BILL ANALYSIS �
AB 1571
Page A
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 1571 (Eggman) - As Amended: April 22, 2014
SUBJECT : Residential Care Facilities for the Elderly (RCFE)
SUMMARY : Places additional requirements on RCFE licensee
applicants and requires the Department of Social Services (DSS)
to establish a RCFE consumer information service system.
Specifically, this bill :
1)Deletes the requirement that an applicant for a RCFE license
identify whether they are applying as firm, association,
organization, partnership, business trust, corporation, or
company.
2)Requires the applicant to disclose whether they are a
for-profit or not-for-profit provider, which shall include the
names and license numbers of other facilities owned, managed,
or operated by the same licensee, and the names and addresses
of any persons or organizations listed as owner of record in
the real estate, including the buildings and grounds
appurtenant to the buildings.
3)Clarifies the requirement that applicants provide information
relating to any prior involvement with a RCFE in California
and adds an additional requirement that the information
include whether that prior involvement included a facility in
another state or another similarly licensed facility,
including the applicant's history of compliance applicable
state and federal laws, regulations, and licensing
requirements, as specified.
4)Requires DSS to cross check all applicant information with the
Department of Public Health (DPH) to determine if the
applicant has a prior history of operating health care
facilities, as specified.
5)Requires specified information be provided to DSS upon initial
application for licensure, and any change in the information
shall be provided to DSS within 30 calendar days of that
change.
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6)Provides that the failure of an applicant to cooperate with
DSS in the completion of an application shall result in the
denial of the application and specifies that failure to
cooperate means statutorily and regulatory required
information, as specified, has not been provided, or has not
been provided in the form requested by DSS.
7)Requires DSS to deny an application for licensure and permits
DSS to subsequently revoke a license on the grounds that the
applicant knowingly made a false statement or withheld
enforcement actions against a previously held license, as
specified.
8)Requires DSS, by July 1, 2015 to post on its Internet Web site
RCFE profiles, with data, including, but not limited to all of
the following:
a) The name, address, and telephone number of the licensed
providers, including the owner and the licensee;
b) The number of licensed beds in the facility, including
the number of nonambulatory beds;
c) Whether the facility is permitted to provide hospice
care services;
d) Whether the facility has a special care unit or program
for people with Alzheimer's disease and other dementias or
has a delayed egress or secured perimeter system in place;
and
e) Aggregate information on each facility, including, for
each of the previous five years, the number of complaints
filed against the facility, the number of deficiencies,
enforcement actions resulting in fines against the
facility, and the amount of the fines assessed and the
amount collected.
9)Requires the system, by July 1, 2017, to include on each RCFE
profile all of the following:
a) Information regarding the nature of complaints, results
of complaint investigations, actions taken, and the dates
the complaints were received, investigated and closed;
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b) Information regarding violations assessed, including the
type of deficiency, status of the violation, the facility's
plan of correction, when the corrections were completed,
information as to whether an appeal has been filed, whether
fines were assessed and the amount collected, and whether a
deficiency was dismissed on appeal;
c) Inspection reports and plans of correction, including
findings of the most recent inspection report and the date
that the inspection was conducted; and
d) Any resolution of an appeal pertaining to a violation or
complaint shall be updated in a timely manner.
10)Requires that , by July 1, 2019, each RCFE submit a profile
of resident characteristics to DSS on an annual basis,
including, but not limited to, the number of residents in the
facility who are bedridden, nonambulatory, receiving hospice
care, have one or more allowable health conditions, have one
or more restricted or prohibitive health conditions, or have
dementia; and requires DSS to annually include this
information on the facility profile and on the online consumer
information system.
11)Requires DSS, by July 1, 2019, to develop and implement a
RCFE rating system and states the intent of the Legislature
that DSS work with stakeholder groups, including consumer
organizations in the development of the system.
12)Requires the rating system to include at a minimum, the most
recent inspection report, as specified, and be based upon a
facility's inspection, and other factors as determined by DSS
and stakeholders.
