Amended in Assembly July 8, 2015

Amended in Senate June 2, 2015

Amended in Senate April 22, 2015

Senate Bill No. 484

Introduced by Senator Beall

(Principal coauthor: Assembly Member Chiu)

(Coauthors: Senators Mitchell and Monning)

February 26, 2015

An act to amend Section 1536 of, and to add Sections 1538.8 and 1538.9 to, the Health and Safety Code, and to amend Section 11469 of the Welfare and Institutions Code, relating to juveniles.

LEGISLATIVE COUNSEL’S DIGEST

SB 484, as amended, Beall. Juveniles.

(1) The California Community Care Facilities Act provides for the licensure and regulation of community care facilities, including foster family homes and group homes, by the State Department of Social Services. A violation of this act is a misdemeanor.

Existing law requires the department director, at least annually, to publish and make available to interested persons a list covering all licensed community care facilities, except as specified, and the services for which each facility has been licensed or issued a special permit.

This bill would require the department director to compile specified information regarding begin delete administering end delete begin insert the administration of end insert psychotropic medications to children in those facilities and to post that information to the department’s Internet Web site. The bill would require the department to establish a methodology to identify those group homes that have disproportionately high begin insert and inappropriate end insert levels of psychotropic drug begin delete usage. end delete begin insert usage, based on specified criteria. end insert The bill would also require the department, for the facilities identified by the methodology that it establishes, to visit those facilities at least once a year to examine specified begin delete factors that contribute to the high utilization of psychotropic medications. end delete begin insert factors. end insert The bill would require a facility that is found to have begin delete a high utilization of dangerous psychotropic medication regimens and end delete begin insert disproportionately high and inappropriate levels of psychotropic drug usage, which may be caused by end insert inadequate begin delete alternative, end delete begin insert alternative and end insert less invasive begin delete psychosocial, end delete begin insert psychosocial services, end insert crisis management, and other services, to submit a plan to address steps the facility shall take to reduce inappropriate prescribing and treatment regimens within begin delete 60 end delete begin insert 30 end insert days of begin delete the visit. end delete begin insert receiving notice of the department’s determination. end insert The bill would require the department to monitor the facility’s implementation of that plan and make a report, as provided. Because this bill would create a new crime, the bill would impose a state-mandated local program.

(2) Existing law requires the department, on or before January 1, 2016, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement programs and services to minimize law enforcement contacts with minors in group homes or under supervision of group home staff.

This bill would require the department, on or before January 1, 2017, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement programs and services to reduce utilization of psychotropic medications for children in group homes. The bill would also delete an obsolete provision.

(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1536 of the Health and Safety Code is
amended to read:

1536.  

(a) (1) At least annually, the director shall publish and
make available to interested persons a list or lists covering all
licensed community care facilities, other than foster family homes
and certified family homes of foster family agencies providing
24-hour care for six or fewer foster children, and the services for
which each facility has been licensed or issued a special permit.

(2) For a group home, transitional housing placement provider,
community treatment facility, or runaway and homeless youth
shelter, the list shall include both of the following:

(A) The number of licensing complaints, types of complaint,
and outcomes of complaints, including citations, fines, exclusion
orders, license suspensions, revocations, and surrenders.

(B) The number, types, and outcomes of law enforcement
contacts made by the facility staff or children, as reported pursuant
to subdivision (a) of Section 1538.7.

(b) Subject to subdivision (c), to encourage the recruitment of
foster family homes and certified family homes of foster family
agencies, protect their personal privacy, and to preserve the security
and confidentiality of the placements in the homes, the names,
addresses, and other identifying information of facilities licensed
as foster family homes and certified family homes of foster family
agencies providing 24-hour care for six or fewer children shall be
considered personal information for purposes of the Information
Practices Act of 1977 (Chapter 1 (commencing with Section 1798)
of Title 1.8 of Part 4 of Division 3 of the Civil Code). This
information shall not be disclosed by any state or local agency
pursuant to the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code), except as necessary for administering the
licensing program, facilitating the placement of children in these
facilities, and providing names and addresses only to bona fide
professional foster parent organizations upon request.

