BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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          |SENATE RULES COMMITTEE            |                       AB 2228|
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                                       CONSENT


          Bill No:  AB 2228
          Author:   Cooley (D)
          Amended:  8/4/14 in Assembly
          Vote:     21


           SENATE HUMAN SERVICES COMMITTEE  :  4-0, 6/24/14
          AYES:  Beall, DeSaulnier, Liu, Wyland
          NO VOTE RECORDED:  Berryhill

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  77-0, 5/27/14 (Consent) - See last page for  
            vote


           SUBJECT  :    Crisis nurseries

           SOURCE  :     California Alliance of Child and Family Services


           DIGEST  :    This bill revises provisions related to crisis  
          nursery programs by requiring crisis nurseries to be licensed by  
          the Department of Social Services (DSS) to operate crisis  
          residential overnight programs, as defined, and authorizes  
          crisis nurseries to provide crisis day services, as defined.   
          This bill establishes the maximum licensed capacity for a crisis  
          residential overnight program at 14 children and requires that  
          the licensee designate at least one lead caregiver, as  
          described, to be present at the crisis nursery at all times when  
          children are present.  This bill also modifies the requirements  
          relating to the use of volunteers to be counted in the  
          staff-to-child ratios in a crisis nursery, as specified, and  
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          prescribes requirements relating to when a child has a health  
          condition that requires medication.

           ANALYSIS  :    

          Existing law:

          1.Enacts the Community Care Facilities Act, which provides for  
            the licensure and oversight of out of home placements of  
            abused and neglected children by the Department of Social  
            Services (DSS) and which defines a "crisis nursery" as a  
            facility licensed 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.

          2.Exempts crisis nurseries from licensure as a child day care  
            facility under the California Child Care and Development  
            Services Act.

          3.Establishes the maximum licensed capacity for a crisis nursery  
            as 14 children and requires each crisis nursery to collect and  
            maintain information indicating the total number of children  
            placed in the program, the length of stay, the reasons given  
            for the use of the crisis nursery, and the age of each child.

          4.Provides that a crisis nursery may provide child day care  
            services for children under the age of six at the same site as  
            the crisis nursery, that each child may receive services for  
            no more than 30 calendar days in a six-month period and that  
            the child receiving such services shall be counted against the  
            licensed capacity of the crisis nursery.

          5.Requires a crisis nursery to employ an administrator who is on  
            the premises for the number of hours necessary to manage and  
            administer the crisis nursery and who has the following  
            qualifications:

             A.   Specified knowledge and abilities regarding the care of  
               children in crisis nurseries and in managing a facility and  
               staff.

             B.   A Master's Degree in social work or social welfare,  
               marriage and family counseling, counseling psychology or  

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               human services; and at least three years of experience in  
               the field of child or family services, two years of which  
               were in a managerial or administrative position.

             C.   A Bachelor's Degree in behavioral science and five years  
               of experience in the field of child and family services,  
               two years of which were in a managerial or administrative  
               position.

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

          2.Requires a licensee 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.  The licensee shall incorporate the training plan  
            in the crisis nursery plan of operation.

          3.Establishes initial and ongoing training and education  
            requirements for lead caregivers, caregivers and volunteers,  
            including training in pediatric first aid and pediatric  
            cardiopulmonary resuscitation (CPR), as specified.

          4.Requires there be at least one employed staff member for every  
            volunteer caregiver used to meet minimum staff requirements,  
            that there be one employee or volunteer caregiver for every  
            three children from 7 a.m. to 7 p.m. and one employee or  
            volunteer caregiver for every four children from 7 p.m. to 7  
            a.m.

          This bill: 

          1.Defines "crisis nursery" to mean a facility licensed to  
            operate a program to provide short-term care and supervision  
            for children under six years of age who are voluntarily placed  
            for temporary care by a parent or legal guardian due to a  
            family crisis or stressful situation.

          2.Requires a crisis nursery to be licensed to operate a crisis  
            residential overnight program and permits a crisis nursery to  
            also provide crisis day services.


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          3.Requires a crisis nursery to be organized and operated on a  
            nonprofit basis by either a private nonprofit corporation or a  
            nonprofit public benefit corporation.

