soco stuff

8/18/2019 SOCO Stuff

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Revision No. 20131002-1

County of SonomaAgenda Item

Summary Report

Agenda Item Number: 49(This Section for use by Clerk of the Board Only.)

Clerk of the Board575 Administration DriveSanta Rosa, CA 95403

To: Board of Supervisors

Board Agenda Date: April 15, 2014 Vote Requirement: No Vote Required

Department or Agency Name(s): County Administrator’s Office

Staff Name and Phone Number: Supervisorial District(s):

Jennifer Milligan, 565-3783 First.

Title: Sonoma Development Center WorkshopRecommended Actions:

Receive presentation regarding the history, status and potential future of the Sonoma DevelopmentCenter.

Executive Summary:

The Sonoma Developmental Center has been serving individuals with developmental disabilities since1891. The Center currently serves 453 residents, including 200 with intermediate care facility needs(behavioral needs) and 253 with nursing facility, or medical needs. The Center currently encompassesapproximately 1,000 acres in the Sonoma Valley with a broad range of facilities on site as well as uniqueand critical habitat and environmental features. As the largest employer in Sonoma, the centercurrently employs 1,394 employees including nursing, professional and administrative staff, amongothers.

The future of the Center has become uncertain as the State of California Health and Human ServicesAgency looks at declining populations in State management developmental centers and fiscal challengessurrounding these facilities. In January 2014 the State released a Task Force report and plan fordevelopmental centers throughout the state. However, the report and plan is not specific as to thefuture of the Sonoma Developmental Center.

The County has a strong and broad interest in the future of the Center, including continuing serviceneeds for the residents and a range of land and environmental interests. This includes the HumanServices and Health Services departments, interested in assuring continued access to prevention-focused, integrated health services required by the residents and the community. To this purpose,Health and Human Services have assisted in facilitating community education and outreach and effortsto preserve the health resources provided at the Center. The Agricultural Preservation and Open SpaceDistrict is interested in permanently protecting the Center’s property for open space, scenic resources,


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and recreational purposes and has been participating in community efforts to support the Center withinterest in the potential for a conservation easement over all or a portion of the property in the future.Similarly, the Regional Parks Department is interested in preserving and expanding public access,regional recreational connections, and supporting natural resource stewardship on the property.Regional Parks has been participating in community efforts with the interest of potentially owningand/or managing portions of the property in the future for public access and resource management. TheSonoma County Water Agency also has a similar interest in the resource management andenvironmental protection of the land, with enhanced wastewater treatment and water supply andcapacity interests existing in the property.

Given the broad range of priority interests from the County, staff have been engaged with variousefforts including community efforts in the form of a Coalition of partners interested in preserving theresources at the center. The Coalition consists of many community members, resident and familyrepresentatives, the County departments noted above, the Sonoma Ecology Center, Sonoma Land Trust,the Economic Development Department, Jack London State Park, and other partners.

Staff have also been actively advocating with the State and pursuing legislative options to maintain theCenter and the County’s and community’s interest in the Center. Staff will provide an update on thestatus current advocacy efforts during the presentation, including SB 1428 (Evans) which was approvedin committee on April 8, 2014 (fact sheet attached).

Given the direct impact any decision or change in the direction of the operations of the Center wouldhave on the County, the Board of Supervisors has included the future of the Sonoma DevelopmentalCenter as one of their work priorities for 2014. As such, staff has prepared a workshop for the Board toprovide more detailed information on the Center. Information provided will include:

• History for the Center, which was opened in 1891• Current Status of the Center including services provided; current facilities/land uses; number of

residents (currently 453 total); and number of employees (currently 1,394, Sonoma’s largestemployer)

• Current status of State efforts, including presentation by Amy Wall, California Department ofDevelopmental Services Assistant Director on the State Task Force Report and ongoing efforts

• Summary of Potential Closing Processes and State options for the Center and property• Impacts of Closure• County interests and potential reuse options• Advocacy and legislative update• And next steps and ongoing staff efforts.

Brief presentations by community advocates and Coalition members will also be included.

Prior Board Actions:

None.

Strategic Plan Alignment Goal 1: Safe, Healthy, and Caring Community

The Sonoma Developmental Center provides unique and necessary services to many clients with various


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developmental disabilities as well as functions as an economic driver as the largest employer in theSonoma Valley. The future of the Center is key to the health and safety of the resident community aswell as the community as a whole.

Fiscal Summary - FY 13-14

Expenditures Funding Source(s)

Budgeted Amount $ County General Fund $

Add Appropriations Reqd. $ State/Federal $

$ Fees/Other $

$ Use of Fund Balance $

$ Contingencies $

$ $

Total Expenditure $ 0 Total Sources $ 0

Narrative Explanation of Fiscal Impacts (If Required):

This Workshop is informational only. Staff will present estimates of costs required to continue staffefforts on this topic during the presentation.

Staffing Impacts

Position Title(Payroll Classification)

Monthly SalaryRange

(A – I Step)

Additions(Number)

Deletions(Number)

Narrative Explanation of Staffing Impacts (If Required):

Attachments:

Attachment A-SDC Coalition Flyer. Attachment B-SB 1428 fact sheet. Attachment C-Land/facility map.State Task Force Report. Attachment D – State Land Use Summary; Attachment E – DC SpecialtyServices; Attachment F – Task Force Report.

Related Items “On File” with the Clerk of the Board:

None.


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Senator Noreen Evans SB 1428 Fact Sheet Updated: 2/28/2014

SB 1428 Evans)Sonoma Developmental Center Land Use

THE GOAL

This bill seeks to establish a framework of protections forthe community surrounding Sonoma DevelopmentalCenter (SDC) by requiring the Department of GeneralServices (DGS) to confer and cooperate with a list of localand state entities before making any decisionsconcerning the land use of SDC.

BACKGROUND

SDC is one of four Developmental Centers (DCs) operatedby the California Department of Developmental Services

and is the oldest facility in the state establishedspecifically to serve the needs individuals withdevelopmental disabilities. At its peak in 1967, DCs acrossthe state were home to 13,000 people. Since then,California has moved away from institutionalization as amethod of care for developmental disabilities, andinstead pursed community based services. This transitionis due in large part to the Lanterman DevelopmentalDisabilities Service Act of 1969 which ensures individualswith developmental disabilities the right to services andsupport that enables them to lead an independent andnormal life. Today, SDC is home to about 460 residents.

The land at SDC is of significant importance to thesurrounding community. Composed of almost 1,000acres, the SDC property is situated at the heart of theSonoma Valley Wildlife Corridor, a crucial passage forwildlife that extends over five miles from SonomaMountains to the Mayacamas Mountains, and provides atherapeutic quality to the residents and community.

In light of recent certification issues at SDC and other DCclosures, the Secretary of Health and Human Services

convened a task force on the Future of DevelopmentalCenters in 2013. The Taskforce has since put forth a set ofrecommendations that call for a transitional downsizingof DCs across the state. To be clear, the taskforce’srecommendations do not call for DC closures, but insteadadvocate for a shift to smaller safety-net crisis andresidential services model of care with an emphasis inspecialized health care resource center and public/

private partnerships. No official plan has been set forthe future of SDC or any of the remaining DCs, but theissue of land use remains a concern to the SonomaCommunity.

THIS BILL

Requires that before DGS make any decisions onwhat to do with land of Sonoma DevelopmentalCenter, they confer and cooperate with a list of localand state entities including but not limited theresidents and families of SDC, Sonoma County local

government, and state and local environmentalgroups. In addition, this bill authorizes a potentialplan to include the development of residential carefacilities, public recreational facilities, and anexpansion of a wildlife habitat corridor and of watersupply facilities.

PREVIOUS LEGISLATION

AB 955 (Wiggins, 2004) Vetoed —would haverequired surplus property of SDC to betransferred to the Department of Parks andRecreation and added to Jack London StatePark.

SB 1392 (Pavley/ Rubio, 2012) Held in Asm.Appropriations —would have authorized thelease of surplus DC property and would havecreated the Californians with DevelopmentalDisabilities Fund for deposit of the generatedrevenue.

SUPPORT

None receivedOPPOSITION

None received.

