CDCAN REPORT #012-2012: No new major issues in "Lanterman Developmental closure plan update" report released last week

DEPARTMENT OF DEVELOPMENTAL SERVICES RELEASES 3RD UPDATE REPORT ON CLOSURE PROCESS OF LANTERMAN DEVELOPMENTAL CENTER

No New Major Issues Reported - No Actual Closure Date Set Until Last Resident Is Actually Placed In A Community-Based Living Situation Says Department - Closure Process Impacts Regional Centers, Medi-Cal Managed Care Plans and Local Community-Based Services and Providers

SACRAMENTO, CA (CDCAN) [Last updated 01/22/2012 09:50 PM] - The Department of Developmental Services earlier last week released its third update report, covering progress between January 1, 2010 to December 1, 2011, on the closure process of Lanterman Developmental Center in Pomona, where just over 290 people with developmental disabilities reside in the 82 year old state owned and operated health facility.

The closure process and transition of those residing at the facility - and the transition of over 1,000 state employees is of a major on-going concern for them, their families, advocates, the employees and their families, including advocates in the Los Angeles area and across the State.  The closure and transition also has major impact on several important rights under federal and state laws - including the Americans with Disabilities Act (ADA) and the 1999 US Supreme Court "Olmstead v. Lois Curtis and Elaine Wilson" landmark lawsuit and California's Lanterman Developmental Disabilities Services Act, the nation's only State civil rights law specifically for persons with developmental disabilities. [CDCAN Note: The 41 page report is attached to this CDCAN Report as a document pdf file titled "2012-01 - Lanterman Developmental Center Update Closure Plan January 2012.pdf"  The document was saved as a document pdf - not as a pdf image which means persons who are blind or sight impaired should be able to read it using a screen reading device.]

The Department of Developmental Services , the state agency responsible for the operation of the state owned health facility, has not set an actual closure date, saying that the closure of the facility will only occur "...after the last resident transitions to his or her new living situation" and that "to ensure the health and safety of individuals" that "...transition will only occur after services and supports are available as identified through the individual planning process."

Closure and Transition Touches on Many Services, Agencies and Issues

• The closure plan and transition process involves bringing together many different programs and services administered by different State and local agencies - and also the federal government.
• It touches on the State's larger complicated efforts to shift people with disabilities and seniors in the Medi-Cal "fee-for-service" program into Medi-Cal managed health care plans.
• And it is impacted by the on-going State budget crisis that makes difficult a closure and transition plan that has a priority in maintaining the same levels of supports and services for people with developmental disabilities now residing in the developmental center who will be moved into the community. Their families and advocates say this major concern is crucial - as it was for the Agnews Developmental Center closure - given the significant health issues of many the Lanterman Developmental Center residents.
• So far, the latest update report by the Department of Developmental Services and the Governor's proposed 2012-2013 released earlier this month, appears to support the most of the major concerns of those families - though anything can happen and change if the State's budget situation gets worse in May when the Governor releases is budget revisions.  Given the uncertainity, many of those families and workers remain worried.

Persons can view the current update and previous update and information on the closure process of Lanterman Developmental Center on the Department of Developmental Services website at:  http://www.dds.ca.gov/LantermanNews/Index.cfm

No Major Issues In Latest Update

• There was no major issues or news in the latest update on the closure and transition process for Lanterman, which is the second such facility that the State is closing this decade - the other being Agnews Developmental Center in San Jose, which finally closed its doors officially in March of 2009.  The State closed two developmental centers during the 1990's - Stockton and Camarillo.
• While the Lanterman closure process has drawn less Statewide attention then the more controversial closure process of Agnews Developmental Center - a process that later ended up being widely praised by advocates and policymakers on all sides of that issue - some families at Lanterman Developmental Center remain deeply concerned or even strongly opposed to closure.
• Others, including those with the family advocacy group representing most of the families with family members residing at Lanterman, the Parents Coordinating Council (PCC), while not wanting the closure to happen, believe there is nothing that can be done to stop it, and instead have been working with the State to make sure their loved ones receive the same levels of supports, services and health care they receive now in the developmental center.
• With no end to the State's budget woes and more reductions coming to developmental and other human services budgets in the coming budget year, Lanterman Developmental Center families, other advocates and the state employees working there are deeply concerned about the on-going impact to a successful transition and closure process that will maintain services, supports and health and safety - as it was done successfully for the former residents at Agnews Developmental Center.

