Loading...
HomeMy WebLinkAboutX-C-01 Special Use Permit - Operation of State Licensed Residential Facility - Rise Up Recovery (303 5th Street E) City Council Memorandum To: Mayor Fasbender and City Council From: John Hinzman, Community Development Director Date: March 7, 2022 Item: Resolution: Special Use Permit - State Licensed Residential Facility - Rise Up Recovery - 303 5th Street E Council Action Requested: Consider approval of the attached resolution approving a Special Use Permit to operate a State Licensed Residential Facility (Providence House) containing board and lodging with special services for substance use disorder recovery. The facility would be located within a home located at 303 East 5th Street purchased from Dennis Sullivan and Martha Sullivan. Approval of the Special Use Permit requires six of seven councilmembers. Background Information: Rise Up would offer the following housing to individuals in conjunction with their counseling facility located at 507 Vermillion Street (located two blocks from 303 5th Street E):  Pre-treatment (short term emergency) - Individuals awaiting enrollment into a treatment program  Post-treatment - Individuals enrolled within a treatment program. Providence House would operate as an “at-will” facility, accepting residents that choose to enter a treatment program. They would not accept those ordered by a court to receive treatment. Rise Up seeks to house 15 individuals at the home. Staff and Planning Commission recommendation is for 10 individuals. Financial Impact: Financial impact is mixed. The housing and treatment of individuals for substance abuse may reduce the financial impact of crime within the City; operation of the facility may increase the number of police and emergency service calls at the location. Advisory Commission Discussion: The Planning Commission voted 6-1 (nay Matzke) to recommend approval of the Special Use Permit, at the February 28, 2022 meeting. Commissioners discussed potential revocation if rules are not adhered to, staffing of facility, what happens if an individual chooses to leave, and fit for the neighborhood. Tiffany Neuharth and Dr. Jeremiah Fairbanks provided comment; no other comments were received at the meeting. The X-C-01 Commission held a public hearing on February 14, 2022, tabling action pending further information. Several comments have been received from the public. Please see the attached Planning Commission Staff Report for further information. Council Committee Discussion: N\A Comments from the Public: Several comments from the public have been received and are included as an attachment to the Planning Commission Staff Report including one comment received since the Planning Commission recommendation. Attachments: • Resolution: Special Use Permit • Planning Commission Staff Report - February 28, 2022 X-C-01 HASTINGS CITY COUNCIL RESOLUTION NO._________ A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HASTINGS GRANTING A SPECIAL USE PERMIT FOR OPERATION OF A STATE LICENSED RESIDENTIAL FACILITY FOR RISE UP RECOVERY AT 303 5TH STREET E Council member ___________________________ introduced the following Resolution and moved its adoption: WHEREAS, Rise Up Recovery has petitioned for a Special Use Permit to operate a State Licensed Residential Facility (Providence House) containing board and lodging with special services for substance use disorder recovery on property presently owned by Martha Sullivan and Dennis Sullivan generally located at 303 5th Street E, legally described as all of Lot 5 and the West Half of Lot 6, Block 31, TOWN OF HASTINGS, Dakota County, Minnesota; and WHEREAS, on February 14, 2022, a public hearing and review of the Special Use Permit was conducted before the Planning Commission of the City of Hastings, as required by state law, city charter, and city ordinance; and WHEREAS, Planning Commission review was continued to the February 28, 2022, and the Commission voted to recommend approval of the request subject to certain conditions of approval; and WHEREAS, The City Council has reviewed the request and recommendation of the Planning Commission. NOW THEREFORE BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF HASTINGS AS FOLLOWS: That the City Council hereby approves the Special Use Permit as presented subject to the following conditions: X-C-01 1) Maintaining a State License for Board and Lodging with Special Services. 2) Maintaining a Rental Housing License from the City of Hastings. 3) Facility must be supervised by a Licensed Alcohol and Drug Counselor. 4) Facility must provide staffing seven days a week, 24 hours a day by certified recovery\support individuals such as Certified Peer Recovery Support Specialists. 5) No more than 10 residents may be housed. Housing shall be limited to medically stabilized pre-treatment (short term emergency) individuals and those enrolled in a qualified post-treatment program. 6) Residents must participate in peer recovery support services. 7) Facility shall maintain rules for conduct and expectations for residents served including the immediate dismissal of residents possessing illicit drugs, alcohol, and mood altering chemicals. 8) Pre-treatment residents shall reside and remain at the Providence House until a treatment placement is made unless accompanied by a member of the post- treatment program to attend recovery meetings only. 9) Residents shall be respectful of neighbors and shall refrain from going indoors or on the front steps of any residence outside of the Providence House property. 10) Outdoor smoking shall be limited to a designated area out of the public view that limits impact to surrounding residences. 11) Residents shall not gather in outdoor areas unless accompanied by staff. 12) Resident intake shall be by appointment only with no walk up intake services. 13) Transportation arrangements must be made for residents discharged from the treatment program. 14) The number of vehicles for residents of the facility is limited to six. 15) Operation must maintain the peace, tranquility, and livability of the surrounding neighborhood. 16) Approval is subject to a one year Sunset Clause; operation must occur within one year of City Council approval or approval is null and void. Council member ______________________ moved a second to this resolution and upon being put to a vote it was adopted by the Council Members present. Adopted by the Hastings City Council on March 7, 2022, by the following vote: Ayes: Nays: Absent: ATTEST: __________________________ Mary Fasbender, Mayor _________________________________ Kelly Murtaugh, City Clerk (City Seal) X-C-01 I HEREBY CERTIFY that the above is a true and correct copy of resolution presented to and adopted by the City of Hastings, County of Dakota, Minnesota, on the 7th day of March, 2022, as disclosed by the records of the City of Hastings on file and of record in the office. ________________________________ Kelly Murtaugh, City Clerk (SEAL) This instrument drafted by: City of Hastings (JH) 101 4th St. E. Hastings, MN 55033 X-C-01 To: Planning Commissioners From: John Hinzman, Community Development Director Date: February 28, 2022 Item: Continued: Rise Up Recovery - Special Use #2022-14 - State Licensed Residential Facility - 303 5th Street E Planning Commission Action Requested Recommend action on the Special Use Permit request of Rise Up Recovery to operate a State Licensed Residential Facility (Providence House) containing board and lodging with special services for substance use disorder recovery. The facility would be located at 303 East 5th Street. Rise Up would purchase the building from Dennis Sullivan and Martha Sullivan. February 14th Planning Commission Meeting The Planning Commission held a public hearing and considered the request at the February 14, 2022 meeting voting 7-0 to table the request pending further information. During the public hearing two individuals provided comment pertaining to the fit of the facility within the neighborhood and specific operational questions. Several comments were also received prior to the meeting and are attached to this report including those that were received after the Planning Commission Meeting. Information Requested by Planning Commission During the February 14th meeting, the Planning Commission requested further details on operation of the facility. Providence House would operate as an “at-will” facility, accepting residents that choose to enter a treatment program. They would not accept those ordered by a court to receive treatment. Rise Up has provided the following documents attached to this report outlining operations: • Letter from Dr. Jeremiah Fairbanks a family medicine and addiction medicine physician in Hastings who serves on the board of Rise Up Recovery • Housing Intake Agreement • Intake Checklist • Screening Form • Service Initiation Policy Planning Commission Memorandum X-C-01 • American Society of Addiction Medicine (ASAM) Risk Rating Severity Matrix • Top 11 Permissions over Apologies outlining expectations and behavior • Certified Peer Specialist Services Qualifications • Behavioral Emergency Procedures • Opioid Overdose Response Utilizing Naloxone (Narcan) • Service Termination Guidelines • Return to Use/Discharge Policy and Procedures • Tobacco Guidelines • Urine Analysis (UA) and Breathalyzer Policy Following are responses to specific questions: • Definition of short term, long term, and pretreatment of residents: o Rise Up would offer the following housing to individuals in conjunction with their counseling facility located at 507 Vermillion Street (located two blocks from 303 5th Street E):  Pre-treatment (short term emergency) - Individuals awaiting enrollment into a treatment program  Post-treatment - Individuals enrolled within a treatment program. • Operation of similar facilities operated by Rise Up in Burnsville and Lakeville: o Rise Up Recovery operates two additional women’s recovery homes. One is located in Burnsville, MN (14632 Greenridge Ln Burnsville, MN 55306) and the other is located in Lakeville (7513 Upper 167th St. W Lakeville, MN 55044). Both homes are located in the heart of residential neighborhoods. They are each 4 bedrooms. The Burnsville residence is licensed as a Board and Lodge facility that houses 6 women and received Housing Support Funding from Dakota County. Just last week they received plan approval from MDH for their licensure application for the Lakeville home. They are pursuing licensure as a Board and Lodge Facility for that home as well which will increase its current occupancy from 4 to 6. Both of these homes provide post-treatment housing for women in recovery from substance use disorder. They provide peer recovery support services on site. The only difference is that we do not offer pre-treatment housing in either home at this time due to size. • Information on other similar types of operation elsewhere: o Rise Up has noted they propose to offer pre-treatment and post-treatment services similar to other facilities. Staff has contacted two facilities with similar operations. Doc’s Recovery operates in Rochester with a 14 bed facility as part of a larger operation within a former college campus that is separated from a residential neighborhood. Beyond Brink operates in Mankato with 13 beds located in a mostly industrial area with some homes in the vicinity. Both facilities noted pre-treatment stays are generally 2-10 days. Post-treatment stays vary in their length of time. Housing is staffed by a Peer Recovery Specialist. X-C-01 • Level of recovery\treatment of individuals served: o Rise Up will provide outpatient community based substance use disorder service. The individuals served are medically stable and some may be in early recovery and using emergency housing beds as a means of stabilization and opportunity to get connected with the services they need elsewhere; they will also have longer term recovery housing and these individuals will have been in recovery for a number of weeks to months and be stabilized. Many will be working or attending school and doing volunteer work in our community. They will be in a mentorship role to the individuals coming into the program for recovery stabilization services. They do not provide treatment services at this time, but have partnerships with various treatment providers to meet these needs. One of those programs is called Care Crossings located out of Stillwater, MN. • Employee staffing at proposed facility including their required expertise and duties. o There is a Licensed Alcohol and Drug Counselor overseeing the home, a Certified Peer Recovery Specialist Approved Supervisor providing supervision to the employees and it will be staffed by Certified Peer Recovery Specialists. They are experts in peer recovery and have lived experience with recovery and recovery resources in our community. The home will be staffed continuously by Certified Peer Recovery Specialists with oversight from the Director who is Licensed Alcohol and Drug Counselor. • Daily schedule of activities – What happens in an average day, staffing, movement of residents, and services: o The nature of peer recovery support is to get participants actively engaged in recovery and community so the goal is to have each participant living a productive life not limited to working, volunteering, working a program of recovery including meeting attendance. Many residents will be brought by peer recovery staff to appointments and assisted with job related activities. It could be several trips per day. • Expectations of resident’s behavior: o Residents will need to abide by certain rules associated with use of phones, curfew, smoking, visitors, belongings, group attendance, meeting attendance, chores and cleanliness, accountability, and respect to others. • Limitations on the number of cars allowed by residents: o The number of vehicles for residents will be limited to six and none of the pre- treatment short-term emergency residents will be allowed to have vehicles. • Will there be a certain number of beds allocated for emergency housing beds vs longer term recovery? o Uncertain at this time. They plan to allocate a minimum of 4 beds for pre- treatment housing but depending upon the need they may have a couple of more. They find tremendous value in having flexibility to meet the community needs which change from season to season. X-C-01 Analysis of Operations Rise Up has developed a very thoughtful and detailed plan of operations detailing rules and expectations for those served and consequences for those that may not follow the rules. The demand and needs for both pre-treatment and post-treatment of individuals has been documented. The treatment of those suffering from substance abuse can often involve a level of volatility. Do the operational procedures and rules established by Rise Up along with conditions established under a Special Use Permit mitigate any operational concerns. Staff has shared concerns that the pre-treatment housing of individuals is subject to further restrictions of movement and activities which may be indicative of a greater chance of volatility and violation of rules. With the close proximity of 303 5th Street E to immediate neighbors the chances for disturbance may increase. The proximity of the house appears much closer to immediate neighbors than Doc’s Recovery (former college campus) and Beyond Brink (mostly industrial). Would eliminating pre-treatment housing from the site be less impactful on the neighborhood and more consistent with other post-treatment and sober houses in residential areas. Rise Up has stated the level of structure, support, and supervision, along with the requirement of medical stability upon admission, and Rise Up’s operation as an “at-will” voluntary program (not accepting court mandated treatment) reduces the risk of rule violation and volatility. The structure provided at Providence house would be greater than other facilities that presently operate in Hastings. They believe the housing of pre-treatment, short term emergency individuals is essential and would provide for the greatest need within Hastings and is critical to their operation. Recommendation Approval of the Special Use Permit is recommended subject to the following conditions: 1) Maintaining a State License for Board and Lodging with Special Services. 