BILL ANALYSIS �
AB 1454
Page A
Date of Hearing: March 25, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 1454 (Ian C. Calderon) - As Amended: March 17, 2014
SUBJECT : Care Facilities: regulatory visits
SUMMARY : Requires the California Department of Social Services
(DSS) to conduct annual licensing inspection visits of all
community care facilities that fall under the jurisdiction of
the California Child Day Care Facilities Act (CDCFA), the
Community Care Facilities Act (CCFA), and the Residential Care
Facility for the Elderly (RCFE) Act. Specifically, this bill :
1)Changes the requirement that DSS conduct an unannounced
licensing inspection visit of child day care facilities,
family day care homes, community care facilities and RCFEs
from once every five years to annually.
2)Requires DSS to conduct "more frequent unannounced visits,"
rather than an annual unannounced visit of a CDCFA, CCFA, and
RCFE Act licensed facility when the terms of the facility's
compliance plan requires it or it is a condition of the
facility receiving federal financial participation.
3)Deletes the requirement that DSS shall conduct an unannounced
visit to no less than 20% of CDCFA, CCFA, and RCFE Act
licensed facilities based upon a random sampling methodology.
4)Deletes the requirement that DSS increase by 10% the random
sampling of CDCFA, CCFA, and RCFE licensed facilities if there
has been a 10% increase in the number of citations in the
previous year.
5)Permits DSS to forego a pre-licensure inspection of a RCFE if
the application is for an exchange of licensees and the
application is in good order.
EXISTING LAW
1)Establishes the California Community Care Facilities Act
(CCFA) to provide a comprehensive statewide service system of
quality community care for people who have a mental illness, a
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developmental or physical disability, and children and adults
who require care or services by a facility or organization.
(H&S Code 1500 and 1501)
2)Defines a "Community care facility" (CCF) as a facility,
place, or building maintained and operated to provide
nonmedical residential care, day treatment, adult day care, or
foster family agency services for children, adults, or
children and adults, including, but not limited to, the
physically handicapped, mentally impaired, incompetent
persons, and abused or neglected children. (H&S Code 1502)
3)Authorizes DSS to license facilities or organizations that
provide services under the jurisdiction of the CCFA,
including, residential facilities, as defined, adult day
programs, therapeutic day services facilities, foster family
agencies and homes, social rehabilitation facilities,
community treatment facilities, full-service adoption
agencies, noncustodial, adoption agencies, transitional
shelter care facilities, transitional housing placement
providers for foster youth. (H&S Code 1520)
4)Exempts certain types of facilities from licensure under the
CCFA, including health facilities, juvenile facilities and
juvenile halls, child day care facilities as defined by the
CDCFA, any supported living arrangement for individuals with
developmental disabilities, and other facilities as specified.
(H&S Code 1505)
5)Establishes the California RCFE Act, which requires facilities
that provide personal care and supervision, protective
supervision or health related services for persons 60 years of
age or older who voluntarily choose to reside in those
facilities to be licensed by DSS. (H&S Code 1569 and 1569.1)
6)Establishes the California CDCFA to provide a comprehensive,
quality system for licensing child day care facilities to
ensure that working families have access to healthy and safe
child care providers and that child care programs contribute
positively to a child's emotional, cognitive, and educational
development, and are able to respond to and provide for the
unique characteristics and needs of children. (H&S Code
1596.70 and 1596.72)
FISCAL EFFECT : Unknown
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COMMENTS :
DSS Community Care Licensing Division (CCLD) : Initially
administered by the Department of Health upon its establishment
in 1973, the CCFA became the jurisdiction of the newly created
Health and Welfare Agency, now referred to as the Health and
Human Services Agency, under which a number of departments were
placed, including the Departments of Social Services and Health
Services. Under today's structure, the responsibility for the
licensing of community care facilities sits with DSS, and the
duty to license health care facilities is with the Department of
Health Care Services (DCHS).
Facilities licensed by CCLD typically provide non-medical care
and supervision for children and adults in need, which includes
persons with disabilities, seniors in need of residential care,
children in foster care and at-risk children needing shelter
services, families in need of early childhood education (child
care), and adult care services. CCLD is responsible for the
licensing of all community care facilities and for investigating
all complaints against those facilities. According to DSS, as
of March 5, 2013 there are 76,663 licensed facilities with a
licensed capacity of 1,395,681 individuals.
Capacity of CCLD and unannounced licensing inspection visits :
Prior to 2003, the required frequency of unannounced licensing
visits was annually for most facility types (and tri-annually
for family child care). However, due to the state's ongoing
budget deficit and declining revenues, it was deemed necessary
to find ways to reduce costs. As a result, the operational
budget for DSS' Community Care Licensing Division (CCLD) is now
required to do unannounced visits annually only when a facility
has a history of compliance problems, which has resulted in
annual visits for approximately 10% of facilities. For all
other 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, which helps to ensure that a
new licensee starts off correctly. However, in most cases five
years could pass before a residential facility is inspected by
CCLD.
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Five years has created a tenuous situation for California's
infrastructure of community care facilities. 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 letter went on to note that
"CCLD's experience with the random sample inspection protocol
and fluctuations in resources have put client health and safety
at risk." Additionally, adding to CCLD's responsibilities, the
2012-13 budget included the elimination of the California
Department of Mental Health (DMH) and transferred its
programmatic and administrative responsibilities to other state
agencies and departments, including DSS, as deemed appropriate.
Today, according to DSS, there are approximately 462 licensing
analysts responsible for the more than 75,000 licensed
facilities and the nearly 1.4 million individuals they serve,
ranging from the earliest stages of life to the end of life
care. This comes to a ratio of one licensing analyst per 162
facilities and 3,030 individuals in care.
