BILL ANALYSIS �
AB 2349
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Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 2349 (Yamada) - As Amended: March 28, 2014
SUBJECT : Developmental services: Sonoma Developmental Center
SUMMARY : Establishes the Office of Community Care Coordination
on the Sonoma Developmental Center campus and requires the
Office to develop a plan to address the needs of former
developmental center residents.
Specifically, this bill :
1)Creates the Office of Community Care Coordination within the
Department of Developmental Services (DDS) to be located on
the grounds of the Sonoma Developmental Center.
2)Requires the Office to develop a plan to establish facilities
to assist former residents of developmental centers and to
expand and enhance existing community services and supports by
January 1, 2016.
3)Requires the plan to be consistent with the master plan for
the future of developmental centers prepared by the California
Health and Human Services Agency and address specific facility
and service needs, as specified.
4)Requires the Office to develop, as part of the plan, a precise
definition of a "placement of last resort" and an "acute
crisis clinic," including a description of the services
offered at each, and requires the Office to identify which
modifications are necessary to enable the Sonoma DC to operate
as a placement of last resort and an acute crisis clinic.
EXISTING LAW
1)Establishes the California Department of Developmental
Services (DDS) as the agency that oversees the state's
developmental centers, and specifies the duties of the
department and developmental center employees. (WIC 4400 et
seq.)
2)Grants all individuals with developmental disabilities, among
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all other rights and responsibilities established for any
individual by the United States Constitution and laws and the
California Constitution and laws, the right to treatment and
habilitation services and supports in the least restrictive
environment and the right to be free from harm, including
unnecessary physical restraint or isolation, excessive
medication, abuse, or neglect. (WIC 4502)
3)Requires DDS to, upon proposing the closure of a state
developmental center, submit a detailed plan to the
Legislature not later than April 1 immediately prior to the
fiscal year in which the plan is to be implemented, and as a
part of the Governor's proposed budget. (WIC 4471 (a))
4)Requires DDS to, prior to submission of the plan to the
Legislature, solicit input from the State Council on
Developmental Disabilities, the Association of Regional Center
Agencies, Disability Rights California, the local area board
on developmental disabilities, the local regional center,
consumers living in the developmental center, parents, family
members, guardians, and conservators of persons living in the
developmental centers or their representative organizations,
persons with developmental disabilities living in the
community, developmental center employees and employee
organizations, community care providers, the affected city and
county governments, and business and civic organizations, as
may be recommended by local state Senate and Assembly
representatives. (WIC 4474.1 (c))
5)Requires DDS to, prior to the submission of the plan to the
Legislature, confer with the county in which the developmental
center is located, the regional centers served by the
developmental center, and other state departments using
similar occupational classifications, to develop a program for
the placement of staff of the developmental center planned for
closure in other developmental centers, as positions become
vacant, or in similar positions in programs operated by, or
through contract with, the county, regional centers, or other
state departments. (WIC 4474.1 (d))
6)Requires DDS to, prior to submission of the plan to the
Legislature, hold at least one public hearing in the community
in which the developmental center is located, with public
comment from that hearing summarized in the plan. (WIC 4474.1
(e))
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7)Requires that the plan submitted to the Legislature include
all of the following:
a) A description of the land and buildings affected;
b) A description of existing lease arrangements at the
developmental center;
c) The impact on residents and their families;
d) Anticipated alternative placements for residents;
e) The impact on regional center services;
f) Where services will be obtained that, upon closure of
the developmental center, will no longer be provided by
that facility;
g) Potential job opportunities for developmental center
employees and other efforts made to mitigate the effect of
the closure on employees;
h) The fiscal impact of the closure; and
i) The timeframe in which closure will be accomplished.
(WIC 4474.1 (f))
FISCAL EFFECT : Unknown
COMMENTS : As momentum continues to build around shifting from
the current reliance on developmental centers to focusing on
smaller, state-run facilities to provide more specialized care
for persons with developmental disabilities, including those
with high-level medical and behavioral needs, this bill seeks to
ensure Sonoma Developmental Center is included among the
resources to meet those needs.
