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HomeMy WebLinkAboutalameda-county-shelter-standards-august-2026-final-v1-1-ada1 V1.12026 ALAMEDA COUNTY EMERGENCY SHELTER STANDARDS FOR YEAR-ROUND SHELTERS August 2026 Update 2 V1.12026 Alameda County Shelter Standards 2026 Revision Table of Contents Preface Glossary Guiding Principles Use of Standards Section A: Program Operations Section B: Health and Safety Section C: Food Service Section D: Service Coordination and Linkage Section E: Physical Plant Section F: Additional Family Shelter Standards Section G: Staffing 3 V1.12026 Preface Alameda County Emergency Shelter Standards were originally adopted by the Board of Supervisors on February 27, 2017. Development of these standards was first led by Alameda County Social Services Agency in collaboration with Alameda County Health (formerly Health Care Services Agency). The standards were developed based on the guiding principles of equity, inclusion, dignity, accessibility, self-determination, and mutual accountability. The standards were intended to ensure a consistent quality of care across all county-funded emergency shelters and to operationalize the County’s commitment to providing low barrier emergency shelter services to those without homes in Alameda County. The standards were originally developed through a community process that included surveying the practices of existing county-funded shelters and reviewing standards from other communities and other public funding standards, such as those required by the federal Emergency Solutions Grants (ESG) program and the Federal Emergency Management Agency (FEMA). Meetings were held with shelter operators and city funders, and the standards were posted online for public comment in March of 2016. Twenty-eight shelter programs and dozens of stakeholders, including people with homelessness expertise, provided feedback that informed the final version of the original shelter standards. In 2026, aligned with the Alameda County Home Together Plan (adopted by the Board of Supervisors in 2022), Alameda County Health Housing and Homelessness Services (H&H) undertook a comprehensive process to update the standards to bring current the previously approved and shared standards document. This process included obtaining stakeholder input through: o Listening sessions with 32 shelter providers representing 15 different agencies. o Listening sessions with 97 participants at 10 shelters throughout the County including adult, family, gender-based violence, and overnight-only. o Surveys from 100 shelter participants at 13 shelter programs throughout the County o Interviews with 74 unsheltered people collected by grass roots agencies and people with lived experience. o Input from Alameda County Health Care for the Homeless (AHCH) Consumer Advisory Board (CCAB) o Input from the Youth Advisory Board. o Written feedback on draft standards from community members with lived experience and shelter providers. H&H is committed to supporting shelters in meeting these standards through ongoing technical assistance, training, and monitoring—extending that support to shelters not funded by Alameda County. These standards are intended to evolve alongside emerging needs, best practices, and community feedback. H&H will continue to partner with providers and community members in this work. Ultimately, the goal is a shelter system that reflects principles of equity, inclusion, dignity, accessibility, self-determination, and mutual accountability, and that serve our community well. 4 V1.12026 Glossary Alameda County Health Care for the Homeless (ACHCH) – A County program housed in Alameda County Health Housing and Homelessness Services dedicated to reducing mortality and improving the health and well-being of people experiencing homelessness by providing health care services, case management, and support through a network of community-based health care providers. (H&H) – A division within Alameda County Health responsible for overseeing housing and homelessness programs, funding distribution, and policy implementation. – Alameda County government agency that provides essential social services, including public assistance, child welfare, employment support, and housing assistance to individuals and families in need within Alameda County. A type of shelter where five or more participants from different households share a room. – A regional planning body designated by the federal Department of Housing and Urban Development (HUD) to coordinate housing and services for individuals and families experiencing homelessness. Alameda County H&H is the management entity for the EveryOne Home CoC. – The approach to coordinate and manage the Homelessness Response System’s resources to enable providers to make equity-consistent decisions to best connect people experiencing homelessness to housing and other interventions to end their homelessness. – A confidential emergency shelter program serving survivors of domestic violence, intimate partner violence, sexual violence, trafficking, stalking, and other forms of gender-based violence. Safe houses utilize trauma-informed, survivor-centered practices designed to promote safety, confidentiality, healing, and long-term housing stability. – A temporary residential facility that provides immediate, short- and long-term housing and support services for people experiencing homelessness. (ESA) – A pet of any species prescribed by a licensed mental health professional to provide therapeutic benefit to a person with a diagnosed mental or emotional disability. (GBV) – Any harmful act directed at an individual because of their gender, gender identity, gender expression, or perceived gender, 5 V1.12026 – Alameda County’s strategic plan for ending homelessness. – A data collection and management system used by shelters and service providers to track participant information, service usage, housing needs, and housing outcomes. – A program within H&H that provides critical services to Medi- Cal members experiencing or at risk of homelessness under the California Advancing and Innovating Medi-Cal (CalAIM) program. These services include finding stable housing, covering move-in deposits, and sustaining tenancy. – Specialized, wrap-around services designed to help people experiencing or at risk of homelessness find, apply for, and secure permanent housing. – 24/7 emergency shelters that provide enhanced medical services (e.g., Registered Nurse or personal care services) for participants. – A primary care provider or clinic, usually assigned by a health plan or insurance plan. – Shelters where up to four participants from the same or different households share a room. – Security, daily maintenance, and daily operations personnel such as program manager, site coordinators, janitorial, safety, intake, kitchen, etc. – Shelters that provide overnight accommodation only and require participants to vacate the premises during the day. – Individuals or families staying in emergency shelters. – A shelter's written, internal document governing its day-to-day operations. A shelter’s Policies and Procedures must meet Alameda County’s Shelter Standards as defined in this document but will contain additional provisions at the discretion of the shelter. – Organizations, both governmental and non-profit, that deliver housing, health care, case management, and other essential services to homeless individuals and families. – Staff who provide service linkage/referral (but not the services themselves) to education support, job search, medical care, housing navigation, benefits enrollment, drug and alcohol support, etc. This is a separate function than shelter operations staff. 6 V1.12026 – An approach grounded in understanding the impact of trauma that emphasizes physical, psychological, and emotional safety, and seeks to avoid practices that retraumatize individuals. – Shelters funded to remain open 24/7 that do not require participants to leave for any portion of the day. – Federal agency that oversees funding for housing and homeless programs including Alameda County’s Continuum of Care, EveryOne Home. For additional terminology please refer to the EveryOne Home Acronym Glossary Guiding Principles Alameda County's Emergency Shelter Standards are built on three principles. They reflect the County's commitment to a shelter system that supports every participant's dignity, self- determination, and capacity to move toward a more stable life. • Provide safe indoor space — a place where basic needs are met, participants feel secure, and staff and participants alike are protected from harm. • Offer an opportunity to stabilize — a supportive environment where participants can catch their breath, access services, and work toward their own goals at their own pace. • Support exit to better circumstances — active connection to housing and resources that open a path forward, delivered with respect for each person's barriers and readiness. Alameda County’s approach to shelter is consistent with the state’s “housing first” approach in that it aims to connect people experiencing homelessness to permanent and stable housing as quickly as possible. Under this model, providers offer services as needed and requested, and participation in services are not a requirement for admittance to shelter. Shelter is often the last option available to people with nowhere else to turn. These standards aim to make every shelter funded through Alameda County Health, not just as a place to sleep, but as a meaningful step toward stability. Alameda County Health Housing and Homelessness Services (H&H) is committed to working in partnership with shelter providers to make this vision a reality. Use of Standards All shelters funded by Alameda County Health Housing and Homelessness Services are required to adhere to the standards, unless exceptions are indicated in the standards based on type of site (e.g., overnight-only shelter). Providers should use these standards as the basis for developing their shelter Policies and Procedures. Where the standards are silent, providers may develop policies that best support their participants and programs. 7 V1.12026 These standards do not cover all applicable state, federal, local, or certification requirements and are not a substitute for any such requirements. Providers are responsible for complying with all governmental and funder requirements that apply to them. Shelter providers must maintain knowledge of, and ensure compliance with, current State of California and federal legislation related to shelter service delivery as shelters serve a diverse group of people, including but not limited to, youth, trafficking crime victims, gender-based violence victims, and survivors. Waivers to specific standards may be requested when the Alameda County Shelter Standards conflict with another governmental or funder requirement, when a provider believes a standard conflicts with participant safety or program quality, or when the site has physical, space, or resource limitations. Providers may request a waiver through the following process: • Submit a request on the provider’s agency letterhead, signed by an agency executive, to H&H at HHinfo@acgov.org • Cite the number and language of the standard for which a waiver is requested. • Cite the shelter location(s) for which the waiver(s) is/are requested. • Explain the policy the provider proposes to implement in its place and the rationale for the waiver, based on one or more of the following: (a) conflict with other rules or regulations, (b) participant safety or well-being, (c) program quality, (d) physical or space limitations, (e) lack of funding. H&H will respond to waiver requests within 30 days of receipt with approval, denial, or request for additional information. For providers contracted with H&H, waivers will be approved for the duration of the provider’s contract and must be renewed upon execution of subsequent contracts. 