BILL ANALYSIS Ó SENATE HUMAN SERVICES COMMITTEE Senator Carol Liu, Chair BILL NO: SB 911 S AUTHOR: Block B VERSION: March 27, 2014 HEARING DATE: April 8, 2014 9 FISCAL: Yes 1 1 CONSULTANT: Sara Rogers SUBJECT Residential Care Facilities for the Elderly SUMMARY This bill increases the number of hours of classroom instruction, and adds to the uniform core of knowledge, that licensees and administrators of Residential Care Facilities for the Elderly (RCFEs) must meet for initial certification and continuing education training. This bill increases the training requirements for facility staff that assist residents with personal activities, as specified, and adds topics that shall be included in the training. Additionally, this bill requires facilities that accept or retain residents with restricted or prohibited health conditions to employ a registered nurse on a full-time or part-time basis and to provide for a registered nurse to be on call 24 hours per day. ABSTRACT Existing Law: 1.Establishes the Residential Care Facilities for the Continued--- STAFF ANALYSIS OF SENATE BILL 911 (Block) PageB Elderly Act which provides for the California Department of Social Services (CDSS) to license and regulate RCFEs as a separate category within the existing residential care licensing structure of CDSS. (HSC 1569 et seq.) 2.Requires applicants for an RCFE license to file an application including a criminal record clearance, employment history, character references, evidence of certification, and disclosure of previous service in other RCFEs, outpatient health clinics, health facilities (including hospitals, skilled nursing facilities or intermediate face facilities), or a community care facility, among other requirements. (HSC 1569.15) 3.Requires a license applicant and an RCFE administrator to successfully complete a certification program approved by the department, which shall include a minimum of 40 hours of classroom instruction including a uniform core of knowledge, as specified. (HSC 1569.23 and HSC 1569.616) 4.Provides that RCFE administrator certification shall be valid for two years and that recertification shall require 40 hours of continuing education. Through regulation provides that an applicant for licensure shall meet the requirements for initial certification of administrators. (HSC 1569.616 (f), Title 22 CCR 87155 and 87406) 5.Provides that the initial certification of administrators shall include successful completion of a department-approved program, passage of a written test administered by the department within 60 days, and a criminal records clearance. (Title 22 CCR 87406) 6.Requires CDSS to develop requirements for a uniform core of knowledge for the initial certification and continuing education requirements for licensees, administrators and staff of RCFEs. Provides that this knowledge base shall include basic understanding of the psychosocial and physical care needs of elderly persons. (HSC 1569.62) STAFF ANALYSIS OF SENATE BILL 911 (Block) PageC 7.Provides that RCFE staff members who assist residents with activities of daily living shall receive at least 10 hours of initial training within the first four weeks of employment and at least four hours annually thereafter. (HSC 1569.625 and Title 22 CCE 87411) 8.Requires CDSS to develop a uniform assessment tool to be used by all RCFEs in identifying resident needs for service and assistance with daily living. (HSC 1569.62) 9.Requires facility personnel to be sufficient in numbers and competent to provide the services necessary to meet resident needs. Provides that the department may require any facility to provide additional staff whenever if determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require additional staff. (Title 22 CCE 87411) This bill: 1.Requires RCFE licensee certification to consist of 100 hours of training, up from the current 40-hour requirement, of which 80 hours shall be classroom instruction. Additionally, expands the uniform core of knowledge to address use of psychotropic drugs, nonpharmacologic approaches to dementia care and the importance of residents' rights training. 2.Requires RCFE administrator initial certification training to include 100 hours of in training and 60 hours of continuing education for recertification. Additionally, expands the uniform core of knowledge to address use of psychotropic drugs, nonpharmacologic approaches to dementia care and the importance of residents' rights training. STAFF ANALYSIS OF SENATE BILL 911 (Block) PageD 3.Adds to the CDSS requirement to develop regulations for licensee and administrator certification and testing the additional participation of stakeholder groups and the requirement to review the test annually and update it as necessary to reflect changes in law and regulations. 4.Prohibits a licensee, or officer or employee of the licensee from discriminating or retaliating against an RCFE resident or employee, on the basis, or for the reason that the person dialed or called 911. 5.Requires an RCFE that accepts or retains residents with prohibited health conditions, as defined by the department, to ensure that residents receive home health or hospice services sufficient in scope and hours to ensure that residents receive medical care as prescribed by the resident's physician and contained in the resident's service plan. 6.Requires an RCFE that accepts or retains residents with restricted health conditions, as defined by the department, to ensure that residents receive medical care as prescribed by the resident's physician and contained in the resident's service plan by appropriately skilled professionals acting within their scope of practice. 