2019 Performance Contract Public Meeting

Transcription

1 San Diego Regional Center Serving Individuals with Developmental Disabilities in San Diego and Imperial Counties 4355 Ruffin Road, San Diego, California (858) Performance Contract Public Meeting DATES TUESDAY 9/11/18 12:15 p.m. 12:45 p.m. San Diego Regional Center Board Room, Suite Ruffin Road San Diego CA THURSDAY 9/13/18 6:00 p.m. to 7:00 p.m. San Diego Regional Center Imperial Office 512 West Aten Road Imperial CA Information, including the first draft of the Performance Contract, will be shared at the public meetings and will be available after 8/24/18 through the SDRC Department of Community Services, , or on the SDRC website at You may submit written comments by 9/28/18 to: Lori K. Sorenson, M.A. Director, Community Services San Diego Regional Center 4355 Ruffin Road, Suite 104 San Diego CA or by East County Office 8760 Cuyamaca St #100 Santee CA Imperial County Office 512 W Aten Rd Imperial CA North County Office 5931 Priestly Dr #100 Carlsbad CA South County Office 2727 Hoover Ave #100 National City CA

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3 San Diego Regional Center Serving Individuals with Developmental Disabilities in San Diego and Imperial Counties 4355 Ruffin Road, San Diego, California (858) Performance Contract Public Meeting AGENDA San Diego Regional Center sponsored by San Diego Regional Center and the State Council on Developmental Disabilities San Diego Imperial Office (SCDD) I. Introductions Board II. Purpose of Meeting Board III. SCDD San Diego Imperial Office Statement SCDD IV. Budget Total Clients Historical Purchase of Service Growth Fiscal Year Purchase of Service Expenditures SDRC Staff V. Performance Contract 2018 Demographic Data Report Performance Contract Pilot o SDRC Performance Contract Status Reports o 2019 Performance Contract Activities Input East County Office 8760 Cuyamaca St #100 Santee CA Imperial County Office 512 W Aten Rd Imperial CA North County Office 5931 Priestly Dr #100 Carlsbad CA South County Office 2727 Hoover Ave #100 National City CA

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5 30,000 25,000 Total Clients 23,731 25,080 26,450 28,269 20,000 18,858 19,147 19,585 20,513 21,460 22,343 15,000 10,000 5,000 0 Jul 09 Jul 10 Jul 11 Jul 12 Jul 13 Jul 14 Jul 15 Jul 16 Jul 17 Jul 18

6 $400.0 $350.0 Purchase of Services Growth (est.) $324.1 $347.7 $300.0 $292.1 $267.2 Millions $250.0 $200.0 $201.9 $205.5 $212.1 $217.2 $231.5 $246.8 $150.0 $100.0 $50.0 $ / / / / / / / / / /18 Fiscal Year

7 Fiscal Year Purchase of Services Expenditures $347,696,980 (estimated) Out of Home $102,425,676 29% Non-Medical $14,384,081 4% Support Services $33,908,970 10% Medical $6,223,500 2% Habilitation $17,069,387 5% Transportation $20,877,704 6% Other $31,411,860 9% Early Start $10,899,072 3% Day Activities $110,496,730 32%

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9 SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION March 12, 2018 TABLE OF CONTENTS Section Page General Demographic Information 1 SDRC Demographic Information 1 Community Living Services 2 Adult Day Services 4 Other Services 4 Glossary of Resource Terms 5 Appendix I General Client Statistics 8 Appendix II SDRC Vendor Category Statistics 12 Appendix III New Vendor Statistics 14 Appendix IV Community Living Situation Statistics 16 Appendix V Licensed Residential Facility/Vacancy Rates 19 Appendix VI Deflection Statistics 21 Appendix VII State Developmental Center Client Statistics 22 Appendix VIII Adult Day Services Statistics 23

10 SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION March 12, 2018 INTRODUCTION This report contains population demographics and client and service provider statistics for the San Diego Regional Center (SDRC). SDRC provides services to persons who meet the state definition of developmental disabilities or, if younger than the age of three, have a developmental delay, or an established risk of a condition causing a developmental delay, or at high risk for a developmental disability, and who reside in San Diego or Imperial Counties. DEMOGRAPHIC INFORMATION San Diego County is the most southwestern county in the state and covers 4,261 square miles. The population of San Diego County as of January 1, 2017, was estimated to be 3,316,192. It is the second largest county in California after Los Angeles County. It encompasses 18 separate municipalities. San Diego is the eighth largest city in the United States. Imperial County is the most southeastern county in the state and covers 4,597 square miles. The population of Imperial County as of January 1, 2017 was approximately 188,334. It is primarily a rural, agricultural area and is sparsely populated when contrasted with San Diego County. Approximately 83% of the population in Imperial County is Latino. In December 2017 the estimated unemployment rate in Imperial County was 17.9%, compared with the California state estimated unemployment rate for December 2017 of 4.3%. SDRC DEMOGRAPHIC INFORMATION San Diego Regional Center is the second largest of the 21 California regional centers, serving 27,262 clients as of January 2, The population eligible for SDRC services has increased by approximately 1,490 clients in calendar year SDRC has a main office located in the city of San Diego, and four satellite offices. Three of the satellite offices are located in San Diego County, in the northern, eastern, and southern geographic portions of the county. Each of these satellite offices serves 16% to 21% of SDRC s clients. The fourth satellite office is located in Imperial County, and serves 11% of SDRC s clients. Sixty-five percent (65%) of the clients served by SDRC who are older than the age of three years have a diagnosis of intellectual disability, fifteen percent (15%) have a diagnosis of epilepsy, fourteen percent (14%) have a diagnosis of cerebral palsy, and thirty-eight percent (38%) have a diagnosis of autism (a client may have more than one diagnosis). 1 P age