(c) Notwithstanding subdivision (b), the department, a county,
or a foster family agency may request information from, or divulge
information to, the department, a county, or a foster family agency,
regarding a prospective certified parent, foster parent, or relative
caregiver for the purpose of, and as necessary to, conduct a
reference check to determine whether it is safe and appropriate to
license, certify, or approve an applicant to be a certified parent,
foster parent, or relative caregiver.

(d) The department may issue a citation and, after the issuance
of that citation, may assess a civil penalty of fifty dollars ($50) per
day for each instance of a foster family agency’s failure to provide
the department with the information required by subdivision (h)
of Section 88061 of Title 22 of the California Code of Regulations.

(e) The Legislature encourages the department, when funds are
available for this purpose, to develop a database that would include
all of the following information:

(1) Monthly reports by a foster family agency regarding family
homes.

(2) A log of family homes certified and decertified, provided
by a foster family agency to the department.

(3) Notification by a foster family agency to the department
informing the department of a foster family agency’s determination
to decertify a certified family home due to any of the following
actions by the certified family parent:

(A) Violating licensing rules and regulations.

(B) Aiding, abetting, or permitting the violation of licensing
rules and regulations.

(C) Conducting oneself in a way that is inimical to the health,
morals, welfare, or safety of a child placed in that certified family
home.

(D) Being convicted of a crime while a certified family parent.

(E) Knowingly allowing any child to have illegal drugs or
alcohol.

(F) Committing an act of child abuse or neglect or an act of
violence against another person.

(f) At least annually, the department shall post to its Internet
Web site a begin insert statewide end insert summary begin delete progress end delete report begin delete with end delete begin insert of the end insert data begin delete that
excludes personally identifiable information of the information end delete
gathered pursuant to begin delete Section 1538.8. end delete begin insert Sections 1538.8 and 1538.9.
The summary report shall exclude all personally identifiable
information and shall not identify individual group homes. end insert

SEC. 2.  

Section 1538.8 is added to the Health and Safety Code,
to read:

1538.8.  

(a) In order to identify group homes in which
psychotropic medications may be inappropriately administered to
children the director shall compile, at least annually, the following
information concerning each home:

(1) The number of children in the facility to whom psychotropic
medications were administered.

(2) The number of children in the facility who are 6 to 11 years
of age, inclusive, to whom psychotropic medications were
administered.

(3) The number of children in the facility who are 12 to 17 years
of age, inclusive, to whom psychotropic medications were
administered.

(4) The number of children for whom the juvenile court
preauthorized the administration of psychotropic medication.

(5) The number of children to whom psychotropic medications
were administered on an emergency basis.

(6) The number of children to whom antipsychotic, mood
stabilizing, or antidepressant medications were administered.

(7) The number of children who received two or more drugs
from the same class, including, but not limited to, antidepressants,
antipsychotics, and antianxiety medications.

(8) The number of children who received two or more
psychotropic medications concurrently, and whether those children
received two, three, four, or more than four psychotropic
medications concurrently.

(9) The number of children who received one or more
medications for more than 90 days.

(10) The number of children who received psychosocial services
while in a group home placement while they received a
psychotropic medication.

(11) The number of children who received a dosage of a
psychotropic medication at a dosage above the maximum dosage
approved by the federal Food and Drug Administration.

(12) The number of children who received metabolic monitoring
in accordance with professional standards of care while they
received psychotropic medication.

(13) The number of children who were prescribed antipsychotic
medications for a use not approved by the federal Food and Drug
Administration.

(b) The data in subdivision (a) concerning psychotropic
medication, mental health services, and placement shall be drawn
from existing data systems, including, but not limited to, the
Medicaid Management Information System’s medical and
pharmacy claims data, and the Child Welfare Services/Case
Management System, through the data sharing agreement between
the State Department of Health Care Services and the State
Department of Social Services.

SEC. 3.  

Section 1538.9 is added to the Health and Safety Code,
to read:

1538.9.  

