BILL NUMBER: SB 962 CHAPTERED
BILL TEXT
CHAPTER 558
FILED WITH SECRETARY OF STATE OCTOBER 5, 2005
APPROVED BY GOVERNOR OCTOBER 5, 2005
PASSED THE SENATE SEPTEMBER 7, 2005
PASSED THE ASSEMBLY AUGUST 31, 2005
AMENDED IN ASSEMBLY AUGUST 25, 2005
AMENDED IN ASSEMBLY JULY 1, 2005
AMENDED IN ASSEMBLY JUNE 22, 2005
AMENDED IN SENATE MAY 27, 2005
INTRODUCED BY Senator Chesbro
(Coauthors: Senators Alquist, Kuehl, and Romero)
(Coauthors: Assembly Members Evans and Laird)
FEBRUARY 22, 2005
An act to amend Sections 1507.3, 1524, 1538, 1562, 1562.3, and
1562.4 of, to add Section 1538.55 to, and to add and repeal Article 9
(commencing with Section 1567.50) to Chapter 3 of Division 2 of, the
Health and Safety Code, and to add and repeal Article 3.5
(commencing with Section 4684.50) to Chapter 6 of Division 4.5 of,
the Welfare and Institutions Code, relating to developmental
services.
LEGISLATIVE COUNSEL'S DIGEST
SB 962, Chesbro Adult Residential Facility for Persons with
Special Health Care Needs: pilot project.
Existing law, the California Community Care Facilities Act,
provides for the licensure and regulation of community care and
residential facilities by the State Department of Social Services.
Under existing law, a violation of any of these provisions is
punishable as a misdemeanor.
Existing law establishes the State Department of Developmental
Services and sets forth its duties and responsibilities, including,
but not limited to, administration and oversight of the state
developmental centers and programs relating to persons with
developmental disabilities. Existing law, the Lanterman Developmental
Disabilities Services Act, requires the department to allocate funds
to private nonprofit regional centers for the provision of community
services and support for persons with developmental disabilities and
their families. Violation of community care licensing provisions is
a crime.
This bill would, until January 1, 2010, authorize the State
Department of Social Services and the State Department of
Developmental Services, to jointly establish and administer a pilot
project for licensing and regulating Adult Residential Facilities for
Persons with Special Health Care Needs, to the extent that funds are
appropriated for this purpose in the annual Budget Act, and would
make conforming changes. The bill would authorize entering into a
contract for independent evaluation of the program, and would require
a report to the Legislature by January 1, 2009. By changing the
definition of crimes provided for under the California Community Care
Facilities Act, this bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1507.3 of the Health and Safety Code is amended
to read:
1507.3. (a) A residential facility that provides care to adults
may obtain a waiver from the department for the purpose of allowing a
resident who has been diagnosed as terminally ill by his or her
physician or surgeon to remain in the facility, or allowing a person
who has been diagnosed as terminally ill by his or her physician and
surgeon to become a resident of the facility if that person is
already receiving hospice services and would continue to receive
hospice services without disruption if he or she became a resident,
when all of the following conditions are met:
(1) The facility agrees to retain the terminally ill resident, or
accept as a resident the terminally ill person, and to seek a waiver
on behalf of the individual, provided the individual has requested
the waiver and is capable of deciding to obtain hospice services.
(2) The terminally ill resident, or the terminally ill person to
be accepted as a resident, has obtained the services of a hospice
certified in accordance with federal medicare conditions of
participation and licensed pursuant to Chapter 8 (commencing with
Section 1725) or Chapter 8.5 (commencing with Section 1745).
(3) The facility, in the judgment of the department, has the
ability to provide care and supervision appropriate to meet the needs
of the terminally ill resident, or the terminally ill person to be
accepted as a resident, and is in substantial compliance with
regulations governing the operation of residential facilities that
provide care to adults.
(4) The hospice has agreed to design and provide for care,
services, and necessary medical intervention related to the terminal
illness as necessary to supplement the care and supervision provided
by the facility.
(5) An agreement has been executed between the facility and the
hospice regarding the care plan for the terminally ill resident, or
the terminally ill person to be accepted as a resident. The care plan
shall designate the primary caregiver, identify other caregivers,
and outline the tasks the facility is responsible for performing and
the approximate frequency with which they shall be performed. The
care plan shall specifically limit the facility's role for care and
supervision to those tasks authorized for a residential facility
under this chapter.
(6) The facility has obtained the agreement of those residents who
share the same room with the terminally ill resident, or any
resident who will share a room with the terminally ill person to be
accepted as a resident, to allow the hospice caregivers into their
residence.
(b) At any time that the licensed hospice, the facility, or the
terminally ill resident determines that the resident's condition has
changed so that continued residence in the facility will pose a
threat to the health and safety of the terminally ill resident or any
other resident, the facility may initiate procedures for a transfer.
(c) A facility that has obtained a hospice waiver from the
department pursuant to this section, or an Adult Residential Facility
for Persons with Special Health Care Needs (ARFPSHN) licensed
pursuant to Article 9 (commencing with Section 1567.50), need not
call emergency response services at the time of a life-threatening
emergency if the hospice agency is notified instead and all of the
following conditions are met:
(1) The resident is receiving hospice services from a licensed
hospice agency.
(2) The resident has completed an advance directive, as defined in
Section 4605 of the Probate Code, requesting to forego resuscitative
measures.
(3) The facility has documented that facility staff have received
training from the hospice agency on the expected course of the
resident's illness and the symptoms of impending death.
(d) Nothing in this section is intended to expand the scope of
care and supervision for a residential facility, as defined in this
chapter, that provides care to adults nor shall a facility be
required to alter or extend its license in order to retain a
terminally ill resident, or allow a terminally ill person to become a
resident of the facility, as authorized by this section.
(e) Nothing in this section shall require any care or supervision
to be provided by the residential facility beyond that which is
permitted in this chapter.
(f) Nothing in this section is intended to expand the scope of
life care contracts or the contractual obligation of continuing care
retirement communities as defined in Section 1771.
(g) The department shall not be responsible for the evaluation of
medical services provided to the resident by the hospice and shall
have no liability for the independent acts of the hospice.
