Amended in Assembly September 3, 2015

Amended in Assembly August 28, 2015

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 Sections 1507.6 and 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.

Under existing law, a child in a group home may receive mental health services, as deemed necessary by the placing agency and under the case management of that agency. Under existing law, only a juvenile court judicial officer may make orders regarding the administration of psychotropic medications to a child adjudged a dependent or ward of the court and removed from the physical custody of the parent. Existing law requires that the order be based on a request from a physician, indicating the reasons for the request and a description of the child’s diagnosis and behavior, among other requirements.

This bill would provide that psychotropic medications may be used at a group home, other than at a runaway and homeless youth shelter, only in accordance with the written directions of the physician prescribing the medication and as authorized by the juvenile court. The bill would require the group home to maintain in the child’s records specified information regarding the administration of those medications.

(2) Existing law requires the Director of Social Services, 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 to compile specified information regarding the administration of psychotropic medications to children in group homes and to post that information on the department’s Internet Web site. The bill would require the department, in consultation with the State Department of Health Care Services and stakeholders, to establish a methodology to identify those group homes that have levels of psychotropic drug utilization warranting additional review, as specified. 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 factors. The bill would begin delete require a facility, for which end delete begin insert authorize end insert the department, begin delete based end delete begin delete on end delete begin insert following end insert that inspection, begin delete finds a risk to the health, safety, or personal rights of clients in care, end delete begin insert to share relevant information and observations with county placing agencies, social workers, probation officers, the court, dependency counsel, or the Medical Board of California, or share relevant information and observations with the facility and require the facility end insert to submit a plan begin delete of correction end delete to the begin delete department end delete begin insert department, end insert within 30 days of receiving begin delete notice of end delete the department’s begin delete findings. end delete begin insert information and observations, to address any identified risks within the control of the facility related to psychotropic medication. end insert The bill would require the department to begin delete monitor the facility’s end delete begin insert end insert begin insert approve the plan and verify the plan’s end insert implementation begin delete of that plan of correction end delete to determine begin delete that the concerns identified during the inspection have been addressed. end delete begin insert whether those identified risks have been remedied. end insert Because the failure of the facility to comply with these provisions would be a misdemeanor, the bill would impose a state-mandated local program.

(3) 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 alternative programs and services, as specified. begin insert The bill would make related changes. end insert

(4) 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 1507.6 of the Health and Safety Code is
amended to read:

1507.6.  

(a) Mental health services, as deemed necessary by
the placing agency, may be provided to children in a group home.
Except for the physical safety and direct care and supervision of
children so placed, the State Department of Social Services and
its agents shall not evaluate or have responsibility or liability for
the evaluation of mental health services provided in those homes.
Supervision of mental health treatment services provided to a child
in a group home shall be a case management responsibility of the
placing agency.

(b) (1) Psychotropic medications shall be used only in
accordance with the written directions of the physician prescribing
the medication and as authorized by the juvenile court pursuant to
Section 369.5 or 739.5 of the Welfare and Institutions Code.

(2) The facility shall maintain in a child’s records all of the
following information:

(A) A copy of any court order authorizing the psychotropic
medication for the child.

(B) A separate log for each psychotropic medication prescribed
for the child, showing all of the following:

(i) The name of the medication.

(ii) The date of the prescription.

(iii) The quantity of medication and number of refills initially
prescribed.

(iv) When applicable, any additional refills prescribed.

(v) The required dosage and directions for use as specified in
writing by the physician prescribing the medication, including any
changes directed by the physician.

(vi) The date and time of each dose taken by the child.

(3) This subdivision does not apply to a runaway and homeless
youth shelter, as defined in Section 1502.

SEC. 2.  

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

1536.  

(a) (1) At least annually, the department 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, begin delete or end delete runaway and homeless youth
shelter, begin insert or short-term residential treatment center, end insert 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 begin delete addresses end delete begin insert addresses, upon
request, end insert only to bona fide professional foster parent organizations
begin delete upon request. end delete begin insert and to professional organizations educating foster
parents, including the Foster and Kinship Care Education Program
of the California Community Colleges. end insert

(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 on its Internet
Web site a statewide summary of the information gathered pursuant
to Sections 1538.8 and 1538.9. The summary shall include only
de-identified and aggregate information that does not violate the
confidentiality of a child’s identity and records.

SEC. 3.  

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

1538.8.  

(a) (1) In order to review and evaluate the use of
psychotropic medications in group homes, the department shall
compile, to the extent feasible and not otherwise prohibited by law
and based on information received from the State Department of
Health Care Services, at least annually, information concerning
each group home, including, but not limited to, the child welfare
psychotropic medication measures developed by the department
and the following Healthcare Effectiveness Data and Information
Set (HEDIS) measures related to psychotropic medications:

(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS ADD), which measures
the number of children 6 to 12 years of age, inclusive, who have
a visit with a provider with prescribing authority within 30 days
of the new prescription.

(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:

(i) Measures the number of children receiving an antipsychotic
medication for at least 60 out of 90 days and the number of children
who additionally receive a second antipsychotic medication that
overlaps with the first.

