BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 911 (Block) - Residential care facilities for the elderly:
training.
Amended: March 27, 2014 Policy Vote: Human Services 3-2
Urgency: No Mandate: Yes
Hearing Date: April 28, 2014
Consultant: Jolie Onodera
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 911 would increase the initial and continuing
education training requirements for licensees, administrators,
and direct care staff of residential care facilities for the
elderly (RCFEs), as specified. In addition, this bill would
prohibit discrimination or retaliation in any manner against a
resident or employee for calling 911.
Fiscal Impact:
Significant one-time costs potentially in excess of
$500,000 (General Fund) for DSS to revise regulations and
consult with specified groups to update the uniform core of
knowledge for RCFE administrators and training for direct
care staff. To the extent DSS elects to develop a
certification training program and standardized testing tool
for direct care staff, costs would be significantly greater.
No new costs to the Department of Aging to continue
existing efforts of collaboration with the DSS in
development of training curriculum and a resident assessment
tool.
Significant ongoing increase in training costs to employees
and/or facilities to meet the enhanced initial and
continuing education training requirements imposed.
Potential minor non-reimbursable local enforcement costs
for violations of any of the provisions of this measure.
Background: The Community Care Licensing Division (CCLD) of the
DSS administers the licensure and oversight of over 7,500
assisted living, board and care, and continuing care retirement
homes that are licensed as RCFEs in California. These residences
are designed to provide home-like environment housing options to
elderly residents who need assistance with activities of daily
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living but otherwise do not require continuous, 24-hour
assistance or nursing care. The RCFE licensure category includes
facilities with as few as six beds to facilities with hundreds
of residents whose needs may vary widely.
Over 20 years have passed since existing RCFE licensing
certification requirements have been changed. The last noted
revision was through the enactment of AB 1615 (Hannigan),
Chapter 848/1991, which required prospective licensees to
undergo an orientation training prior to commencing the licensee
certification process.
RCFE administrator requirements : Currently, licensees and
administrators of RCFEs are required to undergo 40 hours of
training and complete a written exam. However, as noted by the
DSS, "Currently, no proctoring protocol exists, resulting in no
statewide uniformity on how the exams are administered. This
lack of consistency and guidance results in errors and can
ultimately result in candidates getting certified who may not
meet the minimum qualifications."
Concerns have also been raised by advocates about the rigor and
relevance of the administrator exam. According to DSS,
approximately 500 people take the administrator certification
test each month. However, there is no requirement under law that
the exam reflects what is provided in the 40 hours of
administrator/licensee training required for completion prior to
taking the certification exam.
RCFE staff requirements : Licensees employ a wide range of staff
to provide day-to-day support and care for residents of RCFEs.
Although many employ individuals with specific expertise and
certifications, such as Licensed Vocational Nurses and Certified
Nursing Assistants, at minimum, staff who assist residents with
personal activities of daily living are required to be at least
18 years of age and undergo 10 hours of training within four
weeks of being employed by the RCFE and four hours of training
each year thereafter. The training is somewhat similar to that
required of licensees and administrators, but is limited to
covering the physical limitations and needs of the elderly, the
importance and techniques for personal care services, residents'
rights, policies and procedures regarding medications and the
psychosocial needs of the elderly.
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There are also additional training requirements for staff who
work in RCFEs that "provide" dementia care or who assist
residents with managing their medication. Staff who work in a
RCFE that advertises or promotes special care, special
programming, or a special environment for persons with dementia
are required to undergo an additional six hours of training on
providing care to persons with dementia. Staff also must
annually complete eight hours of continuing training on dementia
care. Training for staff who assist residents in the management
and self-administration of medication depends on the size of the
facility in which they work. For facilities with 16 or more
residents, staff must undergo 16 hours of training, and for
facilities with 15 or fewer residents, staff must complete six
hours of training on medication management. Both training
requirements must be completed within the first two weeks of
employment and conclude with an examination. Four hours of
annual continuing medication management training is required, as
well.
In response to recent health and safety issues discovered at
facilities licensed by the CCLD, the 2014-15 Governor's Budget
proposes a comprehensive plan to reform the CCLD program. This
proposal includes an increase of $7.5 million ($5.8 million
General Fund) and 71.5 positions to improve the timeliness of
investigations, ensure the CCLD inspects all facilities at least
once every five years, increase staff training, and establish
clear fiscal, program, and corporate accountability. The
proposal also increases civil penalties assessed for violations
and increases licensing and application fees by 10 percent.
Another component of the plan proposes to strengthen the
Administrator Certification Section to develop regulations,
protocols, and new examinations to ensure the testing
environment and procedures are uniform statewide.
Proposed Law: This bill would expand both the initial and
ongoing training requirements for RCFE licensees,
administrators, and staff, as follows:
Deletes the existing requirement of 40 hours of
classroom instruction for RCFE licensee certification
training programs and replaces it with 100 hours of
required training, 80 hours of which are to consist of
classroom instruction.
Increases continuing education training requirement for
administrators from 20 hours to at least 60 hours during
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each two-year certification period.
Adds the following components to the list of items
required to be covered in the RCFE licensee certification
training program: adverse effects of psychotropic drugs for
use in controlling the behavior of persons with dementia,
non-pharmacologic, person-centered approaches to dementia
care, and residents' rights.
