BILL ANALYSIS �
SB 894
Page 1
Date of Hearing: June 24, 2014
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
SB 894 (Corbett) - As Amended: June 19, 2014
SENATE VOTE : 27-8
SUBJECT : Residential care facilities for the elderly (RCFE):
revocation of license.
SUMMARY : Increases the responsibilities of the California
Department of Social Services (DSS) when issuing a temporary
suspension order (TSO) or when revoking the license of a RCFE.
It also establishes a private right of action for RCFE residents
when a facility is alleged to have violated the law.
Specifically, this bill :
1)Requires DSS to provide the Office of the State Long-Term Care
(LTC) Ombudsman a precautionary notification for the purposes
of providing advocacy services to residents "if the department
begins to prepare to issue" a temporary suspension order (TSO)
to a RCFE or revoking a facility's license.
2)Requires DSS to contact the Office of the State LTC Ombudsman
and local placement and advocacy agencies, as specified, and
to work with local agencies and the licensee if DSS has issued
the facility a TSO or has revoked the facility's license.
3)Prohibits a facility from accepting new residents when it has
received a TSO or has had its license revoked.
4)Upon issuance of a TSO, requires the licensee to provide
written notice of the TSO to residents and the residents'
responsible person, if applicable, as soon as practically
possible, but no later than within 24 hours of receipt of the
TSO.
5)Upon issuance of a TSO, establishes a process by which the
facility's day-to-day operations may be managed by another
individual or entity designated by DSS until an administrative
law hearing is held, as specified.
6)Requires a resident to be refunded their paid preadmission fee
proportionate to the amount of time they have resided in a
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facility if that facility has been issued a TSO or has had its
license revoked, as specified.
7)Specifies that within 24 hours after each resident who is
transferring has left the facility, the licensee that had his
or her license temporarily suspended or revoked is required,
based on information provided by the resident or the
resident's responsible person, to submit a final list of names
and new locations of all residents to DSS and the Office of
the State LTC Ombudsman.
8)Requires DSS, if at any point during or following a TSO or
revocation of a license the director determines that there is
a risk to the residents of a facility from physical or mental
abuse, abandonment, or any other substantial threat to health
or safety, to take any necessary action to minimize trauma for
the residents, including, but not limited to, all of the
following:
a) Contact any local agency that may have placement or
advocacy responsibility for the residents, and work with
those agencies to locate alternative placement sites;
b) Contact the residents' relatives, legal
representatives, authorized agents in a health care
directive, or responsible parties;
c) Assist in the transfer of residents, and, if
necessary, arrange or coordinate transportation;
d) Provide onsite evaluation of the residents and use any
medical personnel deemed appropriate by DSS to provide
onsite evaluation of the residents and assist in any
transfers;
e) Arrange for or coordinate care and supervision;
f) Arrange for the distribution of medications;
g) Arrange for the preparation and service of meals and
snacks;
h) Arrange for the preparation of the residents' records
and medications for transfer of each resident;
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i) Assist in any way necessary to facilitate a safe
transfer of all residents; and
j) Check on the status of each transferred resident
within 24 hours of transfer.
9)Clarifies that DSS' and local agencies' participation in the
relocation of residents from an RCFE does not relieve the
licensee of any responsibility. A licensee that fails to
comply with the requirements, as specified, is required to
reimburse the DSS and local agencies for the cost of
providing these services.
10)Provides that if the licensee fails to provide the services
required, DSS is required to request that the Attorney
General's office, the city attorney's office, or the local
district attorney's office seek injunctive relief and
damages.
11)Holds a licensee who fails to comply with the requirements
to be liable for civil penalties in the amount of five
hundred dollars ($500) per violation, per day for each day
that the licensee is in violation, until the violation has
been corrected. Requires the civil penalties to be issued
immediately following the written notice of violation.
12)Permits a current or former resident of an RCFE to bring a
civil action against any person that owns, operates,
establishes, manages, conducts, or maintains an RCFE that
violates the rights of the resident, as specified.
13)Holds any person that owns, operates, establishes, manages,
conducts, or maintains an RCFE in violation responsible for
the acts of the facility employees and liable for costs and
attorney's fees. Also, permits the RCFE to be enjoined from
permitting the violation to continue.
EXISTING LAW:
1)Establishes the California Community Care Facilities Act
(CCFA) to provide a comprehensive statewide service system of
quality community care for people who have a mental illness, a
developmental or physical disability, and children and adults
who require care or services by a facility or organization.
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2)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 DSS.
3)Prohibits any person, firm, partnership, association,
corporation or public agency from establishing, operating,
managing, conducting or maintaining a Community Care Facility
(CCF) or RCFE without a valid license provided by DSS.
4)Provides that any person who violates the RCFE Act shall be
guilty of a misdemeanor and upon conviction be fined no more
than $1,000, imprisoned in county jail for up to one year, or
both.
