Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, including short-term residential therapeutic programs, by the State Department of Social Services, and defines a short-term residential therapeutic program as a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children that is trauma-informed. Under the act, the department is authorized to issue citations for violations of these provisions.

This bill would, notwithstanding any law and commencing January 1, 2027, require licenses for short-term residential therapeutic programs to be renewed annually if the licensee has a total of 5 or more specified citations in the past 12 months, or if a short-term residential therapeutic program operates in a county with less than 75,000 residents and that does not have a high school or a general acute care hospital operating in the county. months. The bill would require that the licensee not be subject to ongoing annual review if it receives less than 5 violations in the 12 months following an annual license review.

Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, including short-term residential therapeutic programs, by the State Department of Social Services, and defines a short-term residential therapeutic program as a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children that is trauma-informed. A violation of the act is a crime. Under the act, the department is authorized to issue citations for violations of these provisions.

Existing law requires the State Department of Social Services to promote the participation of current and former foster youth in the development of state foster care and child welfare policy and, subject to the availability of funds, to contract with California Youth Connection to provide technical assistance and outreach to current and former foster youth.

This bill would make technical, nonsubstantive changes to that provision.

Date of Hearing: June 30, 2026

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

SBPCA Bill Id:SB 1109

Author:(Alvarado-Gil) – As Amended Ver:April 28, 2026

SENATE VOTE: 33-0

SUBJECT: Short-term residential therapeutic programs

SUMMARY: Subjects licenses issued for the operation of a short-term residential therapeutic program (STRTP) to annual renewal if the licensee has been issued a total of five or more type “A” citations within the past 12 months. Specifically, this bill:

1. Requires, notwithstanding any other law, commencing January 1, 2027, STRTP licenses to be subject to annual renewal by the California Department of Social Services (CDSS) if the licensee has been issued a total of five or more type A citations within the past 12 months.
2. Provides that a licensee shall not be subject to ongoing annual renewal pursuant to a) above if the licensee receives less than five violations in the 12 months following an annual license review.

EXISTING LAW:

1. Establishes the California Community Care Facilities Act and provides for the licensing and regulation of community care facilities, including STRTPs, by CDSS. (Health and Safety Code [HSC] § 1500 et seq.)
2. Defines an STRTP as a residential facility, licensed by CDSS and operated by a public agency or private organization, that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children, and that is trauma-informed. (HSC § 1502(a))
3. Requires CDSS to license STRTPs and requires a program to comply with the requirements applicable to group homes as well as program-specific requirements. (HSC § 1562.01(a))
4. Requires an STRTP to obtain national accreditation from an approved accrediting body within 24 months of licensure. (HSC § 1562.01(b))
5. Requires an STRTP to obtain, within 12 months of licensure, and to maintain in good standing, a mental health program approval that includes a Medi-Cal mental health certification. (HSC § 1562.01(c))
6. Requires an STRTP applicant to submit, with its application, a letter of recommendation in support of its program from a county placing agency, including a statement that the agency reviewed the applicant’s program statement. (HSC § 1562.01(f))
7. Subjects every licensed community care facility to unannounced inspections, requires CDSS to inspect facilities as often as necessary to ensure the quality of care, and requires annual unannounced inspections under specified circumstances. (HSC § 1534)
8. Authorizes CDSS to issue citations and to assess civil penalties for violations, and provides for immediate and escalating penalties for repeated violations within a 12-month period. (HSC § 1548).
9. Authorizes CDSS to deny, suspend, or revoke a license upon specified grounds, including violation of the act or its regulations, aiding or permitting a violation, or conduct that is inimical to the health, morals, welfare, or safety of the people of the state or of an individual receiving services from the facility. (HSC § 1550)
10. Authorizes CDSS to temporarily suspend a license prior to any hearing when the director determines the action is urgent to protect residents from physical or mental abuse, abandonment, or any other substantial threat to health or safety. (HSC § 1550.5)
11. Requires an STRTP applicant to submit an application to CDSS that includes a letter of recommendation in support of its program from a county placing agency. Requires the letter of recommendation to include a statement that the county placing agency reviewed a copy of the applicant’s program statement. Requires the STRTP applicant to include, with its application, if the letter of recommendation is not from the county in which the facility is located, a statement that it provided the county in which the facility is located an opportunity for that county to review the program statement and notified that county that the facility has received a letter of recommendation from another county. (HSC § 1562.01(f)(A))
12. Requires that proceedings to suspend, revoke, or deny a license be conducted under the Administrative Procedure Act, applies a preponderance-of-the-evidence standard, and requires a hearing within 90 days of the notice of defense if the license has not been temporarily suspended. (HSC § 1551; Government Code § 11500 et seq.)
13. Establishes the Continuum of Care Reform (CCR) and limits the use of congregate residential care to short-term, intensive, residentially based interventions intended to transition children into permanent, home-based family settings. (Welfare and Institutions Code § 11462 et seq)

FISCAL EFFECT: According to the Senate Appropriations Committee on May 4, 2026:

Unknown ongoing General Fund costs, potentially hundreds of thousands, for the California Department of Social Services (CDSS) for state administration for licensing renewals.

COMMENTS:

Background: Short-Term Residential Therapeutic Programs Licensure. In California, STRTPs are licensed, 24-hour facilities for high-needs youth with severe emotional, behavioral, or trauma-related challenges. They provide intensive therapeutic care, mental health services, and supervision for children who cannot be safely supported in traditional foster or family-like settings.

CDSS is responsible for the licensure and oversight of STRTPs. CDSS exercises ongoing oversight through inspection and enforcement through unannounced inspections and visits to facilities as often as necessary and, under current law, at no less than once every two years for children’s residential facilities, investigating complaints as they are received. STRRPs must, among other things, obtain national accreditation from an approved accrediting body within two years of licensure; secure and maintain a mental health program approval, including a Medi-Cal mental health certification; maintain a detailed plan of operation and program statement describing how the program will meet the reform’s standards; and, meet heightened staffing, training, and clinical requirements.

