2009 California Welfare and Institutions Code - Section 4684.50-4684.75 :: Article 3.5. Adult Residential Facilities For Persons With Special Health Care Needs: Pilot Program

4684.50.  (a) (1) "Adult Residential Facility for Persons with
Special Health Care Needs (ARFPSHN)" means any adult residential
facility that provides 24-hour health care and intensive support
services in a homelike setting that is licensed to serve up to five
adults with developmental disabilities as defined in Section 4512.
   (2) For purposes of this article, an ARFPSHN may be established in
a facility financed pursuant to Section 4688.5.
   (b) "Consultant" means a person professionally qualified by
training and experience to give expert advice, information, training,
or to provide health-related assessments and interventions specified
in a consumer's individual health care plan.
   (c) "Direct care personnel" means all personnel who directly
provide program or nursing services to consumers. Administrative and
licensed personnel shall be considered direct care personnel when
directly providing program or nursing services to clients.
Consultants shall not be considered direct care personnel.
   (d) "Individual health care plan" means the plan that identifies
and documents the health care and intensive support service needs of
a consumer.
   (e) "Individual health care plan team" means those individuals who
develop, monitor, and revise the individual health care plan for
consumers residing in an Adult Residential Facility for Persons with
Special Health Care Needs. The team shall, at a minimum, be composed
of all of the following individuals:
   (1) Regional center service coordinator and other regional center
representative, as necessary.
   (2) Consumer, and, where appropriate, his or her parents, legal
guardian or conservator, or authorized representative.
   (3) Consumer's primary care physician, or other physician as
designated by the regional center.
   (4) ARFPSHN administrator.
   (5) ARFPSHN registered nurse.
   (6) Others deemed necessary for developing a comprehensive and
effective plan.
   (f) "Intensive support needs" means the consumer requires physical
assistance in performing four or more of the following activities of
daily living:
   (1) Eating.
   (2) Dressing.
   (3) Bathing.
   (4) Transferring.
   (5) Toileting.
   (6) Continence.
   (g) "Special health care needs" means the consumer has health
conditions that are predictable and stable, as determined by the
individual health care plan team, and for which the individual
requires nursing supports for any of the following types of care:
   (1) Nutrition support, including total parenteral feeding and
gastrostomy feeding, and hydration.
   (2) Cardiorespiratory monitoring.
   (3) Oxygen support, including continuous positive airway pressure
and bilevel positive airway pressure, and use of other
inhalation-assistive devices.
   (4) Nursing interventions for tracheostomy care and suctioning.
   (5) Nursing interventions for colostomy, ileostomy, or other
medical or surgical procedures.
   (6) Special medication regimes including injection and intravenous
medications.
   (7) Management of insulin-dependent diabetes.
   (8) Manual fecal impaction, removal, enemas, or suppositories.
   (9) Indwelling urinary catheter/catheter procedure.
   (10) Treatment for staphylococcus infection.
   (11) Treatment for wounds or pressure ulcers (stages 1 and 2).
   (12) Postoperative care and rehabilitation.
   (13) Pain management and palliative care.
   (14) Renal dialysis.

