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Agenda 04/22/2014 Item #11A 4/22/2014 11.A. n EXECUTIVE SUMMARY Recommendation to approve submission of a Site Selection Criteria application to the Florida Department of Veterans'Affairs to be selected as the location for the State's planned seventh State Veterans' Home and include an offer of$500,000 in additional cash funding for the project and approve all necessary budget amendments. OBJECTIVE:To be selected as the location for a State Veterans'Nursing Home. CONSIDERATIONS: The Florida Department of Veterans' Affairs(FDVA)has issued an invitation to governments in ten areas of the state to submit a Site Selection Criteria application to be the location for a State Veterans' Home long-term healthcare facility. The facility envisioned is described as"a new, state- of-the-art 120-bed nursing home facility, which, when completed, will employ approximately 190 personnel and operate with an annual budget of over$7 million." Under the Site Selection process outlined by FDVA,applicants must identify a construction-ready site(20 acres minimum)to be donated for the facility.Competitive applications will also demonstrate the need for the facility based on the number of veterans over the age of sixty-five living within a seventy-five-mile radius of the site, and the availability of healthcare professionals and emergency healthcare facilities within the area. A Letter of Intent indicating that Collier County is an applicant wishing to nominate a site for this facility was submitted by the March 5,2014 deadline and approved by the Board after the fact on March 11,2014 (Agenda item 11D). Staff thoroughly investigated the inventory of County-owned lands and explored potential private-public partnerships to determine the most competitive site or sites to submit to FDVA. No County-owned property met the construction-ready requirements of the application. Most required extensive rezoning actions that would take longer than allowed by the State's target break-ground date of spring 2015. Ave Maria Development, LLLP has offered to participate as a partner in this project by donating the required acreage to the State and assuring all due diligence items are completed to FDVA expressed requirements prior to the application deadline of May 14, 2014. Ave Maria Development has identified two possible sites for the project within the Ave Maria SRA. Site A is located on the north side of Pope John Paul II Boulevard,just west of Camp Keais Road. Site B is located off of Oil Well Road on the east side of Arthrex Commerce Drive. Site A is currently zoned to allow for a nursing home facility. Site B will be zoned for a nursing facility upon final approval of a master plan amendment currently under review by staff. Completion and approval is anticipated for June, after the application deadline. Site B is the preferred location for the land donor. At the time of agenda publication, staff is awaiting direction from the FDVA as to whether or not to submit the sites in two independent applications, or as alternates within one application. Submission of up to two applications is permissible under the FDVA's established guidelines. A statement issued by the FDVA reported that an independent study recommending the construction of additional veterans' homes in Florida indicated the area of Collier and Lee Counties as having the greatest need for a skilled nursing facility. Of the ten counties invited to participate in this process,eight submitted Letters of Intent to submit an application. Staff considers the proposed sites and the attached application competitive in light of the rigorous requirements and tight timetable established by FDVA. A draft of the Packet Page-32- 4/22/2014 11.A. Site B application,as completed to date, is attached for Board review. As indicated in the draft, some due diligence items are forthcoming,but all will be completed by the due date of May 14,2014. FISCAL IMPACT: FDVA anticipates that$17 million in State funds will be used to build this facility and is applying to the United States Department of Veterans Affairs for an additional approximately $30 million. FDVA anticipates that the facility will employee 190 people and have an annual operating budget of over $7 million. As a result of Ave Maria Development's willingness to donate the site and the due diligence items, Collier County's financial commitment to attract this facility is the forfeiture of any impact fees that would have resulted from other development. The Site Selection Criteria states that "applicants are encouraged to provide funding in the amount of$500,000 to be applied toward the project costs, but inability to do this will not disqualify your proposal from consideration." A review of a preliminary assessment of the regional economic impact of this project conducted by the Southwest Florida Regional Planning Council indicates a 10 year return on the Gross.County Product that substantially exceeds the proposed cash investment. A more detailed explanation of this analysis will be presented at the Board meeting. Funds are available in FY 14 general fund operating expenses and reserves will not be impacted. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney. Collier County enjoys broad economic development powers under both its broad Home Rule Powers and more specifically Florida Statutes Sec. 125.045, and as such is authorized to offer $500,000 towards this project. Accordingly, this item is approved as to both form and legality, and requires majority vote for approval. -JAK GROWTH MANAGEMENT IMPACT:None. RECOMMENDATION: That the Board of County Commissioners 1) approves submission of a Site Selection Criteria application to the Florida Department of Veterans' Affairs to be selected as the location for the State's planned seventh State Veterans' Home, 2) approves offering $500,000 in additional cash funding for the project, and 3) authorizes the Chairman to sign the transmittal letter and approve all necessary budget amendments. Prepared by: Amanda Townsend,Public Services Operations Director Packet Page-33- 4/22/2014 11.A. COLLIER COUNTY Board of County Commissioners Item Number: 11.A. Item Summary: Recommendation to approve submission of a Site Selection Criteria application to the Florida Department of