BILL ANALYSIS �
AB 419
Page A
Date of Hearing: April 26, 2011
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall Jr., Chair
AB 419 (Mitchell) - As Amended: April 14, 2011
AS PROPOSED TO BE AMENDED
SUBJECT : Community care facilities
SUMMARY : Increases the frequency of licensing evaluation visits
of most categories of facilities licensed by the Department of
Social Services. Specifically, as proposed to be amended, this
bill :
1)Repeals current law specifying the frequency of inspection
visits for facilities licensed by the Community Care Licensing
Division (CCLD) of the state Department of Social Services
(DSS) and, instead, provides that, with the exception of
Family Day Care Homes, every licensed facility shall be
subject to an unannounced evaluation at least annually and as
often as necessary to ensure the quality of care provided.
Provides that, with the exception of Foster Family Homes, such
evaluation visits shall be unannounced.
2)Provides that Family Day Care Homes shall be subject to an
unannounced evaluation visit at least once every 2 years and
as often as necessary to ensure the quality of care provided,
and that such visits shall take place only during the period
beginning one hour before and ending one hour after the
facility's normal business hours or at any time child care
services are being provided.
3)Provides that inspections shall use inspection protocols that
are research-based, field tested, reviewed by stakeholders and
evaluated annually to ensure their efficacy.
a) Requires that all inspection visits include review of
"zero tolerance" violations for the facility type and that
an annual visit will trigger a comprehensive inspection if
either of the following occurs:
i) One zero tolerance violation, including fire
clearance violations; absence of supervision; accessible
bodies of water; accessible firearms or ammunition;
refused entry to a facility or any part of a facility;
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and the presence of an excluded person on the premises;
or,
ii) A combination of other violations as determined by
DSS and reported to the Legislature. For the first two
years following implementation this is defined as any two
Type A (immediate risk) violations, regardless of whether
they are listed as part of the annual protocol.
b) Requires that CCLD address any violation observed during
an annual inspection, even if not listed as part of the
protocol.
c) Requires, in the case of Residential Care Facilities for
the Elderly (RCFEs), that enhancements to the reviews are
to be included for facilities caring for individuals with
dementia or who are bedridden, and for facilities providing
hospice services.
4)Authorizes CCLD to elect not to conduct a prelicensing visit
in the case of applicants for licensure of certain currently
or previously licensed RCFEs or certain Child Day Care
Facilities; but, authorizes DSS to make an initial site visit
in its discretion.
5)Requires CCLD to conduct its first annual unannounced visit to
an RCFE within 90 days after the facility accepts its first
resident for placement following its initial licensure.
6)Requires that on or before both January 31, 2012 and January
31, 2013, DSS convene a workgroup to review the annual
licensing protocols and their implementation, and to make
recommendations concerning improving the protocols.
a) Requires that the workgroup include representatives from
departments within the Health and Human Services Agency,
legislative staff, and stakeholders representing providers
and consumers of all facility types.
b) Requires that DSS address workgroup activities and
include information and data on the annual visit protocol
in its annual report to the Assembly and Senate budget
sub-committees overseeing CCLD.
EXISTING LAW
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1)Provides for the licensure and regulation by CCLD of
nonmedical community programs and facilities for adults and
children with disabilities, seniors, and abused and neglected
children, including group homes, adult residential care
facilities, RCFEs, adult day programs, child care facilities,
foster family agencies, and foster family homes.
2)Requires DSS to charge specified application fees for the
issuance of a license and annual fees thereafter, based on
facility type and capacity.
3)Establishes requirements for inspection visits to
CCLD-licensed facilities to assess compliance with rules and
regulations and to assess the facility's continuing ability to
meet regulatory requirements, and authorizes DSS to take
appropriate remedial action to address noncompliance.
4)Extends a 3% reduction in payments for services and supports
to most CCLD-licensed providers of services to people with
developmental disabilities under the Lanterman Developmental
Disabilities Services Act (Lanterman Act), and increases the
reduction to 4.25%, through June 30, 2012.