11 SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION March 12, 2018 The percentage of SDRC clients with a diagnosis of autism has increased dramatically over the past 20 years, from 8% of the clients in 1998 to 38% of the clients in Sixty-nine percent (69%) of SDRC clients in the three years to thirteen years age group have a diagnosis of autism, while only nineteen percent (19%) of SDRC clients in the 18 years to 55 years age group have a diagnosis of autism. Thirteen percent (13%) of clients older than the age of 22 have a mental health diagnosis in addition to a developmental disability (Appendix I). Fifty-three percent (53%) of the clients served by SDRC are children, and forty-seven percent (47%) are adults. Fourteen percent (14%) of the clients served by SDRC are three years of age or younger, and are receiving early intervention services. English is the primary language spoken by seventy-five percent (75%) of SDRC s clients, twenty-one percent (21%) of SDRC s clients speak Spanish as their primary language, and less than one percent (1%) speak Vietnamese, Tagalog, or Arabic. Two percent (2%) of SDRC s clients speak a variety of other languages. SDRC employs service coordinators who are bilingual in English and other languages. SDRC has more than 4,460 vendored services. This includes a number of large agencies that often provide a number of vendored services, as each service vendorization is for a specific type of service, provided at a specific location. This also includes more than 2,143 family members of clients who are vendored to obtain respite, nursing, day care, transportation, or supported living services (Appendix IIa). Sixty-six SDRC vendors are located in Imperial County, including one family member of a client (Appendix IIb). In January through December 2017, a total of 293 new services and individuals were vendored in San Diego County (Appendix IIIa). These new services include 53 specialists, seven Adult Day programs, four Independent Living Services Agencies, four Supported Living Service Agencies, four Family Coordinated Supported Living Services, three Day Care/Out-of-Home Respite programs, three In-Home Respite Agencies, 172 family member vendors, and 12 other services. Twenty additional licensed residential homes with a total of 106 additional beds were vendored in COMMUNITY LIVING SERVICES As of January 2018, a total of 21,935 clients were residing with family members, 1,858 clients were residing in their own homes, 399 clients were residing in foster homes, 2,867 clients were residing in residential facilities, and 46 clients were residing in state developmental centers (Appendix IV). More than 97% of the clients younger than the age of 18 live with family members. There has been a decrease in each of the past twenty years in the percentage of SDRC clients living in licensed residential facilities, and an increase in the percentage of SDRC clients living with family members. There has been a slight decrease in the percentage of SDRC clients living in their own homes over the past twenty years, which may be due to the limited affordable housing in San Diego County. 2 P age

12 SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION March 12, 2018 Appendix V summarizes the number of SDRC residential resources of various types and vacancy rates for each type of residential service. The more specialized homes maintain lower vacancy rates and there are generally very few vacancies in licensed residential facilities which provide behavior management services for children. Vacancy rates for health licensed facilities remain very low. When no residential resources are identified for a client through the standard process, the person is referred to the SDRC Deflection Review Team for review and a determination of whether a statewide search for an appropriate resource is warranted. Deflection Review Team statistics from January 2017 through December 2017 are summarized in Appendix VI. A total of 12 clients were identified as needing deflection resources during this 12-month time period. Six(50%) of the clients identified have a mental health diagnosis, in addition to having a developmental disability. Six (26%) clients identified as needing deflection resources have a diagnosis of autism, with 83% of clients younger than the age of 18 having a diagnosis of autism. Eight (75%) of the clients identified for deflection are younger than the age of 30. As of July 1, 2012, a person may only be admitted to a State Developmental Center (SDC) when the person is in acute crisis and there is a transition plan to return that person to the community within six months. Forty-six of SDRC s clients currently live in an SDC, with 29 clients living at Fairview Developmental Center. Fairview Developmental Center is scheduled for closure by December 31, SDRC is developing appropriate community services that will meet the needs of the clients currently residing at SDCs. Demographic information on these clients is summarized in Appendix VII. In contrast to the clients identified for deflection, 74% of these clients are older than the age of 30, and 41% of these clients are older than the age of 50. Appropriate community placements have been identified for twenty-two of these clients. SDRC currently has 1,858 clients who live in their own homes (i.e. their own apartments or houses rather than in the houses of family members). Most of these clients use independent or supported living services to support them in their residence (Appendix IV). Independent Living Services may also be provided to clients living in the home of a parent or relative if the client wants to learn skills that will allow them greater independence in the family home. Three hundred and nine clients receive support through Supported Living Services agencies and 1,761 clients receive services through Independent Living agencies. There are currently 51Independent Living Services vendors, and 28 agencies that provide Supported Living Services. Increased rental costs in San Diego County, combined with very low vacancy rates have made it very difficult for SDRC clients to locate affordable housing. Clients who wish to utilize the Section 8 rental assistance program, a federally funded program, are placed on a waiting list, and often wait for this assistance for more than ten years. SDRC contracts with two different 3 P age

13 SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION March 12, 2018 non-profit corporations to assist clients with accessing affordable housing. One of these non-profit housing corporations is working with local affordable housing developers to increase the availability of affordable housing options for people with developmental disabilities. SDRC also contracts with a non-profit agency to assist clients who are interested in pursuing home ownership. ADULT DAY SERVICES SDRC has 8,989 clients who participate in adult day services (Appendix VIII). SDRC funds adult day services for 7,009 clients. The Department of Rehabilitation funds services for 278 clients. Twelve percent (1,435) of the SDRC clients who participate in adult day services go to a public school program, community college, or other publically and privately funded educational programs. Approximately 404 clients turned 22 years old in 2017 who will consequently need regional center funded adult day services. Appendix V provides estimates, based on recent trends, on the types and locations of the adult day services that will be needed by these clients. Currently there are 213 SDRC vendored adult day programs. Providing services for most of the clients graduating from public school programs in 2018 should be within the capacity of current adult day service resources; however, licensed (site-based) programs in the central area of San Diego County and in Imperial County are near capacity. OTHER SERVICES As of January 2, 2018, SDRC funded respite services for 8,644 clients, which is 39% of the clients who are living with a parent or relative. Most clients authorized for respite services use an In-Home Respite Agency or utilize the Respite Registry Services (Appendix IV). SDRC has two In-Home Respite Agencies that act as employer of record for the respite workers. SDRC funds licensed nursing respite care for 450 clients. The entire country is currently experiencing a shortage of licensed nurses. SDRC has increased the number of individually vendored nurses by 7 additional Registered Nurses and 24 additional Licensed Vocational Nurses. Even with the increase, the current total of 255 vendored nurses and 19 Home Health Agencies is insufficient to meet the needs of SDRC clients who live in other than licensed facilities. 4 P age