4684.53.  (a) The State Department of Developmental Services and the
State Department of Social Services shall jointly implement a pilot
project to test the effectiveness of providing special health care
and intensive support services to adults in homelike community
settings.
   (b) The pilot project shall be implemented through the following
regional centers only:
   (1) The San Andreas Regional Center.
   (2) The Regional Center of the East Bay.
   (3) The Golden Gate Regional Center.
   (c) The regional centers participating in this pilot project may
contract for an aggregate total of services for no more than 120
persons in an ARFPSHN.
   (d) Each ARFPSHN shall possess a community care facility license
issued pursuant to Article 9 (commencing with Section 1567.50) of
Chapter 3 of Division 2 of the Health and Safety Code, and shall be
subject to the requirements of Chapter 1 (commencing with Section
80000) of Division 6 of Title 22 of the California Code of
Regulations, except for Article 8 (commencing with Section 80090).
   (e) For purposes of this article, a health facility licensed
pursuant to subdivision (e) or (h) of Section 1250 may place its
licensed bed capacity in voluntary suspension for the purpose of
using the facility to operate an ARFPSHN if the facility is selected
to participate in the pilot project pursuant to Section 4684.58.
Consistent with subdivision (a) of Section 4684.50, any facility
selected to participate in the program shall be licensed to serve up
to five adults. A facility's bed capacity shall not be placed in
voluntary suspension until all consumers residing in the facility
under the license to be suspended have been relocated. No consumer
may be relocated unless it is reflected in the consumer's individual
program plan developed pursuant to Sections 4646 and 4646.5.
   (f) Each ARFPSHN shall be subject to the requirements of
Subchapters 5 through 9 of Chapter 1 of, and Subchapters 2 and 4 of
Chapter 3 of, Division 2 of Title 17 of the California Code of
Regulations.
   (g) Each ARFPSHN shall ensure that an operable automatic fire
sprinkler system is installed and maintained.
   (h) Each ARFPSHN shall have an operable automatic fire sprinkler
system that is approved by the State Fire Marshal and that meets the
National Fire Protection Association (NFPA) 13D standard for the
installation of sprinkler systems in single- and two-family dwellings
and manufactured homes. A local jurisdiction shall not require a
sprinkler system exceeding this standard by amending the standard or
by applying standards other than NFPA 13D. A public water agency
shall not interpret this section as changing the status of a facility
from a residence entitled to residential water rates, nor shall a
new meter or larger connection pipe be required of the facility.
   (i) Each ARFPSHN shall provide an alternative power source to
operate all functions of the facility for a minimum of six hours in
the event the primary power source is interrupted. The alternative
power source shall comply with Section 517-50 of the California
Electric Code. The alternative power source shall be maintained in
safe operating condition, and shall be tested every 14 days under the
full load condition for a minimum of 10 minutes. Written records of
inspection, performance, exercising period, and repair of the
alternative power source shall be regularly maintained on the
premises and available for inspection by the State Department of
Developmental Services.

4684.55.  (a) No regional center may pay a rate to any ARFPSHN for
any consumer that exceeds the average annual cost of serving a
consumer at Agnews Developmental Center, as determined by the State
Department of Developmental Services.
   (b) The payment rate for ARFPSHN services shall be negotiated
between the regional center and the ARFPSHN, and shall be paid by the
regional center under the service code "Specialized Residential
Facility (Habilitation)."
   (c) The established rate for a full month of service shall be made
by the regional center when a consumer is temporarily absent from
the ARFPSHN 14 days or less per month. When the consumer's temporary
absence is due to the need for inpatient care in a health facility,
as defined in subdivision (a), (b), or (c) of Section 1250 of the
Health and Safety Code, the regional center shall continue to pay the
established rate as long as no other consumer occupies the vacancy
created by the consumer's temporary absence, or until the individual
health care plan team has determined that the consumer will not
return to the facility. In all other cases, the established rate
shall be prorated for a partial month of service by dividing the
established rate by 30.44 then by multiplying the quotient by the
number of days the consumer resided in the facility.

