Existing law establishes the State Department of Social Services and sets forth its powers and duties, including, but not limited to, the licensing and administration of residential care facilities for the elderly. Existing law authorizes any person to request an investigation of a residential care facility for the elderly by making a complaint to the department, as specified. Existing law requires the department to make a preliminary review, except as specified, and make an onsite inspection within 10 days of receiving the complaint unless the visit would adversely affect the investigation, as specified. Existing law requires the department, upon receipt of a complaint, to make a good faith effort to contact and interview the complainant of the departments proposed course of action and relevant deadline for the department to complete the investigation. Existing law requires the department, within 10 days of completing that investigation, to notify the complainant of the departments determination as a result of the investigation.

This bill would instead authorize any person to file a complaint with the department against a residential care facility for the elderly. The bill would require the department to conduct an onsite investigation within one business day of receipt of the complaint if the complaint involves a threat of imminent danger of death or serious harm. The bill would require the department to inform the complainant within 10 calendar days of receipt of the complaint if the department determines that an investigation is not warranted and the reason for that determination. The bill would require the department, prior to conducting an onsite investigation, to send a notification to the complainant notifying them of, among other things, the nature of the allegations to be investigated and the relevant deadline for the department to complete the investigation. The bill would require the department, for complaints received on or after July 1, 2025, to complete an investigation within 60 calendar days of receipt of a complaint, or within 30 calendar days if the complaint involved a threat of imminent danger or death or serious harm. received on or after July 1, 2025, to complete an investigation within a specified amount of time and would allow an extension of these time frames due to extenuating circumstances, as specified. The bill would require the department, when providing notification of the outcome of the investigation, to also provide notification of the right to seek an informal conference, and to provide a copy of any reports describing violations and enforcement actions resulting from the investigation, if applicable. The bill would authorize a complainant to appeal a determination made by the department, as specified.

Existing law establishes the State Department of Social Services and sets forth its powers and duties, including, but not limited to, the licensing and administration of residential care facilities for the elderly. Existing law authorizes any person to request an investigation of a residential care facility for the elderly by making a complaint to the department, as specified. Existing law requires the department to make a preliminary review, except as specified, and make an onsite inspection within 10 days of receiving the complaint unless the visit would adversely affect the investigation, as specified. Existing law requires the department, upon receipt of a complaint, to make a good faith effort to contact and interview the complainant of the departments proposed course of action and relevant deadline for the department to complete the investigation. Existing law requires the department, within 10 days of completing that investigation, to notify the complainant of the departments determination as a result of the investigation.

This bill would instead authorize any person to file a complaint with the department against a residential care facility for the elderly. The bill would require the department to conduct an onsite investigation within one business day of receipt of the complaint if the complaint alleges involves a threat of imminent danger of death or serious harm. The bill would require the department to inform the complainant within 10 calendar days of receipt of the complaint if the department determines that an investigation is not warranted and the reason for that determination. The bill would require the department, prior to conducting an onsite investigation, to send a notification to the complainant notifying them of, among other things, the nature of the allegations to be investigated and the relevant deadline for the department to complete the investigation. The bill would require the department, for complaints received on or after July 1, 2025, to complete an investigation within 60 calendar days of receipt of a complaint, or within 30 calendar days if the complaint involved a threat of imminent danger or death or serious harm. The bill would require the department, when providing notification of the outcome of the investigation, to also provide notification of the right to seek an informal conference, and to provide a copy of any reports describing violations and enforcement actions resulting from the investigation, if applicable. The bill would authorize a complainant to appeal a determination made by the department, as specified.

Existing law establishes the State Department of Social Services and sets forth its powers and duties, including, but not limited to, the licensing and administration of residential care facilities for the elderly. Existing law authorizes any person to request an investigation of a residential care facility for the elderly by making a complaint to the department, as specified. Existing law requires the department to make a preliminary review, except as specified, and make an onsite inspection within 10 days of receiving the complaint unless the visit would adversely affect the investigation, as specified. Existing law requires the department, upon receipt of a complaint, to make a good faith effort to contact and interview the complainant of the departments proposed course of action and relevant deadline for the department to complete the investigation. Existing law requires the department, within 10 days of completing that investigation, to notify the complainant of the departments determination as a result of the investigation.

This bill would instead authorize any person to file a complaint with the department against a residential care facility for the elderly. The bill would require the department to conduct an onsite investigation within one business day of receipt of the complaint if the complaint alleges a threat of imminent danger of death or serious harm. The bill would require the department to inform the complainant within 10 calendar days of receipt of the complaint if the department determines that the complaint is willfully intended to harass a licensee, is without a reasonable basis, or that the department will not investigate the complaint for any other reason. an investigation is not warranted and the reason for that determination. The bill would require the department, prior to conducting an onsite investigation, to send a notification to the complainant notifying them of, among other things, the opportunity to accompany the investigator on the investigation of the facility nature of the allegations to be investigated and the relevant deadline for the department to complete the investigation. The bill would require the department, for complaints received on or after July 1, 2025, to complete an investigation within 60 calendar days of receipt of a complaint, or within 30 calendar days if the complaint involved a threat of imminent danger or death or serious harm. The bill would require the department, when providing notification of the outcome of the investigation, to also provide notification of the right to seek an informal conference, and to provide a copy of any documents reports describing violations and enforcement actions resulting from the investigation, if applicable. The bill would authorize a complainant to appeal a determination made by the department, as specified.

Existing law establishes the State Department of Social Services and sets forth its powers and duties, including, but not limited to, the licensing and administration of residential care facilities for the elderly. Existing law authorizes any person to request an investigation of a residential care facility for the elderly by making a complaint to the department, as specified. Existing law requires the department to make a preliminary review, except as specified, and make an onsite inspection within 10 days of receiving the complaint unless the visit would adversely affect the investigation, as specified. Existing law requires the department, upon receipt of a complaint, to make a good faith effort to contact and interview the complainant of the departments proposed course of action and relevant deadline for the department to complete the investigation. Existing law requires the department, within 10 days of completing that investigation, to notify the complainant of the departments determination as a result of the investigation.

This bill would instead authorize any person to file a complaint with the department against a residential care facility for the elderly. The bill would require the department to conduct an onsite investigation within one business day of receipt of the complaint if the complaint alleges a threat of imminent danger of death or serious harm. The bill would require the department to inform the complainant within 10 days of receipt of the complaint if the department determines that the complaint is willfully intended to harass a licensee, is without a reasonable basis, or that the department will not investigate the complaint for any other reason. The bill would require the department, prior to conducting an onsite investigation, to send a notification to the complainant notifying them of, among other things, the opportunity to accompany the investigator on the investigation of the facility and the relevant deadline for the department to complete the investigation. The bill would require the department, for complaints received on or after July 1, 2025, to complete an investigation within 60 days of receipt of a complaint, or within 30 days if the complaint involved a threat of imminent danger or death or serious harm. The bill would require the department, when providing notification of the outcome of the investigation, to also provide notification of the right to seek an informal conference, and to provide a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable. The bill would authorize a complainant to appeal a determination made by the department, as specified.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 1911 (Reyes) - Residential care facilities: complaints

Bill Summary:

AB 1911 would revise current procedures for complaints against Residential Care Facilities for the Elderly (RCFEs).

Fiscal Impact:

The California Department of Social Services (CDSS) estimates the following General Fund costs:

• Ongoing costs of $62.3 million and 351 permanent positions.
• One-time costs of $2,272,000 for contract funding.

Background:

RCFEs, also known as assisted living facilities, are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living (ADLs) or for the protection of the individual who is 60 years of age or older. RCFEs provide housing, housekeeping, supervision, and personal care assistance with ADLs to individuals who need that level of care. These are nonmedical facilities that are designed for individuals who are unable to live by themselves, but who do not need 24-hour nursing care. As such, these facilities are not required to have nurses, certified nursing assistants or doctors on staff. RCFEs usually centrally store and distribute medications for residents to self-administer. Residents of RCFEs may have mental, behavioral, or physical health needs or a developmental disability that results in their inability to live independently.

