BILL ANALYSIS �
AB 1554
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Date of Hearing: May 21, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1554 (Skinner) - As Amended: April 22, 2014
Policy Committee: Human
ServicesVote:7 - 0
Aging 6 - 0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires the Department of Social Services (DSS)
Community Care Licensing Division (CCL) to investigate
complaints involving abuse, neglect, or serious harm to a RCFE
resident within 24 hours or 10 days, and to complete
investigations within 30 or 90 days, depending on the nature of
the complaint. Specifically, this bill:
1)Allows complaints to be made electronically or verbally, as
well as in writing, and clarifies that complainants may seek
investigations, instead of inspections, when credible,
non-harassing assertions of violations are made by any person.
2)Requires DSS to make a preliminary review of the complaint
upon receipt and to notify the complainant of the name of the
investigator within two working days, and make an onsite
investigation within 10 days after receiving the complaint.
Requires an investigation within 24 hours if the complaint
alleges credible abuse (including neglect) or an imminent
threat of death or serious harm.
3)Assures priority action by DSS when the Long-Term Care
Ombudsman submits a complaint that a licensee fails to provide
the Ombudsman with a roster, census, or list of names and room
numbers and locations of residents, or is restricting the
Ombudsman's access to the facility and inhibits interaction
with its residents.
4)Provides for immediate civil monetary penalty of $1,000 for
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each day, for each violation, and allows the department to
take any other authorized enforcement actions for violations.
5)Requires the investigation to be completed within 90 days
unless law enforcement has established an investigation
already, in which case DSS may extend or temporarily suspend
the investigation.
6)Provides for an appeal process in the event the complainant is
dissatisfied with the department's findings or investigation,
or resulting enforcement actions.
FISCAL EFFECT
On-going costs to DSS, likely in the range of $200,000 to
$400,000, for additional personnel to review complaints, confer
with complainants, and potentially investigate complaints within
the required time frame.
COMMENTS
1)Purpose . The author asserts, "Due to the lack of regular
inspections of RCFEs, it is critical that CCL have a strong
and effective complaint investigation system to identify and
stop instances of abuse and neglect. Yet CCL's current
complaint investigation system is plagued by problems of
inadequate investigation, poor communication with
complainants, lack of transparency, weak enforcement, and
appeal procedures that protect operators and imperil
residents. CCL does not send written findings to complainants
except upon request, and does not give complainants an
opportunity to appeal CCL's findings. Even when complaints
are substantiated, meaningful enforcement action by CCL is
very rare."
This bill seeks to improve the complaint response system by
establishing a strict timeline for CCL to begin and complete
investigations of complaints, and providing opportunities for
all affected parties to participate in process and be informed
of and appeal the outcomes.
2)Background . RCFEs, commonly referred to as assisted living
facilities, are licensed retirement residential homes and
board and care homes that provide personal care and
supervision or health related services to persons who are 60
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years of age and over, who voluntarily choose to reside in the
facility. RCFEs enable older persons to live independently in
a home-like environment rather than in nursing home or other
institutionalized facility. Services include personal care and
protective supervision, including incidental medical services,
based upon the needs of the resident.
There are 7,589 licensed RCFEs in California with a capacity
to serve over 176,000 residents. Licensed by DSS' Community
Care Licensing Division (CCL), RCFEs range in size from
residential homes with six or less beds to more formal
residential facilities with 100 beds or more. DSS is required
to conduct unannounced licensing inspections of the more than
75,000 licensed community care facilities, including RCFEs, at
least once every five years, more often in some circumstances.
3)Complaints. CCL is required to respond to a complaint against
a RCFE within 10 days. However, there is no requirement that
CCL inform the complainant it has received the complaint, what
course of action is necessary, or how long CCL may take to
investigate the complaint. Residents have no recourse if a
complaint takes an unreasonable amount of time to investigate
or is not pursued. Additionally, neither current law nor
regulation provides an appeals process for residents who have
found the outcomes of the complaint investigation to be
dissatisfactory. Conversely, in cases where a RCFE has been
found to have a deficiency or be in violation of law during a
regular inspection visit or complaint investigation,
regulations provide a process for appeal.
According to CCL, it received nearly 3,000 complaints against
RCFEs in 2011-12. The California Long Term Care Ombudsman
Program reported receiving 11,673 complaints against RCFEs in
2012, 1,673 of which involved abuse.
4)Community Care Licensing Capacity . 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 means a ratio of
one licensing analyst per 162 facilities and 3,030
individuals.
It is clear the budget deficits of the last 10 years have
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significantly impacted the ability of DSS to monitor the
health and safety of residents and clients of community care
facilities throughout the state. An increase in oversight
responsibilities, combined with staff reductions and unfilled
staff positions, work furloughs and hiring freezes, has
severely reduced its administrative capacity and imposed
significant workload challenges.
5)Governor's Budget Proposal . In response to recent health and
safety issues discovered at facilities licensed by CCL, the
2014-15 Governor's Budget proposes a comprehensive plan to
reform the CCL program. This proposal includes an increase of
$7.5 million ($5.8 million General Fund) and 71.5 positions to
improve the timeliness of investigations, ensure the CCL
inspects all facilities at least once every five years,
increase staff training, and establish clear fiscal, program,
and corporate accountability. The proposal also increases
civil penalties assessed for violations and increases
licensing and application fees by 10%.
Further, the proposal includes a specialized and centralized
toll-free public complaint hotline, which can help acquire
better initial information, conduct consistent prioritization,
and dispatch incoming complaints to regional offices.
6)Related Legislation . AB 1899 (Brown, 2014) among other
provisions, requires DSS to establish and maintain a telephone
hotline and an internet-based website to accept public
complaints regarding RCFEs. This bill is pending on this
committee's Suspense File.
7)RCFE Reform Package . In response to a number of highly
publicized events at facilities licensed by CCL that have
raised questions regarding the state's ability to comply with
existing oversight and enforcement requirements, a number of
legislative measures are being pursued to strengthen, address
shortcomings, resolve legal liabilities and gaps in the
provision of services, and ultimately reform the RCFE
industry. Several of these measures are pending on this
committee's Suspense File.
Analysis Prepared by : Jennifer Swenson / APPR. / (916)
319-2081
AB 1554
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