2) Maintaining a Rental Housing License from the City of Hastings. 3) Facility must be supervised by a Licensed Alcohol and Drug Counselor. 4) Facility must provide staffing seven days a week, 24 hours a day by certified recovery\support individuals such as Certified Peer Recovery Support Specialists. 5) No more than 10 residents may be housed. Housing shall be limited to medically stabilized pre-treatment (short term emergency) individuals and those enrolled in a qualified post-treatment program. 6) Residents must participate in peer recovery support services. 7) Facility shall maintain rules for conduct and expectations for residents served including the immediate dismissal of residents possessing illicit drugs, alcohol, and mood altering chemicals. X-C-01 8) Pre-treatment residents shall reside and remain at the Providence House until a treatment placement is made unless accompanied by a member of the post-treatment program to attend recovery meetings only. 9) Residents shall be respectful of neighbors and shall refrain from going indoors or on the front steps of any residence outside of the Providence House property. 10) Outdoor smoking shall be limited to a designated area out of the public view that limits impact to surrounding residences. 11) Residents shall not gather in outdoor areas unless accompanied by staff. 12) Resident intake shall be by appointment only with no walk up intake services. 13) Transportation arrangements must be made for residents discharged from the treatment program. 14) The number of vehicles for residents of the facility is limited to six. 15) Operation must maintain the peace, tranquility, and livability of the surrounding neighborhood. 16) Approval is subject to a one year Sunset Clause; operation must occur within one year of City Council approval or approval is null and void. BACKGROUND INFORMATION Comprehensive Plan The property is guided Medium Residential within the 2040 Comprehensive Plan. The proposed use is consistent with the Comprehensive Plan. Zoning The property is zoned R-2 Medium Density Residence. State licensed residential facilities serving 7-16 persons is allowed via a conditional (special) use permit per Minnesota State Statutes 462.357, Subd. 8. Existing Condition The 13,851 s.f. lot contains a 3,302 s.f. home containing six bedrooms. The home was constructed in 1880 and has been used as a single family home for a number of years. Adjacent Zoning and Land Use The following land uses abut the property: Direction Use Comp Plan District Zoning District North Apartment and Single Family Home Medium Residential Low Residential R-2 Medium Density Residence East Duplex Medium Residential R-2 Medium Density Residence X-C-01 South 5th Street Single Family Home Medium Residential Low Residential R-2 Medium Density Residence West Ramsey Street Guardian Angels Townhomes Mixed Use R-4 High Density Residence Notification of Adjacent Owners All property owners within 350 feet of the site were provided notification of the meeting. At the time of this report ten comments have been received with eight individuals in support of the approval and two individuals opposed. All comments have been attached. SPECIAL USE PERMIT REVIEW Request Rise Up Recovery requests the following: “Provide board and lodge facility with special services for substance use disorder recovery, up to 15 beds for adult men. Facility will be staffed 24/7 - we are a Christian organization, will ensure historical integrity is upheld and keep the home held to a high community standard.” Minnesota State Statutes Minnesota State Statutes 462.357, Subd. 8. - Official Controls: Zoning Ordinance - Permitted Multifamily Use allows a state licensed residential facility serving between 7 and 16 persons to be permitted. Municipalities may require a special use permit to assure proper maintenance and operation of the facility. State Licensed Residential Facility Rise Up would apply for a state Boarding and Lodging License with Special Services upon acquisition of the property. Use of the Home Rise Up proposed to use the existing home as follows: Full bathrooms – 3 Living Room Main level - 26 x 14 Sitting Room – 19 x 12 Dining Room – 15 x 14 Kitchen Main level – 25 x 14 Upstairs Kitchen – 14 x 12 Laundry – 10 x 8 Bedroom 1 main level – 14 x 11 (2 occupants) Bedroom 2 main level – 14 x10 (2 occupants) X-C-01 Bedroom 3 upper level – 14 x 14 (3 occupants) Bedroom 4 upper level – 19 x 13 (4 occupants) Bedroom 5 upper level – 14 x 12 (2 occupants) Bedroom 6 upper level – 14 x 12 (2 occupants) Yard and Grounds The site contains backyard area with a covered porch and detached garage. A six foot privacy fence is located along the east side near the driveway. The remaining backyard is surrounded by shrubbery and a picket fence. Rental License Prior to operation of the facility the owner would need to secure a rental license from the City that would include inspection by the Building Official and Fire Marshal. Parking Parking is provided as follows: Parking Calculation Parking Requirement Provided Lodging - 1 per room 6 spaces 6 spaces (3 garage, 3 driveway) Occupancy Limit No more than 10 individuals enrolled in qualified treatment programs shall occupy the dwelling. The occupancy limit is based two people per bedroom for five of the six bedrooms with the final bedroom reserved for staff. ATTACHMENTS • Site Location Map • Site Pictures • Application • Rise Up Operational Information o Letter from Dr. Jeremiah Fairbanks a family medicine and addiction medicine physician in Hastings who serves on the board of Rise Up Recovery o Housing Intake Agreement o Intake Checklist o Screening Form o Service Initiation Policy o American Society of Addiction Medicine (ASAM) Risk Rating Severity Matrix o Top 11 Permissions over Apologies outlining expectations and behavior o Certified Peer Specialist Services Qualifications o Behavioral Emergency Procedures o Opioid Overdose Response Utilizing Naloxone (Narcan) o Service Termination Guidelines o Return to Use/Discharge Policy and Procedures o Tobacco Guidelines X-C-01 o Urine Analysis (UA) and Breathalyzer Policy • Comments LOCATION MAP SITE LOCATION X-C-01 SITE PICTURES X-C-01 X-C-01 To whom it may concern, My name is Jeremiah Fairbanks and I am writing this in support of Rise Up Recovery’s proposed Providence House. I am a family medicine and addiction medicine physician in Hastings and additionally work as a telehealth addiction medicine physician through Allina system wide. I am board certified in both Family Medicine and Addiction Medicine and am a Fellow of the American Society of Addiction Medicine (FASAM). I have been published in medical journals with high impact factors on topics of addiction medicine and have presented on both a state and national level educating both addiction medicine and family medicine providers on the nuances of addiction medicine. Suffice to say I am considered by many to be an expert in the field of addiction medicine. As an addiction medicine expert, I am expected to have an intimate understanding of withdrawal evaluation and management and am further expected to be an expert reference for withdrawal management to other providers in the Emergency Department, Hospital or ICU if needed. I say all of this to address an understandable concern brought forward in a meeting with the city of Hastings regarding the proposed Providence House. The question that was asked was “would Providence House be prepared to adequately assess safety from a withdrawal standpoint for those presenting to this location”. This question is entirely appropriate given that withdrawal from some substances can result in severe complications including death. I have had the distinct pleasure of working with the team at Rise Up Recovery and its president, Tiffany Neuharth, serving on the board of directors since September 2021. During this time I have gotten to know Tiffany and I can say with great certainty that based on her training/licensure and background that Tiffany is well equipped to make safety evaluations at Providence House. I have reviewed the proposed withdrawal management/safety assessment policy for Providence House and it is very consistent with standard of care from a medical prospective. Furthermore, being on the board of directors myself, I am to be utilized as a resource on call for any complicated situations or questions regarding safety. More than attesting to the competency of the staff of the proposed Providence House with safety evaluations, as a physician in the community who helps manage substance use disorders on a regular basis I want to stress how large of a void in comprehensive substance use disorder management that Providence House would fill. I cannot emphasize enough how important rapid access to care is when an individual with substance use disorder is in the action phase of change. Studies and personal experience have shown this over and over again. Having a safe supportive place to go is imperative and an entity the community of Hastings seems to be lacking. Not only would Providence House help fill this need but would help with downstream effects of active substance use disorders in our community including but not limited to financial strain, family separations, exacerbations of mental health conditions and housing instability. It is my sincere hope that the benefit of Providence House is as clear to you as it is to me. Furthermore I could think of nobody better than Tiffany Neuharth to oversee this project. Given this tremendous potential benefit of Providence House in comprehensive substance use disorder management and the project being led by a competent, hardworking and compassionate team I am quite certain the worth of Providence House will become evident quickly on both an individual and community wide basis. Thank you so much for your time and consideration. I am always happy to answer questions or provide additional clarification. X-C-01 Sincerely, Jeremiah Fairbanks, DO (651)707-3989 X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 1 Rise Up Recovery’s Resident Guidelines & Expectations Providence House Program The following resident guidelines have been adopted by Rise Up Recovery staff in order to promote a safe, sober, encouraging and recovery-friendly living environment to all residents. The principles of our program guidelines include: respect and honor for yourself and others, responsibility and accountability for your actions and choices, and an overall commitment to your personal recovery. General house information, expectations, and responsibilities are as follows: 1. Recovery is Our Collective Focus We have a “Recovery First” mentality and value system. Rise Up Recovery and Providence House exists to promote the hope of recovery, and residents residing in our programs will be encouraged and held accountable to a personal recovery commitment. We believe recovery is possible. We are here to support, encourage and empower you. Residents are personally responsible for their own recovery and should lean on staff and peer support as needed. Rise Up Recovery is a peer-based environment, founded, led and staffed by individuals with lived experience in recovery. Peer recovery support is the process of using personal lived experience in recovery to help others by offering feedback, support, and help setting personal recovery goals. Your willingness to use your strengths to work towards recovery goals is the key to a successful recovery, and we want to help you. By staying at Providence House, you’re committing to keeping recovery the focus of your journey, and understand we will offer accountability, feedback and encouragement in this collective goal of the residents in our program. We are an at-will program, meaning that anyone residing at Providence House is here by choice and we do not take “court- ordered” individuals into our program. If you at any time want to leave or find alternative programming, we will assist you in that process. 2. Alcohol and/or Drug Possession or Usage Strictly Prohibited Above all else, Rise Up Recovery is a recovery-oriented environment. Possession of illicit drugs, alcohol, or mood-altering chemicals is strictly prohibited on the premises of Rise Up Recovery and Providence House and in all vehicles owned by the organization. Possession of or use while a resident at Rise Up Recovery’s Providence House is grounds for immediate dismissal – a no tolerance policy will be followed. If you are found to have used or brought any mood-altering substances on Rise Up Recovery or Providence House property, you will be immediately discharged and escorted to an alternative program including but not limited to family member’s house, emergency room, emergency shelter, detox facility, treatment program, or alternative sober housing. 3. Gambling Gambling of any kind on the premises is strictly prohibited. 4. Random UA/Drug Tests Rise Up Recovery administers random UA/breathalyzer/drug screenings throughout a resident’s time in programming to ensure the environment is safe and substance-free. Tests may be random, at the organization’s request and may or may not be monitored. Refusing to test is grounds for immediate discharge from the program. X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 2 5. Medications and Medical Care All medications must be turned in to staff upon admission to be documented by Rise Up Recovery Staff. Residents are expected to be medically compliant and follow-through with any medications prescribed by a physician, in accordance with their written prescription. Rise Up Recovery is not a medical facility and is not responsible for medication tracking or administering prescriptions. Rise Up Recovery will provide locked medication storage and random medication reminders and/or support residents in connecting with medical services. If there are ongoing concerns about a resident’s medication compliance, Rise Up Recovery will assist the resident in contacting their physician, nurse or health advocate for ongoing support. 6. Visiting Hours and Visitors Weekly visiting hours are listed below and are limited to approved immediate family members only. Residents must confirm their visitors by Friday at noon and their visitors must check-in upon arrival and check-out upon departure in the staff office. All visitors must check in their keys, jackets, purses and sign a confidentiality form. No visitors are allowed in resident rooms; common areas only. Residents may not visit with their visitors in visitor cars. Eligible visitors may not be under the influence of any substances during their visit. • Saturday from 1:00 to 5:00 p.m. • Sunday from 1:00 to 5:00 p.m. 7. Resident Rooms Residents are allowed only in the room they are assigned unless they are roommates. Residents are responsible for the neatness and condition of their rooms at all times, which includes beds to be made, personal belongings neatly arranged and the room free of clutter or garbage. Residents are not allowed to hang objects on the walls or in the windows. Weekly room checks will occur to ensure the cleanliness of the facility; residents will be notified if their room needs further cleaning. Staff reserves the right to enter resident rooms at any time, or inspect rooms to ensure belongings, upkeep and behavior meets the guidelines of Rise Up Recovery. 