BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1454
A
AUTHOR: Calderon
B
VERSION: May 23, 2014
HEARING DATE: June 10, 2014
1
FISCAL: Yes
4
5
CONSULTANT: Sara Rogers
4
SUBJECT
Care facilities: regulatory visits
SUMMARY
This bill requires the California Department of Social
Services (CDSS) to increase the frequency of unannounced
licensing visits of community care facilities (CCFs),
Residential Care Facilities for the Elderly (RCFEs), child
day care centers, and family day care homes incrementally
so that by July 1, 2017 every facility shall be visited
annually. Additionally, this bill permits a CDSS the
discretion of completing a prelicensure survey for a new
licensee of a currently licensed RCFE for which there will
be no material change to management or operations when the
license changes hands.
ABSTRACT
Existing Law:
1.Establishes the Community Care Facilities Act, which
provides for the licensure and regulation by CDSS of CCFs
Continued---
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defined as nonmedical residential and non-residential
facilities for mentally ill, developmentally and
physically disabled, and children and adults who require
care or services. (HSC Section 1500 et seq.)
2.Establishes the Residential Care Facilities for the
Elderly Act, which provides for the licensure and
regulation of RCFEs as a separate category within the
existing residential care licensing structure of CDSS.
(HSC 1569 et seq.)
3.Establishes the California Child Day Care Facilities Act
to provide for the licensure and regulation of child day
care and family day care facilities as a separate
licensing category within the existing licensing
structure of CDSS (HSC 1596.72 et seq.)
4.Provides for the CDSS licensure and regulation of small
family day care homes serving between six and eight
children, as specified, in a residentially zoned and
occupied property. (HSC 1597.30 et seq.)
5.Provides that facilities licensed by CDSS shall be
subject to unannounced visits by CDSS and that the
department shall visit facilities as often as necessary
to ensure the quality of care provided. (HSC 1534,
1569.33, 1597.09 and 1597.55a)
6.Requires annual unannounced inspections when a license is
on probation, when required by the terms of a facility
compliance plan, when an accusation is pending, when
required for federal financial participation (CCFs and
RCFEs), or to verify that a person who has been ordered
out of the facility is no longer present. (HSC 1534,
1569.33, 1597.09 and 1597.55a)
7.Requires CDSS to perform random inspections each year on
no fewer than 20 percent of facilities not subject to
annual inspections. Provides that this percentage shall
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increase by 10 percent if the total citations issued by
the department exceeds the previous year by 10 percent.
As a result of this trigger, CDSS currently is required
to perform random inspections on 30 percent of the
facilities not subject to annual inspection. Requires
CDSS to visit every facility no less than every 5 years.
(HSC 1534, 1569.33, 1597.09 and 1597.55a)
8.Requires CDSS to make a determination regarding the
completeness of an RCFE license application, and to
arrange a time for a prelicensure survey if the license
is complete. (HSC 1569.20)
This bill:
1.Requires CDSS to increase the frequency of unannounced
licensing visits of CCFs, RCFEs and child day care
centers as follows:
By July 1, 2015, every facility shall be
visited at least once every three years and
establishes in statute the current practice that 30
percent of all facilities are required to receive a
random unannounced visit each year.
By July 1, 2016 every facility shall be visited
at least once every two years, and 20 percent of all
facilities are required to receive a random
unannounced visit each year (reduced from the
current standard of 30%)
By July 1, 2017 every facility shall visited
annually.
1.Deletes the requirement that CDSS increase by 10 percent
the random sampling of licensed facilities if there has
been a 10 percent increase in the number of citations the
previous year.
2.Provides that a prelicensure survey of a currently
licensed RCFE for which there will be no material change
to management or operations is optional at the discretion
of CDSS.
