AHEAD AND GET STARTED HERE
WELCOME TO THE HEALTH COMMITTEE
INFORMATIONAL HEARING ON
SKILLED NURSING FACILITIES IN
CALIFORNIA LICENSING
INSPECTIONS AND QUALITY OF CARE
ISSUES. REQUIRING A MASS BE
WORN BY ALL MEMBERS OF THE
PUBLIC TESTIFYING IF YOU DO NOT
HAVE A MASS WE CAN PROVIDE ONE
FOR YOU. FOR MEMBERS OF PUBLIC
CALLING IN WE WILL BE USING A
MODERATED TELEPHONE SERVICE
THROUGH THE THROUGH WHICH ANY
MEMBER THE PUBLIC CAN PROVIDE
COMMENTARY WHEN WE GET TO THAT
POINT IN THE AGENDA. PANELISTS
OF ALL BEEN PROVIDED A CALLING
NUMBER PRIOR TO THIS HEARING
THE CALL IN NUMBER FOR PUBLIC
COMMENT FOR THIS HEARING IS.
EIGHT SEVEN SEVEN SIX NINE TWO
EIGHT NINE FIVE SEVEN AND THE
ACCESS CODE IS. ONE THREE ONE
FIVE FOUR TWO ZERO TWO ONCE
AGAIN THAT IS. EIGHT SEVEN
SEVEN SIX NINE TWO EIGHT NINE
FIVE SEVEN. AND THE ACCESS CODE
IS. ONE THREE ONE FIVE FOUR TWO
ZERO TWO YOU CAN ALSO FIND THIS
NUMBER ON THE ASSEMBLY HEALTH
COMMITTEE WEBSITE AS WELL AS ON
YOUR TV SCREEN. THE OPERATOR ON
THE LINE WILL GIVEN YOU
INSTRUCTIONS ON HOW TO BE
PLACED IN OUR QUEUE TO PROVIDE
PURE PUBLIC COMMENT. IF YOU'RE
CALLING IN PLEASE ELIMINATE ALL
BACKGROUND NOISE THIS INCLUDES
MUTING YOUR LIVESTREAM
BROADCAST AND YOUR SMART
DEVICES. TO REDUCE SOUND
DISTORTION. WENCH AT YOUR PLACE
IN THE QUEUE HE WILL BE S. DO
YOU WILL ALSO NEED TO MUTE
YOURSELF UNTIL YOU'RE CALLED
UPON TO SPEAK. IF YOU'RE HAVING
ANY PROBLEMS WITH THE MODERATED
PHONE SERVICE YOU CAN CALL THE
COMMITTEE AT NINE ONE SIX.
THREE ONE NINE TWO ZERO NINE
SEVEN AND MY STAFF WILL BE
THERE TO HELP. I ALSO WANT TO
NOTE THAT WE ARE ACCEPTING
WRITTEN PUBLIC COMMENT THROUGH
THE HEALTH COMMITTEES. PUBLIC
EMAIL WHICH IS A H. E. A. DOT
COMMITTEE. ASSEMBLY DOT C. A.
DOT G. O. V. WHICH CAN ALSO BE
FOUND ON OUR WEBSITE. WE MAY
NEED TO LIMIT HOW LONG EACH
PERSON HAS PROVIDE PUBLIC
COMMENT. THANK YOU FOR YOUR
PATIENCE. AS THE BACKGROUND
PAPER FOR THIS HEARING NOTES WE
HELD THE PREVIOUS HERE- SKILLED
NURSING FACILITY OVERSIGHT
HEARING IN JUNE OF TWENTY
TWENTY. THREE FOCUSED PRIMARILY
ON COVERT NINETEEN IN THE STATE
AND NURSING FACILITIES RESPONSE.
COBIT IS STILL AN IMPORTANT
ISSUE FOR THESE FACILITIES AND
THE LEGISLATURE INTRODUCED
SEVERAL BILLS AT THE BEGINNING
OF THIS YEAR TO ADDRESS COBIT.
MANY OF WHICH WENT TO THE
OVERNOR AND ARE CURRENTLY
PENDING HIS SIGNATURE OR VETO.
THIS HEARING WILL BE FOCUSING
ON THE NURSING. FACILITY
LICENSING AND CHANGE OF
OWNERSHIP PROCESS. DEPARTMENT
OF PUBLIC HEALTH INSPECTION OR
SURVEY PROCESS. AND HOW THOSE
AFFECT THE QUALITY OF CARE. AS
WELL AS THE FACILITY OWNERSHIP
STRUCTURE PARTICULARLY THE USE
OF RELATED PARTIES. WHILE WE
BEGAN PREPARING FOR THIS
HEARING HOWEVER IT BECAME CLEAR
THAT THERE ARE CONTINUING AND
EMERGING STAFFING ISSUES AS
WELL THAT ALSO AFFECT THE
QUALITY OF CARE. SO AS
IMPORTANCE HERE SOMEWHERE
WITNESSES ADDRESS OF TAT THAT
ISSUE AS WELL. WE HAVE SOME
SPECIAL GUESTS WITH US TODAY
JOINING US ASSEMBLY MEMBER AL
MURATSUCHI. ALSO ASSEMBLY
MEMBER. FREDDIE RODRIGUEZ IS
WITH US WE ARE EXPECTING OTHER
MEMBERS- TO ARRIVE AS WELL. I
THANK YOU FOR ALL FOR COMING-
I'D LIKE TO GET START WITH OUR
FIRST PANEL BUT- WHEN TO SEE IF
ANY OF OUR MEMBERS HAVE ANY
OPENING COMMENTS MR MORE
SEARCHING. THANK YOU VERY MUCH
MR CHAIRMAN I JUST WANT TO
THANK YOU FOR. ALLOWING ME TO
JOIN THE HEALTH COMMITTEE. FOR
THIS VERY IMPORTANT-
INFORMATIONAL HEARING- HAS AS
YOU KNOW I. HAVE A- TWO BILLS
THAT DEAL WITH NURSING HOMES
AND ONE IN PARTICULAR THE-
DEALING WITH- THE- OF THE VERY-
CHALLENGING LICENSING ISSUES
THAT WE'RE- SEEING IN THE STATE
OF CALIFORNIA AS IT RELATES TO
NURSING HOMES. AND SO I LOOK
FORWARD TO. DELVING MORE DEEPLY
INTO THESE THESE COMPLICATED
ISSUES THANK YOU. THANK YOU
VERY MUCH MISS MURATSUCHI MISS
RODRIGUEZ AND COMMENTS. THANK
YOU MISTER CHAIR FOR BRING US
TOGETHER TO. TALK ABOUT THESE
VERY IMPORTANT ISSUES AS YOU
KNOW ME WORKING IN THE-
AMBULANCE ENTRY FOR MANY YEARS
I CAME ACROSS MANY. US GOOD
FACILITIES WHEN THEIR CALL NINE
ONE ONE CUT SEE FIRSTHAND HOW
THEY REALLY OPERATE. ESPECIALLY
IN EMERGENCY SITUATIONS ARE
REALLY. GLAD TO HEAR WHAT WE
FIND OUT FROM WHAT WE'RE DOING
TODAY AND MOVING FORWARD SO
THANK YOU. VERY WELL THANK YOU
VERY MUCH WE WILL NOW. GO
AHEAD. TO START OUR FIRST
PANEL- TO ALLOW OUR WITNESSES
ADEQUATE TIME FOR THEIR
TESTIMONY WILL BE HOLDING
QUESTIONS UNTIL THE END OF EACH
PANEL. WOULD LIKE TO WELCOME
OUR STATE AUDITOR ELAINE HOWLE-
KATIE CARDIN YES WITH THE
AUDITOR'S OFFICE. AND SONYA
PADDOCK WITH THE LEGISLATIVE
ANALYST'S OFFICE- WHENEVER
YOU'RE READY MATAMATA AUDITOR.
SO THANK YOU MR CHAIRMAN AND
MEMBERS- HOPEFULLY YOU HAVE THE
HAND OUT IT'S JUST A TWO PAGE
HANDOUT I'M GOING TO USE THAT
KIND OF STEP THROUGH AN AUDIT
THAT WE COMPLETED IT'S A BIT
DATED BUT WE DO HAVE SOME
INFORMATION AS YOU KNOW WE
FOLLOW UP WITH AGENCIES. AND
THEY HAVE TO REPORT BACK TO US
AT CERTAIN INTERVALS AFTER
WE'VE CONDUCTED AN AUDIT SO THE
AUDIT WILL BE TALKING ABOUT
TODAY- BRIEFLY WAS ISSUED IN
MAY OF TWENTY EIGHTEEN AND
ASSEMBLY MEMBER WOULD AND YOU
SENATOR MARK WHAT ARE YOU AND
CENTER MCGUIRE WHERE THE
REQUEST OF THIS AUDIT AND HAD
PARTICULAR CONCERNS ABOUT A
VARIETY OF ISSUES SO WHAT I'M
GOING TO STEP YOU THROUGH WITH
THIS HAND OUT ARE THE KEY
ISSUES THAT WE IDENTIFIED IN
THE AUDIT REPORT WE LOOK AT
LICENSING- WE CERTAINLY LOOKED
AT. THE DEPARTMENT PUBLIC
HEALTH AND THEIR INSPECTION
PRACTICES THEIR ABILITY TO
ISSUE CITATIONS TIMELY AND
WHETHER OR NOT THOSE CITATIONS
ARE EFFECTIVE IN GETTING
QUALITY OF CARE IMPROVED A
LITTLE BIT OF A DISCUSSION ON
AND THE INCENTIVE PROGRAM
THAT'S AVAILABLE AND THEN
CERTAINLY RELATED PARTIES SO
STARTING WITH A LITTLE BIT OF
BACKGROUND AS I'M SURE YOU ARE
AWARE MEMBERS BACK WHEN WE
CONDUCTED THE AUDIT. WE LOOKED
AT A TIME FRAME OF TWO THOUSAND
SIX THROUGH TWO THOUSAND
FIFTEEN ABOUT A TEN YEAR WINDOW
AND FOUND THAT DEFICIENCY SUB
STANDARD CARE HAD BEEN
INCREASING AND HAD INCREASED
PRETTY SIGNIFICANTLY ABOUT
THIRTY ONE PERCENT- BUT THEN
ALSO SITUATIONS WHERE IT'S
IMMEDIATE JEOPARDY WHERE IT
WOULD CAUSE SIGNIFICANT HARM OR
POTENTIALLY DEATH HAD ACTUALLY
INCREASED THIRTY FIVE PERCENT.
SO WHEN WE LOOKED AT WHETHER
PUBLIC HEALTH WAS ISSUING
CITATIONS WE SAW THE OPPOSITE
WE SAW THAT SIDE THE NUMBER OF
CITATIONS HAD ACTUALLY
DECLINED- SO WE WANTED TO SEE
YEARS IT BECAUSE THERE'S A
DIFFERENCE IN THE NUMBER OF
BEDS HAS THE INDUSTRY CHANGED
THERE WASN'T A SIGNIFICANT
CHANGE IN THE INDUSTRY AS FAR
AS THE NUMBER OF NURSING BEDS
AVAILABLE INDUSTRY WIDE SO
THERE CLEARLY WAS A PROBLEM
WITH QUALITY OF CARE AND
CERTAINLY AS ASSEMBLYMEMBER
WOOD AND CENTER MCGUIRE. CITED
IN THEIR REQUEST LETTER. SO THE
FIRST AREA THAT WE LOOKED AT IS
RELATED TO LICENSING AND THAT'S
THE FIRST SECTION WE HAVE AND
HAND OUT FOR YOU AND WHAT WE
LOOK AT WE LOOK AT THREE
DIFFERENT NURSING HOME FACILITY
OWNERS OF PREVIOUS PLOMIN LONG
WORD LONG WORD AND WANTED TO
SEE HOW CONSISTENT DEPARTMENT
OF PUBLIC HEALTH WAS IN
REVIEWING APPLICATIONS FOR
LICENSURE- AND MAKING
DETERMINATIONS AND WHAT WE
FOUND IS PRETTY SIGNIFICANT
INCONSISTENCIES- WE'VE WE
LOOKED AT TEN FILES WE FOUND
THAT NINE FILES WERE INCOMPLETE
SO WHAT WE'RE LOOKING FOR IN
THOSE FILES IS PUBLIC HEALTH IS
SAYING. WE LOOK TO SEE HOW MANY
CITATIONS A PARTICULAR FACILITY
HAD- LOOK TO SEE IF THERE ARE
SIGNIFICANT NUMBER OF
DEFICIENCIES AND WE FACT USE
CELLS AS FACTORS TO DETERMINE
WHETHER OR NOT TO APPROVE A
LICENSE APPLICATION BUT
UNFORTUNATELY WE LOOKED AT TEN
FILES WE FOUND NINE THAT WERE
INCOMPLETE THEY WERE NOT FULLY
DOCUMENTING THE DEFICIENCIES
ANY CITATIONS ANY COMPLAINTS
THAT HAD BEEN RECEIVED- SO WHEN-WE LOOKED AT A DISTINCTION
BETWEEN APPROVING A LICENSE
APPLICATION FROM PLUM VERSUS
ONE FROM LONG WATER FROM YES WE
SAW WHAT LOOKED LIKE SIMILAR
CIRCUMSTANCES BUT DIFFERENT
DECISIONS. SO WE REALLY HAD
SOME SIGNIFICANT CONCERNS ABOUT
THAT INCONSISTENCY AND WHETHER
OR NOT PUBLIC HEALTH REALLY HAD
A GOOD DEFENDABLE PROCESS- IN
ADDITION TO THAT WE'RE LOOKING
TO SEE WHAT ARE THE FACTORS ARE
WHAT KIND OF GUIDANCE ARE
PUBLIC HEALTH- EMPLOYEES
RECEIVING TO DETERMINE DO I
NEED TO ELEVATE THIS TO A
HIGHER LEVEL TO A HIGHER LEVEL
MANAGEMENT WITHIN THE
DEPARTMENT TO MAKE SOME
DECISIONS RELATED TO LICENSURE.
AND AS YOU CAN SEE ON THE ON
THE HAND OUT WE HAVE JUST
DECISIONS WERE INCONSISTENT.
BECAUSE PUBLIC HEALTH HAD A
POOR PROCESS THEY DIDN'T HAVE
ADEQUATE DOCUMENTATION. SO WE
MADE A COUPLE OF
RECOMMENDATIONS HERE WANT TO
THE LEGISLATURE. TO REQUIRE
PUBLIC HEALTH TO OUTLINE THOSE
FACTORS AND THAT THEY WILL
CONSIDER WHEN APPROVING OR
DENYING APPLICATIONS SO THERE'S
SOME CONSISTENCY. THE PROPOSAL
NEEDS OUTLINED SPECIFIC
CRITERIA THAT PUBLIC HEALTH
STAFF WOULD USE TO MAKE THOSE
DECISIONS AS TO WHETHER OR NOT
TO APPROVE OR DENY. AND WHAT WE
ARE SUGGESTING IS A LEGISLATURE
CODIFY. ESTABLISH A STATUTE
THAT KIND OF LAYS OUT WHAT
PUBLIC HEALTH PUT TOGETHER AS
FAR AS WHAT THE FACTOR SHOULD
BE. AND WHAT TYPES OF
CONSIDERATIONS PUBLIC HEALTH
SHOULD. SHOULD BE ADDRESSING.
AS YOU CAN SEE IN OUR DOCUMENT
WE LOOKED AT AB FIFTY NO TO
THAT ASSEMBLY MEMBER TUCCI HAS
AUTHORED AND I'M IT'S M
UNDERSTANDING IT IS- A TWO YEAR
BUILT- BUT WHEN WE LOOKED AT
THAT LEGISLATION THAT BILL. WE
BELIEVE THAT MUCH OF THE BILL
ADDRESSES THE RECOMMENDATION
THAT WE HAD AND IT WILL CODIFY
SOME OF THE FACTORS THAT PUBLIC
HEALTH SHOULD BE CONSIDERING.
WHEN THEY'RE ASSESSING AND WHEN
THEY'RE ESTABLISHING WHAT WE
HOPE TO SEE AS A CONSISTENT
STRONG ROBUST LICENSING REVIEW
PROCESS SO WE THINK THAT.
LEGISLATION GOES A LONG WAY IN
ADDRESSING SOME OF THE ISSUES
WE IDENTIFIED. IN THE AUDIT A
FEW YEARS AGO. IN ADDITION TO
THAT WE MADE RECOMMENDATIONS TO
DEPARTMENT OF PUBLIC HEALTH
THEY NEED TO IMPROVE THEIR
LICENSING REVIEW PROCESS AND WE
LAID OUT HERE AND BULLETS.
ENSURING THAT THE ANALYST
COMPLETE. STANDARDIZED REVIEW
OF APPLICATIONS MAKE SURE
YOU'RE LOOKING FOR ALL THE
CITATIONS THE CAUGHT THAT THE
DEFICIENCIES AT CETERA.
DETERMINE WHAT FACTORS WILL BE
INCLUDED. IN THEIR ANALYSIS AND
HOW DO THEY WAIT THOSE FACTORS
WHICH FACTORS ARE PERHAPS MORE
IMPORTANT THAN OTHERS WE REALLY
DIDN'T SEE ANY OF THAT WE
CONDUCTED THE AUDIT. AND THEN
DEVELOPING THAT THRESHOLD IS
THERE A THRESHOLD WHERE I HAVE
A CERTAIN NUMBER OF
DEFICIENCIES A CERTAIN NUMBER
OF CITATIONS. THAT I AS AN
ANALYST AT PUBLIC HEALTH NEED
TO ELEVATE THIS TO HIGHER LEVEL
MANAGEMENT. SO THAT- THERE'S
CONSISTENT AGAIN PROCESS AND
DECISION MAKING. AND THEN
ADEQUATELY DOCUMENT THOSE
DECISIONS AS WELL AS I SAID IN
NINE OF THE TEN APPLICATIONS WE
LOOKED AT. WE SAW INCOMPLETE
APPLICATIONS POOR DOCUMENTATION
IT WAS DIFFICULT FOR PUBLIC
HEALTH TO EXPLAIN TO US BASED
ON THE MATERIALS IN THE FILES.
WHY DID YOU APPROVE THIS
APPLICATION AND WHITED VERSES
DENYING THIS OTHER ONE SO THERE
NEEDS TO BE CONSISTENCY. AS YOU
CAN SEE AND THE AND THE HANDOUT
WE'RE SAYING PARTIALLY
IMPLEMENTED. SO PUBLIC HEALTH
HAS IMPLEMENTED SOME PROCESSES
TO STANDARDIZE LICENSING
REVIEW. THEY'VE CREATED SOME OF
THOSE THRESHOLDS THAT WOULD
PROMPT. ANALYSTS TO ELEVATE.
THE FIRST. LINE THEIR PUBLIC
HEALTH HAS NOT DETERMINED HOW
ANALYSTS WILL WEIGH THE
FACTORS- AS RECENTLY AS THIS
PAST THURSDAY OR FRIDAY EVENING
WE RECEIVE SOME MATERIALS FROM
PUBLIC HEALTH. THAT THEY ARE
HEADING IN THAT DIRECTION WE
HAVEN'T HAD A CHANCE TO FULLY
REVIEW THOSE TO DETERMINE
WHETHER OR NOT IT FULLY
ADDRESSES. OUR CONCERNS BUT
THAT'S KIND OF LATE BREAKING
NEWS I JUST WANTED TO MAKE SURE
I. I SHARE THAT WITH YOU TODAY
BUT AT THIS POINT UNTIL WE HAVE
A CHANCE TO LOOK AT THAT. WE
BELIEVE THIS IS PARTIALLY
IMPLEMENTED THEY NEED TO DO
SOME ADDITIONAL WORK. SO THAT
WAS THE FIRST AREA OF THE AUDIT
REPORT THAT WE LOOKED AT AS FAR
AS LICENSING AND THE
CONSISTENCY AND WHAT FACTORS
ARE USING ARE YOU TRAINING YOUR
ALICE THOSE SORTS OF THINGS.
THE SECOND AREA WANT TO TALK
ABOUT STATE RELICENSING
INSPECTIONS. AND THESE ARE VERY
IMPORTANT FOR THE STATE OF
CALIFORNIA BECAUSE STATE LAW
REQUIRES THE INSPECTORS
INSPECTIONS TO BE DONE EVERY
TWO YEARS. AND IT'S TO ENSURE
THAT FACILITIES ARE. YOU KNOW
COMPLYING WITH STATE LAW. AND
MEETING THE QUALITY OF STANDARD
REQUIREMENTS THAT A NURSING
FACILITY SHOULD MEET. WHEN WE
CONDUCTED THE AUDIT AGAIN WE
ISSUED THIS REPORT BACK IN
TWENTY EIGHTEEN. WHAT WE FOUND
IS PUBLIC HEALTH WAS
PRIORITIZING THEIR FEDERAL.
RELICENSING INSPECTIONS ARE
THERE FEDERAL INSPECTIONS AS
OPPOSED TO THE STATE
INSPECTIONS PART OF THE PROBLEM
HERE IS. AS WE CITED IN THE
REPORT THE FEDERAL REQUIREMENT
IS EVERY FIFTEEN MONTHS A
FACILITY HAS TO BE REVIEWED.
THE STATE LAW REQUIRES A STATE
INSPECTION AS I SAID EVERY TWO
YEARS SO IT'S TWENTY FOUR
MONTHS IT WAS A DIFFERENT
CYCLE. SO WHAT WE SUGGESTED IS.
WE MAKE THE STATE INSPECTIONS
PERHAPS THIRTY MONTHS AND THEN
IT WOULD BE EASIER BECAUSE
PUBLIC HEALTH SAID IT'S
DIFFICULT FOR US BECAUSE THE
TIMING IS DIFFERENT. WELL IF
YOU MAKE ONE THIRTY MONTHS AND
ONE FIFTEEN MONTHS IT'S
RELATIVELY EASY. TO BE ABLE TO
DO THOSE INSPECTIONS TOGETHER
BECAUSE THE STATE INSPECTIONS
ARE PARTICULARLY IMPORTANT.
BECAUSE SOME OF THE
REQUIREMENTS THAT ARE IN STATE
LAW ARE MORE STRINGENT. AND
MORE ARE NOT ACTUALLY WILL DO A
BETTER JOB OF ENSURING QUALITY
OF CARE IN CALIFORNIA SO- THE
DEPARTMENT PUBLIC HEALTH THE
STATE OF CALIFORNIA NEEDS TO
MAKE SURE THEY'RE DOING THEIR
FOR THOSE STATE RELICENSING
INSPECTIONS- WE MADE A
RECOMMENDATION THE LEGISLATURE
THAT REQUIRES PUBLIC HEALTH TO
CONDUCT THOSE STATE. AND
FEDERAL INSPECTIONS
CONCURRENTLY AND I ALS WANTTO
POINT OUT WHAT WE SAID IN THE
AUDIT REPORT IS A LEGISLATURE
DID TAKE ACTION BACK IN TWO
THOUSAND SEVEN. THAT GAVE THE
DEPARTMENT PUBLIC HEALTH THE
AUTHORITY TO DO DUAL
INSPECTIONS GO OUT THERE DO
YOUR FEDERAL INSPECTION AND
YOUR STATE INSPECTION AT THE
SAME TIME THEY ALREADY HAVE THE
AUTHORITY TO DO THAT- BUT THEY
WEREN'T DOING IT AND THAT WE
STILL THINK THAT'S A VERY
IMPORTANT STEP THAT DEPARTMENT
PUBLIC HEALTH NEEDS TO TAKE IS.
GET THOSE TWO INSPECTIONS
COMBINED MAKE SURE YOU'RE DOING
THE STATE INSPECTION THE
RELICENSING INSPECTION WHEN
YOU'RE DOING THE FEDERAL
INSPECTION- PARTICULARLY
IMPORTANT WHEN WE LOOKED AT.
THE NUMBER OF STATE FEDERAL OR
STATE RELICENSING INSPECTIONS
THAT PUBLIC HEALTH IS
PERFORMING. WE LOOKED AT TWO
YEARS BECAUSE IT'S A TWENTY
FOUR MONTH. THEY WERE SUPPOSED
TO DO ABOUT ELEVEN HUNDRED AND
THEY WERE ABLE TO ACCOMPLISH A
LITTLE OVER FOUR HUNDRED SO
THEY'RE DOING ABOUT FORTY
PERCENT. UNFORTUNATELY WHEN WE
WHEN WE DUG A LITTLE DEEPER
MANY OF THOSE SHOULD HAVE BEEN
OCCURRING AND LOS ANGELES.
BECAUSE L. A. COUNTY OF COURSE
HAS A HIGH NUMBER OF NURSING
HOMES IN CALIFORNIA. AND WE
FOUND THAT MOST OF THE
FACILITIES AND THE LOS ANGELES
AREA WHEN WE CONDUCTED THE
AUDIT. HAD NOT BEEN GETTING NO
STATE RELICENSING INSPECTION SO
AGAIN SOMETHING VERY VERY
IMPORTANT TO THE STATE OF
CALIFORNIA. SO WE WOULD
REITERATE THE IMPORTANCE OF
THAT. THE NEXT AREA CITATIONS-
AND CITATIONS ARE IMPORTANT OF
COURSE- TO TWO THINGS RELATED
TO CITATIONS THAT WE TALK ABOUT
IN THE AUDIT REPORT. TIMELINESS
AND WHETHER OR NOT IT REALLY IS
AN INCENTIVE FOR A FACILITY TO
IMPROVE A PENALTY THE UP TO P2P
HAVE TO PAY A PENALTY. WHAT WE
FOUND WITH- TIMELINESS. THE
STATE LAW REQUIRES PUBLIC
HEALTH ISSUE A CITATION WITHIN
THIRTY DAYS. AFTER COMPLETING
AN INVESTIGATION- BUT WHEN WE
LOOKED AT THAT TIME FRAME TWO
THOUSAND SIX TWO THOUSAND
FIFTEEN. THEY ISSUED MORE THAN
ELEVEN HUNDRED OF THEIR
CITATIONS ISSUED ABOUT FOUR
THOUSAND. THEY ISSUED ELEVEN
HUNDRED MORE THAN SIX MONTHS.
NOT THIRTY DAYS MORE THAN SIX
MONTHS AFTER THEY COMPLETED
THAT INSPECTION. SO THAT IS
VERY POOR PERFORMANCE- ONLY
ABOUT- 60% OR SO- WERE WITHIN.
NOW 67% WERE MORE THAN THIRTY
DAYS. 28% WERE MORE THAN SIX
MONTHS SO SIGNIFICANT NUMBER OF
THE CITATIONS BEING ISSUED VERY
VERY LATE. WHEN YOU COMPARE IT
TO THE STATE- LAW REQUIREMENT
OF THIRTY DAYS. NOW ARE THESE.
PENALTIES SERVING AS AN
EFFECTIVE DISINCENTIVE OR AN
INCENTIVE FORCE FACILITIES TO
IMPROVE THE QUALITY OF CARE.
AND AGAIN WE FOUND THAT NOT
NECESSARILY TO BE TRUE- BECAUSE
A LOT OF THE FACILITIES WERE
ABLE TO LATER PAID FOR. THE
CITATION WITHIN THIRTY DAYS AND
THEY GET A 35% DISCOUNT TO
CENTER- AND THEY DON'T HAVE TO
PAY AND THAT'S STILL IN STATE
LAW THEY DON'T HAVE TO PAY THE
FULL AMOUNT. BUT WHAT WE WERE
MORE CONCERNED ABOUT IS THE
AMOUNT FOR THOSE CITATIONS THE
AMOUNTS FOR MANY OF THEM HAD
NOT BEEN CHANGED FOR A LONG
TIME- IN FACT SOME HAD BEEN THE
SAME AMOUNT SINCE BACK IN TWO
THOUSAND EARLY TWO THOUSANDS.
AND WE COMPLETED THE AUDIT AND
ISSUED IN TWENTY EIGHTEEN.
THAT'S MY UNDERSTANDING AND WE
HAVE IT IN IN THE HAND OUT.
THAT AB THREE TWENTY THREE
ASSEMBLY MEMBER KALRA BILL WAS-
ACTUALLYSIGNED BY THE GOVERNOR
LAST NIGHT. THAT IS A
SIGNIFICANT IMPROVEMENT BECAUSE
THAT DID INCREASE THOSE. A
CITATION AMOUNTS FOR ALL THE
CITATIONS ACROSS THE BORDER
TOOK A QUICK LOOK AT THE BILL
THIS MORNING AND ABSOLUTELY IT
INCREASES A LOT OF THOSE. SO
THAT HOPEFULLY WILL BE AN
INCENTIVE FOR SOME OF THESE
FACILITIES TO WANT TO IMPROVE
THE QUALITY OF CARE AND IN
THEIR AND THEIR PARTICULAR-
NURSING HOMES. ONE THING THAT
IT WAS NOT IN HIS BILL THAT
WASN'T A BILL IN THE PAST WAS
THE INFLATION FACTOR WE WERE
SUGGESTING THERE SHOULD BE AN
INFLATION FACTOR- THERE WAS A
BILL. MR CALLER AGAIN AUTHORED
A BILL- A COUPLE OF YEARS AGO
SUBSEQUENT TO THE AUDIT THAT
DID INCLUDE THAT. INFLATION
FACTOR UNFORTUNATELY THAT BILL
WAS VETOED BY THE GOVERNOR WE
WOULD BELIEVE THAT THAT IS
SOMETHING THAT AGAIN EVEN
THOUGH THERE IS SIGNIFICANT
IMPROVEMENT WITH IT WITH THE
BILL THAT WAS. SIGNED HAVING AN
INFLATION FACTOR ALSO IS VERY
VERY IMPORTANT. FOR CALIFORNIA
AND I THINK IT WILL AGAIN BE AN
INCENTIVE FOR SOME OF THESE
FACILITIES THESE THESE. PENALTY
AMOUNTS ARE GOING TO CONTINUE
TO GO UP AT LEAST ANNUALLY
BASED ON CPI SO YOU KNOW WHAT I
NEED TO IMPROVE THE CARE I
DON'T HAVE TO KEEP PAYING
THESE. THESE THESE CITATIONS
THE CITATION AMOUNTS THESE
PENALTIES. SO AGAIN THE
DEPARTMENT OF PUBLIC HEALTH
NEEDS TO DO A BETTER JOB OF
GETTING ALL CITATIONS ISSUED
TIMELY. I THINK THAT THE
INCREASE IN THE IN THE AMOUNT
OF THE CITATIONS HOPEFULLY WILL
BE AN INCENTIVE. FOR THE
FACILITIES TO IMPROVE THE
QUALITY OF CARE THAT THEY
PROVIDE. SO MOVING ON TO JUST A
COUPLE MARC MAUER AREAS
INCENTIVE PAYMENTS WE LOOKED AT
THE- THE QUALITY OF CARE
IMPROVEMENT THE A. Q. A. S. P.
WHICH WAS INTENDED TO
INCENTIVIZE NURSING HOMES TO
IMPROVE. UNFORTUNATELY WHEN WE
CONDUCTED THE AUDIT WE FOUND
THAT A LOT OF FACILITIES
WEREN'T ELIGIBLE FOR THOSE
FUNDS BECAUSE THEY EITHER HAD
SOME DEFICIENCIES. OR THEY HAD
SOME CITATIONS BUT WHAT WE DID
FIND IS THOSE THAT WERE
ELIGIBLE FOR THE QUALITY
IMPROVEMENT PAYMENTS. YOU DID
SEE AN IMPROVEMENT IT WITH
THOSE FACILITIES THEY GOT THAT
MONEY THEY WERE ABLE TO INVEST
THAT MONEY IN THE QUALITY OF
CARE IMPROVED AT THOSE
FACILITIES SO THERE'S INCENTIVE
PAYMENTS ARE IMPORTANT. IT WAS
JUST FOR US- WHEN WE CONDUCTED
THE AUDIT WE FOUND THAT. THE
WAY THE- THE PROGRAM WAS SET UP
AS IS MANY FACILITIES AND
TYPICALLY THE ONES THAT ARE NOT
AS PROFITABLE REALLY STRUGGLE
TO EVEN QUALIFY FOR THE
INCENTIVE PAYMENTS. SO WE HAVE
SOME RECOMMENDATIONS THERE AS
WELL AS FAR AS- OCCUPIED
CREATING A SCHEDULE THAT WOULD
ALLOW ON THE ANNUAL COST
REPORT. COMPANIES TO BE ABLE TO
REPORT HOW MUCH ARE WE
INVESTING IN QUALITY OF CARE
IMPROVEMENTS- OCCUPIED IS
SUGGESTING. THAT THEY NEEDED TO
DO A REGULATORY CHANGE SO THEY
HAVEN'T FULLY IMPLEMENTED THAT
RECOMMENDATION YET BUT AGAIN WE
STILL FEEL. THAT THAT'S VERY
VERY IMPORTANT BECAUSE IT'S ALL
ABOUT TRANSPARENCY AND
DISCLOSURE OF INFORMATION. WE
ALSO HAD SOME SUGGESTIONS
RELATED TO. THE QUALITY OF CARE
IMPROVEMENT PAYMENTS WHERE. AS
YOU KNOW I'M SURE THERE WAS.
LEGISLATION ESTABLISHED AND IT
ALLOWED US AS A STATE TO GET
MORE FEDERAL MATCHING MONEY. WE
SUGGESTED THERE SHOULD PERHAPS
BE SOME RESTRUCTURING OF HOW
THOSE INCENTIVE PAYMENTS- ARE
PROVIDED TO DIFFERENT
FACILITIES WE HAVEN'T SEEN A
LOT OF ACTION BUT I UNDERSTAND
THERE IS A WORKING GROUP
LOOKING AT SOME OF THAT. THE
LAST AREA WANTED TO GO THROUGH
RELATIVELY QUICKLY AS A RELATED
PARTY TRANSACTIONS- THIS IS AN
AREA THAT WAS OF PARTICULAR
IMPORTANCE TO YOU MISTER WOULD
AND CERTAINLY CENTER MCGUIRE.
WHERE YOU KNOW IT'S CERTAINLY A
PRACTICE THAT'S LEGALLY
ALLOWABLE- THE COMPANIES THAT
WE LOOKED AT BREA'S PLOMIN AND
LONG WITH AT THE TIME. THANK
THEIR THEIR PROFITS INCREASED
SIGNIFICANTLY BECAUSE OF RELATE
RELATED PARTY TRANSACTIONS BUT
WHAT WE FOUND THERE WASN'T
ENOUGH DISCLOSURE AND
TRANSPARENCY. AROUND THESE-
RELATED PARTY TRANSACTIONS AND
SOME OF THE FORMS THAT THE
STATE OF CALIFORNIA WAS USING.
DIDN'T REALLY ALLOW FOR PROPER
DISCLOSURE. DOCTOR WOULD OF
COURSE YOU AUTHORED AB NINETEEN
FIFTY THREE WHICH WE MENTIONED
HERE AND THE HAND OUT. THAT
WAS. A DIRECT RESPONSE TO A
RECOMMENDATION THAT WE HAD TO
THE LEGISLATURE REQUIRE NURSING
FACILITIES TO SUBMIT ON AN
ANNUAL BASIS. THESE RELATED
PARTIES PROFIT LOSS STATEMENTS-
TO D. D. H. C. S. HEALTHCARE
SERVICES AND THE REASON HEALTH
CARE SERVICES IMPORTANT THEY
USE THIS INFORMATION THEY'RE
ABLE NOW TO USE IT. TO
DETERMINE WHICH PLACES THEY
WANT TO AUDIT OR TO REALLY DO
SOME ANALYSIS. OF SOME OF THE
FACILITIES AND PERHAPS USE A
RISK BASED ASSESSMENT WHICH
AUDITORS DO IF THERE'S NON
PROFITS ABOVE A CERTAIN
THRESHOLD WE NEED OR IF
THERE'S- A CHANGE WE START
LOOKING AT TRENDS AND THERE'S A
SIGNIFICANT INCREASE THEN THAT
MIGHT BE A PLACE THAT THE
AUDITORS AT DH CS MIGHT WANT TO
LOOK AT. SO THAT BILL CERTAINLY
DID- IMPROVE THE PROCESS AND
CERTAINLY CREATED MORE
TRANSPARENCY. THE OTHER AREA
THAT WE THINK NEEDS- NEEDED
BECAUSE IT'S BEEN FULLY
IMPLEMENTED IS THE OCCUPIED
ANNUAL COST REPORTS SO AS YOU
KNOW NURSING FACILITIES HAVE TO
REPORT INFORMATION TO. OUR SPOT
I KNOW THEIR CHECK NAME HAS
CHANGED RECENTLY BUT I'LL KEEP
ON MARCH PART. FOR THIS POINT-
THEY ANNUAL COURTS THAT FOR.
HAVE TO REPORT INFORMATION TO
THEM BUT WHETHER ANNUAL COST
REPORT DIDN'T ALLOW FOR IS ALL
OF THE RELATED PARTY
TRANSACTIONS. THEY ONLY HAD
FIVE LINES ON THE FORM SO
BASICALLY WHAT OCCUPIED WAS
TELLING. A NURSING HOME
FACILITIES IS. LIST THE FIVE
BIGGEST. AND THEN. AGGREGATE
EVERYTHING ELSE SO YOU COULDN'T
REALLY TELL WHEN YOU'RE LOOKING
AT AN ANNUAL REPORT. HOW MANY
OF THESE THESE TYPES OF RELATED
PARTY TRANSACTIONS ARE
OCCURRING WHAT TYPES OF GOODS
AND SERVICES YOU KNOW HOW MUCH
MONEY WERE REALLY TALKING ABOUT
SO WHAT WE'RE SUGGESTING GOSH
PRIDE. IS UPDATE THAT ANNUAL
COST REPORT TO ENABLE NURSING
FACILITY TO FULLY DISCLOSE ALL
OF THEIR RELATED PARTY
TRANSACTIONS. IN THE AUDIT
REPORT WE TALK ABOUT OTHER
STATES HAVE HAD THAT TYPE OF
PROCESS OR THAT TYPE OF
REPORTING AVAILABLE AND IT
REALLY DOES ALLOW FOR FULL
TRANSPARENCY- SO WE SUGGESTED
TO ASHFORD CHANGE YOUR ANNUAL
COST REPORT TO ALLOW. NURSING
FACILITIES AND ALLOW THE STATE
OF CALIFORNIA TO CAPTURE
INFORMATION THAT REFLECTS. ALL
OF THE RELATED PARTY
TRANSACTIONS A PARTICULAR
NURSING FACILITY HAS HAD- IN
ADDITION TO THAT- WE WERE WE
WERE. SUGGESTING THAT OFSHE
PART ALSO PROVIDE A SINGLE
LOCATION SO YOU CAN TYPE WHICH
OF THOSE RELATED PARTY
TRANSACTIONS WERE ELIGIBLE FOR
MEDICARE REIMBURSEMENT. BECAUSE
WE WANTED TO MAKE SURE AND WE
SAY IN THE AUDIT REPORT THAT
THE STATE DID A GOOD JOB OF
MAKING SURE THAT. THE THERE WAS
A LIMIT AS FAR AS A NUMBER OF
RELATED PARTY TRANSACTIONS THAT
WERE ELIGIBLE FOR MEDICARE
REIMBURSEMENT THE STATE
ACTUALLY DID A VERY GOOD JOB
OF. CONTROLLING THAT MONITORING
THAT BUT AGAIN WE FELT AT THAT
ANNUAL COST REPORT IS A VEHICLE
FOR THE STATE OF CALIFORNIA. TO
HAVE INFORMATION THAT WOULD BE
BENEFICIAL TO IT IS AS FAR AS
OUR OVERSIGHT ROLE ARE
MONITORING ROLE ETCETERA- AS
YOU CAN SEE ON THE HAND OUT
EFFECTIVE APRIL FIRST OF TWENTY
TWENTY- WE BELIEVE THAT OUR
SUPPORT IS FULLY THEY PROVIDED
US EVIDENCE THAT THEY HAVE
FULLY IMPLEMENTED THAT
RECOMMENDATION. NOW JUST ONE
LAST THING MEMBERS SO AS YOU
KNOW WE SHOULD REPORT IN MAY OF
TWENTY. ARE STANDARD PRACTICES
SIXTY DAY SIX MONTHS ONE YEAR
BUT SUBSEQUENT TO THAT ONE YEAR
WE CONTINUE TO MONITOR STATE
AGENCIES. IF THEY HAVE NOT
FULLY IMPLEMENTED ALL THE
RECOMMENDATIONS THAT WE'VE
MADE. ON AN ANNUAL BASIS AND
THE MOST RECENT UPDATE WE HAD.
I WAS IN TWENTY TWENTY WELL I
DON'T THINK WE RECEIVED
ANYTHING FOR TWENTY TWENTY ONE
WE'RE GETTING A FEW THINGS
BECAUSE OF THIS HEARING- QUITE
FRANKLY. FROM DEPARTMENT OF
PUBLIC HEALTH WE APPRECIATE
THAT AS I SAID WEWILL LOOK AT
THAT INFORMATION. AND BE ABLE
TO GET BACK TO THE COMMITTEE AS
FAR AS- THAT ONE LATE BREAKING
UP PIECE OF INFORMATION THAT.
PUBLIC HEALTH PROVIDED TO US SO
THIS WHAT WITH THAT MISTER
CHAIR- MY KßT AND I WILL BE
AVAILABLE TO ANSWER ANY
QUESTIONS MEMBERS MAY HAVE.
THANK YOU AND WE'LL HOLD
QUESTIONS ARE FOR THE SPELL
CANTIL WE HEAR FROM MATHEMATICS
HONEST TO STAY UP HERE SURE IF
YOU DON'T MIND WHICH IS. TRADE
SO WE WHICH WE CONNECT YOU
COULD STAND IF YOU LIKE OR-
OKAY OKAY SURE. THIS HECK I
DON'T KNOW I MEAN YOU KNOW. AB
AREA. THANK YOU GOOD I MISS
CHAIR AND MY I'M SO NEW PRODUCT
THE LARGEST PANEL OFFICE OUR
OFFICE BEEN ASKED TO PROVIDE AN
OVERVIEW OF THE DEPARTMENT OF
PUBLIC HEALTH'S LICENSING AND
CERTIFICATION PROGRAM IN THE
CONTEXT OF SKILLED NURSING
FACILITIES SO THIS WILL REALLY
BE TAKING A STEP BACK FROM WHAT
THE AUDITOR JUST PRESENTED AND
JUST GIVE AN OVERVIEW OF THE
PROGRAM ITSELF- YOU SHOULD HAVE
A COPY OF THE HANDOUTTHAT WE
PREPARED AND THIS IS ALSO
AVAILABLE ON OUR WEBSITE AT L.