7.Defines appropriately skilled professional to mean an individual who has training and is licensed to perform the necessary medical procedures prescribed by a physician. Specifies that this includes, but is not limited to, a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, or respiratory therapist, as defined. 8.Provides that failure to meet or arrange to meet the needs of residents who require specialized health services, or failure to notify the physician of a resident's illness or injury that poses a danger of death or serious bodily harm is a licensing violation and subject to civil penalty pursuant, as specified. STAFF ANALYSIS OF SENATE BILL 911 (Block) PageE 9.Requires CDSS to develop a uniform resident assessment tool to be used by all residential care facilities for the elderly. The assessment tool shall, in lay terms, help to identify resident needs for service and assistance with activities of daily living. 10.Requires staff who assist residents with activities of daily living to receive 40 hours of training within the first four weeks of employment, an increase from the existing 10-hour requirement. Requires that 24 of them be completed prior to the provision of direct care, and requires staff to receive an additional 20 hours of continuing training annually. Requires the training to be developed in consultation with individuals or organizations with specific expertise in RCFE or assisted living services. 11.Expands the staff training curriculum to address the use, misuse, and interaction of drugs commonly used by the elderly, the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia and nonpharmacologic person-centered approaches to dementia care. 12.Exempts certified nurse assistants with valid certification from the staff training requirements, except that exempted CNAs shall receive eight hours of training on resident characteristics, resident records and facility practices and procedures. 13.Permits CDSS to develop a certification training program with a standardized test for RCFE staff. 14.Requires facilities that advertise or promote special care, special programming or a special environment for persons with dementia to provide to staff 15 hours of resident care orientation (increased from six hours) prior to providing direct care to residents, and removes STAFF ANALYSIS OF SENATE BILL 911 (Block) PageF the requirement that the requirement that the training must be provided within the first four weeks of employment. 15.Requires RCFEs that advertise or promote care for persons with dementia to increase in-service training requirements from eight to 12 hours annually. 16.Requires RCFEs with 16 or more residents to increase training for staff who assist residents with the self-administration of medications from 16 to 32 hours. Of these hours, increases from eight to 12, the number of hours of hands-on shadow training to be completed prior to assisting residents with medications and increases from eight to 20 hours other training or instruction, to be completed within the first four weeks of employment (increased from two weeks). 17.Requires RCFEs with 15 or fewer residents to increase training for staff who assist residents with the self-administration of medications from six to 16 hours. Of these hours, increases, from two to eight, the number of hours of hands-on shadow training to be completed prior to assisting residents with medications and from four to eight hours other training or instruction, to be completed within the first two weeks of employment. 18.Further increases the annual number of continuing training hours, from four to eight, of in-service training on medication-related issues for employees who assist residents with self-administration of medications. 19.Increases the training curriculum for staff assisting with the self-administration of medication to include and explanation of adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia and the increased risk of death when elderly residents with dementia are given anti-psychotic medications. 20.Adds new training requirements for staff working in STAFF ANALYSIS OF SENATE BILL 911 (Block) PageG facilities that serve residents with postural supports, restricted health conditions, or hospice services as follows: 15 hours on the care, supervision, and special needs of those residents prior to providing direct care. 12 hours thereafter of in-service training per year. FISCAL IMPACT This bill has not been analyzed by a fiscal committee. BACKGROUND AND DISCUSSION Purpose of the bill: According to the author, California's RCFE law is more than 20 years old and has not been updated to reflect changes in medical and industry practices in caring for the elderly. The author states that RCFEs now serve more residents with serious health problems and higher levels of dementia who previously would have been treated in nursing homes and that, as a result, the lack of qualifications and training required of administrators and direct care staff are inadequate to meet the residents' needs for care and supervision. The author cites a series of in-depth investigative reports from the San Diego Union Tribune which found that hundreds of seniors have suffered broken bones, deadly bedsores and sexual assaults in San Diego alone. The articles cite repeated incidents in which facility staff failed to contact the residents' physicians or call 911 following serious injuries, often related to falls or severe bedsores. Residential Care Facilities for the Elderly Within California's continuum of long term care, situated STAFF