Clackamas County Board of County Commissioners

Public Meeting Thursday, September 25, 2008

 

Secure Residential Treatment Facility, 2808 SE  Balfour Street, Milwaukie, Oregon

Questions and Answers

 

The following responses are provided by Clackamas County:

 

What is the County’s role in selecting the site?

The County has no role in siting the facility.

The County allocated $195,000 of federal Community Development Block Brant funds for acquisition of a property in Clackamas County.  The funds are part of the 2006-2009 Consolidated Plan generated by the Community Development division.  The County also allocated additional dollars for construction.  The County did not control the selection of the property; that choice was made by the provider, Columbia Care.

 

What are the County options for the facility siting and please address the recent lawsuit from Milwaukie.

Options for the facility siting - If the Board were to take actions to prohibit the facility, it would be in violation of Federal Fair Housing Act which prohibits discrimination in housing-related transactions or opportunities, based on race, color, national origin, religion, sex, familial status….and handicap (disability) as well as Title II of the Americans with Disabilities Act.

 

State Laws, Oregon revised Statutes 197.663 - 197.670 provide that “residential facilities shall be considered as residential property and be located in a residential area”.

 

Recent lawsuit – The County was not a party to the lawsuit and we are unable to provide information.  That information may be available from the City of Milwaukie.

 

What assurances do you have that the community will be safe?

Individuals under the jurisdiction of the Psychiatric Security Review Board (PSRB) would undergo four separate screening and assessment processes conducted by the Oregon State Hospital Staff, the Psychiatric Security Review Board, Clackamas County Community Health, and ColumbiaCare Services to determine if they pose a danger to the community and whether their needs can be appropriately addressed.  The County can decline to accept a placement if they determine the individual is too dangerous to move to the community.

 

Individuals who are recommended for placement out of the Extended Managed Care Unit are screened and assessed by the Oregon State Hospital and ColumbiaCare with the assistance of Clackamas County Community Health.

           

Once placed, residents are under 24 hour awake supervision including on-site treatment and medication management.

 

The facility itself will be secure internally and externally.

 

Help us understand the County role in the resident selection process.

The County has qualified staff who are experienced and dedicated to working with PSRB clients.

Individuals under PSRB undergo extensive monitoring and reporting by the County.  It is the most active level of case management.

 

Will the patients have passes in the community?

It depends upon the conditions of their release.  Eventually, they may earn the privilege to go visit their family, church, the store etc.  Once they no longer need the level of supervision provided in the facility, they will move to a less secure place to live.

 

Talk about the request to relocate the facility; the County cannot make that call?

No, we cannot.  The location of a residential facility is subject to state and federal laws as noted above and is the choice of the developer.

 

How much would a lawsuit cost the taxpayer?

We don’t know; however, Nashville, Tennessee recently lost a similar case where the city interfered with the location of an adolescent treatment facility.  It cost the city around one million dollars and the court determined that the facility had a right to be placed where it originally intended to be located.

 

Shouldn’t the County look for fairer ways to relocate the facility somewhere else?

The state Department of Human Services issued a Request for Applications for Development to develop community-based services and housing for consumers transitioning from the Oregon State Hospital. Although this process included specific counties for development, the developer was chosen by the state and the developer selected the site. 

 

Has the Governors workgroup halted these types of projects?

Not to our knowledge.  The State is continuing development of these facilities.

 

Help us understand the difference between group homes and other places.

There is a continuum of residential services dependent upon the level of staffing and treatment needed.  Examples of community based-facilities include secure and non-secure residential treatment, foster care, group homes, supportive apartments, and independent living. (See Oregon Revised Statutes, chapter 443 regarding definitions for residential facilities and homes.)

 

Why isn’t the facility located in Sandy or Red Soils, in a commercial zone?

Sandy:

In 2006 a site located within the City of Sandy was explored.  The site was not zoned for residential use and would have required a conditional use permit.  It was determined that the site did not offer sufficient space and was too far removed from public services.

 

Red Soils:

In 2007 an inquiry was made to determine if land on the County’s Red Soils campus could be developed for residential use. The land is zoned “mixed used employment” and would have required a conditional use permit.  It was determined that residential facilities are not allowed within that zoning.  Also, the site was not large enough to accommodate the needs of the facility.

