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Caregiver Roulette:

Caliornia Fails to Screenthose who Care or theElderly at Home

April21, 2011

Prepared by John Hill

Caliornia Senate Ofce o

Oversight and Outcomes


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Table o Contents

Executive Summary Page 1

Background Page 5

Some caregivers oering their services on Craigslist have

extensive criminal backgrounds Page 7

A signifcant number o caregivers who get into trouble

have prior criminal records Page 13

Many in-home caregiver agencies claim to do background

checks, but the quality varies and legal roadblocks can

prevent thorough screening Page 19

Private individuals hiring caregivers on their own ace

many obstacles Page 27

Caliornia is one o the ew states that does not regulatein-home care agencies Page 31

Recommendations Page 37

Sources Page 39


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Oversight and OutcomesApril 21, 2011

Executive Summar y

In December 2010, S.K. placed an advertisement on Bay Area Craigslistoering her services as a caregiver everything rom shopping and drivingto hands-on personal care. She wrote that she was experienced in healthcare, and willing to spend nights at the clients home.

Those potential clients would no doubt have been interested in anotheract about S.K. she once described hersel to a sheris investigator asa kleptomaniac with uncontrollable urges. She had just been caughtstealing $2,400 o merchandise rom a garden supply store, which ledto a elony burglary conviction and 90 days in jail. She has also beenconvicted o petty thet, driving under the inuence and vandalizing thecar o an ex-boyriend.

S.K.s Craigslist ad is an illustration o the perils aced by Caliornianssearching or caregivers to work in their homes, the Senate Ofce oOversight and Outcomes has ound.

Unlike most other states, Caliornia does not regulate the burgeoningin-home care industry, leaving consumers prey to individuals who ail todisclose their criminal backgrounds and dependent on agencies whosebackground checks dont come close to digging up unsavory pasts. A2008 law intended to help individuals hiring caregivers on their own haslanguished as the result o conusion over whos supposed to spell out howit will work.

The state does license home health agencies, which provide skillednursing at home in conjunction with a plan prescribed by a doctor. Butagencies that place caregivers who help with activities o daily living -such as bathing, toileting, dressing, walking and eating - do not requireanything more than a business license. Individuals who oer theseservices in newspaper classifed ads or Internet services such as Craigslistare similarly ree o state oversight.

A growing population o elderly and disabled adults is looking oralternatives to long-term care such as nursing homes, assisted living andboard-and-cares. Businesses and individuals have stepped orward to meet


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this need, oering help with activities o daily living short o medical care.There are an estimated 1,200 in-home care agencies in Caliornia and anunknown number o individuals, such as S.K., looking or caregiver jobs

on their own.

The lack o regulation has resulted in an industry compared by morethan one insider to the Wild West. Our report confrms that the currentlandscape is creating risk or consumers that could be alleviated bylegislation, ranging rom ull-scale licensing to narrower measures to helpclients obtain and understand criminal background checks and otherrecords.

Among our fndings:

More than a quarter o caregivers accused or convicted o crimesthat we identifed rom news accounts had committed previousoenses, underscoring the potential value o screening. Givenour ofces limited means o checking criminal backgrounds,this fgure is almost certainly an underestimate. One caregiverwe investigated had been convicted o embezzling $43,000 roma church and, a ew years later, stealing $18,675 rom her bedridden mother. She nonetheless ound a job as a live-in caregiveror an 82-year-old woman. She moved into the womans bedroomand started charging her rent, used the womans accounts to buyhersel cars and other goods, and tried to put the house up or salebeore she was arrested. In most o the cases we looked at, recentcrimes were a good predictor o a caregivers transgressions.

Many in-home care agencies claim to do background checks,but this can range rom a thorough screening required orcertifcation by a state association to a $19.95 instant Internetcheck that experts say yields almost nothing o value. Agencieshave been sued or shoddy background checks that resulted inelonious caregivers being placed with vulnerable seniors andcommitting new crimes. Other lawsuits have revealed instances oagencies fnding out about a caregivers criminal background, but

placing the caregiver in someones home anyway. Even the manyagencies that do more thorough checking can miss convictionsolder than seven years old because o a Caliornia law limiting thereach o consumer background reports.

Few Caliornians who hire caregivers on their own know thatthey have a legal right to request a statewide criminal backgroundcheck through the Department o Justice. In the frst threemonths o this year, no consumers asked or the fngerprint-based screening. Meanwhile, a 2008 law that was meant to help

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consumers get and understand criminal background checksis being ignored. The law envisioned that the help would beprovided by public authorities that train and screen workers in

the states In-Home Supportive Services program. But not a singlepublic authority o the 26 that we contacted said they could assist.The bills backers looked to the Department o Social Services towrite regulations or give other guidance. The department says thelaw never intended it to take on that role.

A survey we conducted o 30 states, covering 83 percent o theU.S. population, ound that Caliornia is part o a small minoritythat does not regulate in-home care agencies. Only fve otherstates in our survey leave the industry unregulated. The 24 otherstates that do regulate in-home care agencies employ a wide

variety o approaches, with some laws encompassing businessesthat reer caregivers to clients as well as those that employ them.Three states either require anyone representing hersel asa caregiver to work or an agency where they are subject tobackground screening, or submit to a criminal background checkas an independent caregiver. Napa County recently passed anordinance requiring all caregivers, whether working or an agencyor independently, to apply or a permit that includes a criminalbackground check. Other counties are considering similar measures.

Two bills now beore the Legislature would regulate in-home care

agencies or the frst time. Because the bills were introduced ater weembarked on this report and will be vetted during the legislative process,we do not analyze them. Our report does make several recommendations,however, including some that deal with the part o the industry that wouldremain unregulated even i the current bills become law. Among theoptions are carving out an exception to a state law that prevents consumerreporting agencies rom disclosing convictions older than seven years,unding a public education campaign to let consumers know how to getand interpret a statewide criminal background check, and legislation tocreate a amily care protection registry that would allow clients to fndcaregivers who have voluntarily undergone screening.

Rosalie Gonsolin, whose mother lost $30,000 to a caregiver with anextensive criminal history, wonders why the in-home care industry isnot subject to the same oversight as day care centers or long-term careacilities such as nursing homes.

There just needs to be regulation in place, Gonsolin said. Why, isomeone wants to stay in their own home, shouldnt they have the sameguidelines?


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Background

The home care industry is growing ast, driven by the desire o manyaging Caliornians to remain in their own homes rather than moving intoassisted living or other types o long-term care acilities.

Because the industry is unregulated in Caliornia, no one knows its exactsize. In 2009, the Caliornia Association or Health Services at Home,which represents in-home care agencies, searched a web-based businessdirectory to identiy frms whose names suggested that they oered in-home care, and ollowed up with phone calls. CAHSAH estimated thatthere were 1,200 such agencies statewide, with annual revenues o $1.2billion.