4684.58.  The regional center may recommend for participation, the
State Department of Developmental Services, an applicant for this
pilot project when the applicant meets all of the following
requirements and has been selected through a request for proposals
process issued by one or more of the three participating regional
centers:
   (a) The applicant employs or contracts with a program
administrator who has a successful record of administering
residential services for at least two years, as evidenced by
substantial compliance with the applicable state licensing
requirements.
   (b) The applicant prepares and submits, to the regional center, a
complete facility program plan that includes, but is not limited to,
all of the following:
   (1) The total number of the consumers to be served.
   (2) A profile of the consumer population to be served, including
their health care and intensive support needs.
   (3) A description of the program components, including a
description of the health care and intensive support services to be
provided.
   (4) A week's program schedule, including proposed consumer day and
community integration activities.
   (5) A week's proposed program staffing pattern, including
licensed, unlicensed, and support personnel and the number and
distribution of hours for such personnel.
   (6) An organizational chart, including identification of lead and
supervisory personnel.
   (7) The consultants to be utilized, including their professional
disciplines and hours to be worked per week or month, as appropriate.
   (8) The plan for accessing and retaining consultant and health
care services, including assessments, in the areas of physical
therapy, occupational therapy, respiratory therapy, speech pathology,
audiology, pharmacy, dietary/nutrition, dental, and other areas
required for meeting the needs identified in consumers' individual
health care plans.
   (9) A description, including the size, layout, location, and
condition of the proposed home.
   (10) A description of the equipment and supplies available, or to
be obtained, for programming and care.
   (11) The type, location, and response time of emergency medical
service personnel.
   (12) The in-service training program plan for at least the next 12
months.
   (13) The plan for ensuring that outside services are coordinated,
integrated, and consistent with those provided by the ARFPSHN.
   (14) Written certification that an alternative power system
required by subdivision (i) of Section 4684.53 meets the manufacturer'
s recommendations for installation and operation.
   (c) Submits a proposed budget itemizing direct and indirect costs,
total costs, and the rate for services.
   (d) Certifies, in writing, that the applicant has the ability to
comply with all of the requirements of Section 1520 of the Health and
Safety Code.
   (e) The regional center shall provide all documentation specified
in subdivisions (b) to (d), inclusive, of Section 4684.58 and a
letter recommending program certification to the State Department of
Developmental Services.
   (f) The State Department of Developmental Services shall either
approve or deny the recommendation and transmit its written decision
to the regional center and to the State Department of Social Services
within 30 days of its decision. The decision of the State Department
of Developmental Services not to approve an application for program
certification shall be the final administrative decision.
   (g) Any change in the ARFPSHN operation that alters the contents
of the approved program plan shall be reported to the State
Department of Developmental Services and the contracting regional
center, and approved by both agencies, prior to implementation.

4684.60.  The vendoring regional center shall, before placing any
consumer into an ARFPSHN, ensure that the ARFPSHN has a license
issued by the State Department of Social Services for not more than
five adults and a contract with the regional center that includes, at
a minimum, all of the following:
   (a) The names of the regional center and the licensee.
   (b) The purpose of the pilot project.
   (c) A requirement that the contractor shall comply with all
applicable statutes and regulations, including Section 4681.1.
   (d) The effective date and termination date of the contract.
   (e) A requirement that, under no circumstances, shall the contract
extend beyond the stated termination date, which shall not be longer
than the pilot legislation end date of January 1, 2011.
   (f) The definition of terms.
   (g) A requirement that the execution of any amendment or
modification to the contract be in accordance with all applicable
federal and state statutes and regulations and be by mutual agreement
of both parties.
   (h) A requirement that the licensee and the agents and employees
of the licensee, in the performance of the contract, shall act in an
independent capacity, and not as officers or employees or agents of
the regional center.
   (i) A requirement that the assignment of the contract for consumer
services shall not be allowed.
   (j) The rate of payment per consumer.
   (k) Incorporation, by reference, of the ARFPSHN's approved program
plan.
   (l) A requirement that the contractor verify, and maintain for the
duration of the project, possession of commercial general liability
insurance in the amount of at least one million dollars ($1,000,000)
per occurrence.
   (m) Contractor performance criteria.
   (n) An agreement to provide, to the evaluation contractor engaged
pursuant to subdivision (a) of Section 4684.74, all information
necessary for evaluating the project.

