Amended in Senate March 27, 2014

Amended in Senate March 4, 2014

Senate BillNo. 911


Introduced by Senator Block

(Coauthor: Senator Correa)

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

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 licensure and regulation of residential care facilities for the elderly by the State Department of Social Services. A person who violates the act is guilty of a misdemeanor and subject to civil penalty and suspension or revocation of license.

Existing law requires an applicant for a license to complete, at a minimum, a 40-hour certification program approved by the department that includes instruction in a uniform code of knowledge, and to pass a written test.

This bill would change the minimum hours of classroom instruction to 100 hours, of which 80 hours are classroom instruction, 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. 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.

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 withbegin delete restricted orend delete prohibited health conditionsbegin insert, as defined by the department,end insert tobegin delete employ 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 or prohibited health conditions would be required to have a registered nurse on call 24 hours per day, as specified.end deletebegin insert ensure that residents receive home health or hospice services sufficient in scope and hours by appropriately skilled professionals, acting within their scope of practice, to ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan. This bill would define an “appropriately skilled professional” as an individual who has training and is licensed to perform the necessary medical procedures prescribed by a physician, which includes, but is not limited to, a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, or respiratory therapist.end insert

(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 knowledgebegin insert jointly with the California Department of Agingend insert 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 least 24 hours of training be completed prior to providing direct care to residents. This bill would exemptbegin delete a residential care facility for the elderly from these training requirements if the facility demonstrates to the department that it only employsend delete certified nurse assistants with valid certificationbegin insert from those requirementsend insert, provided that certified nurse assistants receive 8 hours of training, prior to providing direct care to residents, on resident characteristics, plans of care, resident records, and facility practices and procedures. This bill would also authorize the department to develop a certification training program with a standardized test for specified staff.

(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 orientation, prior to providing direct care to residents, 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,begin insert toend insert 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 residents, prior to providing direct care to residents. This bill also would require 12 hours of in-service training per year on the subject of serving those residents.

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

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:

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 of 100
7hours, of which 80 hours are classroom instruction, and include a
8uniform core of knowledge which shall include all of the following:

9(1) Law, regulations, policies, and procedural standards that
10impact the operations of residential care facilities for the elderly.

11(2) Business operations.

12(3) Management and supervision of staff.

13(4) Psychosocial need of the elderly residents.

14(5) Physical needs for elderly residents.

15(6) Community and support services.

16(7) Use, misuse, and interaction of drugs commonly used by
17the elderly, and the adverse effects of psychotropic drugs for use
18in controlling the behavior of persons with dementia.

P5    1(8) Nonpharmacologic, person-centered approaches to dementia
2care.

3(9) Resident admission, retention, and assessment procedures.

4(10) Residents’ rights, and the importance of initialbegin insert andend insert ongoing
5training for all staff to ensure residents’ rights are fully respected
6and implemented.

7(c) Successful completion of the certification program shall be
8demonstrated by passing a written test and submitting a fee of one
9hundred dollars ($100) to the department for the issuance of a
10certificate of completion.

11(d) The department shall establish by regulation the program
12content, the testing instrument, process for approving certification
13programs, and criteria to be used for authorizing individuals or
14organizations to conduct certification programs. These regulations
15 shall be developed with the participation of provider organizations
16and other stakeholder groups. The department shall review the test
17annually and update it as necessary to reflect changes in law and
18regulations.

19(e) This section shall apply to all applications for licensure
20unless the applicant provides evidence that he or she has a current
21license for another residential care facility for the elderly which
22was initially licensed prior to July 1, 1989, or has successfully
23completed an approved certification program within the prior five
24years.

25(f) If the applicant is a firm, partnership, association, or
26 corporation, the chief executive officer, or other person serving in
27a like capacity, or the designated administrator of the facility shall
28provide evidence of successfully completing an approved
29certification program.

30

SEC. 2.  

Section 1569.371 is added to the Health and Safety
31Code
, to read:

32

1569.371.  

(a) No licensee, or officer or employee of the
33licensee, shall discriminate or retaliate in any manner against any
34person receiving the services of the licensee’s residential care
35facility for the elderly, or against any employee of the licensee’s
36facility, on the basis, or for the reason that, the person, employee,
37or any other person dialed or called 911.

38(b) A violation of this section is subject to civil penalty pursuant
39to Section 1569.49.

P6    1

SEC. 3.  

Section 1569.39 is added to the Health and Safety
2Code
, to read:

3

1569.39.  

(a) A residential care facility for the elderly that
4accepts or retains residents withbegin delete restricted orend delete prohibited health
5conditions, as defined by thebegin delete department to include, at a minimum,
6bedridden, contractures, decubitus ulcers, healing wounds, or
7receipt of hospice services, shall employ a registered nurse on a
8full-time or part-time basis, as appropriate, to oversee the care
9provided to those residents.end delete
begin insert department, in Section 87615 of Title
1022 of the California Code of Regulations, shall ensure that
11residents receive home health or hospice services sufficient in
12scope and hours to ensure that residents receive medical care as
13prescribed by the resident’s physician and contained in the
14resident’s service plan.end insert

begin delete

15(b) A residential care facility for the elderly subject to this
16section shall also provide for a registered nurse to be on call 24
17hours per day. The facility may satisfy this on-call requirement by
18contracting with a nursing agency.