The industry is likely to see explosive growth as a burgeoning seniorpopulation looks or alternatives to institutional care. The percentage oseniors in need o ongoing help with the tasks o daily living is expectedto double by the year 2025, according to Lori Post, Associate Proessor oEmergency Medicine at the Yale School o Medicine.

This new world comes with unprecedented perils. Two recent nationalstudies ound that about one in ten people over the age o 60 hadexperienced some orm o abuse in the previous year. Those who seekhelp rom a caregiver are by defnition unusually susceptible to abuse.

Posts research has shown that those who apply to work in long-term careare three times more likely than the general population to have a criminalrecord. Caregivers in institutional settings such as skilled nursing acilities

are increasingly subject to criminal background screening. Recently,the state started screening all providers in the government-run In-HomeSupportive Services program. As a result o such measures, Post said, itslikely that those with criminal backgrounds are turning to unregulatedhome care or employment.

Were putting them into areas with absolutely the most vulnerablepopulation, with no oversight, she said.

Few studies have ocused on how much elder abuse is perpetrated by paidcaregivers. Anecdotally, several Caliornia prosecutors told the oversight


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Some caregivers oering their services

on Craigslist have extensive criminal

backgrounds

Even a limited oversight ofce review o current ads on Craigslist ound

caregivers who had criminal backgrounds that likely would be o concernto those who hired them, including commercial burglary, narcoticstrafcking and prostitution.

Many elderly or disabled clients and their amilies seek to hire caregiversdirectly, sidestepping agencies in avor o lower rates. Caregivers try toconnect with those potential employers by placing ads in newspapers,Internet services such as Craigslist, or magazines targeting seniors. Inother cases, caregivers and those in need o help may fnd out about eachother through inormal networks riends, amily, religious institutions orsenior centers.

Theyre fnding them through advertising and word o mouth, saidGreenwood, the San Diego elder abuse prosecutor.

Without criminal background checks, these consumers may unwittinglyopen their homes and fnances to those who have shown a willingness toexploit or harm others.

Darlin Miller said it never occurred to her to do a background check oHelen Pursel, a grandmotherly woman who answered Millers newspaperad seeking a caregiver or her ather, who was succumbing to dementia.

Pursel stole $20,000 rom Millers ather beore she was caught and jailedor six months. Miller later ound out that Pursel had been to prisontwice.

I didnt know that a regular person could do (a criminal backgroundcheck), she told the oversight ofce. I I didnt know that, Im sure thereare a lot o other people who dont.

Mary Jane Scanlon, a 70-year-old woman who had been disabled mucho her lie, ound a live-in caregiver named Diane Warrick through a


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Craigslist ad. When she hired Warrick, Scanlon apparently was unawareo her criminal history. In 1997, Warrick tried to take a drug counselorhostage at Napa State Hospital, and shot at sheris deputies. She was

ound not guilty by reason o insanity, and released rom Patton StateHospital in 2002. Beore that, she had been convicted o robbery inColorado. In March, a Contra Costa County jury ound Warrick guilty osecond-degree murder in the stabbing death o Scanlon.

The oversight ofce examined current advertisements on Craigslist tofnd out i individuals with criminal records were oering their servicesas caregivers. Because caregivers generally do not list their ull namesin ads, we relied on telephone numbers to determine identities. Wedid not draw statistical conclusions rom our survey. Many names weretoo common to do criminal history checks. In other cases, criminalbackground searches were inconclusive, or we could not connect thephone number to a name.

Even with these limitations, the investigation ound fve cases in whichthe individual who placed the ad could be identifed as someone witha criminal background. We identiy the caregivers by only their initialsbecause, despite their histories, their attempts to fnd employment ascaregivers do not violate current laws.

One was S.K. In December, S.K. posted an ad in Bay Area Craigslistoering to work as a caregiver, including personal care, shopping, drivingand housecleaning. She said that she was experienced in health care andwould be willing to spend nights at the clients home.

In 2004, S.K. described hersel to a Mendocino County sheri s detectiveas a kleptomaniac with uncontrollable urges. The detective hadjust caught her stealing merchandise valued at more than $2,400 rom agarden supply store in Fort Bragg. S.K. pled guilty to elony burglary andwas sentenced to 90 days jail.

It was not her frst run-in with the law. Two years earlier, S.K. had beencaught shopliting rom two clothing stores, earning her two yearsprobation. Eight years beore that, shed been convicted o drunkendriving in Sacramento ater a CHP ofcer observed her car weaving on awet highway.

Shortly ater the garden supply store arrest, S.K. got in trouble again orvandalizing the car o a ormer boyriend, including breaking o hiswindshield wipers and scrawling epithets on the windows.

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At the time o that arrest, J.M. already had a long acquaintanceshipwith methamphetamine. In 1989, she was convicted o possessing thedrug with the intent to sell it ater police raided her home in Fullerton.

In addition to 20.7 grams o methamphetamine, police ound a scale,baggies, a ledger and a client list. She was also convicted o possessingnunchakus, a martial arts weapon that is illegal in Caliornia. J.M. wassentenced to 60 days in jail and three years o probation.

J.M didnt make it through probation. In 1990, ater submitting 12 dirtydrug tests, police raided her house again and ound methamphetamineand paraphernalia consistent with an intent to sell the drugs. The courtsentenced her to 16 months in prison.

A.P. oers her services as a caregiver on Inland Empire Craigslist orpeople with disabilities or those unable to cope with daily activities. Shewrites that she can help with hygiene, eeding, dressing, bathing anddriving. She oers to work 24-hour shits.

A.P. has run into legal trouble in the care o her own child, accordingto court records. In June, 2009, a Riverside County sheris deputiesresponded to a call rom the 6-year-olds ather, who reported that thechild had been abused. The boy told the deputy that his mother hadspanked him repeatedly with a wooden spoon. The deputy observed agol-ball size purple and green bruise on the boys let thigh.

A.P. was charged with inicting cruel and inhuman corporal punishmenton a child and child endangerment. She later pled to a lesser charge odisturbing the peace.

On that same day, she pled guilty to driving under the inuence aterbeing caught behind the wheel with a blood alcohol level o 0.22 percent,more than twice the legal limit. As part o a plea deal, A.P. was sentencedto 20 days in jail and required to complete parenting classes, as wellas complying with all orders and plans in a Child Protective Servicescase. Our ofce was unable to review that case because it is consideredconfdential.

In her San Diego Craigslist ad, C.W. touts 17 years o experience asa caregiver. She oers to help with personal care such as bathing,medications, driving and shopping. She writes that shes happy to pass anytype o background check.