As part of the licensing standards established under CCR, an applicant seeking to operate an STRTP must, before CDSS will issue a license, obtain and submit a letter of recommendation in support of its program from a county placing agency. The letter must include a statement confirming that the county placing agency has reviewed a copy of the applicant’s program statement, which is the document describing the population the program intends to serve and the services and treatment it will provide. Existing law allows a placing agency in one county (a probation department in El Dorado) to recommend a facility in another county (an STRTP in Alpine), as long as the county where it sits gets notice and a chance to review. An STRTP cannot open unless at least one of the public agencies that will rely on it to place children has reviewed its plan and affirmatively recommended it. The requirement is a one-time condition of initial licensure. A new letter is not required when a program later relocates, and existing law does not establish any similar, recurring placing-agency re-endorsement as a condition of license renewal because, as described above, there is no renewal.

An STRTP license does not expire and is not subject to periodic renewal. Once issued, a license remains in effect until it is surrendered by the licensee, forfeited by operation of law, or suspended or revoked by CDSS. This means California does not conduct an annual “relicensing” of these facilities. Instead, CDSS cites and responds to violations on a rolling basis as they are identified. Oversight is thus continuous and event-driven rather than tied to an annual renewal date.

This bill would add a recurring review to a licensing scheme that was deliberately designed around a single, front-loaded approval supported by input from a county placing agency.

Licensing violations. CDSS classifies STRTP licensing violations, and other licensing categories under the Community Care Act, into three tiers, A, B, or C, according to the severity of the risk they pose to people in care. According to CDSS’ Evaluator Manual, “the basic factors to be considered in making this assessment are the consequences to those in care, the immediacy of the need to correct, the frequency of occurrences and the specific regulatory and/or statutory requirement.”

Type A: Immediate Health, Safety or Personal Rights Impact. Under the Community Care Act, a Type A violation is one that poses a direct and immediate risk to the health, safety, or personal rights of a person receiving care. Examples of Type A violations include: leaving children or dependent adults without adequate supervision; failing to obtain required criminal background clearances for staff or other adults with client contact; unsafe conditions that create an immediate risk of serious injury; physical abuse or actions that place clients in immediate danger; serious medication or care errors that could immediately harm a client. The existing response to a Type A violation pairs a mandatory citation and correction timeline with a set of penalties and administrative remedies that can lead to license revocation if not properly addressed.

Because a Type A citation carries an immediate risk, it must be cited even if it is corrected on site. CDSS documents the violation in a facility evaluation report or notice of deficiency that identifies the specific requirement violated, sets out a plan of correction, and establishes a date by which the deficiency must be corrected. CDSS then conducts a follow-up visit to verify that the correction was made.

If the facility fails to correct the deficiency by the required date, CDSS assesses civil penalties, which can accrue on a per-day basis until the violation is corrected, and a repeat citation within a 12-month period triggers immediate and increasing penalties.

For serious or persistent problems, CDSS can escalate beyond civil penalties to administrative action. Administrative action may result in the licensee being placed on probation, excluding individual staff who pose a risk, temporarily suspending the license, or revoking the license.

Type B: Potential Health, Safety or Personal Rights Impact. A Type B violation is one that, left uncorrected, could become an immediate risk to health, safety, or personal rights, or that involves recordkeeping or service deficiencies affecting care or the protection of residents’ resources. The licensing program analyst has some discretion over whether to cite a Type B deficiency. Common examples include lapses in required staff-training documentation, incomplete personnel or client records, missing required postings, or gaps in staffing-pattern documentation. These are problems that are not an immediate danger but could develop over time into one.

Type C: Technical Conditions. A Type C violation is the least serious violation that involves a technical or administrative violation that presents neither an immediate (Type A) nor a potential (Type B) risk, and for which a facility is generally afforded an opportunity to correct the problem without a citation.

Licensing Violations in STRTPs. In an STRTP, which serves some of the highest-need youth in foster care, a Type A violation may involves circumstances such as a staff member having contact with children before completing a required criminal-background clearance; inadequate supervision that results in, or risks, harm to a child; the improper or unauthorized use of restraint or seclusion; medication errors or unsecured medications; physical-plant conditions that threaten safety; or the failure to report suspected abuse. Each of these, by definition, places a child at immediate risk. STRTPs are not exclusively limited to foster care, but many of their residents are foster youth. Type B violations include instances where prescription medications are failed to be properly logged or possessing insufficient clean dishes or cutlery to support the number of youth on-site. A Type C violation can include failing to post the current calendar date on the weekly facility meal menu displayed in the kitchen or improperly storing facility operational documents or other administrative data entry errors.

CDSS does not routinely publish an aggregate count of STRTPs that receive five or more Type A citations within a 12-month period. Citation histories are maintained for each facility and are publicly available through the CDSS’ Community Care Licensing transparency website using the facility search function. As a result, the number of programs this bill would actually capture is not ascertainable from existing public data.

CDSS’ Existing Authority to Revoke a License. CDSS possesses the authority to revoke a license outright. It may deny, suspend, or revoke a license on several grounds, including a violation of the Community Care Facilities Act or its regulations; aiding, abetting, or permitting such a violation; or conduct that is inimical to the health, morals, welfare, or safety of the people of the state or of an individual receiving services from the facility. A single serious violation can support revocation and CDSS is not required to accumulate a set number of citations first. Under current law, the state can already revoke a license for a single serious violation.

The revocation process is a formal administrative action under the state Administrative Procedure Act. CDSS serves an accusation, and the licensee is entitled to a hearing before an administrative law judge, at which CDSS must prove its case by a preponderance of the evidence. CDSS issues a final decision that is subject to judicial review. When action is necessary to protect residents from physical or mental abuse, abandonment, or another substantial threat to health or safety, CDSS may temporarily suspend a license before any hearing, removing the facility from operation immediately while the administrative process runs its course. Existing law provides CDSS with a set of enforcement tools that include citations, civil penalties, probation, temporary suspension, and revocation that can be calibrated to the severity of the conduct and triggered by just a single serious violation.

