BILL ANALYSIS �
AB 1554
Page A
ASSEMBLY THIRD READING
AB 1554 (Skinner)
As Amended May 23, 2014
Majority vote
HUMAN SERVICES 6-0 AGING 7-0
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|Ayes:|Stone, Maienschein, |Ayes:|Yamada, Wagner, Brown, |
| |Ammiano, | |Daly, Gray, Grove, Levine |
| |Ian Calderon, Garcia, | | |
| |Grove | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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APPROPRIATIONS 16-0
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|Ayes:|Gatto, Bigelow, | | |
| |Bocanegra, Bradford, Ian | | |
| |Calderon, Campos, Eggman, | | |
| |Gomez, Holden, Jones, | | |
| |Linder, Pan, Quirk, | | |
| |Ridley-Thomas, Wagner, | | |
| |Weber | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Makes various changes to the state's Residential Care
Facilities for the Elderly (RCFE) complaint procedures.
Specifically, this bill :
1)States the intent of the Legislature that the Department of
Social Services (DSS) shall conduct investigations in the
manner required to ensure maximum effectiveness while
respecting the rights of residents.
2)Requires the DSS to notify a complainant of the name of the
licensing analyst who will be responsible for the
investigation within two days of receiving a complaint.
3)Requires DSS to conduct an onsite inspection within ten days
if DSS determines that the complaint was not willfully filed
to harass a RCFE licensee or without reasonable basis.
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4)Requires DSS to conduct an onsite inspection of a licensed
RCFE within one working day of receiving a complaint if the
complaint alleges physical or sexual abuse or a threat of
imminent danger or serious harm.
5)Requires DSS to immediately review a complaint if it alleges
the denial of uninhibited access, as specified, to a
representative of the Office of the Long Term Care (LTC)
Ombudsman conducting a complaint investigation, and requires
DSS to contact the LTC Ombudsman, and to notify the
complainant of its proposed course of action.
6)Requires DSS to contact, interview, and notify the complainant
of its proposed course of action prior to conducting an onsite
inspection in response to the complaint.
7)Specifies that, to the extent practicable, the representative
of DSS who conducts the investigation will be the
representative who interviews and makes contact with the
complainant.
8)Requires DSS to coordinate its investigation, to the extent
practicable, with the investigations of other agencies,
including, but not limited to the LTC Ombudsman and law
enforcement agencies.
9)Requires DSS to conduct complaint investigations in the manner
required to ensure maximum effectiveness while respecting the
rights of residents.
10)Requires DSS to interview any residents who are the subject
of the complaint and collect and evaluate all available
evidence, as specified.
11)Requires DSS to complete a complaint investigation within 90
days of the receipt of the complaint.
12)Requires DSS to complete an investigation of a complaint
alleging abuse, neglect, or a threat of imminent danger of
death or serious harm within 30 days of the receipt of the
complaint.
13)Permits DSS to extend a complaint investigation by 30 days,
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as specified.
14)Requires DSS to notify the complainant of the findings of the
investigation and of his or her right to appeal in writing
within 10 days of concluding its investigation, as specified.
15)Permits a complainant to appeal the department's findings to
the program manager who supervises the licensing analyst who
conducted the complaint investigation 15 days after receiving
the notice of the complaint investigation findings.
16)Requires the program manager to hold a meeting or
teleconference with the complainant within 30 days of
receiving an appeal and render a decision on the appeal within
ten days of holding a meeting or teleconference with the
complainant, as specified.
17)Permits the complainant to appeal the program manager's
appeal determination to DSS' Deputy Director for its Community
Care Licensing Division (CCLD), who shall interview the
complainant and render a final appeal decision within 10 days,
and notify the complainant in writing of the decision, as
specified.
18)Permits a complainant to be assisted or represented by any
person of his or her choice in the appeal process.
19)Prohibits a licensee or employee of a RCFE from interfering
with an investigation or inspection conducted in response to a
filed complaint and authorizes DSS to assess an immediate
civil penalty of $1,000 per day per violation of this
prohibition.
20)Requires DSS to ensure that a licensee or his or her employee
complies with existing law prohibiting them from retaliating
against an employee or resident because of their involvement
in the filing or investigation of a complaint.
21)Delays implementation of the bill until July 1, 2015.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
On-going costs to DSS likely in the range of $200,000 to
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$300,000 for additional personnel to review complaints, confer
with complainants, and potentially investigate complaints within
the required time frame.
