BILL ANALYSIS Ó
AB 364
Page A
Date of Hearing: April 2, 2013
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 364 (Ian C. Calderon) - As Amended: April 1, 2013
SUBJECT : Community Care Facilities
SUMMARY : Requires the California Department of Social Services
(DSS) to visit a community care facility and a residential care
facility for the elderly (RCFE) once every two years.
Specifically, this bill :
1)Changes the requirement that DSS visit a licensed community
care facility from no less than once every five years to no
less than once every two years.
EXISTING LAW
1)Establishes the California Community Care Facilities Act
(CCFA) to provide a comprehensive statewide service system of
quality community care for people who have a mental illness, a
developmental or physical disability, and children and adults
who require care or services by a facility or organization.
2)Defines a "Community care facility" (CCF) as a facility,
place, or building maintained and operated to provide
nonmedical residential care, day treatment, adult day care, or
foster family agency services for children, adults, or
children and adults, including, but not limited to, the
physically handicapped, mentally impaired, incompetent
persons, and abused or neglected children.
3)Authorizes DSS to license facilities or organizations that
provide services under the jurisdiction of the CCFA,
including:
a) Residential facilities, as defined;
b) Adult day programs;
c) Therapeutic day services facilities;
d) Foster family agencies and homes.
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e) Social rehabilitation facilities;
f) Community treatment facilities;
g) Full-service adoption agencies;
h) Noncustodial adoption agencies;
i) Transitional shelter care facilities; and
j) Transitional housing placement providers for foster
youth.
4)Provides for the exemption of certain types of facilities,
including:
a) Health facilities;
b) Juvenile facilities and juvenile halls;
c) Child day care facilities as defined by the California
Child Day Care Facility Act;
d) School and college residential facilities;
e) Any facility that provides room and board as long as it
does not require an element of care;
f) Any drug or alcohol recovery or treatment facility;
g) Relative caregiver homes for children as supervised by a
county welfare or probation department;
h) Any supported living arrangement for individuals with
developmental disabilities;
i) Any family home agency, family home, or family teaching
home, as defined, and vendored with the California
Department of Developmental Services;
j) Housing where support services are arranged by the
resident(s) but not provided for or contracted by the owner
of the housing facility; and
aa) Other similar facilities as deemed by the Director of
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DSS.
5)Establishes the California RCFE Act, which requires facilities
that provide personal care and supervision, protective
supervision or health related services for persons 60 years of
age or older who voluntarily choose to reside in that facility
to be licensed by DSS.
6)Prohibits any person, firm, partnership, association,
corporation or public agency from establishing, operating,
managing, conducting or maintaining a CCF or a RCFE without a
valid licensed provided by DSS.
7)Provides that any person who violates the CCFA or the RCFE Act
shall be guilty of a misdemeanor and upon conviction shall be
fined no more than $1,000, imprisoned in county jail for up to
one year, or both.
FISCAL EFFECT : Unknown
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COMMENTS :
CCFA Background
Initially administered by the Department of Health upon its
establishment in 1973, the CCFA became the jurisdiction of the
newly created Health and Welfare Agency, now referred to as the
Health and Human Services Agency, under which a number of
departments were placed, including the Departments of Social
Services and Health Services. Whereas licensing responsibility
for health care facilities remained with the Department of
Health Services, the duty to license and oversee community care
facility licensing was transferred to DSS.
Community care facilities are considered those that provide
non-medical care and supervision for children and adults in
need, which includes persons with disabilities, seniors in need
of residential care, children in foster care and at-risk
children needing shelter services, families in need of early
childhood education (child care), and adult care services.
RCFE Background
It is the intent of the Legislature, in creating RCFEs as its
own licensing category under the RCFE Act, to help provide a
system of residential care to allow older persons to remain as
independent as possible while not forcing them to move between
medical and nonmedical services.
Commonly referred to as assisted living facilities, retirement
homes and board and care homes, RCFEs are licensed facilities
under the CCFA that provide services to individuals who are 60
years of age and older and persons under the age of 60 with
compatible needs. RCFEs provide a wide array of care, which can
include varying levels of personal care and protective
supervision, based upon the needs of the resident.