Lanterman Approved For Closure By Legislature As Part of 2010 State Budget

• Lanterman Developmental Center was proposed for closure by the Schwarzenegger Administration in January 2010, which the Legislature approved, as part of the 2010-2011 State Budget that was passed four months late in October 2010.
• Only 1,797 persons with developmental disabilities reside in the four remaining developmental centers and one smaller health facility that are owned and operated by the Department of Developmental Services.
• Over 250,000 children and adults with developmental disabilities receive different levels of community-based supports and services provided by community-based organizations and individuals funded through the 21 non-profit regional centers under contract by the Department of Developmental Services.
• The department also oversees - coordinated by the 21 non-profit regional centers - the State's federal early intervention program - called "Early Start" in California, to provide services for infants and toddlers up to 3 years with a developmental delay or disability or certain "at risk" conditions.
• The Department of Mental Health (eventually, with Legislative approval this year, to be transitioned into the "Department of State Hospitals") oversees a separate system of state hospitals for persons with mental health needs.  Developmental Centers also used to be known as "state hospitals" until the mid 1980's.

Background of Lanterman Developmental Center

• Executive Director:  Cheryl Bright
• Address of Lanterman Developmental Center:  3530 Pomona Blvd, Pomona, CA 91769-0100
• Lanterman Developmental Center Phone:  Public: (909) 595-1221 - TDD: (909) 595-3971
• Lanterman Developmental Center is located on 302 acres of state-owned land in Pomona, in Los Angeles County.
• The 82-year-old facility provides 24-hour residential care for persons with developmental disabilities, including cerebral palsy, epilepsy, down syndrome, autism and other lifelong conditions.
• Over 3,000 persons with developmental disabilities at one time resided at Lanterman Developmental Center, according to the department, with 295 persons residing there now.
• The center, originally established in 1927 as the "Pacific Colony" and then later "Pacific State Hospital" was re-named in 1979 after the late Republican Assemblymember Frank Lanterman, the author the landmark Lanterman Developmental Disabilities Services Act.  That landmark Act was in 1969 - and remains - the only state law in the nation that protects specifically the rights of children and adults with developmental disabilities (an early version of the law was first passed in 1966).  A regional center in Los Angeles County is also named after the assemblymember.

Population of Lanterman and Other Remaining Developmental Centers

As of December 28, 2011, 1,797 persons with developmental disabilities resided at the state owned and operated developmental centers and a smaller state owned and operated health facility (Agnews Developmental Center was proposed closure as part of the 2003-2004 State Budget and officially closed its doors on March 2009 and a smaller health facility, Sierra Vista in Yuba City was proposed for closure in June 2009 and officially closed its doors on February 28, 2010):

• Fairview Developmental Center (Costa Mesa in Orange County) - 382 residents
• Lanterman Developmental Center (Pomona in Los Angeles County) - 295 residents
• Porterville Developmental Center (Porterville in Kern County) - 511 residents
• Sonoma Developmental Center (Eldridge in Sonoma County) - 558 residents
• Canyon Springs (health facility) (Cathedral City in Riverside County) - 51 residents
• The following is population of the centers - and Lanterman Developmental Center at several points in time since 1994:
  • December 28, 2011:  1,797 persons (295 persons at Lanterman Developmental Center)
  • December 27, 2006:  2,878 persons (513 persons at Lanterman Developmental Center)
  • December 27, 2001:  3,738 persons (655 persons at Lanterman Developmental Center)
  • December 31, 1997:  4,046 persons (720 persons at Lanterman Developmental Center)
  • December 28, 1994:  5,517 persons (911 persons at Lanterman Developmental Center) 

Number of Lanterman Developmental Residents

• As of January 1, 2010, there were 401 residents who are covered by the transition and closure plan.
• Of the 401 persons, 398 were being served at Lanterman Developmental Center, with another 3 individuals temporarily receiving services from nursing facilities in the community.
• As of December 1, 2011, the Lanterman Developmental Center population included 302 people, compared to 340 on April 1, 2011, 363 on December 1, 2010,and 401 on January 1, 2010.
• Of the 302 people, 296 are served at Lanterman with 86 of those individuals (about 29%) living on one of the nursing facility (NF) residences and 210 of those individuals (approximately 71%) residing in one of the Intermediate Care Facility (ICF) residences.  The remaining 6 individuals are temporarily receiving services in nursing facilities (NFs) in the community.
• Length of Residence at Lanterman:  59% of the current Lanterman Developmental Center residents have lived there for more than 30 years, with 16% of the residents residing at Lanterman for 21 to 30 years, 14% for 11 to 20 years, 6% for five to 10 years, and 5% for fewer than five years.
• Age of Residents at Lanterman:  78% of Lanterman Developmental Center’s current population is over age 40. Of this group, residents who are 65 years of age or older make up 6% of the population with the oldest resident being 87 years of age. There are no children under 18 years of age at Lanterman, and only 9 residents (3%) are between 18 and 21 years of age
• Gender and Ethnicity at Lanterman:  The current residents at Lanterman is made up of 56% males and 44% female. The residents are 68% white (Caucasian), 18% Hispanic, 9% African-American, 4% Asian and Pacific Islander, and the remaining 1% is identified as "Filipino" and "Other."