(h) The department, in consultation with the State Fire Marshal,
shall develop and expedite implementation of regulations related to
residents who have been diagnosed as terminally ill who remain in the
facility and who are nonambulatory that ensure resident safety but
also provide flexibility to allow residents to remain in the least
restrictive environment.
(i) Nothing in this section shall be construed to relieve a
licensed residential facility that provides care to adults of its
responsibility, for purposes of allowing a resident who has been
diagnosed as terminally ill to remain in the facility, to do both of
the following:
(1) With regard to any resident who is bedridden, as defined in
subdivision (a) of Section 1566.45, to, within 48 hours of the
resident's retention in the facility, notify the local fire authority
with jurisdiction in the bedridden resident's location of the
estimated length of time the resident will retain his or her
bedridden status in the facility.
(2) Secure a fire clearance approval from the city or county fire
department, fire district, or any other local agency providing fire
protection services, or the State Fire Marshal, whichever has primary
fire protection jurisdiction.
(j) The requirement in paragraph (1) of subdivision (a) to obtain
a waiver, and the requirement in paragraph (1) of subdivision (i) to
notify the local fire authority, shall not apply to a facility
licensed as an ARFPSHN pursuant to Article 9 (commencing with Section
1567.50).
SEC. 1.5. Section 1524 of the Health and Safety Code is amended to
read:
1524. A license shall be forfeited by operation of law when one
of the following occurs:
(a) The licensee sells or otherwise transfers the facility or
facility property, except when change of ownership applies to
transferring of stock when the facility is owned by a corporation,
and when the transfer of stock does not constitute a majority change
of ownership.
(b) The licensee surrenders the license to the department.
(c) The licensee moves a facility from one location to another.
The department shall develop regulations to ensure that the
facilities are not charged a full licensing fee and do not have to
complete the entire application process when applying for a license
for the new location.
(d) The licensee is convicted of an offense specified in Section
220, 243.4, or 264.1, or paragraph (1) of Section 273a, Section 273d,
288, or 289 of the Penal Code, or is convicted of another crime
specified in subdivision (c) of Section 667.5 of the Penal Code.
(e) The licensee dies. If an adult relative notifies the
department of his or her desire to continue operation of the facility
and submits an application, the department shall expedite the
application. The department shall promulgate regulations for
expediting applications submitted pursuant to this subdivision.
(f) The licensee abandons the facility.
(g) When the certification issued by the State Department of
Developmental Services to a licensee of an Adult Residential Facility
for Persons with Special Health Care Needs, licensed pursuant to
Article 9 (commencing with Section 1567.50), is rescinded.
SEC. 2. Section 1538 of the Health and Safety Code is amended to
read:
1538. (a) Any person may request an inspection of any community
care facility or certified family home in accordance with this
chapter by transmitting to the state department notice of an alleged
violation of applicable requirements prescribed by statutes or
regulations of this state, including, but not limited to, a denial of
access of any person authorized to enter the facility pursuant to
Section 9701 of the Welfare and Institutions Code. A complaint may be
made either orally or in writing.
(b) The substance of the complaint shall be provided to the
licensee or certified family home and foster family agency no earlier
than at the time of the inspection. Unless the complainant
specifically requests otherwise, neither the substance of the
complaint provided the licensee or certified family home and foster
family agency nor any copy of the complaint or any record published,
released, or otherwise made available to the licensee or certified
family home and foster family agency shall disclose the name of any
person mentioned in the complaint except the name of any duly
authorized officer, employee, or agent of the state department
conducting the investigation or inspection pursuant to this chapter.
(c) Upon receipt of a complaint, other than a complaint alleging
denial of a statutory right of access to a community care facility or
certified family home, the state department shall make a preliminary
review and, unless the state department determines that the
complaint is willfully intended to harass a licensee or is without
any reasonable basis, it shall make an onsite inspection of the
community care facility or certified family home within 10 days after
receiving the complaint, except where a visit would adversely affect
the licensing investigation or the investigation of other agencies.
In either event, the complainant shall be promptly informed of the
state department's proposed course of action.
If the department determines that the complaint is intended to
harass, is without a reasonable basis, or, after a site inspection,
is unfounded, then the complaint and any documents related to it
shall be marked confidential and shall not be disclosed to the
public. If the complaint investigation included a site visit, the
licensee or certified family home and foster family agency shall be
notified in writing within 30 days of the dismissal that the
complaint has been dismissed.
(d) Upon receipt of a complaint alleging denial of a statutory
right of access to a community care facility or certified family
home, the state department shall review the complaint. The
complainant shall be notified promptly of the state department's
proposed course of action.
(e) The department shall commence performance of complaint
inspections of certified family homes upon the employment of
sufficient personnel to carry out this function, and by no later than
June 30, 1999. Upon implementation, the department shall notify all
licensed foster family agencies.
(f) Upon receipt of a complaint concerning the care of a client in
an Adult Residential Facility for Persons with Special Health Care
Needs licensed pursuant to Article 9 (commencing with Section
1567.50), the department shall notify the appropriate regional center
and the State Department of Developmental Services for the purposes
of investigating the complaint.
(g) Upon receipt of a complaint concerning the vendorization of an
Adult Residential Facility for Persons with Special Health Care
Needs, the department shall notify the State Department of
Developmental Services for purposes of investigating the complaint.
SEC. 3. Section 1538.55 is added to the Health and Safety Code,
immediately following Section 1538.5, to read:
1538.55. (a) The licensee of an Adult Residential Facility for
Persons with Special Health Care Needs (ARFPSHN), licensed pursuant
to Article 9 (commencing with Section 1567.50), shall report to the
department's Community Care Licensing Division, within the department'
s next working day and to the regional center with whom the ARFPSHN
contracts, and the State Department of Developmental Services, within
24 hours upon the occurrence of any of the following events:
(1) The death of any client from any cause.
(2) The use of an automated external defibrillator.
(3) Any injury to any client that requires medical treatment.
(4) Any unusual incident that threatens the physical or emotional
health or safety of any client.
(5) Any suspected physical or psychological abuse of any client.
(6) Epidemic outbreaks.
(7) Poisonings.
(8) Catastrophes.
(9) Fires or explosions that occur in or on the premises.
