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(a) (1) As part of the safety net plan required by Section 4474.16, the department may develop a residential program in the community for adolescents and adults with complex needs. This program shall consist of up to three complex needs homes described in this section. A complex needs home shall not exceed five beds per home and any stay shall not exceed 18 months, except as provided by paragraph (5) of subdivision (e).
(2) If the regional center determines, or is informed by the consumer’s parents, legal guardian, conservator, or authorized representative, that the community placement of a consumer is at risk of failing and that admittance to a complex needs residential home is a likelihood, or the regional center is notified by a court of a potential admission to a complex needs home, the regional center shall immediately notify the appropriate regional resource development project, the consumer, the consumer’s parents, legal guardian, or conservator, and the regional center clients’ rights advocate.
(3) For purposes of this section, notification to the clients’ rights advocate for the consumer’s regional center shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the individual program plan meeting to be held pursuant to paragraph (3) of subdivision (b). The regional center shall provide this notice as soon as practicable, but no later than seven calendar days prior to the meeting.
(b) (1) Upon notification by the regional center, the regional resource development project shall immediately conduct an assessment of the situation that includes all of the following:
(A) Visiting the consumer, if appropriate.
(B) Determining barriers to successful community inclusion.
(C) Providing recommendations on the most appropriate means necessary to assist the consumer to reside in the most inclusive living arrangement.
(2) The regional center shall immediately request assistance from the statewide specialized resource service established pursuant to Section 4418.25 in order to determine the most appropriate means necessary to assist the consumer to reside in the most inclusive living arrangement and shall provide the information obtained from the statewide specialized resource service to the regional resource development project. If, based on the assessment required by paragraph (1), the regional resource development project determines that additional or different services and supports are necessary, the regional center shall provide those services and supports on an emergency basis.
(3) An individual program plan meeting, including the regional resource development project’s representative, if necessary, shall be convened as soon as possible to review the emergency services and supports required by the consumer and to determine the consumer’s ongoing needs for services and supports. The regional resource development project shall follow up with the regional center as to the success of the recommended interventions until the consumer’s living arrangement is stable.
(c) (1) If the regional resource development project determines, based on the assessment conducted pursuant to subdivision (b), that the consumer referred to the regional resource development project by the court cannot be safely served in a complex needs home, the department shall notify the court of that determination in writing and shall continue to work jointly with the regional center to identify or develop alternative services and supports and implement the alternative services and supports that are identified or developed.
(2) (A) If the regional resource development project, in consultation with the regional center, the consumer, and, when appropriate, the consumer’s parents, legal guardian, conservator, or authorized representative, determines that admission to a complex needs home is necessary due to an acute crisis and the director of the department or their designee has approved that admission, the regional center shall immediately pursue a court order for short-term admission and crisis stabilization pursuant to Section 6506.
(B) A determination that admission to a complex needs home is necessary due to an acute crisis shall not be made until the regional center completes a report that includes all of the community-based services and supports considered, including, but not limited to, a community crisis home certified pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5, a supported living arrangement pursuant to Section 4689, including rental subsidies described in subdivision (i) of that section, environmental accessibility adaptions or other home modifications, supplemental services and emergency and crisis intervention services described in subdivision (a) of Section 4648, whether rate adjustments are necessary to secure the services and supports considered, and the reasons those options will not meet the consumer’s needs.
(C) For purposes for the report described in subparagraph (B), a regional center shall not be required to consider out-of-state placements or mental health facilities, including institutions for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5, that are ineligible for federal Medicaid funding.
(d) For purposes of this section, out-of-state placements or mental health facilities and other facilities, including institutions for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5, for which federal Medicaid funding is not available, shall not be deemed to be supplemental services or emergency and crisis intervention services under subdivision (a) of Section 4648.
(e) An admission of an adolescent or adult with complex needs to a complex needs home due to an acute crisis shall meet all of the following requirements:
(1) An initial court commitment pursuant to this section shall not exceed six months. As soon as possible following admission to a complex needs home, a comprehensive assessment shall be completed by the regional center in coordination with the regional resource development project and the complex needs service staff. The comprehensive assessment shall include an identification of the services and supports needed for crisis stabilization and the timeline for identifying or developing the services and supports needed to transition the consumer back to a non-crisis community setting. Upon completion of the assessment, the regional center shall submit a copy of the assessment to the committing court.
(2) Immediately following the assessment, and not later than 30 days following admission, the regional center and the complex needs home shall jointly convene an individual program plan meeting to determine the services and supports needed for crisis stabilization and to develop a plan to transition the consumer back to community living pursuant to Section 4418.3. The clients’ rights advocate for the regional center shall be notified of the consumer’s admission and the time, date, and place of the individual program plan meeting and may participate in the meeting unless the consumer objects on their own behalf.