FOR MORE INFORMATION

Sofia Andrade, [email protected] of Senator Noreen EvansTel: (916) 651-4002 Fax: (916) 323-6958


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Developmental Center Land Use Summary

Sonoma Developmental Center

Sonoma has previously disposed of 740.83 of its original 1669.93 acres by transferringland for state and county parks and conservation easements. The remaining acreage,which consists of 863.21 acres, is considered fully utilized. The property s westernboundary begins at the upper ridge line of Sonoma Mountain and the parcel continueseastward down the mountain and across the valley to Highway 12. There is a

. considerable amount of elevation change between the upper mountain portion of thecampus and the valley below. The upper mountain portion, approximately 600 acres, iscomprised of two parcels and was transferred to the Department of Parks andRecreation in 2002 but remains a critical part of the campus as the parcels providewatershed for the campus water diversion facilities located at the boundary between thetwo properties. The lower Orchard Parcel, s it is commonly known, also containsCamp Via. There is only one road in this section that leads to Camp Via, which is aconsumer outdoor recreation site of approximately 5 acres. The only other accessroutes on this property are unimproved fire roads that are impassable during the rainy

season. A majority of the property in this section is non-arable and contains no utilities.Boundaries include Jack London State Park and private property.

The Sonoma property water is supplied by self-contained water diversion and treatmentplant system. The center has two reservoirs with apprOXimately 8 acre feet that arefed by three diversion sites. The facility also contains a water treatment facility that iscapable of producing all of the potable water required by the campus. Back-up watersupplies are provided by a connection with the Sonoma County Water Agency and nemergency inter-tie connection with the Valley of the Moon Water District. The centerhas riparian and pre-1914 appropriated water rights as well s licensed appropriatedwater diversion and storage rights that we appropriated in the 1930 s. However, thecenter needs to replace the Sonoma Creek water diversion infrastructure (the majorityof SOC s appropriated rights) to avoid forfeiture.

Sonoma s core campus is bisected by Arnold Drive. The core campus is approXimately150 acres and is located on the lower portion of Sonoma Mountain and spans eastwardinto the valley. The eastern boundary of the property is Highway 12 which is adesignated scenic corridor. Approximately 40 acres of the Sonoma property that liesadjacent to Highway 12 was previously transferred to the Sonoma Valley RegionalParks to provide a wildlife corridor adjacent to conservation easements. A small areaadjacent to Highway 12 was retained by the facility to provide a secondary means ofentry and egress to the portion of the campus that is located on the eastern side ofSonoma Creek that bisects the property. This is particularly important given thestructural limitations of the vehicular bridge that spans Sonoma Creek.

t


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Developmental Center Land Use Summary

The Table below details summary data from the Sonoma Building Utilization andMaintenance Report.

Acres:Land lease s)UndevelopedTotal 866.93

Table 3: Sonoma

BuildingFunction

LeasedVacantDTAG

GAG-HospitalN F-ResidentialIGF-ResidentialPublic/Support *

TOTAL

3.72680.00

Number

Gore campusSurplus

Year Ageof

BuildingsConstructed yrs)

3 1954-1980 33-5928 1909-1993 20-10412 1918-2004 9-95

1 1956 574 1948-1967 46-6510 1948-1956 57-6583 1897-1987 26-116

141

183.21o

GrossSquare

Footage

8,864317,666

99,949

5,414127,592189,255585,197

1 333 937

LicenseCapacity

3622753

1 388*Buildings included are not equipped for occupancy, such as storage containers.


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AfLE,

I . Consultation, evaluation, diagnosis, order and fit devices (some)I follow-up by an Audiologist

. Consultation, evaluation, diagnosis, post-hospital follow-up by aist

Exam (includes x-rays), diagnosis, treatment by a Dentist includingcrowns, excision of oral lesions, extractions, fillings, dentures,

cleaning, deep scaling, restoration of carious teeth, root canals

Dental: Treatment under sedation administered and monitored by an(identified level of sedation)

Dental: Treatment under sedation administered without an Anesthesiologist

(identified level of sedation)

. Consultation, evaluation, diagnosis, treatments, post-hospitalby a Dermatologist

Ear, Nose, Throat (ENT): Consultation, evaluation, diagnosis, cleaming, posthospital follow-up by an ENT Specialist

Electrocardiogram (EKG)

Electroencephalogram (EEG)

Gastroenterology: Treatments by Gastroenterologist or General Surgeon

Gastroenterology: Treatments or exams with sedation administered by anAnesthesiologist (identified level of sedation)

Gastroenterology: Treatments or exams with sedation administered without anAnesthesiologist (identified level of sedation)


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SPECIALTY SERVICES AT THE DEVELOPMENTAL CENTERS

Infectious Disease: Consultation, evaluation, diagnosis, post-hospital follow-upby an Infectious Disease specialist

Internal Medicine: Consultation, evaluation, diagnosis, post-hospital follow-up byInternist

Lab draw (24/7)

Lab testing and results

Mortality Review by a Committee

Nephrology: Consultation, evaluation, diagnosis, post-hospital follow-up by aNephrologist

Neurology: Consultation, evaluation, diagnosis, post-hospital follw-up by aNeurologist

Opthalmology: Consultation, evaluation, diagnosis, post-hospital follow-up,and preventative eye care by an Opthalmologist

Optometry/Opthalmology: Order, fit, repair glasses

Optometry: Eye exam

Outpatient Services (non-residents of the DC)

Pharmacy

. Consultation, evaluation, diagnosis, post-hospital follow-up,nd preventative care by a Physiatrist

Physician services (24/7)

Podiatry: Consultation, evaluation, diagnosis, post-hospital follow-up, treatmentpreventative care by a Podiatrist

Podiatry: Treatments or exams with sedation administered by an(identified level of sedation)

Podiatry: Treatments or exams with sedation administered without anI (identified level of sedation)

C

DC DC

DC DC DC

DC (ALSO SEND SOME DC (ALSO SEND SOME DC (ALSO SEND SOMETO OUTSIOE LAB) TO OUTSIDE LAB) TO OUTSIDE LAB)

DC DC DC

C

DC C C

C C C

C C

DC

DC DC DC

DC C

DC DC DC

C DC C

DC (CONSCIOUS DC (CONSCIOUSSEDATION) SEDATION)

DC

DC

DC (ALSO SEND SOMETO OUTSIDE LAB)

DC

C

C

C

DC

DC

DC

C (GENERALANESTHESIA & TWILIGHT

SEDATION)

DC (CONSCIOUSSEDATION)

DC Service provided by Development al Center EmplolyeesC Service Provided by Contracted Consultant (excludes contract services provided offsite)September 2 13 Page 2


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Psychiatry: Consultation, evaluation, diagnosis, post-hospital follow-up by aPsychiatrist

Psychiatry: Direct care and treatment by a Psychiatrist

Pulmonary: Consultation, evaluation, diagnosis, post-hospital follow-up by aPulmonologist

Radiology: X-ray filmstaken onsite, and read onsite by a Radiologist

Radiology:Dexa

bonescan

administeredand read

onsite

Radiology: Echocardiogram administered and read onsite

Radiology: Mammogram administered and read onsite

Radiology: Scans administered under sedation administered by anIArles'the.siolooist (identified level of sedation)

Radiology: Scans administered under sedation administered without anAm sttlesi:ologist(identified level of sedation)

Radiology: Ultrasound administered and read onsite

Surgical clinic: ConsultatiDn, evaluation, recommendations for surgicalprocedures, follow-up of post-op cases, minor procedures (excision ofsebavious cyst, lipomas, skin lesions, incision/drainage) by a Surgeon

Surgical clinic: Treatment and minor procedures with sedation administered byan Anesthesiologist (identify level of sedation)

Surgical clinic: Treatment and minor procedures with sedation administeredwithout an Anesthesiologist (identified level of sedation)

Consultation, evaluation, diagnosis, post-hospital follow-up by a

Urology: Cystocopy with sedation administered by an Anesthesiologist(identified level of sedation)

DC

C

DC (TEST) C (READ)

C (TEST& READ)

C (TEST& READ)

C DC C

DC

C

DC (TEST& READ) DC (TEST READ)

DC (TEST)& C (READ)

DC (TEST)& C (READ)

C (TESTONLY) DC (TEST) C (READ)

DC (CONSCIOUS DC (CONSCIOUSSEDATION) SEDATION)

C (TEST ONLy) DC (TEST)& C (READ)

C C


C C

DC

DC

DC

DC (TEST ONLy)

C

C (GENERALANESTHESIA& TWILIGH

SEDATION)


C

C (GENERALANESTHESIA&TWILIG

SEDATION)

DC: Service provided y Developmental Center EmplolyeesC: Service Provided y Contracted Consultant (excludes contract services provided offsite)September 2 13 Page


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ntral Line: Total Parantaral Nutrition TPN): Maintenance

DC DC DC

DC DC

DC

DC

Intravenous Therapy IV): Placement and maintenance DC DC DC DC

Respiratory Therapy: Consultation, evaluation, post-hospital follow-up by aDC DC C DC DCRespiratory Care Practioner

Respiratory: Bilevel Positive Airway Pressure BIPAP) DC DC C DC DC

ratory: Breathing tr eatments DC DC C DC DC

Respiratory: Continuous Positive Airway Pressure CPAP) DC C DC DC

ratory: Tracheostomy care and changes DC DC DC DC

. Ventilator care and intubation in emergency) DC

Care: Consultation, evaluation, diagnosiS, post-hospital follow-up by aDC DC DCCare Specialist

DC: Service provided by Development al Center EmplolyeesC: Service Provided by Contracted Consultant excludes contract services provided offsite)Septembe r 2 13 Page


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SPECIALT Y SERVICES AT THE DEVELOPMENTAL CENTERS

DC

Adaptive equipment: Customization/fabrication/adaptation for wheelchairs, DC DC DC DCbeds, chairs, helmets, splints, communication devices, recreational items, etc.