Developmental Services : The Lanterman Act guides the provision
of services and supports for Californians with developmental
disabilities. Each individual under the Act, typically referred
to as a "consumer," is legally entitled to treatment and
habilitation services and supports in the least restrictive
environment. Lanterman Act services are designed to enable all
consumers to live more independent and productive lives in the
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community. The term "developmental disability" means a
disability that originates before an individual attains 18 years
of age, is expected to continue indefinitely, and constitutes a
substantial disability for that individual. It includes
intellectual disabilities, cerebral palsy, epilepsy, and autism
spectrum disorders (ASD). Other developmental disabilities are
those disabling conditions similar to an intellectual disability
that require care and management similar to that required by
individuals with intellectual disabilities. This does not
include conditions that are solely psychiatric or physical in
nature, and the conditions must occur before age 18, result in a
substantial disability, be likely to continue indefinitely, and
involve brain damage or dysfunction. Examples of conditions
might include intracranial neoplasms, degenerative brain disease
or brain damage associated with accidents.
The Department of Developmental Services (DDS) contracts with 21
regional centers, which are private nonprofit entities, to carry
out many of the state's responsibilities under the Lanterman
Act. The regional center caseload is comprised of over 265,000
consumers who receive services such as residential placements,
supported living services, respite care, transportation, day
treatment programs, work support programs, and various social
and therapeutic services and activities.
Developmental centers (DCs) : Approximately 1,300 regional
center consumers reside at one of California's four
developmental centers (Lanterman, Porterville, Sonoma, and
Fairview) and one state-operated, specialized community facility
(Canyon Springs). These facilities provide 24-hour habilitation
and medical and social treatment services. While some residents
in these facilities were voluntarily placed by relatives and
conservators due to acute medical needs and other special needs
that made it unsafe for them to live in the community, some
residents have experienced involuntary placements due to court
orders (e.g., forensic placements at Porterville DC).
The first developmental center opened its doors to patients in
1888 and housed and cared for individuals with developmental
disabilities, as well as patients diagnosed with mental illness.
Those two populations were eventually separated into different
facilities, and in 1972 the programs for patients with mental
illness were discontinued, and the center served only persons
with developmental disabilities. In the years following, the
number of state facilities increased throughout the state,
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providing what was, at that time, the only placement option for
many individuals with intellectual and developmental
disabilities that couldn't be cared for at home. Over time,
increased awareness of the unique needs of individuals with
developmental disabilities grew, prompting the establishment of
other state facilities specifically for people with
developmental disabilities. Non-residential community-based
programs, therapeutic strategies and other services were also
developed, providing support and alternatives that allowed more
families to keep their children with intellectual and
developmental disabilities at home. As a result, the resident
population dropped in the DCs from a high of 13,400 in 1968-with
thousands more on a waiting list for admission-to 1,302
residents as of April 9, 2014. At their peak in the late
1960's, the state had eight developmental centers, each of which
was designed to accommodate between 2,500 and 3,500 individuals.
In 1995, the state closed the Stockton State Hospital, and two
years later followed with the shut-down of Camarillo State
Hospital which still housed clients with both mental illness and
developmental disabilities. The historic Olmstead vs LC (1999)
U.S. Supreme Court ruling further spurred the shift to
community-based care, citing that a lack of community supports
was not legal grounds for denying someone a move from an
institution to a community setting, and was, instead, a
violation of individual civil rights. Soon after the ruling,
many states began shuttering their institutions and developing
additional community-based services. Agnews Developmental
Center closed its doors in 2009, and in 2010, Sierra Vista, a
state-operated community facility, was closed. DDS is now in
the process of closing the Lanterman Developmental Center in
Pomona, which had 74 remaining residents as of April 9th of this
year. The Lanterman DC closure is required to be completed by
December 31, 2014.
Sonoma Developmental Center : Of the four remaining DCs, Sonoma
DC has the largest population, with 451 residents. It is the
oldest facility in California that was established specifically
to serve the needs of individuals with developmental
disabilities. The facility was originally opened in Santa Clara
in 1891 and named the California Home for the Care and Training
of the Feeble Minded. A few years later, with financial support
from the State Legislature, the facility was moved to Eldridge,
between the towns of Glen Ellen and Sonoma, on over 1,600 acres
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of land. After undergoing numerous name changes, the facility
was finally named the Sonoma Developmental Center in 1986.
Sonoma DC includes a campus with residential cottages, a
campground, store, post office, petting farm, swimming pool and
other recreational facilities for the residents. It also sits
in the midst of a wildlife corridor that open space advocates
and others have pledged to protect from development, and is
adjacent to Jack London State Park, which features equestrian
trails, camping facilities, lakes and historic buildings.
