BILL ANALYSIS �
AB 1899
Page A
Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 1899 (Brown) - As Amended: March 24, 2014
SUBJECT : Residential Care Facilities for the Elderly (RCFE)
SUMMARY : Prohibits an individual who abandons a RCFE from being
able to reinstate his or her license for ten years and requires
the Department of Social Services (DSS) to operate a RCFE
complaint telephone hotline and Internet Web site.
Specifically, this bill :
1)Prohibits a RCFE licensee, who abandons his or her facility,
from becoming eligible for reinstatement until ten years after
the forfeiture of the facility's license.
2)Specifies that DSS may deny an application for a RCFE license
if the applicant has had a previous license revoked due to his
or her abandonment of a facility.
3)Requires the Director of DSS to establish and maintain a
telephone hotline and Internet Web site for the receipt of
complaints against RCFEs from residents and the public.
4)Requires the Internet Web site to make available to the public
all final complaint actions resulting in citation, suspension,
or revocation taken against each licensee, listed both by the
licensee's name and by the facility's name, and for all
information to be listed in a manner that protects the privacy
of the residents and the confidentiality of resident
information.
EXISTING LAW
1)Establishes the California RCFE Act, which requires facilities
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 a RCFE licensee to forfeit its license when it
expires, is transferred, surrendered, when the facility is
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moved, or when the licensee dies, as specified. (H&S Code
1569.19)
3)Permits any person to request an inspection of a RCFE through
the filing of a complaint, which may be made either orally or
in writing. (H&S Code 1569.35(a))
4)Prohibits the substance of the complaint from being provided
to the licensee no earlier than at the time of the inspection,
unless otherwise permitted by the complainant, as specified.
(H&S Code 1569.25(b))
5)Requires DSS to conduct a preliminary review of every
complaint and conduct an onsite inspection unless it is
determined that the complaint is willfully intended to harass
a licensee or is without any reasonable basis, as specified.
(H&S Code 1569.35(c))
6)Authorizes the Director of DSS to temporarily suspend any
license if he or she determines that the action is necessary
to protect the residents or clients of a RCFE from abuse,
abandonment, or any other substantial threat to health or
safety, as specified. (H&S Code 1569.50(e))
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 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
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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.
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.
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; and
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
---------------------------
<1> Section 87455(b) of Title 22, California Code of
Regulations.
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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 otherwise permitted
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
2002,<3> and continued to grow 16 percent between 2001 and
2010.<4> Nationwide, states reported 1.2 million beds in
licensed RCFEs in 2010.<5> In 2010, 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 DSS, as of March 5, 2014 there are 7,589 licensed
RCFEs in California with a capacity to serve 176,317 residents.
Recent events : A series of recent events has drawn attention to
questions about the adequacy of RCFEs and the CCLD's ability to
comply with existing oversight and enforcement requirements to
help ensure for the health and safety of individuals who receive
services within CCLD-licensed facilities. Over the last several
years, numerous media outlets have documented chronic
understaffing and a lack of required assessments and substandard
care. 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
---------------------------
<2> Section 87455(c) of Title 22, California Code of
Regulations.
<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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in recent years in RCFEs under questionable circumstances that
went ignored or unpunished by CCLD.<7>
The coverage reached a climax with the abandonment of the Valley
Springs Manor, a RCFE with 29 residents in the city of Castro
Valley. The facility, licensed by CCLD in March 2008, had been
frequently visited by CCLD due to numerous violations relating
to the inadequacy of care during its five year existence. In
May 2013 CCLD, taking action in response to its poor care
history, revoked Valley Springs Manor's license. The revocation
was immediately appealed by the licensee, which delayed action
by CCLD and allowed the facility to remain operational. During
this time, CCLD continued to receive and investigate additional
complaints, which culminated with the licensee physically
abandoning the facility sometime in September or October 2013,
leaving its frail seniors under the care of the facility's
administrator and support staff.