A. O. DOT CA DOT GOV. SO JUST-
A QUICK OVERVIEW THE LICENSING
AND CERTIFICATION PROGRAM AT
THE DEPARTMENT- CONDUCTS
OVERSIGHT OF MORE THAN ELEVEN
THOUSAND HEALTH FACILITIES IN
THE STATE. THIS INCLUDES
GENERAL ACUTE CARE HOSPITALS
HOSPICES DIALYSIS CLINICS- AND
ALSO SKILLED NURSING FACILITIES-
THIS WORK IS DONE IN FOURTEEN
DIFFERENT DISTRICTS INCLUDING
LOS ANGELES COUNTY AND WHILE
DEPARTMENT STAFF DO THE WORK-
THROUGHOUT MOST OF THE STATE IT
CONTRACTS WITH THE LOS ANGELES
COUNTY DEPARTMENT OF PUBLIC
HEALTH- FOR OVERSIGHT OF HEALTH
FACILITIES IN THAT COUNTY. SO
WHY A LICENSE- REALLY ALLOWS A
FACILITY TO OPERATE IN THE
STATE IT'S A IT'S A STE. A
LICENSES REQUIRED BY STATE LAW
WHERE CERTIFICATION IS A
FEDERAL REQUIREMENT IF THE
FACILITY WISHES TO RECEIVE
REIMBURSEMENT FROM. THE
MEDICARE AND MEDICAID PROGRAMS
FOR PATIENTS ENROLLED IN THOSE
PROGRAMS. IF YOU TURN TO PAGE
THREE I'LL JUST GO OVER SOME OF
THE KEY RESPONSIBILITIES- IN
STATUTE THESE ARE LAID OUT ON
PAGES THREE FOUR AND FIVE. AND
I'LL TRY NOT TO DUPLICATE SOME
OF THE THINGS THAT THE AUDITOR
ALREADY MENTIONED REALLY THE
KEY RESPONSIBILITIES. INCLUDE
PROCESSING APPLICATIONS- IN
ADDITION TO RENEWING LICENSES
AND DOING RECERTIFICATION. IT
INVOLVES- INSPECTIONS- ALSO
KNOWN AS SURVEYS IT INCLUDES
CONDUCTING INVESTIGATIONS OF
COMPLAINTS AND FACILITY
REPORTED INCIDENTS IT INCLUDES
ISSUING CITATIONS AND CIVIL
MONETARY PENALTIES AND THEN THE
DEPARTMENT ALSO HAS CERTAIN
REQUIREMENTS WHEN IT COMES TO
REPORTING SO FOR EXAMPLE IT HAS
TO PROVIDE AN ANNUAL COST
ESTIMATE WHICH ALSO INCLUDES
SORT OF PROJECTIONS OF
WORKLOAD- IN ADDITION IT HAS TO
REPORT CERTAIN PERFORMANCE
METRICS ON A QUARTERLY BASIS
ONLINE. I AM SO WELL THE
HANDOUT DOES INCLUDE SOME MORE
DETAIL ON EACH OF THOSE I
THOUGHT I WOULD JUST- HIGHLIGHT
A FEW OF THEM AND IT'S
IMPORTANT TO NOTE THAT THESE A
STATUTORY REQUIREMENTS ARE IT
ARE IN ADDITION TO. WHAT THE
FEDERAL GOVERNMENT REQUIRES TO
PARTICIPATE IN MEDICARE AND
MEDICAID- AS WELL AS IN
ADDITION TO STATE REGULATIONS
AND THEN DEPARTMENTAL POLICY-
SO THE PROGRAM MUST REVIEW IN
PROCESS APPLICATIONS NOT ONLY
FOR NEW LICENSES BUT ALSO FOR
CHANGES OF OWNERSHIP- AND OTHER
THINGS THAT WOULD CHANGE THE
LICENSE NUMBER OF BEDS NAME
LOCATION- AND THEN MANY OF
THESE APPLICATIONS REQUIRE AN
ON SITE INSPECTION IN ADDITION
TO THE PAPERWORK PART OF THE
APPLICATION. AND THEN AS
ALREADY NOTED BY THE AUDITOR
THE PROGRAM MUST ALSO CONDUCT
PERIODIC UNANNOUNCED ON SITE
SURVEYS AS PART OF THE LICENSE
RENEWAL OR RE CERTIFICATION
PROCESS- THE DEPARTMENT MUST
CONDUCT- THEIR BROTHER THEIR
STATUTORY REQUIREMENTS- AROUND
THE INVESTIGATIONS THAT THE
PROGRAM MUST CONDUCT- SO FOR
EXAMPLE AN ON SITE
INVESTIGATION MUST BE INITIATED
FOR A COMPLAINT WITHIN TEN DAYS
HOWEVER IF THAT COMPLAINT
CONSTITUTES IMMEDIATE JEOPARDY
AS EARLIER DESCRIBED- THE
DEPARTMENT MUST IN INITIATE
THAT INVESTIGATION WITHIN
TWENTY FOUR HOURS. IF YOU TURN
TO PAGE SIX I'M JUST GONNA GO
OVER SOME HIGHLIGHTS FROM
RECENT BUDGET AUGMENTATIONS
SINCE TWENTY FOURTEEN FIFTEEN.
AND I WOULD NOT THAT OUR HAND
OUT INCLUDES A SORT OF A FULL
LISTING OF THESE AUGMENTATIONS-
INCLUDING THE AMOUNTS AND A
NUMBER OF POSITIONS BUT JUST IN
SOME. SINCE TWENTY FOURTEEN
FIFTEEN THE STATE ANNUAL STATE
BUDGETS HAVE ADDED A HUNDRED
AND FIFTY ABOUT A HUNDRED AND
FIFTY MILLION ANNUALLY ON AN
ONGOING BASIS M. PROVIDED
AUTHORITY FOR ABOUT FIVE
HUNDRED AND THIRTY ADDITIONAL
POSITIONS. CURRENTLY THE TOTAL
LICENSING AND CERTIFICATION
PROGRAM BUDGET IS ABOUT FOUR
HUNDRED MILLION AND INCLUDES
NEARLY FIFTEEN HUNDRED
POSITIONS. SO JUST TO HIGHLIGHT
SOME OF THE EXAMPLES FROM THE
FROM THE BUDGET OUT ACTIONS- IN
TWENTY FOURTEEN THE DEPARTMENTS
RECEIVED APPROVAL TO CONDUCT A
GAP ANALYSIS- IT IT CONTRACTED
WITH AN OUTSIDE COMPANY. AND
THE DEPARTMENT STILL IN THE
PROCESS OF IMPLEMENTING SOME OF
THOSE RECOMMENDATIONS IT ALSO
RECEIVED APPROVAL FOR INCREASES
IN THE NUMBER OF POSITIONS
BASED ON ITS WORKLOAD ANALYSIS
MOST SIGNIFICANTLY THESE
INCREASES TOOK PLACE IN THE
FIFTEEN SIXTEEN BUDGET AND THEN
AGAIN IN TWENTY. TWENTY ONE I'M
IN THIS INCLUDED POSITION OF
THIRTY FOR NURSE SURVEYORS
WHICH I'LL TALK ABOUT IN A
MOMENT- IT ALSO NOTE THAT IN
TWENTY NINETEEN TWENTY THE
DEPARTMENT RECEIVED APPROVAL TO
EXECUTE A NEW PERFORMANCE BASED
CONTRACT WITH THE LUSH BLESS
ANGELES COUNTY. DEPARTMENT OF
PUBLIC HEALTH- THE COUNTY NOW
HAS TO MEET CERTAIN PERFORMANCE
BENCHMARKS IN ORDER TO RECEIVE
CERTAIN- INCENTIVE PAYMENTS.
AND THEN I WOULD JUST NOTE
WHICH IS ALREADY BEEN TOUCHED
ON- THE LET THE BUDGETS FROM
THE LAST TWO YEARS INCLUDED THE
CENTRALIZATION OF SOME.
FUNCTIONS THAT ARE NOT DIRECTLY
RELATED TO PATIENT CARE SORT OF
INSPECTIONS OR INVESTIGATIONS.
SO FOR EXAMPLE- THE
DEPARTMENT'S INVESTIGATION OF
MEDICAL BREACHES OR- THE- WHEN
A PATIENT'S MEDICAL INFORMATION
HAS BEEN COMPROMISED IN SOME
WAY- HAS BEEN CENTRALIZED TO
THE DEPARTMENT- RATHER THAN THE
FIELD OFFICES. THE DEPARTMENT
ALSO RECEIVED APPROVAL TO
CENTRALIZE ITS POLICY
INTERPRETATION WHICH IS
SOMETHING THAT THE AUDITOR WAS
TALKING ABOUT LIKE IN TERMS OF
CONSISTENCY OF. INTERPRETING
POLICY AND APPLYING- ISSUING
SPEED CITATIONS AND- THE LIKE-
SO THAT JUST THOSE TWO THINGS
JUST HAPPENED IN THE LAST TWO
YEARS. IF YOU TURN TO PAGE
EIGHTY I WAS GOING TO HIGHLIGHT
SOME OF THE- CURRENT
PERFORMANCE METRICS THAT ARE
AND I A- WHAT DID THIS
INFORMATION FROM THE ON LINE
DASHBOARDS THAT THE DEPARTMENT
CREATED AS A RESULT OF A BUDGET
REQUIREMENTS I'M A NUMBER OF
YEARS AGO. SO I WOULD ALSO WANT
I ALSO WANTED TO HIGHLIGHT THAT
THE BACKGROUND PIECE FOR THIS
HEARING INCLUDED A LOT OF
ADDITIONAL HELPFUL DETAIL ON
OTHER KEY PERFORMANCE METRICS-
SO. FIRST I WANT TO TALK ABOUT
THE STAFFING LEVEL OF NURSE
SURVEYORS WHO WHO ARE ALSO
KNOWN AS HEALTH FACILITY
EVALUATOR NURSES. THESE ARE
THE- INDIVIDUALS WHO REALLY
LEAD THE INVESTIGATIONS AND
LEAD THE SURVEYS. RIGHT NOW
ABOUT 70% OF THE LICENSING AND
CERTIFICATION PROGRAM STAFF IS
LOCATED IN THE FIELD OFFICES
AND THEN AMONG THE FIELD
OFFICES OF A MAJORITY OF THOSE
STAFF ARE THESE INNER SURVEYORS-
HOWEVER THE RETENTION SORRY THE
RECRUITMENT HIRING AND
RETENTION OF THESE POSITIONS
HAS BEEN SORT OF AN ONGOING
CHALLENGE FOR THE DEPARTMENT
AND THEN ON TOP OF THAT ONCE A
POSITION IS HIRED IT TYPICALLY
TAKES ABOUT TWELVE TO FOURTEEN
MONTHS TO TRAIN THAT. THAT
INDIVIDUAL- THE GRAPHIC ON PAGE
EIGHT OF THE HANDOUT SHOWS THAT
VACANCY RATES IN THIS POSITION.
AT FIRST- I'M SORRY TO VACANCY
RATES FOR THE NURSE SURVEYOR
POSITION- WENT UP.
UNDERSTANDABLY WITH THE
ADDITION OF NEW POSITIONS IN
FIFTEEN SIXTEEN THIS ALSO
HAPPENED IN TWENTY TWENTY ONE
WHEN NEW POSITIONS WERE ADDED
AND ALSO BECAUSE OF COATED. THE
DEPARTMENT EXPERIENCED MORE
DEPARTURES AND RETIREMENTS THAN
WOULD HAVE NORMALLY BEEN
EXPECTED- BUT THE THING I WANT
TO POINT OUT HERE IS THAT FROM
SIXTEEN SEVENTEEN TO TWENTY
TWENTY ONE. THE DEPARTMENT'S
WORKLOAD ANALYSIS INDICATED
THAT THE DEPARTMENT NEEDED MANY
MORE AUTHORIZED POSITIONS TO
CONDUCTS THE WORK ASSOCIATED
WITH THE LICENSING AND
CERTIFICATION OF HEALTH
FACILITIES. THE DEPARTMENT
DIDN'T REQUEST ADDITIONAL
POSITIONS HOWEVER BECAUSE IT
WAS HAVING TROUBLE FILLING OPEN
POSITIONS THAT I ALREADY HAD A
THIRTY FOUR. SO IT DIDN'T MAKE
ANOTHER REQUEST UNTIL TWENTY
TWENTY WHEN THE VACANCY RATE
HAD GOTTEN DOWN TO THREE POINT
6% AND THEN OF COURSE COVERED
NINETEEN HIT. AND WE HAVE NEW
CHALLENGES- BECAUSE OF THAT. IF
YOU TURN TO PAGE NINE I WAS
GOING TO MENTION. SOME OF THE
PERFORMANCE METRICS IN A COUPLE
OF ADDITIONAL AREAS- SO FIRST
IS CENTRALIZED APPLICATION
PROCESSING SO IN FIFTEEN
SIXTEEN THE DEPARTMENT WRIST-
BEGAN TO CENTRALIZE SORT OF
STEP ONE OF THE APPLICATION
PROCESS BASICALLY. DEALING WITH
THE PAPERWORK AND THINGS
ASSOCIATED WITH REVIEWING THE
APPLICATION. BY TWENTY EIGHTEEN
THE DEPARTMENT HAS INDICATED
THAT IT REALIZED IT HAD UNDER
ESTIMATED THE WORK. ASSOCIATED
WITH PROCESSING THOSE
APPLICATIONS AND IT BEGAN TO
HIRE. IT REQUESTED AUTHORITY
THROUGH THE BUDGET PROCESS TO
MAKE THOSE POSITIONS PERMANENT.
THE GRAPHIC ON PAGE NINE SHOWS
THAT THERE HAVE BEEN SOME
IMPROVEMENTS IN THE PROCESSING
TIMES AN AGE OF OPEN
APPLICATIONS DURING THIS
INITIAL STEP- SO FOR EXAMPLE BY
QUARTER TWO OF NINETEEN TWENTY
THE NUMBER OF OPEN APPLICATIONS
HAVE BEEN REDUCED BY MORE THAN
HALF COMPARED TO SEVENTEEN
EIGHTEEN AND NEARLY TWO THIRDS
HAD ONLY BEEN OPEN. FOR ABOUT A
HUNDRED DAYS OR LESS STILL THIS
CAN TAKE SOME TIME SO FOR
EXAMPLE THE CHANGE OF OWNERSHIP
APPLICATIONS WHICH I KNOW IS OF
PARTICULAR INTEREST- THE
CURRENT MEDIAN AGE OF AN
APPLICATION IS ABOUT NINE
MONTHS AND THIS IS JUST THE
FIRST STEP OF THE CHANGE OF
OWNERSHIP APPLICATION PROCESS.
SO THE SECOND STEP IF YOU TURN
TO PAGE TEN AND INVOLVES THE ON
SITE. SURVEY AND THEN OF COURSE
THESE ARE ALSO CONDUCTED AS THE
REGULAR- PART OF. RENEWING THE
LICENSE AND RE CERTIFICATION-
THE PANDEMIC HAS AFFECTED THE
TIMELINESS OF COMPLETION OF
THESE LICENSOR LICENSURE
SURVEYS. SO AT THE END OF MARCH
THERE WERE THIRTY TWO
APPLICATIONS AWAITING A SURVEY.
AND THE MEDIAN AGE OF THESE
APPLICATION- LICENSURE SURVEY
SURVEYS TO COMPLETE THE
APPLICATION WAS NEARLY ONE YEAR-
SO IF WE GO BACK TO OUR EXAMPLE
OF THE CHANGE OF OWNERSHIP
APPLICATION. IN MARCH TWENTY
TWENTY ONE THE MEDIAN AGE OF
THE APPLICATIONS AWAITING A
LICENSE OR SURVEY WAS ABOUT
THREE HUNDRED DAYS. THIS MEANS
THAT THE WHOLE PROCESS FROM
START TO FINISH FOR A CHANGE OF
OWNERSHIP COULD TAKE. A YEAR
AND A HALF OR MORE. I'M NEXT I
WOULD- JUST HIGHLIGHT A
COMPLAINT THE COMPLETION OF
COMPLAINT INVESTIGATIONS-
THERE'S A GRAPHIC ON PAGE
ELEVEN. SO AS YOU KNOW- THE
STATE BUDGET IN FIFTEEN
SIXTEEN. I REQUIRED THE
DEPARTMENT TO BEGIN PHASING IN
SHORTER TIMELINES TO TURN
AROUND COMPLAINT INVESTIGATIONS
AND IT TASTED IN MORE
AGGRESSIVELY FOR THOSE.
COMPLAINTS THAT INVOLVED
IMMEDIATE JEOPARDY- SO SINCE
JULY TWENTY EIGHTEEN ALL OF
THESE COMPLAINT INVESTIGATIONS
HAVE TO BE COMPLETED WITHIN
SIXTY DAYS. HOWEVER THE GRAPHIC
SHOWS THAT SINCE THE RECORD THE
SIXTY DAY REQUIREMENT TOOK
EFFECT THE DEPARTMENT HASN'T
MET THE TIMELINE IN AT LEAST
10% OF THE- OF CASES AND THIS
IS BECOME NOTABLY WORSE SINCE
THE ONSET OF THE PANDEMIC. I'M
SO THE LAST THING I WOULD JUST
MENTION A IS ENFORCEMENT WHICH
HAS ALREADY BEEN DISCUSSED BUT
I WOULD JUST ALSO POINT OUT
THAT- OVER THE LAST COUPLE OF
YEARS. THE DEPRTMENT TOOK ON
AVERAGE TWO HUNDRED AND FORTY
DAYS TO ISSUE MORE THAN TWO
TWENTY TWO HUNDRED PENALTIES
ASSOCIATED WITH THE MORE
SERIOUS SORT OF TYPE A AND TYPE
A- TYPE B. VIOLATIONS-
FACILITIES CAN APPEAL THESE
PENALTIES WHICH FURTHER- DELAYS
THE ENFORCEMENT ACTION. AND
THEN THIS IS PARTICULARLY
COMPLICATED IFISA FACILITY IS
UNDERGOING A CHANGE OF
OWNERSHIP- AND IF THAT PART OF
THE PROCESS IS ALSO DELAYED-
YOU CAN IMAGINE THERE THAT
COULD SORT OF COMPLICATED ABOUT
WHO'S WHO'S RESPONSIBLE FOR
WHAT. SO I JUST WANT TO END. IF
YOU TURN TO PAGE TWELVE WITH
SOME ISSUES FOR LEGISLATIVE
CONSIDERATION WELLTHIS HEARING
IS NOT SPECIFICALLY ABOUT
COVERT NINETEEN WE KNOW THAT
COVERED NINETEEN IS REVEALED
SOME ISSUES IN. ITS SOME
LONGSTANDING ISSUES AND SKILLED
NURSING FACILITIES HIGHLIGHTING
THE IMPORTANCE OF GOOD
OVERSIGHT. YET OF THE PANDEMIC
HAS ALSO HAMPERED THE
DEPARTMENT'S ABILITY TO CONDUCT
ITS OVERSIGHT FOR A COUPLE OF
REASONS NOT ONLY IS IT HARDER
TO CONDUCT TO THE ON SITE
INVESTIGATIONS. BUT THE STAFF
IS REALLY HAD TO PRIORITIZE
THINGS LIKE INFECTION CONTROL-
SORT OF AT THE EXPENSE OF OTHER
COMPLIANCE MONITORING AND THEN
IN ADDITION WE HAVE THE HIGHER
VACANCIES FOR THE NURSE
SURVEYOR POSITIONS. AND IN FACT
A RECENT STATISTICS FROM THE
DEPARTMENT'S WEBSITE SHOWS THAT
THE DEPARTMENT HAS NOT YET
TAKEN ADVANTAGE OF THE NEW
POSITION OF AUTHORITY- APPROVED
IN TWENTY TWENTY ONE. SO JUST
SOME ISSUES THAT WE WOULD RAISE
OR QUESTIONS THAT THE
LEGISLATURE MAY WISH TO
CONSIDER IS WHAT HAS BEEN
LEARNED FROM COVERT NINETEEN
THAT SHOULD BE BUILT IN
PERMANENTLY TO THE LICENSING
AND CERTIFICATION PROGRAM AND
OVERSIGHT OF SKILLED NURSING
FACILITIES- WHAT ADDITIONAL
TECHNOLOGY IMPROVEMENTS WOULD
HELP THE PROGRAM NOT ONLY TO
IMPROVE TIMELINES BUT TO ALSO
IMPROVE CONSISTENCY. AND
QUALITY OF OVERSIGHT- WHAT HAS
BEEN THE EFFECT OF CENTRALIZING
SOME OF THE TASKS THAT THE
DEPARTMENTS RESPONSIBLE FOR
FROM APPLICATION PROCESSING TO
MEDICAL BREACH INVESTIGATIONS
IN POLICY INTERPRETATION. HOW
IS IT HELPED AND HASN'T LED TO
ANY UNINTENDED CONSEQUENCES AND
THEN JUST HOW DOES THE
DEPARTMENT INTENDS TO ADDRESS-
CHALLENGES SUCH AS HIRING AND
RETAINING NURSE SURVEYORS AND
SPEEDING UP- THE APPLICATION.
PROCESS THANK YOU VERY MUCH.
THANK YOU VERY MUCH AND LIKE TO
GO AHEAD AND TURN TO OUR MY
COLLEAGUES TO SEE IF I DO HAVE
QUESTIONS BUT ALL ALL GO LAST
SO PLEASE. MISS RODRIGUEZ AND
QUICK QUESTION- IN THE
BEGINNING LEAN YOU TALKED ABOUT
THE STATE AND FEDERAL
EXPECTATIONS. ARE THOSE
ANNOUNCED OR UNANNOUNCED. ALSO
THAT ARE ON AND- GONNA. OKAY I
WAS JUST MY QUESTIONS ONE
CONFIRM THANK YOU. HUMANOS
MISTER MESSAGING. THANK YOU
VERY MUCH SERVICE CHAIRMAN-
HAVE A FEW QUESTIONS FOR OUR
STATE AUDITOR- SO- THIS HOW
YOU- AND YOUR YOUR HAND OUT YOU
ADDRESS THE AREA OF PUBLIC
HEALTH OVERSIGHT AS IT RELATES
TO LICENSING- AND YOU STRESSED
THE IMPORTANCE OF- CONSISTENCY-
AND DOCUMENTATION. AND YOU
FOUND THAT LACKING. AT LEAST AS
THE DOCUMENTATION OF THE
DEPARTMENT OF PUBLIC HEALTH-
REVEALED- CORRECT THAT'S
CORRECT. AND SO ONE OF THE
PROPOSALS THAT- THAT- YOU AND
YOUR OFFICE IS RECOMMENDING IS-
TO- SPECIFY TO OUTLINE THE
SPECIFIC CRITERIA INCLUDING
RELEVANT QUALITY OF CARE
METRICS AND THAT THAT SHOULD BE
CAUGHT AND CODIFIED. THAT'S
CORRECT MR TWO GS- YOU KNOW.
SERVICE SO AS YOU INDICATED- I
HAVE A BILL THAT'S THAT'S
PROPOSING TO CODIFY THAT-
FOLLOWING YOUR RECOMMENDATION-
BUT- YOU. EVEN BEFORE WE GET TO
THAT STEP I MEAN WHAT WHAT WHAT
IS THE BASIC PURPOSE OF- V.
DEPARTMENT OF PUBLIC HEALTH'S
LICENSING OF A NURSING HOME.
YEAH. SO IN THE DEPARTMENT OF
PUBLIC HEALTH IS LOOKING AT
LICENSING A NURSING HOME REALLY
WHAT THEY'RE TRYING TO ENSURE
IS THAT THE NURSING HOME OWNERS
AND ANYONE WHO'S INVOLVED A LOT
OF THESE AREN'T INDIVIDUALS ARE
LARGE COMPANIES AND THE
OWNERSHIP STRUCTURES CAN BE
QUITE COMPLICATED THEY'RE
TRYING TO ENSURE THAT ITS
ESSENTIALLY A GOOD FAITH EFFORT
TO LICENSE THAT NURSING HOME TO
RUN IT- SO THEY'RE LOOKING AT
PAST PRACTICES IN TERMS OF THE
NUMBER OF DEFICIENCIES THE
NUMBER OF CITATIONS AND THEN
THEY'RE ALSO LOOKING AT THINGS
LIKE YOU THEY HAVE THE
FINANCIAL ABILITY TO BE ABLE.
TO- MAINTAIN THAT NURSING HOME
AT A HIGH LEVEL OF QUALITY OF
CARE. SO. WE HAVE A THE STATE
OF- OUR LICENSING SYSTEM IN THE
STATE OF CALIFORNIA AS RELATES
NURSING HOMES HAS BEEN THE
SUBJECT. ATTAR OF- IN NUMEROUS-
NEWS ARTICLES- THE SACRAMENTO
BEE RAN A MAJOR. EXPOSE ON THE
STATE OF ON THE PROBLEMS THAT
THE GLARING PROBLEMS WITH THE
LACK OF STATE OVERSIGHT OVER
THE NURSING HOMES LICENSING
PROCESS AND- SEVEN YEARS LATER-
WE CONTINUE TO SEE. SIMILAR
PROBLEMS- ONE CASE IN
PARTICULAR- WHICH WAS JUST
COVERED IN. CALMATTERS
YESTERDAY HIGHLIGHTS A LAWSUIT.
THAT WAS FILED AGAINST- ONE OF
THE CHAINS THAT YOU'RE AUDIT
ADDRESSED A BRIEF HEALTHCARE.
AND- THIS LAWSUIT IS
HIGHLIGHTING A ALL TOO COMMON
SITUATION WHERE EVEN THOUGH A-
WHAT THE NURSING HOME OWNER.
HAS HAD ITS LICENCE APPLICATION
DENIED FIVE YEARS AGO IN. JULY
OF TWENTY SIXTEEN. THAT THIS
NURSING HOME IS CONTINUE TO
OPERATE. BUT THROUGH THE
PROCESS OF USING WHAT ARE
CALLED INTERIM MANAGEMENT
AGREEMENTS. SO I MEAN AS THE
STATE AUDITOR YOU KNOW KNOWING
THAT. THE LICENSE TO OPERATE A
NURSING HOME IS THAT THE THAT
THE FUNDAMENTAL- STEP. THAT IS
TAKEN TO REGULATE- THESE
NURSING HOMES. I MEAN DOES IT
MAKE SENSE TO YOU THAT IS THAT
A NURSING HOME CAN CONTINUE TO
OPERATE WHEN THE OWNERS
APPLICATION FOR A LICENSE HAS
BEEN DENIED FIVE YEARS AGO. NOT
A- THANK YOU MISTER MURATSUCHI
NOW AND AS WE DISCUSSED IN THE
AUDIT REPORT AND YOU'RE
ABSOLUTELY RIGHT PREVIOUS WAS
ONE IN PARTICULAR THAT HAD.
MANAGEMENT AGREEMENTS I THINK
THERE REFER TO FOR MANY MANY
YEARS AND THAT'S WHY WE REALLY
HAD CONCERNS ABOUT. THE
DEPARTMENT OF PUBLIC HEALTH AND
MAKING SURE THAT THEY HAVE A
GOOD STRONG PROCESS WHERE THEY
CAN MAKE A DETERMINATION AND
THEY'RE NOT HESITATING. TO DENY
A LICENSE OR TO MAKE A
DETERMINATION AND BE ABLE TO
DEFEND THAT DETERMINATION THAT
THIS FACILITY AS AS K
INDICATED HAVE TOO MANY
CITATIONS HAD TUESDAY TO MANY
DEFICIENCIES WE IN GOOD
CONSCIENCE AS A STATE. CANNOT
AUTHORIZE A LICENSE FOR THAT
FACILITY SO TWO TWO SIX THANK
PLAY ANSWER YOUR QUESTION AFTER
I WENT OUT A LITTLE BIT NO I
THINK FOR A LOT FOR A FACILITY
TO BE ABLE TO CONTINUE TO
OPERATE USING A MANAGEMENT
AGREEMENT OR MANAGEMENT. NOW
CONTRACT TYPE THING. DOES NOT
MAKE SENSE OF THE STATE OF
CALIFORNIA NEEDS TO HAVE A
STRONG PROCESS TO DETERMINE.
YES THIS IS A FACILITY WHERE WE
BELIEVE OUR ELDERS CAN BE TAKEN
CARE OF OR SOMEONE WHO NEEDS
NEW JUST NEEDS THAT KIND OF
CARE AND AS SKILLED NURSING
FACILITY. WE HAVE CONFIDENCE AS
A STATE THAT THE FACILITY IS
CAPABLE OF CARING FOR THOSE
INDIVIDUALS WE CANNOT. WITH ALL
DUE RESPECT TO DEPARTMENT
PUBLIC HEALTH. THOSE DECISIONS
NEED TO BE MADE AND THEY NEED
TO BE MADE PROMPTLY. THANK YOU
AND FOLLOWING THAT-
OBSERVATION- WE HAVE A
SITUATION WELL THE IT IS MY
UNDERSTANDING THAT THE
DEPARTMENT OF PUBLIC HEALTH
POSITION IS THAT. IS THAT TO IN
THIS CASE OF FOCUSING ON THIS
EXAMPLE OF THE WINDS ARE
READING FACILITY- U. P. OWNER-
MR SHLOMO RECHNITZ HAD TO.
PURCHASE THIS PROPERTY FROM THE
PREVIOUS OWNER AND THE AND THE
PREVIOUS OR THE LICENSEE OF
THIS FACILITY WINDS ARE READING.
THE APPLICATION WAS DENIED AND
TWENTY SIXTEEN. AND YET THE
OPERATION OF THE NURSING HOME
CONTINUES WITH THE LICENSEE
BEING THE PREVIOUS OWNER WINS
ARE READY RIGHT. I MEAN WHAT.
WHAT IF ANY. PUBLIC PROTECTION
CONSUMER PROTECTION FUNCTION.
DOES TREATING THE LICENSEE OF
THE PREVIOUS OWNER- SERVE- IN
IN THIS PARTICULAR EXAMPLE.
WELL I I'M NOT SURE THERE IS A
MINUTE AGAIN I HAVE TO DEFER TO
PUBLIC HEALTH BUT THAT WOULD BE
A SIGNIFICANT CONCERN SO IF
YOUR GOING TO DENY THE LICENSE
OF THE NEW OWNER. BASED ON-
CITATIONS DEFICIENCIES THAT THE
PREVIOUS LICENSEE- EXPERIENCED
AS FAR AS PUBLIC HEALTH
PROVIDING OVERSIGHT THEN I
WOULD THINK THAT THE STATE OF
CALIFORNIA WOULD WANT TO MOVE
FORWARD AND SUGGESTED THAT
FACILITY SHOULD NOT BE LICENSE
AND I UNDERSTAND WHAT YOU'RE
SAYING AS FAR AS- IT HAD BEEN
DENIED. BUT AND I DON'T HAVE
THE EXPERTISE TO DETERMINE WHAT
ARE THE NEXT STEPS THAT THE
STATE WOULD NEED TO TAKE TO
MAKE SURE THAT THAT FACILITY
DOES NOT HAVE THE ABILITY TO
OPERATE IF IT HAS HAD A HISTORY
OF DEFICIENCIES AND BEING CITED
BY THE STATE OF CALIFORNIA AND
THE NEW OWNERSHIP HAS BEEN
DENIED A LICENSE THAT THAT
THAT. TO ME FROM PERSONAL
PERSPECTIVE- IS NOT A GOOD
SITUATION FOR INDIVIDUALS WHO
ARE OR HAVE FAMILY MEMBERS- IN
THAT PARTICULAR NURSING HOME
BUT AGAIN I DON'T HAVE THE
EXPERTISE TO DETERMINE WHAT
WOULD BE THE NEXT STEPS THAT
THE STATE WOULD NEED TO TAKE.
IF I MAY I HAVE WRAPPED UP- THE
FOLLOWING THAT- IT IS MY
UNDERSTANDING THAT- ONE OF THE
FACTORS THAT THE DEPARTMENT OF
PUBLIC HEALTH REVIEWS IS THE
COMPLIANCE HISTORY- OF THE
APPLICANT- THE COMPLIANCE
HISTORY OF THE FACILITIES OWNED
MANAGED OR OPERATED EITHER
DIRECTLY OR INDIRECTLY BY THE
APPLICANT. AGAIN WE WERE
PRESENTED WITH THIS- THIS- THIS
CASE FILED AGAINST- APPLICANTS
SLOW MO RECHNITZ. WHO ACCORDING
TO THIS DEPARTMENT OF PUBLIC
HEALTH DENIAL BACK IN TWENTY
SIXTEEN. THEY WERE DOCUMENTED-
WITH- OVER TWO HUNDRED SIXTY
FIVE. FEDERAL REGULATORY
VIOLATIONS- AND SO IT'S IT
SEEMS TO ME TO INDICATE THAT.
AND AND MR RECHNITZ FOR THE
RECORD- IS CALIFORNIA'S LARGEST
THE OWNER OF THE LARGEST NUMBER
OF NURSING HOME FACILITIES IN
THE ENTIRE STATE OF CALIFORNIA.
SO I MEAN WHAT IT WOULD MAKE
SENSE TO YOU BASED ON YOUR
REVIEW. OF- THIS IS A CURRENT
LICENSING SYSTEM. THAT IF AN
APPLICANT HAS ALREADY HAS A
RECORD OF HUNDREDS OF
REGULATORY VIOLATIONS. THAT
PERHAPS THEYSHOULD BE
CONSIDERED FOR SOME KIND OF A
BLACK LIST IN TERMS OF BEING
PROHIBITED FROM PURCHASING ANY
FURTHER NURSING HOMES IN THE
STATE OF CALIFORNIA AGAIN I
DON'T HAVE THAT TYPE OF
EXPERTISE BUT CERTAINLY THE
CONCERNS YOU'RE RAISING OUR OUR
VERY SERIOUS CONCERNS THESE ARE
ISSUES THAT WHEN WE WERE
LOOKING AT THE PROCESS WE HAD
CONCERNS AS I MENTIONED WHEN WE
LOOK AT TEN. TEN LICENSING
APPLICATIONS AND WE LOOK AT THE
FILES AS YOU SAID YOU'RE
SUPPOSED TO LOOK AT
DEFICIENCIES YOU'RE SUPPOSED TO
LOOK AT CITATIONS BUT WHEN WE
WHEN OUR STAFF LOOKED AT THAT
THERE THOSE FILES WERE
INCOMPLETE THEY DIDN'T HAVE ALL
OF THE CITATIONS EVEN IF IT WAS
TWO HUNDRED MAYBE IT SHOULD
HAVE BEEN FIVE HUNDRED. AND THE
OTHER CONCERN WE HAD AND AGAIN
I THINK YOUR BILL AND SOME OF
THE STEPS PUBLIC HEALTH IS
TAKING THEY NEED TO TAKE MORE
STEPS IS TO MAKE SURE THAT WE
HAVE A ROBUST PROCESS THAT IS
CONSISTENT AND DEPENDABLE AND-
THE FACTORS THAT IS THE FACT
THAT IN AN INDIVIDUAL FACILITY
OR AN OWNER WHO OWNS OF
MULTIPLE FACILITIES. HAS HAD
NUMEROUS CITATIONS. NUMEROUS
DEFICIENCIESWHAT TYPE OF
DEFICIENCIES ARE THEY THE
IMMEDIATE YOU KNOW CONCERN AS
FAR AS IMMEDIATE JEOPARDY WHERE
HEALTH CARE SIR I MEAN IF
PUBLIC HEALTH HAD TO GO OUT
WITHIN TWENTY FOUR HOURS TO
INVESTIGATE THAT'S WHAT WE
WEREN'T SEEING WHEN WE
CONDUCTED THE AUDIT BACK IN IN
TWENTY SEVENTEEN ISSUED IN
TWENTY EIGHTEEN- BUT CLEARLY
THOSE ARE WHERE ARE SIGNIFICANT
CONCERNS AT THE STATE OF
CALIFORNIA SHOULD. BE ABLE TO
MAKE DECISIONS AGAIN I DON'T
HAVE THAT AUTHORITY AND THAT
EXPERTISE BUT IF I HAD A LOVED
ONE I WOULD BE VERY CONCERNED
ABOUT HAVING ONE OF MY FAMILY
MEMBERS IN A FACILITY LIKE THAT
I WOULD. NOT DO IT. THANK YOU
FOR MUCH MR. IT WAS MURATSUCHI
MISCARRY. CHECK CHECK HELLO HI
AFTERNOON GOOD AFTERNOON- I
JUST WANTED TO MAYBE OFFER-
MAYBE NOT AN ANSWER BUT A. A
BILL THAT I WROTE IN THE GOT
CHAPTER INTO LAW IN TWENTY
NINETEEN RELATED TO THE
LICENSURE- OF- HEALTH FACILITY
FACILITIES AS YOU MENTIONED AND
THIS BILL AB SIXTEEN NINETY
FIVE I WOULD REQUIRE A LICENSEE
OF A SKILLED NURSING FACILITY
AT LEAST NINETY DAYS. PRIOR TO
FINALIZATION OF SALE TRANSFER
OF OPERATION OR OTHER CHANGER
TRANSFER OF OWNERSHIP INTEREST
TO GIVE A WRITTEN NOTICE OF THE
PROPOSED CHANGE AND THE
LICENSEE OR MANAGEMENT COMPANY
TO ALL RESIDENTS OF THE
FACILITY AND THE
REPRESENTATIVES THAT CONTAIN
SPECIFIC INFORMATION RELATED TO
THE PERSPECTIVE LICENSEE
TRANSFEREE. ASSIGNEE LEE C. OR
LICENSEE PARENT COMPANY OR
MANAGEMENT COMPANY THE BILL
WOULD IMPOSE A CIVIL PENALTY OF
ONE HUNDRED DOLLARS PER DAY ON
A LICENSEE OF EACH DATE THAT
THE NOTICE IS DELAYED THIS WAS
IN PARTICULAR- RELATED TO.
MANAGEMENT CHANGES AND FAMILIES
NOT BEING NOTIFIED THE PATIENTS
NOT BEING NOT NOTIFIED OR THE
RESIDENTS OF THE SKILLED
NURSING FACILITY NOT BEING
NOTIFIED AND I'M WONDERING IF
YOU MAY BE ABLE TO SHARE IF
THAT'S MADE ANY POSITIVE IMPACT
TO DATE OR IF IT'S SOMETHING
THAT WE MIGHT BE ABLE TO LOOK
AT IN TERMS OF. A LOT OF THE
CONCERNS THAT MY COLLEAGUE HAS
RAISED AND HAVE BEEN RAISED
AROUND THESE ISSUES AND WHETHER
THIS BILL- CAN BE PART OF THE
SOLUTION IN TERMS OF WHAT IT
LOOKS LIKE FOR THE FUTURE AND
WHAT IT COULD POTENTIALLY- I
KNOW THAT WE'VE YOU KNOW
EXPERIENCED A YEAR OF CULVERDEN
SKILLED NURSING FACILITIES HAVE
BEEN LARGELY IMPACTED BY THAT.
AND I'D BE CURIOUS HOW THIS
BILL- COULD BE PART OF A
SOLUTION BASED APPROACH. TO THE
CONCERNS ARE BEING RAISED NOW.
WELL FIRST OF ALL MISS KOREA WE
HAVEN'T DONE ANY FOLLOW UP
AUDIT WORK- SUBSEQUENT TO
ISSUING THIS REPORT IN MAY OF
TWENTY EIGHTEEN NOW WE DID I
DID TALK ABOUT THE FOLLOW UP
PROCESS AS FAR AS- PUBLIC
HEALTH AND- ASHKHABAD.
REPORTING TO US ON WITH THEIR
PROGRESS IN IMPLEMENTING
RECOMMENDATIONS THAT WE MADE TO
THE RESPECTIVE DEPARTMENTS WE
CERTAINLY TRACK ANY
LEGISLATION- BECAUSE WE ASSIST
MEMBERS IN ANY WAY WE CAN AS
FAR AS- IF WE MAKE A
LEGISLATIVE RECOMMENDATION WE
WANT TO WORK WITH THE MEMBERS
OFFICE TO ASSIST THEM. IF
THEY'RE INTERESTED IN AND
AUTHORING LEGISLATION IT SOUNDS
LIKE YOUR BILL- WAS ENACTED
SUBSEQUENT TO THIS AUDIT SO WE
HAVEN'T BEEN ABLE TO GO OUT AND
DO ANY AUDIT WORK SPECIFIC TO
WHAT YOU WERE. REFERRING TO IN
YOUR LEGISLATION BUT- FROM
HEARING WHAT YOUR BILL DOES I
THINK ABSOLUTELY IT'S MORE
TRANSPARENCY IT'S INFORMING
INDIVIDUALS WHO. EITHER LIVE IN
THOSE HOMES OR THEIR FAMILY
MEMBERS TO BE. INFORMED ABOUT
ALL THE OWNERSHIP OF THIS
FACILITY IS CHANGING TO THIS
OTHER INDIVIDUAL. AND THIS IS
YOU KNOW THEIR HISTORY WITH THE
DEPARTMENT PUBLIC HEALTH AND
THAT AT THE VERY LEAST. IS
PROVIDING MORE. INFORMATION TO.
INDIVIDUALS IN THOSE FACILITIES
BUT MORE IMPORTANTLY IN MY
OPINION THE FAMILY MEMBERS WHO
ARE GONNA BE ADVOCATES FOR
THOSE INDIVIDUALS. SO I WOULD
PRESUME IT'S A IT'S A
ABSOLUTELY A POSITIVE THING FOR
THE STATE OF CALIFORNIA. BUT WE
HAVEN'T DONE ANY AUDIT WORK IN
THAT PARTICULAR AREA SUBSEQUENT
TO THIS AUDIT. THANK YOU I JUST
WANTED TO WE HAVE A COUPLE MORE
MEMBERS WHO RIDE OBVIOUSLY MISS
CORREOS HERE- MISSING YOUR
CURRY MISTER KALRA- SO FOR
INTERIM- INTERIM HEARING THIS
IS IT THIS IS A GOOD TURN OUT
WE'RE EXPECTING. OTHERS TO
ARRIVE AS WELL SOME PLACES TO
BE HERE IN PERSON EVEN ON MORE
IN A MASS. THANK YOU ABSOLUTELY
IS THANK YOU THANK YOU I JUST A
COUPLE OF COMMENTS A QUESTION
FOR YOU MATAMATA DURING THANK
YOU VERY MUCH FOR YOUR UPDATE.