Recent federal action : In July 2012, California Department of
Public Health (DPH) licensing staff, carrying out state
licensing duties and functioning as a proxy for the federal
Centers on Medicaid and Medicare Services (CMS), conducted an
annual survey of Sonoma DC to assess whether the facility was in
compliance with state and federal licensing regulations. The
resulting 250-page report cited numerous violations, amounting
to lapses in six of the eight categories required for continued
federal funding. Among the findings were that Sonoma DC's
management failed to take actions that identified and resolved
problems of a systemic nature, failed to ensure adequate
facility staffing, failed to provide active treatment, failed to
provide appropriate health care services and several other key
categories. The team also identified four situations that posed
immediate jeopardy to the health and safety of patients at the
facility including 11 clients with injuries that resembled burns
from a stun gun, a finding that also prompted a criminal
investigation.
In response to the high-risk situation at Sonoma DC, CMS planned
to decertify each of the developmental center's 10 Intermediate
Care Facility (ICF) units. Instead, DDS withdrew four of the 10
ICF units from federal certification in January 2013, which
allowed federal certification and funding to be maintained for
the other six ICF units. The loss of certification has cost the
state $1.4 million per month in what would have otherwise been
paid in federal funding. To date, DDS has met all of the
CMS-issued milestones for recertification, and the
Administration has said it expects all units will be fully
certified again in July 2014.
Upon re-inspecting the other developmental centers based on
concerns raised in the Sonoma DC inspection, DPH found
additional federal compliance issues. In January 2014, DDS and
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DPH reached an agreement to avoid decertification through
developing a root-cause analysis and action plan, similar to
what was enacted at Sonoma DC, for Porterville and Fairview
developmental centers.
Task Force on the Future of Developmental Centers : 2013 budget
trailer bill language required California's Health and Human
Services Agency (CHHS) Secretary, Diana Dooley, to submit to the
Legislature a master plan for the future of DCs by November 15,
2013, and to submit to the Legislature, by January 10, 2014, the
Administration's plans to meet the service needs of all current
residents of the DCs. To ensure the consideration of
perspectives from an array of stakeholders, the Secretary formed
the Task Force on the Future of Developmental Centers to offer
input leading to the development of the CHHS plans. The task
force included a broad representation of stakeholders, including
a resident of Sonoma DC, family members, regional center
directors, providers, labor representatives, consumer advocates,
legislators, and DDS and Agency staff. On January 13, 2014,
Secretary Dooley released the "Plan for the Future of
Developmental Centers in California." While the plan meets the
requirements of the master plan, the subsequent plans required
to implement the recommendations of the master plan have yet to
be submitted, and the Secretary has not provided an official
timeline for the release of those plans.
Although some family members and union representatives on the
task force qualified their support for the plan, clarifying that
they do not support any implication that the centers be closed,
the plan provides six consensus recommendations:
1)More community style homes/facilities should be developed to
serve individuals with enduring and complex medical needs
using existing models of care.
2)For individuals with challenging behaviors and support needs,
the state should operate at least two acute crisis facilities
and small transitional facilities. The state should develop a
new "Senate Bill (SB) 962-like" model that would provide a
higher level of behavioral services. Funding should be made
available so that regional centers can expand mobile crisis
response teams, crisis hotlines, day programs, short-term
crisis homes, new-model behavioral homes, and supported living
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services for those transitioning to their own homes.
3)For individuals who have been involved in the criminal justice
system, the state should continue to operate the Porterville
DC's Secure Treatment Program and the transitional program at
Canyon Springs Community Facility. Alternatives to the
Porterville DC Secure Treatment Program also should be
explored.
4)The development of a workable health resource center model
should be explored, to address the complex health needs of DC
residents who transition to community homes.
5)The state should enter into public/private partnerships to
provide integrated community services on existing state lands,
where appropriate. Also, consideration should be given to
repurposing existing buildings on DC property for developing
service models identified in Recommendations 1 through 4.
6)Another task force should be convened to address how to
strengthen the community system.
Need for this bill : This bill establishes a new, state-funded
Office of Community Care Coordination on the Sonoma DC campus,
and tasks the office with developing a plan, consistent with the
CHHS master plan, to assist former residents of developmental
centers and expand and enhance existing community services and
supports. The bill requires the plan to include the following:
1)The operation of at least two acute crisis clinics, each with
a capacity of 15 or fewer beds, to be located in the northern
and southern parts of the state;
2)The operation of transitional facilities to facilitate a
smooth transition of developmental center residents and staff
into the community;
3)The development of residential facilities with specialty
wrap-around services to provide a high level of behavioral
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supports similar to SB 962 homes;
4)Identification of the community capacity in existing models of
care;
5)Support of regional center efforts to enhance supports to
maintain individuals in their own homes;
6)Collaboration with regional centers to do all of the
following:
a) Expand mobile crisis response teams;
b) Expand crisis hotlines;
c) Expand day programs; and
d) Create short-term homes; and
7)Providing developmental center staff for the transition of
individuals with challenging behaviors.
