Existing law vests in the State Department of Developmental Services jurisdiction over state hospitals referred to as developmental centers for the provision of residential care to individuals with developmental disabilities. Existing law requires the department to comply with procedural requirements when closing a developmental center, including submitting a detailed plan to the Legislature and holding at least one public hearing. Under existing law, the department allocates funds to private nonprofit entities known as regional centers, which are required to provide, or arrange for the provision of, services and supports for persons with developmental disabilities.

This bill would require the department to submit a plan to the Legislature by April 1, 2016, to close the Sonoma Developmental Center and the Fairview Developmental Center. The bill would require the plan to meet existing requirements for closing a developmental center and to additionally include, specified components, including a closure plan that will result in each of the 2 developmental centers closing no later than December 31, 2018, except as specified. The bill would also require the plan to include a plan for using the properties occupied by the 2 developmental centers, as specified, and would require the department to work with the Department of General Services to estimate potential revenues that may be generated from different options for use of the properties.

The bill would state the intent of the Legislature that the department minimize the expenditure of state funds related to any developmental center residential units that are decertified for failure to meet federal or state health and safety laws or regulations or that receive notification from a state or federal regulator that they are at risk of decertification for failure to meet those laws or regulations, and that funds previously used to operate developmental centers instead be shifted to support community-based services for individuals with developmental disabilities.

SENATE COMMITTEE ON HUMAN SERVICES

Senator McGuire, Chair

2015 - 2016 Regular

Bill No: SB 639

Subject: Developmental centers: closure

SUMMARY

This bill requires the Department of Developmental Services (DDS) to submit a plan to the Legislature by April 1, 2016, to close the Sonoma and Fairview developmental centers no later than December 31, 2018, except as specifed. The bill requires a plan for using both properties to benefit the developmentally disabled community on an ongoing basis, and requires the state to estimate potential revenues that may be generated from different options for use of the properties. Additionally, this bill includes codified Legislative intent that DDS minimize the expenditure of state funds related to any developmental center residential units that are decertified for failure to meet federal or state health and safety laws or regulations, or that receive notification from a state or federal regulator that they are at risk of decertification. It also includes codified Legislative intent that funds previously used to operate developmental centers instead be shifted to support community-based services for individuals with developmental disabilities.

ABSTRACT

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. Defines a “developmental disability” as a disability that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability. (WIC 4512)

3. Requires that when DDS proposes the closure of a state developmental center, the department shall be required to 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 that prior to submission of the plan to the Legislature, DDS must solicit input from the State Council on Developmental Disabilities, the Association of Regional Center Agencies, the protection and advocacy agency specified in Section 4901, 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 that prior to the submission of the plan to the Legislature, DDS must 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 that prior to submission of the plan to the Legislature, the department shall 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))

7. Requires that the plan submitted to the Legislature include all of the following:

0. a)  A description of the land and buildings affected.

1. b)  A description of existing lease arrangements at the developmental center.

2. c)  The impact on residents and their families.

3. d)  Anticipated alternative placements for residents.

4. e)  The impact on regional center services.

5. f)  Where services will be obtained that, upon closure of the developmental center, will no longer be provided by that facility.

6. g)  Potential job opportunities for developmental center employees and other efforts made to mitigate the effect of the closure on employees.

7. h)  The fiscal impact of the closure.

8. i)  The time frame in which closure will be accomplished. (WIC 4474.1 (f))

This bill:

1. States various uncodified Legislative findings and declarations about the developmental center system, including the intent of the Legislature to carry out the principles reflected in a 2014 task force report on the future of the Developmental Centers. Includes the assertion that in the four- and five-year closure processes of prior developmental centers, while care and caution were essential to ensure that residents found suitable housing and services in their communities, these facilities took more time than necessary to achieve these goals.

2. Requires DDS to submit a plan to the Legislature by April 1, 2016, to close the Sonoma and Fairview developmental centers which meets the requirements for closure established in statute. (WIC 4474.1)

3. Requires the closure plan to result in closure of both Sonoma and Fairview developmental centers no later than December 31, 2018. If the department concludes that it is not feasible to close both developmental centers by that date, the plan shall provide a detailed rationale for that conclusion and a revised date for closure of each of the two centers. Requires the revised date to be no later than December 21, 2019.

4. Requires a plan to reduce developmental center staff in an efficient manner that facilitates shifting funds from developmental center options to community services, as warranted by the transition of the developmental center population to the community.

5. Requires a plan for using the properties occupied by the two developmental centers to benefit the developmentally disabled community on an ongoing basis.

6. Requires DDS to work with the Department of General Services to estimate potential revenues that may be generated from different options for use of the properties, as specified, and including but not limited to:

1. Providing ongoing revenues to support community-based services through lease or rental agreements between DDS and private entities, local governments or other state departments.