(b) The licensee additionally shall submit a written report to the
department's Community Care Licensing Division, the regional center
with whom the ARFPSHN contracts, and the State Department of
Developmental Services within seven days following any event set
forth in subdivision (a), and shall include the following:
(1) Client's name, age, sex, and date of admission.
(2) The date and nature of event.
(3) The attending physician's name, findings, and treatment, if
any.
(4) The disposition of the case.
(c) The department's Community Care Licensing Division shall
notify the State Department of Developmental Services upon its
findings of any deficiencies or of possible actions to exclude,
pursuant to Section 1558, any individual from an ARFPSHN.
SEC. 4. Section 1562 of the Health and Safety Code is amended to
read:
1562. The director shall ensure that operators and staffs of
community care facilities have appropriate training to provide the
care and services for which a license or certificate is issued. The
section shall not apply to a facility licensed as an Adult
Residential Facility for Persons with Special Health Care Needs
pursuant to Article 9 (commencing with Section 1567.50).
SEC. 5. Section 1562.3 of the Health and Safety Code is amended to
read:
1562.3. (a) The Director of Social Services, in consultation with
the Director of Mental Health and the Director of Developmental
Services, shall establish a training program to ensure that
licensees, operators, and staffs of adult residential facilities, as
defined in paragraph (1) of subdivision (a) of Section 1502, have
appropriate training to provide the care and services for which a
license or certificate is issued. The training program shall be
developed in consultation with provider organizations.
(b) (1) An administrator of an adult residential care facility, as
defined in paragraph (1) of subdivision (a) of Section 1502, shall
successfully complete a department approved certification program
pursuant to subdivision (c) prior to employment.
(2) In those cases where the individual is both the licensee and
the administrator of a facility, the individual shall comply with
both the licensee and administrator requirements of this section.
(3) Failure to comply with this section shall constitute cause for
revocation of the license of the facility.
(4) The licensee shall notify the department within 30 days of any
change in administrators.
(c) (1) The administrator certification program shall require a
minimum of 35 hours of classroom instruction that provides training
on a uniform core of knowledge in each of the following areas:
(A) Laws, regulations, and policies and procedural standards that
impact the operations of the type of facility for which the applicant
will be an administrator.
(B) Business operations.
(C) Management and supervision of staff.
(D) Psychosocial needs of the facility residents.
(E) Community and support services.
(F) Physical needs for facility residents.
(G) Use, misuse, and interaction of medication commonly used by
facility residents.
(H) Resident admission, retention, and assessment procedures.
(I) Nonviolent crisis intervention for administrators.
(2) The requirement for 35 hours of classroom instruction pursuant
to this subdivision shall not apply to persons who were employed as
administrators prior to July 1, 1996. A person holding the position
of administrator of an adult residential facility on June 30, 1996,
shall file a completed application for certification with the
department on or before April 1, 1998. In order to be exempt from the
35-hour training program and the test component, the application
shall include documentation showing proof of continuous employment as
the administrator of an adult residential facility between, at a
minimum, June 30, 1994, and June 30, 1996. An administrator of an
adult residential facility who became certified as a result of
passing the department-administered challenge test, that was offered
between October 1, 1996, and December 23, 1996, shall be deemed to
have fulfilled the requirements of this paragraph.
(3) Unless an extension is granted to the applicant by the
department, an applicant for an administrator's certificate shall,
within 60 days of the applicant's completion of classroom
instruction, pass the written test provided in this section.
(d) The department shall not begin the process of issuing a
certificate until receipt of all of the following:
(1) A certificate of completion of the administrator training
required pursuant to this chapter.
(2) The fee required for issuance of the certificate. A fee of one
hundred dollars ($100) shall be charged by the department to cover
the costs of processing the application for certification.
(3) Documentation from the applicant that he or she has passed the
written test.
(4) Submission of fingerprints. The department and the Department
of Justice shall expedite the criminal record clearance for holders
of certificates of completion. The department may waive the
submission for those persons who have a current clearance on file.
(e) It shall be unlawful for any person not certified under this
section to hold himself or herself out as a certified administrator
of an adult residential facility. Any person willfully making any
false representation as being a certified administrator is guilty of
a misdemeanor.
(f) (1) Certificates issued under this section shall be renewed
every two years and renewal shall be conditional upon the certificate
holder submitting documentation of completion of 40 hours of
continuing education related to the core of knowledge specified in
subdivision (c). For purposes of this section, an individual who is
an adult residential facility administrator and who is required to
complete the continuing education hours required by the regulations
of the State Department of Developmental Services, and approved by
the regional center, shall be permitted to have up to 24 of the
required continuing education course hours credited toward the
40-hour continuing education requirement of this section. Community
college course hours approved by the regional centers shall be
accepted by the department for certification.
(2) Every licensee and administrator of an adult residential
facility is required to complete the continuing education
requirements of this subdivision.
(3) Certificates issued under this section shall expire every two
years, on the anniversary date of the initial issuance of the
certificate, except that any administrator receiving his or her
initial certification on or after January 1, 1999, shall make an
irrevocable election to have his or her recertification date for any
subsequent recertification either on the date two years from the date
of issuance of the certificate or on the individual's birthday
during the second calendar year following certification. The
department shall send a renewal notice to the certificate holder 90
days prior to the expiration date of the certificate. If the
certificate is not renewed prior to its expiration date,
reinstatement shall only be permitted after the certificate holder
has paid a delinquency fee equal to three times the renewal fee and
has provided evidence of completion of the continuing education
required.
(4) To renew a certificate, the certificate holder shall, on or
before the certificate expiration date, request renewal by submitting
to the department documentation of completion of the required
continuing education courses and pay the renewal fee of one hundred
dollars ($100), irrespective of receipt of the department's
notification of the renewal. A renewal request postmarked on or
before the expiration of the certificate is proof of compliance with
this paragraph.
(5) A suspended or revoked certificate is subject to expiration as
provided for in this section. If reinstatement of the certificate is
approved by the department, the certificate holder, as a condition
precedent to reinstatement, shall submit proof of compliance with
paragraphs (1) and (2) of subdivision (f) and shall pay a fee in an
amount equal to the renewal fee, plus the delinquency fee, if any,
accrued at the time of its revocation or suspension. Delinquency
fees, if any, accrued subsequent to the time of its revocation or
suspension and prior to an order for reinstatement, shall be waived
for one year to allow the individual sufficient time to complete the
required continuing education units and to submit the required
documentation. Individuals whose certificates will expire within 90
days after the order for reinstatement may be granted a three-month
extension to renew their certificates during which time the
delinquency fees shall not accrue.
