What are the details as we know them?

The City of San Jose is using the COVID-19 emergency declaration and Shelter Crisis Act to get around traditional zoning, building, and environmental laws (CEQA) to fast-track homeless dorms at the juncture of Bernal and Monterey Road, Rue Ferrari, and now Branham/Monterey.   The City created 80 prefabricated Tiny Dorms at the Bernal site and 120 units at the Rue Ferrari location.  As of the meeting of the San Jose City Council, the Council has recommended a 3rd D2 border site at the corner of Branham and Monterey Road.

The City's goal is to shelter the homeless as quickly as possible.   They are expecting these sites to be active 10-15 years!

The dorms will serve multiple interim emergency purposes:

• Most alarmingly, they intend these shelter to provide emergency interim housing for COVID-19 positive homeless.

• These locations may also serve as a landing spot for those leaving decommissioned mass homeless shelters all over San Jose.

• Per the Mayor, these will not be like the tiny homes we have seen, and that he helped construct.  They will not be that nice. They will be prefabricated modular dorms.

• The builder is Habitat for Humanity. 

• The City will be following the Housing First model. This approach does not require drug testing, sobriety, substance abuse/addiction treatment, mental health treatment, or other program participation, nor does it deny housing to those with criminal records.   Per the HUD website on Housing First: 

Everyone is “housing ready.” Sobriety, compliance in treatment, or even criminal histories are not necessary to succeed in housing. Rather, homelessness programs and housing providers must be “consumer” ready. 

• The City had previously back-tracked on basic site criteria for Tiny Homes that stated a site must provide ready access to transportation, in a backhanded attempt to qualify sites like Bernal that would otherwise not qualify. The revised site criteria language requires only "access to transportation or a commitment from another agency to provide transportation".  

•  The Bernal site is... at its furthest point...528 feet from residential properties. Proposed locations in District 2 are just too close to quiet residential neighborhoods and at-risk communities to include the elderly, those with cardiovascular disease, immune suppressive disorders, etc. 

• The Monterey Road site is in close proximity to railroad tracks, high-speed roadways, with little in terms of safe egress, and a bar.  So, this begs the question....are these sites optimal for housing the homeless, 70% of which will likely suffer, per the City's numbers, from mental health and or substance abuse problems?

• Although the City suggests that this is a temporary project, they plan on its operation for the next 10-15 years!. 

•  "Even though there's no rule that homeless shelters are usually accompanied by higher rates of crime, shelters do certainly attract motley groups of people, necessitate emergency calls, and require more police in otherwise quiet, safe neighborhoods"

• At the same time of this development, the City is cutting 400,000 from the budget for code compliance.

• The City will not guarantee, and the Mayor suggested monies will likely not be available, for additional policing and even continuing security services. 

• The City is proposing to place these dorms, serving COVID-19 infected homeless, in residential neighborhoods at great risk to the health and safety of the local community, especially those at high-risk for this deadly disease.

• The Bernal location will offer exhaust filled hot boxes on an on/off ramp, surrounded by high-speed roadways, without legally required setbacks from the roadway, a stones throw from the railroad tracks, with no manner of egress, no transportation or sewage (a site requirement), at a location within the CAHSR build corridor, and adjacent to quiet residential neighborhoods and schools filled with at-risk community members.  This site is not good for the homeless and not good for the community!  

CDC -Considerations for Alternate Care Sites

Key Concepts

• Establishing alternate care sites will help address surge in the response to COVID-19.

• Since care will be provided in a non-traditional environment, it is critical to ensure these facilities can support the implementation of recommended infection prevention and control practices.

An increase in the number of patients seeking medical care might require jurisdictions to establish alternate care sites (ACS) where patients with COVID-19 can receive medical care for the duration of their isolation period. These are typically established in non-traditional environments, such as converted hotels or mobile field medical units.1  Depending on the jurisdictional needs, ACS could provide two levels of care:

1. General (non-acute) Care: General, low‐level care for mildly to moderately symptomatic COVID‐19 patients. This includes patients that may need oxygen (less than or equal to 2L/min), who do not require extensive nursing care, and who can generally move about on their own. This type of ACS might care for nursing home residents who have COVID-19 and need to be moved out of their facility or patients with COVID-19 who are currently hospitalized but can be discharged to a lower level of care.

