ATTACHMENT H St. Theresa's Retreat Licensing Questions for the MAY 27 2009 Department of Alcohol and Drug Programs (ADP) A. General Licensing Questions: 1. Can you describe some of the glitches ADP typically runs into during the licensing process and what happens in those cases? 2. Does ADP determine whether other agencies or departments are required to license a residential treatment facility, and will ADP notify the applicant of those requirements? 3. The licensing instructions indicate that "the Initial Licensing Application Section A and B documents must be completed and submitted to ADP," and "applicants must demonstrate a capability to meet the goals and objectives of an alcoholism or drug abuse recovery or treatment facility." How does an applicant demonstrate "a capability to meet the goals and objectives of an alcoholism or drug abuse recovery or treatment facility?" 4. Will ADP determine the application packet to be complete in cases where the applicant hasn't obtained city approval for a conditional use permit or variance? 5. Is smoking permitted at residential treatment facilities and, if so, where is smoking permitted? 6. Does ADP review the conditions included in a city's conditional use permit and make any recommendations regarding those conditions or other necessary conditions of use? 7. ADP's licensing process appears to focus primarily on the health, safety and welfare considerations of program participants. Who is principally responsible for ensuring the health, safety and welfare of the public where residential treatment facilities are concerned - the State or the City? Page 1 of 8
B. Certification vs. Licensing: 8. Your March 2006 Fact Sheet indicates that most of the 837 residential treatment facilities licensed by ADP (as of December 2005) are certified. The same Fact Sheet indicates that ADP had certified 962 nonresidential programs (programs that offer less than twenty-four hour services) as of December 2005. How many residential treatment facilities are ADP-licensed today and how many of those facilities are also certified? 9. Can you briefly describe some of the additional requirements or standards of operation that must be met to obtain certification (as opposed to licensing)? 10. What are the advantages or disadvantages of certification? 11. Is a Community Advisory Board required in the case of certified facilities and not required in the case of licensed residential treatment facilities? 12. Does ADP ever require certification or is this strictly voluntary? 13. Are you aware of any situations where a city has included certification as a condition or requirement of the city's conditional use permit? C. Grounds for Denying/Revoking License: 14. Has ADP ever denied an initial license application and, if so, what were the grounds for denying the application? 15. Has ADP ever refused to renew a license and, if so, what were the grounds for refusing to renew the license? 16. Under what circumstances will ADP deny an initial license application or refuse to renew a license? 17. Has ADP ever revoked a license and, if so, what were the grounds for revoking the license? 18. Under what circumstances will ADP revoke a license? Page 2 of 8
D. Monitoring Activities: 19. How does ADP monitor residential treatment facilities following approval of the initial licensing application? 20. Does ADP review all data reports filed by licensed residential treatment facilities in connection with ADP's regular monitoring of these facilities? Examples of reports that may be required depending on funding:. CalOMS. DATAR. UFOS. NMMRDR. AMR. Dosing. Injury/Death/ - Disaster California Outcomes Measurement System (upon admission, upon discharge and every twelve months) Drug and Alcohol Treatment Access Report (monthly) Uniform Facility Data Set (formerly NDA TUS, annual federal survey) Narcotic Maintenance Multiple Registration Detection Report (annual) Annual Maintenance Report (formerly Semi-Annual Methadone Report) (1)Take-Home Dose Over 80 Milligrams, (2) Notification of Program Exceptions Injury, Death, Disaster Report 21. Does ADP review CalOMS (California Outcomes Measurement System) data to monitor a facility's achievements? 22. Where can the public obtain a copy of the CalOMS data for specific residential treatment facilities? E. Complaints: 23. Your March 2006 Fact Sheet indicates that ADP received 31 complaints a month, on average, as of December 2005. How many complaints a month does ADP currently receive and what are the different types of complaints you receive? 24. When (or under what circumstances) should someone contact ADP to make a complaint? Page 3 of 8
