BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1571
A
AUTHOR: Eggman
B
VERSION: May 23, 2014
HEARING DATE: June 24, 2014
1
FISCAL: Yes
5
7
CONSULTANT: Sara Rogers
1
SUBJECT
Residential Care Facilities for the Elderly: licensing and
regulation
SUMMARY
This bill expands the scope of information that prospective
Residential Care for the Elderly (RCFE) licensees must
provide to the California Department of Social Services
(CDSS). Additionally, this bill requires CDSS to
cross-check all applicant information with the California
Department of Public Health (CDPH). This bill requires CDSS
to post specified information regarding RCFE facilities on
its internet website within specified timeframes. This bill
also requires CDSS, by July 1, 2019, to develop and
implement a RCFE rating system designed to allow consumers
to compare RCFEs.
ABSTRACT
Existing Law:
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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1.Establishes the Residential Care Facilities for the
Elderly Act, which provides for the CDSS to license and
regulate RCFEs as a separate category within the existing
residential care licensing structure of CDSS. (HSC 1569
et seq.)
2.Requires applicants for an RCFE license to file an
application which includes a criminal record clearance,
employment history, character references, evidence of
certification, and disclosure of previous service in
other RCFEs, outpatient health clinics, health facilities
(including hospitals, skilled nursing facilities or
intermediate care facilities), or a community care
facility, and other requirements. (HSC 1569.15)
3.Within the application, requires the applicant to
disclose prior or present service as an administrator,
general partner, corporate officer or director of, or as
a person who has held or holds a beneficial ownership of
10 percent or more in, any RCFE, health facility or
community care facility. (HSC 1569.15 (d))
4.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, or to
verify that a person who has been ordered out of the
facility is no longer present. (HSC 1569.33)
5.Requires CDSS to perform random inspections each year on
no fewer than 20 percent of the RCFE facilities not
subject to annual inspections. Provides that this
percentage shall 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 RCFE facilities not subject to annual
inspection. Requires CDSS to visit every facility no less
than every 5 years. (HSC 1569.33)
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6.Requires CDSS to visit a newly licensed facility within
90 days after a facility accepts its first resident to
evaluate compliance with regulatory requirements. (HSC
1569.24)
7.Permits any person to request an inspection of any RCFE
by transmitting notice of an alleged violation orally or
in writing. Requires CDSS to make a preliminary review
and an onsite inspection within 10 days after receiving
the complaint except where the visit would adversely
affect the licensing investigation or the investigation
of other agencies, including, but not limited to, law
enforcement agencies (HSC 1569.35)
This bill:
1.Requires an applicant for an RCFE license to disclose
whether the licensee is a for-profit or not-for-profit
provider, 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 belonging to
the buildings.
2.Expands current requirement to disclose ownership of
other community care facilities, health facilities or
RCFEs to additionally require disclosure of other
similarly licensed facilities, and the applicant's
history of compliance with the requirements imposed under
those licenses.
3.Requires a licensee to disclose evidence of the right of
possession of the facility at the time the application is
granted, as specified and including the names and
addresses of any persons or organizations listed as
owners of the real estate.
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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4.Requires CDSS to cross-check all applicant information
with CDPH to determine an applicant's prior history of
operating, holding a position in, or having ownership in
a health facility.
5.Requires an applicant to provide information upon initial
application of licensure and requires changes in the
information to be disclosed within 30 days of the change.
6.Requires CDSS to post the following information on its
internet website by July 1, 2015:
Name, address and telephone number of licensed
providers, including the owner and the licensee;
Number of licensed beds in the facility,
including the number of nonambulatory beds;
Whether the facility is permitted to provide
hospice care services;
Whether the facility has a special unit or
program for people with Alzheimer's disease and
other dementias and has a delayed egress or secured
perimeter;
Other information statutorily required to be
included in an RCFE license application including
evidence that the licensee is of reputable and
responsible character, has financial resources to
meet the regulatory requirements for the level of
care the facility intends to provide, and others.
Five years of aggregate information on the
number of complaints, deficiencies, enforcement
actions resulting in fines and the amount of any
fines;
Department actions including license
suspensions, revocations, probations, settlements,
stipulations, accusations, audits, noncompliance
conference summaries or other administrative or
legal actions, and when the administrative or legal
action was taken, and will be terminated.
