CITY OF Los ANGELES CALIFORNIA

DEPARTMENT OF CITY PLANNING 200 N. SPRING STREET,ROOM 525 Los ANGELES, CA 90012-4801 AND 6262 VAN NUYS BLVD., SUITE351 VAN NUYS, CA 91401 ClTY PLANNING COMMISSION RENEE DAKE WILSON PRESIDENT DANA M. PERLMAN VICE-PRESIDENT ROBERT L AHN DAVlD H. J. AMBROZ MARlA CABILDO CAROUNE CHOE RICHARD KATZ JOHN W.MACK MARTA SEGURA JAMES K. WILUAMS COMMlSSlON EXECUTIVE ASSISTANT n (213) 978-1300 CITY OF Los ANGELES CALIFORNIA ERIC GARCETTI MAYOR EXECUTIVE OFFICES MICHAEL J. LOGRANDE DIRECTOR {213) 978-1271 ALAN BELL, AIe? DEPUTY DIRECTOR (213) 978-1272 USA M. WEBBER, AICP DEPUTY DIRECTOR (213) 978-1274 81A YUAN-MCDANIEL DEPUTY DIRECTOR (213) 978-1273 FAX: (213) 978-1275 INFORMATION www.planning.ladty.org January 31,2014 Los Angeles City Council C/O City Clerk's Office 200 N. Spring Street, Room 395 Los Angeles CA 90012 Council File No. 14-0118 Attention: Ad Hoc Committee on Community Care Facilities MOTION - STATE LICENSED RESIDENTIAL COMMUNITY CARE FACILITIES Dear Honorable Members: In response to a January 28, 2014 motion introduced by Councilman Mitchell Englandar (14-0118) and approved by the City Council, the Department of City Planning has conducted a study of state-licensed Community Care Facilities. The motion instructed that the report include information on the State Community Care Facilities Act of 1973, requirements for State licensing, inspection and enforcement requirements and a flowchart illustrating the licensing and enforcement processes. To provide additional background information, this report briefly analyzes the various Community Care Facilities that currently exist in the City of Los Angeles. The locations of the facilities by Council District are located in the attached map, Exhibit A. Background In 1973, the California Legislature enacted the Community Care Facilities Act. The purpose of the Act was to establish a statewide system of community facilities for persons with mental and developmental disabilities and socially dependent children and adults. Community Care Facilities (CCFs) are meant to provide a "normalizing and least

January 27,2014 Page 12 restrictive environment" for persons who cannot live alone but who do not need extensive medical services. They should not be confused with health-based facilities for inpatient and outpatient care, which are regulated through a different agency and Statute. According to California Health and Safety Code Section 1502, "Community Care Facility" means: "Any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children... " Residential Community Care Facilities The nature of community care has expanded since the initial 1973 CCF Act and new types of CCFs have been established over time. The Code now lists twelve types of facilities defined in the California Community Care Facilities Act, several of which deal only with children or day care". A "residential facility" is defined in Health and Safety Code Section 1502, as follows: "Any family home, group care facility, or similar facility determined by the director, for 24-hour non-medical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual." Despite the state's more expansive definition, this study is focused on residential facilities for adults and the elderly, which is the subject of the motion and potential city regulation. The services provided in residential facilities vary according to the needs of the individual, but typically include health checks, help with medications, money management and assistance with personal hygiene, dressing and grooming. Residents generally share responsibilities, meals, and recreational activities. Of the eight types of residential aduluelderly CCFs identified for this report, the three most prominent categories are Adult Residential Facilities, Residential Care Facilities for the Elderly and Alcohol and Drug Treatment Facilities. The State's description of each type of facility is provided below. Adult Residential Facilities provide care for adults age 18-59, who are unable to provide for their own daily needs, or adults older than 60 in accordance with Section 85068.4 (e.g. they do not require any additional care and supervision). Adult Residential Facilities for Persons with Special Health Care Needs provide 24-hour services in a homelike setting, for up to five adults with I A copy of relevant Health and Safety Code Statutes as well as Regulations Procedures) for Community Care Facilities is attached as Exhibit B. (Manual of Policies and

