BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 1344
S
AUTHOR: Evans
B
VERSION: March 26, 2014
HEARING DATE: April 22, 2014
1
FISCAL: Yes
3
4
CONSULTANT: Mareva Brown
4
SUBJECT
Developmental services: Sonoma Developmental Center
SUMMARY
This bill would require the state to establish the Sonoma
Developmental Center as the center of last resort for
Northern California. The bill would require the Department
of Developmental Services (DDS) to confer and cooperate
with the County of Sonoma to develop a detailed action
plan, as specified, prior to establishing the Sonoma
Developmental Center as a center of last resort and would
require the County of Sonoma to ensure the inclusion and
participation of certain community entities, including
consumers living in the developmental center. By imposing
additional duties on the County of Sonoma, this bill would
impose a state-mandated local program.
ABSTRACT
Existing law:
1)Establishes the California Department of Developmental
Services (DDS) as the agency that oversees the state's
Continued---
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
2
developmental centers, and specifies the duties of the
department and developmental center employees. (WIC 4400
et seq.)
2)Defines a "developmental disability" as a disability that
originates before the age of 18, continues, or can be
expected to continue, indefinitely, and constitutes a
substantial disability. (WIC 4512)
3)Requires that when DDS proposes the closure of a state
developmental center, the department shall be required to
submit a detailed plan to the Legislature not later than
April 1 immediately prior to the fiscal year in which the
plan is to be implemented, and as a part of the
Governor's proposed budget. (WIC 4471 (a))
4)Requires that prior to submission of the plan to the
Legislature, DDS must solicit input from the State
Council on Developmental Disabilities, the Association of
Regional Center Agencies, the protection and advocacy
agency specified in Section 4901, the local area board on
developmental disabilities, the local regional center,
consumers living in the developmental center, parents,
family members, guardians, and conservators of persons
living in the developmental centers or their
representative organizations, persons with developmental
disabilities living in the community, developmental
center employees and employee organizations, community
care providers, the affected city and county governments,
and business and civic organizations, as may be
recommended by local state Senate and Assembly
representatives. (WIC 4474.1 (c))
5)Requires that prior to the submission of the plan to the
Legislature, DDS must confer with the county in which the
developmental center is located, the regional centers
served by the developmental center, and other state
departments using similar occupational classifications,
to develop a program for the placement of staff of the
developmental center planned for closure in other
developmental centers, as positions become vacant, or in
similar positions in programs operated by, or through
contract with, the county, regional centers, or other
state departments. (WIC 4474.1 (d))
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
3
6)Requires that prior to submission of the plan to the
Legislature, the department shall hold at least one
public hearing in the community in which the
developmental center is located, with public comment from
that hearing summarized in the plan. (WIC 4474.1 (e))
7)Requires that the plan submitted to the Legislature
include all of the following:
a) A description of the land and buildings affected.
b) A description of existing lease arrangements at the
developmental center.
c) The impact on residents and their families.
d) Anticipated alternative placements for residents.
e) The impact on regional center services.
f) Where services will be obtained that, upon closure
of the developmental center, will no longer be
provided by that facility.
g) Potential job opportunities for developmental
center employees and other efforts made to mitigate
the effect of the closure on employees.
h) The fiscal impact of the closure.
i) The timeframe in which closure will be
accomplished. (WIC 4474.1 (f))
This bill:
1) States various findings and declarations including:
a. There is a need to establish a formal
communication process between DDS and the
community within and surrounding Sonoma
Developmental Center (DC) in order to ensure that
all stakeholders are involved in the process to
determine the center's future.
b. There is a population within the
developmentally disabled community for whom
community placement may not be appropriate and
this act is necessary to best meet the unique
medical and behavioral needs of the residents of
the Sonoma Developmental Center.
2) Requires DDS to establish Sonoma DC as the center
of last resort for Northern California.
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
4
3) Defines "center of last resort," to mean a
developmental center that provides services to a small
population of residents for whom community placement
has been deemed insufficient.
4) Requires that before DDS establishes Sonoma DC as
the developmental center of last resort, the
department shall confer and cooperate with the County
of Sonoma, as the lead local agency, to develop a
detailed action plan.