ANALYSIS OF SENATE BILL 911 (Block) PageH between in-home care and skilled nursing facilities, is the RCFE, also commonly called Assisted Living, Board and Care, or Residential Care. There are approximately 8,000 Assisted Living, Board and Care, and Continuing Care Retirement homes that are licensed as RCFEs in California. These residences are designed to provide homelike housing options to seniors and other adults who need some help with activities of daily living, such as cooking, bathing, or getting dressed, but otherwise do not need continuous, 24-hour assistance or nursing care. Increasingly residents are entering RCFEs with significant health needs including diabetes, bedsores, or require the use of oxygen tanks, catheters, colostomies or ileostomies. The RCFE licensure category includes facilities with as few as six beds to those with hundreds of residents, whose needs may vary widely. Typically, the smaller facilities are homes in residential neighborhoods while the larger facilities resemble apartment complexes with structured activities for their residents. Residents may reside in their own apartment, or may share a bedroom. Generally, residents are free to leave the facility if they choose, and may entertain guests, and otherwise maintain a high level of independence. Facilities licensed to serve residents with dementia or Alzheimer's disease, also known as "memory care units" may maintain a secure perimeter. Licensee and Administrator training requirements Existing law requires prospective licensees and facility administrators to complete a certification program approved by the department consisting of 40 hours of classroom instruction. Statute requires that the curriculum for both include: Laws, regulations, policies and procedural standards that impact RCFE operations, including residents personal rights (8 hours); Business operations (3 hours); Management and supervision of staff (3 hours); Psychosocial need of elderly residents (5 hours); STAFF ANALYSIS OF SENATE BILL 911 (Block) PageI Physical needs for elderly residents (5 hours); Community and support services (2 hours); Use, misuse and interaction of drugs commonly used by the elderly (5 hours); Resident admission, retention, and assessment procedures (5 hours); Care of residents with Alzheimer's Disease and other dementias (4 hours) This bill requires a total of 100 hours of initial instruction as well as 60 hours annually of continuing education instruction and would expand the curriculum to additionally include: Adverse effects of psychotropic drugs for use in controlling behavior of persons with dementia; Nonpharmacologic, person centered approaches to dementia care; Residents rights and residents rights and the importance of ongoing training for staff to ensure residents rights. Typically, the 40-hour requirements are met through private vendors who have been approved by CDSS to conduct these trainings. The courses are generally scheduled as four, consecutive 10-hour-day trainings, costing approximately $200 to $300. Following the training, prospective administrators are required to pass a 40-question test administered by the Department that has not been changed since its initial release. Approximately 500 individuals take the exam every month. Reportedly, the several versions of the test are available online to be studied in advance and few individuals fail the exam. Licensees must only pass their initial certification and are not required to maintain a current certification which expires after two years. Additionally, corporate owners of a facility, who are not the official licensee, are not themselves required to be licensed or have any training despite having financial and managerial control over the facilities they manage. Restricted or Prohibited Health Conditions STAFF ANALYSIS OF SENATE BILL 911 (Block) PageJ California law provides that RCFEs may accept or retain persons who are capable of administering their own medications (or need only be reminded due to forgetfulness or assisted due to physical limitations), who receive medical care outside the facility or from a visiting nurse, persons with mild temporary emotional disturbance, forgetfulness, irritability, wandering, confusion, or inability to manage money, or persons who are bedridden (provided fire clearance requirements are met). (Title 22 CCR 87455) California statute prohibits RCFEs from accepting residents who require 24-hour skilled nursing or intermediate care. Additionally, regulation prohibits RCFEs from accepting residents who depend on others to perform all activities of daily living, residents whose primary need for care and supervision results from an ongoing behavior caused by a mental disorder<1> and prohibits the acceptance of residents with certain medical conditions including stage 3 or 4 pressure sores, gastronomy care, naso-gastric tubes, staph infections or other serious infections, and tracheotomies.<2> RCFEs may accept residents who are permanently bedridden if the facilities meet requirements pertaining to sufficiency and training of staff, availability of appropriate equipment or devices and obtain the proper fire clearances.<3> Regulations require that RCFES that accept bedridden residents must include a statement of how the facility intends to meet those residents' overall health, safety and care needs in the facility Plan of Operation. This plan must include how the facility will meet the needs ------------------------- <1> Title 22 CCR 87455 <2> Title 22 CCR 87615 <3> CCL Information Release 2007-04 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageK of bedridden residents with dementia, or those who are terminally ill. In addition, each bedridden resident's record must include documentation to demonstrate the facility is meeting the needs of individual residents, staff must receive training specific to care of bedridden residents, and the facility's register of residents much include information related to bedridden residents.