14 GLOSSARY OF RESOURCE TERMS Adult Developmental Center (ADC): A day program that serves adults who are in the process of acquiring self-help skills, need sustained support and direction in developing the ability to interact with others, need support to make their needs known, and need support to respond to instructions. ADC programs focus on the development and maintenance of the functional skills required for self-advocacy, community integration, employment and self-care. Activity Center (AC): A day program that serves adults who generally have acquired most basic self-care skills, have some ability to interact with others, and are able to make their needs known and respond to instructions. AC programs focus on the development and maintenance of the functional skills required for self-advocacy, community integration, and employment. Behavior Management Program: A day program that serves adults with severe behavior challenges and/or a mental health diagnosis who have not been accepted into any other adult day program because of their behaviors. Behavior Management programs work towards understanding the function of the behavior and assisting clients with communicating their needs effectively so that transition to another program can take place. Community Based Adult Service (CBAS) Centers: CBAS centers offer a package of health, therapeutic and social services in a communitybased day health care program. Services are provided according to a six-month plan of care developed by the CBAS center s multidisciplinary team. The services are designed to prevent premature and unnecessary institutionalization and to keep recipients as independent as possible in the community. Client Development Evaluation Report (CDER): The CDER is an assessment instrument containing diagnostic and developmental information. Completion of the CDER for clients older than the age of three years is required by DDS. Community Placement Plan (CPP): The plan developed by the regional center to return clients placed in state developmental centers to the local community, and to deflect clients who might otherwise be placed in a state developmental center so that they can remain in the local community. Foster Family Agency: A non-profit organization which is community care licensed to recruit, train, certify, and support foster families who provide specialized care to 1-2 children in their own homes. 5 P age

15 Family Home Agency A Family Home Agency (FHA) approves family homes which offer the opportunity for up to two adults with developmental disabilities per home to reside with a family and share in the interaction and responsibilities of being part of a family. Infant Development Program: A training and activity program for infants and their families designed to encourage the development and adjustment of the infants in the community and their homes, and to prepare the infants for entrance into the classes of local schools. Intermediate Care Facility/Developmentally Disabled (ICF/DD) A health care licensed residential facility that offers special programming in sensory motor skills, self-help skills, behavior management, and close monitoring of medical needs. These facilities are larger, more institutional, more restrictive, and more structured than other levels of care available in the community. Intermediate Care Facility/Developmentally Disabled-Habilitative (ICF/DD-H): A health care licensed residential facility which provides personal care, habilitation and supported health services to 15 or fewer (usually 6) individuals with developmental disabilities who have intermittent recurring needs for nursing services but have been certified by a physician as not requiring availability of continuous skilled nursing care. Intermediate Care Facility/Developmentally Disabled-Nursing (ICF/DD-N): A health care licensed residential facility which provides personal care, habilitation, and nursing staff for 15 or fewer individuals with developmental disabilities who are medically fragile. Level 2 Home: A community care licensed residential facility with a staffing level of one staff for up to six residents. These homes offer training, supervision, activities and intervention as needed during the normal activities of the day. Level 3 Home: A community care licensed residential facility that serves individuals who need extensive assistance with behavior challenges, self-help skills, and/or who are non-ambulatory. The home provides structured programming, including planned instruction and activities with an average staff to client ratio of 1:3. Level 4 Home: A community care licensed residential facility that specializes in behavior management. Objectives and plans are developed to diminish challenging behaviors. High staff/client ratios and a licensed behavioral consultant are provided. Level 4 homes may also be approved to serve clients with special medical needs. High staff/client ratios and a licensed medical consultant are provided in these homes. 6 P age

16 Respite: Temporary or intermittent care and supervision which can be provided in the family home or a licensed facility that relieves family members from the constantly demanding responsibility of caring for a client. Specialized Residential Facility: A community care licensed residential facility that is designed to meet the needs of clients that are either exiting a developmental center or who are being deflected from placement in a developmental center. These homes have staff/client ratios that are greater than those in Level 4 homes, and an interdisciplinary team of consultants (behavior management consultants, registered nurses, occupational therapists, etc.) Tailored Day Service: Tailored Day Services are designed to maximize a client's individualized choices and needs, with customization of day services through individualized services. Tailored Day Services provide opportunities for increased integration and inclusion, as well as further opportunities for the consumer to develop or maintain employment/volunteer activities, and pursue postsecondary education. San Diego Information System (SANDIS): SANDIS is a software database for client information used by the San Diego Regional Center. Skilled Nursing Facility (SNF): A health care licensed facility which offers skilled nursing and supportive care. A SNF- Distinct Part is a SNF that has a contract with, and is in close proximity to an acute care hospital. State Developmental Center: A large institution owned and operated by the State of California. As of July 1, 2012, a person may be admitted to a State Developmental Center only when the person is in acute crisis. Any person admitted to a State Developmental Center must be transitioned back to the community within six months of admission. All State Developmental Centers, with the exception of the Secure Treatment Area of Porterville Developmental Center are scheduled to close before P age

