planning Commission and adopt GPA 84-4b by the approval of Resolution No. 84-80. EDWARD M. NIGHT Associate Planner EMK/cas . .... 1 RESOLUTION NO. 84-80 2 3 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TUSTIN, CALIFORNIA. AMENDING THE LAND USE 4 ELEMENT OF THE GENERAL PLAN FOR CERTAIN PROPERTIES AS SHOWN IN EXHIBITS A THROUGH F. 5 6 The City Council of the City of Tustin does hereby resolve as follows: 7 1. The City Council finds and determines as follows: g A. Section 65356.1 of the Government . Code of the State of California provides that when it is deemed to be in the public 9 interest, the legislative body may amend a part of the General Plan. 10 B. That in accordance with Section 65356 of the Government Code of 11 the -State of California, a public hearing was duly called, noticed, and held on the application of the City of Tustin to 12 reclassify the land use on certain properties as indicated herein and shown on Exhibits A through F, enclosed. 13 1. 15601 South "B" Street, from Multiple Family (MF) to Mobile 14 Home (MH). 15 2. 1571, 1631, 1671 Laguna, 13852 Redhill Ave. from Multiple Family (MF) to Commercial (C). 16 3. 165 N. Myrtle, 14851 Yorba, from Professional (PR) to 17 Public & Institutional (P&I). 18 4. 17011-17092 Whitby Circle, from Single Family (SF) to Multiple Family (MF) . 19 5. 13701-13732 Charloma, 1281 San Juan from Public & 20 Institutional (P&I) to Multiple Family (MF). 21 6. 1362-1372 Nisson, 14012 Utt Drive, from Single Family (SF) to Multiple Family (MF). 22 C. That a Negative Declaration has been prepared in accordance witty 23 the requirements of the California Environmental Quality Act and is hereby adopted. 24 D. That a change in classification would be in the public interest 25 and not detrimental to the welfare of the public or the surrounding property owners. 26 27 28 1 Resolution No. 84-80 2 Page two 3 4 E. That the Planning Commission adopted Resolution No. 2180, recommending that the City Council adopt General Plan Amendment 5 84-4b. 6 11. The City Council hereby adopts General Plan Amendment 84-4b amending the Land Use Element for certain properties as shown in Exhibits A 7 through F, enclosed. 8 PASSED AND ADOPTED at a regular meeting of the Tustin City Council held on the day of 1984. 9 10 11 URSULA E. KENNEDY, Mayor 12 13 MARY E. WYNN, 14 City Clerk 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PUBLIC HEARING N0. 5 Repor l - to the Planning Commission DATE: September 24, 1984 SUBJECT: AMENDMENT TO THE LAND USE ELEMENT OF THE TUSTIN AREA GENERAL PLAN GPA 84-4b APPLICANT: CITY OF TUSTIN BACKGROUND: Section 65302 of the California Government Code states that a city' s General Plan and zoning roust be consistent. Recently, a property owner requested that the current zoning designation on his property be changed to reflect the existing land use designation. As a part of this request, the Council directed staff to review the city's land use map and identify any inconsistencies. Staff has reviewed the land use and zoning maps and presented a report to Council outlined each inconsistency. Council accepted this report and directed staff to advertise a public hearing before the Planning Commission to consider these amendments. DISCUSSION: The only purpose for these proposed land use element changes is to bring the land use and zoning maps into conformance. They will result in no change from the existing use or zoning, with the exception of 165 N. Myrtle and 14851 Yorba. In that case, both the zoning and land use must be changed to bring this property into conformance with the existing use of the land. Attached with this staff report is a map and description for each of the proposed land use amendments. RECOMMENDATION: Staff recommends that the Planning Commission adopt Resolution No. 2180 which recommends that the City Council approve GPA 84-4b. W. 4fIGHT, Associate Planner EK:do attachment: Resolution No. 2180 Community Development Department 1 RESOLUTION NO. 2180 2 3 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY 'OF TUSTIN, CALIFORNIA, RECOMMENDING THAT 4 THE CITY COUNCIL AMEND THE LAND USE ELEMENT OF THE GENERAL FOR CERTAIN PROPERTIES AS SHOWN IN 5 EXHIBITS A THROUGH F. 6 The Planning Commission of the City of Tustin does hereby resolve as 7 follows: 8 I. The Planning Commission finds and determines as follows: 9 A. Section 65356.1 of the Government Code of the State of California provides that when it is deemed _to be in the public 10 interest, the legislative body may amend a part of the General Plan. 11 B. That in accordance with Section 65356 of the Government Code of 12 the State of California, a public hearing was duly called, noticed, and held on the application of the City of Tustin to 13 reclassify the land use on certain properties as indicated herein and shown on Exhibits A through F. enclosed. 14 1. 15601 South "B" Street, from Multiple Family (MF) to Mobile 15 Home (MH). 16 2. 1571, 1631, 1671 Laguna, 13852 Redhill Ave. from .Multiple Family (MF) to- Commercial (C). 17 3. 165 N. Myrtle, 14851 Yorba, from Professional (PR) to 18 Public & Institutional (P&I). 19 4. 17011-17092 Whitby Circle, from Single Family (SF) to Multiple Family (MF) . 20 5. 13701-13732 Charloma, 1281 San Juan from Public & 21 Institutional (P&I) to Multiple Family (MF). 22 6. 1362-1372 Nisson, 14012 Utt Drive, from Single Family (SF) to Multiple Family (MF). 23 C. That a Negative Declaration has been prepared in accordance with 24 the, requirements of the California Environmental Quality Act and is hereby recommended for adoption. 25 D. That a change in classification would be in the public interest 26 and not detrimental to the welfare of the public or the surrounding property owners. 27 28 i Resolution No. _180 Page two 1 2 II. The Planning Commission hereby recommends to the City Council that. General Plan Amendment 84-4b be adopted, amending the Land Use 3 Element for certain properties as shown in Exhibits A through F, enclosed. 4 PASSED AND ADOPTED aft a regular , meeting of the Tustin Planning 5 Commission held on the C Vo l day of ,_ �' r �'.-, .% E. _, 1984. 6 7 RONALD H. WHITE, 8 Chairman 9 10 DONNA ORR, Recording Secretary 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AMAGANSET ;I f .1 �N WISTERIA • • �> BE N ROS A F AV V ,i +, z MELEN ES - AV E f v� e► NS "A 1 165 North Myrtle & 14851 Yorba 1 �� � v 3d From Professional .(PR) �� • to Public and Institu- tional (P & I). 9 • 160 i Y Z'r l.s K v 9 oft 4 ±2 �70 7 In ° SECOND MEMO* 220 1� I OT ti a ao 2$0 13S = c jo 240 4270 S1 sic LU 3to Q EXHIBIT "C" c �► J3• lam- 7E NO. 10 E 4 R1 » s � i. W PC R 1 _ r R 1 IL PC O N N L[ lSTL ! KM T seNoo� Pr STMCET Pr Pr J P r Pr Pr Pr W R1 R1 R3 R1 R1 ` R1 C 3 1 1eCG 1; C2 CG : PU PUD �CGPUD .00. - zoow PUD CG ST11([T C 2 PUD R Pup C2P CV PD . ~ � P R1 yR1 eF� » R 1 °" �s gECOMO ST _ _. IR 1 1 _ C27P C1) LOCATION: Northerly Terminus of Myrtle Avenue and Yiorba ZONE: Multiple Family Residential (R-3) GEN. pLAM Professional Office ( PR) SiIMMY ANALYSIS: The subject parcel has a land use designation of Professional Office (PR) and a zoning designation of Multiple Family (R-3) . The use of the property is a convalescent hospital , and is licensed by the State of California. The state is quite precise in its terminology, and in order for the facility to be known as a "hospital" it must meet certain criteria, which it evidently does. The only zoning district that permits hospitals is the Public A Institutional zone, so staff recommends that the land use and zoning be changed to the P & I designation. REC01+KMDED ACTION: LAMD USE CHANGE ZONE CHANGE rom: o: R-3 PAI AUGUST 1984 Attachment B Admissions Policies Policy Statement Written policies and procedures governing admissions to the facility will be maintained on a current basis to ensure fair and impartial admission practices. Policy Interpretation and Implementation 1. The primary purpose of our admission policies is to establish uniform guidelines for personnel to follow in admitting residents to the facility. 2. Our admission policies apply to all residents admitted to the facility without regard to race, color, creed, national origin, age, sex, religion, handicap, ancestry, marital or veteran status, and/or payment source. 