2. Acute Care: Higher acuity care for COVID‐19 patients. This level includes critical care, emergency care, and advanced cardiovascular life support (ACLS).

The expected duration of care for patients in ACS would be based on their clinical needs and the timeline for discontinuation of Transmission-Based Precautions. If ACS will be used to care for both confirmed and suspected COVID-19 patients, or for patients without COVID-19 who require care for other reasons, additional infection prevention and control considerations will apply. For example, planning would need to address physical separation between the cohorts and assignment of different healthcare personnel (HCP) with dedicated equipment to each section.

This guidance provides critical infection prevention and control (IPC) considerations for ACS and is intended to supplement existing plans (created by jurisdictions as part of pandemic planning). It does not address other important aspects of an ACS, such as supplies, accessibility (e.g., doors are wide enough for wheelchairs and stretchers), or patient transportation to and from nearby healthcare facilities. Jurisdictions should consider how close the ACS is to nearby healthcare facilities, including acute care hospitals, and may need to have agreements in place with surrounding healthcare facilities regarding patient transfer.

CDC Guidelines for Physical Infrastructure

Layout

• Layout plan for all areas of the facility with consideration given for the type of personal protective equipment (PPE) that should be worn in each area

• Patient triage

• Staff only respite area separate from patient care area with a bathroom and space to store personal belongings, take breaks, and eat

• Area for staff to put on and remove PPE

• Patient care area or rooms with access to patient bathrooms/shower areas

• Designated area in patient care area where staff can document and monitor patients

• Clean supply area

• Medication storage/preparation area

• Dirty utility area including space for reprocessing reusable medical equipment

Air conditioning and heating

• Functional HVAC (heating and cooling) system

• ACS with individual patient rooms (such as hotel): ideally a facility whose HVAC units are mounted on an external wall and able to accommodate some outdoor air dilution as opposed to internal, 100% recirculation units

• ACS with open floor plan: care is provided in a large open space; ideally the HVAC has air supply at one end of the space and air return at the other end of the space

  • Staff respite area would ideally be in a room separate from the patient care area; at a minimum it should not be in a location near the air return

  • Facilities with generator support are optimal

Spacing between patients

• Determine maximum number of patients who can safely receive care in the facility

• Plan for safe spacing between patients

• ACS with individual patient rooms (such as hotel): ideally each patient should have a separate room with a separate bathroom

• ACS with open floor plan: To prevent the spread of other pathogens, there should be:

  • At least 6 feet of space between beds

  • Physical barrier between beds, if possible

  • Bed placement alternating in a head-to-toe configuration; ideally beds and barriers should be oriented parallel to directional airflow (if applicable)

Storage areas

• Space for clean storage

• Space for dirty storage

• Clean storage would ideally have a refrigerated section for medications that require refrigeration and a room temperature section for other medications and clean supplies such as linen and PPE

• Dirty storage would have space for medical and non-medical waste and dirty equipment waiting to be reprocessed

Floors and surfaces

• Cleanable floors and surfaces2

• Avoid porous surfaces such as upholstered furniture, carpet, and rugs as much as possible

Visitor access

• Prohibit visitors and pets in order to avoid unnecessary risks to patients and staff; post signage at entrances to the facility indicating this policy

• Post signage at entrances to the facility indicating this policy

Services

Food services

• Catering provided with disposable plates/utensils

• Separate place for staff to eat without wearing PPE

Environmental services

• Environmental services can be provided regularly and safely by trained staff

• Environmental services staff have all necessary training and wear appropriate PPE for exposure to disinfectants and patients with COVID-19

• EPA-registered disinfectants from List Nexternal icon are used according to label instructions for routine cleaning and disinfection