8. Telephone A house phone for incoming and outgoing calls is provided for resident use in the kitchen of the house. Residents may talk in common areas. The resident phone line is (xxx)xxx-xxxx. This number should be given only to those individuals you wish to talk to during your stay at Providence House. This phone will not be available to residents during morning meditation, daily groups, or meals. There are to be no incoming or outgoing calls for residents after 10:00 p.m. or before 6:00 a.m. each day, unless under emergency circumstances. The resident phone will be answered by residents and triaged to residents; staff will not manage this phone. No information can be disclosed about a past, present, or future resident. There is a 10-minute time limit on all phone conversations, and appropriate dialogue must be used. Being rude, yelling, swearing, or using phone during restricted times may lead to loss of phone privileges. 9. Housekeeping and Maintenance The grounds and home of Providence House are community spaces that we collectively take pride in and work together to maintain. Residents are responsible for weekly housekeeping assignments for the house, which will be posted weekly. Residents are responsible for finding coverage for their chore when they have another obligation. We place high value being good neighbors and good stewards of this beautiful home; please take care of it accordingly. The resident leader will check chores weekly and X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 3 there is opportunity to earn rewards for jobs well done. Make sure you sign off on your chore when it is completed. 10. Tobacco Rise Up Recovery is a smoke-free facility and smoking is only permitted at designated areas outdoors. Smoking or vaping indoors is considered to be a serious disrespect to the organization and facility, and a resident may be asked to leave the program if this occurs. Use of the proper receptacles is required for cigarettes, and no cigarette butts are to be found on the grounds as a commitment to respect of the community, the culture and personal responsibility. Upkeep and respect for the grounds and neighborhood is to be adhered to at all times. There is no smoking between the hours of weekdays Sunday through Thursday: 10pm – 6am, weekends Friday - Saturday: 11pm – 6am. 11. Mail Mail will be retrieved from the mailbox by staff only. After a resident moves out or is discharged from Providence House, all mail will be returned to the sender. It is a resident’s responsibility to contact USPS and senders with a change of address after they move out of the facility or to make alternate arrangements for the receipt of mail. 12. Personal Property – Residents All personal property must be inspected upon its arrival to Providence House to ensure the fidelity and safety of our program and residents. Personal property including cash, jewelry, or other valuables is the responsibility of each resident. Rise Up Recovery is not responsible for damage, theft or loss of personal property. Room and storage space is limited. Residents will be expected to limit personal belongings brought to the house and acquired during their stay. There is a 2 bag limit! Abandoned personal property will be held for 30 days after the date the resident last resided at the facility, and then recycled or donated. Weapons, explosives, drug paraphernalia, or pornographic materials are prohibited and possession of any such items is grounds for discharged from the program. Television sets are not allowed in resident rooms in the primary program to encourage communal living and engagement with peers. Personal tablets and laptops must be checked into the staff office overnight. A community laptop is kept in the staff office for resident use and can be checked out for 30 minutes at a time and must be used in the dining room only. Computer use is limited to job applications, job searches, legal or medical business. Residents must consult staff to request other use privileges, including arranged computer use for educational purposes. 13. Property – Rise Up Recovery Rise Up Recovery works to provide a safe, healing environment for all residents. It is expected that residents will respect the facility and furnishings by refraining from any abusive or destructive actions. Intentional destruction of the property or furnishings will be grounds for discharge from the program. Residents are also required to respect their neighbors and their property. Residents are asked to refrain from rearranging furniture or moving furniture from one room to another unless approved by the Providence House team. 14. Linens and Laundry Clean sheets, pillowcases, mattress protectors and towels will be provided for each new resident admission. For resident stays that are longer than 1 week, linens are to be cleaned weekly. Laundry is available on the main floor of the house and residents are responsible for their personal X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 4 laundry. There is a laundry sign up sheet. Please sign up and stick to the allotted time frame to ensure everyone has access to the laundry facilities. Laundry detergent and dryer sheets are provided in the staff office. Residents are responsible for promptly removing their personal items from the laundry areas and the neatness of the area. All resident laundry must be removed from the machines by lights out each night to allow for staff laundry usage. If linens become damaged or ripped during your stay, please consult a staff member for a replacement. 15. Kitchen, Meals and Snacking All meals are provided by Rise Up Recovery, including self-service breakfast and lunch in the kitchen, and a hot meal prepared each night by residents on a rotating basis. Residents at Rise Up Recovery’s Providence House are expected to participate in setting the weekly menu and helping prepare meals on a regular basis. Eating, snacking, or drinking beverages is limited to the dining areas. No eating or drinking beverages is allowed in resident rooms or shared living spaces, aside from drinking water. It is the resident’s responsibility to keep the dining area clean and to adhere to personal hygiene and food safety while handling food or in the shared kitchen area. 16. Weekly House Meeting There is a weekly house meeting at (to be determined) in the dining/living area of the house. All residents are expected to attend and contribute to the next week’s meal planning. Residents who are unable to attend the weekly house meeting must attend the 15-minute make-up meeting on (to be determined but the following morning) If they are unable to attend either meeting, they must meet directly with a member of the Providence House staff to receive updates, announcements, etc. After the weekly house meeting, weekly room checks will be conducted by a member of our staff. Staff will notify residents via room check slips what may need further cleaning. Rooms are expected to be clean, free of garbage, and in respectful condition each week. Residents can earn rewards by receiving clean room slips! 17. Program Orientation Pre-Treatment Limitations The goal of the pre-treatment program is to provide a safe, sober environment for residents seeking placement in a residential treatment facility. Our goal is to provide connection and support while treatment coordination occurs. For residents in the pre-treatment program, participating in all scheduled groups, meetings and programs at the Providence House premises is required. Pre-treatment residents are expected to remain on the Rise Up Recovery’s Providence House grounds until a treatment placement has been made. Post-Treatment Orientation In the post-treatment program, the first 2 days after admission are considered the orientation phase, in which all residents must participate in all activities and stay on the Rise Up Recovery’s Providence House grounds, following limited phone schedules and utilizing this time to get to know peers, the Rise Up Recovery program, and guidelines. Once the orientation phase is completed, residents in the post- treatment program are expected to prioritize recovery, aftercare requirements and developing a consistent recovery plan, including meetings, outpatient treatment, mental health appointments, peer recovery support services and other recovery supports recommended by a resident’s clinician or referring treatment provider. X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 5 18. Program Participation All residents must adhere to the daily schedule and punctually attend all program activities, including morning meditation, morning groups, evening groups, extracurricular activities, volunteer and service work in our commiunity, and gratitude meetings. Pre-treatment residents and those in the orientation phase are required to attend all program functions, and residents in the post-treatment program must attend a minimum of one group or scheduled function per day. Rise Up Recovery hosts peer recovery groups Monday through Friday at 9:00 a.m. and various recovery-related meetings in the evenings between the hours of 6:00 and 8:00 p.m. Pre-treatment residents are expected to attend all groups; post-treatment residents must attend at least one group per day. Residents must attend a minimum of 3 recovery support meetings per week – including either AA/NA, Celebrate Recovery, Made in Christ, Smart Recovery, etc., in addition to attending peer-led recovery groups at Rise Up Recovery. Residents should have a sponsor or recovery coach, who are expected to have a minimum of one year sobriety. All residents are expected to participate in daily or weekly peer recovery support services provided on site by Rise Up Recovery staff. Residents will have the opportunity to attend church service on Sunday at New Life Evangelical Free Church at 10:45am. 19. Employment Post Treatment Residents: Once recovery programming is established, residents may begin searching for employment, attending school, or working. If a resident in the post-treatment program has obtained employment and is working overnight, program staff must be notified for awareness of a resident working hours outside of normal curfew and sleeping hours. For residents working overnight, participation in Rise Up Recovery programming is required, including the attendance of either one morning or evening group per day, whichever the resident chooses. Employment must be conducive to recovery. Peer group attendance and weekly one on one sessions with a peer recovery specialist are required; a resident’s work schedule must accommodate house expectations. Once employment is secured, employment details need to be given to program staff for financial requirements of the Housing Support program, in addition to providing Rise Up Recovery Recovery House with a general understanding of the resident’s work schedule in order to coordinate alternate ways for the resident to stay engaged in Rise Up Recovery programming outside of work obligations. 20. Leaving The House Pre-treatment residents: Pre-treatment residents are expected to reside and remain at Rise Up Recovery’s Providence House until a treatment placement is made, however they may leave the house with a member of the post- treatment program to attend recovery meetings only. Time away from Providence House is limited to 1 hour for recovery meetings, and staff must be made aware of, and approve of, the activity. Post-treatment residents: Post-treatment residents who have completed the orientation phase are free to leave the house outside of curfew hours, but must maintain participation in the required peer recovery groups, meetings and activities at Rise Up Recovery’s Providence House. When leaving the house, each resident is required to sign in and out on the log located in the entryway. Accurate information is to be entered on the log, including the estimated return time. Residents are responsible for notifying staff of any change in plans while away for safety and accountability. The (TBD) door is the only door to be used by residents; the secondary door is an emergency exit only. Curfew is 10:00 p.m. Sunday through Thursday Lights out and phones, tablets, and devices turned in at 10:30 p.m. Curfew is 11:00 p.m. Friday and Saturday Lights out and phones, tablets, and devices turned in at 12:00 a.m. X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 6 21. Overnight Pass Residents may request an overnight pass, where they are allowed to be away from the house during sleeping hours, after 60 days at Rise Up Recovery’s Providence House. Two non-consecutive overnights are allowed within a one-month period. Approval from staff is required, and if the overnight occurs on the weekend, approval must be obtained by Friday at noon. For overnight requests relevant to a medical or family emergency, please contact staff for approval and support. 22. Resident Illness Residents must notify staff if they are having any symptoms of illness or feel sick and must refrain from touching common surfaces and equipment in the kitchen. They are to stay in their room and use the bathroom nearest their room, and are to coordinate other arrangements for meals with staff to reduce the spread of germs or illness to peers. On the second day of illness or if symptoms worsen, residents will be referred to urgent care or to contact their primary physician. 23. Dress Code Appropriate attire is required at all times. Sexually explicit/revealing clothing or clothing with drug/alcohol/paraphernalia/sex/gang-related inscription or styles is prohibited. You will be asked to change immediately if any of the above clothing is worn. Staff will confiscate said attire until your time of discharge when any confiscated clothing items will be returned. 24. Television No televisions are allowed in resident rooms while in the Providence House (pre-treatment and post- treatment programs) to encourage community with peers. Two community televisions are available to residents, but must be turned off during morning meditation, morning group, evening meal and evening groups. Access to television should occur only after personal recovery commitments and program- related requirements have been met, including groups, chores, etc. Televisions will be turned off at lights out to observe quiet sleeping hours overnight. Pirated movies, inappropriate content (violent, explicit, promoting use of drugs and alcohol) are not allowed, in order to keep the environment inclusive, safe and recovery-oriented. 25. Automobiles Vehicles are not allowed for residents in the pre-treatment program. Post-treatment residents cannot use their car during the orientation phase (2 days), unless the resident has occupational obligations and receives approval from staff. After the orientation phase, residents must register their vehicle by completing an automobile agreement with Rise Up Recovery, and by presenting (1) a valid driver’s license, (2) title card, (3) proof of insurance and (4) proof of current license plates. We have a maximum of 6 vehicles to be on the property per City of Hastings Special Use Permit. Ability to have car on site for Post-treatment residents is based on seniority. A resident’s vehicle cannot be loaned to another resident. Vehicle repairs are not permitted on Rise Up Recovery’s Providence House property. Residents must respect the traffic regulations and speed limits of the City of Hastings, and be respectful of our neighbors. No loud music from vehicles is allowed. If noise becomes an issue, restrictions will be enforced including and not limited to loss of vehicle privileges. 26. Bicycles Bikes must have proper equipment. Reflectors are recommended for night riding. Bikes must be stored at the bike rack closest to the facility. Rise Up Recovery recommends securing bikes to the bike rack with a lock; we are not responsible for stolen or lost bicycles. X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 7 27. Contact Among Residents Respectful conduct with peer residents at Rise Up Recovery is required at all times. Rise Up Recovery residents that leave against staff advice or at staff request are restricted from contacting current house residents to ensure the safety of the program and environment. 