17 Appendix I SAN DIEGO REGIONAL CENTER GENERAL CLIENT STATISTICS (based on CDER data of 1/2/18) Persons Served by San Diego Regional Center Intake Case Management Genetics Total Total Number , ,262 Diagram 1 Client Caseload Growth Number of Clients Intake Case Management Persons Served by Each Area Office San Diego (Main Office) Santee (East County Office) Carlsbad (North County Office) National City (Southbay Office) Imperial (Imperial County Office) 9596(35%) 4551 (16%) 5901 (21%) 4731 (17%) 2938 (11%) 8 P age

18 Appendix I SAN DIEGO REGIONAL CENTER GENERAL CLIENT STATISTICS (based on CDER data of 1/2/18) Age > > (change based on CDER data of 1/3/17) Diagram 2 Client Age Groups Older than 55 Years 6.09% Younger than Age % 22 to 55 Years Old 33.34% 3 to 18 Years old 38.58% 18 to 22 Years Old 8.04% Primary Language English Spanish Vietnamese Tagalog Arabic All Other 20,805 (75%) 5,693 (21%) 202 (0.7%) 142(0.5%) 189 (0.6%) 546 (1.9%) 9 P age

19 Appendix I SAN DIEGO REGIONAL CENTER GENERAL CLIENT STASTICS (based on CDER data of 1/2/18) Intellectual Disability (ID) Qualifying Diagnosis of Clients age 3 and older (each person may have more than one diagnosis) Epilepsy (EP) Cerebral Palsy (CP) Autism (AU) Other 15,266 (65%) 3,579 (15%) 3,324 (14%) 9,021 (38%) 1,590(7%) Diagram 3 SDRC Clients Types of Developmental Disabilities CP Only 2.84% ID/CP 5.10% EP Only 1.83% EP/CP 0.87% Other Only 1.05% ID/EP/AU 0.82% ID/CP/AU 0.18% ID/AU/CP/EP 0.09% ID/CP/EP 5.61% ID/EP 6.51% ID Only 41.72% ID/AU 12.86% AU Only 25.84% Ages Psychiatric Diagnosis Additional Client Diagnostic/Service Needs G-Tube Feeding Injections (weekly or more often) Tracheostomy Care Under (2.5%) 118 (0.7%) 26 (0.2%) 15 (0.1%) 22 and over 1376 (12.7%) 188 (1.7%) 191 (1.8%) 32 (0.3%) 10 P age

20 Appendix I SAN DIEGO REGIONAL CENTER GENERAL CLIENT STASTICS (based on CDER data of 1/2/18) Diagram 4 Changes in Client Diagnoses 100 Percentage with Diagnosis Intellectual Disability Cerebral Palsy Epilepsy Autism Jan-98 Jan-03 Jan-08 Jan-13 Jan-18 Diagram 5 Current Client Diagnoses by Age Groups 100 Percentage with Diagnosis Intellectual Disability Cerebral Palsy Epilepsy Autism Children (3 to 13) Adolescents (13 to 18) Adults (18 to 55) Seniors (Over 55) 11 P age

21 Appendix IIa SAN DIEGO REGIONAL CENTER VENDORS* by category of vendorization 1/2/18 *includes vendors not currently being used Education Resources Day Programs Medical Services Developmental Spec. 1 Sup. Employ. Ind. 17 Physicians 72 Teacher 9 Sup. Employ. - Group 15 Dentists 65 Ind. or Family Train. 64 Work Activity Prog. 13 Psychiatrists 7 Tutor Services 1 Activity Centers 14 R.N.s 51 ADCs 100 LVNs 204 Psychology Resources B. Mod. Programs 30 Hospitals 20 Clinical Psychologists 65 Community Pharmacies 31 B. Mod. Consultants 23 Integration Training 9 Dietary Services 10 Behavior Analyst 58 Socialization Train. 5 Med. Equipment 22 Counseling Services 2 CBAS Centers 17 Audiology 6 Family Services Comm. Act. Support 3 Speech/PT/OT 54 Respite Voucher 51 Community Living Lab/Radiology 16 Nursing Voucher 4 Licensed Facilities 576 Orthoptic Service 7 Day Care Voucher 175 Ind. Living Agencies 51 Early Start Spec. Ther. 243 Early Start Voucher 49 Sup. Living Agencies 28 Home Health Agency 19 Day Care Facility 42 Parent Coord. SL 7 Other Med. Service 12 Camps 14 Adult Fam. Home Ag. 3 Other Services In-Home Res. Agency 43 Personal Assist. Serv. 15 Translators/Interpret. 10 Out-of-Home Respite 10 Transportation Mobile Crisis Team 4 Parent Coordinated Trans. Voucher 1913 Legal Services 11 Behavioral Interven. 2 Trans. Company 20 Sports Club 2 Homemaker Program 2 T-Add. Component 20 Housing Service 2 Infant Dev. Programs 63 Public Transit Co. 10 Retail Stores 3 Infant Dev. Specialist 11 Mobility Training 4 Interdisciplin. Assess. 9 Fiscal Management 3 Vehicle Modification 2 Lifeline Emergency 1 Total Vendors 4461 Total Vouchers 2143 Total Vendors w/o Vouchers 12 P age 2318

