Welfare and Institutions Code § 4418.7

(a)(1) 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 an acute crisis home operated by the department is a likelihood, or the regional center is notified by a court of a potential admission to an acute crisis home operated by the department, 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. For purposes of this section, “acute crisis home operated by the department” means property

used to provide Stabilization, Training, Assistance and Reintegration (STAR) services.

(2)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 an individual program plan meeting held pursuant to subdivision (b). The regional center shall provide this notice as soon as practicable, but not less than seven calendar days prior to the meeting.

(b)In these cases, the regional resource development project shall immediately arrange for an assessment of the situation, including, visiting the consumer, if appropriate, determining barriers to successful integration, and recommending the most appropriate means

necessary to assist the consumer to remain in the community. The regional center shall request assistance from the statewide specialized resource service pursuant to Section

4418.25, as necessary, in order to determine the most appropriate means necessary to assist the consumer to remain in the community and shall provide the information obtained from the statewide specialized resource service to the regional resource development project. If, based on the assessment, the regional resource development project determines that additional or different services and supports are necessary, the department shall ensure that the regional center provides those services and supports on an emergency basis. 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 and 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 an acute crisis home operated by the department, the department shall notify the court 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 the consumer’s

parents, legal guardian, or conservator, when appropriate, determines that admittance to an acute crisis home operated by the department is necessary due to an acute crisis, as

defined in paragraph (1) of subdivision (d), and the director of the department or their designee has approved admission, the regional center shall immediately pursue the obtainment of a court order pursuant to Section 6506 for short-term admission and crisis stabilization.

(B)(i) 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, shall not make a determination that admittance to an acute crisis home operated by the department is necessary due to an acute crisis, as defined in paragraph (1) of subdivision (d), unless the determination includes a regional center report detailing all considered community-based services and supports, 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 Section 4689, 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 an explanation of why those options could not meet the consumer’s needs at the time of the determination.

(ii) For purposes of complying with clause (i), the 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)(1) For purposes of this section, the following terms have the following meanings:

(A) “Acute crisis” means, as a result of the consumer’s behavior, all of the following are met:

(i)There is imminent risk for substantial harm to the consumer or others.

(ii) The service and support needs of the consumer cannot be met in the community, including with supplemental services, as set forth in subparagraph (F) of paragraph (10) of subdivision (a) of Section 4648, and emergency and crisis intervention services, as set forth in

paragraph (11) of subdivision (a) of Section 4648.

(iii) Due to serious and potentially life-threatening conditions, the consumer requires a specialized environment for crisis stabilization.

(B) “Containment” has the same meaning as defined in Section 59000 of Title 17 of the California Code of Regulations.

(C) “Emergency intervention” has the same meaning as defined in Section 59000 of Title 17 of the California Code of Regulations.

(D) “Physical restraint” has the same meaning as defined in Section 59000 of Title 17 of the California Code of Regulations.

(E) “Prone restraint” has the same meaning as defined

in Section 59000 of Title 17 of the California Code of Regulations.

(F) “Seclusion” has the same meaning as defined in Section 59000 of Title 17 of the California Code of Regulations.

(2)For purposes of paragraph (1), 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.

(e)When an admission occurs due to an acute crisis, all of the following shall apply:

(1)As soon as possible

following admission to an acute crisis home operated by the department, a comprehensive assessment shall be completed by the regional center in coordination with the regional resource development project and the acute crisis service staff. The comprehensive assessment shall include the 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 noncrisis community setting. The regional center shall immediately submit a copy of the comprehensive assessment to the committing court. Immediately following the assessment, and not later than 30 days following admission, the regional center and the acute crisis home operated by the department 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 into community living pursuant to Section 4418.3. The clients’ rights advocate for the regional center shall be notified of the admission and the individual program plan meeting and may participate in the individual program plan meeting unless the consumer objects on their own behalf.

(2)If transition is not expected within 90 days of admission, an individual program plan meeting shall be held to discuss the status of 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 stay at the acute crisis home operated by the department of up to 90 days.

(3)(A) A consumer shall reside in an acute crisis home operated by the department no longer than six months before being placed into a community living arrangement pursuant to Section 4418.3, unless, prior to the end of the six months, all of the following have occurred:

(i)The regional center has conducted an additional comprehensive assessment based on information provided by the regional center, and the department determines that the consumer continues to be in an acute crisis.

(ii) The individual program planning team has developed a plan that identifies the specific services and supports necessary to transition the consumer into the community, and the plan includes a timeline to obtain or develop those services and supports.

(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 the proposed extension pursuant to clause (iii) of subparagraph (A) and the individual program plan meeting to consider the extension, and may participate in the individual program plan meeting unless the consumer objects on their own behalf.

(C) (i) A consumer’s placement at an acute crisis home operated by the department shall not exceed one year unless both of the following occur:

(I) The regional center demonstrates significant progress toward implementing the plan

specified in clause (ii) of subparagraph (A) identifying the specific services and supports necessary to transition the consumer into the community.

(II) Extraordinary circumstances exist beyond the regional center’s control that have prevented the regional center from obtaining those services and supports within the timeline based on the plan.

(ii) If both of the circumstances described in subclauses (I) and (II) of clause (i) exist, the regional center may request, and the committing court may grant, an additional extension of the commitment, not to exceed 30 days.

(D) Consumers placed in the community after admission to an acute crisis home operated by the department pursuant to this section shall be considered

to have moved from a developmental center for purposes of Section 4640.6.

(f)The department shall collect data on the outcomes of efforts to assist at-risk consumers to remain in the community. The department shall make aggregate data on the implementation of the requirements of this section available, upon request.

(g)Commencing January 1, 2015, admissions to an acute crisis home operated by the department pursuant to a court order for an acute crisis, as described in this section, shall be limited to a property used to provide STAR services.

(h)Acute crisis consumers may participate in day, work, education, and recreational programs when the individual program plan identifies it is appropriate and consistent with

the individual’s treatment plan. The acute crisis 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.

(i)The department may execute leases, lease-purchases, or leases with the option to purchase for real property necessary for the establishment or maintenance of STAR homes to serve as acute crisis homes operated by the department.

(j)Notwithstanding any other law or regulation, an acute crisis home operated by the department shall not utilize any of the following interventions:

(1)A prone restraint.

(2)A physical

restraint or containment, 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 an acute crisis home operated by the department 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 a person’s freedom of movement if that medication is not a standard treatment for the person’s individualized

medical or psychiatric condition.