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6Beds Lobby Day: Dozens and Dozens of 6Beds Members Flood the State Capitol for Testimony in Opposition to the Civil Penalties Bill (AB 2231)

Dozens and dozens of 6Beds members and supporters flooded the State Capitol on April 12, 2016 for 6Beds’ Lobby Day with 6Beds’ testimony before the Assembly Human Services Committee in opposition to the civil penalties bill, AB 2231, one of the focal points of the day.

AB 2231 addresses violations, including repeat violations and serious/zero tolerance violations, as well as the civil penalties associated with these types of violations.  6Beds’ official comment letter on the bill can also be found here as well as the Assembly Human Services Committee’s bill analysis, which incorporated 6Beds’ comments.  Similar to the complainant appeal process that was proposed in 2015, 6Beds was once again the only provider organization to formally take an opposition position.

Although AB 2231 did not propose to change the highest civil penalty amounts of $15,000 and $10,000, which took effect with the passage of AB 2236 two years ago, 6Beds advocated that AB 2231 be amended to include the scaling down of these penalty amounts for RCFEs and ARFs serving six or fewer persons given the disproportionate economic impact and risk of closure these penalties expose small facilities to.  6Beds also advocated for an amendment that would tighten up the definition of a repeat violation to prevent situations where violations with different facts and circumstances could unfairly be labeled as repeat violations, subjecting licensees to costly civil penalties.  Finally, in light of Community Care Licensing’s (CCL) move towards collecting civil penalties upfront even if the deficiency is under appeal, 6Beds advocated for an amendment that would codify historic practice of having to pay a civil penalty only after the conclusion of an unsuccessful appeal.  It is fundamentally unfair for licensees to be asked to pay civil penalties while their appeals are pending.

The audience in the room that held the Assembly Human Services Committee hearing resembled a sea of blue, dominated by a large number of 6Beds members wearing blue 6Beds shirts. 6Beds’ testimony and the dozens of 6Beds members that formed a long line to individually express their opposition following the testimony made a powerful statement to both legislators and CCL that licensees of small residential care facilities are not to be ignored.  In response to 6Beds’ message and presence, the Chair of the Assembly Human Services Committee, Susan Bonilla (D – Concord), and the author of AB 2231, Ian Calderon (D – Whittier) both recognized the treatment of licensees with respect to sometimes inconsistent and subjective enforcement by CCL.  In the longer term, 6Beds believes that this recognition may help pave the way for future reforms of the Community Care Licensing system with the aim of improving the treatment and rights of licensees.  In the immediate term, 6Beds’ advocacy has caused Mr. Calderon to commit to working with 6Beds, particularly on amendments related to the definition of a repeat violation as well as the timing of civil penalty payments.

6Beds’ leadership would like to convey a heartfelt thank you to all of its members and supporters for their participation on April 12, 2016.  Everyone did a tremendous job of representing 6Beds, which has only increased 6Beds’ efficacy and will help 6Beds build upon the following positive changes relative to previous proposals for the bill that were already made prior to April 12, 2016:

Civil Penalty Amounts

The bill proposes to increase civil penalty amounts for serious/zero tolerance violations (e.g. fire clearance violations, overcapacity, ambulatory status, inoperable smoke alarms, absence of supervision, accessible bodies of water, accessible firearms/ammunition, refused entry to a facility, etc.).  Currently, the civil penalty amount for these types of violations is $150.  Prior to the introduction of AB 2231, it was proposed that the civil penalty amount for serious/zero tolerance violations be $1,000.  6Beds’ advocacy helped reduce this amount to the $500 that is currently proposed in AB 2231.

AB 2231 also proposes to increase civil penalty amounts for repeat violations of serious/zero tolerance violations, as well as other violation types.  Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations of serious/zero tolerance violations be $2,000 plus $1,500 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $1,000 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations that were not of the serious/zero tolerance type be $500 plus $100 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $250 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Imposition of Separate Civil Penalty for Underlying Violations

Prior to AB 2231, it was proposed that there could be imposed a separate civil penalty for an underlying violation that resulted in the imposition of a larger civil penalty.  For example, if absence of supervision resulted in the death of a resident, the previous proposal would have allowed for the imposition of a civil penalty for the death of the resident as well as a civil penalty for absence of supervision.  As a result of 6Beds’ advocacy, AB 2231 would only allow for the imposition of the higher civil penalty amount.  No double dipping.