13)Permits DSS to deny an application for licensure on the
grounds that the applicant has a history of noncompliance with
the requirements of a licensed health clinic, health care
facility, community care facility, as defined, or a similarly
licensed facility in another state, applicable state and
federal laws and regulations, and the requirements governing
the operators of those facilities, as specified.
EXISTING LAW
1)Establishes the California RCFE Act, which requires facilities
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that provide personal care and supervision, protective
supervision or health related services for persons 60 years of
age or older who voluntarily choose to reside in that facility
to be licensed by the California Department of Social Services
(DSS). (H&S Code 1569 and 1569.1)
2)Requires RCFE licensee applicants to attend an orientation
given by the department which outlines the applicable rules
and regulations, and the scope and responsibility for
operation of a RCFE. (H&S Code 1569.235)
3)Requires RCFE licensee applicants to successfully complete a
certification program approved by DSS, consisting of a minimum
of 40 hours of classroom instruction, as specified, and
passage of a written test. (H&S Code 1569.23)
4)Requires DSS to authorize organizations, as specified, to
provide certificate and continuing education courses for RCFE
administrators. (H&S Code 1596.616(i))
5)Requires RCFE licensees, administrators, facility managers and
staff to undergo a criminal background check and clearance
prior to operation or employment. (H&S Code 1569.17)
6)Requires any person applying for a RCFE license to provide all
of the following to DSS:
a) Evidence satisfactory to DSS of the ability of the
applicant to comply with existing laws, is of reputable and
responsible character, has sufficient financial resources
to maintain the standards of service required of a RCFE,
the ability to meet regulatory requirements for the level
of care the facility intends to provide, and adequate
knowledge of supportive services and other community
supports which may be necessary to meet the needs of
elderly residents; and
b) The applicant's prior or present involvement with a
RCFE, disclosure of any revocation or other disciplinary
action taken, or in the process of being taken against a
RCFE with which the applicant is involved or was previously
involved, and any other information as may be required by
DSS, as specified. (H&S Code 1596.15)
1)Requires DSS to establish an automated RCFE license
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information system on licensees and former licensees of
licensed RCFEs, which shall include information that may be
pertinent for licensure, as determined by the director, and
may include, but is not limited to, the licensees' addresses,
telephone numbers, violations of any laws related to the care
of clients in a residential care facility for the elderly,
licenses, revocation of any licenses and, to the extent
permitted by federal law, social security numbers. (H&S Code
1569.335)
FISCAL EFFECT : Unknown
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 to 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 DSS' Community Care Licensing Division (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.
When 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.
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Existing regulations also lay out the circumstances under which
an individual may be allowed to reside in RCFEs. Specifically,
they include persons:<1>
Capable of administering their own medications;
Receiving medical care and treatment outside the
facility or who are receiving needed medical care from a
visiting nurse;
Who because of forgetfulness or physical limitations
need only be reminded or to be assisted to take medication
usually prescribed for self-administration;
With problems including, but not limited to,
forgetfulness, wandering, confusion, irritability, and
inability to manage money;
With mild temporary emotional disturbance resulting from
personal loss or change in living arrangement;
Who are temporarily bedridden, as specified; or
Who are under 60 years of age whose needs are compatible
with other residents in care, if they require the same
amount of care and supervision as do the other residents in
the facility.
Regulations also provide specific prohibitions on individuals
who are allowed to reside in a RCFE, which includes whether the
resident has active communicable tuberculosis, requires 24-hour
skilled nursing or intermediate care, has an ongoing behavioral
or mental disorder, or has dementia, unless the individual is
otherwise permitted to be cared for in a RCFE by CCLD.<2>
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
---------------------------
<1> Section 87455(b) of Title 22, California Code of
Regulations.
<2> Section 87455(c) of Title 22, California Code of
Regulations.
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2002,<3> and continued to grow 16% between 2001 and 2010.<4>
Nationwide, states reported 1.2 million beds in licensed RCFEs
in 2010.<5> 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.<6>
According to March 5, 2014 data from DSS, there are currently
7,589 licensed RCFEs in California with a capacity to serve
176,317 residents.