<4> Regulation permits a licensee to submit a written exception request for prohibited and or restricted health conditions, and CDSS states that it evaluates every exception request to ensure that the resident's physician has determined that it remains an appropriate placement for the resident and that the facility is equipped to address the medical needs of the resident. CDSS provides facilities that intend to serve hospice patients with facility-wide hospice waivers instead of approving case-by-case exceptions determined by individual LPAs. Residents with "restricted health conditions," which otherwise fall short of a prohibited condition or hospice care, may be cared for in an RCFE by "appropriately skilled staff" either through home health agencies or by hired medical staff. Any medical care provided in this manner must be provided consistent with the medical practitioner's scope of practice. Regulation defines "Appropriately Skilled Professional" to mean: "[A]n individual that has training and is licensed to perform the necessary medical procedures prescribed by a physician. This includes but is not limited to the following: Registered Nurse (RN), Licensed Vocational Nurse (LVN), Physical Therapist (PT), Occupational Therapist (OT) and Respiratory Therapist (RT). These professionals may include, but are not limited to, those persons employed by a home health agency, the resident, or facilities and who are currently licensed in California." ---------------------- <4> Title 22 CCR 87606 (f) STAFF ANALYSIS OF SENATE BILL 911 (Block) PageL RCFEs are prohibited from permitting facility staff from administering injections, or from forcing or camouflaging medications and staff may assist with the self-administration of medications only when the medications have been prescribed by the resident's physician. If a resident's physician states in writing that the resident is unable to determine his/her need for PRN (as needed) medication and is unable to communicate symptoms clearly then facility staff is only permitted to assist in the self-administration of medications after having contacted the resident's physician. The physician must be contacted prior to each dose being administered, and this information must be recorded in the patient's record, along with the date and time that the medication was taken.<5> Facilities are additionally permitted to accept and retain residents with health conditions that require incidental medical services that may be provided through a licensed home health agency. In such instances, the facility is required to provide the care and supervision to the residents and the facility and home health agency must agree in writing on the responsibilities of each party. The licensee must inform the home health agency of any duties that facility staff members are prohibited from performing.<6> Staffing requirements ------------------------- <5> Title 22 CCR 87465 <6> Title 22 CCR 87609 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageM Existing law requires facility personnel to be sufficient in numbers and competent to provide the services necessary to meet resident needs. The department may require a facility to provide additional staff whenever it determines that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require additional staff. Additionally, regulations require RCFEs to ensure that the resident is cared for in accordance with the physician's orders and that the resident's medical needs are met. Facility staff members are required to have the knowledge and skills to respond to problems and to contact the physician, appropriately skilled professional or vendor as necessary.<7> Residents are required to have a preadmission appraisal performed and documented that includes an evaluation of the resident's functional, mental and social needs, in order to determine the level of care and supervision that each resident requires. Additionally, residents must have a medical assessment completed that must be signed by a physician, made within the last year and kept on file. The functional assessment is required to determine the prospective resident's ability to perform detailed activities of daily living including bathing, dressing, grooming, continence, eating and physical condition. Additionally facilities are required to complete a needs and services appraisal/plan to determine the amount of supervision that is necessary.<8> Placement agencies (defined to include county welfare, social service or mental health departments, county public guardians, hospital discharge planners or coordinators public or private agencies providing placement or referral services, conservators and regional centers) who are engaged in finding homes or other places for the placement ------------------------- <7> Title 22 CCR 87411 and 87611 <8> Title 22 CCR 87458, 87459 and 87461 and LIC forms 602A, 603, 603A, 604A and 625 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageN of elderly persons for temporary or permanent care are required to report to the department any situation in which a facility has insufficient personnel or incompetent personnel on duty. Regulations additionally require facilities to have and maintain a current, written definitive plan of operation that is required to be submitted to the licensing agency with their application.