The CDSS licenses and investigates complaints against RCFEs. Current law requires CDSS to make an onsite inspection within 10 days of the receipt of the complaint, except as specified. Current law requires CDSS, within 10 business days of completing the investigation of a complaint, to notify the complainant in writing of the department’s determination as a result of the investigation.

Proposed Law:

Specific provisions of the bill would:

• Require, in any case in which the complaint involves a threat of imminent danger of death or serious harm, the CDSS to conduct an onsite investigation within one business day of the receipt of the complaint.
• Require CDSS to notify the complainant, in writing, within 10 calendar days after receiving the complaint if the department determines an investigation is not warranted and the reason for the determination.
• Require, for a complaint that involves a threat of imminent danger of death or serious harm, that is received on or after July 1, 2025, CDSS to complete an investigation of the complaint within 90 calendar days of receipt of the complaint, as specified.
• Require, for a complaint that does not involve a threat of imminent danger of death or serious bodily harm and that is received on or after July 1, 2026, and prior to July 1, 2027, CDSS to complete an investigation of the complaint within 90 calendar days of receipt of the complaint, as specified.
• Require, for a complaint that is received on or after July 1, 2027, CDSS to complete an investigation of the complaint within 60 calendar days of receipt of the complaint, as specified.
• Establish a process for a complainant to appeal the CDSS’s determination of the complaint as a result of the investigation.

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SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Residential care facilities: complaints

SUMMARY

This bill modifies the current procedures for complaints against Residential Care Facilities for the Elderly (RCFEs) to the California Department of Social Services (CDSS). Requires CDSS to investigate complaints within specified timelines and to provide written notifications to complainants. The bill also provides a process for a complainant to appeal the outcome of an investigation.

ABSTRACT

Existing Law:

1. Establishes the Residential Care Facilities for the Elderly Act which provides for the CDSS to license and regulate RCFEs as a separate category within the existing residential care licensing structure of CDSS. (Health and Safety Code [HSC] 1569 et seq.)
   
2. Provides that RCFEs shall be subject to unannounced visits by CDSS and be visited as often as necessary to ensure the quality of care provided. (HSC 1569.33)
   
3. Requires annual unannounced inspections when a license is on probation, when required by the terms of a facility compliance plan, when an accusation is pending, when required for federal financial participation, or to verify that a person who has been ordered out of the facility is no longer present. (HSC 1569.33)
   
4. Requires CDSS to perform random inspections each year on no fewer than 20 percent of the RCFE facilities not subject to annual inspections. Provides that this percentage shall increase by 10 percent if the total citations issued by CDSS exceeds the previous year by 10 percent. As a result of this trigger, CDSS currently is required to perform random inspections on 30 percent of the RCFE facilities not subject to annual inspection. Requires CDSS to visit every facility no less than every 5 years. (HSC 1569.33)
   
5. Requires CDSS to visit a newly licensed facility within 90 days after a facility accepts its first resident to evaluate compliance with regulatory requirements. (HSC 1569.24)
   
6. Permits any person to request an inspection of any RCFE by transmitting notice of an alleged violation orally or in writing. Requires CDSS to make a preliminary review and an onsite inspection within 10 days after receiving the complaint except where the visit would adversely affect the licensing investigation or the investigation of other agencies, including, but not limited to, law enforcement agencies (HSC 1569.35)
   
7. Through regulation, requires CDSS to conduct a follow-up visit 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 required. Provides that no penalty shall be assessed unless a follow-up visit is conducted. (Title 22 CCR 87759)

This Bill:

1. Requires CDSS to conduct an onsite investigation within one business day of all complaints that allege a threat of imminent danger of death or serious harm.
   
2. Requires CDSS to communicate, in writing within 10 calendar days of receiving the complaint, if the department determines an investigation is not warranted and the reason for the determination. The complainant has the right to seek review of that determination by the regional office manager, or their designee.
   
3. Requires CDSS to send a written notification to the complainant of the following:
   
   1. Complaint tracking number;
      
   2. Proposed course of action;
      
   3. Name and contact information of the analyst who will conduct the investigation;
      
   4. Nature of the allegations to be investigated;
      
   5. Opportunity to accompany the investigator on the investigation of the facility; and
      
   6. Relevant deadline for the department to complete its investigation.
      
4. Commencing July 1, 2025, imposes a 60 calendar day timeline for CDSS to complete an investigation of a complaint and 30 day timeline for a complaint that entails a threat of imminent danger of death or serious harm.
   
5. Permits CDSS to extend the investigation by additional 60 calendar days due to good cause with documentation of the circumstances in its final determination and requires CDSS to notify the facility and the complainant in writing of the basis for the extension and the estimated completion date.
   
6. Requires CDSS to interview any residents who are the subject of the investigation.
   
7. Requires CDSS to notify the complainant within 10 business days of the complainant’s right to seek an informal conference, and the process for seeking an informal conference.
   
8. Requires CDSS to provide the complainant a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable, with the notification.
   
9. Specifies an appeal process as follows:
   
   1. A complainant may, within 30 calendar days after receipt of the notice, notify the regional office manager in writing of their request for an informal conference.
      
   2. Requires the informal conference to be held with the regional office manager or their designee within 30 calendar days of the receipt of the request, and requires CDSS to summarize to the complainant all of the evidence and information it reviewed pursuant to its investigation
      
   3. Requires the regional office manager to notify the complainant, in writing, of their determination within 10 working days after the informal conference and shall apprise the complainant and licensee, in writing, of the right to a review by the deputy director.
      
   4. Permits the complainant to appeal the determination of the regional office manager, within 30 days after receipt of this determination, notifying in writing the deputy director.
      
   5. Requires the deputy director to review the facts that led to both determinations, within 30 days of the receipt of the notice.
      
   6. Requires the deputy director or their designee to interview the complainant. Requires, the deputy director to make an independent determination and notify the complainant, in writing, of their determination and reasons therefor, within 30 calendar days after receipt of the request for review.
      
10. Permits a complainant may be assisted or represented by any person of their choice in the appeal process described in this subdivision.

FISCAL IMPACT

According to the Assembly Appropriations Committee analysis, “Ongoing General Fund costs to CDSS of an unknown amount, but likely in the mid- to high-tens of millions of dollars annually for additional personnel to investigate and close cases per the accelerated timeline in the bill and to develop and administer an appeals process for complainants. CDSS received nearly 5,470 complaints in fiscal year 2022-23.

“According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the

tens of billions of dollars over the next several fiscal years.”

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “AB 1911 will improve RCFE complaint investigations performed by the California Department of Social Services' Community Care Licensing Division. It ensures that all complainants receive a response and provides for more effective and timely investigations and appeals for dissatisfied complainants. Currently, the experience for individuals who file complaints against an RCFE is inadequate and discourages individuals from filing complaints. Often times, CDSS determinations on complaints are not communicated to complainants, leaving them without the information they need to follow-up on complaints and unaware of whether their complaints will be investigated. When CDSS determines that a complaint warrants an investigation, current law does not require written notification to the complainant that their complaint has been received or information regarding the process for the investigation. AB 1911 will improve the complaint process by improving CDSS' communication with complainants and imposing clear deadlines on complaint investigations.”

Residential Care Facilities for the Elderly (RCFEs)

RCFEs, also known as assisted living facilities, are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living (ADLs) or for the protection of the individual who is 60 years of age or older.

RCFEs provide housing, housekeeping, supervision, and personal care assistance with ADLs to individuals who need that level of care. These are nonmedical facilities that are designed for individuals who are unable to live by themselves, but who do not need 24-hour nursing care. As such, these facilities are not required to have nurses, certified nursing assistants or doctors on staff. RCFEs usually centrally store and distribute medications for residents to self-administer. Residents of RCFEs may have mental, behavioral, or physical health needs or a developmental disability that results in their inability to live independently. These facilities range in size from small facilities operating out of single family homes serving a handful of residents to larger buildings that can house over 100 residents.