(6) A certificate that is not renewed within four years after its
expiration shall not be renewed, restored, reissued, or reinstated
except upon completion of a certification training program, passing
any test that may be required of an applicant for a new certificate
at that time, and paying the appropriate fees provided for in this
section.
(7) A fee of twenty-five dollars ($25) shall be charged for the
reissuance of a lost certificate.
(8) A certificate holder shall inform the department of his or her
employment status within 30 days of any change.
(g) The certificate shall be considered forfeited under the
following conditions:
(1) The administrator has had a license revoked, suspended, or
denied as authorized under Section 1550.
(2) The administrator has been denied employment, residence, or
presence in a facility based on action resulting from an
administrative hearing pursuant to Section 1522 or Section 1558.
(h) (1) The department, in consultation with the State Department
of Mental Health and the State Department of Developmental Services,
shall establish, by regulation, the program content, the testing
instrument, the process for approving certification training
programs, and criteria to be used in authorizing individuals,
organizations, or educational institutions to conduct certification
training programs and continuing education courses. These regulations
shall be developed in consultation with provider organizations, and
shall be made available at least six months prior to the deadline
required for certification. The department may deny vendor approval
to any agency or person in any of the following circumstances:
(A) The applicant has not provided the department with evidence
satisfactory to the department of the ability of the applicant to
satisfy the requirements of vendorization set out in the regulations
adopted by the department pursuant to subdivision (i).
(B) The applicant person or agency has a conflict of interest in
that the person or agency places its clients in adult residential
facilities.
(C) The applicant public or private agency has a conflict of
interest in that the agency is mandated to place clients in adult
residential facilities and to pay directly for the services. The
department may deny vendorization to this type of agency only as long
as there are other vendor programs available to conduct the
certification training programs and conduct education courses.
(2) The department may authorize vendors to conduct the
administrator's certification training program pursuant to provisions
set forth in this section. The department shall conduct the written
test pursuant to regulations adopted by the department.
(3) The department shall prepare and maintain an updated list of
approved training vendors.
(4) The department may inspect certification training programs and
continuing education courses to determine if content and teaching
methods comply with regulations. If the department determines that
any vendor is not complying with the intent of this section, the
department shall take appropriate action to bring the program into
compliance, which may include removing the vendor from the approved
list.
(5) The department shall establish reasonable procedures and
timeframes not to exceed 30 days for the approval of vendor training
programs.
(6) The department may charge a reasonable fee, not to exceed one
hundred fifty dollars ($150) every two years to certification program
vendors for review and approval of the initial 35-hour training
program pursuant to subdivision (c). The department may also charge
the vendor a fee not to exceed one hundred dollars ($100) every two
years for the review and approval of the continuing education courses
needed for recertification pursuant to this subdivision.
(i) This section shall be operative upon regulations being adopted
by the department, no later than July 1, 1996, to implement the
administrator certification program as provided for in this section.
If regulations are not adopted by the department, or are adopted
after July 1, 1996, this section shall not become operative.
(j) The department shall establish a registry for holders of
certificates that shall include, at a minimum, information on
employment status and criminal record clearance.
SEC. 6. Section 1562.4 of the Health and Safety Code is amended to
read:
1562.4. Any person who becomes an administrator of an adult
residential facility, as defined in paragraph (1) of subdivision (a)
of Section 1502, on or after July 1, 1996, shall, at a minimum,
fulfill all of the following requirements:
(a) Be at least 21 years of age.
(b) Provide documentation of having successfully completed a
certification program approved by the department and successfully
passing the state examination.
(c) Have a high school diploma or pass a general educational
development test as described in Article 3 (commencing with Section
51420) of Chapter 3 of Part 28 of the Education Code.
(d) Obtain a criminal record clearance as provided for in
Sections 1522 and 1522.03.
SEC. 7. Article 9
(commencing with Section 1567.50) is added to Chapter 3 of Division 2
of the Health and Safety Code, to read:
Article 9. Adult Residential Facilities for Persons with
Special Health Care Needs: Licensing
1567.50. (a) Notwithstanding that a community care facility means
a place that provides nonmedical care under subdivision (a) of
Section 1502, pursuant to Article 3.5 (commencing with Section
4684.50) of Chapter 6 of Division 4.5 of the Welfare and Institutions
Code, the department shall jointly implement with the State
Department of Developmental Services a pilot project to test the
effectiveness of providing special health care and intensive support
services to adults in homelike community settings.
(b) The State Department of Social Services may license, subject
to the following conditions, an Adult Residential Facility for
Persons with Special Health Care Needs to provide 24-hour services to
up to five adults with developmental disabilities who have special
health care and intensive support needs, as defined in subdivisions
(f) and (g) of Section 4684.50 of the Welfare and Institutions Code.
(1) The State Department of Developmental Services shall be
responsible for granting the certificate of program approval for an
Adult Residential Facility for Persons with Special Health Care Needs
(ARFPSHN). The State Department of Social Services shall not issue a
license unless the applicant has obtained a certification of program
approval from the State Department of Developmental Services.
(2) The State Department of Social Services shall ensure that the
ARFPSHN meets the administration requirements under Article 2
(commencing with Section 1520) including, but not limited to,
requirements relating to fingerprinting and criminal records under
Section 1522.
(3) The State Department of Social Services shall administer
employee actions under Article 5.5 (commencing with Section 1558).
(4) The regional center shall monitor and enforce compliance of
the program and health and safety requirements, including monitoring
and evaluating the quality of care and intensive support services.
The State Department of Developmental Services shall ensure that the
regional center performs these functions.
(5) The State Department of Developmental Services may decertify
any ARFPSHN that does not comply with program requirements. When the
State Department of Developmental Services determines that urgent
action is necessary to protect clients of the ARFPSHN from physical
or mental abuse, abandonment, or any other substantial threat to
their health and safety, the State Department of Developmental
Services may request the regional center or centers to remove the
clients from the ARFPSHN or direct the regional center or centers to
obtain alternative services for the consumers within 24 hours.
