87605 HEALTH AND SAFETY PROTECTION
(a) Acceptance by the licensee of residents with incidental medical needs shall be in accordance with
the conditions specified in this article.
(b) The provisions of this Article 11 shall be applicable and in conjunction with Articles 1 through 10
and 12 through 13 of this chapter 8.
(c) Licensees who employ or permit health care practitioners to provide care to residents shall post a
visible notice in a prominent location that states, “Section 680 of the Business and Professions Code
requires health care practitioners to disclose their name and license status on a name tag in at least
18-point type while working in this facility.”
87606 CARE OF BEDRIDDEN RESIDENTS
(a) Unless otherwise specified, this section applies to licensees who accept or retain residents who are
bedridden. The licensee shall be permitted to accept and retain residents who are or shall become
bedridden, if all the following conditions are met.
(b) A facility shall notify the local fire jurisdiction within 48 hours of accepting or retaining any
bedridden person, as specified in Health and Safety Code Section 1569.72(f).
(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery,
a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a).
(d) For the purposes of this section, “temporary illness” is defined in Health and Safety Code Section
1569.72(d)(1).
(e) A facility may retain a bedridden resident for more than 14 days if all of the requirements of
Health and Safety Code Section 1569.72(e) are met.
87607 AUTOMATED EXTERNAL DEFIBRILLATORS (AEDS)
(a) A licensee is permitted to maintain and operate an AED at the facility if all of the following
requirements are met:
(1) The licensee shall notify the licensing agency in writing that an AED is in the facility and will
be used in accordance with all applicable federal and other state requirements.
(2) The AED shall be used in accordance with all applicable federal and other state requirements.
(3) The licensee shall maintain at the facility the following:
(A) A copy of the required physician’s prescription for the AED.
(B) A training manual from an American Heart Association- or American Red Cross recognized AED training class.
(C) A log of checks of operation of the AED containing the dates checked and the name
of person checking.(D) A copy of a valid AED operator’s certificate for any employee(s) authorized by the
licensee to operate the AED. The certificate shall indicate that the AED training
course completed complies with the standards of the American Heart Association or
the American Red Cross. If it does not, then other evidence indicating that the AED
training course completed complies with the standards of the American Heart
Association or the American Red Cross shall be available at the facility.
(E) A log of quarterly proficiency demonstrations for each holder of an AED operator’s
certificate who is authorized by the licensee to operate the AED. The log shall
contain the dates of the demonstrations and the manner of demonstration.(4) A supply kit shall be maintained at the facility and be readily available for use with the AED.
The kit shall contain at least the following:
(A) A back-up battery set.
(B) An extra set of pads.
(C) A safety razor for shaving chest hair when necessary to apply the pads.
(D) A cardiovascular pulmonary resuscitation barrier (a face shield or mask) for
protection from transmission of infectious disease.
(E) Two pairs of unused medical examination gloves (latex or non-latex).
(5) Use of an AED shall be reported as specified in Section 87211, Reporting Requirements.
(6) Requests to Forego Resuscitative Measures, Advance Directives and Do-Not-Resuscitate
Orders shall be observed as specified in Section 87469, Advance Health Care Directives,
Requests to Forego Resuscitative Measures, and Do-Not Resuscitate Forms.
87608 POSTURAL SUPPORTS
(a) Based on the individual’s preadmission appraisal, and subsequent changes to that appraisal, the
facility shall provide assistance and care for the resident in those activities of daily living which the
resident is unable to do for himself/herself. Postural supports may be used under the following
conditions.
(1) Postural supports shall be limited to appliances or devices such as braces, spring release trays,
or soft ties, used to achieve proper body position and balance, to improve a resident’s
mobility and independent functioning, or to position rather than restrict movement including,
but not limited to, preventing a resident from falling out of bed, a chair, etc.
(A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a
weakened body part or correction of body parts, are considered postural supports.
(2) Postural supports shall be fastened or tied in a manner that permits quick release by the resident.
(3) A written order from a physician indicating the need for the postural support shall be
maintained in the resident’s record. The licensing agency shall be authorized to require other
additional documentation if needed to verify the order.
(4) Prior to the use of postural supports that change the ambulatory status of a resident to non ambulatory, the licensee shall ensure that the appropriate fire clearance, as required by
Section 87202, Fire Clearance has been secured.
(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of
a resident’s hands or feet.
(A) A bed rail that extends from the head half the length of the bed and used only for
assistance with mobility shall be allowed.
