BILL ANALYSIS                                                                                                                                                                                                    Ó




                                                                  AB 2228
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          Date of Hearing:   April 29, 2014

                        ASSEMBLY COMMITTEE ON HUMAN SERVICES
                                  Mark Stone, Chair
                AB 2228 ( Cooley) - As Introduced:  February 20, 2014
           
          SUBJECT  :  Crisis Nurseries

           SUMMARY  :  Makes a number of changes to existing requirements for  
          crisis nurseries.  Specifically,  this bill  :   

          1)Deletes the authority of a crisis nursery to provide child day  
            care services for children under six years of age and instead  
            permits a crisis nursery to provide "crisis day respite  
            services."

          2)Deletes the prohibition on a crisis nursery providing child  
            day care services to eligible children for more than 30  
            calendar days within a six-month period, unless otherwise  
            permitted by the Department of Social Services (DSS).

          3)Deletes the requirement that a child receiving child day care  
            services from a crisis nursery are counted towards its  
            licensed capacity.

          4)Permits a crisis nursery's licensed capacity to be based upon  
            35 square feet of indoor activity space per child, as  
            specified.

          5)Requires at least one crisis nursery caregiver to have  
            certification in cardiopulmonary resuscitation (CPR) and  
            pediatric first aid, as specified.

          6)Requires crisis nursery licensees to develop, maintain and  
            implement a written staff training plan for the orientation,  
            continuing education, on-the-job training and development,  
            supervision, and evaluation of all lead caregivers,  
            caregivers, and volunteers, which shall be included in the  
            facility's plan of operation.

          7)Requires crisis nursery licensees to designate at least one  
            lead caregiver to be present at the crisis nursery at all  
            times when children are present. 

          8)Requires lead caregivers to have one of the following  









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            education and experience qualifications:

             a)   Completion of 12 postsecondary units, as specified, in  
               classes with a focus on early childhood education, child  
               development, or child health at an accredited college or  
               university, and six months of work experience in a licensed  
               group home, licensed infant care center, or comparable  
               group child care program or family day care;

             b)   A current and valid Child Development Associate (CDA)  
               credential, with the appropriate age level endorsement  
               issued by the CDA National Credentialing Program, and at  
               least six months of on-the-job training or work experience  
               in a licensed child care center or comparable group child  
               care program; or

             c)   A current and valid Child Development Associate Teacher  
               Permit issued by the California Commission on Teacher  
               Credentialing, as specified.

          9)Requires lead caregivers to have a minimum of 24 hours of  
            training and orientation before working with children, permits  
            one year experience in a supervisory position in a child care  
            or group care facility to be substituted for 16 hours of  
            training and orientation, and requires lead caregivers to  
            undergo at least 20 hours of ongoing training, as specified.

          10)Requires general caregiver staff to complete a minimum of 24  
            hours of initial training within the first 90 days of  
            employment, which may include first aid and CPR and shall be  
            included in the written staff training plan, and requires that  
            at least eight hours of training be completed before the  
            caregiver may be left alone with children or counted in the  
            staff-to-child ratios, as specified.

          11)Reduces the number of hours of training a person must undergo  
            in order to volunteer at a crisis nursery from eight to five  
            hours in the following ways:

             a)   Reduces crisis nursery job shadowing from four to two  
               hours; and

             b)   Reduces from two hours to one hour the amount of  
               training a volunteer must receive on community care  
               licensing regulations.









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          12)Adds "child guidance techniques" to existing training  
            requirements for volunteers.

          13)Reduces the number of hours of training a volunteer must  
            undergo before being included in staff-to-child ratio  
            requirements from 20 to eight hours. 

          14)Deletes existing training requirements that volunteers must  
            undergo 12 hours of CPR training and eight hours of child  
            health and safety training and instead requires eight hours of  
            training that covers child care health and safety issues,  
            trauma informed care, the importance of family and sibling  
            relationships, temperaments of children, self-regulation  
            skills and techniques, and program child guidance techniques.

