BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      AB 74


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          Date of Hearing:   April 21, 2015


                   ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE


                                 Cheryl Brown, Chair


          AB 74  
          Calderon - As Amended April 7, 2015


          SUBJECT:  Care facilities:  regulatory visits.


          SUMMARY:  Revises inspection schedules of facilities licensed by  
          the Department of Social Services, except Foster Care Homes.   
          Specifically, this bill:  



          1)Shortens existing increments of time between unannounced  
            inspections of all facilities licensed by the Department of  
            Social Services Community Care Licensing Division, except  
            Foster Family Homes, from 5 years to:


               a.     3 years beginning July 1, 2016 


               b.     2 years beginning July 1, 2017, and


               c.     1 year beginning July 1, 2018,


            Unless, (for a and b above),  the license for a facility is on  
            probation, the facility is under annual inspection orders  








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            based upon a plan of correction, a formal accusation against a  
            facility license is pending, or the terms of federal financial  
            participation already dictate annual unannounced inspections.   



          2)Provides for a random sampling process to select which  
            facilities will be subject to a once-every-three year  
            unannounced inspection beginning July 1, 2016, and a  
            once-every-two year inspection beginning July 1, 2017.


          EXISTING LAW:  


          1)Establishes the Community Care Licensing Division (CCLD)  
            within the Department of Social Services with the power and  
            authority to enforce laws and regulations related to  
            facilities that it licenses.


          2)Permits the Department of Social Services to inspect  
            facilities to inspections as often as necessary to assure  
            quality of care, but under no circumstances may inspections  
            occur less than once every 5 years.


          3)Directs the Department of Social Services to conduct annual  
            unannounced inspections when a license is on probation, a  
            compliance plan or plan of corrections requires annual  
            unannounced inspections, an accusation against a facility is  
            pending, the facility is on probation, or the facility is  
            under order for annual inspections.


          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 that facility to be  
            licensed by DSS.





          5)Prohibits any person, firm, partnership, association,  
            corporation or public agency from establishing, operating,  
            managing, conducting or maintaining a RCFE without a valid  
            licensed provided by DSS.





          6)Provides that any person who violates the CCFA or the RCFE Act  
            shall be guilty of a misdemeanor and upon conviction shall be  
            fined no more than $1,000, imprisoned in county jail for up to  
            one year, or both.





          FISCAL EFFECT:  Unknown.


          COMMENTS:  


          AB 74 creates a statutory plan which will direct annual,  
          unannounced licensing visits by Community Care Licensing  
          personnel to all facilities licensed by the Department of Social  
          Services by July 1, 2018, (except Foster Family Homes which are  
          subject to annual announced visits) unless a complaint has been  
          filed, a plan of correction directs unannounced inspections, the  
          license is on probation, an accusation is pending, or federal  
          financing dictates annual unannounced inspections as a condition  








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          of participation.  Until then, AB 74 directs unannounced visits  
          to facilities (other than Foster Family Homes) no less often  
          than every 3 years by 


          July 1, 2016, and no less often than once every other year by  
          July 1, 2017.
          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 (cared  
          for) properly."


          Background:  Community care facilities are considered those that  
          provide non-medical care and supervision for children and adults  
          in need, which includes persons with disabilities, seniors in  
          need of residential care, children in foster care and at-risk  
          children needing shelter services, families in need of early  
          childhood education (child care), and adult care services.   
          Community care facilities are overseen by the Community Care  
          Licensing Division (CCLD) of the Department of Social Services.   
          CCLD is responsible for conducting facility inspections, and  
          when necessary, administrative actions when licensing standards  
          are not met.  CCLD may also assist providers to maintain  
          compliance with licensing regulations.  











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          The RCFE Act was established to help provide a system of  
          residential care to allow older persons to remain as independent  
          as possible while not forcing them to move between medical and  
          nonmedical facilities.  Commonly referred to as assisted living  
          facilities, retirement homes and board and care homes, RCFEs are  
          licensed facilities that provide services to individuals who are  
          60 years of age and older and persons under the age of 60 with  
          compatible needs.  RCFEs provide a wide array of care, which can  
          include varying levels of personal care and protective  
          supervision, based upon the needs of the resident.