(a) (1) (A) The begin delete department, based upon the
information compiled pursuant to Section 1538.8, end delete begin insert department end insert shall
consult with the foster care ombudsman and begin delete stakeholder quality
improvement workgroups end delete begin insert the Quality Improvement Project Clinical
Workgroup end insert to establish a methodology begin delete to identify end delete begin insert for identifying end insert
those group homes that have disproportionately high begin insert and
inappropriate end insert levels of psychotropic drug usage warranting
additional review of the begin delete facility. end delete begin insert facility. The criteria for
determining if a group home has disproportionately high and
inappropriate levels of psychotropic drug usage shall be based
upon the end insert begin insert California Guidelines for the Use of Psychotropic
Medication with Children and Youth in Foster Care end insert begin insert and shall take
into consideration, among other things, the factors listed in
paragraphs (1) to (13), inclusive, of subdivision (a) of Section
1538.8. The methodology shall be adopted on or before July 1,
2016. end insert

(B)  begin delete On or after January 1, 2020, end delete begin insert Every three years after adopting
the methodology developed under subparagraph (A), or earlier if
needed, end insert the department shall consult with the foster care
ombudsman begin delete and stakeholder quality improvement workgroups end delete
begin insert and the Quality Improvement Project Clinical Workgroup end insert and
begin delete revise, if necessary, end delete begin insert revise end insert the begin delete methodology developed under
subparagraph (A). end delete begin insert methodology. end insert

begin insert

(2) If the department, applying the methodology described in
paragraph (1), determines that a facility appears to have
disproportionately high and inappropriate levels of psychotropic
drug usage, which may be caused by, among other things,
inadequate alternative and less invasive psychosocial services,
crisis management, and other services, it shall inspect the facility
at least once a year.

end insert begin delete

(2) The department shall visit facilities identified in paragraph
(1) at least once a year to review the facilities’ plans of operation,
policies, procedures, practices, child-to-staff ratios, staff
qualifications and training, implementation of children’s needs
and services plan, and other factors that the department determines
contribute to the high utilization of dangerous psychotropic
medication regimens and low utilization of monitoring and
psychosocial services.

end delete begin insert

(3) The inspection of the facility shall include, but not be limited
to, the following:

end insert begin insert

(A) A review of the facility’s:

end insert begin insert

(i) Plan of operation, policies, procedures, and practices.

end insert begin insert

(ii) Child-to-staff ratios.

end insert begin insert

(iii) Staff qualifications and training.

end insert begin insert

(iv) Implementation of children’s needs and services plan.

end insert begin insert

(v) Availability of psychosocial and other alternative treatments
to the use of psychotropic medications.

end insert begin insert

(vi) Other factors that the department determines contribute to
disproportionately high and inappropriate levels of psychotropic
drug usage.

end insert begin insert

(B) Confidential interviews with youth residing in the facility
at the time of the inspection, with youth who resided in the facility
within the last six months, and confidential discussions with
physicians identified as prescribing the medications. The State
Department of Health Care Services and the State Department of
Social Services shall, using existing data systems, identify
prescribers’ names, addresses, and contact information in order
to facilitate interviews with prescribers.

end insert begin delete

(3) The department shall perform visits pursuant to paragraph
(2) with input from stakeholders, including, but not limited to, the
foster care ombudsman and foster care mental health ombudsman,
foster youth, foster youth advocates, county welfare departments,
and county mental health departments.

(4) The department shall include in each visit confidential
discussions with current and former foster youth placed in the
facility’s care and confidential discussions with physicians
identified as prescribing the medications. The State Department
of Health Care Services and the State Department of Social
Services shall, using existing data systems, identify prescribers’
names, addresses, and contact information in order to facilitate
interviews with providers.