28. Neighbors Respectful conduct with other members of Hastings community and our neighborhood is required at all times, including those living next door to and in surrounding neighborhood of Rise Up Recovery Recovery’s Providence House. Rise Up Recovery residents are encouraged to have healthy, supportive relationships with peers and neighbors, but are asked to do so in communal spaces only and refrain from going indoors or on the front steps of any house or residence outside from the Rise Up Recovery Providence House buildings. Neighbors must refrain from coming onto the Rise Up Recovery House living premises, including the outdoor area by the houses and entryways. Any issues identified by residents should be routed to Rise Up Recovery House staff directly. 29. Violent or Threatening Behavior Violent, threatening or discriminatory behavior towards other residents or staff will not be tolerated and may be grounds for removal from the program to ensure safety of all residents, staff and guests. This includes blatant or abusive language concerning race, class, sexual preference, age, or religion, and any other profane language. 30. Resident Confidentiality Residents and staff are expected to honor the confidentiality of all residents and peers. This may include any verbal, written, photographing, or other identity outside the house unless specifically authorized to do so. There may be instances when a member of our staff is taking photos or videos for marketing, documentation or fundraising-related purposes. Residents reserve the right to be included or not, and to offer consent to utilize these assets for these purposes. 31. Resident Conduct Negative situations, environments, bars or any other harmful places or situations to a person’s recovery are not allowed. Residents in the pre-treatment program are only allowed on the Rise Up Recovery and Providence House premises or approved program locations (meetings, medical appointments, legal appointments – accompanied by a staff member or post-treatment or step-up resident). 32. Resident Conduct continued Any conduct that is detrimental to the safe and peaceful environment of Rise Up Recovery Recovery’s Providence House, i.e. loud, vulgar, obnoxious language and behavior, glorifying and talking about old alcohol and drug using days is not allowed and in extreme circumstances, may be grounds for discharge. 33. Audio/Video Surveillance For the safety and accountability of all residents and staff, outdoor and common areas have continuous audio and video recording. The use of these are only to ensure the safety of all residents, staff, neighbors and Rise Up Recovery property. Recordings will not be listened to or used to settle minor disputes. Signs are posted where audio/video surveillance is occurring. Posted signs constitute consent by residents and visitors. Surveillance is ONLY in the common areas and bedrooms/bathrooms are not recorded for privacy purposes. Audio/video recordings are kept confidential and viewed only by Rise Up X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 8 Recovery’s Providence House staff and Program Director as needed. By signing below, you acknowledge that you have been informed of Audio/Video Surveillance and consent to its policy and procedure. Resident Initials___________________ Staff Initials______________________ Date:_______________ 34. Cellphones Cellphones are allowed at Rise Up Recovery, but they must be turned in by lights out. If a resident does not turn their cell phone in, a staff member will retrieve it. Residents in the pre-treatment program, and post-treatment residents in the 2-day orientation phase, can access their phone two times per day only, from 8:00 to 9:00 a.m. and 4:00 to 5:00 p.m. It is the resident’s responsibility to retrieve their phone if they choose, and is not a staff responsibility to remind you. Outside of these hours, a public phone is available in the dining room for resident use. Phones are limited in the pre-treatment program to limit contact with negative or triggering situations, and to keep a resident’s focus on recovery- oriented goals, as well as promote connection and communication with peers and peer recovery specialists. Phones are limited in the post-treatment orientation phase to allow residents to get to know one another and get established with the culture, program and peers at Rise Up Recovery’s Providence House. Following is a copy of the cellphone agreement, outlining the rules and limitations of having a cellphone. This contract needs to be signed with program staff upon admission acknowledging understanding and agreement with cell-phone rules/expectations. Cellphone Contract: a. I will register my phone number with Rise Up Recovery. b. I can only have one cell phone while a resident at Rise Up Recovery. c. During group times, I need to turn my cell phone off for respect and privacy. d. I am responsible for charging my own cell phone. e. I will respect the confidentiality of my peers and staff at Rise Up Recovery. I cannot take pictures or recordings while I am in the house. f. Post-treatment residents can check out cell phone after 5:00 a.m. and must check it in with staff by lights out each night. g. Pre-treatment residents can check out cell phone from 8:00am-9:00 am and 4:00pm-5:00pm. h. Lack of following these rules is a display of disrespect to the policies and culture of the program, and may prohibit continued residency at Rise Up Recovery. Resident Initials___________________ Staff Initials______________________ Date:_______________ 35. Respectful Move-Out If a resident is asked to leave, decides to leave, or successfully completes the program, they are expected to leave the program peacefully. We understand our culture may not be a fit for everyone, we are open to feedback, and are available to help you find another living arrangement if you feel there is a better fit. Recovery is our ultimate goal. We welcome the ability to help you find the arrangement that is the best fit for your recovery goals. 36. Additional Guidelines Rise Up Recovery’s Providence House staff will clarify the items included or omitted from the above expectations, responsibilities, and privileges, and will notify residents if and when changes have been made. The Rise Up Recovery’s Providence House staff will function as a team. Any changes in the guidelines, along with addressing discrepancies, will be addressed by staff and leadership. X-C-01 Rise Up Recovery’s Providence House Housing Agreement pg. 9 I have read the Rise Up Recovery’s Providence House guidelines and understand the program of Rise Up Recovery’s Providence House. My questions about these guidelines have been answered to my satisfaction, and I will follow them to the best of my ability. I understand that not doing so may result in my being asked to exit the program. _________________________________________ _____________________ Resident Signature Date ________________________________________ _____________________ Staff Signature Date X-C-01 Providence House Intake Checklist Tasks To Be Completed by Intake Coordinator and Providence House Staff Members prior to admission Completed By (Staff initials) Date Completed 1. Set up interview with applicant. 2. Complete Admission Screening Form with applicant and initial each area indicated. 3. Forward Completed Screening questionnaire to Director for Intake approval for Pre-treatment Housing program. 4. If medical detox is deemed necessary by assessor or director, provide referral to detox facility and require written or verbal verification from doctor of medical stability before proceeding with admission. 5. Check BCA website and run background check. 6. Check bed availability on Behave EHR (electronic health record) if beds are full, place applicant on waiting list. 7. Schedule for admission and coordinate with Providence House Staff. 8. Input applicant information into Behave. 9. Obtain copy of DL, Insurance Card and ID if possible BEFORE Admission 10. Print off GRH Paperwork. To Be Completed by Providence House Staff Upon Intake Completed By (Staff Initials) Date Completed 1. Greet new resident (set the tone for respect and honor), offer a snack and water. 2. Help them carry in belongings, bring ALL belongings into staff office to be thoroughly checked. 3. Obtain a UA as soon as resident is able. Record results. 4. With two staff, thoroughly check new resident’s belongings for any prohibited items. Check in and log valuables including phone, and any other electronics. Log medications and provide lock-box to resident with their medications secure. 5. Complete onboarding paperwork with resident in Behave for PRS services. Obtain all necessary ROI’s. 6. Have resident complete GRH paperwork and send into county along with copy of resident ID. 7. If they need an assessment, get assessment appointment scheduled within 24-48 hours. X-C-01 8. Orient to program, go over resident agreement and ensure news resident acknowledges understanding and agrees both verbally and written. 9. Provide resident with copy of Housing Agreement and orientation packet including group schedule. 10. Provide a tour of the house, show smoking areas, laundry, kitchen, and show resident to their room and bathroom. 11. Provide new resident with towels, linens and any other needed toiletries. 12. Introduce them to their “Big Brother” and other residents. 13. For all pre-treatment residents, document visual and verbal checks every 2 hours. Same for first 48 hours of those in orientation phase of post-treatment program. 14. Meet with pre-treatment housing residents daily for check in and to assist with treatment coordination services. 15. Within 3 days of admission, meet with each new resident and complete the Permission over Apologies form. 16. Complete Recovery Wellness Plan with each resident within first 5 days of admission. X-C-01 Rise Up Recovery’s Providence House Phone Screening Form PART ONE - RECOVERY AND PERSONAL HISTORY Date of Phone Screening: ____________ Completed By: ______________________________ Program: _____ Pre-Treatment _____ Post-Treatment Personal Information: Name: ________________________________________________________________________ Date of Birth: __________________ County of Residence: ______________________________ Gender: _____ Male _____ Female _____ Non-Binary Current Living Situation and address: ___________________________________________________________________________- ______________________________________________________________________________ Referral and Personal Information Date Housing Needed: _________________________ Transitioning From: ______________________________________ Most Recent Rule 25 or SUD Assessment___________________________________________ Place of Most Recent Assessment_________________________________________________ Demographic Information Sexual Orientation: _____ Heterosexual _____ Homosexual _____ Bisexual _____Asexual Cultural background:____________________________________________________________ Spoken and Written Language: ___________________________________________________ Employment:__________________________________________________________________ Highest level of education: _______________________________________________________ Substance Use and Recovery History What is your substance of choice? ______________________________________________________________________________ ______________________________________________________________________________ What is your last date of use? _____________________________________________________ Any withdrawal symptoms?_______________________________________________________ Is the individual an intravenous (IV) drug user? _____ No _____ Yes Have you been to treatment for substance use, mental health or compulsive gambling? If so, how many times? Where did you go last time? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Any substantial periods of abstinence? When? _____________________________________________________________________________ What are things that typically cause you to return to using substances after longer periods of X-C-01 abstinence? ______________________________________________________________________________ ______________________________________________________________________________ Have you engaged in any unsafe behaviors while under the influence? ____ Yes ____ No ______________________________________________________________________________ Family History What is your marital status? Any children? ______________________________________________________________________________ Is your family supportive of your recovery or treatment process? ____ Yes ____ No What family members are supportive? __________________________________________________________________ Do you want your family involved in your recovery process? ____ Yes ____ No Any family history of substance use or mental illness in your family? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Do you have a history of any physical, sexual or emotional abuse? ____ Yes ____ No Physical Health History Any physical concerns or physical health diagnoses? _____________________________________________________________________________ Do you take any medications for your physical health? Last time you you’re your medication? ______________________________________________________________________________ ______________________________________________________________________________ Do you have a primary care provider? ____ Yes ____ No Name and location of provider (if available) _____________________________________________________________________________ Mental Health History Any mental health concerns or diagnoses? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Any mental or learning disabilities? ______________________________________________________________________________ Do you take any medications for your mental health? ______________________________________________________________________________ Do you have refills for your medications? _____________________________________________________________________________ When is the last time you took your mental health medications? ______________________________________________________________________________ Do you see a therapist or psychiatrist? If so, name and last time you were seen? X-C-01 ______________________________________________________________________________ Recovery Support & Other Details Do you currently have any support system for your recovery? If so, who? ______________________________________________________________________________ ______________________________________________________________________________ What is your legal history? Any criminal charges or upcoming court dates? ______________________________________________________________________________ ______________________________________________________________________________ Are you on probation? ____ Yes ____ No Name and county of probation officer (if applicable) ____________________________________________________ PART TWO - ADMISSION SCREENING TO RISE UP RECOVERY’S PROVIDENCE HOUSE Do you have any sexual offenses? ____ Yes ____ No explain:____________________________ Do you have a vehicle that you plan on having while at Providence House? ____ Yes ____ No Do you have a valid driver’s license? ____ Yes ____ No ____ N/A Do you have valid car insurance? ____ Yes ____ No ____ N/A Are you able to walk up and down stairs? ____ Yes ____ No Do you have any dietary restrictions? ____ Yes ____ No If so, note here: ______________________________________________________________________________ ______________________________________________________________________________ Explain the following things at the end of the phone interview: Funding Rise Up Recovery’s Providence House is a nonprofit funded through grants and donations. We are also funded in part through the Housing Support Program and billable peer support services. We will help fill out paperwork when you arrive to set you up with these benefits. We will also need a copy of your insurance card. If you are not covered through Housing Support, self-payment for rent may be required. The nightly rate for our pre-treatment program is $35 and the monthly rent for our long-term program is $954. _________ Individual verbally acknowledges and understands (staff initials) [PRE-TREATMENT ONLY] – GUIDELINES Our pre-treatment program is designed to help offer safe, supportive housing and peer support while you wait for treatment. We are not a medical facility and do not provide detoxification services. Residents are required to be medically stable and not in need of medically monitored detoxification services. Residents in our pre-treatment program are expected to stay at Rise Up Recovery’s Providence House 24/7 until their treatment admission, outside of RUR’s sponsored events, or recovery meetings with peers. You are also required to turn in your phone upon X-C-01 admission, but can access it for two hours per day, in the morning and in the evening. There is a community phone available 24/7 if needed, and we help you in coordinating your plans for treatment including transportation to treatment. *Do you have any questions? ________ Individual verbally acknowledges and understands; all questions have been answered (staff initials verifying verbal consent) ________ N/A [POST-TREATMENT ONLY] – GUIDELINES Rise Up Recovery’s Providence House is a recovery community. We offer 24/7 peer recovery support and are staffed by people with lived experience in recovery. We also have guidelines to ensure the safety of the environment. A few of the most important guidelines include:  Phones - Residents must turn in their phones, tablets, and laptops in the evening.  