BILL ANALYSIS Ó
AB 74
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Date of Hearing: March 24, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Chu, Chair
AB
74 (Calderon) - As Introduced January 5, 2015
SUBJECT: Care facilities: regulatory visits
SUMMARY: Phases in annual unannounced inspection visits in
community care facilities, residential care facilities for the
elderly, child day care centers, and family day care homes
licensed by the Department of Social Services.
Specifically, this bill:
1)Requires the Department of Social Services (DSS) to increase
the frequency of annual unannounced licensing visits of
Community Care Facilities, Residential Care Facilities for the
Elderly, licensed child day care centers and family day care
homes per the following:
a) By July 1, 2016, requires DSS to conduct annual
unannounced visits to at least a 30% random sample of
facilities not otherwise subject to an annual inspections
to address compliance issues or meet federal funding
requirements, and requires that facilities are visited at
least once every three years;
b) By July 1, 2017, requires DSS to conduct annual
unannounced visits to no less than a 20% random sample of
facilities not otherwise subject to an annual inspection,
and requires that facilities are visited at least once
every two years; and
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c) Requires DSS to conduct at least one annual unannounced
visit in each licensed facility on and after July 1, 2018.
1)Deletes provisions requiring DSS to conduct an unannounced
visit at least once every five years.
EXISTING LAW:
1)Establishes the California Community Care Facilities Act
(CCFA) to provide a comprehensive statewide service system of
quality community care for people who have a mental illness, a
developmental or physical disability, and children and adults
who require care or services by a facility or organization.
(H&S Code 1500 and 1501)
2)Defines a "Community care facility" (CCF) as a facility,
place, or building maintained and operated to provide
nonmedical residential care, day treatment, adult day care, or
foster family agency services for children, adults, or
children and adults, including, but not limited to,
individuals with cognitive or physical disabilities, as
specified, and abused or neglected children. (H&S Code 1502)
3)Authorizes DSS to license facilities or organizations that
provide services under the jurisdiction of the CCFA,
including, residential facilities, as defined, adult day
programs, therapeutic day services facilities, foster family
agencies and homes, social rehabilitation facilities,
community treatment facilities, full-service adoption
agencies, noncustodial, adoption agencies, transitional
shelter care facilities, and transitional housing placement
providers for foster youth. (H&S Code 1520)
4)Establishes the California Residential Care Facility for the
Elderly (RCFE) Act, which requires facilities that provide
personal care and supervision, protective supervision, or
health related services for persons 60 years of age or older
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who voluntarily choose to reside in those facilities to be
licensed by DSS. (H&S Code 1569 et seq.)
5)Establishes the California Child Day Care Facilities Act to
provide a comprehensive, quality system for licensing child
day care facilities to ensure that working families have
access to healthy and safe child care providers and that child
care programs contribute positively to a child's emotional,
cognitive, and educational development, and are able to
respond to, and provide for, the unique characteristics and
needs of children. (H&S Code 1596.70 et seq.)
6)Subjects all licensed community care facilities to unannounced
inspections by DSS, with certain exceptions in foster family
homes, as specified. (H&S 1534, 1569.33, 1597.09 and
1597.55a)
7)Provides that facilities licensed by DSS shall be subject to
unannounced visits by DSS and that the department shall visit
facilities as often as necessary to ensure the quality of care
provided. (H&S 1534, 1569.33, 1597.09 and 1597.55a)
8)Requires annual unannounced inspections when a license is on
probation, when required by the terms of a facility compliance
plan, when an accusation is pending, when required for federal
financial participation (CCFs and RCFEs), or to verify that a
person who has been ordered out of the facility is no longer
present. (H&S 1534, 1569.33, 1597.09 and 1597.55a)
9)Requires DSS to perform random inspections each year in no
fewer than 20% of facilities not subject to annual
inspections. Provides that this percentage shall increase by
10% if the total citations issued by the department exceeds
the previous year by 10%. Requires DSS to visit every
facility no less than every 5 years. (H&S 1534, 1569.33,
1597.09 and 1597.55a)
FISCAL EFFECT: Unknown
COMMENTS:
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Background: The Community Care Licensing Division (CCLD) of the
Department of Social Services is responsible for the regulatory
and licensing activities related to residential and
non-residential programs. CCLD is charged with providing
preventative and protective services to people in "community
care facilities"; 24-hour senior, adult, and child residential
care homes, as well as non-residential programs (e.g., child
care centers and adult day programs). In the facilities it
licenses, CCLD is responsible for conducting facility
inspections, pursuing administrative actions when licensing
standards are not met and assisting providers to maintain
compliance with licensing regulations. CCLD also conducts
criminal background checks of licensees, employees and all
adults providing direct services to, or having routine contact
with, clients in care.
According to CCLD statistics, as of June, 2014, there were
nearly 1.4 million children and adults served in 76,416 licensed
residential and non-residential programs overseen by CCLD (these
include 8,700 foster family homes and family child care homes
licensed by counties through contracts with DSS).