(3) If transition back to the community is not expected to be achieved within 180 days of admission, an individual program plan meeting shall be held to discuss the status of the transition and to determine if the consumer is still in need of crisis stabilization. If crisis services continue to be necessary, the regional center shall submit to the department an updated transition plan and a request for an extension of the consumer’s stay at the complex needs home for a period not to exceed 180 days. A consumer may reside in a complex needs home for up to one year, after which the consumer shall transition into a community living arrangement pursuant to Section 4418.3.
(4) (A) Notwithstanding paragraph (3), a consumer may continue to reside in a complex needs home for a period not to exceed 18 months if all of the following conditions are met:
(i) After an additional comprehensive assessment by the regional center, the department determines that the consumer requires continued placement in a complex needs home.
(ii) An individual program plan is developed that identifies the specific services and supports necessary for the consumer to transition back into the community and includes a timeline to obtain those supports and services.
(iii) The committing court has reviewed and, if appropriate, extended the commitment.
(B) The clients’ rights advocate for the regional center shall be notified of any proposed extension under subparagraph (A). The clients’ rights advocate shall also be notified of the time, date, and place of any individual program plan meeting to consider the extension and may participate in the meeting unless the consumer objects on their own behalf.
(5) Notwithstanding paragraph (4), the regional center may request, and the committing court may grant, an additional extension of a consumer’s commitment, not to exceed 90 days, if both of the following conditions are met:
(A) The regional center has demonstrated significant progress towards implementing the individual program plan required by clause (ii) of subparagraph (A) of paragraph (4).
(B) Extraordinary circumstances exist beyond the regional center’s control that prevent the regional center from obtaining the services and supports required by the consumer according to the timeline included in the individual program plan.
(6) A consumer who transitions into the community after admission to a complex needs home pursuant to this section shall be considered to have complex needs for purposes of Section 4640.6.
(f) Consumers with complex needs may participate in day, work, educational, and recreational programs when the individual program plan identifies it is appropriate and consistent with the individual’s treatment plan. The complex needs homes shall assist the consumer with transitioning back to their prior residence, or an alternative community-based residential setting, within the timeframe described in this section.
(g) (1) The department may execute leases, lease-purchases, or leases with the option to purchase for real property necessary for the establishment or maintenance of homes to serve as complex needs homes.
(2) A complex needs home shall not be established or maintained in an existing building on the grounds of a developmental center described in Section 7505 that, at any point prior to June 30, 2023, had been licensed as a skilled nursing facility, intermediate care facility, or general acute care hospital, or was otherwise used for the purpose of the treatment or residential placement of consumers.
(h) For purposes of this section, the following definitions shall apply:
(1) “Acute crisis” means a circumstance that necessitates the admission of a consumer to a complex needs home due to the existence of both of the following conditions:
(A) There is imminent risk for substantial harm to the consumer or others.
(B) Existing services and supports available to the consumer in the community, including supplemental services and emergency and crisis intervention services provided pursuant to subdivision (a) of Section 4648, are insufficient and a more specialized environment for crisis stabilization is required to meet the consumer’s needs.
(2) “Complex needs” means the concurrent dual diagnosis of an intellectual or developmental disability and a mental health disorder.
(3) “Complex needs home” means a property operated by the department and designated to provide Stabilization, Training, Assistance and Reintegration (STAR) services for complex needs.
(4) “Containment” has the same meaning as that term is defined in Section 59000 of Title 17 of the California Code of Regulations.
(5) “Emergency intervention” has the same meaning as that term is defined in Section 59000 of Title 17 of the California Code of Regulations.
(6) “Prone restraint” has the same meaning as that term is defined in Section 59000 of Title 17 of the California Code of Regulations.
(7) “Physical restraint” has the same meaning as that term is defined in Section 59000 of Title 17 of the California Code of Regulations.
(8) “Seclusion” has the same meaning as that term is defined in Section 59000 of Title 17 of the California Code of Regulations.
(i) Notwithstanding any other law or regulation, a complex needs home shall not utilize any of the following interventions:
(1) A prone restraint.
(2) A physical restraint or containment procedure, unless the consumer presents an imminent risk of serious physical harm to themselves or others that cannot be prevented using a less restrictive technique. In no circumstance shall a complex needs home utilize an emergency intervention technique that obstructs a consumer’s respiratory airway or impairs the consumer’s breathing or respiratory capacity.
(3) Seclusion.
(4) The emergency interventions described in Section 85102 of Title 22 of the California Code of Regulations.
(5) Psychotropic or behavior-modifying medications used to control behavior or to restrict the person’s freedom of movement if that medication is not a standard treatment for the person’s individualized medical or psychiatric condition.