5) Requires the County of Sonoma to ensure inclusion
and participation in developing the action plan of
community entities, including, but not limited to, the
following:
a. Consumers living in the developmental
center.
b. Parents, family members, guardians, and
conservators of persons living in the
developmental center or their representative
organizations, including, but not limited to, the
Parent Hospital Association of Sonoma DC.
c. Developmental center employees and
employee organizations.
d. The local regional center.
6) Permits the action plan to address all of the
following:
a. The appropriate strategy to ensure that
the best Medi-Cal funding structure is available
to a consumer, wherever he or she may live, who
transitions from the Sonoma DC as a result of the
implementation the declaration of Sonoma DC as
the center of last resort for Northern
California.
b. A program for the placement of staff of
the Sonoma DC who may be displaced as a result of
this declaration in similar positions in programs
operated by, or through contract with, the
county, regional centers, or other state
departments.
c. The disposition and re-use of medical and
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
5
housing facilities located on Sonoma DC grounds,
including, but not limited to, reuse of land and
open space that is a part of the campus, that may
no longer be required for the operation of Sonoma
DC as a result it becoming the center of last
resort.
7) Requires that if the Commission on State Mandates
determines that this act contains costs mandated by
the state, reimbursement to local agencies and school
districts for those costs be made.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
The author states that in response to the release of a task
force report by California's Secretary of Health and Human
Services on the future of the developmental centers, it is
necessary to ensure the involvement of the Sonoma DC
community in decision making. Among other recommendations,
the task force identified a need for smaller facilities to
serve those consumers who could not be easily cared for in
the community. The author states that the changes proposed
by the taskforce pose several significant and real changes
to the lives of those who reside in the DCs and their
families. Specifically, the community surrounding Sonoma DC
has been concerned of how these changes will be implemented
and the extent of their involvement in the decision-making
process.
According to the author, this bill will do two key things
to ensure the impact is lessened for family members and
consumers:
1. Locating a "center of last resort" in Northern
California would ensure that families would not have
to make the arduous journey to Southern California to
visit their loved ones while preserving the expertise
of the staff who have vital skills, knowledge and
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
6
experience required of those who work with such a
vulnerable population.
2. Creating a framework of communication between DDS
and the community, led by the County of Sonoma, would
ensure a variety of stakeholders are involved in
creating the plan of action for Sonoma DC.
Developmental disabilities
A developmental disability is defined as a severe and
chronic disability that is attributable to a mental or
physical impairment that begins before age 18 and is
expected to continue indefinitely. These disabilities
include mental retardation, cerebral palsy, autism,
epilepsy, and other similar conditions. Infants and
toddlers (age 0 to 36 months) may also be eligible for some
developmental services if they are at risk of having
developmental disabilities or if they have a developmental
delay.
Developmental Centers:
DDS operates four Developmental Centers and one smaller
state-operated community facility, Canyon Springs, that
together care for 1,300 adults and children across the
state. These DCs are part of a larger system of
developmental services overseen by DDS, which also includes
services and supports for approximately 265,000 people who
live in their communities.
The first DC opened in 1888, and residents with
developmental disabilities initially shared the state
hospitals with patients diagnosed with mental illness.
Eventually, those populations were separated into different
facilities. For many years, the state hospitals were the
only alternative available to families of children with
intellectual and developmental disabilities who were unable
to be cared for at home. Over time, community services and
supports for individuals with developmental disabilities
became the programs of choice and the resident population
dropped in the DCs from a high of 13,400 in 1968, with
thousands more on a waiting list for admission, to 1,302
residents as of April 9, 2014. At its peak, the state had
eight developmental centers, each of which was designed to
accommodate between 2,500 and 3,500 individuals.
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
7
California's current effort to close the Lanterman
Developmental Center in Pomona was preceded by four other
closures in the past two decades. In 1995, the state
shuttered the Stockton State Hospital. In 1997, the state
closed Camarillo State Hospital, which had housed clients
with both mental illness and developmental disabilities. In
2009, DDS closed Agnews Developmental Center, and a year
later, in 2010, Sierra Vista, a state-operated community
facility, was closed. Of the four remaining DCs, Sonoma has
the largest population, with 451 residents, and Lanterman,
which is in the midst of closure, had 74 residents as of
April 9.
