The Impact of Inspection Visit Policy on Assisted Living in California

In 2004, California changed the annual inspection practice of its assisted living residences  (ALs) in an attempt to create a more problem-driven inspection system. A new study examines the impact of these changes on type of citations issued by state regulatory agencies that monitor the quality of life in ALs.

California state law has ongoing care requirements similar to most other states. They include mandates for ongoing care (medications, personal accommodations, and services), disaster preparedness and injury prevention, etc.

Prior to 2004, the Community Care Licensing Division (CCLD) of the state government was required to make yearly inspections of each AL. State budget problems led to difficulties in being able to perform yearly inspections.  Since that time the required visits were changed to once every five years.

Researchers at the University of California-San Francisco utilized the administrative records of a stratified probability sample of ALs in California. The sampled ALs are located in 49 of California’s 58 counties and represented nearly 50% of the ALs in the state.

The study found that after the inspection policy change routine survey visits became highly varied between different offices of the CCLD and were largely replaced by complaint or problem-based visits resulting in increased quality of care citations directly related to complaints. These results indicate that the inspection system became less proactive and had resorted to merely reaction to quality of care complaints.

Questions abound as to whether the new complaint-based inspection system is adequate for ensuring quality of care in assisted living. The new system has produced more uncertainty in the assisted living market than existed prior to the change. Concerns that the inspection system was not proactive enough seem are justified by the data presented in this study.

Flores, C., Bostrom, A., Newcomer, R. 2009. Inspection visits in residential care facilities for the elderly: The effects of a policy change in California. Journal of Applied Gerontology 28: 539-559.

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