1.Requires CDSS, to the extent that its computer system can
accommodate additional profile information, to post the
following information on its internet website as soon as
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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possible but no later than January 1, 2019:
Complaints, including the nature of complaints,
results of complaint investigations, actions taken,
and the dates the complaints were received,
investigated and closed;
Violations assessed, including the type of
deficiency, status of the violation, the facility's
plan of correction, when the corrections were
completed, whether an appeal has been filed, whether
fines were assessed and the amount collected, and
whether a deficiency was dismissed on appeal;
Inspection reports and plans of correction,
including findings of the most recent inspection
report and the date that the inspection was
conducted; and
Any resolution of an appeal pertaining to a
violation or complaint shall be updated in a timely
manner.
1.Requires by July 1, 2019, that each RCFE submit a profile
of resident characteristics to CDSS 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 CDSS to
include this information on the facility profile and on
the online consumer information system annually.
2.Requires CDSS, by July 1, 2019, to develop and implement
a RCFE rating system designed to allow consumers to
compare RCFEs.
3.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
determined by CDSS and stakeholders.
4.Requires CDSS to ensure the confidentiality of personal
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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and identifying information of residents and employees as
specified.
5.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.
FISCAL IMPACT
According to an Assembly Appropriations analysis, this bill
would result in ongoing minor costs for CDSS to cross check
all applicant information with CDPH for prior history of
operating health care facilities. CDSS indicates they do
this now for applicants who self-identify with this type of
prior history. Additionally, the analysis projects one-time
costs to CDSS in the range of $1 million in 2014/15 and
ongoing costs of approximately $700,000 for project
development, testing and maintenance and other related IT
contract work related to website improvement and the
development and implementation of a RCFE rating system.
Finally, the committee projects ongoing costs, likely
minor, to maintain and periodically update the facility
rating system.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, consumers of RCFEs do not have
access to substantive facility information that may help
them make a more informed choice when selecting a facility.
Additionally, the author states that the departments of
Public Health and Social Services are not required to
communicate when an applicant applies for an RCFE license.
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This bill is sponsored by California Advocates for Nursing
Home Reform (CANHR) as one of a large package of bills
responding 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.<1> 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.
Additionally, 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 the Community Care Licensing Division of CDSS.<2>
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.
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<1>
http://www.propublica.org/article/life-and-death-in-assisted
-living-single
<2> "Care Home Deaths Show System Failures," San Diego
Union Tribune, Sept.7, 2013
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The author notes that the owner of this facility had
previously owned a nursing home facility licensed by CDPH.
Over the course of that ownership, the owner lost the
nursing home license and had significant accumulated fines.
The author states that if CDSS had been required to cross
check an applicant's information with CDPH, the incident
may have been prevented.
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 or bedsores, or require the use of oxygen tanks,
catheters, colostomies or ileostomies.
The RCFE licensure category includes facilities with as few
as six beds to those with hundreds of residents, whose
needs may vary widely. Typically, the smaller facilities
are homes in residential neighborhoods while the larger
facilities resemble apartment complexes with structured
activities for their residents. Residents may live in their
own apartment, or may share a bedroom. Generally, residents
are free to leave the facility if they choose, and may
entertain guests, and otherwise maintain a high level of
independence. Facilities licensed to serve residents with
dementia or Alzheimer's disease, also known as "memory care
units" may maintain a secure perimeter.
Financial Structure
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More than 90 percent of RCFE licenses in California are
held by for-profit providers, and the majority of those
facilities have six or fewer beds.<3> Most residents pay
privately or with long-term care insurance since there is
very little public funding available through Medi-Cal,
Supplemental Security Income (SSI/SSP) or Medicare, and
fees can range from $2,500 to more than $8,000 per month. A
very few beds are available to seniors who pay their entire
SSI/SSP checks in rent. In 2013 the maximum SSI/SSP grant
was $866.40. Residents who rely solely on Social Security
Income may have a maximum payment of $2,642 per month in
2014, although the amount varies widely based on the
recipient's prior income while working.
Increasingly, complex corporate mergers and acquisitions
have meant that many RCFEs are owned by national corporate
chains that control more than one facility. Administrators
employed by these chains may also oversee multiple
facilities. This development has led to regulatory
challenges since Community Care Licensing citations and
other licensing reports are facility specific, and
management problems common to multiple RCFEs with the same
owner may easily go unnoticed.
Licensee and administrator requirements
California statute differentiates between facility
licensees, who often are the business owners and may be
property owners, and administrators, who are charged with
overseeing the quality of the day-to-day operations and are
generally required to be present at the facility during
normal working hours.
State law requires prospective RCFE licensees to provide
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<3> "Residential Care in California: Unsafe, Unregulated &
Unaccountable," California Advocates for Nursing Home
Reform, 2013
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evidence that he or she is of "reputable and responsible
character"<4> including a criminal background clearance,
employment history and character references. Licensees must
document sufficient financial resources to maintain the
standard of care required by law, must disclose any prior
role as an administrator or owner of any community care
facility and any prior disciplinary action. In order to be
certified, each licensee must complete at least 40 hours of
classroom instruction covering relevant laws and
regulations, management of staff, physical and psychosocial
needs of elderly residents, and other issues.