(B) Bed rails that extend the entire length of the bed are prohibited except for residents
who are currently receiving hospice care and have a hospice care plan that specifies
the need for full bed rails.
87609 ALLOWABLE HEALTH CONDITIONS AND THE USE OF HOME HEALTH AGENCIES
(a) A licensee shall be permitted to accept or retain persons who have a health condition(s) which
requires incidental medical services including, but not limited to, the conditions specified in Section
87612, Restricted Health Conditions.
(b) Incidental medical care may be provided to residents through a licensed home health agency
provided the following conditions are met:
(1) The licensee is in substantial compliance with the requirements of Health and Safety Code
Sections 1569-1569.87, and of Chapter 8, Division 6, of Title 22, CCR, governing Residential
Care Facilities for the Elderly.
(2) The licensee provides the supporting care and supervision needed to meet the needs of the
resident receiving home health care.
(3) The licensee informs the home health agency of any duties the regulations prohibit facility
staff from performing, and of any regulations that address the resident’s specific condition(s).
(4) The licensee and home health agency agree in writing on the responsibilities of the home
health agency, and those of the licensee in caring for the resident’s medical condition(s).
(A) The written agreement shall reflect the services, frequency and duration of care.
(B) The written agreement shall include day and evening contact information for the
home health agency, and the method of communication between the agency and the
facility, which may include verbal contact, electronic mail, or logbook.
(C) The written agreement shall be signed by the licensee or licensee representative, and
representative of the home health agency, and placed in the resident’s file.
(c) The use of home health agencies to care for a resident’s medical condition(s) does not expand the
scope of care and supervision that the licensee is required to provide
87611 GENERAL REQUIREMENTS FOR ALLOWABLE HEALTH CONDITIONS
(a) Prior to accepting or retaining a resident with an allowable health condition as specified in Section
87618, Oxygen Administration – Gas and Liquid; Section 87619, Intermittent Positive Pressure
Breathing (IPPB) Machine; Section 87621, Colostomy/Ileostomy; Section 87626, Contractures; or
Section 87631, Healing Wounds; licensees who have, or have had, any of the following within the
last two years, shall obtain Department approval:
(1) Probationary license;
(2) Administrative action filed against them;
(3) A Non-Compliance Conference as defined in Section 87101(n) that resulted in a corrective plan of action; or
(4) A notice of deficiency concerning direct care and supervision of a resident with a health
condition specified in Section 87612, Restricted Health Conditions, that required correction within 24 hours.
(b) The licensee shall complete and maintain a current, written record of care for each resident that
includes, but is not limited to, the following:
(1) Documentation from the physician of the following:
(A) Stability of the medical condition(s);
(B) Medical condition(s) which require incidental medical services;
(C) Method of intervention;
(D) Resident’s ability to perform the procedure; and
(E) An appropriately skilled professional shall be identified who will perform the
procedure if the resident needs assistance.
(2) The names, address and telephone number of vendors, if any, and all appropriately skilled professionals providing services.
(3) Emergency contacts.
87612 RESTRICTED HEALTH CONDITIONS
(a) The licensee may provide care for residents who have any of the following restricted health
conditions, or who require any of the following health services:
(1) Administration of oxygen as specified in Section 87618.
(2) Catheter care as specified in Section 87623.
(3) Colostomy/ileostomy care as specified in Section 87621.
(4) Contractures as specified in Section 87626.
(5) Diabetes as specified in Section 87628.
(6) Enemas, suppositories, and/or fecal impaction removal as specified in Section 87622.
(7) Incontinence of bowel and/or bladder as specified in Section 87625.
(8) Injections as specified in Section 87629.
(9) Intermittent Positive Pressure Breathing Machine use as specified in Section 87619.(10) Stage 1 and 2 pressure sores (dermal ulcers) as specified in Section 87631(a)(3).
(11) Wound care as specified in Section 87631.
87613 GENERAL REQUIREMENTS FOR RESTRICTED HEALTH CONDITIONS
(a) Prior to admission of a resident with a restricted health condition, the licensee shall:
(1) Communicate with all other persons who provide care to that resident to ensure consistency
of care for the condition.
(2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs
complete training provided by a licensed professional sufficient to meet those needs.
(A) Training shall include hands-on instruction in both general procedures and resident specific procedures.
(B) Training shall be completed prior to the staff providing services to the resident.
(b) Should the condition of the resident change, all facility staff providing care to that resident shall
complete any additional training required to meet the resident’s new needs, as determined by the
resident’s physician or a licensed professional designated by the physician.