end delete

(b) If, begin delete during a visit end delete begin insert as a result of an inspection end insert pursuant to
subdivision (a), the department begin delete finds end delete begin insert finds, based on measures
established pursuant to this section, end insert that the facility has begin delete a high
utilization of dangerous psychotropic medication regimens, based
on measures established pursuant to this section and end delete
begin insert disproportionately high and inappropriate levels of psychotropic
drug usage, which may be caused by, among other things, end insert
inadequate begin delete alternative, end delete begin insert alternative and end insert less invasive begin delete psychosocial, end delete
begin insert psychosocial services, end insert crisis management, and other services, the
facility shall submit to the department a plan begin delete to address end delete begin insert of
correction describing end insert the steps begin delete that the facility end delete begin insert it end insert shall take to
reduce begin insert or eliminate end insert inappropriate begin delete prescribing and treatment
regimens within 60 days of the visit. end delete begin insert psychotropic drug usage. The
plan of correction shall be submitted to the department within 30
days after the facility has received the department’s notice of a
determination of disproportionately high and inappropriate levels
of psychotropic drug usage at the facility. end insert The plan begin delete shall do the
following: end delete begin insert of correction may include, but not be limited to, the
following: end insert

(1)  begin delete Include an end delete begin insert An end insert improved crisis management plan, including
deescalation techniques and procedures in which their staff will
be trained.

(2)  begin delete Include an end delete begin insert An end insert overall behavioral management plan which
shall be a trauma-informed plan.

(3)  begin delete Identify a end delete begin insert A end insert quantifiable goal to decrease the use of
antipsychotic medications for behavioral control, to decrease
polypharmacy, and to decrease the use of pro re nata medications.

(4)  begin delete Identify a end delete begin insert A end insert quantifiable goal begin delete of end delete begin insert for improving end insert appropriate
metabolic monitoring as set forth in the begin delete state prescribing guidelines end delete begin insert California Guidelines for the Use of Psychotropic Medication with
Children and Youth in Foster Care end insert begin insert , end insert and begin insert increasing end insert psychosocial,
physical, mental, behavioral, and nutritional services for children
begin delete previously or currently end delete prescribed psychotropic medications while
placed in that facility.

(c) The department shall monitor a facility’s implementation of
the plan submitted pursuant to subdivision (b) to determine all of
the following:

(1) Whether the facility has reduced the rate at which residents
are administered pro re nata, multiple, and off-label psychotropic
medications, and, if so, the percentage decrease in the
administration of those medications.

(2) Whether and to what extent alternative, less invasive
treatments are being provided to residents, and, if so, the percentage
increase in the provision of those services.

(3) Whether and to what extent appropriate metabolic monitoring
is being conducted and, if so, the percentage increase in the
provision of appropriate monitoring.

(d)  begin insert (1) end insert begin insert   end insert Following an inspection pursuant to subdivision (a), the
Community Care Licensing Division shall provide a report to the
department’s Children and Family Services Division and to any
other public agency that has certified the facility’s program or any
component of the facility’s program, including, but not limited to,
the State Department of Health Care Services, which certifies
group homes pursuant to Section 4096.5 of the Welfare and
Institutions Code.

begin insert

(2) If, as a result of the inspection, the Community Care
Licensing Division suspects that a prescriber has failed to comply
with Section 2242 of the Business and Professions Code, or with
the California Guidelines for the Use of Psychotropic Medication
with Children and Youth in Foster Care, it shall report its concerns
to the Medical Board of California.

end insert begin insert

(3) If, as a result of the inspection, the Community Care
Licensing Division suspects there has been a violation of applicable
requirements prescribed by statutes or regulations of this state, it
shall conduct the appropriate investigation pursuant to Section
1538 of the Health and Safety Code.

end insert

(e) (1) Notwithstanding the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code), until emergency regulations are filed with the Secretary of
State, the department may implement this section through
all-county letters or similar instructions from the director.