RCFEs are licensed and regulated by CDSS’s Community Care Licensing Division. The Division protects the health and safety of persons residing in RCFEs through its regulatory and enforcement programs. In addition to its licensing requirements, the Division conducts regular inspections of facilities to assess compliance with applicable laws and regulations. Violations can result in citations, fines and, in extreme cases, loss of a license to operate a facility.

Continuing Care Retirement Communities

CCRCs offer people age 60 and older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows senior residents to move from independence to high levels of care without leaving the community in which they reside. Typically, this is provided in a campus-like community setting, usually for a resident’s lifetime, and always for at least one year. CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain a RCFE license and if they offer skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.

Skilled Nursing Facilities (SNF) Complaint Process

SNFs are health facilities that provide skilled nursing care and supportive care to patients whose primary need is for skilled nursing care on an extended basis. As health care facilities, SNFs are licensed and overseen by the California Department of Public Health. The SNF complaint process is used as a model for the proposed changes to the RCFE complaint process in this bill.

Any person or organization may file a complaint against a SNF to the Licensing and Certification Division of the California Department of Public Health. Complaints can be filed about abuse, neglect, violations of rights, poor care, lack of staffing, unsafe conditions, mistreatment, improper charges, among other things. Complaints can be made orally or in writing, and filed in person or electronically.

Once a complaint is filed, the Department of Public Health must notify the complainant within two working days of receipt of the complaint of the name of the investigator assigned to the case. The Department of Public Health must begin an onsite investigation of the complaint within ten working days of receipt of the complaint. If the complaint involves threat of imminent danger or death or serious bodily harm, the onsite investigation must occur within 24 hours of receipt of the complaint. Investigations must be completed within 60 days of receipt. That deadline can be extended 60 days for extenuating circumstances upon written notification to the complainant and facility. Citations resulting from a complaint must be issued within 30 days of the completion of the complaint investigation.

The SNF complaint process also provides complainants with an appeal process. A complainant has the right to an informal conference which is scheduled within 30 days of the appeal. The complainant then meets with the Department of Public Health district manager and potentially the administrator of the nursing home. After this informal conference the Department of Public Health will notify the complainant within 10 working days of its determination.

Current RCFE Complaint Process

The Community Care Licensing division of the CDSS is the agency that investigates complaints against RCFEs. Like SNFs, any person can file a complaint against an RCFE. Complaints can be filed about abuse, neglect, poor care, eviction issues, among other things. The investigation must begin within 10 working days of the receipt of the complaint. Investigation length can vary greatly depending on the severity of the case. There are no timeframes as to how long these investigations can take. This bill seeks to align the RCFE complaint process to more closely follow the procedures currently in use for complaints against SNFs.

Related/Prior Legislation:

AB 348 (Brown, 2015) would require the Department of Public Health to meet the same deadlines for investigating incidents reported by long-term health care facilities that the Department of Public Health is required to meet when investigating incidents reported to the Department of Public Health by members of the public. AB 348 was held on the Senate Appropriations suspense file.

AB 1554 (Skinner, 2014) would make numerous changes, effective July 1, 2015, to the complaint investigation process used by CDSS when responding to complaints submitted against RCFEs and affords complainants with two levels of appeal. This bill would also require CDSS to assess an immediate civil penalty, as specified, for interfering with a complaint investigation or for retaliating against residents or staff involved in the investigation. AB 1554 was held on the Senate Appropriations suspense file.

COMMENTS

Current law does not require the Community Care Licensing Division to notify a complainant that their complaint has been received, does not notify them of what to expect during the investigation and does not provide notice if the Community Care Licensing Division determines the complaint does not meet its standards for review. By aligning the procedures for RCFEs more closely to those for SNFs, this bill will provide complainants more information about the process as well as a fixed timeline for these complaints to be investigated.

PRIOR VOTES

POSITIONS

Support:

California Advocates for Nursing Home Reform (Sponsor)

AARP
Alzheimer's Greater Los Angeles
Alzheimer's Orange County
Alzheimer's San Diego
California Long Term Care Ombudsman Association (CLTCOA)
Office of The State Long-term Care Ombudsman

Oppose:

California Assisted Living Association

Leadingage California

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1911

Author:(Reyes)

As Amended Ver:May 16, 2024

Majority vote

SUMMARY

Imposes specified timelines for the California Department of Social Services (CDSS) to conduct complaint investigations against residential care facilities for the elderly (RCFEs).

Major Provisions

1. Requires CDSS to conduct an onsite investigation within one business day of all complaints that allege a threat of imminent danger of death or serious harm.
2. Requires CDSS to communicate, in writing within 10 calendar days of receiving the complaint, if the department determines an investigation is not warranted and the reason for the determination. The complainant has the right to seek review of that determination by the regional office manager, or their designee.
3. Requires CDSS to send a written notification to the complainant of the following:
   1. Complaint tracking number;
   2. Proposed course of action;
   3. Name and contact information of the analyst who will conduct the investigation;
   4. Nature of the allegations to be investigated;
   5. Opportunity to accompany the investigator on the investigation of the facility; and,
   6. Relevant deadline for the department to complete its investigation.
4. Allows CDSS, after its initial onsite investigation, to perform subsequent elements of its investigation via telephone or video conference.
5. Commencing July 1, 2025, imposes a 90 day timeline for a complaint that involves a threat of imminent danger of death or serious harm.
6. Permits CDSS to extend the investigation by additional 60 calendar days due to extenuating circumstances with documentation of the circumstances in its final determination and requires CDSS to notify the facility and the complainant in writing of the basis for the extension and the estimated completion date.
7. Requires CDSS to complete an investigation of the complaint within 90 calendar days of receipt of the complaint for a complaint that does not involve a threat of imminent danger of death or serious bodily harm and that is received on or after July 1, 2026, and prior to July 1, 2027.
8. Permits the time period described in 7) to be extended up to an additional 90 calendar days if the investigation cannot be completed due to extenuating circumstances.
9. Requires, for complaints received on or after July 1, 2027, CDSS to complete an investigation within 60 calendar days of receipt of the complaint.
10. Permits the time period described in 9) above, to be extended up to an additional 60 calendar days if the investigation cannot be completed due to extenuating circumstances.
11. Requires CDSS to interview any residents who are the subject of the investigation.
12. Requires CDSS to notify the complainant within 10 business days the complainant's right to seek an informal conference, and the process for seeking an informal conference.
13. Requires CDSS to provide the complainant a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable, with the notification.
14. Specifies an appeal process as follows:
    1. A complainant may, within 30 calendar days after receipt of the notice, notify the regional office manager in writing of their request for an informal conference;
    2. Requires the informal conference to be held with the regional office manager or their designee within 30 calendar days of the receipt of the request, and requires CDSS to summarize to the complainant all of the evidence and information it reviewed pursuant to its investigation;
    3. Requires the regional office manager to notify the complainant, in writing, of their determination within 10 working days after the informal conference and shall apprise the complainant and licensee, in writing, of the right to a review by the deputy director of CDSS;
    4. Permits the complainant to appeal the determination of the regional office manager, within 30 days after receipt of this determination by notifying the deputy director in writing;
    5. Requires the deputy director to review the facts that led to both determinations, within 30 days of the receipt of the notice; and,
    6. Requires the deputy director or their designee to interview the complainant. Requires the deputy director to make an independent determination and notify the complainant, in writing, of their determination and reasons therefor, within 30 calendar days after receipt of the request for review.
15. Permits a complainant may be assisted or represented by any person of their choice in the appeal process.

COMMENTS

Background: Residential Care Facilities for the Elderly. RCFEs are situated between in-home care and skilled nursing facilities. RCFEs are most commonly referred to as Assisted Living, Board and Care, or Residential Care. These residences are designed to provide homelike housing options to residents 60 years of age and older who need some help with activities of daily living, such as cooking, bathing, or getting dressed, but otherwise do not need continuous, 24-hour assistance or nursing care. RCFEs do not have a uniform care model and have a wide variation in the level of services and independence available to residents. This flexibility is intended to allow aging individuals the ability to find care that fits within their lifestyle and personality.