(c) The licensee shall document any significant occurrences that result in changes in the resident’s
physical, mental and/or functional capabilities and immediately report these changes to the
resident’s physician and authorized representative.
(d) A resident’s right to receive or reject medical care or services, as specified in Section 87468,
Personal Rights, shall not be affected by this section.
(1) If a resident refuses medical services the licensee shall immediately notify the resident’s
physician or licensed professional designated by the physician and the resident’s authorized
reprehensive, if any, and shall participate in developing a plan for meeting the resident’s
needs.
87615 PROHIBITED HEALTH CONDITIONS
(a) Persons who require health services or have a health condition including, but not limited to, those
specified below shall not be admitted or retained in a residential care facility for the elderly:
(1) Stage 3 and 4 pressure sores (dermal ulcers).
(2) Gastrostomy care.
(3) Naso-gastric tubes.
(4) Staph infection or other serious infection.
(5) Residents who depend on others to perform all activities of daily living for them as set forth
in Section 87459, Functional Capabilities.
(6) Tracheotomies.
87616 EXCEPTIONS FOR HEALTH CONDITIONS
(a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception
request if he/she agrees that the resident has a prohibited and/or restrictive health condition but
believes that the intent of the law can be met through alternative means.
(b) Written requests shall include, but are not limited to, the following:
(1) Documentation of the resident’s current health condition including updated medical reports,
other documentation of the current health, prognosis, and expected duration of condition.
(2) The licensee’s plan for ensuring that the resident’s health related needs can be met by the
facility.
(3) Plan for minimizing the impact on other residents.
(c) Facilities that have satisfied the requirements of Section 87632, Hospice Care Waiver, are not
required to submit written exception requests under this section for residents or prospective
residents with restricted health conditions under Section 87612 and/or prohibited health
conditions under Section 87615 provided those residents have been diagnosed as terminally ill
and are receiving hospice services in accordance with a hospice care plan as required under
Section 87633, Hospice Care for Terminally Ill Residents, and the treatment of such restricted
and/or prohibited health conditions is specifically addressed in the hospice care plan.
87617 DEPARTMENTAL REVIEW OF HEALTH CONDITIONS
(a) Certain health conditions as specified in Sections 87618, Oxygen Administration-Gas and Liquid,
through 87631, Healing Wounds, may require review by Department staff to determine if the
resident will be allowed to remain in the facility. The Department shall inform the licensee that the
health condition of the resident requires review and shall specify documentation which the licensee
shall submit to the Department.
(1) Documentation shall include, but not be limited to the following:
(A) Physician’s assessment(s).
(B) Pre-admission appraisal.
(C) Copies of prescriptions for incidental medical services and/or medical equipment.
(2) The documentation shall be submitted to the Department within 10 days.
(b) If the Department determines that the resident has an allowable health condition, the licensee shall
provide care and supervision to the resident in accordance with the conditions specified in Sections
87618, Oxygen Administration-Gas and Liquid, through 87631, Healing Wounds.
87618 OXYGEN ADMINISTRATION – GAS AND LIQUID
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident
who requires the use of oxygen gas administration under the following circumstances:
(1) If the resident is mentally and physically capable of operating the equipment, is able to
determine his/her need for oxygen, and is able to administer it him/herself.
OR
(2) If intermittent oxygen administration is performed by an appropriately skilled professional.
(b) In addition to Section 87611(b), the licensee shall be responsible for the following:
(1) Monitoring of the resident’s ongoing ability to operate the equipment in accordance with the
physician’s orders.
(2) Ensuring that oxygen administration is provided by an appropriately skilled professional should the resident require assistance.
(3) Ensuring that the use of oxygen equipment meets the following requirements:
(A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility.
(B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas.
(C) Smoking shall be prohibited where oxygen is in use.
(D) All electrical equipment shall be checked for defects which may cause sparks.
(E) Oxygen tanks that are not portable shall be secured in a stand or to the wall.
(F) Plastic tubing from the nasal canula or mask to the oxygen source shall be long enough to allow the resident movement within his/her room but does not constitute a hazard to the resident or others.
(G) Oxygen from a portable source shall be used by residents when they are outside of their rooms.
(H) Equipment shall be operable.
(I) Equipment shall be removed from the facility when no longer in use by the resident.
(4) Determining that room size can accommodate equipment in accordance with Section 87307,
Personal Accommodations and Services.
(5) Ensuring that facility staff have knowledge of, and ability in the operation of the oxygen equipment.
(c) The licensee shall be permitted to accept or retain a resident who requires the use of liquid oxygen under the following circumstances:
(1) The licensee obtains prior approval from the licensing agency.
