87705 CARE OF PERSONS WITH DEMENTIA
(a) This section applies to licensees who accept or retain residents diagnosed by a physician to have
dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be
dementia.
(b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of
operation shall address the needs of residents with dementia, including:
(1) Procedures for notifying the resident’s physician, family members and responsible persons
who have requested notification, and conservator, if any, when a resident’s behavior or
condition changes.
(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion
of toxic materials.
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the
following:
(1) The facility has a non ambulatory fire clearance for each room that will be used to
accommodate a resident with dementia who is unable to or unlikely to respond either
physically or mentally to oral instructions relating to fire or other dangers and to
independently take appropriate actions during emergencies or drills.
(2) The Emergency Disaster Plan, as required in Section 87212, addresses the safety of residents
with dementia.
(3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide
direct care to residents with dementia shall receive the following training as appropriate for
the job assigned and as evidenced by safe and effective job performance:
(A) Dementia care including, but not limited to, knowledge about hydration, skin care,
communication, therapeutic activities, behavioral challenges, the environment, and
assisting with activities of daily living;
(B) Recognizing symptoms that may create or aggravate dementia behaviors, including,
but not limited to, dehydration, urinary tract infections, and problems with
swallowing; and
(C) Recognizing the effects of medications commonly used to treat the symptoms of
dementia
(4) There is an adequate number of direct care staff to support each resident’s physical, social,
emotional, safety and health care needs as identified in his/her current appraisal.
(A) In addition to requirements specified in Section 87415, Night Supervision, a facility
with fewer than 16 residents shall have at least one night staff person awake and on
duty if any resident with dementia is determined through a pre-admission appraisal,
reappraisal or observation to require awake night supervision.
(5) Each resident with dementia shall have an annual medical assessment as specified in Section
87458, Medical Assessment, and a reappraisal done at least annually, both of which shall
include a reassessment of the resident’s dementia care needs.
(A) When any medical assessment, appraisal, or observation indicates that the resident’s
dementia care needs have changed, corresponding changes shall be made in the care
and supervision provided to that resident.
(6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals.
(7) An activity program shall address the needs and limitations of residents with dementia and
include large motor activities and perceptual and sensory stimulation.
(d) In addition to requirements specified in Section 87303, Maintenance and Operation, safety
modifications shall include, but not be limited to, inaccessibility of ranges, heaters, wood stoves,
inserts, and other heating devices to residents with dementia.
(e) Swimming pools and other bodies of water shall be fenced and in compliance with state and local
building codes.
(f) The following shall be stored inaccessible to residents with dementia:
(1) Knives, matches, firearms, tools and other items that could constitute a danger to the
resident(s).
(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and
toxic substances such as certain plants, gardening supplies, cleaning supplies and
disinfectants.
(g) As required by Section 87468(a)(12), residents with dementia shall be allowed to keep personal
grooming and hygiene items in their own possession, unless there is evidence to substantiate that
the resident cannot safely manage the items.
(1) Evidence means documentation from the resident’s physician that the resident is at risk if
allowed direct access to personal grooming and hygiene items.
(h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a
fence with self-closing latches and gates, or walls, to protect the safety of residents.
(i) The licensee may use wrist bands or other egress alert devices worn by the resident, with the prior
written approval of the resident or conservator, provided that such devices do not violate the
resident’s rights as specified in Section 87468, Personal Rights.
(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting
presents a hazard to any resident.
(k) The following initial and continuing requirements must be met for the licensee to utilize delayed
egress devices on exterior doors or perimeter fence gates:
(1) The licensee shall notify the licensing agency immediately after determining the date that the
device will be installed.
(2) The licensee shall ensure that the fire clearance includes approval of delayed egress devices.
(3) Fire and earthquake drills shall be conducted at least once every three months on each shift
and shall include, at a minimum, all direct care staff.
(4) Without violating Section 87468, Personal Rights, facility staff shall attempt to redirect a
resident who attempts to leave the facility.
(5) Residents who continue to indicate a desire to leave the facility following redirection shall be
permitted to do so with staff supervision.
(6) Without violating Section 87468, Personal Rights, facility staff shall ensure the continued
safety of residents if they wander away from the facility.