 

Residential use in Commercial Zone; state zoning laws found in Oregon Revised Statues (ORS) chapter 197 determine where residential facilities may be located; two relevant laws are listed below:

ORS  197.665  Locations of residential homes.

(1) Residential homes shall be a permitted use in:

      (a) Any residential zone, including a residential zone which allows a single-family dwelling;

                  and

      (b) Any commercial zone which allows a single-family dwelling.

      (2) A city or county may not impose any zoning requirement on the establishment and maintenance of a residential home in a zone described in subsection (1) of this section that is more restrictive than a zoning requirement imposed on a single-family dwelling in the same zone.

 

ORS 197.667  Location of residential facility; application and supporting documentation.

(1) A residential facility shall be a permitted use in any zone where multifamily residential uses are a permitted use.

 

What is the environmental impact?

The County, Community Development program conducted an environmental review and found that the project would have no significant impact on the human environment and made a “Finding of No Significant Impact” to the US Department of Housing and Urban Development (HUD).  Consistent with HUD regulations an Environmental Impact Statement is not required by HUD or the National Environmental Policy Act (NEPA) of 1969 based upon the county’s finding. 

 

Where is the common sense in this?

State and federal laws are very clear and dictate what the County can and cannot do with respect to interfering in residential development that is protected by the federal Fair Housing Act. 

 

Are the Commissioners required to sign contracts with Columbia Care and have no say in siting the facility?

Federal law prohibits the County from imposing conditions on the developer of housing protected by the federal Fair Housing Act that it could not also impose on other developers building multi-family housing in permitted residential zones. This would include where to build housing when zoning permits its use. 

 

The following responses are provided by ColumbiaCare Services (CCS).

 

ColumbiaCare Services name change 2003.  Why?

Our previous name was Oregon Regional Behavioral Services.  We changed our name in January of 2008 due to expansion of services into other states (Idaho), and we no longer felt this name was representative of our agency.  We also felt it was time to update our website to become more informative, welcoming, and user friendly.  It made sense to make some of these organizational changes at the same time.    

 

Has this management company managed a facility of this size and clientele?  If so, for how long and where?

Yes. The Executive Director of ColumbiaCare (and other administrative staff) have developed and operated a 16 bed, a 15 bed and two 12 bed residential facilities.  In addition we have developed two 16 bed facilities for others to operate.  ColumbiaCare has extensive history and experience in designing, developing, and operating residential treatment facilities in Oregon and Idaho, and has a proven track record of providing quality services that produce positive outcomes for residents, safety for residents and community members, and positive professional relationships with partnering agencies and communities. 

  

The current principals of ColumbiaCare collectively have over 50 years of combined experience, and prior to forming ColumbiaCare, operated a comprehensive community mental health program with over 200 employees.  Since forming ColumbiaCare Services in 2003, the company has designed, developed and is now operating 10 licensed treatment facilities providing 24-hour residential services to adults with a primary diagnosis of mental illness, operates 3 supportive housing apartment buildings, and has 2 more facilities under construction or development.  For more information and photographs of our facilities and programs, please visit our website at www.columbiacare.org 

 

Credentials

 

• ColumbiaCare is licensed to operate Residential Treatment Homes and Facilities for Adults with Mental Illnesses in 5 Oregon counties (Coos, Curry, Morrow, Multnomah, Wasco)-State of Oregon Addictions and Mental Health Division.
• ColumbiaCare has a Certificate of Approval to provide Adult Mental Health Outpatient Services in 4 Oregon counties Coos, Curry, Morrow, Multnomah)-State of Oregon Addictions and Mental Health Division.
• ColumbiaCare is an approved Community Rehabilitation Provider of Supported Employment Services state wide- State of Oregon Office of Vocational Rehabilitation Services
• ColumbiaCare is licensed to provide Secure Transportation Services-State of Oregon
• ColumbiaCare has developed a Center for Suicide Prevention which offers consultation, training and curricula development services with the goal of creating suicide-safer communities.   ColumbiaCare sponsors ASIST and RESPONSE programs.