Thanks again to everyone for their support and stay tuned for more updates on this bill as 6Beds works diligently to improve upon the bill.

Regards,

George Kutnerian

Advocacy, All Posts, Issues, RCFE

Resident Refund After Only a 5-Day Notice: 6Beds Submits Public Comments In Opposition To Proposed Title 22 Regulation

The Department of Social Services’ (DSS) Office of Regulation Development has proposed a number of regulations pertaining to admission agreements, most notably the following related to refunds:

87507(g)(5)(C)

Proposed Regulation: A refund of any prepaid monthly fees shall be given if the resident provides notice five days before the resident leaves the facility.  The refund shall be a proportional daily amount of any prepaid monthly fee(s), and shall be refunded at the time the resident leaves the facility and the unit is vacated.

 

DSS opened up its proposed regulations to public comment and 6Beds took the opportunity to address the proposed regulations with these comments, which were submitted on February 2, 2016.  Notably, 6Beds provided the following comment in response to the above proposed regulation that would allow for a refund after only providing a five day notice before the resident leaves the facility:

6Beds Comment: The proposed regulation misapplies Health & Safety Section 1569.682, which references a resident receiving a refund upon the resident’s leaving the facility after a five day notice only in the context of a forfeiture of license or change of use of the facility.  Instead, the proposed regulation would allow a resident to provide a five day notice and obtain a refund of any prepaid fees beyond the five days under any and all circumstances.  However, under circumstances outside of forfeiture of license or change of use of the facility, residents must provide a 30 day notice.

6Beds Recommendation: 6Beds recommends that the proposed regulation be modified to reflect that the five day notice and corresponding refund applies only in the event of forfeiture of license or change of use of the facility.

 

6Beds will provide an update after DSS’ Office of Regulation Development has responded to its comments.

Advocacy, All Posts, Issues, RCFE

WATCH: 6Beds’ Senate Human Services Committee Testimony In Opposition to Complainant Appeal Process

Hopefully, as a licensee you’ve never had to deal with a complaint against your facility, but if you have been a licensee long enough the odds are that at some point you’ve had a complaint made against your facility.  When a Licensing Program Analyst (LPA) comes to your facility to inform you that a complaint has been made against your facility, you probably get that feeling of a pit in your stomach.  When you work hard and do your best to please your residents and their families while maintaining compliance only to learn that a complaint has been filed against your facility, it can be a very deflating experience.
Blog - Complainant Appeal Process - Photo

Dealing with complaints can take up valuable time, cost you money, and be emotionally draining.  When you’re in the midst of a complaint investigation, what you’re probably looking forward to most is getting it behind you as fast as possible and, most importantly, with a favorable result.  If you get to the end of a complaint investigation with an “Inconclusive” or, better yet, an “Unfounded” result, you probably get that feeling that you can finally breathe a deep sigh of relief.  Well, what if I told you that as licensees we had to live in a world where a complainant, which is the party that made the complaint, could file an appeal if they were dissatisfied with Community Care Licensing’s (CCL) investigation findings?  Imagine getting that “Inconclusive” or “Unfounded” result and just as you’re in the midst of breathing that deep sigh of relief, you learn that the complainant has appealed your favorable investigation finding and that feeling of being able to breathe a deep sigh of relief has just reverted back to that feeling of having a pit in your stomach.  Well, that was almost our reality as of January 1, 2016 had 6Beds not intervened to have AB 1387 amended prior to its passage.

The June 25, 2015 version of AB 1387 included a two-level complainant appeal process that could potentially extend the complaint investigation process by 120 business days.  Keep in mind that I’m referring to 120 business days, which translates to a complainant appeal process that could last between five and six calendar months.

6Beds took decisive action when it learned of the proposed complainant appeal process in AB 1387.  In addition to writing a comment letter to the office of AB 1387’s author, Assembly Member Kansen Chu, I testified on behalf of 6Beds before the Senate Human Services Committee on July 14, 2015 in order to voice 6Beds’ concerns regarding the proposed complainant appeal process.  6Beds’ part of the testimony begins at the 4:52 mark and the entire AB 1387 hearing is 11:31 long.  However, I encourage you to watch the entire video in order to get full context.

