BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  May 6, 2015


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                                 Jimmy Gomez, Chair


          AB  
          74 (Calderon) - As Amended April 7, 2015


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          |Policy       |Human Services                 |Vote:|7 - 0        |
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          |             |Aging and Long Term Care       |     |7 - 0        |
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          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


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


          1)Requires the Department of Social Services (DSS) to increase  
            the frequency of annual unannounced licensing visits of  








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            community care facilities, residential care facilities for the  
            elderly (RCFEs), licensed child day care centers and family  
            day care homes, from once every 5 years to:


               a.     Once every 3 years beginning July 1, 2016. 


               b.     Once every 2 years beginning July 1, 2017.


               c.     Annually 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  
            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.


          FISCAL EFFECT:


          1)Ongoing major future costs in the range of $20 million (GF)  
            once the frequency of inspections in all facility types is  
            completed annually. 
          2)The Governor's 2015-16 January budget proposal includes $3  
            million (GF) and 28.5 positions for CCLD to address a backlog  
            of complaint cases and to expand training and technical  
            assistance.  In addition, the proposal requires DSS to  
            phase-in increased inspection frequency to once every three  








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            years starting January 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. Ongoing staffing costs are  
            estimated at $14 million (GF).



          





          COMMENTS:


          1)Purpose.  This legislation seeks to significantly increase the  
            number of inspection visits to licensed facilities such as  
            child care centers, residential care facilities for the  
            elderly, and family child care homes. The author notes that  
            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. 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."
          
          2)Background.  The Community Care Licensing Division (CCLD) of  
            DSS is responsible for the regulatory and licensing activities  
            related to residential and non-residential programs licensed  
            by DSS.  These include 24-hour senior, adult, and child  
            residential care homes, as well as non-residential programs  
            (e.g., child care centers and adult day programs).  CCLD is  








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            responsible for conducting facility inspections, pursuing  
            administrative actions when licensing standards are not met,  
            and assisting providers to maintain compliance with licensing  
            regulations. 
          
            Prior to 2003, the required frequency of CCLD licensing visits  
            was annually for most facility types. Subsequently, in  
            response to the state's fiscal situation, legislation was  
            enacted to lengthen the interval between visits in an effort  
            to reduce program costs. CCLD now conducts 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.  

            In response to health and safety issues discovered at  
            facilities licensed by the CCLD, the 2014-15 Governor's Budget  
            included a comprehensive plan to reform the CCLD program. The  
            plan included an increase of $7.5 million ($5.8 million GF)  
            and 71.5 positions to improve the timeliness of  
            investigations, ensure the CCLD inspects all facilities at  
            least once every five years, increase staff training, and  
            establish clear fiscal, program, and corporate accountability.  
            The plan did not change the mandated inspection frequency, but  
            the number and frequency of visits was expected to increase  
            due to the additional resources dedicated to specialized  
            workloads, thereby permitting licensing program analysts to  
            conduct more facility inspections.

            In addition, SB 855 (Committee on Budget and Fiscal Review)  
            Chapter 29, Statutes of 2014, included legislative intent  
            language stating "it is the intent of the Legislature to, over  
            a period of time, increase the frequency of facility  
            inspections resulting in annual inspections for some or all  
            facility types."









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          3)Prior Legislation. 
             a)   AB 1454 (Calderon), 2014, was substantially similar to  
               this bill. It would have phased in annual licensing  
               inspection visits by July 1, 2017. It was held on the  
               Senate Appropriations Suspense File.
             b)   AB 364 (Calderon), 2013, required CCL to conduct  
               licensing inspections in most community care facilities at  
               least once every two years. It was held on the Assembly  
               Appropriations Suspense File.





             c)   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 was held on the Assembly  
               Appropriations Committee Suspense File.



          Analysis Prepared by:Jennifer Swenson / APPR. / (916)  
          319-2081


















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