C.W. can be confdent in that last assertion, but only because Caliornialaw limits commercial credit and background checking to seven years.Beore that, C. W. has an extensive criminal background, including

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two separate prison terms totaling fve years. In 1986, she pled guiltyto receiving stolen property. In a letter to the judge, she admitted to adrug problem. Two years later, she was convicted o petty thet with a

prior conviction. Ater numerous probation violations, a judge in 1991sentenced her to three years in prison, citing her numerous crimes oincreasing seriousness. In 1994, she was charged with transportingcocaine and heroin. She pled guilty to one count o possession, and wassentenced to another two years in state prison.

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A signiicant number o caregivers who

get into trouble have prior criminal

records

In addition to our review o Craigslist ads, we did an exhaustive search

o Caliornia newspapers over the past seven years to fnd accounts ocaregivers accused or convicted o crimes. In more than a quarter othe cases we ound, criminal caregivers had committed earlier crimes,underscoring the potential value o criminal background checks.

Our search identifed 64 private, in-home caregivers who got into legaltrouble in the past seven years as a result o a transgression on the job. In17 o these cases 27 percent o the total we were able to determinethat the caregiver had previously been convicted o a crime. We didntcount inractions such as driving oenses, including driving under theinuence.

Our fgure is almost certainly an underestimate. The oversight ofcedoes not have access to data available to law enorcement. Instead, werelied on searches o Superior Court records, the commercial databaseLexisNexis and inormation gleaned rom the news articles themselves.

In 13 o the 17 cases in which the oender had a prior record, theold crimes mirrored the new charges. Caregivers who had previouslycommitted a property crime such as burglary, or instance, stole romclients. Property oenses were the most common type o crime, bothor the earlier oenses and the caregiver case. In our instances, the

deendants earlier conviction was or stealing rom an elderly or disabledclient. These caregivers had been caught victimizing the vulnerable, andthen went on to do it again.

Most o these cases went ar beyond missing jewelry. Losses added up totens or even hundreds o thousands o dollars. Caregiver Gina Trevinowas sentenced by a San Diego County judge to eight years in prison atershe and her husband admitting stealing the home o their elderly clientsby getting them to sign over the deed, according to the San Diego Union

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Tribune. Trevino had previously served prison time or cruelty to a child,receiving stolen property and orging checks, the paper reported.

Not all the caretakers engaged in property crimes. One man with ahistory o battery, or instance, was convicted o assaulting his infrmclient and throwing her dog against a piece o urniture. In another case,a caregiver with a history o drug use was convicted o killing her elderlycharge with an overdose o painkillers while she was under the inuenceo prescription medications.

Researchers debate whether a prior criminal history is a good predictor oa caregivers propensity to take advantage o a client. Alan Blumstein, acriminologist rom Carnegie Mellon University, has ound evidence thatthe longer an individual goes without committing a crime, the lower therisk.

And those without criminal histories may pose a risk o their own. Somesuggest that low-paid workers in private homes where they have access tocheckbooks, credit cards, jewelry and cash may succumb to temptation,committing crimes o opportunity inconsistent with previous behavior.

Others, such as Post, the Yale emergency medicine proessor, suspect thator some types o crime, there is a correlation between a past record andthe likelihood o committing crimes as a caregiver. A drunken drivingarrest at the age o 17 may have little bearing on uture criminal behavior,or instance, while violence and to a lesser extent property crimes predicttransgressions as a caregiver.

The debate is more than academic. I there is weak correlation betweenpast behavior and conduct as a caregiver, theres little need or criminalbackground screening. I the opposite is true, policymakers should pushor more stringent criminal checks.

Our examination involved too small a sample to answer this questiondefnitively. But it shows that a signifcant percentage o caregiver crimescould have been prevented by criminal background checks.

Caregivers repeat past behavior

One such case involved a caregiver named Cindi Dee Powell. In 1998,she was convicted o stealing $43,000 rom the church where she wasworking as a bookkeeper, according to Barrie Pink, an Orange Countydeputy district attorney. She didnt do any jail time or that oense. Butin 2006, she was convicted o thet rom an elder adult and sentenced to180 days or stealing $18,675 rom her bed-ridden mother, Pink said.

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Within two months o being released, Powell responded to an ad in theOrange County Register placed by a woman seeking a live-in caregiver orher 82-year-old mother, Constance Wakefeld. The mother and daughter

were impressed by Powells charming manner and assured by the cross shewore to the interview, and hired her. Ater the daughter returned to herhome and three children in South Arica, Powell took over Wakefeldsfnances. She prevented Wakefeld rom opening her own mail. Shemoved into the master bedroom, and started charging her client rent.She bought a car with the payments deducted rom Wakefelds account.She took out a credit card, listing hersel as Wakefelds daughter, andthen a home equity line o credit backed by the elderly womans home.Powell got Wakefeld to sign over a Toyota pick-up truck, which she sold,and then used Wakefelds accounts to buy another car. A year ater shedmoved in, Powell put up Wakefelds Huntington Beach house or sale.

With her fnances in disarray, Wakefeld eventually lost her home o 47years to oreclosure.

A tip led police to question Powell, who was later convicted andsentenced to our years in prison.

Darlin Miller tells a similar story about Helen Pursel, the caregiver shehired to move in with her ather, Barney Massman o Danville, whowas suering rom dementia. Pursel responded to a classifed ad Millertook out in the local newspaper. The two met at a restaurant, wherePursel showed her what appeared to be a current registered nurse licenseand supplied her with fve reerences o people she had worked or as acaregiver.

She just passed with ying colors, Miller recalled. She was likesomeones grandmother.

Soon, however, Miller started getting disquieting reports rom her ather,who said that Pursel reused to cook or him and once let him lying onthe oor under a dining room table much o the night when he got uprom bed and tripped. But Miller wasnt sure how much was true and howmuch could be attributed to her athers worsening dementia.

Then Miller, who lives in Stockton, came to Danville one day toreconcile her athers checkbook and discovered that some checks weremissing. Her ather told her that Pursel had been taking him to the bankand orcing him to withdraw money or her. Miller said she dismissedthe caregiver on the spot. Later, when her athers next bank statementarrived, she discovered that $20,000 was missing and fled a police report.

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It was only then that she learned that Pursel had an extensive criminalrecord. Pursels crimes date at least to 1981, and include convictions ororgery, grand thet and alsely claiming to be a registered nurse. Miller

said she was told by Contra Costa authorities that some o these crimesinvolved elderly victims Pursel was supposed to be caring or, and that shehad been to prison twice.

The judge sentenced Pursel to 365 days in jail and ordered her to payback the money. Miller said her ather got one monthly payment o $50,and then she quit. Pursel was also ordered not to work as a caregiver.Miller is skeptical that anyone is keeping track.