DC (SEAT MOLDINGequipment: Pressure ma pping and seat molding DC DC DCONLY)

Adaptive equipment: Shoe customization/fabrication/adaptation DC

Adaptive technology: Switch Lab where individuals are assessed for type andproper placement of adaptive switch es to utilize to maximize independent job DCperformance, time on task, and making choices

Dysphagia evaluation by a Dysphagia Specialist DC DC DC DC

of the movement of the horse as a therapeuticby a physician and delivered by a team that includes a licensed, DC

Opportunities Via Educa tion MOVE) program: Coordinated instructionof adaptive equipment to improve skills and independence to sit, stand, DC DCtransition in everyday activities of daily living

Therapy: Consultation, evaluation, treaments by an OccupationalDC C DC DC DC

Consultation, evaluation, diagnosis, order, maintain and fitand cast managem ent, post-hospital follow-up by an DC C DC

Order, maintain and fit orthodics by a professional other than an C ORTHOTIST) DC DTIPT)

equipment: TailorlSeamer specialized in adaptive clothing

specify)

Physical Therapy: Consultation, evaluation, tr eatment by a Physical Therapist D C C DC C DC DC

Speech Therapy: Consultation, evaluation, and treatment by a Speech DC DC DC DC

DC Service provided by Developmental Center EmplolyeesC Service Provided by Contracted Consultant iexcJudes contract services provided offsite)

PageSeptember 2 13


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SPECIAL TV SERVICES T THE DEVELOPMENTAL CENTERS

Crisis Admission Services

Autism Services: Consultation, evaluation, treatment by a certified AutismSpecialist

Court- Competency Restoration Training

Drug Regimen Review by committee

Human Rights Committee reviews

Secure Treatment

Sex Offender Relapse Prevention Program

DC

DC

DC

DC DC DC

DC DC DC

DC

DC

DC

DC

DC Service provided y Developmental Center EmplolyeesC Service Prov ided y Contracted Consultant (excludes contract services provided offsite)

eptember 2 13 Page 6


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California Developmental enter Services and Supports

(Submitted by Theresa DeBell, Developmental Centers (DC) Task Force member, n August 2013,and compiled from CA Health and Human Services Agency handout on DC Services with inputfrom Fairview, Porterville and Lantelman Developmental Centers families and staff.)

HEALTH• All facilities are licensed and certified as General Acute Care hospitals (GAC)

with distinct parts for Skilled Nursing Facilities (SNF) and Intermediate CareFacilities/Intellectually Disabled (ICF/ID).

• The GAC units care for individuals in needof acute care. They also provide clinic servicesincluding but not limited to dental, laboratory, x-ray, podiatry, primary care physicians, etc.The DCs also operate phannacies, and can customize adaptive equipment such aswheelchairs, footwear, etc. for the residents on site.

• 24 hour nursing care is provided at each level as needed, includingthe following:-IV Therapy-Porta-Cath Therapy-Hickman Catheter Therapy-G-Tube-End of Life Care-24 hour on campus physician care, with daily visits as needed-24 hour pharmacy services-Medical lab services-X -ray services-Dental services, including monitored anesthesia care-Respiratory Care Therapist-Extended Care

• Adjunctive medical and therapeutic services-Wheelchair clinic-Registered Clinical Dieticians-clinical nasal gastric tubes-clinical gastronomy tubes- J-tube-Hyper Alimentation

-Speech Therapy-Communication Therapy with computers-Mobility training-Podiatry Clinic-Animal Assisted Therapy

-Transportation for off campus treatment provided by licensed escort• Specialty Clinics are arranged with outside physician and therapists:

-Orthopedics-Physical Medicine Rehabilitation-Ophthalmo logy-Ear, Nose Throat-Gynecology (GYN)-Urology-Neurology


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-Psychiatry-Dermatology

EDUCATIONAL. EMPLOYlVIENT, LEISURE and COMMMUNITY INTEGRATIONSERVICES

• All DCs provide special education, adult education, and vocational training services toresidents.

• Butterfield Charter School at Porterville DC provides high school classes with graduations.and fEP services participation.

• Goodell School at Fairview DC provides a special education curriculum• Coastline CommUl1ity College provides 011 campus classes in music, computer lab and

a variety of other classes for residents (FDC).• Off-campus vendorized day programs (Westside, Ehvyn, Cole)• LDC has a vendorized and accredited vocational program for consumers referred to as

Community Industries. This program provides paid employment for consumers who live inthe community as well as residentsof the DC. .

• Swimming Pool on some grounds• Beauty Shop and Barbershop on some grounds• Campuses have a large activity area with TVs, art supplies and a music listening area• Campus petting zoo• Hippotherapy.. Off Campus Trips to movies, dinning, shopping, nature trips, Angel Baseball

games, Duck games, Disneyland, The Aquarium of the Pacific, County Fairs, Sea World,San Diego Zoo, San Diego Wild Animal Park, ConceLis in the Park, pumpkin Christmastree shopping, participation in The Special Olympics.

• On Campus Pmiies for everything: Traditional Holidays, Cinco de Mayo, ChineseNew Year, 4th of July Carnival. Other parties held on a regular basis, some at individual

units and some campus wide... Staff puts on numerous multi-cultural events. Food from different ethnicities provided.

Food trucks set up on campus... Monthly dances with live enteliainment bands, DJ, carolers, orchestras... People's First Group at all DCs

RELIGIOUS NEEDS• On campus services include the Catholic, Protestant, Jewish Muslim faiths... TranspOliation can be provided to off campus religious services.

VOLUNTEER SERVICES - suppOli residents in the following ways:

.. -the SUPPOli Special Arts Festival

.. -provide uniforms, registration fees and transportation to Special Olympics

.. -Golf Tournament fund raiser

.. -Christmas Boutique attended by vendors from the community

.. -Donations of items and money to help with residents' field trips and to donateto the Residents Benefit Fund

• -Foster Grandparent Program.. -Senior Companion Program


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OFFICE OF PROTECTIVE SERVICESAll DCs have a local Officeof Protective Services, which provides public safety and security forthe DC campus and residents, responds to incidents and conducts investigations, and liaisons withexternal law enforcement entities.

STAFFDCs provide some continuing educational and training courses (CPR, Resident Wel1nessProgram, Nursing Competency). Independent Staff Developmental, on Campus Staff Library.

DCs are a source for licensed Psychiatric Technicians through affiliations with training programsat local community colleges.STAFF.;.

• -Psychologists: licensed PhD• -Social Workers: licensed clinical workers with a Masters Degree• -Psych Techs: 2 yearsof college and must pass state licensing exam• -Nutritionists: must hold at least a Bachelor's Degree• -Coastline College Classes for Residents: credentialed teachers• -Day Training: credentialed teachers

• -Rehabilitation therapists• -Registered Nurses (2 and 4 year): must pass state exams• -Pharn1acist: licensed• -Pharmacy Tech: must pass state exam• -Psych Tech AssistantslNurse's Aides: 6 weeks of 40 hour training per

week. Ongoing training and must be certified.

FAMILIES:Many families are active participants in the livesof their relatives at DCs. There is strong familySUppOlt and advocacy through individual family groups at DCs. Residents receive emotional,political, programmatic and monetary support from the residents' family groups.

• Fairview DC serves consumers in need of acute crisis admissions. The admissions areconsidered short-term and intended for stabilization and preparation to return to their homecommunities as soon as they are able. Fairview and the Cityof Costa Mesa have a uniqueagreement in which the City, in exchange for refurbishing 2 soccer fields at Fairview, isallowed to use those fields for its youth soccer program. The agreement clearly gives theresidents at Fairview first useofthe fields (the City's programs are scheduled around theneeds of the residents).

