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Description
Purpose: The purpose of this study was to describe and characterize irregular administrative and enforcement practices and patterns of regulation by Community Care Licensing Division (CCL), Department of Social Services (DSS) of Residential Care Facilities for the Elderly (RCFEs). The study was a ten-year retrospective descriptive study reviewing 50% (348 files) of the population of RCFEs licensed in San Diego and Imperial counties. Design and Methods: This is a ten-year retrospective descriptive study, which reviewed the public files of 348 RCFEs licensed to provide care and supervision pursuant to Title 22 of California's Civil Code. Files obtained through California Public Records Act requests were reviewed in detail, and data corresponding to defined parameters was obtained. Data was analyzed in aggregate, as well as by facility size: each facility was categorized by bed capacity and placed into one of five strata (e.g. Strata 1 = 1 to 6 bed facilities.) Individual databases were maintained for Facility Characteristics (ownership, business-model type, Facility Licenses), Staffing, Finances and Enforcement variables (citations by type, by inspector). Appendices to the study provide detail of all collected variables. Findings: In addition to demographic characteristics, this study found irregularities of incorrect licenses; staffing practices by total facility staffing, the role the regulations play in understaffed RCFEs. Financial characteristics including average room rental rates, average monthly and daily food allowances per resident, and average monthly profits allowed analysis of operational costs, raising questions about abnormally-low food budgets, and over-industry profit margins. Irregularities in Enforcement findings include the Top Ten regulations cited over the retrospective 10-year time period, irregular LPA patterns of citation emerge, findings that 25% of Civil Penalties have been collected. The data also shows a widespread pattern of missing and incomplete data in nearly every category of data in the file. Implications: The findings imply that CCL is either incompetent, or that the regulations are so imprecise as to prevent meaningful enforcement of the law. Patterns of missing and incomplete data skew the public file in favor of the Licensee (RCFE owners) and may contribute to information asymmetry by preventing the consumer of long-term care from accessing a complete public record on individual RCFE performance. The findings further imply that CCL has ignored the public trust to provide meaningful and complete documentation in the public file, and has contributed to creating an information gap being filled with provider-generated information about assisted living, and residential care facilities for the elderly.
