BILL ANALYSIS Ó
AB 1405
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Date of Hearing: June 9, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
AB 1405
(Grove) - As Amended June 3, 2015
SUBJECT: Developmental centers: closure.
SUMMARY: Requires the Department of Developmental Services
(DDS) to close the Fairview and Sonoma Developmental Centers and
requires 50% of the proceeds from the lease of the developmental
center properties to be redirected to regional center services
in the community.
Specifically, this bill:
1)Requires DDS to close the Sonoma Developmental Center by the
end of 2018, and requires the Fairview Developmental Center to
be closed no later than December 31, 2021.
2)Requires the director of the Department of General Services to
upon the closure, lease all or part of the parcels at the
Sonoma and Fairview Developmental Centers, as specified.
3)Requires any use of the parcels to be ratified by a vote of
the appropriate state and local government agencies with
authority to make decisions about the use of that land, as
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specified.
4)Establishes the Lanterman Act Community-Based Services Fund in
the State Treasury, and requires all moneys in the fund to be
continuously appropriated to DDS to supplement, and not
supplant, existing purchase of services funds used by regional
centers to purchase services and supports for persons with
developmental disabilities.
5)Requires 50% of the net proceeds received by the state for the
lease of the property, as defined, to be deposited into the
Budget Stabilization Account, as specified, and requires the
other 50% of the net proceeds to be deposited into the
Lanterman Act Community-Based Services Fund created by this
bill.
6)Expresses the intent of the Legislature to transfer current
funding for the operations of the Fairview Developmental
Center and the Sonoma Developmental Center to fund purchase of
services at regional centers.
7)Provides that this act is an urgency statute in order to, at
the earliest possible time, facilitate the orderly closure of
the Sonoma and Fairview Developmental Centers.
EXISTING LAW:
1)Establishes DDS as the agency that oversees the state's
developmental centers, and specifies the duties of the
department and developmental center employees. (WIC 4400 et
seq.)
2)Grants all individuals with developmental disabilities, among
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all other rights and responsibilities established for any
individual by the United States Constitution and laws and the
California Constitution and laws, the right to treatment and
habilitation services and supports in the least restrictive
environment and the right to be free from harm, including
unnecessary physical restraint or isolation, excessive
medication, abuse, or neglect. (WIC 4502)
3)Requires DDS to, upon proposing the closure of a state
developmental center, submit a detailed plan to the
Legislature not later than April 1 immediately prior to the
fiscal year in which the plan is to be implemented, and as a
part of the Governor's proposed budget. (WIC 4471 (a))
4)Requires DDS to, prior to submission of the plan to the
Legislature, solicit input from the State Council on
Developmental Disabilities, the Association of Regional Center
Agencies, Disability Rights California, the local area board
on developmental disabilities, the local regional center,
consumers living in the developmental center, parents, family
members, guardians, and conservators of persons living in the
developmental centers or their representative organizations,
persons with developmental disabilities living in the
community, developmental center employees and employee
organizations, community care providers, the affected city and
county governments, and business and civic organizations, as
may be recommended by local state Senate and Assembly
representatives. (WIC 4474.1 (c))
5)Requires DDS to, prior to the submission of the plan to the
Legislature, confer with the county in which the developmental
center is located, the regional centers served by the
developmental center, and other state departments using
similar occupational classifications, to develop a program for
the placement of staff of the developmental center planned for
closure in other developmental centers, as positions become
vacant, or in similar positions in programs operated by, or
through contract with, the county, regional centers, or other
state departments. (WIC 4474.1 (d))
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6)Requires DDS to, prior to submission of the plan to the
Legislature, hold at least one public hearing in the community
in which the developmental center is located, with public
comment from that hearing summarized in the plan. (WIC 4474.1
(e))
FISCAL EFFECT: Unknown
COMMENTS:
Developmental Services: The Lanterman Act guides the provision
of services and supports for Californians with developmental
disabilities. Each individual under the Act, typically referred
to as a "consumer," is legally entitled to treatment and
habilitation services and supports in the least restrictive
environment. Lanterman Act services are designed to enable all
consumers to live more independent and productive lives in the
community. The term "developmental disability" means a
disability that originates before an individual attains 18 years
of age, is expected to continue indefinitely, and constitutes a
substantial disability for that individual. It includes
intellectual disability, cerebral palsy, epilepsy, and autism
spectrum disorders (ASD). Other developmental disabilities are
those disabling conditions similar to an intellectual disability
that require care and management similar to that required by
individuals with intellectual disabilities. This does not
include conditions that are solely psychiatric or physical in
nature, and the conditions must occur before age 18, result in a
substantial disability, be likely to continue indefinitely, and
involve brain damage or dysfunction. Examples of conditions
might include intracranial neoplasms, degenerative brain disease
or brain damage associated with accidents.