Curfew - We have a nightly curfew that residents are expected to respect.  Belongings - All belongings will be checked upon admission.  Group Attendance - We have daily peer recovery groups that residents are expected to attend.  Meeting Attendance - We require a minimum of 3 recovery support meetings each week.  Chores & Cleanliness - All residents participate in keeping their room and the house clean including cooking.  Accountability and Respect - We are a respect and recovery-oriented community. *Do you have any questions? _______ Individual verbally acknowledges and understands; all questions have been answered _______ N/A How are you feeling about coming to Rise Up Recovery’s Providence House? (Or about going to treatment or continuing your recovery?) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Staff Comments: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ X-C-01 1 Policy No. 5 Est. Date 08/01/2021 TREATMENT SERVICES INITIATION POLICY Rise Up Recovery is a Recovery Community Organization providing substance use disorder treatment/recovery services and housing services to adult males and females residing in Minnesota, due to the accessibility and its familiarity with continuing care services. Rise Up Recovery offers flexible programming to fit each person’s needs and allows each person to continue to engage in employment, education, family and community obligations while receiving its services and/or referrals, or otherwise learning about their substance use disorder and its effect on their lives. Rise Up Recovery’s Office Site and Community Center is located in the City of Hastings, Minnesota in a professional/retail zoned neighborhood. It’s housing program, Providence House is located 2 blocks away in a residential neighborhood. Rise Up Recovery does not discriminate against anyone during admission, discharge, or in the provision of program services in accordance with Minnesota Statutes. Discrimination on the basis of race, creed, color, national origin, religion, disability, and marital status, status in regard to public assistance, familial status or sexual preference is strictly prohibited. CRITERIA FOR SERVICE INITIATION Rise Up Recovery utilizes the Minnesota Dimension Criteria to determine admission service initiation for treatment. • Dimension 1-Risk levels of 0, 1 and 2 (if receiving ambulatory services through approved provider). • Dimension 2, 3, 4, 5, and 6- Risk levels of 0, 1, and 2. • Risk levels of 3 and 4 may or may be admitted at the discretion of the clinical supervising staff. The following person will be admitted if any one of the following criteria is met: • A person has been assessed or will be assessed within 3 business days as having substance use disorder and/or mental illness and requires peer recovery support and housing support services. • A person has been assessed as chemically dependent or a chemical abuser and meets placement criteria per Rule 25. The client placement authorization will verify the appropriate level of care. • A person has financial resources and a qualified assessment [a chemical dependency evaluation] indicates the need for peer recovery support and housing support services. The following person will be admitted if any one of the following criteria is met: • A person has a chemical dependency evaluation and possibly an ASUDS (Adult Substance Use and Driving Survey) indicates the need for recovery community organization education/treatment services. A prescreening assessment has been completed as deemed high likelihood of person having substance use disorder in need of peer recovery support services and stable recovery housing. • A person has been assessed as and meets placement criteria per Rule 25. The client placement authorization will verify the appropriate level of care. • A person has financial resources and a documented referral from the court and is not in need of a higher level care. X-C-01 2 PREFERENCE • Preferential service initiation status will be given as follows in accordance with Chapter 245G and Code of Federal Regulations, title 45, part 96.131. 1. Pregnant injecting drug users; 2. Pregnant substance abusers; 3. Injecting drug users; and 4. All others. Documentation of assessment/evaluation in each client's file will indicate service initiation criteria is met, and that placement is appropriate. Assessment/evaluation with be completed within 3 business days of admission. *Rise Up Recovery will not initiate services for individuals who do not meet the service initiation criteria. CATEGORIES OF PLACEMENT Rationale for: 1. Voluntarily Court Referred Placement: • Treatment as a condition of probation/parole • To regain custody of children • To regain driver’s license/license plates 2. Legally Ordered Treatment: Rise up Recovery Does NOT accept Legally Ordered Residents. Residents MUST BE voluntary for consideration of admission. • Emergency/court hold order • Court Commitment – Chemical Dependency • Criminal Court Order • Civil Court Order • Physician Emergency 3. Voluntary Placement: • Lose custody of children • To avoid loss of relationship • To maintain employment • To retain professional license • To secure safe sober housing and prevent homelessness • Other REFERRAL SOURCES Court Services • Commitments/pre-petition screening • Treatment or discharge evaluation ordered as a referral of probation/parole. • Law enforcement/corrections referral • Federal Probation Self-Referral • Client is self-pay or has insurance to cover Recovery Community Organization treatment services. • Family/relatives/friend/neighbor. Community Providers/Professional Services • School • Employee Assistance Plan/Employer X-C-01 3 • Clergy • Information and referral agencies • Rule 25 assessors Health Care Facility • Mental health center • Crisis center • Another substance use disorder treatment facility • Medical facility/hospitals • HIV/Aids support programming Referral Agencies will be contacted regarding: • Admission of person into treatment • Verification of funding approval • Input into the Individual Treatment Plan • Input in continue care planning The Director may authorize admissions. If additional screening for medical stability and withdrawal risk assessment is required, Dr. Jeremiah Fairbanks, OD will be consulted as needed. Director, Tiffany Neuharth, will handle such consultation. The Director may give the directive to other staff to carry out her instructions via telephone if she is off the premises at the time. X-C-01 ASAM Risk Rating Severity Matrix None / 0 Low / 1 Moderate / 2 High / 3 Severe / 4 Dimension 1 Fully functioning, no signs of intoxication or withdrawal present. Mild to moderate ability to tolerate or cope with withdrawal Difficulty tolerating or coping with withdrawal Poor ability to tolerate or cope with withdrawal Incapacitated with severe signs and symptoms Acute Intoxication and/or Withdrawal Potential Dimension 2 Fully functioning and able to cope with any physical discomfort or pain Mild to moderate ability to tolerate or cope with physical discomfort or pain Difficulty tolerating or coping with physical discomfort or pain Poor ability to tolerate or cope with physical discomfort or pain Incapacitated with severe medical problems Biomedical Conditions and Complications Dimension 3 Good impulse control and coping skills Adequate impulse control and coping skills Difficulty managing symptoms, frequent symptoms and needs Poor ability to control impulses, lack of coping skills to control harm to self and/or others Severe psychiatric symptoms, high risk of harm to self and/or others Emotional, Behavioral, or Cognitive Conditions and Complications Dimension 4 Willing, engaged in treatment Willing able to explore change Reluctant to agree to treatment, low readiness to change Unaware of need to change, not engaged in treatment No immediate action needed if there's low motivation to change but no imminent risk of harm to self/others Immediate action needed if there is high risk of harm to self or others Readiness to Change Dimension 5 Low or no potential for relapse, good coping skills Minimal relapse potential, fair ability to care for self Impaired ability to recognize relapse signs, able to self manage with prompting Little ability to recognize relapse signs, poor coping skills to avoid relapse No immediate action needed if poor skills to avoid relapse but no risk of harm to self Immediate action needed if member has no skills to cope with addiction and there is risk of harm to self Relapse, Continued Use, or Continued Problem Potential Dimension 6 Supportive environment and/or able to cope in environment Able to cope, even if support is not adequate Nonsupportive environment, client can cope with clinical help Nonsupportive environment, client having problems coping with with clinical help No immediate action needed if member is in a nonsupportive or hostile environment but is able to cope Immediate action needed if member is in a nonsupportive, hostile environment and isn't safe Recovery Environment X-C-01 Providence House Top 11 Permissions over Apologies Reminder of Key Guidelines in the Housing Program Name: ______________________________ Program I’m In: _________________________ ______ Phones: I understand that residents can have one phone during their time at Providence House House. Pre-treatment residents can access their cell phone (2) times daily, from 8:00 to 9:00 a.m. and 4:00 to 5:00 p.m. It is the resident's responsibility to check out their phone if they choose. For post-treatment residents, all phones, tablets and computers must be checked into the staff office by lights out each night. ______ Curfew: I understand that residents in the pre-treatment program are to remain at Providence House for the entirety of their stay until admission into a residential treatment program. Pre-treatment residents can only leave the premises for recovery meetings with a peer in the post-treatment program or staff. The curfew for post-treatment residents is Sunday through Thursday at 10:00 p.m. and Friday and Saturday at 11:00 p.m. ______ Smoking: I understand there is no smoking, vaping or chewing tobacco use in the house, and only in designated smoking areas. I understand I am to be a good steward of Providence House property and grounds by only placing cigarette butts and garbage in receptacles and garbage cans. I acknowledge that there is NO smoking between the hours of 10pm – 6am Sunday through Thursday and 11pm – 6am Friday and Saturday. We want to be good neighbors and I agree to be mindful of noise and respectful in conversation while in designated smoking areas. ______ Visitors: Visiting hours are Saturday and Sunday from 1:00 to 5:00 p.m. and must meet in common areas. Visitors are limited to immediate family members only and are not allowed on the premises if they are under the influence of mood altering chemicals. All visitors must sign in upon arrival and sign out upon departure. All visitors are expected to adhere to program rules and expectations. ______ Belongings: I understand my belongings will be checked upon admission. All new belongings purchased or obtained during my time at Providence House need to be checked in with staff prior to taking them to my room. ______ Group Attendance: I understand that pre-treatment residents must attend all scheduled meetings and activities during their stay at Providence House and that post- treatment residents must attend a minimum of one meeting or activity at Providence House per day. ______ Meeting Attendance: I understand I am expected to attend a minimum of 3 AA/NA or other recovery support group meetings per week, or another recovery support meeting I agree upon with program staff. X-C-01 ______ Chores & Cleanliness: I understand I am expected to do my weekly chores as assigned and contribute to the clean upkeep of the grounds and my room. I will keep my room clean and free of clutter and understand the general cleanliness of my room will be checked weekly. ______ Accountability: I understand that accountability at Providence House is intended to keep all residents safe by ensuring a substance-free, recovery-oriented environment. I understand I will be given random UAs and that my room may be inspected. ______ Respect to Others: I understand I must treat my peers with respect, including respecting their belongings, their recovery, their progress, their privacy and their space. I understand that progress for one person may not look the same as the next and I am to be respectful of the process of recovery in each resident’s life. ______ Recovery-Oriented: I understand that Providence House is a recovery community and that I will only get out of it what I put into it. I understand it is my responsibility to treat my peers with respect, to focus solely on my recovery and to put my recovery first. I understand these are the guidelines of my voluntary admission into Providence House and agree to respect and comply with these requirements during my time in the program. I understand that not doing so may result in a loss of privileges or discharge from the program. ____________________________________ _______________________________________ Resident Signature Staff Signature ______________________________ ________________________________ Date Date X-C-01 FROM Minnesota Certification Board’s website: https://www.mcboard.org/peer-recovery/ Definition of Peer Recovery Specialist Peer Recovery Specialists help a person become ready and willing to seek treatment (if needed) and enter recovery by helping the person explore their options for recovery or treatment. Peer Recovery Specialists ask questions, offer insight, and help service recipients as they become whole, resourceful, and capable of choosing what is best for them. Peer Recovery Specialists use a strengths-based approach helping service recipients find and utilize their values, assets, and strengths while supporting them in achieving success. They recognize that it is