BILL ANALYSIS �
AB 2162
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Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 2162 ( Fox) - As Amended: March 28, 2014
SUBJECT : Residential Care Facilities for the Elderly (RCFE):
Automatic Fire Sprinkler Systems.
SUMMARY : Requires RCFEs that care for no more than six
residents to have an approved, operable automatic fire sprinkler
system installed no later than January 1, 2019. Specifically,
this bill :
1)Requires all existing RCFEs with six beds or less that are
licensed prior to January 1, 2015 to have installed and
maintained an operable automatic fire sprinkler system
approved by the State Fire Marshall (SFM) no later than
January 1, 2019.
2)Requires all licensed RCFEs with six beds or less that are
licensed on or after January 1, 2015 to have installed and
maintained an operable automatic fire sprinkler system
approved by the State Fire Marshall (SFM) no later than
January 1, 2018.
3)Requires the SFM to establish and approve standards for
automatic fire sprinkler systems to be installed in RCFEs no
later than December 31, 2015.
4)Requires the SFM to establish and approve standards, in
consultation with the Department of Housing and Community
Development, for automatic fire sprinkler systems to be
installed in manufactured homes that are licensed as RCFEs no
later than December 31, 2015.
5)Requires the design criteria to comply with California
Building Standards Code, as specified.
6)Prohibits a local jurisdiction from requiring require a
sprinkler system that exceeds the standards established by the
SFM.
7)Provides that the RCFE property owner or the property owner's
agent shall determine all phases of construction, including
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selection of a contractor, improvements, and design.
8)Requires the SFM to adopt regulations to implement these
requirements, as specified, no later than January 1, 2017.
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) Community Care Licensing Division (CCLD).
(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 a RCFE administrator to be at least 21 years of age,
have a valid RCFE administrator certificate, as specified, and
hold a high school diploma or a general educational
development (GED), as specified. (H&S Code 1569.613).
4)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)
5)Requires DSS to request a fire safety clearance from the
appropriate fire marshal within five days of receipt of a RCFE
license application. (H&S Code 1569.150(b))
6)Requires RCFEs of more than six beds to have State Fire
Marshal approved fully automatic fire extinguishing system, as
specified. (H&S Code 13131.5)
7)Requires RCFEs to have an emergency plan that includes, but is
not limited to evacuation procedures and responding to
resident's needs in the event emergency call buttons are
inoperable, as specified, and require the emergency plan to be
made available to all residents and local emergency
responders. (H&S Code 1569.695)
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8)Requires RCFEs to maintain a fire clearance approved by its
local fire protection services district, county fire
department, or the SFM and for the RCFE to inform DSS whether
any of its residents are nonambulatory or bedridden. (�87202
of Title 22, CCR)
9)Requires RCFEs to conform to SFM regulations for the
protection of life and property against fire and panic.
(�87203 of Title 22, CCR)
10)Defines "nonambulatory person" as a person who is unable to
leave a building unassisted under emergency conditions, which
includes, but is not limited to, persons who depend upon
mechanical aids or who are unable, or likely to be unable, to
physically or mentally to respond to instruction.
(�87101(n)(1) of Title 22, CCR)
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
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
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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
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
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<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 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>
Responses to deaths due to fires : Since 2000 the Legislature
has considered six separate measures seeking to require RCFEs
and/or adult residential facilities (ARF) to install automatic
fire sprinkler systems. However, each measure has either failed
to pass out of the Legislature or has been vetoed by the
Governor. Considered a matter of health and safety policy, each
previous piece of legislation coincided or was associated with a
fatal fire incident in a residential facility. Of those known
to the committee, there have been five fatal fires in separate
residential facilities located in different geographic areas of
the state over the last 15 years:
1)January 2014 - Residential Home (ARF) in Santa Ana - Two
killed.
2)November 2011 - Mount Carmel Adult Residential Facility (ARF)
in Marina - Five killed.
3)November 2006 - Lynch Residential Care Facility (RCFE) in
Citrus Heights - Two killed.
4)January 2003 - Pleasantdale Care Home (RCFE) in Auburn - One
killed.
5)December 2002 - Anchor Guest Home (RCFE) in Torrance - Three
killed.
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<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 most cases, as reported by the media, those who lost their
lives in the fires were unable to escape because they were
either bedridden or nonambulatory. Facility staff were on hand
to help residents evacuate, however, due to the disabilities or
physical limitations of the residents, staff were unable to
evacuate all residents.