Soon after, however, due to lack of compensation and leadership,
the administrator and a majority of the support staff quit,
leaving only the cook and janitor, still unpaid, to provide care
for residents. In response to its inability to reach the
licensee or any administrative staff, CCLD initiated its
temporary suspension order (TSO) process on October 17, 2013
whereby the license would be immediately revoked. The TSO was
delivered four days later for enactment on Thursday, October 24,
2013. After the TSO was delivered, and the licensing analyst's
inspection was concluded, the analyst delivered a $3,800 fine to
the cook for operating an unlicensed facility, even though the
fine should have been delivered either to the administrator or
licensee, and left. No less than an hour after the analyst
left, feeling overwhelmed and unsure about what to do, the cook
and janitor called 911. Immediately thereafter, emergency
services arrived and worked to remove all infirm and at-risk
seniors to local hospital or known relatives.
The following day, upon initial review, according to DSS, CCLD
"made a judgment call that the facility could continue to
function for several more days while the last residents were
relocated, but that judgment was in error." DSS acknowledges,
in retrospect, that CCLD "staff should have been engaged on
Friday to address the developing crisis and make appropriate
---------------------------
---------------------------
<7> "Care Home Deaths Show System Failures," San Diego Union
Tribune, Sept.7, 2013
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arrangements to ensure the safety of remaining residents."<8>
Exacerbating the circumstances of the Castro Valley situation
was the discovery that its licensee also owned and operated two
other RCFEs; a smaller facility in Oakland and another larger
facility in Modesto. Concerned that similar circumstances would
occur at these two facilities, CCLD acted quickly to help
transfer the license of the Oakland facility to another
operator, however, it faced a much more difficult task of
stabilizing and transferring the Modesto facility; Sundial Palms
to another operator. Over the course of three months, CCLD and
DSS executive leadership worked to put in place an intermediate
facility administrator at Sundial Palms, which had nearly twice
the number of residents than Valley Springs Manor in Castro
Valley, and worked to identify and transfer the license to
another operator.
Lack of transparency : 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 SB 185 (Mello),
Chapter 1127, Statutes of 1985, it is unclear how DSS is
complying with it. DSS 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 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.
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
---------------------------
<8> Departmental (DSS) Report on the Closure of the Valley
Springs Residential Care Facility for the Elderly. Page 2
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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 license 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 whether they operate other facilities
that should undergo additional scrutiny.
According to DSS, there are approximately 462 licensing 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 its severity and whether the 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
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
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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 will be
limited to basic demographic information related to the
facility.
Need for this bill : Stating the need for a ten-year ban on
licensees who abandon their facility, the author writes:
"AB 1899 seeks to address the abandonment of residential
care facilities and the need to have an efficient and
centralized system of obtaining accurate information about
these facilities to prevent violators from repeatedly
violating health and safety codes with impunity."
The author goes on to write regarding the need for a centralized
system for the filing and public reporting of complaints that:
"A centralized and modernized method of inquiring,
obtaining, and reporting information about these facilities
through the creation of a telephone hotline and a
progressive internet website program would allow CDSS to
better monitor and track licensure of RCFEs and help
protect California's elderly RCFE consumers."
Oppose unless amended : The California Commission on Aging has
taken an "oppose unless amended" position on the measure. The
Commission writes that it "believes there can be no justifiable
reason for abandoning vulnerable RCFE residents, and for this
reason, there can be no reason for reinstating a license when
abandonment has occurred. We appreciate the bill's intent of
strengthening the state's response to abandonment, but believe
this bill does not go far enough."
RECOMMENDED AMENDMENTS:
Committee staff agrees that should a licensee abandon his or her
RCFE, leaving its vulnerable residents in a position where their
health and safety is at great risk, he or she should not be
allowed to have a license reinstated or be approved for a new
license.
Specifically, staff recommends the following amendments:
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Amendment #1 - On page 3, lines 7 and 8 delete ", until 10 years
have elapsed since the forfeiture"
Amendment #2 - On page 5, lines 24 and 25 delete ", until 10
years have elapsed since the revocation"
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Aging and Long Term Care Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
California Assisted Living Association (CALA)
California Long-Term Care Ombudsman Association (CLTCOA)
California Police Chiefs Association
Community Residential Care Association of CA
Opposition
None on File.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089