BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1570
A
AUTHOR: Chesbro
B
VERSION: May 23, 2014
HEARING DATE: June 24, 2014
1
FISCAL: Yes
5
7
CONSULTANT: Sara Rogers
0
SUBJECT
Residential Care Facilities for the Elderly
SUMMARY
This bill increases the number of hours of classroom
instruction, and adds to the uniform core of knowledge,
that licensees of Residential Care Facilities for the
Elderly (RCFEs) must meet for initial certification and
continuing education training. This bill increases the
training requirements for facility staff that assist
residents with personal activities, as specified, and adds
topics that shall be included in the training.
ABSTRACT
Existing Law:
1.Establishes the Residential Care Facilities for the
Elderly Act, which provides for the California Department
of Social Services (CDSS) to license and regulate RCFEs
as a separate category within the existing residential
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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care licensing structure of CDSS. (HSC 1569 et seq.)
2.Requires applicants for an RCFE license to submit a
criminal record clearance, employment history, character
references, evidence of certification, and disclosure of
previous service in other RCFEs, outpatient health
clinics, health facilities (including hospitals, skilled
nursing facilities or intermediate face facilities), or a
community care facility, among other requirements. (HSC
1569.15)
3.Requires a license applicant and an RCFE administrator to
successfully complete a certification program approved by
the department, which shall include a minimum of 40 hours
of classroom instruction including a uniform core of
knowledge, as specified. (HSC 1569.23 and HSC 1569.616)
4.Provides that RCFE administrator certification shall be
valid for two years and that recertification shall
require 40 hours of continuing education. Through
regulation provides that an applicant for licensure shall
meet the requirements for initial certification of
administrators. (HSC 1569.616 (f), Title 22 CCR 87155 and
87406)
5.Provides that the initial certification of administrators
shall include successful completion of a
department-approved program, passage of a written test
administered by the department within 60 days, and a
criminal records clearance. (Title 22 CCR 87406)
6.Requires CDSS to develop requirements for a uniform core
of knowledge for the initial certification and continuing
education requirements for licensees, administrators and
staff of RCFEs. Provides that this knowledge base shall
include basic understanding of the psychosocial and
physical care needs of elderly persons. (HSC 1569.62)
7.Provides that RCFE staff members who assist residents
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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with activities of daily living shall receive at least 10
hours of initial training within the first four weeks of
employment and at least four hours annually thereafter.
(HSC 1569.625 and Title 22 CCE 87411)
8.Requires CDSS to develop a uniform assessment tool to be
used by all RCFEs in identifying resident needs for
service and assistance with daily living. (HSC 1569.62)
9.Requires facility personnel to be sufficient in numbers
and competent to provide the services necessary to meet
resident needs. Provides that the department may require
any facility to provide additional staff whenever if
determines through documentation that the needs of the
particular residents, the extent of services provided, or
the physical arrangements of the facility require
additional staff. (Title 22 CCE 87411)
This bill:
1.Increases the required licensee certification training to
100 hours of coursework, at least 40 hours of which shall
be attended in person (increased from 40 hours of
classroom instruction).
2.Expands the required state-administered examination from
40 questions to no less than 100 questions and allows an
applicant to have access to the RCFE Act statutes,
related regulations, and the evaluator manual during the
examination.
3.Expands the required uniform core of knowledge to
additionally include:
a. Personal rights;
b. Medication management, including use, misuse, and
interaction of drugs commonly used by the elderly,
including antipsychotics;
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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c. Managing Alzheimer's disease and related dementias;
d. Managing the physical environment, including
maintenance and housekeeping.
1.Requires CDSS to review and revise the examination to
reflect changes in law and regulations in order to ensure
the rigor and quality of the examination.
2.Requires CDSS to adopt regulations requiring RCFE
direct-care staff members to receive 40 hours of training
prior to working independently with residents. Requires
the 40 hours of training to consist of 24 hours of
coursework training, as specified, prior to resident
contact, including 12 hours specific to dementia care, as
specified. Requires the additional 16 hours shall be
hands-on training.