2. Developing community-based, integrated housing resources for use by individuals with developmental disabilities in a manner similar to the Harbor Village development located adjacent to the Fairview Developmental Center.

3. Other proposals for commercial development that would provide ongoing revenues to the state for purposes of supporting community-based services for individuals with developmental disabilities.

7. States codified Legislative intent that DDS minimize the expenditure of state funds related to any developmental center residential units that are decertified for failure to meet federal or state health and safety laws or regulations, or that receive notification from a state or federal regulator that they are at risk of decertification for failure to meet those laws or regulations.

8. States codified Legislative intent that DDS make moving residents of decertified units, or units at risk of federal or state decertification, a priority for movement into a community-based residence with appropriate community supports and services, as specified.

9. States codified Legislative intent that funds previously used to operate developmental centers instead be shifted to support community-based services for individuals with developmental disabilities.

FISCAL IMPACT

This bill has not been analyzed by a fiscal committee.

BACKGROUND AND DISCUSSION

Purpose of the bill:

The author states that the vision to create fulfilling lives for this population launched in 1969 through the Lanterman Developmental Disabilities Services Act, “which envisioned a system in which individuals with DD could maximize their potential and control over their own lives by living in communities of their choosing. While the vast majority of the DD individuals do live in community settings, roughly 1,100 continue to languish in archaic developmental centers (DCs), which do not fulfill the Lanterman Act’s vision,” the author states.

According to the author, the developmenetal center system is plagued with resident health and safety problems, as indicated in reports by journalists and inspections by the state Department of Public Health. Sonoma Developmental Center lost its federal certification in 2012 due to significant health and safety violations, which not only harmed residents but also resulted in the loss of millions of dollars annually in federal funds, the author states. Other DCs are also facing the possibility of decertification based on violations of federal health and safety standards. Additionally, the author states, the three DCs consume a disproportionate share of state spending, receiving more than $563 million for 2014-15, or $504,000 for each DC resident.

Developmental disabilities

A developmental disability is defined as a severe and chronic disability that is attributable to a mental or physical impairment that begins before age 18 and is expected to continue indefinitely. These disabilities include mental retardation, cerebral palsy, autism, epilepsy, and other similar conditions. Infants and toddlers (age 0 to 36 months) may also be eligible for some developmental services if they are at risk of having developmental disabilities or if they have a developmental delay.

Developmental Centers

DDS operates three Developmental Centers and one smaller state-operated community facility, Canyon Springs, that together care for 1,100 consumers across the state. These DCs are part of a larger system of developmental services overseen by DDS, which also includes services and supports for approximately 280,000 people who live in their communities.

The first DC opened in 1888, and residents with developmental disabilities initially shared the state hospitals with patients diagnosed with mental illness. Eventually, those populations were separated into different facilities. For many years, the state hospitals were the only alternative available to families of children with intellectual and developmental disabilities who were unable to be cared for at home. Over time, community services and supports for individuals with developmental disabilities became the programs of choice and 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 1,109 residents as of April 22, 2015. At its peak, the state had eight developmental centers, each of which was designed to accommodate between 2,500 and 3,500 individuals.

California’s closure last year of the Lanterman Developmental Center in Pomona was preceded by four other closures in the past two decades. In 1995, the state shuttered the Stockton State Hospital. In 1997, the state closed Camarillo State Hospital, which had housed clients with both mental illness and developmental disabilities. In 2009, DDS closed Agnews Developmental Center, and a year later, in 2010, Sierra Vista, a state-operated community facility, was closed. Of the three remaining DCs, Sonoma has the largest population, with 408 residents, and Fairview had 281 residents as of April 22.

Sonoma Developmental Center

Sonoma Developmental Center is the oldest facility in California that was established specifically to serve the needs of individuals with developmental disabilities. The facility was opened on November 24, 1891 and in 1909 was renamed the California Home for the Care and Training of the Feeble Minded. Later, it became the Sonoma State Hospital and eventually, Sonoma DC. The facility is in Eldridge, between the towns of Glen Ellen and Sonoma, on approximately 1,000 acres of land that is bisected by Highway 12.

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 sits in the midst of a wildlife corridor that open space advocates and others have pledged to protect from development and adjacent to Jack London State Park which features equestrian trails, camping facilities, lakes and historic buildings.

Fairview Developmental Center

Fairview Developmental Center in Costa Mesa is the newest of the state's developmental centers officially opening on January 5, 1959. It originally occupied 752 acres, and had an initial bed capacity of 2,622 and was intended to house some 4,125 residents. The actual population peaked in 1967 at 2,700 and much of the original land was transferred in 1979 to the city of Costa Mesa. The population on March 25, 2015 was 281.

