BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 1382
S
AUTHOR: Block
B
VERSION: March 25, 2014
HEARING DATE: April 8, 2014
1
FISCAL: No
3
8
CONSULTANT: Sara Rogers
2
SUBJECT
Residential Care Facilities for the Elderly
SUMMARY
This bill increases the initial and annual licensing fees
for Residential Fees for the Elderly (RCFEs) by 30 percent
for every sized facility.
ABSTRACT
Existing Law:
1.Establishes the Residential Care Facilities for the
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.Provides that CDSS shall charge all RCFE applications a
fee adjusted by the size of the facility and capacity for
Continued---
STAFF ANALYSIS OF SENATE BILL 1382 (Block)
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the issuance of a license. (HSC 1569.185)
3.Provides that, following initial licensure, CDSS shall
charge an annual fee on each anniversary of the effective
date of the license. (HSC 1569.185)
4.Establishes in statute the specific fee amounts according
to facility capacity, for both initial and annual
licensing fees. (HSC 1569.185)
5.Provides that CDSS shall charge a licensee 50 percent of
the application fee when moving the facility to a new
address, or when a corporate licensee changes who has the
authority to select a majority of the board of directors.
(HSC 1569.185)
6.Provides that CDSS shall charge a late fee that
represents an additional 50 percent of the established
annual fee when a licensee fails to pay the annual
licensing fee on or before the due date as indicated by
postmark on the payment. (HSC 1569.185)
7.Provides that the revenues collected from these licensing
fees shall be utilized by the department for the purpose
of ensuring the health and safety of all individuals
provided care or supervision by licensees and to support
the activities of the licensing programs, when
appropriated for these purposes. (HSC 1569.185)
This bill:
1.This bill increases the initial and annual licensing fees
for RCFEs by 30 percent for every sized facility.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
STAFF ANALYSIS OF SENATE BILL 1382 (Block)
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BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, licensing fees for new and current
Residential Care Facilities for the Elderly (RCFEs) have
only marginally increased three times in the last 20 years,
and have been low since the establishment of the program
and have not kept pace with the need for increased
oversight by the California Department of Social Services
(CDSS). The author states that recent scrutiny of RCFEs
has highlighted the need for increased regulation and
supervision to better protect residents.
The author states that this bill is part of a broad package
of legislation sponsored by California Advocates for
Nursing Home Reform in response to these and other
instances of inadequate regulatory oversight of RCFEs. This
moderate 30 percent increase to the licensees will improve
the department's oversight and regulation of RCFEs and
ensure better protection and care of residents, according
to the author.
Recent events
A series of recent events has drawn attention to questions
about the adequacy of CCL oversight and the state's ability
to protect people who receive services within CDSS-licensed
facilities.
In July 2013, ProPublica and Frontline reporters wrote
and produced a series of stories on Emeritus, the
nation's largest RCFE provider.<1> Featured in the
article was a woman who died after receiving poor care at
-------------------------
<1>
http://www.propublica.org/article/life-and-death-in-assisted
-living-single
STAFF ANALYSIS OF SENATE BILL 1382 (Block)
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in a facility in Auburn, California. The series
documented chronic understaffing and 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 CCL.<2>
In late October 2013, 19 frail seniors were abandoned at
Valley Springs Manor in Castro Valley by the licensee and
all but two staff after the state began license
revocation proceedings for the facility. CDSS inspectors,
noting the facility had been abandoned, left the two
unpaid service staff to care for the abandoned residents
with insufficient food and medication, handing them a
$3,800 citation before leaving for the weekend. The next
day sheriff's deputies and paramedics sent the patients
to local hospitals.
Residential Care Facilities for the Elderly
Within California's continuum of long term care, situated
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 residents 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
-------------------------
<2> "Care Home Deaths Show System Failures," San Diego
Union Tribune, Sept.7, 2013
STAFF ANALYSIS OF SENATE BILL 1382 (Block)
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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.
Joint Hearing on RCFEs
On February 11, 2014, the Senate and Assembly Human
Services Committees jointly held an oversight hearing about
the state's ability to safeguard residents in Assisted
Living Facilities. Hearing testimony highlighted
significant technological barriers to the tracking of
complaints and deficiencies, limited follow-up practices by
the department to ensure that deficiencies are corrected,
frequent failure to collect assessed fines and penalties, a
lengthy appeals process that hinders immediate action when
necessary, and use of a shortened inspection tool that has
not been validated for use in RCFEs.
CDSS acknowledged serious long-term gaps and failures in
regulatory oversight over RCFEs, highlighted most recently
at Valley Springs Manor in Alameda County. The Department
has acknowledged that it waited until after the facility
administrator left the facility to take emergency action to
close the facility, despite receiving no communication or
response from the licensee during the nearly five months
since the Department had initiated license revocation
proceedings. CDSS said its analyst made a "judgment error"
in deciding that the facility, with all staff having
abandoned the residents except for an untrained janitor and
cook, and without access to medications or sufficient food,
STAFF ANALYSIS OF SENATE BILL 1382 (Block)
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could continue to function without assistance through the
weekend.
The Department has additionally stated that the Division
erred in not directing existing staff or deploying
additional field staff to remain on site until the transfer
of the residents was completed and the facility was closed.
Governor's Budget Proposal
As part of the Governor's 2014-2015 proposed budget, the
Administration has put forth trailer bill language that has
substantial overlap with provisions of this bill. The
Administration proposes to increase the initial and annual
licensing fee structure by 10 percent.
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 911 (Block) Would increase certification training
requirements for RCFE licensees, and staff who care for
residents, increases training requirements for staff
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providing dementia care.
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
subsequent violations of the same law within 12 months, or
has failed to pay existing fines.
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.
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AB 1570 (Chesbro) Would increase the certification training
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.
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Prior legislation
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.
POSITIONS
Support: California Advocates for Nursing Home Reform
(sponsor)
Oppose: None received.
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