Requires the participation of "other stakeholder groups"
(undefined) in the development of regulations of
certification program content, testing, process for
approving programs, and criteria to be used for authorizing
individuals or organizations to conduct certification
programs. Further, requires DSS to review the test annually
and update as necessary to reflect changes in law and
regulations.
Prohibits a licensee, or officer or employee of the
licensee, from discriminating or retaliating in any manner
against a resident or employee of the facility, on the
basis or for the reason that the person, employee, or any
other person dialed or called 911.
Eliminates the requirement that a RCFE staff person must
undergo ten hours of training within the first four weeks
of employment and, instead, requires a RCFE staff person to
undergo 40 hours of training within the first four weeks of
employment, at least 24 hours of which must be completed
prior to providing direct care to residents, and 20 hours
annually thereafter.
Requires DSS to establish the subject matter required
for the staff training and develop the training in
consultation with individuals or organizations with
specific expertise in RCFE or assisted living services, or
by an outside source with expertise, as specified.
Expands RCFE staff training components to include the
use, misuse, and interaction of drugs commonly used by the
elderly, the adverse effects of psychotropic drugs for use
in controlling the behavior of persons with dementia, and
the special needs of persons with Alzheimer's disease and
dementia, including non-pharmacologic person-centered
approaches to dementia care.
Authorizes DSS to develop a certification program with a
standardized test for RCFE staff.
Increases training requirements for RCFE staff at
facilities that provide special care from six hours to 15
hours of resident care, and requires all 15 hours to be
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completed prior to providing direct care to residents. Also
increases in-service training from eight hours to 12 hours
on the subject of providing care and supervision to
residents with dementia.
Requires an RCFE that accepts or retains residents with
prohibited health conditions or restricted health
conditions, as specified, to ensure that residents receive
care as prescribed by the resident's physician and
contained in the resident's service plan.
Requires staff in RCFEs providing care to more than 16
persons to complete 32 hours, instead of 16 hours, of
initial training, as specified. Requires staff in RCFEs
providing care to 15 or fewer persons to complete 16 hours,
instead of six hours, of initial training, as specified.
Adds new training requirements for RCFE staff at
facilities serving residents with postural supports,
restricted health conditions or who receive hospice
services to include 1) 15 hours of training prior to
providing direct care to residents on the care,
supervision, and special needs of those residents, and, 2)
12 hours annually thereafter of in-service training on the
subject of serving those residents.
Related Legislation: AB 1570 (Chesbro) 2014 would increase the
certification training requirements for RCFE administrators,
increase training requirements for RCFE staff that care for
residents, including staff providing dementia care.
Additionally, this bill would require the certification exam to
be state-administered. This bill is pending hearing in the
Assembly Committee on Appropriations.
The following bills regarding licensing and inspections at
community care facilities, and RCFEs specifically, have been
introduced this session:
SB 894 (Corbett) RCFEs: revocation of license.
SB 895 (Corbett) RCFEs: annual inspections.
SB 1153 (Leno) RCFEs: suspension of new admissions.
SB 1382 (Block) RCFEs: licensure fees.
AB 1436 (Waldron) RCFEs: internet posting of inspection reports.
AB 1523 (Atkins) RCFEs: liability insurance.
AB 1554 (Skinner) RCFEs: complaint procedures.
AB 1571 (Eggman) RCFEs: disclosure requirements.
AB 1572 (Eggman) RCFEs: single resident council.
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AB 1899 (Brown) RCFEs: prohibitions on licensure reinstatement.
AB 2044 (Rodriguez) RCFEs: 24-hour presence of
administrator/staff.
AB 2171 (Wieckowski) RCFEs: residents' rights.
Staff Comments: The DSS would likely incur one-time costs
potentially in excess of $500,000 (General Fund) to develop
revised regulations after consultation with "other stakeholder
groups" (undefined) in the development of the uniform core of
knowledge for RCFE administrator certification program content,
testing, and criteria to be used for authorizing individuals or
organizations to conduct the certification programs. The DSS
would also incur ongoing workload to review the test annually
and update as necessary to reflect changes in law and
regulations.
Additional regulations for RCFE staff training provisions would
also be adopted once DSS establishes the subject matter required
for staff training and develops the training in consultation
with individuals or organizations with specific expertise in
RCFE or assisted living services, as required under the
provisions of this bill. To the extent DSS chooses to develop a
certification training program and standardized testing tool for
direct care staff (optional), costs to DSS would be
significantly greater.
Under existing law, any person who violates the California
Residential Care Facilities for the Elderly Act (Act), is guilty
of a misdemeanor and subject to civil penalties and suspension
or revocation of his or her license. To the extent the
provisions of this measure result in future violations of the
Act, could result in non-reimbursable local enforcement costs.
Recommended amendments: This bill requires licensees to meet
significantly higher training standards as a condition of
licensure and RCFE staff to meet enhanced training requirements
prior to direct care. The author may wish to consider a delayed
implementation date for compliance in order for the revised
training standards to be developed and tested, and to ensure
existing and prospective licensees, staff, and vendors who
administer certification programs are adequately notified of the
changes.
Section 3 of the bill provides that failure of an RCFE to meet
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or arrange to meet the needs of those residents who require
specialized health services, or failure to notify the physician
of a resident's illness or injury that poses a danger of death
or serious bodily harm is a licensing violation and subject to
civil penalty, as specified. As currently drafted, "specialized
health services" is undefined. For clarity, staff recommends an
amendment to define this term or cross-reference an existing
code section that provides a definition of this term.