<9> The plan includes, among other things, a statement of admission policies and procedures for accepting residents as well as the staffing plan, qualifications and duties. Additionally, facilities are required to submit a written report to the licensing agency and the resident's responsible person when certain incidents occur that may impact the health and safety of residents.<10> Staff training requirements Existing law permits CDSS to adopt regulations to require RCFE staff members who assist residents with activities of daily living to receive ten hours of training. Statute and regulation provide that this training shall include:<11> The aging process and physical limitations and special needs of the elderly (at least two hours). Importance and techniques of personal care services, including bathing, grooming, dressing, feeding, toileting and universal precautions (at least three hours). Residents rights as specified in Title 22 CCR 87468. ----------------------- <9> Title 22 CCR 87208 <10> Title 22 CCR 87211 <11> HSC 1569.625 and Title 22 CCR 87411 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageO Policies and procedures regarding medications, including knowledge to safely assist with self-administered prescribed medications (at least two hours). Psychosocial needs of the elderly, such as recreation, companionship, independence, etc. Recognizing signs and symptoms of dementia. This bill would require staff to receive 40 hours of training within the first four weeks of employment, with 24 of them to be provided prior to the provision of direct care, and would require staff to receive an additional 20 hours of continuing training annually. The curriculum of the training is expanded under this bill to include: The use, misuse, and interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. The special needs of persons with Alzheimer disease and dementia, including nonpharmacologic person-centered approaches to dementia care. This bill would exempt certified nurse assistants (CNAs) with valid certification from these requirements except that exempted CNAs would still be required to receive eight hours of training on resident characteristics, resident records and facility practices and procedures. Additionally, this bill requires additional hours of staff training for staff that assist in the self-administration of medication, staff that work in facilities advertising special care for residents with dementia, as well as staff members that serve residents with postural supports, have restricted health conditions, or are receiving hospice services. In total, in facilities serving these residents, staff would be required to complete the following training schedule: ------------------------------------------------------------ | | |Overall requirements: 40 hours total; 24 prior to | STAFF ANALYSIS OF SENATE BILL 911 (Block) PageP |providing care; and 20 annually | |Dementia care: 15 hours total prior to | |providing care; and 12 annually | |Medication Assistance: | | Large facilities - 32 hours total; 12 prior to | |providing care; and 8 annually | | Small facilities - 16 hours total; 8 prior to | |providing care; and 8 annually | |Postural, Restricted, Hospice: 15 hours total prior to | |providing care; and 12 annually | | | ------------------------------------------------------------ Through regulation, existing law provides that all training shall be conducted by a person who is knowledgeable in a relevant subject area of the training and who has one of the following: a four year degree or graduate degree as well as two years of experience; a license to work as a health care provider; at least two years of experience in California as an RCFE administrator with a record of administering facilities with substantial compliance. This bill would require that the training shall be developed in consultation with individuals or organization with specific expertise in RCFE or assisted living services, or by an outside source with such expertise. Use of anti-psychotic medications in Assisted Living Recent research suggests that between 35% and 53% of assisted living residents receive one or more psychotropic medications.<12> Numerous studies document that older adults are particularly susceptible vulnerable to adverse ------------------------- ------------------------- <12> Smith M, Buckwalter KC, Hyunwook K, Ellingrod V, Schultz SK. Dementia-specific assisted living: Clinical factors and psychotropic medication use. Journal of the American Psychiatric Nurses Association. 2008;14:39-49 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageQ STAFF ANALYSIS OF SENATE BILL 911 (Block) PageR effects of psychotropic medications.<13> Those older than age 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions associated with psychotropic medications. Additionally, the risk for adverse reactions increases dramatically with the number of medications used and with increasing age.<14> In 2012, the Centers for Medicare and Medicaid Services (CMS) launched the National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes. A recent memorandum submitted to CMS state surveyor agency directors, citing numerous peer reviewed academic studies, states that: The problematic use of medications, such as antipsychotics, is part of a larger, growing concern. This concern is that nursing homes and other settings (i.e. hospitals, ambulatory care) may use medications as a "quick fix" for behavioral symptoms or as a substitute for a holistic approach that involves a thorough assessment of underlying causes of behaviors and individualized, person-centered interventions? When antipsychotic medications are used without an adequate rationale, or for the purpose of limiting or controlling behavior of an unidentified cause, there is little chance that they will be effective. In addition, they commonly cause complications such as movement disorders, falls, hip fractures, cerebrovascular adverse events (cerebrovascular accidents and transient ischemic events) and increased ---------------------- ---------------------- <13> Lindsey, Pamela. Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. Journal of Gerontol Nursing. Sep 2009; 35(9): 28-38 <14> Brooks JO, Hoblyn JC. Neurocognitive costs and benefits of psychotropic medications in older adults. Journal of Geriatric Psychiatry and Neurology. 2007;20:199-214 STAFF ANALYSIS OF SENATE BILL 911 (Block) PageS STAFF ANALYSIS OF SENATE BILL 911 (Block) PageT risk of death. <15> Additionally, the memorandum cites a Food and Drug Administration (FDA) public health advisory which found that elderly patients with dementia-related psychosis treated with second generation antipsychotic drugs are at a 1.6-1.7 fold increased risk of death compared to placebo.<16> According to the FDA, the specific causes of these deaths were largely either due to heart related events (e.g., heart failure, sudden death) or infections (mostly pneumonia). The FDA notes that none of the antipsychotic drugs have been approved for the treatment of behavioral disorders in patients with dementia and has required drug manufactures to include a boxed warning in their labeling. In setting standards for use of these medications in nursing homes, CMS has put forward a series of dementia care principles that attempts to foster a person centered approach to care better ensures the judicial use of pharmalogical approaches to dementia care, that they are clinically indicated and gradually reduced in an effort to discontinue the drugs over time. Although this CMS guidance is directed specifically toward nursing homes, its findings and subsequent policy approaches are substantially relevant to assisted living facilities which presumably serve a similar demographic of residents who are potentially less acute than those of nursing homes. Governor's Budget Proposal ------------------------- <15> S&C: 13-35-NH http://www.cms.gov/Medicare/Provider-Enrollment-and-Certific ation/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-L etter-13-35.pdf <16> FDA Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInfo rmationforPatientsandProviders/DrugSafetyInformationforHeath careProfessionals/PublicHealthAdvisories/ucm053171.htm STAFF ANALYSIS OF SENATE BILL 911 (Block) PageU As part of the Governor's 2014-2015 proposed budget the Administration has put forth a Budget Change Proposal that intends to address some of the policy issues that this bill also seeks to address. The Administration does not propose to increase the training hours or curriculum for licensees, administrators or staff of RCFEs. Instead, the proposal seeks to strengthen the administrator certification process by adding three new positions that would enhance current testing policies and procedures establish statewide uniformity in the administration of the test and update the exams themselves. Additionally, the Administration proposes to hire a nurse practitioner position to assist with the development of regulatory policies related to medical care in RCFEs as well as a mental health populations unit to provide technical assistance to enforcement staff. Prior/Related Legislation Current legislation SB 894 (Corbett) Would expand numerous requirements for RCFE licensees in the event of a temporary license suspension or license revocation. Additionally, would expand the responsibilities of CDSS in overseeing a temporary suspension or revocation of an RCFE license and in protecting the health and safety of affected residents. SB 895 (Corbett) Would require CDSS to conduct annual unannounced comprehensive inspections for all facilities, requires CDSS to verify compliance following deficiencies within 10 days, and requires results of inspections to be available on the CDSS website. SB 1153 (Leno) Would permit CDSS to order a suspension of new admissions for an RCFE when the facility has violated applicable laws and regulations that present a direct risk to the health and safety or residents, is not providing adequate care and supervision, has been cited for STAFF ANALYSIS OF SENATE BILL 911 (Block) PageV subsequent violations of the same law within 12 months, or has failed to pay existing fines. SB 1382 (Block) Would increase the annual licensure fees by 30 percent and would make related findings and declarations. AB 1571 (Eggman) Would increase disclosure requirements for RCFE licensee applicants and require applicant information to be cross referenced with the State Department of Public Health. Would require, by 2015, CDSS to create an online inquiry system posting detailed information about RCFE facilities including complaints, deficiencies and enforcement actions resulting in fines. In subsequent years, would require CDSS to post additional information, as specified. AB 1572 (Eggman) Would require RCFEs, at the request of two or more residents, to assist the residents in establishing and maintaining a single resident council, as specified, and requires the facility to interact with the council in specified ways. AB 1523 (Atkins and Weber) Would require RCFEs to maintain liability insurance covering injury to residents and guests in the amount