California Advocates for Nursing Home Reform (CANHR) was the primary supporter of the complainant appeal process.  CANHR is the same group that sponsored the RCFE Reform Act of 2014.  6Beds’ position on the version of AB 1387 that included the complainant appeal process was “oppose unless amended”.  Not even the California Assisted Living Association (CALA), which represents many of the largest assisted living companies, opposed the version of the bill that included the complainant appeal process.

6Beds’ comment letter, testimony before the Senate Human Services Committee, and the aggressive advocacy of 6Beds’ lobbyists before and after the Senate Human Services Committee hearing played a significant role in the complainant appeal process being removed from the final version of AB 1387.  Read AB 1387 – Complainant Appeal Process for the portion of the final version of AB 1387 compared to the June 25, 2015 version that shows in red strikethrough the removal of the complainant appeal process from the bill.

The entirety of the June 25, 2015 version of AB 1387 was not detrimental to RCFE licensees.  In fact, the bill did contain important licensee appeal process reforms, which 6Beds strongly supported and even made improvements to that were incorporated into the final version of the bill.  However, where others took the easy position of compromising to accept the complainant appeal process in exchange for a reformed licensee appeal process, 6Beds took the more aggressive, but calculated approach of advocating for a bill that contained licensee appeal reforms without introducing a new and cumbersome complainant appeal process.

In a future blog post, I’ll address the new licensee appeal process that the final version of AB 1387 gave effect to on January 1, 2016.

Advocacy, All Posts, ARF, Issues, RCFE

Newly Sworn in Assembly Speaker Anthony Rendon Announces Assembly Floor Leadership Team

New Assembly Speaker Anthony Rendon (D-Paramount) announced his floor leadership team effective March 10, 2016.

The Assembly Democratic leadership appointments are as follows:

 

Speaker pro Tempore – Assemblymember Kevin Mullin (D-South San Francisco)

Assistant Speaker pro Tempore – Assemblymember Autumn R. Burke (D-Inglewood)

Majority Floor Leader – Assemblymember Ian C. Calderon (D-Whittier)

Assistant Majority Floor Leader – Assemblymember Jim Cooper (D-Elk Grove)

Majority Whip – Assemblymember Miguel Santiago (D-Los Angeles)

Democratic Whip – Assemblymember Nora Campos (D-San Jose)

Assistant Majority Whip – Assemblymember Evan Low (D-Silicon Valley)

Democratic Caucus Chair – Assemblymember Mike A. Gipson (D-Carson)

 

6Beds will continue to provide updates on new developments as it pertains to legislative leadership in Sacramento.

All Posts, RCFE

Download CCL’s New Resident Personal Rights Document: Compliance with AB 2171

Community Care Licensing (CCL) recently published Personal Rights – LIC613C-2, which incorporates the Resident’s Bill of Rights that was added to the Health & Safety Code by AB 2171 in addition to the personal rights in Title 22 regulations that were already found in CCL’s previous Personal Rights document.  AB 2171 was a part of the RCFE Reform Act of 2014 and took effect on January 1, 2015.  However, until the publishing of the Personal Rights – LIC613C-2 form this year, licensees had to come up with their own Personal Rights document and posting to comply with AB 2171.

AB 2171 requires licensees to advise and provide a copy of the rights in the Resident’s Bill of Rights and the personal rights in Title 22 regulations.  Licensees must have each resident and resident’s representative sign and date a copy of the resident’s rights and the licensee must include a signed and dated copy in the resident’s record.  The licensee must post a copy of the resident’s rights in the facility and must also post these rights in other languages when five percent or more of the residents can only read that other language.

The Personal Rights – LIC613C-2 form should help licensees comply with the requirements of AB 2171.

Advocacy, All Posts, Issues, RCFE

A Sneak Peek Into CCL’s Upcoming RCFE Medication Management Best Practices Guide

6Beds met with CCL in Sacramento on March 2, 2016 to review and discuss a draft copy of its upcoming RCFE medication management best practices guide for RCFEs.  I attended the meeting in person on behalf of 6Beds and was accompanied via teleconference by fellow 6Beds leader, Cyndy Minnery, R.N.