The RCFE licensure category includes facilities with as few as six beds to those with hundreds of residents, whose needs may vary widely. Typically, the smaller facilities are homes in residential neighborhoods while the larger facilities resemble apartment complexes with structured activities for their residents. Residents may reside in their own apartment or may share a bedroom.

State Oversight Responsibly for Facilities Serving the Aging Population. CDSS is charged with regulating and licensing non-medical residential facilities and community services. CDSS is required to make unscheduled visits to all licensed RCFEs "as often as necessary," and is required to do so annually in certain instances, such as when a licensee is on probation, the facility compliance plan requires annual visits, or when an accusation against a licensee is pending, among others. CDSS is required to visit all RCFEs no less than once every five years and any individual may request an inspection of an RCFE.

In 2023, CDSS inspected 75% of all adult and senior facilities, and CDSS reports they anticipate a higher rate of inspection in 2024.

CDSS publicly posts a transparency dashboard for each licensed facility that shows a tab for all visits, citations, inspections, complaints, other visits, locations, and reports. Within these tabs, you can see how many inspections they have received and how many, if any, A or B citations have been found. The dashboard also permits someone to subscribe and receive updates about specific facilities.

California Department of Social Services' Complaint Process. CDSS' Community Care Licensing Division is responsible for receiving and investigating complaints. Licensing complaints can be filed by anyone who believes a licensee is violating applicable laws and regulations including loved ones, facility residents, and staff. CDSS has the following posted on its website to inform the public how the complaint will be handled:

1. The local licensing office will make an unannounced visit to the facility to investigate the complaint within 10 days of receipt of the complaint.
2. You will be notified in writing that your complaint has been received, if you have provided your contact information, and a Licensing Program Analyst (LPA) or Enforcement Analyst will be assigned to your case who will be your point of contact throughout the investigation.
3. When reaching a determination on a complaint, Community Care Licensing uses a "Preponderance of the Evidence" standard, meaning the available evidence must show that it is more likely than not (more than 50%) that the allegation is true. If this standard is met, the allegation will be "Substantiated." The LPA or Enforcement Analyst may reach a finding of "Unsubstantiated" if the investigation shows that this standard hasn't been met, meaning there isn't enough evidence to prove a violation occurred. The LPA or Enforcement Analyst may reach a finding of "Unfounded" if the evidence shows an allegation could not have happened, is false, and/or is without a reasonable basis.
4. Once the investigation is completed, the department will notify you in writing of the findings if you have provided your contact information. The length of the investigation depends on the complexity of the case."

There are two types of violations CDSS issues – A or B. An "A" citation is for the most serious type of violation in which there is an immediate risk to the health, safety, or personal rights of those in care. A "B" citation is for licensing violations that if corrected may not pose an immediate danger to residents. This bill would require CDSS to investigate "A" violations within one business day of receiving the complaint.

Beginning in late 2019, CDSS began using Compliance and Regulatory Enforcement (CARE) Tools as developed by the Inspection Process Project. The CARE tools were designed to focus on prevention, compliance, and enforcement.

To aid in the efficiency of the inspection process, the CARE Tools were developed utilizing a tiered approach which allows efforts to be focused on areas where compliance issues are likely to be found. As such, the CARE Tools are broken out into four distinct parts, the standard tool, domain-focused tools, correlated domains, and the comprehensive tool. Statistically derived triggers will automatically add these additional elements to the CARE Tools based on violations found during the inspection process.

Complaint Investigations Timelines. Over the last fiscal year (FY), CDSS has met the statutory requirement of initiating a complaint investigation within 10 days 98% of the time, with an average of six days from receiving a complaint to the first complaint investigation visit. In FY 2022- 23, including complex investigations and their backlog, CDSS took approximately 229 days from the beginning of the investigation to finalizing and closing it. Due to severity, complexity, the number of allegations, and the involvement of law enforcement, some investigations take longer to investigate and close. Excluding investigations that might take longer due to the nature of the complaint, in FY 2022-23 CDSS took approximately 74 days from the beginning of the investigation to finalizing and closing it. The following is a table showing complaints received and approved for completion:

Of note, the COVID-19 pandemic shifted CDSS' Adult and Senior Care Program priorities from fieldwork to providing COVID-19-related technical support and assistance to licensees. CDSS reports this contributed to the backlog.

Equity Implications: Currently, there are more than 6.1 million residents over the age of 65. According to Justice in Aging, 10.8 million Californians will be over 60 years of age by 2030, accounting for 25% of the state's total population. Aging adults reside in RCFEs to receive assistance with daily tasks, find community, and secure housing. RCFEs can also be an alternative to more costly care at skilled nursing homes. Without RCFEs, many of these adults would be forced to be without care, lack access to regular hygiene, or become homeless. This is why ensuring RCFEs are safe places is crucial to keeping the aging population safe.

According to the Author

"[This bill] will improve Residential Care Facility for the Elderly (RCFE) complaint investigations performed by the California Department of Social Services' Community Care Licensing Division (CCLD). It ensures that all complainants receive a response and provides for more effective and timely investigations and appeals for dissatisfied complainants. Currently, the experience for individuals who file complaints against an RCFE is inadequate and discourages individuals from filing complaints. Often times, CDSS determinations on complaints are not communicated to complainants, leaving them without the information they need to follow-up on complaints and unaware of whether their complaints will be investigated. When CDSS determines that a complaint warrants an investigation, current law does not require written notification to the complainant that their complaint has been received or information regarding the process for the investigation. [This bill] will improve the complaint process by improving CDSS' communication with complainants and imposing clear deadlines on complaint investigations."

Arguments in Support

According to the sponsors of this bill, California Advocates for Nursing Home Reform:

"[This bill] improves the RCFE complaint process by:

1. Requiring notice to complainants when their complaint is set aside and not investigated. [This bill] gives these complainants the chance to appeal the determination that their complaint does not merit an investigation.
2. Requiring DSS to send complainants written notice that their complaint has been received and to tell complainants the case tracking number, the proposed course of action, the name and contact information of the analyst who will conduct the investigation, the nature of the allegations to be investigated so the complainant can verify that DSS has not missed anything.
3. Extending the right to accompany the investigator on the investigation of the facility. This right provides important accountability to inspections, ensuring they are reasonably thorough.
4. Imposing deadlines for complaint investigations, ending the often-interminable wait for complaint closures. In contrast, nursing home complaints must be completed within sixty days of receipt of the complaint with a 60-day good cause extension. [This bill] imposes the same deadline for RCFE complaint investigations. The bill also sets a one business day deadline for initiating investigations when a complaint alleges the threat of imminent death or serious harm.
5. Giving complainants the right to appeal an outcome they find unsatisfactory. Again, the bill borrows heavily from nursing home complaint investigations, which include a two-level appeal process for complainants. RCFE licensees are afforded a four-level appeal process; complainants ought to have access to appeals too."

Arguments in Opposition

LeadingAge California and California Association of Assisted Living jointly write as oppose unless amended, "We are also concerned with the department's ability to establish and maintain an additional, multi-step appeal process as proposed in Section 1569.35(g), without creating further backlogs in existing functions. Cost is not the only concern as the department currently struggles with limited workforce availability in general."

FISCAL COMMENTS

According to the Assembly Committee on Appropriations on May 16, 2024:

Ongoing General Fund costs to CDSS of an unknown amount, but likely in the low millions of dollars annually for additional personnel to investigate and close cases per the phased-in accelerated timeline and to develop and administer an appeals process for complainants. CDSS received nearly 5,470 complaints in fiscal year 2022-23.

According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

VOTES

ASM HUMAN SERVICES: 7-0-0

YES: Lee, Essayli, Calderon, Gipson, Jackson, Ta, Ortega

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin, Villapudua

ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta

UPDATED

VERSION: May 16, 2024

CONSULTANT: Alexandria Smith / HUM. S. / (916) 319-2089 FN: 0003425

Date of Hearing: April 17, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1911

Author:(Reyes) – As Amended Ver:April 4, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Social Services (CDSS) to conduct investigations of complaints against residential care facility for the elderly (RCFE) within specified timelines and to provide written notifications to complainants. The bill also provides a process for a complainant to appeal the outcome of an investigation.