Administrators are required to hold a department-approved
certificate, similar to the licensee certificate, which
must be renewed every two years. Other requirements for
administrators are that they must be at least 21 years of
age, have a high-school diploma and undergo a criminal
record clearance. Those working in larger facilities are
required to meet additional educational or experience
requirements. Facility administrators may lose
certification if they are found to have "engaged in conduct
which is inimical to the health, morals, welfare, or safety
of either an individual in or receiving services from the
facility or the people of the State of California."<5>
2014-15 Budget Act
Included in the 2014-2015 budget are new staff resources to
establish a statewide quality assurance unit, which will
report directly to the Deputy Director of Community Care
Licensing. The unit will focus on conducting reviews at the
division, program and regional office levels to do the
following:
Identify immediate health and safety risks to clients and
ensure appropriate follow-up
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<4> HSC 1569.15
<5> Title 22 CCR 87408
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Develop a statewide quality assurance review model
Identify training needs on the basis of quality assurance
reviews
Coordinate licensing case file responses to Public Record
Act requests, include redaction as necessary
Identify policy, procedural, and information systems
weaknesses, and
Ensure that policies, procedures, laws and regulations
are followed consistently.
Additionally, the proposal calls for the addition of six
new Special Investigator Assistants to support the CDSS
Investigators who have peace officer status and who are
cited as essential to improving the timeliness of
investigations. The proposal also calls for the
establishment of a statewide toll-free hotline to receive
and review public complaints and for an expansion of the
Licensing Program Analyst training for the LPAs who are
responsible for responding to complaints.
Transparency
Existing law requires CDSS to publish and make available
lists of all licensed RCFEs and to develop a written notice
to be provided by RCFEs to interested parties, informing
them that the department licensing analyst inspection
reports on all RCFEs are on file and are available for
public view in the departments community care licensing
district office nearest to each RCFE.<6> RCFEs are required
to publish the current license number in all outreach
materials and correspondence. These materials, while
available online in other states, can only be accessed by
the public by physically visiting a regional office and
requesting the inspection reports.
CDSS publishes on its website a "myccl" webpage in which
the public can search for providers of adult residential
care and child care by zip code. Information found on the
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<6> HSC 1569.76
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website includes the facility's license number, its
capacity and which CDSS district office houses additional
materials. However, the website does not provide
information about citations or sanctions against providers.
The primary reason for this is a technology barrier,
according CDSS.
Currently, LPAs input survey results, including citation
information, into an antiquated word processing system,
Lotus Notes, that does not interact with any of the
department's other data collection tools. As a result, the
department is unable to track patterns of poor care within
a single facility, much less across facilities with the
same owner. CDSS is also unable to upload information to
its web site for the public to see citation information on
facilities. Efforts have been made to bridge the antiquated
field information system to data collection systems,
including a grant from the California Health Care
Foundation in 2008. However the Lotus system is so old
those technology patches have been unsuccessful. In order
for CDSS to comply with some of the 2015 requirements and
all of the 2019 requirements, a new licensing database
would need to be developed and implemented.
Related Legislation:
AB 1436 (Waldron) 2014 would have required CDSS to post
specified information on its website regarding Residential
Care Facilities for the Elderly (RCFE), including results
of licensing inspections reports, consultation reports,
violations, plans of correction, appeal requests, and the
number, nature and status of complaints filed against a
facility. This bill was held in the Assembly Appropriations
Committee.
AB 1899 (Brown) 2014 requires CDSS to establish and
maintain a telephone hotline and an internet-based website
to accept public complaints regarding RCFEs, and requires
the website to include final actions resulting in citation,
suspension, or revocation against each licensee, indexed by
name of the licensee and by the name of the facility. This
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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bill is set to be heard in this committee on June 24.
AB 2621 (Garcia) 2014 would require CDSS to post specified
information on their website regarding child day care
facilities. This bill is set to be heard in this committee
on June 24.
SB 895 (Corbett) 2014 would require all inspection reports,
consultation reports, lists of deficiencies, and plans of
correction to be open to public inspection on the
department's Internet Web site and in its district offices.
That bill passed the Assembly Human Services Committee on
June 17.
COMMENTS
1.CDSS released an online searchable database this month
with up to five years of historical information on RCFEs,
including:
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;
The number of inspections, complaint
investigations, and general visits to the facility.
The current language of this bill is significantly broader
than what the department has indicated it is able to
provide online prior to completion of a new data system.