(6) The State Department of Social Services may initiate
proceedings for temporary suspension of the license pursuant to
Section 1550.5.
(7) The State Department of Developmental Services, upon its
decertification, shall inform the State Department of Social Services
of the licensee's decertification, with its recommendation
concerning revocation of the license, for which the State Department
of Social Services may initiate proceedings pursuant to Section 1550.
(8) The State Department of Developmental Services and the
regional centers shall provide the State Department of Social
Services all available documentation and evidentiary support
necessary for any enforcement proceedings to suspend the license
pursuant to Section 1550.5, to revoke or deny a license pursuant to
Section 1551, or to exclude an individual pursuant to Section 1558.
(9) The State Department of Social Services Community Care
Licensing Division shall enter into a memorandum of understanding
with the State Department of Developmental Services to outline a
formal protocol to address shared responsibilities, including
monitoring responsibilities, complaint investigations, administrative
actions, and closures.
(10) The licensee shall provide documentation that, in addition to
the administrator requirements set forth under paragraph (4) of
subdivision (a) of Section 4684.63 of the Welfare and Institutions
Code, the administrator, prior to employment, has completed a minimum
of 35 hours of initial training in the general laws, regulations and
policies and procedural standards applicable to facilities licensed
by the State Department of Social Services under Article 2
(commencing with Section 1520). Thereafter, the licensee shall
provide documentation every two years that the administrator has
completed 40 hours of continuing education in the general laws,
regulations and policies and procedural standards applicable to adult
residential facilities. The training specified in this section shall
be provided by a vendor approved by the State Department of Social
Services and the cost of the training shall be borne by the
administrator or licensee.
(c) The article shall remain in effect only until January 1, 2010,
and as of that date is repealed, unless a later enacted statute
extends or deletes that date.
(d) This article shall only be implemented to the extent that
funds are made available through an appropriation in the annual
Budget Act.
SEC. 8. Article 3.5 (commencing with Section 4684.50) is added to
Chapter 6 of Division 4.5 of the Welfare and Institutions Code, to
read:
Article 3.5. Adult Residential Facilities for Persons with
Special Health Care Needs: Pilot Program
4684.50. (a) (1) "Adult Residential Facility for Persons with
Special Health Care Needs (ARFPSHN)" means any adult residential
facility that provides 24-hour health care and intensive support
services in a homelike setting that is licensed to serve up to five
adults with developmental disabilities as defined in Section 4512.
(2) For purposes of this article, an ARFPSHN may be established in
a facility financed pursuant to Section 4688.5.
(b) "Consultant" means a person professionally qualified by
training and experience to give expert advice, information, training,
or to provide health-related assessments and interventions specified
in a consumer's individual health care plan.
(c) "Direct care personnel" means all personnel who directly
provide program or nursing services to consumers. Administrative and
licensed personnel shall be considered direct care personnel when
directly providing program or nursing services to clients.
Consultants shall not be considered direct care personnel.
(d) "Individual health care plan" means the plan that identifies
and documents the health care and intensive support service needs of
a consumer.
(e) "Individual health care plan team" means those individuals who
develop, monitor, and revise the individual health care plan for
consumers residing in an Adult Residential Facility for Persons with
Special Health Care Needs. The team shall, at a minimum, be composed
of all of the following individuals:
(1) Regional center service coordinator and other regional center
representative, as necessary.
(2) Consumer, and, where appropriate, his or her parents, legal
guardian or conservator, or authorized representative.
(3) Consumer's primary care physician, or other physician as
designated by the regional center.
(4) ARFPSHN administrator.
(5) ARFPSHN registered nurse.
(6) Others deemed necessary for developing a comprehensive and
effective plan.
(f) "Intensive support needs" means the consumer requires physical
assistance in performing four or more of the following activities of
daily living:
(1) Eating.
(2) Dressing.
(3) Bathing.
(4) Transferring.
(5) Toileting.
(6) Continence.
(g) "Special health care needs" means the consumer has health
conditions that are predictable and stable, as determined by the
individual health care plan team, and for which the individual
requires nursing supports for any of the following types of care:
(1) Nutrition support, including total parenteral feeding and
gastrostomy feeding, and hydration.
(2) Cardiorespiratory monitoring.
(3) Oxygen support, including continuous positive airway pressure
and bilevel positive airway pressure, and use of other
inhalation-assistive devices.
(4) Nursing interventions for tracheostomy care and suctioning.
(5) Nursing interventions for colostomy, ileostomy, or other
medical or surgical procedures.
(6) Special medication regimes including injection and intravenous
medications.
(7) Management of insulin-dependent diabetes.
(8) Manual fecal impaction, removal, enemas, or suppositories.
(9) Indwelling urinary catheter/catheter procedure.
(10) Treatment for staphylococcus infection.
(11) Treatment for wounds or pressure ulcers (stages 1 and 2).
(12) Postoperative care and rehabilitation.
(13) Pain management and palliative care.
(14) Renal dialysis.
4684.53. (a) The State Department of Developmental Services and
the State Department of Social Services shall jointly implement a
pilot project to test the effectiveness of providing special health
care and intensive support services to adults in homelike community
settings.
(b) The pilot project shall be implemented through the following
regional centers only:
(1) The San Andreas Regional Center.
(2) The Regional Center of the East Bay.
(3) The Golden Gate Regional Center.
(c) The regional centers participating in this pilot project may
contract for an aggregate total of services for no more than 120
persons in an ARFPSHN.
(d) Each ARFPSHN shall possess a community care facility license
issued pursuant to Article 9 (commencing with Section 1567.50) of
Chapter 3 of Division 2 of the Health and Safety Code, and shall be
subject to the requirements of Chapter 1 (commencing with Section
80000) of Division 6 of Title 22 of the California Code of
Regulations, except for Article 8 (commencing with Section 80090).
(e) For purposes of this article, a health facility licensed
pursuant to subdivision (e) or (h) of Section 1250 may place its
licensed bed capacity in voluntary suspension for the purpose of
using the facility to operate an ARFPSHN if the facility is selected
to participate in the pilot project pursuant to Section 4684.58.