Veterans'Affairs to be selected as the location for the State's planned seventh State Veterans'Home and include an offer of$500,000 in additional cash funding for the project and approve all necessary budget amendments. (Steve Carnell,Public Services Administrator) Meeting Date: 4/22/2014 Prepared By Name: HaileyAlonso Title: Operations Analyst,Public Services Division Approved By Name: HaileyAlonso Title: Operations Analyst,Public Services Division Date: 04/03/2014 10:25:29 AM Name: townsendamanda Title: Director-Operations Support,Public Services Division Date: 04/04/2014 08:56:52 AM Name: ericarobinson Title: Accountant, Senior, Grants Management Office Date: 04/07/2014 08:06:30 AM Name: carnell_s Title: Administrator-Public Services, Public Services Division Date: 04/16/2014 11:31:06 AM Name: klatzkowjeff Title: County Attorney, Date: 04/16/2014 01:13:14 PM Name: EdFinn Title: Management/Budget Analyst, Senior,Transportation Engineering& Construction Management Date: 04/16/2014 04:01:35 PM Packet Page-34- 4/22/2014 11.A. Name: ochs_1 Title: County Manager,County Managers Office Date: 04/16/2014 04:50:02 PM n Packet Page-35- 4/22/2014 11 .A. April 16,2014 Florida Nursing Home Site Selection Committee State Veterans' Home Program Attention: Connie Tolley, RNC, CNHA,Program Administrator 11351 Ulmerton Road, Room 311-K Largo, Florida 33778-1630 Dear Selection Committee Members: On behalf of the Collier County Board of County.Commissioners,I am pleased to submit the enclosed Site Selection Criteria application to have Collier County be considered the location for the planned seventh State Veterans' Nursing Home. If the project site is selected,the Board of County Commissioners is committed to fulfilling all commitments made in the application,including the offer of a cash incentive in the amount of $500,000. • Amanda Townsend, Public Services Operations Director, is authorized to act as the key contact for the project. All correspondence concerning this application may be directed to her. Sincerely, Tom Henning, Chairman Collier County Board of County Commissioners Packet Page-36- 4/22/2014 11.A. FLORIDA DEPARTMENT OF VETERANS AFFAIRS State Veterans' Home Program SITE SELECTION CRITERIA—COLLIER COUNTY SUBMISSION TABLE OF CONTENTS Part I Need for Veteran Nursing Home Care A.Veteran Population 50 points page x B. Nursing Home Beds and Other Medical Services 50 points page x Part II Suitability of Donated Site A.Suitability of Donated Site(Narrative) 50 points page x B.Specific Land Requirement 50 points page x C.Assurances page x Part III Availability of Infrastructure at Site A. Narrative page x B.Assurance Checklist page x Part IV Availability of Health Care Professionals 50 points A. Narrative page x B. Institutions page x C. Nursing Workforce page x Part V Availability of Emergency Health Care 50 points A. Emergency Health Care Facilities page x B. Emergency Room Holding Beds page x C. In-House Physicians page x D. ER Visitation Rates page x E. Medical Specialties and Equipment page x Florida State Veterans Home Site Selection Criteria—Packet Page-37-ion Page 1 4/22/2014 11.A. PART I: NEED FOR STATE VETERAN NURSING HOME A.Veteran Population 1.The exact location of a proposed site is 8261 Oil Well Road, Naples, Florida 34142. For a location map of the site, please see Exhibit A. 2.The counties that are within the 75-mile radius of a site,the veteran population,and the aging veteran population of those counties are to be set forth below. For a 75-mile radius map, please see Exhibit B. County Veteran Pop. Population>65 Collier 27,056 18,413 Lee 53,892 32,062 Hendry 1,823 951 Charlotte 19,138 12,542 Glades 971 549 DeSoto 2,412 1,503 Highlands* 9,887 6,282 Broward** 84,388 37,490 • TOTAL 199,567 109,792 * Highlands County data is included because greater than 25% of county population lives within the Lake Placid CCD, according to the 2010 US Census.The Lake Placid CCD is within the 75-mile radius of the Collier site. •*Broward County data is included because greater than 25%of the county population lives within the Plantation, Conservation, Coral Springs/Margate and Davie CCDs, according to the 2010 US Census. These CCDs are mostly within the 75-mile radius of the site.Two other CCDs, Deerfield Beach and Pembrook Pines, have portions within the 75-mile radius, but were excluded to offset the portions of those counted that are outside the radius. B. Nursing Home Beds and Other Medical Services 1.A second descriptor of need for a State Veterans' Nursing Home is the number of licensed nursing home and ALF beds located within 10 miles of the proposed site. Please provide the information requested below for the last twelve (12) months,or the last twelve(12) month period available, and specify the twelve (12) month period used. Florida State Veterans Home Site Selection Criteria—Packet Page-38-ion Page 2 4/22/2014 11 .A. There are 32 nursing homes or assisted living facilities in Collier County,with a total of 908 nursing beds and 1709 ALF beds countywide. Only one facility is within 10 miles of the project site. Fora map of the nursing homes and assisted living facilities in Collier County, please see Exhibit C. Time period for data below: Current license effective:4/18/2013; license expires: 4/17/2015 Facility #of Licensed Occupancy #of Licensed ALF Occupancy Name Nursing Beds Rates beds Rates The Paradise Facility Home Care, Inc. 0 n/a 6 unknown 2. For each of the above-named facilities, please provide the following: Facility Facility Services Average Daily Name Address Provided Cost of Care The Paradise Facility Medicaid Services:Assistive Care Services, Home Care, inc. 3431 Wilson Blvd. N. Assisted Living Waiver;Specialty License: unknown* Limited Nursing Services *The average daily cost of care for the facility in question was unavailable.The Florida State-Specific Data from the Genworth 2013 Cost of Care Survey indicates that median daily costs of care in the Naples/Marco metropolitan area are as follows: nursing home semi-private room,$250; nursing home private,$304;assisted living,$150.The report can be accessed at this hyperlink. Florida State Veterans Home Site Selection Criteria-Packet Page-39-;ion Page 3 4/22/2014 11 .A. PART II:SUITABILITY OF DONATED SITE Utilizing the criteria below,each site will be evaluated based upon the