Here’s a sneak peek at what topics you can expect CCL’s upcoming RCFE medication management guide will cover:

General Guidance:

  • Designation of Staff to Handle and Store Medication
  • New Arrivals with Medication and Refills
  • Medication Placed on Hold, Expired or Resident Dies
  • Medication is Refused, Missed, or Needs to Be Crushed or Altered
  • Medication Set Up, Home Visits, and Medication from Other Countries
  • Medication Destruction

Guidance for Specific Medications

  • PRN Medication
  • Injectable Medications
  • Narcotics
  • Hospice
  • Ear and Eye Drops or Nasal Sprays and Over-the-Counter Medications
  • Emergency Medication
  • Pre-Packaged Medications, Sample Medications, PRN Medication, and Psychotropic Medications
  • Medication Training

6Beds provided significant feedback regarding a number of areas addressed in the draft copy of the guide that we feel will result in positive developments for RCFE licensees that will be reflected in the final version of the guide.

Stay tuned for updates regarding these developments and information regarding the release of the guide.

Advocacy, All Posts, ARF, Issues, RCFE

CCL Announces that Complaint Investigation Reports Being Posted to Transparency Website – 6Beds Meets with CCL Regarding Concerns

Community Care Licensing (CCL) announced on February 26, 2016 that on Tuesday, March 1, 2016 it would begin online posting of Complaint Investigation Reports (LIC 9099s), making them available for public online consumption for the first time via its Transparency Website.

Given that 6Beds has become aware of a number of inconsistencies in practice, it has not been entirely clear as to what CCL’s policies are regarding whether a Complaint Investigation Report is classified as either “Public” or “Confidential”  based on either the completion status of the investigation or the actual investigation findings.  For example, for Complaint Investigation Reports that are not yet completed and where the reports identify that further investigation is required, 6Beds is aware of some of these reports being labeled as “Confidential”, some of them being labeled as “Public”, and some of them not being labeled at all.  However, all complaint investigations that are not yet completed should be marked “Confidential” until a resolution is reached.

In general, 6Beds is not opposed to the idea of information being available for public consumption.  However, the public should be entitled only to information that is legitimately and legally “Public” and the availability of information should not come at the expense of accuracy, consistency, and fairness.  Earlier this week, 6Beds formally registered its concerns regarding this issue with CCL and has sought clarification regarding its policies.

On Wednesday, March 2, 2016, CCL Deputy Director Pam Dickfoss and Statewide Adult and Senior Care Program Administrator Ley Arquisola were kind enough to meet with me to discuss 6Beds’ concerns and to provide clarification.  In this meeting, CCL was able to confirm the following:

  • Complaint Investigation Reports that indicate that further investigation is required should be marked “Confidential” and not posted to the Transparency Website until a resolution is reached.
  • For RCFEs, all Complaint Investigation Reports with approved complaint findings, even if the findings are “Inconclusive” or “Unfounded”, are to be marked “Public”. This is an area that has been a source of confusion for RCFE licensees as many RCFE licensees have been under the impression that “Unfounded” complaint findings are to be labeled “Confidential,” which would make sense.  However, CCL has clarified that based on statute all approved complaint findings for RCFEs are “Public”.
  • For ARF licensees, however, “Unfounded” complaint findings are “Confidential”. “Inconclusive” and “Substantiated” complaint findings are “Public”.
  • Only Complaint Investigation Reports with complaint findings approved after January 1, 2016 will be posted to the Transparency Website. This is positive news because the inconsistencies that 6Beds is aware of are from before January 1, 2016 and 6Beds, therefore, was concerned that Complaint Investigation Reports with complaint findings issued prior to January 1, 2016 would be posted to the Transparency Website.

CCL has also committed to producing a document explaining these policies, which I will distribute once it’s made available.  6Beds is also working internally and with CCL on a process whereby licensees can report to 6Beds any inconsistencies or inaccuracies related to confidential Complaint Investigation Reports inappropriately being labeled “Public” and posted to the Transparency Website.  The inquiries from licensees would then be vetted by 6Beds and forwarded directly to CCL headquarters for review and follow-up.

Stay tuned for updates on this issue as they become available.