COMMENTS :
Background: It is the intent of the Legislature, in
establishing the RCFE Act, to help provide a system of
residential care to allow older persons be able to voluntarily
live independently in a homelike environment as opposed to being
forced to live in an institutionalized facility, such as a
nursing home, or having to move between medical and nonmedical
environments. RCFEs, commonly referred to as assisted living
facilities, are licensed retirement residential homes and board
and care homes that accommodate and provide services to meet the
varying, and at times, fluctuating health care needs of
individuals who are 60 years of age and over, and persons under
the age of 60 with compatible needs. Licensed by the DSS CCLD,
they can range in size from residential homes with six or less
beds to more formal residential facilities with 100 beds or
more.
There is also no uniform common care model; rather the types of
assistive services can vary widely, which can include differing
levels of personal care and protective supervision, based upon
the needs of the resident.
If a resident needs medical care in his or her residence in
order to maintain an independent lifestyle, incidental medical
services are permitted to be provided by a licensed or otherwise
approved external provider, such as a home healthcare agency
(HHA), which is licensed by the California Department of Public
Health. Additionally, some RCFEs, upon approval of DSS and
after having met specified orientation and training
requirements, may provide assistive memory care services to
individuals with dementia or Alzheimer's disease.
Growing demand: Over the past thirty years, the demand for
RCFEs has grown substantially. Although RCFEs have been
generally available, they experienced explosive growth in the
1990s, more than doubling the number of beds between 1990 and
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2002,<1> and continued to grow 16 percent between 2001 and
2010.<2> Nationwide, states reported 1.2 million beds in
licensed RCFEs in 2010.<3> That same year, the national Centers
for Disease Control reported that 40% of RCFE residents needed
help with three or more activities of daily living and
three-fourths of residents had at least two of the 10 most
common chronic conditions.<4>
According to DSS, as of March 5, 2014 there are 7,589 licensed
RCFEs in California with a capacity to serve 176,317 residents.
Complaints: Under current law, CCLD is supposed to respond to a
complaint against a RCFE within ten days. However, there is no
requirement of CCLD pertaining to whether it is supposed to
inform the complainant that it has received his or her
complaint, whether it has to be resolved, or how long CCLD may
take to investigate a complaint. Residents also have no recourse
if a complaint takes an unreasonable amount of time to
investigate or is not pursued. Additionally, neither current
law nor regulations provides an appeals process for residents
who have found the outcomes of the complaint as 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 and possible expulsion of the deficiency or
complaint.
DSS states that thousands of complaints are received every year.
However, advocates state that complaints are frequently ignored
or remain unaddressed, and that CCLD staff is struggling to meet
the statutory requirement to visit facilities no less than once
every 5 years.
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<1> Flores and Newcomer, "Monitoring Quality of Care in
Residential Care for the Elderly: The Information Challenge".
Journal of Aging and Social Policy, 21:225-242, 2009.
<2> SCAN Foundation. "Long Term Care Fundamentals: Residential
Care Facilities for the Elderly." March 2011.
http://thescanfoundation.org/sites/thescanfoundation.org/files/LT
C_Fundamental_7_0.pdf
<3> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
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Need for this bill: Stating the need for the bill, the author
writes:
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 the opposite is
true. 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.
Elders living in RCFEs today are especially vulnerable
to abuse, neglect and other types of mistreatment.
Many, if not most of them, suffer from dementia, are
in poor health and are physically and emotionally
fragile. Despite their growing needs, they live in
facilities that are loosely regulated and are not
necessarily designed or required to accommodate their
needs.
According to CCL, it received nearly 3,000 complaints
against RCFEs in FY 2011/12, an astounding number when
one considers that many residents and their families
may have never seen a CCL inspector. These complaints
may be the tip of the iceberg. The California Long
Term Care Ombudsman Program reported receiving 11,673
complaints against RCFEs in 2012, 1,673 of which
involved abuse.
From one end of the state to the other, there has been
an explosion of media and other reports documenting
that CCL is failing its mission to protect RCFE
residents from harm and to ensure they are treated
with dignity. The broken complaint investigation
system is central to these failures. AB 1554 responds
to this crisis by requiring CCL to conduct timely,
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thorough investigations of complaints against RCFEs.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0003803