quality of the response to Part II and awarded 0-50 points. Each site must consist of 20 or more acres for a 120 bed facility. The parcel that is being donated must not be in one of the following hurricane evacuation zones A, B,C, D, or E. It should be appropriate for a building, roads, retention ponds and parking as necessary to meet local government requirements. The intended construction of a multi-bed nursing facility must be consistent with all state and local land use laws, rules,and regulations.Appropriate verification of said laws and zoning will be required. All fill and other preparation necessary to place a site above the flood plain,and make suitable for construction will be provided at no cost to the state. All environmental concerns of the U.S Department of Veterans Affairs(VA) and the State must be met.A Phase I Environmental Assessment will be required for all submissions.All requirements of a Phase I Environmental Assessment will be required for all submissions.These assessments will be due before site selection is complete. Exact time frames will be specified when site selection commences. Soil samples of the proposed site will be required for all land that is being considered for construction. The reports will include soil borings one(1) per acre throughout the parcel under consideration.The reports must be done by a certified Geotechnical firm,and be properly certified.These reports will be due before selection is complete. The State Land Trust will not accept land until the donor has successfully completed the "ENVIRONMENTAL AUDIT REQUIREMENTS FOR BOARD OF TRUSTEES OF THE INTERNAL IMPROVEMENT TRUST FUND OF THE STATE OF FLORIDA."A site must be able to qualify for a favorable review by the Florida Department of State, Division of Historical Resources,conducted pursuant to convey clear and unencumbered title to the property before the commencement of construction. Failure to meet any of these requirements will eliminate a site from consideration. Failure on the part of a sponsor to meet these requirements will disqualify a site from further consideration.The environmental assurances that the state must make to the VA regarding a site selected are shown on page 6.A series of questions designed to determine if a proposed site can be approved are set forth beginning on page 5.Each of these questions MUST be answered in the affirmative. A.Suitability of Donated Site(Narrative) Provide a narrative description of the site in terms of its general surrounding and support capabilities. Clarifying comments may be added and may address any of the following items.(This list is not all- inclusive;additional items may be added at your discretion) Land:Shape of the parcel,soil types and quality, surrounding area land usage,urban or rural setting, trees on site,and types of ground cover, indications of pesticides or herbicides,strong or pungent odors Florida State Veterans Home Site Selection Criteria-Packet Page-40-;ion Page 4 4/22/2014 11.A. History:Any historical significance, usage history,title history, environmental liens, land fill history,if applicable Misc.Availability of all pertinent utilities Description of area transportation network Availability of community support services and facilities. General:Site B is located in the Ave Maria community within eastern Collier County.Ave Maria is being developed by a joint venture between Barron Collier Companies,and Tom Monahan,founder of Domino's Pizza.To date,this joint venture,Ave Maria Development, LLLP, has been responsible for the development of more than 550 homes, approximately 500,000 square feet of commercial uses, and numerous community service facilities and amenities to serve the community's residents and businesses. In addition, Mr.Monahan has led the development of Ave Maria University which currently has more than 900 students enrolled.Among numerous ancillary uses needed to support a town, the Ave Maria community is entitled for up 11,000 residential units, more than 1.1 million square feet of commercial uses, and 6,000 students. Land: Site B is off Oil Well Road, in the Arthrex Commerce Park which is located within the southern portion of the rural Ave Maria community.The 20 acre parcel is primarily rectangular in shape and has approximately 959 feet of frontage along Arthrex Commerce Drive. Existing land uses directly surrounding Site B include manufacturing to the west, and pasture to the south, north, and east.These pasture uses will ultimately be converted to allowable Town Center uses as Arthrex Commerce Park ^' continues to develop.The existing soil type is very loose to medium dense sand with occasional gravel, and existing vegetation is minimal with the primary ground cover being grasses. Site B's past land uses have been for agricultural purposes. Crops grown on the property included avocados and tomatoes; however,the property has not been used for crops for more than four years. A Phase 1 environmental assessment of the property did not indicate odors, observable spills or releases of hazardous substances on the property; however, because of the past uses included the cultivation of crops, the probable application of pesticides and herbicides is considered a Recognized Environmental Condition ("REC").A Phase 2 environmental assessment was performed and soil samples taken did not indicate the need for additional assessment of the REC. History:There are no items of historical significance related to Site B.An archaeological assessment was performed for the Ave Maria community which concluded- and the Florida Division of Historical Resources concurred-that the development had no impacts of sites of archaeological significance.As previously indicated above,the historical uses of the property were agricultural.There are no title defects,or environmental liens associated with Site B. Miscellaneous: Site B is currently,or will be served, by all pertinent utilities prior to the beginning of construction in 2015.Access to the property is from Arthrex Commerce Drive which intersections with Oil Well Road.This recently widened roadway is the main access for the Ave Maria community, and provides access to Immokalee Road and, ultimately Interstate 75.Travel time from Site B to Interstate 75 is approximately 20 to 25 minutes.The Ave Maria community is served by the Immokalee Fire Control Florida State Veterans Home Site Selection Criteria—Packet Page-41-ion Page 5 4/22/2014 11.A. District,and Collier County Emergency Management Services. Both entities maintain a joint station in the Ave Maria community, approximately two miles from Site B. DaVita Dialysis, and a small medical office, are also located within the community. B.Specific Land Requirements Respond to the Following Questions by Answering'Yes" or"No" 1. Is the land use of each site for a nursing home consistent with the community's comprehensive plan adopted and approved pursuant to Part II chapter 163, Florida Statutes(2013)? Please attach a copy of the county's Land Use Plan. No A Zoning Verification Letter is attached. 