Amended in Senate March 4, 2014

Senate BillNo. 911


Introduced by Senator Block

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(Coauthor: Senator Correa)

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(Coauthors: Assembly Members Ammiano, Brown, Chávez, Skinner, Ting, Wieckowski, and Yamada)

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January 23, 2014


An act to amend Sections 1569.23, 1569.62, 1569.625, 1569.626, and 1569.69 of, and to add Sections 1569.371, 1569.39, and 1569.696 to, the Health and Safety Code, relating to residential care facilities for the elderly.

LEGISLATIVE COUNSEL’S DIGEST

SB 911, as amended, Block. Residential care facilities for the elderly.

(1) Existing law, the California Residential Care Facilities for the Elderly Act, provides for the licensurebegin insert and regulationend insert of residential care facilities for the elderly by the State Department of Social Services. A person who violates the act is guilty of a misdemeanorbegin insert and subject to civil penalty and suspension or revocation of licenseend insert.

Existing law requiresbegin delete thatend delete an applicant for a licensebegin insert toend insert complete, at a minimum, a 40-hour certification program approved by the departmentbegin delete whichend deletebegin insert thatend insert includes instruction in a uniform code of knowledgebegin insert, and to pass a written testend insert.

This bill would change the minimum hours of classroom instruction tobegin delete 80end deletebegin insert 100end insert hoursbegin insert, of which 80 hours are classroom instruction,end insert and would add additional topics to the uniform code of knowledge, including, but not limited to, the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia.begin insert The bill would also require the department to annually review the test and update it as necessary to reflect changes in the law and regulations.end insert

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By expanding the scope of an existing crime, this bill impose a state-mandated local program.

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This bill would require that no licensee, or officer or employee of the licensee, shall discriminate or retaliate against any person receiving the services of the licensee’s residential care facility for the elderly, or against any employee of the licensee’s facility, on the basis, or for the reason that, the person, employee, or any other person dialed or called 911.

This bill would require a residential care facility for the elderly that accepts or retains residents with restricted orbegin delete specializedend deletebegin insert prohibitedend insert health conditions begin insertto end insertemploy a registered nurse on a full-time or part-time basis, as appropriate, to oversee the care provided to those residents. A residential care facility for the elderly that accepts or retains residents with restricted orbegin delete specializedend deletebegin insert prohibitedend insert health conditions would be required to have a registered nurse on call 24 hours per day, as specified.

(2) Existing law requires the Director of Social Services to ensure that licensees, administrators, and staffs of residential care facilities for the elderly have appropriate training to provide the care and services for which a license or certificate is issued. The department is required to develop a uniform code of knowledge for the continuing education of administrators of residential care facilities for the elderly.

This bill would also require the department to develop a uniform code of knowledge for the initial certification of administrators, and add additional topics to the uniform code of knowledge, including, but not limited to, applicable laws and regulations and residents’ rights.

(3) Existing law requires the department to adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive 10 hours of training within the first 4 weeks of employment, and 4 hours of training annually thereafter on topics, including, but not limited to, policies and procedures regarding medications.

This bill would increase that training to 40 hours of training within the first 4 weeks of employment, 20 hours of training annually thereafter, and would also require that at leastbegin delete 8end deletebegin insert 24end insert hours of training be completed prior to providing direct care to residents. This bill would exempt a residential care facility for the elderly from these training requirements ifbegin delete they demonstrateend deletebegin insert the facility demonstratesend insert to the department that it only employs certified nurse assistants with valid certification, provided that certified nurse assistants receive 8 hours of trainingbegin delete within the first 10 days of employmentend deletebegin insert, prior to providing direct care to residents,end insert on resident characteristics, plans of care, resident records, and facility practices and procedures.begin insert This bill would also authorize the department to develop a certification training program with a standardized test for specified staff.end insert

(4) Existing law requires all direct care staff of a residential care facility for the elderly, which advertises or promotes special care, programming, or environment for persons with dementia, receive 6 hours of resident care orientation within the first 4 weeks of employment and 8 hours of in-service training per year.

This bill would increase that training to 15 hours of resident care orientationbegin delete within the first 4 weeks of employmentend deletebegin insert, prior to providing direct care to residents,end insert and 12 hours of in-service training per year on the subject of providing care and supervision to residents with dementia.

