BILL ANALYSIS �
AB 1899
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Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 1899 (Brown) - As Amended: April 22, 2014
SUBJECT : Residential care facilities for the elderly licensure:
internet complaint reporting, license forfeiture and lifetime
ban.
SUMMARY : This measure establishes a telephonic hotline and an
internet-based complaint intake mechanism at the Department of
Social Services (DSS) for consumers who wish to register a
complaint about a Residential Care Facility for the Elderly
(RCFE), and requires an RCFE license to be revoked when the
licensee abandons a facility, and then bans that individual from
licensure for life. Specifically, this bill :
1)As of January 1, 2015, establishes a lifetime ban upon an RCFE
licensee who is required to forfeit his/her license for
abandoning an RCFE.
2)Requires the Director of the Department of Social Services to
establish and maintain a telephone hotline, and an
internet-based web-site dedicated to accepting public
complaints regarding RCFEs.
3)Requires the web-site to host data related to final actions
resulting in citation, suspension, or revocation taken against
each licensee, indexed by the name of the licensee and by the
name of the facility.
EXISTING LAW :
1)Establishes the California Community Care Facilities Act which
includes licensing and regulation provisions relative to adult
residential facilities, group homes, and RCFEs.
2)Establishes that RCFEs will provide a model of non-medical
residential care for persons 60 years of age or over, and
permits RCFEs to provide varying levels and intensities of
care and supervision based on the resident's needs.
3)Provides for the licensure and regulation of RCFEs by the
State Department of Social Services (DSS) and establishes the
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requirements for licensure and license renewal.
4)Requires that an RCFE license must be forfeited prior to
expiration when a licensee sells or transfers a facility or
facility property, is convicted of assault, sexual battery,
rape, cruel or inhuman punishment, lewd and lascivious acts,
or any violent felony, or upon death of the licensee.
5)Allows any person to request an inspection of a RCFE by filing
a complaint - orally or in writing.
6)Requires DSS to conduct a preliminary review of every
complaint and conduct an onsite inspection within 10 days
unless the complaint is determined to be willful harassment,
and the complainant was promptly informed of the Department's
course of action.
7)Authorizes the Director of DSS to deny, suspend or revoke an
RCFE license under specified conditions.
FISCAL EFFECT : Unknown
COMMENTS :
Background : California's aged population is growing rapidly.
The state's 65+ population will reach 5 million people, or about
14% of the population, this year. By 2035, the state's
population profile will consist of one-in-five over age 65, a
demographic shift expected to present vexing problems for policy
makers and governmental agencies attempting to address care
needs of this expanding and diversifying population while the
pool of those available to give care remains flat.
Residential Care Facilities for the Elderly (RCFE) is a model of
care overseen by the Department of Social Services. RCFEs
provide care, supervision and assistance with activities of
daily living, such as bathing, dressing, ambulating, grooming,
and other personal activities. They may also provide incidental
medical services under special care plans. Facilities provide
services to persons 60 years of age and over and persons under
60 with compatible needs. RCFEs are also referred to as
assisted living facilities or board and care homes. Facilities
can range in size from six or fewer, to over 100 beds.
Residents in RCFEs require varying levels of personal care and
protective supervision. Since RCFEs are non-medical facilities,
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they are not required to have nurses or other health personnel
on staff.
The DSS has overseen a rapid increase of RCFEs, along with a
recent plateau of that growth trend. Between 2001 and 2009,
RCFE licensees increased from about 6,200 to about 7,850,
representing 26.8% growth. By March of this year, the number of
RCFE licensees was 7570, reflecting a 3.5% decline since 2009.
Fiscal Year: Number of Licenses
FY 2000-2001 6,187
FY 2001-2002 6,204
FY 2002-2003 6,313
FY 2003-2004 6,491
FY 2004-2005 6,730
FY 2005-2006 6,992
FY 2006-2007 7,334
FY 2007-2008 7,707
FY 2008-2009 7,847
FY 2009-2010 7,822
FY 2010-2011 7,681
FY 2011-2012 7,695
Recent media has captured the ramifications of the rapid
expansion, and diversification of the RCFE industry and DSS
oversight, as the industry and regulators struggle to meet the
housing and care needs of a growing aged population, and the
corresponding increased presence of disabilities within our
communities. One case that received significant media attention
focused upon the abandonment of Valley Springs Manor, a RCFE
with 19 residents in the city of Castro Valley. The facility
had been frequently visited by Community Care Licensing
Division, (CCLD) the unit within DSS designated to enforce
standards due to numerous regulatory violations. In May 2013
CCLD, taking action in response to the beleaguered facility's
poor care history, revoked Valley Springs Manor's license.