Consistent with subdivision (a) of Section 4684.50, any facility
selected to participate in the program shall be licensed to serve up
to five adults. A facility's bed capacity shall not be placed in
voluntary suspension until all consumers residing in the facility
under the license to be suspended have been relocated. No consumer
may be relocated unless it is reflected in the consumer's individual
program plan developed pursuant to Sections 4646 and 4646.5.
(f) Each ARFPSHN shall be subject to the requirements of
Subchapters 5 through 9 of Chapter 1 of, and Subchapters 2 and 4 of
Chapter 3 of, Division 2 of Title 17 of the California Code of
Regulations.
(g) Each ARFPSHN shall ensure that an operable automatic fire
sprinkler system is installed and maintained.
(h) Each ARFPSHN shall have an operable automatic fire sprinkler
system that is approved by the State Fire Marshal and that meets the
National Fire Protection Association (NFPA) 13D standard for the
installation of sprinkler systems in single- and two-family dwellings
and manufactured homes. A local jurisdiction shall not require a
sprinkler system exceeding this standard by amending the standard or
by applying standards other than NFPA 13D. A public water agency
shall not interpret this section as changing the status of a facility
from a residence entitled to residential water rates, nor shall a
new meter or larger connection pipe be required of the facility.
(i) Each ARFPSHN shall provide an alternative power source to
operate all functions of the facility for a minimum of six hours in
the event the primary power source is interrupted. The alternative
power source shall comply with Section 517-50 of the California
Electric Code. The alternative power source shall be maintained in
safe operating condition, and shall be tested every 14 days under the
full load condition for a minimum of 10 minutes. Written records of
inspection, performance, exercising period, and repair of the
alternative power source shall be regularly maintained on the
premises and available for inspection by the State Department of
Developmental Services.
4684.55. (a) No regional center may pay a rate to any ARFPSHN for
any consumer that exceeds the average annual cost of serving a
consumer at Agnews Developmental Center, as determined by the State
Department of Developmental Services.
(b) The payment rate for ARFPSHN services shall be negotiated
between the regional center and the ARFPSHN, and shall be paid by the
regional center under the service code "Specialized Residential
Facility (Habilitation)."
(c) The established rate for a full month of service shall be made
by the regional center when a consumer is temporarily absent from
the ARFPSHN 14 days or less per month. When the consumer's temporary
absence is due to the need for inpatient care in a health facility,
as defined in subdivision (a), (b), or (c) of Section 1250 of the
Health and Safety Code, the regional center shall continue to pay the
established rate as long as no other consumer occupies the vacancy
created by the consumer's temporary absence, or until the individual
health care plan team has determined that the consumer will not
return to the facility. In all other cases, the established rate
shall be prorated for a partial month of service by dividing the
established rate by 30.44 then by multiplying the quotient by the
number of days the consumer resided in the facility.
4684.58. The regional center may recommend for participation, the
State Department of Developmental Services, an applicant for this
pilot project when the applicant meets all of the following
requirements and has been selected through a request for proposals
process issued by one or more of the three participating regional
centers:
(a) The applicant employs or contracts with a program
administrator who has a successful record of administering
residential services for at least two years, as evidenced by
substantial compliance with the applicable state licensing
requirements.
(b) The applicant prepares and submits, to the regional center, a
complete facility program plan that includes, but is not limited to,
all of the following:
(1) The total number of the consumers to be served.
(2) A profile of the consumer population to be served, including
their health care and intensive support needs.
(3) A description of the program components, including a
description of the health care and intensive support services to be
provided.
(4) A week's program schedule, including proposed consumer day and
community integration activities.
(5) A week's proposed program staffing pattern, including
licensed, unlicensed, and support personnel and the number and
distribution of hours for such personnel.
(6) An organizational chart, including identification of lead and
supervisory personnel.
(7) The consultants to be utilized, including their professional
disciplines and hours to be worked per week or month, as appropriate.
(8) The plan for accessing and retaining consultant and health
care services, including assessments, in the areas of physical
therapy, occupational therapy, respiratory therapy, speech pathology,
audiology, pharmacy, dietary/nutrition, dental, and other areas
required for meeting the needs identified in consumers' individual
health care plans.
(9) A description, including the size, layout, location, and
condition of the proposed home.
(10) A description of the equipment and supplies available, or to
be obtained, for programming and care.
(11) The type, location, and response time of emergency medical
service personnel.
(12) The in-service training program plan for at least the next 12
months.
(13) The plan for ensuring that outside services are coordinated,
integrated, and consistent with those provided by the ARFPSHN.
(14) Written certification that an alternative power system
required by subdivision (i) of Section 4684.53 meets the manufacturer'
s recommendations for installation and operation.
(c) Submits a proposed budget itemizing direct and indirect costs,
total costs, and the rate for services.
(d) Certifies, in writing, that the applicant has the ability to
comply with all of the requirements of Section 1520 of the Health and
Safety Code.
(e) The regional center shall provide all documentation specified
in subdivisions (b) to (d), inclusive, of Section 4684.58 and a
letter recommending program certification to the State Department of
Developmental Services.
(f) The State Department of Developmental Services shall either
approve or deny the recommendation and transmit its written decision
to the regional center and to the State Department of Social Services
within 30 days of its decision. The decision of the State Department
of Developmental Services not to approve an application for program
certification shall be the final administrative decision.
(g) Any change in the ARFPSHN operation that alters the contents
of the approved program plan shall be reported to the State
Department of Developmental Services and the contracting regional
center, and approved by both agencies, prior to implementation.
4684.60. The vendoring regional center shall, before placing any
consumer into an ARFPSHN, ensure that the ARFPSHN has a license
issued by the State Department of Social Services for not more than
five adults and a contract with the regional center that includes, at
a minimum, all of the following:
(a) The names of the regional center and the licensee.
(b) The purpose of the pilot project.
(c) A requirement that the contractor shall comply with all
applicable statutes and regulations, including Section 4681.1.
(d) The effective date and termination date of the contract.
(e) A requirement that, under no circumstances, shall the contract
extend beyond the stated termination date, which shall not be longer
than the pilot legislation end date of January 1, 2010.
(f) The definition of terms.