          15)Permits volunteers who have not met specified training  
            requirements necessary to be included in staff-to-child ratio  
            requirements to supervise napping children without being under  
            the direct supervision of staff. 

          16)Increases staff-to-child ratio requirements for preschool age  
            children from one-to-three to one-to-six.

          17)Increases staff-to-child ratio requirements for infants from  
            one-to-three to one-to-four during the hours of operation  
            between 7 am and 7 pm.

          18)Increases staff-to-child ratio requirements for all children  
            from one-to-four to one-to-six during the hours of operation  
            between 7 pm and 7 am. 

          19)Requires licensees and caregivers who provide medication  
            assistance to children to do all of the following:

             a)   Assist children with the taking of the medication,  
               follow instructions as provided by an appropriate medical  
               professional, store the medication appropriately, as  
               specified, and administer the medication as directed on the  
               label or as advised by a physician in writing; 

             b)   Administer nonprescription medication without the  
               consent of the child's physician as long as the medication  
               is administered in accordance with the product label and  
               the child's parent has consented in writing to the use of  









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               the medication, as specified; 

             c)   Develop and implement a written plan to record the  
               administration of prescription and nonprescription  
               medications and to inform the child's authorized  
               representative daily, for day care, and upon discharge for  
               overnight care, when the medications have been given; and

             d)   Return all medications to the child's authorized  
               representative when the child is withdrawn from the  
               facility, as specified.

           EXISTING LAW   

          1)Defines a "crisis nursery" as a facility licensed by DSS under  
            the Community Care Facilities Act (CCFA) to provide  
            short-term, 24 hour residential care and supervision for  
            children under the age of six, who are voluntarily placed by  
            their parent or guardian due to a family crisis or stressful  
            situation for not more than 30 days.  (H&S Code 1516)

          2)Exempts crisis nurseries from having to be licensed as a child  
            day care facility under the California Child Care and  
            Development Services Act.  (H&S Code 1596.792)

          3)Permits a crisis nursery to provide child day care services  
            for children under six years of age for no more than 30 days  
            in a six-month period, unless otherwise permitted by DSS.   
            (H&S Code 1516(f))

          4)Requires crisis nurseries to collect and maintain information,  
            as specified, indicating the total number of children placed  
            in the program, the length of stay for each child, the reasons  
            given for the use of the crisis nursery, and the age of each  
            child, as specified.  (H&S Code 1516(e))

          5)Requires any person who owns, operates, administers, is  
            employed by, or is a volunteer of a community care facility,  
            under the CCFA, including a crisis nursery to undergo a  
            criminal background check and receive a criminal record  
            clearance prior to working with or providing care for clients  
            or residents of a community care facility.  (H&S Code 1522) 

          6)Requires a crisis nursery licensee to have an administrator  
            who meets one of the following requirements:  









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             a)   A Master's Degree in social work or social welfare,  
               marriage, family and child counseling, or counseling  
               psychology or human services; and have at least three years  
               of experience in the field of child and family services, as  
               specified; or

             b)   A Bachelor's Degree in behavioral science and has five  
               years of experience in the field of child and family  
               services, as specified. (§86564(d) of Title 22, CCR)

          7)Requires an administrator to "be on the premises for the  
            number of hours necessary to manage and administer the crisis  
            nursery in compliance with applicable law and regulation."   
            (§86564(c) of Title 22, CCR)

          8)Requires licensees to designate at least one lead caregiver to  
            be present at the crisis nursery at all times when children  
            are present.  (§86565(p) of Title 22, CCR)

          9)Provides minimum levels of qualifications, educational  
            experience and ongoing training lead caregivers and caregiver  
            staff must undergo in order to work with and provide care for  
            children in crisis nurseries, including but not limited to 24  
            hours of initial training and 20 hours of annual training, as  
            specified.  (§86565 of Title 22, CCR)