8 V1.12026 Section A: Program Operations A.1 Shelter Policies and Procedures and Program Agreements Standards A.1.1 Shelters maintain written that are consistent with these Standards (Alameda County Emergency Shelter Standards). a. Shelter Policies and Procedures are implemented consistently and fairly to avoid perceptions of favoritism and to create a culture of trust and transparency. A.1.2 Shelters create a written that contains information from the Policies and Procedures relevant to participants. A.1.3 Program Agreements include the following content at a minimum: a. Participant rights (Section A.7). b. Privacy and confidentiality practices, including HIPAA when applicable (Section A.10). c. Storage Policies (Section A.15). d. Enforcement process (Section A.19). e. Grievance Form and process (Section A.20). f. Reasons for discharge (Section A.21). g. Medication Policies (Section B.3). h. Substandard site conditions grievance form (Section E.1). i. All program rules (e.g., weapons, security, drug and alcohol use, chores, curfew, visitation, social media, internet use, and others as relevant to shelter policies). j. Release of Information Form. A.1.4 The Program Agreement is translated, as needed, into a participant’s primary language. A.1.5 At intake the Program Agreement is verbally explained to each participant in their primary language and provided to the participant in writing. A.1.6 Participants sign an acknowledgement that they received and reviewed the Program Agreement, and this acknowledgment must be retained in the participant's file. Guidance/Resources Shelters are encouraged to translate Program Agreements into Alameda County's threshold languages (currently Spanish, Chinese (Cantonese), Vietnamese, Mandarin, Farsi, Cambodian, and Tagalog). 9 V1.12026 A.2 Admission Standards A.2.1 Shelter Policies and Procedures cover hours of admission for new participants and admission procedures, and at a minimum, meet the requirements in A.2.2 through A.2.5 below. A.2.2 Shelters accept new participant admissions Monday through Friday for at least four hours daily when the shelter is open and beds are available. Shelters may schedule these hours to best meet participant and staff needs. Accepting admission through a 24/7 crisis line meets the four-hour threshold. A.2.3 Shelters adhere to the current admission protocols established through Alameda County's Coordinated Entry System (CES) or complementary systems for special populations such as transition aged youth or GBV. A.2.4 Shelters only deny admission to an applicant for the reasons listed below. Shelters can, at their discretion, opt to admit applicants who fall into these categories, but they cannot deny admission for any reasons other than the six listed below. a. Eligibility. The applicant does not meet the basic eligibility criteria for the shelter type (e.g., gender, age, homeless status, gender-based violence victim). Shelters with beds designated by funding sources with additional restrictions (e.g., Veterans Administration (VA) beds requiring advance VA approval) may deny entry to those not meeting funder requirements. i. Shelters may not exclude applicants who meet the requirements for their type of shelter just because they also qualify for another type of shelter. ii. Single adult shelters must accept applicants based on present day eligibility and may not exclude applicants based on pregnancy status. b. Criminal Record. The applicant has a criminal record involving sex offenses, arson, or violent crime that poses a current risk to the health and safety of staff and/or participants as defined in Shelter Policies and Procedures. i. Shelters are not required to assess criminal history. However, if a shelter does consider criminal history, it must also assess the length of time since the offense and any efforts toward rehabilitation. c. Restraining Order. A restraining order prohibits the applicant’s admission to the facility, or there is a protected party already present in the facility. The protected party may be a staff member or a participant. d. Applicant Behavior. i. Applicant is currently exhibiting violent or threatening behavior. ii. Applicant has a history of violent or threatening behavior or conduct from a prior stay and continues to pose a risk to the health and safety of staff or participants (e.g., violence, weapons violations, disclosing the confidential location of the shelter, egregious property damage). Shelters must assess the length of time 10 V1.12026 since prior behaviors occurred. If admission is denied on this basis, the applicant must be informed of: • the reason for denial. • the conditions for lifting the restriction. • their right to appeal, including whom to contact and how to initiate the appeal process. e. Infectious Disease. The applicant has an infectious disease that significantly increases the risk of harm to other participants. See Section B: Health and Safety for all requirements on responding to participants presenting with symptoms of infectious disease. f. Activities of Daily Living (ADL). The applicant requires care and supervision to manage activities of daily living (feeding, toileting, selecting proper attire, grooming, maintaining continence, bathing, walking, and transferring) without appropriate supports available on-site. A.2.5 Notification of denial of admission and reason for denial must be provided in writing to the applicant within 3 days and accompanied with a grievance form unless there is no way to contact the applicant. Guidance/Resources • Where feasible, shelters should accept after hours, crisis response, health and safety relocations, and other emergency admissions, as well as expand hours to include weekends to put the fewest restrictions possible on admissions. • If shelters choose to admit applicants who fall into one of the categories listed in A.2.4, they should consult with their legal counsel when developing their Policies and Procedures. A.3 Intake Standards A.3.1 Intake is conducted as soon as possible upon a participant’s arrival, based on shelter Policies and Procedure with a recommended timeframe of 24 hours. A.3.2 Intake is welcoming and trauma-informed, recognizing that many participants are arriving in crisis. A.3.3 Staff review the Program Agreement (see A.1) with the participant in their primary language and provide them with a written copy (or offer an electronic copy if the participant prefers). A.3.4 Staff obtain a signed acknowledgement from all participants that they received and reviewed the Program Agreement; this acknowledgement is kept in the participant’s file. A.3.5 Participants are provided with clean linens, a pillow, and basic hygiene supplies. A.3.6 Information collected at intake is standardized based on Shelter Policies and Procedures as appropriate for either 24/7 or overnight-only shelters but must meet the requirements listed below: 11 V1.12026 a. The Bay Area Shelter to Emergency Department Transfer Face Sheet must be completed at time of intake. This should be printed and kept in a secure location, accessible to on- duty staff at all times, and restricted to a need-to-know basis to protect participant confidentiality. b. The following information must be documented for the purpose of facilitating access to service linkage and ensuring that participants are safe and served appropriately: i. Health insurance (Medi-Cal, Medicare, or other insurance). ii. Primary care provider/medical home or source of medical care (24/7 shelters only). iii. Regular pharmacy (24/7 shelters only). iv. Pet allergies. v. Food allergies and dietary restrictions. This information is shared on an as-needed basis with appropriate staff to inform service linkage (e.g., health care information), participant safety (e.g., food allergies) and appropriate shelter services (e.g., pet allergies and dietary restrictions). See Section D: Service Coordination and Linkage for requirements on linkage to health services. c. For the protection of participant privacy, no additional medical questions may be asked at intake beyond those required in HMIS unless a shelter is contracted to provide medically enhanced services, or unless the participant has symptoms suggestive of a communicable disease as outlined in Section B.4. d. Additional questions related to health and behavioral health care beyond those listed above may be asked at the time of HMIS program enrollment and subsequent assessments. Guidance/Resources • Shelters providing medically enhanced services are not limited to the data listed in A.3.8 or required in HMIS. These shelters should collect information from participants on their medical needs, as required by their contracts and as needed to provide medically enhanced services. • Program enrollment in HMIS or equivalent GBV data system is required but does not need to be completed at the initial intake. See Section A.22. for data collection requirements. • Bay Area Shelter to Emergency Department Transfer Face Sheet is provided by H&H and can be requested by sending an email to HHinfo@acgov.org A.4 Length of Stay Standards A.4.1 Shelters do not establish a maximum length of stay for any beds/units funded by H&H. A.4.2 Participants are only discharged for the reasons specified in Section A.21. 12 V1.12026 Guidance/Resources The intent of this standard is for each participant or household's shelter stay to be focused on exiting to stable housing, and to prevent returns to homelessness due to arbitrary time limits. This flexibility acknowledges that obtaining permanent housing within a set timeframe is not always the reality in the current housing market. A.5 Accessibility and Non-Discrimination Standards Disability Access A.5.1 Shelters comply with all requirements of the Americans with Disabilities Act (ADA). A.5.2 Reasonable modifications are made to programs, activities, and services to ensure equal access for individuals with medically documented disabilities, unless such modifications would fundamentally alter the nature of the program. In addition, every effort should be made to accommodate individuals with self-identified disabilities regardless of formal documentation. A.5.3 The Program Agreement and other important information is available in formats accessible to hearing-impaired and sight-impaired individuals upon request. A.5.4 If the shelter provides transportation, it is accessible to participants who use wheelchairs. A.5.5 Shelters prioritize ADA-accessible beds for participants with disabilities. Accessible beds comply with federal height and distance standards requiring a minimum of 36 inches between sleeping units and a sleeping surface height between 17-19 inches above the finished floor. Shelters are encouraged to provide as many ADA accessible beds as possible, but it is not required or expected that all beds meet these requirements. Transgender Access A.5.6 Shelters comply with California state law which provides protections against discrimination on the basis of gender identity. A.5.7 Participants are placed in shelter rooms/beds consistent with their gender identity and with consideration of participants’ own views regarding placements that protect their health and safety. A.5.8 Shelters may not ask questions or seek information or documentation concerning a participant’s anatomy, medical history, or gender assigned at birth when making placement decisions. A.5.9 Shelters may not deny placement or make placement decisions based on complaints of other participants when the sole basis of the complaint is a participant’s non-conformance with gender stereotypes. Language Access A.5.10 Shelters strive to make all information and services available to all participants regardless of their primary language or English proficiency through the following measures: 13 V1.12026 a. Posted policies, announcements, and materials are translated into languages understood by the current participants at the shelter. b. Translation and interpretation for non-English speaking participants is available ideally through bi-lingual staff or, if not, through a telephonic translation service. Guidance/Resources The ACLU of Southern California summarizes California law as it related to transgender access to shelters. A.6 Pets and Service Animals Standards A.6.1 Shelters comply with the ADA and must allow access to any person with a disability who uses a service animal. a. To determine if an animal is a service animal, staff may ask only the following two questions: i. Is the dog a service animal required because of a disability? ii. What work or task has the dog been trained to perform? b. Shelters may not: i. Ask about the nature of the person's disability. ii. Require documentation, certification, identification cards, or proof of training as a condition of allowing a service animal. iii. Require the animal to demonstrate its task. iv. Exclude a service animal unless certain conditions are met related to the behavior and control of the animal. Please see the ADA website for exact exclusion criteria. A.6.2 In addition to complying with ADA, Shelter Policies and Procedures address whether pets and emotional support animals (ESAs) are permitted in the facility. Shelters may choose to accommodate either, or both, types of animals but are not required to do so. a. ESAs are not service animals under the ADA because they do not perform a specific task related to a disability. Shelters may require a letter from a provider documenting the participants’ need for an ESA. b. Shelter policies may limit the number and type of pets/ESAs any participant can bring into the shelter. A.6.3 Shelter Policies and Procedures establish behavior-based criteria for admission and continued stay — for example, that an animal must not have demonstrated aggression toward people or other animals — and apply those criteria consistently based on observed behavior rather than breed or appearance. A.6.4 Shelters ask all participants about animal allergies at intake and use this information to inform room/bed assignments to separate participants with allergies from animals when possible. 