2. Does the sponsor assure that the following will be provided with no additional cost to the State? a.All fill necessary to meet the VA requirement that the building,access road,and parking be above the flood plain. No b.All site preparation necessary to include, but not limited to fill necessary to make the site suitable for the construction of the building No 3. Has the sponsor reviewed the U.S Department of Veterans Affairs environmental documentation requirements found at 38 CFR Part 26 and does the sponsor provide the following assurances?The site will qualify for a Categorical Exclusion;or an Environmental Assessment prepared in accordance with the above cited VA regulation will reveal no significant effect on the human environment? No 4. Has the sponsor reviewed the Florida Department of Environmental Protection Division of State Lands, Bureau of Land Acquisition, Environmental Audit Requirements which must be met before land will be accepted by the State Land Trust that a favorable environmental audit of a proposed site can be certified to the Board of Trustees of the Internal Improvement Trust Fund of the State of Florida? No 5.Title transfer must be completed before construction begins, but after selection. Can the sponsor assure that a clear and unencumbered title to the real property be obtained and the site will be conveyed to the State Land Trust by deed in a timely manner? Florida State Veterans Home Site Selection Criteria— Packet Page-42- on Page 6 4/22/2014 11.A. No The proposed site is owned by Ave Maria Development, LLLC.A letter of commitment indicating that the owner intends to deed the site to the State is attached. C.Assurances As part of the application process of the USDVA,the following"Assurances"concerning environmental matters must be given by the State at the time of pre-application is filed and again when the application is filed.The assurances below are directly related to the selection of a suitable site: 1.The site will comply with environmental standards,which may be prescribed pursuant to the following: Institutions of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190), and Executive Order, (EO), 11514 Notification of violating facilities pursuant to EO 11738 Protection of wetlands pursuant to EO 11990 Evaluation of flood hazards in flood plains in accordance with EO 11988 Assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972, 16 Conformity of federal actions to state (Clean Air) implementations plans under section 176(c)of the Clean Air Act of 1955, as amended 42 U.S.C. §7401 et seq Protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, P.L. 93-523 Protection of endangered species under the Endangered Species Act of 1973,as amended P.L. 93-205 2.The applicant will comply with the Wild and Scenic Rivers Act of 1968, related to protecting components or potential components of the national wild and scenic rivers system. 3.The State will assist the awarded applicant in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended 16 U.S.C. §470, EO 11593, Identification and Preservation of Historic Properties, and the Archaeological and Historic Preservation Act of 1974, 16 U.S.C. §§469a-1 et seq. Are there any known reasons or conditions that would in any way inhibit State from certifying compliance with the conditions listed above in "C"? Yes Florida State Veterans Home Site Selection Criteria—Packet Page-43-ion Page 7 4/22/2014 11.A. PART III: AVAILABILITY OF INFRASTRUCTURE AT SITE It is essential that roads and utility infrastructure services be available to the property. Roads,water, sewer,telephone lines, electricity and/or natural gas services must be brought to the property line as required by local code before construction begins at no cost to the State. Since no funds are provided by the federal grant to bring these services to the property it is necessary that the donor or local community provide them to the site at no cost to the project.A series of questions designed to ascertain the willingness of the sponsor of a site to provide the needed services and infrastructure to a site are set forth below.Infrastructure requirements must be completed before construction commences. If concurrency requirements are not met,and further infrastructure services are not adequate and timely,then a site cannot be approved,and no further consideration is warranted. A qualifying official must make the following assurances in writing: The FDVA will not be charged any impact or any other type of fees by either the County or the City in which the site is located. Infrastructure will be in place at the beginning of construction. If grants or any other application for funding to provide infrastructure are needed to secure the infrastructure requirement,the FDVA will not be a participant in that process.The applicant cannot obligate the FDVA for additional requirements or information.All infrastructure requirements must be completed as outlined above. If construction is delayed due to the applicant's inability to provide infrastructure to the site any costs associated with the delay will be solely the responsibility of the applicant. A.Narrative Provide a narrative description of the infrastructure that is currently in place. Include identification of roads that provide access to a site; main, county,state,or federal roads and/or interstate highways,and average travel time from major population centers to the site. Indicate the availability of water and sewage treatment facilities. Indicate the source of telephone,electric power,and a natural gas supplier, if available, in