Has the mental health division investigated this management company’s survey history over the last six years?  What were the results?

Every one of ColumbiaCare’s facilities is licensed and inspected for compliance by the State of Oregon at least every 2 years.  Every one of our facilities has always been re-licensed.

 

Has the sheriff, police department, and/or fire and ambulance service been called for information on the emergencies they have received from CCS facilities during the time they have managed these facilities?

Yes of course, in a period of 14 years there have been all kinds of emergencies.  ColumbiaCare has operated multiple facilities, all with several, unrelated residents living under one roof, 24 hours a day over many years.  When you add the dynamic of some individuals dealing with physical health issues and all recovering from a severe and persistent mental illness- there is the unavoidable reality of calls to emergency services.  We feel that that the amount of emergency calls from our facilities is very acceptable, and actually quite low considering the treatment environment and nature of our business. 

 

Has Protective Services been called?  How often and for what reason?

No.

 

Turn over rate of staffing?  Workers Comp Issues?

ColumbiaCare does not have a cumulative turn over rate available but it is monitored by Administrative staff and the Board of Directors, and it has been very low.  There have been no significant workers compensation claims due to client actions.

 

What is the criteria to determine if a client is appropriate?

First, prospective residents are evaluated and approved by the Psychiatrists and treatment team at the Oregon State Hospital for their ability to live in a residential treatment facility and a determination is made that this placement will be safe for the community.  Second, Clackamas County Community Health determines the prospective resident’s ability to live in a residential treatment facility and whether the prospective resident would be a danger to the community.  After these two reviews ColumbiaCare evaluates the placement based upon community safety and they also take into account resident mix, mental health history, physical health needs, availability and qualifications of staff and ability to benefit from treatment.  This screening includes a visit to the prospective resident at the State Hospital by our Clinical Director (PhD) and/or Facility Administrator (QMHP-Qualified Mental Health Professional-Master’s Level Therapist), as well as stringent resident file review. If approved, the resident is transferred from the State Hospital and admitted to a ColumbiaCare Facility.

 

*If the client is under the jurisdiction of the PSRB, a final plan for the resident is submitted to the Psychiatric Security Review Board by ColumbiaCare and Clackamas County Community Health.  Only after PSRB approval is the resident transferred from the State Hospital and admitted to a ColumbiaCare Facility.

 

If a resident becomes out of control, who is called, how is this handled by various agencies, and where will this individual be placed if all avenues are full?

Again, the answer is dependent on the type of resident and definition and level of “out of control”.  If the resident is under the jurisdiction of the PSRB and has violated the terms of their Conditional Discharge Plan, law enforcement would be called and they would be returned to the State Hospital.  If a resident were found to be “out of control” such that staff felt they or another resident were in danger, law enforcement would be called.  If a resident were psychiatrically decompensating (becoming unstable), they would be transported to the hospital emergency room either by staff or by ambulance, whichever was appropriate.

 

What has been the impact on the neighborhood?

Our facilities are very well designed and we have not historically found there to be any negative impact on property values.  We make every reasonable effort to design the facility so that it blends in as much as possible.  Often times, the development of our new facilities and/or renovation of existing homes enhance the look of the neighborhood, specifically when development calls for street improvements.  We take great pride in the appearance of our facilities, both inside and out.  This is not just for our reputation, but to be a benefit to the community and because it is an importance piece of ColumbiaCare’s Treatment Philosophy to provide a warm, welcoming, upscale environment for our residents.  Our residents are less likely to want to leave without authorization when they are receiving quality treatment provided by a caring staff, eating home-cooked meals in a comfortable, safe, and nice looking home.  For some, our facility-their home, is the nicest environment they have ever lived in, and it can lend to their desire to improve their situation. 

 

Has the City Manager of each city, where facilities are located, been called for their input?

ColumbiaCare follows City, County, State and Federal regulations when it comes to developing new facilities.  The City Planning Department’s approval is one of the very first steps in the development process, even before purchasing a piece of property.  Our facilities do not go in secretly.  We also are bound by Federal Fair Housing laws about where disabled citizens have a right to live and what notifications and to who we are allowed to make.

