BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2228
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 2228 (Cooley)
          As Amended  August 21, 2014
          Majority vote
           
           ----------------------------------------------------------------- 
          |ASSEMBLY:  |77-0 |(May 27, 2014)  |SENATE: |34-0 |(August 25,    |
          |           |     |                |        |     |2014)          |
           ----------------------------------------------------------------- 
            
           Original Committee Reference:    HUM. S.  

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

             1)   Clarifies the definition of crisis nursery to specify  
               that a nursery provides non-medical care, and may provide  
               both an overnight residential and day services program.

             2)   Limits the time period a child may receive crisis day  
               services to no more than 30 calendar days, a 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.

             3)   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.

             4)   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.

             5)   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.

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








                                                                  AB 2228
                                                                  Page  2


          7)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.

          8)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. 

          9)Requires lead caregivers to have one of the following  
            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 CDA Teacher Permit issued by the  
               California Commission on Teacher Credentialing, as  
               specified.

          10)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.

          11)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  








                                                                  AB 2228
                                                                  Page  3

            caregiver may be left alone with children or counted in the  
            staff-to-child ratios, as specified.

          12)Doubles the number of hours of training a person must undergo  
            in order to volunteer at a crisis nursery 

          13)Reduces the number of hours of training a volunteer must  
            undergo before being included in staff-to-child ratio  
            requirements from 20 to 16 hours. 

          14)Increases staff-to-child ratio requirements for children over  
            the age of 18 months from one-to-three to one-to-six.

          15)Increases staff-to-child ratio requirements for children  
            under the age of 18 months from one-to-three to one-to-four  
            during the hours of operation between 7 p.m. and 7 a.m. 

          16)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  
               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.

           The Senate amendments  :

             1)   Clarify the definition of crisis nursery to specify that  








                                                                  AB 2228
                                                                  Page  4

               a nursery provides non-medical care, and may provide both  
               an overnight residential and day services program.

             2)   Limit the time period a child may receive crisis day  
               services to no more than 30 calendar days, a 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.

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

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

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

             6)   Specify 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.

             7)   Requires a nursery's plan of operation to address how it  
               will deal with unexpected circumstances related to staffing  
               and ensure that additional caregivers are available when  
               needed.

             8)   Modifies the staff-to-child ratio for children under the  
               age of 18 months.

           AS PASSED BY THE ASSEMBLY  , this bill:








                                                                  AB 2228
                                                                  Page  5


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

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

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

          6)Required 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)Required 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)Required lead caregivers to have one of the following  
            education and experience qualifications, as specified. 

          9)Required 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)Required general caregiver staff to complete a minimum of 24  








                                                                 AB 2228
                                                                  Page  6

            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)Reduced the number of hours of training a person must undergo  
            in order to volunteer at a crisis nursery from eight to five  
            hours, as specified.

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

          13)Reduced 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)Deleted 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)Permitted 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)Increased staff-to-child ratio requirements for preschool age  
            children from one-to-three to one-to-six.

          17)Increased staff-to-child ratio requirements for infants from  
            one-to-three to one-to-four during the hours of operation  
            between 7 a.m. and 7 p.m.

          18)Increased staff-to-child ratio requirements for all children  
            from one-to-four to one-to-six during the hours of operation  
            between 7 p.m. and 7 a.m. 

          19)Required licensees and caregivers who provide medication  
            assistance to children to follow specified instructions as  
            provided for by a licensed medical professional, as specified.








                                                                  AB 2228
                                                                  Page  7


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

           COMMENTS  :    

          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 Community Care Facilities  
          Act (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.  








                                                                  AB 2228
                                                                  Page  8


          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,  
          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.

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


                                                                FN: 0005470