          4.Defines "crisis day services" to mean temporary, nonmedical  
            care and supervision for children under six years of age who  
            are voluntarily placed by a parent or legal guardian due to a  
            family crisis or stressful situation for less than 24 hours  
            per day.  Prohibits a child from receiving crisis day services  
            at a crisis nursery for more than 30 calendar days, or a total  
            of 360 hours, in a six-month period unless an exception is  
            issued.
           
           5.Defines "crisis residential overnight program" to mean a  
            short-term, 24-hour nonmedical residential care and  
            supervision, including overnight, for children under six years  
            of age who are voluntarily placed by a parent or legal  
            guardian due to a family crisis or stressful situation for no  
            more than 30 days.
           
           6.Defines "voluntarily placed" to mean a child, who is not  
            receiving Aid to Families with Dependent Children-Foster Care,  
            placed by a parent or legal guardian who retains physical  
            custody of, and remains responsible for, the care of his/her  
            children who are placed for temporary emergency care.   
            Specifies that "voluntarily placed" does not include placement  
            of a child who has been removed from the care and custody of  
            his/her parent or legal guardian and placed in foster care by  
            a child welfare services agency.
           
           7.Permits a crisis nursery to provide crisis day services for  
            children under six years of age at the same site that it is  
            providing crisis residential overnight services.
           
           8.Prohibits a child from receiving crisis day services at a  
            crisis nursery for more than 30 calendar days, maximum of 12  
            hours per day, or a total of 360 hours, in a six-month period  
            unless an exception is issued to allow a child to receive  
            additional crisis day services in a six-month period, as  
            specified.

          9.Clarifies that no more than two exceptions, in seven-calendar  
            day or 84-hour increments, may be granted per child in a  
            six-month period.

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          1.Requires a crisis nursery license to be issued for a specific  
            capacity, as determined.

          2.Requires the maximum licensed capacity for crisis day services  
            to be based on 35 square feet of indoor activity space per  
            child.  Specifies that bedrooms, bathrooms, halls, offices,  
            isolation areas, food-preparation areas, and storage places  
            shall not be included in the calculation of indoor activity  
            space.  Includes floor area under tables, desks, chairs, and  
            other equipment intended for use as part of children's  
            activities in the calculation of indoor space.

          3.Requires at least 75-square feet per child of outdoor activity  
            space based on the total licensed capacity.  Specifies that  
            swimming pools, adjacent pool decking, and natural or man-made  
            hazards shall not be included in the calculation of outdoor  
            activity space.

          4.Specifies the maximum licensed capacity for a crisis  
            residential overnight program shall be 14 children and that a  
            child who has been voluntarily placed in a crisis residential  
            overnight program shall be included in the licensed capacity  
            for crisis day services.

          5.Requires all caregivers to be certified in pediatric CPR and  
            pediatric first aid, as specified.

          6.Requires the licensee 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 and to incorporate the training plan in the crisis  
            nursery plan of operation.

          7.Requires the licensee to designate at least one lead caregiver  
            to be present at the crisis nursery at all times when children  
            are present. Requires the lead caregiver to have one of the  
            following education and experience qualifications:

             A.   Completion of 12 postsecondary semester units or  
               equivalent quarter units, with a passing grade, as  
               determined by the institution, in classes with a focus on  
               early childhood education, child development, or child  

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               health at an accredited college or university, as  
               determined, 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. At least three  
               semester units, or equivalent quarter units, or equivalent  
               experience shall include coursework or experience in the  
               care of infants.

             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.

             C.   A current and valid Child Development Associate Teacher  
               Permit issued by the California Commission on Teacher  
               Credentialing.

          1.Requires lead caregivers to have a minimum of 24 hours of  
            training and orientation before working with children.  One  
            year experience in a supervisory position in a child care or  
            group care facility may substitute for 16 hours of training  
            and orientation.  The written staff training plan shall  
            require the lead caregiver to receive and document a minimum  
            of 20 hours of annual training directly related to the  
            functions of his/her position.