(5) Existing law requires that employees who assist residents with the self-administration of medications at a licensed residential care facility for the elderly, which provides care for 16 or more persons, complete 16 hours of initial training, consisting of 8 hours of hands-on shadowing training and 8 hours of other training or instruction, to be completed within the first 2 weeks of employment. If that facility provides care for 15 or fewer persons, employees are required to complete 6 hours of initial training, consisting of 2 hours of hands-on shadowing training and 4 hours of other training or instruction, to be completed within the first 2 weeks of employment.

This bill would require employees at a licensed residential care facility for the elderly that provides care for 16 or more persons, complete 32 hours of initial training, consisting of 12 hours of hands-on shadowing training and 20 hours of other training or instruction, to be completed within the first 4 weeks of employment. For facilities providing care for 15 or fewer persons, this bill would increase those training requirements to 16 hours of initial training, consisting of 8 hours of hands-on shadowing training, and 8 hours of other training.

This bill would require all direct care staff of residential care facilities for the elderly that serve residents with postural supports, or restricted health conditions or health services, or who receive hospice care services, as described in specified regulations, in addition to other training requirements, receive 15 hours of training on the care, supervision, and special needs of those residentsbegin delete within the first 6 weeks of employment.end deletebegin insert, prior to providing direct care to residents.end insert This bill also would require 12 hours of in-service training per year on the subject of serving those residents.

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(6) Because a violation of any of the above provisions would be a misdemeanor, this bill would impose a state-mandated local program.

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(6) The

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begin insertThe end insertCalifornia 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:

P4    1

SECTION 1.  

Section 1569.23 of the Health and Safety Code
2 is amended to read:

3

1569.23.  

(a) As a requirement for licensure, the applicant shall
4demonstrate that he or she has successfully completed a
5certification program approved by the department.

6(b) The certification program shall be for a minimum ofbegin delete 80end deletebegin insert 100 end insert
7 hoursbegin insert,end insert ofbegin insert which 80 hours areend insert classroom instructionbegin insert,end insert and include
8a uniform core of knowledge which shall include all of the
9following:

10(1) Law, regulations, policies, and procedural standards that
11impact the operations of residential care facilities for the elderly.

12(2) Business operations.

13(3) Management and supervision of staff.

14(4) Psychosocial need of the elderly residents.

15(5) Physical needs for elderly residents.

16(6) Community and support services.

17(7) Use, misuse, and interaction of drugs commonly used by
18the elderly, and the adverse effects of psychotropic drugs for use
19in controlling the behavior of persons with dementia.

20(8) Nonpharmacologic, person-centered approaches to dementia
21care.

22(9) Resident admission, retention, and assessment procedures.

23(10) Residents’ rights, and the importance of initial ongoing
24training for all staff to ensure residents’ rights are fully respected
25and implemented.

P5    1(c) Successful completion of the certification program shall be
2demonstrated by passing a written test and submitting a fee of one
3hundred dollars ($100) to the department for the issuance of a
4certificate of completion.

5(d) The department shall establish by regulation the program
6content, the testing instrument, process for approving certification
7programs, and criteria to be used for authorizing individuals or
8organizations to conduct certification programs. These regulations
9shall be developed with the participation of provider organizations
10begin insert and other stakeholder groupsend insertbegin insert. The department shall review the
11test annually and update it as necessary to reflect changes in law
12and regulationsend insert
.

13(e) This section shall apply to all applications for licensure
14unless the applicant provides evidence that he or she has a current
15license for another residential care facility for the elderly which
16was initially licensed prior to July 1, 1989, or has successfully
17completed an approved certification program within the prior five
18years.

19(f) If the applicant is a firm, partnership, association, or
20 corporation, the chief executive officer, or other person serving in
21a like capacity, or the designated administrator of the facility shall
22provide evidence of successfully completing an approved
23certification program.

24

SEC. 2.  

Section 1569.371 is added to the Health and Safety
25Code
, to read:

26

1569.371.  

begin insert(a)end insertbegin insertend insert No licensee, or officer or employee of the
27licensee, shall discriminate or retaliate in any manner against any
28person receiving the services of the licensee’s residential care
29facility for the elderly, or against any employee of the licensee’s
30facility, on the basis, or for the reason that, the person, employee,
31or any other person dialed or called 911.

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32(b) A violation of this section is subject to civil penalty pursuant
33to Section 1569.49.

end insert
34

SEC. 3.  

Section 1569.39 is added to the Health and Safety
35Code
, to read:

36

1569.39.  

(a) A residential care facility for the elderly that
37accepts or retains residents with restricted orbegin delete specializedend deletebegin insert prohibitedend insert
38 health conditions, as defined by the department to include, at a
39minimum, bedridden, contractures, decubitus ulcers, healing
40wounds, or receipt of hospice services, shall employ a registered
P6    1nurse on a full-time or part-time basis, as appropriate, to oversee
2the care provided to those residents.

