BILL ANALYSIS �
SB 894
Page A
SENATE THIRD READING
SB 894 (Corbett)
As Amended June 26, 2014
Majority vote
SENATE VOTE :27-8
HUMAN SERVICES 5-0 AGING 5-0
-----------------------------------------------------------------
|Ayes:|Stone, Ammiano, Ian |Ayes:|Yamada, Brown, Daly, |
| |Calderon, Garcia, | |Gray, Levine |
| |Lowenthal | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
-----------------------------------------------------------------
APPROPRIATIONS 15-0
-----------------------------------------------------------------
|Ayes:|Gatto, Bocanegra, | | |
| |Bradford, | | |
| |Ian Calderon, Campos, | | |
| |Donnelly, Eggman, Gomez, | | |
| |Holden, Linder, Pan, | | |
| |Quirk, Ridley-Thomas, | | |
| |Wagner, Weber | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
-----------------------------------------------------------------
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
Residential Care Facility for the Elderly (RCFE). Specifically,
this bill :
1)Requires DSS to provide the Office of the State Long-Term Care
(LTC) Ombudsman a pre-emptive notification for the purposes of
providing advocacy services to residents if the Director is
"reasonably contemplating" issuing a 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
SB 894
Page B
the facility a TSO or has revoked the facility's license.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible fiscal impact to DSS to send, and to the
Department of Aging to receive, additional notifications from
DSS of pending suspension and revocation orders.
COMMENTS :
Background: 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 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.
Growing demand: Over the past 30 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 2002,<1> and
continued to grow 16% between 2001 and 2010.<2> Nationwide,
states reported 1.2 million beds in licensed RCFEs in 2010.<3>
That same year, the national Centers for Disease Control and
Prevention 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.<4>
According to DSS, as of June 2, 2014, there are 7,587 licensed
---------------------------
<1> 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.
<2> 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
<3> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
SB 894
Page C
RCFEs in California with a capacity to serve 176,891 residents.
Recent events: A series of recent events has drawn attention to
questions about the adequacy of RCFEs and the CCLD's ability to
comply with existing oversight and enforcement requirements to
help ensure for the health and safety of individuals who receive
services within CCLD-licensed facilities. Over the last several
years, numerous media outlets have documented chronic
understaffing and a lack of required assessments and substandard
care. Reports in September 2013, prompted by a consumer
watchdog group that had hand-culled through stacks of documents
in San Diego, revealed that more than two dozen seniors had died
in recent years in RCFEs under questionable circumstances that
went ignored or unpunished by CCLD.<5>
The coverage reached a climax with the abandonment of the Valley
Springs Manor, a RCFE with 29 residents in the city of Castro
Valley. The facility, licensed by CCLD in March 2008, had been
frequently visited by CCLD due to numerous violations relating
to the inadequacy of care during its five year existence. In
May 2013, CCLD, taking action in response to its poor care
history, revoked Valley Springs Manor's license. The revocation
was immediately appealed by the licensee, which delayed action
by CCLD and allowed the facility to remain operational. During
this time, CCLD continued to receive and investigate additional
complaints, which culminated with the licensee physically
abandoning the facility sometime in September or October 2013,
leaving its frail seniors under the care of the facility's
administrator and support staff.
Soon after, however, due to lack of compensation and leadership,
the administrator and a majority of the support staff quit,
leaving only the cook and janitor, still unpaid, to provide care
for residents. In response to its inability to reach the
licensee or any administrative staff, CCLD initiated its TSO
process on October 17, 2013, whereby the license would be
immediately revoked. The TSO was delivered seven days later for
enactment on Thursday, October 24, 2013. After the TSO was
delivered, and the licensing analyst's inspection was concluded,
the analyst delivered a $3,800 fine to the cook for operating an
unlicensed facility, even though the fine should have been
delivered either to the administrator or licensee, and left. No
---------------------------
<5> "Care Home Deaths Show System Failures," San Diego Union
Tribune, Sept.7, 2013
SB 894
Page D
less than an hour after the analyst left, feeling overwhelmed
and unsure about what to do, the cook and janitor called 911.
Immediately thereafter, emergency services arrived and worked to
remove all of the infirm and at-risk seniors and take them to
local hospital or known relatives.
The following day, upon initial review, according to DSS, the
CCLD "made a judgment call that the facility could continue to
function for several more days while the last residents were
relocated, but that judgment was in error." DSS acknowledges,
in retrospect, that CCLD "staff should have been engaged on
Friday to address the developing crisis and make appropriate
arrangements to ensure the safety of remaining residents."<6>
Exacerbating the circumstances of the Castro Valley situation
was the discovery that its licensee also owned and operated two
other RCFEs; a smaller facility in Oakland and another larger
facility in Modesto. Concerned that similar circumstances would
occur at these two facilities, CCLD acted quickly to help
transfer the license of the Oakland facility to another
operator, however, it faced a much more difficult task of
stabilizing and transferring the Modesto facility; Sundial Palms
to another operator. Over the course of three months, CCLD and
DSS executive leadership worked to put in place an intermediate
facility administrator at Sundial Palms, which had nearly twice
the number of residents than Valley Springs Manor in Castro
Valley, and worked to identify and transfer the license to
another operator.
Need for the bill: Stating the need for the bill, the author
writes:
SB 894 strives to prevent the unimaginable tragedy
that happened at Valley Springs Manor from ever
happening again. SB 894 prioritizes 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.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
---------------------------
<6> Departmental (DSS) Report on the Closure of the Valley
Springs Residential Care Facility for the Elderly. Page 2
SB 894
Page E
FN: 0004483