Facility inspection priorities: 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, CCLD is now required to conduct unannounced visits
annually only when a facility is experiencing program compliance
problems, or when it is required as a condition of federal
funding participation.
For all other facilities not subject to annual inspections, CCLD
is required to conduct comprehensive compliance inspections of a
20% random sample of facilities each year, with no facility
being visited less than once every five years. CCLD also
conducts investigations when a complaint is filed against a
facility, and 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 between CCLD inspection visits
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at a residential facility, often jeopardizing resident or client
safety. Today, according to DSS, there are approximately 500
licensing program analysts responsible for conducting
inspections in licensed community care facilities.
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 for certain mental health facilities, staff
reductions and vacancies, and on-again off-again work furloughs
and hiring freezes have all severely reduced the department's
administrative capacity. Although this does not clear the state
of its responsibility to ensure community care facilities'
compliance with statutory program requirements, it does
demonstrate the significant challenges DSS faces in ensuring
that children, adults and seniors in need of care and
supervision are not put at risk.
Governor's budget proposal: The Governor's 2015-16 January
budget proposal included increased funding and 28.5 positions
within CCLD to address a facility complaint backlog and to
expand training and technical assistance. This proposal for
licensing positions was accompanied by a plan to phase-in
increased inspection frequency to once every three years by
2017, for all facilities, once every two years by 2018 for all
facility types except child care, and annually by 2019 for adult
day care and residential care facilities for the elderly.
Need for this bill: 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 in the community. They ensure that basic health
and safety requirements are being met and provide opportunities
for increased technical assistance to programs, enhanced
information sharing, the development of best practices and,
overall, an improvement in the quality of life for clients of
care facilities.
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
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being provided to consumers. According to Child Care Aware of
America, 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 an increased number of 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." DSS went on to note that increased annual
inspections result in better quality of care and a smaller risk
to the health and safety of clients.
According to the author, "Increasing the frequency of licensing
visits will demonstrate that California is serious about
addressing the deficiency in our inspection process for
Community Care Facilities and will put California on par with
the inspection procedures of other states. Currently we have a
complaint based oversight system that is reactive to issues in
our facilities instead of being proactive to prevent issues or
fix and stop these issues before they become deadly. By at
least having a licensing program analyst, or inspector, in these
facilities, boots on the ground, once a year we will be able to
be proactive and no longer be operating under a complaints based
system. Facilities are in need of frequent inspections because
of the vulnerability of the clients these facilities serve and
it is our job to make sure these individuals are being properly
taken care of."
Recommended amendments: As introduced, this bill requires that
the phase-in toward annual unannounced CCLD visits begins with
an increase to a 30% random sampling of facilities not otherwise
necessitating annual inspections, and a visit no less than once
every three years, by July 1, 2016. This bill goes on to
require that facilities are visited no less than once every two
years by July 1, 2017, but only requires CCLD to conduct annual
inspections in a 20% random sampling of facilities not otherwise
necessitating annual inspections to meet that goal.
In order to gradually increase the number of annual unannounced
inspections, committee staff recommends that the 20% sampling of
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facilities in which annual unannounced visits are required to
take place on or before July 1, 2017 be replaced with a 40%
sampling in the following sections of the bill in print: Health
& Safety Code Sections 1534(a)(2)(D)(2), 1569.33(c)(3),
1597.09(c)(3), and 1597.55a(c)(3).
PRIOR LEGISLATION:
AB 1454 (Calderon), 2014, was substantially similar to this
bill. It would have phased in annual licensing inspection visits
by July 1, 2017 and deleted language requiring inspection visits
at least once every 5 years. It died on the Senate
Appropriations Suspense File.
AB 364 (Calderon), 2013, required CCL to conduct licensing
inspections in most community care facilities at least once
every two years. It died on the Assembly Appropriations
Suspense File.
AB 419 (Mitchell), 2011, would have required DSS to conduct an
unannounced inspection of a care facility, using prescribed
inspection protocols, at least once each year and as often as
necessary to ensure the quality of care provided, except for
family day care centers, which the department would have been
required to inspect at least once every 2 years. It died on the
Assembly Appropriations Committee Suspense File.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Committee on Aging and Long-Term Care.
REGISTERED SUPPORT / OPPOSITION:
Support
American Federation of State, County and Municipal Employees
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(AFSCME) AFL-CIO
California Commission on Aging
Advancement Project
California Alternative Payment Program Association (CAPPA)
California Assisted Living Association (CALA)
California Child care Resource & Referral Network
California Communities United Institute
California Retired Teachers Association (CalRTA)
Child Care Alliance of Los Angeles
Child Development Resources of Ventura County
Community Action Partnership of Madera County (CAPMC)
Community Resources for Children
Del Norte Child Care Council
FIRST 5 Santa Clara
Leading Age California
Solano Family & Children's Services
Special Needs Network (SNN)
Opposition
None on file.
Analysis Prepared
by: Myesha Jackson/HUM. S./(916) 319-2089