5)Pursuant to the Fiscal Year 2011-12 human services budget
trailer bill (Chapter 8, Statutes of 2011), further reduces
cash assistance provided through the Supplemental Security
Income/State Supplementary Payment (SSI/SSP) Program for
individuals by $15 per month effective July 1, 2011, reducing
the maximum grant from $845 to $830, the minimum level allowed
by federal law.
FISCAL EFFECT : Unknown
COMMENTS :
Annual inspection visits
Prior to 2003, the required frequency of CCLD facility visits
was annually for most facility types (and tri-annually for
family child care). Since then, in response to the state's
fiscal situation, it was deemed necessary to find ways to reduce
costs. As a result, under the Community Care Facilities Act and
RCFE Act, CCLD is now required to do unannounced visits annually
only in circumstances when the facility has a history of
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compliance problems-approximately 10% of facilities.<1> For
those residential facilities not subject to annual inspections,
CCLD is currently required to conduct comprehensive compliance
inspections of a 30% random sample of facilities each year, with
no facility being visited less than once every 5 years. There
are additional inspection requirements for new facilities or
when changes occur to the license. These pre-licensing
inspection and post-licensing inspections help to ensure that a
new licensee starts off correctly.
In a Spring Finance Letter from February, 2010, DSS stated that
"�a]s the result of several consecutive years of unallocated
reductions and position sweeps, CCLD is no longer able to
sustain the required inspection frequency." The Spring Finance
Letter also noted that "CCLD's experience with the random sample
inspection protocol and fluctuations in resources have put
client health and safety at risk." As a result, CCLD has been
in the process of developing a "Key Indicator Compliance
Inspection" protocol for prioritizing its inspection activities.
DSS intends to use the key indicator protocols for licensing
inspections to increase the frequency and efficiency of
licensing visits while maintaining the health & safety oversight
of all facilities. These key indicators are research-based and
pilot tested.
This bill, while not explicitly referencing the key indicator
method, authorizes the use of inspection protocols-which must be
"research based, field tested, reviewed by stakeholders, and
evaluated annually"-to enable CCLD to increase both the
frequency of visits and the efficient use of staff time in
maintaining the oversight of facilities. This bill requires
CCLD-licensed facilities to be inspected annually (except for
family child care home which will be inspected biannually). The
author of this bill notes that increasing the frequency of
licensing visits "demonstrates that in the State of California
---------------------------
<1> Annual unannounced visits are also required "when a facility
requires an annual visit as a condition of receiving federal
financial participation." Health & Safety Code Section
1534(a)(1)(A)(iv). This includes facilities vendorized by
regional centers for people with developmental disabilities that
provide services to individuals funded under the federal Home
and Community Based Services Waiver for Individuals with
Developmental Disabilities (DD Waiver). According to DSS, this
requirement applies to approximately 2,800 of 5,000 adult care
programs.
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we value those we care for and place their health and safety as
a high priority."
A letter from Penn State University Professor, Richard Fiene,
Ph.D., indicates that he developed the Key Indicator Methodology
being used by DSS in the 1970s and 1980s. According to Dr.
Fiene, "�b]y using the Key Indicator System, �California] will
be able to do more, not less, program reviews of facilities.
This is in the best interests of all clients being served by
your state and is clearly a win-win situation given the present
budget scenario we face as a nation and in California."
Preschool California, a co-sponsor of this bill, says that "�b]y
focusing inspections on key indicators that are predictive of
compliance with all of the licensing regulations, as opposed to
the existing comprehensive review, significantly less time will
be spent on individual inspections and therefore facilities will
be able to be visited more frequently at no additional cost to
the state." In support of this bill, Aging Services of
California says that: "National best practices for human care
regulatory agencies issued by the National Association for
Regulatory Administration (NARA) recommend inspection occur
'with sufficient frequency to protect consumers and to prevent
or reduce compliance deterioration-at least twice yearly, unless
the agency has a reliable system to reduce the frequency of
routine monitoring for stable, high compliance facilities,
provided that all facilities are inspected at least once a
year.'"
