BILL ANALYSIS Ó
SB 895
Page A
SENATE THIRD READING
SB 895 (Corbett)
As Amended August 18, 2014
Majority vote
SENATE VOTE :36-0
HUMAN SERVICES 6-0 APPROPRIATIONS 12-0
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|Ayes:|Stone, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Ammiano, | |Bradford, |
| |Ian Calderon, Garcia, | |Ian Calderon, Campos, |
| |Lowenthal | |Eggman, Gomez, Holden, |
| | | |Pan, Quirk, |
| | | |Ridley-Thomas, Weber |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Adds additional requirements to the Residential Care
Facilities for the Elderly Act (RCFE) and requires the
Department of Social Services (DSS) to post specified licensing
information on its website and provide additional information on
the projected costs of conducting annual licensing inspections
for RCFEs. Specifically, this bill :
1)Brings statute into alignment with regulations pertaining to
the time period a RCFE must remedy a deficiency, as specified.
2)Provides that the failure to remedy a deficiency within the
prescribed timeline would not result in a misdemeanor.
3)Requires DSS to post on its Internet Web site information on
how to obtain an inspection report, and would state the intent
of the Legislature that the department make inspection reports
available on its Internet Web site by January 1, 2020.
4)Requires DSS to design, or cause to be designed, a poster that
contains information on the appropriate reporting agency in
case of a complaint or emergency.
5)Requires RCFEs to post the poster in the main entry way of its
facility, and would provide that a violation of this provision
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is not a misdemeanor under the act, but may be subject to
civil penalties.
6)Requires DSS to report the projected costs of conducting
annual inspections of residential care facilities for the
elderly beginning January 1, 2018.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Ongoing costs to DSS of approximately $5 million General Fund
(GF) once the inspection frequency has increased to at least
annually for all RCFEs.
2)Initial costs to DSS in the low millions (GF) annually for
approximately three years during the inspection frequency
phase-in period.
3)Ongoing costs to DSS in the low hundreds of thousands for
project development, testing and maintenance and other related
IT contract work necessary to make inspection result details
available on its Web site.
4)Ongoing costs to DSS of approximately $50,000 (GF) to verify
that deficiencies have been corrected within 10 days of
notification to the facility.
COMMENTS :
Background: RCFEs, commonly referred to as assisted living
facilities, are licensed retirement residential homes and board
and care homes that accommodate and provide services to meet the
varying, and at times, fluctuating health care needs of
individuals who are 60 years of age and over, and persons under
the age of 60 with compatible needs. Licensed by DSS Community
Care Licensing Division (CCLD), they can range in size from
residential homes with six or less beds to more formal
residential facilities with 100 beds or more.
Growing demand: Over the past thirty years, the demand for
RCFEs has grown substantially. Although RCFEs have been
generally available, they experienced explosive growth in the
1990s, more than doubling the number of beds between 1990 and
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2002,<1> and continued to grow 16% between 2001 and 2010.<2>
Nationwide, states reported 1.2 million beds in licensed RCFEs
in 2010.<3> That same year, the national Centers for Disease
Control and Prevention reported that 40% of RCFE residents
needed help with three or more activities of daily living and
three-fourths of residents had at least two of the 10 most
common chronic conditions.<4>
According to DSS, as of June 2, 2014, there are 7,587 licensed
RCFEs in California with a capacity to serve 176,891 residents.
Capacity of CCLD and unannounced licensing inspection visits:
Prior to 2003, the required frequency of unannounced licensing
visits was annually for most facility types (and tri-annually
for family child care). However, due to the state's ongoing
budget deficit and declining revenues, it was deemed necessary
to find ways to reduce costs. As a result, the operational
budget for DSS' CCLD is now required to do unannounced visits
annually only when a facility has a history of compliance
problems, which has resulted in annual visits for approximately
10% of facilities. For all other facilities not subject to
annual inspections, CCLD is currently required to conduct
comprehensive compliance inspections of a 30% random sample of
facilities each year, with no facility being visited less than
once every five years. There are additional inspection
requirements for new facilities or when changes occur to the
license, which helps to ensure that a new licensee starts off
correctly. However, in most cases five years could pass before
a residential facility is inspected by CCLD.