Staff recommends amending this bill to reflect the
information the department has currently made available.
Additionally, staff recommends that the provisions of this
bill requiring additional information to be provided by
2019, instead require the information to be provided upon
completion of a new data system.
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2. There is little detail provided regarding the quality
rating system and although the bill calls for the
consultation with stakeholders, the author may wish to
consider amending the bill to instead require the creation
of a stakeholder workgroup to develop a proposed rating
system for future consideration by the legislature.
Staff recommends that Section 2 be amended as follows:
1569.356.
(a) By July 1, 2015, the department shall post on its
Internet Web site residential care facility for the elderly
profiles, with data, including, but not limited to, all of
the following:
(1) The name, address and telephone number of the licensed
providers, the status of the license, and the facility
capacity.
(1) The name, address, and telephone number of the licensed
providers, including the owner and the licensee, the number
of licensed beds in the facility, including the number of
nonambulatory beds, whether the facility is permitted to
provide hospice care services, whether the facility has a
special care unit or program for people with Alzheimer's
disease and other dementias and has a delayed egress or
secured perimeter system in place, and information required
pursuant to Section 1569.15.
(2) Aggregate information on each facility, including, for
each of the previous five years, the number of site visits
and inspections, the number of substantiated and
inconclusive complaint allegations filed against the
facility, and the number and type of citations assessed
against the facility. 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.
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(3) Department actions, including license suspensions,
revocations, and probations. settlements, stipulations,
accusations, audits, noncompliance conference summaries or
other administrative or legal actions, and when the
administrative or legal action was taken and will be
terminated .
(b) The department shall actively seek technologies that
enable it to post the following information on its Internet
Web site, or if none exist, upon completion of a new
Community Care Licensing data system , To the extent that
the department's computer system can accommodate additional
residential care facility for the elderly profile
information, the department shall, as soon as possible but
no later than January 1, 2019, post on its Internet Web
site the following information:
(1) The name, address, and telephone number of the licensed
providers, including the owner and the licensee, the number
of licensed beds in the facility, including the number of
nonambulatory beds, whether the facility is permitted to
provide hospice care services, whether the facility has a
special care unit or program for people with Alzheimer's
disease and other dementias and has a delayed egress or
secured perimeter system in place, and information required
pursuant to Section 1569.15.
(2) Complaints, including the nature of the complaint,
results of the complaint investigation, actions taken, and
the dates that the complaint was received, investigated,
and closed.
(3) 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.
(4) Posting of the facility inspection reports and plans of
correction, including findings of the most recent
inspection report and the date that the inspection was
conducted.
(c) Any resolution of an appeal pertaining to a violation
or complaint shall be updated in a timely manner.
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(c) By July 1, 2019, Upon completion of a new Community
Care Licensing data system, or as soon as the current data
system permits, each licensee of a residential care
facility for the elderly shall submit a profile of resident
characteristics to the department 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. The department shall include
this information on the facility profile and on the online
consumer information system annually.
(d) By July 1, 2019, the department shall develop and
implement a ratings system designed to allow consumers to
compare residential care facilities for the elderly.
(1) At a minimum, the ratings system shall be updated to
reflect the most recent inspection report, as required by
Section 1569.33.
(2) The ratings shall be based on a facility's inspection,
and other factors as determined by the department in
consultation with stakeholders.
(e) It is the intent of the Legislature that the
department, in developing and establishing the system
pursuant to this section, shall work with stakeholder
groups, including consumer organizations.
(f) In implementing this section, the department shall
ensure the confidentiality of personal and identifying
information of residents and employees and shall not
disclose this information through the consumer information
service system developed pursuant to this section.
PRIOR VOTES
Assembly Floor 72 - 1
Assembly Appropriations 13 - 0
Assembly Human Services 6 - 0
POSITIONS
Support: California Advocates for Nursing Home Reform
(sponsor)
Assisted Living Consumer Alliance
California Alliance for Retired Americans
California Assisted Living Association
California Continuing Care Residents
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Eggman)
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Association
California Long-Term Care Ombudsman
Association
California Senior Legislature
Consumer Attorneys of California
Consumer Federation of California
Contra Costa Advisory Council on Aging
County of San Diego
Disability Rights California
Elder Law & Advocacy
Jewish Family Services of Los Angeles
Johnson Moore Trial Lawyers
Law Offices of Sanford Horowitz
Long Term Care Services of Ventura County,
Inc.
National Association of Social Workers
National Consumer Voice for Quality
Long-Term Care
Ombudsman Services of Contra Costa
Stanislaus County Commission on Aging
Valentine Law Group, APC
2 individuals
Oppose: California Right to Life Committee, Inc.
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