22 Appendix IIb SAN DIEGO REGIONAL CENTER VENDORS Located* in Imperial County by category of vendorization 1/2/18 * This list only includes vendors whose office address is in Imperial County. There are some agencies and individuals who provide services in Imperial County with a home office address in San Diego County Respite/Family Services Community Living Services Early Start Voucher 1 Licensed Facilities 9 In-Home Respite Agency 1 Independent Living Agencies 3 Infant Development Program Day Care Facility 1 1 Supported Living Agencies 1 Homemaker Program 1 Day Programs Clinical Services Work Activity Program 1 Physician 1 Adult Development Center (1:4) 1 Dentist 3 Activity Centers 1 Teacher 1 Adult Development Centers (1:3) 2 Dietary Services 3 Behavior Management Program 2 Pharmacy 2 Socialization Training 2 Audiology 1 Adult Day Health Center 2 Orthoptic Service 1 Supported Employment Ind. 3 Physical Therapy 2 Hospital 1 Home Health Agency 1 Transportation Resources Behavior Analyst 2 Public Transit Company 4 Early Start Specialized Therapy Occupational Therapist 1 5 Transportation-Add. Component 2 Total Vendors 66 Total Vendors w/o Vouchers P age

23 Appendix IIIa SAN DIEGO REGIONAL CENTER NEW VENDORS by category of vendorization January through December 2017 Specialists Licensed Residential Facilities 2 - Dentists Level 3 homes for Adults 4 homes/22 beds 10 - Behavior Analysts Level 4 homes for Adults 10 homes/48 beds 3 - Physicians Specialized Res. for Children - 1 home/4 beds 1 - Speech Therapist Specialized Res. for Adults 3 homes/12 beds 9 - Registered Nurse Memory Care Facilities 2 homes/20 beds 23 - Licensed Vocational Nurses Total: 20 New Homes/106 beds 1 - Translator 4 - Clinical Psychologists Total: 53 New Specialists Programs 2 Personal Assistance Service Other Services 1 Supported Employment Service-Individual 1 - Hospital 9 Infant Development Programs 4 Conferences (Ind. & Family Training) 3 - Adult Development Centers 1 Environmental Accessibility 1 Behavior Management Program 1 Vehicle Modification 1 Community Integration Training Program 1 Mobility Trainer 1 Community Support Service 1 Communication Aide 3 - In-Home Respite Agencies 3 Money Management Agency 3 - Day Care/Out-of-Home Respite Programs Total: 12 Other New Services 4 Supported Living Agencies 4 Family Coordinated Supported Living Service 4 - Independent Living Agencies Total: 36 New Programs Parent Directed Services (Vouchers) 157- Transportation/Family Member 15- Day Care/Family Member Total: 172 New Family Member Vendors 14 P age

24 Appendix IIIb SAN DIEGO REGIONAL CENTER DEVELOPMENT OF NEW OR ENHANCED PROGRAM SERVICES January 2013 through December 2017 Community Integration Program for Adults designed to serve clients who need intensive staffing in Adult Day Services - 3 Programs Tailored Day Services for Adults - 22 Programs Behavior Support Module for a CBAS Center Substance Use Disorder (SUD) Treatment services including recovery coaching that assist clients with accessing community SUD treatment and recovery services Specialized Mental Health Counseling and Support Programs - 2 Programs Cross Systems Support & Treatment Team for individuals with complex/high profile forensic needs Specialized Residential Facilities with intensive levels of staffing, licensed professional interdisciplinary consultation, and a variety of other services - 10 four bed homes for adults - 2 four bed homes for adolescents Wraparound program developed in collaboration with San Diego Mental Health Services for adolescents with a developmental disability and a mental health diagnosis Non-Profit Housing Organization which purchases and renovates residential homes to be used as Specialized Residential Facilities. These homes are deed restricted to be maintained and used solely for the benefit of SDRC clients in perpetuity homes purchased and renovated before 1/1/18 Specialized Competency Training provided by vendors who are also contractors with San Diego Behavioral Health Services 15 P age

25 Appendix IV SAN DIEGO REGIONAL CENTER COMMUNITY LIVING SITUATION STATISTICS (based on SANDIS data of 1/2/18) Community Living Situation Under 18 Years Old Over 18 Years Old Totals Total on 1/2/18 Change from 1/3/17 Total on 1/2/18 Change from 1/3/17 Total on 1/2/18 Change from 1/3/17 Parent or Relative Independent/Supported Living Foster Home/Family Home Agency Community Care Facility ICF/DD-H Health Facility Developmental Center Other Total INDEPENDENT AND SUPPORTED LIVING SERVICE AUTHORIZATIONS as of 1/2/18 Service Number of Clients Change from 1/3/17 Supported Living Services Independent Living Services TOTAL RESPITE SERVICE AUTHORIZATIONS as of 1/2/18 Service Type Number of Clients Change from 1/3/17 In-Home Respite Agency 6752(79%) +657 Respite Registry 1053(12%) +39 Nursing Respite 450(5%) +14 Out-of-Home Respite (Day/Evening) 262(3%) +8 Out-of-Home Respite (Overnight) 127(1%) +4 TOTAL P age

26 Appendix IV SAN DIEGO REGIONAL CENTER COMMUNITY LIVING SITUATION STATISTICS (based on SANDIS data of 1/2/18) Diagram 6 Client Living Situations Children (under age 18) Health Facility 0.06% Community Care Facility 0.34% Foster Home 1.98% Parent or Relative 97.63% Diagram 7 Client Living Situations Adults (Age 18 and older) ICF/DD-H 3.46% Developmental Center 0.36% Parent or Relative 62.57% Independent or Supported Living 14.42% Community Care Facility 15.89% Health Facility 2.93% Adult Family Home 0.83% 17 P age

27 Appendix IV SAN DIEGO REGIONAL CENTER COMMUNITY LIVING SITUATION STATISTICS (based on SANDIS data of 1/2/18) Diagram 8 Changes in Client Living Situations Children (Under 18) Health Facility Jan-18 Foster Home Community Care Facility Jan-13 Jan-08 Jan-03 Jan-98 Parent or Relative Percentage of Clients in Living Situation Diagram 9 Changes in Client Living Situations Adults (18 and older) Parent or Relative Independent and Supported Living Jan-18 Community Care Facility Health Facility Jan-13 Jan-08 Jan-03 Jan-98 Developmental Center Percentage of Clients in Living Situation 18 P age