3.Requires direct-care staff to receive an additional 12
hours annually, including the first year of employment,
eight hours of which shall be dementia care training, as
specified.
4.Permits the department to establish the subject matter
required for the training in consultation with provider
organizations and adds dementia care training, including
the misuse of antipsychotics to the currently required
topics.
FISCAL IMPACT
An Assembly Appropriations analysis states there are costs
to CDSS in the range of $300,000 (GF) to review
certification training programs, proctor and process
completed tests, review applications, process certificates
and perform related administrative functions. Additionally
the analysis states there are potential minor
non-reimbursable local enforcement costs for violations of
any of the provisions of this measure.
BACKGROUND AND DISCUSSION
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Purpose of the bill:
According to the author, general training standards for
RCFEs have not been revised in a decade, yet expectations
have grown and supportive services have become more
sophisticated. The author states that having an
appropriately trained staff will result in better care,
which benefits residents, families and the licensees.
This bill, sponsored by the California Assisted Living
Association (CALA) a membership organization of RCFEs, has
substantial overlap with SB 911 (Block), which is sponsored
by California Advocates for Nursing Home Reform (CANHR) as
one of a large package of bills responding to a series of
recent events calling into question the adequacy of CDSS
oversight and the state's ability to protect people who
reside in RCFEs.
Specifically, in July 2013, ProPublica and Frontline
reporters wrote and produced a series of stories on
Emeritus, the nation's largest RCFE provider.<1> Featured
in the article was a woman who died after receiving poor
care at in a facility in Auburn, California. The series
documented chronic understaffing and a lack of required
assessments and substandard care. Reports in September
2013, prompted by a consumer watchdog group that had
hand-culled through stacks of documents in San Diego,
revealed that more than two dozen seniors had died in
recent years in RCFEs under questionable circumstances that
went ignored or unpunished by CDSS.<2>
-------------------------
<1>
http://www.propublica.org/article/life-and-death-in-assisted
-living-single
<2> "Care Home Deaths Show System Failures," San Diego
Union Tribune, Sept.7, 2013
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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Most recently, in late October 2013, 19 frail seniors were
abandoned at Valley Springs Manor in Castro Valley by the
licensee and all but two staff after the state began
license revocation proceedings. CDSS inspectors, noting the
facility had been abandoned, left the two unpaid service
staff to care for the abandoned residents with insufficient
food and medication, handing them a $3,800 citation before
leaving for the weekend. The next day sheriff's deputies
and paramedics sent the patients to local hospitals.
Residential Care Facilities for the Elderly
Within California's continuum of long term care, situated
between in-home care and skilled nursing facilities, is the
RCFE, also commonly called Assisted Living, Board and Care,
or Residential Care. There are approximately 8,000 Assisted
Living, Board and Care, and Continuing Care Retirement
homes that are licensed as RCFEs in California. These
residences are designed to provide homelike housing options
to seniors and other adults who need some help with
activities of daily living, such as cooking, bathing, or
getting dressed, but otherwise do not need continuous,
24-hour assistance or nursing care. Increasingly residents
are entering RCFEs with significant health needs including
diabetes, bedsores, or require the use of oxygen tanks,
catheters or colostomies.
The RCFE licensure category includes facilities with as few
as six beds to those with hundreds of residents, whose
needs may vary widely. Typically, the smaller facilities
are homes in residential neighborhoods while the larger
facilities resemble apartment complexes with structured
activities for their residents. Residents may reside in
their own apartment, or may share a bedroom. Generally,
residents are free to leave the facility if they choose,
and may entertain guests, and otherwise maintain a high
level of independence. Facilities licensed to serve
residents with dementia or Alzheimer's disease, also known
as "memory care units" may maintain a secure perimeter.
