BILL ANALYSIS �
AB 1454
Page A
ASSEMBLY THIRD READING
AB 1454 (Ian Calderon)
As Amended May 23, 2014
Majority vote
HUMAN SERVICES 7-0 APPROPRIATIONS 16-0
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|Ayes:|Stone, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Ammiano, Ian Calderon, | |Bocanegra, Bradford, Ian |
| |Garcia, Grove, Hall | |Calderon, Campos, Eggman, |
| | | |Gomez, Holden, Jones, |
| | | |Linder, Pan, Quirk, |
| | | |Ridley-Thomas, Wagner, |
| | | |Weber |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires the California Department of Social Services
(DSS) to conduct additional 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, phased in over three
years.
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
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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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
Annual costs of approximately $12.5 million (General Fund) to
Department of Social Services (DSS) to conduct the increased
inspections once the phase-in is complete. This assumes DSS
continues to use its "key indicator" approach during
inspections. The cost of conducting comprehensive inspections
would be much higher.
COMMENTS :
DSS Community Care Licensing Division (CCLD): 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 the DSS 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
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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.
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 budgets 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.
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.
Numerous studies have also been conducted, which document a
connection between increased licensing visits with a decrease in
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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."
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.
---------------------------
<1> Fine, 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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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
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."
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0003792