          10)Requires all lead caregivers, caregivers, and volunteers to  
            have a current and valid pediatric CPR and pediatric first aid  
            certification, as specified.  (§86565(n) of Title 22, CCR)

          11)Requires all volunteers to undergo eight hours of initial  
            training prior to being allowed to provide staff supervised  
            care to children in a crisis nursery.  (§86565(w)(1) of Title  
            22, CCR)

          12)Allows a volunteer who undergoes an additional 20 hours of  
            training within 90 days of becoming a volunteer to provide  
            unsupervised care to children and to count towards caregiver  
            staff-to-child ratio requirements.  (§86565(x) of Title 22,  
            CCR)

           FISCAL EFFECT  :  Unknown

           COMMENTS  :    









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           Background on crisis nurseries  :  Established in 2004 by SB 855  
          (Machado), Chapter 664, Statutes of 2004, crisis nurseries were  
          created as a separate licensing category to provide a temporary  
          housing and shelter facility placement option for parents.  The  
          goal of crisis nurseries is to provide an alternative voluntary  
          placement option for families with young children who are facing  
          difficult or extreme financial, health, or other challenges and  
          to prevent the need for or the engagement of child welfare  
          services.  This limits the role of crisis nurseries to only  
          serve children under the age of six who are voluntarily placed  
          by their parent or guardian under their temporary care.

          Prior to SB 855's adoption, crisis nurseries were subject to  
          licensure as a group home under the CCFA.  According to the  
          Assembly Human Services August 26, 2004 analysis of SB 855, the  
          author argued that group home licensing requirements were  
          "inappropriate for crisis nurseries, since the demands of very  
          young children who are voluntarily placed by a parent are less  
          serious than those of older children who have been removed from  
          parental custody by county child protective services workers due  
          to abuse or neglect."  Further, operators of crisis nurseries  
          argued "that the costs of complying with group home regulations  
          are excessive and threaten their viability." 

          To allow for the monitoring and evaluation of this licensing  
          category, SB 855 was approved with a sunset of January 1, 2008.   
          That sunset was extended by two subsequent measures to establish  
          the current sunset of January 1, 2014 to provide additional time  
          for DSS to establish licensing regulations.  Crisis nurseries  
          were originally allowed to serve a limited number of foster  
          youth, however, that authority was eliminated effective January  
          1, 2012 pursuant to SB 1214 (Wolk), Chapter 519, Statutes of  
          2010.  Finally, in 2012, the state adopted SB 1319 (Liu),  
          Chapter 663, Statutes of 2012, which eliminated the sunset and  
          allowed crisis nurseries to exist in perpetuity.  Had the sunset  
          been allowed to take effect, crisis nurseries would have, again,  
          had to comply with group home licensing requirements under the  
          CCFA.  

          According to DSS, there are currently five licensed crisis  
          nurseries in California.  All five are located in northern  
          California; Concord, Davis, Nevada City and two in Sacramento.   
          Since 2009, approximately 9,155 children have been served by  
          these nurseries, except for the Concord facility.  On average,  









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          the lengths of stay have ranged from eight hours to just over 24  
          hours with 44 children staying for the maximum allowable days.   
          No exemptions have been requested or granted for children to  
          stay beyond the 30-day limit. 

           Need for the bill  :  Stating the need for the bill, the author  
          writes:

               The current law and regulations governing Crisis Nurseries  
               has not been updated to reflect changes made by SB 1214  
               (Wolk) Chapter 93, Statutes of 2010, prohibiting the use of  
               Crisis Nurseries for foster children, effective July 1,  
               2012.  This has resulted in laws and regulations that are  
               unnecessary for Crisis Nurseries.  The increased cost of  
               providing services is preventing Crisis Nurseries from  
               making the most effective use of qualified volunteers, in  
               support of paid employees, to care for children voluntarily  
               placed by their own parents or legal guardians.