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FISCAL IMPACT
An Assembly Appropriations analysis estimates costs in the
range of $20 million (GF) to increase Community Care
Licensing Division inspections to once every year. The
Governor's current budget proposal includes an increase of
$7.5 million for CCLD to restructure the licensing
structure.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, California's licensing program
performs the essential function of protecting the basic
health and safety of children and adults in care. The
author states that currently five years or more may elapse
between site visits from the licensing program, hardly
frequent enough to ensure minimum safety in an industry
with high staff turnover.
The author additionally states that many recent news
reports have highlighted the lack of frequent inspections
in facilities across California and the dangers faced by
children and the elderly noting that seniors have suffered
broken bones, deadly bed sores, sexual assaults and other
injuries in assisted living facilities. Additionally, the
author states that children have been victims of neglect,
endangerment, unkempt conditions, and injuries and that
this bill will work to address these problems by requiring
CDSS to phase in annual unannounced visits for all
community care facilities. The author notes that the bill
does not require every inspection to be a comprehensive
inspection and will allow the department to continue using
its key indicator tool, as well as comprehensive
inspections when needed.
Regulatory Oversight
The Community Care Licensing Division (CCLD) of CDSS
provides the primary regulatory oversight over the quality
and care in 76,627 licensed community care facilities.
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These facilities fall under 23 separate licensure
categories including adoption agencies, foster family
homes, RCFEs, group homes, adult residential facilities,
adult day care, child day care facilities and others which
provide primarily non-medical care and supervision to 1.4
million children and adults in California.<1>
Prior to January 2004, CCLD was required to conduct at
least annual visits for all licensed community care
facilities within its jurisdiction. However, in 2003 under
a budget trailer bill enacting substantial budget cuts due
to the ongoing deficit, this statute was changed to require
that only those facilities which warrant close monitoring
because of a poor history of compliance or are federally
required to be inspected annually are subject to annual
visits (about 10 percent of facilities). The trailer bill
required that 10 percent of the remaining facilities not
subject to annual inspection would be randomly inspected
each year and that no facility shall be visited less than
once every five years.<2>
The bill included a trigger increasing the percent of
random inspections by 10 percent if total citations
increased over the prior year by 10 percent or more. Later
statute was changed to impose a 20 percent random
inspection standard. Today, as a result of the trigger, 30
percent of facilities are randomly selected for inspection
each year.
Currently, CDSS reports there are approximately 462
licensing analysts monitoring the care of more than 66,000
licensed facilities. In California, 40 counties contract to
provide licensing oversight to foster family homes and a
handful of counties contract to license family child care
homes. The department reports it makes more than 24,000
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<1> http://ccld.ca.gov/res/pdf/countylist.pdf
<2> AB 1752 (Committee on Budget) Chapter 225, Statutes of
2003
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annual inspections and investigates more than 13,000
complaints involving licensed care. Due to extremely
antiquated technology, the department is unable to provide
detailed information on the nature of those complaints or
how they were resolved.
Impact of reduced visit frequency
A 2008 study published by the California Health Care
Foundation investigated the impact on the truncated
frequency of visits on RCFEs, and found that "routine
visits were replaced with significant increases in the
number of complaint and problem-driven visits" and that
"the monitoring of quality of care in RCFEs has become a
complaint and problem driven process." <3> CCL has
repeatedly sought to restore the cuts made to licensing,
arguing that the cuts to staff and resulting changed
protocols "have put client health and safety at risk. By
not consistently inspecting facilities, or inspecting a
facility only as the result of a complaint, CCL (analysts)
have lost rapport with licensees, which in turn has not
been conducive to helping clients in those facilities."<4>
Governor's Budget Proposal
As part of the Governor's 2014-2015 proposed budget, the
Administration has put forth a proposal that overlaps with
provisions of this bill. Specifically, it proposes to
increase CCLD staff by 71.5 positions, with an increase of
$7.5 million, creating more specialized workloads that are
intended to free up the workload of its Licensing Program
Analysts, who then will presumably be able to increase the
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<3> Inspection Visits in Residential Care Facilities for
the Elderly. C. Flores, A. Bostrom, and R. Newcomer.
California Health Care Foundation, 2008.