Author’s Statement: According to the Author, "[This bill] addresses a gap in current oversight that allows Short-Term Residential Therapeutic Programs (STRTPs) to operate despite numerous serious health and safety concerns to youth clients. In Alpine County - the smallest county in California, with approximately 1,150 residents - two STRTP facilities were placed without a valid letter of support from a placing agency. Due to the absence of basic infrastructure such as a general acute care hospital, a high school, and sufficient emergency and law enforcement resources in rural areas, [this bill] calls for the state to intervene when facilities raise red flags. [This bill] requires the state to annually review the licensure of STRTP facilities who have 5 or more 'type A' citations within a year. According to the California Department of Social Services, Community Care Licensing Division, 'type A' citations refer to “the most serious type of violations in which there is an immediate risk to the health, safety, or personal rights of those in care”. The example of Alpine County exemplifies the gap that [this bill] fills statewide. Where STRTPs are placed is just as important as the critical services they provide. [This bill] will ensure the state is aware of and prompted to take action in dire situations where at-risk youth are not being served to the best standard possible."

Equity Implications: The youth served in STRTPs are among the highest-acuity children in foster care, for whom placement stability is both important and difficult to achieve, and statewide STRTP capacity is limited due to staffing issues and the need for highly individualized care. A license renewal process that can interrupt operations carries a risk of displacing children from programs that are meeting their needs due to an arbitrary administrative timeline rather than because a placement has been found unsafe. Because statewide STRTP capacity is limited and unevenly distributed, a renewal requirement that increases the risk of closure or non-renewal could reduce the number of available beds. That outcome runs counter to the central premise of CCR, which favors placing children in the least restrictive, most family-connected setting appropriate to their needs and prioritizes placement stability.

Policy Concerns: CDSS already possesses broad statutory authority to oversee, discipline, and when appropriate, revoke or suspend the licenses of STRTPs. As described above, California has an established licensing and enforcement framework that authorizes CDSS to investigate complaints, issue citations, impose civil penalties, require corrective action plans, place facilities on probation, suspend admissions, and revoke licenses when necessary. Ensuring the safety and well-being of children in these facilities is already one of CDSS's core responsibilities.

It is true that some STRTPs accumulate significantly more Type A citations than others. However, because CDSS does not maintain or publish aggregated data regarding citation trends across STRTPs, it is difficult to determine whether those disparities reflect shortcomings in the existing enforcement process, inconsistent application of enforcement authority, or recurring operational failures at individual facilities. Regardless, this bill does not address the underlying cause. Instead, it creates a new licensing requirement that duplicates existing enforcement authority without demonstrating why the current statutory framework is insufficient.

Rather than strengthening oversight, the bill risks disrupting placements for some of California's most vulnerable youth. Children placed in STRTPs are typically involved with child welfare or juvenile probation and exhibit significant behavioral, emotional, or clinical needs that cannot be safely or appropriately met in a family setting. Placement in an STRTP occurs only after review by the interagency placement committee and assessment by a qualified individual, both of whom determine that the youth requires the state's most intensive level of congregate care. These placements are made because less restrictive alternatives have already been determined to be inappropriate.

This bill would require an STRTP that receives five or more Type A citations within a 12-month period to annually renew its license, but it does not specify what occurs while that renewal is pending. It is unclear whether the facility may continue operating during the review, whether counties may continue placing youth there, or what standards CDSS would apply in granting or denying the renewal. Because a license is the legal authority to operate, any delay, lapse, or denial could force an STRTP to cease operations, requiring counties to relocate every child currently placed in the program.

Those consequences extend beyond administrative inconvenience. STRTPs are licensed and approved to serve distinct populations based on age, gender, treatment needs, and clinical specialization. They are not interchangeable, and facilities may decline referrals when they cannot safely meet a youth's needs. As a result, relocating children because of an unresolved licensing renewal may separate them from established treatment teams, interrupt mental health services, disrupt educational stability, and increase trauma for youth who have already experienced significant instability.

When an STRTP fails to comply with licensing requirements, accountability should be directed toward the operators responsible for those violations. A licensing framework that results in the displacement of children, rather than targeted enforcement against deficient providers, risks imposing the consequences of adult failures on the very youth the system is intended to protect.

Arguments in Support: The County of Alpine Probation Department states that, “Alpine County’s remote and rugged environment, including extreme winter conditions and wild animal encounters, creates heightened safety risks when youth leave placement setting and limits timely emergency response. The placement of STRTP facilities in such a setting can result in a disproportionate demand on public safety and emergency response systems. In the last five years, a single digit number of placements has resulted in 12% of law enforcement calls for services. This has placed significant strain on already limited resources and created safety concerns for both youth and the broader community.”

Arguments in Opposition: The California Alliance of Child and Family Services writes, “These new renewal triggers are overbroad, untethered to actual risk, duplicative of existing oversight, and likely to further destabilize STRTP capacity at a time when the State urgently needs to preserve it.”

RELATED AND PRIOR LEGISLATION:

SB 1943 (Grove), Chapter 628, Statutes of 2024, required facilities operating STRTPs to provide specified information to a child subject to seclusion or behavioral restraints, their parent, foster parent, guardian, or tribal representative, and CDSS. Required CDSS to review all reported incidents involving the use of seclusion or behavioral restraints and investigate any incidents that indicate a potential health and safety concern or licensing violation. Required CDSS to display data that is specific to STRTPs on its website regarding the use of seclusion or behavioral restraints.

SB 426 (Jackson), Chapter 438, Statutes of 2023, authorized CDSS to assess an immediate civil penalty in the amount of $1,000 per day for providing unlicensed residential care to children. Required CDSS to inform the County Welfare Director and the Board of Supervisors by written notice identifying the legal compliance issues if a county is failing to comply with current law and CDSS determines that county action is necessary.

