BILL ANALYSIS Ó AB 2228 Page A 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 AB 2228 Page B 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. AB 2228 Page C 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 AB 2228 Page D 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: AB 2228 Page E 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 : AB 2228 Page F 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, AB 2228 Page G 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. AB 2228 Page H 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 AB 2228 Page I 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