normal for recovering service recipients to have gaps in their skills or development. The role of the specialist is to help service recipients recognize and fill these gaps with the skills needed. Peer Recovery services focus on the present and future and are based on partnership with the recipient. The role of Peer Recovery Specialists can be viewed on a continuum of services and falls between the role of recovery support individuals/recovery sponsor and the substance abuse or mental health counselors. The role of the Peer Recovery Specialist has emerged from the recognition of a need to reconnect substance abuse and mental health treatment to the larger continuum of recovery management. The peer is not a sponsor or a therapist but rather a role model, mentor, advocate, and motivator. Requirements for Certification of Peer Recovery Support Specialist • Initial Training: 46 hours of training provided by approved training program • Opioid Use Disorders Training: The initial 46 hours of training will include information on the principals and the characteristics of substance use and opioid use disorder, evidence-based approaches to their treatment, and understanding of Medication Assisted Treatment (MAT) and the potential for rejection of MAT as part of treatment by some cultural communities. This will provide certified peer recovery specialists with critical information that will help them to be effective in the work with peers. • Approved Education Providers: The initial 46 hours of training must be provided by an approved training provider. This will help to ensure that applicants will receive quality training that is consistent with the standards of the credential. MCB will offer a list of approved providers on its website. • Supervision Requirement: MCB has simplified it’s supervision requirements for the CPRS credential. Under the new requirements, if you are employed as a Peer Recovery Specialist by a Department of Human Services licensed facility or a Recovery Community Organization (RCO) (as defined by Minn. Stat. § 254B.01, subd. 8), you will be supervised by a licensed professional at that facility and MCB will have no additional requirements X-C-01 for supervision. If you are practicing as a Peer Recovery Specialist outside of a Department of Human Services licensed facility or a Recovery Community Organization, you must be working under the supervision of an MCB approved supervisor or Certified Peer Recovery Specialist Reciprocal (CPRSR) and maintain logs of your supervision. • Exam: Must have a passing score on the IC&RC Peer Recovery exam. • Increased Continuing Education. MCB has increased the hours of continuing education necessary during each two-year recertification period from 20 hours to 30 hours. This change will help to keep certified peer recovery specialists apprised of the vast amount of information necessary to be successful in their roles. You will be expected to demonstrate 30 hours of continuing education (including a minimum of 6 hours in professional ethics and responsibilities) at the time of your recertification. Taken from IC&RC (International Certification Reciprocity and Consortium) Training Domains of CPRS: Domain 1: Advocacy - Associated Tasks: • Relate to the individual as an advocate. • Advocate within systems to promote person-centered recovery/wellness support services. • Describe the individual's rights and responsibilities. • Apply the principles of individual choice and self-determination. • Explain importance of self-advocacy as a component of recovery/wellness. • Recognize and use person-centered language. • Practice effective communication skills. • Differentiate between the types and levels of advocacy. • Collaborate with individual to identify, link, and coordinate choices with resources. • Advocate for multiple pathways to recovery/wellness. • Recognize the importance of a holistic (e.g., mind, body, spirit, environment) approach to recovery/wellness. Domain 2: Ethical Responsibility - Associated Tasks: • Recognize risk indicators that may affect the individual's welfare and safety. • Respond to personal risk indicators to assure welfare and safety. • Communicate to support network personal issues that impact ability to perform job duties. • Report suspicions of abuse or neglect to appropriate authority. • Evaluate the individual’s satisfaction with their progress toward recovery/wellness goals. • Maintain documentation and collect data as required. • Adhere to responsibilities and limits of the role. • Apply fundamentals of cultural competency. • Recognize and adhere to the rules of confidentiality. • Recognize and maintain professional and personal boundaries. X-C-01 • Recognize and address personal and institutional biases and behaviors. • Maintain current, accurate knowledge of trends and issues related to wellness and recovery. • Recognize various crisis and emergency situations. • Use organizational/departmental chain of command to address or resolve issues. • Practice non-judgmental behavior. Domain 3: Mentoring and Education - Associated Tasks: • Serve as a role model for an individual. • Recognize the importance of self-care. • Establish and maintain a peer relationship rather than a hierarchical relationship. • Educate through shared experiences. • Support the development of healthy behavior that is based on choice. • Describe the skills needed to self-advocate. • Assist the individual in identifying and establishing positive relationships. • Establish a respectful, trusting relationship with the individual. • Demonstrate consistency by supporting individuals during ordinary and extraordinary times. • Support the development of effective communication skills. • Support the development of conflict resolution skills. • Support the development of problem-solving skills. • Apply principles of empowerment. • Provide resource linkage to community supports and professional services. Domain 4: Recovery/Wellness Support - Associated Tasks: • Assist the individual with setting goals. • Recognize that there are multiple pathways to recovery/wellness. • Contribute to the individual’s recovery/wellness team(s). • Assist the individual to identify and build on their strengths and resiliencies. • Apply effective coaching techniques such as Motivational Interviewing. • Recognize the stages of change. • Recognize the stages of recovery/wellness. • Recognize signs of distress. • Develop tools for effective outreach and continued support. • Assist the individual in identifying support systems. • Practice a strengths-based approach to recovery/wellness. • Assist the individual in identifying basic needs. • Apply basic supportive group facilitation techniques. • Recognize and understand the impact of trauma. X-C-01 Policy No. Est. Date Behavioral Emergency Procedures Purpose: To establish guidelines for how Rise Up Recovery staff will respond to a participant who exhibits behaviors that are threatening to him/herself or others. Policy: Rise Up Recovery recognizes that, at times, a participant may require additional support to fully benefit from treatment services. Staff members are expected to access and provide supports needed by the participants served. Examples include, but are not limited to, environmental supports, verbal prompts, written expectations, clarification of rules/responsibilities, and praise/encouragement. Even with these supports in place, there will be times when a participant continues to show signs of fear, anger, and/or pain, which may lead to agitation and/or aggression. Staff members are trained to recognize and respond to such behaviors through the use of proactive and nonviolent interventions strategies such as deescalation, changes to the physical environment, implementation of meaningful and engaging activities, redirection, active listening, etc. In the event a participant’s behavior escalates to the point that he or she becomes threatening to him/herself or others, Rise Up Recovery staff members will implement behavioral emergency procedures. These procedures will not be used to enforce facility rules for the convenience of staff, or be part of any participant treatment plan. Additionally, at no time will the procedures established by this policy be used for any reason other than to respond to specific, current behaviors that threaten the safety of the participant or others. Behavioral emergency procedures will not include the use of seclusion or restraint. In the event of an emergency where staff member must leave the premises to assist with transporting a resident to hospital, detox, etc an on-call staff member will be contacted. If unable to reach on-call staff member, program director will be contacted. Providence House will never be left unstaffed at any point in time, for any reason. Procedure: 1. Attempt to verbally deescalate the participant. 2. Remove all other participants from the area. Residents are to return to their bedrooms and close the door until staff gives the all clear. 3. If threatening behavior continues or a crime has been committed, any staff person can call 911. 4. The incident will be documented in the participant’s chart. 5. No seclusion, physical or chemical restraints will be used. 6. The Behavioral Emergency Procedures policy will be reviewed and approved prior to implementation and on an annual basis thereafter. Additional reviews will be conducted as necessary and appropriate measures and/or modifications will be implemented. X-C-01 1 Policy No. Est. Date Opioid OD Response Utilizing Naloxone (Narcan) Purpose: To establish a protocol and procedure for Rise Up Recovery staff in response to a suspected opioid overdose. Policy: Opioid overdose can lead to respiratory depression and death if not managed appropriately. Opioid receptor antagonists such as naloxone (Narcan) can be used to temporarily reverse the adverse side effects of opioids. All staff member is to be trained in administration of Naloxone within 2 weeks of employment. Any staff member who has successfully completed training on opioid overdose response and naloxone (Narcan) administration is authorized to administer naloxone to a person who is believed to be experiencing an opioid overdose. Procedure: Each facility will keep a supply of Naloxone in its emergency supply kit where it can easily be accessed by staff in the event of a suspected overdose. At minimum, each kit will contain either (2) 0.1ml intranasal spray units of Naloxone Hydrochloride (concentration 4mg/0.1ml) or (2) 1cc vials of Naloxone with (2) 3ml syringes with 25g 1" needles. Naloxone supply will be monitored monthly by the nurse manager to ensure that stock is replenished when used or expired. Expired naloxone will be destroyed via the facilities medication destruction policy. Staff Training Requirements: Staff must successfully complete opiate overdose response training prior to administering naloxone. The training will be provided by a registered nurse and will include indications for use and proper administration and response protocols. Upon completion of the training session, staff will be assessed by the trainer on their understanding of the information and their comfort with the basic components of overdose response. Protocol for Administering Naloxone: In the event of a suspected opioid overdose, call 911 and the initiate one of the following procedures: Protocol utilizing intranasal naloxone: o Retrieve (1) intranasal naloxone kit from the facility’s emergency supply kit containing two 0.1ml intranasal spray units Naloxone Hydrochloride (concentration 4mg/0.1ml). o Open box and remove the 2 units. o Peel back tab on one unit. o Place thumb on plunger and first and middle fingers on outside of the plunger. X-C-01 2 o Tilt persons head back. o Place the tip of the unit inside the nostril until your first and middle finger are against nostril. o Push plunger till plunger stops inside of the unit. o Begin rescue breathing until the person experiencing the overdose beings to breathe on their own and shows signs of responsiveness. o Administer second dose (0.1ml) of naloxone if there is no response after approximately 2-3 minutes. o Remain with the person until emergency medical personnel arrive. Protocol utilizing IM naloxone: o Staff will retrieve (1) naloxone kit from the facility’s emergency supply kit. The kit contains two 1cc vials of Naloxone Hydrochloride (concentration .4mg/ml) and two 3m I syringes with 25g 1" needles. o Pop off the orange cap from the vial of naloxone, exposing the rubber seal. o Open one intramuscular syringe with needle. o Draw the enter contents of the 1cc vial of naloxone into the syringe. o Inject the naloxone into the muscle of the upper, outer shoulder or the front, outer thigh. o Begin rescue breathing until the person experiencing the overdose beings to breathe on their own and shows signs of responsiveness. o Administer second dose (lcc) of naloxone if there is no response after approximately 2- 3 minutes. o Remain with the person until emergency medical personnel arrive. X-C-01 1 Policy No. Est. Date Service Termination Guidelines Residential All service terminations regardless of status will follow the guidelines below: • Documentation of incident and/or situation relating to discharge including discharge status, how the resident left and where they went. This documentation will be made a part of the resident’s chart. • Resident will be advised of their rights and responsibilities and the reason for the discharge status. • Residents may file a grievance should they wish to contest their discharge status. CONDITIONS AND PROCEDURES: With Staff Approval (WSA) Conditions for With Staff Approval discharges may include but are not limited to: • Completion of individual treatment goals or steady progress towards completion of treatment goals • Progress toward a lower level of risk as defined by the Minnesota Matrix Placement Dimension Rating and documented by the resident’s practitioner in resident record. • Attendance and participation in lectures, groups, and other therapeutic activities. • Development of a continuing care plan • Expectations will be communicated to the resident by a licensed professional during initial treatment session and documented in the progress notes and notes on the individual treatment plan. Procedures for WSA discharge • Resident and treatment team meet to develop a continuing care plan. • Contact referral source. Provisional Discharge (PD) Conditions for Provisional Discharge may include but are not limited to: X-C-01 2 • A committed resident can receive a provisional discharge after completing the above requirements for WSA discharge. Procedures for Provisional Discharge Procedure to follow for residents discharged with staff approval, provisionally, or transferred to another facility, who have been committed under the Minnesota Commitment Act, Minnesota Statutes, Section 253b.16, subdivision 2 • The director or designee shall notify the appropriate agency. • The resident's documented list of individuals referred to on commitment papers shall be notified by certified mail with the following information: – The proposed date of provisional discharge. – The date, time and place of the continuing care planning meeting with the treatment team to discuss follow-up plans. – The fact that the resident will be present. – This information shall be sent at least a week in advance of the meeting. Additionally, the director or designee shall notify the resident’s spouse, or if there is no spouse, then an adult child, or if there is none, the next of kin of the resident: • Of the proposed discharge. • The notice shall be sent to the last known address of the person to be notified by certified mail with return receipt; and • The fact the next of kin may attend that staff meeting and present any information relevant to the discharge of the resident. The above individuals will be notified with proper release of information