Sonoma Developmental Center
Sonoma DC is the oldest facility in California that was
established specifically to serve the needs of individuals
with developmental disabilities. The facility was opened on
November 24, 1891 and in 1909 was renamed the California
Home for the Care and Training of the Feeble Minded. Later,
it became the Sonoma State Hospital and eventually, Sonoma
DC. The facility is in Eldridge, between the towns of Glen
Ellen and Sonoma, on approximately 1,000 acres of land that
is bisected by Highway 12. The DC includes a campus with
residential cottages, a campground, store, post office,
petting farm, swimming pool and other recreational
facilities for the residents. It also sits in the midst of
a wildlife corridor that open space advocates and others
have pledged to protect from development and adjacent to
Jack London State Park which features equestrian trails,
camping facilities, lakes and historic buildings.
Federal involvement
On July 3, 2012, licensing staff from the California
Department of Public Health (CDPH) conducted an annual
survey of Sonoma DC to assess whether the facility was in
compliance with state licensing regulations, as well as to
conduct, by proxy, a federal licensing review by the
Centers on Medicaid and Medicare Services (CMS). Officials
detailed in a 250-page report numerous violations which
amounted to lapses in six of the eight categories required
for continued federal funding. Among the findings were that
Sonoma DC's management failed to take actions that
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
8
identified and resolved problems of a systemic nature,
failed to ensure adequate facility staffing, failed to
provide active treatment, failed to provide appropriate
health care services and several other key categories. The
team also identified four situations that posed immediate
jeopardy to the health and safety of patients at the
facility including 11 clients with injuries that resembled
burns from a stun gun, a finding that also prompted a
criminal investigation.
In January 2013, four of the 10 Intermediate Care Facility
(ICF) units at Sonoma DC were withdrawn from federal
certification by DDS, in response to notice that the
federal government was moving to decertify the full group
of ICF units. The loss of certification has cost the state
$1.4 million per month in federal funds. To date, DDS has
met all of the CMS-issued milestones for recertification
and the Administration has said it expects all units will
be fully certified again July 2014.
Concerns about the poor patient care, client safety and
improper individual treatment plans also prompted
re-inspection of the other DDS institutions, which have
subsequently been found to be out of compliance with
federal requirements. In January, DDS and DPH reached an
agreement to avoid decertification, which will require the
development of a root-cause analysis and action plan for
Porterville and Fairview DCs, similar to what was required
at Sonoma.
Task Force
On January 13, 2014, California's Health and Human Services
Secretary Diana Dooley released a 59-page "Plan for the
Future of Developmental Centers in California." The Plan
was developed pursuant to trailer bill language adopted in
2013 that required the Secretary to submit to the
Legislature a master plan for the future of DCs by November
15, 2013; and to submit to the Legislature by January 10,
2014, the Administration's plans to meet the service needs
of all current residents of the DCs. While the plan that
was submitted on January 13 does meet the requirements of
the master plan, the subsequent plans required to implement
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
9
the recommendations of the master plan have yet to be
submitted and the Secretary has not provided an official
timeline for its release.
The task force included a broad representation of
stakeholders including a resident of Sonoma DC, family
members, regional center directors, providers, labor
representatives, consumer advocates, legislators, and DDS
and Agency staff. While noting that some family members and
union representatives on the task force qualified their
support for the plan to clarify that they do not support
any implication that the centers be closed, the plan
provides six consensus recommendations:
1. More community style homes/facilities should be
developed to serve individuals with enduring and
complex medical needs using existing models of care.
2. For individuals with challenging behaviors and
support needs, the state should operate at least two
acute crisis facilities and small transitional
facilities. The state should develop a new "Senate
Bill (SB) 962 like" model that would provide a higher
level of behavioral services. Funding should be made
available so that regional centers can expand mobile
crisis response teams, crisis hotlines, day programs,
short-term crisis homes, new-model behavioral homes,
and supported living services for those transitioning
to their own homes.
3. For individuals who have been involved in the
criminal justice system, the state should continue to
operate the Porterville DC's Secure Treatment Program
and the transitional program at Canyon Springs
Community Facility. Alternatives to the Porterville DC
Secure Treatment Program also should be explored.
4. The development of a workable health resource
center model should be explored, to address the
complex health needs of DC residents who transition to
community homes.
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
10
5. The state should enter into public/private
partnerships to provide integrated community services
on existing state lands, where appropriate. Also,
consideration should be given to repurposing existing
buildings on DC property for developing service models
identified in Recommendations 1 through 4.
6. Another task force should be convened to address
how to make the community system stronger.