3(b) A residential care facility for the elderly subject to this
4section shall also provide for a registered nurse to be on call 24
5hours per day. The facility may satisfy this on-call requirement by
6contracting with a nursing agency.

7

SEC. 4.  

Section 1569.62 of the Health and Safety Code is
8amended to read:

9

1569.62.  

(a) The director shall ensure that licensees,
10administrators, and staffs of residential care facilities for the elderly
11have appropriate training to provide the care and services for which
12a license or certificate is issued.

13(b) The department shall develop requirements for a uniform
14core of knowledge for the required initial certification and
15continuing education for administrators, and their designated
16substitutes, and for recertification of administrators of residential
17care facilities for the elderly. This knowledge base shall include,
18as a minimum, basic understanding of the psychosocial and
19physical care needs of elderly persons, applicable laws and
20regulations, residents’ rights, and administration. This training
21shall be developed in consultation with individuals or organizations
22with specific expertise in residential care facilities for the elderly
23or assisted living services, or by an outside source with expertise
24in residential care facilities for the elderly or assisted living
25services.

26(1) The initial certification training for administrators shall
27consist of at leastbegin delete 80end deletebegin insert 100end insert hours.

28(2) The continuing education requirement for administrators is
29at least 60 hours of training during each two-year certification
30period.

31(c) (1) The department shall develop a uniform resident
32assessment tool to be used by all residential care facilities for the
33elderly. The assessment tool shall, in lay terms, help to identify
34resident needs for service and assistance with activities of daily
35living.

36(2) The departments shall develop a mandatory training program
37 on the utilization of the assessment tool to be given to
38administrators and their designated substitutes.

39

SEC. 5.  

Section 1569.625 of the Health and Safety Code is
40amended to read:

P7    1

1569.625.  

(a)  The Legislature finds that the quality of services
2provided to residents of residential care facilities for the elderly is
3dependent upon the training and skills of staff.

4(b) The current training requirements for staff of residential care
5facilities for the elderly are insufficient to meet the range of care
6needs of the residents of those facilities. It is the intent of the
7Legislature in enacting this section to ensure thatbegin delete direct-careend deletebegin insert direct
8careend insert
staff have the knowledge and proficiency to carry out the
9tasks of their jobs.

10(c) The department shall adopt regulations to require staff
11members of residential care facilities for the elderly who assist
12residents with personal activities of daily living to receive
13appropriate training. This training shall consist of 40 hours of
14training within the first four weeks of employment, at leastbegin delete eightend delete
15begin insert 24end insert of whichbegin delete mustend deletebegin insert shallend insert be completed prior to providing direct care
16to residents, and 20 hours annually thereafter. This training shall
17be administered on the job, or in a classroom setting, or any
18combination of the two. The department shall establish the subject
19matter required for this training. This training shall be developed
20in consultation with individuals or organizations with specific
21expertise in residential care facilities for the elderly or assisted
22living services, or by an outside source with expertise in residential
23care facilities for the elderly or assisted living services, as defined
24in Section 1771.

25(d) The training shall include, but not be limited to, the
26following:

27(1) Physical limitations and needs of the elderly.

28(2) Importance and techniques for personal care services.

29(3) Residents’ rights.

30(4) Policies and procedures regarding medications.

31(5) FDA-approved uses for psychoactive drugs, common side
32effects, and the increased risk of death when elderly residents with
33dementia are given antipsychotic medications.

34(6) The special needs of persons with Alzheimer’s disease and
35dementia, including nonpharmacologic person-centered approaches
36to dementia care.

37(7) Psychosocial needs of the elderly.

38(8) This subdivision shall not apply to a residential care facility
39for the elderly that demonstrates to the department that the facility
40employs only certified nurse assistants with valid certification,
P8    1pursuant to Section 1337.2, except that certified nurse assistants
2with valid certification shall receive eight hours of trainingbegin delete within
3the first 10 days of employmentend delete
begin insert, prior to providing direct care to
4residents,end insert
on resident characteristics, resident records, and facility
5practices and procedures.

begin insert

6(e) The department may develop a certification training program
7with a standardized test for staff pursuant to this section and
8Sections 1569.626, 1569.69, and 1569.696.

end insert
9

SEC. 6.  

Section 1569.626 of the Health and Safety Code is
10amended to read:

11

1569.626.  