          2.Requires caregiver staff to complete a minimum of 24 hours of  
            initial training within the first 90 days of employment.   
            Eight hours of training shall be completed before the  
            caregiver staff is responsible for children, left alone with  
            children, and counted in the staff-to-child ratios, as  
            described.  A maximum of four hours of training may be  
            satisfied by job shadowing.

          3.Requires volunteers to complete a minimum of 16 hours of  
            training, as specified.

          4.Requires, prior to assuming the duties and responsibilities of  
            a crisis caregiver or being counted in the staff-to-child  
            ratio, volunteers to complete at five hours of initial  
            training divided as follows:


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             A.   Two hours of crisis nursery job shadowing.

             B.   One hour of review of community care licensing  
               regulations.

             C.   Two hours of review of the crisis nursery program,  
               including the facility mission statement, goals and  
               objectives, child guidance techniques, and special needs of  
               the client population they serve.
           
           1.Requires, within 90 days, volunteers who are included in the  
            staff-to-child ratios to do both of the following:

             A.   Acquire a certification in pediatric first aid and  
               pediatric cardiopulmonary resuscitation.

             B.   Complete at least 11 hours of training covering 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.
        
           1.Requires at least one employed staff or volunteer caregiver  
            for each group of six preschool age children, or fraction  
            thereof, and one employed staff or volunteer caregiver for  
            each group of four infants, or fraction thereof, from 
          7 a.m. to 7 p.m.

          2.Requires there to be at least one paid caregiver or volunteer  
            caregiver for each group of six children, or fraction thereof,  
            from 7 p.m. to 7 a.m.

          3.Specifies that when a child has a health condition that  
            requires prescription medication, the licensee shall ensure  
            that the caregiver does all of the following:

             A.   Assists children with the taking of the medication as  
               needed.

             B.   Ensures that instructions are followed as outlined by  
               the appropriate medical professional.

             C.   Stores the medication in accordance with the label  
               instructions in the original container with the original  

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               unaltered label in a locked and safe area that is not  
               accessible to children.

             D.   Administers the medication as directed on the label and  
               prescribed by the physician in writing.

          1.Requires the licensee to obtain, in writing, approval and  
            instructions from the child's authorized representative for  
            administration of the prescription medication for the child.   
            This documentation shall be kept in the child's record.

          2.Prohibits the licensee from administering prescription  
            medication to a child in accordance with instructions from the  
            child's authorized representative if the authorized  
            representative's instructions conflict with the physician's  
            written instructions or the label directions as prescribed by  
            the child's physician.

          3.Permits nonprescription medications to be administered without  
            approval or instructions from the child's physician if all of  
            the following conditions are met:

             A.   Nonprescription medications shall be administered in  
               accordance with the product label directions on the  
               nonprescription medication container or containers.

             B.   For each nonprescription medication, the licensee shall  
               obtain, in writing, approval and instructions from the  
               child's authorized representative for administration of the  
               nonprescription medication to the child.  This  
               documentation shall be kept in the child's record.

          1.Prohibits the licensee from administering nonprescription  
            medication to a child in accordance with instructions from the  
            child's authorized representative if the authorized  
            representative's instructions conflict with the product label  
            directions on the nonprescription medication container or  
            containers.

          2.Requires the licensee to develop and implement a written plan  
            to record the administration of the prescription and  
            nonprescription medications and to inform the child's  
            authorized representative daily, for crisis day services, and  
            upon discharge for overnight care, when the medications have  

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            been given.

          3.Requires, when no longer needed by the child, or when the  
            child is removed or discharged from the crisis nursery, all  
            medications to be returned to the child's authorized  
            representative or disposed of after an attempt to reach the  
            authorized representative.

           Background
           
           Crisis Nursery Model  .  Crisis nurseries were created as a  
          separate licensing category under the Community Care Facilities  
          Act under SB 855 (Machado, Chapter 664, Statutes of 2004) to  
          provide a temporary and emergency housing and shelter facility  
          placement option for parents.  The intent of the care model is  
          to provide a voluntary 24-hour placement option for families  
          with young children who are facing difficult or extreme  
          financial, health, or other challenges to prevent the need for  
          or the engagement of child welfare services.  Under the statute,  
          the crisis nurseries were limited to specified counties and were  
          intended to serve children under the age of six who were  
          voluntarily placed by their parent or guardian under their  
          temporary care or, under limited circumstances, were temporarily  
          placed by a county child welfare service agency.

