CARR's Reform Platform


/rəˈfôrm/ - To improve by alteration, correction of error, or removal of defects; put into a better form or condition.

Diversity reigns in California’s assisted living care industry, with a variety of models in operation ranging from strictly hospitality, housing, health care or some combination of these three (“hybrids”).[1]   Consumer demand and funding sources, however, are pressuring all models to incorporate more health care services and this is occurring in the absence of evidence-based decisions, a thoroughly-informed legislature and sufficient government resources.  Listed below are CARR’s Board- Approved Reform Planks.  In keeping with CARR’s mission, the implementation of these reforms would affect significant improvements to resident health, quality of care, and safety; strengthen consumer protections; and increase industry and state agency accountability and operations.

To ensure appropriate care and oversight for residents -

  1. Establish and enforce mandatory nursing and/or staffing ratios when certain populations of high need residents are present in an RCFE. 
  2. Move licensing, surveillance and regulatory enforcement of RCFEs from California’s Department of Social Services to California’s Department of Public Health, or sufficiently staff California’s Department of Social Services, Community Care Licensing Division (DSS/CCL) with analyst who have certified medical backgrounds in recognition of the ever growing number of residents having chronic and severe medical conditions who are being admitted and retained in RCFEs and who need consistent and competent oversight and protection.
  3. Legislate mandatory investigations by local law enforcement agencies (local District Attorney’s office, police, Adult Protective Services agencies) for RCFE complaints alleging elder abuse or neglect. 

To improve Department of Social Services/Community Care Licensing (DSS/CCL) operations -

  1. Redraft Title 22 to eliminate equivocating or ambiguous language that results in the inconsistent citation of deficiencies which (1) undermines DSS/CCL’s credibility and authority and (2) obstructs meaningful facility accountability.
  2. Annual renewals of RCFE licenses would be contingent on presentation of current documentation including proof of worker’s compensation, CASOS registration, civil penalties (not under appeal) paid in full, statutory insurance requirements met, evidence of compliance with all statutorily required training and certifications, and a current staff roster.  In this way, DSS/CCL can focus on resident care during facility visits and less on routine administrative documentation.
  3. Establish a point system for cited Title 22 violations.  Cited violations should carry points based on the severity of the violation to the resident’s health and safety.  A noncompliance conference should be automatically triggered by an accumulation of a pre-determined number of points over the last three DSS/CCL visits to the facility.  Renewal fees should be increased for facilities with higher deficiency scores.

To honor the public’s right to know-

  1. Given the increased use of KITs (Key Indicator Tools) during inspections, these forms should be made available for public review both in the public file and on DSS/CCL’s Transparency Website.
  2. Standardize the facility license (LIC 203A) to assure clear, accurate and complete information regardless of which state inspector creates the license.  The license should state, in checklist format, all services a facility is approved, via waiver or exception, to provide.  (This should include Specialized Dementia Care, despite the absence of an authorizing waiver.)
  3. State licensing form documents (LIC 809s Facility Evaluation Reports, LIC 9099s Complaint Investigations and Incident Reports) containing confidential information should be removed from the confidential file, redacted and those redacted copies should be placed in the public file.
  4. DSS should post, on its Transparency Website, the names of all individuals who have received Lifetime Bans against them as a result of Stipulations and Waivers or Decisions and Orders.  The associated public documents should be posted in an easily accessible location on DSS/CCL’s website and should be updated quarterly.
  5. DSS should provide information on relicensing activity of RCFEs on its Transparency Website.
  6. A regular audit of DSS/CCL’s Investigations Bureau Office (an internal DSS/CCL branch responsible for investigating elder abuse inside RCFEs) should be conducted to ensure the proper handling of elder abuse inside RCFEs and to promote discussions about ways to improve the oversight and investigation of elder abuse inside RCFEs.
  7. Similar to the Stark Act for physicians, RCFEs should disclose to families any financial interests the licensee(s) may have with third party agencies they refer to. [2] 

[1] Wilson, Keren Brown (2007). Historical Evolution of Assisted Living in the United States, 1979 to the Present. The Gerontologist, Vol. 47, Special Issue III, 8-22.

[2] Retrieved on November 19, 2016 from



This page was updated 11/21/16