5)Establishes the Long-Term Care Ombudsman program as a result
of the federal Older Americans Act (OAA) and the
Mello-Granlund Older Californians Act (OCA), and places it
within the California Department of Aging to encourage
community contact and involvement with elderly patients or
residents of long-term care facilities through the use of
volunteers and volunteer programs.
6)Requires the Ombudsman, either personally or through
representatives, to identify, investigate, and resolve
complaints that may adversely affect the health, safety,
welfare, or rights of residents of long-term care facilities.
7)Provides that representatives of the Ombudsman program have
access to long-term care facilities and residents, and the
medical and social records of residents.
8)Prohibits willful interference with the functions of the
Ombudsman representative and the Ombudsman program.
9)Prohibits retaliation and reprisals by a long-term care
facility, and provides for sanctions with respect to
interference, retaliation, and reprisals.
10)Provides that representatives of the Ombudsman program have
the right to enter and move about long-term care facilities to
identify, hear, investigate, and resolve complaints; observe
and monitor conditions of residents and facilities; speak
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confidentially with residents; and provide services to assist
residents in protecting their health, safety, welfare, and
rights.
11)Prohibits RCFE licensees or their staff from discriminating
or retaliating against a resident if the resident has
participated in the filing of a complaint, grievance, or
request for inspection with the California Department of
Social Services (DSS) or with a local or state ombudsman.
12)Prohibits an RCFE licensee or their staff from discriminating
or retaliating against a fellow staff person, as specified, if
the staff person has participated in the filing of a
complaint, grievance, or request for inspection with DSS or
with a local or state ombudsman.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
1)Potentially significant initial and future costs in the high
hundreds of thousands of dollars (General Fund/Special Fund).
One-time costs to establish the response plan and protocol
will likely be in the low hundreds of thousands of dollars.
Future costs will be dependent on the number of residents
requiring DSS to provide the expanded duties of care
enumerated in this bill in the event of a license suspension
or revocation.
2)Unknown, additional state costs, should the DSS seek
injunctive relief and damages through the Attorney General for
reimbursement of costs from the licensee.
3)Minor fiscal impact to the Department of Aging to receive
additional notifications from DSS of pending suspension and
revocation orders.
COMMENTS :
Background : California has the largest population of people age
65 and older of any state in the nation. California's 65+
population is projected to double from its 2010 census of about
4.3, to 8.4 million 2030. By 2035, the 65+ population will
exceed 20 percent of the population. This year, California's
65+ population will reach 5 million people. Although research
shows that older, low-income women's life-spans are decreasing,
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most other populations are experiencing longer life-spans. As
California's population ages, it is becoming more culturally and
ethnically diverse. Disability is highly associated with age,
and as the aged population expands, so will the presence of
disabilities within our communities.
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, they are not required to have nurses or other health
personnel on staff. Oversight of RCFEs consists of licensing
visits once every 5 years. For RCFEs under the scrutiny of the
Community Care Licensing (CCL) division, or on probation, annual
unannounced visits from CCL occur.
The number of RCFEs, and corresponding workload to oversee and
enforce laws and regulations therein, has grown rapidly during
the past decade. In 2004, there were about 6,500 licensed
facilities. By 2014, nearly 7,600 facilities housing over
175,000 people are in operation throughout the state. Recent
media has captured the ramifications of the rapid expansion, and
diversification of the RCFE industry, as it struggles to meet
the housing and care needs of a growing aged population, and the
growing presence of more disabilities. Although most RCFE's are
administered and staffed by competent caregivers and people
committed to the wellbeing of their clients, frightening
accounts of poor care and administration has focused policy
makers on the RCFE model of care. In September 2013, the
California Health Care Foundation (CHCF) Center for Health
Reporting and San Diego Union Tribune reported that at least 27
San Diego County seniors died from neglect and injuries in
RCFEs, in some cases with no investigation by CCL. Also
reported, The CCL Investigations Branch, an internal police
force, has not made an arrest in nine years even though the
investigation found that hundreds of RCFE residents have
suffered sexual assaults, physical abuse, medication errors,
life threatening bedsores and other abuses. During the past
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year, Californians monitoring local, state and national media
have been confronted with no less than the following range of
media reports about RCFEs:
PBS Frontline/ProPublica: "Life and Death in Assisted Living"
and "Elderly, At Risk and Haphazardly Protected" July, 2013.
San Diego Union Tribune, California Health Care Foundation
Center for Health Reporting: "Deadly Neglect, Medical Errors,
Weaker Rules Signal Safety Problems in California Assisted
Living Homes" September, 2013.
San Jose Mercury: "Shuttering Castro Valley Senior Care
Facility Sparks Criminal Investigation" October, 2013.
The Sacramento Bee: "Care Home Owner to Stand Trial" March
2013.
Author's Statement : "SB 894 strives to prevent the unimaginable
tragedy that happened at Valley Springs Manor from ever
happening again. SB 894 prioritizes the ongoing safety of
elderly and sick residents at assisted living facilities in
California by ensuring that the facility closure process is both
robust and comprehensive."