AB 2317 (Ramos), Chapter 589, Statutes of 2022, required the Department of Health Care Services (DHCS) to license and establish regulations for psychiatric residential treatment facilities. Further, required DHCS’ regulations and certifications to be consistent with federal Medicaid regulations governing psychiatric residential treatment facilities in order to maximize federal financial participation. Adds inpatient psychiatric services to individuals under 21 years of age provided in a licensed children’s crisis psychiatric residential treatment facility as mental health services provided under the Medi-Cal Program.

REGISTERED SUPPORT / OPPOSITION:

Support

Alpine County Probation Department

Calaveras County Probation Department

David Griffith, Alpine County District 5 Supervisor

South Bay People Power

Three private citizens

Opposition

None on file.

Analysis Prepared by: Jessica Langtry / HUM. S. / (916) 319-2089

 THIRD READING  

Bill No: SB 1109

Author: Alvarado-Gil (R), et al.

Amended: 4/28/26

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 4-0, 4/20/26

AYES: Becker, Niello, Laird, Weber Pierson

NO VOTE RECORDED: Pérez

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/14/26

AYES: Cervantes, Seyarto, Cabaldon, Dahle, Grayson, Richardson, Wahab

SUBJECT: Short-term residential therapeutic programs

SOURCE: Author

DIGEST:

This bill provides that beginning January 1, 2027, all licenses issued for the operation of a short-term residential therapeutic program (STRTP) are subject to renewal annually by the California Department of Social Services (CDSS) if the licensee has been issued a total of five or more type “A” citations within the past 12 months.

ANALYSIS:

Existing law:

1. Defines an STRTP as a residential facility operated by a public agency or private organization and licensed by CDSS that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. (Health and Safety Code (HSC) 1502(a)(18)) 2)
2. Establishes the “California Community Care Facilities Act” and requires CDSS to administer and license community care facilities providing nonmedical services, including adult residential facilities and STRTPs, among others. (HSC 1500 et seq.)

This bill:

1. Provides that, beginning January 1, 2027, all licenses issued for the operation of an STRTP shall be subject to renewal annually by CDSS if the licensee has been issued a total of 5 or more type “A” citations within the past 12 months.
2. Provides that a licensee subject to annual renewal as a result of having been issued a total of five or more type “A” citations within the past 12 months shall not be subject to ongoing annual renewal if they have less than five violations in the 12 months following an annual license review.

Background

Author Statement. According to the author, “SB 1109 addresses a gap in current oversight that allows Short-Term Residential Therapeutic Programs (STRTPs) to operate despite numerous serious health and safety concerns to youth clients. In Alpine County - the smallest county in California, with approximately 1,150 residents - two STRTP facilities were placed without a valid letter of support from a placing agency. Due to the absence of basic infrastructure such as a general acute care hospital, a high school, and sufficient emergency and law enforcement resources in rural areas, SB 1109 calls for the state to intervene when facilities raise red flags.  SB 1109 requires the state to annually review the licensure of STRTP facilities who have 5 or more ‘type A’ citations within a year. According to the California Department of Social Services, Community Care Licensing Division, ‘type A’ citations refer to ‘the most serious type of violations in which there is an immediate risk to the health, safety, or personal rights of those in care’. The example of Alpine County exemplifies the gap that SB 1109 fills statewide. Where STRTPs are placed is just as important as the critical services they provide. SB 1109 will ensure the state is aware of and prompted to take action in dire situations where at-risk youth are not being served to the best standard possible.”

Movement to Family Based Care. In 2011, the California Legislature directed the CDSS to reduce the child welfare system’s dependence on congregate care. In 2015, after a three-year workgroup co-led by the County Welfare Directors Association of California, the CDSS published a report entitled “California’s Child Welfare Continuum of Care Reform (CCR),” as required by the legislature in SB 1013 (Committee on Budget and Fiscal Review, Chapter 35, Statutes of 2012). The 56-page report, developed in collaboration with stakeholders, provided recommendations for restructuring the child welfare system to care for children in foster homes. The CCR report outlined a reform of California’s child welfare system by improving assessments of children and families, emphasizing home-based family placements of foster children and changing the goals of congregate care placements. The report noted: “Children should live in their communities in home-based family care settings.” This move mirrored changes being made at the federal level.

CCR was designed to reduce the number of foster children placed in congregate care settings by improving the assessments of children and families and establishing child and family teams for each child in foster care. AB 403 (Stone, Chapter 773, Statutes of 2015) was the first of six CDSS-sponsored CCR bills and provided the statutory and policy framework to ensure services and supports provided to the child or youth and their family are tailored toward the ultimate goal of maintaining a stable permanent family. AB 403 advanced California’s goal to move away from the use of long-term group home care by enacting a sunset for group home licenses, increasing youth placement into family settings, strengthening training and supports through the development of child and family teams. Subsequent bills established requirements for mental health certification of STRTPs, made changes to the Resource Family Approval process, and provided additional oversight of foster homes (the Intensive Services Foster Care category for children with high needs), and added an option to license respite caregivers, among other changes. A sunset was also placed on federal and state participation in rates paid to group homes, effectively eliminating placement into group home care.

In the years leading up to California’s CCR efforts, federal law directed states to implement policies to ensure children are placed in a permanent home quickly through reunification, adoption, guardianship, or permanent placement with a fit and willing relative. Changes in federal law included prohibiting a plan of long-term foster care for children younger than 16 years old, expanding the requirement to notify relatives when a child is brought into care, and increased incentives for adoption and guardianship. The reforms also created the STRTP model, which requires an integration of federal Title IV-E and Medi-Cal funded services.

Short-Term Residential Therapeutic Programs (STRTPs). A key component of CCR was the goal of reducing youth placement in congregate care facilities and placing youth in family homes in the community. Under CCR, traditional group homes were permitted to transition to STRTPs, which provide short-term, 24-hour care and supervision to youth, and are intended to provide short-term mental health interventions to stabilize, support, and transition youth with high-level mental health needs to lower levels of care. As part of its program model, a STRTP must make available a core set of trauma-informed, culturally relevant services and must be prepared to provide a broad range of services that are tailored to the individual needs of a child. STRTPs are required to obtain a contract with a county mental health plan in order to provide specialty mental health services to youth and must demonstrate the ability to meet the individual therapeutic needs of each child. As of June 2025, the CDSS oversees 340 STRTPs with a total capacity of 2,470 children.

