BILL ANALYSIS �
SB 1153
Page 1
Date of Hearing: June 24, 2014
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
SB 1153 (Leno) - As Amended: April 10, 2014
SENATE VOTE : 36-0
SUBJECT : Residential care facilities for the elderly (RCFE):
Admissions
SUMMARY : Authorizes the Department of Social Services (DSS) to
order a suspension of new admissions prohibiting a residential
care facility for the elderly (RCFE) from admitting new
residents if the facility has failed to pay a fine assessed by
DSS or if DSS finds that the facility has violated applicable
laws and the violation presents a direct or immediate risk to
the health, safety, or personal rights of a resident and is not
corrected immediately. Specifically, this bill :
1)Authorizes DSS to order a suspension of new admissions for a
facility in either of the following circumstances:
a) The RCFE has violated statute or any applicable
regulations, the violation presents a direct and immediate
risk to the health, safety, or personal rights of a
resident or residents of the facility, and the violation is
not corrected immediately; or
b) The RCFE has failed to pay a fine assessed by the
department after the facility's appeal rights have been
exhausted.
2)Provides that any suspension of new admissions for a failure
to pay a fine, as specified, shall remain in effect until the
facility pays the assessed find.
3)Requires a suspension of new admissions to remain in effect
until DSS determines that the facility has corrected the
violation.
4)Requires DSS to conduct a follow-up visit to determine
compliance within 10 working days following the latest date of
correction specified in the notice of deficiency, unless the
licensee has demonstrated that the deficiency was corrected as
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required in the notice.
5)Authorizes DSS to make unannounced visits after the suspension
of new admissions is lifted to ensure that the facility
continues to maintain correction of the violation and permits
DSS to order another suspension of new admissions or take
other appropriate enforcement action if the facility does not
maintain correction of the violation.
6)Provides appeal rights for RCFEs who have received an
admissions suspension.
7)Requires DSS to adopt regulations that specify the appeal
procedure.
8)Provides that a suspension of new admissions ordered may not
be stayed pending the facility's appeal or request for review.
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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.
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.
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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
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: Per Senate Rule 28.8 - "a) any additional state costs
are not significant and do not and will not require the
appropriation of additional state funds, and (b) the bill will
cause no significant reduction in revenues."
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 in 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,
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.
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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
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.
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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 : According to the author:
California needs tougher enforcement tools to help
ensure that assisted living facilities comply with the
state's critical health and safety regulations, which
are designed to keep elderly people safe during a
critical time in their lives. SB 1153 allows
Community Care Licensing (CCL) to ban all new
admissions to care facilities that have serious
violations of health and safety regulations. It gives
assisted living facilities an opportunity to focus on
correcting the identified problems before admitting
new, paying clients. The bill would also ban new
admissions if a facility has not paid its fines. It
is unacceptable to allow elderly Californians,
especially those who are most vulnerable, to become
residents of care homes that we already know are
unsafe. Under no circumstances should new patients
enter a facility that has documented and unaddressed
health and safety violations.
Supporters : In support of the bill, AARP writes that:
SB 1153 is a vital legislative improvement that will
allow California to achieve one of our highest
priorities: replacing California's current disjointed
and dysfunctional system with a comprehensive and
coherent systems of long-term services and supports,
including reform of the current system of Residential
Care Facility for the Elderly.
Previous Hearing : SB 1153 was previously heard in the Assembly
Human Services Committee where it passed on consent with a vote
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of 6-0-1 (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 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.
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.
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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
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
California Advocates for Nursing Home Reform (CANHR) - Sponsor
AARP
Advocacy, Inc.
American Federation of State, County and municipal Employees
(AFSCME), AFL-CIO
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Alliance on Aging of Monterey County
Assisted Living Consumer Alliance (ALCA)
California Assisted Living Association (CALA)
California Association of Public Authorities
California Commission on Aging
California Continuing Care Residents Association (CALCRA)
California Long-Term Care Ombudsman Association (CLTCOA)
California Senior Legislature (CSL)
Congress of California Seniors
Consumer Attorneys of California
Consumer Federation of California (CFC)
Contra Costa County Area Agency on Aging (CCACOA)
County of San Diego
Elder Abuse Task Force of Santa Clara County
Elder Law & Advocacy
Johnson Moore Trial Lawyers
LeadingAge California
Long Term Care Ombudsman Services of San Luis Obispo County
Long Term Care Services of Ventura County, Inc.
National Consumer Voice for Quality Long-Term Care
National Senior Citizens Law Center (NSCLC)
Ombudsman & HICAP Services of Northern California
Ombudsman Services of Contra Costa
Riverside County Advisory Council on Aging
Valentine Law Group
Opposition
None on file.
Analysis Prepared by : Eric Astacaan / AGING & L.T.C. / (916)
319-3990