 

How can the State, City, and CCS guarantee the safety of the disabled and elderly who live in the immediate area?  Hillside Manor and Hillside Park have approximately 135 disabled, 77 elderly (some of these residents are both) and 43 children who live in the immediate area.  In the neighborhood, many children, some disabled, live either directly across the street from the proposed facility on Balfour Street.

ColumbiaCare is committed to the safety and well-being of both our residents and community members.  As we develop residential service programs, we put this statement into action by adhering to a community integration process which includes:

 

• Ensuring appropriate resident placement through careful and appropriate screening and placement procedures;
• Carefully designing and building each particular facility with the appropriate level of physical safeguards based on the level of care;
• Coordinating with local law enforcement, public officials, partnering provider agencies and interested community members to proactively address emergency response plans which may include instructions such as when and how the general public should communicate concerns, and to whom; when and how staff will report facility incidents to local law enforcement; and how both local law enforcement and ColumbiaCare can best respond to an issue should one arise, in a timely, respectful and safe manner.
• Going above and beyond to recruit and retain highly qualified and professional staff to provide the appropriate level of staff supervision and treatment;
• Staying dedicated to the ColumbiaCare mission and ultimate goal of providing quality treatment which “provides residents a pathway to achieving the same things that all humans need to not only feel safe and well taken care of, but to contribute and thrive”.

ColumbiaCare has a long record of quality treatment for our residents and an exemplary safety record for our neighbors.  We do not and will not admit residents that will be a threat to the neighborhood in which our facilities are located.  We design facilities, treatment plans and hire staff to insure good treatment and safe conditions for residents and neighbors alike.   

 

What type of citizen involvement will be encouraged?

ColumbiaCare has developed a Project Communication Plan which includes working with partner agencies to make sure everyone involved in the project is involved in helping provide accurate information. 

 

We have developed a new website for the purpose of providing information to the public and to provide progress reports and development updates, but also to try and help educate the public about us, our services, resident rights, etc.  www.communitycares.info

 

We are developing information packets to go out in the mail, in case there are those who do not have access to computers or the internet (we don’t to miss anyone). 

 

We have plans to not just to respond when a neighbor has a question, but to initiate discussions with individuals and the Neighborhood Association.  We want the Association to help us facilitate neighborhood information meetings where we share information, but also spend a great deal of time (however much it takes) to hear concerns and take into consideration reasonable suggestions about the operations and physical building itself. 

 

We plan to meet with local law enforcement at the appropriate time to have discussions about how to report/respond to incidents that may arise so that a safety plan is in place that will benefit everyone involved.  This will help us to avoid under reaction and overreaction. 

 

We plan to hold an Open House just prior to residents moving in so citizens can take a tour and meet staff. 

 

We will have our Facility Administrator join or attend the Neighborhood Association/Meetings to give regular updates or address ongoing questions.  They will become a familiar face and be easily accessible. 

 

It is important to remember that these communications will take place as the project unfolds and all information will not be available immediately as preliminary information may be inaccurate.  There will be time to do all of the things mentioned above. 

 

We are not required to do all of this-we WANT to do it, and are offering to do it.  We want to be good neighbors, we want to alleviate fear, and we want to provide the best services we can. In the meantime, we have made efforts to contact various members of the Neighborhood Association, attended the Commissioners Information meeting, and published the website, all before we have even purchased the property.

 

What type of further communications will be given to the neighborhood association, by whom, and by what time frame?

See response directly above.

 

In one communication, the ratio of the 15 residents states: 5 severe persistent mental illness; 8 with mental illness under jurisdiction of the PSRB; 2 CC Community Health clients with mental illness.  Is this correct?

This is possible.  The State and the County determine the mix of residents, not ColumbiaCare.  Those agencies are still working on that.  There will be no more than 15 residents.  The exact mix is yet to be determined, but should be decided very soon.  When the information becomes available, we will share it.