Number of Persons Moved From Lanterman Between January 2010 - December 2011

The update reported that from January 2010 and December 1, 2011, 84 persons from Lanterman Developmental Center were to community living arrangements; specifically:

• 72 to an Adult Residential Facility, licensed by the Department of Social Services (DSS);
• 4 to a Residential Care Facility for the Elderly, licensed by Department of Social Services;
• 2 to a Congregate Living Health Facility, licensed by the Department of Public Health (CDPH);
• 2 to their own homes and being served by Regional Center-vendored Supported Living Services providers;
• 2 to an Intermediate Care Facility (ICF), licensed by Department of Public Health;
• 1 to a "962 Home" (Adult Resident For Persons with Special Heathcare Needs, licensed by Department of Social Services); and
• 1 to the individual’s family home.

Numbers of Lanterman Developmental Center Employees

• As of December 1, 2011, there were 1,026 staff at Lanterman Developmental Center, all State employees.
• 50% are direct care nursing staff, 41% are non-level-of-care and administrative support staff, and 9% are level-of-care professional staff.
• Of these employees, 92% are full-time, 3% are part-time, and the remaining 5% are intermittent, temporary, or limited-term.
• Length of Service at Lanterman:  35% of the employees have worked at Lanterman Developmental Center for 10 years or less, while 38% of the workforce have worked at the facility between 11 and 20 years. The remaining 27% have worked at there for 20 years or more
• Age, Gender and Ethnicity at Lanterman:  65% of the workforce is female and 35% male. Of the total workforce, 50% of employees are 50 years of age or older and 23% are between 43 and 50 years of age. Hispanics make up 28% of the total workforce at Lanterman, with whites (Caucasians) making up 26%, followed by 24% who are African-Americans, 10% Asians, 9% Filipinos and the remaining 3% who identified themselves as "other".
• For the period of January 1, 2010 to December 1, 2011, a total of 273 employees separated from Lanterman through transfer, retirement, resignation, dismissal or other cause.
• The Department of Developmental Service said it is working directly with Lanterman Developmental Center management and staff to "...closely monitor staffing levels in all areas to ensure that staffing standards are met and that the quality of services at Lanterman is maintained".
• As of December 2011, level of care staffing meets certification standards throughout the facility, according to the Department report.

CDCAN SUMMARY OF THE LANTERMAN DEVELOPMENTAL CENTER CLOSURE JANUARY 2012 UPDATE REPORT

The following is the CDCAN summary of the Department of Developmental Services' January 2012 Update report to the Legislature, required under State law:

RESIDENT TRANSITION PLANNING PROCESS

• Before a resident moves from Lanterman, the Department of Developmental Services says an "Individual Health Transition Plan" will be developed by the planning team so that special attention is given to assure all of the necessary health supports are in place prior to the resident transitioning to a new living arrangement.
• The Department of Developmental Services in its update report says that "...only through careful planning and oversight can a safe transition for each person be assured. Because of its importance, the [Closure] Plan identified the need for the RTAG [Resident Transition Advisory Group] to consider the practices that were utilized during Agnews’ closure and the lessons learned and make recommendations to the Department for enhancements and improvements".
• The Resident Transition Advisory Group was established to make recommendations to the Department to enhance the transition planning process in place for residents at Lanterman. Membership includes representatives from the Lanterman Resident Council, parents and family members of Lanterman residents, the involved regional centers, advocacy groups, and employees of Lanterman and Department of Developmental Services.
• The Resident Transition Advisory Group began meeting in September 2010 and members held their final meeting in February 2011.
• Three documents were developed by the group and presented to the Department of Developmental Services for implementation. In addition to the Resident Transition Guidelines, "Transition Plan" and "Individual Health Transition Plan" and "Transition Activities" were also produced. The "Transition Plan" and "Individual Health Transition Plan" provides the template for capturing critical information about the resident’s preferences, needs and effective next steps.
• It is meant to serve as a reference document during the transition planning process, by the service provider upon the individual’s placement, and for post-placement monitoring. The "Transition Activities"  is a supplemental document that is used by the RRDP to track and coordinate resident activities as part of the planning team process.
• The Department is in the final stages of reviewing "Narrative Guidelines for Resident Transition". The "Transition Plan" and "Individual Health Transition Plan" and "Transition Activities" have been finalized and were introduced at the Parent Coordinating Council meeting in April 2011. The new process was implemented at Lanterman Developmental Center in July 2011.

ACCESS TO COMMUNITY HEALTH AND MEDICAL SERVICES

CDCAN Note: Lanterman Developmental Center - like the other remaining developmental centers, is a licensed health facility with services provided under three levels of care: licensed as a General Acute Care Hospital with distinct or separate licenses for as an Intermediate Care Facility (or ICF) and Nursing Facility (NF), that is matched by Medicaid dollars). The developmental center provides nearly all of the basic health care needs for the people residing there.  Like the Agnews closure in the Bay Area, the issue of maintaining that level of health care is of major concern to the people residing there and their families and other advocates, when residents are moved into community-based settings.