14 V1.12026 Guidance/Resources • See the ADA website for comprehensive guidance on ADA service animal requirements, including permitted inquiries and exclusion criteria. • For guidance on distinguishing service animals from emotional support animals, see the Department of Justice FAQ. • Because pets are an important part of many people’s well-being, when possible, shelters should try to accommodate pets and offer resources that enable people to remain connected to their animals. • It is a best practice for shelters to ask all incoming participants about animal allergies and note any animals already present in the shelter. When a participant with allergies and a person with an animal must share a facility, shelters should attempt to accommodate both by assigning them to different areas or rooms where possible. • It is a best practice to ask participants what their plan is for care for their pets in an emergency and to inform them that the shelter will be unable to care for their animals in the event of their absence. • If providers cannot determine whether an animal poses a safety risk to participants, they should seek consultation from partner organizations such as the East Bay SPCA which offers behavior and training programs and humane advocacy services that may support shelters and participants navigating animal-related challenges. • When an animal's behavior creates safety concerns, the first step should be to engage the owner directly. If the situation cannot be resolved, shelters should have a process for facilitating temporary fostering so that the person can remain in the shelter while the animal is cared for elsewhere. The East Bay SPCA's program provides temporary boarding for pets of people experiencing a crisis in Alameda and Contra Costa Counties and accepts referrals from social service providers. Contact: HumaneAdvocate@EastBaySPCA.org. • The National Alliance to End Homelessness offers a resource on implementing a pet-friendly shelter model. A.7 Participant Rights Standards A.7.1 Shelters develop a statement of participant rights that must be included in the Program Agreement, provided to all participants in writing, and posted in the facility in the languages spoken by participants to ensure accessibility and understanding for all. A.7.2 At a minimum, participant rights include: a. Be treated with dignity, respect, and cultural sensitivity and be provided services in a non- judgmental manner. 15 V1.12026 b. Be protected against all forms of discrimination and receive shelter services regardless of religious affiliation, race, color, national origin, ancestry, political or religious beliefs, language, disability, family composition, gender identity and/or sexual orientation. c. Have a safe shelter environment, including personal safety, a healthy setting, and access to health care services. d. Use self-determination in identifying and setting goals. e. Have privacy respected and confidential information protected. f. Receive services consistently and fairly in accordance with the shelter’s Policies and Procedures and with Alameda County’s Shelter Standards. A.8 Participant Input Standards A.8.1 Shelters lead participant meetings at least once per month at times when a maximum number of participants can attend, providing at least 24 hours advance notice of the meeting time and location. A.8.2 Shelters make a secure comment box available to all participants where they can submit anonymous written comments. A.8.3 Shelters facilitate ongoing opportunities to obtain participant feedback, including collecting participant surveys at least twice a year. A.8.4 Shelters provide a summary of participant input and quality improvement efforts informed by participant feedback in an annual report submitted to the County and made available to shelter participants. Guidance/Resources • Shelters are encouraged to promote transparency and communication by using monthly community meetings with participants to review shelter policies and discuss the type of concerns participants have expressed and how the shelter is responding. These conversations should never result in disclosure of the names or identities of any participants or staff who may be the subject of those concerns. • In addition to the requirements above, shelters are encouraged to provide participants with ongoing opportunities to provide input. Methods for gathering input may include exit interviews, discharge surveys, one-on-one interviews, participant surveys, focus groups, inclusion of homeless or formerly homeless members on the shelter's board of directors, hiring of homeless or formerly homeless people as staff, and/or the creation of a participants’ advisory council. • Shelters are encouraged to provide opportunities for former participants and/or people with lived experience (not previously connected to program) to be part of advisory boards and committees related to the direct service and leadership of the shelter or provider agency. 16 V1.12026 A.9 Hours, Facility Access, and Curfew Standards A.9.1 Shelter Policies and Procedures cover hours of operation, facility access, and curfew. At a minimum, these policies must meet the requirements below and must be included in the Program Agreement. A.9.2 Shelters remain open 24/7 unless funded as an overnight-only shelter. A.9.3 Shelters provide sleeping facilities for a minimum of eight (8) consecutive hours. A.9.4 Shelters post hours of operation in a visible location. A.9.5 To the extent possible, overnight-only shelters: a. extend or modify hours of operation for illness, weather, disabilities, participants working second and third shifts, and other reasonable requests. b. make alternate spaces on the premises accessible to participants during the day to shelter from rain or extreme temperatures. A.9.6 24/7 shelters allow participants access to their possessions, sleeping quarters, and common spaces. A.9.8 Shelters may choose to establish a curfew policy centered around participants’ needs. Curfew covers when participants must be present on the shelter premises. If any curfew policy is established, it must meet the following requirements: a. Is clearly written and explained to participants at intake. b. Is consistently enforced. c. Clearly states if/when a missing person’s report will be filed. d. Makes exceptions for work, education, and health care. e. Stipulates that missing a curfew is not a reason for denial of entry or discharge unless: i. The curfew violation compromises the health or safety of the participant or other participants or staff. ii. The participant's curfew violation repeatedly interferes with the rights of other participants to peaceful enjoyment of the facility. A.9.9 If quiet or light-out hours are established, participants have access to common areas where they can engage in quiet personal activities that do not disrupt other participants, as defined in the Program Agreement. Guidance/Resources • In mixed gender congregate facilities, shelters should create privacy for participants based on gender to the extent possible given physical space limitations. • Whenever possible, shelters should allow participants access to sleeping areas 24/7. 17 V1.12026 A.10 Privacy, Confidentiality, and Abuse Reporting Standards A.10.1 Shelters have privacy, confidentiality, and abuse reporting policies that are consistent with the provider agency and state regulations, and, where applicable, HMIS privacy and security requirements. A.10.2 Participant files are confidential and stored in a secure, locked location. Electronic files are password-protected and accessed in a manner that prevents others from viewing the screen. A.10.3 Participants sign a Release of Information (ROI) before their personal information is disclosed to outside parties. The ROI is included in the Program Agreement packet reviewed by participants at intake. A.10.4 Participants are informed of when and to whom their personal information may be disclosed. A.10.5 Verbal communication of confidential information is conducted in a way that avoids unintended disclosure. A.10.6 Shelters establish procedures for handling visitor, call, or message requests. Unless a participant requests an exception, staff never confirm or deny a participant's presence at the shelter, but they always inform the participant of any attempts made to contact them. A.10.7 Participants are allowed to use pseudonyms within the shelter to protect their identity when they feel their safety is at risk. A.10.8 While shelters may develop policies related to participant phone, internet, and social media usage to protect identity and confidentiality, these policies may not impose barriers to participants’ ability to engage in necessary communications for approved school, work, or other purposes. A.10.9 Shelter Policies and Procedures include guidance regarding who is a mandated reporter and on how to report and address any type of abuse, including child, spousal, or elder abuse. A.10.10 Shelters have a written plan and trauma-informed process for handling any abuse reports that are made to appropriate reporting agencies. A.11 Drug and Alcohol Use and Possession Standards A.11.1 Shelter Policies and Procedures cover drug and alcohol use and possession that, at a minimum, meet the requirements in A.11.2 through A.11.12 below and are included in the Program Agreement. A.11.2 Possession, use, and distribution of alcohol, marijuana, or illegal drugs is prohibited on the shelter premises. 18 V1.12026 a. Participants with a current valid medical marijuana card may possess marijuana but may not consume it in smokable form on shelter premises. A.11.3 Substance use is recognized as a personal choice and/or clinical disorder and approached with a harm reduction orientation. A.11.4 Visible drug paraphernalia, or substance use materials is kept out of sight as it may negatively affect other participants, particularly those in recovery, families with children, or individuals with mental health conditions. A.11.5 Shelters provide referrals to substance use services including, but not limited to, outpatient treatment, Medication Assisted Treatment, 12-step/peer support programs, and harm reduction services. a. Shelter policies state that engaging in substance use treatment is a participant’s choice and is not a requirement to remain in the shelter. A.11.6 Shelters cannot discharge individuals for use of substances while off-site. A.11.7 Being under the influence, or suspected of being under the influence, of a substance on-site may not be the basis for discharge unless the participant’s behavior interferes with other participants’ health, safety, or peaceful enjoyment of the facility. A.11.8 Shelter policies clearly define behavior that meets the threshold for “interference with other participants’ health, safety or peaceful enjoyment of the facility.” This definition must be: a. based on objective, observable criteria. b. justified based on the needs of the population served by the shelter. c. applied fairly and uniformly to all participants. A.11.9 Shelter policies require that staff engage with participants to offer services and resolve disruptive behaviors related to off-site substance use prior to penalizing or discharging the participant. A.11.10 Shelter policies give participants the opportunity to dispose of any prohibited substance found in their possession or to leave the shelter for that night if they do not wish to dispose of prohibited substances in their possession. A.11.11 Shelter policies cannot require drug testing of participants. A.11.12 Shelter policies on drug and alcohol use and possession are posted in a visible location. Guidance/Resources • Staff may direct participants who wish to dispose of controlled substances to a MED-Project take- back kiosk (locations at StopWaste.org/medicine). • For substances found unattended on premises with no identified owner, shelters should consult with legal counsel to develop policies for disposing of illicit substances. A.12 Smoking Standards A.12.1 Shelters prohibit smoking and vaping indoors. 