Licensees are granted appeal rights in such instances and the
revocation was immediately appealed, which allowed the facility
to remain operational. The licensee abandoned the facility
during the fall of 2013, ultimately leaving its frail clientele
under the care of the facility cook, a noble effort for which he
was rewarded a $3,800 citation which CCLD later rescinded. Even
though CCLD issued the citation, it was not until the cook
called "911" that emergency protocol to protect the residents
was activated.
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Governor's Proposal : The Governor has proposed the following
budget initiatives to assist DSS with their oversight
activities. Though budget initiatives, these proposals carry
significant policy implications as well, including #8 below,
similar to the complaint mechanism embodied in
AB 1899.
1)Additional positions. An additional 71.5 positions to assist in
CCLD enforcement activities including six special investigator
assistants, a nurse practitioner, five licensing program
managers, and others.
2)Staff training and development for new field staff and training
for supervisors and managers by expanding the Licensing
Program Analyst academy, implementing ongoing training, and
strengthening the Administrator Certification Section.
3)Recognizing the changing needs of clients in RCFEs, the
Governor's budget proposes that DSS will assist with policy
and practice development for medical and mental health
conditions in community facilities, by establishing medical
expertise resources. Although CCLD has no staff with medical
expertise, DSS licenses facilities that do allow for
incidental medical care.
4)Create a Mental Health Populations Unit which would provide
technical assistance to enforcement staff and licensees, as
well as to individuals who reside in facilities who have
increasing mental health care needs.
5)Establish a Corporate Accountability Unit. With increased
applications for Residential Care Facilities for the Elderly,
corporate mergers and acquisitions, the additional attorney
and associate governmental program analyst would perform
systemic noncompliance analysis and ensure corrective actions;
create management reports that identify patterns and trends;
make corrective action recommendations; and, follow-up on
corrective action plans.
6)Increased civil penalties. Because the current civil penalty
structure is related to a "per violation" event, the current
maximum civil penalty, even in response to serious injury or
death of a resident, is $150.
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7)Establish a Temporary Manager and Receivership Process to appoint
a temporary manager or receiver to act as the provisional
licensee, if DSS determines that residents of a facility are
likely to be in danger of serious injury or death, and the
immediate relocation of clients is not feasible.
8)Specialized complaint hotline: a specialized and centralized
toll-free public complaint hotline, which can help acquire
better initial information, conduct consistent prioritization,
and dispatch incoming complaints to regional offices.
9)Centralized application processing for Adult and Senior Care
facilities, which is expected to increase inspections of
licensed facilities to at least once every two years.
10)Establish a statewide Quality Assurance Unit to track
information statewide, including complaints, actions, or
performance.
11)Establish an Emergency Client/Resident Contingency Account to be
used at the discretion of the Director of DSS for the care and
relocation of clients and residents, when a facility's license
is revoked or temporarily suspended.
Author's Statement : "It is estimated that by 2020 our senior
population will increase and total 15.7 million seniors, which
will comprise 14% of the nation's population. This will
increase the numbers of seniors in residential care facilities
and the accompanying health and safety code violations, which
lead to abandonment of a facility. 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.
"AB 1899 is designed with the anticipation of our growing senior
population and the changing role of residential care facilities
for the elderly (RCFE) in California. Data from the Medicare
Current Beneficiary Survey, or MCBS, the elderly nursing home
population has declined over the past 10 years; more elderly
people are living in residential care facilities and other types
of care facilities, in community-based housing with supportive
services, and in houses in a regular community with no
supportive services. That trend is especially pronounced for
people 85 or older. Recent reports about health and safety code
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violations and the incidents occurring in California's RCFEs
warrants the need for license revocation for abandonment of a
facility. 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."
Supporters Argue : Industry, local government and advocates
support AB 1899 for the provisions related to banning licensees
from obtaining new licenses once they have abandoned a facility.