(2) If the resident is mentally and physically capable of operating the equipment, is able to determine his/her need for oxygen, and is able to administer it him/herself.
87619 INTERMITTENT POSITIVE PRESSURE BREATHING(IPPB) MACHINE
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident
who requires the use of an IPPB machine under the following circumstances:
(1) If the resident is mentally and physically capable of operating his/her own equipment and is
able to determine his/her own need.
OR
(2) If the device is operated and cared for by an appropriately skilled professional.
(b) In addition to Section 87611(b), the licensee shall be responsible for the following:
(1) Monitoring of the resident’s ongoing ability to operate the equipment in accordance with the physician’s orders.
(2) Ensuring that the procedure is administered by an appropriately skilled professional should the resident require assistance.
(3) Ensuring that the use of the equipment meets the following requirements:
(A) Equipment shall be operable.
(B) Equipment shall be removed from the facility when no longer in use by the resident.
(4) Determining that room size can accommodate equipment in accordance with Section 87307(a)(2)(A).
(5) Ensuring that facility staff have knowledge of and ability in the operation of the equipment.
87621 COLOSTOMY/ILEOSTOMY
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident
who has a colostomy or ileostomy under the following circumstances:
(1) If the resident is mentally and physically capable of providing all routine care for his/her
ostomy, and the physician has documented that the ostomy is completely healed.
OR
(2) If assistance in the care of the ostomy is provided by an appropriately skilled professional.
(b) In addition to Section 87611(b), the licensees shall be responsible for the following:
(1) Ensuring that ostomy care is provided by an appropriately skilled professional.
(A) The ostomy bag and adhesive may be changed by facility staff who have been
instructed by the professional.
(B) There shall be written documentation by an appropriately skilled professional
outlining the instruction of the procedures delegated and the names of the facility
staff who have been instructed.
(C) The professional shall review the procedures and techniques no less than twice a
month.
(2) Ensuring that used bags are discarded as specified in Section 87303(f)(1).
(3) Privacy shall be afforded when ostomy care is provided.
87622 FECAL IMPACTION REMOVAL, ENEMAS, AND/OR SUPPOSITORIES
(a) The licensee shall be permitted to accept or retain a resident who requires manual fecal impaction
removal, enemas, or use of suppositories under the following circumstances:
(1) Self care by the resident.
(2) Manual fecal impaction removal, enemas, and/or suppositories shall be permitted if
administered according to physician’s orders by either the resident or an appropriately skilled
professional.
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee
shall be responsible for the following:
(1) Ensuring that the administration of enemas or suppositories or manual fecal impaction
removal is performed by an appropriately skilled professional should the resident require
assistance.
(2) Privacy shall be afforded when care is being provided.
87623 INDWELLING URINARY CATHETER
(a) The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling
catheter under the following circumstances:
(1) If the resident is physically and mentally capable of caring for all aspects of the condition
except insertion and irrigation.
(A) Irrigation shall only be performed by an appropriately skilled professional in
accordance with the physician’s orders.
(B) A catheter shall only be inserted and removed by an appropriately skilled
professional under physician’s orders.
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee
shall be responsible for the following:
(1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately
skilled professional.
87625 MANAGED INCONTINENCE
(a) The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or
bladder incontinence condition under the following circumstances:
(1) The condition can be managed with any of the following:
(A) Self care by the resident.
(B) A structured bowel and/or bladder retraining program to assist the resident in
restoring a normal pattern of continence.
(C) A program of scheduled toileting at regular intervals.
(D) The use of incontinent care products.
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee
shall be responsible for the following:
(1) Ensuring that residents who can benefit from scheduled toileting are assisted or reminded to
go to the bathroom at regular intervals rather than being diapered.
(2) Ensuring that incontinent residents are checked during those periods of time when they are
known to be incontinent, including during the night.
(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of
odors from incontinence.
(4) Ensuring that bowel and/or bladder programs are designed by an appropriately skilled
professional with training and experience in care of elderly persons with bowel and/or
bladder dysfunction and development of retraining programs for restoration of normal
patterns of continence.
(5) Ensuring that the appropriately skilled professional developing the bowel and/or bladder
program provide training to facility staff responsible for implementation of the program.
(6) Ensuring that re-assessment of the resident’s condition and the evaluation of the effectiveness
of the bowel and/or bladder program be performed by an appropriately skilled professional.
(7) Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to
ensure that skin breakdown is not occurring.