• The Department of Developmental Services, in its January 2011 update, said that "assuring that the health needs of all Lanterman residents are accurately and comprehensively addressed, while at the facility, throughout transition, and then ongoing, is essential to support the quality of life for each person affected by the closure" and that "several of the services and tools that were put into place during the closure of Agnews [Developmental Center] are being reviewed and adapted..." for the closure of Lanterman Developmental Center including the following "essential health services components":
• A "comprehensive" nursing and risk assessment tool that is completed for each individual prior to leaving Lanterman Developmental Center. This tool includes over 60 health-related items including risk conditions, special health care needs and dietary needs.
• An Individual Health Transition Plan (IHTP) that comprehensively assesses, records and plans for all consumer health needs before, during and after transition to a community living arrangement. Included within that plan are community behavior assessments for consumers with behavioral or transition challenges.
• The work of the Resident Transition Advisory Group (RTAG) will, according to the department, play a key role in ensuring the health and well being of Lanterman Developmental Center residents, and providing transition guidelines for comprehensive planning purposes.
• Further supplemented by the work of the Quality Management Advisory Group (QMAG), recommendations have been made to the Department of Developmental Services for improving quality management systems not only for transition, but for ongoing quality assurance and positive consumer outcomes.

MEDI-CAL MANAGED HEALTH CARE IMPACTED BY LANTERMAN CLOSURE

CDCAN Note: The movement of people with disabilities and seniors into Medi-Cal managed care involves different programs, projects and initiatives, including the closure of Lanterman Developmental Center.  Like those who moved from Agnews in the Bay Area, people residing at Lanterman Developmental Center transitioning in the nearby community would also transition into a Medi-Cal managed health care plan.  What is not clear is if those residents moving into those health plans would maintain the same level of Medi-Cal benefits they currently received in a developmental center (about nine adult Medi-Cal benefits outside of nursing facilities and intermediate care facilities in 2009 were eliminated).  An adult dental program however - through Medi-Cal's Denti-Cal program - is available to replace the eliminated Medi-Cal adult dental benefit for persons with developmental disabilities eligible for regional center services (which includes Lanterman Developmental Center residents moving into the community).

• The Department of Developmental Services and the Department of Health Care Services continue to work together to identify, clarify and resolve issues and implement requirements related to the health care for Lanterman residents who will move into the community. A critical component for transition is to ensure immediate access to appropriate health care.
• The budget related bill to the 2010-2011 State Budget (SB 853, Chapter 717, Statutes of 2010) as enacted October 19, 2010, extended the same provisions in State law that were put in place for the Agnews closure to also cover Lanterman closure. Those provisions (in Welfare and Institutions Code sections 4474.4 and 4474.5), authorizes health care through Medi-Cal managed care health plans for persons meeting specified requirements.
• In March 2011, to increase health care choices for those people with developmental disabilities transitioning from Lanterman Developmental Center, those provisions were amended by a budget related bill to the 2011-2012 State Budget (AB 97, Chapter 3, Statutes of 2011) to clarify that all health plans operating in the various central and southern California counties impacted by the closure of Lanterman Developmental Center are included.  The Brown Administration is hoping that through Medi-Cal managed health care the former residents of Lanterman Developmental Center will receive improved access to health services and enhanced case management.

As with Agnews closure, the regional centers and the Medi-Cal managed health plan will have case managers that coordinate and understand the person’s special health care needs. For regional centers the "Health Care Community Specialist" position will be funded through the federal Money Follows the Person grant (see section on that grant).

Following are key areas of work dealing with the Medi-Cal Managed Health Care and Lanterman Closure:

• Regional centers and health plans generally already have "well established partnerships" in the counties impacted by the closure of Lanterman Developmental Center according to the department's January 2012 update report. The Department of Developmental Services and the Department of Health Care Services have provided information to the regional centers and health plans so they can plan for the health needs of people transitioning from Lanterman Developmental Center into the community, with technical assistance provided as needed.
• As a priority, regional centers and the Medi-Cal health plans developed MOUs (Memorandums of Understanding - an informal agreement or contract) that specifically defines the protocols (procedures or process) that will implement requirements of state and federal laws to ensure the health and welfare of each person transitioning from Lanterman; that makes clear roles and responsibilities, and that all are appropriately accountable for maximizing the health and welfare of each individual.
• The Department of Health Care Services and the Department of Developmental Services have finalized the MOU (Memorandum of Understanding) between the two departments for the Lanterman closure. It defines the respective responsibilities and commitments of the two departments, including for all parts of the Lanterman closure that require Department of Health Care Services specific action or involvement, including those for implementing Medi-Cal managed care.
• The Department of Developmental Services reported that procedures have been put into place to expedite (speed up) health plan eligibility and enrollment prior to persons with developmental disabilities leaving Lanterman Developmental Center so that they have "timely access to health care in the community". These procedures define the role and responsibilities of Lanterman Developmental Center, regional centers, the Department of Health Care Services, and the Medi-Cal health plans involved.
• The Department of Developmental Services and the Department of Health Care Services in April 2011, entered into a "Data Use Agreement" and began sharing data, following appropriate security measures as defined in the agreement. The Department of Health Care Services used the data to develop rates for reimbursing the health plans under the new state law. Additionally, the department said in its January 2012 report that this data is critical for expediting the health care eligibility and enrollment processes as consumers transition to the community.
• The Department of Health Care Services, according to the Department of Developmental Service's update, is working with the Medi-Cal managed care health plans to ensure that provider networks are in place to "...meet the unique medical needs of individuals transitioning to the community".
• The Department of Developmental Services and the Department of Health Care Services will address any policy or procedural issues that are identified throughout this process, and will seek approval from the federal Centers on Medicare and Medicaid Services (CMS) (the federal agency that oversees both programs nationwide) or other approvals, as determined appropriate.

LANTERMAN OUTPATIENT CLINIC

• One of the budget related bills to the 2010-2011 State Budget (SB 853, Chapter 717, Statutes of 2010) enacted October 19, 2010, authorized the operation of an Outpatient Clinic at Lanterman Developmental Center.
• Similar to the Outpatient Clinic at Agnews, that 2010 budget related bill required that available health and dental services be provided to persons with developmental disabilities who move from Lanterman Developmental Center into the community, "..to ensure continuity of medical care and services" as they transfer to new health care providers.
• The 2010 budget related bill requires that the Department of Developmental Services to operate the Outpatient Clinic until the Department is no longer responsible for the property.
• July 26, 2011:  Lanterman Developmental Center applied for and received approval from the California Department of Public Health to expand its current license to provide outpatient services.
• August 23, 2011:  The grand opening for the Outpatient Clinic was held at Lanterman Developmental Center on August 23, 2011 and was attended by various stakeholders including local regional centers, community-based service providers, relatives of Lanterman Developmental Center residents, and employees of the center. Since the opening, the Outpatient Clinic has been accepting referrals for clinic services. At present, only former residents of Lanterman Developmental Center are being served by the clinic.
• December 1, 2011 - as of this date, the Outpatient Clinic had provided services to 3 former Lanterman Developmental Center residents for dental care and was proceeding with additional requests for services.

