Other Related Spending Plan Posts
The Community Care Licensing Division (CCL or CCLD) develops and enforces regulations designed to protect the health and safety of individuals in state licensed 24-hour residential care facilities and day care programs. CCL’s primary roles and responsibilities include preventing noncompliance by conducting facility visits and background checks and providing technical assistance to licensees, and enforcing rules and regulations when licensees are found to be out of compliance. In 2022, CCL monitored roughly 684,000 licensed facilities, which include child care, children’s residential, and adult and senior care facilities. For the 2023-24 budget year, the division comprises 1,595 authorized staff positions, with an operating budget of $136 million General Fund.
Caregiver Background Check System Resources. As part of obtaining a license to operate a CCL facility, individuals must complete a background check process using the Guardian system. Guardian, which replaced CCL’s former background check processing data system and user interface, was implemented in early 2021. Shortly thereafter, the system began experiencing a number of challenges, such as significant backlogs in application processing times and long wait times for system users attempting to call for assistance.
To help address these challenges in the near term, the spending plan allocates $4 million in one-time General Fund, available over four years, for additional staffing and support for the Guardian system. In addition, the spending plan includes $600,000 General Fund one time for the Department of Social Services (DSS) to initiate planning activities and enter into the “alternatives analysis” stage of the Department of Technology’s Project Approval Lifecycle (PAL), through which CCL will explore developing a new background check system to replace Guardian. (Guardian is an off-the-shelf product—used by several other government agencies—which did not go through the PAL process but was adapted for CCL’s needs, with limitations.) Finally, budget language directs DSS to provide quarterly updates to the Legislature on the status of the Guardian system backlog, beginning August 1, 2023.
Funding to Establish Medical Foster Homes for Veterans Licensing Category. The 2023-24 spending plan includes $1.3 million General Fund ongoing to support eight new positions to implement Chapter 381 of 2022 (AB 2119, Flora), which requires medical foster homes authorized by the United States Department of Veterans Affairs (USDVA) to be licensed as state medical foster homes for veterans by CCL. This enacted legislation authorizes CCL to establish the new licensing program no sooner than July 1, 2024. Under this new licensing category, medical foster homes approved by the USDVA will be authorized to operate in California subject to licensure, inspection, training, and other oversight activities by CCL. In addition, legislation allows DSS to implement and administer the program through written directives until regulations are adopted.
Assessment of Home Care Fund and Pause in General Fund Loan Repayment. CCL’s Home Care Services Bureau is responsible for the state’s Home Care Program, which licenses and oversees home care organizations and maintains the state’s registry of independent home care aides. Elderly and disabled individuals who hire private aides to come into their homes and provide assistance with activities of daily living hire through a CCL-licensed home care organization or the CCL registry of independent aides (although CCL has asserted many unlicensed home care organizations continue to operate illegally). The Home Care Program is a relatively new licensing program, created by legislation in 2013 and implemented beginning in 2016 (prior to this time, home care organizations and aides were not regulated by the state). Licensing and registration fees, as well as revenues from enforcement actions, are allocated to the Home Care Fund. At the time the program and fund were created, the state provided a General Fund loan to begin implementation, while planning for the fund to repay the General Fund loan over several years and envisioning the fund’s revenues in the long term would be sufficient to fully fund the program’s operations. However, initial assumptions around the number of licensed home care organizations have since proven incorrect. Along with licensing and enforcement staffing shortages that limited CCL’s capacity to identify violations and assess fines, these incorrect assumptions have meant the Home Care Fund’s actual revenues to date are insufficient to sustainably fund the Home Care Program going forward (and the current outstanding General Fund loan balance is around $5 million).
Accordingly, the 2023-24 spending plan elevates the Home Care Services Bureau into a Branch, adding 15 positions to help set policy and to increase enforcement over unlicensed/unregistered home care organizations and aides. The budget package also includes language directing the department to reassess the fee structure needed for long-term stability of the Home Care Fund, and provides limited-term General Fund resources of $2.3 million in 2023-24 and 2024-25 to support the 15 new positions while CCL carries out the fee structure assessment. Additionally, the spending plan defers the General Fund loan repayment of $711,000 in 2023-24. Budget language further requires the department to submit a report to the Legislature by January 10, 2025 on the solvency of the Home Care Fund, including any new resources and recommendations for an updated fee structure that allows the program to become self-sustaining. In the lead up to that report, beginning January 1, 2024, the department is also required to submit quarterly written progress updates to the Legislature on the status of the fund and enforcement actions.
Temporary Manager Contracts for Adult and Senior Care Facilities. The spending plan includes $5.1 million General Fund ongoing to support temporary manager contracts for adult and senior care facilities. DSS assigns temporary managers to residential facilities when it is necessary to temporarily suspend (or permanently revoke) a license for the welfare and safety of the residents. Temporary managers serve to bring the facility into compliance with the law, or—when necessary due to a permanent license revocation—facilitate a transfer of ownership to a new licensee, or oversee the transfer of residents should the facility be required to close.
Funding to Implement Legislation Around Safe Use of Outdoor Play Spaces. The spending plan includes around $150,000 General Fund ongoing to provide CCL with resources to implement statutory changes mandated by Chapter 916 of 2022 (AB 2827, Quirk-Silva). This statutory change aims to ensure children with exceptional needs can safely use outdoor play spaces in licensed child care settings simultaneously with nondisabled children and charges DSS to implement the necessary changes to child care facility licensing regulations by January 1, 2024.
Reappropriation of Facility Management System Project Planning Resources. The 2023-24 budget package appropriates and extends expenditure authority through June 30, 2026 for $21.1 million General Fund unspent from 2020-21 and 2022-23 related to CCL’s ongoing effort to create a new facility management data system, replacing and improving upon the functionalities of several legacy systems. The development of the new system currently is in the “procurement” stage of the PAL process; the department anticipates releasing the request for proposals in mid-2023, with an anticipated contractor start in mid- to late 2024.
Changes to Administrator Certification Training Requirements. Individuals licensed as administrators, who oversee CCL-licensed facilities, are required to complete a department-approved certification program. Program requirements include a specified minimum number of hours of instruction, depending on the facility type. In addition, statute requires administrators to renew their certificates every two years, a process which includes completing a specified number of hours of continuing education, again depending on the facility type. Prior to the passage of the 2023-24 budget package, statute permitted up to half of the required continuing education hours to be satisfied through online courses, with the remainder completed in a classroom instructional setting. The 2023-24 budget package includes language revising this requirement, now allowing administrators to complete their certification requirements entirely online. Language specifies that up to half of the required hours may be completed as self-paced online courses and at least half of the required hours fulfilled via instruction that is conducive to learning and allows participants to simultaneously interact with each other as well as with the instructor (this could be in a classroom or through an interactive online course).