19 V1.12026 A.12.2 Shelters prohibit smoking within 25 feet of shelter facilities unless the layout of the grounds makes this infeasible and must make reasonable efforts to prevent smoke from entering buildings. A.12.3 Shelters follow all local ordinances regarding smoking in public areas. Guidance/Resources Information about tobacco cessation resources should be posted in common areas when possible. A.13 Security and Search of Participant Possessions Standards A.13.1 Shelter’s develop Policies and Procedures for security practices that best meet the needs of its participants and staff while protecting privacy and autonomy to the greatest degree possible. A. 13.2 Shelter policies state that threats of violence, intimidation, or credible threats made toward other participants or staff must be taken seriously and cannot be ignored. When credible safety concerns exist, shelters should take immediate action to protect impacted participants and staff, which may include increased supervision, separation of participants, or searches of personal property when there is reasonable belief that weapons or dangerous items may be present. A.13.3 Shelters Policies and Procedures explicitly state how and when searches of participants' private possessions may be conducted and include the following: a. The policy states that the provider respects the right of participants to privacy and personal autonomy. b. Search procedures reflect a trauma-informed approach and respect participant privacy to the greatest degree possible. c. If a participant does not consent to a search, the shelter must provide the participant with options other than discharge, using discharge only as the last resort. d. Shelters may choose to implement universal search procedures (e.g., upon entry to the facility) but must apply these procedures consistently, uniformly, and fairly to all participants. e. Any searches that are not universal but rather conducted of specific individuals must be based on credible evidence that the participant possesses items not allowed in the shelter or that pose a risk to the health and safety of participants or staff. 20 V1.12026 Guidance/Resources • Due to the invasive nature of search, shelters should be proactive and intentional in communicating search policies and reasons for search so that participants do not feel targeted or traumatized. • Shelters are encouraged to develop practical plans to respond to enforcement actions and requests for information directed at shelter participants and members of the public generally. A.14 Weapons Standards A.14.1 Shelter Policies and Procedures include a weapons policy that, at a minimum, meets the County requirements listed below: a. Shelter policies prohibit weapons on the premises, including but not limited to, firearms, explosives, pepper spray, mace, and knives, or any item that may be construed as such. i. This policy is applied to all participants and visitors regardless of whether a federal or state license to possess a weapon has been issued. b. Items that constitute weapons are clearly defined, including which types of knives are prohibited. c. For non-firearm weapons (including knives, pepper spray, mace, and similar items), shelters: i. Maintain a mechanism for securely storing these items when participants enter the shelter. ii. Make stored items accessible to the participant upon exit on a daily basis within specified hours, unless advance arrangements have been made for retrieval outside those hours. iii. Maintain a log of all items held in weapons storage, including a description of each item, the name of the participant, the date received, and the date returned. A.14.2 For firearms, shelters must consult legal counsel before establishing any firearm storage procedure. A.14.3 Participants arriving with firearms are informed of local law enforcement options for surrender or safekeeping. Guidance/Resources • When developing their weapons policies, particularly regarding firearms, shelters should consult legal counsel and any city or county ordinances that may impose additional requirements. • California law imposes specific criminal and civil liability on any person or organization that keeps firearms on premises under their custody or control without adequate security, particularly where prohibited persons may be present. Because shelter populations may include individuals who are legally prohibited from possessing firearms, and because shelters may not be equipped to meet 21 V1.12026 the legal standard for secure firearm storage, shelters should consult legal counsel before taking custody of firearms. • The California Department of Justice's summary of firearm storage laws provides more information. A.15 Storage of Participant Belongings Standards A.15.1 Shelter Policies and Procedures cover: a. What provision is made for securing belongings. b. How participants access their belongings. c. What possessions can be held by the program at the participant's request (e.g., money, medications, vital documents). d. Practices and procedures related to post-discharge storage in their policies (e.g., number of days of storage, procedures for contacting the former participant, disposition of unclaimed property). A.15.2 Shelter policies related to storage of belongings are included in the Program Agreement and reviewed with participants at intake. A.15.3 24/7 shelter policies related to storage of participants’ belongings meet the following County requirements: a. The shelter provides lockable lockers, storage trunks, or other accommodations that allow participants to securely store their belongings. b. Minimum storage capacity per participant is 20 cubic feet (equivalent to three 55-gallon trash bags). c. Participants are provided with reasonable and regular access to their belongings including a process to address lost keys, broken locks or other barriers to accessing storage. d. If holding funds or possessions on behalf of participants, the shelter must: i. Make it clear to participants that this service is voluntary. ii. Maintain a log of participant’s items in the shelter's possession (this does not include all possessions brought into the shelter) including a description of each item, the name of the participant, the date received, and the date returned. iii. Ensure confidentiality and privacy of all participants in storing and accessing their funds or possessions. iv. Ensure participant access to funds or possessions when needed by the participant. v. Return funds or possessions promptly upon the participant's request. e. Participant belongings are stored for a minimum of two weeks after the participant exits. 22 V1.12026 Guidance/Resources • For guidance on storage of participant medication, see Section B: Health and Safety. • Shelter policies should address situations where the accumulation of belongings exceeds designated storage capacity or creates health, sanitation, fire safety, mobility, or comfort concerns for other participants. Shelters should have clear procedures for addressing excessive accumulation while respecting participant dignity and property rights. A.16 Guests and Visitors Standards A.16.1 Shelter Policies and Procedures include a guest policy that balances participant safety and confidentiality with the need for access to service providers and non-participants (guests). With the exception of safe houses or GBV shelters, guest policies meet the following requirements: a. Guest policies are in writing, posted in a visible location, provided to each participant at intake, and enforced uniformly. b. Service providers from other programs or agencies are allowed to meet with participants. c. Participants’ minor children are allowed to visit with shelter approval and under approved supervision. A.16.2 Safe houses or GBV shelters should develop guest policies that protect participants’ safety while making arrangement for participants to meet with services providers and their minor children at another location if necessary. Guidance/Resources When possible, shelters should adopt policies that allow visits from family members, friends, and other supports to enable participants to maintain a circle of support and avoid losing important social connections. A.17 Chores Standards A.17.1 Shelters may offer participants the opportunity to engage in activities/tasks related to the maintenance of the facility in accordance with labor law and HUD requirements, if applicable. A.17.2 If chore policies are implemented, they must allow for accommodation for those who cannot participate in chores due to disability, pregnancy, illness, or school/work schedules. 23 V1.12026 A.17.3 Noncompliance with a chore policy cannot be a reason for discharge unless there is a repeated pattern of violation that impacts other participants and a corrective action plan was implemented for a period of time as specified in the shelter’s Policies and Procedures. Guidance/Resources Shelters that assign participants chores are encouraged to make chore assignments with consideration of participants’ schedules, capabilities, and interests while ensuring fairness and avoiding stereotyping. Chore policies should also allow sufficient flexibility to allow chores to be completed during times that do not conflict with a participant’s school or work schedule. A.18 Participant Mail Standards A.18.1 Shelters implement a mechanism for participants to receive mail, if possible. A.18.2 If receiving mail for participants, shelters do not open participants’ mail or interfere with any mail sent or received. A.18.3 If receiving mail for participants, it is provided to participants on the day it was received or as soon as possible. Guidance/Resources • To the extent feasible, shelters should ensure the privacy and security of participants’ mail, with particular consideration given to medication and medical documents. • If receiving mail for participants, shelters should institute a process to forward mail after participants have left the shelter when possible. A.19 Enforcement of Compliance with Program Agreement Standards A.19.1 Shelter Program Agreements clearly identify non-compliance issues that are grounds for discharge. A.19.2 Shelter Policies and Procedures include a progressive response system that is consistently applied before a participant is discharged for noncompliance unless the participant poses an immediate danger to themselves, other participants or staff. The progressive response must include: a. Warnings, reminders, and direct support from staff or peers, documented in writing and signed by the participant. If the participant refuses, the refusal should be documented. 24 V1.12026 b. Opportunities for the participant to correct behavior and receive feedback from staff. c. A requirement to meet with the participant within three (3) days of identifying noncompliance to discuss the concern and identify ways to correct it. d. A requirement for participants with repeated noncompliance to develop a corrective action plan with shelter staff that identifies: the responsibilities being violated and their impact on the shelter, strategies and a timeline for correction, supports provided to assist the participant, and consequences of noncompliance by an agreed-upon target date. i. The corrective action plan must be signed by a staff member and the participant. If the participant refuses, the refusal should be documented. e. Documentation in HMIS and case notes of all observations of and communications with participants regarding noncompliance, including meetings, conversations, and corrective action plans. f. A requirement for staff to keep site supervisors informed of all noncompliance observations, communications, and interventions. A.19.3 Staff receive training on the enforcement of compliance as detailed in the Policies and Procedures. A.20 Grievance and Appeals Standards Policies and Forms A.20.1 Shelter Policies and Procedures include a fair and comprehensive policy for receiving and handling grievances that complies with requirements of the U.S. Department of Housing and Urban Development (HUD) as adopted by Alameda County’s Continuum of Care (CoC), EveryOne Home. A.20.2 Shelters have a written grievance form using simple language that explains the grievance protocol at the provider agency level and the steps to escalate a grievance to the County level. a. Participants are provided with a verbal explanation of the grievance process and the grievance form at intake in their primary language. (See Section A.1. for translation resources.) b. Copies of the grievance form are also available in visible locations in common areas. c. The grievance form is provided to all participants at exit or upon request to individuals denied admission. Process A.20.3 Participants have the option to file a grievance in person by handing it to a staff person, by mail to the shelter’s administrative office, by email to a general mailbox for the provider 25 V1.12026 agency, or to an administrative staff