Los Angeles City Council - Ad Hoc Committee on Com t.nit) Care Facilities January 27, 2014 1/ Pagel3,t Ii I developmental disabilities, who are being transitioned from a developmental center, and who have special health care and intensive support needs. Alcohol and Drug Treatment Facilities provide 24-hour residential non-medical services to eligible adults who are recovering from problems related to alcohol or other drug (AOD) misuse or abuse. Community Treatment Facilities are a sub-acute mental health treatment facility that will be authorized to lock its doors and to utilize restraint and seclusion. Residential Care Facilities for the Chronically III provide care and supervision to adults who have Acquired Immune Deficiency Syndrome (AIDS) or the Human Immunodeficiency Virus (HIV). Residential Care Facilities for the Elderly provide non-medical care to persons 60 years of age and over but also persons under 60 with compatible needs. Residential Care Facilities for the Elderly - Continuing Care Retirement Community provides for housing, residential services, and nursing care for the elderly, usually in one location, and usually for a resident's lifetime. Social Rehabilitation Facilities provide care in a group setting to adults recovering from mental illnesses who temporarily need assistance, guidance, or counseling. Number of Facilities The Department of City Planning obtained the most recent lists of licensed CCFs as of January 21, 2014, from the websites of both the State Department of Social Services and the Department of Health Care Services. The Department combined the data to create a spreadsheet from which non-residential and children-only facilities were removed, leaving only the adult/elderly residential care facilities described above. Then the information was mapped by Council District using Geographic Information Systems and is shown in Exhibit A. The City of Los Angeles has a total of 934 licensed residential CCFs for adults or the elderly. More than 92% of these facilities are licensed by the CA Department of Social Services (CDSS), while the rest are residential facilities for Alcohol and Drug Treatment Facilities licensed by the CA Department of Health Care Services (DHCS). Adult Residential Facilities and Residential Care Facilities for the Elderly are, by far, the most common facilities, each comprising about 46% of the total. The remainder of facilities (8%) are largely Alcohol and Drug Treatment Facilities, with just a handful of the other types found citywide. The 934 CCFs in the City of Los Angeles have a total citywide capacity of 18,723 beds. This equates to an average capacity of 20 beds per facility. Alcohol and Drug Treatment Facilities are generally larger than other types of care facilities, with an average size of 37 beds. However, the figure is skewed by a relatively small number of large facilities. The median number of beds for Alcohol and Drug Treatment Facilities is 22, while the mode (most common occurring number among all facility types) is six.

e=», I Los Angeles City Council - Ad Hoc coml'~! Jon January 27,2014! 1 Community Care Facilities Pagel4 f. The number of Community Care Facilities, below: by Council District, is shown in the chart Chart 1 - Number of Residential Community Care Facilities for Adults and the Elderlv in the City of Los Anaeles Total Average Capacity (Beds) Council Number of Capacity Persons per Facilities as as Percent of District Facilities (Beds) Facility Percent of Total Total 1 25 1,470 59 2.7% 7.9% 2 60 842 14 6.4% 4.5% 3 110 2,256 21 11.8% 12.0% 4 51 934 18 5.5% 5.0% 5 73 3,190 44 7.8% 17.0% 6 33 852 ~ 26 3.5% 4.6% 7 36 764 21 3.9% 4.1% 8 115 910 8 12.3% 4.9% 9 37 629 17 4.0% 3.4% 10 84 1,248 15 9.0% 6.7% 11 41 629 15 4.4% 3.4% 12 170 1,926 11 18.2% 10.3% 13 44 1,522 35 4.7% 8.1% 14 32 1,212 38 3.4% 6.5% 15 23 339 15 2.5% 1.8% Citywide 934 18,723 20 As can be seen by the map (Exhibit A) and chart, residential care facilities are fairly well dispersed throughout the city, although numbers vary. While CD 12 and CD 8 have the most number of facilities, CD 5 and CD 3 have the highest number of beds. CD 15 has the lowest number of both facilities and beds. State Land Use and Zoning Requirements for CCFs Small CCFs Treated Like Single-Family Homes Of all the CCFs, the City is only preempted from regulating residential facilities for six or. fewer persons. California Health and Safety Code Section 1566.3 regulates residential care facilities for six or fewer persons and states: 'Whether or not unrelated persons are living together, a residential facility, which serves six, or fewer persons shall be considered a residential use of property for the purposes of this article. In addition, the residents and operators of such a facility shall be considered a family for the purposes of any law or zoning ordinance which relates to the residential use of property pursuant to this article.