3. The objectives of our admission policies are to: a. Provide uniform guidelines in the admission of residents to the facility; b. Admit residents who can be adequately cared for by the facility; c. Reduce the fears and anxieties of the resident and family during the admission process; d. Review with the resident, and/or his/her representative (sponsor), the facility's policies and procedures relating to resident rights, resident care, financial obligations, visiting hours, etc.; and e. Assure that appropriate medical and financial records are provided to the facility prior to or upon the resident's admission. 4. It shall be the responsibility of the Administrator, through the admissions department, to assure that the established admission policies, as they may apply, are followed by the facility and resident. 5. Our admission policies and procedures are reviewed for revisions and updates as necessary, but at least annually. Records of such revisions and/or reviews are maintained in the business office. References OBRA Regulatory Reference Numbers §483.15(b)Equal access to quality care. Survey Tag Numbers F621 Other References Related Documents Version 1.0(H5MAPL0968) C 2001 MED-PASS,Inc.(Revised December 2006) Record of Admissions Policy Statement A Record of Admissions will be maintained for each resident admitted to the facility. Policy Interpretation and Implementation 1. At the time of the resident's admission, a resident identification and summary record is completed. 2. A copy of this record must be placed on the resident's chart, and a copy must be provided to the Medical Records Department. 3. Our identification and summary record includes, but is not limited to: a. The resident's full name and social security number; b. The date and time of this admission; c. The medical record number; d. The resident's date of birth, place of birth, citizenship, and marital status; e. The resident's age, sex, race, height, weight, color of hair and eyes, and identifying marks; f. The current diagnoses and competency level of the resident; g. The type of admission (i.e., Medicare, Medicaid, VA, private, etc.); h. The name, address, and telephone number of the resident's representative (sponsor); i. The name and telephone number of the resident's Attending and Alternate Physician; j. The name and telephone number of the resident's pastor, priest, and/or rabbi, if any; k. The name and telephone number of the mortuary requested by the family; 1. Languages spoken or understood; m. Reports of preadmission evaluations; n. Information relative to advance directives; and o. Others as necessary or appropriate. 4. Social, dietary, and activity summaries are completed by the directors of those departments. References OBRA Regulatory §483.20(f)(5)Resident-identifiable information.; §483.70(i)Medical records. Reference Numbers Survey Tag Numbers F842 Other References Related Documents Version 1.1 (H5MAPL0713) C 2001 MED-PASS,Inc.(Revised December 2006) Admission Criteria Policy Statement Our facility admits only residents whose medical and nursing care needs can be met. Policy Interpretation and Implementation 1. The objectives of our admission criteria policy are to: a. provide uniform criteria for admitting residents to the facility; b. admit residents who can be cared for adequately by the facility; c. address concerns of residents and families during the admission process; d. review with the resident, and/or his/her representative,the facility's policies and procedures relating to resident rights, resident care, financial obligations,visiting hours,etc.; and e. assure that the facility receives appropriate medical and financial records prior to or upon the resident's admission. 2. Residents (and potential residents) are not asked or required to: a. waive their rights to Medicare or Medicaid benefits; b. submit written assurance that they are not eligible for or will not apply for Medicare or Medicaid benefits; c. waive facility liability for losses of personal property; or d. provide a third party guarantee of payment as a condition of admission, expected admission or continued stay. 3. Resident representatives may be requested to or required to sign a contract or agreement that he or she will provide facility payment from the resident's income or resources as long as the representative: a. has legal access to the resident's income or resources; and b. is not incurring personal financial liability to the facility. 4. Prior to admission, the resident or representative is informed of any service limitations or special characteristics of the facility. 5. Prior to or at the time of admission,the resident's attending physician provides the facility with information needed for the immediate care of the resident, including orders covering at least: a. type of diet(e.g.,regular,mechanical, etc.); b. medication orders, including (as necessary) a medical condition or problem associated with each medication; and c. routine care orders to maintain or improve the resident's function until the physician and care planning team can conduct a comprehensive assessment and develop a more detailed interdisciplinary care plan. 6. Residents are admitted to this facility as long as their needs can be met adequately by the facility.Examples of conditions that can be treated adequately in this facility include: a. diabetes; b. COPD; c. neuromuscular disorders; d. dementia; continues on next page C 2001 MED-PASS,Inc.(Revised March 2019) e. ; f. ; and 9. 7. Examples of nursing/medical needs that can be met adequately include: a. medication management; b. limited mobility; c. post-operative care needs; d. incontinence; e. catheterization (urinary or intravenous); f. enteral nutrition; 9. h. ; and i. 8. The acceptance of residents with certain conditions or needs may require authorization or approval by the medical director, director of nursing services, and/or the administrator. 9. All new admissions and readmissions are screened for mental disorders (MD),intellectual disabilities (ID) or related disorders (RD) per the Medicaid Pre-Admission Screening and Resident Review (PASARR) process. a. The discharging hospital will complete a Level I PASARR screen for all potential admissions, regardless of payer source,to determine if the individual meets the criteria for a MD,ID or RD. b. If the level I screen indicates that the individual may meet the criteria for a MD, ID, or RD, he or she is referred to the state PASARR representative for the Level 11(evaluation and determination)screening process. (1) The nurse notifies the social services department when a resident is identified as having a possible (or evident) MD, ID or RD. (2) The social worker is responsible for making referrals to the appropriate state-designated authority. c. Upon completion of the Level 11 evaluation, the state PASARR representative determines if the individual has a physical or mental condition, what specialized or rehabilitative services he or she needs, and whether placement in the facility is appropriate. d. The state PASARR representative provides a copy of the report to the facility. e. The interdisciplinary team determines whether the facility is capable of meeting the needs and services of the potential resident that are outlined in the evaluation. f. Once a decision is made, the state PASARR representative, the potential resident and his or her representative are notified. 10. The preadmission screening program requirements do not apply to residents who, after being admitted to the facility,were transferred to a hospital. 11. The state may choose not to apply the preadmission screening requirement if a. the individual is admitted directly to the facility from a hospital where he or she received acute inpatient care; b. the individual requires facility services for the condition for which he or she received care in the hospital; and c. the attending physician has certified (prior to admission)that the individual will likely need less than 30 days of care at the facility. continues on next page C 2001 MED-PASS,Inc.(Revised March 2019) 12. Our admission policies apply to all residents admitted to the facility regardless of race,color,creed,national origin, age, sex,religion,handicap, ancestry,marital or veteran status, and/or payment source. 