28 Appendix V RESIDENTIAL RESOURCES & VACANCY RATES January 2, 2018 Level 2O Level 2S Homes Beds Vac. Homes Beds Vac. Adults Children Totals Level 3 O Level 3 S Level 4 Homes Beds Vac. Homes Beds Vac. Homes Beds Vac. Adults Children Children-Spec. Needs N/A Totals Community Care Licensed Homes - Totals Homes Beds Vacancies/% Non-amb. Beds Homes with > 6 beds Homes with 4 beds or less Level /10% /29% Level /10% /12% Level /7% /24% Spec.Res /4% /92% TOTAL /9% /29% Health Care Licensed Homes - Totals Homes Beds Vacancies/% Non-amb. Beds Homes with > 6 beds ICF/DD-H /3% ICF/DD-N /5% ICF/DD /4% 57 1 SNF-Distinct Part /9% 59 1 TOTAL /4% P age TOTALS - ALL RESIDENTIAL Homes Beds Vacancies/% /7%

29 Appendix V RESIDENTIAL RESOURCES & VACANCY RATES January 2, 2018 Diagram 10 Residential Homes-Licensed Beds ICF/DD-H 15.2% ICF/DD 1.8% ICF/DD-N 4.9% SNF-Distinct Part 1.9% Level % Specialized Residential Facility 6.7% Level % Level % Diagram 11 Residential Homes-Vacancies Health Licensed Facilities 13% Level 2 29% Level 4 19% Level 3 36% Specialized Residential Facility 3% 20 P age

30 Appendix VI SAN DIEGO REGIONAL CENTER IDENTIFIED AS NEEDING DEFLECTION January December 2017 Level of Intellectual Disability None/Border. Mild Moderate Severe Profound Total 4(33%) 3(25%) 5(42%) Age and Gender Total Male (75%) Female (25%) Mental Health Diagnosis Other Background Factors Autism-Under 18 5(83%) 6(50%) Autism-Over 18 1(17%) Residence on 12/31/17 Residence at the time of referral Family Jail Specialized Residential Facility ICF- DD/H Psychiatric Hospital Total Family Level ICF-DD/H 1 1 Psych. Hospital 2 2 Jail 2 2 Total P age

31 Appendix VII SAN DIEGO REGIONAL CENTER Clients living in State Developmental Centers 1/3/17 Age and Gender Total Male (77%) Female (23%) Qualifying Diagnosis (each person may have more than one diagnosis) Intellectual Disability (ID) Epilepsy (EP) Cerebral Palsy (CP) Autism (AU) 42 (91%) 5 (11%) 11 (24%) 3 (7%) Level of Intellectual Disability None/Border. Mild Moderate Severe Profound Total 4 25(54%) (22%) 46 Legal Commitment to State Developmental Center HOP (Gravely Disabled) 19(41%) 6500 (Danger to Self or Others) 21(46%) (Penal Code Competency Training) 6 Other Important Information Specific Community Placement has been identified for the Client Needs an Adult Residential Facility for People with Special Healthcare Needs (ARF-PSHN) 22(48%) 12(26%) 22 P age

32 Appendix VIII SAN DIEGO REGIONAL CENTER ADULT DAY SERVICES STATISTICS (based on SANDIS data of 1/2/18) Type of Program/Activity Number of Clients Competitively Employed (without funded supports) 267 Department of Rehabilitation Funded Services 278 Other Publicly and Privately Funded Programs 291 Educational Programs (Community College, Public School, Adult Education, etc.) 1144 No Day Services 3202 Regional Center Funded Services 7009 Diagram 12 Adult Client-Day Program/Activity Competitively Employed 2.2% Educational Program 9.4% No Day Services 26.3% Department of Rehabilitation Funded Services 2.3% Other Programs 2.4% Regional Center Funded Services 57.5% 23 P age

33 Appendix VIII SAN DIEGO REGIONAL CENTER REGIONAL CENTER FUNDED ADULT DAY SERVICES STATISTICS (based on SANDIS data of 1/2/18) REGIONAL CENTER FUNDED DAY SERVICE Supported Employment- Individual Placement Supported Employment- Group Placement Staff: Client Ratio Number of Clients Change from 1/3/17 1: : Work Activity Program 1: Activity Center 1: : : Adult Development Center 1: : Behavior Management Program 1: Tailored Day Services 1: Intensive Daytime Support Program 1: Diagram 13 Clients in SDRC Funded Adult Day Services Activity Center (1:8) 2.1% Activity Center (1:7) Work Activity Program 7.7% Supported Employment-Group Placement 9.7% Tailored Day Services 13.7% 0.4% Activity Center (1:6) 4.5% Adult Development Center (1:4) 15.2% Supported Employment- Individual Placement 7.5% Intensive Day Support Program 1.1% Behavior Management Program (1:3) 12.4% Adult Development Center (1:3) 25.7% 24 P age

34 Appendix VIII Clients turning 22 years old in 2018 by Geographic Area and Estimated Adult Day Service needs Geographic Area # Needing Activity Center # Needing ADC # Needing Behav. Manage. # Needing Hab. Services # Needing Other (Tailored Day, Intensive, etc) Total Central San Diego North County Southbay East County Imperial County Total Licensed Program Capacities compared to Authorizations (1/2/18) by Type of Program and Location Central East County North County Southbay Imperial County Cap. Auth. Cap. Auth. Cap. Auth. Cap. Auth. Cap. Auth. AC ADC Behavior Manage. Intensive Day Seniors P age