January 27, 2014 Page 16 governed by three separate licensing Acts and a fourth statute that was enacted in 1990 4. Before applying to become a licensed CCF, an initial orientation for potential applicants covers licensing requirements and the licensee's responsibilities. Applicants then submit the official application forms (Exhibit C), as well as a licensing fee and a financial plan of operation. If granted initial approval, the licensing agency completes a background check on the applicant and an on-site facility inspection to ensure that the facility meets health and safety standards. When all requirements are met, the state issues a license valid for two years. The application processes is summarized in Exhibit D. State licensing agencies are also responsible for overseeing residential care facilities and ensuring that they are in compliance with health and safety laws and regulations. The State conducts a comprehensive unannounced facility evaluation on an annual (DHSS) or bi-annual (DHCS) basis", DHSS inspections are unannounced. In addition, the licensing agency may contact local law enforcement to see if any problems have been reported, or to follow up on neighborhood issues that have surfaced. During the inspection, the licensing agency inspects the facility; reviews administrative, personnel, and resident files; and interviews staff and residents. It also reviews the staffing ratios and staff qualifications. Licensing regulations require that at least one qualified staff person be with the residents and/or on the premises at all times. The minimum number of direct care staff required to be present is based on the number of residents. All staff must be at least 18 years of age, have a medical and criminal record clearance as well as first aid certification. Staff must also receive appropriate training and have certain qualifications for the different types of facilities. Reports of violations or other complaints are investigated by DHSS and DHCS staff. When deficiencies are found, the licensing agency gives a written notice to the licensee and verifies in a follow-up visit that the corrections were made. If the deficiencies are not corrected, the licensing agency issues civil penalties. It can ultimately revoke the facility's license if the licensee does not comply with requirements. Information about specific facilities, such as licensing status, complaints lodged against them, and pending investigations is also made public through the state agencies. Alcoholism or Drug Abuse Recovery or Treatment Facilities The licensing of Alcoholism or Drug Abuse Recovery or Treatment Facilities operates slightly different than other types of care facilities. Facilities providing 24-hour residential nonmedical services to eligible adults who are recovering from problems related to 4 Community Care Licensing Division, Department of Social Services. http://www.ccld.ca.gov/pg521.htm 5 The current inspections protocols are included for the record as Exhibit F.

January 27,2014 Page 15 No conditional use permit, zoning variance, or other zoning clearance shall be required of a residential facility which serves six or fewer persons which is not required of a family dwelling of the same type in the same zone." Therefore, by State law, facilities with a capacity of six or fewer are permitted in all zones in the City of los Angeles that permit residential uses (including "R" residential zones, "C" commercial zone, "A" agricultural zones). Accordingly, if a facility houses six or fewer residents, local governments are confined to only the same restrictions that would apply to any other residential project in the area. Larger CCFs Subject to Local Land Use Regulations Unlike small CCFs, those with seven or more residents are subject to local land use regulations. local government entities are also required to make reasonable accommodations for facilities serving individuals with disabilities. In some instances, accommodation may include exceptions or modifications to local zoning ordinances. Prevention of Overconcentration To prevent over concentration, the State requires that certain community care facilities be at least 300 feet from another like facility. Prior to approving any application for a new residential care facility; the DSS must notify the local planning agency of the proposed location ofthe facility. This notification requirement pertains to adult and juvenile facilities and those that serve other special needs facilities but does not apply to senior facilities. For non-senior facilities, State licensing for projects is automatically denied unless the local jurisdiction approves an exemption based upon local needs and conditions. Licensing and Oversight Residential CCFs are required by state law to have a valid license to operate. Most residential CCFs are licensed through the Community Care Licensing Division (CClD) of the CA Dept. of Social Services (CDSS) (part of the CA Dept. of Health and Human Services). The Alcohol and Drug Treatment Facilities are now regulated by the Department of Health Care Services (DHCSf The licensing process for different types of CCFs is largely the same". However, in order to give emphasis to the different populations served, the licensing program is now 2 Alcohol and Drug Treatment Facilities had been regulated and licensed by the Department of Alcohol and Drug Programs until 2013. 3 Much of the information in this section is taken from "Residential Care Facilities in the Neighborhood: Federal, State, and Local Requirements" by the CA Research Bureau (Lisa K. Foster, M.S.W., M.P.A). The report is made available as Exhibit E.