13. The administrator, through the admissions department, ensures that the resident and the facility follow applicable admission policies. References OBRA Regulatory §483.15(a)Admissions policy; §483.20(e)Coordination; §483.20(k) Reference Numbers Survey Tag Numbers F620;F644;F645 Other References http://www.pasrrassist.org/resources/personnel/Pasrr-state-lead-contactinfonnation Related Documents Acute Condition Change—Clinical Protocol Care Plans,Comprehensive Person-Centered Version 2.1 (H5MAPL0047) C 2001 MED-PASS,Inc.(Revised March 2019) Admission Agreement Policy Statement All residents have a signed and dated Admission Agreement on file. Policy Interpretation and Implementation 1. At the time of admission, the resident (or his/her representative) must sign an Admission Agreement (contract). 2. The Admission Agreement (contract) will reflect all charges for covered and non-covered items, as well as identify the parties that are responsible for the payment of such services. 3. With respect to our Admission Agreement, our facility will not ask or require residents/potential residents to: �i. waive their rights to Medicare or Medicaid benefits; l . submit written assurance that they are not eligible for or will not apply for Medicare or Medicaid benefits; waive facility liability for losses of personal property; or d- provide a third party guarantee of payment as a condition of admission, expedited admission or continued stay. 4. A copy of the Admission Agreement is provided to the resident or his/her representative (sponsor), and a copy placed in the resident's permanent file. 5. Inquiries concerning the facility's Admission Agreement should be referred to the Administrator and/or business office. References OBRA Regulatory §483.15(a)Admissions policy. Reference Numbers Survey Tag Numbers F620 Other References Related Documents Model Nursing Facility Admission Agreement Version 1.2(H5MAPL0032) ©2001 MED-PASS,Inc.(Revised August 2018) Admission Notes Policy Statement Preliminary resident information shall be documented upon a resident's admission to the facility. Policy Interpretation and Implementation 1. When a resident is admitted to the nursing unit, the admitting Nurse must document the following information (as each may apply) in the nurses' notes, admission form, or other appropriate place, as designated by facility protocol: a. The date and time of the resident's admission; b. The resident's age, sex, race, and marital status; c. From where the resident was admitted (i.e., hospital, home, other facility); d. Reason for the admission; e. The admitting diagnosis; f. The general condition of the resident upon admission; g. The time the Attending Physician was notified of the resident's admission; h. The time the physician's orders were received and verified; i. Description of any lab work completed or the time specimens were sent to the lab; j. The presence of a catheter, dressings, etc.; k. The time the Dietary Department was notified of the diet order; 1. The time medications were ordered from the pharmacy; In. A brief description of any disabilities (i.e., blind, deaf, hemiplegia, speech impairment, paralysis, mobility, etc.); n. Any known allergies; o. Prosthesis required (i.e., glasses, dentures, hearing aid, artificial limbs, eye, etc.); p. The height and weight of the resident; q. A statement indicating that the nursing history and preliminary assessment is completed or has been started; r. Notation of any signs or symptoms of an infectious or communicable disease; s. Notation as to whether or not advance directives apply; and t. The signature and title of the person recording the data. 2. This initial information-gathering precedes the complete history and physical assessment that also accompanies the resident admission process. C 2001 MED-PASS,Inc.(Revised September 2012) continues on next page 3. The nurses' original admission note must remain on the resident's chart maintained at the nurses' station. 4. Should a resident be discharged from and readmitted to the facility, new admission data must be recorded. References OBRA Regulatory §483.70(i)(5)The medical record must contain- Reference Numbers Survey Tag Numbers F842 Other References Related Documents Admission Evaluation and Interim Care Plan(CP1204) Version 1.1 (1-15MAPL0034) C 2001 MED-PASS,Inc.(Revised September 2012) Attachment C Discharge Summary and Plan Policy Statement When a resident's discharge is anticipated, a discharge summary and post-discharge plan is developed to assist the resident with discharge. Policy Interpretation and Implementation 1. The discharge summary includes a recapitulation of the resident's stay at the facility and a final summary of the resident's status at the time of the discharge in accordance with established regulations governing release of resident information and as permitted by the resident. The discharge summary shall include a description of the resident's: a. current diagnosis; b. medical history (including any history of mental disorders and intellectual disabilities); c. course of illness,treatment and/or therapy since entering the facility; d. current laboratory, radiology, consultation, and diagnostic test results; e. physical and mental functional status; f. ability to perform activities of daily living including: (1) bathing, dressing and grooming,transferring and ambulating,toilet use, eating, and using speech, language, and other communication systems; (2) the need for staff assistance and assistive devices or equipment to maintain or improve functional abilities; and (3) the ability to form relationships, make decisions including health care decisions, and participate (to the extent physically able) in the day-to-day activities of the facility; g. sensory and physical impairments(neurological,or muscular deficits;for example,a decrease in vision and hearing,paralysis, and bladder incontinence); h. nutritional status and requirements including: (1) weight and height; (2) nutritional intake; and (3) eating habits,preferences and dietary restrictions; i. special treatments or procedures (treatments and procedures that are not part of basic services provided); j. mental and psychosocial status (ability to deal with life, interpersonal relationships and goals, make health care decisions, and indicators of resident behavior and mood); k. discharge potential (the expectation of discharging the resident from the facility within the next three months); 1. dental condition(the condition of the teeth,gums,and other structures of the oral cavity that may affect a resident's nutritional status, communications abilities, quality of life, and the need for and use of dentures or other dental appliances); in. activities potential (the ability and desire to take part in activity pursuits which maintain or improve physical,mental, and psychosocial well-being); n. rehabilitation potential (the ability to improve independence in functional status through restorative care programs); continues on next page C 2001 MED-PASS,Inc.(Revised October 2022) o. cognitive status (the ability to problem solve,decide,remember,and be aware of and respond to safety hazards); and p. medication therapy (all prescription and over-the-counter medications taken by the resident including dosage, frequency of administration, and recognition of significant side effects that would be most likely to occur in the resident). 2. As part of the discharge summary, the nurse reconciles all pre-discharge medication with the resident's post-discharge medications. The medication reconciliation is documented. 3. Every resident is evaluated for his or her discharge needs and has an individualized post-discharge plan. 4. The post-discharge plan is developed by the care planning/interdisciplinary team with the assistance of the resident and his or her family and includes: a. where the individual plans to reside; b. arrangements that have been made for follow-up care and services; c. a description of the resident's stated discharge goals; d. the degree of caregiver/support person availability, capacity and capability to perform required care; e. how the IDT will support the resident or representative in the transition to post-discharge care; f. what factors may make the resident vulnerable to preventable readmission; and g. how those factors will be addressed. 