Specifically, this bill:

1. Requires CDSS to conduct an onsite investigation within one business day of any complaints that involves a threat of imminent danger of death or serious harm.
2. Requires CDSS to communicate, in writing within 10 calendar days of receiving the complaint, if CDSS determines an investigation is not warranted and the reason for the determination. The complainant has the right to seek review of that determination by the regional office manager.
3. Requires CDSS, prior to conducting an onsite investigation, to send a written notification to the complainant containing the complaint tracking number, the proposed course of action, the name and contact information of the analyst who will conduct the investigation, nature of the allegations to be investigated, and the relevant deadline for CDSS to complete its investigation.
4. Allows CDSS, after its initial onsite investigation, to perform subsequent elements of its investigation via telephone or video conference. 
5. Requires CDSS, beginning July 1, 2025, to complete an investigation of a complaint within 60 calendar days of receipt of the complaint; 30 days if the complaint involves a threat of imminent danger of death or serious harm.
6. Allows CDSS to extend the investigation an additional 60 calendar days for good cause and requires CDSS to notify the facility and the complainant in writing of the basis for the extension and the estimated completion date.
7. Requires CDSS to interview any residents who are the subject of the complaint.
8. Requires CDSS to notify the complainant within 10 business days of completing the investigation of the complainant’s right to seek an informal conference, the process for doing so, and to provide the complainant a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable, with the notification.
9. Allows a complainant who is dissatisfied with CDSS’ determination to, within 30 days after the receipt of the notice, notify the regional office manager in writing of their request for an informal conference and requires the regional office manager to hold the informal conference within 30 calendar days, as specified.

FISCAL EFFECT:

Ongoing General Fund costs to CDSS of an unknown amount, but likely in the mid- to high-tens of millions of dollars annually for additional personnel to investigate and close cases per the accelerated timeline in the bill and to develop and administer an appeals process for complainants. CDSS received nearly 5,470 complaints in fiscal year 2022-23.

According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years. 

COMMENTS:

1. Purpose. The author seeks to ensure older adults and their families receive information from CDSS when they submit complaints related to RCFEs and that their complaints are investigated in a timely manner. According to the author:

[This bill] ensures that all complainants receive a response and provides for more effective and timely investigations and appeals for dissatisfied complainants. Currently, the experience for individuals who file complaints against an RCFE is inadequate and discourages individuals from filing complaints. [This bill] will improve the complaint process by improving CDSS' communication with complainants and imposing clear deadlines on complaint investigations.

1. Background. The Community Care Licensing Division (CCLD) within CDSS administers the licensure and oversight of nearly 7,500 assisted living, board and care, and continuing care retirement homes licensed as RCFEs in California. These residences provide home-like environment housing options to elderly residents who need assistance with activities of daily living but otherwise do not require 24-hour nursing care. RCFEs range from residential homes with six or fewer beds to residential facilities with 100 beds or more. CDSS is required to conduct unannounced licensing inspections of all licensed community care facilities, including RCFEs, at least once every five years, more often in some circumstances.

Under existing law, upon receipt of a complaint against an RCFE, CDSS must initially respond within 10 calendar days and must also make a good faith effort to contact and interview the complainant and inform the complainant of CDSS’s proposed course of action and the relevant deadline to complete its investigation. In addition, CDSS must, within 10 days of completing the investigation, notify the complainant of CDSS’s determination as a result of the investigation. There is no statutory deadline for CDSS to complete an investigation and no recourse for a complainant if an investigation is prolonged or not pursued. Further, neither existing law nor regulation provides an appeals process for a complainant who is dissatisfied with the outcome of a complaint investigation.

In fiscal year (FY) 2022-23, CDSS received 5,467 complaints involving RCFEs and met (and continues to meet) its 10-day statutory requirement 98% of the time, averaging six days from the receipt of a complaint to the first complaint investigation visit. However, the time for CDSS to investigate and close a case varies widely depending on the number, severity, and complexity of the allegations, as well as the involvement of law enforcement. For example, building maintenance complaints are often quickly resolved, while alleged abuse complaints are far more complex and often take much longer due to the nature of the complaint and the involvement of additional agencies with their own timelines.

Including complex investigations and backlog, in FY 2022-23, CDSS averaged approximately 229 days to finalize and close a case. When complex cases are excluded, this average drops to 74 days.

This bill strengthens existing notification requirements, imposes timelines on CDSS for the completion of investigations and creates an appeals process for complainants who are dissatisfied with the outcome of an investigation.

1. Prior Legislation. AB 1387 (Chu), Chapter 486, Statutes of 2015, streamlined the appeals process for community care facility civil penalty and violation appeals and enhanced the complaint process for RCFEs.

AB 1554 (Skinner), of the 2013-14 Legislative Session, would have updated the RCFE complaint investigation process used by the CDSS and provided complainants with an appeals process. AB 1554 was held on the suspense file in the Senate Committee on Appropriations.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 1911 (

Author:Reyes) – As Amended Ver:March 19, 2024

SUBJECT: Residential care facilities: complaints

SUMMARY: Imposes specified timelines for the California Department of Social Services (CDSS) to conduct complaint investigations. Specifically, this bill:

1. Requires (CDSS) to conduct an onsite investigation within one business day of all complaints that allege a threat of imminent danger of death or serious harm.
2. Requires CDSS to communicate, in writing within 10 calendar days of receiving the complaint, if the department determines an investigation is not warranted and the reason for the determination. The complainant has the right to seek review of that determination by the regional office manager, or their designee.
3. Requires CDSS to send a written notification to the complainant of the following:
   1. Complaint tracking number;
   2. Proposed course of action;
   3. Name and contact information of the analyst who will conduct the investigation;
   4. Nature of the allegations to be investigated;
   5. Opportunity to accompany the investigator on the investigation of the facility; and
   6. Relevant deadline for the department to complete its investigation.
4. Commencing July 1, 2025, imposes a 60 calendar day timeline for CDSS to complete an investigation of a complaint and 30 day timeline for a complaint that entails a treat of imminent danger of death or serious harm.
5. Permits CDSS to extend the investigation by additional 60 calendar days due to good cause with documentation of the circumstances in its final determination and requires CDSS to notify the facility and the complainant in writing of the basis for the extension and the estimated completion date.
   
6. Requires CDSS to interview any residents who are the subject of the investigation.
7. Requires CDSS to notify the complainant within 10 business days the complainant’s right to seek an informal conference, and the process for seeking an informal conference.
   
8. Requires CDSS to provide the complainant a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable, with the notification.
   
9. Specifies an appeal process as follows:
   1. A complainant may, within 30 calendar days after receipt of the notice, notify the regional office manager in writing of their request for an informal conference.
   2. Requires the informal conference to be held with the regional office manager or their designee within 30 calendar days of the receipt of the request, and requires CDSS to summarize to the complainant all of the evidence and information it reviewed pursuant to its investigation
   3. Requires the regional office manager to notify the complainant, in writing, of their determination within 10 working days after the informal conference and shall apprise the complainant and licensee, in writing, of the right to a review by the deputy director.
   4. Permits the complainant to appeal the determination of the regional office manager, within 30 days after receipt of this determination, notify in writing the deputy director,
   5. Requires the deputy director to review the facts that led to both determinations, within 30 days of the receipt of the notice.
   6. Requires the deputy director or their designee to interview the complainant. Requires, the deputy director to make an independent determination and notify the complainant, in writing, of their determination and reasons therefor, within 30 calendar days after receipt of the request for review.
10. Permits a complainant may be assisted or represented by any person of their choice in the appeal process described in this subdivision.