DO YOU HAVE ANY THOUGHTS ON
WHICH- OF THE PROPOSED
RECOMMENDATIONS FOR LEGISLATION
AND OVERSIGHT ARE MOST URGENTLY
NEEDED. OBVIOUSLY WE KNOW THAT
THERE'S THINGS THAT ARE- HI
NOMIS RESEARCH IS WORKING ON A
BILL DESERVES SOMETHING THAT
JUMPS OUT AT YOU WAS LIKE WOW
THIS IS LIKE. THIS IS LIKE
PRIORITY NUMBER ONE OR PRIORITY
NUMBER TWO WELL I THINK-
THANKFULLY THE MEMBERS YOURSELF
AND OTHERS MISTER MERCER CHEESE
BILL- MISTER KALRA BUILD THOSE
ARE ALL WE ALL REALLY- I THINK
EXCELLENT STEPS IN THE RIGHT
DIRECTION TO IMPROVE.
CALIFORNIA'S OVERSIGHT OF
NURSING HOME FACILITIES IN
CALIFORNIA. THE THEY WON
OUTSTANDING RECOMMENDATION THAT
WE HAD- WITH RESPECT TO
LEGISLATION IT A COUPLE OF
THEM. THE ONE RELATED TO THE RE
INSPECTIONS TO TRY TO GET THE
TIMELINE SIMILAR BECAUSE- IT
WOULD BE MORE EFFICIENT FOR
PUBLIC HEALTH TO BE ABLE TO GO
OUT THERE AND DO THE FEDERAL
INSPECTION WHICH THEY HAVE TO
DO EVERY FIFTEEN MONTHS. AND
GET THAT STATE. ARE RE
LICENSING RECERTIFICATION
INSPECTION DONE BECAUSE AGAIN
AS I SAID SOME OF THE STATE
REQUIREMENTS ARE MORE
STRINGENT. AND FOR THE PUBLIC
HEALTH TO BE ABLE TO LOOK AT
THOSE AT THE SAME TIME THEY'RE
SATISFYING REQUIREMENTS FOR
FEDERAL. CERTIFICATION FOR
MEDICARE MEDICARE AT CETERA I
MEAN MEDICARE- WOULD BE REALLY
REALLY. IMPORTANT THE ONLY
OTHER RECOMMENDATION THAT WE
HAD LEGISLATIVELY REALLY WAS
RELATED TO THE QUALITY
INCENTIVE PAYMENTS- BECAUSE AS
WE MENTIONED IN THE AUDIT
REPORT I BRIEFLY MENTIONED- A
LOT OF FACILITIES. DIDN'T
QUALIFY BECAUSE THEY HAD
CITATIONS THEY HAVE
DEFICIENCIES SO MAYBE THERE
NEEDS TO BE SOME RESTRUCTURING
THERE. BECAUSE THOSE THAT DID
RECEIVE THOSE INCENTIVE
PAYMENTS WE DID SEE WHEN WE
LOOK AT THE INDICATORS- AS FAR
AS- AND THEIR QUALITY OF CARE
SCORES COMPARED TO THE
STATEWIDE AVERAGE THEY GOT
BETTER THEY DID IMPROVE SO
THERE'S INCENTIVE PAYMENTS-
DID. AFFECT CHANGE THEY THEY
WERE WORTHWHILE SO- I THINK THE
RE LICENSURE TO GETTING THOSE
TWO TIME FRAMES TO MERA I MEAN
ONE FIFTEEN MONTHS ONE THIRTY
BUT- EASY ENOUGH- WOULD BE
REALLY REALLY IMPORTANT BECAUSE
THOSE IN REAL RE CERTIFICATION
RELICENSING INSPECTIONS ARE ARE
REALLY REALLY IMPORTANT FOR THE
STATE. SO THAT SEEMS REALLY
SIMPLE REALLY RUDIMENTARY AND I
GOT THE IMPRESSION FROM AN
EARLIER COMMENT THAT THEY
ACTUALLY HAVE THE AUTHORITY TO
DO THAT. THEYHAVE THE
AUTHORITY DO THAT WILL ANSWER
SO WHAT WE MENTION IN THE AUDIT
REPORT IS A TWO THOUSAND AND
SEVEN LINE I REMEMBER LOOKING
AT IT FOR YOU. AUTHORIZED DUAL
INSPECTIONS WERE PUBLIC HEALTH
CAN GO AND WE'RE GONNA
INSPECTOR FOR THE FEDERAL
REQUIREMENTS WERE EXPECTED AT
THE SAME TIME FOR THE STATE
REQUIREMENTS. BUT WHEN WE DID
THE OTTAWA PUBLIC HEALTH SAID
IS. WELL THE TIME FRAMES ARE
DIFFERENT IT'S HARD TO
COORDINATE THIS ONE'S FIFTEEN
MONTHS THIS ONE TWENTY FOUR
STATES TWENTY FOUR MONTHS. WE
SAIDOKAY WELL WE'LL MAKE THE
STATE THIRTY MONTHS AND THEN
IT'S EASY ENOUGH. BECAUSE YOU
DO THE FEDERAL AND YOU KNOW
IT'S LIKE EVERY TWO YEARS. IT'S
SERVICE RUN BY SOMEONE WHO YOU.
SAMPLE THING TO CHANGE. SO IS
IT YOUR IMPRESSION IT'S OF. A
WILL OR OR IS THERE SOME
STATUTORY REQUIREMENTS AS
PREVENTING THEM FROM DOING THIS
OFTENTIMES WILL SEE. BUT
DEPARTMENTS HAVE AUTHORITY TO
DO SOMETHING BUT THEY DON'T
EXERCISE IT UNTIL THEIR IT'S
EXPLICITLY TOLD BY THE
LEGISLATURE YOU HAVE TO DO THIS
SO I'M KIND UNDERSTRENGTH
STAND. DO YOU THINK THEY HAVE
pJUST CHOOSING TO NOT FOR
WHATEVER VARIETY REASONS OR ARE
THEY WAITING FOR US TO SAY. YOU
HAVE TO DO THIS. GO AHEAD
PLEASE. IF YOU THE BUTTON THERE
TOO I THINK THE RED LIGHT NEEDS
TO BE ON FOR US IS IT I CAN'T
SEE FROM RIGHT- SO THERE IS A
DISCONNECT AND STAY LAW IN
TERMS OF THE TIMING IF YOU
INCREASED IT LIKE- THE STATE
AUDITOR SAID FROM THE TWENTY
FOUR MONTHS TO THE THIRTY
MONTHS IT WOULD MAKE IT EASIER
FOR THEM TO SCHEDULE AND MORE
EFFICIENT FOR THEM TO SCHEDULE
THOSE. RELICENSING INSPECTIONS
I BELIEVE RIGHT NOW- IN THE
INFORMATION THAT WAS PROVIDED
AS PART OF THIS HEARING THERE
SAYING THEY'RE CONDUCTING THE
INSPECTIONS ON AVERAGE EVERY
TWELVE MONTHS AND I THINK
THAT'S AN INABILITY TO TRY TO
CREATE SOME EFFICIENCIES BUT IF
THE LAW WAS CHANGED FROM THE
TWENTY FOUR MONTHS OF THE
THIRTY MONTH THEY WOULD MAKE IT
MORE EFFICIENT FOR THEM. OKAY
WELL. IT YES I JUST WONDER HOW
MUCH FLEXIBILITY THEY ACTUALLY
HAVE TO DO THIS AND- AND IT IT
IT SEEMS SO SIMPLE- BUT YOU
KNOW. REMEMBER WHERE WE ARE
IT'S NOT ALWAYS NOTHING IS
ALWAYS THAT SIMPLE SO
APPARENTLY SO- FROM THANK YOU.
VERY MUCH FOR YOUR SUPPORT MISS
PETTICOAT THANK YOU ALSO FOR
YOUR PRESENTATION AND I WAS
OPPOSITE SPECIALLY INTERESTED
IN IN ANY RECOMMENDATIONS YOU
KNOW THAT THAT HAVE SWINE AND
FOR CONSIDERATION AND YOUR YOUR
COMMENTS WERE THOUGHTFUL. SO AS
WE LOOK AT THE AT THE STAFFING
ISSUES- DO YOU THINK THIS IS A
BUDGETARY OR RESISTS. MAKE THE
MECHANICS IN NOW HAVE WE HAVE
WE AT SOME POINT REDUCE THE
BUDGET TO ALLOW FOR IT DID NOT
MAKE THIS. DOABLE FOR FOLKS OR
FOR THE FOR THE DEPARTMENT OR
IS THIS JUST. IS THE PAY
STRUCTURE SO SUCH THAT IT'S
HARD TO ATTRACT PEOPLE. OR IS
THERE NOT ENOUGH MONEY TO FILL
THE POSITIONS. I THINK IT'S- I
THINK IT'S A LITTLE BIT OF A
NUMBER OF DIFFERENT THINGS SO
FOR ONE THING THE JOB IS WELL
FOR ONE THING. A LOT OF THESE
POSITIONS REQUIRE THE PERSON TO
BE A REGISTERED NURSE SO THERE
MAY BE COMPETING- PRESSURES IN
THE MARKET- BETTER JOB YOU KNOW
BUT OF. DECISIONS PEOPLE WOULD
RATHER TAKE THAN BEING A NURSE-
SURVEYOR WITH THE DEPARTMENT-
IN ADDITION IT'S MY
UNDERSTANDING FROM TALKING TO
THE DEPARTMENT THAT THEY
SOMETIMES STRUGGLE WITH MORALE
TAPE ISSUES BECAUSE YOU'RE
YOU'RE YOU'RE GOING IN AND
YOU'RE BASICALLY LOOKING FOR
DEFICIENCIES AT THESE
FACILITIES AND IT'S NOT THE
EASIEST. OF JOBS THE TIME WHAT
THERE'S YOU KNOW PRESSURE WITH
THE TIME LINES THE TURNAROUND
IS REALLY FAST- IT'S SUPPOSED
TO BE REALLY FAST THERE AND
THEY'RE GOING YOU KNOW. EVERY
TWO WEEKS OR SO GOING INTO A
NEW- FACILITY TO CONDUCT THIS
WORK SO THE POSITION OF
AUTHORITY HAS BEEN THERE BUT
THERE HAS BEEN THESE ISSUES
WITH RETAINING YOU KNOW FIRST
OF ALL THE RECRUITING THE STAFF
AND THEN RETAINING THE STAFF.
AND THE THAT- TIME THAT IT
TAKES TO REALLY TRAIN SOMEONE
ALSO DOESN'T HELP BECAUSE ONCE
YOU DO HIRE SOMEBODY IT'S-
ANOTHER TWELVE TO FOURTEEN
MONTHS BEFORE THAT PERSON IS
READY TO GO OUT ON THEIR OWN
AND DO YOU- A SURVEY. OF THE
LAST THING I WOULD MENTION IS
IT'S MY UNDERSTANDING FROM
TALKING TO THE DEPARTMENT A
YEAR OR TWO AGO. THEY HAD
BROUGHT IN A CONSULTANT TO HELP
WITH SOME OF THESE ISSUES THAT
I'VE RAISED TO- WHEN IT COMES
TO EITHER RECRUITING PEOPLE
INTO THE JOB OR OR RETAINING
THEM. AND THAT SEEMS TO HAVE
HELPED IT HELPED- GET THAT
VACANCY RATE DOWN TO THREE
POINT SIX- PERCENT BUT IT'S MY
UNDERSTANDING THEY'RE NO LONGER
WORKING WITH THAT. CONSULTANT
SO THE EXTENT TO WHICH THOSE
PRACTICES ARE STILL IN PLACE IN
PARTICULAR IN COMBINATION WITH
COVETED- I I'M NOT SURE I WOULD
HAVE TO. TO ASK THEM ABOUT THAT
AGAIN. THANK YOU I'M JUST
CURIOUS- WE TALKED ABOUT THE
SOME OF THESE INSPECTIONS ARE
UNANNOUNCED SO OBVIOUSLY. I
LIKE THAT- IF YOU KNOW
SOMEONE'S COMING IN YOU KNOW
THE IT'S IF YOU GOT GAS COMING
USUALLY CLEAN UP A LITTLE BIT
YOU KNOW- AND PUT THE DISHES
AWAY AND THINGS LIKE THAT BUT
YOU DON'T KNOW- AND THINGS ARE
JUST OPERATE NORTH HOUND HOW
MUCH. HAS HAS THERE BEEN A
CHANGE IT WAS AT ANY PART OF
ANYTHING THAT YOU LOOKED
ANYBODY LOOKED AT IN A NUMBER
OF UNANNOUNCED VISITS. THAT ARE
HAPPENING AS PART OF THE
LICENSING PROCESS DOES ANYBODY
KNOW THAT. WELL IT'S MY
UNDERSTANDING THAT MOST OF THE
VISITS ARE UNANNOUNCED UNLESS
IT'S- A COMPLAINT INVESTIGATION
WHICH HAS TO BE INITIATED
WITHIN A CERTAIN AMOUNT OF
TIME. SO I AM IT'S MY
UNDERSTANDING THAT MOST OF THE
SURVEYS ASSOCIATED WITH
APPLICATIONS AS WELL AS THE
JUST THE REGULAR ONGOING
LICENSE RENEWAL OR RE
CERTIFICATION. THOSE ARE
SUPPOSED TO BE ANNOUNCED ON.
AND IN ONE FINAL QUESTION
ACTUALLY ANALYSIS QUESTION TO
DPS BECAUSE THEY'LL BE ABLE TO
ANSWER THAT ONE DIRECTLY SO DID
YOU DO YOU HAVE A QUESTION OR
ANYTHING THIS FIGURE CARILLO.
PLEASE THANK YOU AND I WANTED
TO REALLY LIKE YOUR AUDIT
HEARING HAND UP IT'S VERY CLEAR
AND CONCISE- THE QUESTION I
HAVE IS THAT YOU KNOW SO. SO
MANY TIMES WE HAVE TO COMPETE
WITH THE STATE AND THE FEDERAL.
TO BRINGING DATES AND TIME
FRAMES TOGETHER. IS THAT
SOMETHING THAT- WE NEED TO
COORDINATE WITH THE FEDERAL.
FOR THE FEDERAL GOVERNMENT
RIGHT NOW TO BE ABLE TO LIST
CHANGE THE TIME FRAME AND SO
OVERALL. DISPARITY BETWEEN THE
TWO. WE'RE DOING OUR-
INSPECTIONS. THANKS I SAID I'LL
I'LL LET K ANSWER AS WELL I
DON'T THINK SO AS SHE INDICATED
THAT THE STATE LAW REQUIRES A
TWENTY FOUR MONTHS THE FEDERAL
IS FIFTEEN SO. THE SIMPLE FIXES
TO IS ABOUT ABOUT MODIFY THAT
THE STATE REQUIREMENT TO THIRTY
MONTHS AND THAT WOULD MAKE IT
EASIER FOR THE DEPARTMENT. OKAY
I REALLY APPRECIATE WHAT'S BEEN
PUT TOGETHER HERE IT. MAKES A
PRETTY BLACK AND WHITE- AND
IT'S SAD. THAT WE'VE HAD TO DO
THIS WHEN I LOOK BACK AT SOME
OF THOSE OLDER LEGISLATION.
IT'S GREAT THAT WE DO
LEGISLATION BUT GOSH DARN IT WE
NEED TO IMPLEMENT IT RIGHT AND
SO MANY TIMES WE SEE AS I'M
GOING THROUGH BILLS EVEN. NON
AND THIS COMMITTEE RATHER
COMMITTEES WE MAKE SOME KIND
OF. YOU KNOW STATEMENT GETS ON
THE FRONT PAGE OF THE PAPER BUT
I'LL BE DARNED IF IT'S NOT
IMPLEMENTED WHAT GOOD IS IT.
AND AS I GET OLDER I WANNA MAKE
SURE. THAT YOU KNOW OUR HOUSE
IN OUR- THANK. THANK YOU FOR
THE WORK ON THE REALLY THINK
THAT CUT. IS IT'S VERY WELL
DONE THANK YOU. AND THANK YOU
AGAIN DISCOUNT I JUST I WANT TO
SAY ONE THING BEFORE. WE MOVE
ON TO OUR NEXT PANEL AND THAT'S
THAT- I GUESS IT'S I GUESS IT'S
DISAPPOINTING AS OF THE
LEGISLATURE. YOU'VE MADE
RECOMMENDATIONS. AND WE-
HAVEN'T HEARD FROM THE
DEPARTMENT. ABOUT A RECALL I'VE
NOT HEARD OF ANY REQUEST HEY
WOULD YOU CONSIDER DOING THIS
SO THAT WE CAN COMPLY WITH THE
AUDITOR'S RECOMMENDATION.
THAT'S DISAPPOINTING. THAT'S A
REALLY REASONABLE
RECOMMENDATION. AND YET HERE WE
ARE- AND- AND HE WOULD THINK
THAT IN THE EFFORT TO IMPROVE.
THE SAID THAT THEY MIGHT
ACTUALLY SAY WELL WE CAN'T FIX
THIS WE AGREE WITH THE AUDITOR
THAT WOULD BE NICE TO
COORDINATE. REACH OUT WE CAN DO
THAT YOU KNOW I COULD BE PART
OF THAT COULD BE A COMMITTEE
BILL YOU KNOW IT'S NOT THAT
ISN'T ROCKET SCIENCE AND THAT'S
DISAPPOINTING. THAT'S VERY
DISAPPOINTING AND I SO ANYWAY.
SO I THANK YOU BOTH ALL THE
THROUGH ALL THREE OF YOU. AND I
APPRECIATE THAT WILL GO AHEAD
AND MOVE ON TO OUR NEXT. TIME
THANK YOU. OUR SECOND PANEL I
DEALS WITH THE QUALITY OF CARE
CHALLENGES IN SKILLED NURSING
FACILITIES. WE HAVE JOINING US.
TODAY I BELIEVE IN PERSON- THE
IS A KIM VALENTINE. IN. THE
CALIFORNIA ASSOCIATION CONSUMER
ATTORNEYS- DOCKED KARL
STEINBERG WILL BE JOINING US
VIA WEBEX- HE REPRESENTS A
SOCIETY PROPOSED ACUTE AND LONG
TERM CARE MEDICINE- TONY CHEN
COULD TELL THE STAFF ATTORNEY
FOR CALIFORNIA ASSOCIATES FOR
NURSING HOME REFORM- CASEY
DUNHAM. THE ACTING DEPUTY
DIRECTOR CENTER FOR HEALTH CARE
QUALITY CALIFORNIA APARTMENT
PUBLIC HEALTH VIA WEBEX. AND
THEN SCOTT MONA- ALSO ASSISTANT
DEPUTY DIRECTOR LICENSING AND
CERTIFICATION DIVISION
DEPARTMENT OF PUBLIC HEALTH. WE
WILL BE JOINED US VIA WEBEX SO.
AS VALENTINE PLEASE GO AHEAD
WHEN YOU'RE READY. MY NAME IS
KEN VALENTINE AND I'M HERE AS A
MEMBER OF THE CONSUMER
ATTORNEYS OF CALIFORNIA. AND
I'M A PLANNER CIVIL LITIGATOR
WHO HAS PRACTICED IN THE AREA
OF NEGLECT AND ABUSE OF ELDERS
IN NURSING HOMES FOR OVER
TWENTY YEARS. I WAS ASKED TO
COME HERE TODAY AND TALK TO YOU
ABOUT WHY OWNERSHIP IN NURSING
HOMES MATTER. SO AS IT SOUNDS
LIKE A LOT OF YOU ALREADY KNOW
THE PRIMARY PROBLEM IN A
NURSING HOME SIMPLY PUT IT IS
UNDERSTAFFING. STUDY AFTER
STUDY SHOWS THAT INCREASE
STOPPING LEADS TO HIGHER
QUALITY OF CARE. BUT OBVIOUSLY
IT TAKES MONEY TO INCREASED OFF.
AND MOST NURSING HOMES ON PAPER
RIGHT IN THE RIDE AND CRY
POVERTY. THIS IS WHILE THE
OWNERS ARE OFTEN MAKING
MILLIONS AND SOMETIMES BILLIONS
OF DOLLARS. 85% OF NURSING HOME
REVENUE IS GENERATED FROM STATE
AND FEDERAL MONEY. SO HOW ARE
WE CREATING BILLIONAIRES. I
CAN'T TELL YOU HOW MANY TIMES
I'VE HEARD THAT NURSING HOMES
ARE UNDERSTAFFED AND DON'T HAVE
THE MONEY TO HIRE MORE. SINCE
THE NURSING HOME. IS OFTEN THE
LAST PLACE THAT MY CLIENTS ARE
EVER GOING TO LIVE. I MAKE IT A
POINT. TO LOOK UP THE HOME. IN
WHICH THE OWNER OF THAT NURSING
HOME LIVE. AND I STRUGGLE TO
ACCEPT THE PREMISE THAT NURSING
HOMES ARE UNDERFUNDED WHEN
THEIR OWNERS ARE LIVING IN
HOMES THAT ARE SOMETIMES WORTH
ELEVEN MILLION DOLLARS TRUE
STORY. AND MY FIRM I SEE REPEAT
DEFICIENCIES AND GOT CASES ALL
THE TIME. BECAUSE OF THE
CONDUCT THAT I AM COVER OVER
AND OVER AGAIN. I HAVE STOPPED
ASKING MYSELF THE QUESTION OF
WHETHER OR NOT THERE'S GOING TO
BE FRAUD. I JUST ASK MYSELF THE
QUESTION CAN I PROVE FRAUD IN
THIS CASE HOW ARE THEY DOING AT
THIS TIME. WHICH IS WHY I VERY
MUCH APPRECIATE THE FACT THAT
THERE ARE SO MANY OF YOU HERE
THAT OBVIOUSLY CARE ABOUT THIS
ISSUE. BECAUSE QUITE FRANKLY I
HAVE FELT LIKE I HAVE BEEN
CARRYING ALL OF OUR FUTURES. AS
WE AGE ON MY SHOULDERS AND I
HAVE FELT LIKE IT HAS BEEN A
VERY LONELY ROAD. TWENTY YEARS
AGO I FELT LIKE THE DEPARTMENT
OF HEALTH SERVICES NOW THE
DEPARTMENT OF PUBLIC HEALTH.
WAS ACTUALLY A PART PARTNER AND
TRYING TO HOLD NURSING HOMES
ACCOUNTABLE. THE REALITY IS NOW
WHEN THE CURRENT CLIENT COMES
TO ME AND BAD CONDUCT HAS
OCCURRED I DON'T EVEN TELL THEM
TO FILE A COMPLAINT WITH THE
DEPARTMENT OF PUBLIC HEALTH.
BECAUSE IT IS POINTLESS. MY
EXPERIENCE IS THE AGENCY HAS
REDUCED ENFORCEMENT. OF QUALITY
OF CARE BY ISSUING 35% LESS
CITATIONS THAN EVER BEFORE.
THIS WHILE THE PATIENTS AND
NURSING HOMES ARE ABSOLUTELY
GETTING SICKER AND SICKER EVERY
SINGLE YEAR AND THE QUALITY OF
CARE HAS NOT IMPROVED. THERE IS
NO CONSISTENCY AND THE
PENALTIES OR THE ACCOUNTABILITY
OUTCOMES FROM ONE NURSING HOME
CHAIN WHEN COMPARED TO ANOTHER.
AND TO ADDRESS YOUR QUESTION
ABOUT UNANNOUNCED VISITS. I
WANT TO MAKE SURE THAT EACH OF
YOU KNOW THAT THESE NURSING
HOMES ABSOLUTELY NOW WHEN THOSE
VISITS ARE GOING TO OCCUR. THEY
HAVE CORPORATE INDIVIDUALS WHO
TRACK WHEN THE SURVEYORS ARE
GOING TO BE THERE THEY SAID AND
THE BUILDINGS AND THEY WAIT.
THEY ADD THE STAFFING HOURS
FROM THOSE CORPORATE
REPRESENTATIVES INTO THEIR
STOPPING TO MISLEAD THOSE
SURVEYORS ABOUT WHAT'S REALLY
GOING ON IN THE FACILITY SO
DON'T BE FOOLED INTO THINKING
THAT THEY DON'T KNOW WHEN
THEY'RE OMING. THEY MIGHT NOT
KNOW THAT DAY BUT THEY KNOW THE
WINDOW AND THEY'RE DEFINITELY
TRACKING IT. SO MOST NURSING
HOMES AROUND BY LARGE CHAINS
LIFE CARE CENTERS OF AMERICA IS
ONE OF THE LARGEST CHANGE IN
THE UNITED STATES WITH OVER TWO
HUNDRED BUILDINGS IN TWENTY
EIGHT STATES WITH ANNUAL
REVENUE OF TEN BILLION DOLLARS
AND WITH FORTY TWO THOUSAND
EMPLOYEES. MANY OF THOSE
FACILITIES ARE HERRON
CALIFORNIA. LIFE CARE CENTERS
OF AMERICA PAID THE LARGEST
SETTLEMENT TO THE OFFICE OF THE
INSPECTOR GENERAL OF A HUNDRED
AND FORTY FIVE MILLION DOLLARS.
TO RESOLVE FALSE CLAIMS
ALLEGATIONS RELATING TO THE
PROVISION OF MEDICAL GOVERNMENT
OVERBILLING. LIFE CARE CENTERS
OF AMERICA WAS STARTED BY AND
CONTINUES TO BE OWNED BY
FORREST PRESTON NOW A
BILLIONAIRE. ENSIGN SERVICES
INC IS ALSO ONE OF THE LARGEST
CHAINS IN THE UNITED STATES
WITH WELL OVER TWO HUNDRED
BUILDINGS AND TWENTY EIGHT
THOUSAND EMPLOYEES. THEY ARE
FORTY FACILITIES HERE IN
CALIFORNIA THEY ALSO PAID A
SETTLEMENT OF FORTY EIGHT
MILLION DOLLARS TO RESOLVE
FALSE CLAIMS ACT ALLEGATIONS
RELATING TO GOVERNMENT
OVERBILLING. GENESIS HEALTHCARE
IS ALSO ONE OF THE LARGEST WITH
FACILITIES AND TWENTY THREE
STATES INCLUDING CALIFORNIA.
AND TWO THOUSAND AND SEVENTEEN
THEY PAID FIFTY THREE POINT SIX
MILLION DOLLARS TO RESOLVE SIX
FALSE CLAIMS WHISTLEBLOWER
LAWSUITS. SOON THE LARGEST
OPERATOR IN CALIFORNIA IS GOING
TO BE PROVIDENCE GROUPING AS
THEY ARE BUYING OUT PLAN
HEALTHCARE WHO JUST PAID FOUR
HUNDRED FIFTY THOUSAND DOLLARS
TO RESOLVE FALSE CLAIMS
ALLEGATIONS. PROVIDENCE
GROUPING HAS GROWN FROM TWO. TO
OVER A HUNDRED FACILITIES IN
SIX YEARS. YES LOC CHAIN
OPERATES EIGHTY ONE NURSING
HOMES ARE NOW YOU KNOW IT'S
CURRENTLY OUR LARGEST OPERATOR.
WHO'D WHICH IS OWNED BY SONOMA
WRECK NEXT A MILLIONAIRE WHO IS
ACTIVELY AND AGGRESSIVELY
PURSUING HIS GOAL TO BECOME A
BILLIONAIRE. HCR MANORCARE NOW
OWNED BY PROMEDICA IS THE FIFTH
LARGEST NURSING HOME CHAIN IN
THE UNITED STATES AND HOUSE
MULTIPLE BUILDINGS HERE IN
CALIFORNIA. WHAT THESE ENTITIES
HAVE IN COMMON IS HOW THEY PAY
OR SIPHON MONEY OUT OF THE
NURSING HOMES TO WHAT THEY CALL
RELATED PARTIES. WHICH ARE
BUSINESSES THAT THEY ALSO ON
THOSE BUSINESSES RANGE FROM
ADMINISTRATIVE SERVICES
COMPANIES PHARMACIES SUPPLY
COMPANIES INTERIOR DECORATING
FARMS. PHYSICAL THERAPY
COMPANIES FINANCIAL CONSULTANTS
INSURANCE COMPANIES A REAL
ESTATE COMPANIES JUST TO NAME A
FEW. SO LET ME GIVE YOU SOME
REAL LIFE EXAMPLES OF HOW THIS
WORKS. MOST OF THESE CHAIN
ORGANIZATIONS CREATE A WHOLLY
OWNED. RELATED PARTY LIABILITY
INSURANCE COMPANY. WITH THE
SAME OFFICERS AND DIRECTORS AND
OWNERS OF THE OTHER RELATED
ENTITIES. IN THIS REAL LIFE
EXAMPLE ALL THE NURSING HOMES
AND NOT CHANGE. YOUR PREMIUM OF
ABOUT A MILLION DOLLARS PER
BUILDING. TO HAVE INSURANCE. AT
THE END OF THAT YEAR THE WHOLLY
OWNED INSURANCE COMPANY MAKES A
PROFIT OF TWENTY MILLION
DOLLARS. PREMIUMS TO
TRADITIONAL INSURANCE COMPANIES
ARE OFTEN ONE THIRD TO ONE HALF
THE SAME COST. IN THIS EXAMPLE
THE CALIFORNIA NURSING HOME IS
PAYING A MILLION DOLLARS TO
HAVE COVERAGE THAT LEAVES IT TO
BEAR MEANING NO INSURANCE FOR
THE FIRST SIX MILLION DOLLARS.
NOW IN THE STATE OF CALIFORNIA
WE HAVE CAPS. ON HOW MUCH YOU
CAN GET AN ELDER ABUSE OR
NEGLECT KIND. AND THE ONLY WAY
A CASE COULD EVER GET PAST SIX
MILLION DOLLARS IS IF THERE WAS
A PUNITIVE DAMAGES CLAIM. BUT
UNITIVE DAMAGES ARE NOT COVERED
BY INSURANCE. SHOW THAT NURSING
HOME IS PAYING A MILLION
DOLLARS A YEAR. THE HOBBIT
ESSENTIALLY USELESS INSURANCE
I'M NOT MILLION DOLLARS COULD
HAVE BEEN USED TO PAY FOR STAFF.
MANY OF THESE CHAINS HAVE VERY
FAVORABLE REAL ESTATE LOANS.
AGAIN THE REAL ESTATE OWNER IS
A RELATED PARTY AND TO TEAM
WITH OVERLAPPING OFFICERS
DIRECTORS AND ULTIMATE OWNERS.
THE REAL ESTATE ENTITY THAN
RENTS OR LEASES THE BUILDING TO
YET ANOTHER RELATED ENTITY.
OFTEN A SHELL COMPANY ALL OF
THESE COULD CHANGE HAVE LAYERS
AND LAYERS OF CORPORATE
ENTITIES TO INSULATE THEM.
RENTER LEASE PAYMENTS FOR
BUILDINGS AND A CHAIN ARE OFTEN
PAID AT SUBSTANTIALLY HIGHER
PERCENTAGE PER BED THEN
COMPARABLE HOMES IN CALIFORNIA.
THE SHELL ENTITY AGREES TO PAY
THREE MILLION A YEAR FOR RENT
OR LEASE. BUT THAT ENTITIES SUB
LEASES THE BUILDING TO THE
ACTUAL NURSING HOME FOR THREE
POINT FIVE MILLION DOLLARS. THE
HALF A MILLION DOLLAR PROFIT
DIFFERENCE IS THEN UNTRACEABLE.
THAT'S JUST ONE BUILDING.
IMAGINE NOT PROFIT. FOR EACH
BUILDING WITH AND THE CHAIN. MY
PERSONAL FAVORITE SARIM OR
EXAMPLE WAS A RELATED PARTY
FINANCIAL CONSULTING COMPANY
THAT WAS PAID SEVENTY THOUSAND
DOLLARS PER YEAR PER FACILITY
TO REVIEW THEIR OWN FINANCIALS.
THE RELATED PARTY FINANCIAL
COMPANY EMPLOYED ONE PERSON.
THAT ONE PERSON AS THE OWNER OF
ALL OF THE NURSING HOMES CHOI
PAID HIMSELF SEVENTY THOUSAND
DOLLARS PER BUILDING. LIKE THAT
MUCH MONEY AND TELL YOU TIMES
IT BY ALL THE NEW BUILDINGS IN
HIS PORTFOLIO IT TURNED OUT TO
BE OVER FIVE MILLION DOLLARS A
YEAR TO REVIEW HIS OWN BOOKS.
MANY OF THESE CORPORATE CHAINS
ARE S. CORPORATIONS WHICH FINAL
ALL THE MONEY TO THE ULTIMATE
OWNER. THERE IS ZERO
TRANSPARENCY OF THESE CHAINS AS
A WHOLE. SERVE THE ONEROUS
MAKING SUBSTANTIAL PROFITS ON
THE REAL ESTATE WHERE INSURANCE
COMPANIES OR SUPPLY COMPANIES
IT BENEFITS THEM. TO RUN THE
BUILDINGS IN THE RIDE AND SHOW
LOSSES SO THAT THEY CAN OFFSET
THE PROFITS THAT THEY'RE MAKING
ELSEWHERE. FOR TAX PURPOSES OUR
CURRENT SYSTEM ONLY REVIEWS
WHAT IS HAPPENING IN ONE
BUILDING IT DOESN'T SHOW IF
MONEY IS SIPHONED OR MOVE FROM
ONE ENTITY WITHIN THE OVERALL
CHANGE TO ANOTHER WHICH COULD
BE USED TO PAY FOR STAFFING. TO
DATE RELATED PARTIES HAVE NEVER
HOW TO REPORT FOR PROFITS
SENATE BILL SIX FIFTY IS A
REALLY GOOD START. TO TRY AND
BRING SOME DEGREE OF
ACCOUNTABILITY BY REQUIRING
THESE RELATED PARTIES TO
DISCLOSE PROFIT AND LOSS
STATEMENTS. IT'S A START. BUT
THE ONLY REAL WAY TO ENSURE
COMPLETE ACCOUNTABILITY IS TO
REQUIRE COMPLETE TRANSPARENCY.
NURSING HOMES ARE VERY GOOD AT
MANIPULATING FINANCIAL DATA.
FACILITIES HAVE BEEN REQUIRED
SINCE NINETEEN NINETY SIX TO
SUBMIT ANNUAL COST REPORTS. IN
MY CASES WHEN QUESTIONED ABOUT
THE LINE ITEMS ON THESE COST
REPORTS. OPERATIONS CLAIM THAT
THE REPORTS THAT THEY SUBMITTED
ARE NOW WRONG. WELL WE HAVE
FOUND IS THAT THEY ARE
CONSISTENTLY MANIPULATED. IT
SHOULD ALSO BE NOTED THAT SINCE
NINETEEN NINETY SIX THIS
INFORMATION HAS ALWAYS BEEN
FREELY AVAILABLE TO THE PUBLIC
AND COULD BE OBTAINED WITH THE
SIMPLE FREEDOM OF INFORMATION
ACT REQUEST. HOWEVER UNDER OUR
PRIOR ADMINISTRATION AND CMS
INSTITUTED A POLICY IN WHICH
THEY REFUSED TO RELEASE THESE
REPORTS TO THE PUBLIC CLAIMING
THEY WERE TRADE SECRETS WHY.
BECAUSE THE NURSING HOME OWNERS
HAVE SUBSTANTIAL POLITICAL PULL
TO KEEP THIS INFORMATION
PRIVATE AND AGAIN I ASK WHY IF
THERE IS NOTHING TO HIDE WHY
CHANGE THE PRACTICE THAT HAS
BEEN IN PLACE FOR OVER TWENTY
YEARS. OTHER EXAMPLES OF HOW
OFTEN OWNERS MANIPULATE DATA
VIRTUALLY EVERY SINGLE NURSING
HOME CHAIN HAS A RELATED PARTY
ADMINISTRATIVE SERVICES
COMPANY. THAT GETS PAID 526% OF
THE NURSING HOMES GROSS
PROFITS. EVEN IF THE FACILITY
IS FINANCIALLY RUNNING IN THE
RED. THESE ADMINISTRATIVE
SERVICES SERVICES COMPANY ARE
AGAIN OWNED BY THE SAME OWNERS.
ADMINISTRATIVE SERVICES COMPANY
EMPLOYS THE INDIVIDUALS WHO
HIRES. THE TOP EXECUTIVE OF THE
OF THE BUILDING WHICH IS THE
ADMINISTRATOR THEY DETERMINE
HIS OR HER COMPETENCY IF HERE
SHE KEEPS HER JOB THEY SET THE
ADMINISTRATORS PAY STRUCTURE.
MOSTLY ALWAYS INCENTIVIZED BY
FINANCIAL TARGETS. THE
ADMINISTRATIVE SERVICES COMPANY
APPROVED ASSETS THE BUDGET THAT
DICTATES THE DOLLARS ALLOWED
FOR STAFFING THEY CREATE THE
NURSING AND ADMINISTRATIVE
POLICIES AND PROCEDURES RIGHT
THE EMPLOYEE HANDBOOK POLICIES.
SET THE PAY STRUCTURES FOR
NURSING STAFF SET UP AND MANAGE
THE BANK ACCOUNTS FOR THEIR
NURSING HOME NEGOTIATE
CONTRACTS COLLECT THE MONEY
DECIDE HOW THE MONEY WILL BE
SPENT. AND TOLD THE NURSING
HOME WHAT INSURANCE COMPANIES
AND ELECTRONIC MEDICAL RECORD
SYSTEMS THEY WILL USE. THE
ADMINISTRATIVE SERVICES COMPANY
DOES NOT GIVE THE NURSING HOME
THE OPTION OF THEIR YEARS THEY
SIMPLY DICTATE WITHOUT REGARD
FOR DEBT BUT THEY WILL BE PAID
THE 526% OF FOR THEIR
MANAGEMENT FEE. YET THEY CLAIM
IN EVERY SINGLE CASE THAT THEY
DO NOT OPERATE THE BUILDING.
THESE ENTITIES ARE SIMPLY
FORMED AS ANOTHER RELATED PARTY
ENTITY BECAUSE MEDICAID
REIMBURSEMENT IS BASED ON THE
COST OF SERVICES. SO THE MORE
MONEY THE NURSING HOME CAN SAY
IT'S SPENDING EVEN OF GIVING
THE MONEY TO THEMSELVES. AND
INCREASES THEIR REIMBURSEMENT
RIGHT. THE ONLY TRUE MEASURE TO
DETERMINE OF NURSING HOME
OWNERS HAVE MONEY TURN CREASE
DROPPING AS TRANSPARENCY ALL
THE WAY TO THE TOP OF THE
ORGANIZATION TO THE OWNERS AND
THE OPERATORS. COMPLETE
TRANSPARENCY VERIFIABLE
TRANSPARENCY AUDITED
TRANSPARENCY. THE QUESTION
SHOULDN'T BE OF A SINGLE
NURSING HOMES PROFITABLE THE
QUESTION SHOULD BE IF THE CHAIN
AS A WHOLE IS PROFITABLE. AND
IF THE CHAIN AS A WHOLE IS
PROFITABLE THE PEOPLE AT THE
TOP OF THAT CHANGE SHOULD BE
ACCOUNTABLE FOR UNDERSTAFFING
INDIVIDUAL NURSING HOMES. THIS
IS WHY WHO OWNS THE NURSING
HOME MATTERS. WHAT WE NEED FROM
YOU KNOW AS LEGISLATION THAT
REQUIRES COMPLETE FISCAL
AUDITED TRANSPARENCY.
LEGISLATION THAT SPECIFICALLY
REQUIRES THE OFFICERS THE
MANAGERS AND OWNERS OF ANY
NURSING HOME OR CHANGE TO BE
KNOWLEDGEABLE AND ULTIMATELY
ACCOUNTABLE FOR THE STAFFING
LEVELS IN THOSE BUILDINGS. AT
PRESENT WE ALLOW THEM TO TAKE
THE PROFITS OF THESE NURSING
HOMES BUT WE DO NOT REQUIRE
THEM TO BE ACCOUNTABLE OR EVEN
KNOWLEDGEABLE ABOUT THE SINGLE
MOST IMPORTANT FACTOR THAT
RELATES TO THE QUALITY OF CARE.
CAPITALISM IS A GOOD THING. BUT
WE SHOULDN'T BE BREEDING
BILLIONAIRES AND A SYSTEM THAT
IS PREDOMINANTLY FUNDED BY OUR
STATE AND FEDERAL DOLLARS. WHAT
I AM PERSONALLY ASKING FROM YOU
IS TO PLEASE CONSIDER THE
VERACITY OF HOW AND WHY THIS IS
HAPPENING. IT'S A BREEDING
GROUND FOR BILLIONAIRES BECAUSE
IT'S A BREEDING GROUND FOR
FRAUD. WE ARE LETTING THIS
HAPPEN RIGHT IN FRONT OF OUR
EYES. I CAME HERE TODAY TO
SHARE MY PERSONAL EXPERIENCES
WITH YOU BECAUSE AFTER TWENTY
THREE YEARS I AM PETRIFIED TO
GET OLD. THIS DISGRACEFUL
BROKEN SYSTEM OF SENIOR LIVING
CARE IS SOMETHING THAT WE ALL
NEED TO CARE ABOUT. BECAUSE
THIS IS OUR FUTURE. THANK YOU.
THANK YOU VERY MUCH MISS
VALENTINE. PAUSE FOR A SECOND
THERE- OUR NEXT TO US BECAUSE-
IS SAID DR- CARL STEINBERG ON
VIA WEBEX SO PLEASE GO AHEAD
DOCTOR WHENEVER YOU'RE READY.
THANK YOU MISTER CHAIR AND-
MEMBERS. BUT I WANTED TO BE
HERE WE SHOULD THE OPPORTUNITY
TO ADDRESS YOU. ON THIS VITALLY
IMPORTANT TOPIC OF QUALITY IN
CALIFORNIA'S NURSING FACILITY.