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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Licensee and Administrator training requirements
Existing law requires prospective licensees and facility
administrators to complete a certification program approved
by the department consisting of 40 hours of classroom
instruction. Statute requires that the curriculum for both
include:
Laws, regulations, policies and procedural
standards that impact RCFE operations, including
residents personal rights (8 hours);
Business operations (3 hours);
Management and supervision of staff (3 hours);
Psychosocial need of elderly residents (5 hours);
Physical needs for elderly residents (5 hours);
Community and support services (2 hours);
Use, misuse and interaction of drugs commonly used
by the elderly (5 hours);
Resident admission, retention, and assessment
procedures (5 hours);
Care of residents with Alzheimer's Disease and
other dementias (4 hours)
Typically, the 40-hour training requirements are met
through private vendors who have been approved by CDSS to
conduct these trainings. The courses are generally
scheduled as four, consecutive, 10-hour-day trainings,
costing approximately $200 to $300. Following the training,
prospective administrators are required to pass a
40-question test administered by CDSS that has not been
changed since its initial release. Approximately 500
individuals take the exam every month. Reportedly, the
several versions of the test are available online to be
studied in advance and few individuals fail the exam.
Licensees must only pass their initial certification and
are not required to maintain a current certification, which
expires after two years.
Additionally, corporate owners of a facility, who are not
the official licensee, are not themselves required to be
licensed or have any training despite having financial and
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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managerial control over the facilities they manage.
Staffing requirements
Existing law requires facility personnel to be sufficient
in numbers and competent to provide the services necessary
to meet resident needs. The department may require a
facility to provide additional staff whenever it determines
that the needs of the particular residents, the extent of
services provided, or the physical arrangements of the
facility require additional staff. Additionally,
regulations require RCFEs to ensure that the resident is
cared for in accordance with the physician's orders and
that the resident's medical needs are met. Facility staff
members are required to have the knowledge and skills to
respond to problems and to contact the physician,
appropriately skilled professional or vendor as necessary.
Residents are required to have a preadmission appraisal
performed and documented that includes an evaluation of the
resident's functional, mental and social needs, in order to
determine the level of care and supervision that each
resident requires. Additionally, residents must have a
medical assessment completed that must be signed by a
physician, made within the last year and kept on file. The
functional assessment is required to determine the
prospective resident's ability to perform detailed
activities of daily living including bathing, dressing,
grooming, continence, eating and physical condition.
Additionally facilities are required to complete a needs
and services appraisal to determine the amount of
supervision that is necessary.
Placement agencies (defined to include county welfare,
social service or mental health departments, county public
guardians, hospital discharge planners or coordinators
public or private agencies providing placement or referral
services, conservators and regional centers) who are
engaged in finding homes or other places for the placement
of elderly persons for temporary or permanent care are
required to report to the department any situation in which
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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a facility has insufficient personnel or incompetent
personnel on duty.
Regulations additionally require facilities to have and
maintain a current, written definitive plan of operation
that is required to be submitted to the licensing agency
with their application.<3> The plan includes, among other
things, a statement of admission policies and procedures
for accepting residents as well as the staffing plan,
qualifications and duties. Additionally, facilities are
required to submit a written report to the licensing agency
and the resident's responsible person when certain
incidents occur that may impact the health and safety of
residents.
Staff training requirements
Existing law permits CDSS to adopt regulations to require
RCFE staff members who assist residents with activities of
daily living to receive ten hours of training. Statute and
regulation provide that this training shall include:<4>
The aging process and physical limitations and
special needs of the elderly (at least two hours).
Importance and techniques of personal care
services, including bathing, grooming, dressing,
feeding, toileting and universal precautions (at least
three hours).
Resident's rights as specified in Title 22 CCR
-----------------------
<3> Title 22 CCR 87208
<4> HSC 1569.625 and Title 22 CCR 87411
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87468.
Policies and procedures regarding medications,
including knowledge to safely assist with
self-administered prescribed medications (at least two
hours).
Psychosocial needs of the elderly, such as
recreation, companionship, independence, etc.
Recognizing signs and symptoms of dementia.