a site area. Site B is located off of the four-lane Arthrex Commerce Drive which intersects with County Road 858 ("Oil Well Road"). Recently widened,Oil Well Road provides access to County Road 846("Immokalee Road")ten miles to the west, and Immokalee Road intersects with Federal Interstate 75 ("1-75") another 10 miles to the west. Travel time between Site B and the intersection of Immokalee Road and 1-75 ("a major population center")is twenty minutes. Ave Maria Utility Company, LLLP ("AMUC") provides water and wastewater service within the community. Existing facilities adjacent to Site B include an 8-inch gravity sewer main,and 12-inch potable water. AMUC's water and wastewater treatment facilities have sufficient capacity to meet the estimated potable demands and sewage flows of the nursing home. Ave Maria Stewardship Community District provides irrigation within the community,and has an existing 6-inch irrigation main adjacent to the site. Florida State veterans Home Site Selection Criteria—Packet Page 44-ion Page 8 4/22/2014 11 .A. Dry utility provides include Lee County Electric Cooperative for electricity, Century Link for telephone,. and Comcast for cable television. Currently,there is no natural gas supplier for the Ave Maria community. Electrical,telephone, and cable television service is currently available for Site B. B.Assurance Checklist Respond to the following questions by responding"YES or"NO" 1. Does a site provide 20 acres or more acres clear of any easements that would interfere with the construction of a 120 bed facility, and such additional space for access roads,retention,and parking as required by the local governing body? No 2. Will the local governing body ensure that all concurrency requirements made necessary by the development of a site for the proposed use will be provided? • No 3.Are the local utility companies capable of ensuring that utility services adequate for the needs of the proposed facility can be brought to the property line in accordance with local government code requirements? n No Florida State Veterans Nome Site Selection Criteria—Packet Page 45 ion Page 9 4/22/2014 11.A. PART IV: AVAILABIUTY OF HEALTH CARE PROFESSIONALS A major concern when you site a Nursing Home is the national shortage of health care professionals. It is essential that a supply of health care professionals sufficient to support this facility be available in the surrounding community.Out of state resources are not to be excluded.The presence in the community or area of accredited educational institutions offering health care programs that can provide a source for these professionals can ameliorate this condition.Willingness on the part of these institutions to establish or expand such programs is essential. Scoring in Part IV will be subjective based upon the total section response and will result in a total point award in the range of 0-50 points.The presence of accredited health care training in the community is important to the success of the home.Given the national shortage of health-care professionals,the presence in the vicinity of the site of educational institutions accredited to train health-care professionals is a key to having a steady production of individuals to support the Home who can render valuable service as student or graduate assistants. A.Narrative Provide a narrative description of the accredited educational institution(s) located within 50 miles of a site that offer health-care programs,and describe the programs offered. Thirteen institutions within fifty miles of the project site offer healthcare education, including Ave Maria University, the Immokalee iTECH technical school, and Florida Gulf Coast University. For a map of educational institutions providing healthcare programs within a 50-mile radius of the project site, see Exhibit D. B.Institutions 1. List the institution(s) described above and the healthcare program(s) offered by each. Institution Programs Offered Florida State University Family Medicine, Internal Medicine, Obstetrics&Gynecology, Pediatric Immokalee Health Education Site Residency Medical Career Institute Paramedic, EMT,AHA, EVOC, Phlebotomy Med-Life Institute Nursing, Patient Care, Medical Assistant, Home Health Aide Southwest Florida College Sonography, Health Information, Medical Assistant, Medical Laboratory Technician,Surgical Technician Edison College Cardiopulmonary Science, Nursing, Dental Hygiene,Emergency Medical Services, Radio logic Technician, Respiratory Care, Firefighter, Paramedic Hodges College Health Studies, Medical Assistant, Physical Therapist Assistant, Psychology, Clinical Mental Health Counseling Florida State Veterans Home Site Selection Criteria— Packet Page-46-ion Page 10 4/22/2014 11 .A. Ave Maria University Nursing, Psychology, Health Science Florida Gulf Coast Nursing, Health Services Administration, Health Professions Education, University Nutrition, Clinical Laboratory Science, Exercise Physiology, Occupational Therapy, Clinical Mental Health Counseling Wolford College Nurse Anesthesia Lorenzo Walker Institute Medical Administrative Specialist,Medical Assisting, Nursing Assistant of Technology (Articulated), Pharmacy Technician, Phlebotomy, Practical Nursing, Surgical Technology iTECH lmmokalee Nursing Assistant, Licensed Practical Nurse, Medical Administrative Technical Center Specialist, Medical Coding and Billing Registered Nurse;Associate of Arts in Health Services Administration; Associate of Science in Sports Medicine and Fitness, Diagnostic Sonography, Medical Assisting,Occupational Therapy,Sports Medicine and Keiser University Fitness Technology; Bachelor of Arts in Psychology, Health Services Administration; Bachelor of Science in Nursing, Biomedical Sciences, Health Science, Sports Medicine and Fitness Technology; Master of Science in Nursing, Psychology;Graduate Certificate in Health Services Management; Nurse Practitioner Rasmussen College Health Information Technician, Medical Administration, Medical Coding and Billing, Pharmacy Technician 2. Provide data that shows the title of health care programs and the number of health care graduates that each institution or program has produced annually for the last five years. Data forthcoming. 