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DDS contracts with 21 regional centers, which are private
nonprofit entities, to carry out many of the state's
responsibilities under the Lanterman Act. The regional center
caseload is comprised of over 280,000 consumers who receive
services such as residential placements, supported living
services, respite care, transportation, day treatment programs,
work support programs, and various social and therapeutic
services and activities.
Developmental centers (DCs): Approximately 1,100 regional
center consumers reside at one of California's three
developmental centers (Porterville, Sonoma, and Fairview) and
one state-operated, specialized community facility (Canyon
Springs). These facilities provide 24-hour habilitation and
medical and social treatment services. While some residents in
these facilities were voluntarily placed by relatives and
conservators due to acute medical needs and other special needs
that made it unsafe for them to live in the community, some
residents have experienced involuntary placements due to court
orders (e.g., forensic placements at Porterville DC).
The first developmental center opened its doors to patients in
1888 and housed and cared for individuals with developmental
disabilities, as well as patients diagnosed with mental illness.
Those two populations were eventually separated into different
facilities, and in 1972 the programs for patients with mental
illness were discontinued, and the center served only persons
with developmental disabilities. In the years following, the
number of state facilities increased throughout the state,
providing what was, at that time, the only placement option for
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many individuals with intellectual and developmental
disabilities who couldn't be cared for at home. Over time,
increased awareness of the unique needs of individuals with
developmental disabilities grew, prompting the establishment of
other state facilities specifically for people with
developmental disabilities. Non-residential community-based
programs, therapeutic strategies and other services were also
developed, providing support and alternatives that allowed more
families to keep their children with intellectual and
developmental disabilities at home. As a result, the resident
population dropped in the DCs from a high of 13,400 in 1968-with
thousands more on a waiting list for admission-to 1,302
residents as of April 9, 2014. At their peak in the late
1960's, the state had eight developmental centers, each of which
was designed to accommodate between 2,500 and 3,500 individuals.
In 1995, the state closed the Stockton State Hospital, and two
years later followed with the shut-down of Camarillo State
Hospital which still housed clients with both mental illness and
developmental disabilities. The historic Olmstead vs LC (1999)
U.S. Supreme Court ruling further spurred the shift to
community-based care, citing that a lack of community supports
was not legal grounds for denying someone a move from an
institution to a community setting, and was, instead, a
violation of individual civil rights. Soon after the ruling,
many states began shuttering their institutions and developing
additional community-based services. Agnews Developmental
Center closed its doors in 2009, and in 2010, Sierra Vista, a
state-operated community facility, was closed. Most recently,
DDS completed closure of the Lanterman Developmental Center in
Pomona on December 31, 2014.
Sonoma Developmental Center: Of the three remaining DCs, Sonoma
DC has the largest population, with 404 residents. It is the
oldest facility in California that was established specifically
to serve the needs of individuals with developmental
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disabilities. The facility was originally opened in Santa Clara
in 1891 and named the California Home for the Care and Training
of the Feeble Minded. A few years later, with financial support
from the State Legislature, the facility was moved to Eldridge,
between the towns of Glen Ellen and Sonoma, on over 1,600 acres
of land. After undergoing numerous name changes, the facility
was finally named the Sonoma Developmental Center in 1986.
Sonoma DC includes a campus with residential cottages, a
campground, store, post office, petting farm, swimming pool and
other recreational facilities for the residents. It also sits
in the midst of a wildlife corridor that open space advocates
and others have pledged to protect from development, and is
adjacent to Jack London State Park, which features equestrian
trails, camping facilities, lakes and historic buildings.