Transparency or lack thereof : Under current law, DSS is
required to operate an automated RCFE license information system
to provide information on licensees and former licensees of
licensed RCFEs. Although this requirement was established in
statute in 1985 (SB 185 (Mello) Chapter 1127, Statutes of 1985),
it is unclear how DSS is complying with this requirement. It
currently has available a searchable database of RCFEs on its
website, however information is limited to the name, location,
contact information, type of facility and whether the facility's
license is current or pending. It does not provide information
such as a facility's licensing history, the expertise and
certification of staff, or its complaints history, including
whether the complaint was resolved. In order to acquire
additional information relating to the quality of a facility, a
person must travel to one of DSS' eight regional licensing
offices and request the information in person.
DSS also currently operates a webpage entitled "myccl" on its
departmental Internet Web site. However, it is only accessible
to RCFE licensees, administrators, board members of the RCFE,
staff, or related individuals per the approval of DSS.
---------------------------
<3> 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.
<4> 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
<5> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<6> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
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Other than DSS' searchable database, which is limited to general
information of RCFEs, there currently does not exist an online
or other automated system provided by DSS whereby the public can
review or learn more about licensed RCFEs. This not only limits
the public's access to information about RCFEs, but it is also
limits CCLD's internal ability to track patterns of poor care
within a single facility, much less across facilities with the
same licensee. Under current practice, when a licensee
undergoes a licensing inspection or is subject to a complaint
investigation, the information reported by CCLD is maintained in
a paper-based format. This limits CCLD's ability to track
licensees overtime and know whether they operate other
facilities that should undergo additional scrutiny.
According to DSS, there are approximately 462 licensing program
analysts responsible for the more than 75,000 licensed community
care facilities, including RCFEs, 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.
In response to increased media coverage of incidences that have
occurred in RCFEs across the state, DSS is currently working to
provide more robust information of licensed RCFEs on its
website. It is anticipated that DSS will be providing an online
searchable database, where the public can access up to five
years of historical information on RCFEs. This searchable
database is proposed to include the following:
The name of the facility and its licensee's name and
contact information;
The number of substantiated, unsubstantiated, and
inconclusive complaints filed against the facility,
including complaint severity and whether a complaint
resulted in a citation; and
The number of inspections, complaint investigations, and
general visits the facility has received.
A timeline for the availability of this searchable database has
not been established.
However, due to the current statutory requirement that all
community care facilities, including RCFEs, undergo an
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unannounced licensing inspection visit at least once every five
years, rather than annually as required prior to 2003, the
reliability and relevance of information included in this
database will be limited. Whereas more information would be
available for those facilities that have recently been inspected
or undergone a complaint investigation, information for a
facility that has not had any complaints filed against it nor
has undergone a licensing inspection in several years be limited
to basic demographic information related to the facility.
Need for the bill : Stating the need for the bill, the author
writes:
Consumers do not have online access to public information
that could help them make an informed choice when choosing
a RCFE. If a consumer wants to view a facility's record,
the consumer must drive to a regional office that may be
far away and require hours of driving.
This bill will require DSS to establish an on-line Consumer
Information System so that consumers have important
information readily accessible. This bill will also
require complete disclosure of ownership and prior
ownership of any type of facility, in any state, including
a history of compliance and will also require DSS to cross
check applicant information with the Department of Public
Health.
Staff comments : This measure seeks to improve RCFE consumer and
resident access to information in three ways. First, it
provides additional clarification as to the types of information
a prospective RCFE licensee must disclose through the
application process. Within this process, it also requires DSS
to deny an application if the prospective licensee is
uncooperative or otherwise unresponsive in completing the
application, if he or she withholds required information, or
provides falsified information. Second, it requires the
establishment of a RCFE consumer information system, which would
include a wide array of licensee information, demographic
information related to the residents of a RCFE, and an overall
profile of RCFEs. Lastly, it requires the development, in
consultation with specified stakeholders, of a RCFE rating
system to allow current and potential residents to compare and
contrast RCFEs.