DEVELOPMENT OF HOUSING AND COMMUNITY RESOURCES

• The Community Placement Plan (CCP) is designed to assist regional centers with funding to "...enhance the capacity of the community service delivery system to enable individuals with developmental disabilities the opportunity to live in the least restrictive living arrangement appropriate for their needs" according to the Department of Developmental Services' January 2012 update report on the Lanterman closure process.
• Developing community capacity through this process, according to the department update, "...provides the necessary resources to prevent individuals [with developmental disabilities] from admission to a developmental center, as well as the necessary services and supports for individuals transitioning from a developmental center to the community, when appropriate. The CPP encompasses the full breadth of resource needs including the development of both residential and day services."
• Under state law, the Department of Developmental Services is responsible for reviewing and approving Community Placement Plan proposals for each regional center. Based on the needs of each regional center's developmental center residents, regional centers propose development of housing and other projects using guidelines issued by the Department of Developmental Services. Funds for the Community Placement Plan are appropriated in the annual State budget process based on those projects approved by the department and then allocated to the regional centers.
• Community Placement Plan efforts for regional centers impacted by the closure process of Lanterman Developmental Center have focused, according to the department's January 2012 update report, on developing resources needed to achieve "...a safe and successful transition of individuals from Lanterman to other appropriate living arrangements".
• The Community Placement Plan includes community-based services and supports needed by each individual including (but not limited to): living options, day services, health services and other supports, are being identified through in-depth assessment and the planning team’s development of the Individual Program Plan (IPP).
• The Department of Developmental Services reports that it meets regularly with the Southern California Conference of Regional Center Directors (SCCRCD) and Community Placement Plan liaisons to focus on the specific needs of the residents for planning and resource development.
• The Southern California Integrated Health and Living Project (SCIHLP) is providing additional support in accessing available resources and developing additional housing. This project was established in the 2005-2006 State Budget when 9 regional centers in Southern California joined together to form this collaborative partnership to create permanent living options and individualized supports for persons who currently live in a developmental center or other large congregate care facility. The project's resource development and staffing resources are now focused on assisting regional centers in developing regional resources to meet the specialized needs of Lanterman Developmental Center residents by assisting regional centers and Lanterman staff with assessments, identifying barriers, and developing smaller community-based settings for individuals.
• The Department of Developmental Services reported that it has secured the services of a "licensing liaison" to provide expert assistance with licensing, permitting, tracks the progress of all new community living arrangements for licensing in a timely manner, obtaining fire clearances, and supporting residential development involved with opening a licensed community living arrangement, with a focus on coordinating licensing applications for new homes with the Department of Social Services' (DSS) licensing offices, ensures appropriate trainings and communications are occurring, and provides support and education to all concerned with the development and licensing of the "962 Homes" (see below) . The liaison meets with other state and local groups on a regular basis.
• The Department of Developmental Services reports in its January 2012 update that regional centers are "...engaged in a variety of efforts and strategies to communicate and collaborate about Lanterman closure" including outreach with families and advisory groups, and involvement with various aspects of the closure process.
• As part of the transition planning process, RC staffs are meeting with individuals and their family members to facilitate the development of an individualized, tailored plan that addresses person-specific questions and concerns.
• Regional centers, according to the update report, are also regularly participating in meetings with parents and advocacy groups in order to share information, increase collaboration, coordinate transition planning, and provide notification of processes such as when Requests for Proposals (RFPs) are distributed.  Several regional centers are conducting quarterly parent meetings designed to provide residents and family members a forum to address specific issues directly with both regional center staff and prospective vendors. Tours of potential homes, day programs, and other support services are continuing to provide informational opportunities for individuals transitioning to the community, their family and friends, and other interested parties.
• In June 2011, regional center and providers participated in a provider fair organized by the Parent Coordinating Council (PCC). A second fair for providers organized by Lanterman Developmental Center employees was held in November 2011. Regional centers, as part of the quality assurance system, are completing "Provider Profiles" for each service provider identified to serve individuals transitioning from Lanterman Developmental Center. These profiles give consumers and families information about potential service providers.
• Regional centers and the Department of Developmental Services are also making efforts to access other resources such as the federal "Section 8" housing vouchers and the development of specialized residential services, which the department reports is "well underway", including approval for 14 "962 Homes" (officially known as Adult Residential Facilities for Persons with Special Health Care Needs or ARFPSHNs), enhanced behavioral support homes, and wraparound services.
• The Department of Developmental Services reports in its update that in providing support for the needs of consumers transitioning to the community, "...day programs and employment opportunities are being designed to consider the needs of consumers who may have PICA, medical or behavioral issues, and/or physical challenges. Customizing programs for in-home implementation, obtaining consultation from experts in the field during the program design development stage, and specializing existing services in the community are a few ways in which RCs are enhancing resource development".

"962 HOMES"

• As part of the Plan for the Closure of Agnews Development Center, legislation authored by then State Sen. Wes Chesbro (SB 962, Chapter 558, Statutes of 2005) authorized the Department of Developmental Services and the Department of Social Services to establish and administer a pilot project for certifying and licensing a new residential model to support those with unique needs within a homelike community setting.  This new model is officially called "Adult Residential Facilities for Persons with Special Health Care Needs (ARFPSHN), but is more often referred to as the "962 Homes".
• A budget related bill to the 2010-2011 State Budget (SB 853, Chapter 717, Statutes of 2010), enacted October 19, 2010, expanded use of the "962 Homes" licensure category for persons who require this level of care and are transitioning from Lanterman Developmental Center into the community. With Department of Developmental Services approval, resources within the existing budget for the Regional Centers' Community Placement Plan have been made available to fund the start-up and development of these homes.
• The "962 Homes" require 24-hour-per-day licensed nursing staff (Registered Nurse, Licensed Vocational Nurse, and Psychiatric Technician); Department of Developmental Services program certification; and mandatory safety features (fire sprinkler system and an alternative back-up power source).
• Chesbro, the Department of Developmental Services and advocates believed that the creation of the new "962 Homes" model was necessary to fill a critical gap in the existing residential licensure categories; specifically, residences for people with developmental disabilities who have a combination of specialized health care and intensive support needs. Under the "962 Homes" the person with developmental disabilities' health conditions must be "predictable and stable" at the time of admission, according to the department's January 2012 update report, as determined by the individual health care planning team and stated in writing by a physician. In addition to 24-hour-per-day nursing supervision, the state law requires:
  • Development of a written individual health care plan that lists the intensive health care and service supports for each resident and is updated at least every six months;
  • Examination by the resident’s primary care physician at least once every 60 days;
  • At least monthly face-to-face visits with the resident by a RC nurse;
  • Department of Developmental Services approval of the program plan and on-site visits to the homes at least every six months; and - Department of Social Services licensure of the homes, which includes criminal background clearance, Administrator orientation, annual facility monitoring visits, and complaint resolution.
• Regional Center representatives, parents and families of Lanterman Developmental Center residents have toured Bay Area "962 Homes" (ARFPSHN) homes. Regional Centers have received, according to the Department of Developmental Services January 2012 update report, comprehensive training on how these homes operate, who they are designed to serve, the requirements under State and federal law, and resource development considerations involved in developing "962 Homes" for Lanterman Developmental Center residents. Regional Centers continue to conduct assessments to determine the individual needs of each Lanterman Developmental Center resident and whether their needs could be met in a "962 Home".
• Through the Community Placement Plan process, regional centers have proposed, and the Department of Developmental Services has approved, the development of 14 "962 Homes" (ARFPSHNs) for the closure of Lanterman.