• Protocols are in place for cleaning spills of blood or other body fluids2

• Responsibility for reprocessing reusable medical equipment is assigned to appropriately trained personnel

• ACS with individual patient rooms (e.g., hotel): environmental services staff perform terminal cleaning of rooms and patients ideally perform daily cleaning

  • Patients should be provided cleaning materials (disinfectant wipes, gloves) and instructed to clean high-touch surfaces and any surfaces that may have blood, stool, or body fluids on them daily, according to the label instructions

  • Establish a process for at least daily removal of trash from rooms

• ACS with open floor plan: environmental services staff would perform both daily and terminal cleaning

  • Wipe-down of all floors and horizontal surfaces at least once daily

  • Immediate clean-up of all spills of blood or body fluids2

  • Regular disinfection of high-touch surfaces such as doorknobs

  • At least daily cleaning of bathrooms

Sanitation

• Sanitation and waste services are available for medical waste (if required); refer to local regulations for handling of medical waste

• Sanitation and waste services are available for routine waste

Laundry facilities

• Laundry services are provided in accordance with routine laundering practices using either washer and dryers on site or through a contract with a laundry service

Pharmacy access

• Medications are properly labeled and stored

• The layout has designated a space for medication preparation activities that is not in the immediate patient care area and is away from potential sources of contamination such as sinks

• Staff who prepare and administer medications have been appropriately trained on methods to prevent medication errors and contamination; those who prepare or administer injectable medications should be educated on safe injection practices such as not reusing single-dose medications or injection equipment, preparing medications as close as possible to the time of administration3

Diagnostics

• If point of care testing meters (blood glucose, anticoagulation meters) must be used for more than one patient they should be labeled for multi-patient use and be cleaned and disinfected after each use, according to the instructions for use. Otherwise, each individual should have their own dedicated glucometer for exclusive use at the ACS.

• Care must also be taken to ensure that only single-use auto-disabling lancets are used to perform fingerstick procedures for point-of-care testing.

• Diagnostic testing should not be performed in the same area where medications are stored or prepared

Additional Planned City Actions Related to the Temporary Sheltering Operations and Services for COVID-19 Emergency Response. 

Recommendation: Adopt a resolution authorizing the City Manager or designee to negotiate and execute the following agreements and amendments for increased or additional temporary sheltering operation services necessary for COVID-19 emergency response, with any necessary ancillary documents, retroactive to March 16, 2020: 

(a) Second Amendment to the Overnight Warming Location grant agreement with HomeFirst Services of Santa Clara County, adding locations, increasing hours and increasing the maximum amount of compensation by $2,850,860 from $1,484,180 to $4,335,040 at the following City facilities: (1) Bascom Community Center and Library, 1000 S. Bascom Avenue; (2) South Hall, 435 S. Market Street; (3) Parkside Hall, 180 Park Avenue; and (4) Camden Community Center, 3369 Union Avenue. 

(b) First Amendment to the Bridge Housing Community grant agreement with HomeFirst Services of Santa Clara County in the amount of $3,178,000, with no increase in funding, at the Maybury Road bridge housing site to allow emergency placement of vulnerable persons at the site during the COVID-19 emergency; 

(c) Third Amendment to the lease between the City and Allied Services to allow up to 23 units, at the Plaza Hotel located at 96 S. Almaden Avenue, to be used for emergency placement of vulnerable persons during the COVID-19 emergency and making amendments to the method of compensation for the emergency placement, without adding funding; and 

(d) Third Amendment to the Rapid Rehousing grant agreement with The Health Trust in the amount of $7,752,235, with no increase in funding, to extend the agreement to December 30, 2020 and make amendments as needed for subsidizing emergency placements and FEMA reimbursement. CEQA: Statutorily Exempt, File No. ER20-081 CEQA Guidelines Section 15269, Emergency Projects, Section (c) Specific actions necessary to prevent or mitigate an emergency. (Housing) [Rules Committee referral 4/15/20 - Item A.1.a]