How are you going to stop her? Miller said. I eel sorry or anyone whopicks her.

An in-home care agency did pick Daisy Lee Joubert to care or Ileen andNorman Jonas, despite Jouberts earlier conviction or embezzlement. Inher job at a skilled nursing acility in Palm Springs, Joubert had stolen thelast paychecks o terminated employees, as well as the reund checks romtrust accounts o residents who had died or moved into other acilities.The total added up to more than $13,000, according to a police report.

The agency nonetheless placed Joubert in the home o the Jonases tohelp Norman while Ileen had surgery or a brain tumor. Ileen sueredcomplications rom the surgery, and soon, Joubert became their live-in caregiver, according to their daughters, Kathleen Jonas and KellieIkenberry. Joubert quit the agency and went to work or the Jonasesdirectly.

The Jonases came to rely on Joubert despite her repeated absences atnight when she was supposed to be with them. One time, a woman whodidnt know the Jonases called police to report that she had seen thecaregiver slapping Norman Jonas in a discount store parking lot. Butwhen police showed up at their house, the Jonases denied that anythinghad happened, Ikenberry said.

My parents were convinced they would die without Daisy, Ikenberrysaid. Its very easy to ingratiate yoursel into older peoples lives.

Joubert had taken a week o to get dental work done when Ileen Jonasnoticed that some jewelry was missing. Police interviewed caregivers whohad been flling in, but soon ocused on Joubert because o her criminalrecord. It turned out Joubert had been pawning Ileen Jonass jewelry orsome time. Shed been stealing in other ways, such as signing over checksrom Ileen Jonas retirement account to hersel. The amily estimates

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the total loss at close to $100,000. Joubert pled guilty to eight counts ocaretaker embezzlement and was sentenced to 180 days in jail.

Among the other cases examined by the oversight ofce:

Well-known La Jolla cookbook author Jeanne Jones hired CarlaCarrillo to care or her elderly mother, unaware o Carrillos longrap sheet and history o drug addiction. Carrillo did jail time in1995 or two separate crimes petty thet with a prior and orgeryat a Bank o America. In 1996, she was convicted o grand thetrom a Bullocks department store. Ater two new burglaries in1998 and 1999, she was sent to prison or a term o three years andour months. The court declared Carrillo to be an addict. Severalyears later, Jones hired Carrillo to care or her 91-year-old mother.Jewelry went missing, and eventually, Carrillo and her boyriendwere charged with stealing jewelry worth about $63,000 andselling it to retailers. That case is still pending.

Kenneth Lee Morton ran up a string o domestic abuse, drugand drunken driving charges beore running into trouble as acaregiver. In 2004, he pled guilty and did jail time or battering histhen-girlriend. The court ordered him to get domestic violencecounseling. But by 2005, he was back in court again, accused odomestic battery o a dierent woman. He did another monthlong stint in the county jail, and returned on probation violations.

Morton met Kathleen Clara Soswa when she hired him to painther house. He rented a room rom her and became her caregiverand, according to Soswa, her fanc. In late 2007, he was accusedo elder abuse or twisting Soswas arm and throwing her 9-poundPapillon Papi against a piece o urniture. He was sentenced to180 days in jail. In early 2009, while still on probation or severalmatters, he died. In addition to her troubles with Morton, Soswatold the oversight ofce that she has been victimized by a series ocaregivers who stole rom her.

Janet Marie Montero was convicted o petty thet in SanBernardino County in 2004. In March, 2008, she was convictedo shopliting rom a Wal-Mart in Palm Desert and did three daysin jail. Several months later, back in San Bernardino, she rackedup a conviction or petty thet with a prior. Then, in 2010, shewas accused o stealing $13,000 in jewelry rom 69-year-old EdithGoetz in Desert Hot Springs. She was sentenced to 180 days injail.

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Many in-home caregiver agencies

claim to do background checks, but the

quality varies and legal roadblocks can

prevent thorough screening

In the absence o a state requirement to perorm criminal backgroundchecks on caregivers, many agencies claim to do them anyway to assureclients that they are minimizing risk.

But a review o lawsuits against agencies and news accounts o caregivercrimes shows tremendous variability in what passes or a backgroundcheck. Agencies have been sued or doing cursory checks that gaveconsumers a alse sense o security.

They know what to say to amilies that are desperate to get care or their

aged parents, said Rosalie Gonsolin, whose mothers caregiver stole$30,000.

Other agencies have been taken to court or ignoring the criminalbackgrounds they uncovered and placing caregivers in private homesanyway.

Even agencies intent on doing thorough screenings can fnd themselveshamstrung by a state law limiting how ar back consumer reportingbusinesses can search or criminal convictions. While the ederal lawon credit and background checks allows any criminal conviction to be

reported to an employer, Caliornia companies can only go back sevenyears. There is no exception in Caliornia law or in-home care businessesthat place caregivers in private homes with vulnerable adults.

The thoroughness o the criminal background check was the central issuein a lawsuit brought by a 92-year-old Contra Costa County woman againstHome Care Assistance, Inc., the company that placed a elon in herhome.

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Rose Michaels amily became suspicious when they discovered that thecaregiver, Wessa Tanupo, had been taking her on long car trips withouttheir permission and charging the gas to their mothers credit card.Ater the agency removed Tanupo, the amily discovered that she hadbeen writing checks on their mothers bank account and making otherunauthorized charges to her credit cards. The total loss added up to$30,000.

A detective investigating the case remarked to Gonsolin, Rose Michaelsdaughter, This person was placed in your mothers home? She has anextensive criminal history. The rap sheet came as a surprise to the amily,Gonsolin said, because HCA had assured them that Tanupos criminalcheck had come back clean. In act, she had been sentenced to threeyears in prison or selling crack cocaine in 1993. As a result o paroleviolations, she had been incarcerated as recently as 2003 and releasedrom parole in 2004, three years beore being placed in Rose Michaelshouse.

In her lawsuit, Rose Michael alleged that HCA misled her by claiming itdid a thorough background check. HCA used an Internet service calledCriminal SuperSearch oered by Intellicorps, according to the lawsuit.The search does not include court records rom Santa Clara County,where Tanupo was prosecuted, or rom the Caliornia Department oCorrections. The only Caliornia records in the database were rom a sexoender registry, the suit alleges.

The parties settled out o court or an undisclosed sum.

In a similar case in Fresno County, a ranchisee o one o the mostsuccessul in-home care businesses in the U.S. is accused o inadequatelyscreening a caregiver who ended up killing her client.

Visiting Angels, based in Virginia, ranchises in-home care agencies inCaliornia and across the nation. A ranchisee in Fresno County placedKelly Jones in the home o Patricia Stovall. Jones was convicted o

manslaughter ater Stovall, who was 85, died o an overdose o painkillers.Jones appeared disoriented around the time o her clients death andtested positive or high levels o the anti-anxiety medication Xanax,according to press accounts at the time.