5. The discharge plan is re-evaluated based on changes in the resident's condition or needs prior to discharge. 6. The resident/representative is involved in the post-discharge planning process and informed of the final post-discharge plan. 7. Residents are asked about their interest in returning to the community. If the resident indicates an interest in returning to the community, he or she will be referred to local agencies and support services that can assist in accommodating the resident's post-discharge preferences. 8. If it is determined that returning to the community is not feasible,it will be documented why this is the case and who made the determination. 9. Residents transferring to another skilled nursing facility or who are discharged to a home health agency, long-term care hospital or inpatient rehabilitation facility are assisted in selecting a post-acute care provider that is relevant and applicable to the resident's goals of care and treatment preferences.Data used in helping the resident select an appropriate facility include the receiving facility's: a. standardized patient assessment data; b. quality measure data; and c. data on resource use. 10. The resident or representative (sponsor) is asked to provide the facility with a minimum of a seventy-two (72)hour notice of a discharge to assure that an adequate discharge evaluation and post-discharge plan can be developed. 11. A member of the IDT reviews the final post-discharge plan with the resident and family at least twenty- four(24)hours before the discharge is to take place. continues on next page C 2001 MED-PASS,Inc.(Revised October 2022) 12. A copy of the following is provided to the resident and receiving facility and a copy will be filed in the resident's medical records: a. An evaluation of the resident's discharge needs; b. The post-discharge plan; and c. The discharge summary. References OBRA Regulatory §483.21(c)(1)Discharge Planning Process; §483.21(c)(2)Discharge Summary Reference Numbers Survey Tag Numbers F660;F661 Other References Related Documents Discharge Evaluation and Plan(MP5423) Version 2.1 (H5MAPL0208) C 2001 MED-PASS,Inc.(Revised October 2022) Attachment D Food and Nutrition Services Policy Statement Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs,taking into consideration the preferences of each resident. Policy Interpretation and Implementation 1. The multidisciplinary staff, including nursing staff, the attending physician and the dietitian will assess each resident's nutritional needs, food likes, dislikes and eating habits, as well as physical, functional, and psychosocial factors that affect eating and nutritional intake and utilization. 2. A resident-centered diet and nutrition plan will be based on this assessment. 3. Meals and/or nutritional supplements will be provided within 45 minutes of either resident request or scheduled meal time, and in accordance with the resident's medication requirements. 4. Reasonable efforts will be made to accommodate resident choices and preferences. 5. The food and nutrition staff will be available and adequately staffed to assist residents with eating as needed. Nurse aides and feeding assistants will provide support to enhance the resident experience, but not as a critical component to the functioning of the department. 6. Nursing staff will ensure that assistive devices are available to residents as needed. 7. Food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident,the food appears palatable and attractive, and it is served at a safe and appetizing temperature. a. If an incorrect meal is provided to a resident, or a meal does not appear palatable, nursing staff will report it to the Food Service Manager so that a new food tray can be issued. b. Foods that are left without a source of heat(for hot foods) or refrigeration(for cold foods)longer than 2 hours will be discarded. 8. Nursing personnel, with the assistance of the food and nutrition services staff, will evaluate (and document as indicated) food and fluid intake of residents with, or at risk for, significant nutritional problems. a. Variations from usual eating or intake patterns will be recorded in the resident's medical record and brought to the attention of the nurse. b. A nurse will evaluate the significance of such information and report it, as indicated, to the attending physician and dietitian. 9. Meals are scheduled at regular times to assure that each resident receives at least three (3) meals per day. Meal times are posted in facility common areas. 10. Nourishing snacks are available to the residents 24 hours a day. The resident may request snacks as desired, or snacks may be scheduled between meals to accommodate the resident's typical eating patterns. continues on next page C 2001 MED-PASS,Inc.(Revised October 2017) References §483.20(b) Comprehensive Assessments; §483.21(b) Comprehensive Care OBRA Regulatory Plans; §483.60 Food and nutrition services.; §483.60(c) Menus and nutritional Reference Numbers adequacy.; §483.60(d) Food and drink; §483.60(f)Frequency of Meals; §483.60(h)Paid feeding assistants- Survey Tag Numbers F636; F656; F800; F803; F804; F806; F807; F809; F811 Other References Food and Nutrition Services Staff Related Documents Nutritional Assessment Version 2.3 (H5MAPL0764) C 2001 MED-PASS,Inc.(Revised October 2017) 000 00 NUTRITION SERVICES y "f Policy and Procedure Manual r�. MED•PASS® The Fine Art of Document Design MEQJAA W 11 MEDePASS MW RESQURCE 800-438-8884 (phone) 800-230-8687 (fax) www.med-pass.com ©2001 MED-PASS,Inc.Copyright claimed in all chapters,exclusive of the text of U.S.Government statutes and implementing regulations. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is intended for use by qualified health care practitioners and other qualified professionals in regard to the subject matter covered. It is sold as a guideline in meeting compliance with OBRA, OSHA, CDC, FDA, and JCAHO regulations governing long-term care facilities and with the understanding that the authors and the publisher are not engaged in rendering medical,legal,accounting,or other professional service.This manual does not instruct--and is not intended to instruct--a user about how to treat any medical condition.The information in this manual is not intended and should not be construed as a substitute for a physician's medical advice or a medical director's input about caring for patients and meeting legal and regulatory requirements. If medical or legal advice or other expert assistance is required,the services of a competent professional person should be sought. The authors,editors, and the publisher expressly disclaim responsibility for any adverse effects or consequences resulting from the use of any of the practices or procedures presented or discussed in this manual.They shall not be liable for any damages whatsoever resulting from the use of this manual. The authors have made every effort to ensure the accuracy of the information herein.However,appropriate information sources should be consulted, especially for new or unfamiliar policies or procedures. It is the responsibility of every user of this manual to evaluate the appropriateness of a particular opinion in the context of actual clinical situations and with due considerations to new developments.Authors, editors, and the publisher cannot be held responsible for any typographical or other errors found in this book. From a Declaration of Principles jointly adopted by a Committee of the American Bar Association and a Committee of Publishers and Associations. All rights reserved. No parts of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying,recording,or any information storage and retrieval system,without permission in writing from the publisher. MED-PASS and Heaton Resources and the MED-PASS and Heaton Resources logos contained herein are either registered trademarks or trademarks of MED-PASS,Inc.Other product and company names mentioned herein may be the trademarks of their respective owners. Published by MED PASS,Inc. Printed in the United States of America Revised February 2018 Contributing Editor: Stacy Lundin Yale, RN, BSN Assistant Editor: Laura Lewis Product number H50025 Food and Nutrition Services Policy and Procedure Manual Nutritional Assessments and Care Planning Table of Contents Policies Advance Directives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I Care Area Assessments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Care Planning—Interdisciplinary Team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Care Plans, Comprehensive Person-Centered. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Care Plans—Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Change in a Resident's Condition or Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I Goals and Objectives, Care Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Nutritional Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Problem Identification List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Resident Participation—Assessment/Care Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Weight Assessment and Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Procedures Weighing and Measuring the Resident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Food and Nutrition Services Policy and Procedure Manual C 2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Nutrition and Hydration Support Table of Contents Clinical Protocols Bowel(Lower Gastrointestinal Tract)Disorders—Clinical Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I Diabetes—Clinical Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Dysphagia—Clinical Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Hydration—Clinical Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I Nutrition(Impaired)/IJnplanned Weight Loss—Clinical Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Policies Assistance with Meals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 CalorieCounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Enteral Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Food Allergies and Intolerances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Foods Brought by Family/Visitors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Resident Food Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Resident Hydration and Prevention of Dehydration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 TherapeuticDiets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Procedures Changing a Feeding Tube. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Checking Gastric Residual Volume(GRV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Confirming Placement of Feeding Tubes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Encouraging and Restricting Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Enteral Feeding Syringes, Sanitization of Reusable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Enteral Feedings—Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Enteral Tube Feeding via Continuous Pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Enteral Tube Feeding via Gravity Bag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Enteral Tube Feeding via Syringe(Bolus) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Gastrostomy/Jejunostomy Site Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Intake,Measuring and Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Intravenous Administration of Fluids and Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Maintaining Patency of a Feeding Tube(Flushing). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Nasogastric Tube Insertion and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 Food and Nutrition Services Policy and Procedure Manual C2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Nutrition and Hydration Support Table of Contents Nasogastric Tube Removal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Nutrition and Hydration to Maintain Skin Integrity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 Output,Measuring and Recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Parenteral Lipid Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Parenteral Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Parenteral Nutrition-Placement of Additives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Parenteral Nutrition(PN)—Continuous vs. Cycled. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Serving Drinking Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 Snacks(Between Meal and Bedtime), Serving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Food and Nutrition Services Policy and Procedure Manual ii C2001 MED-PASS,Inc.(February 2018) Food and Nutrition Services Policy and Procedure Manual Food and Nutrition Services Table of Contents Policies Department Hours,Food and Nutrition Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I DiningRoom Audits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Dishwashing Machine Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Disposable Dishes and Utensils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Food Preparation and Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Food Receiving and Storage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Food-Related Garbage and Refuse Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Food and Nutrition Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Frequencyof Meals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Ice Machines and Ice Storage Chests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Interdepartmental Notification of Diet(Including Changes and Reports) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Kitchen Weights and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Nutrient Retention of Foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Quality Assurance and Performance Improvement(QAPI) Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Refrigerators and Freezers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Resident-Maintained Gardens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Residents on Leave or Pass. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Sanitization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 StandardizedRecipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Substitutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Tray Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Procedures Assisting the Impaired Resident with In-Room Meals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Assisting the Resident with In-Room Meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Preparing the Resident fora Meal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Food and Nutrition Services Policy and Procedure Manual C 2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Staffing Table of Contents Policies Assignment of Additional Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I Changes in Job Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Delegation of Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Dietitian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Employee Review of Job Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 EssentialFunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Exposure Determinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Food and Nutrition Services Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I Job Descriptions and Performance Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Job Descriptions—Written. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 JobSafety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Non-Disclosure of Resident or Facility Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Non-Discrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Paid Feeding Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Performance Evaluation Ratings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Performance Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Signing Performance Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Food and Nutrition Services Policy and Procedure Manual C 2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Staffing - Appendix A Table of Contents Tools Performance Evaluation Record. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1 Performance Evaluator's Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2 Model Business Associate Agreement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4 Job Descriptions (see flash drive) Consultant Dietitian Cook Dietary Aide Dietitian Director of Food and Nutrition Services Head Cook Food and Nutrition Services Policy and Procedure Manual C2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Safety Table of Contents Policies Accidents and Incidents—Investigating and Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Employee Information and Training—Hazard Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Employees of Other Employers,Hazard Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Fire Safety Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Hazard Communication Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Hazard Communication Program Coordinator—Duties and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I Hazard Communication Program,Posting of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 HazardLabeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Hazardous Chemical Inventory Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Location of Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 OSHA Forms 300, 300A,and 301 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Performing Hazardous Non-Routine Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Poisonous and Toxic Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Preventing Foodborne Illness—Employee Hygiene and Sanitary Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Preventing Foodborne Illness—Food Handling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Purchasing Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Quality Assurance,Hazard Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Receiving New Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Safety Data Sheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Safetyof Employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Safety Precautions,Electrical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Safety Precautions,Food Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Safety Precautions, General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Safety Precautions,Hand Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Safety Precautions,Hand Trucks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Safety Precautions,Lifting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Safety Precautions,Lockout/Tagout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Safety Precautions, Stepladders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Food and Nutrition Services Policy and Procedure Manual C2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Supplemental Materials Table of Contents Tools 2013 Food Code Annex 4-Management of Food Safety Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2013 Food Code Annex 4-Summary Chart for Minimum Cooking Food Temperatures and Holding Times. . . . . .41 Food Establishment Inspection Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Sources of Food Contamination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 U.S.Measurement Equivalents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Conversion Chart-Can Size Equivalents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Guidelines Food Pyramid Mini Poster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Critical Element Pathways (See flash drive) CMS-20053 Dining CMS-20055 Kitchen CMS-20075 Nutrition CMS-20092 Hydration CMS-20093 Tube Feeding CMS-20131 Resident Assessment Food and Nutrition Services Policy and Procedure Manual C2001 MED-PASS,Inc.(Revised February 2018) i Food and Nutrition Services Policy and Procedure Manual Recordkeeping and Documentation Table of Contents Documentation Change of Diet(MP5016). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Data Collection/Evaluation Nutritional(CP1708) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Diet Order&Communication(MP5015). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Dietary Enteral Review(CP1713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Dietary Intake Record(CP1719) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Enteral Flow Record(MP921 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Food and Beverage Preference List(CP1711) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II Nutritional Evaluation of Tube Fed Resident(CP1714). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Nutritional Review(CP1718). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Hydration Risk Evaluation(MP5474) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Vital Signs and Weight Record(MP5439). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Recordkeeping Food Service Safety Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Hazardous Chemical Inventory Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Hazardous Chemical Inventory Listing Letter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 OSHA Forms for Recording Work-Related Injuries and Illnesses(forms 300,300A,301) . . . . . . . . . . . . . . . . . . . .25 Food and Nutrition Services Policy and Procedure Manual C2001 MED-PASS,Inc.(Revised February 2018) i ATTACHMENT E RESOLUTION NO. 4519 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF TUSTIN, CALIFORNIA, APPROVING CUP 2024-0018, FOR THE ESTABLISHMENT AND OPERATION OF A SKILLED NURSING FACILITY LICENSED THROUGH THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, PURSUANT TO CALIFORNIA CODE OF REGULATIONS, TITLE 22, DIVISION 5 AT 14851 YORBA STREET AND 165 NORTH MYRTLE AVENUE (APN: 402-302-14) The Planning Commission does hereby resolve as follows: I. The Planning Commission finds and determines as follows: A. That a proper application for Conditional Use Permit (CUP) 2024- 0018 was filed by Robert Mooney, on behalf of Life Generations Healthcare, LLC requesting authorization to establish a skilled nursing facility (specialty hospital) at 14851 Yorba Street and 165 North Myrtle Avenue. B. That the subject property is located within the Public and Institutional (P&I) district, Professional (Pr) district, and Specific Plan No. 9 (SP9- Yorba Specific Plan) and the property has a Public/Institutional General Plan land use designation. For purposes of this project, the P&I zoning district standards apply because the existing buildings are located in the P&I zone. C. That pursuant to Tustin City Code (TCC) 9245b, Hospitals are conditionally permitted uses in the P&I zoning district. D. That the project site was formally constructed for, and occupied by, a skilled nursing facility and a rehabilitation hospital, and both uses were considered hospitals when approved. E. That pursuant to California Code of Regulations, Title 22, Division 5, skilled nursing facilities are hospital-like in that they provide 24-hour care to patients whose primary need is for availability of skilled nursing care on an extended basis. F. That pursuant to TCC Section 9291 grants the Planning Commission the authority to consider and act on requests for a CUP. G. That a public hearing was duly called, noticed, and held for CUP 2024-0018 on January 28, 2025, by the Planning Commission. H. That the project has been reviewed for consistency with the Air Quality Sub-element of the City of Tustin General Plan and has been determined to be consistent with the Air Quality Sub-element. PC Reso. No. 4519 CUP 2024-0018 I. That in determining whether to approve the CUP, the Planning Commission finds that the establishment, maintenance, and operation of the proposed uses will not, under the circumstances of this case, be detrimental to the health, safety, morals, comfort, or general welfare of the persons residing or working in the neighborhood of such proposed use, nor be injurious or detrimental to the property and improvements in the neighborhood of the subject property, or to the general welfare of the City of Tustin, in that: 1. That conditionally permitted uses in the P & I zoning district include hospitals. Pursuant to California Code of Regulations, Title 22, Division 5, skilled nursing facilities are under a list of classes that include hospitals, and skilled nursing facilities support hospitals, including Special Treatment Programs, in that they provide 24-hour care to patients whose primary need is for availability of skilled nursing care on an extended basis. The project site was previously designed and approved for a skilled nursing facility and rehabilitation hospital and the applicant would be re-activating the site with similar operational characteristics as the previous uses. 2. That the proposed skilled nursing facility (Specialty Hospital) is located within the P & I zoning district. As conditioned, the proposed Hospital (skilled nursing facility) characteristics and hours of operation, would align with those of existing uses in the area, ensuring compatibility with the surrounding businesses. 