BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair SB 895 (Corbett) - Residential care facilities for the elderly: unannounced visits. Amended: April 23, 2014 Policy Vote: Human Services 5-0 Urgency: No Mandate: No Hearing Date: May 23, 2014 Consultant: Jolie Onodera SUSPENSE FILE. AS AMENDED. Bill Summary: SB 895 would require the Department of Social Services (DSS) to conduct unannounced inspections of residential care facilities for the elderly (RCFEs) at least annually, as specified. Additionally, this bill requires the DSS to verify that a deficiency has been corrected no later than 10 days after notification to a facility. Fiscal Impact (as approved on May 23, 2014): Initial costs in the low millions of dollars, increasing to about $5 million (General Fund) per year once the inspection frequency has increased to at least annually for all RCFEs. Background: The Community Care Licensing Division (CCLD) of the DSS administers the licensure and oversight of over 7,500 assisted living, board and care, and continuing care retirement homes that are licensed as RCFEs in California. These residences are designed to provide home-like environment housing options to elderly residents who need assistance with activities of daily living but otherwise do not require continuous, 24-hour assistance or nursing care. The RCFE licensure category includes facilities with as few as six beds to facilities with hundreds of residents whose needs may vary widely. Prior to 2003, the required frequency of CCLD facility visits was annually for most facility types. Subsequently, in response to the state's fiscal situation, legislation was enacted to lengthen the interval between visits in an effort to reduce program costs. As a result, the CCLD is now required to conduct unannounced visits annually only in circumstances in which a facility has a history of compliance issues. For those residential facilities not subject to annual inspections, the CCLD is currently required to conduct comprehensive compliance SB 895 (Corbett) Page 1 inspections on a 30 percent random sample basis each year, with no facility being visited less than once every five years. In response to recent health and safety issues discovered at facilities licensed by the CCLD, the 2014-15 Governor's Budget proposes a comprehensive plan to reform the CCLD program. This proposal includes an increase of $7.5 million ($5.8 million General Fund) and 71.5 positions to improve the timeliness of investigations, ensure the CCLD inspects all facilities at least once every five years, increase staff training, and establish clear fiscal, program, and corporate accountability. The proposal also increases civil penalties assessed for violations and increases licensing and application fees by 10 percent. While the proposal does not include any statutory changes to the mandated inspection frequency, the number and frequency of visits is expected to increase due to the addition of resources dedicated to specialized workloads, thereby permitting licensing program analysts to conduct more facility inspections. The proposed budget for CCLD in 2014-15 is $118 million ($36 million General Fund). This represents an 11 percent increase above estimated 2013-14 total expenditures (37 percent above 2013-14 General Fund expenditures). Proposed Law: This bill requires the DSS to conduct unannounced inspections of all RCFEs at least once each year. Specifically, this bill: Requires DSS to conduct a comprehensive evaluation of each facility for compliance with the laws and regulations governing RCFEs. Permits DSS to conduct additional unannounced inspections when a licensee is on probation, when required by the terms of a facility compliance plan, when an accusation against a licensee is pending, when required for receipt of federal financial participation, or to verify that a person who has been ordered out of a facility is no longer present. Requires DSS to verify compliance no later than 10 days after the notification of a deficiency or up to an additional 30 days if the DSS determines the delay will not adversely impact the health and/or safety of facility residents. Deletes existing provisions of law requiring annual unannounced visits of no less than 20 percent of RCFEs, and the 10 percent trigger. Deletes the existing provision of law specifying DSS is to visit a RCFE no less than once every five SB 895 (Corbett) Page 2 years. Requires all inspection reports, evaluations, or consultations to be available to the public on the DSS website and in its district offices. Related Legislation: AB 1454 (Calderon) 2014 would require all licensed community care facilities, RCFEs, and child day care centers to be subject to annual unannounced visits by the DSS. This bill is currently on the Suspense File of the Assembly Committee on Appropriations. Due to long-term reform efforts by the California Advocates for Nursing Home Reform (CANHR), as well as in response to a growing number of highly publicized incidents at licensed community care facilities throughout the state, the following bills regarding licensing and inspections at community care facilities, and RCFEs specifically, have been introduced this session: SB 894 (Corbett) RCFEs: revocation of license. SB 911 (Block) RCFEs: licensing and training requirements. SB 1153 (Leno) RCFEs: suspension of new admissions. SB 1382 (Block) RCFEs: licensure fees. AB 1436 (Waldron) RCFEs: internet posting of inspection reports. AB 1523 (Atkins) RCFEs: liability insurance. AB 1554 (Skinner) RCFEs: complaint procedures. AB 1570 (Chesbro) RCFEs: training requirements. AB 1571 (Eggman) RCFEs: disclosure requirements. AB 1572 (Eggman) RCFEs: single resident council. AB 1899 (Brown) RCFEs: prohibitions on licensure reinstatement. AB 2044 (Rodriguez) RCFEs: 24-hour presence of administrator/staff. AB 2171 (Wieckowski) RCFEs: residents' rights. Prior Legislation: AB 364 (Calderon) 2013 would have required the DSS CCLD inspectors to make unannounced visits to most licensed facilities (with the exception of licensed child care facilities) at least once every two years. This bill was held on the Suspense File of the Assembly Committee on Appropriations. AB 419 (Mitchell) 2011 would have required the DSS to conduct an unannounced inspection of a care facility at least once each year and as often as necessary to ensure the quality of care provided. This bill was held on the Suspense File of the Assembly Committee on Appropriations. SB 895 (Corbett) Page 3 Staff Comments: It is estimated the DSS would require additional resources in the range of $5 million (General Fund) ongoing to meet the annual inspection requirements of this bill. Author amendments phase-in the frequency of required inspections as follows: On or before July 1, 2016, the DSS must ensure that each facility is inspected at least once every three years and as often as necessary to ensure the quality of care provided. On or before July 1, 2017, the DSS must ensure that each facility is inspected at least once every two years and as often as necessary to ensure the quality of care provided. On or before July 1, 2018, and each year thereafter, the DSS must ensure that each facility is inspected at least annually. Author amendments also make various other technical changes.