I'M REALLY HONORED TO BE IN THE
SYSTEM PANEL WITH SUCH LEADERS
IN THE FIELD AND WITH CDPH
UNLIKE OUR OTHER PANELISTS
THOUGH I ACTUALLY FOR THE BULK
OF MY PROFESSIONAL TIME
ACTUALLY PROVIDING CARE IN
NURSING HOMES I'VE BEEN A
NURSING HOME MEDICAL DIRECTOR
AN ATTENDING PHYSICIAN IN SAN
DIEGO COUNTY FOR OVER TWENTY
FIVE YEARS. I'M A PAST
PRESIDENT OF CAL TCM AND
CURRENT PRESIDENT OF AMDA THE
SOCIETY FOR POST ACUTE AND LONG
TERM CARE MEDICINE. IN THAT
CAPACITY I'VE HAD THE
OPPORTUNITY TO WITNESS FIRST
HAND MANY OF THE PROBLEMS ARE
NURSING HOMES AND EXPERIENCE
I'VE ALSO BEEN PERENNIALLY
AMAZED AT THE LOVE AND
COMPASSION ARE SHARED BY
OVERSEEING A STAFF WITH THE
VULNERABLE RESIDENTS UNDER OUR
CARE AND SOMETIMES THAT DOESN'T
GET DISCUSSED IN THESE
MEETINGS. IT'S REALLY
UNFORTUNATE THAT STAFFING
ESPECIALLY NURSES AND CNA'S HAS
BECOME SO MUCH MORE OF A CRISIS
DURING THIS PANDEMIC BUT IT'S
NOT A PROBLEM FOR MANY YEARS I
DON'T THINK THERE'S A SIMPLE
SOLUTION TO THIS PROBLEM AND I
THINK IT'S NAIVE TO BELIEVE
THAT A FACILITIES ONLY RAISE
WAGES THIS PROBLEM WOULD BE
SOLVED. ALTHOUGH IT WOULD HELP
WE NEED A MUCH MORE
COMPREHENSIVE PLAN TO GET
PEOPLE INTO THE WORKFORCE GET
THEM INTO NURSING HOMES AND
KEEP THEM THERE ALL THE TALK
ABOUT HOSPITAL AT HOME AND
SNIFF AT HOME PROGRAMS IS GREAT
BUT WE ARE ALWAYS GOING TO NEED
NURSING HOMES. AND I WANNA MAKE
IT CLEAR I'M SPEAKING ON BEHALF
OF PROFESSIONALS WHO WORK IN
POST ACUTE AND LONG TERM CARE
NOT ON BEHALF OF THE PEOPLE WHO
OWN AND OPERATE THE FOR THE
HOMES WITH THE INDIVIDUALS WHO
CHOOSE TO DEVOTE OUR CAREERS TO
WORKING THERE DOCTORS NURSE
PRACTITIONERS PHARMACISTS
NURSES SOCIAL WORKERS AND ALL
TEAM OF OTHERS. OUR MISSION IS
ALL ABOUT PROVIDING HIGH
QUALITY PERSON CENTRED
COMPASSIONATE CARE TO OUR
PATIENTS SO IT'S VERY. MUCH IN
LINE WITH THE GOALS OF THIS
SESSION. NURSING HOMES FACED.
BECAUSE THERE POP. AND I'M SURE
YOU'RE AWAREOF. THERE'S A LONG
TERM CUSTODY OLD TRADITIONAL
KIND OF MOSTLY MEDIC CAL
POPULATION. WILL LIVE OUT THEIR
DAYS IN OUR HOMES- AND THEN THE
MOSTLY MEDICARE PART A POST
ACUTE PATIENTS. WHO COME IN FOR
REHAB AND SKILLED CARE AFTER A
HOSPITALIZATION. SO THAT
COMPLICATES THINGS A LITTLE BIT
THAT LATTER POPULATION IS OFTEN
HIGHLY MEDICALLY COMPLEX AND
STILL QUITE ILL. LEADING SOME
TO CALL TODAY'S NURSING HOMES
MANY HOSPITALS. MANY OF OUR
FACILITIES DO IV INFUSIONS
COMPLEX WOUND CARE FREAKY
OSTOMY CARE. VENTILATOR
MANAGEMENT AND WE THINK YOU'RE
REALLY SICK PEOPLE. YEP ONE
ASPECT OF QUALITY THAT OFTEN
GETS IGNORED IN NURSING HOMES
IS THE QUALITY OF THE ACTUAL
MEDICAL CARE. ACUTE CARE
HOSPITALS HAVE ROBUST
CREDENTIALING AND PROCTER AND
PROCESSES. FOR PHYSICIAN
PRIVILEGES. THE PATIENTS HAVE
TO BE SEEN BY THEIR DOCTOR DAY.
NURSING HOMES HAVE NOTHING OF
THE SORT LIKE THOSE SAFEGUARDS
THE DOCTOR ONLY HAS TO SEE THE
PATIENT ONCE EVERY THIRTY DAYS.
THERE'S ZERO REQUIREMENT FOR
CREDENTIALING AND PRIVILEGING
THE FACILITY HAS TO EVACUATE
COMMITTEE THAT INCLUDES THE
MEDICAL DIRECTOR BUT THERE'S NO
REQUIREMENT FOR SPECIFIC
MONITORING OR AUDITING OF OTHER
PHYSICIANS PERFORMANCE. AND
THOSE Q. A MEETINGS DON'T HAVE
TO OCCUR ANYMORE THAT ONCE A
QUARTER. THE MEDICAL DIRECTORS
REALLY THE ONLY MECHANISM FOR
ASSESSING PHYSICIAN PERFORMANCE
AND THE ACTUAL MEDICAL CARE IN
THE BUILDING. YET THE AVERAGE
MEDICAL DIRECTOR POSITION CALLS
FOR ONLY A FEW HOURS A MONTH.
WHAT'S MORE SHOCKING THOUGH IS
THAT THERE IS NO REQUIREMENT AT
ALL BEYOND A VALID MEDICAL
LICENSES FOR A DOCTOR TO BE A
NURSING HOME MEDICAL DIRECTOR.
SO SOME FACILITIES HIRE RETIRED
PEDIATRICIANS ARE SURGEONS WHO
HAVE NO KNOWLEDGE OF GERIATRICS
OR OF THE COMPLEX REGULATORY
FRAMEWORK THAT NURSING HOMES
OPERATED IN. WELL OTHER
FACILITIES BAY HIGHER
HOSPITALIST YOU CAN JUST DRIVE
EMISSIONS AND FILL THE BEDS.
CLEARLY THIS CREATES A HIGHER
RISK OF QUALITY LAPSES AND WE
HAVE SEEN UNFOLD TRAGICALLY
DURING THIS PANDEMIC. MEDICAL
DOCTORS CAN'T SINGLE HANDEDLY
SOLVE THE QUALITY PROBLEMS OF
NURSING HOMES BUT THERE'S NO
DOUBT THAT ENGAGED COMPETENT
ETHICAL MEDICAL DIRECTOR CAN
MAKE A BIG DIFFERENCE SO PLEASE
CONSIDER THAT. MAYBE SEVEN
FORTY NINE WHICH I THANK YOU
FOR PASSING THROUGH THIS
COMMITTEE THE FULL ASSEMBLY AND
THE SENATE WITHOUT A SINGLE NO
VOTE. WOULD REQUIRE ALL
CALIFORNIA NURSING HOMES THAT
CERTIFIED MEDICAL DIRECTORS
WITHIN FIVE YEARS THIS BILL IS
SITTING ON THE GOVERNOR'S DESK
IT WAS NOT SIGNED WITH THE
OTHER NURSING HOME BILLS LAST
NIGHT AND I'M PUZZLED AND
CONCERNED. IT HAD VIRTUALLY NO
OPPOSITION I HOPE AND PRAY THAT
BECOMES LAW SOON. YOU'LL HEAR A
LOT TODAY ABOUT WHAT'S WRONG
WITH LICENSING THE SURVEY
PROCESS TRANSPARENCY ISSUES AND
THE WORK FORCE SHORTAGE IT'S
CLEAR THAT STAFFING ISSUES
EXTENT TO CDPH THROUGH. AND I
KNOW IT'S HARD TO CLEAR A
BACKLOG WHEN YOU JUST DON'T
HAVE ENOUGH PEOPLE. SERVICE
RECORD AND WHILE I THINK THE
SURVEY PROCESS IS. OVERLY
ADVERSARIAL AND QUITE ENTRANCE.
WE DO NEED OUR HOMES TO BECOME.
BUT HIGHER FINES AT A LOWER FOR
A THEM. UNLIKE WHAT WE'VE BEEN
DOING HERE LATELY IS NOT LIKELY
TO IMPROVE QUALITY I'M SORRY TO
SAY IT'S LIKE PUNISHING A POOR
PERFORMING URBAN SCHOOL. BY
REDUCING THEIR FUNDING THE
PEOPLE OF SOFTWARE GOING TO BE
THE ONES INSIDE THE SCHOOL. SO
I LOOK FORWARD TO FURTHER
DISCUSSION I WANT TO ASSURE YOU
THAT COUNTY CM THE CALIFORNIA
ASSOCIATION OF LONG TERM CARE
MEDICINE STANDS READY TO
COLLABORATE. AND ASSIST DOOZY
ASK WITH ANY EFFORTS TO IMPROVE
THE QUALITY OF CARE OR NURSING
HOME RESIDENTS RECEIVE. THANK
YOU VERY MUCH. THANK YOU VERY
MUCH TO A DOCTOR STEINBERG AND
I HOPE YOU CAN HANG WITH US
WE'VE GOT A COUPLE OF OTHER.
OTHER PEOPLE TESTIFIED AND THEN
I KNOW WE'LL HAVE QUESTIONS FOR
EVERYONE SO THANK YOU VERY
MUCH. MISTER MISTER SHE COULD
TELL. I REQUEST A NOON. PLEASE
GO AHEAD AND TURN THIS ON. I
THINK YOU'RE ON YOU'RE GETTING
YEAH THANKS. THANK YOU TO THE
COMMITTEE CHAIR AND THE-
MEMBERS AND THE STAFF FOR THE
OPPORTUNITY TO TESTIFY TODAY. I
REALLY APPRECIATE. THE IDEA OF
HAVING THIS HEARING. I AM VERY
GRATEFUL FOR MY ABILITY TO
COMMON TALK ON BEHALF OF. ABOUT
A QUARTER OF A MILLION
CALIFORNIANS WILL TO LIVE IN A
NURSING HOME AT SOME POINT THIS
YEAR. AND THE FAMILIES OF OVER
NINE THOUSAND RESIDENTS WHO
HAVE PASSED. AWAY DUE TO COVERT
NINETEEN IN NURSING HOMES. THE
LARGEST. OCCASIONALLY EXPRESSES
INTEREST IN ADDRESSING POOR
CARE THAT MANY RESIDENTS
RECEIVE. AUDITS HAVE BEEN
CONDUCTED REALLY GREAT AUDITS
BILLS HAVE BEEN WRITTEN SOME
REALLY GREAT BILLS. AND
HEARINGS ARE HELD BUT THE
RESULTS ARE OFTEN WANTING. WELL
WE HAVE SOME OF THE MOST
RESIDENT PROTECTIVE NURSING
HOME POLICIES IN THE COUNTRY.
THE ENFORCEMENT HAS BEEN AND
REMAINS TOTALLY MORE ABOUND.
THE REPORTS BILLS IN HEARINGS
TYPICALLY CALL OUT CDPH
FAILURES GOING BACK FORTY
YEARS. BUT IT'S PERFORMANCE
NEVER REALLY IMPROVES. THERE
ARE THREE FACTS THAT I THINK
ARE MOST IMPORTANT FOR THE
LEGISLATURE IN THE PUBLIC TO
KNOW. ONE DPH HAS NO CONTROL
OVER NURSING HOME QUALITY. DPH
IS LACK OF CONTROL IS MOST
PROFOUND ON THE ISSUE OF
NURSING HOME OWNERSHIP. I KNOW
IT'S ALREADY BEEN COVERED A
LITTLE BIT BUT- THIS IS WHAT I
GAP. IT SYSTEM FOR APPROVING A
LICENSING THE PEOPLE WHO OWN
AND OPERATE NURSING HOMES IS
STRAIGHT BANANAS. CORROSIVE DPH
INACTION HAS CREATED A SYSTEM
WHERE OPERATORS WITH TERRIBLE
TRACK WORKERS TRUCK TRACK
RECORDS TAKEOVER NURSING HOMES
WITHOUT APPROVAL. WHAT'S WORSE
WHEN THE STATE ACTUALLY DENIES
A LICENSE IT DOESN'T REALLY
MATTER. THE UNFIT OPERATOR CAN
JUST KEEP OPERATING VARIOUS
NURSING HOME SLUMLORDS OPERATE
WITHOUT THE FAINTEST CONCERNED
THAT EVEN THE MOST SHOCKING
CASES OF ABUSE OR NEGLECT. ARE
GOING TO AFFECT THEIR BOTTOM
LINES. HERE IS HOW CALIFORNIA'S
LUDICROUSLY DISORDERED
LICENSING SYSTEM WORKS. ONE
TAKEOVER NURSING HOME TO APPLY
FOR A LICENSE AFTER YOU'VE
TAKEN OVER WHEN YOU FEEL LIKE
IT OR MAYBE DON'T. THREE TAKE
TENS OF MILLIONS OF DOLLARS IN
TAXPAYER REVENUE FOR YEARS
WITHOUT A LICENSE. FOUR IF DPH
EVENTUALLY TURNED YOU DOWN
APPEAL. OR MAYBE DON'T. IF YOU
APPEAL WAIT UNTIL THE EVE OF
THE HEARING AND WITHDRAW YOUR
APPEAL AND REAPPLY. SIX REPEAT
THIS CYCLE ADD INFINITUM. I
TOOK LATIN IN HIGH SCHOOL. MUCH
OF THIS INANE PROCESS WAS
HIGHLIGHTED IN TO NEWTON TO
RECENT NEWS STORIES FROM
CALMATTERS AND L. A. S.
OPERATING WITHOUT STATE
APPROVAL WHAT WE CALL NURSING
HOME SQUATTING IS NOT JUST A
VIOLATION OF OUR STATE POLICY
IN OUR PUBLIC SAFETY NORMS. IT
INVITES SUFFERING AND DEATH.
FACILITIES RUN BY SQUATTERS ARE
AMONG THE WORST NURSING HOMES
IN THE STATE. SQUATTERS HAVE
24% LESS REGISTERED NURSE
STAFFING. MORE STAFF TURNOVER
MORE STATE ISSUE DEFICIENCIES
AND LOWER STAR RATINGS. AND
SQUATTERS TAKE CARE MORE PEOPLE
WHO ARE POOR AND OF COLOR. THE
CHANGE OF OWNERSHIP FARCE IS
BEST ILLUSTRATED BY ANALOGY.
LET'S SAY ON MY WAY HERE I SOLD
MY DRIVER'S LICENSE TO A PERSON
WHO HAS A HORRIBLE HISTORY OF
BAD DRIVING. AND THE DMV HAS NO
SAY. THAT WOULD BE TROUBLING.
NOW IMAGINE MY LICENSE WAS A
COMMERCIAL DRIVER'S LICENSE AND
I SOLD IT TO A PERSON WHO
DRIVES A BUS FULL OF SCHOOL
KIDS EVERY DAY. THAT'S WHAT
WE'VE DONE IN CALIFORNIA. WE
ALLOW LICENSEES TO SELL OR
OUTSOURCE THEIR LICENSES.
UNIMPEDED TO FOLKS WITH VERY
BAD TRACK RECORDS. AND THEN WE
PAY THEM TENS OF MILLIONS OF
DOLLARS TO DO IT. THERE IS
NOTHING MORE FOUNDATIONAL TO
NURSING HOMES AND WHO OWNS AND
OPERATES THEM AND THIS ON THIS
MOST IMPORTANT CONCERN. DPH
JUST TOTALLY FAILS TO GOVERN.
THE SECOND IMPORTANT FACTOR
KNOW ABOUT NURSING HOMES IS
THAT THE MAJORITY THE VAST
MAJORITY. ARE FOR PROFIT
NURSING HOMES RUN BY FINANCE
PEOPLE. THESE FOLKS COULD CARE
LESS ABOUT NURSING OR RESIDENTS
OR QUALITY OF CARE EXCEPT AS IT
RELATES TO MONEY. THE PEOPLE AT
THE CORPORATE LEADERSHIP LEVELS
ARE LIKE MACHINES. PROGRAM TO
FIND THE INCENTIVES AND WEAK
POINTS IN THE SYSTEM AND THEN
EXPLOIT THEM. THERE ARE MYRIAD
INCENTIVES AND WEAK POINTS TO
EXPLOIT MOST OF WHICH HAVE
LITTLE TO DO WITH GOOD CARE.
DPH HAS BEEN NO MATCH FOR THESE
PROFIT MAXIMIZING MACHINES. THE
LAST IMPORTANT FACTOR KNOWS
THAT THERE ARE EPIDEMIC LEVELS
OF ELDER ABUSE AND NEGLECT
OCCURRING CALIFORNIA NURSING
HOMES. WEAK ENFORCEMENT ENABLES
BAD CARE AND DPH ENFORCEMENT IS
EXTRAORDINARILY WEAK. DPH
STREET STANDARDS OF CARE AS
GOALS RATHER THAN ACTUAL
REQUIREMENTS. IN THE PAST THREE
YEARS 97% THREE YEARS. OF THE
THIRTY THREE THOUSAND FEDERAL
DEFICIENCIES THAT HAVE BEEN
ISSUED AGAINST CALIFORNIA
NURSING HOMES INCLUDING STUFF
LIKE. THE ASSAULTS CHEMICAL
RESTRAINTS ILLEGAL EVICTIONS
FALLS BED SORES CHOKING.
CHRONIC UNDERSTAFFING YOU NAME
IT. 97% OF THESE THIRTY
THOUSAND WERE FOUND TO BE QUOTE
NON HARMFUL. THIS WARPED SENSE
OF RESIDENT INJURY LOS
DEMONSTRATES A NURSING HOMES
RATHER THAN THE RESIDENTS ARE
THE CONSTITUENCY WHOSE
INTERESTS ARE PROTECTED BY CDPH.
I ALSO WANT TO MENTION BECAUSE
THIS CAME UP IN THE AUDITOR'S
REPORT- IN TERMS OF
RECERTIFICATION AS I WENT ON
THE ON THE DPH WEBSITE AND I
FOUND IN THE YEAR TWENTY TWENTY
TO TWENTY TWENTY ONE TO FIND
IT. THE FINANCIAL YEAR. THERE
WAS ONE. RECERTIFICATION AND
OVER TWELVE HUNDRED NURSING
HOMES IN THE WHOLE YEAR. ONE
STATE RECERTIFICATION SURVEY.
IN NINETEEN EIGHTY NINE THE
LITTLE HOOVER COMMISSION HAS
GOES BACK TO THE EIGHTIES
EXAMINE DPH AND CONCLUDED
QUOTE. IT DOES NOT HAVE A WHOLE
HEARTED COMMITMENT TO
ENFORCEMENT OF ITS OWN
REGULATIONS. AND QUOTE. THAT IS
IT PRECISELY IN NINETEEN EIGHTY
NINE AND IN TWENTY TWENTY ONE.
REAL ENFORCEMENT REQUIRES A
WHOLE HEARTED COMMITMENT TO THE
WELFARE OF RESIDENTS THEIR
MISTREATMENT ISOLATION AND PAIN
MUST BE VIEWED AS EMBARRASSING
FAILURES. IT MUST BE HANDED.
BUT INSTEAD OF EMPATHY AND
COMMITMENT AND RESOLUTION DPH
REMAINS HALF HEARTED AND
COMPLETELY IMPERVIOUS TO
CRITICISM. THE DEPARTMENT
WEATHER'S ALL CUT DEPARTMENT
WEATHER'S HEARINGS LIKE THIS
NEWS REPORTS LITIGATION. AND
OTHER KINDS OF THINGS NONE OF
IT MATTERS. DPH LEADERS HAVE ON
ROLL THE WELCOME MA FOR BED
NURSING HOME OPERATORS AND
TURNED THEIR BACKS ON THE
RESIDENTS. AS A RESULT OF THIS
APPLICATION CALIFORNIA NURSING
HOMES ARE DOMINATED BY FOR
PROFIT CHAINS THAT AT BEST ARE
KNOWN FOR PUTTING PROFITS OVER
CARE AND IT WORSE FOR ROUTINELY
EXPOSING RESIDENTS TO ABUSE AND
NEGLECT. ARE GOOD RULES MEANT
TO MAXIMIZE THE QUALITY OF LIFE
FOR RESIDENTS ARE ROUTINELY
VIOLATED BECAUSE THERE ARE SO
FEW CONSEQUENCES. HOW CAN YOU
MAKE A DIFFERENCE WELL AB
FIFTEEN OH TWO WOULD BE A VERY
GOOD START. AB FIFTEEN OH TWO
WOULD RAMP UP THE STATE'S
SUITABILITY STANDARDS FOR
OWNERSHIP AND FINALLY AND THE
ZOMBIE NURSING HOME LICENSING
SYSTEM IN CALIFORNIA. AB
FIFTEEN OH TWO WOULD FORCE DPH
BACK INTO ITS ROLE AS A
LICENSING AGENCY. AND A
CONSUMER PROTECTION AGENCY. AND
LET THE BAD OPERATORS KNOW THAT
CALIFORNIA IS NO LONGER OPEN
FOR THEIR KIND OF BUSINESS. I
WOULD LIKE TO PUBLICLY EXPRESS
MY DEEP APPRECIATION. TO MEMBER
MERIT SUCI FOR CHAMPIONING LONG
TERM CARE RESIDENTS THIS PAST
YEAR AND MANY OF MANY OTHER
MEMBERS. THE PANDEMIC HAS
OPENED OUR EYES TO ALL THAT IS
WRONG WITH NURSING HOMES INTO
THE TREMENDOUS SUFFERING
RESIDENTS AND THEIR FAMILIES
ARE EXPERIENCING. WE OWE IT TO
THEM TO TAKE STRONG ACTIONS
THAT WILL REALLY MAKE A
DIFFERENCE IN THEIR LIVES.
LET'S NOT SWEEP THESE TERRIBLE
PROBLEMS UNDER THE RUG ONCE
AGAIN. THANK YOU AGAIN FOR THE
OPPORTUNITY TO TESTIFY AT THIS
VERY IMPORTANT HERE. THANK YOU
VERY MUCH SIR APPRECIATE THAT.
WE WILL NOW GO AHEAD AND MOVE
ON WE HAVE- TWO REPRESENTATIVES
FROM THE DEPARTMENT OF PUBLIC
HEALTH. CASSIE AND SCOTT. HI
GOOD AFTERNOON- THANK YOU
ASSEMBLY MEMBERS PALACE AND
GUESTS- MY NAME IS KATHY DONE
ON MONDAY ACTING DEPUTY
DIRECTOR PERCENT OR PROPER CARE
QUALITY. PLEASE ALLOW ME TO
FIRST- START BY EXPRESSING MY
SINCERE CONDOLENCES TO THE MANY
FAMILIES WHO HAVE EXPERIENCED
LOSSES DUE TO COVER NINETEEN.
DEMOCRATS PRESENTED
UNIMAGINABLE CHALLENGES IN
CALIFORNIA AND ACROSS THE
NATION. DROP THE RESPONSE THE
DEPARTMENT ABSOLUTE FOCUS HAS
BEEN ON SAVING LIVES I
DEMóCRATAS THE WORK OF OUR
STAFF WHO ACTED WITHOUT
HESITANCY TO PROTECT RESIDENTS
IN STOP AND GO NURSING FACILITY.
AT THE SAME TIME EVERY LOST IS
ONE TOO MANY AND WE MUST ALL
REMAIN FULLY COMMITTED TO
IDENTIFYING AND IMPLEMENTING
SOLUTIONS THAT EFFECTIVELY
MITIGATES. RISK FOR OUR
VULNERABLE RESIDENTS IN LONG
TERM CARE. AS WELL AS OUR
COMMUNITY STATEWIDE. AS WE
PROGRESS BEYOND THE MOST
CRITICAL PIECES OF THIS
PANDEMIC AND PLAN FOR THE
FUTURE. WE MUST REVISIT OUR
ACTIONS AND LESSONS LEARNED
FROM THE PAST TWENTY MONTHS.
WHEN WE ENCOUNTERED THE FIRST
SEVERE REACTION TO CODED IN
CALIFORNIA SKILLED NURSING
FACILITIES IN APRIL TWENTY
TWENTY WE IMMEDIATELY
RECOGNIZED THAT THE STATE AND
THE NATION WERE FACING AND ON
PRETENDED. UNPRECEDENTED PUBLIC
HEALTH CRISIS. WITHIN THIRTY
SIX HOURS OF THOSE FIRST EVENT
THE DEPARTMENT SET UP MANDATORY
DAILY REPORTING OF NEW COVET
CASES. FOR ALL TWELVE HUNDRED
SKILLED. OOPS WE LOST OUR- AB
URGENT NEEDS INCLUDING
EQUIPMENT SUPPLIES AND STAFFING.
HARTMAN IMMEDIATELY COORDINATED
DEPLOYMENT OF RESOURCES TO
FACILITIES BASED ON THOSE
RECORDED NEEDS. MONITORING
SYSTEM AND ANINTERNAL
DASHBOARD USING RECORDED NEEDS
INFORMATION COMBINED WITH RISK
DATA THIS INFORMATION WITH THAT
INFORMATION WE WERE ABLE TO
IDENTIFY FACILITIES THAT WERE
AT HIGH RISK FOR OUTBREAKS. AND
REDUCE SHORTAGES. AND THAT'S
TAKE PRO ACTIVE MEASURES TO
ADDRESS THOSE RISK FACTORS.
CENTER RESPONDED TO EVERY
REPORT BY FACILITIES BY WAY OF
TELEPHONE CALLS ARE ON SITE
VISIT. WE ALSO ENGAGED
FACILITIES YOUR WEEKLY WEBINARS
TELECONFERENCES HAS YOUR
UPDATED INFORMATION AND ADDRESS
QUESTIONS AND CONCERNS
EXPRESSED BY FACILITIES. EXPERT
PANELISTS IN AREAS OF TESTING
VACCINE AND THERAPEUTICS AMONG
OTHERS WERE ALSO INCLUDED TO
ANSWER QUESTIONS AND PREVENT
PRESENT NEW INFORMATION. EACH
WEEK TO- DURING A GOLF FACILITY
CALLED. DISSENTER PROACTIVELY
DEPLOYED TEAMS OF INFECTION
CONTROL EXPERTS TO FACILITIES
THAT NOT ONLY HAD OUT ACTIVE
OUTBREAK BUT THAT ALSO WERE
IDENTIFIED. AS HIGH RISK
MODERATE RISK AFTER OUTBREAK
THESE TANKS CONDUCTED FOCUS
ASSESSMENT TO PROVIDE EDUCATION
AND TECHNICAL ASSISTANCE
FACILITY TO IMPROVE INFECTION
CONTROL POLICIES PROTOCOLS AND
REDUCE TRANSMISSION. BETWEEN
JANUARY ONE TWENTY TWENTY AND
SEPTEMBER TWENTIETH TWENTY
TWENTY ONE C. H. C. Q.
COMPLETED OVER THIRTEEN
THOUSAND INFECTION CONTROL
SURVEYS WITHIN SKILLED NURSING
FACILITY. THE SURVEYS NOT ONLY
AFFECT FACILITIES FOR
COMPLIANCE WITH MINIMUM STATE
AND FEDERAL STANDARDS FOR STATE
CARE BUT ALSO AFFORDED THE
CENTER'S STAFF THE OPPORTUNITY
TO WORK COLLABORATIVELY WITH
THE ABILITY TO PROVIDE
TECHNICAL ASSISTANCE AND
EDUCATION AIMED AT MITIGATING
THE SPREAD OF THE VIRUS. AND
SAFEGUARD TO HELP THE RESIDENTS
AND STAFF. THE CENTER ALSO
PARTICIPATED IN ON SITE AND
VIRTUAL SURVEYS- FOR ASSISTED
LIVING FACILITIES LICENSED BY
THE CALIFORNIA DEPARTMENT OF
SOCIAL SERVICES WITH A FOCUS AS
WELL ON INFECTION CONTROL
MEDICATION AND EDUCATION. IN
ADDITION THE DEPARTMENT TOOK
ACTION TO APPROVE TRANSPARENCY
AND ENHANCED COMMUNICATION TO
THE PUBLIC. ABOUT HEALTHCARE
FACILITIES BY CREATING A CO THE
NINETEEN WEBSITES HIGHLIGHT
MITIGATION STRATEGIES SUCH AS
INCREASING INFECTION PREVENTION
EDUCATION AND FACILITIES. TO
RELEASE SOME REAL TIME CHIEF
DATA TO DISPLAY INTERACTIVE
NATIONAL GRAFT ENSURE UP TO
DATE FACILITY INFORMATION FOR
FACILITIES CONCERNED ABOUT
THEIR LOVED ONES. THROUGHOUT
THE PANDEMIC IN CONTINUING
TODAY THE THUNDER CONTINUES TO
CONDUCT INFECTION CONTROL
MEDICATION SERVICE ON SITE. AND
KILL NURSING FACILITIES TO
ENSURE COMPLIANCE WITH CDC AND
CDPH RECOMMENDS STATIONS AND
REQUIREMENTS FOR PROTECTING THE
HEALTH AND SAFETY OF RESIDENTS
AND STAFF. ONE OF THE MAJOR
CHALLENGES WE FACED PRIOR TO
AND DURING THE PANDEMIC AS
WELL- AS SOME OF THE PRIOR-
ANALYSTS HAVE MENTIONED IS A
WORKFORCE SHORTAGE IN HEALTH
CARE SETTINGS AND IN PARTICULAR
LONG TERM CARE. THE STATE TOOK
PROACTIVE EFFORTS TO ACQUIRE
STAFF NATIONWIDE TO ASSIST IN
CALIFORNIA'S RESPONSE. JUST TAP
SHORTAGES I THINK THE POINT
MORE THAN WHITE FIVE THOUSAND
HEALTH CARE PROFESSIONALS WHO
PROVIDED DIRECT PATIENT CARE
AND HEALTH CARE FACILITIES.
DURING THE PEAK OF THE
HEALTHCARE CRISIS. WHILE
EXACERBATED BY THE PANDEMIC
WEEK KNOWLEDGE THE ONGOING
CRITICAL HEALTHCARE WORKFORCE
SHORTAGE IN CALIFORNIA AND LOOK
FORWARD TO PARTNERING. WITH AT
THE AYE YOU CAST. THAT THE
LADIES AND OTHERS TO IMPLEMENT
EFFECTIVE STRATEGIES TO BOLSTER
OUR RESOURCES AND ADDRESS THIS
CRITICAL ISSUE. A SOLUTION TO
THIS LONGSTANDING PROBLEM WILL
REQUIRE A THOUGHTFUL ROBOT AND
WELL DEVELOPED PLAN OVER THE
SHORT AND LONG TERM. THE
CENTER'S EFFORTS WERE AIDED BY
CONTINUED INPUT FROM OUR
STAKEHOLDERS. ADVOCACY GROUPS
AND THE PUBLIC. WHO INFORMED
THE DEPARTMENT ON HOW OUR
POLICIES AND PROCEDURES
AFFECTED RESIDENTS AND FAMILY.
THEIR INSIGHTS ARE CRUCIAL
TOWARDS ACHIEVING OUR SHARED
GOAL OF PATIENT AND REGISTER
RESIDENTS. SAFETY AND QUALITY
OF CARE. ON WEEKLY CALLED AND
WRITTEN TO. THE CENTER HAS
COMMUNICATED THE BENEFITS OF
VACCINATION AND CONTINUE TO
ENCOURAGE VISIBILITY STAFF
RESIDENTS TO BECOME VACCINATED
AS A BEST PRACTICE. TO KEEP
THEM SAFE FROM SEVERE DISEASE.
THE DEPARTMENT HAVE ALSO
PROVIDED USEFUL RESOURCES TO
FACILITY TO PROMOTE VACCINATION
EFFORT. FROM A BROAD
PERSPECTIVE LOOKING BACK THE
ACTIONS OF THE DEPARTMENT IN
PARTNERSHIP WITH THE ABILITY
OPERATORS TAKE COLDER THAN
ADVOCATE HAS TRANSFORMED
OPERATIONS AND THE
RELATIONSHIPS BY WHICH WE
INTERACT AS WE SHIFT OUR FOCUS
TOWARDS THE FUTURE IT IS VITAL
THAT WE INCORPORATE LESSONS
LEARNED. FROM THE PAST. THE
COSBY NINETEEN PANDEMIC HAS
ELIMINATED THE NEED FOR
PREDICTIVE ANALYTICS AS A TOOL
TO HELP OVERSIGHT AGENCIES AND
FACILITIES LIKE. TO PREPARE FOR
AND RESPOND TO OUTBREAKS. WE
CONTINUE TO REFINE THE PROCESS
AS NEW DATA EMERGES AND FOR
FUTURE INFECTIOUS DISEASE
OUTBREAKS AND MONITORING OF
COMPLIANCE TRENDS. THANK YOU
FOR THE OPPORTUNITY TO
PARTICIPATE IN TODAY'S
CONVERSATION I APPRECIATE THE
COLLECTIVE PASSION AND
DEDICATION OF OUR INDUSTRY
LEADERS ARE STAKEHOLDERS ARE
ADVOCATE. ANALYST TODAY AND MY
OWN TEAM. I AM PROUD TO SERVE
ALONGSIDE YOU- AS WE AWAITED
THERE AT THE IMPACT OF COKE AT
NINETEEN AND AS WE APPROACH THE
FUTURE. BEFORE I- INVITE MY
ASSISTANT DEPUTY DIRECTOR TO
SPEAK- AND PROVIDE MORE
ADDITIONAL INFORMATION ABOUT-
OUR CENTERS CURRENT AN ONGOING
OBJECTIVES. I DO WANT TO
BRIEFLY JUST TOUCH ON A FEW
TOPICS MENTIONED BY SOME OF THE
OP PREVIOUS PANELISTS- THE
CITATION- TIMELINE THAT WAS
MENTIONED BY. THE AUDITOR- OUR
MOST RECENT- QUARTERLY METRICS
DO INDICATE THAT THE DEPARTMENT
THE CENTER IS 84% COMPLIANCE-
FOR ISSUING OUR CITIZENS WITHIN
THIRTY DAY TIMELINE- OUR
IMMEDIATE JEOPARDY ARE MOST
SEVERE- LEVEL ALLEGATIONS ARE
WHETHER THEY BE COMPLAINTS OR A
FACILITY REPORTED EVENT. WE ARE
83% COMPLIANT IN INITIATING
THOSE WITHIN THE TWENTY FOUR
HOUR TIME LINE- WITH REGARD TO
HIRING AND RETAINING PURVEYOR
THIS IS AN ABSOLUTE- IMPORTANT
TOPIC THAT WE HAVE BEEN-
ADDRESSING AT THE- A FORMER
PANELISTS MENTIONED WE DID
ENTER INTO A CONTRACT WE HAD.
GREAT SUCCESS WITH THAT
RELATIONSHIP AND THE WORK THAT
WAS DONE THERE AND BECAUSE WE
KNOW THAT THIS IS A LONG TERM
INITIATIVES THAT WE NEED TO
GIVE APPROPRIATE ATTENTION TO
WE HAVE BEGUN BUILDING OUT- A
RESOURCE UNIT OCT THE TYPICALLY
FOCUSED ON ONGOING HIRING AND
RETENTION EFFORTS WITHIN OUR
CENTER- WITH REGARD TO RE
LICENSING SURVEYS. AND THE- THE
TIMELINE CYCLE FOR THE TWELVE
MONTHS OR PERSONS TWENTY FOUR
MONTHS- AND AS WELL AS THE
FIFTEEN POINT NINE ONE CYCLE
FOR- RE CERTIFICATION SURVEY
TRUSTKILL NURSING FACILITIES.
NOTHING WOULD PROHIBIT THE
DEPARTMENT FROM. COMPLETING OUR
RELICENSING SURVEY CYCLE AT THE
RECERTIFICATION PROCESS THAT
SOMETHING THAT WE HAVE ADOPTED
OVER THE YEARS- WHAT THAT MEANS
IS THAT WE WOULD BE POTENTIALLY
DELAYED- BY THREE MONTHS IF
THAT WERE THE CASE. OR THE
FEDERAL RECERTIFICATION CYCLE
WOULD OCCUR MORE FREQUENTLY ON
THE TWELVE MONTH CYCLE- ONE OF
THE CHALLENGES AND
COMPLICATIONS OF THAT OF
COURSE- THAT MAKES IT A LITTLE
LESS EFFICIENT IN FACT THE
FEDERAL PROCESS IS ANY OUR
DATABASE- LIKE TRONIC- SURVEY
PROCESS. WHERE THE STATE
PROCESS CANNOT BE FOLDED INTO
THAT ELECTRONIC INVESTIGATION
AND SO THERE'S HAVE TO
SIMULTANEOUS FUNCTIONS THAT
OCCUR AT THE SAME TIME. AND
THEN LASTLY I JUST WANT TO SAY
THAT THAT WE TO SHARE THE
CONCERNS- ABOUT- COST REPORTING
AND FINANCIAL DATA- BUT YOU
WANT TO CLARIFY THAT THIS IS
OUT OF THE SCOPE OF CDPH CENTER
FOR HEALTH CARE QUALITY. AND
IS- RESPONSIBILITY IN WITHIN
THE SCOPE OF SOME OF OUR OTHER-
PARTNER DEPARTMENT IN
CALIFORNIA. BUT THAT I- IN. GOT
MY MEN ARE GET THE DIRECTOR TO-
ACIDENTE ACTOR CHAD MORE
INFORMATION TO BACK. THANK YOU.
GOOD AFTERNOON CHAIRMAN
COMMITTEE MY NAME IS COME UPON
AND BECAUSE YOU MENTIONED I AM
THE ASSISTANT DEPUTY DIRECTOR
OF THE CENTER OKAY IN THE
LICENSING IS DIVISION. WE'RE
GONNA. OUR COURT. INCREASING
BACKS RATES HAVE SLOWED
TRANSMISSION. REDUCE SERVICE
UNLESS BOTH RESIDENTS AND THE
TIME IS NOW PART OF TO BEGIN
PLANNING FOR THE FUTURE. AS WE
LOOK BACK TO PRE PANDEMIC
MANDATED WORK MORE. SEE SECURES
BOUNCING THE RESUMPTION OF
ROUTINE CYCLICAL WORK WITH
RESPONSE FIRST YEAR LOCALIZED
SEARCHES NUMBER REGENCY
SITUATIONS SUCH AS FIRES. IN
PUBLIC SAFETY PARKS ON ARTS. WE
ARE CURRENTLY DEVELOPING A
FEDERAL WORKER TENT WHICH WILL
GRADUALLY INCREASE OUR ROUTINE
FEDERAL WORK OVERTIME RESTORE
PRE PANDEMIC OVERSIGHT. THIS
RECOVERY PLAN IS IMPACTED BY
SEVERAL FACTORS. SAMPLE SOME
PLEASE ON THE GO FULL THROTTLE
SERVICE ONCE EVERY THREE YEARS
OTHERS ARE SURVEYED ANNUALLY.
TEACHING SECURITAS RECEPTIONIST
RECTORY'S WITH ANY IMMEDIATE
NEEDS FOR FEDERAL AND STATE
INFECTION CONTROL RESPONSE
ACTIVITIES ESPECIALLY WITH NEW
CODE NINETEEN OUTBREAKS AND
SEARCHES. AND SEE CURES
ACTUALLY ADDRESSING WORKFORCE
NEEDS RESUMING OFFICER TRAINING
CORPS NEW STAFF WHO HAS TURN
OVER THIS LAST IN EIGHTEEN
NINETEEN MONTHS. WHAT WE
PRIORITIZE A TRAINING OVER
NURSING SO WE MUST ALSO
CONSIDER. TRAINING FOR OTHER
CRITICAL JUST WANTS TO ENSURE
SAFETY ALL FACILITIES REQUIRES
THAT WE- AND OVERSEE. THE
DEPARTMENT ACKNOWLEDGES THAT
REGULATIONS HAVE A DIRECT
IMPACT ON THE QUALITY OF CARE
IN OUR STATE SKILLED NURSING
FACILITIES IN SETTINGS. AND
WE'VE IDENTIFIED THE NEED TO
REVISE THIRTY DIFFERENT
REGULATION PACKAGES. TO UPDATE
OUR TELEPHONE THROUGH
REGULATIONS. OF THE THREE TOTAL
PACKAGES CCQ CURRENTLY HAS.
TWELVE VARIOUS STAGES OF
DEVELOPMENT. OVER THE LAST
TWENTY HOWEVER PROGRESS HAS
BEEN DELAY DUE TO REDUCE OF
THOSE POLICY STAFF TO COURT
NINETEEN GUIDANCE FOR HELP TO
PROVIDE. WRITERS AS WE
TRANSITION BACK TO OUR REGULAR
WORKLOAD CCQ HAS RESUMED WORK
ON REGULATION DEVELOPMENT AND
DISCUSSION STAKEHOLDER MEETINGS
ON THOSE ACTIONS. SEE YOUR IS
ALSO COMMITTED TO ADDRESSING
CAJUN AND UNRESOLVED COMPLAINTS
AGAINST INSULATION PROVIDERS.
RIGHT HANDER RICK CDPH WATCH IN
ADDITION TO ADDRESS OUR LONG
STANDING BACK LOOKING
COMPLAINTS. WELL WE HAVE HAD TO
CONTEND WITH BECAUSE- THIS
BOOKS ADDITION OF. DURING
PERIODS OF HEIGHTENED CODE
NINETEEN RESPOND. WE CONTINUE
CONDUCTING ABSOLUTE REPORT AND
WISHES AS EXPERT AS POSSIBLE.
TO DATE WE HAVE REDUCED OVERALL
COMPLAINT BACKLOG FOR BOTH NOT
A LONG TERM CARE AND TERM CARE
PLEASE BY FORTY THREE POINT 4%
WELL SLIGHTLY MORE THAN 50%
REDUCTION SPECIFICALLY OR LONG
TERM CARE UNIVERSE. OUR
COMMITMENT TO APPROVING
TIMELINESS OF. FURTHER MY
CURRENT OF THE PEOPLE'S NATION
PROCESS TO INCREASE IN THE TO.
NO NO SKATER MY- TO BE CLEAR.
AS ALWAYS DURING AS ALWAYS
ANOTHER EPIDEMIC CDC. TYSON
THIS CASE INSTEAD OR- AS WE
REMAIN TO CONSIDER QUALITY.
SPEECH THAT YOU'RE WELCOME
SURVIVAL RIGHT THIS FUNDING
AGENCIES AND WE NOTE THAT SEATS
THE CURE HAS CLOSED A TOTAL OF
THIRTY SIX I DON'T SEE A STATE
AUDIT RECOMMENDATIONS SAYS
TWENTY THIRTEEN AS OF THIS
MONTH OCTOBER TWENTY TWENTY ONE
ONLY THREE NATIONS REMAIN OPEN
ONE OTHER. THING WE PROJECT
FOR. GILBERTO'S RECOGNITION AND
TO RIGHT TO. RECOGNITION OF
ARCHIVE FORCED IN. CCH HAS
INCREASES THAT RESTRICT
EXPEDITIONS THREE APPROVED.
AUGMENTATIONS AS WELL AS
RENEWAL NURSES CERTIFICATION.