member who does not provide services at the shelter site. a. The name and contact information for an off-site shelter supervisor is publicly posted. b. Grievances can be filed verbally with a staff person who should assist the participant in documenting the grievance in writing. c. Participants are not expected to submit grievances to staff members who may be the subject of the grievance. d. Participants receive a dated receipt, copy, or written acknowledgment confirming the grievance was received. A.20.4 If a meeting is held to address the grievance it will: a. Allow participants to present their case before a supervisor or manager who was not directly involved in the incident or situation giving rise to the grievance. b. Accommodate third-party advocates in the grievance process, with reasonable efforts made to coordinate scheduling with the participant’s advocate. A.20.5 All grievances are treated confidentially and handled in a manner that does not expose participants to any form of retaliation or punishment for having filed a grievance. Retaliation includes reduction in services, differential treatment, threats, intimidation, changes in placement, increased rule enforcement directed at the participant, or any adverse action connected to filing a grievance. A.20.6 Grievance forms specify a timeframe in which a participant will receive a written acknowledgement that their grievance was received, and shelters must adhere to this timeframe. a. If a participant is asked to exit due to a violent event, the written acknowledgement may be provided at the next feasible contact with the participant. A.20.7 Participants are provided with a written response to their grievance within two weeks of the time the grievance was filed. a. Any action affecting a participant’s ability to stay in the shelter must be suspended until the grievance process is completed, unless continued residence poses a risk to the health and safety of other participants and/or staff. b. Grievances involving health, safety, threats of violence, discrimination, or staff misconduct should require expedited review within 24–72 hours. Appeals A.20.8 The grievance protocol includes a clear statement of the right to appeal and contact information for the relevant County agency or other relevant funding or oversight agencies. a. Appeals are allowed, at minimum, for the following: admissions denials for cause, discharges, and disciplinary actions. Record Keeping and Reporting A.20.9 All written grievances, shelter responses, and associated case notes are kept in participant case files and made available to funding agencies. A.20.10 Shelters keep a record of number, content, and resolution of grievances. 26 V1.12026 Guidance/Resources • Additional requirements related to grievance procedures at the point of discharge are included in Section A.21. • Homebase, the nonprofit that supports Alameda’s CoC, has created a detailed FAQ for grievance policy requirements for HUD CoC-funded programs, Coordinated Entry, and HMIS. A.21 Discharge Standards A.21.1 Unless a participant’s behavior poses an immediate danger or credible threat to participants or staff, shelters implement corrective actions plans as described in A.19 prior to discharging a participant for the reasons listed in A.21.3. A.21.2 Shelters conduct involuntary discharges fairly and with appropriate oversight, as follows: a. Involuntary discharges are approved by a supervisor. During hours when no supervisor is on site, a supervisor must be available on call to approve discharge decisions. Approval may be given verbally but must be documented in case notes. b. Participants are not discharged after business hours unless the participant poses an immediate threat to the health and safety of other participants and/or staff. c. Shelters provide participants with a written copy of the grievance procedure at the time of involuntary discharge. If this is infeasible at the time of discharge (e.g., the participant is being removed by law enforcement), the grievance procedure must be provided if the participant subsequently returns to the facility. d. If a participant may be denied future readmission because of the circumstances of discharge, they are informed of: i. The reason for denial. ii. The conditions for lifting the restriction. iii. Their right to appeal, including whom to contact and how to initiate the appeal process. A.21.3 Shelters only discharge a participant for the following reasons: a. Possession of a weapon at the facility. b. Possession of illegal drugs on the premises. c. Assault or other violent behavior. d. Poses an immediate danger or credible threat to participant or staff safety. e. Theft. f. Destruction of property. g. Restraining order precludes continued residence. h. Participant behavior endangers the health or safety of participants or staff. i. Disclosure of the confidential location of the shelter. j. Repeated interference with the rights of other participants to peaceful enjoyment of the facility. 27 V1.12026 k. Presence of an infectious disease that has been confirmed by a health care provider and that significantly increases the risk of harm to other participants. See Infectious Disease and Public Health Emergencies for further details. l. The participant requires care and supervision to manage activities of daily living that the site is not appropriately staffed to support. In such situations, staff should contact AC Health Housing and Homelessness for guidance and support on appropriate discharge locations. Participants discharged for this reason may not be discharged to the streets. m. Repeated refusal to engage in housing services, provided there is documented evidence of refusal to meet with housing navigation provider over a 90-day period. n. Absence from the shelter for 72 hours or longer without notification to shelter staff. o. Exhibiting symptoms of TB and refusing to comply with testing and treatment recommendations, where continued presence poses a risk to the health and safety of other participants and staff, as determined by a health care provider. (Note: While participants may be encouraged to get a TB test, lack of a test cannot be used as a reason for discharge unless the above condition is met.) A.21.4. Shelters keep a written record of all involuntary discharges that documents the reason for discharge. Guidance/Resources Additional information regarding control of infectious disease and how to evaluate whether a participant exhibits signs of TB is included in Appendix A of “Preventing Tuberculosis (TB) in Homeless Shelters” published by the Los Angeles County Department of Public Health. A.22 Data Collection Standards A.22.1 Shelters participate in HMIS or a comparable system for gender-based violence programs. A.22.2 Shelters utilize HMIS (or comparable GBV system) data quality reports to ensure the accuracy of submitted information. A.22.3 Shelters track all reasons for denial based on cause (excluding denials due to capacity) in HMIS (or comparable GBV system) per CES policies and procedures and be able to report this information. A.22.4 Shelters track all discharges and reasons for discharge in HMIS (or comparable GBV system) and be able to report this information for all participants. Guidance • For more information on policies, trainings, and other resources for HMIS visit the Alameda County Bitfocus website 28 V1.12026 Section B: Health and Safety B.1 Participant Information Standards B.1.1 Shelters collect emergency contact and accommodation needs related to emergency response from each participant at intake and keep this information in a secure location, accessible to on-duty staff at all times, and restricted to a need-to-know basis to protect participant privacy. B.1.2 24/7 shelters collect information at intake to facilitate access to service linkage and to ensure that participants are safe and served appropriately. This information must include and be limited to: a. Health insurance (Medi-Cal, Medicare, or other insurance). b. Primary care provider/medical home or source of medical care. c. Regular pharmacy. d. Pet allergies. e. Food allergies and dietary restrictions. B.1.3 Overnight-only shelter intakes include collection of information to ensure that participants are safe and served appropriately. This information must include and be limited to: a. Health insurance (Medi-Cal, Medicare, or other insurance). b. Pet allergies. c. Food allergies and dietary restrictions. B.1.4 Information collected at intake is shared with appropriate staff to inform service linkage (e.g., health care information), participant safety (e.g., food allergies), and appropriate shelter services (e.g., pet allergies and dietary restrictions). Guidance/Resources • Shelters should encourage participants to obtain and maintain health insurance, a regular doctor/primary care provider, and immunization services. • Alameda County Health offers assistance with linkage to health insurance and benefits as well as to primary care. 29 V1.12026 B.2 On-Site Health and Emergency Preparedness Standards B.2.1 Shelters maintain basic first aid supplies including Automated External Defibrillators (AEDs) for cardiac arrest, and naloxone on-site and accessible to staff whenever participants are present. (See Section G for staff training requirements.) B.2.2 Shelter Policies and Procedures cover universal precautions protocols (to prevent spread of infectious and communicable diseases) and proper sharps disposal procedures that must be followed at all times. B.2.3 The following hygiene supplies are accessible to participants and staff at multiple locations throughout the shelter at all times: a. Soap, water, and hand-drying resources. b. Hand sanitizer. c. Tissues. d. Face masks. e. Wastebaskets emptied at least daily. B.2.4 Shelters have a written emergency response plan describing procedures for responding to emergencies that may affect shelter operations or the safety of participants and staff. B.2.5 Shelters own and maintain an AED and document its maintenance. Its operation is the responsibility of the on-duty staff trained in CPR. B.2.6 Shelter emergency response plans include provisions for identifying and assisting participants with limited mobility. B.2.7 After-hours shelter contact information is provided to Social Work/Discharge Planning departments at hospitals serving shelter participants as the availability of a shelter bed will affect hospital discharge planning. Guidance/Resources • Multi-story shelters are encouraged to have emergency evacuation chairs in their stairwells, scaling the number to the size of the shelter. • If there is a need to call 911, having the participant’s Bay Area Shelter to Emergency Department Transfer Face Sheet in hand will be helpful for answering questions from the 911 dispatchers. B.3 Participant Medication Standards Medication Storage B.3.1 Shelters make individual, freely accessible, lockable storage (e.g., lockable storage boxes) available for each participant’s own medications upon entry. 30 V1.12026 B.3.2 Participants may be encouraged to lock medications in secure storage but may not be required to do so. B.3.3 In a facility where minors are present all medications is stored in locked containers. B.3.4 Shelters provide access to refrigeration for medications. (A locked box within a shared refrigerator is acceptable.) B.3.5 Shelters do not require participants to turn over their medication (prescription or over the counter) but may choose to securely store medications for participants upon request in a manner that protects participant privacy. B.3.6 Shelters Policies and Procedures specify: a. The length of the grace period, which must be no less than two weeks, during which a participant’s medications will be held after their exit. b. The disposal method of unclaimed medications after the grace period. Medication Access B.3.7 Participants have primary possession and free access to their prescription medication. B.3.8 Shelters do not administer or dispense medication to participants. a. Administration of medication means directly giving a medication to a participant — such as handing them a pill to swallow, applying a topical treatment, or providing an injection or inhaler dose. b. Dispensing of medication means determining when and in what quantity a person receives medication (e.g., counting out pills, limiting access). B.3.9 Shelters do not deny participants access to their medications or interfere with participants' self-administration in any way, including by restricting timing or dosage. B.3.10 Participants holding a valid California medical marijuana card may possess and use medical cannabis on-site, provided it is in non-smokable form. Guidance/Resources • Waivers to the prohibition on administration can be requested by facilities subject to other requirements or by facilities with licensed personnel such as a registered nurse (RN) or medical provider (e.g., physician, nurse practitioner, physician assistant). • When creating policies on medication disposal, shelter providers may reference this resource from the Food and Drug Administration for guidance on proper disposal of medications. • Information about the California Medical Marijuana Program is available on the California Department of Public Health website. The validity of a medical marijuana ID card can be checked at the California Department of Public Health verification website without providing any personal information. 