(ii) Reports a total rate and age stratifications including 6 to 11
years of age, inclusive, and 12 to 17 years of age, inclusive.

(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS APP), which measures
whether a child has received psychosocial services 90 days before
through 30 days after receiving a new prescription for an
antipsychotic medication.

(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:

(i) Measures testing for glucose or HbA1c and lipid or
cholesterol of a child who has received at least two different
antipsychotic prescriptions on different days.

(ii) Reports a total rate and age stratifications including 6 to 11
years of age, inclusive, and 12 to 17 years of age, inclusive.

(2) The department shall post the list of data to be collected
pursuant to this subdivision on the department’s Internet Web site.

(b) The data in subdivision (a) concerning psychotropic
medication, mental health services, and placement shall be drawn
from existing data maintained by the State Department of Health
Care Services and the State Department of Social Services and
shared pursuant to a data sharing agreement meeting the
requirements of all applicable state and federal laws and
regulations.

(c) This section does not apply to a runaway and homeless youth
shelter, as defined in Section 1502.

SEC. 4.  

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

1538.9.  

(a) (1) (A) The department shall consult with the
State Department of Health Care Services and stakeholders to
establish a methodology for identifying those group homes
providing begin delete services end delete begin insert care end insert under the AFDC-FC program pursuant to
Sections 11460 and 11462 of the Welfare and Institutions Code
that have levels of psychotropic drug utilization warranting
additional review. The methodology shall be adopted on or before
July 1, 2016.

(B) Every three years after adopting the methodology developed
under subparagraph (A), or earlier if needed, the department shall
consult with the State Department of Health Care Services and
stakeholders and revise the methodology, if necessary.

(2) If the department, applying the methodology described in
paragraph (1), determines that a facility appears to have levels of
psychotropic drug utilization warranting additional review, it shall
inspect the facility at least once a year.

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

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

(B) Child-to-staff ratios.

(C) Staff qualifications and training.

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

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

(F) Other factors that the department determines contribute to
levels of psychotropic drug utilization that warrant additional
review.

(G) Confidential interviews of children residing in the facility
at the time of the inspection.

(4) The inspection of the facility may include, but is not limited
to, the following:

(A) Confidential interviews of children who resided in the
facility within the last six months.

(B) Confidential discussions with physicians identified as
prescribing the medications.

begin delete

(b) Based upon an inspection conducted pursuant to subdivision
(a), the department shall share relevant information or observations
with county placing agencies, social workers, probation officers,
the court, dependency counsel, or the Medical Board of California.
If, as a result of the inspection conducted pursuant to subdivision
(a), the department finds a risk to the health, safety, or personal
rights of clients in care, the facility shall submit a plan of correction
to the department. The plan of correction shall be submitted to the
department within 30 days after the facility has received the
department’s notice of findings. The department shall monitor the
implementation of the plan of correction to determine that the
concerns identified during the inspection have been addressed.
This subdivision does not prevent the department from taking any
other corrective action as permitted under any other law or any
regulation adopted pursuant to this chapter.

end delete begin insert

(b) Following an inspection conducted pursuant to this section,
the department, as it deems appropriate, may do either or both of
the following:

end insert begin insert

(1) Share relevant information and observations with county
placing agencies, social workers, probation officers, the court,
dependency counsel, or the Medical Board of California, as
applicable.

end insert begin insert

(2) Share relevant information and observations with the facility
and require the facility to submit a plan, within 30 days of receiving
the information and observations from the department, to address
any identified risks within the control of the facility related to
psychotropic medication. The department shall approve the plan
and verify implementation of the plan to determine whether those
risks have been remedied.

end insert

(c) (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.

(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.

(d) Nothing in this section begin delete is intended to replace or alter other end delete
begin insert does any of the following: end insert

begin insert (1) end insert begin insert   end insert begin insert Replaces or alters other end insert 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.

begin insert

(2) Prevents or precludes the department from taking any other
action permitted under any other law, including any regulation
adopted pursuant to this chapter.

end insert

(e) This section does not apply to a runaway and homeless youth
shelter, as defined in Section 1502.

SEC. 5.  

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

11469.  

(a) The department shall develop, following
consultation with group home providers, the County Welfare
Directors Association of California, the Chief Probation Officers
of California, the County Behavioral Health Directors Association
of California, the State Department of Health Care Services, and
stakeholders, 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 shall develop,
following consultation with the County Welfare Directors
Association of California, the Chief Probation Officers of
California, the County Behavioral Health Directors Association
of California, research entities, foster children, advocates for foster
children, foster care provider business entities organized and
operated on a nonprofit basis, Indian tribes, and other stakeholders,
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 shall develop,
following consultation with the County Welfare Directors
Association of California, the Chief Probation Officers of
California, the County Behavioral Health Directors Association
of California, the Medical Board of California, research entities,
foster children advocates for foster children, foster care provider
business entities organized and operated on a nonprofit basis,
Indian tribes, and other stakeholders, additional performance
standards and outcome measures that require group homes to
implement alternative programs and services, including
individualized behavior management programs, emergency
intervention plans, and conflict resolution processes.

SEC. 6.  

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.