          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.  They ensure  
          that basic health and safety requirements are being met and also  
          provide opportunities for increased technical assistance to  
          programs, enhanced information sharing, the development of best  
          practices, and ultimately lead to an improvement in the quality  
          of life for clients under care.  





          Unannounced Inspections:  Numerous studies document a connection  
          between increased licensing visits with a decrease in accidents  
          requiring medical attention and greater provider compliance with  
          health and safety standards.  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 offered, by facility.  In a 2010-11 Spring Finance  
          Letter, DSS asserted 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."  Specifically, "more annual inspections  
          equates to better quality of care" and "more annual inspections  








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          equates to a smaller risk to the health and safety of clients."





          Prior to 2003, the required frequency of unannounced licensing  
          visits was annually for most facility types.  Due to the state's  
          budget deficit at the time, 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.  





          Media reports began revealing disturbing developments within the  
          assisted living/RCFE industry stirring rage and fear, most  
          notably during September and October, 2013, which left the  
          public with questions about the state's role to assure safe  
          environments for vulnerable populations.  Most notably:





           In San Diego County, more than two dozen recent, questionable  
            deaths in RCFEs with little or no response by CCL were  
            disclosed; and, 
           In Contra Costa County, 19 frail seniors were abandoned at  
            Valley Springs Manor.  Though CCL was present throughout the  
            process, CCL's action was to cite the cook, the last remaining  
            unpaid staff member, and fine him $3,800 for inadequate food  
            and medication.  That staff member eventually called 911 which  
            activated a Sherriff response, hospital placements, and a  
            range of other costly accommodations.  








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          The Governor's 2015-16 January budget proposal includes  
          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. 





          PRIOR LEGISLATION:  


          


          AB 1454 (Ian 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 (Ian 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.








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          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.





          SB 185 (Mello, Chapter 1127, Statutes of 1985) established the  
          "Residential Care Facilities for the Elderly Act" which provides  
          for the licensing, regulation, and operation of RCFEs and found  
          that due to shortages in affordable housing and a greater demand  
          for residences for the elderly providing some care and  
          supervision, a growing number of elderly persons with health and  
          social care needs were residing in community care facilities  
          that were not necessarily designed to meet their needs, and that  
          therefore, residential care facilities for the elderly should be  
          licensed and overseen as a separate category within the existing  
          licensing structure of the State Department of Social Services,  
          and that consulting services by the Department be offered to  
          licensees to assure compliance.  





          CONFLICT:  The office of Legislative Counsel has notified the  
          committee that AB 74 is in conflict with AB 403 (Stone).










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          DOUBLE REFERRAL:  This bill was previously heard by the Assembly  
          Committee on Human Services on April 2, 2015 and passed, as  
          amended, on a vote of 7-0.





          REGISTERED SUPPORT / OPPOSITION:




          Support


          Advancement Project


          The Alliance


          American Federation of State, County and Municipal Employees  
          (AFSCME) AFL-CIO


          California Advocates for Nursing Home Reform (CANHR) - Support  
          if amended.


          California Alternative Payment Program Association (CAPPA)


          California Assisted Living Association (CALA)










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          California Association of Area Agencies on Aging (C4A)


          California Child Care Resource & Referral Network


          California Commission Aging


          California Communities United Institute


          California Continuing Care Residents Association (CALCRA)


          California Long-Term Care Ombudsman Association (CLTCOA)


          California Retired Teachers Association


          California State PTA


          Child Care Alliance Los Angeles


          Child Development Resources


          Children Now


          Community Action Partnership of Madera County


          Community Residential Care Association of California










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          Community Resources for Children


          County of San Bernardino


          County of San Diego


          Del Norte Child Care Council


          Department of Defense State Liaison Office


          Early Edge California


          First 5 California


          LeadingAge California


          League of California Cities


          Los Angeles Universal Preschool


          Office of State Long-Term Care Ombudsman


          Special Needs Network (SNN)


          Solano Family & Children's Services










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          Numerous individuals.




          Opposition


          None on file.




          Analysis Prepared by:Robert MacLaughlin / AGING & L.T.C. / (916)  
          319-3990