31 V1.12026 B.4 Infectious Disease Policies and Prevention Standards B.4.1 Shelter Policies and Procedures cover prevention of, and response to, infectious and communicable disease, including but not limited to tuberculosis (TB), lice, and scabies. B.4.2 Protocols must be included for: a. Responding to participants who are coughing (“cough alert”). b. Making referrals to health care providers when a participant shows symptoms of infectious and/or communicable diseases including but not limited to TB (including, but not limited to, cough, weight loss and night sweats), lice, or scabies. c. Notifying participants when there is a possibility, they were exposed to a communicable disease spread through casual contact. d. Protecting participant confidentiality related to communicable diseases. e. Responding to any identified communicable disease, including consultation with a medical professional when determining if a participant is infected with a contagious disease that might seriously endanger the health of other participants. i. Shelters must notify Alameda County Health Care for the Homeless (ACHCH) if a shelter determines the presence of a communicable disease that seriously endangers the health of participants or staff. f. Responding to public health emergencies under the guidance of Alameda County Public Health Department, including identifying spaces that can be used for isolation and quarantine in the event of an outbreak. B.4.3 TB testing cannot be required as a condition of entry. a. Shelters should strongly encourage, and facilitate, participants to receive TB testing at a nearby clinic, or participant’s medical home, within 90 days of intake. B.4.4 Participants with symptoms of active TB are allowed to stay, required to mask, and referred to a health care provider for treatment as soon as possible or within one week. B.4.5 Participants with symptoms of lice or scabies (including, but not limited to, an itchy rash) are allowed to stay, and isolated from other shelter participants as much as feasible and referred to a health care provider for treatment as soon as possible or within one week. B.4.6 Shelters only deny admission or discharge a participant with an infectious disease under the following conditions, following technical assistance from ACHCH: a. The disease or infestation cannot be appropriately contained (e.g., due to close quarters of the facility or lack of ability to isolate patients). b. The participant is not compliant with treatment or containment measures and endangers other participants health and safety. c. The infectious disease significantly increases the risk of harm to other participants. 32 V1.12026 B.4.7 If shelter staff become aware of a participant who has tested positive for TB with a skin or lab test, and the participant does not have an active cough, the participant must obtain a medical evaluation and chest x-ray, which should occur as soon as possible and within a week. If this participant has an active cough, they must be immediately required to mask and be sent to the hospital for an evaluation. Staff should immediately contact ACHCH for further guidance. B.4.8 Shelters encourage the use of vaccines when available, including annual flu vaccines for staff. B.4.9 Shelters maintain adequate Personal Protective Equipment (PPE) supplies and train staff, volunteers, and participants (as needed), in proper PPE use. B.4.10 Sleeping and common areas are adequately ventilated. B.4.11 Shelters comply with California Code of Regulations, Title 8, Section 5199 regarding Aerosol Transmissible Diseases (ATD) control and the safety of workers and participants. Shelters also maintain facility standards that are well above the conditions of a "substandard building," as defined in California Health and Safety Code §17920.3 and amended by AB 130. B.4.12 Health information is communicated to participants using methods that overcome language, cultural, and disability barriers, including the use of multilingual staff or language interpretation services as described in Section A.5. Guidance/Resources ● County requirements for infectious disease policies balance the risk of spread with individual autonomy and realistic barriers to medical care – ensuring the greatest possible number of participants is screened without needlessly turning anyone away from shelter. TB can remain in the body for years without causing illness, but in some people becomes active and highly contagious, spreading through airborne droplets. Other ATDs, including influenza and whooping cough, spread similarly through coughing, sneezing, or talking. Because congregate settings create favorable conditions for transmission, it is essential that shelters take precautions to protect participants and staff. ● ACHCH will provide best practices and templates to assist shelters in developing policies and procedures related to infectious disease control and response. ● The ACHCH cough alert protocol can be used as a resource for shelters to develop their cough alert policies. ● Shelters can consult with ACHCH to determine whether ventilation is adequate and how it could be improved. ● Additional guidance on ATD compliance and best practices for control of infectious disease can be found in Preventing Tuberculosis (TB) in Homeless Shelters published by the Los Angeles County Department of Public Health. ● Additional guidance on compliance with California Code of Regulations, Title 8, Section 5199 can be found in California Workplace Guidance on Aerosol Transmissible Diseases published by CalOSHA. ● Shelters are encouraged to establish partnerships with local health providers for vaccination and medical care. 33 V1.12026 B.5 Outbreak Response Standards B.5.1 During a public health emergency, as declared by the Alameda County Health Officer, shelters stay current and in compliance with all local and state health officer orders. a. Shelters ensure that all participants and staff follow current orders from the Alameda County Health Officer for safe physical distancing. b. Shelters designate a staff person as a single point of contact with the ACHCH program and consult with ACHCH for additional guidance as needed. The single point of contact maintains relationships with local health authorities and other shelters for knowledge sharing and mutual support. c. Shelters regularly review and update their public health emergency response plan based on new information and best practices from ACHCH and maintain a list of key resources and contacts for reliable health-related information. B.5.2 Beds and rooms are filled at reduced capacity at levels confirmed with ACHCH and their Alameda County funding agency. B.5.3 Newly admitted participants are notified about the status of the outbreak at intake. B.5.4 Adequate ventilation is maintained by keeping windows and doors ajar to create airflow as much as possible, using filters in HVAC systems and portable air filters, and maintaining appropriate spacing of people, furniture, and activities. B.5.5 Designated isolation spaces are provided for symptomatic persons. B.5.6 The shelter is regularly cleaned and disinfected. Participants must have access to adequate cleaning and disinfecting supplies to clean and disinfect their assigned rooms, spaces, and personal possessions. B.5.7 A communication plan is implemented for regular updates to participants and staff regarding the shelter's public health response, including a system for addressing concerns and questions. B.5.8 A plan is made for staff absences and turnover to ensure adequate supervision of shelter activities during public health emergencies, to the extent possible. 34 V1.12026 Section C: Food Service C.1 Food Procurement and Safety Standards C.1.1 Shelters develop their own procedures for procuring, preparing, handling, and distributing food to best meet the needs of their participants based on their facilities and resources. C.1.2 Shelters ensure all areas used for food storage, preparation, and distribution meet the highest standards for safety and sanitation. C.1.3 Shelters comply with state and county food safety codes that apply to the facilities and procedures the shelter has in place for food handling and preparation a. If shelters are obtaining food from an outside third party, they must ensure that the donor or vendor also complies with all applicable health and safety codes. C.1.4 Shelters may not accept participants' CalFresh benefits as payment for food provided by the shelter. Guidance/Resources • Shelters should consult the California Retail Food Code for requirements that apply to their facilities. • To ensure food safety, programs are discouraged from accepting food prepared off-site by intermittent donors. C.2 Dietary Accommodations Standards C.2.1 Shelters that provide meals adhere to USDA Dietary Guidelines for all meals and food provided. C.2.2 Shelters make dietary modifications and/or provide appropriate alternative food options based on participants' food allergies, health, religious, and/or cultural practices. C.3 Meals and Dining Standards C.3.1 24/7 shelters provide a minimum of two meals per day. Overnight-only shelters provide a minimum of one meal and one morning snack. C.3.2 Provisions are made for participants to obtain meals when they are unable to be on-site during mealtimes due to work, school, appointments, or other conflicts. 35 V1.12026 C.3.3 The meal schedule is posted in a visible location. C.3.4 Tables and chairs are provided for food service. Guidance/Resources • Recognizing the importance of meals in participant health and quality of life, shelters are encouraged to engage participants in providing feedback or making decisions related to meal planning. • Whenever possible, shelters should provide participants with a place to store and cook their own food to promote autonomy, better meet participants’ dietary needs, and to create community. 36 V1.12026 Section D: Service Coordination and Linkage (24/7 Shelters Only) D.1 Service Plan Standards D.1.1 Shelters conduct or update a basic service plan for all participants/households within 30 days that includes an evaluation of service needs, information about past or current services received, and other information necessary to connect participants to services. D.1.2 The service plan takes a holistic, strengths-based approach that focuses not only on solving specific problems participants are confronting but also on helping them engage in meaningful and fulfilling activities. D.1.3 As specified in Section A.3, information collected to facilitate linkage to health care must include: a. Health insurance (Medi-Cal, Medicare, or other insurance) b. Primary care provider or source of medical care c. Regular pharmacy d. No additional questions related to physical or behavioral health may be asked of participants beyond those required in HMIS. D.1.4 Shelters develop exit plans with all participants/households served, including linkage to aftercare resources. D.2 Housing Service Linkage Standards D.2.1 Shelters ensure that all participants receive housing navigation services. a. If a household already has an existing housing navigation provider, they should maintain that provider. D.2.2 Shelters collaborate with housing navigation providers by, at a minimum, providing space for providers to meet with participants, meeting twice a month for case conferencing, and assisting participants in completing steps in the housing plan. D.2.3 Shelters can, at their discretion, discharge participants who repeatedly refuse to engage in housing navigation services, provided there is documented evidence of refusal to meet with the housing navigation provider over a 90-day period. 