3. That the project site has frontage along Yorba Street and primary vehicle access from Myrtle Avenue. On-site parking is available and sufficient for skilled nursing facility (Specialty Hospital) uses. 4. That the project site currently provides a total of 165 parking spaces, which includes six surface parking spaces and 159 subterranean spaces. With a maximum patient capacity of 121 beds, medical and administrative staff, the facility requires a total of 85 parking spaces (90 if Special Treatment Program is established). As currently provided onsite, the site exceeds the required parking for Hospital (skilled nursing facilities). J. The Tustin Police Department has reviewed the application and has no concerns as conditioned. K. That this project is Categorically Exempt pursuant to Section 15301 (Class 1 — Existing Facilities) of the California Code of Regulations (Guidelines for the California Environmental Quality Act). PC Reso. No. 4519 CUP 2024-0018 II. The Planning Commission hereby approves CUP 2024-0018 authorizing the establishment of a specialty hospital use required to be licensed as a Skilled Nursing Facility through the California Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5 within the existing buildings located at 14851 Yorba Street and 165 North Myrtle Avenue, subject to the conditions contained within Exhibit A attached hereto. PASSED AND ADOPTED by the Planning Commission of the City of Tustin at a regular meeting on the 11th day of February, 2025. ERIC HIGUCHI Chairperson JUSTINA L. WILLKOM Planning Commission Secretary APPROVED AS TO FORM: MICHAEL DAUDT Assistant City Attorney PC Reso. No. 4519 CUP 2024-0018 STATE OF CALIFORNIA ) COUNTY OF ORANGE ) CITY OF TUSTIN ) I, Justina L. Willkom, the undersigned, hereby certify that I am the Planning Commission Secretary of the City of Tustin, California; that Resolution No. 4519 was duly passed and adopted at a regular meeting of the Tustin Planning Commission, held on the 11t" day of February 2025. PLANNING COMMISSIONER AYES: PLANNING COMMISSIONER NOES: PLANNING COMMISSIONER ABSTAINED: PLANNING COMMISSIONER ABSENT: JUSTINA L. WILLKOM Planning Commission Secretary EXHIBIT A CONDITIONS OF APPROVAL CONDITIONAL USE PERMIT 2024-0018 14851 YORBA STREET AND 165 N. MYRTLE AVENUE GENERAL (1) 1.1 The proposed project shall substantially conform with the submitted plans for the project date stamped February 11 , 2025, on file with the Community Development Department, as herein modified, or as modified by the Community Development Director in accordance with this Exhibit. The Community Development Director may also approve of subsequent minor modifications to plans during plan check if such modifications are consistent with provisions of the Tustin City Code (TCC). (1) 1.2 This approval shall become null and void unless the use is established within twelve (12) months of the date of this Exhibit. Time extensions may be granted if a written request is received by the Community Development Department within thirty (30) days prior to expiration. (1) 1.3 Unless otherwise specified, the conditions contained in this Exhibit shall be complied with as specified, subject to review and approval by the Community Development Department. (1) 1.4 Approval of Conditional Use Permit (CUP) 2024-0018 is contingent upon the applicant and property owner signing and returning to the Community Development Department a notarized "Agreement to Conditions Imposed" form and the property owner signing and recording with the County Clerk- Recorder a notarized "Notice of Discretionary Permit Approval and Conditions of Approval" form. The forms shall be established by the Community Development Director, and evidence of recordation shall be provided to the Community Development Department. (1) 1.5 Any violation of any of the conditions imposed is subject to issuance of an Administrative Citation pursuant to TCC Section 1162(a). (1) 1.6 The applicant shall be responsible for costs associated with any necessary code enforcement action, including attorney fees, subject to the applicable notice, hearing, and appeal process as established by the City Council by ordinance. (1) 1.7 As a condition of approval of CUP 2024-0018, the applicant shall agree, at is sole costs and expense, to defend, indemnify, and hold harmless the City, its officers, employees, agents, and consultants from any claim, action, or SOURCE CODES (1) STANDARD CONDITION (5) RESPONSIBLE AGENCY REQUIREMENT (2) CEQA MITIGATION (6) LANDSCAPING GUIDELINES (3) UNIFORM BUILDING CODE/S (7) PC/CC POLICY (4) DESIGN REVIEW *** EXCEPTION Conditions of Approval Exhibit A CUP 2024-0018 Page 2 proceeding brought by a third party against the City, its officers, agents, and employees, which seeks to attack, set aside, challenge, void, or annul an approval of the City Council, the Planning Commission, or any other decision-making body, including staff, concerning this project. The City agrees to promptly notify the applicant of any such claim or action filed against the City and to fully cooperate in the defense of any such action. The City may, at its sole cost and expense, elect to participate in defense of any such action under this condition. (1) 1.8 CUP 2024-0018 may be reviewed annually or more often, if deemed necessary by the Community Development Department, to ensure compatibility with the area and compliance with the conditions contained herein. If the use is found to be a nuisance or negative impacts are affecting the surrounding tenants or neighborhood, the Community Development Director may impose additional conditions to eliminate the nuisance or negative impacts or may initiate proceedings to revoke the CUP. Use Restrictions (1) 2.1 The applicant is approved to establish a Skilled Nursing Facility (Specialty Hospital) that would accommodate 121 patients and offer skilled nursing and supportive care, including 24-hour inpatient care (dietary, pharmaceutical services and activity programs). The following services are allowed: ■ Room and board; ■ Nursing care (skilled observation and assessment); ■ Respiratory care; ■ Physical, speech, and occupational therapies; ■ Catheterizations; ■ Wound care; ■ Intravenous (IV) fluids; ■ IV, intramuscular and subcutaneous medications; ■ Pain control; ■ Feedings such as parenteral nutrition; ■ Ventilator care; ■ Medication management (as ordered by the patient's physician); ■ Vaccine administration; and ■ Special Treatment Program. Security policies and procedures for the Special Treatment Program that may be established at the facility shall be reviewed and maybe augmented to ensure efficient coordination with the Tustin Police Department. The security policies and procedures shall be submitted to the Community Development Director and the Chief of Police, and any modifications shall be incorporated into said documents prior to implementation of said Program/Unit. Conditions of Approval Exhibit A CUP 2024-0018 Page 3 (***) 2.2 The facility shall be licensed at all times as a Skilled Nursing Facility through the California Department of Public Health, pursuant to California Code of Regulations, Title 22, Division 5. Any change in use type may require review and approval of a new CUP. Changes in use type and/or license type by California Department of Public Health and pursuant to California Code of Regulations, Title 22, Division 5 is subject to review and