EXISTING LAW:

1. Establishes the Residential Care Facilities for the Elderly Act which provides for the CDSS to license and regulate RCFEs as a separate category within the existing residential care licensing structure of CDSS. (Health and Safety Code [HSC] § 1569 et seq.)
2. Provides that RCFEs shall be subject to unannounced visits by CDSS and be visited as often as necessary to ensure the quality of care provided. (HSC § 1569.33)
3. Requires annual unannounced inspections when a license is on probation, when required by the terms of a facility compliance plan, when an accusation is pending, when required for federal financial participation, or to verify that a person who has been ordered out of the facility is no longer present. (HSC § 1569.33)
4. Requires CDSS to perform random inspections each year on no fewer than 20 percent of the RCFE facilities not subject to annual inspections. Provides that this percentage shall increase by 10 percent if the total citations issued by the department exceeds the previous year by 10 percent. As a result of this trigger, CDSS currently is required to perform random inspections on 30 percent of the RCFE facilities not subject to annual inspection. Requires CDSS to visit every facility no less than every 5 years. (HSC § 1569.33)
5. Requires CDSS to visit a newly licensed facility within 90 days after a facility accepts its first resident to evaluate compliance with regulatory requirements. (HSC § 1569.24)
6. Permits any person to request an inspection of any RCFE by transmitting notice of an alleged violation orally or in writing. Requires CDSS to make a preliminary review and an onsite inspection within 10 days after receiving the complaint except where the visit would adversely affect the licensing investigation or the investigation of other agencies, including, but not limited to, law enforcement agencies (HSC § 1569.35)
7. Through regulation, requires CDSS to conduct a follow-up visit 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 required. Provides that no penalty shall be assessed unless a follow-up visit is conducted. (Title 22 CCR 87759)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: Residential Care Facilities for the Elderly. RCFEs are situated between in-home care and skilled nursing facilities. RCFEs are most commonly referred Assisted Living, Board and Care, or Residential Care. These residences are designed to provide homelike housing options to residents who need some help with activities of daily living, such as cooking, bathing, or getting dressed, but otherwise do not need continuous, 24-hour assistance or nursing care. RCFEs do not have a uniform care model and a wide variation in the level of services and independence available to residents. This flexibility is intended to allow aging individuals the ability to find care that fits within their lifestyle and personality.

The RCFE licensure category includes facilities with as few as six beds to those with hundreds of residents, whose needs may vary widely. Typically, the smaller facilities are homes in residential neighborhoods while the larger facilities resemble apartment complexes with structured activities for their residents. Residents may reside in their own apartment or may share a bedroom.

State Oversight Responsibly for Facilities Serving the Aging Population. CDSS is charged with regulating and licensing non-medical residential facilities and community services. CDSS is required to make unscheduled visits to all licensed RCFEs “as often as necessary,” and is required to do so annually in certain instances, such as when a licensee is on probation, the facility compliance plan requires annual visits, or when an accusation against a licensee is pending, among others. CDSS is required to visit all RCFEs no less than once every five years and any individual may request an inspection of an RCFE.

In 2023, CDSS inspected 75% of all adult and senior facilities, and CDSS reports they anticipate a higher rate of inspection in 2024.

CDSS publicly posts a transparency dashboard for each licensed facility that shows a tab for all visits, citations, inspections, complaints, other visits, locations, and reports. Within these tabs, you can see how many inspections they have received and how many, if any, A or B citations have been found. The dashboard also permits someone to subscribe and receive updates about specific facilities.

CDSS’ Complaint Process. CDSS’ Community Care Licensing Division is responsible for receiving and investigating complaints. Licensing complaints can be filed by anyone who believes a licensee is violating applicable laws and regulations including loved ones, facility residents, and staff. CDSS has the following posted on its website to inform the public how the complaint will be handled:

• “The local licensing office will make an unannounced visit to the facility to investigate the complaint within 10 days of receipt of the complaint.
• You will be notified in writing that your complaint has been received, if you have provided your contact information, and a Licensing Program Analyst (LPA) or Enforcement Analyst will be assigned to your case who will be your point of contact throughout the investigation.
• When reaching a determination on a complaint, Community Care Licensing uses a “Preponderance of the Evidence” standard, meaning the available evidence must show that it is more likely than not (more than 50%) that the allegation is true. If this standard is met, the allegation will be “Substantiated.” The LPA or Enforcement Analyst may reach a finding of “Unsubstantiated” if the investigation shows that this standard hasn't been met, meaning there isn't enough evidence to prove a violation occurred. The LPA or Enforcement Analyst may reach a finding of “Unfounded” if the evidence shows an allegation could not have happened, is false, and/or is without a reasonable basis.
• Once the investigation is completed, the Department will notify you in writing of the findings if you have provided your contact information. The length of the investigation depends on the complexity of the case.”

There are two types of violations CDSS issues – A or B. An “A” citation is for the most serious type of violation in which there is an immediate risk to the health, safety, or personal rights of those in care. A “B” citation is for licensing violations that if corrected may not pose an immediate danger to residents. This bill would require CDSS to investigate “A” violations within one business day of receiving the complaint.

Beginning in late 2019, CDSS began using Compliance and Regulatory Enforcement (CARE) Tools as developed by the Inspection Process Project. The CARE tools were designed to focus on Prevention, Compliance, and Enforcement.

To aid in the efficiency of the inspection process, the CARE Tools were developed utilizing a tiered approach which allows efforts to be focused on areas where compliance issues are likely to be found. As such, the CARE Tools are broken out into four distinct parts, the standard tool, domain-focused tools, correlated domains, and the comprehensive tool. Statistically derived triggers will automatically add these additional elements to the CARE Tools based on violations found during the inspection process.

Complaint Investigations Timelines. Over the last fiscal year (FY), CDSS has met the statutory requirement of initiating a complaint investigation within 10 days 98% of the time, with an average of six days from receiving a complaint to the first complaint investigation visit. In FY 2022- 23, including complex investigations and their backlog, CDSS took approximately 229 days from beginning on investigation to finalizing and closing it. Due to severity, complexity, the number of allegations, and the involvement of law enforcement, some investigations take longer to investigate and close. Excluding investigations that might take longer due to the nature of the complaint, in FY 2022-23 CDSS took approximately 229 days from beginning on investigation to finalizing and closing it. The following is a table showing complaints received and approved for completion:

Of note, the COVID-19 pandemic shifted CDSS’ Adult and Senior Care Program priorities from fieldwork to providing COVID-19-related technical support and assistance to licensees. CDSS reports this contributes to the backlog.

Author’s Statement: According to the Author, “AB 1911 will improve Residential Care Facility for the Elderly (RCFE) complaint investigations performed by the California Department of Social Services' Community Care Licensing Division (CCLD). It ensures that all complainants receive a response and provides for more effective and timely investigations and appeals for dissatisfied complainants. Currently, the experience for individuals who file complaints against an RCFE is inadequate and discourages individuals from filing complaints. Often times, CDSS determinations on complaints are not communicated to complainants, leaving them without the information they need to follow-up on complaints and unaware of whether their complaints will be investigated. When CDSS determines that a complaint warrants an investigation, current law does not require written notification to the complainant that their complaint has been received or information regarding the process for the investigation. AB 1911 will improve the complaint process by improving CDSS' communication with complainants and imposing clear deadlines on complaint investigations.”

Equity Implications: Currently, there are more than 6.1 million residents over the age of 65. According to Justice in Aging, 10.8 million Californians will be over the age of 60 by 2030, accounting for 25% of the state’s total population. Aging adults reside in RCFEs to receive assistance with daily tasks, and find community, and housing. RCFEs can also be an alternative to more costly care at skilled nursing homes. Without RCFEs, many of these adults would be forced to be without care, lack hygiene, or become homeless. This is why ensuring RCFEs are safe places is crucial to keeping the aging population safe.

Policy Considerations: As in print, this bill does not allow for technological advances in communication. The COVID-19 pandemic showed that the state is capable of harnessing technology in a way that is beneficial to access and efficiency. This bill sets forth a timeline that is about 1/3 of the average time CDSS is processing complaints. To meet timelines, it is prudent to allow technological communication when appropriate.