37 V1.12026 D.3 Referral and Linkage Standards D.3.1 Shelter linkage staff conduct a landscape scan of resources, programs, services, and activities available in the region or accessible to participants online that support their transition to stable housing as well as their health, well-being, personal fulfillment, and quality of life. D.3.2 The shelter compiles an updated list of these resources that is continually expanded to meet new participant needs and is available to participants without staff assistance. D.3.3 Shelter linkage staff contact providers, become familiar with their services, and build relationships with their staff when possible. D.3.4 Shelter linkage staff facilitate participants’ access to services by making appointments, troubleshooting barriers, and providing personal introductions and warm handoffs when possible. D.3.5 Shelters actively assist individuals with obtaining health insurance, a primary care provider, and other public benefits and income sources D.3.6 Shelters publicly post or otherwise make available information about health-related services. D.3.7 Shelters serving minor-age youth comply with Family Code Section 6924 which addresses minor consent and responsibilities related to mental health treatment or counseling, and to residential shelter services. D.3.8 Shelters inform participants that all services except housing navigation are voluntary. Note: GBV shelters funded by the Domestic Violence Shelter-based Programs Act (Welfare and Institutions Code § 18294) should adhere to the requirements of that program. Guidance/Resources Developing deep knowledge of resources for participants takes time. Shelters are not expected to develop this capacity overnight but should work toward maintaining a resource network including, but not limited to, the following types of services: • Physical, mental health, and dental services. • Benefits enrollment. • Substance use services including detox, medication-assisted treatment, counseling, and peer support such as AA or NA. • Public libraries. • Local events such as resource fairs or cultural events. • Food pantries and free clothing. • Low-income Clipper cards. • Arts, parks, and recreation programs. • Community college, GED, and other education and job training opportunities. • Employment resources. • Homeless and Caring Court. 38 V1.12026 • Legal services such as expungement clinics, family court, and immigration services. • Childcare and early childhood programs. • Pet and animal services. • Volunteer opportunities. • Financial services such as tax filing or debt reduction. • Family reunification services • Relocation Services • 211 • Faith-based services. D.4 Follow-up and Tracking Standards D.4.1 Shelters offer participants a monthly check-in to follow up on progress and assess new needs. D.4.2 For every participant engaged in service linkage, shelters update HMIS with the service plan and participant service notes. D.4.3 Shelters respect participants’ decisions not to pursue a referral. D.4.4 When participants are attempting to engage in services but are experiencing barriers, shelter service linkage staff offer support and problem-solving. D.5 Transportation Standards D.5.1 Shelter Policies and Procedures include a transportation policy that covers required transportation services taking into consideration the site location, facility transportation resources, and public transportation. D.5.2 24/7 shelters provide transportation to assist participants in getting to medical appointments (not covered by health plan), job interviews, jobs (until receipt of first paycheck), school for adults (one week), and housing appointments. a. Transportation may be provided via the provider agency’s vehicle, rideshare, and/or public transportation. Guidance/Resources • Shelters are permitted, but not required, to have policies for prioritizing limited transportation resources such as bus passes or taxi vouchers. • Medi-Cal covers transportation arrangements free-of-cost for people who have Medi-Cal and are enrolled in a health plan (e.g., Alameda Alliance for Health) and who need transportation to health-related appointments. The health plan can provide details. • Clipper’s low-income START program provides a 50% discount on all single ride fares for adults with incomes under 200% of federal poverty level. 39 V1.12026 • The McKinney-Vento program requires that the school district provide transportation for homeless children. Shelters should ensure that families are connected to this program. D.6 Staffing Standards D.6.1 24/7 shelters have one FTE service linkage staff for every 30 households. D.6.2 Shelters provide ongoing professional development and supervision, which may include case conferences, case supervision, workshops, and training courses. D.6.3 Shelters clearly post and provide participants with the name and contact information of the supervisor responsible for overseeing service linkage and case management staff to give participants the ability to directly contact supervisory staff when they believe services are not being provided appropriately or when concerns regarding staff performance arise. 40 V1.12026 Section E: Physical Plant E.1 Building and Safety Standards Standards E.1.1 Shelters provide evidence of compliance with applicable local building and fire codes, as well as state and local health, environmental, and safety standards. E.1.2 Shelters maintain facility standards that are well above the conditions of a "substandard building," as defined in California Health and Safety Code §17920.3, and perform timely inspections in response to any complaints from shelter participants or staff about possible substandard conditions. Shelters coordinate with the County to accommodate County site inspections in response to such complaints. E.1.3 Shelters have a disaster plan that covers policies and procedures for a wide array of incidents such as fires, earthquakes, and extended utility failures. E.1.4 Training is provided to staff on the disaster plans. E.1.5 Exits are clearly marked and kept clear of blockage and tripping hazards. Exit signage must be consistent with all applicable codes. E.1.6 All steps have handrails as required by applicable codes. Steps have treads or similar accommodation to prevent slipping. E.1.7 Shelters comply with annual inspections conducted by the local jurisdiction pursuant to California Health and Safety Code §17974.1, as amended by AB 130 (2025). These inspections may be announced or unannounced. Shelters cooperate with inspectors and correct any cited violations within the timeframe specified in any notice of violation. E.1.8 Shelters prominently display the substandard site condition grievance form that complies with the requirements of California Health and Safety Code §17974.1.5. E.2 Sanitation Facilities Standards E.2.1 Shelters provide sufficient toilets and wash basins with warm and cold running water. The participant to toilet ratio is 1 toilet for every 15 participants (excluding infants) or 1 toilet for every 30 participants, if over 100 participants. E.2.2 Shelters make a reasonable supply of showers available or provide referrals to community shower access. The participant to shower ratio must be at least 1 shower for every 20 participants (excluding infants). E.2.3 Every shelter ensures access to sanitation facilities for participants of all gender identities. E.2.4 Shower access is not restricted for any reason other than for cleaning or quiet hours. E.2.5 Shelters provide toilet tissue, soap, towels, and feminine hygiene products, if applicable. 41 V1.12026 E.3 Sleeping Facilities and Basic Amenities Standards E.3.1 Shelters provide a bed, crib or cot, clean mattress and pillow, and newly laundered linens and towels. E.3.2 Linens is laundered minimum twice a month. If there is cause such as bedbugs or lice, linens must be laundered more frequently. E.3.3 Overnight-only shelters provide each participant their own linens or provide laundered linens each night. E.3.4 Soiled linens are replaced immediately. E.3.5 Linens are laundered by shelter staff, or a shelter may require participants to launder their own linens if facilities are available. E.3.6 Shelters always provide access to drinking water. E.3.7 Shelters provide access to electrical outlets for charging cell phones and medical equipment. Guidance/Resources Mats may be used for overflow capacity and by seasonal shelters. E.4 Maintenance and Cleanliness Standards E.4.1 Bath/toilet areas, hallways, and other common use areas are cleaned daily. Shelters have proper trash receptacles that are emptied daily. E.4.2 Both the interior and exterior of the facility are free of debris, clutter, and unsanitary items, and there are no obvious safety risks. E.4.3 Shelters provide adequate fresh air ventilation and filtration. Shelters assess and provide the safest possible sleeping and eating arrangements that reduce staff and participant risk of airborne transmitted diseases, as well as improve air quality during smoke and air quality emergencies. E.4.4 Shelters ensure adequate provision of pest control services and must have a protocol in place for the prevention and control of bed bugs. 24-hour notice is provided to participants of pest control activities unless the type and degree of infestation requires an immediate response (e.g., bed bugs). E.4.5 Facilities are maintained in good repair, including all aspects of infrastructure ensuring good overall appearance of the building and property, including roofs, floors, walls, plumbing, electrical, waste disposal, appliances, elevators, landscaping, etc. There is a written housekeeping and maintenance plan. 42 V1.12026 E.4.6 Shelters post the process for reporting maintenance concerns, acknowledge issues reported within two days, and identify the timeframe for addressing the concern. Emergency maintenance items are immediately addressed. E.4.7 Shelters label all chemicals and cleaning supplies and keep all such materials out of reach of children. Any hazardous materials are stored separate from food. E.5 Telephones Standards E.5.1 A telephone is available to staff for emergencies. Emergency numbers are posted by the telephone or otherwise made available to on-duty staff. E.5.2 Shelters take emergency phone messages and messages from service providers for participants without confirming or denying participant presence at the shelter. E.5.3 If the shelter has periods during which no staff are on duty, participants have access to a telephone for emergencies, and emergency contact numbers are posted nearby. E.5.4 There is a phone number available for participants to leave messages to contact staff 24/7. E.6 Agency Vehicle Standards E.6.1 If a shelter maintains a vehicle used for participant transport, the vehicle is properly maintained, licensed, and insured. E.6.2 All drivers are properly licensed and insured. E.6.3 Car seats are used by children in compliance with California law based on the child’s height, weight, and age. E.6.4 Provisions are made to provide equal access to transportation services for disabled participants. Guidance/Resources California Highway Patrol provides guidance on California law regarding children’s car seats. 43 V1.12026 Section F: Additional Family Shelter Standards F.1 Eligibility for Admission to Family Shelters Standards F.1.1 A family is defined as a household that includes at least one adult with one or more minor children (age 17 or under). The default assumption should be that a household presenting as a family is a family, and the goal should be to keep them together and maintain contact. F.1.2 Family shelters may not deny admission on the basis of family configuration. Families with one or two parent households, same-sex partners, teenage children, intergenerational, adult dependents, or extended family members, unmarried couples, adults who are not biological parents, and other family configurations are eligible for admission. F.1.3 Households where at least one adult has legal custody are eligible for admission; additional adults in the household are not required to independently demonstrate custody. a. Shelter Policies and Procedures define the minimum percentage of custody/timeshare required for eligibility for family shelter. b. Shelter Policies and Procedures are flexible in accepting multiple forms of documentation to establish custody of minor children. c. Households are given reasonable time to obtain this documentation before an eligibility determination is made. F.1.4 Any documentation the shelter requires to verify eligibility is applied uniformly to all adults regardless of gender. Guidance/Resources • Shelters should exercise maximum flexibility in room assignments and sleeping configurations due to varying family sizes, ages of children, sibling compositions, and infant needs. Family shelters should adapt sleeping arrangements while maintaining safety, privacy, and compliance with occupancy requirements. • Shelters should, whenever possible, include households with adult-dependent children as eligible for family shelter beds. • Shelters should, whenever possible, include households or persons expecting a child to as eligible for