Through regulation, existing law provides that all training
shall be conducted by a person who is knowledgeable in a
relevant subject area of the training and who has a
four-year degree or graduate degree as well as two years of
experience, or a license to work as a health care provider,
or at least two years of experience in California as an
RCFE administrator with a record of administering
facilities with substantial compliance.
Use of anti-psychotic medications in Assisted Living
Recent research suggests that between 35 percent and 53
percent of assisted living residents receive one or more
psychotropic medications.<5> Numerous studies document that
older adults are particularly susceptible vulnerable to
adverse effects of psychotropic medications.<6> Those older
than age 70 are 3.5 times more likely than younger
individuals to be admitted to the hospital due to adverse
drug reactions associated with psychotropic medications.
Additionally, the risk for adverse reactions increases
dramatically with the number of medications used and with
-------------------------
<5> Smith M, Buckwalter KC, Hyunwook K, Ellingrod V,
Schultz SK. Dementia-specific assisted living: Clinical
factors and psychotropic medication use. Journal of the
American Psychiatric Nurses Association. 2008;14:39-49
<6> Lindsey, Pamela. Psychotropic Medication Use among
Older Adults: What All Nurses Need to Know. Journal of
Gerontol Nursing. Sep 2009; 35(9): 28-38
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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increasing age.<7>
In 2012, the Centers for Medicare and Medicaid Services
(CMS) launched the National Partnership to Improve Dementia
Care and Reduce Unnecessary Antipsychotic Drug Use in
Nursing Homes. A recent memorandum submitted to CMS state
surveyor agency directors, citing numerous peer reviewed
academic studies, states that:
The problematic use of medications, such as
antipsychotics, is part of a larger, growing concern.
This concern is that nursing homes and other settings
(i.e. hospitals, ambulatory care) may use medications
as a "quick fix" for behavioral symptoms or as a
substitute for a holistic approach that involves a
thorough assessment of underlying causes of behaviors
and individualized, person-centered interventions?
When antipsychotic medications are used without an
adequate rationale, or for the purpose of limiting or
controlling behavior of an unidentified cause, there
is little chance that they will be effective. In
addition, they commonly cause complications such as
movement disorders, falls, hip fractures,
cerebrovascular adverse events (cerebrovascular
accidents and transient ischemic events) and increased
risk of death. <8>
The memorandum cites a Food and Drug Administration (FDA)
public health advisory, which found that elderly patients
with dementia-related psychosis treated with second
-------------------------
<7> Brooks JO, Hoblyn JC. Neurocognitive costs and benefits
of psychotropic medications in older adults. Journal of
Geriatric Psychiatry and Neurology. 2007;20:199-214
<8> S&C: 13-35-NH
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certific
ation/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-L
etter-13-35.pdf
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generation antipsychotic drugs are more than 1.5 times as
likely to face increased risk of death compared to taking a
placebo.<9> According to the FDA, the specific causes of
these deaths were largely either due to heart related
events (e.g., heart failure, sudden death) or infections
(mostly pneumonia). The FDA notes that none of the
antipsychotic drugs have been approved for the treatment of
behavioral disorders in patients with dementia and has
required drug manufactures to include a boxed warning in
their labeling.
In setting standards for use of these medications in
nursing homes, CMS has put forward a series of dementia
care principles that attempts to foster a person centered
approach to care better ensures the judicial use of
pharmacological approaches to dementia care, that they are
clinically indicated and gradually reduced in an effort to
discontinue the drugs over time. Although this CMS guidance
is directed specifically toward nursing homes, its findings
and subsequent policy approaches are substantially relevant
to assisted living facilities which presumably serve a
similar demographic of residents who are potentially less
acute than those of nursing homes.
