BILL NUMBER: AB 1075 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 18, 2001
INTRODUCED BY Assembly Member Shelley
(Coauthors: Assembly Members Alquist, Aroner, Corbett, Diaz,
Havice, and Strom-Martin)
(Coauthors: Senators Kuehl, Ortiz, and Romero)
FEBRUARY 23, 2001
An act to add Section 1276.65 to the Health and Safety Code,
relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 1075, as amended, Shelley. Skilled nursing facilities:
staffing ratios.
Existing law provides for the licensure and regulation of health
facilities, including skilled nursing facilities, by the State
Department of Health Services. Existing law specifies various
minimum staff-to-patient ratio requirements in skilled nursing
facilities. A violation of these provisions by health facilities is
subject to criminal sanction.
This bill, commencing January 1, 2002, would require every skilled
nursing facility to meet specified minimum staff-to-patient ratios
with regard to direct caregivers, as defined, and licensed nurses.
The bill would require the facility to post the staffing ratio
requirements as provided under the bill. The bill would make a
violation of these provisions subject to citation and fine. Because
the bill would change the definition of a crime with regard to health
facilities, it would impose a state-mandated local program.
The bill would require the department, no later than January 1,
2006, and every 5 years thereafter, to consult with designated
entities to determine the sufficiency of the staffing standards, to
adopt regulations to increase the minimum staffing ratios to adequate
levels, as necessary, and to examine the effectiveness of the
implementation and enforcement of the bill.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares all of the
following:
(1) Skilled nursing facilities need adequate staffing levels in
order to provide the decent and humane care that patients deserve.
(2) Compliance with minimum staffing requirements will be
increased if residents, residents' families, facility employees, and
state inspectors can determine easily whether or not a skilled
nursing facility is in compliance.
(3) It is difficult for residents, residents' families, facility
employees, and state inspectors to monitor a skilled nursing facility'
s compliance with a staffing standard based on the nursing hours per
patient day provided by a facility.
(b) It is the intent of the Legislature to enact legislation that
does all of the following:
(1) Increases minimum staffing requirements to a level that
assures decent and humane care for patients.
(2) Requires that minimum staffing requirements be set forth as
ratios of patients per direct caregiver, so that residents, residents'
families, facility employees, state inspectors, and others may
assist in ensuring compliance with the law.
SEC. 2. Section 1276.65 is added to the Health and Safety Code, to
read:
1276.65. (a) For purposes of this section, the following
definitions shall apply:
(1) "Direct caregiver" means a registered nurse, as referred to in
Section 2732 of the Business and Professions Code, a licensed
vocational nurse, as referred to in Section 2864 of the Business and
Professions Code, and a certified nurse assistant, as defined in
Section 1337.
(2) "Skilled nursing facility" means a skilled nursing facility as
defined in subdivision (c) of Section 1250.
(b) A person employed to provide services such as food
preparation, housekeeping, laundry, or maintenance services shall not
provide nursing care to residents and shall not be counted in
determining ratios under this section.
(c) (1) Effective January 1, 2002, in a skilled nursing facility,
there shall be direct caregivers working in at least the following
ratios:
(A) During the day shift, the direct caregiver to patient ratio
shall be one direct caregiver for each seven or fewer patients at all
times.
(B) During the afternoon shift, the direct caregiver to patient
ratio shall be one direct caregiver for each 12 or fewer patients at
all times.
(C) During the night shift, the direct caregiver to patient ratio
shall be one direct caregiver for each 17 or fewer patients at all
times.
(2) Effective January 1, 2004, in a skilled nursing facility,
there shall be direct caregivers working in at least the following
ratios:
(A) During the day shift, the direct caregiver to patient ratio
shall be one direct caregiver for each five or fewer patients at all
times.
(B) During the afternoon shift, the direct caregiver to patient
ratio shall be one direct caregiver for each 10 or fewer patients at
all times.
(C) During the night shift, the direct caregiver to patient ratio
shall be one direct caregiver for each 15 or fewer patients at all
times.
(d) (1) Effective January 1, 2002, a skilled nursing facility, in
addition to the staff required in subdivision (b)
direct caregivers required in paragraph (1) of subdivision (c)
, shall employ licensed nurses to provide direct care in at
least the following ratios:
(A) During the day shift, the licensed nurse to patient ratio
shall be one licensed nurse for each 20 or fewer patients at all
times.
(B) During the afternoon shift, the licensed nurse to patient
ratio shall be one licensed nurse for each 25 or fewer patients at
all times.
(C) During the night shift, the licensed nurse to patient ratio
shall be one licensed nurse for each 35 or fewer patients at all
times.
(2) Effective January 1, 2004, a skilled nursing facility, in
addition to the staff required in subdivision (b)
direct caregivers required in paragraph (2) of subdivision (c)
, shall employ licensed nurses to provide direct care in at
least the following ratios:
(A) During the day shift, the licensed nurse to patient ratio
shall be one licensed nurse for each 15 or fewer patients at all
times.
(B) During the afternoon shift, the licensed nurse to patient
ratio shall be one licensed nurse for each 20 or fewer patients at
all times.
(C) During the night shift, the licensed nurse to patient ratio
shall be one licensed nurse for each 30 or fewer patients at all
times.
(e) The staffing ratios set forth in this section are minimum
standards only. Nursing facilities shall employ and schedule
additional staff as needed to ensure quality resident care and
compliance with all relevant staffing requirements.
(f) No later than January 1, 2006, and every five years
thereafter, the department shall consult with consumers, consumer
advocates, recognized collective bargaining agents, and providers to
determine the sufficiency of the staffing standards provided in this
section and, as necessary, shall adopt regulations to increase the
minimum staffing ratios to adequate levels. In this consultation and
review process, the department shall also examine the effectiveness
of the implementation and enforcement of this section.
(g) Every skilled nursing facility shall post the staffing ratios
required by this section and any regulations adopted pursuant thereto
in a prominent location in the facility. The posted information
shall be in a poster format approved by the department.
(h) (1) Notwithstanding any other provision of law, the department
shall inspect for compliance with this section during inspection
required under Section 1422. This inspection requirement shall not
limit the department's authority in other circumstances to cite for
violations of this section or to inspect for compliance with this
section.
(2) A violation of this section shall be subject to citation under
Section 1424. A violation shall constitute no less than a Class "B"
violation, and may constitute a Class "A" or "AA" violation pursuant
to the standards set forth in Section 1424.
(i) The requirements of this section are in addition to any
requirement set forth in Sections Section
1276.5 of this code and Section 14110.7 of the Welfare and
Institutions Code.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB of the California Constitution because the
only costs that may be incurred by a local agency or school district
will be incurred because this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the Government
Code, or changes the definition of a crime within the meaning of
Section 6 of Article XIIIB of the California Constitution.