(2) On or before January 1, 2017, the department shall adopt
regulations to implement this section. The initial adoption,
amendment, or repeal of a regulation authorized by this subdivision
is deemed to address an emergency, for purposes of Sections
11346.1 and 11349.6 of the Government Code, and the department
is hereby exempted for that purpose from the requirements of
subdivision (b) of Section 11346.1 of the Government Code. After
the initial adoption, amendment, or repeal of an emergency
regulation pursuant to this section, the department may twice
request approval from the Office of Administrative Law to readopt
the regulation as an emergency regulation pursuant to Section
11346.1 of the Government Code. The department shall adopt final
regulations on or before January 1, 2018.

begin insert

(f) Nothing in this section is intended to replace or alter other
requirements for responding to complaints and making inspections
or visits to group homes, including, but not limited to, those set
forth in Sections 1534 and 1538.

end insert

SEC. 4.  

Section 11469 of the Welfare and Institutions Code is
amended to read:

11469.  

(a) The department, in consultation with group home
providers, the County Welfare Directors Association of California,
the Chief Probation Officers of California, the California Mental
Health Directors Association, and the State Department of Health
Care Services, shall develop performance standards and outcome
measures for determining the effectiveness of the care and
supervision, as defined in subdivision (b) of Section 11460,
provided by group homes under the AFDC-FC program pursuant
to Sections 11460 and 11462. These standards shall be designed
to measure group home program performance for the client group
that the group home program is designed to serve.

(1) The performance standards and outcome measures shall be
designed to measure the performance of group home programs in
areas over which the programs have some degree of influence, and
in other areas of measurable program performance that the
department can demonstrate are areas over which group home
programs have meaningful managerial or administrative influence.

(2) These standards and outcome measures shall include, but
are not limited to, the effectiveness of services provided by each
group home program, and the extent to which the services provided
by the group home assist in obtaining the child welfare case plan
objectives for the child.

(3) In addition, when the group home provider has identified
as part of its program for licensing, ratesetting, or county placement
purposes, or has included as a part of a child’s case plan by mutual
agreement between the group home and the placing agency,
specific mental health, education, medical, and other child-related
services, the performance standards and outcome measures may
also measure the effectiveness of those services.

(b) Regulations regarding the implementation of the group home
performance standards system required by this section shall be
adopted no later than one year prior to implementation. The
regulations shall specify both the performance standards system
and the manner by which the AFDC-FC rate of a group home
program shall be adjusted if performance standards are not met.

(c) Except as provided in subdivision (d), effective July 1, 1995,
group home performance standards shall be implemented. Any
group home program not meeting the performance standards shall
have its AFDC-FC rate, set pursuant to Section 11462, adjusted
according to the regulations required by this section.

(d) A group home program shall be classified at rate
classification level 13 or 14 only if all of the following are met:

(1) The program generates the requisite number of points for
rate classification level 13 or 14.

(2) The program only accepts children with special treatment
needs as determined through the assessment process pursuant to
paragraph (2) of subdivision (a) of Section 11462.01.

(3) The program meets the performance standards designed
pursuant to this section.

(e) Notwithstanding subdivision (c), the group home program
performance standards system shall not be implemented prior to
the implementation of the AFDC-FC performance standards
system.

(f) On or before January 1, 2016, the department, in consultation
with the County Welfare Directors Association of California, the
Chief Probation Officers of California, the California Mental
Health Directors Association, research entities, foster youth,
advocates for foster youth, foster care provider business entities
organized and operated on a nonprofit basis, Indian tribes, and
other stakeholders, shall develop additional performance standards
and outcome measures that require group homes to implement
programs and services to minimize law enforcement contacts and
delinquency petition filings arising from incidents of allegedly
unlawful behavior by minors occurring in group homes or under
the supervision of group home staff, including individualized
behavior management programs, emergency intervention plans,
and conflict resolution processes.

(g) On or before January 1, 2017, the department, in consultation
with the County Welfare Directors Association of California, the
Chief Probation Officers of California, the California Mental
Health Directors Association, research entities, foster youth,
advocates for foster youth, foster care provider business entities
organized and operated on a nonprofit basis, Indian tribes, and
other stakeholders, shall develop additional performance standards
and outcome measures that require group homes to implement
programs and services to reduce the utilization of psychotropic
medications for children in group homes, including individualized
behavior management programs, emergency intervention plans,
and conflict resolution processes.

SEC. 5.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.