documentation in resident record. Administrative Discharge (AD) Conditions for Administrative Discharge may include but are not limited to: • Loss Of Financial Support • Ancillary service providers and treatment team agree on an alternative course of action with resident. • Medical Discharges Procedures for Administrative Discharge X-C-01 3 Medical Discharge • Contact appropriate medical resource. • Resident and treatment team meet to discuss options. • Contact referral source. • Develop a follow-up plan, discharge summary and continuing care plan. • Transportation will be arranged and/or provided. Loss of Funding • Resident and treatment team meet to discuss options. • Develop a follow-up plan, discharge summary and continuing care plan. • Contact referral source. • Transportation will be arranged and/or provided. Against Staff Advice (ASA) Discharge Conditions for Against Staff Advice discharge may include but are not limited to: • Resident leaves treatment prematurely. Procedures for Against Staff Advice • Resident and treatment team meet to develop a follow-up plan, discharge summary and continuing care plan if able. • Contact referral source. • Provide resident referrals as appropriate for the client’s needs and offer to assist the client to access the services. At Staff Request (ASR) Discharge Conditions for At Staff Request discharge may include but are not limited to: • Resident who engages in sexual activity with another resident and chooses not to discontinue such activity/relationship interactions while in treatment. • Resident who engages in sexual harassment of other residents or staff. • Resident who makes threats, or becomes violent with other residents or staff. • Resident who violates program rules and resident responsibilities. X-C-01 4 • Resident who fails to make progress toward their treatment goals and refuse to participate in the scheduled program. • Resident who exhibits behavior that requires a higher level of care (return to substance use or bringing substances on property or vehicles). • Resident who is involved in the commission of a crime against a license holder, including property, people, etc. • Resident who smokes in prohibited areas. Procedures for ASR discharge: • When a resident is being discharged ASR, the resident’s file must include documentation describing the reasons for the discharge, the alternatives considered or attempted before discharging, and why the decision to discharge ASR is warranted. • Terminations involving an individual is in need of a higher level of substance disorder treatment will be referred to a facility that is capable of admitting them. • Contact referral source and other significant professionals and emergency contacts involved in current resident care. • Provide resident referrals as appropriate for the client’s needs and offer to assist the client to access the services. • Best practice is to wait to inform the resident until transfer and transport arrangements are made. • Once the transfer and transport arrangements are made and the resident is informed, they should be monitored by staff to ensure campus and resident safety. Procedure to follow when resident is involved in the commission of a crime against a license holder's employee or on a license holder's property, consistent with Code Of Federal Regulations, Title 42, Section 2.12(c)(5). • Call local County Sheriff • Contact the Director or designee. • Referral source will be informed immediately of resident’s departure. Community Resources that may be utilized if resident is considered inappropriate for continued stay at a Rise Up Recovery program. • Referral Source • Hospital/County Medical Centers X-C-01 5 • County Mental Health Center • County Adult Social Services • County Human Services • County Crisis Unit • United Way Information and Referral Services • Other substance abuse programs Discharge Authority • The Treatment Director will authorize all At Staff Request discharges. Contact the Director for approval and guidance, Directors may give the directive to other staff to carry out their instructions for ASR termination of services via telephone if they are off premise at the time. • The Director and a Licensed Counselor may authorize service terminations other than ASR. X-C-01 Rise Up Recovery’s Return to Use/Discharge Policy and Procedures Above all else, Rise Up Recovery’s Providence House is a recovery-oriented environment. Possession of illicit drugs, alcohol, or mood-altering chemicals is strictly prohibited on the premises of Rise Up Recovery and Providence House and in all vehicles owned by the organization. Possession of or use while a resident at Rise Up Recovery’s Providence House is grounds for immediate dismissal – a no tolerance policy will be followed. If a resident is found to have used or brought any mood-altering substances on Rise Up Recovery or Providence House property, they will be immediately discharged and escorted to an alternative program including but not limited to family member’s house, emergency room, emergency shelter, detox facility, treatment program, or alternative sober housing. The following procedures will be immediately implemented for any resident reported to be impaired: 1) Rise Up Recovery’s Providence House staff who is notified of the possible impairment will assess the following of the resident in question: a) Is the resident’s behavior erratic or uncharacteristic? b) Does the resident have slurred speech or unsteady gait? c) Are the resident’s pupils dilated or constricted and/or eyes bloodshot? d) Does the resident have an odor of alcohol or another substance? e) If the resident is incapacitated and/or behavior is a danger to themselves or others, staff is to follow emergency protocol including clearing the area of all other residents who are to return to their rooms and shut their bedroom doors, and utilize motivational interviewing and de-escalation techniques with resident to maintain peaceful environment. 2) Providence House Staff member will ask the resident in question if they have used a substance and/or consumed alcohol. A urine analysis and Breathalyzer will then be administered. 3) If the resident tests negative for intoxicating substances and alcohol, a house meeting will be called to discuss the behavior that lead to the concern. a) If the resident is visibly impaired, even with a negative screen, Providence Housing staff and Program Director can determine the resident to be impaired and discharge the resident to a higher level of care. 4) If the resident tests positive for mood altering substance or acknowledge the return to use they will meet with program staff and program staff will assist in finding alternative placement. 5) Once the resident is deemed to be impaired the emergency contact is notified to assist in the transition to a higher level of care. The plan is clearly communicated with the emergency contact. The housing staff will provide transportation to the higher level of care if emergency contact cannot. Resident is to be escorted to place of referral. Staff is to avoid having resident leave without proper transportation to the best of their ability. Options for referral and placement are in the following order: a) Detox/Treatment Center/Recovery Program/Emergency Room • Gate Recovery Center (PH: 833-338-6980, 6775 Cahill Avenue East Inver Grove Heights, MN 55076) Ramsey County Detox Center (PH: 651-266-4009, 402 X-C-01 University Ave E, St. Paul, MN 55130) Regina Medical Center Emergency Department (PH: 651-404-1000, 1175 Nininger Rd, Hastings, MN 55033) b) Safe Family Member or Friend • Emergency Contact, Parents, Sponsor c) Mental Health Crisis Center • Nancy Page Crisis Center (PH: 612-870-3787, 245 South Clifton Ave, Minneapolis, MN 55403) Diane Ahrens Crisis Residence (PH: 651-645-9424, 1784 Lacrosse Ave, St. Paul, MN 55119) d) Hotel/Motel e) Emergency Shelter • Union Gospel Mission (PH: 651-292-1721, 435 University Ave E, St. Paul, MN 55130), Kingdom Pathways (PH: 651-387-8393, 1088 University Ave W, St. Paul, MN 55104) The Salvation Army Harbor Light Center (PH: 612-767-3100, 1010 Currie Ave, Minneapolis, MN 55403), Adult Shelter Connect (PH: 612-248-2350, 215 S 8th St Minneapolis, MN 55402) 6) A room search will then be completed by Providence House staff to ensure no illegal or dangerous substances have been brought into the residence. If substance is found, Director will be contacted along with local police to help dispose of substance safely. 7)Providence House staff will document the incident and send the report to the Director. 8) If the resident completes the recommended higher level(s) of care, the resident may be eligible to re-interview at Providence House. Resident must be stabilized and medically cleared for readmission. Discharges other than relapse related: 10) If a resident has displayed violent or threatening behaviors, they will be discharged immediately and police may be contacted for assistance if necessary. Rise Up Recovery’s Providence House staff will use every means of de-escalation and safety measures before authorities are called but if staff feels threatened in any way, they are to immediately call for law enforcement’s assistance. The resident will be asked to leave immediately and escorted by either Providence House Staff or local law enforcement who will assist them with packing their belongings. They will be escorted by either Providence House Staff, an approved emergency contact or law enforcement to appropriate referral in this order: a) Detox/Treatment Center/Recovery Program/Emergency Room • Gate Recovery Center (PH: 833-338-6980, 6775 Cahill Avenue East Inver Grove Heights, MN 55076) Ramsey County Detox Center (PH: 651-266-4009, 402 University Ave E, St. Paul, MN 55130) Regina Medical Center Emergency Department (PH: 651-404-1000, 1175 Nininger Rd, Hastings, MN 55033) X-C-01 b) Mental Health Crisis Center • Nancy Page Crisis Center (PH: 612-870-3787, 245 South Clifton Ave, Minneapolis, MN 55403) Diane Ahrens Crisis Residence (PH: 651-645-9424, 1784 Lacrosse Ave, St. Paul, MN 55119) c) Safe Family Member or Friend • Emergency Contact, Parents, Sponsor d) Hotel/Motel e) Emergency Shelter • Union Gospel Mission (PH: 651-292-1721, 435 University Ave E, St. Paul, MN 55130), Kingdom Pathways (PH: 651-387-8393, 1088 University Ave W, St. Paul, MN 55104) The Salvation Army Harbor Light Center (PH: 612-767-3100, 1010 Currie Ave, Minneapolis, MN 55403), Adult Shelter Connect (PH: 612-248-2350, 215 S 8th St Minneapolis, MN 55402) 11) All resident’s belongings will be stored on premise for a period of 30 days. Residents are required to pick up their belongings within that 30 day period. Belongings will not be stored for longer than 30 days. After 30 days, belongs will be donated to local charity or recycled. X-C-01 Policy No. Est. Date Tobacco Guidelines Rise Up Recovery programs and locations will adhere to the following practices as they apply to tobacco use: Tobacco, e-cigarette, or chewing tobacco use is strictly forbidden inside of any facility. Participants will be encouraged not to use these products. However, they will be made aware of the designated smoking area(s) at each facility: • Outside in the vicinity of of the building. Refer to your location’s written participant rules/expectations for specific guidelines. • Smoking hours are Sunday – Thursday 6am – 10pm Fridays – Saturdays 6am – 11pm. There is to be NO smoking or hanging out the house outside of these hours. • Ashtrays are to be provided. Disposal and cleanup of all residual matter shall be performed daily, at minimum. • All tobacco product use and disposal must be undertaken in a safe and responsible manner. Tobacco use will not be tolerated at any time by anyone under-age. There will be a tobacco store run with PRS 1x/week. Any rolling of cigarettes must be done in common area and mess cleaned up thoroughly upon completion. Employee smoking is allowed in designated areas only. Rise Up Recovery acknowledges the religious value of tobacco in some cultures. When a participant indicates they use tobacco as part of spiritual ritual, Rise Up will incorporate this into the participant’s treatment planning process outside of the treatment setting if such practice were to conflict with the designated tobacco use areas. X-C-01 Policy No. Est. Date UAs and Breathalyzers Purpose: To detect alcohol or illicit drug use of a participant or a participant’s visitor(s) while on Rise Up Recovery property and to ensure the safety of all residents while maintaining a culture and environment that is recovery focused. Policy: Rise Up Recovery will test participants randomly an upon and suspected return to use for alcohol and illicit drug use. Residents will be tested upon admission into both pre-treatment and post-treatment housing programs. Testing will be done according to prescribed methods by breath, saliva or urine analysis. Results of testing may only be forwarded to external parties with a signed release of information. X-C-01 Comments Rise Up Recovery Special Use Permit Melissa Spicer - 2/12/22 Hello, My name is Melissa spicer and I am writing to you in regards to rise up recovery possibly coming to Hastings! To say I am excited for Hastings to have this is not even enough to explain how I feel! I lost my brother on January 20th 2022. He had many years as a drug addict. He fought dark demons. He seeked help around the cities because there weren't many options around Hastings. However we lost him to his battle and our hearts are forever shattered. This type of program is beyond important, especially for our families in Hastings! Local places to reach out to for these people who don't know where to go. I would love nothing more then to support this program as a family member who has lived the nightmare of addiction. Sorry this is getting sent in so late and kind of informal but I just found out about this and I am all in to support this!!!!!! We do not way any other families to ever have to feel this pain. My brother, their uncle and my best friend. Addiction has a face... and they also have family. Sincerely, Melissa spicer X-C-01 Susan Stanley - 2/12/22 Dear Mr. Hinzman and Tiffany My name is Susan Stanley. I am a resident of Hastings, MN and 1 week ago my nephew committed suicide by an overdose and he also had mental depression. He really needed help and sadly there really isn't any place here to get that help. We need to make sure there's a place for people of all ages especially younger adults and teenagers to get that help. I'm writing to you to ask that RISE UP Recoverys special permit request be approved so they can open Providence House so they can help someone else's nephew brother or son before it's to late. Rise Up Recovery is a valuable asset to our community that shouldn't be denied their request Please help RISE UP Recovery help our community save lives . Respectfully Susan Stanley Sasha Sobaszkiewicz-Griner - 517 Ramsey St - 2/14/22 - Telephone Message Summary Not in support of issuing the Special Use Permit. She is a stay at home mom with four kids, does not support having up to 15 adult males in treatment. The transient nature of the facility does make her feel safe. Does not fit into a residential neighborhood. X-C-01 Bridgette Norring - 2/9/22 X-C-01 X-C-01 Hayley Norring - 2/12/22 Dear Mr. Hinzman, My name is Hayley Norring. I am a resident of Hastings, MN. On April 4th, 2020, my brother, Devin Norring lost his life to fentanyl poisoning after he and a friend purchased what they believed was a Percocet from a well known 'alleged' Hastings drug dealer. I am devastated without my brother. I recently purchased my own home here in Hastings not far from RISE UP Recovery. I am also expecting my first child on May 8th, 2022. My brother will never get to experience these next few chapters of mine and my family's life. He'll never get to see my new home. Devin will never get to meet his niece. I know in my