BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 2228| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 CONTINUED AB 2228 Page 2 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 CONTINUED AB 2228 Page 3 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. CONTINUED AB 2228 Page 4 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. CONTINUED AB 2228 Page 5 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 CONTINUED AB 2228 Page 6 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: CONTINUED AB 2228 Page 7 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 CONTINUED AB 2228 Page 8 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 CONTINUED AB 2228 Page 9 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). CONTINUED AB 2228 Page 10 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 CONTINUED AB 2228 Page 11 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 **** END **** CONTINUED