2014-2015 Budget
The 2014-2015 budget, as proposed by the Administration,
includes funding intended to address some of the policy
issues that this bill also seeks to address. While the
budget does not increase the training hours or curriculum
for licensees, administrators or staff of RCFEs, it instead
seeks to strengthen the administrator certification process
by adding three new positions to enhance current testing
policies and procedures to establish statewide uniformity
-------------------------
<9> FDA Public Health Advisory: Deaths with Antipsychotics
in Elderly Patients with Behavioral Disturbances.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInfo
rmationforPatientsandProviders/DrugSafetyInformationforHeath
careProfessionals/PublicHealthAdvisories/ucm053171.htm
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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in the administration of the test and update the exams
themselves. Additionally, the Administration proposed to
hire a nurse practitioner position to assist with the
development of regulatory policies related to medical care
in RCFEs as well as a mental health populations unit to
provide technical assistance to enforcement staff.
Comparison with SB 911
Both AB 1570 and SB 911 make similar changes to the
required curriculum for licensee and direct-care staff, but
a key difference relates to specialized training for
dementia care, postural supports, restricted health
conditions and hospice care. AB 1570 requires licensee and
direct-staff training in "dementia care, including the
misuse of antipsychotics" while SB 911 requires licensee,
administrator and staff training in the "use, misuse, and
interaction of drugs commonly used by the elderly, and the
adverse effects of psychotropic drugs for use in
controlling the behavior of persons with dementia" as well
as "non-pharmacologic, person-centered approaches to
dementia care." SB 911 also adds training requirements for
administrators, but AB 1570 does not.
AB 1570 (Chesbo) training requirements
------------------------------------------------------------
|Licensee training: 100 hours total; 40 hours of which in |
|person; 100 question exam |
|Administrator training: not specified |
|Direct-care staff basic: 40 hours total; 24 prior to |
|providing care; and 12 annually |
|Dementia care (inclusive): 12 hours prior to providing |
|care; and 8 annually |
|Medication Assistance: not specified |
|Postural, Restricted, Hospice: not specified |
|*new staff to receive 52 hrs total (basic + |
|annual) |
------------------------------------------------------------
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SB 911 (Block) training requirements
------------------------------------------------------------
|Licensee training: 100 hours; 80 hours of which in |
|classroom; number of questions not specified |
|Administrator training: 100 hours; 60 hours every 2 years |
|Direct-care staff basic: 40 hours total; 24 prior to |
|providing care; and 20 annually |
|Dementia care (additional): 15 hours total prior to |
|providing care; and 12 annually |
|Medication Assistance: |
| Large facilities - 32 hours total; 12 prior to |
|providing care; and 8 annually |
| Small facilities - 16 hours total; 8 prior to |
|providing care; and 8 annually |
|Postural, Restricted, Hospice: 15 hours total prior to |
|providing care; and 12 annually |
| |
------------------------------------------------------------
COMMENTS
1.This bill does not provide for corollary changes to the
administrator training requirements, which is the
individual that is specifically responsible for the
management and operation of the facility. Staff
recommends this bill be amended to reflect a compromise
with the author and sponsors of SB 911 to conform the
licensee training provisions with the administrator
training provisions.
2.This bill requires that 40 hours of licensee training
shall be in person with the remaining instruction
presumably to be met via online courses and training
materials. Staff recommends this bill be amended to
reflect a compromise between SB 911 and this bill to
require 60 hours of in person training.
3.Staff recommends this bill conform to the training
curriculum specified in SB 911 pertaining to the
"non-pharmacological, person-centered approaches to
dementia care." This bill merely refers to the "misuse of
antipsychotics" however staff notes that antipsychotics
are currently not approved by the FDA for treatment of
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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dementia, despite being frequently prescribed by the
resident's physician. Best practices with regard to
serving persons with dementia care call for a persistent
effort at minimizing the behaviors for which a physician
has prescribed an antipsychotic medication.
For specific language please see the attached mock-up at
the end of this analysis.
PRIOR VOTES
Assembly Floor 79 - 0
Assembly Appropriations 17 - 0
Assembly Human Services 6 - 0
POSITIONS
Support: Alzheimer's Association
California Long-Term Care Ombudsman
Association
County of San Diego
National Association of Social Workers
Retired Public Employees Association
Oppose: California Right to Life Committee, Inc.