Current Licensing Requirements. STRTPs are subject to strict licensing requirements under Interim Licensing Standards. Interim Licensing Standards are rules issued by CDSS as a tool to implement a law that was recently passed and will be replaced with Title 22 regulations once written and approved. The current licensing standards are contained within a 341-page Interim Licensing Standards document.

If a facility is licensed, they are then subject to inspections by the CDSS Community Care Licensing Division. During those inspections, citations may be issued for type A violations regarding immediate health, safety, or personal rights impacts, or type B violations regarding potential health, safety, or personal rights impacts. Citations are issued on a preponderance of the evidence standard. If complaints are made against the facility or its staff, those are also investigated, and citations may be issued. The reports for the inspections and the complaint investigations are posted on CDSS’s website along with the number of citations issued and any corrective action taken or needed. Once a license is obtained, the STRTP has 24 months to obtain accreditation from The Council on Accreditation, Commission on Accreditation of Rehabilitation Facilities or The Joint Commission and must update CDSS on its accreditation status at 12 months and 18 months after the date of licensure. STRTPs have 12 months from the date of licensure to obtain mental health program approval from the California Department of Health Care Services or from a delegated county Mental Health Plan. STRTPs must also abide by requirements related to staffing, training, and supervision.

Related/Prior Legislation

SB 1043 (Grove, Chapter 628, Statutes of 2024) requires facilities operating STRTPs to provide specified information to a child subject to seclusion or behavioral restraints, their parent, foster parent, guardian, or tribal representative, and CDSS. Requires CDSS to review all reported incidents involving the use of seclusion or behavioral restraints and investigate any incidents that indicate a potential health and safety concern or licensing violation. Requires CDSS to display data that is specific to STRTPs on its website regarding the use of seclusion or behavioral restraints.

AB 2317 (Ramos, Chapter 589, Statutes of 2022) requires the Department of Health Care Services to license and establish regulations for psychiatric residential treatment facilities. Further requires the Department of Health Care Services’ regulations and certifications to be consistent with federal Medicaid regulations governing psychiatric residential treatment facilities in order to maximize federal financial participation. Adds inpatient psychiatric services to individuals under 21 years of age provided in a licensed children’s crisis psychiatric residential treatment facility as mental health services provided under the Medi-Cal Program.

AB 808 (Stone) of 2021 would have proposed numerous changes to address the continuum of care needs of high acuity foster youth, including the creation of a of a Specialized Foster Home to provide 24-hour care for foster children in the residence of the foster parent with enhanced care and supervision provided by foster parent that have completed specialized training; would have placed additional responsibilities on the Integrated Resolution Team to include making specified recommendations to the Legislature; and would have created a five-year children’s crisis continuum pilot program; among other provisions. The policy of AB 808 was included in a budget trailer bill.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, “Unknown ongoing General Fund costs, potentially hundreds of thousands, for the California Department of Social Services (CDSS) for state administration for licensing renewals.”

SUPPORT: (5/14/26)

16 Individuals
Alpine County
Alpine County Probation Department
Inyo County Board of Supervisors
Rural County Representatives of California

OPPOSITION: (5/14/26)

None on file

Prepared by: Heather Hopkins / HUMAN S. / (916) 651-1524

5/16/26 10:34:02

**** END ****

SENATE COMMITTEE ON

Senator Sabrina Cervantes, Chair

2025 - 2026 Regular Session

SB 1109 (Alvarado-Gil) - Short-term residential therapeutic programs

Bill Summary:

SB 1109 would require that Short-Term Residential Therapeutic Program (STRTP) licensees be subject to renewal annually if the licensee has been issued certain citations, as specified.

Fiscal Impact:

Unknown ongoing General Fund costs, potentially hundreds of thousands, for the California Department of Social Services (CDSS) for state administration for licensing renewals.

Background:

STRTPs, licensed by CDSS, provide short-term, 24-hour care and supervision to youth, and are intended to provide short-term mental health interventions to stabilize, support, and transition youth with high-level mental health needs to lower levels of care. As part of its program model, a STRTP must make available a core set of trauma-informed, culturally relevant services and must be prepared to provide a broad range of services that are tailored to the individual needs of a child. STRTPs are required to obtain a contract with a county mental health plan in order to provide specialty mental health services to youth and must demonstrate the ability to meet the individual therapeutic needs of each child.

During licensing inspections, CDSS may issue citations for type A violations regarding immediate health, safety, or personal rights impacts, or type B violations regarding potential health, safety, or personal rights impacts. The reports for the inspections and the complaint investigations are posted on CDSS’s website.

Once a license is obtained, the STRTP has 24 months to obtain national accreditation and must update CDSS on its accreditation status at 12 months and 18 months after the date of licensure. STRTPs have 12 months from the date of licensure to obtain a mental health program approval, as specified under existing law. There are no requirements for license renewal.

Proposed Law:

SB 1109 would require that STRTP licensees be subject to renewal annually by CDSS if the licensee has been issued a total of five or more type “A” citations within the past 12 months.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Becker, Chair

2025 - 2026 Regular

Subject: Short-term residential therapeutic programs

SUMMARY

This bill provides that beginning January 1, 2027, all licenses issued for the operation of a short-term residential therapeutic program (STRTP) are subject to renewal annually by the California Department of Social Services (CDSS) if either of the following are met: the licensee has been issued a total of five or more type “A” or type “B” citations within the past 12 months or the county in which the STRTP operates has a population of less than 75,000 residents and there is no high school or general acute care hospital operating in the county.