Related legislation:
SB 1428 (Evans) 2014, would require that, prior to the
development of any plan for the sale, lease, transfer, or
major change of use of any portion of the Sonoma DC, DDS
and the Department of General Services confer and cooperate
with public and private entities in the development of an
improvement and redevelopment plan for the center. The bill
would authorize the plan to contain specific elements for
residences, the wildlife habitat corridor and public
recreational facilities.
AB 2349 (Yamada) 2014, would establish the Office of
Community Care Coordination within the DDS, located at
Sonoma DC, and would require the office to develop a plan,
on or before January 1, 2016, that addresses, among other
things, the operation of at least two acute crisis clinics,
as specified. The bill would also require the office to
identify which modifications are necessary to enable the
Sonoma DC to operate as a placement of last resort and as
an acute crisis clinic.
AB 89 Chapter 25, Statutes of 2013, a 2013-2014 budget
trailer bill, required the Secretary of the Health and
Human Services Agency to submit a master plan for the
future of DCs and subsequent plan for individuals living in
those centers.
AB 1472 (Chapter 25, Statutes of 2012), a 2012-2013 budget
trailer bill, included a moratorium for new admissions to
the DCs, with limited exception, limitations on the use of
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
11
locked mental health facilities and out-of-state
placements, and provisions to strengthen the capacity of
the community to serve individuals with challenging needs
including the creation of a statewide Specialized Resource
Service.
Comments :
1. This bill seeks to reassure the Sonoma County
community as well as families of residents at Sonoma
DC that they will have some control over the future of
the campus, should the state decide to shut the
facility without an official closure plan. However,
many elements of this bill are premature, given that
the state has yet to release any specifics for the
future of developmental centers, as is required. There
is an expectation that some specifics will be released
in the Governor's May Revise budget, and associated
trailer bill language.
Among the issues needing clarification from the
Administration in order to consider whether Sonoma
Developmental Center can be the Northern California
center of last resort are:
A. The definition of a "center of last resort."
B. Whether the state intends to open state- or
privately run facilities.
C. What process the state will use to determine
locations for the smaller, state- or privately run
facilities, should the state move forward with these
types of facilities.
D. Whether the state intends to place these
smaller facilities on the campuses of existing
developmental centers.
E. Whether the Sonoma Developmental Center is an
appropriate location for future developmental
services, either in existing structures or in new
ones.
Staff recommends that the author consider amending the
language of this bill if trailer bill language is
released in May that affects this language.
1. This bill seeks to ensure that members of the
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
12
Sonoma community, parents of residents and individuals
who live at Sonoma have a voice in the future plans,
should the campus be closed without officially
declaring a closure. Existing statute dictates the
state's responsibility to engage stakeholders in the
closure process of a developmental center. While this
bill includes some of those stakeholders, it omits
others who are identified in the mandated closure
process in WIC 4474.1 (c), including:
The State Council on Developmental Disabilities, the
Association of Regional Center Agencies, the
protection and advocacy agency specified in Section
4901, the local area board on developmental
disabilities, persons with developmental disabilities
living in the community, community care providers, and
affected city and county governments (with the
exception of Sonoma County).
Staff recommends that, should the bill proceed, the
author add the remainder of the stakeholders
identified in WIC 4474.1 (c) to this bill beginning on
line 18 on page 3.
2. This bill includes a declaration that there is a
population within the developmentally disabled
community for whom community placement may not be
appropriate. This declaration is contrary to the
testimony of numerous officials, state and federal
court decisions and the task force report, which all
declare that individuals with similar needs and
conditions to those in developmental centers are being
served in their communities and that any individual
can be served in the community with appropriate
supports. Specifically, the task force notes:
"Although there are larger concentrations of people
with severe disabilities and complex needs in the DCs,
people with similar characteristics are being served
successfully in the community. While some residents
could successfully be served in the community today,
additional specialized resources are required to meet
the intense needs of the more difficult to serve DC
population." Pg 11.
STAFF ANALYSIS OF SENATE BILL 1344 (Evans) Page
13
Staff recommends striking the following declaration:
There is a population within the developmentally
disabled community for whom community placement may
not be appropriate and this act is necessary to best
meet the unique medical and behavioral needs of the
residents of the Sonoma Developmental Center.
POSITIONS
Support: County of Sonoma, Board of Supervisors
Parent Hospital Association of Sonoma
Developmental Center
4 individuals
Oppose: None received.
-- END --