BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1570|
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THIRD READING
Bill No: AB 1570
Author: Chesbro (D)
Amended: 8/18/14 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 4-0, 6/24/14
AYES: Beall, DeSaulnier, Liu, Wyland
NO VOTE RECORDED: Berryhill
SENATE APPROPRIATIONS COMMITTEE : 5-0, 8/14/14
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NO VOTE RECORDED: Walters, Gaines
ASSEMBLY FLOOR : 79-0, 5/28/14 - See last page for vote
SUBJECT : Residential care facilities for the elderly
SOURCE : California Assisted Living Association
California Council for the Alzheimers Association
LeadingAge California
DIGEST : This bill, effective January 1, 2016, requires the
certification program for an applicant for licensure of a
Residential Care Facility for the Elderly (RCFE) to consist of
100 hours of course work and a state-administered examination of
no less than 100 questions; requires the examination to reflect
the uniform core of knowledge required and requires the
Department of Social Services (DSS) to, every other year, review
and revise the examination to reflect changes in law and
regulations; changes the certification fee to an amount not to
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exceed $150 and requires staff members of RCFEs who assist
residents with personal activities of daily living to receive 20
hours of training before working independently with residents,
an additional 20 hours within the first four weeks of
employment, and an additional 20 hours annually, as prescribed;
and applies the training requirements specific to dementia care
to all RCFEs.
ANALYSIS : Existing law:
1.Establishes the Residential Care Facilities for the Elderly
Act (Act), which provides for DSS to license and regulate
RCFEs as a separate category within the existing residential
care licensing structure of DSS.
2.Requires a license applicant and an RCFE administrator to
successfully complete a certification program approved by DSS,
which includes a minimum of 40 hours of classroom instruction
including a uniform core of knowledge, as specified.
3.Specifies that an RCFE administrator certification is valid
for two years and that recertification requires 40 hours of
continuing education. Provides through regulation that an
applicant for licensure is required to meet the requirements
for initial certification of administrators.
4.Provides that the initial certification of administrators
shall include successful completion of a department-approved
program, passage of a written test administered by DSS within
60 days, and a criminal records clearance.
5.Requires DSS to develop requirements for a uniform core of
knowledge for the initial certification and continuing
education requirements for licensees, administrators and staff
of RCFEs. Provides that this knowledge base shall include
basic understanding of the psychosocial and physical care
needs of elderly persons.
6.Provides that RCFE staff members who assist residents with
activities of daily living shall receive at least 10 hours of
initial training within the first four weeks of employment and
at least four hours annually thereafter.
7.Requires DSS to develop a uniform assessment tool to be used
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by all RCFEs in identifying resident needs for service and
assistance with daily living.
8.Requires facility personnel to be sufficient in numbers and
competent to provide the services necessary to meet resident
needs. Provides that DSS may require any facility to provide
additional staff whenever if determines through documentation
that the needs of the particular residents, the extent of
services provided, or the physical arrangements of the
facility require additional staff.
This bill:
1.Increases the required licensee certification training to 100
hours of coursework, at least 60 hours of which is required to
be attended in person.
2.Expands the required state-administered examination to no less
than 100 questions, increases the fee submission to no less
than $150, and allows an applicant to have access to the RCFE
Act and related regulations, during the examination.
3.Expands the required uniform core of knowledge to additionally
include:
A. Medication management, including use, misuse, and
interaction of drugs commonly used by the elderly,
including antipsychotics, and the adverse effects of
psychotropic drugs for use in controlling the behavior of
persons with dementia.
B. Managing Alzheimer's disease and related dementias,
including nonpharmacologic, person-centered approaches to
dementia care.
C. Managing the physical environment, including maintenance
and housekeeping.
D. Residents' rights, and the importance of initial and
ongoing training for all staff to ensure residents' rights
are fully respected and implemented.
E. Cultural competency and sensitivity in issues relating
to the underserved, aging, lesbian, gay, bisexual, and
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transgender community.
F. Postural supports, restricted health conditions, and
hospice care.
1.Requires DSS, no later than July 1 of every other year, to
review and revise the examination in order to ensure the rigor
and quality of the examination, and to ensure, on an annual
basis, that the exam is not in conflict with existing law.
Permits DSS to convene a stakeholder group to assist in
developing and reviewing test questions.
2.Requires DSS to adopt regulations to require staff members of
RCFEs who assist residents with personal activities of daily
living to receive appropriate training consisting of 40 hours
training. Specifies that a staff member shall complete 20
hours, including six hours specific to dementia care and four
hours specific to postural supports, restricted health
conditions, and hospice care, before working independently
with residents. Specifies the remaining 20 hours shall
include six hours specific to dementia care and shall be
completed within the first four weeks of employment. Permits
the training coursework to utilize various methods of
instruction, including, but not limited to, lectures,
instructional videos, and interactive online courses.