(g) A requirement that the execution of any amendment or
modification to the contract be in accordance with all applicable
federal and state statutes and regulations and be by mutual agreement
of both parties.
(h) A requirement that the licensee and the agents and employees
of the licensee, in the performance of the contract, shall act in an
independent capacity, and not as officers or employees or agents of
the regional center.
(i) A requirement that the assignment of the contract for consumer
services shall not be allowed.
(j) The rate of payment per consumer.
(k) Incorporation, by reference, of the ARFPSHN's approved program
plan.
(l) A requirement that the contractor verify, and maintain for the
duration of the project, possession of commercial general liability
insurance in the amount of at least one million dollars ($1,000,000)
per occurrence.
(m) Contractor performance criteria.
(n) An agreement to provide, to the evaluation contractor engaged
pursuant to subdivision (a) of Section 4684.74, all information
necessary for evaluating the project.
4684.63. (a) Each ARFPSHN shall do all of the following:
(1) Meet the minimum requirements for a Residential Facility
Service Level 4-i pursuant to Sections 56004 and 56013 of Title 17 of
the California Code of Regulations, and ensure that all of the
following conditions are met:
(A) That a licensed registered nurse, licensed vocational nurse,
or licensed psychiatric technician, is awake and on duty 24-hours per
day, seven days per week.
(B) That a licensed registered nurse is awake and on duty at least
eight hours per person, per week.
(C) That at least two staff on the premises are awake and on duty
when providing care to four or more consumers.
(2) Ensure the consumer remains under the care of a physician at
all times and is examined by the primary care physician at least once
every 60 days, or more often if required by the consumer's
individual health care plan.
(3) Ensure that an administrator is on duty at least 20 hours per
week to ensure the effective operation of the ARFPSHN.
(4) The administrator shall have at least one year of
administrative and supervisory experience in a licensed residential
program for persons with developmental disabilities and shall meet
one or more of the following qualifications:
(A) Be a licensed registered nurse.
(B) Be a licensed nursing home administrator.
(C) Be a licensed psychiatric technician with at least five years
of experience serving individuals with developmental disabilities.
(D) Be an individual with a bachelors degree in the health or
human services field and two years experience working in a licensed
residential program for persons with developmental disabilities and
special health care needs.
(b) The regional center may require an ARFPSHN to provide
additional professional, administrative, or supportive personnel
whenever the regional center determines, in consultation with the
individual health care plan team, that additional personnel are
needed to provide for the health and safety of consumers.
(c) ARFPSHNs may utilize appropriate staff from Agnews
Developmental Center.
(d) All direct care personnel shall be subject to the training
requirements specified in Section 4695.2.
4684.65. (a) A regional center shall not place, or fund the
placement for, any consumer in an ARFPSHN until the individual health
care plan team has prepared a written individual health care plan
that can be fully and immediately implemented upon the consumer's
placement.
(b) (1) An ARFPSHN shall only accept, for initial admission,
consumers who meet the following requirements:
(A) Reside at Agnews Developmental Center at the time of the
proposed placement.
(B) Have an individual program plan that specifies placement in an
ARFPSHN.
(C) Have special health care and intensive support needs.
(2) Except as provided in paragraph (3), when a vacancy in an
ARFPSHN occurs due to the permanent relocation or death of a
resident, the vacancy may only be filled by a consumer who meets the
requirements of paragraph (1).
(3) If there is no resident residing at Agnews Developmental
Center who meets the requirements of subparagraphs (B) and (C) of
paragraph (1), a vacancy may be filled by a consumer who is residing
at another developmental center or who is at risk of placement into a
developmental center, as determined by the regional center, and who
meets the requirements of subparagraphs (B) and (C) of paragraph (1).
(c) The ARFPSHN shall not admit a consumer if the individual
health care plan team determines that the consumer is likely to
exhibit behaviors posing a threat of substantial harm to others, or
has a serious health condition that is unpredictable or unstable. A
determination that the individual is a threat to others may only be
based on objective evidence or recent behavior and a determination
that the threat cannot be mitigated by reasonable interventions.
4684.68. (a) The individual health care plan shall include, at a
minimum, all of the following:
(1) An evaluation of the consumer's current health.
(2) A description of the consumer's ability to perform the
activities of daily living.
(3) A list of all current prescription and nonprescription
medications the consumer is using.
(4) A list of all health care and intensive support services the
consumer is currently receiving or may need upon placement in the
ARFPSHN.
(5) A written statement from the consumer's primary care physician
familiar with the health care needs of the consumer, or other
physician as designated by the regional center, that the consumer's
medical condition is predictable and stable, and that the consumer's
level of care is appropriate for the ARFPSHN.
(6) Provision for the consumer to be examined by his or her
primary care physician at least once every 60 days, or more
frequently if indicated.
(7) A list of the appropriate professionals assigned to provide
the health care as described in the plan.
(8) A description of, and plan for providing, any training
required for all direct care personnel to meet individuals' needs.
(9) The name of the individual health care plan team member, and
an alternate designee, who is responsible for day-to-day monitoring
of the consumer's health care plan and ensuring its implementation as
written.
(10) Identification of the legally authorized representative to
make health care decisions on the consumer's behalf, if the consumer
lacks the capacity to give informed consent.
(11) The name and telephone number of the person or persons to
notify in case of an emergency.
(12) The next meeting date of the individual health care plan
team, which shall be at least every six months, to evaluate and
update the individual health care plan.
(b) In addition to Section 80075 of Title 22 of the California
Code of Regulations, the ARFPSHN shall comply with all of the
following requirements:
(1) Medications shall be given only on the order of a person
lawfully authorized to prescribe.
(2) Medications shall be administered as prescribed and shall be
recorded in the consumer record. The name and title of the person
administering the medication or treatment, and the date, time, and
dosage of the medication administered shall be recorded. Initials may
be used provided the signature of the person administering the
medication or treatment is recorded on the medication or treatment
record.
(3) Preparation of dosages for more than one scheduled
administration time shall not be permitted.
(4) Persons administering medications shall confirm each consumer'
s identity prior to the administration.
(5) Medications shall be administered within two hours after
dosages are prepared and shall be administered by the same person who
prepared the dosages. Dosages shall be administered within one hour
of the prescribed time unless otherwise indicated by the prescriber.