• Lanterman DC has an outpatient clinic to serve former residentsof the DC who havetransitioned to the community. This is palt of the closure plan.

• Porten'iIle DC has a secure treatment program (STP), primarily serving individuals whohave been ordered for restoration of court competency associated with the criminal justicesystem. The STP is licensed as an ICF/ID, but not certified. This program requires asecured perimeter with a sallyPOlt for entrance/exit, video surveillance of the area, andincreased OPS operations.

• Sonoma DC has a fully operational fire department. The fire department responds not onlyto calls at the DC butin the surrounding communities in Sonoma County.

• Canyon Springs is the only small facility operated by the state. The facilityis leased, notowned by, the state.


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DI N S. DOOLEYSECRETARY

EDMUND G . BROWN JR.GOVERNOR

Aging

Child Supportervices

Community Serv ices

and Development

Developmentalervices

Emergency MedicalServices Authority

Health Care Services

Managed Health Care

Managed RiskMedical Insurance Board

Office of Patient Advocate

Office of SystemIntegration

Public Health

Rehabilitation

Social Services

State Hospitals

Statewide HealthPlanning andDevelopment

State o CaliforniaHEALTH AND HUMAN SERVICES AGENCY

January 13,2014

The Honorable Darrell Steinberg The Honorable John A. PerezPresident Pro Tempore Speaker o the AssemblyCalifornia State Senate California State AssemblyState Capitol Building , Room 205 State Capitol Building, Room 219Sacramento , CA 95814 Sacramento , CA 95814

Dear Senator Steinberg and Assembly Member Perez:

Pursuant to the commitment I made last spring to address the declining population in thedevelopmental centers , the resulting fiscal pressures, the challenges o maintaining federalcertification in aging facilities and the repeated calls to close these facilities immediately, andto fulfill the requirements o Section 14 a) o Assembly Bill AB) 89 Chapter 25 , Statutes2013) , I respectfully submit the enclosed Plan for the Future o Developmental Centers inCalifornia.

To begin this effort, I invited a broad cross-section o seasoned leaders committed to meetingthe needs o people with developmental disabilities to serve on a Task Force to identifychallenges, gather facts, share opinions and seek opportunities for improvement. The TaskForce included consumers , family members , regional center directors, consumer rightsadvocates, labor union members , community service providers , and s taff from the Departmeno Developmental Services. At the outset, there was great division and very little expectationthat any consensus could be reached but throughout the six months o intense inquiry andeffort, there was a unifYing commitment that the well-being o each and every developmenta

center resident was at the center o our work.

By keeping our focus on the residents and through the open , honest and candid sharing oinformation and opinions, the full Task Force agreed to present this report and its sixrecommendations on behalf o us all. Some o the parents and some o the unions havequalified their support to be clear that they do not support any implication that the centersshould be closed but the commitment to the need for fundamental transformation o thedevelopmental centers system is shared by all.

I have been humbled and inspired by the understanding I have gained through the work oTask Force. The Administration is committed to the goals set forth in this report and will

continue the active stakeholder engagement that contributed so significantly to this work aswe move forward with its implementation.

Respectfully,

f \ t l k H ~Diana S DooleySecretary

1600 Ninth Street · Room 460 . Sacramento , C 95814 · Telephone (916) 654-3454 . Fax (916) 654-3343Internet Address : www .chhs.ca .gov

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Page 2The Future of Developmental Centers in CaliforniaJanuary 13, 2014

cc: Senator Leland Yee, Chair, Senate Human Services CommitteeSenator Tom Berryhill, Vice Chair, Senate Human Services CommitteeSenator Mark Leno, Chair, Senate Budget & Fiscal Review CommitteeSenator Jim Nielsen, Vice Chair, Senate Budget & Fiscal Review CommitteeSenator Kevin De Le ó n, Chair, Senate Appropriations CommitteeSenator Mimi Walters, Vice Chair, Senate Appropriations CommitteeAssembly Member Mark Stone, Chair, Assembly Human Services CommitteeAssembly Member Brian Maienschein, Vice Chair, Assembly Human Services CommitteeAssembly Member Nancy Skinner, Chair, Assembly Budget CommitteeAssembly Member Jeff Gorell, Vice Chair, Assembly Budget CommitteeAssembly Member Mike Gatto, Chair, Assembly Appropriations CommitteeAssembly Member Frank Bigelow, Vice Chair, Assembly Appropriations Committee

Senator William MonningSenator Mark DeSaulnierAssembly Member Shirley WeberAssembly Member Wesley ChesbroAssembly Member Mariko Yamada, Chair, Aging and Long Term Care CommitteeGail GronertMareva BrownBrendan McCarthyRyan Guillen

Indira McDonald

Jackie WongMyesha Jackson

Nicole VasquezPeggy Collins

Robert MacLaughlinJoe ParraKirk FeelyMary BellamyJulie SouliereDaphne HuntGinni BellaRashi Kesarwani


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PLAN FOR THE FUTUREOF DEVELOPMENTAL CENTERS

IN CALIFORNIA

Report to the LegislatureSubmitted pursuant to Assembly Bill 89, Section 14(a)

(Chapter 25, Statutes of 2013)

Submitted by theCalifornia Health and Human Services Agency

On behalf of the Task Force on the Future of Developmental Centers1600 9 th Street, Room 460

Sacramento, California 95814

January 13, 2014


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TABLE OF CONTENTS

EXECUTIVE SUMMARY…………………………………………………………………....... 1

I. INTRODUCTION…………………………………………………………………………. 3

HISTORICAL PERSPECTIVE………………………………………………………...... 3

DEVELOPMENTAL CENTERS TODAY………………………………………………. 6

CREATION OF THE TASK FORCE………………………………………………...... . 8

II. TASK FORCE PROCESS AND DELIBERATIONS…………………………………..9

SERVICE AND SUPPORT NEEDS OF DEVELOPMENTAL CENTER

DEVELOPMENTAL CENTER SERVICES AND RESOURCES……………………18

PLAN DEVELOPMENT PROCESS………………………………………………........ 9

WORK OF THE TASK FORCE…………………………………………………........... 9

RESIDENTS……………………………………………………………………….......... 11

COMMUNITY SERVICE MODELS AND OTHER RESOURCES…………………. 19

FUNDING CONSIDERATIONS……………………………………………………….. 20

III. TASK FORCE RECOMMENDATIONS FOR FUTURE SERVICES FOR DEVELOPMENTAL CENTER RESIDENTS…………………………………..22

TASK FORCE RECOMMENDATIONS……………………………………………….23

NEXT STEPS…………………………………………………………………………….28

ATTACHMENTS 1-8..…………………………………………………………………………29

http:///reader/full/RECOMMENDATIONS%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85.23http:///reader/full/STEPS%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%AE28http:///reader/full/RECOMMENDATIONS%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85.23http:///reader/full/STEPS%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%85%E5%85%AE28


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EXECUTIVE SUMMARY

Since the 1960s, with the passage of the Lanterman Developmental DisabilitiesServices Act (Lanterman Act), the role of the State-operated Developmental Centers(DC) has been changing. The resident population has dropped from a high in 1968 of13,400, with thousands on a waiting list for admission, to 1,335 residents as ofJanuary 1, 2014. The population at each of the four facilities, originally designed toserve between 2,500 and 3,500 individuals, is now below 500, with Fairview DC at 318residents and Lanterman DC at 101. Additionally, the trailer bill to the 2012-13 budgetimposed a moratorium on admissions to DCs except for individuals involved in thecriminal justice system and consumers in an acute crisis needing short-termstabilization.

Each year Community Placement Plan (CPP) funding ($67 million in Fiscal Year {FY}

2013-14) is provided to regional centers to expand and improve services to meet theneeds of DC residents transitioning to the community. As new CPP-funded resourcesbecome available, on average 175 to 200 consumers move out of a DC intocommunity-based services each year. With the CPP funding provided in FY 2011-12through 2013-14, over 500 new residential beds will be available for DC movers duringthe next 18 months.

The moratorium, coupled with CPP placements and prior changes in the servicedelivery system, has reduced the reliance on State-operated DCs and expedited thedecline in resident population in these facilities.

Without intervention, the role of the State in delivering direct services is rapidlydiminishing. With the input and assistance of the Task Force, the State now has anopportunity to define and manage the transition from historically large congregate livingfacilities to more integrated and specialized services using the expertise and resourcesof the DCs to benefit the consumers.