Law enforcement cites their support for the telephone hotline
and internet website dedicated to complaint reporting, and
posting of enforcement actions. The California Commission on
Aging, the state's designated principle advocate for older
adults, stresses that licensees not be allowed to return to the
industry if they have abandoned a facility. The California
Long-Term Care Ombudsman Association stresses the value to
consumers when they have an on-line resource to consult about
concerns related to facility quality and licensing compliance.
Lifetime Ban : The author may wish to consider developing
language to provide for a mechanism that offers due process to a
former licensee whose license was revoked for allegedly
abandoning a facility and its residents, and who is subsequently
banned from re-licensure. A lifetime ban, though understandable
as a remedy for the state to keep untrustworthy licensees with
histories of neglect and abandonment out of the RCFE industry,
is a powerful and heavy "tool" to deliver to a state regulator.
Previous Hearing : AB 1899 was heard in the Assembly Human
Services Committee on
April 8, 2014, and passed on a 6-0 vote.
Related Past Legislation :
AB 2262 (Lanterman, Lewis, and Brown, Ch. 1203, Stats. 1973)
established the
Community Care Facilities Act and provided a coordinated
comprehensive statewide service system of quality community care
for mentally ill, developmentally and physically disabled, and
children and adults who require care or services by a facility
or organization.
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SB 185 (Mello, Ch. 1127, Stats. 1985) was enacted to provide for
the licensing, regulation, and operation of residential care
facilities for the elderly (RCFE).
AB 3459 (Friedman, Ch. 1333, Stats. 1990) was enacted to provide
for the licensing, regulation, and operation of residential care
facilities for persons with a chronic, life-threatening illness.
Current Session :
SB 894 (Corbett) Suspensions and Revocation: this bill would
amend current law to strengthen and improve the procedures
regarding suspension and/or revocation of licenses and to create
expedited timelines for the safe relocation of residents when a
facility's license has been revoked.
SB 895 (Corbett) Annual Inspections: this bill would amend
Health and Safety Code section 1569.33 to require CCL to conduct
unannounced, comprehensive inspections of all RCFEs at least
annually.
SB 911 (Block) Administrator and Staff Training: increases the
hours of training for both administrators and direct care staff;
increases the training requirements for staff serving persons
with dementia or who distribute medication for resident
self-administration.
SB 1153 (Leno) Ban on Admissions: this bill gives DSS the
ability to impose a ban on new admissions to a RCFE. This will
protect unknowing future residents and give the facility time to
focus their resources on fixing its problems before taking on
additional care responsibilities.
AB 1554 (Skinner) Complaint Investigations: This bill would
require CCL to begin investigations of complaints involving
abuse, neglect, or serious harm to a RCFE resident within 24
hours; to complete investigations of these highest priority
complaints within 30 days; and to ensure the confidentiality of
patients, staff and whistleblowers.
AB 1571 (Eggman) Online Consumer Information System: AB 1571
would require that DSS/CCL establish an on-line RCFE Consumer
Information System to include specified, updated and accurate
license, ownership, survey and enforcement information on every
licensed RCFE in California with components to be phased in over
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a five (5) year period ending June 30, 2019.
AB 1572 (Eggman) Resident and Family Councils: will promote the
development of Resident Councils and Family Councils in RCFEs by
requiring RCFEs to, among other things, assist in the formation
of Resident Councils at the request of two or more residents and
prohibit RCFEs from interfering with the formation of Family
Councils.
AB 2171 (Wieckowski) Resident Bill of Rights: would establish a
statutory bill of rights that addresses the needs and interests
of RCFE residents in areas such as visitation, privacy,
confidentiality, personalized care, autonomy, informed consent,
freedom from abuse and restraint, adequate staffing and others.
AB 2236 (Stone and Maienschein) Residential Care Facilities:
would increase fines for violating laws and regulations and give
"teeth" to CCL to stop and deter threats to resident health and
safety.
REGISTERED SUPPORT / OPPOSITION :
Support
California Advocates for Nursing Home Reform (CANHR)
California Assisted Living Association (CALA)
California Commission on Aging
California Police Chiefs Association
Community Residential Care Association of California
County of San Diego
LeadingAge California - Support if Amended
Long Term Care Ombudsman Services of San Luis Obispo County
National Association of Social Workers, California Chapter
(NASW-CA)
Opposition
None on file.
Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990
AB 1899
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