           Staff comments  :  This bill seeks to modify current operating  
          requirements for crisis nurseries in three ways.  First, it  
          lifts the 30-day limitation on the use of crisis nurseries and  
          aligns facility capacity and operating requirements to reflect  
          the practical realities that night and day respite care have  
          different needs.  Secondly, it modifies training requirements  
          for lead caregivers, caregivers, volunteers who may be counted  
          as a caregiver, and general volunteers.  Lastly, it eliminates  
          the requirement that staff and certain volunteers be certified  
          in pediatric first aid and CPR.

          Under current statute, no child may utilize a crisis nursery for  
          more than 30-days in a six-month period, but exemptions can be  
          provided as determined by DSS.  However, under current  
          regulations, DSS is required to respond to an exemption request  
          within 30-days.  This is untenable, as it is difficult to  
          determine whether a child's family, upon the child's entry into  
          a crisis nursery, would still require respite care after 30  
          days.  It is also unclear whether the 30-day limit should be  
          eliminated, as current data does not demonstrate that the 30-day  
          exemption has been granted.  Rather than delete the 30-day  
          limitation altogether, and in order to maintain the purpose of  
          crisis nurseries to be a temporary crisis respite service, the  
          bill should reflect reasonable operating standards to allow that  
          extensions, instead of exemptions, be granted. 










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          Regarding the fiscal operating model of crisis nurseries, all  
          five nurseries rely upon philanthropic support and local funds  
          to operate.  As a result, they rely substantially on trained  
          volunteers to serve in the capacity of caregiving staff in order  
          to meet state staff-to-child ratio requirements.  Because of  
          this, the sponsor argues that current requirements "artificially  
          drive up the cost of providing the services" and that  
          "continuing to operate under these requirements will force  
          crisis nurseries to close."<1>  In attempting to lessen some of  
          these requirements and to draw upon nearly ten years of  
          experience on how crisis nurseries have fared, the bill seeks to  
          increase child-to-staff ratios by bringing them into alignment  
          with current day child care licensing ratio standards.  It also  
          increases the content and quality of training for all staff,  
          including volunteers must undergo, but eliminates the  
          requirement that staff and volunteers who may count in staffing  
          ratios are certified in pediatric first aid and CPR.  If staff,  
          and especially volunteers, are to be recognized for purposes of  
          meeting facility staff-to-child ratios and allowed to be left  
          alone with children, they should meet a higher level of training  
          than general volunteers.  Eliminating the pediatric first aid  
          and CPR certification requirement is unnecessary, as it provides  
          a minimum level of health and safety training and experience for  
          caregiver staff and volunteers who count as staff.

           RECOMMENDED AMENDMENTS:  

          To provide a more responsive and timely process to request and  
          receive an extension of the 30-day limit, the bill should be  
          amended to provide a process on how extensions, rather than  
          exemptions are provided.  It should also retain requirements of  
          staff and volunteers who may count in staff-to-child ratios to  
          be certified in pediatric first aid and CPR. 

          Specifically, committee staff recommends the following  
          amendments:

          1)Provide that two extensions of no more than seven calendar  
            days may be provided and require DSS to respond to an  
            extension request within five working days.

            --------------------------
          <1> California Alliance for Child and Family Services. Crisis  
          Nurseries: Use of Volunteers and Other Improvements. Issue:  
          Amending statutory provisions to facilitate the effectiveness of  
          Crisis Nurseries. October 1, 2013








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          2)Retain the requirement of staff and volunteers who may count  
            in staff-to-child ratios to be certified in pediatric first  
            aid and CPR.

          3)Delete the permission of volunteers to be alone with children  
            while napping without having a certification in pediatric  
            first aid and CPR.

           REGISTERED SUPPORT / OPPOSITION :   

           Support 

           California Alliance of Child and Family Services 

           Opposition 
           
          None on file.
           
          Analysis Prepared by  :    Chris Reefe / HUM. S. / (916) 319-2089