3. Provide a narrative statement, supported by assurances from the institution(s) Involved,setting forth their willingness to utilize existing programs, or add additional programs to the health care curriculums of the institution to provide a source/supply of health care professionals. Narrative forthcoming. 4. Provide a narrative statement of the willingness of local institution(s) located within 50 miles of a site to cooperate with the Home by supplying student assistants to render services to veterans in the home as a part of its curriculum of training. Narrative forthcoming. C. Nursing Workforce Florida State Veterans Home Site Selection Criteria—Packet Page-47 ion Page 11 4/22/2014 11.A. 1. Please provide the following information for both Registered Nurses and Licensed Practical Nurses by county: a. RNs per 100,000; b. LPNs per 100,000 Numbers of employed nurses per 100,000 population in Southwest Florida (Collier, Lee Hendry, Charlotte,and Glades Counties)are as follows: Position Number per 100,000 Pop. RN 815 LPN 253 Source:Florida Center for Nursing,Southwest Florida Status Report on Nursing Supply,Demand and Education,July 2013.hyperlinked here 2.Turnover Rate: The turnover rates for nurses working in Skilled Nursing facilities in the Southwest Florida Region (Collier, Lee Hendry,Charlotte, and Glades Counties)were as follows for 2010-2011: Position Turnover rate RN 39.2% LPN 45.4% Source:Florida Center for Nursing,Southwest Florida Status Report on Nursing Supply,Demand and Education,July 2013. hyperlinked here 3.Vacancy Rate: The vacancy rates for nurses working in Skilled Nursing facilities in the Southwest Florida Region (Collier, Lee Hendry, Charlotte, and Glades Counties)were as follows as of June 30, 2011: Position Vacancy rate RN 4.8% LPN 3.9% Source:Florida Center for Nursing,Southwest Florida Status Report on Nursing Supply,Demand and Education,July 2013.hyperlinked here 4.Average Hourly Wage:This should be reasonable within the state average as defined by the AAHSA Nursing Home Salary and Benefits Report. Florida State Veterans Home Site Selection Criteria— Packet Pane-48-ion Page 12 4/22/2014 11.A. The average hourly wages of nurses in Collier County were as follows as of May 2012: Position Average Hourly Wage RN $31.12 LPN $21.33 Source:US Department of Labor,Bureau of Labor Statistics.RN information is hvperlinked here.LPN information is hvperlinked here. • Florida State Veterans Home Site Selection Criteria—Packet Pa a-49-ion Page 13 4/22/2014 11.A. PART V: AVAILABILITY OF 24 HOUR EMERGENCY HEALTH CARE It is essential that emergency healthcare facilities be available near each State Veterans' Nursing Home to provide rapid response to emergency situations and to accommodate acute conditions.A health care facility capable of providing emergency services and care for any emergency medical condition as defined at F.S.Section 395.1041, must be within a 25-mile radius of a proposed site. The following questions are designed to ascertain the adequacy of available emergency medical health care. Part V points will be awarded based upon distance between the proposed site and the nearest emergency health care facility. Provide the following information for all emergency medical services within a 25-mile radius. A. Emergency Health Care Facilities Identify each hospital and/or emergency care center within 25 miles of the proposed site. For each, specify the distance to the proposed site: Facility Distance from Proposed Site Naples Community Hospital Downtown 24.21 miles NCH Healthcare System North Naples Hospital 21.23 miles Physicians Regional Medical Center-Collier Boulevard 20.03 miles Physicians Regional Medical Center-Pine Ridge Road 18.84 miles Lehigh Regional Medical Center 25.51 miles For a map of hospitals within a 25-mile radius, please see Exhibit E. B. Emergency Room Holding Beds Provide an inventory of the number of ER holding beds per facility. Facility Number of Beds Naples Community Hospital Downtown 32 beds NCH Healthcare System North Naples Hospital 53 beds Physicians Regional Medical Center-Collier Boulevard 18 beds Physicians Regional Medical Center- Pine Ridge Road 101 beds Lehigh Regional Medical Center 17 beds Packet Pa a 50-• Page 14 Florida State Veterans Home Site Selection Criteria—__..._. ___.., ___,. .__ion g 4/22/2014 11 .A. C. In-House Physicians Indicate whether the facility maintains in-house physicians on staff in the emergency department/room 24 hours,seven days a week: Facility Physician on Duty 24/7(y/n) Naples Community Hospital Downtown yes NCH Healthcare System North Naples Hospital yes Physicians Regional Medical Center-Collier Boulevard yes Physicians Regional Medical Center- Pine Ridge Road yes Lehigh Regional Medical Center yes D. ER Visitation List the number of ER visits within six months of this application, per facility. Facility Approximate Number of Visits ^' Naples Community Hospital Downtown 12,682 NCH Healthcare System North Naples Hospital 20,904 Physicians Regional Medical Center-Collier Boulevard 10,263 Physicians Regional Medical Center- Pine Ridge Road 9,156 Lehigh Regional Medical Center 16,952 Source:The Florida Agency for Health Care Administration reports annual statistics for emergency room visits.The most recent available data is from July 2012 to June 2013.Numbers reported above are one-half of the most recent available data.No adjustment has been made for seasonality.The database query can be duplicated at this hyperlink. E. Medical Specialties Identify all medical specialties available on staff,all specialized services provided,and all major medical equipment owned or utilized by the hospital. Facility Specialties 3 Psychiatry, Obstetrics& Gynecology,Cardiology,Cardiac Aneurysms,Advanced Heart Failure& -r- o Transplant Cardiology, Podiatric Surgery, Diagnostic Radiology, Gastroenterology, Critical Care • z Medicine, Pulmonology, Facial Plastic& Reconstructive Surgery, Facial Plastic Surgery, n eS Osteopathic Manipulative Therapy, Rheumatology,Critical Care Medicine,Sleep Medicine, Internal Medicine, Anesthesiology, Physical Therapy, Emergency Medicine, Oral& Florida State Veterans Home Site Selection Criteria— PaCket Pd a 51-ion Page 15 4/22/2014 11.A. Maxillofacial Pathology, Neurology, Interventional Pain Medicine,Gastroenterology, Family Medicine, Ear, Nose,and Throat, Infectious Disease Medicine,Ophthalmology, Orthopedic