(7) For each incident in which a resident wanders away from the facility unsupervised, the
licensee shall report the incident to the licensing agency, the resident’s conservator and/or
other responsible person, if any, and to any family member who has requested notification.
The report shall be made by telephone no later than the next working day and in writing
within seven calendar days.
(8) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the
care and supervision needs of all residents and to escort residents who leave the facility.
(9) The licensee shall not accept or retain residents determined by a physician to have a primary
diagnosis of a mental disorder unrelated to dementia.
(l) The following initial and continuing requirements shall be met for the licensee to lock exterior
doors or perimeter fence gates:
(1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or
perimeter fence gates.
(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or
locked perimeter fence gates.
(3) The licensee shall obtain a waiver from Section 87468(a)(6), to prevent residents from
leaving the facility.
(A) Facility staff shall attempt to redirect any unaccompanied resident(s) leaving the
facility.
(4) The licensee shall maintain either of the following documents in the resident’s record at the
facility:
(A) The conservator’s written consent for admission for each resident who has been
conserved under the Probate Code or the Lanterman-Petri’s-Short Act; or
(B) A written statement signed by each non-conserved resident that states the resident
understands that the facility has exterior door locks or perimeter fence gate locks and
that the resident voluntarily consents to admission.
(5) Interior and exterior space shall be available on the facility premises to permit residents with
dementia to wander freely and safely.
(6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained
staff in sufficient numbers to meet the care and supervision needs of all residents.
(7) The licensee shall not accept or retain residents determined by a physician to have a primary
diagnosis of a mental disorder unrelated to dementia.
(8) Fire and earthquake drills shall be conducted at least once every three months on each shift
and shall include, at a minimum, all direct care staff.
87706 ADVERTISING DEMENTIA SPECIAL CARE, PROGRAMMING, AND ENVIRONMENTS
(a) In addition to the requirements in Section 87705, Care of Persons with Dementia, licensees who
advertise, promote, or otherwise hold themselves out as providing special care, programming,
and/or environments for residents with dementia or related disorders shall meet the following
requirements:
(1) The licensee shall ensure that direct care staff who provide care to any resident(s) with
dementia meet the training requirements in Section 87707, Training Requirements if
Advertising Dementia Special Care, Programming, and Environments, including six hours of
resident care orientation within the first four weeks of employment and eight hours of in-service training per year on the subject of serving residents with dementia.
(A) Direct care staff includes staff used for staff mealtime and break relief.
(B) Direct care staff may provide dementia special care to residents in the facility or in
designated areas of the facility.
(2) In addition to the requirements specified in Sections 87208(a) and 87705(b), the licensee
shall include in the plan of operation a brief narrative description of the following facility
features:
(A) Philosophy, including, but not limited to, program goals/objectives in relation to
meeting the needs of residents with dementia.
(B) Pre-admission assessment, including the types of assessment tools used to determine
residents’ dementia care needs and who will participate in the assessment.
(C) Admission, including the following items that must be addressed when admitting a
resident who requires dementia special care:
1. Specification of the designated areas in the facility where dementia special
care is provided, which may be the entire facility or only parts of it.
2. Services available specific to residents with dementia.
3. Procedures in place to ensure that the plan of 2. Who will participate in resident assessments and procedures for ensuring the
opportunity for resident and family involvement; and
3. Frequency of assessments.
(E) Activity program for residents with dementia, including, but not limited to:
1. Types of activities;
a. Activities may include cognitive/mental stimulation (e.g., crafts,
reading, writing, music, current events, reminiscences, movies);
physical activities (e.g., gross and fine motor skills); work activities
and life skills; social activities; cultural/religious activities; sensory
activities; individual/group activities (e.g., games); pet care; and
outdoor activities (e.g., field trips, gardening).
2. Frequency of activities; and
3. The process to determine what types of activities shall be planned to
encompass residents’ needs.
a. These needs are based on personal preferences, age, beliefs, culture,
values, attention span, and life experiences (e.g., family and friend
involvement, favorite pastimes, occupations, and geographic areas
lived in and visited).
(F) Staff qualifications. Describe the experience and education required for prospective
direct care staff who will provide dementia special care.
(G) Staff training. Describe the required training for direct care staff who provide
dementia special care. At a minimum, the description shall include information on
the time frame for training, as specified in Section 87707(a)(2), and the training
topics, as specified in Section 87707(a)(2)(A).