25. What steps should the public take (what other entities or agencies should the public notify) before filing a complaint with ADP? F. Zoning/Density/Occupancy: 26. Is there a connection between ADP licensing requirements and zoning for residential treatment facilities? Please describe that connection. 27.ls there a connection between ADP licensing requirements and the State's recent development of zoning for "transit-oriented development corridors" (R-4)? 28. Can ADP accept an initial licensing application for review before receiving documentation of the City's approved conditional use permit or zoning variance? 29. Does ADP licensing address density (for example, the proximity of one treatment facility to another treatment facility)? 30. Does ADP licensing address occupancy (other than to restrict maximum occupancy to the number of residents and employees authorized by the Fire District)? 31. Does ADP licensing address issues concerning compatibility of adjacent property uses (such as, a daycare and a residential treatment facility)? G. Like-Facilities: 32. Of the facilities currently licensed and operating in California, how many are congregate care, limited facilities and how many are congregate care, general facilities? 33. Do you maintain records that indicate how many facilities accept six or fewer clients, how many accept seven to ten, eleven to fifteen, sixteen to twenty, exactly twenty, more than twenty and, if so, who should we contact to obtain that information? 34. Of the facilities currently licensed and operating, how many are licensed for twenty program participants and are located in one residence (one building and one address) in a single-family neighborhood and where can we obtain the names and addresses of those facilities? Page 4 of 8
35. Of the facilities currently licensed and operating, how many are situated immediately adjacent to a daycare facility and where can we obtain the names and addresses of those facilities? 36. Of the facilities currently licensed and operating, how many hold weekly family visits and meetings offsite? 37. Of the facilities currently licensed and operating, how many hold onsite Narcotics Anonymous and Alcoholics Anonymous or other Self-Help Meetings; how many invite sponsors or other visitors to those meetings; and, how frequently are those onsite meetings held? 38. Is ADP able to survey its licensed and/or certified residential treatment facilities to obtain answers to these kinds of questions? (Are you, for example, able to send out mass mailings or emails to licensed and/or certified residential treatment facilities to conduct a quick survey of operating characteristics)? 39. What is the role of "precedent" in the licensing process and can you explain how the licensing process differs when reviewing unique cases such as this? For example, will the process differ in cases where ADP has never (or has rarely) approved a license for twenty program participants in one house in a single-family residential neighborhood, or a license for a facility that regularly conducts all family visits at an offsite location? H. Program Components and Other Considerations: 40. Does ADP require residential treatment facilities to offer specific programs or services? If so, what specific programs or services are required? 41. Does ADP require residential treatment facilities to implement their own emergency response programs as back-up to 911 and, if so, can you provide examples of these supplemental emergency response programs and explain why these back-up programs are necessary? 42. Does ADP require specific security systems such as alarms to detect intruders or participants attempting to leave the facility without permission? Page 5 of 8
43. Will ADP require specific programs that other treatment facilities and program participants have found necessary to initiate and sustain long-term recovery (such as 12-step meetings)? 44. In the case of substance abuse clinics, ADP evaluates each clinic as well as each clinic's "satellite sites." Additionally, each clinic must notify ADP when the clinic moves its programs or services to a new "satellite site." Does ADP evaluate satellite sites in the case of residential treatment facilities? In other words, in cases where major program components, activities or operations are conducted offsite (such as family visits and facilitated group meetings/training of families and program participants), will ADP evaluate these satellite sites in addition to the proposed residential treatment facility's site? 45. St. Theresa's Retreat will not allow visits at the facility. Assuming this means no family visits (including children) except at the weekly family visits held offsite, will ADP review and propose or require changes to these and other programmatic decisions? 46. Does ADP require residential treatment facilities to allow family visits? 47. If a facility indicates that it offers regular weekly family visits (including a meeting and instruction), does ADP consider these visits to be necessary programs or operations? 48. Does ADP require facilities to allow additional visits (other than weekly family visits) by children and public agencies such as Child Protective Services, Social Services, etc.? I. Staffing: 49. Does ADP set standards for staffing (for example, total number of employees on staff, ratio of participants to staff, ratio of participants to counselors, number of staff for each shift, and minimum qualifications including education, experience, certification or license, etc.) and, if so, can you describe each of those minimum standards? 50.Are consultants, volunteers and/or unlicensed or uncertified staff included in the minimum staff to participant ratios? Page 6 of 8