4684.63.  (a) Each ARFPSHN shall do all of the following:
   (1) Meet the minimum requirements for a Residential Facility
Service Level 4-i pursuant to Sections 56004 and 56013 of Title 17 of
the California Code of Regulations, and ensure that all of the
following conditions are met:
   (A) That a licensed registered nurse, licensed vocational nurse,
or licensed psychiatric technician, is awake and on duty 24-hours per
day, seven days per week.
   (B) That a licensed registered nurse is awake and on duty at least
eight hours per person, per week.
   (C) That at least two staff on the premises are awake and on duty
when providing care to four or more consumers.
   (2) Ensure the consumer remains under the care of a physician at
all times and is examined by the primary care physician at least once
every 60 days, or more often if required by the consumer's
individual health care plan.
   (3) Ensure that an administrator is on duty at least 20 hours per
week to ensure the effective operation of the ARFPSHN.
   (4) The administrator shall have at least one year of
administrative and supervisory experience in a licensed residential
program for persons with developmental disabilities and shall meet
one or more of the following qualifications:
   (A) Be a licensed registered nurse.
   (B) Be a licensed nursing home administrator.
   (C) Be a licensed psychiatric technician with at least five years
of experience serving individuals with developmental disabilities.
   (D) Be an individual with a bachelors degree in the health or
human services field and two years experience working in a licensed
residential program for persons with developmental disabilities and
special health care needs.
   (b) The regional center may require an ARFPSHN to provide
additional professional, administrative, or supportive personnel
whenever the regional center determines, in consultation with the
individual health care plan team, that additional personnel are
needed to provide for the health and safety of consumers.
   (c) ARFPSHNs may utilize appropriate staff from Agnews
Developmental Center.
   (d) All direct care personnel shall be subject to the training
requirements specified in Section 4695.2.

4684.65.  (a) A regional center shall not place, or fund the
placement for, any consumer in an ARFPSHN until the individual health
care plan team has prepared a written individual health care plan
that can be fully and immediately implemented upon the consumer's
placement.
   (b) (1) An ARFPSHN shall only accept, for initial admission,
consumers who meet the following requirements:
   (A) Reside at Agnews Developmental Center at the time of the
proposed placement.
   (B) Have an individual program plan that specifies placement in an
ARFPSHN.
   (C) Have special health care and intensive support needs.
   (2) Except as provided in paragraph (3), when a vacancy in an
ARFPSHN occurs due to the permanent relocation or death of a
resident, the vacancy may only be filled by a consumer who meets the
requirements of paragraph (1).
   (3) If there is no resident residing at Agnews Developmental
Center who meets the requirements of subparagraphs (B) and (C) of
paragraph (1), a vacancy may be filled by a consumer who is residing
at another developmental center or who is at risk of placement into a
developmental center, as determined by the regional center, and who
meets the requirements of subparagraphs (B) and (C) of paragraph (1).
   (c) The ARFPSHN shall not admit a consumer if the individual
health care plan team determines that the consumer is likely to
exhibit behaviors posing a threat of substantial harm to others, or
has a serious health condition that is unpredictable or unstable. A
determination that the individual is a threat to others may only be
based on objective evidence or recent behavior and a determination
that the threat cannot be mitigated by reasonable interventions.

