BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1387 (Chu) - Care facilities:  civil penalties, deficiencies,  
          and appeal procedures
          
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          |Version: July 16, 2015          |Policy Vote: HUMAN S. 3 - 0     |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 17, 2015   |Consultant: Jolie Onodera       |
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          This bill meets the criteria for referral to the Suspense File. 

          

          Bill  
          Summary:  AB 1387 would revise the civil penalty review and  
          appeals process for violations resulting in death or serious  
          bodily injury of a child or resident in a community are  
          facility, residential care facility for the elderly (RCFE), or  
          child day care facility. This bill would also establish a civil  
          penalty review and appeals process for all other violations, as  
          specified. Additionally, this bill would establish an appeals  
          process for complainants against an RCFE who are dissatisfied  
          with the investigation, findings, enforcement actions, or  
          decision regarding a complaint, as specified. 


          Fiscal  
          Impact:  
            Appeals process for death/serious violations  :  Potential  
            future cost savings due to simplification of the civil penalty  
            review and appeals process from a four-tiered to two-tiered  
            level of review. 







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            Appeals process for all other violations  :  Potentially  
            significant ongoing costs in excess of $150,000 (General Fund)  
            annually.  
            Appeals process for RCFE complaints  :  Potentially significant  
            ongoing costs in excess of $1 million (General Fund) annually  
            for DSS to review complaints, confer with complainants,  
            conduct complaint investigations, provide notifications, and  
            conduct the two-tiered appeals process within the prescribed  
            timeframes.


          Background:  The Community Care Licensing Division (CCLD) of the Department  
          of Social Services (DSS) administers the licensure and oversight  
          of over 7,500 assisted living, board and care, and continuing  
          care retirement homes that are licensed as RCFEs in California.  
          These residences are designed to provide home-like environment  
          housing options to elderly residents who need assistance with  
          activities of daily living but otherwise do not require  
          continuous, 24-hour assistance or nursing care. The RCFE  
          licensure category includes facilities with as few as six beds  
          to facilities with hundreds of residents whose needs may vary  
          widely. 
          In response to numerous health and safety issues discovered at  
          facilities licensed by the CCLD, the 2014 and 2015 Budget Acts  
          include funding for a comprehensive plan to reform the CCLD  
          program. The 2014 Budget Act included an increase of $7.5  
          million ($5.8 million General Fund) 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 2014 Budget also increased  
          licensing and application fees by 10 percent. The recently  
          enacted 2015 Budget Act additionally includes $3 million General  
          Fund and 28.5 positions to address a backlog of complaint cases  
          and expand training and technical assistance. Beginning in  
          January 2017, the DSS will begin increasing inspection frequency  
          to every three years for all facilities, every two years by 2018  
          for all facility types except child care, and annually by 2019  
          for adult day care and RCFEs.


          Proposed Law:  
           This bill would revise the civil penalty review and appeals  
          process for violations in licensed community care facilities,  








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          RCFEs, and child day care facilities, as follows:
           Requires civil penalties assessed by the CCLD due to death or  
            serious bodily injury to be approved by the program  
            administrator prior to issuance, instead of by the Director of  
            DSS.
           Requires notification of a deficiency by the CCLD to include a  
            factual description of the nature of the deficiency fully  
            stating the manner in which the licensee failed to comply with  
            the specified statute or regulation, and if applicable, the  
            particular place or area in the facility in which the  
            deficiency occurred.
           Subsequent to approval of the civil penalty by the program  
            administrator, establishes two levels of formal appeal and  
            review (instead of four) that a licensee may request,  
            initially by the deputy director of the CCLD and subsequently  
            by an administrative law judge.
           Permits a licensee to request a two-tier review of any other  
            civil penalty or deficiency within 10 days of receiving notice  
            of a civil penalty, as specified. Provides that review of  
            these civil penalties shall be conducted by a regional manager  
            of the CCLD, as specified, and requires that the licensee  
            shall be notified of the decision within 60 days. Subsequent  
            to the decision, permits a licensee to request a second review  
            to be conducted by a program administrator of CCLD within 10  
            days of receipt of the regional manager's decision, and the  
            licensee be notified of the final decision within 60 days.
           Provides that a complaint filed by a local long-term care  
            ombudsman or the state Long-Term Care Ombudsman alleging  
            denial of a statutory right of access to an RCFE shall be  
            given priority by DSS which shall notify the officer of the  
            State Long-Term Care Ombudsman that an investigation has been  
            initiated.
           Prior to conducting an onsite complaint investigation,  
            requires DSS to document in writing a good-faith effort to  
            contact and interview the complainant and to inform the  
            complainant of the department's proposed course of action, as  
            specified. Within 10 days of a decision, requires DSS to  
            notify the complainant in writing of the department's  
            determination.
           Provides a complainant who is dissatisfied with the  
            department's investigation, findings, enforcement actions, or  
            decision with regard to the complaint to file an appeal by  
            notifying a program manager in writing within 15 business days  
            of receiving notice.








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           Requires the program manager to schedule a meeting or  
            teleconference with the complainant within 30 business days of  
            receiving an appeal, as specified, and to notify the  
            complainant of the decision within 10 business days of a  
            decision.
           Permits the complainant to further appeal the decision to the  
            Quality Assurance Unit of CCLD, which must interview the  
            complainant, consider any information presented, review the  
            complaint record, and no later than 10 days after completing  
            the review to notify the complainant in writing of the  
            decision.
           Deletes the requirement that revenues from civil penalties  
            levied by DSS against licensed day care providers and family  
            day care home providers be used to assist families with the  
            identification, transportation, and enrollment of children to  
            another center when a center's license is revoked or  
            temporarily suspended. 


          Related  
          Legislation:  AB 1554 (Skinner) 2014 was similar to this  
          measure. This bill was held on the Suspense File of this  
          Committee.
          AB 2236 (Maienschein) Chapter 813/2014 established civil penalty  
          assessments for violations that lead to death or serious bodily  
          injury of a resident or child in a community care facility, an  
          RCFE, or a child day care facility. This bill also established  
          the four-tier appeals process for violations resulting in death  
          or serious bodily injury to a resident or child, as specified.




          Staff  
          Comments:  In order to comply with the revised complaint  
          investigation processes and timelines established in this bill,  
          the DSS would incur additional costs above what was provided in  
          the 2014 and 2015 Budget Acts for investigations. While the  
          additional resource needs would be dependent on the volume of  
          complaints to be addressed pursuant to the new process, it is  
          estimated costs could potentially be in excess of $1 million  
          annually to review complaints, confer with complainants, conduct  
          complaint investigations, provide notifications, and conduct the  
          two-tiered appeals process within the prescribed timeframes of  








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          the bill.
          As noted in the Background Section above, the 2014 Budget Act  
          included funding for a comprehensive plan to reform the CCLD  
          program. The Budget includes an increase of $7.5 million ($5.8  
          million General Fund) 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. While the Budget includes positions to improve  
          the timeliness of investigations, it did not contemplate an  
          expedited process for complaint investigations as mandated under  
          the provisions of this bill, nor did it provide for the two  
          levels of appeals for complainants dissatisfied with DSS  
          investigations, findings, or enforcement actions resulting from  
          the investigations.


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