This bill also requires CDSS to complete an investigation of the complaint within 30 calendar days of receipt of the complaint if the complaint alleges a threat of imminent danger of death or serious harm. As written, this puts the onus of a complaint to allege imminent danger. Complainants may not know the issue they are bringing forward constitutes imminent danger.

Proposed Committee Amendments:

The Committee proposes amendments to address policy considerations stated above to do the following:

• Permit CDSS to use phone or video conference after an initial onsite investigation has been conducted.
• Clarify that complaints involving a threat of imminent danger of death or serious harm shall be investigated within 30 calendar days.

RELATED AND PRIOR LEGISLATION:

AB 1387 (Chu), Chapter 486, Statutes of 2015, streamlined the appeals process for community care facility civil penalty and violation appeals and enhanced the complaint process for residential care facilities for the elderly

AB 1554 (Skinner) of 2014, would have updated the complaint investigation process used by the CDSS when responding to complaints submitted against RCFEs and affords complainants with two levels of appeal.

SB 895 (Corbett), Chapter 704, Statutes of 2014, requires CDSS to conduct annual unannounced comprehensive inspections for all facilities by 2018, requires CDSS to verify compliance following deficiencies within 10 days, and requires results of inspections to be available on the CDSS website.

AB 1436 (Waldron) of 2014, would have required 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 1436 was held on the Assembly Appropriations Committee suspense file.

AB 1454 (Calderon) of 2014, would require all licensed community care facilities, RCFEs, and child day care centers to be subject to an annual unannounced visits visit by CDSS. AB 1454 was held on the Assembly Appropriations Committee suspense file.

AB 2171 (Wieckowski), Chapter 702, Statutes of 2014, established specified RCFE residents’ rights and required facilities to inform residents of these rights as specified.

AB 2236 (Mainschein), Chapter 813, Statutes of 2014, among other provisions, imposed a new civil penalty structure, commencing July 1, 2015, for program violations in facilities licensed by the Community Care Licensing Division of CDSS involving the death or physical abuse of, or serious bodily injury to, a resident or child at the care facility.

AB 581 (Ammiano), Chapter 295, Statutes of 2013, strengthened protections against retaliation or discrimination when complaints are made.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform (Sponsor)
AARP
Alzheimer's Greater Los Angeles
Alzheimer's Orange County
Alzheimer's San Diego
Community Legal Services in East Palo Alto
Justice in Aging
Legal Assistance for Seniors
Office of The State Long-term Care Ombudsman
The Geriatric Circle

Opposition

None on file.

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 1911 (

Author:Reyes) – As Amended Ver:March 19, 2024

SUBJECT: Residential care facilities: complaints

SUMMARY: Imposes specified timelines for the California Department of Social Services (CDSS) to conduct complaint investigations. Specifically, this bill:

1. Requires (CDSS) to conduct an onsite investigation within one business day of all complaints that allege a threat of imminent danger of death or serious harm.
2. Requires CDSS to communicate, in writing within 10 calendar days of receiving the complaint, if the department determines an investigation is not warranted and the reason for the determination. The complainant has the right to seek review of that determination by the regional office manager, or their designee.
3. Requires CDSS to send a written notification to the complainant of the following:
   1. Complaint tracking number;
   2. Proposed course of action;
   3. Name and contact information of the analyst who will conduct the investigation;
   4. Nature of the allegations to be investigated;
   5. Opportunity to accompany the investigator on the investigation of the facility; and
   6. Relevant deadline for the department to complete its investigation.
4. Commencing July 1, 2025, imposes a 60 calendar day timeline for CDSS to complete an investigation of a complaint and 30 day timeline for a complaint that entails a treat of imminent danger of death or serious harm.
5. Permits CDSS to extend the investigation by additional 60 calendar days due to good cause with documentation of the circumstances in its final determination and requires CDSS to notify the facility and the complainant in writing of the basis for the extension and the estimated completion date.
   
6. Requires CDSS to interview any residents who are the subject of the investigation.
7. Requires CDSS to notify the complainant within 10 business days the complainant’s right to seek an informal conference, and the process for seeking an informal conference.
   
8. Requires CDSS to provide the complainant a copy of any documents describing violations and enforcement actions resulting from the investigation, if applicable, with the notification.
   
9. Specifies an appeal process as follows:
   1. A complainant may, within 30 calendar days after receipt of the notice, notify the regional office manager in writing of their request for an informal conference.
   2. Requires the informal conference to be held with the regional office manager or their designee within 30 calendar days of the receipt of the request, and requires CDSS to summarize to the complainant all of the evidence and information it reviewed pursuant to its investigation
   3. Requires the regional office manager to notify the complainant, in writing, of their determination within 10 working days after the informal conference and shall apprise the complainant and licensee, in writing, of the right to a review by the deputy director.
   4. Permits the complainant to appeal the determination of the regional office manager, within 30 days after receipt of this determination, notify in writing the deputy director,
   5. Requires the deputy director to review the facts that led to both determinations, within 30 days of the receipt of the notice.
   6. Requires the deputy director or their designee to interview the complainant. Requires, the deputy director to make an independent determination and notify the complainant, in writing, of their determination and reasons therefor, within 30 calendar days after receipt of the request for review.
10. Permits a complainant may be assisted or represented by any person of their choice in the appeal process described in this subdivision.

EXISTING LAW:

1. Establishes the Residential Care Facilities for the Elderly Act which provides for the CDSS to license and regulate RCFEs as a separate category within the existing residential care licensing structure of CDSS. (Health and Safety Code [HSC] § 1569 et seq.)
2. Provides that RCFEs shall be subject to unannounced visits by CDSS and be visited as often as necessary to ensure the quality of care provided. (HSC § 1569.33)
3. Requires annual unannounced inspections when a license is on probation, when required by the terms of a facility compliance plan, when an accusation is pending, when required for federal financial participation, or to verify that a person who has been ordered out of the facility is no longer present. (HSC § 1569.33)
4. Requires CDSS to perform random inspections each year on no fewer than 20 percent of the RCFE facilities not subject to annual inspections. Provides that this percentage shall increase by 10 percent if the total citations issued by the department exceeds the previous year by 10 percent. As a result of this trigger, CDSS currently is required to perform random inspections on 30 percent of the RCFE facilities not subject to annual inspection. Requires CDSS to visit every facility no less than every 5 years. (HSC § 1569.33)
5. Requires CDSS to visit a newly licensed facility within 90 days after a facility accepts its first resident to evaluate compliance with regulatory requirements. (HSC § 1569.24)
6. Permits any person to request an inspection of any RCFE by transmitting notice of an alleged violation orally or in writing. Requires CDSS to make a preliminary review and an onsite inspection within 10 days after receiving the complaint except where the visit would adversely affect the licensing investigation or the investigation of other agencies, including, but not limited to, law enforcement agencies (HSC § 1569.35)
7. Through regulation, requires CDSS to conduct a follow-up visit 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 required. Provides that no penalty shall be assessed unless a follow-up visit is conducted. (Title 22 CCR 87759)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: Residential Care Facilities for the Elderly. RCFEs are situated between in-home care and skilled nursing facilities. RCFEs are most commonly referred Assisted Living, Board and Care, or Residential Care. These residences are designed to provide homelike housing options to residents who need some help with activities of daily living, such as cooking, bathing, or getting dressed, but otherwise do not need continuous, 24-hour assistance or nursing care. RCFEs do not have a uniform care model and a wide variation in the level of services and independence available to residents. This flexibility is intended to allow aging individuals the ability to find care that fits within their lifestyle and personality.

The RCFE licensure category includes facilities with as few as six beds to those with hundreds of residents, whose needs may vary widely. Typically, the smaller facilities are homes in residential neighborhoods while the larger facilities resemble apartment complexes with structured activities for their residents. Residents may reside in their own apartment or may share a bedroom.