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Amendments Mock-up for 2013-2014 AB-1570 (Chesbro (A))
******Amendments are underlined in BOLD ******
Mock-up based on Version Number 97 - Amended Assembly
5/23/14
The people of the State of California do enact as follows:
SECTION 1. Section 1569.23 of the Health and Safety Code is
amended to read:
1569.23. (a) As a requirement for licensure, the applicant
shall demonstrate that he or she has successfully completed
a certification program approved by the department.
(b) The certification program shall be for a minimum of 40
hours of classroom instruction and include a uniform core
of knowledge which shall include all of the following:
(1) Law, regulations, policies, and procedural standards
that impact the operations of residential care facilities
for the elderly.
(2) Business operations.
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(3) Management and supervision of staff.
(4) Psychosocial need of the elderly residents.
(5) Physical needs for elderly residents.
(6) Community and support services.
(7) Use, misuse, and interaction of drugs commonly used by
the elderly.
(8) Resident admission, retention, and assessment
procedures.
(c) Successful completion of the certification program
shall be demonstrated by passing a written test and
submitting a fee of one hundred dollars ($100) to the
department for the issuance of a certificate of completion.
(d) The department shall establish by regulation the
program content, the testing instrument, process for
approving certification programs, and criteria to be used
for authorizing individuals or organizations to conduct
certification programs. These regulations shall be
developed with the participation of provider organizations.
(e) This section shall apply to all applications for
licensure unless the applicant provides evidence that he or
she has a current license for another residential care
facility for the elderly which was initially licensed prior
to July 1, 1989, or has successfully completed an approved
certification program within the prior five years.
(f) If the applicant is a firm, partnership, association,
or corporation, the chief executive officer, or other
person serving in a like capacity, or the designated
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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administrator of the facility shall provide evidence of
successfully completing an approved certification program.
(g) This section shall become inoperative on January 1,
2016 July 1, 2015 and, as of January 1, 2016, that date is
repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2016, deletes or extends
the dates on which it becomes inoperative and is repealed.
SEC. 2. Section 1569.23 is added to the Health and Safety
Code, to read:
1569.23. (a) As a requirement for licensure, the applicant
shall demonstrate that he or she has successfully completed
a certification program approved by the department.
(b) The certification program shall consist of both of the
following:
(1) One hundred hours of coursework, at least 40 60 hours
of which shall be attended in person.
(2) A state-administered examination consisting of no less
than 100 questions. The examination shall reflect the
uniform core of knowledge required pursuant to subdivision
(c).
(c) The certification program shall include a uniform core
of knowledge which shall include all of the following:
(1) Law, including personal rights, regulations, policies,
and procedural standards that impact the operations of
residential care facilities for the elderly.
(2) Business operations.
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(3) Management and supervision of staff.
(4) Psychosocial need of the elderly residents.
(5) Physical needs for elderly residents.
(6) Community and support services.
(7) Medication management, including use, misuse, and
interaction of drugs commonly used by the elderly,
including antipsychotics and the adverse effects of
psychotropic drugs for use in controlling the behavior of
persons with dementia .
(8) Resident admission, retention, and assessment
procedures.
(9) Managing Alzheimer's disease and related dementias,
including nonpharmacologic, person-centered approaches to
dementia care.
(10) Managing the physical environment, including
maintenance and housekeeping.
(11) Residents' rights, and the importance of initial and
ongoing training for all staff to ensure residents' rights
are fully respected and implemented.
(12) Cultural competency and sensitivity in issues relating
to the underserved aging lesbian, gay, bisexual, and
transgender community.
(13) Postural supports, restricted health conditions and
hospice care.
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(d) Successful completion of the certification program
shall be demonstrated by passing the state-administered
examination and submitting a fee of one hundred dollars
($100) to the department for the issuance of a certificate
of completion.