January 27, 2014 Page 17 alcohol or other drug misuse or abuse are licensed by the Department of Health Care Services (DHCS). Licensure is required when at least one of the following services is provided: detoxification, group sessions, individual sessions, educational sessions, or alcoholism or drug abuse recovery or treatment planning. In addition to the steps outlined for all CCFs above, applicants to administer an Alcoholism or Drug Abuse Recovery or Treatment Facilities must demonstrate a capability to meet the goals and objectives of an alcoholism or drug abuse recovery or treatment facility and obtain a valid and appropriate fire clearance. Investigation and Enforcement against Unlicensed Facilities A property shall be deemed to be an unlicensed community care facility if it is maintained and operated to provide nonmedical care, is not exempt from licensure and anyone of the following conditions exists: The facility is providing care or supervision, as defined in the California Code of Regulations (Health and Safety Code section 1569.2). The facility is represented as providing care and supervision to a client, or clients not otherwise exempt from licensure. The facility accepts or retains residents who demonstrate supervision whether the facility provides that care or not. the need for care and The facility represents itself as a licensed Community Care Facility, Residential Care Facility for the Chronically III, Residential Care Facility for the Elderly, or Community Care Facility. When an unlicensed facility operation is identified, a Notice of Operation in Violation of Law (LiC 195) is issued. Civil penalties are generally assessed unless a completed application is submitted or operation does not cease within 15 calendar days of the Notice. On day 16 a civil penalty of $100-$200 per day is assessed until a completed application is submitted or operation ceases If DHCS or DHSS receives a complaint in which a facility is alleged to be operating without a license, staff investigates the complaint. If DHCS finds that alcohol and/or drug services are being provided unlawfully, DHCS will notify the operator to cease operation. DHCS also has the authority to assess fines for noncompliance if unlicensed. facilities fail to comply, and may ask for court assistance to order the closure of an unlicensed facility. Reporting Requirements Licensed facilities are required to maintain and submit complete records on clients being served at the facility, including name, date of admission, medical assessment, record of any injuries at the facility, record of current medications and an account of

January 27,2014 Page 18 client's personal property entrusted to the facility for safe keeping. Each licensee or applicant must also furnish to the licensing agency reports on any injuries that require medical treatments, incidents that threatens the physical or emotional health or safety of any client, or other serious events. Any changes to the administrator must also be reported to the relevant state agency. Conclusion This report was compiled for informational purposes only and does not contain any additional analysis or land use recommendations. The Ad Hoc Committee on Community Care Facilities will direct staff to produce additional reports on topics as they see fit. For any questions, please do not hesitate to contact Matthew Glesne in the Department of City Planning, at (213) 978.2666 or matthew.glesne@lacity.org. Sincerely, Alan Bell, AICP Deputy Director of Planning Attachments: Motion Exhibit A - Map of Licensed Residential Adult/Elderly Community Care Facilities Exhibit B - Relevant State Codes and Regulations for Community Care Facilities Exhibit C - Relevant Licensing Applications Exhibit D - Summary of Licensing Policies for Community Care Facilities Exhibit E - "Residential Care Facilities in the Neighborhood: Federal, State and local Requirements" - CA Research Bureau, 2002. Exhibit F - CClD Fact Sheet - Frequency of Inspections, 2010