51. Does ADP require background checks for all residential treatment facility personnel, including back-up personnel? 52. Does ADP require the same background checks for consultants and volunteers? 53. If ADP imposes specific staffing requirements on licensed residential treatment facilities, are these requirements or standards identical to the ones that ADP imposes on certified residential treatment facilities? 54. Does ADP ever require a licensed alcohol and drug counselor (LADC) in addition to certified alcohol and drug addiction counselors (CADACs) or CADAC interns? 55. Does ADP adjust minimum staffing requirements depending on the unique circumstances of the facility in question (for example, could ADP decide to increase the minimum staffing requirements in cases where the facility conducts necessary operations, such as weekly family visits, at an offsite location)? J. Sources of Funding and Referral: 56. Does ADP review the applicant's proposed sources of funding and referral in connection with ADPs evaluation of the licensing application? 57. Does ADP make any recommendations or impose any specific standards or restrictions based on the applicant's planned sources of funding and referral? 58. Does ADP recommend or require that residential treatment facilities obtain a county contract and is a county contract required if a facility intends to apply for county funding? 59. Can a residential treatment facility refuse funding and referrals from the Department of Corrections (i.e. Bay Area Services Network, Prison Project Network, and Parole Partnership Program) and still apply for and receive funding from other public sources? 60. If a residential treatment facility receives public funding (county, state or federal) or pass-through funding (i.e. from state to county, federal to county, etc.) can the facility refuse admission to any individual referred by another county, state or federally-funded program? We understand a facility can exclude men if the facility offers a program exclusively for women, and the facility can refuse admission to individuals who exceed the facility's level of care. But, we want to know if the facility would be required to accept any otherwise qualified woman regardless of the federal, state or county program making the referral. Page 7 of 8
K. Admission and Other Policies and Procedures: 61. Does ADP make any recommendations or impose any restrictions concerning a residential treatment facility's selection criteria for program participants? 62. Do co-morbidities, dual diagnosis, and co-occurring disorders essentially mean the same thing and, do any conditions involving co-morbidities, dual diagnosis and/or co-occurring disorders result in any additional regulatory requirements (such as obtaining licensing from another department or agency)? 63. What co-occurring disorders will generally place an applicant out of a residential treatment facility's level of care? 64. Can a residential treatment facility offer detoxification services? 65. What are the different types of background checks or clearances a residential treatment facility can perform or obtain when screening program applicants? 66. Can a residential treatment facility perform or obtain the same types of background checks or clearances on anyone who will be visiting the program participants? 67. Can a residential treatment facility implement a zero-tolerance policy for infractions or offenses that shall automatically result in an immediate discharge from the facility and an immediate termination of the agreement? 68. Health Related Documents and Policies [Regulations Section 10572(e)] indicates "there shall be written rules and policies to prevent persons (except in detoxification programs) who have consumed alcohol or other drugs from being on the premises." Does this requirement apply only to program participants or does it to apply to visitors and can you give examples of specific written rules or policies that are effective in preventing these individuals from being on the premises? 69. Does a participant's right to confidentiality [Title 42, Section 2.1 through 2.67-1, Code of Federal Regulations] mean that a residential treatment facility cannot report some incidents or crimes (missing persons, runaways, drug use, drug dealing, shoplifting, etc.) to city employees, including police officers and, if not, can a city require a residential treatment facility to report certain incidents or crimes to a designated city employee? Page 8 of 8