BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1899
A
AUTHOR: Brown
B
VERSION: May 23, 2014
HEARING DATE: June 24, 2014
1
FISCAL: Yes
8
9
CONSULTANT: Sara Rogers
9
SUBJECT
Residential Care Facilities For the Elderly
SUMMARY
This bill provides that a license that is forfeited or
revoked following abandonment of a facility shall not be
eligible for reinstatement on or after January 1, 2015.
ABSTRACT
Existing Law:
1.Establishes the Residential Care Facilities for the
Elderly (RCFE) Act which requires the California
Department of Social Services (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 including a criminal record clearance,
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
PageB
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 face facilities), or a community care
facility, among other requirements. (HSC 1569.15)
3.Requires that procedures for the suspension, revocation
or denial of license be conducted in accordance with the
administrative adjudication provisions of the
Administrative Procedure Act that grants a licensee the
right to appeal a license denial, revocation or
suspension to the Office of Administrative Hearings. (HSC
1569.51 and GC 11500 et seq.)
4.Permits the director of CDSS to temporarily suspend any
license, prior to any hearing when, in the opinion of the
director, the action is necessary to protect residents or
clients of the facility from physical or mental abuse,
abandonment, or any other substantial threat to health or
safety. Requires the department to verify within 30 days
that the facility is nonoperational. (HSC 1569.50,
1569.510 and GC 11460.10 et seq.)
5.Provides that the failure of an applicant for licensure
or a licensee to pay all applicable and accrued fees and
civil penalties shall constitute grounds for denial or
forfeiture of a license. (HSC 1569.185)
6.Provides that a license shall be forfeited when a
licensee sells the facility, surrenders the license to
CDSS, is convicted of a prohibited offense, dies, or
abandons the facility. (HSC 1569.19)
7.Through regulation, defines "licensee abandons the
facility" to mean either of the following:
The licensee informs the licensing agency that
the licensee no longer accepts responsibility for
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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the facility, or
The licensing agency is unable to determine the
licensee's whereabouts after the following:
i. The licensing agency requests
information of the licensee's whereabouts from
the facility's staff if any staff can be
contacted; and.
ii. The licensing agency has made at
least one (1) phone call per day, to the
licensee's last telephone number of record, for
five (5) consecutive workdays with no response;
and
iii. The licensing agency has sent a
certified letter, requesting the licensee to
contact the licensing agency, to the licensee's
last mailing address of record with no response
within seven (7) calendar days. (CCR Title 22
87112)
1.Requires the director, when it is necessary to suspend or
revoke an RCFE license, to make every effort to minimize
trauma for residents. Permits CDSS to require the
licensee to prepare a written relocation plan for
residents. Requires the licensee to provide a 60-day
written notice of license revocation within 24 hours of
receipt of a revocation order. (HSC 1569.525)
2.Requires RCFE licensees, prior to transferring residents
as a result of a specified instances of license
forfeiture, to take certain actions to minimize transfer
trauma including providing 60-day written notice,
preparing a relocation evaluation, providing a list of
nearby facilities, and other actions. (HSC 1569.682)
This bill:
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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1.Prohibits a license forfeited following abandonment of a
facility from being eligible for reinstatement on or
after January 1, 2015.
2.Prohibits that a license revoked following the licensee's
abandonment of a facility from being be eligible for
reinstatement on or after January 1, 2015.
FISCAL IMPACT
The current provisions of this bill have not been analyzed
by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
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 that call into
question the adequacy of CDSS oversight and the state's
ability to protect people who reside in RCFEs.
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. The
Department indicated that the owner of this facility had
previously owned a nursing home facility licensed by CDPH,
and another facility in Modesto owned by the same licensee
was subsequently taken over by CDSS, which appointed a
temporary manager.
The author states that nothing in existing law would
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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prevent this licensee from seeking licensure again in the
future. The Department stated that the maximum civil
penalty that it could assess on the licensee for abandoning
the facility was the $150 per day per violation. This bill
seeks to block licensees who are the subject of revocation
or who abandon a facility from being granted licensure
again.
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 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.
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 reside 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, the majority of which have
six or fewer beds.<1> 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 that amount varies widely based on the recipient's
prior income while working.<2>
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 CCL 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.