35 San Diego Regional Center Carlos Flores, Executive Director 4355 Ruffin Road, Suite 200, San Diego, CA Phone: (858) Fax: (858) Spring 2018 Performance Report for San Diego Regional Center Every year, the Department of Developmental Services (DDS) contracts with regional centers in California to serve clients and families. And, every year DDS looks at how well the regional centers are doing. This report will give you information about your regional center. Last year, at San Diego Regional Center (SDRC) we served about 27,300 clients. The charts on page two tell you about the clients we serve. You ll also see how well we are doing in meeting our goals and in fulfilling our contract with DDS. At SDRC, we want to improve every year, do better than the state average, and meet or exceed the DDS standard. As you can see in this report, we did well in We hope this report helps you learn more about SDRC. If you have any questions or comments, please contact us! This report is a summary. To see the complete report, go to: Or contact the SDRC Community Services Department at Carlos Flores Executive Director, San Diego Regional Center Summary Performance Report for San Diego Regional Center, Spring

36 Who uses SDRC? These charts tell you about who SDRC clients are and where they live. DIAGNOSIS OF SDRC CLIENTS ETHNICITY OF SDRC CLIENTS Latino/Hispanic 38% AGE OF SDRC CLIENTS WHERE SDRC CLIENTS LIVE How well is SDRC performing? This chart tells you about five areas where DDS wants each regional center to keep improving. The first column tells you how SDRC was doing at the end of 2016, and the second column shows how SDRC was doing at the end of To see how SDRC compares to the other regional centers in the state, compare the numbers to the state averages (in the shaded columns). Regional Center Goals (based on Lanterman Act) December 2016 December 2017 State Average SDRC State Average SDRC Fewer clients live in developmental centers 0.30% 0.25% 0.21% 0.17% More children live with families 99.24% 99.34% 99.32% 99.44% More adults live in home settings* 78.89% 76.94% 79.61% 77.25% Fewer children live in large facilities (more than 6 people) 0.05% 0.08% 0.04% 0.06% Fewer adults live in large facilities (more than 6 people) 2.60% 2.47% 2.47% 2.51% Notes: 1) Clients can be included in more than one diagnosis category. 2) Residence Types: CCF/ICF is Community Care Facility/Intermediate Care Facility; ILS/SLS is Independent Living Services/Supported Living Services. 3) Home settings include independent living, supported living, Adult Family Home Agency homes, and clients family homes. 4) Green text indicates the RC remained the same or improved from the previous year, red indicates the RC did not improve. Summary Performance Report for San Diego Regional Center, Spring

37 Did SDRC meet DDS standards? Read below to see how well SDRC did in meeting DDS compliance standards: Areas Measured Last Period Current Period Passes independent audit Yes Yes Passes DDS audit Yes Yes Audits vendors as required Met Met Didn t overspend operations budget Yes Yes Participates in the federal waiver Yes Yes CDERs and ESRs are updated as required (CDER is the Client Development Evaluation Report and ESR is the Early Start Report. Both contain information about clients, including diagnosis.)* 93.44% 94.34% Intake/Assessment timelines for clients age 3 or older met 98.55% 100% IPP (Individual Program Plan) requirements met 98.66% 98.36% IFSP (Individualized Family Service Plan) requirements met 88.4% 88.1% Notes: 1) The federal waiver refers to the Medicaid Home and Community-Based Services Waiver program that allows California to offer services not otherwise available through the Medi-Cal program to serve people (including individuals with developmental disabilities) in their own homes and communities. 2) The CDER and ESR currency percentages were weighted based on the RC s Status 1 and Status 2 caseloads to arrive at a composite score. 3) The IFSP calculation methodology was changed from composite to average in order to more accurately reflect the RC s performance by only including children reviewed during monitoring and not all Early Start clients. 4) N/A indicates that the regional center was not reviewed for the measure during the current period. Summary Performance Report for San Diego Regional Center, Spring

38 How well is SDRC doing at reducing disparities and improving equity? These tables show you how well the regional center is doing at providing services equally for all clients. Residence Type Home ILS/SLS Institutions Residential Med/Rehab/ Psych Other Measure Percent of Authorized Services and Clients by Residence Type and Ethnicity/Race Fiscal Years and American Indian or Alaska Native Asian Black/African American Latino/ Hispanic Native Hawaiian or Other Pacific Islander White Other Ethnicity or Race Clients 0% 0% 6% 8% 4% 5% 31% 40% 0% 0.4% 19% 26% 39% 20% Authorized Services 0% 0% 8% 9% 5% 6% 36% 37% 0% 0% 29% 31% 21% 16% Clients 1% 1% 3% 3% 13% 13% 20% 22% 1% 0.6% 54% 55% 10% 6% Authorized Services 0% 0% 3% 3% 11% 11% 16% 15% 0% 0% 62% 64% 7% 7% Clients 0% 0% 0% 1% 7% 14% 21% 22% 0% 0.0% 60% 48% 12% 14% Authorized Services 0% 0% 0% 2% 4% 14% 34% 24% 0% 0% 31% 37% 30% 23% Clients 0% 1% 3% 4% 6% 7% 17% 18% 0% 0.4% 64% 65% 8% 5% Authorized Services 0% 0% 4% 4% 7% 7% 20% 20% 1% 1% 63% 63% 5% 5% Clients 1% 1% 3% 5% 14% 12% 18% 23% 1% 0.6% 51% 53% 13% 7% Authorized Services 0% 0% 4% 3% 6% 5% 13% 42% 0% 0% 63% 49% 13% 1% Clients 1% 1% 4% 2% 18% 23% 22% 25% 0% 1% 38% 40% 16% 9% Authorized Services 0% 0% 1% 0% 9% 14% 30% 34% 0% 0% 48% 45% 13% 6% Note: 1) Institutions include developmental centers, state hospitals, and correctional facilities. 2) Residential includes care facilities intermediate care facilities, and continuous nursing facilities. 3) Med/Rehab/Psych include skilled nursing facilities, psychiatric treatment and rehabilitation centers, acute general hospitals, sub-acute care services, and community treatment facilities. 4) Other includes clients who are out-of-state, in hospice, transient/homeless, or not listed elsewhere. Summary Performance Report for San Diego Regional Center, Spring