DURING THE PANDEMIC SEASICK
HERE RELAX REQUIREMENTS FOR
CERTIFIED NURSING ASSISTANTS
WORK WITHOUT DISTURBING
ADDITIONAL CONTINUING EDUCATION
ANALOG SYSTEMS TO WORK WHAT I
SPENT TIME WITH UP AND COMING
STAR. TO SECURE CURRENTLY
DEVELOPING AN ELECTRONIC SYSTEM
AUTOMATION FOR THE REGISTRY
UNIT THIS SYSTEM IS EXPECTED TO
GO PUBLIC IN EARLY TWENTY
TWENTY TWO. WITH THIS NEW
SYSTEM. WILL BE ABLE TO SUBMIT
THEIR APPLICATIONS ARE NOT
GREAT THE SIMPSONS PORTAL THIS
CYNICAL YOU'RE DECREASING
PROCESSING. FOR NEW RENDERINGS
UNITED'S. WELL THIS WILL
ADDRESS SOME IMMEDIATE
CHALLENGES ADDRESSING THE
OVERALL ISSUES WILL REQUIRE
CONTINUED PARTNERSHIP WITH
STAKEHOLDERS THE- ADVOCATES.
AND EDUCATIONAL ORGANIZATIONS
TO DEVELOP. SHORT AND LONG TERM
SOLUTIONS. I WANT TO THANK THE
COMMITTEE FOR HOLDING THIS
HEARING IN FLORIDA BRANCH. ITS
RESIDENTS. THANK YOU VERY MUCH-
LIKE TO TURN TO THE COMMITTEE
FOR QUESTIONS MISTER KALRA. I
THANK YOU FOR THAT THANK VERY
MUCH MATURE INTO TO ALL THE
PANELISTS ARE FOR YOUR
EXPERTISE- AND- DO YOU WANT TO
THE PRESENT ORDER REFERRED SB
THIRTY THREE TWENTY THREE I
WANT TO. THANK THE GOVERNOR
SIGNED THE BILL ON OUR CHILDREN
AND STAFF FOR FIVE YEARS TO
WORK ON IT. THAT'S HOW LONG IT
TOOK TO GET A BETWEEN TWENTY TO
GET IT SIGNED INTO LAW. I THINK
IT'S AN EXAMPLE OF- THE
IMPORTANCE OF WHAT WE'RE DOING
HERE TODAY BUT ALSO THE FACT
THAT WE DO NEED TO I THINK
WE'VE HEARD FROM SO MANY FOLKS
AS SPOKEN READY- AND BE MORE
URGENT. AND HOW WE RESPOND
RESPOND AND REACT. TO WHAT WE
KNOW- IS A CRISIS. AND I THINK
THAT- AS ARCHER INDICATED WE
GET. RIVER TOLD OFTENTIMES
YOU'LL THERE'S A WE NEED TO DO.
WE TRY TO ACT AS A- AS A
LEGISLATURE AND IT JUST SEEMS
LIKE WE GET STALLED. FAR TOO
OFTEN- AND SORT OF JUST A
COUPLE OF QUESTIONS WHEN I HAVE
PER ROOMS. BALLANTINE- THANKS
FOR YOUR YOUR YOUR YOUR PASS
INTO- STATEMENT. WHERE DO YOU
THINK I WANT ONE QUESTION IS
REGARDING THE KIND OF THE- THE
REGULATIONS AND WHERE THE STATE
CAN IMPROVE- IN ITS REGULATORY
DUTIES. TO REDUCE NURSING HOME
KIND THE KIND OF REDUCE THE-
NOT JUST THE LIABILITY BUT
REALLY I THINK THAT YOU YOU
POINTED TO THE FACT THAT OFTEN
TIMES. IT'S REALLY DIFFICULT-
FOR. PATIENTS ARE OR FOR THOSE
THAT ARE RESIDENTS TO ACTUALLY
ACCESS JUSTICE- IS ONE OF THE
THINGS THAT WE CAN DO FROM A
REGULATORY PERSPECTIVE THAT
WOULD. HELP I HAVE YOUR BACK-
THE OR PUT THE CURTAIN OR OR
PULL BACK TO SOMEWHAT. ON
WHAT'S HAPPENING- TO SO MANY
BECAUSE I'VE HEARD SO MANY
ANECDOTALLY I'VE HEARD SOME
FROM SOMEBODY MY CONSTITUENTS
ON ISSUES THAT OF CARD WHAT CAN
YOU DO. REGULATORY PERSPECTIVE-
IF YOU HAVE THE NAME DISPLAY A
LOT OF THINGS WERE ONE OR TWO
THINGS THAT YOU THINK ARE THE
MOST URGENT. SO I THINK ONE OF
THE THINGS THAT I WOULD HIGHLY
RECOMMEND IS THAT CONSISTENT
APPLICATION OF THE REGULATIONS-
THAT'S THE NUMBER ONE THING AND
QUITE FRANKLY THAT DOESN'T
OCCUR I'M I WAS I KNOW WE WHAT
WE BALLING DRASTIC HERE TODAY
I'M THE APPLICATION OF A
PARTICULAR REGULATORY VIOLATION
AND ONE FACILITY VERSUS ANOTHER
FACILITY THE OUTCOMES ARE
INCREDIBLY DIFFERENT. I'M AND I
MEAN QUITE FRANKLY. I NEVER
MENTIONING THAT BEFORE WE CAME
IN TODAY THOUGHT WHEN YOU LOOK
AT THE HISTORY OF HOW THE-
SADLY HOW THE DEPARTMENT OF
PUBLIC HEALTH HAS NOT STOPPED
UP I AND HOW THEIR HISTORY JUST
CONTINUES TO REPEAT ITSELF IT'S
NO WONDER. THAT THE FACILITY
OWNERS AND KNOW THAT THEY CAN
GAME NOT SYSTEM. AND BEER AS I
MENTIONED AND MY REMARKS- WHEN
I FIRST STARTED DOING ELDER
ABUSE LITIGATION THERE WERE
QUITE A NUMBER OF DEFICIENCIES
AND QUIET A NUMBER OF
CITATIONS. AND IT WAS WEDNESDAY
WHEN SOMEONE DIED IN A NURSING
HOME THERE SEEM TO BE AN ACTUAL
REVIEW OR TO TRY AND DETERMINE
IF THOUGHT DEATH WAS ACTUALLY
RELATED. WHERE I WAS NOW WHAT I
SAW THERE WAS THIS PROGRESSION
AND WHAT I SAW WAS THIS VERY
SHARP DROP OFF. WHERE WE WENT
FROM CITING NURSING HOMES.
CLASSE DOUBLE A. CITATIONS WE
STOP DOING NOT AND WHAT
HAPPENED WAS THEY JUST BECAME
SUB STANDARD DEFICIENCY SO THEY
WERE THERE'S A SCOPE AND
SEVERITY FOR EACH OF THE
DEFICIENCIES AND THAT AND THEY
BECAME A SUB STANDARD
DEFICIENCY WHICH WAS PERHAPS A
G. SUCH A DEFICIENCY BUT NO
LONGER WEAR THOSE DEFICIENCIES-
RISING TO THE LEVEL THAT THEY
WERE CLASS A. R. W. CITATION. I
ONLY KNOW MY LITTLE WORLD OF
WHAT I DO ALL I CAN TELL YOU IS
WHAT I'VE SEEN OVER THE LAST
TWENTY THREE YEARS. BUT IT WAS
VERY VERY VERY OBVIOUS TO ME
THERE ARE STILL IT'S LIKE.
BLACK AND WHITE WHAT IS NOW A
G. DEFICIENCY USED TO BE AN
ESSAY OR A DOUBLE A CITATION.
SO I DON'T KNOW WHAT HAPPENED
IN THAT PROCESS I FEEL LIKE
THERE NEEDS TO BE. AS A CIVIL
LITIGATOR WHAT I FIND IS THAT
PEOPLE ONLY SEEM TO CARE WHEN
YOU HIT THEM AND THE ONE THING
THEY CARE ABOUT WHICH IS MONEY.
AND THAT'S A VERY SAD. STATE OF
AFFAIRS BUT IT IS THE REALITY.
SAYS CITING THE FOR DEFINING
THESE FACILITIES DEFICIENT AND
SITTING GIVING THEM ALL OF THE
STATEMENTS OF DEFICIENCIES THEY
DON'T EVEN THEY DON'T EVEN CARE
AND QUITE HONESTLY ALL THEY
TELL ME. WHEN I ASK THEM ABOUT
THESE REPEAT DEFICIENCIES WHERE
YEAR AFTER YEAR AFTER YEAR THEY
JUST KEEP GETTING CITED FOR THE
SAME THING. ALL THEY TELL ME IS
THAT THE DEPARTMENT OF PUBLIC
HEALTH. QUITE FRANKLY DOESN'T
KNOW WHAT THEY'RE DOING. I'M
NOT THE WHOLE PROCESS DOESN'T
REALLY WORK AND THAT THEY DON'T
REALLY PAY ATTENTION TO THOSE
STATEMENTS OF DEFICIENCIES
ANYWAY. AND THEY LITERALLY JUST
BALK AT THE ENTIRE SYSTEM AND
PAY IT NO NEVER MIND. NOW WHAT
THEY WOULD CARE ABOUT IS IF THE
STATE ONE IN AND LEVY A FINE
AGAINST THEM. AND IF IT'S NOT
ACTIVE THOUGHT PROCESS ACTUALLY
WORK I THINK THAT THEN AT LEAST
IT MIGHT CAUSE THEM TO HOP SOME
LEVEL OF POLISH. SO I WHATEVER
WE WERE DOING BEFORE WHERE WE
WERE ISSUING MONEY- CITATION.
NEEDS. TO BE RE IMPLEMENTED IF
YOU WERE TO ASK ME. YOU CAN
TELL CAN ZURCHER. I MEAN COMMON
THE- YES I'D BE DELIGHTED TO-
SO THERE'S A LITTLE BIT OF A
PROBLEM WITH THIS BECAUSE IT'S
IT BRINGS IN A LOT OF THE
FEDERAL RULES AND LAWS BUT I
THINK ONE THING WE COULD DO
RIGHT AWAY IS TO. CHANGE THE
PRESUMPTION FROM NO HARM ON A
LOT OF THESE DEFICIENCIES AND
CITATIONS TO A RESUMPTION OF
HARM- ESPECIALLY ON ISSUES LIKE
CHEMICAL RESTRAINTS- WHICH WE
SEE TIME AND TIME AGAIN. IF
YOU'RE TAKING AN INAPPROPRIATE
MEDICATION THAT CHANGES THE WAY
YOUR MIND WORKS AND IT'S AN
APPROPRIATE I THINK THAT THAT'S
DE FACTO HARMFUL AND IN THE
DEPARTMENT NEVER TREATS THINGS
THIS WAY- SO THAT'S WHAT NUMBER
ONE NUMBER TWO I THINK THAT'S
REALLY IMPORTANT IS. THAT YOU
KNOW. MY STRONGEST FEELINGS IS
THAT. THE BEST ENFORCEMENT
GONNA COME FROM THE CONSUMERS
THEMSELVES IF THEY'RE IN POWER
TO DO THAT AND ASSEMBLY BILL
EIGHT FORTY NINE WHICH-
REINVIGORATED HEALTH AND SAFETY
CODE FOURTEEN THIRTY B. IS A
GREAT STEP IN THAT DIRECTION
BUT GIVING CONSUMERS THE
ABILITY TO SELF AND FORCE A LOT
OF THESE REGULATORY
REQUIREMENTS I THINK IS THAT
WOULD BE IT WOULD BE AWESOME-
AND GIVING. THEIR CONSUMERS
MORE CONTROL OVER HOW THEIR
MONEY IS SPENT IF THEY HAVE A
GREAT EXPERIENCE THEY THEY PAY
MORE MORE MONEY IS A LOT OF SO
EVEN IF THEY HAVE A BAD
EXPERIENCE. AND THEN. WE REALLY
NEED TO END THIS IS WHAT I CALL
THE WEEKEND AT BERNIE'S PROBLEM
WHERE WE'VE GOT ON. ON THE
DEPARTMENT'S CONSUMER WEBSITE
IS THE- WEBSITE WE INVITE
CONSUMERS TO GO TO GET
INFORMATION ABOUT THE FACILITY.
YOU SEE. AN ENTITY THAT NO
LONGER EXISTS AS A LICENSING
HASN'T EXISTED FOR YEARS. AS
THE LICENSEE AND THERE'S NO
INDICATIONS TO THE PUBLIC AS TO
WHO'S ACTUALLY CONTROLLING IT
SO WE NEED TO. AND THAT
COULDN'T GET INFORMATION. SO
THAT THEY'RE NOT. THE FACILITY
NO LONGER CONNECTED WITH
BURNING A DEAD GUY WE'RE
CONNECTED TO THE ACTUAL PERSON
WHO LIVES THERE. ARE WHO'S
WHO'S RUNNING THE PLACE. AND WE
ALSO NEED TO BE ABLE TO
IDENTIFY FACILITIES BY CHANGE
YOU GO ON THE WEBSITE. YOU SEE
ONE FACILITY THERE'S NO
CONNECTION THERE'S YOU REALLY
HAVE TO SEARCH HARD. AND
CONSUMERS CAN'T DO THIS TO FIND
OUT WHAT OTHER FACILITIES ARE
CONNECTED TO. THANK YOU. THANK
YOU. OTHER MEMBERS RESPUESTA.
THANK YOU VERY MUCH I I'D LIKE
TO- ASK YOU THAT- MS DUNHAM. HE
BROUGHT TO THE HER. HEARING
ROOM MONITOR IF NOT TO IS THERE
ANYBODY THERE. I AM HERE OKAY
THANK YOU. SO OF. IS DONE- AS
THE ACTING DEPUTY DIRECTOR FOR
THE CENTER FOR HEALTH CARE
QUALITY. WHAT WHAT WE'RE
HEARING OR OR WHAT I'M HEARING.
IS A LENGTHY HISTORY THAT GOES
BACK DECADES. OF THE DEPARTMENT
OF PUBLIC HEALTH- FAILING TO
CRACK DOWN ON BAD ACTORS THAT
ARE GAMING. THE SYSTEM WHERE
TAXPAYER DOLLARS ARE NOT GOING
TO NURSING HOME CARE. I'D
RATHER THEIR ENRICHING THE
NURSING HOME OWNERS- AND IT
SEEMS I MEAN I I'VE ONLY BEEN
STARTED TO DELVE INTO. THESE
NURSING HOME IN- INDUSTRY
ISSUES. AND IN THE LAST TWO
YEARS- RELYING. ON MANY PEOPLE
THAT TO HAVE BEEN WORKING
COLLECTING CALIFORNIA.
ADVOCATES FOR NURSING HOME
REFORM- FOR MUCH LONGER PERIOD
OF TIME BUT IT SEEMS LIKE. WE
REPEATEDLY SEE THE SAME BAD
ACTORS COMING FORWARD- CITED IN.
LAWSUITS CITED IN- EVEN
DEPARTMENT OF PUBLIC HEALTH
APPLICATION DENIALS. AND I AM.
I DISCUSSED EARLIER. A LAWSUIT.
THAT WAS FILED BY RESIDENTS IN
THE READING AREA OF THE FAMILY
MEMBERS OF RESIDENTS AT THE
FORMER WINDSOR READING NURSING
HOME FACILITY. AGAINST WHEN'S
THE RIGHT READING SLOW MO
RECHNITZ. YES MANAGEMENT IN
OTHER RELATED PARTIES. AND THIS
FACILITY. IS BEING IS OWNED. BY
MR RECHNITZ. WHOSE APPLICATION
FOR A LICENSE TO. OPERATE THIS
FACILITY WAS DENIED BY THE
DEPARTMENT OF PUBLIC HEALTH IN
JULY OF TWENTY SIXTEEN ARE YOU
ARE YOU ARE YOU AWARE OF THIS-
THIS DENIAL THE APPLICATION.
YEAH. NO I'M NOT REFERRING TO
THE LETTER FROM THE DEPARTMENT
OF PUBLIC HEALTH DATED JULY
EIGHTH OF TWENTY SIXTEEN SIGNED
BY THERESA GOOD TERRACE CHIEF
CENTER FOR HEALTH CARE QUALITY
NOTICE OF DENIAL APPLICATION.
AND IT STAYS IN RELEVANT PART
THAT THE CDPH DENIES YOUR
APPLICATION FOR A LICENSE TO
OPERATE. THE ABOVE REFERENCE
FACILITY. AND IN DETERMINING AN
APPLICANT'S ABILITY TO COMPLY
WITH THE RELEVANT HEALTH AND
SAFETY CODE REGULATIONS THE
CDPH REVIEWS THE COMPLIANCE
HISTORY OF FACILITIES OWNED
MANAGED OR OPERATED EITHER
INDIRECTLY TO OR DIRECTLY BY
THE APPLICANT. AND IT GOES ON
TO CITE OVER TWO HUNDRED SIXTY
FIVE REGULATORY VIOLATIONS AS
THE BASIS FOR THE DENIAL OF
THIS APPLICATION. AND YET. MR
RECHNITZ CONTINUES TO. OPERATE
THIS. NURSING HOME. UNDER THE-
THE FORM THE LEGAL- FORMS OF
THE PREVIOUS OWNER FROM WHICH
MR RECHNITZ BOX BOB THE HOPE
NURSING HOME FROM AS THE
CURRENT LICENSEE HOW IS THIS.
PROTECTING THE NURSING HOME
RESIDENTS AT. THIS FACILITY
WHEN SOMEONE CAN CONTINUE TO
OPERATE A NURSING HOME WHEN
THEY HAVE THEIR LICENSE
APPLICATION DENIED. THANK YOU
FOR THAT THAT'S A VERY
IMPORTANT QUESTION- I DO WANT
TO ACKNOWLEDGE THAT THE
DEPARTMENT HAS RECOGNIZED THAT-
STATUTE CURRENTLY GOVERNING
SKILLED NURSING FACILITY NOT
ONLY OVERSIGHT BUT CHANGE OF
OWNERSHIP PROCESS- MAY BE
LACKING AND MAYBE. NOT
PREVENTING CERTAIN SITUATIONS
FROM OCCURRING- I WANTED TO
SHARE THAT- CURRENT STATUTE
DOES NOT PROHIBIT A AN EXISTING
LICENSE FEE FROM ENTERING INTO
A CONTRACT. THAT ALLOWS-
MANAGEMENT OF THE FACILITY TO
BE PERFORMED BY ANOTHER PARTY-
IN THIS PARTICULAR CASE BECAUSE
THEY'RE THEY- CHANGE OF
OWNERSHIP THAT WAS PENDING AT
THE TIME. THE CURRENT AND-
EXISTING- LICENSE HOLDER I.
ENTERED INTO IN A- MANAGEMENT-
TRANSFER AGREEMENT WHICH IS A
TEMPORARY AGREEMENT BETWEEN THE
CURRENT LICENSE IN THE
PERSPECTIVE LICENSEE- OR THE
APPLICANT- Q. YOU KNOW BEGIN
OPERATING ON THEIR BEHALF WHILE
THE CHANGE OF OWNERSHIP
APPLICATION IS UNDER
CONSIDERATION. AT THE TIME THAT
THE- IN THE EVENT THAT AN
APPLICATION IS DENIED THE
REQUIREMENT FOR OPERATIONS
STILL REMAINS AND FALLS TO THAT
PERMANENT LICENSE FEE THAT'S ON
RECORD- BUT AGAIN- THERE IS NO
RESTRICTION OR PROHIBITION-
THAT THE- LICENSE HOLDER- NOT
BE ABLE TO ENGAGE IN A BUSINESS
AGREEMENT WITH- AN OPERATING
PARTY OUR MANAGEMENT- ENTITY.
TO CONTROL THE DAY TO DAY
OPERATIONS IN THE BUILDING AND
THAT IS THAT IS THE EXAMPLE OF
WHAT YOU HAVE IN THIS
PARTICULAR CASE. SO. I
APPRECIATE TO YOUR EXPLANATION
OF THE DEPARTMENT OF PUBLIC
HEALTH POSITION- I OF. AND
FOCUSING ON YOUR USE OF THAT
THE THAT THE- THE WORD
TEMPORARY IN AND IN TERMS OF
THE TEMPORARY OPERATION OF THE
FACILITY WHILE THE- LICENSEE OF
RECORD CONTINUES TO BE. NOT THE
CURRENT OWNER OF THE NURSING
HOME BUT THE PREVIOUS OWNER THE
OWNER WHO SOLD THE PROPERTY AND
PRESUMABLY HAS NO. CONTROL OVER
THE CURRENT OPERATION OF THE
NURSING HOME. FIRST OF ALL ON
ON THE TEMPORARY ASPECT OF IT I
MEAN THIS PARTICULAR EXAMPLE
BUT THAT ARE RAISED REGARDING
WINDS WINDSOR- READING. THE
DENIAL WAS IN TWENTY SIXTEEN
AND WE ARE MORE THAN FIVE YEARS
AFTER THAT. ONE DOES TEMPORARY
STOP BECOMING TEMPORARY IN
TERMS OF ALLOWING. SOMEONE WHO
APPLICATION WAS DENIED TO
CONTINUE TO BE ABLE TO OPERATE
THE FACILITY. SO THE TEMPORARY
NATURE OF THAT AGREEMENT- WAS
DURING THE PERIOD THAT THE
APPLICATION WAS UNDER REVIEW BY
THE DEPARTMENT. SUBSEQUENT TO
THE DENIAL THE LICENSEE WHO
REMAINS THE ORIGINAL LICENSEE.
HAS ENTERED INTO AN AGREEMENT
AND IT'S NOT OTHERWISE
PROHIBITED FROM DOING SO BY
STATUTE OR REGULATION. I HAD TO
ENTER INTO A BUSINESS AGREEMENT
TO HAVE ANOTHER ENTITY OPERATE
THE DAY TODAY- CARE AND DIRECT
THE DAY TO DAY CARE IN THE
FACILITY SO WHILE TEMPORARY AT
THE TIME FOLLOWING THE DENIAL
IT'S NO LONGER TEMPORARY
THERE'S A PERMANENT AGREEMENT
BETWEEN THE TWO ENTITIES. OKAY
SO YOU SEE YOU'VE YOU'VE
NOTICED SEVERAL TIMES THAT. THE
CURRENT STATUTE AND CURRENT
REGULATIONS. DO NOT PROHIBIT
THESE TYPE OF ARRANGEMENTS.
WOULD YOU SAY THAT. THE CURRENT
STATUTES- ARE IN NEED OF.
REFORM. TO PROHIBIT THIS TYPE
OF PRACTICE. THE DEPARTMENT
WOULD CERTAINLY YOU KNOW TAKE
THE OPPORTUNITY TO WEIGH IN ON
ANY PROPOSALS AND PROVIDE SOME-
CLARIFYING- TECHNICAL
ASSISTANCE ON ANYTHING THAT MAY
BE PROPOSED- YOU KNOW AS I
MENTIONED I THINK THAT I WOULD
BE- KIND OF BUSINESS STRUCTURE
AND OPERATIONS THE FACILITY HAS
BEGUN ARE CONTINUE TO DEVELOP
OVER TIME- I THINK THAT- YOU
KNOW THERE'S OPPORTUNITIES
WITHIN THE STATUTE TO LOOK AT-
PERHAPS NEEDS AND WAYS. TO
ADDRESS- MORE- CURRENT BUSINESS
PRACTICES THAT OCCUR. THANK YOU
I LOOK FORWARD TO WORKING WITH
THE DEPARTMENT OF PUBLIC HEALTH
TO REVISE WHAT I BELIEVE IT OR
ARE. LAWS THAT DESPERATELY NEED
TO BE. REVISED AND CHANGED I
I'D LIKE TO GO BACK TO YOUR
YOUR DENIAL LETTER THE
DEPARTMENT OF PUBLIC HEALTH AND
I LETTER OF TWENTY SIXTEEN IN
THIS LETTER YOU SPECIFICALLY
SITE. THE BASIS FOR THE DENIAL
OF MR RECHNITZ IS APPLICATION
BEING HAS EXTENSIVE- HISTORY OF-
FEDERAL AND STATE VIOLATIONS OF
HEALTH AND SAFETY CODE
PROVISIONS AND REGULATIONS. IF
THE TIM IT IN MY MIND THAT BEGS
THE QUESTION IF. MR RECHNITZ IS
APPLICATION IS STUDENT DENIED
IN THIS ONE INSTANCE THEN WHY
WOULDN'T HE BE PERMANENTLY
DENIED IN ORDER TO YOU KNOW AS
A SEVERAL PANELISTS HAVE.
CALLED FOR TODAY YOU KNOW CALL
FOR THE CONSISTENT APPLICATION
OF LAWS AND REGULATIONS WHY
WOULDN'T SOMEONE WITH A
DOCUMENTED HISTORY OF
VIOLATIONS NOT YOU KNOW
CONSISTENTLY BE REAPED. DENIED
FOR FROM FROM ANY OWNERSHIP OF
ANY- FEATURED NURSE NURSING
HOME ACQUISITIONS. YEAH I
APPRECIATE THAT QUESTION- DAY
IN THE COMPLIANCE HISTORY
REVIEW A CURRENT- KIND OF AN UP
AND A POINT IN TIME- PROCESS
MEANING THAT- YOU KNOW AS
MONTHS AND YEARS HAVE
COMPLIANCE HISTORY MAY CHANGE
OPERATORS MAY I IMPROVING THEIR
PERFORMANCE OPERATORS MAY
DECLINE IN THEIR PERFORMANCE-
AND THE STATUTE DOES NOT
PROHIBIT. AN APPLICANT FROM-
ESTIMATING FUTURE APPLICATIONS
IF THEY WERE DENIED AS I
BELIEVE MR TICKET TELL HAD
MENTIONED- SO WHEN I NEW
APPLICATION MAY COME IN AT THAT
POINT IN TIME THAT WE'RE
EVALUATING THAT APPLICATION
THAT WE LOOK. PERFORMANCE AT
THAT THAT POINT IN TIME AND
THAT THE RECENT. RYCHEL PATH-
SHOW IN IN CASES WHERE AN
INDIVIDUAL MAY HAVE RECEIVED IN
THE DIAL- THAT INDIVIDUAL DOES
HAVE THE OPTION TO EITHER RE
APPLY. FOR THAT BEING FACILITY
LICENSURE OR POTENTIALLY COMMIT
AN APPLICATION FOR A NEW
FACILITY. OKAY SO WHEN I HEAR
YOU SAYING IS BASICALLY YOUR-
EVALUATING EACH APPLICATION ON
A CASE BY CASE BASIS AND THAT
YOU MAY. HOPE THAT- AB IS BAD
ACTORS CAN SOMEHOW IMPROVE ON
THE PERFORMANCE IS THAT CORRECT.
I THINK THAT'S AN ACCURATE
STATEMENT OR YOU KNOW ALL
FACILITY OPERATORS INCLUDING
AND I'M LIKE DEFINITELY SKILLED
NURSING FACILITIES BUT IN
GENERAL YOU KNOW OUR GOAL IS TO
SEE IMPROVEMENT IN QUALITY AND
SAFETY- ACROSS THE ENTIRE
HEALTHCARE AT. CONTINUE ON- BUT
YES CERTAINLY WE WOULD WE WOULD
LIKE TO SEE- ANY ACTION THE
DEPARTMENT TAKE RESULT IN
IMPROVEMENT OVERALL PERFORMANCE
OF AN OPERATOR. OKAY BUT BUT IN
EVALUATING DID THE TALLY OF AN
APPLICANT'S HISTORY AND RECORD
WE HEARD TO. MS VALENTINE
TESTIFYING HOW THEY'RE THERE
ARE. THESE BAD ACTORS- IN THE
STATE OF CALIFORNIA THAT ARE
USING. THIS SHELL GAME OF
RELATED PARTIES IN ORDER TO
ENRICH THEMSELVES AT THE
EXPENSE NOT ONLY OF TAXPAYERS
BUT OF THE NURSING HOME
RESIDENTS WHO ARE BEING DENIED
CARE WHO ARE BEING DENIED THE
SPENDING FOR WHAT'S THOSE MEDIC
HAL AND MEDICARE DOLLARS WERE
INTENDED FOR. DOES THE
DEPARTMENT OF PUBLIC HEALTH
TAKE THAT INTO ACCOUNT. YOU
KNOW AS TO WHETHER AN APPLICANT
HAS A EXTENSIVE HISTORY OF
ENRICHING THEMSELVES- AT THE
EXPENSE OF NURSING HOME
RESIDENTS. SO THE DEPARTMENT
FOCUS IS ON THE DELIVERY OF
CARE- WHICH IS YOU KNOW THAT
THE QUALITY OF THE SAFETY AND
THE CONSISTENCY- OF HEALTH CARE
AT THE DELIVERED IN THE SKILLED
NURSING FACILITIES- OUR PROCESS
WHILE WE DO TAKE INTO
CONSIDERATION- ADDITIONAL
FACTORS THAT ARE AN INDICATOR
OF AN OPERATOR'S ABILITY TO
COMPLY WITH STATE LAW. AND
FEDERAL LAW- WHERE THERE MAY BE
NON COMPLIANCE WITH EIGHT EIGHT
KOSTER BILLING ISSUE AT
SOMETHING THAT WE CAN TAKE INTO
CONSIDERATION BUT AGAIN BY
REVIEWING AUDITING AND TRACKING
COST REPORT OR- OP PROFIT
STATEMENT ONLINE OPERATOR IS
OUTSIDE OF. OUR IMMEDIATE NEEDS
THANK YOU ACCORDINGLY- SO AGAIN
IF THERE WERE YOU KNOW KNOWN
COMPLIANCE IS ISSUES WITH
OTHER- STATE LAWS OR
REGULATIONS. THAT ARE ENFORCED
BY OTHER ENTITIES- IT CAN BE
TAKEN INTO CONSIDERATION- WITH
REGARDS TO DEMONSTRATION OF
THAT IN THE THAT OPERATORS
ABILITY TO COMPLY WITH STATE
AND FEDERAL REQUIREMENTS. BUT
AT THE SAME TIME- AGAIN PROFIT-
PROFIT MARGINS OR COST
REPORTING- OR BILLING PRACTICES
IT'S NOT- DIRECTLY WITHIN OUR
OVERSIGHT. OKAY HI I I'M I'M
HOLDING IN MY HAND HERE A- AN
ARTICLE THAT- SUMMARIZES A
PROGRAM THAT EIGHT EIGHT EIGHT
NEWS- PROGRAM THAT WAS HEARD ON
THE MORNING EDITION OF NATIONAL
PUBLIC RADIO- ENTITLED IN
CALIFORNIA NURSING HOME OWNERS
CAN OPERATE AFTER THEY THEY'RE
DENIED A LICENSE. AND THEY-
SITES. ANOTHER REPEAT BAD ACTOR
THAT I'VE SEEN- HER NAME
MENTIONED NUMEROUS TIMES IN
THESE CASES THAT COME BEFORE US.
CRYSTAL SOLAR SANO. AND THE
ARTICLE INDICATES THAT- AND
NUMEROUS LICENSE DENIAL LETTERS
TO THEM AS SELLERS AUTO THE
DEPARTMENT OF PUBLIC HEALTH.
SENATE BASED THAT DECISION ON A
LONG RECORD OF VIOLATIONS AT
HER NURSING HOMES. BUT- CAN GET
YOU'RE YOU'RE INDICATING THAT
DESPITE THAT LONG RECORD- YOU
THE YEAR THE DEPARTMENT WOULD
CONTINUE TO EVALUATE INDIVIDUAL
APPLICATIONS- AS THEY CAN AND
IS THAT CORRECT. THAT IS
CORRECT THERE'S NO PROCESS- OR
A STATUTORY AUTHORITY FOR THE
DEPARTMENT YOU PERMANENTLY-
ESTABLISH A AUTOMATIC THE NILE
OR AN APPLICATION- FOR A TOP
RATED SKILLED NURSING FACILITY
SHOULD THERE BE. A LAW OR
REGULATION TO ESTABLISH REPEAT
BAD ACTORS FROM FROM BEING ABLE
TO- NURSING HOMES IN THE STATE
OF CALIFORNIA. I THINK THAT
THERE'S CERTAINLY OPPORTUNITY
FOR US TO- LOOK AT WAYS TO
DETERMINE- PROVIDERS OR
OPERATORS OR- AND THAT. BEING
AN APPROPRIATE CANDIDATE OR
BEING AN APPROPRIATE
APPLICANTS- TO OPERATE A
SKILLED NURSING FACILITY- I
WOULD CERTAINLY INVITE YOU KNOW
OUR OUR PARTNERS IN THE
INDUSTRY ARE STAKEHOLDERS AN
ADVOCATE Q. YOU KNOW JOINING IN
CONVERSATIONS AND EXPLORING
WHAT THAT MIGHT LOOK LIKE AND
CERTAINLY. I'M WILLING TO WORK
WITH- ANY MEMBERS OFFICE THAT
MIGHT HAVE QUESTIONS ABOUT HOW
WE COULD- EXPLORE WHAT THAT
MIGHT LOOK LIKE. OKAY WELL-
I'LL I'LL WRAP UP WITH THIS THE
AND THAT SAME NPR ARTICLE. GOES
ON TO TALK ABOUT. HOW THE
DEPARTMENT OF PUBLIC HEALTH-
ALSO LOOKS I IN REVIEWING
CHANGE OF OWNERSHIP
APPLICATIONS SIX TO DETERMINE
WHETHER A APPLICANT IS OF
REPUTABLE AND RESPONSIBLE
CHARACTER. EVEN ARTICLE THE
DEPARTMENT FOUND SELLERS ON A
LACKING ACCORDING TO THE DENIAL
LETTERS THE DEPARTMENT'S REVIEW
QUOTE REVEALED THAT IN OR
AROUND JULY OF TWENTY TWO
THOUSAND EIGHT YOU SUBMITTED
FRAUDULENT DOCUMENTS TO OBTAIN
YOUR NURSING HOME ADMINISTRATOR
LICENSE SPECIFICALLY A
FRAUDULENT COLLEGE TRANSCRIPT
FROM TORO COLLEGE. AND
ACCORDING TO THE ARTICLE TOTAL
COLLEGE TOUR UNIVERSITY
CONFIRMED THAT SOLAR SANO HAD
NOT RECEIVED A DEGREE FROM
THEIR INSTITUTIONS SO YOU'RE
YOU'RE SAYING THAT DESPITE.
HAVING THIS REPEAT AFTER REPEAT
APPLICANT AND- TO THE
DEPARTMENT OF PUBLIC HEALTH. OF
CLEAR EXAMPLE OF SUBMITTING A
FRAUDULENT COLLEGE TRANSCRIPT
YOU WOULD CONTINUE TO. TO YOU
KNOW GIVE EACH ARE. AND
SEPARATE APPLICATION FROM
SOMEONE LIKE MS SOLAR SANO ON A
CASE BY CASE BASIS. THAT IS
CORRECT WE WOULD CONTINUE TO-
ACCEPT AND REVIEW- USING OUR
PROCESS ANY APPLICATION THAT
CAME I FROM ANY ENTITY THAT
THINKING- A LICENSE TO OPERATE
A FACILITY. ANY CONSIDERATIONS
LIKE THOSE THAT YOU MENTIONED
WHICH I BELIEVE- IT'S STILL-
BEING LOOKED INTO- THOSE WOULD
BE ADDITIONAL CONSIDERATIONS
THAT WE WOULD MAKE AN
EVALUATING A POTENTIAL LICENSEE.
MISTER CHAIRMAN I LOOK FORWARD
TO CHANGING THESE LOS THANK YOU
VERY MUCH THE COMMISSIONER SU
CHI- OTHER MEMBERS. OKAY MISS
MISS AGUIAR-CURRY QUICKLOGIC- I
UNDERSTAND DURING OUR CD PH AND
WHEN WE ARE WHEN YOU WERE
HAVING A CONVERSATION YOU
MENTIONED THAT YOU'RE NOT THE
ONLY ONES THAT REVIEW THE-
APPLICATIONS OR OTHER
DEPARTMENTS REVIEWING PORTIONS
OF THOSE APPLICATIONS. I MAYOR
APPLIQUE. I APOLOGIZE
APPLICATIONS FOR FACILITY
LICENSURE FOR STILL NURSING
FACILITIES IN THEIR
RESPONSIBILITY- CDPH CENTER FOR
HEALTH CARE QUALITY- OTHER
DEPARTMENT WOULD NOT BE
REVIEWING THAT APPLICATION-
PORTION OF THE SUBSEQUENT IN A
FIFTY ADDED APPLICATIONS LIKE-
DOCUMENTS FOR ENROLLMENT AND-
BOTH THE- DAY THE FEDERAL
MEDICARE PROGRAM OR STATE
MEDICAID PROGRAMS- THERE'S
ADDITIONAL DOCUMENTATION THAT
WE DO REVIEW AND THEN PARTNER
WITH EITHER ON CENTERS FOR
MEDICARE MEDICAID SERVICES OR-
OUR OUR PARTNER DEPARTMENT
DEPARTMENT HEALTH CARE SERVICES
FOR INVOLVEMENT AND- THE STATE
MEDICAID PROGRAM BUT- FOR
LICENSING PURPOSES- THAT REVIEW.
IS WITH THE CENTER FOR HEALTH
CARE QUALITY. THANK YOU FOR THE
CUP CARE. APPRECIATE THANK YOU
I JUST WANT TO SAY BUT I DO
HAVE SOME QUESTIONS BUT I- TO-
AND DIRECTED DPT PH I WANT TO
THANK MISS VALENTINE MISTER
CHECKED OUT FOR YOUR YOUR- YOUR
COMMENTS AND- AND I THE
QUESTIONS I HAVE FOR YOU I
THINK I'VE BEEN HAVE BEEN
ANSWERED- THREE YOUR COMMENTS-
CLEARLY. CLEARLY WE HAVE A
CHALLENGES- THAT I THINK AND WE
DO HAVE SOLUTIONS THAT COULD
ACTUALLY IMPROVE QUALITY OUT
THERE IT IS OFTEN THE WILL TO
SEE THAT HAPPEN. MOVING
FORWARD- I WOULD SAY AND IT
ALSO THANK YOU TO DR STEINBERG-
I UNDERSTAND YOUR PERSPECTIVE
THAT SOMETIMES OF FINANCIAL
PENALTIES ARE NOT ALWAYS THE
BEST THING OUT THERE- I WOULD
PROPOSE THAT- YOU KNOW A LOT OF
SOLUTIONS ALONG WITH FINANCIAL
PENALTIES. CAN CAN BE CAN BE
POTENT MOTIVATORS- AND WE WANT
TO WE WERE ACTUALLY IF PEOPLE
CAN DO THE RIGHT THING AND DO
THAT DO THIS WORK THERE ARE
THERE ARE MECHANISMS FOR
QUALITY- QUALITY PAYMENTS THAT
FOR PROVIDING HIGHER QUALITY
PERE. YEAH CARE SO THERE ARE
THERE ARE CARROTS BUT WE
DEFINITELY NEED TO STICK AND-
AND IT'S IMPORTANT WEEK WE HAVE
BOTH A AND R. AT OUR DISPOSAL-
I WANNA I'M GONNA I'M GONNA ASK
HIM. A CUT. D. TWO D. PH HERE I.
YOUR YOUR WRIST. THAT AND THIS
TO MISS- MISS DONNA. YOUR
SPONSOR NOW WE ARE 83% RATE 83%
RESPONSE TO IMMEDIATE JEOPARDY-
THAT'S STILL PRETTY TROUBLING
TO SEE QITE FRANKLY- THAT
MEANS THAT OUT OF A HUNDRED
PEOPLE SEVENTEEN PEOPLE. OUT
THERE WOULDN'T GET THIS
RESPONSE WITHIN TWENTY FOUR
HOURS WHAT I DON'T KNOW IS THAT
IT WAS A RESPOND IN TWENTY FIVE
HOURS PER TWENTY FIVE DAYS I
DON'T KNOW WHAT THAT MEANS SO
ALL WE KNOW IS IT IS NOT IN
TWENTY FOUR HOURS I'M SURE YOU
HAVE THE DATA. THAT WOULD HELP
US TO UNDERSTAND YOU KNOW WHAT
IS YOU KNOW WIN WIN DID YOU
FOLLOW UP WENT WITH WAS IT WAS
IT DID YOU MISS IT BY A FEW
HOURS DID YOU MISS IT BY A FEW
DAYS- YOU KNOW 83% ISN'T ISN'T
A GOOD NUMBER YOU KNOW I'M-
I'LL GVE AN EXAMPLE I'M NOT
COMPARING THIS BY ANY MEANS
BUT- PUT IN PERSPECTIVE. IN MY
DISTRICT. 83% OF MY-
CONSTITUENTS HAVE. ACCESS TO
BROADBAND INTERNET. THAT MIGHT
SOUND PRETTY GOOD THAT'S THE
LOWEST IN THE STATE. SO THAT
83% DOESN'T IMPRESS ME-
ESPECIALLY SINCE THERE YEARS
BACK WHEN YOU WERE NINETY. AND
I DO APPRECIATE THAT YOU KNOW
WE HEARD A LOT ABOUT KOBE ED
AND KOPIN WE HAD A HEARING ON
THAT. WE HAD SPECIFIC WE HAD
ASKS- AND I DON'T YOU KNOW WITH
ALL DUE RESPECT WE- AT THE WORK
BEING DONE BANK WITH KOBE BUT
WITH THAT WASN'T WHAT WE'RE
HERE FOR. THESE ISSUES WE HAVE
BEEN HERE BEFORE. THIS
COMMITTEE HELD A HEARING TWENTY
FOURTEEN BEFORE MY TIME. ON
THESE ISSUES AND SO WHILE
PREPPING FOR THIS HEARING.
WE'RE LOOKING AT THE NOW SAYS
THE BILL CREATING THE
DEPARTMENT PUBLIC HEALTH. AND
THEIR CONCERNS DAN. REGARDING
LICENSING ISSUES AND WHETHER
DPH WOULD BE THE APPROPRIATE
PLACE TO HILES ALLIES HOUSE
LICENSING AGREEMENT AND
CREDENTIALING. WHY ARE WE STILL
HERE. IT'S NOT JUST BECAUSE OF
IT. IT'S NOT JUST BECAUSE OF IT.
THESE ARE LONG STANDING ISSUES
WE WANT TO WORK WITH YOU- L. A.
O. TESTIFIED TO THE MONEY WE
THROW AT THIS PROBLEM WE KNOW
THAT THERE ARE CHALLENGES WITH
STAFFING WE KNOW THAT THERE ARE
THINGS. THAT NEED TO BE DONE.