Fairview Developmental Center: Fairview Developmental Center
officially opened in January 1959 and originally occupied 752
acres of land in Costa Mesa. The Fairview DC population peaked
in 1967 at 2,700 and much of the original land was transferred
in 1979 to the city of Costa Mesa. The population was 277 as of
May 27, 2015.
A 36-hole golf course surrounds the campus on three sides, which
was built on land that was sold to the city, and the on-site
facilities include a swimming pool, work activity center,
auditorium, park, small animal farm, recreational campsite, and
a library. Services available at Fairview DC, which are
described on the DDS website, include training in daily living,
vocational, leisure, academic, communication, mobility,
socialization, and community skills provided both on campus and
in community settings. The Harbor Village Apartments, a
residential rental project consisting of 568 units, are located
on the northern portion of the campus. Harbor Village was
initially developed in the late 1980s to provide housing for
employees and consumers of Fairview Developmental Center, but
tenants now include the local community, staff and consumers of
Fairview DC, as well as other individuals with developmental
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disabilities. Another residential development, Shannon's
Mountain, is being discussed to be built on the Fairview
Property.
Recent federal action: In July 2012, California Department of
Public Health (DPH) licensing staff, which functions as a proxy
for the federal Centers on Medicaid and Medicare Services (CMS)
and carries out state licensing duties, conducted an annual
survey of Sonoma DC to assess whether the facility was in
compliance with state and federal licensing regulations.
Numerous violations were cited in the resulting 250-page report,
which revealed a lack of compliance in six of the eight
categories required for continued federal funding. Among the
findings were that Sonoma DC's management failed to ensure
adequate facility staffing, failed to provide active treatment,
failed to provide appropriate health care services, failed to
take actions that identified and resolved problems of a systemic
nature and several other key categories. The team also
identified four situations that posed immediate jeopardy to the
health and safety of patients at the facility including 11
clients with injuries that resembled burns from a stun gun, a
finding that also prompted a criminal investigation.
In response to the program and patient safety violations
uncovered at Sonoma DC, CMS planned to decertify each of the
developmental center's 10 intermediate care facility (ICF)
units. Instead, DDS withdrew four of the 10 ICF units from
federal certification in January 2013, which allowed federal
certification and funding to be maintained for the other six ICF
units. The loss of certification has cost the state millions in
what would have otherwise been paid in federal funding.
Based on the findings of the Sonoma DC inspection, DPH
re-inspected the other developmental centers and found
additional federal compliance issues. In January 2014, DDS and
DPH reached an agreement to avoid decertification through
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developing a root-cause analysis and action plan, similar to
what was enacted at Sonoma DC, for Porterville DC and Fairview
DC.
Task Force on the Future of Developmental Centers: 2013 budget
trailer bill language required California's Health and Human
Services Agency (CHHS) Secretary to submit to the Legislature a
master plan for the future of DCs by November 15, 2013, and to
submit to the Legislature, by January 10, 2014, the
Administration's plans to meet the service needs of all current
residents of the DCs. To ensure the consideration of
perspectives from an array of stakeholders, the Secretary formed
the Task Force on the Future of Developmental Centers to offer
input leading to the development of the CHHS plans. The task
force included a broad representation of stakeholders, including
a resident of Sonoma DC, family members, regional center
directors, providers, labor representatives, consumer advocates,
legislators, and DDS and Agency staff. On January 13, 2014, the
Secretary released the "Plan for the Future of Developmental
Centers in California." While the plan meets the requirements
of the master plan, the subsequent plans required to implement
the recommendations of the master plan have yet to be submitted,
and the Secretary has not provided an official timeline for the
release of those plans.