The Office established in this bill is also tasked with
developing a precise definition of a "placement of last resort"
and an "acute crisis clinic," including a description of the
services offered by those facilities, and must identify which
modifications are necessary to enable the Sonoma DC to operate
as a placement of last resort and as an acute crisis clinic.
The development of the Office and these latter few duties of the
Office pertaining to the role of Sonoma DC moving forward are
the only provisions that are not included in the official Plan
submitted by CHHS in January. However, a memo submitted by the
Sonoma DC Parent Hospital Association for attachment to the Plan
does include continued use of the Sonoma DC property for the
establishment of crises services and a placement of last resort
(referred to in the memo as a "zero reject facility," which was
the terminology used by many stakeholders throughout the task
force process).
According to the author, "The Sonoma Developmental Center (SDC)
has faithfully served the needs of residents who have
challenging behavioral and complex medical needs and is an
invaluable part of the Sonoma Valley. The challenges faced by
SDC uniquely position it to develop and implement the changes
called for in the recommendations made by the Future of
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Developmental Centers Task Force. [This bill] would implement
the recommendations outlined in the Task Force's findings and
ensure that a plan is in place to care for the developmental
center's neediest residents."
Staff comments : This bill codifies the recommendations provided
in the Administration's Plan for the Future of Developmental
Centers in California with respect to individuals with
challenging behavior and support needs, and seeks to ensure that
the Sonoma DC campus becomes an indispensable component of that
Plan moving forward. The 2013-14 developmental services Budget
Act trailer bill, (AB 89, Chapter 25, Statutes of 2013) outlined
the contents of the CHHS report that was required to be
submitted by January 10 of this year. They include:
?the agency's plans to address the service needs of all
developmental center residents, the fiscal and budget
implications of the declining developmental center population
and the aging infrastructure, staffing, and resource
constraints, the availability of community resources to meet the
specialized needs of residents now living in the developmental
centers, a timeline for future closures, and the statutory and
regulatory changes that may be needed to ensure the delivery of
cost-effective, integrated, quality services for this
population.
While the Legislature awaits the additional CHHS report, this
bill may be preemptive in its assumption that Sonoma DC will be
a primary resource moving forward. Should the Committee wish to
pass this bill, the author should be asked to explain how she
intends to work with the Administration moving forward to ensure
the provisions of this bill facilitate, rather than duplicate,
the goals that are expected to be addressed by CHHS, as required
by the Legislature.
RELATED LEGISLATION
SB 1344 (Evans) 2014 requires the state to establish the Sonoma
Developmental Center as the center of last resort for Northern
California, and requires DDS to confer and cooperate with the
County of Sonoma to develop a detailed action plan, as
specified, prior to establishing the Sonoma Developmental Center
as a center of last resort and would require the County of
Sonoma to ensure the inclusion and participation of certain
community entities, including consumers living in the
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developmental center and the State Council on Developmental
Disabilities.
SB 1428 (Evans) 2014, requires that, prior to the development of
any plan for the sale, lease, transfer, or major change of use
of any portion of the Sonoma DC, DDS and the Department of
General Services confer and cooperate with public and private
entities in the development of an improvement and redevelopment
plan for the center. The bill authorizes the plan to contain
specific elements for residences, the wildlife habitat corridor
and public recreational facilities.
AB 89 Chapter 25, Statutes of 2013, a 2013-2014 budget trailer
bill, required the Secretary of the Health and Human Services
Agency to submit a master plan for the future of DCs and
subsequent plan for individuals living in those centers.
AB 1472 (Chapter 25, Statutes of 2012), a 2012-2013 budget
trailer bill, included a moratorium for new admissions to the
DCs, with limited exception, limitations on the use of locked
mental health facilities and out-of-state placements, and
provisions to strengthen the capacity of the community to serve
individuals with challenging needs including the creation of a
statewide Specialized Resource Service.
REGISTERED SUPPORT / OPPOSITION :
Support
Sonoma County Board of Supervisors
Sonoma Land Trust (SLT)
The Parent Hospital Association of Sonoma Developmental Center
(PHA)
2 Individuals
Opposition
None on file.
Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089
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