YOU HAVE SAID THAT YOU WILL
WORK WITH US WITH TECHNICAL
ASSISTANCE. ON UPON ON
SOLUTIONS CORRECT. CORRECT MY
EXPERIENCE. WITH TECHNICAL
ASSISTANCE WITH SOME OF OUR
AGENCIES IS THAT COMES A FEW
DAYS BEFORE THE BILL NEEDS TO
GET OUT OF ITS LAST COMMITTEE.
SO WHAT I'M ASKING FOR YOU FROM
YOU AND YOUR DEPARTMENT IS WE
ACTUALLY HAVE THE TECHNICAL
ASSISTANCE EARLY WELL THIS
WHILE THIS BILL MISTER
MURATSUCHI IS GOING TO MOVE
FORWARD. I AM GOING TO JOIN
AUTHOR WITH HIM. THAT WE
ACTUALLY HAVE THAT TECHNICAL
ASSISTANCE EARLY IN THIS HOUSE.
NOT WHEN IT'S IN THE SENATE.
WAITING TO GET OUT OF
APPROPRIATIONS TO GO TO THE
FLOOR. CAN WE GET THAT
ASSURANCE FROM HIM. WE ARE
ABSOLUTELY- WELCOME THE
OPPORTUNITY TO WORK WITH YOU ON
THAT AND I THINK THIS IS AN
INCREDIBLY IMPORTANT TOPIC. AND
TODAY'S CONVERSATION I THINK IS
A GREAT PLATFORM FOR US TO
START THOSE CONVERSATIONS AND-
REALLY TAKE THE TIME TO MAKE
SOME MEANING CALL- PROGRESS- ON
THIS PARTICULAR ISSUE. I
APPRECIATE THAT AND WE
ABSOLUTELY WILL BE REACHING OUT
I WILL BE WORKING CLOSELY WITH
MR RCG. OUR CONSULTANTS THIS IS
A REALLY REALLY IMPORTANT ISSUE
TO ALL OF US- THE- VERY
TROUBLED BY- SO SOME OF WHAT I
HEARD FROM MR CHICKEN TELL
ABOUT. HOW LICENSING CAN HAPPEN.
IT'S AN APPLICANT. COULD
CONTINUE TO BE AN COULD COULD
BE AN OPERATOR EVEN THOUGH THEY
KNOW THEY'RE GOING TO BE DENIED
THE LICENSE IN THE CASE OF A OF
THE WINDSOR READING THING NOW
THEY'RE GOING TO BE DENIED
THEY'VE ALREADY BEEN DENIED.
AND HERE WE ARE FIVE YEARS
LATER AND THAT. THAT APPLICANT
IS THE OPERATOR. THE DE FACTO
OPERATOR THERE'S NO QUESTION. I
GUESS THAT THAT IS HAPPENING.
THAT IS THE DE FACTO OPERATOR.
HAVE THIS LAWSUIT NOT HAPPEN.
AND HAD. IT HAD HAD THERE NOT
BEEN DESK. IT FEELS LIKE THIS
COULD GO ON IN PERPETUITY. IS
THAT A FAIR CHARACTERIZATION.
WITHOUT THAT BACKSTORY THAT
STATUTORY GUIDELINES BEING
ADDRESSED- THERE THAT IS A
POSSIBILITY- BASED ON THE
CURRENT STRUCTURE OF THE LAW.
SO KNOWING KNOWING SEEING THESE
THINGS HAPPEN. I GUESS THE BEGS
THE QUESTION WHAT. WHY HASN'T
THE DEPARTMENT OF PUBLIC HEALTH
COME FORWARDS RIGHT YOU KNOW
WHAT WHY DOES IT TAKE FOR THIS
TO GET TO THIS POINT YOU KNOW
THAT YOU KNOW THAT SOME OF
THESE PROBLEMS EXIST WHY
HAVEN'T HAVEN'T YOU COME TO OUR
COMMUNITY- TO THE LEGISLATURE
AND JUST SAID HEY WE COULD USE
SOME ASSISTANCE HERE BECAUSE
WE'VE GOT SOME CHALLENGES. WHY
DO WE HAVE TO DISCOVER IT THIS
WAY. WHY CAN'T WHAT WHERE IS
THE PROACTIVE- PATIENT
CENTERED. PUBLIC SAFETY
APPROACH HERE WHERE IS THAT
BECAUSE I DON'T FEEL IT RIGHT
NOW WE SHOULDN'T HAVE TO DIG
FOR THIS. THIS SHOULD COME TO
US HEY WE GOT A PROBLEM WE GET
PEOPLE THAT APPLY MULTIPLE
TIMES FOR LICENSES. AND THEY'RE
NOT GOING TO GET A LICENSE
THEY'RE OPERATING THEM THEY'RE
OPERATING THESE HOMES. AND YET.
HERE WE ARE HERE WE SAID. WE
YOU KNOW WE HAVE TO WAIT FOR
NEWS ARTICLES. IT TO PAY FOR
PEOPLE TO DIE. AND WE HAVE TO
WAIT FOR SOMEONE FOR PEOPLE
CONTINUE OPERATE FOR YEARS AND
YEARS AND YEARS AT A TIME. SO
WHERE IS THE PROACTIVE APPROACH.
FIVE I WOULD LIKE TO SHARE THAT
THE DEPARTMENT- FOR THE LAST
FEW YEARS HAS BEGUN DEVELOPING
USING ITS EXISTING AUTHORITY A
CHANGE OF OWNERSHIP REGULATORY
REGULATION PACKAGE- THAT WOULD
ADDRESS SOME OF THESE ISSUES-
TO THE EXTENT THAT WE CAN UNDER
CURRENT STATUTORY- GUIDELINES-
UNFORTUNATELY DURING PREVENT
THE DEVELOPMENT OF THOSE- AND
CRYPTOGRAPHY DOES REGULATION
PACKAGES- WHAT DELAYED FOR A
PERIOD OF TIME THAT WE HAVE-
BEEN- SPEAKING AND SHARING WITH
OUR STAKEHOLDERS THAT WE ARE
PREPARING. HERE TO READ THEM ON
A SCHEDULING OF THE STAKEHOLDER
MEETINGS ASSOCIATED WITH THOSE
REGULATION PACKAGES AND WE'RE
LOOKING FORWARD TO MOVING OUT
THOUGH THE DEPARTMENT HAS BEEN-
TAKING THE INITIATIVE I TO BE
PROACTIVE TO THE EXTENT THAT WE
CAN- TO DRAFT- SOME OF THE
ISSUES. AROUND THE FASCICULUS
OPIC. WHEN I APPRECIATE AND WE
LOOK FOR THAT I WILL JUST POINT
OUT THAT TWO THOUSAND TO
SIXTEEN TO MARCH OF TWENTY
TWENTY. WAS A FORTY IS A FOR
LIKE A FOUR YEAR PERIOD THERE-
AND NOW YES WE HAVE HAD COATED
BUT YOU KNOW. LIKE I SAID
EARLIER THIS IS A LONG STANDING
PROBLEM. AND SO WE WOULD HOPE
THAT IN FUTURE THAT WHEN YOU
SEE PROBLEMS LIKE THIS OR
CHALLENGES WERE NEED FOR
SOMETHING REGULATORY OR ARE FOR
LEGISLATIVE ASSISTANCE TO HELP
WITH PROBLEMS THAT ARE CLEARLY
RECOGNIZE WHEN ADVOCATES ARE
ARE ARE ARE ARE ARE HAVING
CHALLENGES. THAT WE CAN SEE A
MORE PROACTIVE APPROACH.
ABSOLUTELY WE LOOK FORWARD TO
THE OPPORTUNITY TO WORK WITH
YOU ON ON VARIOUS
RECOMMENDATIONS THANK YOU-
THANK YOU TO OUR WITNESSES AND-
I'M SORRY WE GET. GIVEN THE
WOUND UP HERE AND I I'M NOT
GOING TO APOLOGIZE FOR THAT HI
THIS IS THIS IS THIS IS REALLY
IMPORTANT TO MISTER MURATSUCHI
IS REALLY IMPORTANT TO MYSELF-
SOMETHING NEEDS TO CHANGE. WE
NEED. THE STATE TO SHOW THE
SAME URGENCY. I AM PLEASED THAT
YOU'RE HEARING FROM OUR
WITNESSES AND ARE AND THE AND
THE CONCERNS FROM FROM FROM THE
MEMBERS OF THIS OF THIS-
HEARING TODAY. THANK YOU. WITH
THAT- I'D LIKE TO GO AHEAD MOVE
ONTO OUR FINAL PINE A PANEL.
WE'RE GONNA BE RUNNING A LITTLE
LATE- AND I HOPE THAT PEOPLE
WILL STICK WITH US HERE WE
STILL WILL DO PUBLIC COMMENT WE
MAY LIMIT THE AMOUNT OF TIME
THAT WE ARE ABLE TO DO HAT. WE
WILL ACCEPT PUBLIC COMMENT IN
WRITING AS WELL SO BUT PLEASE
COME FORWARD- TIFFANY TIFFANY
WHITEN- MISTER CORNET CREEK
CORNET- TIFFANY WHITENED- THIS
WITH THE SEIU- MISTER CORNET AS
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH. HEALTH FACILITIES.
AND THEN JOIN US- VIA WEBEX
ADOPT DOCTOR ROBIN ROBIN STONE
THE SENIOR VICE PRESIDENT
RESEARCH CO DIRECTOR FOR
LEADING H. L. T. S. S. CENTER-
MISS WAITING TO SEE IF. GOOD
AFTERNOON MR CHAIRMAN MEMBERS.
TIFFANY WHITEN THEM. ANYONE
WITH A CA YOU CALIFORNIA
REPRESENTING OVER TWENTY
THOUSAND NURSING HOME WORKERS
AND OVER TWO HUNDRED SMITH
THANK YOU FOR THIS OPPORTUNITY
TO SPEAK WITH YOU ALL TODAY
WE'VE HEARD A LOT OF
INORMATION TODAY BUT I WOULD
LIKE TO FOCUS SPECIFICALLY ON
QUALITY OF CARE AS IT RELATES
TO STAFFING. APPROPRIATE
INSUFFICIENT STAFFING IS
INCREDIBLY IMPORTANT AND
SEVERAL STUDIES HAVE LINKED
STAFFING WITH BETTER RESIDENT
CARE AND OUTCOMES LIKE LET'S
FALLS RESULTING IN INJURIES
LESS PRESSURE ULCERS AND BEEN
ABLE TO RETURN TO THE COMMUNITY
SOONER. SUFFICIENT STAFFING
ALSO PLAYS A CRITICAL ROLE IN
PREVENTING AND COMBATING PUBLIC
NINETEEN. THE RECOMMENDED
FEDERAL STANDARD FOR SUFFICIENT
STAFFING IS AT LEAST FOUR POINT
ONE HOURS PER RESIDENT DAY.
HOWEVER THERE IS NO FEDERAL
REQUIREMENT OTHER THAN
SUFFICIENT STAFFING. AND TWENTY
SEVENTEEN AT THE ARE YOU DIRECT
CARE CARE CARE GIVERS IN
CALIFORNIA. BUT EXTREMELY HARD
TO PASS A LAW TO INCREASE OUR
CALIFORNIA STAFFING MINIMUM TO
THREE POINT FIVE HOURS PER
RESIDENT DAY. WITH TWO POINT
FOUR OF THOSE BEING DELIVERED
BY C. N. A.'S THE INDIVIDUALS
WHO PROVIDE THE MOST HANDS ON
DIE RIGHT CARE TO NURSING HOME
RESIDENTS. HOWEVER ONE
CONCERNING ELEMENT IS THAT 34%
OF FACILITIES HAVE RECEIVE A
STAFFING WAIVER FROM CDPH TO
PROVIDE LESS THAN. THE TWO
POINT FOUR HOURS PER RESIDENT
DAY AT SEA AND I CARE FOR
TWENTY TWENTY ONE TWENTY TWENTY
TWO. THIS IS AN UNACCEPTABLY
HIGH NUMBER OF STAFFING WAIVERS
BEING APPROVED. R. C. N. A.'S
ARE OFTENTIMES RESPONSIBLE FOR
THIRTEEN OR MORE RESIDENTS ON
THE DAY SHIFT AND THIRTY OR
MORE RESIDENTS DURING THE NIGHT
SHIFT. IMAGINE TRYING TO ASSIST
THIRTEEN RESIDENTS WITH GETTING
OUT OF BED DRESSING AND BATHING
AND HELPING FEED THEIR MAILS
ALL NEARLY AT THE SAME TIME. AS
WELL AS TRYING TO ATTEND TO
THEIR MEDICAL NEEDS AND TRYING
TO RESPOND IN A TIMELY MANNER
AND ALL WE'RE TRYING TO ADHERE
TO PERSON CENTERED CARE
PRINCIPLES. EVEN THE BEST MULTI
TASKER CANNOT ACCOMPLISH ALL OF
THIS WHEN YOU ARE RESPONSIBLE
FOR CARING FOR SO MANY
RESIDENTS. THE LACK OF
SUFFICIENT STAFFING HAVE LED TO
C. N. A.'S HAVING ONE OF THE
HIGHEST INJURY RATES OF ALL JOB
CLASIFICATIONS. AND THE STRESS
LEADS TO BURNOUT AND RAPID TURN
STAFF TURNOVER IN THIS INDUSTRY.
THE RESIDENTS SUFFER SINCE
THEIR CARE NEEDS ARE NOT
SUFFICIENTLY MET. AND IF THEIR
CARE GIVER IS INJURED OR LEAVE
IT IS VERY UPSETTING TO
TRANSITION TO ANOTHER NEW STAFF
MEMBER SAYS THE RELATIONSHIP
BETWEEN THE RESIDENTS. AND THE
CARE GIVER IS TYPICALLY VERY
VERY STRONG. OUR MEMBERS STRIVE
TO PROVIDE THE UTMOST QUALITY
PERSON CENTRED CARE. BUT THERE
ARE MANY BARRIERS AND
CHALLENGES THAT PLAY A ROLE IN
THEM NOT BEING ABLE TO DO SO.
HAVING THE ABILITY TO GET OUT
OF MINIMUM STAFFING
REQUIREMENTS NOT ONLY HARMS THE
PRESIDENT BUSH DRAINS THE CARE
PROVIDERS. IT'S BEYOND TIME TO
REFORM THE ENTIRE NURSING HOME
INDUSTRY AN INDUSTRY THAT
RELIES ON TAXPAYER DOLLARS THAT
ARE NOT BEING SUFFICIENTLY
SPENT. AND CALIFORNIA OVER
NINETY ONE PERCENT. OF ALL
NURSING HOME RESIDENTS CARE
REVENUES ARE FROM MEDIC HAL AND
MEDICARE BOTH FEE FOR SERVICE
AND MANAGED CARE PLANS. THIS
MEANS THAT THIS INDUSTRY IS
OVERWHELMINGLY FUNDED BY
TAXPAYER DOLLARS. THIS IS MUCH
HIGHER THAN MOST OTHER TYPES OF
HEALTH CARE SETTINGS SINCE THEY
HAVE A SIGNIFICANT PORTION OF
NON GOVERNMENTAL COMMERCIAL AND
PRIVATE PAYERS. WITH BILLIONS
OF DOLLARS BOTH STATE AND
FEDERAL GOING TO THIS INDUSTRY
IT'S TIME FOR TRANSPARENCY
ACCOUNTABILITY AND BETTER WAGES
AND TREATMENT FOR THESE CARE
GIVERS. SMITH NOT ONLY RECEIVE
STAFFING WAIVERS BUT THEY
CONTINUE TO RECEIVE THE
MEDICARE ADD ON PAYMENTS TO
COME INTO COMPLIANCE WITH NEW
STEPPING MINIMUM REQUIREMENTS.
FILE ANNUAL CONSOLIDATED
FINANCIAL STATEMENTS GIVEN THE
STATE AND THE PUBLIC MORE
TRANSPARENCY FOR NURSING HOME
PAYMENTS AND REQUIRES NURSING
HOME MANAGEMENT. AND PROPERTY
COMPANIES TO SUBMIT CERTIFIED
FINANCIAL REPORTS. THE PUBLIC
HAS A RIGHT TO KNOW HOW MUCH OF
ITS MONEY IS SUPPORTING NURSING
HOME RESIDENTS VERSUS HOW MUCH
IS BEING SPENT ON THE LIFESTYLE
THE BILLIONAIRE NURSING HOME
OWNERS. THESE BILLS ALONG WITH
OTHER SIGNED YESTERDAY ARE A
STEP IN THE RIGHT DIRECTION TO
ADDRESS SOME MAJOR CONCERNS IN
THIS AILING INDUSTRY BUT MUCH
MORE IS NEEDED. IN ORDER TO GET
QUALITY OUTCOMES WE MUST INVEST
IN QUALITY STAFFING AD QUALITY
OF CARE RATHER THAN PROFITS. IF
WE DON'T SOLVE THE PROBLEM OF
RETENTION WE AT THE STATE ARE
THROWING MONEY DOWN THE DRAIN.
CARE GIVERS HAVE PUT THEIR
LIVES ON THE LINE TIME AND TIME
AGAIN AS SHOWN THROUGH THE
PANDEMIC AND DESERVE TO BE
TREATED WITH DIGNITY DIGNITY
AND PAID APPROPRIATELY. WE CAN
DEBATE IF THERE'S TRULY A
WORKER SHORTAGE OR IF
INDIVIDUALS ARE JUST TIRED OF
PUTTING THEIR LIVES ON THE LINE
FOR FIFTEEN DOLLARS AN HOUR OR
MAYBE IT'S BOTH. WHAT WE'RE
WHAT WE'RE WHAT REMAINS TRUE IS
THAT 86% OF CNA'S ARE PEOPLE OF
COLOR AND THE MEDIAN ANNUAL
EARNINGS OF TWENTY FOUR
THOUSAND DOLLARS AND 33% OF
THESE CARE GIVERS RECEIVE
SOMETHING SOME FORM OF PUBLIC
ASSISTANCE. IT'S TIME TO TREAT
OUR WORKERS BETTER AND IN DOING
SO OUR RESIDENTS TO SNIFF WILL
GET THE LEVEL IN THE QUALITY OF
CARE THEY SO. RIGHTFULLY
DESERVE. FINALLY GIVEN THAT
CALIFORNIA SPENDS BILLIONS ON
NURSING FACILITY SERVICES. AND
THE REIMBURSEMENT METHODOLOGY
EXPIRES NEXT YEAR. WE LOOK
FORWARD TO CONTINUING WORKING
WITH THE LEGISLATURE AND
ADMINISTRATION. ON REFORMS THAT
INVEST IN IN THE DIRECT AND
INDIRECT CARE WORK FORCE. AND
IMPROVE QUALITY PERFORMANCE. AS
WELL AS MAINTAIN THE COST IN
SOME FASHION WHICH IS
CONSISTENT WITH THE REMARKS
THAT WE HEARD HERE TODAY BY THE
STATE AUDITOR. THANK YOU FOR
YOUR TIME AND BE AND FOR BEING
ABLE TO SHARE WITH YOU TODAY.
THANK YOU VERY MUCH- MISTER
CORNET. YEAH YES THAT THANK YOU
THANK YOU MISTER CHAIRMAN AT
AND ASSEMBLY MEMBER MURATSUCHI
AND OTHER MEMBERS OF I'M CRAIG
CORNET THE PRESIDENT OF THE
CALIFORNIA ASSOCIATION OF
HEALTH FACILITIES OTHERWISE
KNOWN AS CALF CAPITAL STATE'S
LARGEST AND OLDEST NONPROFIT
PROFESSIONAL ORGANIZATION
SUPPORTING THE LONG TERM CARE
PROFESSION. WE REPRESENT MORE
THAN NINE HUNDRED SKILLED
NURSING FACILITIES AND MORE
THAN FOUR HUNDRED INTERMEDIATE
CARE FACILITIES FOR PERSONS
EACH YEAR MORE THAN A HUNDRED
AND FORTY SEVEN THOUSAND CARE
GIVERS PROVIDE CARE TO MORE
THAN FOUR HUNDRED THOUSAND
PATIENTS IN OUR FACILITIES
THROUGHOUT THE STATE. I'VE BEEN
ASKED TO PROVIDE SOME REMARKS
TODAY ABOUT THAT APARTMENT A
PUBLIC HEALTH LICENSING
INSPECTION IT INSPECTION AND
CHANGE OF OWNERSHIP PROCESS FOR
SKILLED NURSING FACILITIES BUT
AT THE OUTSET I WANT TO BEGIN
BY JUST PAYING TRIBUTE HERE TO
THE TIRELESS WORK OF IT HAS NOT
REALLY BEEN SAID TODAY THE
TIRELESS WORK OF THE PEOPLE WHO
WORK IN OUR FACILITIES. THE
STAFF THE R. ENDS THE LV ENDS
THE C. N. A.'S THE
ADMINISTRATORS- THE- THE
GROUNDS KEEPERS THE DIET TO THE
DIETARY STAFF WHO PROVIDED
TWENTY FOUR HOUR CARE TO OUR
FRAIL AND ELDERLY RESIDENTS
PARTICULARLY THROUGH THE COBIT
PANDEMIC. ARE SKILLED NURSING
FACILITIES IN CALIFORNIA HAD
THE LOWEST MORTALITY RATE OF
ANY STATE IN THE COUNTRY- THE
BEST REPEATED DECISION THAT THE
STATE AND FEDERAL GOVERNMENT
MADE WAS TO PRIORITIZE NURSING
HOME RESIDENTS AND STAFF FOR
THE COPA NINETEEN VACCINE AND
THAT HAS- I THINK OUR FACILITY
STEPPED UP TO THE PLATE WELL ON
THAT WE HAVE THE HIGHEST SOME
OF THE HIGHEST STAFF AND
RESIDENT. VACCINATION RATES IN
THE COUNTRY OUR STAFF IS THE
SECOND HIGHEST VACCINATED STAFF
AT ABOUT 92% OF OUR STAFF
VACCINATED ONLY BEHIND HAWAII
AT THIS POINT. AS A RESULT OF
OUR HIGH VACCINATION RATES. THE
COBIT HAS WHO. BROUGH DENTAL
FOR THE BUILDING NOT TOTALLY
BUT AS AS OF YESTERDAY'S
NUMBERS THAT WERE ELEVEN NEW
CASES. AND TOTAL OF TWO HUNDRED
AND FORTY S. CASES OF COLD WITH
A HUNDRED THOUSAND RESIDENTS SO
I THINK WE DID IT THINGS ARE
MUCH MUCH BETTER THAN THEY WERE
ON THAT STANDPOINT. I'M ALSO
HAPPY TO REPORT THAT RESIDENTS
WILL SOON BE RECEIVING THEIR
COPA NINETY BOOSTER SHOTS.
WHICH WILL EVEN PROVIDE MORE
PROTECTION TO OUR PATIENTS AND
STAFF. IN TERMS OF QUALITY-
BEFORE I GO REAL VERY QUICKLY I
WANTED TO POINT OUT TO THAT
SNIFFS ARE RANKED IN CALIFORNIA
ARE RANKED VERY HIGH NATIONALLY
IN TERMS OF QUALITY OF ROADS
FOR. CARE FOR RESIDENTS. CMS'S
ANNUAL- TWO THOUSAND TWENTY ONE
NURSING HOME COMPARE DATA.
SHOWS THAT CALIFORNIA HAD THE
TOP NATIONAL RANKING. IN ELEVEN
OF THE ROUGHLY TWENTY FOUR
MEASURES ANOTHER WHICH WE WERE
EITHER FIRST OR SECOND IN THE
NATION. IN ALMOST HALF OF THE
OF THE QUALITY MEASURES TO CMS
LOOKS AT. THESE INCLUDE SUCH
IMPORTANT METRICS AS NURSING
HOURS PER RESIDENT DAY.
ACTIVITIES OF DAILY LIVING
PREVENTION OF INFECTIONS FLU
AND PNEUMONIA VACCINATION RATES
PREVENTING OF INTEREST FALLS.
AND REDUCING THE USE OF ANTI
PSYCHOTICS JUST MENTION SOME-
ON LEGISLATION YOU'VE HEARD
TODAY AND I WANTED JUST TO SAY
WE WERE VERY SUPPORTIVE OF MANY
OF THE BILLS THAT WENT THROUGH
THIS YEAR WE WERE- VERY
SUPPORTIVE OF AB- SEVEN FORTY
NINE THAT THAT. DOCTOR
STEINBERG MENTIONED TO I
REQUIRE MEDICAL DIRECTORS
NURSING HOMES TO BE CERTIFIED
WITHIN FIVE YEARS. WE ALSO WORK
CLOSELY WITH THE LEGISLATURE-
TO COME TO POSITIONS ON SB SIX
FIFTY- THE TRANSFORMATIONAL
TRANSPARENCY BILL AND WE THINK
THAT ACTUALLY WASN'T
ADVANCEMENT WE ARE HAPPY TO
WORK WITH THE SENATOR STERN IN
THE COMMITTEES ON THAT. I WANT
TO TURN THE LICENSING FEES NOW.
AND I WOULD LIKE TO START
DESPITE WITH THE GRAPHIC I
BELIEVE HERE. IN FRONT OF YOU
THIS THIS FIRST GRAPHIC FROM
OUR POWER POINT SLIDE SHOWS THE
NURSING HOME TO SEE A DRAMATIC
INCREASE. IN LICENSING FEES
OVER THE LAST SEVEN YEARS- IN
THE FIFTY SEVEN COUNTIES
OUTSIDE OF LOS ANGELES THE
RATES OF BASICALLY TRIPLED. IN
THE- SINCE TWO THOUSAND
FOURTEEN FIFTEEN- SO NOW- AND
THEN IN THE LOS ANGELES COUNTY
IT'S BEEN ABOUT A FIVE TIMES
HIGHER RATE FOR THE LICENSING
FEES. AT SOME POINTS THESE
THESE INCREASE LICENSING FEES
WILL BECOME UNSUSTAINABLE. WE
UNDERSTAND THE IMPORTANCE OF
THE LICENSING FEES TO SUPPORT.
THE LICENSURE ENFORCEMENT
PROVISIONS UNFORTUNATELY- THAT
THE FEES IN SOME CASES ARE.
BEING PAID TO THE DEPARTMENT
WHEN THESE POSITIONS ARE NOT
BEING FILLED YOU'VE ALREADY
HEARD THAT- FROM SOME OF THE
PRIOR- A TESTIMONY SOME OF
THESE POSITIONS NOT BEING
FILLED. IN OUR FACILITIES
REALLY WANT TO SEE COMPLAINTS
AND INCIDENTS INVESTIGATED AND
CLOSED HAVING THESE THINGS
LINGER FOR A LONG PERIOD OF
TIME. IS NOT GOOD FOR THE
PATIENTS AND THE RESIDENTS IT'S
NOT GOOD FOR THE STAFF IT'S NOT
GOOD FOR THE FACILITIES. WE THE
WAIT TIME FOR INVESTIGATIONS
AND THE FOLLOW UP ENFORCEMENT
SOMETIMES. JUST TAKES IT JUST
TAKES TOO LONG SO WE DO THINK
IT MAKES THE SURVEYS LESS
EFFECTIVE. AT ADDRESSING THE
CONCERNS FOR PATIENT CARE SO
WE- STRONGLY URGE THE THAT THE-
THAT THE ENFORCEMENT PROCESS
BEAT BE SPEEDED UP. SO THAT
THESE THINGS DO NOT LINGER SO
LONG. I WANT TO TURN NOW TO THE
CHANGE OF OWNERSHIP ISSUE. THE
COMMITTEES ASK US DISCUSS THE
PROCESS FOR CHANGE OF OWNERSHIP.
MY ASSOCIATION BELIEVES THERE
IS ROOM FOR. SUBSTANTIAL HAS
ISSUES WITH AN UNDERLINE
SUBSTANTIAL IMPROVEMENT IN THE
THIS EXTREMELY COMPLICATED
PROCESS. THE TIMELY EFFICIENT
AND CONSISTENT CHANGE OF
OWNERSHIP PROCESS. BENEFITS OUR
RESIDENTS IT BENEFITS OUR LINE
STAFF IT VOTER BENEFITS THE
ADMINISTRATORS AND IT BENEFITS
THE COMMUNITY AS A WHOLE-
JOINING ME TODAY IN THE
AUDIENCE IS SOON BURNAM SOON
WOULD JUST RAISE YOUR HAND. SHE
IS THE DIRECTOR OF LICENSING
AND REGULATORY SERVICES FOR
INSIDE SERVICES SHE FLEW UP
HERE TODAY FROM SOUTHERN
CALIFORNIA SHE IS AN EXPERT ON
LICENSING- CHANGES OF OWNERSHIP
AND HAS ASSISTED AND FINE WITH
CHANGES OF OWNERSHIP
APPLICATIONS IN CALIFORNIA. AND
IN A NUMBER OF OTHER STATES SHE
IS AVAILABLE TO ANSWER
QUESTIONS SPECIFIC QUESTIONS OF
THE COMMITTEE NOW OR LATER- AS
YOU CONSIDER THESE CHANGE OF
OWNERSHIP ISSUES. I SPEAK
REGULARLY WITH MY COUNTERPARTS
IN THE OTHER FORTY NINE STATES
AND I CAN TELL YOU THAT THE
CALIFORNIA'S CHANGE OF
OWNERSHIP FOR LICENSE FOR
NURSING HOMES TAKES LONGER THAN
VIRTUALLY ANY OTHER STATE. WE
NOW FIND THAT THE CHANGES TAKE
IT YOU ALREADY HEARD FROM THE
LA- ABOUT FIFTEEN MONTHS. INTO
CONTRAST MOST OTHER STATES ARE
ABLE TO DEAL WITH THIS PROCESS
AND A MUCH MORE SPEEDY WAY AND
THERE'S A LOT OF BENEFITS FOR
THAT NOW I WANT TO. TURN TO THE
TO THE GRAPHIC HERE THIS IS
HARD TO READ BUT THIS IS A
CHART THAT ACTUALLY
DEMONSTRATES WHAT THE CHANGE OF
OWNERSHIP PROCESS IS LIKE IN
CALIFORNIA. AND I WANTED JUST
TO SHOW YOU CHOSE TO TABLE THAT
ABOUT IT. THE COLOR CODING
ACTUALLY REFLECTS THE SIX
DIFFERENT ENTITIES THAT ARE
INVOLVED IN THE CHANGE OF
OWNERSHIP PROCESS. THIS SHOULD
THE BLUE SHADES ARE ACTUALLY.
UP DIVISIONS WITHIN THE
DEPARTMENT OF PUBLIC HEALTH
WHETHER THE CENTRALIZED
APPLICATION BRANCH THE DISTRICT
OFFICE. OR THE PROVIDER
CERTIFICATION UNIT. THE GREEN
REFLECTS THE MAX THE MEDICARE
ADMINISTRATIVE CONTRACTOR. THE
PURPLE REFLECTS THE CMS OF- OF
ROLE AND THEN THE ORANGE IS THE
DH CS THE DEPARTMENT HEALTH
CARE SERVICES. EACH LINE SHOWS
YOU JUST HOW COMPLICATED THIS
IS BETWEEN THE LICENSING. AND
THEN THE MEDICARE CERTIFICATION
AND THE MEDIC HEALTH
CERTIFICATION. THERE ARE SO
MANY ISSUES IN THIS PROCESS
RIGHT NOW- THAT THAT THAT
REALLY NEED TO BE ADDRESSED AND
WE TOTALLY AGREE THAT THERE
NEEDS TO BE A LOOK AT THIS
LENGTHY AND CONVOLUTED PROCESS
FOR CHANGE OF OWNERSHIP PUBLIC
APPLICATIONS. WE ARE HOWEVER
OPPOSED TO EIGHT TWO MISTER
MAYOR CITIES BILL AS CURRENTLY
WRITTEN. BECAUSE WE THINK IT
PROPOSES AN OVERARCHING AND
PUNITIVE APPROACH THE PROCESS
RATHER THAN ADDRESSING THE
FUNDAMENTAL PROBLEMS WITH THE
PROCESS. AS LONG AS THE LENGTH
OF TIME FOR IT THE OWNERSHIP
TAKES YEARS AND YOU'VE HEARD
SOME OF THIS. IT'S CRITICAL
THAT THEY HAD SOME SORT OF
INTIMATE INNER A MANAGEMENT
AGREEMENT BE ALLOWED TO OPERATE
WHILE THOSE APPLICATIONS ARE
PENDING IF THE APPLICATIONS
COULD BE PROCESSED IN A
REASONABLE PERIOD OF TIME I
DON'T THINK WE WOULD BE IN THE
SITUATION- NOTHING PENALTIES
FINES AND BAN ON ADMISSIONS FOR
FACILITIES. THAT HAVE TO
UTILIZE IN OUR MANAGERS JUST
GOES TOO FAR- I WANT ALSO POINT
OUT THE LAST ROW I DON'T THINK
YOU CAN SEE IT ON YOUR GRAPHIC
BUT YOU'VE GOT A HARD COPY I
BELIEVE- THERE'S PROCESS
CHANGES THAT WE THINK. CAN BE
MADE HERE THAT WE THINK WOULD
ACTUALLY. GET VERY MUCH OF SOME
OF THE ISSUES YOU'VE HEARD. A
MORE STREAMLINED APPLICATION
PROCESS INCLUDING A MORE
CENTRALIZED APPROACH. WITHIN CD
PH THE LICENSING AND
CERTIFICATION DIVISION AND THE
DISTRICT OFFICES. ADDITIONAL
TRAINING FOR THE CDPH STAFF.
ALSO WHEN CONSIDERING POTENTIAL
DISQUALIFICATION FOR OWNERSHIP.
DUE TO AN EDITOR AND ENTITIES
HISTORY OF CITATIONS IT'S
IMPORTANT TO LOOK AT SCALE. A
COMPANY THAT OPERATES FIVE OR
LESS FACILITIES SHOULD NOT HAVE
THE SAME CRITERIA AS A FIX AS A
COMPANY THAT OPERATES FORTY OR
FIFTY. UP AND TAKEN OVER. THAT
HIS AND THAT THAT HAS A HISTORY
OF SPECIALLY ONE THAT HAS A
HISTORY. OF TAKING OVER NURSING
HOMES AND SUCCESSFULLY
IMPROVING THE CARE OF THE
RESIDENTS. OF IN ADDITION WE
BELIEVE CD PH SHOULD CONSIDER A
FAST TRACK PROCESS. FOR
COMPANIES THAT APPLIED FOR A
CHANGE IN THE LAST YEAR HAVE
BEEN PREVIOUSLY APPROVED. THEY
START OVER ALL OVER WITH EACH
OF THESE APPLICATIONS. THE
DEPARTMENT ALREADY HAS ALL THAT
INFORMATION REQUIRED FOR THE
PARTICULAR COMPANY. AND SHOULD
BE ABLE TO REVIEW MORE QUICKLY.
FOR THOSE BUILDINGS IN
FINANCIAL DISTRESS OR
EXPERIENCING OTHER IMMEDIATE
REGULATORY ISSUES. A FAST TRACK.
PROCESS QUé SHOULD BE
UTILIZED. WHICH WOULD BE IN THE
BEST INTEREST OF THE RESIDENTS
THE STAFF AND THE FACILITY FOR
NEW OWNER TO TAKE OVER QUICKLY.
I WANT TO SAY THAT MAKE TREAT
EVERYONE THE HERE'S THIS TO.
IT'S IMPORTANT FOR A FACILITY
TO BE ABLE TO ESTABLISH A NEW
META CAL RATE YOUR RATES ARE
BASED ON FEE. FOR SERVICE AND
YOU CAN'T ESTABLISH A NEW RATE
EVEN THE FIRST THAT PUTTING IN
MORE MONEY IT WANTS TO SPEND
MORE MONEY FOR SERVICES THEY
CAN'T DO THAT UNTIL THE CHANGE
OF OWNERSHIP IS COMPLETE. FOR
APPLICATIONS THE LAST MONTHS TO
YEARS THESE FACILITIES ARE
STILL RECEIVING A MEDIC CAL
RAPE WHICH IS AYBE THREE YEARS
OLD AND DOESN'T REFLECT THE
COST OF WHAT THEY'RE- THEY'RE
ACTUALLY INCURRING. FURTHER
NURSING FACILITY SHOULD NOT BE
CHARGED DOUBLE FEES. DUTY
EXTENDED TO IT CHANGE OF
OWNERSHIP PROCESS. APPLICANTS
ARE REQUIRED TO PAY A CHANGE OF
OWNERSHIP FEE WHEN FIRST
APPLYING. A RENEWAL FEE OF FOR
OUR FACILITY THEY DO NOT EVEN
KNOW. IF THE PROCESS TAKES
LONGER THAN A YEAR. THEN THE
BUYER HAS TO PAY ANOTHER
OWNERSHIP OUR ANNUAL LICENSING
FEES. WE KNOW THAT IT'S IN THE
BEST INTEREST OF RESIDENTS
STAFF AND THE COMMUNITY. FOR
FACILITY TO CHANGE OWNERSHIP
ESPECIALLY FOR A STRUGGLING
BUILDING. THAT THAT'S IMPORTANT
IT'S IMPORTANT TO AT. AND FOR
AN OPERATOR WHO WISHES TO
RETIRE AND MOVE THE BALL AND WE
HEAR ABOUT THAT ALL THE TIME.
UNFORTUNATELY THIS PROCESS IS
NOT SET UP WELL TO. FACILITATE
ANY OF THAT. SO OUT WE DO NOT
THERE'S NOT ENOUGH TIME TO
SHARE ALL OF OUR
RECOMMENDATIONS REGARDING THE
CHANGE OF OWNERSHIP. BUT WE
LOOK FORWARD TO WORKING WITH
THE CHAIRMAN WOULD AND- SOME
WINDERMERE SEARCHING THE
COMMITTEE. UP ON THESE
IMPORTANT ISSUES OVER THE
COMING MONTHS- AND BEFORE I
LEAVE I DO WANT TO MENTION ONE
LAST COMMENT. ABOUT THE SEVERE
WORKFORCE SHORTAGE. THAT WE'RE
EXPERIENCING RIGHT NOW UP WE'RE
IN A STAFFING CRISIS PURE AND
SIMPLE- PRIOR TO THE CODE
PANDEMIC. HOTSPOT HAD ALREADY
ESTIMATED THAT- WE WOULD HAVE
TO SHORTAGE OF THIRTY THOUSAND
NURSE ASSISTANTS BY THE YEAR OF
THIRD OF TWENTY THIRTY. UP
DEPARTMENT HEALTH HUMAN
SERVICES JUST RETHINK CAME OUT
AND REVISED THAT TO FORTY FIVE
THOUSAND- CNA'S LV ENDS AND
OURENSE THEY'RE BURNED OUT
EVERYBODY'S REALLY BURNED OUT
RIGHT NOW- WE HAVE A GREATER
DEMAND. WITH THE RISING AGING
POPULATION AND WE NEED MORE-
NURSING PROGRAMS AND FOR
FACULTY TO PAIR. UP MORE NURSES
AND CAREGIVERS FOR THE LONG
TERM- IT'S IMPERATIVE THAT THE
ADMINISTRATION AND LET'S.
PRIORITIZE THE STAFFING NEEDS
FOR FACILITIES. FACILITIES
ACROSS THE STATE HAVE RAISED
SALARIES PAID RETENTION BONUSES
OF UP PAID SIGNING BONUSES AND-
THAT'S GOING TO CONTINUE BUT
THAT THAT'S THE ONLY PART OF
THE SOLUTION. WE ALSO NEED.
MORE FLEX ESTABAN FLEXIBILITY
AND PAY FOR PAYING FACILITIES.
THE FULL MEDICARE REIMBURSEMENT
FOR THEIR LABOR COSTS. AND
QUICKLY UTILIZING FORTY THREE
MILLION DOLLARS THAT WAS
INCLUDED IN THIS YEAR'S BUDGET-
TO BUILD A CNA WORK FORCE- THAT
STILL HAS NOT. STARTED
EXPANDING IT FOR THE YEAH YEAH.
WE'D LIKE TO SEE THAT- GET
GOING AS SOON AS POSSIBLE SO
THANK YOU VERY MUCH AND I'M
HAPPY TO ANSWER QUESTIONS THANK
YOU WE WILL HAVE QUESTIONS BUT
YOU CAN HANG WITH US UNTIL WE
HEAR. FROM OUR FINAL PANELIST
APPRECIATE THE- OUR FINAL PANEL-
DOCTOR UP IN STONE WHENEVER
YOU'RE READY I KNOW YOU'RE WITH
US VIA WEBEX. YES I'M WITH YOU
WEBEX AND I'M IN REHOBOTH BEACH
DELAWARE. EVEN THOUGH I
ACTUALLY HAVE MY HEADQUARTERS
IN WASHINGTON DC I WANT TO
THANK THE- CALIFORNIA ASSEMBLY
COMMITTEE AND EVERYBODY ELSE
IT'S ACTUALLY BEEN ON ON AYE
OPENING- OUR- OWN IT DOWN FOR
ME TO LISTEN STATE THROUGH THIS
HOLD. NINE YARDS AND TO TRY TO
WRAP IT UP- I AM HERE TODAY
REALLY REPRESENTING. MY GROUP
WHICH IS THE LONG TERM AND SO
RESEARCH ON- WITHIN LEADING AGE
WE IS THE NAY. SALES FOR NOT
FOR. AGING SERVER PRO INCLUDING
NURSING ASSISTED LIVING HOME
CARE HOME HEALTH AND HOSPICE
AND MY- STATE AFFILIATE
CALIFORNIA LEADING H- BEFORE I
JUST STARTED VERY QUICKLY ON
WHAT I'M HERE TO SAY I. I WANNA
LET YOU KNOW THAT I HAVE FORTY
FIVE YEARS OF WORK IN THIS BILL-
I. WHEN I WAS A MY TO AND I'M
SEVENTY ONE NOW. AND IT SEEMS
TO ME TO SEE THAT WE ARE GOING
THROUGH THE SAME THING THAT I
HAVE BEEN THROUGH. YEAR AFTER
YEAR AFTER YEAR AS THE
ASSISTANT SECRETARY FOR AGING
IN THE CLINTON ADMINISTRATION
AS A DEPUTY ASSISTANT SECRETARY
IN THE DEPARTMENT HEALTH AND
SERVICES AS A DOCTORAL. AT CAL.
I HAVE MY DOCTORATE IN PUBLIC
HEALTH FROM UC BERKELEY AND
WORKED FOR MANY YEARS AT UCSF.
