BILL ANALYSIS                                                                                                                                                                                                    Ó




                                                                  AB 2044
                                                                  Page A
          CONCURRENCE IN SENATE AMENDMENTS
          AB 2044 (Rodriguez)
          As Amended  August 21, 2014
          Majority vote
           
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          |ASSEMBLY:  |64-1 |(May 19, 2014)  |SENATE: |33-0 |(August 25,    |
          |           |     |                |        |     |2014)          |
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           Original Committee Reference:    HUM. S.  

           SUMMARY  :  Places additional staffing and health and safety  
          requirements on residential care facilities for the elderly  
          (RCFE).  Specifically,  this bill  :   

          1)This bill would require that at least one administrator,  
            facility manager, or designated substitute who is at least 21  
            years of age and has adequate qualifications, as specified, be  
            on the premises of the facility 24 hours per day. 

          2)Requires RCFEs to employ, and the administrator to schedule, a  
            sufficient number of staff members, as prescribed.

          3)Requires RCFE staff training also include training on building  
            and fire safety and how to appropriately respond to  
            emergencies.

          4)Requires that at least one staff member with a certification  
            in cardiopulmonary resuscitation (CPR) and first aid training  
            is on duty at all times and provides that this requirement may  
            not be construed to require staff to provide CPR to a resident  
            who has requested to forgo resuscitative measures, as  
            specified. 

          5)Clarifies that RCFEs must be clean, safe, sanitary, and in  
            good repair at all times for the safety and well-being of  
            residents, staff, and visitors, as specified.

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee, pursuant to Senate Rule 28.8, negligible state costs.

           The Senate amendments  :
           
           1)Clarify that an individual appointed by the administrator to  









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            serve in the capacity of the administrator shall have the  
            necessary qualifications to serve that role.  

           2)Clarify that staff are not required to provide CPR to a  
            resident who has requested to forgo resuscitative measures, as  
            specified.  
                 
           3)Require that at least one administrator, facility manager, or  
            designated substitute who is at least 21 years of age and has  
            adequate qualifications, as specified, be on the premises of  
            the facility 24 hours per day. 

          4)Require RCFEs to employ, and the administrator to schedule, a  
            sufficient number of staff members, as prescribed.

          5)Require RCFE staff training also include training on building  
            and fire safety and how to appropriately respond to  
            emergencies.

          6)Makes chaptering out amendments to avoid conflict with AB 1570  
            (Chesbro) of the current legislative session.
           
          AS PASSED BY THE ASSEMBLY  , this bill:

          1)Required that at least one administrator, facility manager, or  
            other person designated to serve in the capacity of the  
            administrator are on the premises of a RCFE at all times. 

          2)Clarified the requirement that RCFEs employ a sufficient  
            number of staff to meet the needs of its residents as provided  
            in their service agreements and to ensure the health, safety,  
            comfort, and supervision of residents.

          3)Required that at least one staff member with a certification  
            in CPR and first aid training is on duty at all times, as  
            specified. 

          4)Clarified that RCFEs must be clean, safe, sanitary, and in  
            good repair at all times for the safety and well-being of  
            residents, staff, and visitors, as specified.

           COMMENTS  :    

          Background:  RCFEs, commonly referred to as assisted living  
          facilities, are licensed retirement residential homes and board  









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          and care homes that accommodate and provide services to meet the  
          varying, and at times, fluctuating health care needs of  
          individuals who are 60 years of age and over, and persons under  
          the age of 60 with compatible needs.  Licensed by the Department  
          of Social Services' (DSS') Community Care Licensing Division  
          (CCLD), they can range in size from residential homes with six  
          or less beds to more formal residential facilities with 100 beds  
          or more. 

          There is also no uniform common care model; rather the types of  
          assistive services can vary widely, which can include differing  
          levels of personal care and protective supervision, based upon  
          the needs of the resident. 

          Growing demand:  Over the past 30 years, the demand for RCFEs  
          has grown substantially.  Although RCFEs have been generally  
          available, they experienced explosive growth in the 1990s, more  
          than doubling the number of beds between 1990 and 2002,<1> and  
          continued to grow by 16% between 2001 and 2010.<2>  Nationwide,  
          states reported 1.2 million beds in licensed RCFEs in 2010.<3>   
          In 2010, the national Centers for Disease Control and Prevention  
          reported that 40% of RCFE residents needed help with three or  
          more activities of daily living and three-fourths of residents  
          had at least two of the 10 most common chronic conditions.<4>
          According to DSS, as of June 2, 2014, there are 7,587 licensed  
          RCFEs in California with a capacity to serve 176,891 residents. 

          RCFE licensee and administrator requirements:  California  
          statute differentiates between facility licensees, who often are  
          the business owners and may be property owners and  
          administrators who are charged with overseeing the quality of  
          the day-to-day operations and are generally required to be  
          present at the facility during normal working hours.  However,  
          ---------------------------
          <1>  Flores and Newcomer, "Monitoring Quality of Care in  
          Residential Care for the Elderly: The Information Challenge".  
          Journal of Aging and Social Policy, 21:225-242, 2009.
          <2>  SCAN Foundation. "Long Term Care Fundamentals: Residential  
          Care Facilities for the Elderly." March 2011.
          http://thescanfoundation.org/sites/thescanfoundation.org/files/LT 
          C_Fundamental_7_0.pdf
          <3>  "Assisted Living and Residential Care in the States in  
          2010," Mollica, Robert, AARP Public Policy Institute
          <4>  "Residents Living in Residential Care Facilities: United  
          States, 2010, Caffrey, Christine, et al., US Centers for
          Disease Control, April 2012








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          initial training and certification requirements for licensees  
          and administrators are similar. 

          At minimum, in order to be eligible to apply for a RCFE license,  
          a person must be at least 21 years of age, pass a criminal  
          background check, and have a high school diploma or pass a  
          general educational development test.  A prospective licensee  
          must then provide evidence that he or she is of "reputable and  
          responsible character,"<5> which includes providing their  
          employment history and character references.  A prospective  
          licensee must also document that he or she has sufficient  
          financial resources to maintain the standard of care required by  
          law and disclose any prior role as an administrator or licensee  
          of another community care facility, including whether any  
          disciplinary action was taken against him or her. 

          RCFE staff requirements:  Licensees employ a wide range of staff  
          to provide day-to-day support and care for residents of RCFEs.   
          Although many employ individuals with specific expertise and  
          certifications, such as Licensed Vocational Nurses and Certified  
          Nursing Assistants, at minimum, staff "who assist residents with  
          personal activities of daily living"<6> are required to be at  
          least 18 years of age and undergo 10 hours of training within  
          four weeks of being employed by the RCFE and four hours of  
          training each year thereafter.  The training is somewhat similar  
          to that required of licensees and administrators, but  is  
          limited to covering the physical limitations and needs of the  
          elderly, the importance and techniques for personal care  
          services, residents' rights, policies and procedures regarding  
          medications, and the psychosocial needs of the elderly. 

          All personnel, including the licensee, administrator and staff,  
          are required to undergo and receive a criminal background  
          clearance, and must demonstrate they are of good health, which  
          means they must be physically and mentally capable of performing  
          assigned tasks.  In order to ensure that all personnel are of  
          good health, they are required to undergo a health screening not  
          more than six months prior to, or seven days after, employment  
          or licensure.<7>

           
          ---------------------------
          <5> Health and Safety Code Section 1569.15
          <6> Health and Safety Code Section 1569.625(b)
          <7> Section 87411(f) of Title 22, California Code of  
          Regulations.








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          Analysis Prepared by  :    Chris Reefe / HUM. S. / (916) 319-2089 


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