<4> Department of Social Services spring finance letter
CCLD-1, 2011-12
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frequency of inspections.<5> The Governor's budget proposal
provides no statutory change to the required visit
frequency, though the department indicates that visit
frequency is expected to generally increase to each
facility being visited at least every two years.
Overlap with RCFE Reform Act Package
This bill has substantial overlap with SB 895 (Corbett)
which requires incremental build-up to annual visits for
RCFE facilities by 2018. That bill, sponsored by California
Advocates for Nursing Home Reform is one of a large package
of bills that respond to a series of recent events calling
into question the adequacy of CDSS oversight and the
state's ability to protect people who reside in RCFEs.
Specifically, in July 2013, ProPublica and Frontline
reporters wrote and produced a series of stories on
Emeritus, the nation's largest RCFE provider.<6> Featured
in the article was a woman who died after receiving poor
care at in a facility in Auburn, California. The series
documented chronic understaffing and a lack of required
assessments and substandard care.
Reports in September 2013, prompted by a consumer watchdog
group that had hand-culled through stacks of documents in
San Diego, revealed that more than two dozen seniors had
died in recent years in RCFEs under questionable
circumstances that went ignored or unpunished by CCL.<7>
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<5> 2014-2015 Budget Change Proposal #CCLD-2; Department of
Social Services
<6>
http://www.propublica.org/article/life-and-death-in-assisted
-living-single
<7> "Care Home Deaths Show System Failures," San Diego
Union Tribune, Sept.7, 2013
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Most recently, in late October 2013, 19 frail seniors were
abandoned at Valley Springs Manor in Castro Valley by the
licensee and all but two staff after the state began
license revocation proceedings. CDSS inspectors, noting the
facility had been abandoned, left the two unpaid service
staff to care for the abandoned residents with insufficient
food and medication, handing them a $3,800 citation before
leaving for the weekend. The next day sheriff's deputies
and paramedics sent the patients to local hospitals.
The California Council of Community Mental Health Agencies,
representing county-funded nonprofit agencies providing
services for seriously emotionally disturbed children,
writes in opposition to the bill and states that additional
audits will not induce change and that instead residential
facilities would be better served with oversight and audits
conducted by county mental health which conduct Medi-Cal
audits.
COMMENTS
This bill is substantially similar to SB 895 (which only
applies to RCFEs) which pushes the phase-in back by one
year, requiring three-year inspections by July 1, 2016,
two-year inspections by July 1, 2017, and annual
inspections by July 1, 2018 and which removes the
provisions requiring a certain percentage of facilities be
inspected each year. Additionally, SB 895 provides that the
department shall conduct an evaluation for compliance with
the laws and regulations governing residential care
facilities for the elderly, which may require the
department to amend or retire use of its current key
indicator inspection tool. SB 895 additionally requires
that deficiencies shall be verified to have been corrected
within 10 days following notification to the facility.
PRIOR VOTES
Assembly Floor 79 - 0
Assembly Appropriations 16 - 0
Assembly Human Services 7 - 0
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POSITIONS
Support: Advancement Project
AFSCME
AFSCME Local 2620
BANANAS
California Alliance of Child and Family
Services
California Alternative Payment Program
California Assisted Living Association
California Child Care Resource & Referral
Network
California Commission on Aging
California Communities United Institute
California Continuing Care Residents
Association
California food Policy Advocates
Child Care Alliance of Los Angeles
Child Care Law Center
Child Care Resource Center
Children Now
Consumer Advocates for RCFE Reform
Community Residential Care Association of
California
County of San Diego
County Welfare Directors Association of
California
First 5 LA
Leading Age California
Local Early Education Planning Council of
Santa Clara County
Los Angeles County Board of Supervisors
Marin Child Care Council
Northern Directors Group
Policy Roundtable for Child Care, Los
Angeles
San Francisco Child Care Planning and
Advisory Council
Solano County Board of Supervisors
Oppose: California Council of Community Mental Health
Agencies
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