BILL ANALYSIS �
AB 2228
Page A
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 2228 ( Cooley) - As Introduced: February 20, 2014
SUBJECT : Crisis Nurseries
SUMMARY : Makes a number of changes to existing requirements for
crisis nurseries. Specifically, this bill :
1)Deletes the authority of a crisis nursery to provide child day
care services for children under six years of age and instead
permits a crisis nursery to provide "crisis day respite
services."
2)Deletes the prohibition on a crisis nursery providing child
day care services to eligible children for more than 30
calendar days within a six-month period, unless otherwise
permitted by the Department of Social Services (DSS).
3)Deletes the requirement that a child receiving child day care
services from a crisis nursery are counted towards its
licensed capacity.
4)Permits a crisis nursery's licensed capacity to be based upon
35 square feet of indoor activity space per child, as
specified.
5)Requires at least one crisis nursery caregiver to have
certification in cardiopulmonary resuscitation (CPR) and
pediatric first aid, as specified.
6)Requires crisis nursery licensees to develop, maintain and
implement a written staff training plan for the orientation,
continuing education, on-the-job training and development,
supervision, and evaluation of all lead caregivers,
caregivers, and volunteers, which shall be included in the
facility's plan of operation.
7)Requires crisis nursery licensees to designate at least one
lead caregiver to be present at the crisis nursery at all
times when children are present.
8)Requires lead caregivers to have one of the following
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education and experience qualifications:
a) Completion of 12 postsecondary units, as specified, in
classes with a focus on early childhood education, child
development, or child health at an accredited college or
university, and six months of work experience in a licensed
group home, licensed infant care center, or comparable
group child care program or family day care;
b) A current and valid Child Development Associate (CDA)
credential, with the appropriate age level endorsement
issued by the CDA National Credentialing Program, and at
least six months of on-the-job training or work experience
in a licensed child care center or comparable group child
care program; or
c) A current and valid Child Development Associate Teacher
Permit issued by the California Commission on Teacher
Credentialing, as specified.
9)Requires lead caregivers to have a minimum of 24 hours of
training and orientation before working with children, permits
one year experience in a supervisory position in a child care
or group care facility to be substituted for 16 hours of
training and orientation, and requires lead caregivers to
undergo at least 20 hours of ongoing training, as specified.
10)Requires general caregiver staff to complete a minimum of 24
hours of initial training within the first 90 days of
employment, which may include first aid and CPR and shall be
included in the written staff training plan, and requires that
at least eight hours of training be completed before the
caregiver may be left alone with children or counted in the
staff-to-child ratios, as specified.
11)Reduces the number of hours of training a person must undergo
in order to volunteer at a crisis nursery from eight to five
hours in the following ways:
a) Reduces crisis nursery job shadowing from four to two
hours; and
b) Reduces from two hours to one hour the amount of
training a volunteer must receive on community care
licensing regulations.
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12)Adds "child guidance techniques" to existing training
requirements for volunteers.
13)Reduces the number of hours of training a volunteer must
undergo before being included in staff-to-child ratio
requirements from 20 to eight hours.
14)Deletes existing training requirements that volunteers must
undergo 12 hours of CPR training and eight hours of child
health and safety training and instead requires eight hours of
training that covers child care health and safety issues,
trauma informed care, the importance of family and sibling
relationships, temperaments of children, self-regulation
skills and techniques, and program child guidance techniques.
15)Permits volunteers who have not met specified training
requirements necessary to be included in staff-to-child ratio
requirements to supervise napping children without being under
the direct supervision of staff.
16)Increases staff-to-child ratio requirements for preschool age
children from one-to-three to one-to-six.
17)Increases staff-to-child ratio requirements for infants from
one-to-three to one-to-four during the hours of operation
between 7 am and 7 pm.
18)Increases staff-to-child ratio requirements for all children
from one-to-four to one-to-six during the hours of operation
between 7 pm and 7 am.
19)Requires licensees and caregivers who provide medication
assistance to children to do all of the following:
a) Assist children with the taking of the medication,
follow instructions as provided by an appropriate medical
professional, store the medication appropriately, as
specified, and administer the medication as directed on the
label or as advised by a physician in writing;
b) Administer nonprescription medication without the
consent of the child's physician as long as the medication
is administered in accordance with the product label and
the child's parent has consented in writing to the use of
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the medication, as specified;
c) Develop and implement a written plan to record the
administration of prescription and nonprescription
medications and to inform the child's authorized
representative daily, for day care, and upon discharge for
overnight care, when the medications have been given; and
d) Return all medications to the child's authorized
representative when the child is withdrawn from the
facility, as specified.