I REMEMBER TWO OR THREE LITTLE
HOOVER COMMISSION STARTUP OUT
THE SAME ISSUE.AND NOW I'M
SEVENTY ONE AND I'M JUST
LOOKING AT THE KNOCKING ON THE
DOOR OF PERHAPS HAVING TO USE
ONE OF THESE SERVICES. I'M I
WILL TELL YOU THAT IT IS
INCREDIBLY IMPORTANT. FOR US TO
HAVE THE ULTIMATE IN
TRANSPARENCY WITH RESPECT TO
THE NURSING HOME SECTOR. I WILL
ALSO TELL YOU THAT WE CAN GET
RID OF BAD APPLES AND I HOPE
THAT WE DO. BUT THAT WILL NOT
IMPROVE THE MEDIOCRITY OF MOST
OF OUR NURSING HOMES IN THIS
COUNTRY TODAY AND THAT'S WHAT I
WANT TO TALK ABOUT. WHICH IS
THAT WE NEED TO INVEST. IN OUR
HUMAN CAPITAL. AND THE STATE
NEEDS TO PAY SIGNIFICANT
ATTENTION TO THE ISSUE HER
DOCTOR STEINBERG TALK ABOUT ONE
ASPECT OF THIS WHICH IS THE
MEDICAL DIRECTORS AND SOME OF
THE CLINICIANS THAT NEED TO BE
DOING BETTER MEDICAL CARE IN A
NURSING HOMES PARTICULARLY ON
THE POST ACUTE SIDE. BUT I WANT
TO TURN MY CHECK MY ATTENTION.
IF WE MOVE TO THE NEXT SLIDE.
TO THE DIRECT CARE. OCCUPATIONS
AND YOU HEARD OUR RESPONSE
PERSON FROM THE S. UNITE YOU.
TALKING ABOUT THIS. BUT THESE
ARE THE FOLKS THAT DO 6280% OF
ALL THE CARE WE CAN O BACK.
ONE ONE SIDE- THEY DO ALL OF
THAT ALL. OF THE CHAIR WELL AS
A HANDS ON CARE SOME. FOR HIGH.
IN NURSE HOMES. SO WE MIGHT PAY
ATTENTION TO THIS POPULATION
WHO ARE PROFESSIONALS. THEY'RE
NOT BUT FIRST. THEY'RE NOT MATE
THEY'RE NOT BUCKLERS. THEY'RE
NOT PEOPLE WHO ARE DOING PERSON
JUST PERSONAL CARE. THEY ARE
MOSTLY FEMALE THEY ARE LOW
INCOME THERE ARE PEOPLE OF
COLOR AND THEY ARE PRIMARILY.
IN A LARGE PART IN PARTICULAR
IN CALIFORNIA IMMIGRANTS. CAN
TURN TO THE NEXT SLIDE. YOU CAN
SAY IMMIGRATION STATUS YOU KNOW
A LARGE PROPORTION 27% OF THIS
POPULATION ARE FOREIGN BORN AND
A LARGE PROPORTION OF THEM ARE
NON WHITE THIS IS HEALTH
DISPARITIES AT ITS ALTERNATE
AND WE NEED TO START THINKING
ABOUT THIS AND AN EXTREMELY
DIFFERENT WAY THESE ARE NOT
WHAT WAGE WORKERS. THESE ARE
CARE PROFESSIONALS WHO ARE
BEING PAID LOW WAGES AND WE
NEED TO TURN THAT ON ITS HEAD
SO IF I CAN MOVE TO THE NEXT
SLIDE. I JUST WANT TO SHOW YOU-
RESULTS FROM A MODELING EFFORT
THAT WE DID IT FOR THE UNITED
STATES CALLED MAKING CARE WORK
HEY. AND WE LOOKED AT WHAT THE
EFFECTS WOULD BE ACTUALLY
RAISING THE FRONTLINE CARE
PROFESSIONAL WAGES TO A LIVABLE
WAGE. NOT JUST A MINIMUM WAGE
FIFTEEN DOLLARS IN CALIFORNIA
FIFTEEN DOLLARS IN WASHINGTON
DC WHERE I LIVE IT'S NOT ENOUGH
TO LEVEL. WE'RE TALKING ABOUT.
A LIVABLE WAGE HERE AND IF YOU
MOVE TO THE NEXT UP TO SHOW A
COUPLE OF THE ROOMS. THREE
QUARTERS THE DIRECT CARE WORK
WOULD HIGHER WHEN THAT TODAY
TALKING ABOUT ON AVERAGE OF A
FIFTH OVER LITTLE OVER. PER
AVERAGE WAGE GAINS. YOU WORST
SHORT. WE WENT THREE AND
THOUSAND NEW DIRECT CARE JOBS
AND A NINE POINT 1% EMPLOYMENT
BOOST IN OUR ECONOMY IN THE
UNITED STATES. A FAIRLY MODEST
PRICE TAG FOR THE WHOLE U. S.
AND WE ACTUALLY HAVE NUMBERS
FOR CALIFORNIA IF YOU WANT TO
TAKE A LOOK AT THAT. NINE POINT
FOUR BILLION PRICE TAG COMPARED
WITH THE FOUR HUNDRED BILLION
TODAY THAT WE'RE SPENDING IN
THIS FIELD. AND WE ALSO HAVE
TURNOVER REDUCTIONS- WITH A
FIVE BILLION PRODUCTIVITY
INCREASE THAT WOULD OFFSET THE
COSTS OF THIS HIGHER K. AROUND
LIVABLE WAGE. THE MOVE TO THE
NEXT SLIDE AND I'LL SHOW YOU A
COUPLE OF OTHER THINGS. I
ROBUST ECONOMIC GROWTH
ADDITIONAL DIRECT CARE WORKER
SPENDING ADDS SEVENTEEN TO
TWENTY TWO BILLION DOLLARS TO
THIRTY. HE STROKES. THEIR MONEY
BACK INTO THEIR LOCAL
NEIGHBORHOODS IN EVERY SINGLE
COMMUNITY IN CALIFORNIA.
RELATIVE TO HIGHER WAGE WORKERS
THEY PAY MORE AND INVEST MORE
IN THE ECONOMY SO YOU ARE
GETTING A SIGNIFICANT ECONOMIC
BOOST. WITH A LIVABLE WAGE AND
I'M FUNDING FINALLY WE'RE
ENHANCING THE DIRECT CARE
WORKER FINANCIAL WELL. BEING
YOU'RE DOUBLING THEIR RETURN
THURMOND SAVING AND REDUCING
THE USE OF PUBLIC AS- THAT YOU
HEARD FROM THE S. OUT YES YEAH
YOU. PRESENTATION BY ABOUT ONE
POINT SIX BILLION DOLLARS A
YEAR. THIS IS JUST A LIVABLE
WAGE PIECE OF THIS. SORT
RETURNED ON THE NEXT SLIDE. I
JUST WANT TO SHOW YOU WHAT WE
THINK. BUT THE STATE'S OUGHT TO
BE THINKING ABOUT AS YOU LOOK
AT THE IMPORTANCE OF
TRANSPARENCY IN THIS SECTOR YOU
ALSO HAVE TO BE THINKING ABOUT
THE HUMAN CAPITAL WE DON'T GET
QUALITY MAGICALLY. EVEN IF YOU
GOT RID OF THESE BAD APPLES
WE'VE GOT TO HAVE AN INVESTMENT
A POSITIVE INVESTMENT IN
EXPANDING THIS CARE GIVER PIPE.
IN ENHANCING TRAINING AND
EDUCATION. AND THAT MEANS I AND
I KNOW THE CNA TRAINING IN
CALIFORNIA DONE WORKING
CALIFORNIA FOR THE MORE
FOUNDATION WE FOR CALIFORNIA IS
NOT IN THE FOREFRONT OF
TRAINING AND EDUCATION THERE
ARE MANY STATES THAT ARE MUCH
FURTHER ALONG. IN TERMS OF
TRAINING AND EDUCATION AND ON
GOING IN SERVICE SUPPORT FOR
THIS FRONTLINE STAFF. WE GOT TO
THINK. ABOUT HOW WE ACTUALLY
FACILITATE CO ADVANCE WHICH
COULD NOT US TO THE WHERE WE
WOULD HAVE MORE NOR TO IN HER
SECTOR MORRELL THE END. MORE
SOCIAL. MORE H. R. MANA AND BY
THE SOME THE BEST HOME THEN.
THAT WE HAVE MET IN THE HIGH OF
NURSING HOME THAT I DO IN OVER
YEARS. STARTED OUT AS C. N. SO
WE MAY TO THINK ABOUT A REAL
INVESTMENT AT THE STATE LEVEL
WITH THEIR COMMUNITY COLLEGES
WITH ARAB OTHER EDUCATIONAL
INSTITUTIONS. TO ACTUALLY
ADVANCE CAREERS. RACING CAR. IS
GOING TO BE ESSENTIAL. PART OF
THIS HAS TO DO WITH WHAT
PROVIDERS ARE WILLING TO PAY AN
ABLE TO PAY PART OF THIS HAS TO
DO WITH MEDICARE REIMBURSEMENT
RATES. PART OF THIS HAS TO DO
WITH HOW WE REACH REDISTRIBUTE
DOLLARS WITHIN OUR SYSTEM AND
PART OF THIS HAS TO BE A
SOCIETAL COMMITMENT. TO PAYING
HIGHER WAGES. TO A PROFESSIONAL
WORKING STAFF. ON THESE ARE
SEEN AS THE- WORKERS. AND THEY
ARE. THEY ARE CARING. FOR WE
RECOMMEND THAT WE PREPARE
UNIVERSAL WORKERS AND WE
ACTUALLY WERE WORKING WITH THE
MORE FOUNDATION TO EXPLORE HOW
CALIFORNIA MIGHT BE ABLE TO
ACHIEVE THIS. THAT IS WE
PREPARE WORKERS ACROSS ALL
SETTINGS. WE DON'T HAVE A
SEPARATE CERTIFICATION FOR
CNA'S FOR HOME CARE AIDES WE.
START TO BEGIN TO BUILD AN
OCCUPATION ACROSS ALL OF THE
SETTINGS SO THAT THEY CAN NO.
VERY FLEXIBLE. INCOME OF THE
TIME WOULD HAVE BEEN ABLE TO
HELP A LOT MORE SO. IN NURSING.
IF WE HAD BEEN ABLE TO TRAIN
HARD CARE WORK UP THE C. STAY.
THAT'S WHAT IN. STATE RIGHT NOW
WE NEED TO BE LOOKING AT OTHER
STATES IN ORDER TO THINK ABOUT
FRANCE AND FINALLY I THINK WE
NEED TO BE LOOKING AT THE STATE
LEVEL AT REFORMING LONG TERM
SERVICES AND SUPPORT FINANCING.
JUST AS WASHINGTON STATE AND
NUMBER NUMBER OF OTHER STATES
ARE LOOKING AT AND I KNOW THE
CALIFORNIA ALSO IS TAKING A
LOOK AT THIS. HOW DO WE MAKE
SURE THAT PEOPLE WHO ARE NOT ON
MEDICAID. BUT JUST ABOVE THAT
ONE MIGHT THE MODERATE INCOME
IN CALIFORNIA WHICH IS PRETTY
DARN HOT AT THIS POINT I KNOW I
USED TO LIVE THERE AND I HAVE
FRIENDS WHO STILL DO. HOW CAN
THEY AFFORD TO PAY. FOR THE
SERVICE. I DON'T HAVE MEDICATE.
HOW TO THEY PAY PRIVATE IN A
NURSING HOME WHEN WE KNOW.
I
MEAN DOES IT MAKE SENSE THAT
THAT AN INTERIM MANAGEMENT
AGREEMENT WOULD ALLOW- YOU KNOW
THE- THE APPLICANT WHOSE
APPLICATION WAS DENIED TO
CONTINUE TO BE ABLE TO OPERATE
YEAH I GUESS I WOULD JUST TELL
YOU THAT. MY UNDERSTANDING AT
LEAST AND I DON'T KNOW THIS
PARTICULAR SITUATIONS I DON'T
KNOW THAT I WANT TO COMMENT ON
ON ON THAT ONE BUT I WOULD JUST
SAY. THAT SOMETIMES
APPLICATIONS ARE DENIED FOR AN
ACCURATE BASED ON INACCURATE
INFORMATION ENACTED REASONS
THERE IS AN APPEAL PROCESS
THROUGH THESE AND FREQUENTLY
THOSE DECISIONS ARE OVERTURNED
SO I'VE AGAIN NOT KNOWING THAT
THE PARTICULAR SITUATION I DO
THANK. YOU NOTE DUE PROCESS AND
REVIEW OF THESE OF TE HAVE ANY
KIND OF DENIAL IS AN IMPORTANT
FACTOR IS CERTAINLY AS AS AS A
FORMER PROSECUTOR AND PUBLIC
DEFENDER I CAN CERTAINLY
APPRECIATE THE IMPORTANCE OF
DUE PROCESS BUT- I THINK FROM
THE PERSPECTIVE OF A NURSING
HOME RESIDENT PROTECTION
CONSUMER PROTECTION- PUBLIC
HEALTH PROTECTION. I MEAN
WOULDN'T AS AS THE LICENSING
AGENCY- AND THE ENFORCEMENT
AGENCY WE WOULDN'T- WOULDN'T IT
MAKE MORE SENSE THAT THAT IF A
APPLICANTS AB AN APPLICATION
FOR OPERATING AND KNOWS THE
NURSING HOME WAS DENIED THEN
YOU KNOW WHILE THEY'RE
CERTAINLY ENTITLED TO THEIR
RIGHT TO APPEAL. THAT IN THE
MEANTIME YOU KNOW THE PER
SHOULD BE WITH THE FINDING OF
THE AGENCY THAT THAT THEIR
APPLICATION TO OPERATE THE
FACILITY WAS DENIED WELL LET ME
BRING LET ME LET ME PLAY THIS
OUT JUST A LITTLE BIT. WHERE
DOES THE FACILITY GO THEM. GOOD
TO GO BACK TO THE PRIOR.
OPERATOR IN SOME CASES WE KNOW
A SITUATE WE KNOW OF SITUATIONS
FREQUENTLY WERE SOMETIMES.
MAYBE A SITUATION WOULD BE
THAT- MAYBE WOULD. NOT I DON'T
WANT FREELY BUT A SITUATION
WHERE. A FACILITY HAS. CHANGED
OWNERSHIP BE UP PRIOR OWNER HAS
GOTTEN OUT OF THE BUSINESS-
RETIRED MOVED ON. AND IN SOME
CASES THAT IF THE NEW OWNER IS
SHIP IS DENIED WHETHER INTERIM
OR PERMANENT. WHERE DOES THAT
GO. WHO WHO'S GONNA WHO'S GONNA
BECOME THE NEW OPERATOR YEAH
AND I THINK THAT THAT THAT'S A
CONSIDERATION I THINK TO MAKE
YOU KNOW SORT OF A BLANKET
NOTION THAT SOMEONE TONIGHT
CANNOT. THE ALL THOSE
CONSIDERATIONS IN THOSE DOWN
THE LINE. ISSUES HAVE TO BE
CONSIDERED. I KNOW I APPRECIATE
YOU RAISING THAT POINT BECAUSE
LIKE I KNOW THAT THAT'S BEEN A-
IN AN UNSPOKEN OR UNDER DRESSED
TO THE CHALLENGE IN IN IN THE
INDUSTRY I MEAN WHAT HAPPENS.
YOU KNOW IF WE DO- CALL UPON
OUR REGULATORY AGENCIES TO
ENFORCE. YOU KNOW OUR OUR
PUBLIC HEALTH REGULATIONS IS I
MEAN THAT THAT ULTIMATELY IT'S
GOING TO SHUT DOWN AND LEAD TO
THE LOSS OF THAT THAT THAT
NURSING HOME BEDS- BUT I MEAN
IS. THERE THAT THE LAW DOES
ALLOW FOR. THE DEPARTMENT OF
PUBLIC HEALTH TO PETITION FOR
RECEIVERSHIP. IT DOES AND- WHY
WHY WOULDN'T IT MAKE SENSE FOR
I WOULD JUST SAY THAT THAT'S
PROBABLY NOT A PARTICULARLY
APPEALING PLACE FOR PEOPLE TO
WORK. I MEAN I THINK YOU HAVE
TO ALSO CONSIDER THAT TOOTH THE
BILL BUILDINGS NEED STABILITY.
IN TERMS OF BEING ABLE TO
ATTRACT WORK RETRACT AND RETAIN
WORKFORCE AS WELL AND THEN THEY
NEED THEY NEED THAT IN TERMS OF
THEIR ABILITY TO- WORK WITH
THEIR HOSPITAL PARTNERS AND
WITH THEIR STAFF AS WELL.
BUILDINGS IN RECEIVERSHIP IN
AND IN TURMOIL ARE NOT GOOD FOR
ANYBODY I WOULD SAY SO I THINK
THAT THAT'S A CONSIDERATION AS
WELL I MEAN I DON'T AGAIN. I
DON'T THINK I DON'T THINK WITH
THERE'S A ONE SIZE ON IN A LOT
OF THESE ISSUES I THINK IT'S A
CHALLENGE TO KIND OF RESPOND IN
THAT BUT I JUST BE CAUTIOUS
ABOUT THAT. NOTION I BELIEVE
GOING RECEIVERSHIP WHO'S GOT
AYE AGAIN WHO'S GOING TO
OPERATE THEM. DEPARTMENT OF
PUBLIC HEALTH KEEP THE LIST I
NOW. OF POTENTIAL
ADMINISTRATORS TO GO IN AND
STEP IN BUT THOSE ARE NEVER.
PARTICULARLY GOOD SITUATIONS
WELL I MEAN IT AND AS I
UNDERSTAND IT- MR RECHNITZ A-
GOT A START IN THE CALIFORNIA
NURSING HOME INDUSTRY BY- BY
BEING APPOINTED AS A RECEIVER
AND- AND- AT THE- SEVERAL
NURSING HOME. FACILITIES BUT-
YEAH AND I'M NOT SAYING THEY'RE
NOT THAT'S NOT AN IMPORTANT
FUNCTION I THINK THAT'S IT IS
IMPORTANT IMPORTANT SAFETY
VALVE. THING THAT'S NOT
SOMETHING THAT SHOULD BE A
PREFERABLE PREFERABLE. LOCATION
FOR ANYBODY. WHAT WHAT ABOUT
THE MISTER CORNET THE EXAMPLE
THAT I RAISED EARLIER THEY THE
EXAMPLE THAT WAS CITED IN THE-
THE NPR ARTICLE LET ME SHOULD
THE SOMEONE WHO CLAIMS WHO
PRESENTLY CLAIMS TAKE A COLLEGE
TRANSCRIPT TO BE. SHOULD THEY
BE ALLOWED TO OPERATE A NURSING
HOME IN THE STATE OF CALIFORNIA
YEP THIS MESSAGE I DO NOT KNOW
THAT SITUATION WHATSOEVER SO I
DON'T FEEL COMFORTABLE
COMMENTING ON THAT OKAY. BUT-
HYPOTHETICALLY SPEAKING IF
SOMEONE OF FRAUDULENTLY CLAIMED
THAT THEY HAD A DEGREE FROM
UNIVERSITY. SHOULD THEY BE
ALLOWED TO OPERATE NURSING
HOMES DID CALIFORNIA I SUSPECT
ANYONE WHO HAS COMMITTED FRAUD
THAT IT'S GOING TO BE. CAUGHT
THAT IS THAT IS GOING TO BE
ADDRESSED IT IS TO SOME ONE
MECHANISM OR ANOTHER. AGAIN NOT
KNOWING I DON'T WANT TO. SPEAK
TO THE SITUATION AND AGAIN I
WOULD ALSO JUST SAY TO YOU-
WHAT WE HAVE SEEN A LOT OF
EXAMPLES. WERE WHETHER
DEPARTMENT OF PUBLIC HEALTH OR
OTHER GOVERNMENTAL AND
ENTITIES. HAVE INFORMATION THEY
THINK IS ACCURATE THAT IS NOT.
BY JUST CAUTION ON THAT I WHY
DON'T KNOW WHAT'S GOING ON
BEHIND THEIR SOME OF THESE
THINGS ARE CONFIDENTIAL I
SUSPECT I DON'T KNOW THOUGH. I
CAN'T SPEAK TO THAT. THANK YOU.
THANK YOU MISTER MURATSUCHI- I
HAVE A FEW QUESTIONS I KNOW I
KNOW TO A CLOSER WAITING FOR
PUBLIC COMMENT WE WILL WE WILL
TAKE SOME PUBLIC COMMENT- BUT I
THINK THE GRAVITY OF THE OF
THIS HEARING AND THE
INFORMATION ARE GETTING I
THINK. I DON'T MIND STAYING A
LITTLE LATER TO- TO GET THIS
INFORMATION SO I WAS WOULDN'T
DONE DO YOU ASSOCIATE YOU HAVE-
PROPOSAL THAT DID THE WE MIGHT
CONSIDER IN CHANGING HOW
QUALITY ASSURANCE FUNDS ARE.
ARE DISPERSED TO MEET IS THERE.
I WAS YOU SPOKE ABOUT QUALITY
ASSURANCE FUNDS AND I THINK
QUALITY ASSURANCE AS SURE AS
FUNDS ARE ARE VERY IMPORTANT.
FOR NAY YOUR PERSPECTIVE- DO
YOU TO ASSOCIATE YOU HAVE ANY
POSITION ON ON HOW THAT WOULD
PLAY OUT YES THANK YOU- MISTER
FOR THE QUESTION I THINK- IN
PARTICULAR DURING THE SIXTEEN
TWENTY NINE PROCESS ALL WE'RE
TALKING ABOUT REIMBURSEMENT
THEY WERE TALKING ABOUT- HOW DO
WE MOVE THE STRUCTURE WE
DEFINITELY HAVE TALKED ABOUT
QUALITY ONE OF THE THINGS. IN
PARTICULAR HAS BEEN TALKED
ABOUT THE QUALITY-
ACCOUNTABILITY SUPPLEMENTAL
PAYMENT ALSO KNOWN AS THE COST.
AND THE CURRENT STRUCTURE WHICH
THAT WE THE STATE IS GOING TO
MOVE WE ARE IT'S OUR
UNDERSTANDING THAT THAT QUALITY
PAYMENT WOULD GO AWAY TO THE
AUTHORS POINT. THOSE FACILITIES
I DID RECEIVE THIS COST DID
THEY ACTUALLY DID BETTER WHEN
IT CAME TO QUALITY- TO HER
POINT A LOT OF THOSE FACILITIES
THAN A QUALIFIED BECAUSE OF
OTHER REASONS CITATIONS AND
STUFF. BUT I THINK THAT THE
SIXTEEN TWENTY NINE PROCESS
GIVES US THE ABILITY TO HAVE A
REAL CONVERSATION ABOUT WHAT
QUALITY LOOKS LIKE WHAT ARE THE
APPROPRIATE MEASURES. WHAT WHAT
IT'S BEING USED CURRENTLY THAT
CAN BE MAYBE LOOK RE LOOKED AT-
AND RESTRUCTURED SO THAT IN THE
NEW STRUCTURE IN WHICH THE
STATE IS GOING THAT WE WOULD BE
ABLE TO. IMPROVE QUALITY SO WE
HAVE PROPOSALS WE'RE BRINGING
THEM TO THE SIXTEEN TWENTY
NINE- STAKEHOLDER PROCESS AND
REALLY LOOK FORWARD TO WORKING
WITH YOU AND THE ADMINISTRATION
TO. TO WORK ON THIS THANK YOU-
A QUESTION- ARE MOST OF THEM
MOST OF YOUR MEMBERS WHO WORK
IN NURSING HOMES THE SEIU
MEMBERS. ARE THOUGH ARE THEY
WORKING IN NOT FOR PROFIT
SETTINGS OR THEY WORKING IN FOR
PROFIT SETTINGS. I DO NOT WANT
TO GIVE YOU FALSE INFORMATION
SO I WOULD HAVE TO GO BACK TO
MY LOCAL AND I CAN GET YOU
THAT. INFORMATION THANK YOU I
APPRECIATE THAT SO. SO AND THE
AND THANK YOU FOR BEING HERE AS
WELL IN PERSON- YES THANK YOU
FOR HAVING ARMS AND MISTER
CORNET- CUT SOME QUESTIONS FOR
YOU- SO APPRECIATE. THAT THANK
YOU. FOR YOU'RE YOU'RE- GONNA.
THOUGHTS ON THE LICENSE PROCESS
AND I CAN IMAGINE. FROM
INDUSTRY PERSPECTIVE THAT THAT
IT IS IT IS FRUSTRATING. FOR
THOSE OPERATORS WHO ARE WHO ARE
DOING THEIR VERY BEST AND- AND
TRYING TO WORK WITHIN THE
SYSTEM AND- AND I DO WANT TO
SAY YOU KNOW I. YOU KNOW I
DON'T WANT I DON'T WANT ANYBODY
TO HAVE THE IMPRESSION THAT.
THAT THAT WE ARE ON THIS DIET-
DON'T BELIEVE THAT THERE ARE
REALLY HIGH QUALITY OPERATORS
OUT THERE WE KNOW THERE ARE.
ABSOLUTELY NO THERE ARE- BUT
YOU'VE BEEN YOU'VE YOU'VE BEEN
AROUND A LONG TIME. AND YOU
UNDERSTAND THAT. WE AS A
LEGISLATORS RESPOND. TO BAD
ACTORS QUITE FRANKLY OR THINGS
THAT SIMPLY AREN'T WORKING.
THIS IS A CLASSIC. THIS COULD
BE THE POSTER CHILD FOR CLASSIC
A DYSFUNCTIONAL OF THINGS- IN
IN GOVERNMENT YOU KNOW AND OUR
ABILITY OVERSEE THE PUBLIC
SAFETY. AND QUALITY CARE FOR
OUR FOR SOME OF OUR MOST
VULNERABLE PEOPLE AND SO. I
UNDERSTAND STAFF DIFFICULT TO
FIND IT'S PARTICULARLY
DIFFICULT MY DISTRICT- RURAL
AREAS OR ARE ARE NOTORIOUSLY
CHALLENGING FOR ALL HEALTH
CARE- A PERSONAL AS WELL. I
KNOW MEDICARE RATES ARE NOT AS
HIGH AS A- PEOPLE WOULD LIKE
THEM TO BE. BUT THERE'S
SOMETHING PECULIAR HAPPENING
OUT THERE AND THAT'S THE
ENTRANCE OF. PRIVATE EQUITY
INVESTING INVESTING IN SKILLED
NURSING FACILITIES. SO THAT
TELLS ME THERE'S MONEY OUT
THERE THERE'S PROFIT OUT THERE
BECAUSE PRIVATE EQUITY IS NOT
GOING TO GO INTO FACILITIES IF
THEY DON'T HAVE A CHANCE TO
MAKE A PRETTY SIGNIFICANT
RETURN- THAT'S- AND I'VE I'VE
HEARD THIS FROM REPRESENTATIVES
OF PUBLIC OF PRIVATE EQUITY SO.
THIS IS I'M NOT JUST PULLING
THIS OUT OF THE YEAR. THEY'RE
GOING TO DO SOMETHING FOR AN
OPPORTUNITY TO MAKE MONEY.
THAT'S WHAT THEY DO THAT'S
THAT'S WHAT THEY DO. SO MANY
OF- MANY OF THE OWNERS OF A LOT
OF HOMES MAKE A CONSIDERABLE
AMOUNT OF MONEY- ESPECIALLY
THROUGH THEIR USE OF- RELATED
PARTIES. WE BECAME AWARE THAT
SEVERAL YEARS AGO LOOK AT THAT.
IT'S ALLOWED- BUT. IT'S STILL
TROUBLING BECAUSE- IT FEELS A
LITTLE LIKE. ROBBING PETER TO
PAY PAUL I CAN'T THINK OF
ANOTHER WAY TO SAY THAT AT THIS
POINT SO CAN YOU GIVE US. AN
ESTIMATE AS TO HOW MANY SKILLED
NURSING FACILITIES IN
CALIFORNIA. MIGHT BE USING
SKINNER THE RELATED PARTIES AND
HOW PROFITABLE THOSE
ARRANGEMENTS ARE FOR OWNERS WE
HEARD FROM WAS VALENTINE. IT IS
REALLY PROFITABLE WELL I HAVE
TO- WELL FOR THE RECORD I
DISAGREED WITH ALMOST
EVERYTHING WITH OUTSIDE SAID.
SO AND I WITHOUT GETTING INTO
THAT I DON'T THINK WE NEED TO
GET INTO THAT BUT I WANT TO I
DID I I'M NOT SURE THAT I CAN
GIVE YOU FIGURES ON THIS BUT I
WANT I WANT TO GIVE YOU ALL
PERSPECTIVE. ON THIS ISSUE OF
RELATED PARTIES THE DEPARTMENT
OF. HEALTH CARE SERVICES AUDITS
IN MINUTE DETAIL EVERY
EXPENDITURE OF A SKILLED
NURSING FACILITY THEY DO
ACTUALLY TWO YEARS IN ARREARS-
AND THEN THAT'S HOW FACILITIES
ARE PAID THIS THE FEE FOR
SERVICE- SITUATION THEY HAVE
FACILITIES HAVE TO DOCUMENT
EVERY SINGLE THING IF CD IF THE
DH CS FIND SOMETHING. THAT IS
OUT OF LINE IN SOME WAY THAT IS
DENIED AND THOSE AT FACILITIES
pARE NOT REIMBURSED FOR THAT
THEM SO I THINK THERE'S A LOT
OF CHECKS ON RELATED PARTIES
NOW I WILL I WILL TAKE IT-
RIGHT RIGHT AWAY. THE ISSUE A
PRIVATE EQUITY. I WILL TAKE IT.
THANK YOU BYE AS YOU SAID YOU
SAID IT MR CHAIRMAN WOULD. THE
OTHER WAY TO THINK ABOUT THIS
THOUGH IS IF THERE WAS IF THERE
WAS SUCH A- PROFITABLE
SITUATION. WE WOULD HAVE MORE
PEOPLE. RUSHING TO GET INTO
THIS PROFESSION THAT IS NOT THE
CASE THERE ARE ALMOST NO NEW
SKILLED NURSING FACILITIES
BEING CONSTRUCTED IN
CALIFORNIA. THAT THAT'S JUST
NOT THE CASE IT IS NOT A PLACE
THAT IS. A PLACE TO COME IN AND
DO PARTICULARLY WELL RIGHT NOW
IT JUST ISN'T THE COST OF THE
COST OF OPERATING CALIFORNIA
THE COST THE REGULATORY COSTS
ARE ENORMOUS. SO I THINK THAT'S
A LITTLE BIT OF A AB PROVE IT
MAY NOT BE. EXACTLY WHAT IT
APPEARS I WOULD ALSO JUST
MENTION TO YOU THAT- TO
EFFECTIVE IN REFERENCE TO THE
QUESTION DO YOU HAVE FROM
SWEDEN. OF THE FACILITIES IN
CALIFORNIA. I'VE GOT ROUGHLY
CORRECT. BUT 85% OF PRIVATELY
OWNED. BUT- TEN PERCENT. ARE
PUB ARE ARE- ARE- NONPROFITS
ABOUT 5% I BELIEVE. OUR
GOVERNMENTAL OUT THAT WOULD BE
LIKE THE VETS HOMES- ADVOCATES
HOMES NOT THAT KIND OF THING. I
WOULD ALSO SAY THAT THERE'S A
BIG DIFFERENCE IN WHO IS CARED
FOR BETWEEN. THE NONPROFITS AND
THE OF THE OTHERS. MOST OF THE
MEDIC CAL POPULATION IS CARED
FOR IN THE LARGEST GROUP. THE
NONPROFITS TEND TO CARE FOR
MOSTLY MORE THAN MEDICARE
SHORTER TERM POPULATIONS AND
THAT'S AN IMPORTANT DISTINCTION
I THINK- THAT THAT I THINK
SOMETIMES GETS MISSED AND SOME
OF THESE DISCUSSIONS AS WELL.
SO I WANTED TO HAVE A LITTLE
DEEPER HERE BECAUSE- I WAS A
MID PACK REPORT- LITERATURE
REVIEW ABOUT PRIVATE EQUITY
INVOLVED. AND THEY LOOKED AT A
VARIETY OF ISSUES IT WAS A
LITERATURE REVIEW SO- IT'S NOT
RAW DATA LOVE TO SEE RAW DATA
QUITE FRANKLY- BUT- 4% OF
HOSPITALS. ARE ARE HAVE PRIVATE
EQUITY. INVESTMENT THERE. 11%
OF SKILLED NURSING FACILITIES.
11% THERE'S MONEY TO BE MADE
THERE OBVIOUSLY IF THAT'S
HAPPENING AND THESE THIRD PARTY
ARRANGEMENTS. YOU WOULDN'T GO
TO A LOT OF EFFORT TO DO THAT
IF THERE WASN'T SOME SORT OF A
MOTIVE TO MAKE TO MAKE MORE
MONEY OR TO TRY TO CREATE A
BETTER TAX INCENTIVE OR PROCESS
FOR YOURSELF. SO YOU KNOW WE I
WOULD LIKE TO SEE YOU KNOW
WE'VE WE'VE TALKED ABOUT THIS
IN THE PAST OF LET'S SEE. HOW
WE YOU KNOW HOW WE CAN DIG
DEEPER INTO THAT AND GET GET
MORE INFORMATION SO. I SAY TO
WIN THERE WITH TWELVE HUNDRED
AND ONE ALSO MAKE REFERENCE TO
A POINT YOU MADE EARLIER TO-
MISTER CHAIRMAN I'VE BECAUSE I
APPRECIATED THE POINT YOU MADE.
AND THAT IS BEING RESPONSIVE
TO- PARTICULAR INCIDENTS IN
PARTICULAR FACILITIES YOU HERE
AND I APPRECIATE THAT I WORK IN
THE LEGISLATURE FOR THIRTY
YEARS I UNDERSTAND THAT THE
IMPORTANCE OF WHAT YOU HAVE TO
DO WHAT YOU DO HERE. AND BEING
RESPONSIVE TO YOUR TO YOUR
CONSTITUENTS I WOULD JUST URGE
YOU THOUGH PLEASE DON'T MAKE
POLICY BASED ON A FEW OF THOSE
THIS TWELVE HUNDRED TWENTY ONE
FACILITY. SKILLED NURSING
FACILITIES IN CALIFORNIA. THIS
I MEAN I DON'T SAY MAJORITY I
WOULD SAY. THE VAST VAST VAST
VAST VAST GROUP PROVIDE GREAT
QUALITY CARE EVERY DAY AND THE
ONES THAT HAVE ARE STRUGGLING
ARE STRUGGLING FOR A LOT OF
DIFFERENT REASONS. AND FOR ME
AT LAST IT'S ALL IT'S ALMOST
AN ISSUE HOW DO WE IMPROVE THE
STRUGGLING FACILITIES VERSUS
DOING SOMETHING LEGISLATIVELY
THAT MAKES IT HARDER IN THE
ENTIRE SECTOR GOING FOR THAT'S
COUNTERPRODUCTIVE. ON THE
PRIVATE EQUITY- I GUESS THE
ONLY THING I'D SAY TO WITH IF
IT'S 11% OF TWELVE HUNDRED
FACILITIES THAT'S A RELATIVELY
SMALL NUMBER AND I DON'T KNOW
ENOUGH ABOUT. THIS PARTICULAR
SITUATIONS YOU'RE TALKING ABOUT
I DO KNOW. AT LEAST NATIONALLY
BECAUSE I LOOK AT THAT A LOT OF
THE NATIONAL DATA ON THIS AS
WELL. THERE'S A LOT OF. BAD
BUSINESS DECISIONS THAT BEEN
MADE BY SOME IN THE PRIVATE
EQUITY WORLD TO AS TO WHAT
THEY'VE GOTTEN INTO COULD HAVE
BEEN IT'S BENEFICIAL TO THEM IN
SOME CASES. SOME PRIVATE EQUITY
WITH OWNING THE LAND AND OVER
THE LAST FEW YEARS ON THE LAND
THAT FACILITIES THAN WE'RE
PAYING THE RENT ON THAT AS
ACTUALLY DROVE A LOT OF
FACILITIES. OUT OF BUSINESS
BECAUSE THE OWNERSHIP OF THE
LAND BUT WITH THEY WERE
CHARGING. EXORBITANT RATES TO
THE OPERATORS OF THE FACILITIES
THAT ACTUALLY WAS ONE OF THE
CRISES WE THOUGHT A LOT ABOUT
THE STATE'S. AND THAT THAT
INFORMATION THAT WAS NATIONAL
DATA THAT WASN'T I WOULD LOVE
TO SEE STATE DATA I DON'T WE
DON'T HAVE IT AND I WOULD LOVE
TO SEE THAT- GOING FORWARD SO.
HAPPY TO WORK WITH YOU ON THAT
SO I KNOW THAT- I KNOW IT'S
ALWAYS WE'RE ALWAYS HEARING
IT'S YOU KNOW WE WANT HIGHER
REIMBURSEMENT RATES WE WANT
STAFFING WAIVERS- GET YET YOU
HAVE. YOU MANY OF YOUR OWNERS
MAKING MILLIONS AND MILLIONS
AND MILLIONS OF DOLLARS. NOT
ALL BUT MANY OF THEM- IN RENT.
AND CONSULTING FEES AND-
THROUGH SOME OF THESE THIRD
PARTY ARRANGEMENTS- CAN YOU
HELP US THAT FEELS LIKE A BIG
DISCONNECT. I WOULD SAY. GO
BACK WHAT I WHAT I WOULD GO
BACK TO WHAT I SAID EARLIER.
ALL THOSE ARRANGEMENTS ARE ALL
REVIEWED BY THE DEPARTMENT OF
HEALTH CARE SERVICES AN AUDITED
IF SOMETHING IS. IN CORRECTLY
DONE. IT IS DISALLOWED. SO I
JUST I DON'T KNOW THAT THAT. I
MEAN I THINK THERE'S A LOT OF
ALLEGATIONS ABOUT THIS BUT-
THIS THIS SECTOR IS. MORE
TRANSPARENT THAN ANY OTHER PART
OF THE HEALTHCARE WORLD. IN
TERMS OF ITS FINANCES. SO WE
SHALL SEE YEAH I THOUGHT I'D I
JUST. BY THAT I DON'T I DON'T
THINK THIS IS EXACTLY AS IS
BEING PORTRAYED FREQUENTLY
HOMES. IT'S HARD NOT TO BE
SKEPTICAL FROM OUR POSITION-
WHEN WE HEAR SOME. SOME PRETTY
EGREGIOUS EGREGIOUS STORIES AND
I WOULD I WOULD ASK YOU KNOW.
YOU HAVE SAID THAT YOU AS THAT
THAT JUROR YOUR YOUR
ASSOCIATION IS INTERESTED IN
WORKING THIS WE HAVE A
COMMITMENT FROM DEPARTMENT OF
HEALTH TO WORK FOR THIS I HOPE
THAT WE CAN ALL SIT DOWN AND
REALLY WORK ON THIS ISSUE- AND-
AND HELP WITH THIS LICENSING
PROCESS. AND RE CERTIFICATION
PROCESS THAT GOES ALONG WITH
IT. WE CAN'T AFFORD TO HAVE
FACILITIES CLOSE THAT IS THAT
IS THE THAT'S THE FINE LINE WE
WALK HERE IT'S REALLY REALLY
CHALLENGING. BUT WE HAVE TO BE
QUALITY THEY HAVE TO BE SERVING
THE NEEDS OF PEOPLE- AND I
RECOGNIZE THAT IT'S A DIFFICULT
THAT IT'S A DIFFICULT INDUSTRY
IT'S IS NOT WITHOUT CHALLENGES.
IT'S BUT THERE ARE A LOT OF
DIFFICULT INDUSTRIES OUT THERE
THAT ARE NOT WITHOUT
CHALLENGES- BUT I WOULD LOVE TO
SEE WE PUT YOU KNOW PUT OUR
PATIENTS FIRST OUR PROFIT
SECOND- YOU TAKE YOUR YOUR
PATIENCE WELL. THE PROFITS DO
FOLLOW- AND I AND- AND THEY
DIED BUT I THINK THEY NEED TO
BE REASONABLE- AND- AND I THINK
THEY NEED TO BE FAIR. BUT FIRST
AND FOREMOST PATIENCE. THE
RESIDENTS NEED TO BE WELL CARED
FOR AND I HOPE WE CAN GET
THERE. CAN AGREE MORE- MISTER
CHAIRMAN WE LOOK FORWARD TO
WORKING WITH YOU ON THIS
BECAUSE OF A WEAK WE ABSOLUTELY
BELIEVE. THERE IS I GOT SO SAID
SUBSTANTIAL ROOM FOR
IMPROVEMENT AND THIS ONE ALSO
EMPHASIZED. MY ASSOCIATION IS
TOTALLY DRIVEN TO. TOTALLY
OBSESSED WITH DRIVING QUALITY.
DRIVING INCREASED IN QUALITY.
WE WORKED- AND OUR LAST AT
SIXTEEN TWENTY NINE DEAL WE
WORK VERY CLOSELY WITH THE
STATE. TO TRY TO IN BED IN OUR
RATES. PART OF THE RATE
INCREASES. WOULD HAVE BEEN TIED
TO QUALITY THAT THE STATE
ABANDONED THAT PROCESS AS WE
WENT THROUGH IT BUT WE ACTUALLY
THOUGHT THE WITH A LOT OF
BENEFIT THAT. THERE ARE A LOT
OF PROBLEMS WITH THE WAY THE
STATE- MONITOR SOME OF THE
QUALITY FUNCTION BUT I WILL
TELL YOU THAT TOO AND I THINK
WE'VE GOT CONCERNED ABOUT THAT
BUT WE ARE VERY. WE BELIEVE.
YOU KNOW QUALITY IS. AS THE
ADAGE GOES QUALITY IS JOB ONE
AND THERE'S JUST NO QUESTION
THAT'S GOOD FOR. ITS GOOD FOR
COMMUNITIES THAT'S GOOD FOR
PATIENTS IT'S GOOD FOR THEIR
FAMILIES. AND IT'S GOOD FOR OUR
STAFF. TO WELL I THINK M. AND I
WAS. QUIT BUT IT WASN'T JUST
ONE MINUTE SO AND UP MISTER
MERCY JUST A COMMENT THAT I DO
HAVE ONE MORE QUICK QUESTION
FOR THE DOCTOR STONE BUT- YOU
KNOW. WE DON'T LIKE HAVING TO
LEGISLATE TO- THE BAD ACTORS.
WHAT WE WOULD REALLY LOVE IS
FOR THE INDUSTRY. TO PUT
PRESSURE ON THE BAD ACTORS TO
CHANGE THEIR BEHAVIOR THAT IS
THAT WOULD BE HELPFUL- WE SEE
BUT WE SEE THIS THROUGHOUT
THROUGHOUT HEALTHCARE WE SEE
THIS THROUGHOUT THE INDUSTRY.