heart, Devin would've been an amazing uncle because he was an amazing brother. Devin and several other young adults that I went to school with here in Hastings have also lost their lives these last 2 years to fentanyl poisonings. I have attended far too many funerals because of fentanyl, Mr. Hinzman. We need to find a way to stop people my age, all ages, from dying. I know if my brother had lived, we'd be doing everything in our power to make sure he got the help he needed. Sadly, that help is very limited here in Hastings, Mr. Hinzman. I am writing to ask that you approve RISE UP Recovery's special permit request so that they can open Providence House so that they can help someone else's brother before it is too late. With around the clock care those with substance use disorders will get the proper care that th ey are deserving of and will give them a chance to live a life well deserved; a life my brother was robbed of. They will be given the adequate tools and resources to help them live. RISE UP Recovery is a valuable asset to our community that should not be denied their request. Please help RISE UP Recovery help our community and my family save lives here, Mr. Hinzman. Respectfully, Hayley Norring Devin Norring's Sister - Forever 19 Poisoned by Fentanyl X-C-01 Brenda Reedy - 2/9/22 X-C-01 Dean Markuson - 2/7/22 X-C-01 Doc’s Recovery House - 2/10/22 X-C-01 Terri Whipple - 314 5th St E - 2/14/22 X-C-01 Wilson Vave - 2/15/22 Letter of Support for Rise Up Recovery To The City of Hastings Council Members, I am writing to encourage you to consider the missions, values, and goals of Rise Up Recovery as of keen interest for the City of Hastings and the future culture surrounding drug and alcohol abuse and recovery. Specifically, I am encouraging you to approve their application for a Special-Use Permit for the 303 5th St. East property. I hope to convince you that the City Council of Hastings should be interested in the success of Rise Up Recovery’s missions and goals, confident in the strategies for recovery employed by RUR, and intentional in being agents of change surrounding the culture of drug and alcohol addictions. The founders of Rise Up Recovery, Chad and Tiffany Neuharth, are passionate individuals who are in long-term recovery themselves. They are both deeply involved in their community through church and volunteering. Chad and Tiffany have been working on Rise Up Recovery since October, 2020. For Rise Up Recovery to have gone so far in just one year is a testament, not just to the work ethic and passion shown by them, but to the needs and desires shown through the support of the Hastings community. I hope you find that it is appropriate that the City Council should reflect the community’s interest in the success of Rise Up Recovery. As you may know already, Rise Up Recovery is a not-for-profit recovery community organization dedicated to creating meaningful connections that lead to a web of support from other recovering folks. Their strategy is to create a culture that prevents drug and alcohol abuse, which is coupled with harm reduction services, both of which are nested in a supportive recovery community. While creating a culture takes time, Rise Up Recovery has already begun harm reduction services along with recovery support. One of which is the Naloxone Access Point program, which is a partnership between Rise Up Recovery and the Rummler Hope Network1 to provide Naloxone kits, as well as the training to administer the life-saving antidote. The other program for harm reduction is the reason I’m writing today, the Providence House. Rise Up Recovery (RUR) is actively applying for a Special-Use Permit for the 303 5th St. East property. This house will be used for their Providence House program, a short-term emergency sober-housing program that connects its residents to the care they need, which might be addiction treatment programs. In terms of long-term recovery, it is crucial that the people who need immediate emergency sober housing are given access to it, and the providers make that connection with them. Again, RUR’s strategy for helping people to grow is through meaningful connections. It’s important to emphasize that the people going through the Providence house are not simply going through a machine that will churn out a healthy and productive member of society. It’s creating a community of people who have experienced these difficult, unspoken trials of overdose, neglect, depression, etc. and empowering each other to rise up from the cycle of addiction. X-C-01 The recovery community is an intentional group of people who want to see their friends succeed. After rehabilitation for its emergency housing guests, Rise Up Recovery wants to continue developing connections. The dream is to see a community of short-term recoverees grow into long-term recoverees, while also learning more about themselves apart from addiction. Opportunities to learn new skills will be provided, helping them achieve their own personal goals of mental, physical, financial, and spiritual well- being. So, even though Providence House is a harm reduction program, it is an integral part of the preventative strategies for drug-overdose. I would like to acknowledge the fact that Rise Up Recovery’s multidisciplinary strategies of prevention, harm reduction, and recovery support are not new and experimental but researched and evidenced-based. Please visit the U.S Department of Health & Human Services website2 for an overwhelming number of advanced research into the strategies Rise Up Recovery is investing in. And take note the four strategies they mention: Primary Prevention, Harm Reduction, Evidence-Based Treatment, and Recovery Support. You will find that the programs Rise Up Recovery has dutifully and faithfully worked towards align in these areas. In conclusion, Rise Up Recovery is what the City of Hastings need. It’s reflected by the people who have shown incredible support this past few months. It’s reflected by the told and untold stories of pain and suffering from addiction. I won’t provide anecdotes to illustrate the need for your Special Use Permit approval. If you’re listening to the people of Hastings, I’m sure the need is evident. I do hope this letter gives you confidence in trusting Rise Up Recovery to meet those needs. Sincerely, Wilson Vave ________________________________________________________________________________ Emily Mellingen - 309 5th Street E - 2/28/22 with Staff Response - 3/2/22 Hi Emily, Thanks for your email. Please see my responses in red below. I have also included Tiffany Neuharth of Rise Up Recovery on this email for any information Rise Up may be able to provide. The Planning Commission voted 6-1 to recommend approval of the Special Use Permit on February 28th. Approval was subject to a number of conditions of operations. Access to the Planning Commission's report can be found here. The City Council is scheduled to review the item on March 7th beginning at 7pm. The City Council report will be posted here after by the end of the day Thursday. I will also include your comments in the Council report. Please let me know if you have additional questions. Emily Mellingen 309 5th st. E Hastings, MN 55033 651-600-5481 X-C-01 February 19th, 2022 John Hinzman Community Development Director 101 4th St. E Hastings, MN 55033 Dear Mr. Hinzman, As a resident, constituent and home owner in Hastings historic district, I am writing to further convey concerns regarding Rise Up Recovery's application for a special use permit. I did attend the public hearing on February 14th, 2022 and appreciate the opportunity to ask questions regarding the proposed special use permit. However, during the course of the public hearing I felt that I was left with more questions than answers. This email is to convey my concerns and additional questions I have pertaining to this application. I first would like to reiterate that I have 10 years of experience as a nurse in the field of behavioral health, addiction and corrections. I have dedicated my professional career to serving and advocating for under served populations. I strongly believe that everyone, no matter their past deserves to be treated with dignity and respect and should have a right to equal and fair housing opportunities. Below are my listed concerns regarding Rise up Recovery; 1.) Rise up Recovery was established with its 501c3 being granted on 4/2021. This is clearly a very new business. To my knowledge, Rise up Recovery does not have any professional affiliations in its field. Cochran Recovery in Hastings has been in business since 1974 and is professionally managed by NUWAY, who has been in business since 1966. They are accredited by the Joint Commission for Behavioral Health, the United States largest healthcare accrediting body. They are also members of the National Association of Addiction Treatment Providers. Meridian Behavioral Health is another provider that I have experience working with, is another example of an established provider owning 10 residential homes in the Twin Cities Metro area. They are also members of the National Association of Addiction Treatment Providers as well as being accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities. Professional Associations as well as Accreditation are important aspects of successfully running these types of facilities for several reasons, they establish performance, professional and treatment standards as well as mitigate risk management and safety for the people they serve. Acknowledged. 2.) Tiffany Neuharth the President of Rise up Recovery is also an LADC, Licensed Alcohol and Drug Counselor. Is she the only person in the company that holds this certification? I am not aware of any other LADC's within the company. This certification is mandatory to operating these types of facilities. With this company operating two homes, one in Lakeville and one in Burnsville, how do they plan on managing an additional home with 10 residents, with some needing emergent help? Recommendation that facility be supervised by a LADC and recommendation that facility must provide staffing 24/7 by certified recovery\support individuals such as Certified Peer Recovery Support Specialists were included in the Planning Commission's recommendation for approval. This is really a large caseload for one LADC, even with two. Consideration must also be given to the geographical distance between their facilities. X-C-01 3.) State Licensing. I personally have not been able to locate a License for this company. Has the Council verified this? Facility must obtain a State License for Board and Lodging with Special Services as a condition of approval. I do not believe Rise Up has obtained the licenses at this time. 4.) Their website www.riseuprecoverymn.com under the staff tab, board members lists a board secretary, attorney by the name of Kevin Joyce. A Kevin Joyce is not listed in the State of MN MARS system (Minnesota Attorney Registration System). This is a requirement to practice law in the State of Minnesota. Acknowledged, I'm not certain if there is a requirement for an attorney to be on the board. 5.) Their staff listing also includes Dr. Jeremiah Fairbanks, which is great, however Rise up Recovery stated they do not provide medical services. Acknowledged. 6.) During the public hearing, I had asked the question on their policy of eloped residents. Their response was, “We will give them a ride anywhere anytime”. This response did not really answer the question. In my experience, there have been many residents that elope without any warning. This also lead to my question if the live staff were awake 24/7. Rise Up will be required to provide staff on site 24/7, it is my understanding that staff on duty would not be asleep. Requirement established to require transportation arrangements must be made for residents discharged from the treatment program. 7.) During the public hearing Rise up Recovery stated that their model is a new model with regards to the emergency shelter operations, however later in the hearing they gave names of several other facilities that operate similar to their business model. This is a clear contradiction. Acknowledged. Rise Up has cited Doc's Recovery in Rochester and Beyond Brink in Mankato as operations that offer both pre-treatment (short term emergency) and post-treatment services. 8.) During the public hearing Rise up Recovery eluded to the fact that they are not a “zero tolerance” sober facility. If residents of their facility are using or have recently used drugs or alcohol in the last 24- 48 hours, they are at risk of withdrawal and potentially in need of medically managed detox services. Without the proper care team in place, this puts their residents health at risk, with also the potential to overburden Regina ED with emergent detox services as well as legal risk incurred by Rise up Recovery. Further, I believe it is a disservice to the longer term residents in a sober living home to be subjected to chemical use as this is the very premise of sober housing and is a proven treatment strategy to remaining abstinent. Acknowledged. Additional questions; 1.) Will new residents of the home be drug tested upon admission? Providence House's intake checklist includes obtaining a UA as soon as the resident is able. Will they have random drug testing? Providence House's UA's and Breathalyzer Policy includes random testing. Will breath alcohol testing be conducted after outings? Uncertain. These are all requirements that I have seen in my professional practice. In the public hearing there was no mention of this. They eluded to the fact that people getting out of jail may need a short place to stay as a rationale as to why they do not need medical services, insinuating that they were in forced sobriety due to being incarcerated. This couldn’t be further from the truth. Drug use happens in jails and correctional facilities, there is no guarantee. Acknowledged 2.) How will the medications Methadone and Suboxone be handled? Uncertain. These very common narcotic medications for preventing withdrawal in opioid addicts and are heavily regulated. In the community this means they must report to a medical facility for direct observation of medication X-C-01 administration 7 days a week. In treatment facilities they are able to get a few days at a time delivered to the facility, however this requires supervision of a Registered Nurse and special consideration is given to securing narcotic medications as well as administration by trained personnel under the supervision of a Registered Nurse. Further, if the peer recovery specialists are taking people to these medical facilities 7 days a week, I am not seeing how they can provide adequate supervision with one or even two peer specialists. During the public hearing, a lot of focus was placed on the addiction treatment aspect of things, such as how would they manage to supervise a home with the peer specialist needed to bring someone somewhere in an urgent or emergent matter. I would like the council to consider that there is much more to treating folks in this realm other than urgent or emergent matters. Patients with these issues commonly have co- morbid health issues requiring many medical appointments, dental appointments, court hearings, supervised children visitation, trips to the store for necessities etc. It was common for the facilities I have experience with to have a full time driver just for this. Acknowledged I ask the council to consider the potential impacts a poorly executed business model with little experience will have in our residential area. The services they aim to provide is commendable and needed, however it must be done in a manner that is safe to the people they serve, well organized and has clear established policy and procedure. The residents of 309 5th St E oppose this proposal for a special use permit. Thank you, Emily Mellingen X-C-01