The plan provided six consensus recommendations:
1)More community style homes/facilities should be developed to
serve individuals with enduring and complex medical needs
using existing models of care;
2)For individuals with challenging behaviors and support needs,
the state should operate at least two acute crisis facilities
and small transitional facilities. The state should develop a
new "Senate Bill (SB) 962-like" model that would provide a
higher level of behavioral services. Funding should be made
available so that regional centers can expand mobile crisis
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response teams, crisis hotlines, day programs, short-term
crisis homes, new-model behavioral homes, and supported living
services for those transitioning to their own homes;
3)For individuals who have been involved in the criminal justice
system, the state should continue to operate the Porterville
DC's Secure Treatment Program and the transitional program at
Canyon Springs Community Facility. Alternatives to the
Porterville DC Secure Treatment Program also should be
explored;
4)The development of a workable health resource center model
should be explored, to address the complex health needs of DC
residents who transition to community homes;
5)The state should enter into public/private partnerships to
provide integrated community services on existing state lands,
where appropriate. Also, consideration should be given to
repurposing existing buildings on DC property for developing
service models identified in Recommendations 1 through 4; and
6)Another task force should be convened to address how to
strengthen the community system. (The Developmental Services
Task Force was subsequently established and continues to meet
and discuss how to improve community-based services for
regional center clients.)
Need for this bill: According to the author, "California is at
a dramatic crossroads in meeting its philosophical and actual
commitments to its citizens with developmental disabilities
under the state's historic and famed Lanterman Act.
Philosophically, institutional settings are no longer considered
appropriate, and the federal government is moving away from this
model under its new CMS guidelines. Additionally, the State's
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funding of community-based programs serving the approximately
280,000 persons with developmental disabilities is inadequate to
sustain quality programs for this population? Community-based
agencies throughout California are struggling to provide quality
services. [This bill] addresses all of these concerns in a
constructive way. It gives certainty to the process of closure,
and guarantees that these funds will stay in the community.
This is necessary to 'keep the promise' of the Lanterman Act."
Staff comments: The May Revision of the Governor's 2015-16
Budget includes a proposal for closure of the Sonoma and
Fairview Developmental Centers, in addition to the closure of
the non-secure treatment portion of the Porterville
Developmental Center. Closure of the Sonoma DC would take place
by the end of 2018, with the other two developmental centers
closing no later than 2021. While this bill has been amended to
align the closure dates for the Sonoma and Fairview DCs with the
dates included in the Governor's budget proposal, it lacks any
detail about what the process will be for assessing resident
needs and finding appropriate, safe alternatives for residents
transitioning out of the DCs and into the community.
Current law requires DDS, upon announcing the closure of a
developmental center, to develop a closure plan and submit it to
the Legislature by April 1 immediately prior to the fiscal year
in which the plan is to be implemented. The plan is required to
include the following elements:
a) A description of the land and buildings affected;
b) A description of existing lease arrangements at the
developmental center;
c) The impact on residents and their families;
d) Anticipated alternative placements for residents;
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e) The impact on regional center services;
f) Where services will be obtained that, upon closure of
the developmental center, will no longer be provided by
that facility;
g) Potential job opportunities for developmental center
employees and other efforts made to mitigate the effect of
the closure on employees;
h) The fiscal impact of the closure; and
i) The timeframe in which closure will be accomplished.
Trailer bill language submitted as part of the Governor's May
Revision requires DDS to submit a plan or plans for the closure
of one or more developmental centers to the Legislature no later
than October 1, 2015 and specifies that the plan may be modified
during the subsequent legislative review process. The revised
budget proposal also includes $49.3 million to coordinate the
Sonoma DC closure and begin developing community-based resources
to support the Sonoma DC residents transitioning into the
community.
During the closure processes of both the Agnews and Lanterman
developmental centers, DDS upheld the need to secure appropriate
placements and services for each individual moving out of their
respective developmental center prior to closure. Closure of
the Agnews Developmental Center was announced as part of the
Governor's January 2003 Budget proposal, and the plan was
presented in January of 2005. The last consumer was moved out
of Agnews in March 2009. The Lanterman DC closure was announced
in January 2010, the plan was presented that April and the last
person moved out in December 2014. In both of those closure
processes, the Administration and the Legislature developed a
number of new placement types and services, such as homes to
care for medically fragile residents, a clinic that remained on
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the developmental center campus for movers to bridge needed
medical and dental treatment in their new homes, as well as
other innovative services. The prior closure processes for the
Stockton and Camarillo Developmental Centers where much quicker,
taking less than one year for each. However, in both of those
cases, the vast majority of residents were quickly moved to
other developmental centers, which is no longer an option.