Concerns : Advocates for seniors and others who receive services
from CCLD-licensed facilities have been working with the author
to address concerns with this bill. The amendments proposed by
the author are an effort to address many of those concerns;
however, others remain unresolved. California Advocates for
Nursing Home Reform, for example, believes this bill should more
explicitly identify core standards for RCFE inspections, and
that key indicator protocols should evaluate compliance with
residents' rights. CANHR says that it is committed to working
with the author's office to address its concerns, and the author
and sponsors report that they are continuing to work with
advocates to address outstanding issues.
Fee increases
In addition to increasing the frequency of inspections of
CCLD-licensed facilities, the most recent amended version of
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this bill also increases initial application and annual
licensing fees for these facilities by 10% and modifies
provisions concerning compliance fees. As noted in the February
2010 Spring Finance Letter in which DSS proposed the fee
increase, however, this proposal was intended to "help stabilize
the funding for the Community Care Licensing Program and ensure
these critical health and safety resources are less reliant on
the GF." That is, the proposal to increase fees was not
directly tied to the proposal for annual inspections using key
indicators.
With limited exceptions, most community provider rates for
CCLD-licensed facilities serving people with developmental
disabilities under the Lanterman Act have been frozen since
fiscal year 2003-04. The limited cost-of-living and other rate
adjustments granted by the Legislature for residential and day
programs in the past two decades have been far outstripped by
inflation. The Fiscal Year (FY) 2008-09 and FY 2009-10 state
budgets included an additional 3% reduction in provider rates.
The FY 2010-11 budget continues the 3% reduction and includes an
additional 1.25% reduction. Therefore, a 10% fee increase would
hit these programs particularly hard. While the fee increase is
not directly tied to the provisions of this bill increasing the
frequency of inspections, as noted in footnote 1, most community
programs for people with developmental disabilities, serving
individuals funded in part under the federal DD Waiver, are
already subject to annual inspections.
The California Council of Community Mental Health Agencies also
notes, as the basis for its opposition to this bill, that
facilities cannot afford fee increases at a time when SSI
payments-often the sole source of payments for residential
care-are being further reduced.
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Amendments proposed by the author
1)Because the annual inspection protocols are not directly tied
to or dependent on the fee increases provided for in this
bill, the author proposes to delete the provisions of this
bill related to application fees, annual licensing fee
increases, and reinspection fees.
2)As proposed to be amended, this bill also makes technical and
clarifying amendments in response to input from stakeholders,
including providers, advocates for seniors and other service
recipient constituencies, and DSS.
REGISTERED SUPPORT / OPPOSITION :
Support
Advancement Project
Aging Services of California
Alzheimer's Association
BANANAS Inc.
Bay Area Council
California Assisted Living Association (CALA)
California Child Care Coordinators Association
California Child Care Resource & Referral Network (co-sponsor)
California Child Development Administrators Association
California Head Start Association
California State PTA
Central Valley Children's Services Network
Child Care Resource Center
Child Development Policy Institute
Children Now
Choices for Children
Community Child Care Council of Alameda County
Community Child Care Council of Sonoma County
Community Resources for Children
Contra Costa Child Care Council
Crystal Stairs, Inc.
Del Norte Child Care Council
Department of Defense-State Liaison Office, Military Community
and Family Policy
Early Care and Education Consortium
Family Resource and Referral Center
Fresno County Office of Education
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Los Angeles Universal Preschool (LAUP)
Marin Child Care Council
Mexican American Opportunity Foundation
Pathways
Preschool California (co-sponsor)
Professional Association for Childhood Education
Solano Family & Children's Services
Valley Oak Children's Services
Wu Yee Children's Services
Zero To Three
1 individual
Opposition
California Council of Community Mental Health Agencies
Analysis Prepared by : Eric Gelber / HUM. S. / (916) 319-2089