The DCs will need to transition from large congregate 24-hour nursing and IntermediateCare Facility services to a new model. The recommendations of this Task Force arethat the future role of the State is to operate a limited number of smaller, safety-netcrisis and residential services coupled with specialized health care resource centers andpublic/private partnerships, as well as the Porterville DC - Secure Treatment Program(STP) and the Canyon Springs Community Facility.

Following are the six consensus recommendations endorsed by the Task Force with thequalifications and exceptions set forth in the attached letter from the Sonoma DC ParentHospital Association (PHA), the California Association of Psychiatric Technicians(CAPT), and the California Statewide Law Enforcement Association (CSLEA).

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• Recommendation 1: More community style homes/facilities should be developedto serve individuals with enduring and complex medical needs using existingmodels of care.

• Recommendation 2: For individuals with challenging behaviors and supportneeds, the State should operate at least two acute crisis facilities (like theprogram at Fairview DC), and small transitional facilities. The State shoulddevelop a new “Senate Bill (SB) 962 like” model that would provide a higher levelof behavioral services. Funding should be made available so that regionalcenters can expand mobile crisis response teams, crisis hotlines, day programs,short-term crisis homes, new-model behavioral homes, and supported livingservices for those transitioning to their own homes.

• Recommendation 3: For individuals who have been involved in the criminal

justice system, the State should continue to operate the Porterville DC-STP andthe transitional program at Canyon Springs Community Facility. Alternatives tothe Porterville DC-STP should also be explored.

• Recommendation 4: The development of a workable health resource centermodel should be explored, to address the complex health needs of DC residentswho transition to community homes.

• Recommendation 5: The State should enter into public/private partnerships toprovide integrated community services on existing State lands, whereappropriate. Also, consideration should be given to repurposing existingbuildings on DC property for developing service models identified inRecommendations 1 through 4.

• Recommendation 6: Another task force should be convened to address how tomake the community system stronger.

The Administration is committed to these goals and will continue the active stakeholderengagement that contributed so significantly to this work through an approach modeled

on the Agnews DC closure. The design and implementation of a fundamentaltransformation of the remaining DCs is essential and must proceed as quickly aspossible.

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I.INTRODUCTION

The California Health and Human Services Agency (CHHS) submits this plan on behalf

of the Task Force on the Future of the Developmental Centers (Task Force) and to fulfillthe requirements of Section 14(a) of Assembly Bill (AB) 89 (Chapter 25, Statutes of2013) which states:

SEC.14. (a) The California Health and Human Services Agency shall, on orbefore November 15, 2013, submit to the appropriate policy and fiscalcommittees of the Legislature a master plan for the future of developmentalcenters. In the preparation of this plan, the agency shall consult with a cross-section of consumers, family members, regional centers, consumer advocates,community service providers, organized labor, the State Department of

Developmental Services, and representatives of the Legislature.

This chapter provides pertinent background information and history leading to thecreation of the Task Force. Chapter II describes the Task Force approach, the data andinformation considered by the Task Force, and the Task Force’s observations covering:who is currently being served in a DC and their service and support needs; theresources that are or could be available in the community and in the DCs to meet thoseneeds; other service models and their viability for improving services to this population;and funding considerations. Chapter III presents the recommendations of the TaskForce for serving DC residents in the future.

HISTORICAL PERSPECTIVE

A need has always existed to provide care and services to individuals with intellectualand developmental disabilities. In 1853, a California system of large, public hospitalsfor the “mentally disadvantaged” began with the establishment of the Insane Asylum ofCalifornia at Stockton (which later became Stockton DC) to provide in-patient care andtreatment. In 1968 at its highest point, the system of state hospitals for thedevelopmentally disabled served approximately 13,400 individuals in eight facilities, with

another 3,000 individuals on waiting lists. For many years the state hospitals, nowreferred to as DCs, were the only alternative available to families of children withintellectual and developmental disabilities who were unable to be cared for at home.

Changes began in the mid-1960s, both in California and nationally, that would lead tothe creation of community alternatives. California initiated a community program in1965 by establishing two regional centers (now Golden Gate Regional Center andFrank D. Lanterman Regional Center) to test the concept of providing local,

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community-based services for persons who otherwise would require services in statehospitals. This experience formed the basis of the Lanterman Mental RetardationServices Act (now the Lanterman Developmental Disabilities Services Act [Lanterman

Act], Welfare and Institutions Code Section 4500 et seq.) that extended the regionalcenter system statewide in 1969, and established the foundation of the communityprogram today.

With the development of the regional center system, dependence on institutionalservices declined over time. By 1979, the DC population was 9,000 with virtually nowaiting lists for admission. Since then, the trend away from institutional care tocommunity services has been accelerated through various laws and court cases, asbriefly summarized below:

1. Association for Retarded Citizens v. Department of Developmental Services (1985),38 Cal.3d 384 (ARC). In the ARC decision, among other holdings, the Court

interpreted the Lanterman Act as creating an “entitlement” to services that enableseach person with intellectual and developmental disabilities to live a moreindependent and productive life in the community.

2. Americans with Disabilities Act, 42 U.S.C. sec. 12100, et seq. (ADA). In 1990, the ADA was enacted to prohibit discrimination on the basis of disability in the provisionof government programs and services.

3. Coffelt v. Department of Developmental Services (1990) (Coffelt). The Coffelt classaction lawsuit alleged unnecessary placements of persons in DCs who could live inthe community. The case was settled in 1994 resulting in more than 2,000 DCresidents moving into the community over five years, and other system reforms. Asa result of this lawsuit, the Department of Developmental Services (Department orDDS) budget was augmented for annual CPP funding, currently $67 million, whichincludes dedicated funding for the development of community-based resources thatassist individuals transitioning from a DC to the community, and those beingdeflected from placement into a DC.

4. Olmstead v. L.C. (1999), 527 U.S. 581 (Olmstead). In Olmstead, the United StatesSupreme Court held that discrimination under the ADA includes unnecessaryinstitutionalization of people with disabilities who can live in the community. Thedecision stated that “states are required to place persons with mental disabilities incommunity settings rather than institutions when the State’s treatment professionalshave determined that community placement is appropriate, the transfer frominstitutional care to a less restrictive setting is not opposed by the affected individual,and the placement can be reasonably accommodated, taking into account theresources available to the State and the needs of others with mental disabilities.”

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The federal Centers for Medicare and Medicaid Services subsequently noted in acommuniqué to states that Olmstead challenges states to prevent and correctinappropriate institutionalization, and to review intake and admissions processes toassure that persons with disabilities are served in the most integrated settingappropriate.

5. Capitol People First v. Department of Developmental Services (2001) (CPF). TheCPF class action lawsuit alleged unnecessary segregation of Californians withdevelopmental disabilities in large congregate public and private institutions. Thelawsuit was settled in 2009, resulting in a greater focus on development ofcommunity resources, DC residents and families being provided information oncommunity living options, and regional center resources to work with the DCresidents and families.

6. AB 1472 (Chapter 25, Statutes of 2012). With ongoing budget constraints and many

challenges facing the DCs, significant new policy limiting DC admissions and the useof institutional care in the community was enacted in the trailer bill to the 2012-13Budget. Among other provisions, a moratorium was placed on DC admissions, withonly limited exceptions for individuals involved with the criminal justice system or inacute crisis; comprehensive assessments were required for all DC residents todetermine if community services are available to meet their needs; a new model ofcare was authorized that would allow for secured perimeters with delayed egress ina community home; and resources were prioritized to reduce state and localinstitutionalization.

Today, state and federal laws and court decisions clearly favor community integrationover institutional care, defined nationally as congregate facilities with a capacity of16 residents or more. Throughout the United States the population of persons withdevelopmental disabilities receiving services in large settings of 16 or more hasdramatically decreased. In 1977, this population represented 83.7 percent of the totalnumber served. In 2007, 30 years later, it represented 14.3 percent. Thirteen statesand the District of Columbia have no large state-operated institutions, while many otherstates have active plans for closure of some, if not all, of their large facilities. InCalifornia, the Lanterman Act entitlement to services ensures that an individual willreceive appropriate services with any transition out of a large state-operated facility.