4684.68.  (a) The individual health care plan shall include, at a
minimum, all of the following:
   (1) An evaluation of the consumer's current health.
   (2) A description of the consumer's ability to perform the
activities of daily living.
   (3) A list of all current prescription and nonprescription
medications the consumer is using.
   (4) A list of all health care and intensive support services the
consumer is currently receiving or may need upon placement in the
ARFPSHN.
   (5) A written statement from the consumer's primary care physician
familiar with the health care needs of the consumer, or other
physician as designated by the regional center, that the consumer's
medical condition is predictable and stable, and that the consumer's
level of care is appropriate for the ARFPSHN.
   (6) Provision for the consumer to be examined by his or her
primary care physician at least once every 60 days, or more
frequently if indicated.
   (7) A list of the appropriate professionals assigned to provide
the health care as described in the plan.
   (8) A description of, and plan for providing, any training
required for all direct care personnel to meet individuals' needs.
   (9) The name of the individual health care plan team member, and
an alternate designee, who is responsible for day-to-day monitoring
of the consumer's health care plan and ensuring its implementation as
written.
   (10) Identification of the legally authorized representative to
make health care decisions on the consumer's behalf, if the consumer
lacks the capacity to give informed consent.
   (11) The name and telephone number of the person or persons to
notify in case of an emergency.
   (12) The next meeting date of the individual health care plan
team, which shall be at least every six months, to evaluate and
update the individual health care plan.
   (b) In addition to Section 80075 of Title 22 of the California
Code of Regulations, the ARFPSHN shall comply with all of the
following requirements:
   (1) Medications shall be given only on the order of a person
lawfully authorized to prescribe.
   (2) Medications shall be administered as prescribed and shall be
recorded in the consumer record. The name and title of the person
administering the medication or treatment, and the date, time, and
dosage of the medication administered shall be recorded. Initials may
be used provided the signature of the person administering the
medication or treatment is recorded on the medication or treatment
record.
   (3) Preparation of dosages for more than one scheduled
administration time shall not be permitted.
   (4) Persons administering medications shall confirm each consumer'
s identity prior to the administration.
   (5) Medications shall be administered within two hours after
dosages are prepared and shall be administered by the same person who
prepared the dosages. Dosages shall be administered within one hour
of the prescribed time unless otherwise indicated by the prescriber.
   (6) All medications shall be administered only by those persons
specifically authorized to do so by their respective scope of
practice.
   (7) No medication shall be administered to or used by any consumer
other than the consumer for whom the medication was prescribed.
   (8) Medication errors and adverse drug reactions shall be recorded
and reported immediately to the practitioner who ordered the drug or
another practitioner responsible for the medical care of the
consumer. Minor adverse reactions which are identified in the
literature accompanying the product as a usual or common side effect,
need not be reported to the practitioner immediately, but in all
cases shall be recorded in the consumer's record. Medication errors
include, but are not limited to, the failure to administer a drug
ordered by a prescriber within one hour of the time prescribed,
administration of any drugs other than prescribed or the
administration of a dose not prescribed.

4684.70.  (a) The State Department of Social Services, in
administering the licensing program, shall not have any
responsibility for evaluating consumers' level of care or health care
provided by ARFPSHN. Any suspected deficiencies in a consumer's
level of care or health care identified by the State Department of
Social Services' personnel shall be reported immediately to the
appropriate regional center and the State Department of Developmental
Services for investigation.
   (b) The regional center shall have responsibility for monitoring
and evaluating the implementation of the consumer's individual plan
objectives, including, but not limited to, the health care and
intensive support service needs identified in the consumer's
individual health care plan and the consumer's integration and
participation in community life.
   (c) For each consumer placed in an ARFPSHN, the regional center
shall assign a service coordinator pursuant to subdivision (b) of
Section 4647.
   (d) A regional center licensed registered nurse shall visit, with
or without prior notice, the consumer, in person, at least monthly in
the ARFPSHN, or more frequently if specified in the consumer's
individual health care plan. At least four of these visits, annually,
shall be unannounced.
   (e) The State Department of Developmental Services shall monitor
and ensure the regional centers' compliance with the requirements of
this article. The monitoring shall include onsite visits to all the
ARFPSHNs at least every six months for the duration of the pilot
project.