Surgery, Pediatrics, Nephrology, Geriatric Medicine,Anatomic&Clinical Pathology, Pathology, Anatomic Pathology, Clinical Pathology, Nursing,Addiction Psychiatry, Forensic Psychiatry, Dermatology, Diagnostic Radiology,General Surgery,Vascular Surgery, Neonatal Medicine, Oral&Maxillofacial Surgery, Pediatric Pulmonology, Radiation Oncology, Endocrinology, Diabetes& Metabolism, Bariatric Surgery, Geriatric Psychiatry, Medical Surgical Nursing, Vascular& Interventional Radiology, Interventional Radiology,Sports Medicine, Blood Banking &Transfusion Medicine,Clinical Cardiac Electrophysiology, Hospice & Palliative Medicine, Hospice& Palliative Medicine (Radiology), Female Pelvic Medicine&Reconstructive Surgery Equipment 3-open heart operating rooms, 1-laminar flow orthopedic specialty room, 1-cystoscopy room for urology procedures,5-operating rooms for general surgery, 3-endoscopy rooms for examining the stomach and colon and 1-specialized bronchoscopy room for examining the lungs Facility Specialties Teleradiology, Emergency Medicine Kid Care, Geriatric Medicine,Vascular Surgery, Gastroenterology, Allergy/Immunology, Maternal& Fetal Medicine,Obstetrics/Gynecology, Hospitalist, Interventional Radiology,Oral/Maxillofacial Surgery, Plastic Surgery,Cardiovascular cu } - Surgery, Radiation Oncology, Neurosurgery, Orthopaedic Surgery, Pediatrics, ", ° Allergy/Immunology, Internal Medicine, Hematology-Oncology, Podiatric Sure General cv = gY/ gY, , Surgery, 3 v Surgery, obstetrics/gynecology, a Level II neonatal nursery,orthopedics,diagnostic cardiac catheterization,general surgery, Pediatric Gastroenterology, emergency medicine, progressive care, intensive care, pediatrics and pediatric progressive care ,, ° Equipment z Four surgical suites,one endoscopy suite,and one catheterization lab,geriatric unit has 32 acute care beds Facility Specialties Cardiology, Bariatric Surgery, Breast Cancer Surgery, Cardiothoracic/Thoracic Surgery, Colorectal Surgery, Cosmetic Surgery,Cranial Surgery, Eye Surgery,Gynecological Surgery, > Laser Surgery, Neurosurgery,Orthopedic Surgery, Plastic Surgery, Robotic Surgery,Spine Surgery, Urological Surgery,Vascular Surgery, Comprehensive Breast Center,Optical Center, c c° Orthopedics,Stroke Care Center,Vein Center, Ear, Nose and Throat, Neurologic Care, a Orthopedics, Neurovascular&Stroke Institute, Women's Health, Knee Resurfacing (MAKO c° plasty), Biopsy, CT Breast Imaging, MRI, Ultrasound c .ro L Equipment Cardiology Center,Women's Center,24-hour Emergency Room (ER)services, General n a medical/surgical services, Robotic Surgery Center(da Vinci®SiTM and makoplasty®'), Outpatient services including radiology, laboratory and rehabilitation, Hand Surgery Institute, Florida State Veterans Home Site Selection Criteria—Packet Pa a-52-ion Page 16 4/22/2014 11.A. Wound Care Center, Hospice,Sleep Disorders Center, ENT Specialty Care Center Facility Specialties Cardiology, Bariatric Surgery, Breast Cancer Surgery, Cardiothoracic/Thoracic Surgery, Colorectal Surgery, Cosmetic Surgery,Cranial Surgery, Eye Surgery,Gynecological Surgery, Laser Surgery, Neurosurgery, Orthopedic Surgery, Plastic Surgery, Robotic Surgery,Spine = Surgery, Urological Surgery,Vascular Surgery,Comprehensive Breast Center, Optical Center, a) Orthopedics,Stroke Care Center,Vein Center, Ear, Nose and Throat, Neurologic Care, 0 Orthopedics, Neurovascular&Stroke Institute,Women's Health, Knee Resurfacing(MAKO plasty), Biopsy, CT Breast Imaging, MRI, Ultrasound,General medical/surgical services, Robotic Surgery Center(da Vinci 'SiTM and MAKOplasty°), Neurovascular and Stroke Institute, Cardiology Center,Vein Center, Optical Center, Orthopaedic and Spine Center, ENT Specialty Care Center CL Equipment a 24-hour Emergency Room (ER)services, Outpatient services including radiology, laboratory and rehabilitation,General medical/surgical services, Robotic Surgery Center(da Vinci°SiTM and MAKOplasty'),Neurovascular and Stroke Institute, Cardiology Center,Vein Center, Optical Center,Orthopaedic and Spine Center, ENT Specialty Care Center Facility Specialties Cancer Care (Oncology),Critical Care Medicine (ICU), Dermatology, Diabetes Care, Digestive Care, Ear, Nose and Throat, (Otolaryngology),Allergy Care, Head and Neck Care, Hearing and Balance (Audiology),Sinus Care,Throat and Voice, Emergency Medicine Center,Geriatric Medicine, Cardiology, Cardiovascular Diagnosis,Vascular Medicine, Hospitalists, Radiology, Biopsy,CT Scan, Echocardiogram, Interventional Radiology, MRI, Nuclear Medicine, Ultrasound, X-ray, Infusion Services, Kidney Disorders (Nephrology), Pathology, Neurologic Care, Brain Care,Orthopedic Center,Arthritis,Joint Replacement and Reconstruction, Sports Medicine, Primary Care, internal medicine, and OB/GYN, Family Practice,Senior Care, To Rehabilitation Service,Acute Care, Heart and Vascular Rehabilitation, Neurologic Rehabilitation,Occupational Therapy, Respiratory Care (Pulmonary Medicine), Sleep Medicine, Surgery Center, Cardiothoracic/Thoracic Surgery,Colonoscopy,Colorectal Surgery, Ear, Nose and Throat(ENT)Surgery, Endoscopy, Gynecological Surgery, Hand Surgery, Hernia Surgery, •6 Oral and Maxillofacial Surgery, Orthopedic Surgery, Plastic Surgery, Urological Surgery, Urology, Nutritional Services, Gynecology, Heart Care, Wound Care Center, Hyperbaric Oxygen Therapy a—' Equipment X-rays, PET Scans, Emergency Department features eight state-of-the-art treatment bays, dual- head spiral CT scanner(computer tomography), magnetic resonance imaging(MRI), nuclear medicine, digital fluoroscopy, cardiovascular ultrasound with capabilities for transesophageal echocardiograms and stress echocardiograms,and ultrasound, Hyperbaric Chambers, CAT Scan, and mammography Florida State Veterans Home Site Selection Criteria—Packet Pale 53_ion Page 17 •„. , 4/22/2014 11 .A. 