of $1 million per occurrence and $3 million annually. AB 1436 (Waldron) Would require the results of all reports of inspections, evaluations or consultations and lists of deficiencies to be posted on the departments Internet Web site. AB 1454 (Calderon) Would require all licensed community care facilities, RCFEs, and child day care centers to be subject to an annual unannounced visits visit by CDSS. AB 1570 (Chesbro) Would increase the certification training STAFF ANALYSIS OF SENATE BILL 911 (Block) PageW requirements for RCFE administrators, increases training requirements for RCFE staff that care for residents, and increases training requirements for staff providing dementia care. AB 1554 (Skinner) Would make various changes to existing RCFE complaint procedures including require the department to make an onsite inspection within 24 hours of a complaint alleging abuse, neglect or a threat of imminent danger. Additionally would require the department to complete its investigation within 90 days of receiving a complaint. Would permit a complainant to file an appeal of departmental findings. AB 1899 (Brown) Would make a person whose license is revoked or forfeited for abandonment of the facility ineligible for reinstatement of the license for a period of 10 years following the revocation or forfeiture. Additionally would require CDSS to establish and maintain a telephone hotline and an Internet Web site dedicated to receiving complaints. AB 2171 (Wieckowski) Would establish specified RCFE resident's rights and require facilities to inform residents of these rights as specified. AB 2044 (Rodriguez) Would require every licensed residential care facility to be subject to an annual unannounced visit by the department, as prescribed. Additionally would require complaints to be inspected within 3 days if the complaint involves alleged abuse or serious neglect, or within 10 days for all other complaints and would require investigations to be completed within 30 days. Would provide a complainant with the right to request an informal conference and subsequent appeal, as specified. Also would require certain staff to be present in the facility for specified times. Prior legislation STAFF ANALYSIS OF SENATE BILL 911 (Block) PageX AB 313 (Monning, Chapter 365, Statutes of 2011) Requires each RCFE to provide residents, their responsible party, and the local long-term care ombudsman with a 10 day written notice when CDSS commences proceedings to suspend or revoke its license, or a criminal action relating to health or safety of the residents is brought against the facility, and makes other changes related to these actions. AB 2066 (Monning, Chapter 643 Statutes of 2012) Requires RCFEs to provide a 60 day written notice to residents or the responsible person within 24 following receipt of CDSSs order of revocation. Permits the licensee to secure an alternative manager, as specified. Requires RCFEs to refund all or a portion of preadmission fees to residents transferring as the result of a license revocation, as specified. SB 897 (Leno, Chapter 376, Statutes of 2011) Requires licensed residential care facilities for the elderly (RCFEs) to notify CDSS, the state's Long-Term Care Ombudsman and the facility's residents when the property is subject to foreclosure or certain other events occur due to financial distress. AB 419 (Mitchell, 2011) Would have required every community care facility licensed by CDSS to be inspected unannounced at least once per year using research based, field tested inspection protocols, as specified. This bill died in the Assembly Appropriations Committee. Comments: The California Association for Health Services at Home and the California Assisted Living Association raise a concern that this bill may permit an RCFE to oversee or direct the care of a home health or hospice agency that is caring for a resident that has a prohibited health condition. The author states that the intent of the bill is for a facility to ensure that it has the capacity to safely care for a resident with a prohibited condition, and not to permit the facility to directly oversee the care of the licensed STAFF ANALYSIS OF SENATE BILL 911 (Block) PageY agency. Staff recommends the author continue working with these organizations to clarify the intent of the bill. Provisions of this bill are substantially similar to AB 1570 (Chesbro) but have different requirements in terms of the number of hours of training and the scope of the training. Staff recommends the author work with sponsor and author of AB 1570 to seek to address these differences. POSITIONS Support: Hazel's Army (co-sponsor) Stand Up for Rosie (co-sponsor) AFSCME California Advocates for Nursing Home Reform California Assisted Living Association California Continuing Care Residents Association California Senior Legislature Catholic Charities Diocese of Stockton Consumer Attorneys of California Consumer Federation of California County of San Diego Elder Law and Advocacy Jewish Family service of Los Angeles Johnson Moore Trial Lawyers Long-Term Care Ombudsman of Ventura County Office of the State Long-Term Care Ombudsman Ombudsman & HICAP Services of Northern California Ombudsman Services of Contra Costa Valentine Law Group 202 individuals Oppose: Angel Care Community Services, Inc. California Assisted Living Association (unless amended) California Assoc. for Health Services at Home (unless amended) STAFF ANALYSIS OF SENATE BILL 911 (Block) PageZ California Association of Health Facilities (unless amended) California Right To Life Committee, Inc. Leading Age California (unless amended) -- END --