In early 2003, the Department, in collaboration with three Bay Area regional centers,consumers, families, and other stakeholders, initiated a planning process for the closureof Agnews DC. In January 2005, the Department submitted the resulting “Plan for theClosure of Agnews Developmental Center” to the Legislature. Unlike prior DC closuresthat relied in large part on consolidation of populations, Agnews DC was the first closureto incorporate the concept of community integration as the primary objective by

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developing community living options and supports. The foundation of the closure planwas the establishment of a stable source of housing with new residential serviceoptions; a community health care system that provides access to needed services; andstate staff who continue to support DC residents once they move into the community.The final closure process was not driven by a specific date for closure, but by theavailability of housing and support services. The health and safety of each consumerwas the highest priority; transition to the community only occurred when all necessaryservices and supports were in place. In order to protect the civil rights of this vulnerablepopulation in all environments, it is essential to prioritize policies and proceduressurrounding the prevention, reporting, and management of abuse and neglect. Most ofthe approximately 400 Agnews residents moved to the community, only 20 individualstransferred to another DC.

DEVELOPMENTAL CENTERS TODAY

Currently, the Department operates four large DCs and one smaller community facilitywhich, with some exceptions, are licensed and certified as Skilled Nursing Facilities(SNF), Intermediate Care Facilities/Developmentally Disabled (ICF/DD), and General

Acute Care hospitals. The facilities provide 24-hour habilitation and treatment servicesdesigned to increase the residents’ levels of independence, functional skills, andopportunities for making choices that affect a person’s life. Before a person can beadmitted to a DC, a court must determine that there is no other appropriate placementin the community and the individual is eligible for DC services pursuant to current law,and then issue an order for DC admission. As of January 1, 2014, these facilities wereserving 1,335 residents with the number steadily decreasing. Services are provided bylicensed medical staff including doctors, nurses, dentists, psychologists, and psychiatrictechnicians, along with many other professional and administrative staff.

In the community, the Department provides services and supports through contractswith 21 private, nonprofit regional centers to approximately 270,000 individuals withdevelopmental disabilities. The DC population represents less than 1 percent of thetotal DDS consumer population in California. All DC residents are also served by aregional center.

As the population in the DCs has declined, the average acuity level of the remainingresidents has increased considerably. Today the individuals residing in a DC typicallyhave significant behavioral support needs or are very medically involved. Also, asubstantial number of individuals have been dually diagnosed with mental health issuesand/or have been involved in the criminal justice system. Many of these residentsrequire one-to-one staffing at all times to prevent harm to themselves or others. Suchsignificant changes in the DC population require ongoing adjustments in service deliveryand staff support.

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Although there are larger concentrations of people with severe disabilities and complexneeds in the DCs, people with similar characteristics are being served successfully inthe community. While some residents could successfully be served in the communitytoday, additional specialized resources are required to meet the intense needs of themore difficult to serve DC population.

With significant budget reductions over recent years, various hiring freezes and stafffurloughs, the DCs have struggled to meet the intense staffing needs and provide thelevel of service required in the facilities. Tragically, some incidents of abuse haveoccurred. Incidents of abuse compounded with staffing problems have resulted inlicensing deficiencies at Sonoma DC, including partial federal decertification and loss offederal funding. Other DCs are also facing intense scrutiny from state and federalregulators.

The DCs are large institutions which were each designed to serve from 2,500 to 3,500

residents. As the population decreases, the average cost per resident increases dueprimarily to the high cost of maintenance and repair of the aging infrastructure designedto support a large facility with a higher resident population. The average cost of DCservices is estimated to be over $400,000 per resident in FY 2013-14, an increase ofalmost $60,000 per resident from FY 2012-13. In addition, infrastructure needs areoften not addressed due to the significant costs to repair or replace antiquated systemsand a hesitancy to invest in these aging facilities with declining populations.

The reduction in population over the years and the associated costs of operation haveled to the closure of three large DCs and one state-operated community facility since1996. Currently, Lanterman DC is in the process of closing. New trailer bill language in

AB 89, Section 13 (Chapter 25, Statutes of 2013), requires that the closure ofLanterman DC be completed no later than December 31, 2014. Today, each DC servesfewer than 500 residents, making these large institutions increasingly cost inefficient.

The current DC resident population and aging infrastructure, coupled with recentlegislative action that significantly limits admissions to these institutions (most notably

AB 1472 [Chapter 25, Statutes of 2012]), generates significant debate surrounding theDCs. Many stakeholders from within the disabilities community speak out against DCs,calling for their immediate closure; while many parents and families of DC residentsstrongly support the services and benefits provided by these facilities and believe thatsafety and stability of their loved ones’ are dependent on the continued operation of theDCs.

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CREATION OF THE TASK FORCE

Responding to the legal, fiscal, and legislative environment, and recognizing the need todefine a path for the future of the DCs, the Secretary of CHHS, Diana S. Dooley,announced through a press release (Attachment 1) on May 22, 2013, that she wasestablishing a “Task Force on the Future of Developmental Centers.” She appointedrepresentatives of consumers, family members, regional centers, consumer advocates,community service providers, organized labor, and the Department. The charge of theTask Force was to advise the Administration on the development of a master plan forthe future of the DCs that, after careful consideration of specified factors, addresses theservice needs of all DC residents and ensures the delivery of cost-effective, integrated,quality services for this special population. This initiative was later incorporated into thetrailer bill to the 2013-14 Budget (AB 89, Section 14 [Chapter 25, Statutes of 2013]) andwas supported by a grant from the SCAN Foundation.

Secretary Dooley sought diverse and important perspectives by selecting individualswho have proven themselves to be knowledgeable, caring and committed to theintegrity of the system, and who would provide valuable thinking and insight to theprocess. Additionally, she invited the Assembly Speaker and the Senate President ProTem to designate a member from each House to represent the Legislature. SecretaryDooley announced the 21 members of the Task Force in a press release datedJune 5, 2013 (Attachment 2). The members then embarked on a journey together topursue questions and sources of information that would create a commonunderstanding of the facts and prompt their constructive thinking on how to best serveDC residents in the future.

The deliberations and work of the Task Force culminated in six recommendations toimprove the service delivery system. This plan lays out the data and materials thatinformed the process, and presents the general agreements reached for the future ofthe DCs. Although some members of the Task Force do not agree in all respects withthe recommendations as stated, care has been taken to present a balanced perspectiveon the issues throughout this plan. Letters submitted by the Sonoma DC PHA, CAPTand CSLEA in response to the draft report are included as attachments 6, 7, and 8respectively.

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II.TASK FORCE PROCESS AND DELIBERATIONS

PLAN DEVELOPMENT PROCESS

In the June 5, 2013, press release (Attachment 2) Secretary Dooley announced the21 members of the Task Force on the Future of the Developmental Centers and laid outan ambitious agenda. The basic charge of the Task Force was to “gather facts, shareopinions and seek agreement, where possible, on options for the future ofdevelopmental centers.” The result was to be “a plan to assure quality, effective andefficient delivery of integrated services to meet the special needs of current residentsliving in the developmental centers.” The last meeting of the Task Force wasDecember 13, 2013, with the report and recommendations finalized for publication inJanuary 2014.

Secretary Dooley convened and chaired a total of four Task Force meetings, with thefirst occurring on June 17, 2013. The meetings were open to the public, and publiccomments were received and recorded. To make best use of the members’ time, aWork Group of Task Force members met between Task Force meetings and, based onidentified topics, developed information, materials, and agenda items for Task Forceconsideration. Almost all of the Task Force members made themselves available forthe Work Group meetings and additionally performed preparatory work outside of themeetings. Throughout the plan development process, data and historical documentswere provided by the Department, and Work Group participants contributed importantinformation from other sources. All materials were provided to the Task Force memberselectronically and made available on the CHHS website at www.chhs.ca.gov .

Additionally, materials were submitted by the public participants. Task Force memberswere invited to tour DC programs which were coordinated by DDS staff according toindividual schedules and preferences.

Packets of materials were prepared and provided before each Task Force meeting.These packets are included as attachments to this plan. They are described generallybelow, along with observations made by Task Force members.

WORK OF THE TASK FORCE

The work of the Task Force began with presentations and discussions regardingbackground information, pertinent data, and the important elements of the system ofcare. The overarching theme for the Task Force was to ensure the health and safety ofthe individuals being served, regardless of where they live. The Task Force members,although diverse in opinions and perspectives, shared significant common ground

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because, by virtue of receiving services, providing services, and/or having a friend orfamily member who is a consumer, they were all a part of the service system and ableto contribute experiences and examples of best practices. The following observationswere shared and became regular topics throughout the discussions:

1. A carefully crafted, comprehensive person-centered Individual Program Plan (IPP) isessential to the planning process and service delivery; one which utilizesassessments but is not solely driven by them, and one that incorporates input from arobust Interdisciplinary Team process.