approval by the Community Development Director. Establishment and renewals of the California Department of Public Health shall be submitted to the Community Development Director. The applicant shall notify the City when a subsidiary is selected or when there is a change of subsidiary. Notice shall be delivered to the Community Development Director for review. (***) 2.3 Change of license type to a use other than a Skilled Nursing Facility, pursuant to California Code of Regulations, Title 22, Division 5 is not allowed, and this approval does not allow the establishment of short-term housing uses such as Recuperative Care or Post-Hospitalization Housing. Proposals for the establishment of housing-related uses may be subject to a new CUP and legislative actions such as a zone change or a specific plan amendment. (1) 2.4 Pursuant to TCC 9403(h), a Master Sign Plan is required for a single development project of at least thirty thousand (30,000) building square feet or one (1) acre in project size. The applicant shall submit a Master Sign Plan and obtain sign permits prior to signs installation. {***} 2.5 A minimum of 85 parking spaces shall be maintained at all times (90 if Special Treatment Program is established). Any reduction of on-site parking stalls or changes to parking area and/or circulation shall be reviewed and approved by the Community Development Director. (***) 2.6 A designated parking stall shall be provided for intake/discharge purposes within the surface parking lot fronting Yorba Street. The designated parking stall shall be reviewed and approved by the Community Development Director during the Building plan check process. Signage shall be posted identifying the designated parking stall and included in the Master Sign Plan. (***) 2.7 Signage directing visitors to designated visitor parking areas shall be installed on the property and included in the Master Sign Plan. (***) 2.8 If proposed, exterior improvements plans shall be submitted to the Planning division for review and approval prior to permitting through HCAI. New color choices, new exterior treatments, fencing, and any other improvements shall be included in the plan set. Modifications to the exterior of the building may require Design Review (DR). If required, DR may be processed prior to, Conditions of Approval Exhibit A CUP 2024-0018 Page 4 concurrently with, or after State or other agency review; however, DR approval shall be required prior to exterior modifications. (***) 2.9 The Skilled Nursing Facility is allowed to operate 24 hours a day, 365 days a year with three shifts and staffing count per shift as shown below: r Hours of Operation Shift No. of Employees A.M. Hours 7:00 a.m. to 3:00 .m. 35 P.M. Hours 3:00 p.m. to 11:00 .m. 34 Night Hours 11:00 p.m. to 7:00 a.m. 15 w/Securit During Business Hours 8:00 a.m. to 5:00 .m. 19 *Five additional staff members for the AM and PM hours may be added if STP is established (***) 2.10 Emergency room services are not approved at the subject facility. (1) 2.11 All activities shall comply with the City's Noise Ordinance (1) 2.12 No outdoor storage shall be permitted except as approved by the Community Development Director. (***) 2.13 If in the future the City's Community Development Director, Police Chief, and/or Public Works Department determine that a parking, traffic, or noise problem exists on the site or in the vicinity as a result of the facility, the Community Development Director, Police Chief, and/or Public Works Department may require that the applicant prepare a parking demand analysis, traffic or noise analysis and the applicant shall bear all costs. If said study indicates that there is inadequate parking or a traffic or noise problem, the applicant shall be required to provide measures to be reviewed and approved by the Community Development Department, Police Chief, and/or Public Works Department. Said mitigation measures may include, but are not limited to, the following: A. Adjust hours of operations. B. Provide additional parking. C. Reduce the number of patients and/or employees. Building Division (1) 3.1 OSHPD 2 is the agency responsible for reviewing and approval of the applications for skilled nursing facility and intermediate care facility buildings. The office shall also enforce the Division of the State Architect—Access Compliance regulations and the regulations of the Office of the State Fire Marshal for the above-stated facility type. Conditions of Approval Exhibit A CUP 2024-0018 Page 5 A copy of the OSHPD 2 approved plans must be submitted to City of Tustin Community Development Department. Police Department (1) 4.1 Surveillance cameras shall cover the parking lot and other outside areas with 30-day video retention. (1) 4.2 Effective lighting shall be installed in the parking lot to ensure illumination of all areas. (1) 4.3 On-site security shall be employed or contracted and present during business and non-business hours. (1) 4.4 Vehicle gates shall be equipped with emergency systems to allow First Responders to access the facility. (1) 4.5 Posted signs shall be placed at all vehicle entrances/exits stating "No Overnight Parking Violators Will be Towed" in compliance with TCC 5342b(2). (1) 4.6 Posted signs shall be placed at all pedestrian and vehicle entrances stating "No Trespassing" in compliance with TCC 6350c. (1) 4.7 Address numbering shall be large enough to be visible from the street and not obstructed by trees. Public Works Department (1) 5.1 Construction and Demolition (C&D) Waste Recycling and Reduction Plan (WRRP). A. The applicant/contractor is required to submit a WRRP to the Public Works Department. The WRRP must indicate how the applicant will comply with the City's requirement (City Code Section 4351 , et al) to recycle at least sixty-five (65%) percent of the project waste material or the amount required by the California Green Building Standards Code. B. Prior to the issuance of, any building or demolition permit that involves the creation of C&D debris, each applicant for covered projects shall pay to the City an application fee in the amount set forth in a resolution of the City Council sufficient to cover the City's costs of reviewing an application and monitoring compliance with this section and/or the WRRP, or reviewing an application for exemption. Conditions of Approval Exhibit A CUP 2024-0018 Page 6 C. Security deposit. In addition to the application fee, each applicant shall deposit with the City a security deposit as security for performance. The security deposit is remitted at the same time the permit application is filed. The security deposit in the amount of five (5) percent of the project's valuation as determined by the Building Official, rounded to the nearest thousand, or two thousand five hundred dollars ($2,500.00), whichever is greater. In no event shall a deposit exceed twenty-five thousand dollars ($25,000.00). The security deposit may be in the form of cash, cashier's check, personal check, money order, or may be applied to a credit card in accordance with standards set by the Finance Department. Orange County Fire Authority (1) 6.1 The applicant shall secure all applicable permits and inspections as mandated by the Office of Statewide Health Planning and Development (OSHPD). Should the proposed scope of work fall outside OSHPD's jurisdiction, the following requirements shall be submitted to the Orange County Fire Authority (OCFA) for review and approval: ■ Architectural Plans; ■ Hazardous materials compliance and chemical classification; ■ Fire sprinkler system; ■ Fire alarm system. FEES (1,5) 7.1 Within forty-eight (48) hours of approval of the subject project, the applicant shall deliver to the Community Development Department, a cashier's check payable to the COUNTY CLERK in the amount of fifty dollars ($50.00) to enable the City to file the appropriate environmental documentation for the project. If within such forty-eight (48) hour period the applicant has not delivered to the Community Development Department the above-noted check, the statute of limitations for any interested party to challenge the environmental determination under the provisions of the California Environmental Quality Act could be significantly lengthened.