Stovalls amily sued Visiting Angels. The suit alleges that caregiverJones, who was sentenced to three years in prison, had two previous drugconvictions that should have been discovered by a criminal backgroundcheck beore she was placed in a household where she would have accessto prescription drugs.

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The Visiting Angels ranchisee checked only Fresno County records,attorney Eric Oren said. That search was inadequate, because one oJones convictions was out-o-state and the other in ederal court, Orensaid.

It really didnt cover very much, so it wasnt a very good backgroundcheck, he said. The bottom line is that she had a history o drugabuse and was placed in a situation where she had access to drugs.

Visiting Angels maintains that the Fresno ranchisee did not ollow itsguidelines, Oren said. The ranchisee, meanwhile, claims that Jones wasan independent contractor. The case is scheduled to go to trial in May.

In another incident involving Visiting Angels, a Long Beach ranchiseeplaced Kenya Mitchell, a convicted elon, in the home o an elderlycouple to take care o the 80-year-old husband. Mitchell proceeded tosteal the couples credit card and run up a $5,500 bill. She was sentencedto three years in prison.

The local Visiting Angels branch explained to the Press-Telegram inLong Beach that the criminal background company hired by the previousowner had done an incomplete data search. Somehow, that search missedthree thet convictions in the previous fve years in Los Angeles County including one that occurred a month beore Mitchell applied or theVisiting Angels job. The new ranchisee told the newspaper she changedthe procedure so that it included a check at the county courthouse.

Marin Community Healthcare hired Maria Quierrez ater her criminalrecord came back clean. But the caregiver had given the agency a alsename and social security number, according to Douglas Van Vlear, anattorney or the company, now known as Acclaim Homecare. She alsoalsely claimed to be a certifed nurse assistant, which requires its ownstringent background check, Van Vlear said.

In act, Quierrezs record was not clean she did 30 days in jail ater she

and a male caretaker ripped o their elderly charge in Solano Countyin 2003, the oversight ofce discovered in a review o criminal records.Sometime ater being hired by Marin Community Healthcare, she madea separate arrangement to care or an elderly woman in Terra Linda. In2007, she was arrested again and charged with stealing $9,000 rom her84-year-old client. Quierrez was sentenced to six months in jail.

As it exists now, the ability to access the applicants rap sheet variesrom nonexistent to difcult and expensive, Randy de Leon, Acclaimsmanaging director, wrote in a statement to the oversight ofce.

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Not all criminal background checks are created equal

Experts in criminal background checking say that doing the job right

requires laborious and time-consuming research rom a variety o sources.On-line databases are woeully incomplete, they say. In an eectivecriminal record search, researchers must fgure out where a person livedand visit the courthouses in those locations.

In San Francisco, or example, a runner sent to check criminal recordsmust frst search seven sets o books or misdemeanors, said LynnPeterson, President o PFC Inormation Services, Inc. an Oakland publicrecords research frm that specializes in caregiver background checks.I theres a match, the runner has to stand in line to submit a request tohave the fle pulled, and then go back the next day to look at it. Feloniesare located in a dierent room and require a similar time-consumingprocedure.

Its incredibly labor intensive and low-tech, Peterson said, not whatyoud expect when you see TV programs.

The association that represents in-home care agencies runs a certifcationprogram that requires agencies to hire consumer reporting companiesto do traces o social security numbers, searches in counties and ederaldistricts where the applicant has lived, and checks o commercial criminaldatabases. Alternately, the agency can search Caliornia Departmento Justice and FBI databases. In-home care agencies are authorized byCaliornia law to consult these government databases, which would allowthem to avoid the pitalls o instant Internet searches and the painstakingjob o county-by-county courthouse checks.

But its unknown whether a majority o agencies ollow the proceduresrequired or certifcation by the Caliornia Association or Health ServicesAt Home. Only about 19 percent o in-home care agencies in Caliorniahave been certifed. While many o the 81 percent who are not certifedclaim to do background checks, that can mean anything rom thethorough vetting required by the association to a $19.95 instant Internetsearch that those in the industry say is almost worthless.

Its a generic term that doesnt mean anything, said Lester Rosen, anattorney and President o Employment Screening Resources in Novatowho helped ound the frst nationwide association o background screeners.

Not every background check is created equal, said Denise Collins, chieexecutive ofcer o Aunt Anns Agency, an in-home elder care and homestafng business in Daly City. You get what you pay or.

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On-line databases, in particular, are ull o holes and run the risk ocreating a alse sense o security or agencies and their clients, experts say.While many oer a search o nationwide criminal records, Peterson said,

there really is no such thing available to the general public.

Many on-line databases include only people who have been sent to prison- the most hardened criminals - or those on sex oender registries, shesaid. Lesser crimes that would be o interest to clients and agencies, suchas burglary or thet, dont appear. Any on-line search would not turn updata rom jurisdictions such as San Francisco that dont have publicallyavailable electronic indexes. For those that do, inormation oten is notcurrent.

Those databases are worse than no check at all, because you think youdid a background check and you didnt, said Glenn Hammer, ounderand President o A Matter o Fact, a background screening frm in Colax.In an industry like in-home care with low margins and high turnover,however, it can be tempting to go or the cheaper alternative.

A lot o companies do (cheap Internet searches) because they will getback a clear piece o paper and think theyre o the hook, Peterson said.

Caliornia law limits the reach o background checks

Even those that do pay investigative consumer reporting agencies todo county courthouses searches can miss convictions as the result o aCaliornia law that is ar more restrictive than ederal law.

The ederal Fair Credit Reporting Act allows consumer reporting agenciesto reveal criminal convictions to their clients, regardless o when thecrime occurred. It also allows arrests that didnt result in a convictionto be reported or seven years. Caliornias law, the Consumer CreditReporting Agencies Act, allows convictions to be reported only withinseven years o the person being released rom incarceration. Arrests thatdont result in conviction cannot be reported at all. In addition, employersare barred by state labor law rom asking applicants about arrests thatdidnt result in conviction or using that inormation in employmentdecisions. The labor law includes an exception that allows health acilitiesto consider sex oenses and serious drug crimes.

The Caliornia law was intended to keep people rom being permanentlystigmatized or youthul indiscretions. But its limitations when applied tothe in-home care industry are evident in the San Diego case mentionedabove, in which a couple was convicted o stealing the home o theirelderly clients. The local Visiting Angels ranchise placed Gina Trevino

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in the home o Pat and Dorothy Torano despite her extensive criminalbackground. Shortly ater Trevino went to work or the Toranos, she letVisiting Angels and worked or the couple directly. The Visiting Angels

ranchisee told The San Diego Union Tribune that the company hadordered a criminal background check that went back seven years, thelimit under Caliornia law. The check missed Trevinos criminal historybecause the oenses occurred more than ten years earlier. Trevino haddone prison time or cruelty to a child, receiving stolen property andorging checks.