(e) (1) The department shall establish by regulation the
program content, the testing instrument, process for
approving certification programs, and criteria to be used
for authorizing individuals or organizations to conduct
certification programs. These regulations shall be
developed with the participation of provider organizations.
(2) The department shall ensure that the examination
consists of at least 100 questions and allows an applicant
to have access to the California Residential Care Facility
for the Elderly Act, related regulations, and the evaluator
manual during the examination. The department, no later
than July 1 of every other year, shall review and revise
the examination to reflect changes in law and regulations
in order to ensure the rigor and quality of the
examination. Each year, the department shall ensure by
January 1 that the exam is not in conflict with current
law. The department may convene a stakeholder group to
assist in developing and reviewing test questions.
(f) This section shall apply to all applications for
licensure unless the applicant provides evidence that he or
she has a current license for another residential care
facility for the elderly which was initially licensed prior
to July 1, 1989, or has successfully completed an approved
certification program within the prior five years.
(g) If the applicant is a firm, partnership, association,
or corporation, the chief executive officer, or other
person serving in a like capacity, or the designated
administrator of the facility shall provide evidence of
successfully completing an approved certification program.
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(h) This section shall become operative on January 1, 2016
July 1, 2015 .
SEC. 3. Section 1569.625 of the Health and Safety Code is
amended to read:
1569.625. (a) The Legislature finds that the quality of
services provided to residents of residential care
facilities for the elderly is dependent upon the training
and skills of staff. It is the intent of the Legislature in
enacting this section to ensure that direct-care staff have
the knowledge and proficiency to carry out the tasks of
their jobs.
(b) The department shall adopt regulations to require
staff members of residential care facilities for the
elderly who assist residents with personal activities of
daily living to receive appropriate training. This training
shall consist of 10 hours of training within the first four
weeks of employment and four hours annually thereafter.
This training shall be administered on the job, or in a
classroom setting, or any combination of the two. The
department shall establish, in consultation with provider
organizations, the subject matter required for this
training.
(c) The training shall include, but not be limited to, all
of the following:
(1) Physical limitations and needs of the elderly.
(2) Importance and techniques for personal care services.
(3) Residents' rights.
(4) Policies and procedures regarding medications.
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(5) Psychosocial needs of the elderly.
(d) This section shall become inoperative on January 1,
2016 July 1, 2015 and, as of January 1, 2016, that date is
repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2016, deletes or extends
the dates on which it becomes inoperative and is repealed.
SEC. 4. Section 1569.625 is added to the Health and Safety
Code, to read:
1569.625. (a) The Legislature finds that the quality of
services provided to residents of residential care
facilities for the elderly is dependent upon the training
and skills of the staff. It is the intent of the
Legislature in enacting this section to ensure that
direct-care staff have the knowledge and proficiency to
carry out the tasks of their jobs.
(b) (1) The department shall adopt regulations to require
staff members of residential care facilities for the
elderly who assist residents with personal activities of
daily living to receive appropriate training. This training
shall consist of 40 hours of training to be completed
before a staff member begins working independently with
residents. The 40 hours of training shall consist of 24
hours of coursework training prior to resident contact,
including 12 hours specific to dementia care, as required
by subdivision (a) of Section 1569.626 and 4 hours specific
to postural supports, restricted health conditions and
hospice care, as required by subdivision (a) of Section
1569.696 . The training coursework may utilize various
methods of instruction, including, but not limited to,
lectures, instructional videos, and interactive online
courses. The additional 16 hours shall be hands-on
training.
(2) In addition to paragraph (1), training requirements
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shall also include an additional 12 20 hours annually,
including the first year of employment, eight hours of
which shall be dementia care training, as required by
subdivision (b) of Section 1569.626 and 2 hours specific to
postural supports, restricted health conditions and hospice
care, as required by subdivision (a) of Section 1569.696.
This training shall be administered on the job, or in a
classroom setting, or any combination of the two.
(3) The department shall establish, in consultation with
provider organizations, the subject matter required for the
training required by this section.