 

Will there be murders, rapists, and pedophiles placed at this facility.  If so, what precautions will be taken to protect the other patients as well as the neighborhood?  What will be the age mix?  Will there be both men and women and in what ratio?  Will each room have its own bathroom?  Will patients have the ability to lock their rooms in order to feel safe from other patients?  Will there be ‘holding cells’ and if so, will these cells be considered as a bedroom or will they be in addition to those already allocated?

Residents under the jurisdiction of the PSRB may have committed crimes ranging from misdemeanors to felonies, as a result of their mental illness.  All residents will be over 18.  There will be men and women, however; the ratio is unknown until the actual residents are selected about 60-90 days before opening.  There will not be private bathrooms.  Individual rooms may be locked by the resident for privacy but staff will have keys and access.  There will be no “holding cells”.  This is a residential treatment facility with rooms, not cells.   The facility may or may not include crisis-respite beds, which are rooms that would provide services to Clackamas County residents for up to 30 days.   Again, the State and the County determine the mix of residents not ColumbiaCare.  Despite the type of rooms and type of service and residents, there will be no more than 15 residents total.    If the building plans appear to have more than 15 bedrooms, it is only to provide flexibility in office space, bedrooms, other uses, etc.

 

Will the CC Community Health provide psychiatric consultation/medication management, etc. and oversight of the Oregon Admin Rules compliance?

Columbia Care will provide the psychiatric services and the medication management but Clackamas County Community Health will provide supervision of any residents under PSRB jurisdiction and will also inspect the facility for compliance with Oregon Administrative Rules along with the State.

 

Since the OAR under Residential Treatment Facilities do not apply to this type of occupancy, will there be new rules adopted?  Who will draft them and under what time frame?

OAR’s (Oregon Administrative Rules) for a Residential Treatment Facility do apply.

 

Will there be certified Nurses aides, LPNs, and/or RNs on duty 24 hours per day?  What will the staff ratio to patients per shift be?

Because the exact mix of resident population is unknown at this time, we are unable to provide exact staff to patient ratio per shift.  As soon as we know for sure, we will provide that information.  We can tell you that the Secure Residential Treatment Facility will have approximately 24 total ColumbiaCare staff that will be administrating and providing treatment services.  This will be in addition to State and County employees that will provide on-site monitoring and case management services.  ColumbiaCare staff will likely include a Psychiatrist, Nurse Practitioner, Registered Nurse, Qualified Mental Health Professionals (Master’s Level Therapists), and QMHAs (Bachelor’s level degree in psychology or related degree, or combined education or experience in psychology or related field).   The facility will be staffed with 24-hour awake staff, providing uninterrupted supervision.  Again, when more detailed information becomes available, we will share it.

 

What guidelines, policy and procedures will this facility allow during this interim period?

We are unaware of any “interim period”.  ColumbiaCare has current policies and procedures required by Oregon Administrative Rule, as well as additional internal facility operations policies and procedures. 

 

How can we, as concerned citizens, have input into these requirements?

In regard to state law and administrative rules, every citizen has the opportunity to vote for the elected representatives who pass the related laws.  If the question refers to opportunities for concerned citizens to provide input related to facility design and security measures; ColumbiaCare will consider any reasonable suggestions.   

I have 20 plus years experience as an Administrator in the nursing home field with the last 8 years at a 30 bed secured psychiatric facility.  Patients that are mentally challenged and/or have been violent, in my opinion, should not be released into a community setting until they have been observed in an Enhanced Care Facility which is one step below the State Hospital placement.  Being placed in a “residential treatment facility” as it is being called, saves the State money, is not as regulated, and is a disservice to the patients, neighborhoods, and the community in general.

Secure Residential Treatment Facilities are licensed by the State of Oregon.  They are carefully and thoroughly regulated and no patient from the State Hospital is, or will be, placed in this or any other Secure Residential Treatment Facility unless the psychiatrists and treatment team at the State Hospital, the Psychiatric Security Review Board (if the resident is under their jurisdiction), the mental health evaluation team at Clackamas County Community Health, and the appropriate ColumbiaCare clinical evaluation finds that the placement is appropriate for the resident and safe for the community.  We do not agree in any way that this is a disservice to patients, neighborhoods or the community in general in fact this has proved to be a better treatment modality for our residents and completely safe for neighborhoods.