(8) Privacy shall be afforded when care is provided.
(9) Ensuring that fluids are not withheld to control incontinence.
(10) Ensuring that an incontinent resident is not catheterized to control incontinence for the
convenience of the licensee.
87626 CONTRACTURES
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident
who has contractures under the following circumstances:
(1) If the contractures do not severely affect functional ability and the resident is able to care for
the contractures by him/herself.
OR
(2) If the contractures do not severely affect functional ability and care and/or supervision is
provided by an appropriately skilled professional.
87628 DIABETES
(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able
to perform his/her own glucose testing with blood or urine specimens, and is able to administer
his/her own medication including medication administered orally or through injection, or has it
administered by an appropriately skilled professional.
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee
shall be responsible for the following:
(1) Assisting residents with self-administered medication as specified in Section 87465,
Incidental Medical and Dental Care Services.
(2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other
supplies are maintained and stored in the facility as specified in Section 87465(c).
(3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2).
(4) Providing modified diets as prescribed by a resident’s physician as specified in Section
87555(b)(7).
87629 INJECTIONS
(a) The licensee shall be permitted to accept or retain a resident who requires intramuscular,
subcutaneous, or intradermal injections if the injections are administered by the resident or by an
appropriately skilled professional.
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees
who admit or retain residents who require injections shall be responsible for the following:
(1) Ensuring that injections are administered by an appropriately skilled professional should the
resident require assistance.
(2) Ensuring that sufficient amounts of medicines, test equipment, syringes, needles and other
supplies are maintained in the facility and are stored as specified in Section 87465(c).
(3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2).
87631 HEALING WOUNDS
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident
who has a healing wound under the following circumstances:
(1) When care is performed by or under the supervision of an appropriately skilled professional.
(2) When the wound is the result of surgical intervention and care is performed as directed by the surgeon.
(3) Residents with a stage one or two pressure sore (dermal ulcer) must have the condition
diagnosed by an appropriately skilled professional.
(A) The resident shall receive care for the pressure sore (dermal ulcer) from an appropriately skilled professional.
(B) All aspects of care performed by the medical professional and facility staff shall be documented in the resident’s file.
(b) A skin tear is not a healing wound.
87632 HOSPICE CARE WAIVER
(a) In order to accept or retain terminally ill residents and permit them to receive care from a hospice
agency, the licensee shall have obtained a facility hospice care waiver from the Department. To
obtain this waiver the licensee shall submit a written request for a waiver to the Department on
behalf of any residents who may request retention, and any future residents who may request
acceptance, along with the provision of hospice services in the facility. The request shall include,
but not be limited to the following:
(1) Specification of the maximum number of terminally ill residents which the facility wants to have at any one time.
(2) A statement by the licensee that they have read, Section 87633, Hospice Care for Terminally
Ill Residents, this section, and all other requirements within Chapter 8 of Title 22 of the
California Code of Regulations governing Residential Care Facilities for the Elderly and that
they will comply with these requirements.
(3) A statement by the licensee that the terms and conditions of all hospice care plans which are designated as the responsibility of the licensee, or under the control of the licensee, shall be adhered to by the licensee.
(4) A statement by the licensee that an agreement with the hospice agency will be entered into
regarding the care plan for the terminally ill resident to be accepted and/or retained in the
facility. The agreement with hospice shall design and provide for the care, services, and
necessary medical intervention related to the terminal illness as necessary to supplement the
care and supervision provided by the licensee.
(b) The Department shall deny a waiver request if the licensee is not in substantial compliance with the
provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section
1569 et seq.) and the requirements of Chapter 8 of Title 22 of the California Code of Regulations
governing Residential Care Facilities for the Elderly.
(c) No waiver request will be approved unless the facility demonstrates the ability to meet the care and
supervision needs of terminally ill residents, and states a willingness to provide additional care staff
if required by the hospice care plan.
(d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver
as necessary to ensure the well-being of terminally ill residents and of all other facility residents,
which shall include, but not be limited to, the following requirements:
(1) A written request shall be signed by each terminally ill resident or prospective resident upon
admission, or by the resident’s or prospective resident’s health care surrogate decision maker
to allow for his or her acceptance or retention in the facility while receiving hospice services.
(A) The request shall be maintained in the resident’s record at the facility, as specified in
Section 87633(h)(1).
87633 HOSPICE CARE FOR TERMINALLY ILL RESIDENTS
(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally
ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited
health conditions, to reside in the facility and receive hospice services from a hospice agency in the
facility, when all of the following conditions are met:
(1) The licensee has received a hospice care waiver from the department.
