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