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<1> "Residential Care in California: Unsafe, Unregulated &
Unaccountable," California Advocates for Nursing Home
Reform, 2013
<2>
http://www.ssa.gov/pressoffice/factsheets/colafacts2014.pdf
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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State law requires prospective RCFE licensees to provide
evidence that he or she is of "reputable and responsible
character"<3> 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."<4>
Related legislation:
SB 894 (Corbett) 2014 establishes revises the
responsibilities of a licensee under a temporary suspension
order or license revocation order and establishes specified
actions CDSS must take to protect residents who have been
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<3> HSC 1569.15
<4> Title 22 CCR 87408
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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abandoned by the licensee. This bill is in Assembly
Appropriations Committee.
SB 855 (Committee on Budget) 2014 provides for CDSS to
impose a temporary manager or a receiver if a licensee has
failed to comply with statutory requirements to protect
residents pursuant to a temporary suspension order or
license revocation. This bill is before the Governor
awaiting signature.
COMMENTS
Staff recommends the author clarify that a licensee shall
be subject to the provisions of this bill, only if the
facility is abandoned prior to all residents being safely
transferred out of the facility, with no residents
remaining under the care of the licensee as follows:
Page 3, lines 1-3
(f) The licensee abandons the facility. A licensee who
abandons the facility and the residents in care resulting
in an immediate and substantial threat to the health and
safety of the abandoned residents, in addition to
forfeiture of the license pursuant to this Section, shall
be excluded from licensure in facilities licensed by the
department pursuant to section 1569.58 without the right to
petition for reinstatement. A license forfeited pursuant to
this subdivision shall not be eligible for reinstatement on
or after January 1, 2015 .
Page 5, lines 12-14
(c) A licensee who abandons the facility and the residents
in care resulting in an immediate and substantial threat to
the health and safety of the abandoned residents, in
addition to revocation of the license pursuant to this
Section, shall be excluded from licensure in facilities
licensed by the department pursuant to section 1569.58
without the right to petition for reinstatement. A license
that is revoked pursuant to this section due to the
licensee's abandonment of the facility shall not be
eligible for reinstatement on or after January 1, 2015 .
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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Add a new Section to amend Section 1569.682 as follows:
(e) A licensee who, on or after January 1, 2015, fails to
comply with this section and abandons the facility and the
residents in care resulting in an immediate and substantial
threat to the health and safety of the abandoned residents,
in addition to forfeiture of the license pursuant to
Section 1569.19, shall be excluded from licensure in
facilities licensed by the department pursuant to section
1569.58 without the right to petition for reinstatement.
(e)( f) A resident of a residential care facility for the
elderly covered under this section, may bring a civil
action against any person, firm, partnership, or
corporation who owns, operates, establishes, manages,
conducts, or maintains a residential care facility for the
elderly who violates the rights of a resident, as set forth
in this section. Any person, firm, partnership, or
corporation who owns, operates, establishes, manages,
conducts, or maintains a residential care facility for the
elderly who violates this section shall be responsible for
the acts of the facility's employees and shall be liable
for costs and attorney's fees. Any such residential care
facility for the elderly may also be enjoined from
permitting the violation to continue. The remedies
specified in this section shall be in addition to any other
remedy provided by law.
( f) ( g) This section shall not apply to a licensee that has
obtained a certificate of authority to offer continuing
care contracts, as defined in paragraph (8) of subdivision
(c) of Section 1771.
PRIOR VOTES
Assembly Floor 77 - 0
Assembly Appropriations 17 - 0
Assembly Aging and Long Term Care 7 - 0
Assembly Human Services 6 - 0
STAFF ANALYSIS OF ASSEMBLY BILL 1899 (Brown)
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POSITIONS
Support: California Advocates for Nursing Home Reform
California Commission on Aging
California Long-Term Care Ombudsman
Association
California Police Chiefs Association, Inc.
Community Residential Care Association of
California
County of San Diego
Disability Rights California
Long Term Care Ombudsman Services of San
Luis Obispo County
National Association of Social Workers
Office of the State Long-Term Care Ombudsman
Oppose: None received.
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