(2) The licensee remains in substantial compliance with the requirements of this section, with the
provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code
Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code
of Regulations governing Residential Care Facilities for the Elderly, and with all terms and
conditions of the waiver.
(3) Hospice agency services are contracted for by each terminally ill resident or prospective
resident individually, or the resident’s or prospective resident’s Health Care Surrogate
Decision Maker if the resident or prospective resident is incapacitated, not by the licensee on
behalf of a resident or prospective resident. These hospice agency services must be provided
by a hospice agency both licensed by the state and certified by the federal Medicare program.
(4) A written hospice care plan which specifies the care, services, and necessary medical
intervention related to the terminal illness as necessary to supplement the care and
supervision provided by the facility is developed for each terminally ill resident or
prospective resident by that resident’s hospice agency, and agreed to by the licensee and the
resident, or prospective resident, or the resident’s or prospective resident’s Health Care
Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for
that resident, and all hospice care plans are fully implemented by the licensee and by the
hospice(s).
(5) The acceptance or retention of any terminally ill resident or prospective resident in the
facility does not represent a threat to the health and safety of any facility resident, or result in
a violation of the personal rights of any facility resident.
(6) The hospice agency and the resident or prospective resident agree to provide the licensee with
all information necessary to allow the licensee to comply with all regulations and to assure
that the resident’s or prospective resident’s needs will be met.
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice
resident and include the following:
(1) The name, office address, business telephone number, and 24-hour emergency telephone
number of the hospice agency and the resident’s physician.
(2) A description of the services to be provided in the facility by the hospice agency including
but not limited to the type and frequency of services to be provided.
(3) Designation of the resident’s primary contact person at the hospice agency, and resident’s
primary and alternate care giver at the facility.
(4) A description of the area of licensee’s responsibility for implementing the plan including, but
not limited to, facility staff duties; record keeping; and communication with the hospice
agency, resident’s physician, and the resident’s responsible person(s), if any. This description
shall include the type and frequency of the tasks to be performed by the facility.
(A) The plan shall specify all procedures to be implemented by the licensee regarding the
storage and handling of medications or other substances, and the maintenance and
use of medical supplies, equipment, or appliances.
(B) The plan shall specify, by name or job function, the licensed health care professional
on the hospice agency staff who will control and supervise the storage and
administration of all controlled drugs (Schedule II – V) for the hospice client.
Facility staff can assist hospice residents with self-medications without hospice
personnel being present.
(C) The plan shall neither require nor recommend that the licensee or any facility
personnel other than a physician or appropriately skilled professional implement any
health care procedure which may legally be provided only by a physician or
appropriately skilled professional.
(5) A description of all hospice services to be provided or arranged in the facility by persons
other than the licensee, facility personnel, or the hospice agency including, but not limited to,
clergy and the resident’s family members and friends.
(6) Identification of the training needed, which staff members need this training, and who will
provide the training relating to the licensee’s responsibilities for implementation of the
hospice care plan.
(A) The training shall include but not be limited to typical needs of hospice patients, such
as turning and incontinence care to prevent skin breakdown, hydration, and infection
control.
(B) The hospice agency will provide training specific to the current and ongoing needs of
the individual resident receiving hospice care and that training must be completed
before hospice care to the resident begins.
(7) Any other information deemed necessary by the Department to ensure that the terminally ill
resident’s needs for health care, personal care, and supervision are met.
(c) The licensee shall ensure that the hospice care plan complies with the requirements of this section,
with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code
Section 1569 et seq.), and all other requirements of Chapter 8 of Title 22 of the California Code of
Regulations governing Residential Care Facilities for the Elderly.
(d) The licensee shall ensure that the hospice care plan is current, accurately matches the services
actually being provided, and that the client’s care needs are being met at all times.
(e) The Department may require that the licensee obtain a revision of the hospice care plan if the plan
is not fully implemented, or if the Department has determined that revision of the plan is necessary
to protect the health and safety of any facility resident.
(f) The licensee shall maintain a record of all hospice-related training provided to the licensee or
facility personnel for a period of three years. This record shall be available for review by the
Department.
(1) The record of each training session shall specify the names and credentials of the trainer, the
persons in attendance, the subject matter covered, and the date and duration of the training
session.
(g) In addition to the reporting requirements specified in Section 87211, Reporting Requirements, the
licensee shall submit a report to the Department when a terminally ill resident’s hospice services are
interrupted or discontinued for any reason other than the death of the resident, including refusal of
hospice care or discharge from hospice. The licensee shall also report any deviation from the
resident’s hospice care plan, or other incident, which threatens the health and safety of any resident.