All residential care facilities for the elderly that
12advertise or promote special care, special programming, or a special
13environment for persons with dementia, in addition to complying
14with the training requirements described in Section 1569.625, shall
15meet the following training requirements for all direct care staff:

16(a) Fifteen hours of resident care orientationbegin delete within the first four
17weeks of employment.end delete
begin insert, prior to providing direct care to residents.end insert
18 All 15 hours shall be devoted to the care of persons with dementia.
19The facility may utilize various methods of instruction including,
20but not limited to, preceptorship, mentoring, and other forms of
21observation and demonstration. The orientation time shall be
22exclusive of any administrative instruction.

23(b) Twelve hours of in-service training per year on the subject
24of providing care and supervision to residents with dementia. This
25training shall be developed in consultation with individuals or
26organizations with specific expertise in dementia care or by an
27outside source with expertise in dementia care. In formulating and
28providing this training, reference may be made to written materials
29and literature on dementia and the care and treatment of persons
30with dementia. This training requirement may be provided at the
31facility or offsite and may include a combination of observation
32and practical application.

33

SEC. 7.  

Section 1569.69 of the Health and Safety Code is
34amended to read:

35

1569.69.  

(a) Each residential care facility for the elderly
36licensed under this chapter shall ensure that each employee of the
37facility who assists residents with the self-administration of
38medications meets the following training requirements:

39(1) In facilities licensed to provide care for 16 or more persons,
40the employee shall complete 32 hours of initial training. This
P9    1training shall consist of 12 hours of hands-on shadowing training,
2which shall be completed prior to assisting with the
3self-administration of medications, and 20 hours of other training
4or instruction, as described in subdivision (f), which shall be
5completed within the first four weeks of employment.

6(2) In facilities licensed to provide care for 15 or fewer persons,
7the employee shall complete 16 hours of initial training. This
8training shall consist of eight hours of hands-on shadowing training,
9which shall be completed prior to assisting with the
10self-administration of medications, and eight hours of other training
11or instruction, as described in subdivision (f), which shall be
12completed within the first two weeks of employment.

13(3) An employee shall be required to complete the training
14requirements for hands-on shadowing training described in this
15subdivision prior to assisting any resident in the self-administration
16of medications. The training and instruction described in this
17subdivision shall be completed, in their entirety, within the first
18two weeks of employment.

19(4) The training shall cover all of the following areas:

20(A) The role, responsibilities, and limitations of staff who assist
21residents with the self-administration of medication, including
22tasks limited to licensed medical professionals.

23(B) An explanation of the terminology specific to medication
24assistance.

25(C) An explanation of the different types of medication orders:
26prescription, over-the-counter, controlled, and other medications.

27(D) An explanation of the basic rules and precautions of
28medication assistance.

29(E) Information on medication forms and routes for medication
30taken by residents.

31(F) A description of procedures for providing assistance with
32the self-administration of medications in and out of the facility,
33and information on the medication documentation system used in
34the facility.

35(G) An explanation of guidelines for the proper storage, security,
36and documentation of centrally stored medications.

37(H) A description of the processes used for medication ordering,
38refills, and the receipt of medications from the pharmacy.

39(I) An explanation of medication side effects, adverse reactions,
40errors, the adverse effects of psychotropic drugs for use in
P10   1controlling the behavior of persons with dementia, and the
2increased risk of death when elderly residents with dementia are
3given antipsychotic medications.

4(5) To complete the training requirements set forth in this
5subdivision, each employee shall pass an examination that tests
6the employee’s comprehension of, and competency in, the subjects
7listed in paragraph (4).

8(6) Residential care facilities for the elderly shall encourage
9pharmacists and licensed medical professionals to use plain English
10when preparing labels on medications supplied to residents. As
11used in this section, “plain English” means that no abbreviations,
12symbols, or Latin medical terms shall be used in the instructions
13for the self-administration of medication.

14(7) The training requirements of this section are not intended
15to replace or supplant those required of all staff members who
16assist residents with personal activities of daily living as set forth
17in Sections 1569.625 and 1569.696.

18(8) The training requirements of this section shall be repeated
19if either of the following occurs:

20(A) An employee returns to work for the same licensee after a
21break of service of more than 180 consecutive calendar days.

22(B) An employee goes to work for another licensee in a facility
23in which he or she assists residents with the self-administration of
24medication.

25(b) Each employee who received training and passed the
26examination required in paragraph (5) of subdivision (a), and who
27continues to assist with the self-administration of medicines, shall
28also complete eight hours of in-service training on
29medication-related issues in each succeeding 12-month period.