Some agencies fnd criminal raps, but place the caregiver in a vulnerablepersons home anyway.

The Monterey County District Attorney sued Central Coast SeniorServices in 2007, alleging that the company had made deceptivemarketing claims about conducting criminal background checks anddrug tests. The advertising created the alse perception that the companydid not hire caregivers with criminal records, the lawsuit alleged. In act,it had hired eight, including our elons, Deputy District Attorney JohnHubanks said.

The owner claimed that there was no law prohibiting the company romhiring individuals with criminal pasts, Hubanks said. But the DistrictAttorney relied on unair competition law, arguing that the companysadvertising implied that it did checks to keep criminals rom being placedin clients homes.

The company eventually settled. While not admitting wrongdoing, itagreed to an injunction and court monitoring o its advertising, Hubankssaid. It sent letters to all o its clients warning them to check theirbelongings, and paid civil penalties o $225,000.

Santa Clara County settled a similar case against an in-home care agencyin 2010. The case came to the attention o the district attorney whena caregiver with a history o thets was prosecuted or stealing rom aclient with dementia. Aterwards, the district attorney sued HomewatchCaregivers o Santa Clara Valley, alleging that the agency had ailed todisclose to the client the caregivers criminal history despite advertisingthat it screened its employees to protect customers.

The case was complicated by the act that the agency was a ranchisee oa corporation in Colorado, Deputy District Attorney S. Michael Lee said.Eventually, the ranchiser put pressure on the ranchisee to settle. Thecompany agreed to inorm clients o any criminal histories it turned up,including elonies and serious misdemeanors. It also agreed to start using

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competent and well-qualifed background services, and paid $10,000 incivil penalties and ees. But the district attorneys ofce was unable torecommend a particular background screening company, given the huge

variability o quality in the industry.

You can tell its all over the place, Lee said.

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Private individuals hiring caregivers on

their own ace many obstacles

Caliornians who hire caregivers on their own have the legal right tocheck criminal histories through the state Department o Justice. But ewpeople know about this option. The Department o Justice received norequests rom private parties in the frst three months o 2011, and onlya handul in previous years. In addition, a law meant to help consumersnavigate this process is being ignored.

Caliornia Welare and Institutions Code Section 15660 allows privateindividuals who are thinking o hiring an in-home caregiver to requestthe statewide Department o Justice screening, which goes back 10 years.The person must frst get a orm rom the Department o Justice, andthen ask the potential employee to take the orm to one o dozens o Live

Scan technology vendors or fngerprinting. The results are sent to theemployer within 30 days. The cost is $32. The law also mandates that ithe caregiver commits a new reportable oense, the employer will get anotifcation the so-called rap back process.

Few people use this service. Since the beginning o 2006, only 179 privateindividuals who wanted to screen a caregiver have made a Department oJustice request, according to Julie Basco, Chie o the Bureau o CriminalInormation and Analysis. The numbers have dwindled in recent years.In 2007, 71 individuals asked or a Live Scan o caregivers. In 2010, thenumber ell to 22. As o March 31, 2011, there have been no requests,

Basco told the oversight ofce.

The Department o Justice records, like other criminal databases, are in aconstant state o update and revision. The department relies on countiesto orward inormation, and that doesnt always happen, especially withmisdemeanors. Some crimes are not included in the Department oJustice reports. Neither are arrests that have been adjudicated without aconviction.

The report itsel can be conusing to the uninitiated.

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Caliornia Senate Ofce oApril 21, 2011


Its probably oreign to most people, Basco said. Its an excerpt rom arap sheet. Its something that someone is really going to have to sit down

and absorb.

A legislative fx alls short

With that obstacle in mind, the Legislature in 2008 passed Senate Bill692. The bill amended Welare and Institutions Code to make it clearthat private employers o in-home caregivers could request Departmento Justice checks. It also said that public authorities in the states In-HomeSupportive Services Program which recruit, screen and train IHSSworkers could help private employers o in-home caregivers navigatethe criminal background process. Senate Bill 692 was backed by theCaliornia Senior Legislature, which saw it as a top priority or protectingvulnerable seniors.

A survey by the oversight ofce revealed that very ew i any IHSS publicauthorities oer that kind o help. We called 26 o the 56 IHSS publicauthorities, asking the person who answered the phone whether thepublic authority could help a private consumer check out a potentialcaregiver. All 26 said they could not.

Several suggested that private clients could go through a Live Scanvendor to do their own Department o Justice check. But none oered tohelp with the process. Some did not even recommend that option.

We actually dont do background checks, said a woman who answeredthe phone at the San Diego public authority. Well, we do, but only orproviders in our agencyI wouldnt even know who to reer you to.

The answer in Sonoma County was similar: I just dont know how that

Individual requests received by the Department of Justicefor criminal background checks of caregivers

2006 46

2007 71

2008 26

2009 14

2010 22

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happens. At the Ventura County IHSS Authority: I dont see how youcouldI dont know how to help you with that. And in Los Angeles: Wecant assist with a background check.

One reason the law has been ineective is that the bill was amended tobe permissive IHSS public authorities may help consumers navigate thebackground screening process, but are not required to. The change wasmade ater public authorities said they were worried about cost and thepotential or liability.

There has also been conusion about whether the Department o SocialServices would write regulations or send out a directive to all IHSS publicauthorities explaining how to put the law into eect. Ken DeVore, who atthe time was Capitol Director or Senator Roy Ashburn, author o SB 692,said that the expectation was that Social Services would write regulationsor issue instructions. Others involved in the bill have also said theyexpected Social Services to take a lead role.

But the law does not call or that, said Patti Huston, Deputy Director orLegislation or the Department o Social Services. The language in SB692 that appears to call or regulations was actually copied and pastedrom Senate Bill 868, which would have prohibited IHSS providers rombeing charged or background checks i certain conditions were met, shesaid. The two bills, signed within a ew months o each other, amendedthe same section o law. So the language o SB 868, which was signedearlier, carried over into the new bill. The sharing o language made itappear to some that regulations would be written regarding SB 692.

Social Services main concern about SB 692 was that public authoritiesbe careul not to spend state General Fund money on backgroundchecks or private individuals. Doing so would run aoul o Medicaidrules. Monitoring the public authorities would have required SocialServices to dedicate sta, Huston said, but the cost was never authorized.In the meantime, public authorities have not sought direction rom thedepartment about how to implement the law, she said.