EXISTING LAW
1)Defines a "crisis nursery" as a facility licensed by DSS under
the Community Care Facilities Act (CCFA) to provide
short-term, 24 hour residential care and supervision for
children under the age of six, who are voluntarily placed by
their parent or guardian due to a family crisis or stressful
situation for not more than 30 days. (H&S Code 1516)
2)Exempts crisis nurseries from having to be licensed as a child
day care facility under the California Child Care and
Development Services Act. (H&S Code 1596.792)
3)Permits a crisis nursery to provide child day care services
for children under six years of age for no more than 30 days
in a six-month period, unless otherwise permitted by DSS.
(H&S Code 1516(f))
4)Requires crisis nurseries to collect and maintain information,
as specified, indicating the total number of children placed
in the program, the length of stay for each child, the reasons
given for the use of the crisis nursery, and the age of each
child, as specified. (H&S Code 1516(e))
5)Requires any person who owns, operates, administers, is
employed by, or is a volunteer of a community care facility,
under the CCFA, including a crisis nursery to undergo a
criminal background check and receive a criminal record
clearance prior to working with or providing care for clients
or residents of a community care facility. (H&S Code 1522)
6)Requires a crisis nursery licensee to have an administrator
who meets one of the following requirements:
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a) A Master's Degree in social work or social welfare,
marriage, family and child counseling, or counseling
psychology or human services; and have at least three years
of experience in the field of child and family services, as
specified; or
b) A Bachelor's Degree in behavioral science and has five
years of experience in the field of child and family
services, as specified. (�86564(d) of Title 22, CCR)
7)Requires an administrator to "be on the premises for the
number of hours necessary to manage and administer the crisis
nursery in compliance with applicable law and regulation."
(�86564(c) of Title 22, CCR)
8)Requires licensees to designate at least one lead caregiver to
be present at the crisis nursery at all times when children
are present. (�86565(p) of Title 22, CCR)
9)Provides minimum levels of qualifications, educational
experience and ongoing training lead caregivers and caregiver
staff must undergo in order to work with and provide care for
children in crisis nurseries, including but not limited to 24
hours of initial training and 20 hours of annual training, as
specified. (�86565 of Title 22, CCR)
10)Requires all lead caregivers, caregivers, and volunteers to
have a current and valid pediatric CPR and pediatric first aid
certification, as specified. (�86565(n) of Title 22, CCR)
11)Requires all volunteers to undergo eight hours of initial
training prior to being allowed to provide staff supervised
care to children in a crisis nursery. (�86565(w)(1) of Title
22, CCR)
12)Allows a volunteer who undergoes an additional 20 hours of
training within 90 days of becoming a volunteer to provide
unsupervised care to children and to count towards caregiver
staff-to-child ratio requirements. (�86565(x) of Title 22,
CCR)
FISCAL EFFECT : Unknown
COMMENTS :
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Background on crisis nurseries : Established in 2004 by SB 855
(Machado), Chapter 664, Statutes of 2004, crisis nurseries were
created as a separate licensing category to provide a temporary
housing and shelter facility placement option for parents. The
goal of crisis nurseries is to provide an alternative voluntary
placement option for families with young children who are facing
difficult or extreme financial, health, or other challenges and
to prevent the need for or the engagement of child welfare
services. This limits the role of crisis nurseries to only
serve children under the age of six who are voluntarily placed
by their parent or guardian under their temporary care.
Prior to SB 855's adoption, crisis nurseries were subject to
licensure as a group home under the CCFA. According to the
Assembly Human Services August 26, 2004 analysis of SB 855, the
author argued that group home licensing requirements were
"inappropriate for crisis nurseries, since the demands of very
young children who are voluntarily placed by a parent are less
serious than those of older children who have been removed from
parental custody by county child protective services workers due
to abuse or neglect." Further, operators of crisis nurseries
argued "that the costs of complying with group home regulations
are excessive and threaten their viability."
To allow for the monitoring and evaluation of this licensing
category, SB 855 was approved with a sunset of January 1, 2008.
That sunset was extended by two subsequent measures to establish
the current sunset of January 1, 2014 to provide additional time
for DSS to establish licensing regulations. Crisis nurseries
were originally allowed to serve a limited number of foster
youth, however, that authority was eliminated effective January
1, 2012 pursuant to SB 1214 (Wolk), Chapter 519, Statutes of
2010. Finally, in 2012, the state adopted SB 1319 (Liu),
Chapter 663, Statutes of 2012, which eliminated the sunset and
allowed crisis nurseries to exist in perpetuity. Had the sunset
been allowed to take effect, crisis nurseries would have, again,
had to comply with group home licensing requirements under the
CCFA.