DSS Community Care Licensing Division
DSS' Community Care Licensing Division (CCLD) is responsible for
carrying out the duties established by the CCFA and the RCFE
Act, in addition to other licensing categories, which include:
Processing license applications;
Providing monitoring, oversight and technical
assistance;
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Conducting facility visits;
Pursuing investigations of complaints; and
Enforcement through the levying of penalties, fines and
administrative legal action
According to DSS, as of February 6, 2013 there were 77,243
licensed facilities in California under the jurisdiction of CCLD
with a capacity to serve 1,395,577 residents.
Prior to 2003, CCLD was required to visit most licensed
facilities once per year and family child care homes once every
three years. However, due to the state's ongoing budget
deficit, the state eliminated these requirements in the 2003-04
budget and limited visits to ten percent of facilities based
upon their poor performance history.
For those residential facilities not subject to annual
inspections, CCLD is currently required to conduct comprehensive
compliance inspections of a 30% random sample of facilities each
year, with each facility required to be visited as least once
every 5 years. There are additional inspection requirements for
new facilities or when changes occur to the license, which
includes pre-licensing and post-licensing inspections help to
ensure that a new licensee starts off correctly.
The 2012-13 budget included the elimination of the California
Department of Mental Health (DMH) and transferred its
programmatic and administrative responsibilities to other state
agencies and departments as deemed appropriate. As a result,
CCLD is also now responsible for the licensing of mental health
rehabilitation centers and psychiatric health facilities, as
well as the responsibility for overseeing the system that
authorizes 72-hour holds of individuals with several mental
health needs.
Importance of unannounced licensing visits
Unannounced licensing visits are of fundamental importance in
protecting the health and safety of children and adults
receiving care through facility or home-based care. They ensure
that basic health and safety requirements are being met and also
provide opportunities for increased technical assistance to
programs, enhanced information sharing, the development of best
practices, and ultimately lead to an improvement in the quality
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of life for clients under care.
Numerous studies have also been conducted, which document a
connection between increased licensing visits with a decrease in
accidents requiring medical attention<1> and greater provider
compliance with health and safety standards.<2>
Additionally, regular and frequent unannounced inspection visits
allow for state and local agencies to provide relevant and
up-to-date information to the public on the quality of care
being provided to consumers. According to Child Care Aware of
America (CCAA), formerly the National Association of Child Care
Resource and Referral Agencies (NACCRRA), a study conducted by
the National Bureau of Economic Research in Florida found that
frequent inspections, which were made available to the public,
"increased the quality of the inspections and the productivity
of the inspectors" and resulted in increased inspections that
were carried out more consistently. Further, DSS also stated,
in a 2010-11 Spring Finance Letter, that "regular and frequent
inspections of facilities improve client health and safety as
evidenced by reductions in the percentage of the more serious
imminent risk to total citations." Specifically, "more annual
inspections equates to better quality of care" and "more annual
inspections equates to a smaller risk to the health and safety
of clients."
It is clear that the state's ongoing budget deficit has
significantly hampered its ability to provide for the health and
safety of clients in community care facilities. Over the past
ten years, DSS, like many other agencies throughout the state,
has experienced the elimination of vacant staff positions,
on-again off-again hiring freezes, and rolling staff furloughs.
Although this does not clear the state of its responsibility to
ensure community care facilities' compliance with the CCFA, it
raises significant challenges to ensure that children, adults
---------------------------
<1> Fiene, R. (2002). 13 indicators of quality child care:
Research update. U.S. Department of Health and Human Services,
Office of Assistant Secretary for Planning and Evaluation, at
http://aspe.hhs.gov/hsp/ccquality-ind02/
<2> Koch Consulting. (2005). Report on effective legal
proceedings to ensure provider compliance: Prepared for the
State of Washington Department of Social and Health Services.
http://www.naralicensing.drivehq.com/publications/archives/nara/E
ffective_Legal_Proceedings.pdf
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and seniors in need of care and supervision are not put at risk.
Need for the bill
In order to begin to bridge the gap of licensing visits created
by the state's budget deficit, steps towards re-establishing
regular and frequent facility visits are essential.
According to the author:
Increasing the frequency of licensing visits will
demonstrate that California is serious about addressing the
deficiency in our inspection process for Community Care
Facilities and will put California on par with the
inspection procedures of other states. Our facilities are
in need of frequent inspections because of the
vulnerability of the clients those facilities serve.
REGISTERED SUPPORT / OPPOSITION :
Support
California Police Chiefs Association
California Food Policy Advocates (CFPA)
County Welfare Directors Association of CA (CWDA)
LeadingAge California
Opposition
None on file
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089