The campus is surrounded on three sides by a 36-hole golf course built on land that was sold to the city. Facilities include a swimming pool, work activity center, auditorium, park, small animal farm, recreational campsite, and library. According to the DDS website, services include training in daily living, vocational, leisure, academic, communication, mobility, socialization, and community skills and are provided both on campus and in community settings. On the northern portion of the Fairview campus are the Harbor Village Apartments, a 568-unit residential rental project. Harbor Village was initially developed in the late 1980s to provide housing for employees and consumers of Fairview Developmental Center, but tenants now include the local community, staff and consumers of Fairview DC, as well as other DDS consumers. A second housing project, Shannon’s Mountain, is being discussed to be built on the Fairview Property.

Federal involvement

On July 3, 2012, licensing staff from the California Department of Public Health (CDPH) conducted an annual survey of Sonoma DC to assess whether the facility was in compliance with state licensing regulations, as well as to conduct, by proxy, a federal licensing review by the Centers on Medicaid and Medicare Services (CMS). Officials detailed in a 250-page report numerous violations which amounted 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 January 2013, four of the 11 Intermediate Care Facility (ICF) units at Sonoma DC were withdrawn from federal certification by DDS, in response to notice that the federal government was moving to decertify the full group of ICF units. The loss of certification has cost the state $1.4 million per month in federal funds. In May 2014, Sonoma participated in a recertification survey for the seven remaining ICF units, but was unsuccessful. DDS also was unsuccessful in an appeal. While CMS has officially decertified all 11 ICF units now at Sonoma, it has extended the date that the state loses federal funding from October 2014 to April 2015 to, now, May 7, 2015. The loss of federal funding is approximately $43 million annually for all eleven ICF units.

Subsequent to Sonoma’s federal survey in 2013, Fairview and Porterville Developmental Centers’ ICF units were found by DPH to be out of compliance with federal certification requirements generally related to clients’ health, safety, and rights. Both developmental centers created program improvement plans, which were approved by DPH, and continue to implement structural changes in order to meet federal certification requirements and to retain federal Medicaid funding. Both facilities were recently surveyed, but results have not been made public for Fairview’s survey.

DC Task Force

On January 13, 2014, California’s Health and Human Services Secretary Diana Dooley released a 59-page “Plan for the Future of Developmental Centers in California.” The Plan was developed pursuant to trailer bill language adopted in 2013 that required the Secretary 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.

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. While noting that some family members and union representatives on the task force qualified their support for the plan to clarify 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 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 make the community system stronger.

DDS and the Health and Human Services agency have begun implementing some of the recommendations, including initiating a Developmental Services Task Force which began meeting last fall to focus the community system. That task force is ongoing.

Crisis units

One issue that emerged from the Future of the DC task force was the desire to have crisis units in both Northern and Southern California. The 2014-15 budget included funding for establishing acute crisis units at Fairview and Sonoma developmental centers to operate as a placement of last resort for consumers living in the community who are found to be a danger to themselves or others and who are in need of short-term crisis stabilization services. While Fairview’s crisis unit has been functioning for several years, the crisis unit at Sonoma Developmental Center is in the process of opening.

Positions

Support

The bill’s sponsor, the California Disability Services Association, writes in support that “these institutions hold hundreds of individuals who have counterparts in the community living lives with greater independence, opportunity, and choice than is possible in a developmental center. Members of CDSA have served many former residents of developmental centers, and they have cast off the behaviors of anger and frustration, expanded their capabilities, and developed a new enthusiasm for life. The current residents of the developmental centers deserve these same opportunities. CDSA also urges recognition of the high cost of care in institutional settings. The average cost for a developmental center resident now exceeds $500,000 per year; in the community, even individuals needing the highest level of care can be served for half this amount. And many need less intensive services, costing far less. The resources devoted to developmental centers can be better invested in helping the 280,000 individuals with developmental disabilities served in the community.”

Opposition

Theresa DeBell, a member of the DC Task Force and president of the California Association of State Hospital Parent Councils for the Retarded, writes in opposition to this bill that the task force did not recommend closure of the DCs for specific reasons.

“The Task Force studied in great detail the needs of the current DC residents, who are very medically fragile or who have complex and challenging behaviors. The Task Force also reviewed the current Developmental Disabilities System capacity to supply those needs in the community setting. It was recognized that currently there were not sufficient numbers or types of specialized service models to care for many community clients with complex needs, let alone the current DC residents. Their recommendations focused on the development of services, on ‘opportunity to define and manage the transition … to integrated and specialized services using the expertise and resources of the DCs to benefit the consumers.’ … There is a process in place for the transition of DC clients to a community setting. That process is IPP-driven, and includes a comprehensive assessment and the judicious use of Community Placement Plan funding to develop necessary services. The lessons of the past include successful community transitions (most recently those of the former Lanterman Developmental Center residents) and unsuccessful ones (some of the quota-driven placements under the Coffelt decision that resulted in increased community deaths among the DC movers). SB 639, by mandating a time-driven closure process, would be a large step away from the focus of the Lanterman Act on the individual.”

