BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 74
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|Author: |Calderon |
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|Version: |April 7, 2015 |Hearing | June 23, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sara Rogers |
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Subject: Care facilities: regulatory visits
SUMMARY
This bill requires the California Department of Social Services
(CDSS) to increase the frequency of random unannounced licensing
visits of Community Care Facilities, Residential Care Facilities
for the Elderly and child day care centers, except Foster Care
Homes, as specified, achieving annual inspections for all
facilities by January 1, 2018.
ABSTRACT
Existing law:
1)Establishes the Community Care Facilities Act, which provides
for the licensure and regulation by CDSS of CCFs defined as
nonmedical residential and non-residential facilities for
mentally ill, developmentally and physically disabled, and
children and adults who require care or services. (HSC 1500 et
seq.)
2)Establishes the Residential Care Facilities for the Elderly
Act, which provides for the licensure and regulation of RCFEs
as a separate category within the existing residential care
licensing structure of CDSS. (HSC 1569 et seq.)
3)Establishes the California Child Day Care Facilities Act to
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provide for the licensure and regulation of child day care and
family day care facilities as a separate licensing category
within the existing licensing structure of CDSS (HSC 1596.72
et seq.)
4)Provides for the CDSS licensure and regulation of small family
day care homes serving between six and eight children, as
specified, in a residentially zoned and occupied property.
(HSC 1597.30 et seq.)
5)Provides that facilities licensed by CDSS shall be subject to
unannounced visits by CDSS and that the department shall visit
facilities as often as necessary to ensure the quality of care
provided. (HSC 1534, 1569.33, 1597.09 and 1597.55a)
6)Requires annual unannounced inspections when a licensee 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. (HSC 1534, 1569.33, 1597.09, 1597.55(a))
7)Requires CDSS to perform random inspections each year on no
fewer than 20 percent of facilities not subject to annual
inspections. Provides that this percentage shall increase by
10 percent if the total citations issued by the department
exceeds the previous year by 10 percent. As a result of this
trigger, CDSS currently is required to perform random
inspections on 30 percent of the facilities not subject to
annual inspection. Requires CDSS to visit every facility no
less than every 5 years. (HSC 1534, 1569.33, 1597.09, 1597.55
(a))
1)Requires CDSS to make a determination regarding the
completeness of an RCFE license application, and to arrange a
time for a prelicensure survey if the license is complete.
(HSC 1569.20)
This bill:
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1)Requires CDSS to increase the frequency of unannounced
licensing visits of CCFs, RCFEs and child day care centers,
except Foster Care Homes, as follows:
By July 1, 2016, every facility shall be visited at
least once every three years and establishes in statute
the current practice that 30 percent of all facilities
are required to receive a random unannounced visit each
year.
By July 1, 2017 every facility shall be visited at
least once every two years, and 40 percent of all
facilities are required to receive a random unannounced
visit each year.
By July 1, 2018 every facility shall be visited
annually.
1)Deletes provisions requiring CDSS to conduct an unannounced
visit at least once every five years.
2)Deletes the requirement that CDSS increase by 10 percent the
random sampling of community care facilities if there has been
a 10 percent increase in the number of citations the previous
year.
FISCAL IMPACT
This bill would increase inspection frequency to annual
inspections for all facilities except foster care homes.
According to an analysis of the Assembly Appropriations
Committee, costs associated with these provisions are estimated
to be in the range of $20 million, once the frequency of
inspections in all facility types is completed annually.
The Senate and Assembly both have approved the Governor's budget
proposal and trailer bill language to increase inspection
frequency to once every three years for child care facilities;
once every two years for children's residential facilities; and
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annual inspections for adult and senior care facilities. Ongoing
staffing cost for the budget proposal is estimated at $14
million.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, California's licensing program performs
the essential function of protecting the basic health and safety
of children and adults in care. The author states that, due to
budget cuts, the frequency of facility visits declined from
annually for most facility types (and tri-annually for family
child care) to the current standard of every five years.
The author writes that recent news reports have highlighted the
lack of frequent inspections in facilities across California and
the dangers faced by children and the elderly, stating that
seniors have suffered broken bones, deadly bed sores, sexual
assaults and other injuries in assisted living facilities while
children have been victims of neglect, endangerment, unkempt
conditions, and injuries. The author states that this bill will
work to address these problems by requiring annual unannounced
visits for all community care facilities licensed by CDSS, which
are fundamental in protecting the health and safety of children
and adults receiving care through facility or home-based care.
Budget Proposal
Both the Senate and Assembly have approved the Governor's budget
proposal and trailer bill language to incrementally increase
inspection frequency such that by January 1, 2019 child care
facilities will be visited once every three years; children's
residential facilities will be visited once every two years; and
adult and senior care facilities will be inspected annually. In
contrast, over the same period of time, AB 74 would achieve
annual inspections for all three facility types.