2. It is critical that safe and secure services are delivered in the least restrictiveenvironment possible, while still addressing personal quality of life. GivenCalifornia’s entitlement to services for persons with intellectual and developmentaldisabilities, it is imperative that comprehensive services and supports are in placebefore a person moves from a DC.

3. Access to quality health and mental health services is essential regardless of wheresomeone lives. DC families highly value the immediate access they have to a widerange of specialists with expertise in serving individuals with intellectual anddevelopmental disabilities. Necessary health and mental health services includecare coordination, appropriate and continuous medication management, and accessto centralized medical records.

4. Stable, qualified staff is key to any successful model of care whether it is stateoperated or privately operated. The Task Force expressed interest in ways tofacilitate the utilization of expert staff from the DC in the transition of residents intothe community, such as the Community State Staff Program first implementedduring the closure of Agnews DC.

5. Any model of care must receive sufficient and stable funding to be successful inaccomplishing its goal.

6. Any solution must be fiscally responsible, including the ability to maximize federalfunding. To meet the service needs of DC residents, alternatives must align withavailable resources. Task Force members sought significant information related toresource development options using CPP funding and the parameters for qualifyingfor federal funding.

7. The Task Force remained sensitive to the fact that, for the residents of the DC, theDC is their home and community, where their relationships are, and where they havelived for a long time. Any changes in their living arrangements must be done verycarefully, with thorough planning, and by taking the time that is needed.

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The initial data that was considered by the Task Force (Attachment 3) included: currentconsumer characteristics taken from the Client Development and Evaluation Report(CDER) for DC residents with comparisons to community consumers; DC populationtrends from 1969-70 to 2011-12; a breakdown of DC residents by level of care andregional center; community population data by regional center; a map showing DClocations and the areas served by each regional center; and, a June 2002 report titled,“Options to Meet the Future Needs of Consumers in Developmental Centers.”

The Task Force carefully considered what additional information it needed throughoutits deliberations. The first order of business was to fully understand the DC residentsand to identify their needs. Information was requested for those individuals considered“difficult to serve.” Task Force members generally shared strong interest in addressingthe needs of persons with challenging behaviors and those involved in the criminal

justice system. They looked at unmet needs, such as crisis intervention services, and

service models from other programs and in other states. The Task Force also focusedon the differences between community services versus the DC programs and services,to fully understand what could be replicated in the community. Information wasrequested both on successful programs as well as challenges from prior DC closureexperiences so that both could be examined.

Following are the key subject areas discussed by the Task Force which lead to therecommendations presented in Chapter III.

SERVICE AND SUPPORT NEEDS OF DEVELOPMENTAL CENTER RESIDENTS

Attachments 3 and 4 contain considerable data from the CDER on the characteristicsand diagnoses of the DC residents, which were reviewed by the Task Force. While theneeds of the individuals are not unique to DCs and individuals with similar needs arealready being served in the community, noteworthy is the concentration of individuals inthe DCs with complex needs requiring higher levels of care. Following is a list ofdiagnoses and the percent of individuals in the DC system (1,484 total population as ofJuly 1, 2013, including Canyon Springs Community Facility) with each diagnosis(Attachment 4, Packet 1, Item 1), as an indicator of service needs:

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Diagnosis Percent Autism 16

Cerebral Palsy 39Dual Diagnosis 48Epilepsy 49Hearing Deficit 9Pervasive Developmental Disorder 2Severe or Profound Intellectual Disability 67Unable to Walk 50Vision Difficulty 32

Additionally, 22 percent of the population has prevailing psychiatric/mental healthissues, and 51 percent is prescribed at least one behavioral medication.

The primary service needs of the population as categorized by the DC programs are as

follows:

Primary Service Need PercentSignificant Health Needs 18Extensive Personal Care 20Significant Behavior Issues 16Protection and Safety 31Low Structured Setting 2Specialized Secure Setting 13

Other significant observations are that 7 percent of the DC population has sex offensecharges and may be Penal Code 290 registrants; 4 percent has assault-related felonycharges; 1 percent has gang and/or drug-related issues; and another 1 percent hasother felony charges.

Also of significance is the fact that the population is generally older with 18 percent over61 years of age, and another 53 percent between the ages of 42 and 61 years. Forty-three (43) percent has lived in a DC for more than 30 years. The needs of an agingpopulation become increasingly complex with time and present greater challenges forproviding health care and appropriate services.

After reviewing the data, the information was organized into three primary servicecategories, although there are common issues and overlap: individuals with enduringand complex medical needs; individuals with challenging behaviors; and individualsinvolved in the criminal justice system. Within each category, there is a range of serviceneeds, with some individuals being more difficult to serve.

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The Task Force focused primarily on the more difficult to serve individuals who wouldrequire specialized services to be supported in the community.

For each of the three identified categories, the Task Force used a structured approachto discuss and analyze three areas of interest. First, the Task Force considered themost challenging aspects of providing services and supports to the particularpopulation. Second, the Task Force identified the services and supports that areavailable in the system to meet those needs. Finally, the Task Force discussed whatadditional services and supports may be needed.

Following is a high-level synthesis of the Task Force discussion. A particular point orobservation may reflect the comment of a single Task Force member.

Individuals with Enduring and Complex Medical Needs. As of October 30, 2013, 445 ofthe total DC population of 1,385, or approximately 32 percent, were receiving care in a

SNF residence, indicating the population of individuals with significant medical needs.When individuals have complex, challenging or multiple medical conditions, certainconditions identified by the Task Force create a generally greater challenge associatedwith their care, as follows:

• Pica• Prader-Willi Syndrome• Seizure Disorders• Feeding-related• Respiratory care-related• Diabetes• Mobility issues• Alzheimer’s or dementia• Osteoporosis• Dual Diagnosis

Various options already exist to serve and support individuals with complex medicalneeds, ranging from the family home with add-on or wrap-around nursing services; tothe residential model authorized under SB 962 and SB 853 (962 homes); to an array of

licensed health facilities, including state-operated alternatives. When considering thesystem needs associated with serving these individuals, the following areas wereidentified:

• Greater capacity is needed in the community for some services, such as 962homes, ICF/DD-Nursing and ICF/DD-Continuous Nursing, with consideration forstatewide locations.

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• SNFs in the community should only be used for addressing short-term, acuteneeds. They are not an appropriate long-term environment for this population ofindividuals with enduring medical needs.

• Better coordination and continuity of health and dental care are needed in thecommunity, such as a central “medical home” to facilitate communication, accessto health records, and access to providers.

• All consumers would benefit from better medication management, which isessential for quality of life.

• Gaps exist in the community for psychiatric services.• Greater access is needed in the community to Durable Medical Equipment

(DME), adaptive technology, and other DC specialty services which utilize theexpertise of DC staff.

• Specialized care is needed in the community for ventilator dependent individuals.• Licensing challenges exist for providing day services to individuals with medical

needs, including the use of medically related restraints and medicationadministration.

Of the 445 individuals residing in a DC SNF, it is estimated that roughly 315, or 70.9percent, would need the services of 962 homes. This approximation is based on thepercentage of individuals who moved from Agnews DC out of the SNF into a 962 home,and those who have moved or who are planning to move out of the SNF into a 962home from Lanterman DC. The other 130 individuals may need the level of health careprovided in an ICF/DD-Nursing or an ICF/DD-Continuous Nursing.

Individuals with Challenging Behaviors. It is estimated that approximately 227 DCresidents have significantly complex and challenging behaviors. The Task Forceconsidered the following behaviors or conditions as presenting the greatest difficulty inidentifying service options when more than one are present:

• Elopement risk• Aggressive social behavior• Self-injurious behavior• Pica• Maladaptive sexual behavior• Dual diagnosis• Drug or alcohol abuse• Vandalism or property destruction, including fire setting

Depending on the severity of the behaviors and the needs of the individual, particularlywhether mental illness is involved, a wide array of service options exist, but with varyinglevels of desirability and availability, as follows:

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• Individuals may reside in the family home with identified supports, such asrespite services, or reside in their own home using Supported Living Services.

• A limited number of licensed residential facilities serve this population, some withdelayed egress and some with psychiatric services.

• Individuals with behavior challenges need various support services, including

specialized day programs.• State-operated facilities serve this population, including crisis services atFairview DC and transitional services at Canyon Springs Community Facility.

• Individuals may need acute psychiatric facilities.• There are a limited number of crisis homes and a limited use of crisis teams

available to serve this population in the community.• The individuals with challenging behaviors are also served by emergency rooms

and local hospitals, usually as a gateway to other mental health services in thecommunity.

• On occasion, these individuals come in contact with local law enforcement andspend time in jail.

