BILL ANALYSIS Ó
SB 911
Page 1
Date of Hearing: August 6, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 911 (Block) - As Amended: June 19, 2014
Policy Committee: Human
ServicesVote:6 - 1
Aging 5 - 0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill increases the initial and continuing education
training requirements for licensees, administrators, and direct
care staff of residential care facilities for the elderly
(RCFEs). This bill also requires any RCFE that accepts or
retains residents with restricted or prohibited health
conditions to ensure trained medical personnel are supervising
the care of these residents. In addition, this bill would
prohibit discrimination or retaliation in any manner against a
resident or employee for calling 911. This bill contains a
delayed implementation date of January 1, 2016.
FISCAL EFFECT
1)Budget year 2015-16 costs in the range of $280,000 (GF),
includes onetime and ongoing costs for the Department of
Social Services (DSS) to add training topics, certify vendors,
revise the CCL Evaluator Manual, revise regulations, consult
with specified groups to update the uniform core of knowledge
for RCFE administrators and training for direct care staff,
and to review training programs and applications.
2)Ongoing costs in the range of $250,000 (GF) for DSS to review
administrator certification training programs and
certification applications. This assumes approximately 3,500
reviews annually at 3.75 hours per review.
3)Unknown, but likely significant, ongoing increase in training
costs to employees and/or facilities to meet the enhanced
initial and continuing education training requirements
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imposed.
4)Potential minor non-reimbursable local enforcement costs for
violations of any of the provisions of this measure.
COMMENTS
1)Purpose . According to the author, 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.
RCFEs now serve more residents with serious health problems
and higher levels of dementia. Five years ago these residents
would have been treated in nursing homes. And although
residents' health care needs are greater, the lack of
qualifications and training required of administrators and
direct care staff is inadequate to meet the residents' needs
for care and supervision, placing RCFE residents at risk. SB
911 seeks to address this situation by increasing
administrator training and training for direct care staff,
increasing staff requirements to care for residents with
higher acuity, and protecting residents and staff from
retaliation when they call 911.
2)Background . The Community Care Licensing Division of DSS
administers the licensure and oversight of more than 7,500
assisted living, board and care, and continuing care
retirement homes that are licensed as RCFEs in California.
RCFEs range in size from residential homes with six or fewer
beds to more formal residential facilities with more than 100
beds. These residences provide personal care and supervision
or health related services to persons who are 60 years of age
and over, who voluntarily choose to reside in the facility.
RCFEs enable older persons to live independently in a
home-like environment rather than in nursing home or other
institutionalized facility.
More than 20 years have passed since existing RCFE licensing
certification requirements have been changed. The last
revision was through the enactment of AB 1615 (Hannigan),
Chapter 848/1991, which required prospective licensees to
undergo an orientation training prior to commencing the
licensee certification process.
3)RCFE licensee requirements . Currently, licensees and
administrators of RCFEs are required to undergo 40 hours of
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training and complete a written exam. However, as noted by
DSS, "Currently, no proctoring protocol exists, resulting in
no statewide uniformity on how the exams are administered.
This lack of consistency and guidance results in errors and
can ultimately result in candidates getting certified who may
not meet the minimum qualifications."
Concerns have also been raised by advocates about the rigor
and relevance of the administrator exam. According to DSS,
approximately 500 people take the administrator certification
test each month. However, there is no requirement under law
that the exam reflects what is provided in the 40 hours of
administrator/licensee training required for completion prior
to taking the certification exam.
4)RCFE staff requirements . Licensees employ a wide range of
staff to provide day-to-day support and care for residents of
RCFEs. Staff who assist residents with personal activities of
daily living are required to be at least 18 years of age and
undergo 10 hours of training within four weeks of being
employed by the RCFE and four hours of training each year
thereafter. There are additional training requirements for
staff who provide dementia care or who assist residents with
managing their medication. All staff must pass a criminal
background check and demonstrate they are physically and
mentally capable of performing assigned tasks.
5)Related Legislation . Previously, SB 911 was in conflict with
AB 1570 (Chesbro), which, like this bill, proposes to increase
training requirements for licensees and staff, and dementia
care. Recent amendments agreed to by the respective authors
of this bill and AB 1570 avoid any conflict and resolve the
policy differences in the training requirements between the
two bills. With the adoption of these amendments, the two
bills are companion measures that provide a holistic and
comprehensive reform of RCFE training requirements.
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 895 (Corbett) RCFEs: annual inspections.
SB 1153 (Leno) RCFEs: suspension of new admissions.
SB 1382 (Block) RCFEs: licensure fees.
SB 911
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AB 1436 (Waldron) RCFEs: internet posting of inspection
reports.
AB 1523 (Atkins) RCFEs: liability insurance.
AB 1554 (Skinner) RCFEs: complaint procedures.
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.
6)Opposition . Some facility and reform groups are opposed to
this bill. They argue that the increased training required in
this bill will not improve the quality of care provided to
residents because no level of mastery or competency is
required and the exam does not accommodate those not fluent in
English. Small facilities worry about the added costs of
meeting the training requirements.
Analysis Prepared by : Jennifer Swenson / APPR. / (916)
319-2081