4684.73.  (a) In addition to any other contract termination
provisions, a regional center may terminate its contract with an
ARFPSHN when the regional center determines that the ARFPSHN is
unable to maintain substantial compliance with state laws,
regulations, or its contract with the regional center, or the ARFPSHN
demonstrates an inability to ensure the health and safety of the
consumers.
   (b) The ARFPSHN may appeal a regional center's decision to
terminate its contract by sending, to the executive director of the
contracting regional center, a detailed statement containing the
reasons and facts demonstrating why the termination is inappropriate.
The appeal must be received by the regional center within 10 working
days from the date of the letter terminating the contract. The
executive director shall respond with his or her decision within 10
working days of the date of receipt of the appeal from the ARFPSHN.
The executive director shall submit his or her decision to the State
Department of Developmental Services on the same date that it is
signed. The decision of the executive director shall be the final
administrative decision.
   (c) The Director of Developmental Services may rescind an ARFPSHN'
s program certification when, in his or her sole discretion, an
ARFPSHN does not maintain substantial compliance with an applicable
statute, regulation, or ordinance, or cannot ensure the health and
safety of the consumers. The decision of the Director of
Developmental Services shall be the final administrative decision.
The Director of Developmental Services shall transmit his or her
decision rescinding an ARFPSHN's program certification to the State
Department of Social Services and the regional center with his or her
recommendation as to whether to revoke the ARFPSHN's license.
   (d) In addition to complying with Section 1524.1 of the Health and
Safety Code, any ARFPSHN licensee that is unable to continue to
provide services to consumers in the facility shall, upon the date on
which a new ARFPSHN license is issued pursuant to Sections 1520 and
1525 of the Health and Safety Code, arrange with the regional center
or department the transfer of all information, property, and
documents related to the operation of the facility and the provision
of services to the consumers. The department or the regional center
shall take all steps permitted by this article to ensure that at all
times the consumers who are residing in the facility receive services
set forth in their individual health care plans.

4684.74.  (a) By July 1, 2006, the State Department of Developmental
Services shall contract with an independent agency or organization
to evaluate the pilot project and prepare a written report of its
findings. The scope of services for the contractor shall be jointly
prepared by the State Department of Developmental Services, the State
Department of Social Services, the State Department of Public
Health, and the State Department of Health Care Services and, at a
minimum, shall address all of the following:
   (1) The number, business status, and location of all the ARFPSHNs.
   (2) The number and characteristics of the consumers served.
   (3) The effectiveness of the pilot project in addressing consumers'
health care and intensive support needs.
   (4) The extent of consumers' community integration and
satisfaction.
   (5) The consumers' access to, and quality of, community-based
health care and dental services.
   (6) The types, amounts, qualifications, and sufficiency of
staffing.
   (7) The overall impressions, problems encountered, and
satisfaction with the ARFPSHN service model by ARFPSHN employees,
regional center participants, state licensing and monitoring
personnel, and consumers and families.
   (8) The costs of all direct, indirect, and ancillary services.
   (9) An analysis and summary findings of all ARFPSHN consumer
special incident reports and unusual occurrences reported during the
evaluation period.
   (10) The recommendations for improving the ARFPSHN service model.
   (11) The cost-effectiveness of the ARFPSHN model of care compared
with other existing public and private models of care serving similar
consumers.
   (b) The contractor's written report shall be submitted to the
State Department of Developmental Services, the State Department of
Social Services, the State Department of Public Health, and the State
Department of Health Care Services. The State Department of
Developmental Services shall submit the report to the appropriate
fiscal and policy committees of the Legislature by January 1, 2010.

4684.75.  (a) The State Department of Developmental Services may
adopt emergency regulations to implement this article. The adoption,
amendment, repeal, or readoption of a regulation authorized by this
section is deemed to be necessary for the immediate preservation of
the public peace, health and safety, or general welfare, for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and the
State Department of Developmental Services is hereby exempted from
the requirement that it describe specific facts showing the need for
immediate action. A certificate of compliance for these implementing
regulations shall be filed within 24 months following the adoption of
the first emergency regulations filed pursuant to this section.
   (b) This article shall remain in effect only until January 1,
2011, and as of that date is repealed, unless a later enacted statute
extends or deletes that date.
   (c) This article shall only be implemented to the extent that
funds are made available through an appropriation in the annual
Budget Act.