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(a) Adult residential facilities (“ARFs”) are group care facilities that provide 24-hour nonmedical care to individuals aged 18-59 who need personal services, supervision, or assistance to support their activities of daily living. ARFs provide rooms, meals, housekeeping, supervision, storage and distribution of medications, and personal care assistance with basic activities like hygiene, dressing, eating, and bathing. ARFs are licensed by the Community Care Licensing Division of the State Department of Social Services (“CCL”).
(b) ARFs play an important role in a locality’s continuum of care by providing people with mental illness an opportunity to live in community-based housing, rather than in institutional care.
(c) A 2018 report by the California Behavioral Health Planning Council observed that due to ARF closures and a lack of new ARFs, many individuals with mental illness are not able to find sustainable community housing options with the appropriate level of care following stays in acute in-patient treatment programs, hospitals, or correctional institutions. The report concludes that the absence of community-based housing options can result in a “revolving door scenario” where people are discharged or released from an institution only to be unable to find appropriate residential care or housing. When another mental health crisis ensues, the absence of community-based housing opportunities can result in a return to high-level crisis programs, facilities, hospitals, jails/prisons, or homelessness.
(d) Since 2005, the San Francisco Department of Public Health (“DPH”) has operated an ARF at 887 Potrero Avenue. This ARF has been licensed by CCL to include 55 beds.
(e) In recent years, DPH has failed to maintain staffing at a level that was sufficient to operate the ARF at 887 Potrero Avenue at full capacity. In 2018-2019, DPH asked CCL for permission to temporarily suspend from licensure a total of 41 ARF beds at 887 Potrero Avenue so that they could be used instead as emergency shelter beds for people experiencing homelessness. CCL granted DPH’s request, thereby temporarily reducing the total number of beds at this ARF from 55 to 14. CCL’s approval extends through June 30, 2020, although DPH may seek CCL approval to restore the beds for use as ARF beds prior to that date subject to CCL’s finding that DPH can meet the licensing standards required to operate the ARF at full capacity.
(f) In October 2018, CCL concluded that on a number of occasions between 2015 and 2018, DPH had failed to comply with applicable laws and regulations in its administration of the ARF at 887 Potrero Avenue. To bring the facility into compliance, CCL required that DPH prepare a corrective action plan, which DPH prepared and submitted to CCL on October 15, 2018 (“Corrective Action Plan”). This plan lays out the steps DPH has taken and will continue to take, including training and monitoring, to ensure that the ARF operates in full compliance with all applicable standards.
(a) As of the effective date of this Article 45, and until March 31, 2020, DPH shall operate 28 of the beds at the ARF located at 887 Potrero Avenue as emergency shelter beds for people experiencing homelessness.
(b) By no later than April 1, 2020, and from that date forward, DPH shall maintain and operate at full capacity a licensed adult residential facility with no fewer than 41 beds, and shall take all steps necessary to ensure that all ARF beds at that facility are occupied by persons who meet the eligibility criteria for residence in an adult residential facility set forth in State law and in the facility’s license.
(c) To ensure compliance with the deadlines established in subsections (a) and (b), DPH shall take immediate action to:
(1) Notify CCL of its intent to operate 41 ARF beds, and take all steps necessary to ensure licensure of all 41 ARF beds;
(2) Identify clinically appropriate alternative placements for five ARF residents, and work with those residents to facilitate their voluntary relocation. Residents who are offered clinically appropriate alternative placements shall be given the opportunity to discuss their options with the ombudsman program before being transferred;
(3) Hire a sufficient number of qualified City staff to operate the 41 ARF beds; and
(4) Identify residents who qualify for placement in any available ARF beds on or after April 1, 2020.
(d) Staff from the Department of Human Resources (“DHR”) shall assist DPH to immediately, and with urgency, hire qualified City staff.
(e) DPH shall provide training to all DPH staff who work at DPH’s Behavioral Health Center located at 887 Potrero Ave on the following topics: trauma-informed care, patient safety, evidence-based de-escalation techniques, medication management, risk management, and first aid and cardiopulmonary resuscitation (CPR). These trainings shall be provided by subject matter experts who do not work at the Behavioral Health Center.
(f) DPH shall conduct an objective analysis and review of the Behavioral Health Center.
By no later than March 31, 2020, DPH shall submit to the Board of Supervisors a report summarizing the actions it has taken in compliance with this Article 45, and its objective analysis and review of the Behavioral Health Center, as referenced in subsection (f) of Section 4502.