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The additional requirements set forth in this bill in order for
an applicant to be licensed, include a requirement that the
applicant disclose whether he or she currently or has previously
operated or worked at a related facility in another state. It
additionally requires the applicant to disclose whether he or
she complied with the respective state and federal statutory,
regulatory and other governing requirements for that facility.
Although this information is helpful to DSS in discovering the
suitability of the prospective licensee, it would require DSS to
research and become familiar with other state's licensing
requirements. While this is a laudable goal, it does raise
questions as to whether DSS has the capacity and resources to
become knowledgeable about the governing statutes, regulations
and other licensing requirements of each state. It is likely
that DSS would have to research and evaluate other state's
licensing requirements and determine whether other state's
requirements are inapplicable or less or more rigorous than
California's and whether compliance with those laws should have
a bearing on the qualifications of the applicant.
In regards to the establishment of the information system, the
current requirements in the measure are substantial. It
includes a wide array of information be included over a
four-year period, which includes general and demographic
information of a facility and its residents; an overview of
types of care; history of inspections, complaints; the outcomes
of complaint investigations, and; audits and legal actions.
Although providing access to this information improves
information and greater awareness of RCFEs and the state's
assisted living infrastructure, unless it is presented in an
understandable context, it can be overwhelming to a current or
prospective consumer, his or her family, and the surrounding
community.
Lastly, the bill requires DSS to develop a RCFE rating system to
allow potential and prospective consumers to compare and
contrast facilities. Rating systems can be helpful in informing
consumers about the quality of facilities and is commonly used
in the customer services industry. However, if not created with
specific criteria and expectations, this requirement can result
in ratings that may not be reflective of the actual performance
of the facility or experiences of the residents. Their use in
residential care facilities is relatively new and should be
developed in a manner that ensures criteria used in developing
the ratings is reflective of common expectations, includes
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relevant information, and ensures inclusive stakeholder input.
POLICY CONSIDERATIONS :
In recognition that this measure is a "work-in-progress" and
that the author is continuing to engage and work with
stakeholders to further develop and improve this measure, the
committee, should it choose to pass this measure, should
strongly encourage the author to do the following:
1)Address how out-of-state applicant information can be balanced
with the existing resources and capacity of DSS to effectively
evaluate prospective licensees without overly burdening DSS
with having to verify an applicant's compliance with other
states' licensing requirements;
2)Work with stakeholders and DSS to ensure that the RCFE
information system is easily navigable and that it makes
relevant information available sufficient to inform the public
about the quality of RCFEs in an understandable manner; and
3)Work with stakeholders and DSS to put in place a more
structured stakeholder process with established criteria and
specific outcome goals for the rating system to ensure that it
interacts with, and is reflective of, information included in
the RCFE information system established by this measure.
Additionally, further language is needed to ensure that there
is a common understanding of its purpose and how it can be
used in an informative manner without placing any undue
expectations on RCFEs or provide otherwise irrelevant
information.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees
(AFSCME)
California Advocates for Nursing Home Reform (CANHR)
California Assisted Living Association (CALA)
California Continuing Care Residents Association (CALCRA)
California Long-Term Care Ombudsman Association (CLTCOA)
Consumer Advocates for RCFE Reform (CARR)
Consumer Attorneys of CA
Consumer Federation of California
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Contra Costa Advisory Council
County of San Diego
Disabilities Rights California
Elder Abuse Task Force of Santa Clara County
Elder Law & Advocacy
Jewish Family Services of Los Angeles (JFS)
JM Trial Lawyers
Long Term Care Ombudsman Services of San Luis Obispo Co.
Long Term Care Services of Ventura County, Inc.
National Association of Social Workers CA Chapter (NASW-CA)
National Consumer Voice for Quality Long-Term Care (Consumer
Voice)
Ombudsman Services of Contra Costa
Valentine Law Group
366 Individuals
Opposition
California Right to Life Committee, Inc.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089