MONEY FOLLOWS THE PERSON GRANT

• The Department of Developmental Services is participating in the federal Money Follows the Person (MFP) grant administered by the Department of Health Care Services. All persons with developmental disabilities transitioning from a developmental center or a state-operated community facility to a four-bed or less community living arrangement will be enrolled by their regional center in "California Community Transitions", a federal Money Follows the Person grant administered through an interagency agreement with the Department of Health Care Services.
• This grant will provide additional opportunities, the Department of Developmental Services believes, for assisting persons in transitioning from Lanterman Developmental Center services to federal Medicaid community-based waiver services and maximizing Federal Financial Participation (FFP) - federal matching funds.
• Through this Money Follows the Person grant, the regional centers receive 100% federal funding in the 2011-2012 State Budget year for 34 additional staff at a cost of $3.5 million (federal funds) to support the development of specialized resources and the transition of Lanterman Developmental Center residents into the community including service brokering and overall coordination to ensure individually-based, comprehensive and interactive transition planning and services for each person transitioning; professional and/or medical assessments for development and subsequent implementation of treatment plans regarding behavioral services and supports needed in the community; conducting activities necessary to develop potential providers of day, residential, transportation, and employment services; monitoring and training of community service providers based upon statutory/regulatory requirements and best practices to ensure quality services; coordination of community health services and provision of in-depth consultation and assistance with the enrollment and transfer of health care coverage to local area health insurance plans; and development of community capacity for medical and dental care in the community.

QUALITY MANAGEMENT SYSTEM FOR LANTERMAN CLOSURE

• The Lanterman "Quality Management Advisory Group" (QMAG) was formed specifically to assure quality services and supports to each individual transitioning from Lanterman.
• This group consists of representatives from the Lanterman Parents Coordinating Council (PCC), the State Council on Developmental Disabilities (SCDD), Area Boards on Developmental Disabilities, Disability Rights California (DRC), People First of California, a Lanterman resident, and 12 regional center representatives.
• The group first convened on August 12, 2010, to discuss the role of the group, to identify additional strategies and enhancements needed for the Lanterman closure, and to review quality assurance tools utilized in the Bay Area Quality Management System (BAQMS) in order to guide the Department of Developmental Services and regional centers during the Lanterman Developmental Center closure process.
• The Lanterman Quality Management Advisory Group last convened on March 7, 2011 (as of the January 2012 update), to provide final input on recommended enhancements to the quality assurance system for individual’s who transition from Lanterman.
• The Quality Management Advisory Group will reconvene during the 2011-2012 State Budget year (that ends June 30, 2012) to review data from the quality management system. One source of data will be the National Core Indicator (NCI) Consumer Survey collected on individuals who have moved from developmental centers, which includes those who have moved from Lanterman Developmental Center.
• The group reviewed the existing Quality Management System requirements and recommended enhancements for both regional centers and residential vendors serving individual’s transitioning from Lanterman Developmental Center.
• A phased-in implementation of the quality assurance changes (as proposed by the group) began in July of 2011, with implementation materials distributed to the regional centers involved in the Lanterman closure process. These changes include:
  • Provider Profiles that include information regarding the qualifications and experience of service providers and specify models for service delivery. Regional centers will share the "Provider Profiles" with the Parent Coordinating Council (PCC), parents, and family members to enhance participation and informed decision-making during the transition planning process;
  • Collection and aggregation (adding up) of data on key quality of life indicators of persons with developmental disabilities residing at Lanterman Developmental Center from multiple sources including the Client Development Evaluation Report (CDER), service coordinators and quality assurance staff during regular monitoring visits, and "Visitor Snapshots". The "Visitor Snapshots" will be a key component of the quality management system as a means to collect information on service quality from families and friends.
  • Recommended changes to Title 17 (of the California Code of Regulations) regarding vendor requirements that include administrator and staff experience, staff continuing education, staffing patterns, monitoring, and transition planning. 