In addition, the author indicates that:
SB 894 will provide for greater notice requirements to
residents in the case of orders to suspend licenses;
tightens the time frame of reporting requirements for
licensees upon the relocation of residents; further
outlines the State's role in protecting the resident
of RCFEs; raises the limit on civil penalties for
licensees who fail to comply with the law from $100 to
$500 per day per violation for each violation; and
provides for civil action for residents against
licensees for any violation of this law. It will also
increase penalties for other violations by residential
care facilities for the elderly licensees."
Supporters : In support of the bill, the National Association
of Social Workers - California Chapter writes that:
SB 894 will strengthen and improve the procedures for
the relocation of the residents of RCFEs. This will
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ensure that California protects the health and safety
of some of our most vulnerable citizens. More
specifically, this bill will work to lessen the trauma
experienced by residents if their RCFE ceases to
operate. Additionally, this bill would give the state
a more punitive method with which to punish those
facilities that violate the law.
Governor's Enacted Budget : As of Friday, June 20, 2014,
Governor Jerry Brown signed the state budget (SB 852) for
2014-15. If and when the Governor signed the budget trailer
bill related to human services (SB 855), the author intends to
amend the provisions of this bill that are included in the
enacted budget.
Previous Hearing : SB 894 was previously heard and amended in
the Assembly Human Services Committee where it passed on a vote
of 5-0-2 (Maienschein, Grove).
Related Current Legislation :
SB 895 (Corbett) - Would require CDSS to conduct annual
unannounced comprehensive inspections for all facilities,
requires CDSS to verify compliance following deficiencies within
10 days, and requires results of inspections to be available on
the CDSS website.
SB 1153 (Leno) - Would permit CDSS to order a suspension of new
admissions for an RCFE when the facility has violated applicable
laws and regulations that present a direct risk to the health
and safety or residents, is not providing adequate care and
supervision, has been cited for subsequent violations of the
same law within 12 months, or has failed to pay existing fines.
SB 911 (Block) - Would increase certification training
requirements for RCFE licensees, and staff who care for
residents, increases training requirements for staff providing
dementia care.
SB 1382 (Block) - Would increase the annual licensure fees by 30
percent and make related findings and declarations.
AB 1571 (Eggman) - Would increase disclosure requirements for
RCFE licensee applicants and require applicant information to be
cross-referenced with the State Department of Public Health.
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Would require, by 2015, CDSS to create an online inquiry system
posting detailed information about RCFE facilities including
complaints, deficiencies and enforcement actions resulting in
fines. In subsequent years, would require CDSS to post
additional information, as specified.
AB 1572 (Eggman) - Would require RCFEs, at the request of two or
more residents, to assist the residents in establishing and
maintaining a single resident council, as specified, and would
require the facility to interact with the council in specified
ways.
AB 1523 (Atkins and Weber) - Would require RCFEs to maintain
liability insurance covering injury to residents and guests in
the amount of $1 million per occurrence and $3 million annually.
AB 1436 (Waldron) - Would require the results of all reports of
inspections, evaluations or consultations and lists of
deficiencies to be posted on the department's Internet Web site.
AB 1454 (Calderon) - Would require all licensed community care
facilities, RCFEs, and child day care centers to be subject to
an annual unannounced visit by CDSS.
AB 1570 (Chesbro) - Would increase the certification training
requirements for RCFE administrators, training requirements for
RCFE staff that care for residents, and training requirements
for staff providing dementia care.
AB 1554 (Skinner) - Would make various changes to existing RCFE
complaint procedures including requiring the department to make
an onsite inspection within 24 hours of a complaint alleging
abuse, neglect or a threat of imminent danger. Additionally
would require the department to complete its investigation
within 90 days of receiving a complaint. Would permit a
complainant to file an appeal of departmental findings.
AB 1899 (Brown) - Would make a person whose license is revoked
or forfeited for abandonment of the facility ineligible for
reinstatement of the license for a period of 10 years following
the revocation or forfeiture. Additionally would require CDSS
to establish and maintain a telephone hotline and an Internet
Web site dedicated to receiving complaints.
AB 2171 (Wieckowski) - Would establish specified RCFE resident's
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rights and require facilities to inform residents of these
rights as specified.
AB 2044 (Rodriguez) - Would require every licensed residential
care facility to be subject to an annual unannounced visit by
the department, as specified. Additionally, would require
complaints to be inspected within three days if the complaint
involves alleged abuse or serious neglect, or within 10 days for
all other complaints and would require investigations to be
completed within 30 days. Would provide a complainant with the
right to request an informal conference and subsequent appeal,
as specified. Also would require certain staff to be present in
the facility for specified times.
REGISTERED SUPPORT / OPPOSITION :
Support
AARP
California Alliance for Retired Americans (CARA)
California Long-Term Care Ombudsman Association (CLTCOA)
Consumer Attorneys of California
Elder Abuse Task Force of Santa Clara County
Los Angeles District Attorney's Office
National Association of Social Workers-California Chapter
(NASW-CA)
Opposition
None on file.
Analysis Prepared by : Eric Astacaan / AGING & L.T.C. / (916)
319-3990