(c) The training shall include, but not be limited to, all
of the following:
(1) Physical limitations and needs of the elderly.
(2) Importance and techniques for personal care services.
(3) Residents' rights.
(4) Policies and procedures regarding medications.
(5) Psychosocial needs of the elderly.
(6) Dementia care, including the use and misuse of
antipsychotics and interaction of drugs commonly used by
the elderly, and the adverse effects of psychotropic drugs
for use in controlling the behavior of persons with
dementia, as required by Section 1569.626 .
(7) The special needs of persons with Alzheimer's disease
and dementia, including nonpharmacologic person-centered
approaches to dementia care.
STAFF ANALYSIS OF ASSEMBLY BILL 1570 (Chesbro)
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(9) Cultural competency and sensitivity in issues relating
to the underserved aging lesbian, gay, bisexual, and
transgender community.
(d) This section shall not apply to certified nurse
assistants, certified pursuant to Section 1337.2, licensed
vocational nurses, certified pursuant to Business and
Professions Code Section 2859, and registered nurses,
certified pursuant to Business and Professions Code Section
2725 except both of the following:
(1) A licensed or certified health professional with valid
certification shall receive eight hours of training prior
to providing direct care to residents, on resident
characteristics, resident records, and facility practices
and procedures.
(2) A Certified nurse assistant shall also receive the 12
hours of dementia care training specified in Section
1569.626 and the ongoing training specified in Section
1569.625(b)(2).
(e) This section shall become operative on January 1, 2016
July 1, 2015 .
SEC. 5. Section 1569.626 of the Health and Safety Code is
amended to read:
1569.626. (a) All residential care facilities for the
elderly that advertise or promote special care, special
programming, or a special environment for persons with
dementia, in addition to complying with the training
requirements described in Section 1569.625, shall meet the
following training requirements for all direct care staff:
(a) (1) Six hours of resident care orientation within the
first four weeks of employment. All six hours shall be
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devoted to the care of persons with dementia. The facility
may utilize various methods of instruction instruction,
including, but not limited to, preceptorship, mentoring,
and other forms of observation and demonstration. The
orientation time shall be exclusive of any administrative
instruction.
(b) (2) Eight hours of in-service training per year on the
subject of serving residents with dementia. This training
shall be developed in consultation with individuals or
organizations with specific expertise in dementia care or
by an outside source with expertise in dementia care. In
formulating and providing this training, reference may be
made to written materials and literature on dementia and
the care and treatment of persons with dementia. This
training requirement may be satisfied in one day or over a
period of time. This training requirement may be provided
at the facility or offsite and may include a combination of
observation and practical application.
(b) This section shall become inoperative on January 1,
2016 July 1, 2015 and, as of January 1, 2016, that date is
repealed, unless a later enacted statute, that becomes
operative on or before January 1, 2016, deletes or extends
the dates on which it becomes inoperative and is repealed.
SEC. 6. Section 1569.626 is added to the Health and Safety
Code, to read:
1569.626. (a) All residential care facilities for the
elderly shall meet the following training requirements, as
described in Section 1569.625, for all direct care staff:
(1) Twelve hours of dementia care training before a staff
member begins working independently with residents. All 12
hours shall be devoted to the care of persons with
dementia. The facility may utilize various methods of
instruction, including, but not limited to, preceptorship,
mentoring, and other forms of observation and
demonstration. The orientation time shall be exclusive of
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any administrative instruction.
(2) Eight hours of in-service training per year on the
subject of serving residents with dementia. This training
shall be developed in consultation with individuals or
organizations with specific expertise in dementia care or
by an outside source with expertise in dementia care. In
formulating and providing this training, reference may be
made to written materials and literature on dementia and
the care and treatment of persons with dementia. This
training requirement may be satisfied in one day or over a
period of time. This training requirement may be provided
at the facility or offsite and may include a combination of
observation and practical application.
(b) This section shall become operative on January 1, 2016
July 1, 2015 .
SEC. 7. 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.
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