WE HAVE TO WE END UP HAVING TO
REGULATE TO TE BAD ACTORS AND
WE DON'T WANT TO PUNISH THE
GOOD ACTORS. BUT IF INDUSTRY
ITSELF'S. BUT HELP FOCUS AND
CHANGE BEHAVIOR SOME OF THE BAD
ACTORS WE WOULDN'T BE HERE THIS
HEARING WILL BE HAPPENING. I
WILL SAY THIS. WHEN I WENT THAT
THE NUMBER OF THE COMMON
INFECTIONS AND DEATHS THAT
HAPPEN AND SKILLED NURSING
FACILITIES IN CALIFORNIA ARE
TRULY APPALLING. IT USE WHAT
YOU SAID HERE THAT THAT WE WERE
LIKE A SHINING STAR IN THE
NATION. I'M SHOCKED. WELL I
THINK DISAPPOINTED WELL EXCEPT
I DON'T SEE A DOCTOR WHAT I
THINK HANG ON BECAUSE I'M NOT
DONE. I'M SORRY. I'M I'M- STILL
WAY TOO MANY DEATHS. WAY TOO
MANY DEATHS. WE SAW THIS
PANDEMIC PLAYING OUT IN
WASHINGTON A COUPLE OF MONTHS
BEFORE. IT STARTED IN
CALIFORNIA AND YET IT TOOK A
COUPLE OF MONTHS TO READY AND
BEGIN TO REACT WE KNEW WHAT WAS
HAPPENING IN WASHINGTON WE KNEW
IT YOU SAW IT PLAYING OUT IT
STILL TOOK A COUPLE OF MONTHS.
AND THAT MEANT PEOPLE GOT SICK
AND THAT MEANT. THAT PEOPLE
DIED. I EXPECT BETTER FROM US
WE DESERVE BETTER HERE IN
CALIFORNIA- AND I DO I'M I'M A
LITTLE PART OF THE YEAH IF
WE'RE IF WE WERE THE BEST A
SHUDDER TO THINK WHAT WAS GOING
ON OTHER STATES AND- PRETTY
PRETTY PRETTY SHOCKED BY THAT
WELL IT JUST IT JUST AS A POINT
ON THAT. EVERY DEATH IS A
TRAGEDY- I WANT TO MAKE THAT
CLEAR TO AND WE KNOW THAT THAT
WOULD THAT IS IT WAS VERY HARD
ON OUR STAFF WHO WORK IN THOSE
FACILITIES CLEARLY ON THE
FAMILIES. NO QUESTION BUT I
THINK WE ALSO HAVE TO REMEMBER
WHAT WE WERE FACING AT THE TIME
WE ARE FACING A PANDEMIC THAT.
IT IT'S THE MOST VULNERABLE
PEOPLE. FOR ELDERLY AND PEOPLE
WITH. MEDIC WITH SERIOUS
MEDICAL CONDITIONS THAT IS A
100% OF THE POPULATION AND
SKILLED NURSING FACILITIES. AT
THE SAME TIME WE WERE FACING A
PANDEMIC. WITH THE GUIDANCE AND
THE CLINICAL GUIDANCE. WITH
CHANGING. RAPIDLY IF YOU RECALL
FRED MONTHS. OF FACILITIES WERE
TOLD AND THE PUBLIC WAS TOLD.
THAT IF YOU WEREN'T. I DID NOT
HAVE SYMPTOMS YOU COULD NOT
SPREAD THE DISEASE. THAT WAS
INCORRECT. WE KNOW THAT NOW IT
THAT WOULD BUT THAT WAS. THAT
THAT IT ENTERED BUILDINGS THAT
WAY INITIALLY AT THE SAME TIME.
WE HAD NO TESTING. WE HAD NO PP
FOR MANY MANY MONTHS. AND AS I
SAID PEOPLE WERE KIND OF UNDER
LEARNING WHAT WAS GOING ON. IN
TIME- IN IN REAL TIME- AS
TRAGIC AS IT IS- THE FACT THAT
WE ARE NOW WHERE WE ARE. I
THINK IT'S A IT'S A TRIBUTE. TO
HOW WELL THE VACCINES OF WORKED
AND HOW WELL OUR FACILITIES
HAVE UP HAVE- YOU KNOW WE'RE
RAISE THE LEVEL THEIR GAME ON
INFECTION PREVENTION- AND
KNOWLEDGE- AND SO I THINK
THAT'S- IF THERE'S ANY IF
THERE'S ANY SILVER LINING TO
THIS VERY DARK CLOUD THAT'S
WHAT I THINK IT IS. APPRECIATE
YOUR PERSPECTIVE I AM. THAT
THAT CLOUT DOESN'T HAVE A
SILVER LINING FOR ME SO. THANK
YOU- DR STONE AND IN A NUMBER
MR RESEARCH HAS QUESTION SO- DO
YOU DO YOU EXPECT UP CONGRESS
TO ACT QUICKLY. ON ANYTHING. I
DON'T KNOW I WAS JUST TRYING TO
FIGURE THAT OUT THIS MORNING-
YOU KNOW IT SOUNDS LIKE. WE MAY
GET CHILD CARE. AND I MEAN
THAT'S THE WHOLE QUESTION OF
WHAT HAPPENS TO THE
RECONCILIATION BILL. WHERE SITE
WORRY ON THE WORK FORCE SIDE
BECAUSE WE HAVE A HUGE
INVESTMENT. FOUR HUNDRED
BILLION FOR HCV ALISON WE'VE
ACTUALLY BEEN TRYING TO MAKE
SURE THAT WE COULD POSSIBLY
EXPAND OUT TO OTHER SETTINGS
THAT'S DEFINITELY GOING TO BE
CUT BUT WE DON'T KNOW HOW MUCH
IT'S GOING TO BE CUT THE OTHER
THING THAT WE WORK ON. IN OUR
GROUP IS AFFORDABLE SENIOR
HOUSING BECAUSE WE HAVE A LOT
OF AFFORDABLE SENIOR HOUSING
PROVIDERS AND LEADING AGE AND
THAT IT MAY BE ON THE CUTTING
BOARD AS WELL SO- I WISH I
COULD TELL YOU I HAVE NO IDEA-
WE NONE OF OUR POLICY PEOPLE
KNOW ANYMORE THAN THOSE OF US
WHO READ THE NEWSPAPER-
SOMETHING I'LL COME OUT OF
CONGRESS- WHAT WHAT ENDS UP
GETTING CUT OF COURSE THE TRUTH
OF THE MATTER IS IF WE GET A
CHILD CARE. BENEFIT THIS HELPS
OUR FRONTLINE CARE
PROFESSIONALS BECAUSE THAT'S
ONE OF THE BENEFITS THAT THEY
NEED AND IT'S EXTREMELY
VARIABLE IN TERMS OF WHAT
ACCESS TO VOTE THROUGH THOSE
TYPES OF BENEFITS THEY GET
THROUGH THE NURSING HOME THESE
DAYS SO ON THE CHILD CARE
BENEFIT WOULD HELP- FAMILY
MEDICAL LEAVE WOULD HELP- SO
WE'LL SEE WHAT HAPPENS- GREAT
THANK YOU THANK YOU I DID WANT
TO SAY ONE OTHER THING THAT
LISTENING TO THE CONVERSATION
AROUND- NO I DON'T. DON'T THINK
IT'S AN EITHER OR WE NEED WE
NEED REGULATION- MY FORTY PLUS
YEARS OF THIS AND- LOOKING AT A
LOT OF STATES. HAS TO DO WITH
THE QUESTION OF. WHERE SHOULD
WE INVEST IN A REGULATORY
PROCESS AND WHERE DO WE NEED
SOMETHING ELSE THAT BOTH HAS
CARROTS AND STICKS ATTACHED TO
IT AND I DO THINK THAT WE NEED
WE NEED A PROCESS A REGULATORY
PROCESS THAT DOES NOT ALLOW-
THESE BAD ACTORS I THINK IT'S
REALLY HARD IN THIS. KIND OF A
SOCIETY FOR THE INDUSTRY ITSELF
TO REGULATE THOSE GUYS OUT
ALTHOUGH I THINK THE MORE THAT
WE GET TO A HIGHER QUALITY
SYSTEM THE BETTER IT'S GOING TO
BE FOR ACTUALLY NOT ALLOWING
THOSE TIES IN TO BEGIN WITH.
BUT I ALSO THINK THAT WE COULD
USE A THINK ABOUT A REGULATORY
APPROACH THAT HAS A LITTLE BIT
MORE OF A- CARROT AND STICK
APPROACH WITHIN IT OKAY FOR
PERFORMANCE. ACTIVITY THAT
REALLY UNDERSTANDS HOW DO YOU
MEASURE GOOD QUALITY HOW DO YOU
AUDIT GOOD QUALITY. I MEAN IT'S
GREAT TO HAVE STAFFING RATIOS
BUT THAT'S THE TIP OF THE
ICEBERG. IN OUR ORGANIZATIONS
WE NEED TO HOLD THESE
ORGANIZATIONS ACCOUNTABLE FOR
HOW THEY DELIVER CARE EVERY
SINGLE DAY. WHAT ARE THEIR WORK
PROCESSES YOU KNOW THIS HAPPENS
IN OTHER INDUSTRIES. IT HAPPENS
IN THE ERROR IN THE AIRPLANE
INDUSTRY. AND WE DON'T HAVE
THAT SAME TYPE OF APPROACH OF
OVERSIGHT AND AUDITING AND I
THINK WE NEED TO BE LOOKING A
LOT MORE AT WHAT HAPPENS IN THE
BLACK BOX WITH IN. THE NURSING
HOME AND I THINK DR STEINBERG
WOULD PROBABLY AGREE WITH ME
THAT IT'S ALL DEVIL IN THE
DETAILS AND IN TERMS OF WHAT
HAPPENS THERE'S TOO MUCH
MEDIOCRITY FOR ME. THAT IS THE
PROBLEM. ASIDE FROM THESE BAD
APPLES. I THINK WE OUGHT TO
RAISE THE BAR. TO AT LEAST
85290% FOR ALL NURSING HOMES.
AND THEN I WOULD BE HAPPY.
THANK YOU THANK YOU DR STONE
THE SUMMER CITY THANK YOU- DR
STONE I- ONE THING I'VE LEARNED
FROM- LEARNING MORE ABOUT THE
NURSING HOME INDUSTRY IS THAT I
CONSISTENTLY HEAR THE- THAT IF
YOU EVER HAVE TO GO TO A
NURSING HOME LOOK FOR A
NONPROFIT NURSING HOME. AND.
AND THAT GUY IT APPEARS THE
DATA APPEARS TO SHOW THAT THAT
THERE ARE THERE ARE HIGHER
QUALITY OF CARE IN THE
NONPROFIT TO- OF THE FACILITIES
IN GENERAL LIKE OF COURSE I'M
SURE THERE ARE THERE ARE-
WONDERFUL FOR PROFIT TO.
NURSING HOMES YEAH BUT- GUY I
WANT TO ASK YOU I MEAN. THANK
YOUNG. WHAT WHAT WHAT IS YOUR-
OPINION AS TO- A NURSING HOME-
OWNER WHOSE LICENSE IS PENDING-
DENIED- I HAD SHOULD SHOULD
SHOULD SUCH A NURSING HOME
OWNER- BE ALLOWED TO CONTINUE
TO OPERATE. THIS IS MY-
PERSONAL OPINION I'M NOT
SPEAKING FOR. WAITING AGE OR
ANY OTHER ENTITY BUT I'VE BEEN
AROUND A LONG TIME AND- NO I
DON'T THINK THAT SOMEONE WHO
HAS HAD A LICENSE DENIED SHOULD
BE. ACCESSING ON THE OTHER HAND
THERE ARE ALSO THE WHOLE
QUESTION OF WHAT WAS RAISED
AROUND INTERIM. WHAT HAPPENS TO
ALL THE PEOPLE LIVING IN THESE
FACILITIES IF YOU DON'T HAVE
SOMEBODY OWNING IT. THE
INSTABILITY OF STAFF WHICH IS
HORRIBLE TO BEGIN WITH ITS
WORST I'VE SEEN A LOT OF THIS
AND WE SEE A LOT MORE TURNOVER
NOW AND CHURNING OF THESE
NURSING HOMES THAN WE'VE SEEN
IN THE PAST. IT IS HORRIFIC FOR
THE PEOPLE THAT LIVE THERE SO.
I DON'T THINK THERE'S AN EASY
ANSWER- SO I BUT I BUT I DO
THINK AGAIN IF WE HELD A
STANDARD. WHAT WHAT SHOULD WE
BE REQUIRING OF ALL OWNERS
LICENSE ALL ADMINISTRATORS. OF
ALL NURSES. 60% OF ONE OF THE
ORGANIZATIONS THAT I AM ON THE
BOARD OF A NONPROFIT NURSING
HOME AND CARE ORGANIZATION AND
I WILL NOT NAME. I KNOW FIRST
COMMAND AND DID A STUDY OF WELL
THE NURSE COMPETENCIES 60% OF
THOSE NURSES FAILED. YOUR
COMPETENCIES AND THEY ARE
IDENTIFIED AS A FAIRLY DECENT
ORGANIZATION. AND THIS IS
BECAUSE WE DO NOT INVEST IN THE
QUALITY OF OUR STAFF SO ARE YOU
KNOW IT'S NOT JUST THIS PART OF
IT IT'S THE WHOLE NINE YARDS.
TO WORK DO YOUR WINDOWS ARE
THEY PRACTICING TO THE HIGHEST
LEVEL OUR OUR FRONT GOING
NURSES ARE LPNS DO THEY KNOW
WHAT THE HELL THEY'RE DOING I
DID A STUDY IN CALIFORNIA IT
WAS SCARY TO ME. I TO
NONPROFITS TO FOR PROFITS IN
NORTHERN CALIFORNIA THAT WE
WERE VALUE WAITING BECAUSE WE
DEVELOP THE NURSE TRAINING
PROGRAM THERE. IT'S THE LEVEL
LACK OF INVESTMENT I MEAN I
DON'T WANT TO GET DR STEINBERG
INVOLVED IN THIS BUT YOU KNOW
THOSE OF US WHO UNDERSTAND WHAT
IT MEANS TO DO GOOD CARE.
UNDERSTAND THAT EVEN IN THE
BETTER ORGANIZATIONS IF YOU
DON'T HAVE PEOPLE TRAINED AND
SUPPORTED ON AN ONGOING BASIS
YOU CAN'T PRODUCE GREAT
QUALITY. THAT'S WHAT I LOOK FOR
WHEN I GO TO A NURSING HOME NOT
JUST THAT THEY'RE NOT FOR
PROFIT. SO THERE'S SOME CRAPPIE.
IT'S IN THIS WORLD. BUT THAT
THEY ACTUALLY HAVE STAFF WHO
KNOW WHAT THEY'RE DOING. OKAY
AND- YEAH SO YOU KNOW I WOULD
JUST SAY THAT WE NEED TO BE
PAYING ATTENTION TO THAT AND-
IF SOMEBODY DOESN'T HAVE A
LICENSE. THEY SHOULD BE
PRACTICING ALL RIGHT LAST
QUESTION TO ADOPT STONED AND
TO- IS THE PRACTICE OF. OF IT-
USING OR TAKING ADVANTAGE OF
RELATED PARTIES IS THAT ALSO
PREVALENT IN THE AMONG
NONPROFIT NURSING HOMES. NOT
YOU KNOW BECAUSE THEY DON'T
HAVE THE SAME INCENTIVE SO-
THANK YOU. IT GREAT OKAY THANK
THANK YOU VERY MUCH- WILL- WILL
TAKE A COUPLE CLOSING COMMENTS
AND THEN WE'LL GO AHEAD AND
OPEN FOR. PUBLIC COMMENT BUT DO
YOU HAVE ANYTHING YOU'D LIKE TO
ANYTHING I SAY. I JUST WANT TO-
SAYING CLOSING HERE BEFORE WE
GO TO PUBLIC COMMENT THANK ALL
WITNESSES FOR BEING HERE TODAY-
WE LEARNED A LOT I'M GRATEFUL
TO MY COLLEAGUES WHO ARE HERE
TO AND WORKING TO LEARN ABOUT
THESE IMPORTANT ISSUES.
RECOGNIZING COVE IT WAS
DIFFICULT FOR ALL OF US- YOU
KNOW PART OF MY- CONCERN AND-
COMMENTS IS- YOU HAVE A MOTHER
WHO LIVES IN ASSISTED LIVING IN
WASHINGTON. THEY DID A FABULOUS
JOB EARLY ON. AND THEY DIDN'T
HAVE CASES THAT I'M AWARE OF IN
HER FACILITY. NONE THEY HAD A
COUPLE STAFF PEOPLE WHO WERE
TAKING UP BUT THEY HAD NO
RESIDENTS THAT I'M AWARE OF
THAT HAD AND THERE'S A COUPLE
HUNDRED PEOPLE THAT LIVE IN THE
FACILITY THEY REACTED QUICKLY
EARLY- WE DIDN'T REACT AS
QUICKLY- IN CALIFORNIA WE
DIDN'T REACT AS EARLY- EVEN
THOUGH WE HAD THE EXAMPLE OF
WHAT WAS HAPPENING WASHINGTON-
BEFORE US. AND SO THAT'S MY
FRUSTRATION AND THAT'S WHERE
I'M COMING FROM WHEN I WHEN I
TALK ABOUT THAT. WE ARE SENIORS
ARE CHRONICALLY ILL INDIVIDUALS
AND PEOPLE WITH DISABILITIES
HAVE SUFFERED SIGNIFICANTLY
MORE DURING COVERT- COBIT
CANNOT BE AN EXCUSE TO NOT DO
BETTER. I RECOGNIZE YOU KNOW
IT'S IT IS A- THROUGHOUT PRETTY
MUCH EVERYTHING THESE DAYS
IT'S- AT THE EVERYTHING IS
DELAYED AND THE ANSWER IS OFTEN
WELL YOU KNOW WITH COCA. AND I
THINK WE'RE BETTER THAN THAT I
THINK THAT'S WHEN YOU DIG IN
YOUR HEELS THAT'S WHEN YOU GET
BETTER THAT'S WHEN YOU. DO YOUR
HEART TO WORK HARDER- NOT
EXCUSES. WE DON'T NEED EXCUSES
WE HAVE TO DO MORE. I WANT TO
CONTINUE I WILL CONTINUE TO
WORK WITH ALL OF YOU- WE WILL.
BE DO YOU ABSOLUTELY DO WANT TO
WORK WITH YOU- THE ON THE
STAKEHOLDERS TO IMPROVE THE
LICENSING PROCESS THE QUALITY
OF CARE. AND THE SAFETY OF ALL
WHO RELY ON NURSING HOMES. BUT
THAT THANK YOU VERY MUCH. GO TO
THE OPERATOR- WE ARE NOW FORTY
MINUTES PAST TIME WE'LL ANOTHER
PEOPLE WHO WANT TO TESTIFY I'M
AND I APOLOGIZE. WE WILL A
MINUTE EACH AND I'M SORRY
THAT'S SHORT- BYE BYE WE DO
WANT TO HONOR HONOR THAT
OPPORTUNITY SO. IF YOU'RE IN
THE IF YOU'RE IN THE ROOM AND
WANT TO SAY SOMETHING PLEASE
COME FOR TO THE MICROPHONE
PLEASE DON'T TOUCH THE
MICROPHONE. PLEASE COME FORWARD
AND- IN ONE MINUTE OR LESS
PLEASE- AND THEN PLEASE ALSO
ANYBODY WHO- WE WILL ACCEPT
WRITTEN TESTIMONY AS WELL AND
I'M HAPPY TO DO THAT AND THAT'S
A TRUST ME WE DO READ THOSE AND
WE DO WE DO TAKE THAT VERY VERY
SERIOUSLY WE ARE NOT TRYING TO
SHORT CHANGE YOU. EVERY EVERY
VOICE IS IMPORTANT. PLEASE GO
AHEAD. GOOD AFTERNOON NUMBERS
MY NAME IS ROUGH GOAL KIANA
REPRESENTING STATE OUR SENIORS
SOS HAVE BEEN WORKING TO DEFEND
BILINGUAL BICULTURAL CARE AT
THE FACILITY SO BYE COMMITTEE
NONPROFIT TO INTERNATIONAL REAL
ESTATE DEVELOPER PACIFICA AT
THE WEST OF OPPOSE THIS
CALIFORNIA PART OF PUBLIC
HEALTH BEATTY DECISION TO CLOSE
THE ONLY BILINGUAL BICULTURAL
INTERMEDIATE. CARE FACILITY.
FOR JAPANESE AMERICANS IN THIS
COUNTRY. SO CAR I FEEL THE LOSS
HAS A 1% COVERED FREE RECORD
DROP THIS PANDEMIC HOWEVER CDPH
APPROVED PACIFICUS PLAN TO
DETECT OVER EIGHTY SENIORS I
GUESS THE PROFESSIONAL ADVICE
OF TEN DOCTORS. THE SENIOR FIND
OUT THIS FIRST ACROSS VERY
FACILITIES WITH POOR CORPORATE
NINETEEN. STATE CONDITIONS AND
LACK OF CARE THERE'S A LACK OF
TRANSPARENCY FROM CDPH
REGARDING THIS DECISION AND A
DERELICT DERELICTION OF PUBLIC
TRUST PATIENTS THE PUBLIC
OVERSIGHT AND PROTECTION FROM
ABUSE WE NEED LAWS THAT
RECOGNIZE THE NECESSITY OF
LINGUISTIC AND CULTURAL THE
QUALITY OF THE HEALTHCARE
ISSUE. PLEASE SUPPORT EIGHTY
FIFTEEN OH TWO AND EIGHTY
FOURTEEN HUNDRED TO ADDRESS
THESE INEQUITIES IN PUBLIC.
HEALTH THANK YOU OKAY THANK YOU.
THANK WITNESS PLEASE. GOOD
AFTERNOON CHAIR WITHIN MEMBERS
OR MEMBER- YEAH NUMBERS IF
MARKLE YOU MODEL FORMER
ASSEMBLYMEMBER FORMER CHAIR OF
THE AGING AND LONG TERM CARE
COMMITTEE- HERE IN THIS
ASSEMBLY- FROM TWENTY TEN TO
TWENTY FOURTEEN- YOU KNOW IT'S
BEEN SEVEN YEARS SINCE I LEFT
THIS BUILDING AND EVERYTHING
THAT I'VE HEARD THIS AFTERNOON
WAS SO TRAGICALLY FAMILIAR TO
THE SAME DISCUSSIONS THAT WE
HAD WHEN I HAD THE PRIVILEGE TO
SERVE. IT'S ACTUALLY MORE LIKE
A RECURRING NIGHTMARE FOR
HUNDREDS OF THOUSANDS OF THE
MOST VULNERABLE RESIDENTS IN
OUR STATE. SO YOU KNOW THE
LEGISLATURE DID A LOT OF HARD
WORK THIS LAST YEAR ON THE
PROTECT PLAN AND I WANT TO
THANK YOU ALL. FOR DOING THAT
HARD WORK AND ALL THE MEMBERS
STATE SUPPORTED THAT IMPORTANT
LEGISLATION FOR THOSE BILLS
WERE AS YOU KNOW SIGNED INTO
LAW LAST NIGHT. I CERTAINLY
HOPE THE REMAINING TO THAT ON
THE GOVERNOR'S DESK INCLUDING
ASSEMBLY MEMBER LAURA TO CHEESE
AB TWO SEVEN NINE WE'LL SOON
SEE- THAT SUPPORT AS WELL. BUT
YOU KNOW I USED TO AND ALL MY
HEARINGS BY SAYING NONE OF US
IS GETTING ANY YOUNGER- AND SO
YOU KNOW THIS IS NOT A PARTISAN
ISSUE THIS IS A- NATION OF
HUMANITY- IF. YOU HAVE NOT BEEN
TOUCHED BY WHAT YOU HEARD THIS
AFTERNOON YET YOU WILL BE SO
WE'VE GOT TO FOCUS ON MAKING
IMPROVEMENTS IN ALL THE SYSTEMS
FOR ELDER CARE IN OUR STATE AND
AROUND THE NATION- WE STAND
READY TO SUPPORT AND HELP YOU
BUT WILL ALSO BE WATCHING.
THANK YOU VERY MUCH FOR THE
TIME THAT YOU'VE TAKEN AND THE
CARE WITH WHICH YOU ARE
ADDRESSING THESE ISSUES. AND
THANK YOU VERY MUCH FOR BEING
HERE IN PERSON IT'S GREAT TO
SEE YOU- REALLY APPRECIATE THE
TESTIMONY IT'S GOOD TO SEE YOU
THANK YOU SO MUCH. WE'LL GO TO
THE PHONE LINES- PLEASE SIR
OPERATOR PLEASE OPEN THE PHONE
LINES- TESTIMONY ARE ON THE- ON
THE SUBJECTS OF THE HEARING
PLEASE. THANK YOU LADIES AND
GENTLEMEN IF YOU WISH TO
PROVIDE A PUBLIC COMMENT OVER
THE PHONE TODAY PLEASE PRESS
ONE THEN ZERO. THAT COMMAND
AGAIN. ONE ZERO. AND WE HAVE A
FEW PUBLIC COMMENTS COMING
THROUGH ONE MOMENT PLEASE WHILE
WE PROVIDE THEM WITH LINE
NUMBERS THANK YOU. BECAUSE.
OKAY THANK YOU. ALIGNMENT
THIRTY SIX YOU'RE MY COULD OPEN.
HELLO MY NAME IS SHUB AT THE
MORRIS I HAD THE I'M WITH THE
CALIFORNIA GRAY PANTHERS LIKE
THE PRIVILEGE OF BEING THE
CONVENER ARE CHAIR OF THE EAST
BAY GRAY PANTHERS CHAPTER.
WORKING AND MYSELF PERSONALLY
BEEN PART OF A NATIONAL-
COUNCIL THAT HAS BEEN WORKING
AND STUDYING FOR THE LAST TWO
YEARS REALLY TO ADDRESS THE
CRISIS THAT SURFACED. WHEN KOBE
STARTED TO UNDERSTAND JUST HOW
IT WAS POSSIBLE THAT- BILLIONS
OF DOLLARS SPENT ON HEALTHCARE
FOR MILLIONS OF PEOPLE IN.
FACILITIES ALL ACROSS THE
COUNTRY AND THE MONEY
APPARENTLY HAS BEEN STUCK DOWN
THE GIANT VOID. A PREDATORY
CAPITALISM AND THAT'S THAT'S
ARE YOU KNOW THERE'S SO MANY
PROFESSIONAL ISSUES THAT CARE
AND QUALITY OF CARE AND
TRAINING. BUT AT THE END OF THE
DAY WE'RE WE'RE BEING BILKED
TAXPAYERS AND IS FEATURE ELDERS
WHO MAY NEED THESE FACILITIES.
WE NEED TO ACTUALLY REALLY
SERIOUSLY TRANSFORM THE SYSTEM
I'M HERE PERFORMING A
POLITICALLY TO SUPPORT THE WORK
OF SCANNER. AND D. TESTIMONY
TODAY IN FAVOR AB FIFTEEN- TO.
TO MAKE THE NOT ONLY BE
OWNERSHIP. BUT THE LICENSURE OF.
NIELSEN HOME FOR BOTH MORE
TRANS. AND MORE. THE PRODUCE
BETTER RESULTS. IT'S HARD TO
FIND EVEN DATE INTO THE
TESTIMONY I ENCOURAGE THANK YOU
FOR YOUR CALL. THANK THANK YOU
AND WE TRY TO PUT THE COULD
PLEASE TRY TO KEEP YOUR
COMMENTS TO ONE MINUTE THANK
YOU I APPRECIATE THAT ANYTHING
WITH A HAPPY TO TAKE THINGS IN
WRITING AS WELL THANK YOU. NEXT
CALLER PLEASE- LINE TEN YOUR
MIKE IS OPEN. THANK YOU AND
THANK YOU SO MUCH- FOR THE
MEETING TODAY MY NAME IS ERIN
HAYES AND I AM I GUESS WE'RE
GOING TO SPEAK ON BEHALF OF
CHARACTER BIRTH MY MOTHER AND
JUST WENT DIRECTLY RED BANK
EXPERIENCE WHERE SHE WAS LOCKED
FOR THREE DAYS NOT BAD AND NOT
GIVING HER MEDICATION THE
ANSWER TO IT ASSEMBLY MEMBER
MARC HE G. QUESTION NO. THESE
PEOPLE SHOULD NOT BE GETTING
THEIR LICENSE IF THEY'RE
FRAUDULENTLY OPERATING THESE
NURSING HOMES- AND YOU KNOW.
I'M APPALLED DISGRACED FORMER
GOT A JET YOU KNOW WITH ELTON
JOHN BUT HE CAMPAIGN FOR
TRAINING FOR STAFF. ACRE BETTER
CARE OF MY MOTHER OUR PARENTS
OUR LOVED ONES OUR SENIOR IS
APPALLING TO ME AND CRAFTING
AND TAKEN ME AND I HOPE THAT IT
GOES OUT TO ALL OF YOU THANK
YOU THANK YOU VERY. MUCH NEXT
CALLER PLEASE. LINE EAGLES.
LINE ELEVEN NUMBER LIKE IT'S
OPEN OKAY THANK YOU HELLO MY
NAME IS TAIJI MIYAGAWA ARE
REPLICAS OF THE PROGRESSIVE
ASIAN NETWORK FOR ACTION THE
REFERENCE TO THE BAY CITY PH
APPROVAL PRIVATE OPERATOR
PACIFIC IT COMPANIES PLAN TO
SHUT DOWN THE ONLY BY LGAL BY
CULTURAL ICF FOR JAPANESE
AMERICANS IN THE U. S. IS
SUPPORT THIS WAS AN EXAMPLE OF
COLLUSION WITH THE PRIVATE
OPERATOR TO THE DETRIMENT OF
PUBLIC HELPED SHAPE. IMPACTED
AND VULNERABLE DEMOGRAPHIC. AND
TIRED. EIGHTY P. H. OF THE
OPERATOR MASS O'CLOCK WITH THE
FULL PACKAGE ABOUT. THAT THERE
EXISTED A NO ADEQUATE. SYSTEM
WOULD WITH COPPER POT. THE
BICULTURAL ACT. DURING THE
MIDDLE OF THE PANDEMIC. YEAH
IT'S A TOUGH TO HIDE AND
UNSUBSTANTIATED CONCERN OVER
POTENTIAL OWNER FINANCIAL
LOSSES WITH SMOKESCREEN
DEMONSTRATING A LACK OF
TRANSPARENCY ABOUT THEIR
DECISION THEY HAVE CONTINUED
THIS DANCE AT THEIR OPPOSITION.
ASSEMBLY BILL TWO SEVEN NINE WE
DO THECDPH DISMISSAL OF
RESPONSIBILITY TO THE PUBLIC
INTEREST THIS CASE AS
CONSISTENT WITH THE PARK
DISTRICT ANTI ASIAN VIOLENCE
LEGISLATION THAT PERMEATES
CALIFORNIA LEGISLATIVE HISTORY
HEALTHCARE OVERSIGHT TO THE
PUBLIC OR FOR PRIVATE PROFIT.
CENTRAL ETHICAL QUESTION TO
ADDRESS AGAIN BEGINNING WITH
ACCOUNTABILITY THANK YOU FOR
YOUR TIME THANK. YOU THE NEXT
CALLER PLEASE. WELL TWENTY SIX
YEAR MIKE IS OPEN. HELLO MY
NAME IS KAREN CLINK- I AM A
MEMBER OF THE ESSENTIAL
CAREGIVERS COALITION AND-
REPRESENT OUT ASSEMBLY MEMBER
AMERICA FIFTY IS MY ASSEMBLY
MEMBER- AND I THANK HIM FOR HIS
WORK IN THIS AREA AND- I AM FOR
THIS BILL AT FIFTEEN OH TWO AND
ANY OTHER A BILL THAT WOULD
HELP THEM. THE LONG TERM CARE-
LONG TERM CARE I REALLY HAVE A
SET LISTENING TO THIS NEW
MISTER CORNET TALK ABOUT HIM
NOT KNOWING ABOUT ANY OF THIS
THAT ANYBODY WHO'S INVOLVED IN
THIS LONG TERM CARE NURSING
HOME OR- ASSISTED LIVING KNOWS
ABOUT THIS SHLOMO RECHNITZ THEN
PEOPLE LIKE PROPOSAL ARE IS ON-
AND TO NOT KNOW MEANS YOU'RE
NOT PAYING ATTENTION- ALSO- WE
HAVE TO- YOU KNOW HAVE BETTER
TRANSPARENCY BETTER CARE BETTER
WAGES FOR ALL PEOPLE INVOLVED
IN THESE PLACES AND THE EOPLE
THAT OWN THEM- IT NEEDS YOU
KNOW ARE MAKING WAY TOO MUCH
MONEY AND THEY'RE NOT PASSING
ALONG. I'M ALSO A PROPONENT OF
H. R. THREE SEVEN THREE THREE
WHICH IS THE FEDERAL BILL FOR
VISITATION NOT BEING SO THAT WE
DON'T GET LOCKED OUT FAMILIES
ARE REALLY IMPORTANT FOR EYES
AND EARS I DON'T KNOW WHAT'S
GOING ON INSIDE THESE PLACES SO
FAR THAT'S IN THE BILL. THAT
WE'RE LOOKING. THANK YOU NEXT
CALL PLEASE- LINE. THIRTY FOUR.
GOOD AFTERNOON THANK YOU MISTER
CHAIRMAN AND DR KENNETH TIGHE
I'M CURRENTLY CHAIRMAN OF THE
COMMUNITY ADVISORY BOARD ON THE
CATO IN PACIFICA SALES
TRANSACTION I WANTED TO POINT
OUT THAT THE HEALTH CARE IMPACT
STATEMENTS THAT ARE REQUIRED-
UNDER EXISTING CALIFORNIA CODE
WERE WAIVED- FIVE YEARS AGO
FROM BEING WRITTEN I NOTICED IN
THE COMMITTEES- DELIBERATIONS
TODAY ONE OF THE DIAGRAMS ON
FACILITY TRANSFER. DID NOT
DIAGRAM APPROPRIATELY OR
INCLUDE THE STEPS RELATED TO
THE OFFICE OF ATTORNEY GENERAL
OVERSIGHT FOR NON PROFIT HEALTH
FACILITY TRANSACTION SO I WANT
TO ENCOURAGE STAFF AND THE
COMMITTEE TO INCLUDE THAT IN
THE OFFICIAL DOCUMENTS AND- IF
YOU NEED MORE INFORMATION HAPPY
TO PROVIDE. AT THIS TIME TO MY
KNOWLEDGE OUR BOARD HAS SENT
OVER ONE HUNDRED AND FIFTY
PAGES OF LETTERS AND QUESTIONS
TO VARIOUS AGENCIES INCLUDING
CD PH TO MY KNOWLEDGE WE'VE NOT
HAD. DANCERS TO MANY OF THESE
QUESTIONS AND OUR BOARD-
CONTINUES TO TRY TO DO ITS JOB
WE THANK YOU FOR PASSING AB TWO
SEVENTY NINE. AND FINAL POINT
MISTER CHAIRMAN- COUNTY CM AND
THE GERIATRIC CIRCLE WERE EARLY
PROPONENTS OF VERY ACTIVE CLEAR
CLINICAL GUIDELINES TO PROTECT
THE LIVES OF PEOPLE IN OUR
NURSING HEALTH. PLAN SO I WANT
TO ENCOURAGE THE CHAIR AND THE
ENTIRE COMMITTEE TO GATHER
INFORMATION FROM CLINICAL
THOUGHT LEADERS BECAUSE THERE
WAS NO CONFUSION IN HOW TO
RESPOND AND I CONCUR 1100% WITH
THE CHAIR WE KNEW WHAT WAS
COMING AND IT WAS TARDINESS IN
RESPONSE IN DIFFERENT LEVELS.
THANK YOU MR CHAIRMAN THANK YOU.
NEXTCODE PLEASE. LINE. TWENTY
HELLO THREE YEARS AGO TODAY
OCTOBER FIFTH MY MOTHER DIED
SHE WAS A RESIDENT IN THE
SKILLED NURSING FACILITY THIS
RESULTED FROM NEGLECT VIOLATING
THE TO PERSON PATIENTS THAT THE
CNA HELPING MY MOTHER TOILETING
WAS MORE CONCERNED ABOUT
TURNING OFF MY MOTHER'S CHAIR
ALARM AND MY MOTHER FELL TO THE
GROUND BEFORE MY THE SCENE THEY
MADE SURE THAT SHE WAS SAFELY
TRANSFERRED TO THE TOILET MY
MOTHER SUFFERS FROM DEMENTIA
SHE WAS A PHARMACIST AND
DIABETIC. IT OF COURSE FOR ONE
IN COURT I TOOK CARE OF MY
SISTER NURSING HOME FOR FOUR
YEARS AND MY MOTHER IN A
SKILLED NURSING FACILITY FOR
SEVEN YEARS I'VE SEEN THE GOOD
THE BAD AND THE UGLY I WOULD
LIKE TO SEE ACCUSATIONS BY
RESIDENTS TO BE TAKEN SERIOUSLY
OPPORTUNITIES FOR SEXUAL ABUSE
CAN OCCUR WHEN MALE STAFF
BREEDING FEMALE RESIDENTS AND
MAIL STAFF TOILETING FEMALE
RESIDENTS INVESTIGATIVE REPORTS
SUCH AS SICK DYING AND RAPED I
HAVE PERSONALLY SPOKEN TO WIN
THE RESIDENTS WHO HAVE BEEN
RAPED BY MALE STAFF AND SKILLED
NURSING FACILITIES. THE ONLY
RESIDENTS WHO HAVE EXPRESSED
CONCERNS BEING PAID BY MAIL
STAFF OF THE GREGIS AND
DISGUSTING TO THINK OF MALE
SEXUALLY RAPING ELDERLY SICK
AND DYING FEMALE RESIDENTS IS
IT REALLY REALLY DOES HAPPEN
THERE'S NOTHING WRONG WITH
TAKING ACCUSATIONS SERIOUSLY
PERFORMING BACKGROUND CHECKS ON
STAFF INCREASING CNA LPN RN
WAGES. AND SPECIFIC MORE
EDUCATION REASONABLY DECREASING
THE NUMBER OF PATIENTS TO SEE
IN A RATIO FOR THAT RESIDENTS
DO NOT SUFFER FROM NEGLECT IT
IS NOT REASONABLE TO THINK THAT
A NIGHT. PATIENTS BUT MY TIME
PATIENTS DO NOT NEED CARE
BECAUSE THEY ARE SLEEPING THAT
IS NOT TRUE PATIENTS NEED TO BE
TRANSFERRED TO THE BATHROOM
THEY HAVE DOWN THERE- SUNDOWNER
SYNDROME AND CONFUSION. AND BE
PATIENT TO FEMALE RATIO SHOULD
BE CONSISTENT TO THE TWENTY
FOUR HOUR PERIOD I WOULD RATHER
DIE THAN GO TO A NURSING HOME
FOR LIFE THANK YOU FOR BRINGING
UP HE SUBJECT. THANK YOU VERY
MUCH JUST JUST TWO COLORS WE'RE
GOING TO GO TILL FIVE THIRTY
AND I APOLOGIZE. SO IN THE
INTEREST OF TRYING TO GET AS
MANY CALLS AS POSSIBLE IN
PLEASE- TRY TO LIMIT YOUR
COMMENTS. TO ONE MINUTE THANK
YOU. NEXT CALL PLEASE. LINE.
FORTY TWO. HELLO MY NAME IS
FANTINI MINE MY MOTHER IS THE
FORMER PRESIDENT OF THE FACT
THAT I YEAH- OWNED BY PACIFICA
AND MY MOTHER JUST PASSED ON
SEPTEMBER ELEVENTH. YOU THE
FACT THAT. ALL RIGHT THEY WERE
NOT ALLOW I TO STAY OPEN AND
THE END OF THE AGAIN. I URGE
YOU TO CLEAN PASSED AB TWO
SEVENTY NINE. EIGHTY ONE FIVE
OF YOU AND EIGHTY FORTY NINETY.
TO PROTECT OUT OF. THANK YOU
THANK YOU VERY MUCH NEXT CALLER
PLEASE. END OF MISTER CHAIR
THERE ARE NO FURTHER QUESTIONS
OR COMMENTS AT THIS TIME OKAY
WELL THANK YOU VERY MUCH MR
OPERATOR. OR THINK ONCE AGAIN
EVERYBODY WHO CALLED IN TODAY
AND EVERYBODY WHO ATTENDED TOWN
OUR WITNESSES ARE VERY MUCH
APPRECIATE THIS OBVIOUSLY WE
HAVE OUR WORK CUT OUT FOR US
AND- APPRECIATE THAT WE WILL
HAVE WE HAVE STAKEHOLDERS WHO
WILL BE. WORKING WITH US THANK
YOU VERY MUCH THIS MEETING IS
ADJOURNED. HELLO MY NAME IS
ROGER GO AHEAD GO AHEAD I'M
SORRY IT WAS A WORK GO AHEAD
PLEASE I'M SORRY. YES MY NAME
IS ROGER MYERS AND AS I WAS
WALKING THROUGH THE- AROUND THE
GROUNDS TODAY- GOD SPOKE TO ME
ABOUT THE MORAL FOUNDATION THAT
WAS LAID BY THE MISSIONS THAT
CAME INTO CALIFORNIA AND NOT
EVERYTHING WAS GOOD AND NOT
EVERYTHING WAS PERFECT BUT
THERE WAS A MORAL FOUNDATION
LAID WHICH ALLOWED CALIFORNIA
TO FIND FAVOR AND TO GROW. AND
I BELIEVE GOD SPOKE TO ME AGAIN
THIS AFTERNOON AND SAID IF
CALIFORNIA DOES NOT FIND THE
MORAL FAVOR THE MORAL
FOUNDATION AGAIN THAT THE STATE
WILL LOSE GOD'S FAVOR AND
THINGS WILL HAPPEN SO I MOST
WANT TO PRAY FOR THE STATE THAT
IT WOULD FIND THE MORAL FAVOR
AGAIN THE MORAL FOUNDATIONS I
HAVE MY FATHERI PRAY FOR
CALIFORNIA I PRAY THAT YOU
WOULD BLESS ITS STATE I PRAY
THAT THE MORAL FOUNDATION WOULD
BE RETURNED. TO THE STATE LORD
THAT YOU WOULD GRANTED FAVOR
ONCE AGAIN. THANK YOU FOR YOUR
TIME. THANK YOU WE ARE
ADJOURNED.