30(c) The requirements set forth in subdivisions (a) and (b) do not
31apply to persons who are licensed medical professionals.

32(d) Each residential care facility for the elderly that provides
33employee training under this section shall use the training material
34and the accompanying examination that are developed by, or in
35consultation with, a licensed nurse, pharmacist, or physician. The
36licensed residential care facility for the elderly shall maintain the
37following documentation for each medical consultant used to
38develop the training:

39(1) The name, address, and telephone number of the consultant.

40(2) The date when consultation was provided.

P11   1(3) The consultant’s organization affiliation, if any, and any
2educational and professional qualifications specific to medication
3management.

4(4) The training topics for which consultation was provided.

5(e) Each person who provides employee training under this
6section shall meet the following education and experience
7requirements:

8(1) A minimum of five hours of initial, or certified continuing,
9education or three semester units, or the equivalent, from an
10accredited educational institution, on topics relevant to medication
11management.

12(2) The person shall meet any of the following practical
13experience or licensure requirements:

14(A) Two years of full-time experience, within the last four years,
15as a consultant with expertise in medication management in areas
16covered by the training described in subdivision (a).

17(B) Two years of full-time experience, or the equivalent, within
18the last four years, as an administrator for a residential care facility
19for the elderly, during which time the individual has acted in
20substantial compliance with applicable regulations.

21(C) Two years of full-time experience, or the equivalent, within
22the last four years, as a direct care provider assisting with the
23self-administration of medications for a residential care facility
24for the elderly, during which time the individual has acted in
25substantial compliance with applicable regulations.

26(D) Possession of a license as a medical professional.

27(3) The licensed residential care facility for the elderly shall
28maintain the following documentation on each person who provides
29employee training under this section:

30(A) The person’s name, address, and telephone number.

31(B) Information on the topics or subject matter covered in the
32training.

33(C) The time, dates, and hours of training provided.

34(f) Other training or instruction, as required in paragraphs (1)
35and (2) of subdivision (a), may be provided offsite, and may use
36various methods of instruction, including, but not limited to, all
37of the following:

38(1) Lectures by presenters who are knowledgeable about
39medication management.

P12   1(2) Video recorded instruction, interactive material, online
2training, and books.

3(3) Other written or visual materials approved by organizations
4or individuals with expertise in medication management.

5(g) Residential care facilities for the elderly licensed to provide
6care for 16 or more persons shall maintain documentation that
7demonstrates that a consultant pharmacist or nurse has reviewed
8the facility’s medication management program and procedures at
9least twice a year.

10(h) Nothing in this section authorizes unlicensed personnel to
11directly administer medications.

12

SEC. 8.  

Section 1569.696 is added to the Health and Safety
13Code
, to read:

14

1569.696.  

(a) All residential care facilities for the elderly that
15serve residents with postural supports, as described in Section
1687608 of Title 22 of the California Code of Regulations, or
17restricted health conditions or health services, as described in
18Section 87612 of Title 22 of the California Code of Regulations,
19or who receive hospice services, as described in Section 87633 of
20Title 22 of the California Code of Regulations, in addition to
21complying with the training requirements in Section 1569.625,
22shall meet the following training requirements for all direct care
23staff:

24(1) Fifteen hours of training on the care, supervision, and special
25needs of those residentsbegin delete within the first six weeks of employment.end deletebegin insert,
26 prior to providing direct care to residents.end insert
The facility may utilize
27various methods of instruction, including, but not limited to,
28preceptorship, mentoring, and other forms of observation and
29demonstration. The orientation time shall be exclusive of any
30administrative instruction.

31(2) Twelve hours thereafter of in-service training per year on
32the subject of serving those residents.

33(b) This training shall be developed in consultation with
34individuals or organizations with specific expertise in the care of
35those residents described in subdivision (a). In formulating and
36providing this training, reference may be made to written materials
37and literature. This training requirement may be provided at the
38facility or offsite and may include a combination of observation
39and practical application.

P13   1

SEC. 9.  

No reimbursement is required by this act pursuant to
2Section 6 of Article XIII B of the California Constitution because
3the only costs that may be incurred by a local agency or school
4district will be incurred because this act creates a new crime or
5infraction, eliminates a crime or infraction, or changes the penalty
6for a crime or infraction, within the meaning of Section 17556 of
7the Government Code, or changes the definition of a crime within
8the meaning of Section 6 of Article XIII B of the California
9Constitution.



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