(1) Such reports shall be made by telephone within one working day, and in writing within five
working days, and shall specify all of the following:
(A) The name, age, sex of each affected resident.
(B) The date and nature of the event and explanatory background information leading up
to the event.
(C) The name and business telephone number of the hospice agency.
(D) Actions taken by the licensee and any other parties to resolve the reportable event
and to prevent similar occurrences in the future.
(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain
the following in the resident’s record:
(1) A written request for acceptance or admittance to or retention in the facility while receiving
hospice services, along with any advance directive and/or request regarding resuscitative
measures form executed by the resident or (in certain instances) the resident’s Health Care
Surrogate Decision Maker.
(2) The name, address, telephone number, and 24-hour emergency telephone number of the
hospice agency and the resident’s Health Care Surrogate Decision Maker, if any, in a manner
that is readily available to the resident, the licensee, and facility staff.
(3) A copy of the written certification statement of the resident’s terminal illness from the
medical director of the hospice or the physician member of the hospice interdisciplinary
group and the individual’s attending physician, if the individual has an attending physician.
(4) A copy of the resident’s current hospice care plan approved by the licensee, the hospice
agency, and the resident, or the resident’s Health Care Surrogate Decision Maker if the
resident is incapacitated.
87637 HEALTH CONDITION RELOCATION ORDER
(a) If a resident has a health condition which cannot be cared for within the limits of the license,
requires inpatient care in a health facility, or has a health condition prohibited by Section 87455(c)
or Section 87615, Prohibited Health Conditions, the Department shall order the licensee to relocate
the resident.
(b) When the Department orders the relocation of a resident, the following shall apply:
(1) The Department shall give written notice to the licensee ordering the relocation of the
resident and informing the licensee of the resident’s right to an interdisciplinary team review
of the relocation order as specified in Section 87638, Resident Request for Review of Health
Condition Relocation Order. Notice of the health condition relocation order and information
about the right to request an interdisciplinary team review of the relocation order shall be
given to the resident, by the Department, and sent to the resident’s responsible person, if any.
(A) If the resident has no responsible person, as defined in Section 87101, the relocation
order shall be sent to the representative payee, if any. In such cases, the Department
shall also notify the State Long-Term Care Ombudsman of the relocation order by
telephone.
(B) The notice shall advise that the licensee may request an administrative review of the
health condition relocation order, and may request that an exception or waiver be
granted or reinstated by the Department to allow retention of the resident in the
facility.
(2) The licensee shall prepare a written relocation plan in any instance where the Department
does not suspend the facility license. The plan shall contain all necessary steps to be taken to
reduce stress to the resident which may result in transfer trauma, and shall include but not be
limited to:
(A) A specific date for beginning and a specific date for completion of the process of
safely relocating the resident. The time frame for relocation may provide for
immediate relocation but shall not exceed 30 days.
(B) A specific date when the resident and the resident’s responsible person, if any, shall
be notified of the need for relocation.
(C) A specific date when consultation with the resident’s physician, and hospice agency,
if any, shall occur to obtain a current medical assessment of the resident’s health
needs, to determine the appropriate facility type for relocation and to ensure that the
resident’s health care needs continue to be met at all times during the relocation
process.
(D) The method by which the licensee shall participate in the identification of an
acceptable relocation site with the resident and the responsible person, if any. The
licensee shall advise the resident and/or the responsible person that if the resident is
to be moved to another residential care facility for the elderly, a determination must
be made that the resident’s needs can be legally met in the new facility before the
move is made. If the resident’s needs cannot be legally met in the new facility, the
resident must be moved to a facility licensed to provide the necessary care.
(E) A list of contacts made or to be made by the licensee with community resources,
including but not limited to, social workers, family members, Long Term Care
Ombudsman, clergy, Multipurpose Senior Services Programs and others as
appropriate to ensure that services are provided to the resident before, during and
after the move. The need for the move shall be discussed with the resident and the
resident assured that support systems will remain in place.
(F) Measures to be taken until relocation to protect the resident and/or meet the resident’s
health and safety needs.
(G) An agreement to notify the Department when the relocation has occurred, including
the resident’s new address, if known.
(3) The relocation plan shall be submitted in writing to the Department within the time set forth
in the LIC 809 (Rev. 5/88) Licensing Report by the Department that the resident requires
health services that the facility cannot legally provide.