In its current version, this bill does not provide any
indication of how the numerous challenges to transitioning
residents to the community will be mitigated. While it
specifies that 50% of the proceeds from leasing both the Sonoma
and Fairview DC properties after they are closed will be
available for regional center purchase of services in the
community, the language provides no direction as to how those
funds will be used to uphold resident health and safety and
ensure the community-based placement and service alternatives
are appropriate for each individual consumer. Current law sets
forth requirements for such details to be included in a plan
submitted by DDS when DDS initiates a DC closure; however, those
same plan requirements are not automatically triggered when the
proposal for a DC closure is generated through a legislative
measure. Should the Committee wish to pass this bill, the
author should explain how the bill will be amended as it moves
forward to address the items included in a DDS closure plan, and
how it will ensure the additional dollars going to the community
will be used to mitigate the numerous challenges to
transitioning DC residents, which include the following issues:
a) About one-third of DC residents have complex medical
needs and are receiving nursing facility-level care for
multiple medical conditions, but the availability of "SB
962" homes (Adult Residential Facilities for Persons with
Special Healthcare Needs) in which they can receive the
individualized attention and medical care they need does
not meet the current demand;
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b) Many DC residents also need a higher level of support
than what currently exists in the community due to their
high behavioral needs. While Enhanced Behavioral Support
Homes and Community Crisis Homes were established as models
to meet these needs, development is still underway for
these placement types, and the need for intensive,
wrap-around therapeutic behavioral services may exceed the
approved projects;
c) The Developmental Center Task Force recommended that the
state should operate 15-bed acute crisis facilities like
the program at Fairview DC at least in the Northern and
Southern part of the state. While these facilities have
now been opened at Fairview and Sonoma DCs, this calls for
closure of those facilities without any indication that
those crisis units would be maintained; and
d) The Task Force also recommended recognizing and
preserving existing specialty services available on the
Developmental Center campuses, such as the shoemaking shops
at Sonoma and Fairview DCs, the wheelchair specialty clinic
at Sonoma DC and the availability of medical professionals
with vast experience in serving individuals with complex
developmental and medical needs. These services include
specialized sedation dentistry services, which are often
not available outside of the Developmental Centers.
PRIOR LEGISLATION:
SB 1344 (Evans) 2014, would have required the state to establish
the Sonoma Developmental Center as the center of last resort for
Northern California, and would have required DDS to confer and
cooperate with the County of Sonoma to develop a detailed action
plan, as specified, and to ensure the inclusion and
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participation of certain community entities in developing the
action plan. Died in the Senate Appropriations Committee.
SB 1428 (Evans) 2014, would have required that, prior to the
development of any plan for the sale, lease, transfer, or major
change of use of any portion of the Sonoma DC, DDS and the
Department of General Services confer and cooperate with public
and private entities in the development of an improvement and
redevelopment plan for the center. The bill would have
authorized the plan to contain specific elements for residences,
the wildlife habitat corridor and public recreational
facilities. Died in the Senate Appropriations Committee.
AB 2349 (Yamada) 2014, would have established the Office of
Community Care Coordination within DDS, located at Sonoma DC,
and would have required the office to develop a plan, on or
before January 1, 2016, that addresses, among other things, the
operation of at least two acute crisis clinics. Died in the
Assembly Appropriations Committee.
AB 89 (Budget and Fiscal Review) Chapter 25, Statutes of 2013,
required the Secretary of the Health and Human Services Agency
to submit a master plan for the future of DCs and subsequent
plan for individuals living in those centers.
AB 1472 (Budget and Fiscal Review) Chapter 25, Statutes of 2012,
included a moratorium for new admissions to the DCs, with
limited exception, limitations on the use of locked mental
health facilities and out-of-state placements, and provisions to
strengthen the capacity of the community to serve individuals
with challenging needs including the creation of a statewide
Specialized Resource Service.
SB 410 (Thompson) Chapter 513, Statutes of 1995, established the
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procedures for closing a developmental center.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Committee on Accountability and Administrative Review.
REGISTERED SUPPORT / OPPOSITION:
Support
California Disability Services Association (CDSA)
Futures Explored, Inc.
NorCal Tea Party
Opposition
California Statewide Law Enforcement Association
Sonoma County Board of Supervisors
Analysis Prepared by:Myesha Jackson / HUM. S. / (916) 319-2089
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