The Task Force considered several areas as common needs for all consumers. Theseareas were mentioned above for individuals with enduring medical needs and include:coordination and continuity of health and dental care; access to health records; as wellas medication management. In addition, the following service needs were identified forindividuals with challenging behaviors:

• This population needs greater access to appropriate, qualified and available

professionals. Greater psychiatric services are needed generally throughout thesystem.• More wrap-around supports for families would help to maintain individuals in the

home.• An increased capacity of crisis homes, crisis response services and step-down or

re-entry programs are needed.• An array of services are needed with the ability of individuals to move between

levels as needs change, particularly for crisis services. There was a strongpreference expressed for an individual to remain in his or her home withnecessary services accessible and available to the provider to address the levelof care changes.

• Better coordination is needed with law enforcement, to address vulnerability andrisk of victimization issues, and prevent unnecessary involvement with thecriminal justice system.

• Resources are needed that provide statewide access and not just access for aparticular regional center’s catchment area.

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A general observation of some of the Task Force members is that the communitysystem of behavioral and psychiatric services is the one area in most need of furtherdevelopment. Managing acute crises and effective coordination of mental healthservices were viewed as overarching system issues.

Individuals Involved in the Criminal Justice System. Roughly 200 individuals in thecurrent DC population have had some involvement with the criminal justice system.

Although the population is relatively small, the needs of the population are great. TheTask Force considered the following factors as significant issues associated with theircare:

• Whether the individual is charged with a felony, particularly a sex offense;• Whether the individual is competent to stand trial; and• For individuals who are incompetent to stand trial, whether they have a dual

diagnosis of mental illness.

Options that exist today for this population include residing in their own or their family’shome with monitoring and supports. Often these individuals reside in a locked facilitythat may include prison, a juvenile justice facility, Porterville DC-STP, or a psychiatricfacility, but very few locked psychiatric facilities exist and their use is limited by recenttrailer bill language. As an extension of these locked options, an individual may live in ahalf-way house, or receive parole or probation services. If an individual is determinedby a court to be incompetent to stand trial, he or she will receive competency restorationtraining.

In addition to the common issues identified previously for all consumers (health anddental care coordination and continuity, medication management and access to healthrecords), the following needs are associated with individuals involved in the criminal

justice system:

• There are not enough locked community facilities to accommodate thispopulation. It was noted, however, that these facilities face significant obstaclesand NIMBY-ism (Not in My Back Yard) during development.

• More psychiatric and rehabilitation services are needed in the community.• More treatment services are needed in the community for drug and alcohol

abuse.• It is difficult to find an appropriate placement for sex offenders released back to

the community.• There are safety issues associated with this population, such as addressing the

risks of victimization and protecting non-offenders in the system.• Increased coordination with the criminal justice system is needed to ensure

appropriate community placements, protections, and monitoring.

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The Task Force generally agreed that the services available at Porterville DC-STP arepreferable for this population over prison or jail. The STP focuses on restoringcompetency as a primary function, but also provides rehabilitation programs, vocationaleducation and other services in a secure environment. Secure treatment was viewedas primarily a responsibility of the State. It was recognized that some facilities servingthe forensic population are funded using 100 percent General Fund.

Consideration was also given to the statutory cap on the STP population of 170residents and whether the cap should be lifted; the possibility of expanding the servicesfor other populations of individuals with challenging behaviors; and the need to addressindividuals with intellectual and developmental disabilities who are in jail (Attachment 5,Packet 5, Item 1).

Other Information Considered. To understand the service needs of the DC residents,the Task Force looked at other related information for additional insights and

perspectives. The Task Force analyzed information concerning individuals who hadpreviously transitioned to the community from a DC, and the subsequent moves bythose individuals to other residential services (Attachment 4, Packet 1, Items 5 and 6,and Attachment 4, Packet 4, Item 3). The information identified the moves, but did notprovide qualitative information about the reasons for the moves. Also considered wasthe client characteristics of DC residents and persons who had moved to the communityfrom a DC (Attachment 4, Packet 4, Items 6 and 7).

The Task Force considered the assessment data being developed by the regionalcenters (Attachment 5, Packet 5, Item 2) as a product of the AB 1472 (Chapter 25,Statutes of 2012) requirements. This information is preliminary and was collectedthrough a survey of regional centers based on comprehensive assessments completedin FY 2012-13. The data provided information about the potential service needs of theDC residents.

The work of the Task Force included data from the Statewide Specialized ResourceService (SSRS, Attachment 4, Packet 3, Item 1). The SSRS was developed inresponse to AB 1472 (Chapter 25, Statutes of 2012) to track the availability of specialtyresidential beds and services, specialty clinical services, and requests for DC servicesand supports when community services have not been identified, so that resources canbe coordinated and accessed on a statewide basis. Only services developed usingCPP funds are included in the SSRS tracking. The Task Force recommends expandingthe SSRS to include non-CPP funded resources. The Task Force also considered theDDS report on “Crisis Intervention for Persons with Developmental Disabilities” datedMay 2013 (Attachment 4, Packet 4, Item 8) while assessing the availability of services inthe community.

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DEVELOPMENTAL CENTER SERVICES AND RESOURCES

To ensure the service needs of DC residents will continue to be met, considerableefforts were made by the Task Force to fully understand the services available in a DCand the associated benefits. Listings of the specialty services at the DCs as well asgeneral information about the various services and supports were part of the TaskForce materials (Attachment 5, Packet 2, Items 1 and 2). Through discussions, thefollowing benefits were associated with DC services:

• DCs have the flexibility to adjust services to meet the changing needs of theresidents, creating a stable environment for each individual.

• DCs serve as a placement of last resort and a safety net for the system.• Residents have access to an array of professional staff to address their health,

treatment and habilitation needs, including specialty services.• The DC employees are qualified, familiar with the special needs of the individuals

they serve, and are compensated for the level of service they provide. If staffleaves their DC employment or has time off, the DC has flexibility to adjuststaffing for proper coverage.

• The DCs’ funding structure contributes to their stability and sustainability as aservice provider.

• Given the property associated with DCs, residents are able to enjoy the freedomof the grounds and benefit from the calming environment while still safe andprotected, which is particularly important for individuals with no safetyawareness.

Another area of exploration was looking at the DCs for what they may offer in the way ofpotential resources. Two specific resources were regularly discussed by the TaskForce. First, there was interest in preserving the expertise of the DC staff within theservice delivery system. The Task Force expressed support for the Community StateStaff Program that was part of the Agnews DC closure, and subsequently part of theLanterman DC closure, whereby the DC contracted with providers and regional centersfor DC staff to fill jobs in the community. DDS was reimbursed for those services, andthe community benefited from the expertise of the staff and the continuity of services.There was general agreement among Task Force members that the system would

benefit from preserving this resource. Also of interest was using the DC staff to bridgeservices with the community using a “health resource center” model.

The second resource of particular interest to the Task Force was the DC property.Materials were provided to the Task Force that described the current land use withmaps of the facilities (Attachment 5, Packet 3, Items 1 and 2). Also, the surplusproperty process was shared, including the requirement that the net proceeds from thedisposition of the surplus property be used for the retirement of State bonds pursuant to

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Government Code Section 11011(g). Many of the members felt that this valuableresource should not be given up as surplus, but instead should be used for the benefitof the service system. The challenge is to define clearly what the future use should be.

In considering the future use of DC land, the Task Force became familiar with theHarbor Village Project at Fairview DC (Attachment 5, Packet 3, Item 3). The State ofCalifornia entered into a public-private partnership using a 55-year lease of 60 acres atFairview DC for the purpose of developing the land for employee and consumerhousing. By leveraging state land resources, community integrated housing wassuccessfully developed. This approach to using DC land generated significant interestfrom the Task Force members as they discussed new models of service delivery.

Additional DC resources identified by the Task Force as gaps in community services arethe provision of DME, assistive technology, and specialty services such as the SonomaDC shoe program, with emphasis on keeping equipment updated and repaired. These

supports are available in the DCs and will be a continuing need for the DC residents,wherever they may reside in the future.

COMMUNITY SERVICE MODELS AND OTHER RESOURCES

The Task Force was interested in new service models for addressing the needs of DCresidents who may be served in the community in the future. In particular, the membersreviewed and discussed the Programs of All-Inclusive Care for the Elderly (PACE,

Attachment 5, Packet 4, Item 1). PACE is a federal program that provides community-based health care and services to people age 55 or older who otherwise would need anursing home level of care. A team of health professionals provide “one-stop”comprehensive health care within a complex of services and functions like a HealthMaintenance Organization (HMO). Under the existing

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