It is clear that the ongoing budget deficit of the last ten
years has had a significant impact on DSS' ability to monitor
the health and safety of residents and clients of community care
facilities throughout the state. An increase in oversight
responsibility of mental health facilities combined with staff
reductions and unfilled staff positions, and on-again off-again
work furloughs and hiring freezes have severely reduced its
administrative capacity. Although this does not clear the state
of its responsibility to ensure community care facilities'
compliance with the CCFA, it raises significant challenges to
ensure that children, adults and seniors in need of care and
supervision are not put at risk.
Importance of unannounced licensing visits : Unannounced
licensing visits are of fundamental importance in protecting the
health and safety of children and adults receiving care through
facility- or home-based care. They ensure that basic health and
safety requirements are being met and also provide opportunities
for increased technical assistance to programs, enhanced
information sharing, the development of best practices, and
ultimately lead to an improvement in the quality of life for
clients under care.
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Numerous studies have also been conducted, which document a
connection between increased licensing visits with a decrease in
accidents requiring medical attention<1> and greater provider
compliance with health and safety standards.<2>
Additionally, regular and frequent unannounced inspection visits
allow for state and local agencies to provide relevant and
up-to-date information to the public on the quality of care
being provided to consumers. According to Child Care Aware of
America (CCAA), formerly the National Association of Child Care
Resource and Referral Agencies (NACCRRA), a study conducted by
the National Bureau of Economic Research in Florida found that
frequent inspections, which were made available to the public,
"increased the quality of the inspections and the productivity
of the inspectors" and resulted in increased inspections that
were carried out more consistently. Further, in a 2010-11
Spring Finance Letter, DSS stated that "regular and frequent
inspections of facilities improve client health and safety as
evidenced by reductions in the percentage of the more serious
imminent risk to total citations." Specifically, as further
written by DSS "more annual inspections equates to better
quality of care" and "more annual inspections equates to a
smaller risk to the health and safety of clients."
The Governor's 2014-15 CCLD budget proposal : In response to a
growing number of highly publicized incidents at licensed
community care facilities throughout the state, most notably the
abandonment of Valley Springs Manor, a licensed RCFE in Castro
Valley, CA, by its owner and licensee, the Governor has proposed
an increase of $7.5 million for CCLD. The proposal includes a
request to increase the number of administrative and inspection
analyst positions to:
"enhance health and safety outcomes for children and adults
in Community Care Facilities by ensuring a robust
-------------------------
<1> Fiene, R. (2002). 13 indicators of quality child care:
Research update. U.S. Department of Health and Human Services,
Office of Assistant Secretary for Planning and Evaluation, at
http://aspe.hhs.gov/hsp/ccquality-ind02/
<2> Koch Consulting. (2005). Report on effective legal
proceedings to ensure provider compliance: Prepared for the
State of Washington Department of Social and Health Services.
http://www.naralicensing.drivehq.com/publications/archives/nara/E
ffective_Legal_Proceedings.pdf
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enforcement program with a continued emphasis on increasing
visits to facilities, qualifications of facility
administrators, and civil penalties; updating facility
fees; establishing clear fiscal, program and corporate
accountability; developing necessary resources for
populations with medical and mental health needs; and
efficiently deploying staff and managers."<3>
Although this proposal attempts to address over ten years of
budget reductions experienced by CCLD, it raises questions as to
whether it is adequate to cover existing statutory licensing
requirements, let alone reverting to a state policy requirement
that every facility is inspected at least once per year.
Need for the bill : According to the Public Policy Institute of
California, California's population growth will continue into
the near and distant future. It is estimated that, according to
the United States Census, California's population will increase
by over ten million people, from 37 million to nearly 50 million
by the year 2040. This has and will continue to increase demand
on the state's social safety net infrastructure, especially its
infrastructure of community care facilities. As the state's
population grows so does its use and demand for social services;
early care and development programs, out-of-home day and
residential care for people with developmental disabilities, and
services for the aging.
Without an adequate inspection requirement, concerns will remain
that the state is not providing sufficient attention and
oversight of licensed facilities and is placing the health and
safety of its most vulnerable populations at risk.
According to the author:
"Increasing the frequency of licensing visits will
demonstrate that California is serious about addressing the
deficiency in our inspection process for Community Care
Facilities and will put California on par with the
inspection procedures of other states. Currently we have a
complaint based oversight system that is reactive to issues
in our facilities instead of being proactive to prevent
issues or fix and stop these issues before they become
deadly. By at least having a licensing program analyst, or
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<3> 2014-15 Budget Change Proposal #CCLD-2; Department of Social
Services; Social Services and Licensing. 2014-15 Budget.
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inspector, in these facilities, boots on the ground, once a
year we will be able to be proactive and no longer be
operating under a complaints based system. Facilities are
in need of frequent inspections because of the
vulnerability of the clients these facilities serve and it
is our job to make sure these individuals are being
properly taken care of."
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees
(AFSCME)
BANANAS
California Alternative Payment Program
California Assisted Living Association (CALA)
California Child Care Resource & Referral Network
California Commission on Aging
California Communities United Institute
California Food Policy Advocates (CFPA)
Child Care Law Center
Children Now
County of San Diego
County Welfare Directors Association of California (CWDA)
First 5 Association of California
LeadingAGE California
Marin Child Care Council
National Association of Social Workers, CA Chapter (NASW-CA)
Northern Director's Group
Opposition
California Council of Community Mental Health Agencies
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089