          Prior to SB 855's adoption, crisis nurseries were licensed as a  
          group home under the Community Care Facility Act, and it was  
          argued that those regulations were excessive and inappropriate  
          for crisis nurseries due to differences in the care needs of  
          very young children who were voluntarily placed by a parent  
          compared to the needs of children that were removed from  
          parental custody by county child protective services workers due  
          to abuse or neglect.  The bill at that time included a sunset of  
          January 1, 2008, which was subsequently extended to January 1,  
          2014.

          Due to concerns with crisis nurseries serving as a temporary  
          placement for children removed from their homes by county social  
          workers, SB 1214 (Wolk, Chapter 519, Statutes of 2010)  
          eliminated crisis nurseries as an allowable child welfare  
          placement effective January 1, 2012.  Following this agreement  
          the state eliminated the sunset, allowing crisis nurseries to  
          exist permanently under SB 1319 (Liu, Chapter 663, Statutes of  
          2012).

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          Five crisis nurseries are licensed in California currently,  
          located in Concord, Davis, Nevada City and two in Sacramento.   
          Since 2009, more than 9,000 children have been served by these  
          nurseries.  On average, 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.

          Currently there are no state of federal monies made available to  
          crisis nurseries, with all five nurseries rely upon  
          philanthropic support and local funds to operate.  In many  
          instances a related group home provider will support and manage  
          a local crisis nursery, usually at a substantial financial loss.  
           As a result, crisis nurseries rely substantially on trained  
          volunteers to meet the staffing requirements.

           Crisis Nursery Day Care Services  .  According to the California  
          Alliance of Child and Family Services, this bill seeks to bring  
          child-to-staff ratios into alignment with current day child care  
          licensing ratio standards, which are based on a square feet per  
          child ratio.

          Current child care regulations require child care facilities to  
          maintain 75 square feet of outdoor space per child and at least  
          35 square feet of indoor space per child.  This bill applies  
          only the latter standard of 35 square feet of indoor space and  
          is silent on outdoor space.  A remaining difference in  
          regulations is that crisis nurseries would permit volunteers to  
          count toward the caregiver-child ratios, whereas child care  
          regulations do not.  Conversely, crisis nurseries have a higher  
          standard of training in pediatric CPR and first aid and must  
          ensure that all staff have such training, while child care  
          providers must only ensure that a staff member with such  
          training is present at all times.  Crisis nursery staff and  
          volunteers are subject to the same criminal record clearance  
          requirements as child care providers and the crisis nursery  
          administrator and lead caregiver education and experience  
          requirements are similar to the teacher requirements provided  
          for under child care regulations.

           Comments
           
          According to the author's office, existing law and regulations  

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          governing crisis nurseries have not been updated to reflect  
          changes made by SB 1214 (Wolk, Chapter 519, Statutes of 2010)  
          which prohibits the use of crisis nurseries as a placement for  
          foster children, effective July 1, 2012.  The author's office  
                                                        states that this bill brings laws and regulations pertaining to  
          crisis nurseries into alignment with child day care regulations  
          in order to make it possible for existing crisis nurseries to  
          remain in operation and provide a safe environment for young  
          children of families in crisis.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/12/14)

          California Alliance of Child and Family Services (source)
          Contra Costa County

           ASSEMBLY FLOOR  :  77-0, 5/27/14
          AYES:  Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,  
            Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,  
            Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,  
            Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,  
            Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,  
            Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,  
            Nazarian, Nestande, Olsen, Pan, Perea, John A. Pérez, V.  
            Manuel Pérez, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas,  
            Skinner, Stone, Ting, Wagner, Waldron, Weber, Wieckowski,  
            Wilk, Williams, Yamada, Atkins
          NO VOTE RECORDED:  Patterson, Quirk-Silva, Vacancy


          JL:e  8/12/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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