ABSTRACT

Existing Law:

1. Defines an STRTP as a residential facility operated by a public agency or private organization and licensed by CDSS that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. Further, requires the care and supervision provided by an STRTP be nonmedical, except as otherwise permitted, as specified. (Health and Safety Code [HSC] 1502(a)(18))
2. Establishes the “California Community Care Facilities Act” and requires CDSS to administer and license community care facilities providing nonmedical services, including adult residential facilities and STRTPs, among others. (HSC 1500 et seq.)
3. Requires interagency placement committees to do the following when placing a child with an STRTP:
   1. Ensure that the care and services the child needs are provided by the STRTP program selected for their placement;
   2. Ensure commonality of need requirements have been met;
   3. Consider the detailed history, which shall be provided by the placing agency to the STRTP provider, outlining behavior that may pose a threat to the health or safety of that child and other children residing in the program and consider any potential interference with the effectiveness of the care and services provided to that child and other children residing in the program;
   4. Describe additional safety measures and therapeutic interventions needed to mitigate identified challenging behaviors or risks to the safety of the child and other children in the facility; and
   5. Present the determination to the placing agency within five business days of the referral. (Welfare and Institutions Code [WIC] 4906(e)(2))
4. Requires STRTP applicants to submit an application to CDSS that includes a letter of recommendation in support of its program from a county placing agency. The letter of recommendation shall include a statement that the county placing agency reviewed a copy of the applicant’s program statement. If the letter of recommendation is not from the county in which the facility is located, the STRTP applicant shall include, with its application, a statement that it provided the county in which the facility is located an opportunity for that county to review the program statement and notified that county that the facility has received a letter of recommendation from another county. (HSC 1562.01(f)(1)(A)
5. Requires CDSS, if the application does not contain a letter of recommendation, to cease review of the application. Provides that this does not constitute a denial of the application. (HSC 1562.01(f)(1)(B)
6. Provides that a new letter of recommendation is not required when a STRTP moves locations. (HSC 1562.01(f)(1)(C)
7. Provides that a STRTP shall submit a copy of its program statement to all county placing agencies from which the STRTP program accepts placements, including the county in which the facility is located, for optional review when the STRTP updates its program statement. (HSC 1562.01(f)(2)

This Bill:

1. Provides that, beginning January 1, 2027, all licenses issued for the operation of an STRTP shall be subject to renewal annually by CDSS if either of the following are met:
   1. The licensee has been issued a total of 5 or more type “A” or type “B” citations within the past 12 months.
   2. The county in which the STRTP operates has a population of less than 75,000 residents and there is no high school or general acute care hospital operating in the county.
2. Provides that a licensee subject to annual renewal as a result of having been issued a total of five or more type “A” or type “B” citations within the past 12 months shall not be subject to ongoing annual renewal if they have less than five violations in the 12 months following an annual license review.

FISCAL IMPACT

This bill has not yet been analyzed by a fiscal committee.

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “SB 1109 addresses a gap in current law that allows Short-Term Residential Therapeutic Programs (STRTPs) to be sited in counties that may lack the infrastructure necessary to support the youth they serve, without meaningful input from the host county. In Alpine County—the smallest county in California, with approximately 1,100 residents—two STRTP facilities were established with approval from another county, despite the absence of a general acute care hospital, a high school, and sufficient emergency and law enforcement resources. SB 1109 requires that STRTPs obtain support from the county in which they operate, establishes a periodic license renewal process to ensure ongoing oversight, and prohibits new or renewed licenses in counties with populations under 75,000 that lack critical infrastructure. This bill seeks to better align placement decisions with local capacity and ensure that youth placed in STRTPs have access to the resources and services necessary to support their care and safety.”

Movement to Family Based Care

In 2011, the California Legislature directed the CDSS to reduce the child welfare system’s dependence on congregate care. In 2015, after a three-year workgroup co-led by the County Welfare Directors Association of California, the CDSS published a report entitled “California’s Child Welfare Continuum of Care Reform (CCR),” as required by the legislature in SB 1013 (Committee on Budget and Fiscal Review, Chapter 35, Statutes of 2012). The 56-page report, developed in collaboration with stakeholders, provided recommendations for restructuring the child welfare system to care for children in foster homes. The CCR report outlined a reform of California’s child welfare system by improving assessments of children and families, emphasizing home-based family placements of foster children and changing the goals of congregate care placements. The report noted: “Children should live in their communities in home-based family care settings.” This move mirrored changes being made at the federal level.

CCR was designed to reduce the number of foster children placed in congregate care settings by improving the assessments of children and families and establishing child and family teams for each child in foster care. AB 403 (Stone, Chapter 773, Statutes of 2015) was the first of six CDSS-sponsored CCR bills and provided the statutory and policy framework to ensure services and supports provided to the child or youth and their family are tailored toward the ultimate goal of maintaining a stable permanent family. AB 403 advanced California’s goal to move away from the use of long-term group home care by enacting a sunset for group home licenses, increasing youth placement into family settings, strengthening training and supports through the development of child and family teams. Subsequent bills established requirements for mental health certification of STRTPs, made changes to the Resource Family Approval process, and provided additional oversight of foster homes (the Intensive Services Foster Care category for children with high needs), and added an option to license respite caregivers, among other changes. A sunset was also placed on federal and state participation in rates paid to group homes, effectively eliminating placement into group home care.

In the years leading up to California’s CCR efforts, federal law directed states to implement policies to ensure children are placed in a permanent home quickly through reunification, adoption, guardianship, or permanent placement with a fit and willing relative. Changes in federal law included prohibiting a plan of long-term foster care for children younger than 16 years old, expanding the requirement to notify relatives when a child is brought into care, and increased incentives for adoption and guardianship. The reforms also created the STRTP model, which requires an integration of federal Title IV-E and Medi-Cal funded services.

Out of State Placement

In April 2020, staff members at a Michigan facility for foster youth restrained 16-year-old Cornelius Frederick for 12 minutes until he lost consciousness. He was in cardiac arrest when the paramedics arrived. Frederick died in a hospital two days later and his death was ruled a homicide. He had been living at the facility for two years. A Michigan state investigation concluded that the facility failed to follow state licensing rules on restraints.

Following Frederick’s death, several fights broke out and 26 of the 124 youth housed there ran away, according to news accounts. The facility was also experiencing widespread exposure of COVID-19 at the time. The Michigan Department of Health and Human Services subsequently ordered all youth be removed from the facility. Forty-one California youth were brought home in May 2020.