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Dear Ms. Townsend: You asked this office to provide verification that a proposed 120-bed nursing home, on approximately 20 acres, can be developed on a site that is Iocated within Town Center 2b as proposed in the application to amend the SRA Master Plan (SRAA-PL20130002012) which is currently under review by staff. Town Center 2b is located along Oil Well Road as depicted on the attached"Proposed SRA Master Plan". Based upon my review of the Ave Maria SRA Document and Master Plan, the proposed nursing home use is listed as a permitted use within all the designated Town Center tracts including the proposed Town Center 2b. In addition, a maximum of 450 beds are permitted for assisted living facilities (ALF) and/or nursing home uses within the SRA project area. Since no ALF/nursing home uses have been developed at this time, there is sufficient capacity to develop the proposed 120-bed nursing home in Town Center 2b. Please be advised that the information presented in this verification letter is based on the Collier County Land Development Code and/or Growth Management Plan in effect as of this date. It is possible that subsequent amendment(s) to any of these documents could affect the validity of this verification letter. It is also possible that development of the subject property could be affected by other issues not addressed in this letter, such as, but not limited to, concurrency related to the provision of adequate public facilities, environmental impact, and other requirements of the Collier County Land Development Code or related ordinances. Department of Planning&Zoning•2800 North Horseshoe Drive•Naples,FL 34104•239-252-5603 Packet Page-59- 4/22/2014 11 .A. Ms. Amanda Townsend April 10, 2014 This letter represents a determination of Planning & Zoning Department staff Should you disagree with this determination, you may request an Official Interpretation by the Planning & Zoning Director of the provisions of the Land Development Code pursuant to Sections 1.06.01.A and 10.02.02.F.1 of that Code. The fee for an Official Interpretation is identified in the most recent Fee Schedule Resolution as approved by the Board of County Commissioners. Should you require further information please do not hesitate to call me at (239) 252- 2931. Sincerely, r(eu..) 6T Re),-- Raym d V. Bellows, Zoning Section Manager Department of Planning and Zoning cc: Mark Strain, Collier County Hearing Examiner Nick Casalanguida, Administrator Growth Management Division Mike Bosi,AICP, Director, Department of Planning &Zoning Steve Carnell, Department Director Laurie Beard, PUD/SRA Monitoring 2 Packet Page-60- 4/22/2014 11 .A. __ ,... , r I 4.4 ul it ! ets — i bj E ! f Poo* 113414 110 _10, ' A `vs"' .,- ,.:•.,,,,,i..4..ipbtr..„,is,z,,,, ',...,142--,-, j: Ili N. .... ...A.44, , rc Q C.' a, F •i2 Z1471 `4' t 4b. re h:•-• r.' t i. c r4... --4 rt. I 7:-. -3 ' • "r• . .• IC 'D. . vl 8 47. b 6 4' ji, 1“. ■13 kt*" ''' ' 11 .4 t, . 4 ...t a t) ....i. 41.1111.6 -110 '1f",:":,!-:,',",c, '.,. ..•-s-1.',.;.is,,,,:',,,, 1?" OOP ,,,'•' ,r,„,:`-‘,.ti'''',"'''',..c- ",,f,:t filming. "ph 011 , 10.11111 I 4: -pi01111111‘ . h.IN ..1 sit. It, A lk 1 fej,e r _ ',:',t4"t"" .."4,44,1.1t7-4"4"i'l';',•''''•.:4 ''' 1 i v. ';".4t.'f'• 4,,,D:.., „yv,.,,,,..,,,,,,T,,..e.: r I ' 1 ' eti4 t!'•••". 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AVE MARIA DEVELOPMENT, LLLP April 11, 2014 Collier County Board of County Commissioners 3299 Tamiami Trail East, Suite 303 Naples, Florida 34112-5746 Re: Site Selection Process - State Veterans Homes Program Florida Department of Veterans' Affairs Dear Chairman Henning: Ave Maria Development, LLLP ("AMD") has been working with Collier County staff ("Staff") in identifying potential sites within the Ave Maria community that the County will use to nominate for the Florida Department of Veterans' Affairs("FDVA") planned seventh State Veterans Home. The purpose of this letter is to serve as AMD's commitment to the Board of County Commissioners that, in cooperation with Staff's preparation of a site selection application, we will agree to donate to the FDVA a suitable site of 20 acres within the Ave Maria community which meets their Site Selection Criteria. Furthermore, all costs associated with the determination of the site suitability pursuant to Part II and Part III of FJJVA's Site Selection Criteria will be borne by AMD. We look forward to working with the Board of County Commissioners and Staff in the preparation of the application. If you have questions regarding this letter please do not hesitate to contact me. Sincerely, )12._ Blake Gable Ave Maria Development, LLLP 2600 Golden Gate Parkway, Naples, Florida 341(Packet Page-62- .2600 Fax 239.403.6808 www.avemaria.com 4/22/2014 11 .A. WF Southwest Florida Regional Planning Council Regional Economic Analysis Program Featuring REMI Policy Insight® Project Collier VA Nursing Home - Assisted Living Facility (ALF) The Southwest Florida Regional Planning Council (SWFRPC) has conducted an analysis on a VA Nursing Home-Assisted Living Facility (ALF) in Collier County. Project VA Nursing Home would expand to employ 120 additional workers. SWFRPC utilized its REMI Policy Insight model to generate the employment forecasts. Employment Impacts The firm would employ 190 new workers. These 190 new direct jobs coupled with the estimated sales are estimated to create an additional 107 indirect and induced jobs for a total of 297 new jobs in Collier County. These combined jobs generate an average of$18.8 million annually in personal income. Total new employment would contribute an average of$20 million to the Gross County Product each year. The Gross County Product is a concept analogous to the national Gross Domestic Product. It is equal to output excluding the intermediate inputs. It represents compensation and profits. Below is a table depicting the annual changes. : .Project Collier VA Nursing Home-Assisted Living Facility(AtLF) N ear Yaar4_'; `Fear > ' ear 5 Year'7 Year.B, ear 9 Year 10 2014 2015 2016 2017 2018 2019 2020 2021 2022 20231 Information/Technology/ Health Employment 190 190 190 190 190 190 190 190 190 190 Average COLLIER IMPACTS Annual rlf Collier Employment 292 296 297 297 295 294 294 294 295 296 Gross County Product($ Mil) 18.79 19.64 20.21 20.67 21.07 21.44_ 21.82 22.25 22.72 23.24 20.07 100 Personal Income($Mil) 14.52 16.94 19.00 20.861 22.56 24.11 25.60 27.13 28.69 30.30 18.78 94 Average Wage $ 49,795 $ 57,180 $ 63,918 $ 70,335 $ 76,374 $ 81,887 $ 87,141 $92,311 $97,396 $102,442 Multiplier 1.54 1.56 1.56 1.56 1.55 1.55 1.55 1.55 1.55 1.56 All figures are in 2014 U.S.Dollars. Averages are calculated for the first 5 years of the report. Otherwise the numbers could be skewed from inflation. Prepared April 14,2014 Packet Page-63-