State Oversight Responsibly for Facilities Serving the Aging Population. CDSS is charged with regulating and licensing non-medical residential facilities and community services. CDSS is required to make unscheduled visits to all licensed RCFEs “as often as necessary,” and is required to do so annually in certain instances, such as when a licensee is on probation, the facility compliance plan requires annual visits, or when an accusation against a licensee is pending, among others. CDSS is required to visit all RCFEs no less than once every five years and any individual may request an inspection of an RCFE.

In 2023, CDSS inspected 75% of all adult and senior facilities, and CDSS reports they anticipate a higher rate of inspection in 2024.

CDSS publicly posts a transparency dashboard for each licensed facility that shows a tab for all visits, citations, inspections, complaints, other visits, locations, and reports. Within these tabs, you can see how many inspections they have received and how many, if any, A or B citations have been found. The dashboard also permits someone to subscribe and receive updates about specific facilities.

CDSS’ Complaint Process. CDSS’ Community Care Licensing Division is responsible for receiving and investigating complaints. Licensing complaints can be filed by anyone who believes a licensee is violating applicable laws and regulations including loved ones, facility residents, and staff. CDSS has the following posted on its website to inform the public how the complaint will be handled:

• “The local licensing office will make an unannounced visit to the facility to investigate the complaint within 10 days of receipt of the complaint.
• You will be notified in writing that your complaint has been received, if you have provided your contact information, and a Licensing Program Analyst (LPA) or Enforcement Analyst will be assigned to your case who will be your point of contact throughout the investigation.
• When reaching a determination on a complaint, Community Care Licensing uses a “Preponderance of the Evidence” standard, meaning the available evidence must show that it is more likely than not (more than 50%) that the allegation is true. If this standard is met, the allegation will be “Substantiated.” The LPA or Enforcement Analyst may reach a finding of “Unsubstantiated” if the investigation shows that this standard hasn't been met, meaning there isn't enough evidence to prove a violation occurred. The LPA or Enforcement Analyst may reach a finding of “Unfounded” if the evidence shows an allegation could not have happened, is false, and/or is without a reasonable basis.
• Once the investigation is completed, the Department will notify you in writing of the findings if you have provided your contact information. The length of the investigation depends on the complexity of the case.”

There are two types of violations CDSS issues – A or B. An “A” citation is for the most serious type of violation in which there is an immediate risk to the health, safety, or personal rights of those in care. A “B” citation is for licensing violations that if corrected may not pose an immediate danger to residents. This bill would require CDSS to investigate “A” violations within one business day of receiving the complaint.

Beginning in late 2019, CDSS began using Compliance and Regulatory Enforcement (CARE) Tools as developed by the Inspection Process Project. The CARE tools were designed to focus on Prevention, Compliance, and Enforcement.

To aid in the efficiency of the inspection process, the CARE Tools were developed utilizing a tiered approach which allows efforts to be focused on areas where compliance issues are likely to be found. As such, the CARE Tools are broken out into four distinct parts, the standard tool, domain-focused tools, correlated domains, and the comprehensive tool. Statistically derived triggers will automatically add these additional elements to the CARE Tools based on violations found during the inspection process.

Complaint Investigations Timelines. Over the last fiscal year (FY), CDSS has met the statutory requirement of initiating a complaint investigation within 10 days 98% of the time, with an average of six days from receiving a complaint to the first complaint investigation visit. In FY 2022- 23, including complex investigations and their backlog, CDSS took approximately 229 days from beginning on investigation to finalizing and closing it. Due to severity, complexity, the number of allegations, and the involvement of law enforcement, some investigations take longer to investigate and close. Excluding investigations that might take longer due to the nature of the complaint, in FY 2022-23 CDSS took approximately 229 days from beginning on investigation to finalizing and closing it. The following is a table showing complaints received and approved for completion:

Of note, the COVID-19 pandemic shifted CDSS’ Adult and Senior Care Program priorities from fieldwork to providing COVID-19-related technical support and assistance to licensees. CDSS reports this contributes to the backlog.

Author’s Statement: According to the Author, “AB 1911 will improve Residential Care Facility for the Elderly (RCFE) complaint investigations performed by the California Department of Social Services' Community Care Licensing Division (CCLD). It ensures that all complainants receive a response and provides for more effective and timely investigations and appeals for dissatisfied complainants. Currently, the experience for individuals who file complaints against an RCFE is inadequate and discourages individuals from filing complaints. Often times, CDSS determinations on complaints are not communicated to complainants, leaving them without the information they need to follow-up on complaints and unaware of whether their complaints will be investigated. When CDSS determines that a complaint warrants an investigation, current law does not require written notification to the complainant that their complaint has been received or information regarding the process for the investigation. AB 1911 will improve the complaint process by improving CDSS' communication with complainants and imposing clear deadlines on complaint investigations.”

Equity Implications: Currently, there are more than 6.1 million residents over the age of 65. According to Justice in Aging, 10.8 million Californians will be over the age of 60 by 2030, accounting for 25% of the state’s total population. Aging adults reside in RCFEs to receive assistance with daily tasks, and find community, and housing. RCFEs can also be an alternative to more costly care at skilled nursing homes. Without RCFEs, many of these adults would be forced to be without care, lack hygiene, or become homeless. This is why ensuring RCFEs are safe places is crucial to keeping the aging population safe.

Policy Considerations: As in print, this bill does not allow for technological advances in communication. The COVID-19 pandemic showed that the state is capable of harnessing technology in a way that is beneficial to access and efficiency. This bill sets forth a timeline that is about 1/3 of the average time CDSS is processing complaints. To meet timelines, it is prudent to allow technological communication when appropriate.

This bill also requires CDSS to complete an investigation of the complaint within 30 calendar days of receipt of the complaint if the complaint alleges a threat of imminent danger of death or serious harm. As written, this puts the onerous of a complaint to allege imminent danger. Complainants may not know the issue they are bringing forward constitutes imminent danger.

Proposed Committee Amendments:

The Committee proposes amendments to address policy considerations stated above to do the following:

• Permit CDSS to use phone or video conference after an initial onsite investigation has been conducted.
• Clarify that complaints involving a threat of imminent danger of death or serious harm shall be investigated within 30 calendar days.

RELATED AND PRIOR LEGISLATION:

AB 1387 (Chu), Chapter 486, Statutes of 2015, streamlined the appeals process for community care facility civil penalty and violation appeals and enhanced the complaint process for residential care facilities for the elderly

AB 1554 (Skinner) of 2014, would have updated the complaint investigation process used by the CDSS when responding to complaints submitted against RCFEs and affords complainants with two levels of appeal.

SB 895 (Corbett), Chapter 704, Statutes of 2014, requires CDSS to conduct annual unannounced comprehensive inspections for all facilities by 2018, requires CDSS to verify compliance following deficiencies within 10 days, and requires results of inspections to be available on the CDSS website.

AB 1436 (Waldron) of 2014, would have required 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 1436 was held on the Assembly Appropriations Committee suspense file.

AB 1454 (Calderon) of 2014, would require all licensed community care facilities, RCFEs, and child day care centers to be subject to an annual unannounced visits visit by CDSS. AB 1454 was held on the Assembly Appropriations Committee suspense file.

AB 2171 (Wieckowski), Chapter 702, Statutes of 2014, established specified RCFE residents’ rights and required facilities to inform residents of these rights as specified.

AB 2236 (Mainschein), Chapter 813, Statutes of 2014, among other provisions, imposed a new civil penalty structure, commencing July 1, 2015, for program violations in facilities licensed by the Community Care Licensing Division of CDSS involving the death or physical abuse of, or serious bodily injury to, a resident or child at the care facility.

AB 581 (Ammiano), Chapter 295, Statutes of 2013, strengthened protections against retaliation or discrimination when complaints are made.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform (Sponsor)
AARP
Alzheimer's Greater Los Angeles
Alzheimer's Orange County
Alzheimer's San Diego
Community Legal Services in East Palo Alto
Justice in Aging
Legal Assistance for Seniors
Office of The State Long-term Care Ombudsman
The Geriatric Circle

Opposition

None on file.

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089