The same year, CDSS reviewed the operations of all certified out-of-state facilities and found significant licensing violations. In December 2020, CDSS decertified the out-of-state facilities failing to meet licensing standards, and returned all youth placed in those facilities back to California. Subsequently, the Legislature passed AB 153 (Committee on Budget, Chapter 86, Statutes of 2021), a budget trailer bill, which phased out the use of out-of-state residential facilities by child welfare and probation departments, removing foster children from out-of-state facilities by July 1, 2022.

Short-Term Residential Therapeutic Programs (STRTPs)

A key component of CCR was the goal of reducing youth placement in congregate care facilities and placing youth in family homes in the community. Under CCR, traditional group homes were permitted to transition to STRTPs, which provide short-term, 24-hour care and supervision to youth, and are intended to provide short-term mental health interventions to stabilize, support, and transition youth with high-level mental health needs to lower levels of care. As part of its program model, a STRTP must make available a core set of trauma-informed, culturally relevant services and must be prepared to provide a broad range of services that are tailored to the individual needs of a child. STRTPs are required to obtain a contract with a county mental health plan in order to provide specialty mental health services to youth and must demonstrate the ability to meet the individual therapeutic needs of each child. As of June 2025, the CDSS oversees 340 STRTPs with a total capacity of 2,470 children.

Current Licensing Requirements

STRTPs are subject to strict licensing requirements under Interim Licensing Standards. Interim Licensing Standards are rules issued by CDSS as a tool to implement a law that was recently passed and will be replaced with Title 22 regulations once written and approved. The current licensing standards are contained within a 341-page Interim Licensing Standards document.^[1]

The Application and Supporting Document Checklist^[2] for STRTPs contains 22 items, including an application for a Community Care Facility, County Letter of Recommendation and Designation of Facility Responsibility. The County Letter of Recommendation plays a key role in how the county where the facility is to be located is involved in the licensing process.

An application requires at least one letter of recommendation in support of its program from a county placing agency. The following outlines this portion of the licensing process.

• An applicant shall submit an application to CDSS that includes at least one letter of recommendation in support of its program from a county placing agency.
  • To obtain a letter of recommendation, an applicant shall submit a copy of its program statement and information to all county placing agencies from which it anticipates receiving placements, including the county in which the facility is located.

The licensing standards go on to outline what documents need to be submitted with the application, including:

• A letter of recommendation in support of its program from a county placing agency.
  • The letter of recommendation shall include a statement that the county placing agency reviewed a copy of the applicant’s program statement.
  • If the letter of recommendation is not from the county in which the facility is located, the letter of recommendation shall include the following:
    • A statement from the supporting county stating that they engaged the county in which the facility is located and notified them of the intent to provide the letter of support. The statement shall include an explanation of why a letter of recommendation was not given by the county in which the facility is located, a summary of any concerns raised by the county in which the facility is located, and a description of if and how any of those concerns were resolved.
  • If the letter of recommendation is not from the county in which the facility is located, the applicant shall provide the following:
    • A statement from the applicant that they engaged the county in which the facility is located and notified them of the intent to operate a STRTP in their county. The statement shall include both of the following:
      • A statement that the applicant provided the county in which the facility is located an opportunity for that county to review the program statement and notified that county that the facility received a letter of recommendation from another county.
      • An explanation of why a letter of recommendation was not given by the county in which the facility is located, a summary of any concerns raised by the county in which the facility is located, and a description of if and how any of those concerns were resolved. This process includes submitting a copy of their program statement and Plan of Operation to all county placing agencies from which it anticipates receiving placements, including the county in which the facility is located.

The letter or recommendation is just one of many requirements before an application can be submitted to CDSS who makes the decision to license the facility or not.

If a facility is licensed, they are then subject to inspections by the CDSS Community Care Licensing Division. During those inspections, citations may be issued for type A violations regarding immediate health, safety, or personal rights impacts, or type B violations regarding potential health, safety, or personal rights impacts. Citations are issued on a preponderance of the evidence standard. If complaints are made against the facility or its staff, those are also investigated, and citations may be issued. The reports for the inspections and the complaint investigations are posted on CDSS’s website along with the number of citations issued and any corrective action taken or needed.

Once a license is obtained, the STRTP has 24 months to obtain accreditation from The Council on Accreditation, Commission on Accreditation of Rehabilitation Facilities or The Joint Commission and must update CDSS on its accreditation status at 12 months and 18 months after the date of licensure. STRTPs have 12 months from the date of licensure to obtain mental health program approval from the California Department of Health Care Services or from a delegated county Mental Health Plan. STRTPs must also abide by requirements related to staffing, training, and supervision.

Related/Prior Legislation:

SB 1943 (Grove, Chapter 628, Statutes of 2024) requires facilities operating STRTPs to provide specified information to a child subject to seclusion or behavioral restraints, their parent, foster parent, guardian, or tribal representative, and CDSS. Requires CDSS to review all reported incidents involving the use of seclusion or behavioral restraints and investigate any incidents that indicate a potential health and safety concern or licensing violation. Requires CDSS to display data that is specific to STRTPs on its website regarding the use of seclusion or behavioral restraints.

AB 2317 (Ramos, Chapter 589, Statutes of 2022) requires the Department of Health Care Services to license and establish regulations for psychiatric residential treatment facilities. Further requires the Department of Health Care Services’ regulations and certifications to be consistent with federal Medicaid regulations governing psychiatric residential treatment facilities in order to maximize federal financial participation. Adds inpatient psychiatric services to individuals under 21 years of age provided in a licensed children’s crisis psychiatric residential treatment facility as mental health services provided under the Medi-Cal Program.