(4) Any changes in the relocation plan shall be submitted in writing to the Department. The
Department shall have the authority to approve, disapprove or modify the plan.
(5) If relocation of more than one (1) resident is required, a separate plan shall be prepared and
submitted in writing for each resident.
(6) The licensee shall comply with all terms and conditions of the approved plan. No written or
oral contract with any other person shall release the licensee from the responsibility specified
in this section or Section 87223, Relocation of Residents, for relocating a resident who has a
health condition(s) which cannot be cared for in the facility and/or which requires inpatient
care in a licensed health facility, nor from taking all necessary actions to reduce stress to the
resident.
(7) In cases where the Department determines that the resident is in imminent danger because of
a health condition(s) which cannot be cared for in the facility or which requires inpatient care
in a licensed health facility, the Department shall order the licensee to immediately relocate
the resident.
(A) No written relocation plan is necessary in cases of immediate relocation.
87638 RESIDENT REQUEST FOR REVIEW OF HEALTH CONDITION RELOCATION ORDER
(a) A resident, or the resident’s responsible person, if any, shall be permitted to request a review and
determination of the Department’s health condition relocation order by the interdisciplinary team.
(1) If the resident has no responsible person, as defined in Section 87101, the Long-Term Care
Ombudsman and/or the resident’s representative payee, if any, shall be permitted to submit a
request for review and determination on behalf of the resident.
(b) The resident, or the resident’s responsible person, if any, shall have three (3) working days, from
receipt of the relocation order, to submit to the licensee a written, signed and dated request for a
review and determination by the interdisciplinary team.
(1) For purposes of this section, a working day is any day except Saturday, Sunday or an official state holiday.
(c) The licensee shall mail or deliver such a request to the Department within two (2) working days of receipt.
(1) Failure or refusal to do so may result in civil penalties, as provided in Section 87761, Penalties.
(d) The Department shall give written notification to the resident, or the resident’s responsible person,
if any, acknowledging receipt of the resident’s request for review of the relocation order.
Notification shall occur within three (3) working days of receipt by the Department of the request for review.
(e) Within ten (10) working days from the date of the resident’s review request, the licensee shall
submit to the Department the documentation specified in Section 87638(g) to complete the resident’s review request.
(f) The licensee shall cooperate with the resident, or the resident’s responsible person, if any, in
gathering the documentation to complete the resident’s review request.
(g) The documentation to complete the resident’s review request shall include, but not be limited to, the following:
(1) The reason(s) for disagreeing that the resident has the health condition identified in the
relocation order and why the resident believes he/she may legally continue to reside in a
residential care facility for the elderly.
(2) A current medical assessment signed by the resident’s physician.
(A) For purposes of this section, this assessment shall include the information specified in Sections 87611(a)(1)(A) through (E).(B) For purposes of this section, “current” shall mean a medical assessment completed on
or after the date of the relocation order.
(3) An appraisal or reappraisal of the resident as specified in Sections 87457(c)(1) and 87463, Reappraisals.
(A) The licensee shall be permitted to use the form LIC 603 (Rev. 6/87), Preplacement
Appraisal Information, to document the appraisal or reappraisal.
(4) A written statement from a placement agency, if any, currently involved with the resident, addressing the relocation order.
(h) The Department shall inform the resident and/or the resident’s responsible person, if any, in writing,
of the interdisciplinary team’s determination and the reason for that determination not more than 30
days after the resident or his/her responsible person, if any, is notified of the need to relocate.
(i) The resident’s right to a review of a health condition relocation order issued by the Department shall not:
(1) Nullify a determination by the Department that the resident must be relocated in order to
protect the resident’s health and safety as specified in Section 87612(a).
(2) Apply to eviction under Section 87224, Eviction Procedures.
(3) Imply a right to a state hearing or any other administrative review beyond that set forth in this section.
(4) Apply if the facility license has been temporarily suspended as specified in Section 87775(c)
87639 ADMINISTRATIVE REVIEW – HEALTH CONDITIONS
(a) For purposes of this article, any request for administrative review of a notice of deficiency, notice
of penalty, or health condition relocation order shall be submitted by the licensee or his/her
designated representative in writing to the Department and, in addition to the requirements of
Section 87763, Appeal Process, shall include the following:
(1) The reason(s) the licensee disagrees with the notice or order.
(2) Information about the resident as specified in Section 87611(a).
(3) A current appraisal or reappraisal of the resident as specified in Sections 87457(c)(1) and
87463, Reappraisals.
(4) A written statement from the resident’s placement agency, if any, addressing the notice or
order.