Related legislation:

SB 1344 (Evans, 2014) would have required the state to establish the Sonoma Developmental Center as the center of last resort for Northern California, and would have required DDS to confer and cooperate with the County of Sonoma to develop a detailed action plan, as specified, and to ensure the inclusion and participation of certain community entities in planning the action plan. Died in the Senate Appropriations Committee.

SB 1428 (Evans, 2014) would have required 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 would authorize the plan to contain specific elements for residences, the wildlife habitat corridor and public recreational facilities. Died in the Senate Appropriations Committee.

AB 2349 (Yamada, 2014), would have established the Office of Community Care Coordination within DDS, located at Sonoma DC, and would have required the office to develop a plan, on or before January 1, 2016, that addresses, among other things, the operation of at least two acute crisis clinics, as specified.

AB 89 (Budget and Fiscal Review, Chapter 25, Statutes of 2013) 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 (Budget and Fiscal Review, Chapter 25, Statutes of 2012) 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.

SB 410 (Thompson, Chapter 513, Statutes of 1995) established the procedures for closing a developmental center.

COMMENTS

This bill proposes to close two troubled developmental centers without addressing a number of critical issues.

Pending federal action

1. The timing of a Legislative mandate to close these two developmental centers comes as word is pending from the federal CMS about its plans for Sonoma Developmental Center. While CMS has notified Sonoma that it has been decertified, it has provided DDS with several extensions to the revocation of federal funding, which may appear to indicate a pending agreement between CMS and the state. Should there be a federally required plan for Sonoma, that plan may dictate the state’s preferred course of action. This bill does not consider whether a federal government’s plan should alter the scope or timing of the plan for Sonoma DC.

Abbreviated time line

2. The time line laid out in this bill is significantly shorter than previous closures. Statute requires that when DDS proposes the closure of a state developmental center, the department must be required to 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)) The earliest that DDS could submit a plan to the Legislature would be April 1, 2016, as the bill reflects. The plan would then be eligible to be adopted in the 2016 budget. That would leave the department two years to move approximately 700 of the state’s most difficult to serve individuals from two developmental centers into community living situations.

Challenges not addressed

3. This bill does not acknowledge or propose to resolve any of the identified challenges to transitioning residents of the DCs to community settings, which include, but are not limited to:

• While about one-third of DC residents have complex medical needs and are receiving nursing facility-level care for multiple medical conditions, the availability of “SB 962” homes to care for individuals with these conditions does not meet demand. The task force recommended targeting $25 million in community placement funding over three years, however it is unclear that the state is on track to meet that recommendation.

• The task force recommended that the state should operate 15-bed acute crisis facilities like the program at Fairview DC at least in the Northern and Southern part of the states. These facilities have now been opened at Fairview and Sonoma DCs, and this bill’s mandate would include closure of those facilities.

• A new model of home is needed to provide intensive, wrap-around therapeutic behavioral services to consumers who need a higher level of support than currently exists in community placements. The task force estimated 36 of these three-bed homes would be needed “if it were determined that this level of care was appropriate for those remaining in the DCs with challenging behaviors.” This model has yet to be developed.

• The task force recommended recognizing and preserving existing DC speciality services such as the shoe making shops at Sonoma and Fairview DCs, the wheelchair specialty clinic at Sonoma DC and the availability of medical professionals with vast experience in serving idividuals with complex developmental and medical needs. An often-cited example is the need for sedation dentistry services, which are scarce in the community.

DDS has maintained over the last two closure processes that no DC should close until there was an appropriate placement for each individual who moved, a person-centered approach. Agnews Developmental Center’s closure was announced with the Governor’s in January 2003, the plan was presented in January of 2005 and the last consumer moved in March 2009. Lanterman’s closure was announced in January 2010, the plan was presented that April and the last person moved in December 2014. In both of those transitions, the state and Legislature created a number of new services, such as homes to care for medically involved residents, a clinic for movers to bridge needed medical and dental treatment in their new homes, as well as other innovations.

In the case of two other closures – at Stockton and Camarillo Developmental Centers – emptying the DCs was much quicker – less than one year for each. However, in both of those cases, the residents were moved en masse to other developmental centers. That option does not exist any more.

POSITIONS

Support:

California Disability Services Association (Sponsor)

Disability Rights California

Futures Explored

Opposition:

California Association of State Hospital Parent Councils for the Retarded

Parent Hospital Association

Sonoma County Board of Supervisors

Sonoma Land Trust

Union of American Physicians and Dentists (UAPD/AFSCME)

VOR

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