The last measure to reach the Governor's desk was AB 759
(Karnette) from 2007, which was vetoed by then Governor
Schwarzenegger. In explaining his veto of AB 759, the Governor
wrote:
"While I appreciate the authors intent to mitigate injuries
and fatal fires in small residential care facilities, this
bill could place a significant economic impact on
residential care providers and the health care industry at
large. Inadequate housing for elderly persons, many who
have disabilities, is already a significant problem. This
bill may result in fewer facilities being available to
serve the elderly."
PRIOR LEGISLATION:
AB 462 (Stone) 2013 - Required all RCFEs and ARFs to have an
automatic fire sprinkler system. Failed to pass the Assembly
Government Organization Committee.
AB 759 (Karnette) 2007 - Required all RCFEs to have an automatic
fire sprinkler system. Vetoed by the Governor.
AB 2836 (Karnette) 2005 - Required all RCFEs to have an
automatic fire sprinkler system. Vetoed by the Governor.
SB 516 (Ortiz) 2005 - Required all RCFEs to have an automatic
fire sprinkler system. Failed to pass the Senate.
AB 2065 (Nakano) 2003 - Required all RCFEs and ARFs to have an
automatic fire sprinkler system. Failed to pass the Senate
Appropriations Committee.
Need for this bill : Stating the need for the bill, the author
writes that this issue was brought to his attention by a local
fire captain in his district who:
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"? became very concerned about the safety of clients in a
small residential care home. Captain Bradley went on a
call to a residential care home to respond to a woman who
had fallen. As he and his team were attending to the
woman, he realized that she and other elderly residents
would have a difficult time exiting the home quickly if
there was a fire. He said he asked the attendant how she
would get the residents out in an emergency. The attendant
said, "call you."
"This story coupled with the tragic deaths that have
occurred in the last decade in residential care homes due
to fire compelled me to bring this bill forward. We cannot
sanction another death that could have been so easily
preventable."
Staff comments: This measure is a re-introduction of AB 462
(Stone), which was introduced in 2013. However, whereas AB 462
required both RCFEs and ARFs to have an automatic fire sprinkler
system installed, this measure applies only to RCFEs.
Additionally, AB 462 also provided the following additional
clarifications:
1)Ensured that a RCFE and ARF licensees reimburses the property
owner for the installation;
2)Limited costs upon RCFEs and ARFs by requiring that the fees
associated with local inspection of automatic fire sprinkler
systems to the actual cost of the inspection, and;
3)Encouraged local governments to work together to minimize the
number of pre-installation and post-installation inspections
and fees in order to reduce costs placed upon residential care
facilities.
These additional requirements are in line with ensuring that all
residential care facilities serving potentially nonambulatory or
bedridden individuals have an automatic fire sprinkler system
and limits the costs to the extent possible.
RECOMMENDED AMENDMENTS:
In keeping with the efforts of past legislation and to ensure
that all residential care facilities residents are protected
while mitigating the costs as best as possible, this measure
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should be amended to apply to ARFs and include past efforts to
reduce costs.
Specifically, committee staff recommends the following
amendments:
Amendment #1 - On page 3, line 2, delete "for the elderly"
Amendment #2 - On page 3, line 3, after "Section 1569.2,"
insert:
or an adult residential facility, as defined in Section
80001(a)(5) of Title 22 of the California Code of Regulations,
Amendment #3 - On page 3, lines 5, 17, 24, and 33, and on page
4, lines 4 and 11 delete "for the elderly"
Amendment #4 - On page 4, line 23 after "design." insert:
At least one year prior to complying with this section, the
residential care facility licensee shall pay the property owner
of the property owner's agent all costs associated with
compliance with this section.
Amendment #5 - On page 4, line 32 after the period, insert:
(f) The fee imposed by a local fire marshal or building
department for plan review or installation inspections of a fire
sprinkler system required by this section shall not exceed the
actual cost of the plan review or installation inspection for
each existing facility undergoing a plan review or inspection,
including if the fire sprinkler system is the sole renovation.
(g) Local government units are encouraged to work together to
minimize the number of preinstallation and postinstallation
inspections and minimize fees imposed on a residential care
facility pursuant to this section.
REGISTERED SUPPORT / OPPOSITION :
Support
Long Term Care Ombudsman Services of San Luis Obispo County
California Association for Nursing Home Reform (CANHR)
Opposition
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Community Residential Care Association of California
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089