Even i regulations were not required, public authorities still wouldneed clear direction rom the state on how to help private employerso caregivers, said Karen Keeslar, Executive Director o the CaliorniaAssociation o Public Authorities. The bill is vague, she said. Thelanguage could mean that public authorities would merely instructconsumers how to do a background check on their own. Or it couldinvolve the public authority requesting the check on behal o a consumerand interpreting the results or them.

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The latter interpretation would raise its own questions, Keeslar said,because there are strict legal limits on what public authorities can share

rom a Criminal Oender Report Inormation. Would the authoritiesbe able to share the whole rap sheet, or just tell the consumer that thecriminal history would prevent the caregiver rom being included on anIHSS registry?

The law has done nothing to help private consumers screen theircaregivers. Even i it had been put into eect, its reach would be limitedi consumers didnt know about it, said Erwin Fromm, a member o theCaliornia Senior Legislature.

The key actor is letting people know they can do this, he said.

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Caliornia is one o the ew states

that does not regulate in-home care

agencies

A survey by our ofce o 30 states, accounting or 83 percent o the U.S

population, ound 24 states that regulate home care agencies and six,including Caliornia, that do not.

New Jersey is one o the states that have chosen to regulate. Ofcialsthere saw the law as an important step to protecting the saety oconsumers.

Its not like at a acility, where there are multiple levels o sta, saidSherl Brand, President o the Home Care Association o New Jersey,which backed the law. When youre in someones home, it becomes aone-on-one situation. Theres no one really watching that.

Our survey results were consistent with others that have ound that moststates regulate in-home care agencies, including criminal backgroundchecks or caregivers.

The survey ound three states Oklahoma, New Jersey and Washington whose laws do not permit caregivers to work independent o an agencyor require those working on their own to submit to a criminal backgroundcheck. Ofcials in those states acknowledged, however, that it is difcultto oversee independent contractors, such as neighbors or those whoadvertise on Craigslist or in newspapers.

A new ordinance in Napa County nonetheless attempts to do just that. Allin-home caregivers must be certifed, which includes being screened orcriminal history. Napa ofcials have said that they would preer the stateperorm these unctions. The Legislature is considering two regulationbills but, unlike Napas ordinance, they do not attempt to regulateindependent workers who fnd caregiving jobs on their own.

The results o our survey o other states were similar to those rom asurvey done last year by the Caliornia Association o Health Services at

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Home. CAHSAH did not get responses rom 14 states that did provideinormation in our survey, but the association received answers rom fvestates we were not able to reach. When those fve states are added to our

data, a total o 29 states regulate in-home care agencies, compared to sixthat do not. The combined surveys account or 89 percent o the U.S.population.

Besides Caliornia, the fve states we ound that do not regulate in-homecare agencies are Arizona, Iowa, Michigan, Missouri and South Carolina(which is considering a regulation bill in the current legislative session).

In Arizona, the association that represents in-home care agencies wouldlike the industry to be regulated, said Mary Wiley, assistant director othe Division o Licensing Services or the state Department o HealthServices. The state has been conronted with the quandary o how todefne an in-home caregiver. Does it include housekeepers in the homeso elderly or dependent adults, or instance, or workers who delivergroceries?

Some state regulations go beyond licensing agencies

New Jersey is one o the three states in our survey that go beyond agenciesto regulate individuals who provide home care. The law applies toanyone who delivers hands-on personal care to people who are over 60 ordisabled. Personal care is defned as dressing, grooming, bathing and thelike. It does not include companion services, said Brand, president o thestates home care association.

Once home health aides have been certifed in New Jersey, they arebarred rom working independently and must go through an agency.I a caregiver held out the state certifcation while oering to workindependently o an agency, the state would take action, Brand said.But it would be very difcult or the state to police every uncertifedindividual who oers to work as a caregiver.

Can we stop Mrs. Jones rom hiring whoever she wants? Brand asked.No.

In Oklahoma, anyone holding themselves out as providing home care anything more than a sitter service must work or a licensed agency andundergo a criminal background check.

I the state fnds out about individuals working on their own withoutlicensing, it sends them letters reminding them that they must complywith the law, said Tom Welin, Chie o Medical Facilities or theOklahoma Department o Health.

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Caliornia Senate Ofce oApril 21, 2011


States thatlicense in-home

care agencies(24)

States that donot license

in-home careagencies (6)

Did not

determine (20)

Colorado Arizona Alabama

Delaware California Alaska

Florida Michigan Arkansas

Georgia Missouri Connecticut

HawaiiSouth Carolina(currently

considering bill)

Idaho

Illinois Iowa Kansas

Indiana Kentucky

Louisiana Minnesota

Maine Mississippi

Maryland Montana

Massachusetts Nebraska

Nevada New Hampshire

New Jersey New Mexico

New York North Dakota

North Carolina South Dakota

Ohio Tennessee

Oklahoma Vermont

Oregon West Virginia

Pennsylvania Wisconsin

Rhode Island Wyoming

Texas

Utah

Virginia

Washington

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places where potential clients and caregivers will see them, includingsenior centers, hair salons, service clubs, the Meals on Wheels program,pharmacies, grocery shopping bags and doctors ofces.

Santa Barbaras Area Agency on Aging is considering pushing or a similarlaw.

Theres a tremendous need, said Joyce Lippman, director o the agency,known as the Central Coast Commission or Senior Citizens. It wouldbe so much nicer to have a statewide system. But our position here is thati we cant get something through the state, we have to do something.Its awulRegulation equals protection. As ar as Im concerned, theseindividuals need protection.

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Recommendations

The Legislature is currently considering two bills that would regulateCaliornias in-home care industry. Our ofce embarked on this reportbeore those bills were introduced, and so does not analyze them, as otherlegislative sta will do. Our recommendations are based on interviewswith those in the feld and an examination o caregiver criminal casesto fnd out what went wrong and how the crimes might have beenprevented.

While the two bills beore the Legislature both propose regulation o in-home care agencies and background checks or caregivers, some o ourrecommendations include measures short o ull licensing. Others addressproblems that would not be solved by regulating in-home care agencies.

The Legislature should consider legislation that would allowconsumer reporting agencies to report convictions more thanseven years old, as well as arrests that do not result in conviction,when the job applicant will be providing hands-on care to anelderly or dependent adult. For many types o jobs, the seven-yearwashout or criminal convictions makes sense. But consideringthe vulnerability o in-home care clients, and the opportunities orcaregivers to exploit them, the Legislature should weigh carvingout an exception to the consumer reporting rules.

Under current Caliornia law, elderly and dependent adultshiring caregivers on their own are entitled to request a fngerprint-based criminal background check rom the Caliornia Departmento Justice. The problem is that most dont know about the law,

how to request the background check or how to interpret theresults. The Senate should consider legislation to create a publicawareness campaign inorming elderly and dependent adults otheir options. Considering the ineectiveness o a law that wouldhave had IHSS public authorities acilitate background checks,the Legislature may want to consider some other mechanism orachieving the same result.