39 Percent of Annual authorized services by diagnosis and ethnicity Ethnicity/Race Autism Intellectual Disability Cerebral Palsy Epilepsy Category 5 American Indian or Alaska Native 0.2% 0.3% 0.4% 0.8% 0.3% Asian 9.7% 5.3% 4.1% 4.6% 3.5% Black/African American 7.0% 8.2% 6.4% 6.4% 7.7% Latino/Hispanic 28.7% 28.1% 26.3% 27.4% 19.8% Native Hawaiian or Other Pacific Islander 0.8% 0.4% 0.1% 0.4% 0.2% Other Ethnicity or Race 6.4% 4.3% 4.2% 4.2% 4.9% White 47.2% 53.4% 58.5% 56.2% 63.6% TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% SDRC identified that there were too many clients whose ethnicity or race were not properly coded in our computer system. During 2017 the SDRC completed a project to fix that problem. As a result these data for 2017 are considerably different than the 2016 data. The 2017 data are correct. Want more information? To see the complete report, go to: Or contact the SDRC Cultural Specialist at Summary Performance Report for San Diego Regional Center, Spring

40 OUTCOMES SDRC PERFORMANCE CONTRACT STATUS REPORT January 1, 2018 through June 30, 2018 INITIAL BASELINE Jan 2002 STATUS as of Dec 2015 STATUS as of Dec 2016 STATUS as of Dec 2017 Decrease percentage of Regional Center caseload in Developmental Centers. 1.48%.28%.25%.17% Increase percentage of minors residing with families % 99.20% 99.34% 99.44% Increase percentage of adults residing in own homes % 76.33% 76.94% 77.25% Decrease percentage of adults living in housing facilities for 7 or more people. 8.60% 2.60% 2.47% 2.51% STATUS as of June 2018 Decrease percentage of children living in housing facilities for 7 or more people..84%.18%.08%.06%.06%.17% 99.46% 77.55% 2.45% Unqualified Independent Audit. Substantial compliance in the DDS Fiscal Audit. Operate within OPS budget. Certified to participate in Waiver. Compliance with vendor audit requirements. Intake/Assessment timelines (0-3). Intake/Assessment timelines (over age 3). CDER Currency Unqualified Audit Substantial Compliance Unqualified Audit Substantial Compliance Unqualified Audit Substantial Compliance Unmodified Audit Substantial Compliance Unmodified Audit Substantial Compliance Yes Yes Yes Yes Yes Certified Certified Certified Certified Certified In Compliance To Be Determined In Compliance To Be Determined In Compliance To Be Determined In Compliance To Be Determined In Compliance To Be Determined 72.36% 97.07% 98.55% 100% 100% 83.47% 94.36% 97.14% 96.62% 97.12%

41 SDRC PERFORMANCE CONTRACT STATUS REPORT January 1, 2018 through June 30, 2018 Page 2 of 2 State-wide processes for tracking the following outcomes have not been developed: Access to medical and dental services; Reduce number of people with developmental disabilities who are abused; Accurate fiscal projection; Timely Individual Program Plans (IPP) (96% as a result of 2002 DDS audit); and, Timely Individual Family Service Plans (IFSP) (95.45% as a result of 2002 DDS audit). SDRC PERFORMANCE CONTRACT STATUS REPORT

42 DRAFT #1 San Diego-Imperial Counties Developmental Services, Inc Performance Contract Plan Outcomes and Activities 1. Outcome: Decrease percentage of Regional Center caseload in Developmental Centers. Activity A: Activity B: Implement the Community Placement Plan (CPP). Complete comprehensive assessments for persons residing in the developmental centers; develop community resources to transition 20 clients into the community. 2. Outcome: Increase percentage of minors residing with families. Activity A: Activity B: Activity C: Activity D: Maximize the use of community resources that provide supports to families to assist them in maintaining their children at home. Provide information and training to community service providers on the special needs of families with children with developmental disabilities. Provide training to service coordinators on how to assist families to be effective advocates for their child related to the IEP process and/or navigating other service systems (e.g. Child Welfare, Behavioral Health, IHSS, SSI, etc.). Continue crisis intervention and wrap-around services. 3. Outcome: Increase number and percentage of adults residing in independent living. Activity A: Activity B: Activity C: Contract with a nonprofit organization to develop and help people access safe and affordable housing. Review living options, including related supports, with clients at the time of the annual review. Assist clients and families to access the assistive technology necessary to live independently.

43 San Diego-Imperial Counties Developmental Services, Inc. DRAFT # Performance Contract Plan Outcomes and Activities Page 2 of 5 4. Outcome: Increase number and percentage of adults residing in supported living. Activity A: Activity B: Activity C: Contract with a nonprofit organization to develop and help people access safe and affordable housing. Review living options, including related supports, with clients at the time of the annual review. Assist clients and families to access the assistive technology necessary to live in their home with supports. 5. Outcome: Increase number and percentage of adults residing in Adult Family Home Agency homes. Activity A: Review living options, including Adult Family Homes with clients at the time of the annual review. 6. Outcome: Increase the number of adults residing in family homes (home of parent or guardian). Activity A: Activity B: Review living options, including related supports with clients at the time of annual review. Provide services and supports to clients and families to live in the family home. 7. Outcome: Increase number and percentage of adults residing in home settings. Activity A: Activity B: Activity C: Activity D: Contract with a nonprofit organization to develop and help people access safe and affordable housing. Review living options, including related supports, with clients at the time of the annual review. Assist clients and families to access the assistive technology necessary to live in a home setting. Provide services and supports to families of clients who are elderly and live with their family.