family shelter beds. 44 V1.12026 F.2 Staffing of Family Shelters Standards F.2.1 At least one staff member has training in child development, early childhood, or education. F.2.2 All staff working in GBV family shelters complete the California Office of Emergency Services 40-hour training on domestic violence prior to beginning work. F.3 Child Supervision Standards F.3.1 Children are always supervised by parents, staff, or volunteers following staff to child ratios established by the shelter. F.3.2 Shelters implement a written permission procedure for parents to voluntarily allow other shelter participants to supervise their children. Guidance/Resources • Service linkage staff in family shelters are encouraged to prioritize connections with organizations that can expand the availability of childcare for participants, such as transitional kindergarten and Head Start. Shelters should also explore partnering with local educational and training institutions to host interns in fields such as education, social work, or child development. • Shelters are encouraged to access resources from First 5, Family Resource Centers, the Help Me Grow program, and to make referrals to County Starting Out Strong Home Visiting program. • Shelters should make the Alameda Kids Resource Directory available to families. F.4 Facilities and Supplies Standards F.4.1 Shelters provide an appropriate sanitary place for diaper changing. F.4.2 The facility is child-proofed, including: a. Childproof electrical outlets are installed. b. Floors above ground have precautions in place to prevent children from falling out of windows. c. Doors open from inside without a key. d. Precautions are in place to protect children from burns (from stoves or other heating units). e. Precautions are in place to protect children from injury from fans. F.4.3 Annual safety inspections are conducted by the provider agency staff to ensure child safety. F.4.4 There is adequate space for bathing and changing young children and for feeding children. 45 V1.12026 F.4.5 Age-appropriate cribs/beds are provided. F.4.6 24/7 shelters permit 24-hour access to an area where children can nap. F.4.7 Space is provided for home visits to occur either on-site or at another location. F.4.8 There are developmentally appropriate toys and books that are clean and in good repair. F.4.9 Refrigeration and cooking equipment to prepare and store formula, baby food, and milk are provided. Guidance/Resources • Play space for children should be provided as feasible within the confines of the physical space available in the shelter. • If the shelter layout allows, private space should be offered for breastfeeding. • Shelters should seek partnerships with other providers or educational institutions to provide a wider array of activities and services for children and families. F.5 Services Standards F.5.1 Family shelters comply with all the requirements in Section D. Service Coordination and Linkage. F.5.2 Family shelters have procedures in place for collaborating with local K-12 education support programs and schools, including: a. Advise heads of household of their rights as they relate to the public education system. b. Ensure shelter policies and practices are consistent with laws related to providing education services to individuals and families. c. Designate a staff person responsible for ensuring that children are enrolled in school and receive educational services, as appropriate. d. Develop working relationships with school district McKinney-Vento liaisons. F.5.3 Family shelters post information about, and collaborate with, local early care and education programs (e.g., Head Start, Early Head Start, childcare subsidy programs) and parenting support. F.5.4 GBV Family shelters also post information about, and collaborate with, services specifically tailored to their participants including, but not limited to, victim services, counseling resources, and legal resources. Guidance/Resources • School House Connection offers resources on federal education protections for children and youth experiencing homelessness and on the McKinney-Vento Act. • The National Center for Homeless Education offers resources on McKinney-Vento and other education related resources. 46 V1.12026 • Families can obtain assistance if they believe their children’s educational rights have been violated from Bay Area Legal Aid, which is part of the American Bar Association’s Homeless Youth Legal Network. 47 V1.12026 Section G: Staffing G.1 Culture and Supervision Standards G.1.1 Shelter staff treat participants with dignity and respect from a trauma-informed perspective that is professional and avoids favoritism. G.1.2 Shelter staff communicate accurately and transparently with participants regarding the housing landscape and placement system. G.1.3 Shelters implement supervision practices that evaluate and promote respectful treatment of participants and work to prevent staff burnout and compassion fatigue. G.2 Hiring and Compensation Standards G.2.1 Shelters conduct minimum required criminal background checks on all staff members appropriate to the population of shelter participants (e.g., youth, families, etc.) and in accordance with local laws. G.2.2 Shelter Policies and Procedures specify when criminal history would disqualify an applicant from hiring. This policy must consider the responsibilities of the position, the population to be served (e.g., will the position be interacting with minors), the nature, severity, and recentness of the crime, and evidence of rehabilitation. G.2.3 If the facility is in a city with a living wage ordinance, the shelter complies with that ordinance. G 2.4 Shelter providers prioritize hiring individuals with lived experience of homelessness, substance use recovery, behavioral health recovery, or system involvement whenever qualifications are substantially comparable. Providers make good faith efforts to incorporate lived experience perspectives throughout staffing whenever possible. G.3 Staff on Duty Standards G.3.1 Shelters always have sufficient staff on duty to effectively manage shelter operations and maintain compliance with shelter standards. G.3.2 24/7 shelters have one FTE service linkage staff for every 30 adult participants. G.3.3 Shelters have at least one staff person on duty and awake during all hours of operation. G.3.4 Shelters have one staff person on duty who is trained in CPR and first aid with a current CPR/AED card. 48 V1.12026 G.3.5 When only one staff person is scheduled, shelters make provisions to have on-call staff available. G.3.6 Shelters always have a supervisor/manager available on call for consultation on challenging participant situations and other urgent matters. G.3.7 Shelters have a consultation policy outlining situations requiring consultation up the chain of command. Guidance/Resources Shelters where size and population do not always warrant on-site staff may request a waiver of the on- site staffing requirement. Shelters granted a waiver must have staff on-call and available by phone during all times that participants are on-site. G.4 First Aid and Overdose Response Standards G.4.1 At least one staff person on duty is trained in emergency first aid and CPR at all times (unless granted a waiver to the on-site staffing requirement). G.4.2 All staff receive naloxone and opioid overdose response training within 60 days of hire and annually. G.4.3 All staff know where naloxone is available, possibly mounted, or stored on the premises. Guidance/Resources • Free virtual Naloxone Overdose Rescue training is available from the National Coalition Against Prescription Drug Abuse. • Shelters can obtain free naloxone from the state’s Naloxone Distribution Program. • When feasible all shelter staff should undergo CPR training. • The County is working to support first aid and CPR training for shelter staff. G.5 Infectious Disease Control Standards G.5.1 All shelter staff, regardless of role, are tested for tuberculosis every 12 months and referred to necessary follow-up and/or treatment if indicated. G.5.2 Staff comply with any recommended follow-up testing and treatment as indicated by a health care provider. a. Staff who test positive and undergo treatment of active or latent tuberculosis undergo annual symptom screening instead of testing, per guidelines from the Centers for Disease Control and Prevention (CDC) and National Tuberculosis Coalition of America. 49 V1.12026 G.5.3 Shelters make available annual TB testing to employees, keep records of staff TB testing, and stay current with all local and state health officer orders. Guidance/Resources • Shelter staff should obtain up-to-date information and guidance from Alameda County Health Care for the Homeless on appropriate protocols. See Section B: Health and Safety for further details. • Staff should be encouraged to obtain annual flu and COVID vaccines. • Cal OSHA provides Frequently Asked Questions on TB testing and Workplace Guidance on ATDs. • The Centers for Disease Control and Prevention provides Clinical Guidelines on TB Infection and guidance on Treatment of Latent TB Infection. • National TB Coalition provides guidance on Testing and Treatment of Latent TB Infection. G.6 Staff Training Standards G.6.1 Shelters recognize that working with people experiencing homelessness is critically important and challenging work and that staff training is essential to providing excellent services and retaining staff. G.6.2 Shelters develop orientation training plans on a timeframe that ensures all staff members are fully competent to perform the tasks assigned to them. G.6.3 Shelters plan for sufficient ongoing training to ensure that staff knowledge remains current and best practices are followed. G.6.4 The following trainings are mandatory for all staff regardless of their role or position. a. Confidentiality protocols. b. Mandatory reporting requirements related to child/elder abuse. c. Ethics/boundaries. d. Crisis prevention and/or verbal de-escalation. d. Universal precautions/infectious disease prevention. f. Managing communicable diseases in congregate settings (provided by ACHCH), including cough-alert protocols and symptom-recognition. g. Shelter Policies and Procedures, including procedures for enforcing compliance with shelter rules. h. Shelter Disaster Plan. i. Overdose detection and response, including naloxone administration and safe use (refreshed annually) from the National Coalition Against Prescription Drug Abuse. j. Anti-discrimination/reasonable accommodation training, including accommodation of transgender participants. k. Diversity awareness, humility, and cultural competence. 50 V1.12026 G.6.5 The following trainings are provided to all staff who work in participant-facing roles except as noted: a. HMIS privacy and security. b. Mental health issues in the homeless population. c. Conflict mediation. d. Gender-based and interpersonal violence recognition and referral. e. Harm reduction approach to substance use disorders. f. Basics in health insurance, primary care navigation, and other public benefits. g. Housing Problem Solving. h. Alameda County Shelter Standards. i. HMIS training and certificates for Coordinated Entry, Shelter Resource Matching, and Looker Access. (Must be completed by at least two full-time shelter staff.) j. Proper food handling and storage. (Must be completed by staff responsible for food handling and preparation. See Guidance below.) k. CPR/AED/First Aid; certification must be renewed as indicated by the training provider. l. California Office of Emergency Services 40-hour domestic violence training. (Must be completed be all staff working in GBV family shelters prior to beginning work.) Guidance/Resources • Alameda County Housing and Homeless Services has many resources and training available to assist shelters in meeting these requirements. Please visit the ACHCH training webpage. • State law requires all food handlers have a California Food Handler Card; new employees have 30 days from date of hire to obtain a card. Online training is available through ServSafe and other vendors. As of January 1, 2024 (SB 476), employers are responsible for all costs associated with mandatory food handler training and examination, including the course and exam price, compensation for time spent as "hours worked," and any other necessary expenditures. G.7 Training Planning and Recordkeeping Standards G.7.1 Shelters create an annual training plan that details how each of the required trainings listed in Section G.6 will be provided or made available to staff. G.7.2 Shelter providers document trainings each staff member has completed in their personnel file. G.7.3 Shelters keep a consolidated record of the number and type of trainings completed by staff members.