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The Legislature is already considering regulation o in-home careagencies. Our report suggests that this could be a good move orthe state, in line with what most other large states already do.

However, any regulation should ocus on protecting consumersand not necessarily on the kinds o oversight that would berequired o businesses that receive government money, such asauditing and inspections. This will keep down costs, allowing theindustry to pay or its own regulation through annual ees. I thecosts o the program and the attendant ees charged by agenciesare too high, more consumers may be driven to hire on their own,leaving them vulnerable to the unregulated sector o the industry.

The Legislature should consider legislation to create a amilycare protection registry. Such a registry would allow caregivers to

voluntarily submit to a criminal background check in return orbeing included on the registry, which would be available to thepublic. The registry also could include the names o those who,because o administrative actions or crimes committed while inother health care jobs - such as certifed nurse assistants or assistedliving caregivers - should not be hired as a private caregiver.These databases already exist. This proposal would merelyinvolve consolidating the data and publicizing its availability toCaliornians who are considering hiring a caregiver on their own.

I the Legislature chooses not to approve bills to regulate in-homecare agencies, it could consider legislation requiring agenciesthat advertise that they have done criminal background checks toadhere to certain standards. These standards could mirror whatsrequired or CAHSAH-certifcation an agency would be requiredto either do a fngerprint-based check through the Departmento Justice and the FBI, or hire a consumer reporting agency to docounty courthouse checks in the places where an applicant haslived.

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Sources o inormation

The ollowing people were interviewed or this report:

MaryAdorno,LegislativeSpecialist,CaliforniaAssociationofHealthServices At Home

JulieBasco,ChiefoftheBureauofCriminalInformationandAnalysis,Caliornia Department o Justice

SherlBrand,PresidentandCEO,HomeCareAssociationofNewJersey

DeniseCollins,ChiefExecutiveOfce,AuntAnnsIn-HouseStafngRandydeLeon,ManagingDirector,AcclaimHomecareLizabethdeVries,SanFranciscoattorneyKenDeVore,ChiefofStaffforAssemblymanDanLogue,formerly

Capitol Director or Senator Roy Ashburn

RebeccaFriedmanZuber,IllinoishealthcareregulationsconsultantErwinFromm,CaliforniaSeniorLegislatureRosalieGonsolinPaulGreenwood, Headof ElderAbuseProsecutions,SanDiego

District Attorneys Ofce

AllenHager,LegislativeCommitteeChair,NationalPrivateDutyAssociation

GlennHammer,founderandPresidentofAMatterofFactinColfaxRochelleHao,DeputyDistrictAttorney,SacramentoCountyJohnHubanks,DeputyDistrictAttorney,MontereyCountyPattiHuston,DeputyDirectorforLegislation,CaliforniaDepartment

o Social Services

KellieIkenberryKathleenJonasRickJury,MissouriDepartmentofHealthandHumanServices

Karen

Keeslar,

Executive

Director

of

the

California

Association

of

Public Authorities

S.MichaelLee,DeputyDistrictAttorney,SantaClaraCountyJordanLindsey,DirectorofPolicyandPublicAffairs,California

Association o Health Services At Home

JoyceLippman,Director, CentralCoastCommissionforSeniorCitizens

SheilaMcMackin,President,NationalPrivateDutyAssociation

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DarlinMillerC.J.Mody,DeputyDistrictAttorney,SanDiego

Sarah

Myers,

Executive

Director,

Oregon

Association

for

Home

Care

EricOren,FresnoattorneyLynnPeterson,President,PFCInformationServices,Inc.BarriePink,DeputyDistrictAttorney,OrangeCountyLoriPost,AssociateProfessorofEmergencyMedicineattheYale

School o Medicine.

LesterRosen,anattorneyandPresidentofEmploymentScreeningResources in Novato

PamelaRossen,BoardLeader,NevadaHomecareAssociation

Kathleen

Soswa

NancySchulz,ProgramManager,NapaCountyMarciaTetterton, ExecutiveDirector,VirginiaAssociationforHome

Care

CatherineValcourt,policyanalyst,MaineDepartmentofHealthandHuman Services

DouglasVanVlear,SanFranciscoattorneyTomWelin,ChiefofMedicalFacilitiesfortheOklahomaDepartment

o Health.

MaryWiley,AssistantDirector,DivisionofLicensingServices,ArizonaDepartment o Health Services

The ollowing documents, reports and other sources o inormation wereused in this report:

Newsaccountsofcaregivercrimesinthefollowingmediaoutlets:TheAssociated Press, Contra Costa Times, The Desert Sun, The FresnoBee, KGO-TV, The Los Angeles Times, Marin Independent Journal,The Modesto Bee, Monterey County Herald, The Orange CountyRegister, The Press Enterprise, Press-Telegram, The Sacramento Bee,

The San Diego Union-Tribune, San Jose Mercury News, The San LuisObispo Tribune, Ventura County Star, The Wall Street Journal

EmailcorrespondencewithofcialsinvariousstatesStateLicensureRequirementsforPersonCareServices,California

Association o Health Services At Home

HowLargeisCaliforniasHomeCareIndustry,CaliforniaAssociationo Health Services At Home

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SuperiorCourtcriminalrecordsfromthefollowingcounties:ContraCosta, Los Angeles, Orange, Riverside, Sacramento, Stanislaus, SanDiego, Ventura

DepartmentofSocialServices,chronologypreparedfortheOfceofOversight and Outcomes o day care acilities run by K.K.

CaliforniaWelfareandInstitutionsCodeSection15660CraigslistadvertisementsSenateBill692of2008AssemblyBill853,TheHomeCareServicesActof2007PeopleoftheStateofCaliforniav.ApexPropertiesTrustCompany,

d.b.a. Homewatch Caregivers o Santa Clara County, Santa ClaraCounty Superior Court

RoseAweekaMichaelv.HomeCareAssistanceInc.,ContraCostaCounty Superior Court

March23,2011letterfromDouglasVanVleartotheSenateOfceofOversight and Outcomes

SafeatHome?:DevelopingEffectiveCriminalBackgroundChecks and Other Screening Policies or Home Care Workers, SaraGalantowicz et. al., AARP Public Policy Institute, 2009

StatePoliciesonCriminalBackgroundChecksforMedicaid-Supported In-Home Direct Care Workers, Donna Folkemer et. al.,National Conerence o State Legislatures, 2008

RedemptioninthePresenceofWidespreadCriminalBackgroundChecks, Alred Blumstein and Kiminori Nakamura, Criminology,May 1, 2009

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2385.Caregiver Roulette