Five years has created a tenuous situation for California's
infrastructure of community care facilities. In a Spring
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<1> Flores and Newcomer, "Monitoring Quality of Care in
Residential Care for the Elderly: The Information Challenge".
Journal of Aging and Social Policy, 21:225-242, 2009.
<2> SCAN Foundation. "Long Term Care Fundamentals: Residential
Care Facilities for the Elderly." March 2011.
http://thescanfoundation.org/sites/thescanfoundation.org/files/LT
C_Fundamental_7_0.pdf
<3> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
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Finance Letter from February, 2010, DSS stated that "[a]s the
result of several consecutive years of unallocated reductions
and position sweeps, CCLD is no longer able to sustain the
required inspection frequency." The letter went on to note that
"CCLD's experience with the random sample inspection protocol
and fluctuations in resources have put client health and safety
at risk."
According to DSS, as of June 2, 2014, there are 7,587 licensed
RCFEs in California with a capacity to serve 176,891 residents.
It is clear that the ongoing budget deficit of the last ten
years has had a significant impact on DSS' ability to monitor
the health and safety of residents and clients of community care
facilities throughout the state. An increase in oversight
responsibility combined with staff reductions and unfilled staff
positions, and on-again off-again work furloughs and hiring
freezes, have severely reduced its administrative capacity.
Although this does not clear the state of its responsibility to
ensure RCFEs' compliance with state law and resident health and
safety requirements, it significantly challenges the state's
ability to ensure that adults and seniors in need of care and
supervision are not put at risk.
Importance of unannounced licensing visits: Unannounced
licensing visits are of fundamental importance in protecting the
health and safety of children and adults receiving care through
facility- or home-based care. They ensure that basic health and
safety requirements are being met and also provide opportunities
for increased technical assistance to programs, enhanced
information sharing, the development of best practices, and
ultimately lead to an improvement in the quality of life for
clients under care.
Numerous studies have also been conducted, which document a
connection between increased licensing visits with a decrease in
accidents requiring medical attention<5> and greater provider
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<5> Fiene, R. (2002). 13 indicators of quality child care:
Research update. U.S. Department of Health and Human Services,
Office of Assistant Secretary for Planning and Evaluation, at
http://aspe.hhs.gov/hsp/ccquality-ind02/
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compliance with health and safety standards.<6>
Additionally, regular and frequent unannounced inspection visits
allow for state and local agencies to provide relevant and
up-to-date information to the public on the quality of care
being provided to consumers. According to Child Care Aware of
America, formerly the National Association of Child Care
Resource and Referral Agencies, a study conducted by the
National Bureau of Economic Research in Florida found that
frequent inspections, which were made available to the public,
"increased the quality of the inspections and the productivity
of the inspectors" and resulted in increased inspections that
were carried out more consistently. Further, in a 2010-11
Spring Finance Letter, DSS stated that "regular and frequent
inspections of facilities improve client health and safety as
evidenced by reductions in the percentage of the more serious
imminent risk to total citations." More specifically, DSS went
on to state, "more annual inspections equates to better quality
of care" and "more annual inspections equates to a smaller risk
to the health and safety of clients."
Recent events: A series of recent events has drawn attention to
questions about the adequacy of RCFEs and the CCLD's ability to
comply with existing oversight and enforcement requirements to
help ensure for the health and safety of individuals who receive
services within CCLD-licensed facilities. Over the last several
years, numerous media outlets have documented chronic
understaffing, a lack of required assessments and substandard
care. Reports in September 2013, prompted by a consumer
watchdog group that had hand-culled through stacks of documents
in San Diego, revealed that more than two dozen seniors had died
in recent years in RCFEs under questionable circumstances that
went ignored or unpunished by CCLD.<7>
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
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<6> Koch Consulting. (2005). Report on effective legal
proceedings to ensure provider compliance: Prepared for the
State of Washington Department of Social and Health Services.
http://www.naralicensing.drivehq.com/publications/archives/nara/E
ffective_Legal_Proceedings.pdf
<7> "Care Home Deaths Show System Failures," San Diego Union
Tribune, Sept.7, 2013
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