According to DSS, there are currently five licensed crisis
nurseries in California. All five are located in northern
California; Concord, Davis, Nevada City and two in Sacramento.
Since 2009, approximately 9,155 children have been served by
these nurseries, except for the Concord facility. On average,
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the lengths of stay have ranged from eight hours to just over 24
hours with 44 children staying for the maximum allowable days.
No exemptions have been requested or granted for children to
stay beyond the 30-day limit.
Need for the bill : Stating the need for the bill, the author
writes:
The current law and regulations governing Crisis Nurseries
has not been updated to reflect changes made by SB 1214
(Wolk) Chapter 93, Statutes of 2010, prohibiting the use of
Crisis Nurseries for foster children, effective July 1,
2012. This has resulted in laws and regulations that are
unnecessary for Crisis Nurseries. The increased cost of
providing services is preventing Crisis Nurseries from
making the most effective use of qualified volunteers, in
support of paid employees, to care for children voluntarily
placed by their own parents or legal guardians.
Staff comments : This bill seeks to modify current operating
requirements for crisis nurseries in three ways. First, it
lifts the 30-day limitation on the use of crisis nurseries and
aligns facility capacity and operating requirements to reflect
the practical realities that night and day respite care have
different needs. Secondly, it modifies training requirements
for lead caregivers, caregivers, volunteers who may be counted
as a caregiver, and general volunteers. Lastly, it eliminates
the requirement that staff and certain volunteers be certified
in pediatric first aid and CPR.
Under current statute, no child may utilize a crisis nursery for
more than 30-days in a six-month period, but exemptions can be
provided as determined by DSS. However, under current
regulations, DSS is required to respond to an exemption request
within 30-days. This is untenable, as it is difficult to
determine whether a child's family, upon the child's entry into
a crisis nursery, would still require respite care after 30
days. It is also unclear whether the 30-day limit should be
eliminated, as current data does not demonstrate that the 30-day
exemption has been granted. Rather than delete the 30-day
limitation altogether, and in order to maintain the purpose of
crisis nurseries to be a temporary crisis respite service, the
bill should reflect reasonable operating standards to allow that
extensions, instead of exemptions, be granted.
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Regarding the fiscal operating model of crisis nurseries, all
five nurseries rely upon philanthropic support and local funds
to operate. As a result, they rely substantially on trained
volunteers to serve in the capacity of caregiving staff in order
to meet state staff-to-child ratio requirements. Because of
this, the sponsor argues that current requirements "artificially
drive up the cost of providing the services" and that
"continuing to operate under these requirements will force
crisis nurseries to close."<1> In attempting to lessen some of
these requirements and to draw upon nearly ten years of
experience on how crisis nurseries have fared, the bill seeks to
increase child-to-staff ratios by bringing them into alignment
with current day child care licensing ratio standards. It also
increases the content and quality of training for all staff,
including volunteers must undergo, but eliminates the
requirement that staff and volunteers who may count in staffing
ratios are certified in pediatric first aid and CPR. If staff,
and especially volunteers, are to be recognized for purposes of
meeting facility staff-to-child ratios and allowed to be left
alone with children, they should meet a higher level of training
than general volunteers. Eliminating the pediatric first aid
and CPR certification requirement is unnecessary, as it provides
a minimum level of health and safety training and experience for
caregiver staff and volunteers who count as staff.
RECOMMENDED AMENDMENTS:
To provide a more responsive and timely process to request and
receive an extension of the 30-day limit, the bill should be
amended to provide a process on how extensions, rather than
exemptions are provided. It should also retain requirements of
staff and volunteers who may count in staff-to-child ratios to
be certified in pediatric first aid and CPR.
Specifically, committee staff recommends the following
amendments:
1)Provide that two extensions of no more than seven calendar
days may be provided and require DSS to respond to an
extension request within five working days.
--------------------------
<1> California Alliance for Child and Family Services. Crisis
Nurseries: Use of Volunteers and Other Improvements. Issue:
Amending statutory provisions to facilitate the effectiveness of
Crisis Nurseries. October 1, 2013
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2)Retain the requirement of staff and volunteers who may count
in staff-to-child ratios to be certified in pediatric first
aid and CPR.
3)Delete the permission of volunteers to be alone with children
while napping without having a certification in pediatric
first aid and CPR.
REGISTERED SUPPORT / OPPOSITION :
Support
California Alliance of Child and Family Services
Opposition
None on file.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089