(H) Physical environment, including environmental factors that ensure a safe, secure,
familiar and consistent environment for residents with dementia. operation is available for
review upon request, as required by Section 87706(a)(3).
(D) Assessment(s), including the following as they pertain to residents receiving
dementia special care:
1. Types of assessments used;
1. Environmental factors that may be considered include: bedroom decor;
architectural and safety features (e.g., wide hallways, handrails, delayed
egress, secured perimeters); lighting; colors and visual contrasts; types of
furniture; signs; noise factors; memory boxes; nourishment and hydration
stations; and functional outdoor space and exercise pathways.
(I) Changes in condition. Procedures to be followed when a resident’s condition
changes, including, but not limited to, an explanation of:
1. When a new care plan is required;
2. At what point a physician (if any) is involved in developing a care plan;
3. Special techniques/programs (if any) used for managing specific types of
behavior; and
4. The conditions that would require a resident to be relocated.
(J) Success indicators, including procedures to:
1. Ensure an ongoing review of facility programs pertaining to care of residents
with dementia;
2. Make necessary adjustments to better meet residents’ needs; and
3. Assess the program’s overall effectiveness/success.
a. Examples of areas that may be reviewed include incident reports,
staffing levels, input from others, and resident participation in
program activities.
(3) The admission agreement, as specified in Section 87507(e), shall inform the resident and the
resident’s responsible person, if any, or the conservator, that the facility features, as specified
in Section 87706(a)(2), are described in the facility’s plan of operation and that the plan of
operation is available for review upon request.
(4) The licensee shall maintain copies of all facility advertisements and marketing/promotional
material that indicate the licensee provides special care, programming, and/or environments
for residents with dementia or related disorders, and shall maintain the information for a
minimum of three years.
(A) This material shall be available to the public upon request.
(B) This material shall also be available to the licensing agency to inspect, audit, copy,
and remove (if necessary for copying) upon demand during normal business hours as
specified in Section 87755(c).
(b) Licensees who will discontinue advertising, promoting, or otherwise holding themselves out as
providing special care, programming, and/or environments for residents with dementia or related
disorders shall:
(1) Provide written notification to the licensing agency and to the resident and the responsible
person, if any, or the conservator, at least 30 calendar days prior to discontinuing advertising
or promoting dementia special care, programming, and/or environments.
(A) The notification shall specify the date that the licensee will cease advertising or
promoting dementia special care, programming, and/or environments; and, therefore,
shall no longer be required to meet the requirements specified in Section 87706(a)
and the training requirements in Section 87707, Training Requirements if Advertising
Dementia Special Care, Programming, and Environments.
(B) The licensee shall maintain a copy of the written notification in each resident’s
records.
(2) On the date specified in the notification, cease all advertisements, publications, and/or
announcements that pertain to dementia special care including, but not limited to, those in
magazines, newspapers, consumer reports, telephone directory yellow pages, professional or
service directories, Internet, radio and/or television commercials.
(A) Long-term advertisements, such as yellow pages, shall be removed at the next
renewal date.
(3) On the date specified in the notification, remove all written references that indicate that the
licensee provides dementia special care, programming, and/or environments from all
promotional material, advertisements, and/or printed material, including admission
agreements and the plan of operation.
87707 TRAINING REQUIREMENTS IF ADVERTISING DEMENTIA SPECIAL CARE, PROGRAMMING, AND ENVIRONMENTS
(a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care,
programming, and/or environments for residents with dementia or related disorders shall ensure that
all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia,
meet the following training requirements:
(1) Direct care staff shall complete six hours of orientation specific to the care of residents with
dementia within the first four weeks of working in the facility.
(A) This orientation shall be repeated if either of the following occur:
1. An employee returns to work for the same licensee after a break in service of
more than 180 consecutive calendar days; or
2. An employee goes to work for another licensee to provide dementia special care.
(B) This orientation shall be separate from other training and be exclusively on the care
of residents with dementia.
(C) Various methods of instruction may be used, including, but not limited to, presenters
knowledgeable about dementia; video instruction tapes; interactive material; books;
and/or other materials approved by organizations or individuals specializing in
dementia as specified in Section 87707(a)(2)(C).