AB 808 (Stone, 2021) would have proposed numerous changes to address the continuum of care needs of high acuity foster youth, including the creation of a of a Specialized Foster Home to provide 24-hour care for foster children in the residence of the foster parent with enhanced care and supervision provided by foster parent that have completed specialized training; would have placed additional responsibilities on the Integrated Resolution Team to include making specified recommendations to the Legislature; and would have created a five-year children’s crisis continuum pilot program; among other provisions. The policy of AB 808 was included in a budget trailer bill.

COMMENTS

STRTPs are part of the CCR that began in California in 2011. These facilities are meant to be short-term placements that provide intensive services for youth with the most complex needs. They are licensed by the state and subject to state regulations and inspections. This bill would require only specified STRTPs be subject to annual license renewal. Currently, there is no license renewal process. This bill provides that such annual license renewal would be required in two circumstances. The first circumstance requiring annual license renewal would be if a STRTP had a total of five type A or type B citations in a 12-month period. Type A citations involve an immediate health, safety, or personal rights impact. Type B citations involve a potential health, safety, or personal rights impact. The type of activity that can result in a citation varies widely, not only between citation types, but within a citation category. In reviewing Facility Evaluation Reports on the CCLD website, type A citations were issued for things such as confiscating a client’s phone and not returning it, allowing a minor to drive a car while impaired, and staff punching a youth during an argument. Type B citations were issued for things such as not having a current CPR/First aid certification, prescriptions not being refilled timely, and not having proof of TB tests for staff on file. Type A are the more serious citations, and it may be more appropriate to limit license renewal to repeated violations in that category.

The second category this bill would require annual license renewal for would be if the STRTP is located in a county with less than 75,000 people and no high school or acute care hospital. This category appears to be directly targeted at the two STRTPs in Alpine County, as that is currently the only county that meets those requirements, effectively changing state licensing for two specific facilities. It is unclear that any issues in facilities in Alpine County were a direct result of not having a high school or acute care hospital within the county. Furthermore, if a county is geographically large, it is possible there could be an acute care hospital or high school within the county, but that hospital is farther away than a hospital across county lines. There appears to be no direct nexus between having a high school or acute care hospital within the county and the success of an STRTP. If there is evidence that the closer in proximity an acute care hospital or high school is the more successful the youth at STRTPs are, then the more prudent approach would be to require those facilities to be within a certain distance or travel time from the STRTP for all STRTPs in the state.

Proposed Amendments: The committee proposes the following amendments to narrow the bill to address only those STRTPs that have received five or more Type A citations in a 12-month period.

1520.15. (a) Notwithstanding any other law, commencing January 1, 2027, all licenses issued for the operation of a short-term residential therapeutic program shall be subject to renewal annually by the department if either of the following are met:

(1) The the licensee has been issued a total of 5 or more type “A” or type “B” citations within the past 12 months.

(2) The county in which the short-term residential therapeutic program operates has a population of less than 75,000 residents and there is no high school or general acute care hospital operating in the county.

(b) A licensee subject to annual review pursuant to paragraph (1) of subdivision (a) shall not be subject to ongoing annual renewal pursuant to paragraph (1) of subdivision (a) if the licensee has less than 5 violations in the 12 months following an annual license review.

SUPPORT/OPPOSITION

Arguments in Support:

Alpine County Probation Department writes, “As the least populous county in California, Alpine County faces unique challenges that are not adequately addressed under the current STRTP framework. While we fully support the intent behind STRTPs and the need to provide trauma-informed care for youth, our experience has demonstrated that rural counties with extremely limited infrastructure are not always suitable environments for these high-acuity placements. Alpine County has limited access to emergency medical services, no general acute care hospital, no high school, and constrained behavioral health resources. At the same time, local law enforcement operates with minimal staffing across a vast geographic area. Alpine County’s remote and rugged environment, including extreme winter conditions and wild animal encounters, creates heightened safety risks when youth leave placement settings and limits timely emergency response. The placement of STRTP facilities in such a setting can result in a disproportionate demand on public safety and emergency response systems. In the last five years, a single digit number of placements has resulted in 12% of law enforcement calls for service. This has placed significant strain on already limited resources and created safety concerns for both youth and the broader community.”

Arguments in Opposition:

The California Alliance of Child and Family Services writes, “SB 1109’s provisions are problematic for several reasons. First, STRTPs already operate within a rigorous state oversight framework. Community Care Licensing (CCL), the licensing division under the California Department of Social Services (CDSS), does not currently place permanently licensed facilities into a routine annual renewal cycle. Instead, CCL uses a risk-based compliance and enforcement structure through their Facility Evaluation and Visit Manual and STRTP CARE Tools that includes required annual visits for specified higher-risk facilities, random-sample comprehensive visits for others, complaint investigations, case management visits, and plan-of-correction follow-up… Separately, STRTPs’ Mental Health Program Approval (MHPA) is itself a condition of permanent licensure and is subject to an annual onsite review by the Department of Health Care Services (DHCS) or its delegate… If the onsite review shows the STRTP is not meeting those requirements, DHCS or its delegate may issue a notice of noncompliance or non-renewal. Against that backdrop, SB 1109 does not fill an accountability gap; it adds another layer of review on top of an already rigorous state regulatory and oversight structure…

“[W]e are also concerned that the bill’s separate trigger language for programs located in counties with fewer than 75,000 residents and no high school or general acute care hospital is arbitrary and disconnected from actual program quality or safety. That provision would single out rural communities that already struggle with limited placement options and could discourage providers from operating where they are often most needed.

“Finally, this bill comes at a time when STRTPs are already facing workforce shortages, rising costs, and serious instability under the upcoming Foster Care Tiered Rate Structure. Adding a new annual renewal regime on top of that reality risks further thinning the provider network and reducing in-state options for foster youth with the most complex needs.”

POSITIONS

Support:

Alpine County
Alpine County Probation Department
Rural County Representatives of California (RCRC)

16 Individuals

Oppose:

California Alliance of Child and Family Services

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1. https://www.cdss.ca.gov/Portals/9/CCL/Childrens-Residential-Licensing/ILS/STRTP_ILS_v5.pdf ↑

2. https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2020/I-L/LIC281E.pdf?ver=2025-01-06-150218-173 ↑