Requires the additional 16 hours to be hands-on training.
3.Requires, in addition to the above, training requirements to
also include an additional 20 hours annually, eight hours of
which are required to be dementia care training, four hours of
which are required to be specific to postural supports,
restricted health conditions, and hospice care. Requires this
training to be administered on the job, or in a classroom
setting, or both, and may include online training.
4.Clarifies that all RCFE direct staff are required to meet the
following training requirements: twelve hours of dementia
care training, six of which shall be completed before a staff
member begins working independently with residents, and the
remaining six hours of which are required be completed within
the first four weeks of employment.
5.Permits DSS to establish the subject matter required for the
training in consultation with provider organizations and adds
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the following to the currently required topics:
A. Dementia care, including the use and misuse of
antipsychotics, the interaction of drugs commonly used by
the elderly, and the adverse effects of psychotropic drugs
for use in controlling the behavior of persons with
dementia.
B. The special needs of persons with Alzheimer's disease
and dementia, including nonpharmacologic, person-centered
approaches to dementia care.
C. Cultural competency and sensitivity in issues relating
to the underserved, aging, lesbian, gay, bisexual, and
transgender community.
1.Specifies the above provisions do not apply to certified nurse
assistants, licensed vocational nurses, and registered nurses,
with specified exceptions.
2. Makes the above provisions operative on January 1, 2016.
Background
Residential Care Facilities for the Elderly. Within
California's continuum of long term care, situated between
in-home care and skilled nursing facilities, is the RCFE, also
commonly called Assisted Living, Board and Care, or Residential
Care. There are approximately 8,000 Assisted Living, Board and
Care, and Continuing Care Retirement homes that are licensed as
RCFEs in California. These residences are designed to provide
homelike housing options to seniors and other adults who need
some help with activities of daily living, such as cooking,
bathing, or getting dressed, but otherwise do not need
continuous, 24-hour assistance or nursing care. Increasingly
residents are entering RCFEs with significant health needs
including diabetes, bedsores, or require the use of oxygen
tanks, catheters or colostomies.
Licensee and Administrator training requirements. Existing law
requires prospective licensees and facility administrators to
complete a certification program approved by DSS consisting of
40 hours of classroom instruction.
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Typically, the 40-hour training requirements are met through
private vendors who have been approved by DSS to conduct these
trainings. The courses are generally scheduled as four,
consecutive, 10-hour-day trainings, costing approximately $200
to $300. Following the training, prospective administrators are
required to pass a 40-question test administered by DSS that has
not been changed since its initial release. Approximately 500
individuals take the exam every month. Reportedly, the several
versions of the test are available online to be studied in
advance and few individuals fail the exam. Licensees must only
pass their initial certification and are not required to
maintain a current certification, which expires after two years.
Additionally, corporate owners of a facility, who are not the
official licensee, are not themselves required to be licensed or
have any training despite having financial and managerial
control over the facilities they manage.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Significant one-time and ongoing costs potentially in excess
of $350,000 (General Fund) for DSS to develop and revise
regulations, review and approve certification programs,
administer and periodically revise the examination for RCFE
licensees, and establish the subject matter required for
training for direct care staff. These costs would be offset
by the increase in fee authority.
Significant increase in training costs to employees and/or
facilities to meet the enhanced initial and continuing
education training requirements imposed.
Potential minor non-reimbursable local enforcement costs for
misdemeanor violations of the provisions of the Act pursuant
to this measure.
SUPPORT : (Verified 8/18/14)
California Assisted Living Association (co-source)
California Council for the Alzheimer's Association (co-source)
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LeadingAge California (co-source)
ActivCare Living
Belmont Village Senior Living
Brookdale Senior Living
Byron Park Senior Living
California Commission on Aging
Cal PACE
Capriana Senior Living
The Carlisle
Chancellor Place of Murrieta
Chancellor Health Care, Inc.
Congress of California Seniors
Cypress Place Senior Living
Emeritus at Alhambra
Emeritus at San Juan Capistrano
Huntington Terrace Senior Living
Inn at the Park Senior Living
MBK Senior Living
Mirage Inn Senior Living
Sandi Flores, RN
The Stratford
Sierra Pointe Vintage Senior Living
Sunrise Senior Living of Beverly Hills, La Jolla, Mission Viejo,
Oakland Hills, Studio City, Westlake Village, and Yorba Linda
Vintage Golden Gate
OPPOSITION : (Verified 8/18/14)
Community Residential Care Association of CA
Consumer Advocates for RCFE Reform
ASSEMBLY FLOOR : 79-0, 05/28/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hern�ndez,
Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,
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Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Vacancy
JL:nl 8/18/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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