Inspection Frequency: Budget proposal compared to AB 74
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| Facility | Current | January 1, | January 1, | January 1, |
| Type | Law | 2016 | 2018 | 2019 |
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|------------+------------+------------+------------+------------+------------+------------+------------|
| | | Budget | AB 74 | Budget | AB 74 | Budget | AB 74 |
|------------+------------+------------+------------+------------+------------+------------+------------|
| Childcare | 5 years | 3 years | 3 years | 3 years | 2 years | 3 years | Annual |
| facilities | | | | | | | |
|------------+------------+------------+------------+------------+------------+------------+------------|
| Children's | 5 years | 3 years | 3 years | 2 years | 2 years | 2 years | Annual |
|residential | | | | | | | |
| care | | | | | | | |
| facilities | | | | | | | |
|------------+------------+------------+------------+------------+------------+------------+------------|
| Adult and | 5 years | 3 years | 3 years | 2 years | 2 years | Annual | Annual |
|senior care | | | | | | | |
| facilities | | | | | | | |
|------------+------------+------------+------------+------------+------------+------------+------------|
| Percentage | 30% | 30 % | 30 % | 30% | 40% | 30% (for | 100% |
| of | | | | | | those not | |
| facilities | | | | | | annually | |
| randomly | | | | | | inspected) | |
| inspected | | | | | | | |
| annually | | | | | | | |
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Regulatory Oversight
The Community Care Licensing Division (CCLD) of CDSS provides
the primary regulatory oversight over the quality and care in
70,907 licensed community care facilities. Counties are
contracted with the department to license an additional 6,222
facilities. These facilities fall under 23 separate licensure
categories including adoption agencies, foster family homes,
RCFEs, group homes, adult residential facilities, adult day
care, child day care facilities and others which provide
primarily non-medical care and supervision to 1.4 million
children and adults in California.<1>
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<1> http://ccld.ca.gov/res/pdf/countylist.pdf
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Prior to January 2004, CCLD was required to conduct at least
annual visits for all licensed community care facilities within
its jurisdiction. However, in 2003 under a budget trailer bill
enacting substantial budget cuts due to the ongoing deficit,
this statute was changed to require that only those facilities
which warrant close monitoring because of a poor history of
compliance or are federally required to be inspected annually
are subject to annual visits (about 10 percent of facilities).
The trailer bill required that 10 percent of the remaining
facilities not subject to annual inspection would be randomly
inspected each year and that no facility shall be visited less
than once every five years.<2>
The bill included a trigger increasing the percentage of random
inspections by 10 percent if total citations increased over the
prior year by 10 percent or more. Later statute was changed to
impose a 20 percent random inspection standard. Today, as a
result of the trigger, 30 percent of facilities are randomly
selected for inspection each year.
Currently, CDSS reports there are approximately 500 licensing
analysts monitoring the care of more than 66,000 licensed
facilities. In California, 40 counties contract to provide
licensing oversight to foster family homes and a handful of
counties contract to license family child care homes. The
department reports it makes more than 24,000 annual inspections
and investigates more than 14,000 complaints involving licensed
care. Due to extremely antiquated technology, the department is
unable to provide detailed information on the nature of those
complaints or how they were resolved.
Impact of reduced visit frequency
A 2008 study published by the California Health Care Foundation
investigated the impact on the truncated frequency of visits on
RCFEs, and found that "routine visits were replaced with
significant increases in the number of complaint and
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<2> AB 1752 (Committee on Budget) Chapter 225, Statutes of 2003
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problem-driven visits" and that "the monitoring of quality of
care in RCFEs has become a complaint and problem driven
process." <3> CCL has repeatedly sought to restore the cuts
made to licensing, arguing that the cuts to staff and resulting
changed protocols "have put client health and safety at risk. By
not consistently inspecting facilities, or inspecting a facility
only as the result of a complaint, CCL (analysts) have lost
rapport with licensees, which in turn has not been conducive to
helping clients in those facilities."<4>
Related 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.
SB 895 (Corbett, Chapter 704, Statutes of 2014) initially
included provisions pertaining only to RCFEs that would have
required three-year inspections by July 1, 2016, two-year
inspections by July 1, 2017, and annual inspections by July 1,
2018 and removed the provisions requiring a certain percentage
of facilities be inspected each year. Those provisions were
removed from the bill in the Assembly Appropriations Committee.
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.
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<3> Inspection Visits in Residential Care Facilities for the
Elderly. C. Flores, A. Bostrom, and R. Newcomer. California
Health Care Foundation, 2008.
<4> Department of Social Services spring finance letter CCLD-1,
2011-12
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AB 419 (Mitchell, 2011) would have required CDSS 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.
COMMENTS
Staff recommends a technical amendment to strike provisions in
current law calling for a 10 percent increase in the random
sample of inspections the following year, if total citations
increase by 10 percent, since the provisions of this bill would
implement a 10 percent increase in random inspections the
following year and achieve 100% random inspections the year
following, regardless of this provision.
Specifically, staff recommends the following amendments:
Page 6, lines 5-10, strike inclusive.
Page 7, lines 30-35, strike inclusive.
Page 8, lines 31-36, strike inclusive.
PRIOR VOTES
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|Assembly Floor: |80 - |
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|Assembly Appropriations Committee: |17 - |
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|Assembly Human Services Committee: |7 - |
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POSITIONS
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Support:
Advancement Project
AFSCME
Alliance
California Advocates for Nursing Home Reform
California Alternative Payment Program Association
California Assisted Living Association
California Childcare Resource & Referral Network
California Commission on Aging
California Communities United Institute
California Continuing Care Residents Association
California Long-Term Care Ombudsman Association.
California Retired Teachers Association
California State PTA
California State Retirees
Childcare Alliance of Los Angeles
Children Now
City of Burbank
City of Fountain Valley
Community Action Partnership of Madera County
Community Resources for Children
Consumer Federation of California
County of San Bernardino
County of San Diego
Del Norte Child Care Council
Early Edge California
First 5 California
First 5 LA
LAUP
Leading Age California
League of California Cities
National Association of Social Workers
Office of the State long-Term Care Ombudsman
Solano Family and Children Services
State Council on Developmental Disabilities
United States Department of Defense
Oppose:
None received.
-- END --
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