(6) All medications shall be administered only by those persons
specifically authorized to do so by their respective scope of
practice.
(7) No medication shall be administered to or used by any consumer
other than the consumer for whom the medication was prescribed.
(8) Medication errors and adverse
drug reactions shall be recorded and reported immediately to the
practitioner who ordered the drug or another practitioner responsible
for the medical care of the consumer. Minor adverse reactions which
are identified in the literature accompanying the product as a usual
or common side effect, need not be reported to the practitioner
immediately, but in all cases shall be recorded in the consumer's
record. Medication errors include, but are not limited to, the
failure to administer a drug ordered by a prescriber within one hour
of the time prescribed, administration of any drugs other than
prescribed or the administration of a dose not prescribed.
4684.70. (a) The State Department of Social Services, in
administering the licensing program, shall not have any
responsibility for evaluating consumers' level of care or health care
provided by ARFPSHN. Any suspected deficiencies in a consumer's
level of care or health care identified by the State Department of
Social Services' personnel shall be reported immediately to the
appropriate regional center and the State Department of Developmental
Services for investigation.
(b) The regional center shall have responsibility for monitoring
and evaluating the implementation of the consumer's individual plan
objectives, including, but not limited to, the health care and
intensive support service needs identified in the consumer's
individual health care plan and the consumer's integration and
participation in community life.
(c) For each consumer placed in an ARFPSHN, the regional center
shall assign a service coordinator pursuant to subdivision (b) of
Section 4647.
(d) A regional center licensed registered nurse shall visit, with
or without prior notice, the consumer, in person, at least monthly in
the ARFPSHN, or more frequently if specified in the consumer's
individual health care plan. At least four of these visits,
annually, shall be unannounced.
(e) The State Department of Developmental Services shall monitor
and ensure the regional centers' compliance with the requirements of
this article. The monitoring shall include onsite visits to all the
ARFPSHNs at least every six months for the duration of the pilot
project.
4684.73. (a) In addition to any other contract termination
provisions, a regional center may terminate its contract with an
ARFPSHN when the regional center determines that the ARFPSHN is
unable to maintain substantial compliance with state laws,
regulations, or its contract with the regional center, or the ARFPSHN
demonstrates an inability to ensure the health and safety of the
consumers.
(b) The ARFPSHN may appeal a regional center's decision to
terminate its contract by sending, to the executive director of the
contracting regional center, a detailed statement containing the
reasons and facts demonstrating why the termination is inappropriate.
The appeal must be received by the regional center within 10 working
days from the date of the letter terminating the contract. The
executive director shall respond with his or her decision within 10
working days of the date of receipt of the appeal from the ARFPSHN.
The executive director shall submit his or her decision to the State
Department of Developmental Services on the same date that it is
signed. The decision of the executive director shall be the final
administrative decision.
(c) The Director of Developmental Services may rescind an ARFPSHN'
s program certification when, in his or her sole discretion, an
ARFPSHN does not maintain substantial compliance with an applicable
statute, regulation, or ordinance, or cannot ensure the health and
safety of the consumers. The decision of the Director of
Developmental Services shall be the final administrative decision.
The Director of Developmental Services shall transmit his or her
decision rescinding an ARFPSHN's program certification to the State
Department of Social Services and the regional center with his or her
recommendation as to whether to revoke the ARFPSHN's license.
(d) In addition to complying with Section 1524.1 of the Health and
Safety Code, any ARFPSHN licensee that is unable to continue to
provide services to consumers in the facility shall, upon the date on
which a new ARFPSHN license is issued pursuant to Sections 1520 and
1525 of the Health and Safety Code, arrange with the regional center
or department the transfer of all information, property, and
documents related to the operation of the facility and the provision
of services to the consumers. The department or the regional center
shall take all steps permitted by this article to ensure that at all
times the consumers who are residing in the facility receive services
set forth in their individual health care plans.
4684.74. (a) By July 1, 2006, the State Department of
Developmental Services shall contract with an independent agency or
organization to evaluate the pilot project and prepare a written
report of its findings. The scope of services for the contractor
shall be jointly prepared by the State Department of Developmental
Services, the State Department of Social Services, and the State
Department of Health Services and, at a minimum, shall address all of
the following:
(1) The number, business status, and location of all the ARFPSHNs.
(2) The number and characteristics of the consumers served.
(3) The effectiveness of the pilot project in addressing consumers'
health care and intensive support needs.
(4) The extent of consumers' community integration and
satisfaction.
(5) The consumers' access to, and quality of, community-based
health care and dental services.
(6) The types, amounts, qualifications, and sufficiency of
staffing.
(7) The overall impressions, problems encountered, and
satisfaction with the ARFPSHN service model by ARFPSHN employees,
regional center participants, state licensing and monitoring
personnel, and consumers and families.
(8) The costs of all direct, indirect, and ancillary services.
(9) An analysis and summary findings of all ARFPSHN consumer
special incident reports and unusual occurrences reported during the
evaluation period.
(10) The recommendations for improving the ARFPSHN service model.
(11) The cost-effectiveness of the ARFPSHN model of care compared
with other existing public and private models of care serving similar
consumers.
(b) The contractor's written report shall be submitted to the
State Department of Developmental Services, the State Department of
Social Services, the State Department of Health Services. The State
Department of Developmental Services shall submit the report to the
appropriate fiscal and policy committees of the Legislature by
January 1, 2009.
4684.75. (a) The State Department of Developmental Services may
adopt emergency regulations to implement this article. The adoption,
amendment, repeal, or readoption of a regulation authorized by this
section is deemed to be necessary for the immediate preservation of
the public peace, health and safety, or general welfare, for purposes
of Sections 11346.1 and 11349.6 of the Government Code, and the
State Department of Developmental Services is hereby exempted from
the requirement that it describe specific facts showing the need for
immediate action. A certificate of compliance for these implementing
regulations shall be filed within 24 months following the adoption of
the first emergency regulations filed pursuant to this section.
(b) This article shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted statute
extends or deletes that date.
(c) This article shall only be implemented to the extent that
funds are made available through an appropriation in the annual
Budget Act.
SEC. 9. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.