1. Instruction may include up to two hours of mentoring and hands-on training
from direct care staff who have completed six hours of orientation specific to
the care of residents with dementia and eight hours of in-service training on
the subject of serving residents with dementia as specified in Sections
87707(a)(1) and (2).
(D) The licensee shall maintain in the personnel records documentation on the orientation
that includes the date(s), the hours provided, the names of staff in attendance, and the
method(s) of instruction used.
(2) Direct care staff shall complete at least eight hours of in-service training on the subject of
serving residents with dementia within 12 months of working in the facility and in each
succeeding 12-month period. Direct care staff hired as of July 3, 2004 shall complete the
eight hours of in-service training within 12 months of that date and in each succeeding 12-
month period.
(A) A minimum of two of the following training topics shall be covered annually, and all
topics shall be covered within a three-year period:
1. Effects of medications on the behavior of residents with dementia;
2. Common problems, such as wandering, aggression, and inappropriate sexual behavior;
3. Positive therapeutic interventions and activities such as exercise, sensory
stimulation, activities of daily living, and social, recreational and
rehabilitative activities.
4. Communication skills (resident/staff relations);
5. Promoting resident dignity, independence, individuality, privacy and choice; and
6. End of life issues, including hospice.
(B) Training may be provided at the facility or offsite and may include a combination of
observation and practical application.
(C) The training shall be developed by, or in consultation with, an individual(s) or
organization(s) with expertise in dementia care and with knowledge on the training
topic areas specified in Section 87707(a)(2)(A).
1. Examples of organizations that specialize in dementia care include, but are
not limited to: the Alzheimer’s Association, Alzheimer’s Disease Diagnostic
and Treatment Centers affiliated with the University of California, Family
Caregiver Alliance and Caregiver Resource Centers, American Society on
Aging, colleges and universities, and individuals with educational and
professional qualifications specific to dementia.
a. If the consultant and trainer are the same person(s), the
documentation requirements specified in Sections 87707(a)(2)(D)
and (F) shall both be met.
(D) The licensee shall maintain the following documentation for the consultant(s)
described in Section 87707(a)(2)(C):
1. Name, address, and telephone number;
2. Date(s) when consultation was provided;
3. Organization affiliation (if any), as specified in Section 87707(a)(2)(C),
and/or educational and professional qualifications specific to dementia; and
4. The training topics, specified in Section 87707(a)(2)(A), for which
consultation was provided.
(E) All trainers shall meet the following education and experience requirements:
1. A minimum of eight hours of certifiable continuing education or three
semester units, or the equivalent, from an accredited educational institution,
on topics relevant to caring for individuals with dementia.
a. Examples of acceptable instruction include, but are not limited to,
classes in aging, gerontology, geriatrics, and/or psychosocial needs
of the elderly.
2. One of the following experience requirements:
a. Current employment as a consultant with expertise in dementia care,
as specified in Section 87707(a)(2)(C).
b. Two years full-time experience, or the equivalent, within the last
four years, as an RCFE administrator or as a direct care provider for
individuals with dementia.
(F) The licensee shall maintain the following documentation on the trainer(s) described
in Section 87707(a)(2)(E):
1. Name, address, and telephone number;
2. Topics/subject matter taught;
3. Dates/hours of training provided;
4. Notation that indicates which of the criteria for experience the trainer meets,
as specified in Section 87707(a)(2)(E)2., and maintain verification of
qualifying criteria; and
5. Proof of completion of the educational requirements, as specified in Section
87707(a)(2)(E)1., which may include the following:
a. If the educational hours/units are obtained through an accredited
educational institution, documentation shall include a copy of a
transcript or official grade slip showing a passing mark.
b. If the educational hours/units are obtained through continuing
education, documentation shall include a transcript or official grade
slip showing a passing mark, if applicable, or a Certificate of
Completion.
(G) The documentation required in Sections 87707(a)(2)(D) and (F) shall be retained for
at least three years following the date consultation services/training were provided.
1. This documentation shall be available to the licensing agency to inspect,
audit, copy, and remove (if necessary for copying) upon demand during
normal business hours as specified in Section 87755(c).
(H) The licensee shall maintain in the personnel records documentation on the in-service
training required in Section 87707(a)(2) for direct care staff and include the training
topic(s) covered, as required in Section 87707(a)(2)(A).