LANTERMAN DEVELOPMENTAL CENTER EMPLOYEES

• The Department of Developmental Services reports that it has already conducted several employee forums for staff to provide input for consideration in the planning process and that department management continues to meet regularly with employees at Lanterman Developmental Center to share information, hear employee issues and respond to questions.
• Special meetings are also held between management and union representatives, specifically the American Federation of State, County, and Municipal Employees (AFSCME) Local 2620, AFL-CIO; the California Association of Psychiatric Technicians (CAPT); the Service Employees International Union (SEIU) Local 1000; the International Union of Operating Engineers (IUOE); the California Statewide Law Enforcement Association (CSLEA); and the Union of American Physicians and Dentists (UAPD) Local 206, AFL-CIO.
• The most recent meeting, according to the Department's January 2012 update report, occurred on November 7, 2011.
• The Department of Developmental Services says in its January 2012 update report the following will be done to "mitigate the impact" on the state employees by doing the following:
  • Provided them with current accurate information to assist them in understanding their choices and rights before making decisions that could impact their futures.
  • Provided encouragement to seek new opportunities to serve individuals with developmental disabilities within the developmental center or community service system.
  • Offered assistance to help develop personal plans that support their objectives and maximize their expertise.
  • Provided with opportunities to enhance their job skills. 

STAFF SUPPORT ADVISORY GROUP

• A "Staff Support Advisory Group" (SSAG) was convened to help determine adequate staffing to maintain normal operations and to assist Lanterman Developmental Center employees in developing personal plans for their future, to make sure there is accurate and timely communication about the closure process for all developmental center employees. The membership includes a large cross section of the developmental center's employees representing all labor bargaining units and management, one family member of a Lanterman resident, and representatives from the Department of Developmental Services.
• This advisory groups makes recommendations to the Lanterman Developmental Center Executive Team and to the Department of Developmental Services to help ensure continuity of the staffing and meet the needs of transitioning employees.

CAREER CENTER / STAFF OPTIONS AND RESOURCE CENTER

• The Staff Options and Resource Center (SOARC or Center), formerly referred to as the Career Center, opened in May 2011. The Center provides personal support for each employee, assists employees in identifying their future interests, and equips employees with the knowledge they need to successfully achieve their goals.
• As part of the Staff Support Advisory Group function, the Lanterman employees were surveyed to obtain information on their future employment interests, including relocation to another developmental center and also to solicit from them the resources and assistance they believe are needed during the closure. The survey results were analyzed and used to prioritize the services Staff Options and Resource Center provides to the employees.
• Services include computer work stations to promote access to various internet sites to assist in searching for employment and professional development, reference materials related to self-help and career development, postings for State and local employment opportunities, on-line courses for resume writing and job-seeking enhancement tools
• On behalf of Lanterman’s employees, contact has already been made with the California Employment Development Department’s Los Angeles County Rapid Response Coordinator and the Los Angeles Urban League Pomona WorkSource Center. These entities, according to the Department's January 2012 update report "...stand ready to provide the comprehensive services as specified in the Workforce Investment Act (WIA) and assist Lanterman in providing Career Center services that include education and information related to interview skills, resume preparation, unemployment benefits, the California Training Benefits program, credit counseling and Employee Assistance Program services".

STATE STAFF IN THE COMMUNITY

• The budget related bill of the 2010-2011 State Budget (SB 853, Chapter 717, Statutes of 2010), enacted October 19, 2010, authorized the Department of Developmental Services employees working at Lanterman Developmental Center to work in the community with former residents while remaining state employees for up to two years following the transfer of the last resident from Lanterman, unless a later enacted statute deletes or extends this provision.
• This program is referred to as the "State Staff in the Community Program", similar to the program for state employees during the Agnews closure.
• Like that program, Lanterman Developmental Center state employees will, through contract, be able to directly support former residents of Lanterman in their new homes, which the Department of Developmental Services believes will "...enhance the quality and promote continuity of services in the community".
• The Department of Developmental Services has worked with the Department of Personnel Administration to establish agreements with the appropriate bargaining units (unions) to support the program.
• A marketing plan is being developed to provide information, generate interest, and obtain feedback from state employees at Lanterman Developmental Center, as well as regional centers and community-based service providers who may seek to contract with Lanterman Developmental Center to participate in the program.
• Lanterman Developmental Center is proceeding with implementation of the program and working with interested parties to develop contracts, job descriptions and advertisements to recruit and select Lanterman employees for the program.
• As of December 1, 2011, no Lanterman Developmental Center state employees are working in the community as part of the Community State Staff (CSS) program. The Department of Developmental Services expects this to change as more community resources come on line.

MANAGEMENT OF EMPLOYEES UNTIL CLOSURE

• The Department of Developmental Services is working directly with the Lanterman Developmental Center Executive Team to "...assure that sufficient staffing levels are maintained to meet certification standards throughout the closure, based on the number and acuity of the residents."
• As of December 2011, level of care staffing meets certification standards throughout the facility.

File Attachments: 

2012-01 - Lanterman Developmental Center Update Closure Plan January 2012.pdf (197.14 KB)