end delete
begin insert

19(b) A residential care facility for the elderly that accepts or
20retains residents with restricted health conditions, as defined by
21the department, shall ensure that residents receive medical care
22as prescribed by the resident’s physician and contained in the
23resident’s service plan by appropriately skilled professionals acting
24within their scope of practice.

end insert
begin insert

25(c) An “appropriately skilled professional” means, for purposes
26of this section, an individual who has training and is licensed to
27perform the necessary medical procedures prescribed by a
28physician. This includes, but is not limited to, a registered nurse,
29licensed vocational nurse, physical therapist, occupational
30therapist, or respiratory therapist. These professionals may include,
31but are not limited to, those persons employed by a home health
32agency, the resident, or a facility, and who are currently licensed
33in this state.

end insert
begin insert

34(d) Failure to meet or arrange to meet the needs of those
35residents who require specialized health services, or failure to
36notify the physician of a resident’s illness or injury that poses a
37danger of death or serious bodily harm is a licensing violation
38and subject to civil penalty pursuant to Section 1569.49.

end insert
39

SEC. 4.  

Section 1569.62 of the Health and Safety Code is
40amended to read:

P7    1

1569.62.  

(a) The director shall ensure that licensees,
2administrators, and staffs of residential care facilities for the elderly
3have appropriate training to provide the care and services for which
4a license or certificate is issued.

5(b) The department shall developbegin insert jointly with the California
6Department of Agingend insert
requirements for a uniform core of knowledge
7for the required initial certification and continuing education for
8administrators, and their designated substitutes, and for
9recertification of administrators of residential care facilities for
10the elderly. This knowledge base shall include, as a minimum,
11basic understanding of the psychosocial and physical care needs
12of elderly persons, applicable laws and regulations, residents’
13rights, and administration. This training shall be developed in
14consultation with individuals or organizations with specific
15expertise in residential care facilities for the elderly or assisted
16living services, or by an outside source with expertise in residential
17care facilities for the elderly or assisted living services.

18(1) The initial certification training for administrators shall
19consist of at least 100 hours.

20(2) The continuing education requirement for administrators is
21at least 60 hours of training during each two-year certification
22period.

23(c) (1) The department shall develop a uniform resident
24assessment tool to be used by all residential care facilities for the
25elderly. The assessment tool shall, in lay terms, help to identify
26resident needs for service and assistance with activities of daily
27living.

28(2) The departments shall develop a mandatory training program
29 on the utilization of the assessment tool to be given to
30administrators and their designated substitutes.

31

SEC. 5.  

Section 1569.625 of the Health and Safety Code is
32amended to read:

33

1569.625.  

(a)  The Legislature finds that the quality of services
34provided to residents of residential care facilities for the elderly is
35dependent upon the training and skills of staff.

36(b) The current training requirements for staff of residential care
37facilities for the elderly are insufficient to meet the range of care
38needs of the residents of those facilities. It is the intent of the
39Legislature in enacting this section to ensure that direct care staff
P8    1have the knowledge and proficiency to carry out the tasks of their
2jobs.

3(c) The department shall adopt regulations to require staff
4members of residential care facilities for the elderly who assist
5residents with personal activities of daily living to receive
6appropriate training. This training shall consist of 40 hours of
7training within the first four weeks of employment, at least 24
8begin insert hoursend insert of which shall be completed prior to providing direct care
9to residents, and 20 hours annually thereafter. This training shall
10be administered on the job, or in a classroom setting, or any
11combination of the two. The department shall establish the subject
12matter required for this training. This training shall be developed
13in consultation with individuals or organizations with specific
14expertise in residential care facilities for the elderly or assisted
15living services, or by an outside source with expertise in residential
16care facilities for the elderly or assisted living services, as defined
17in Section 1771.

18(d) The training shall include, but not be limited to, the
19following:

20(1) Physical limitations and needs of the elderly.

21(2) Importance and techniques for personal care services.

22(3) Residents’ rights.

23(4) Policies and procedures regarding medications.

begin delete

24(5) FDA-approved uses for psychoactive drugs, common side
25effects, and the increased risk of death when elderly residents with
26dementia are given antipsychotic medications.

end delete
begin insert

27(5) Use, misuse, and interaction of drugs commonly used by the
28elderly, and the adverse effects of psychotropic drugs for use in
29controlling the behavior of persons with dementia.

end insert

30(6) The special needs of persons with Alzheimer’s disease and
31dementia, including nonpharmacologic person-centered approaches
32to dementia care.

33(7) Psychosocial needs of the elderly.

34(8) This subdivision shall not apply to begin delete a residential care facility
35for the elderly that demonstrates to the department that the facility
36employs only certified nurse assistants with valid certificationend delete

37begin insert certified nurse assistantsend insert,begin insert certifiedend insert pursuant to Section 1337.2,
38except that certified nurse assistants with valid certification shall
39receive eight hours of trainingbegin delete, end deleteprior to providing direct care to
P9    1residents, on resident characteristics, resident records, and facility
2practices and procedures.

3(e) The department may develop a certification training program
4with a standardized test for staff pursuant to this section and
5Sections 1569.626, 1569.69, and 1569.696.

6

SEC. 6.  

Section 1569.626 of the Health and Safety Code is
7amended to read:

8

1569.626.  

All residential care facilities for the elderly that
9advertise or promote special care, special programming, or a special
10environment for persons with dementia, in addition to complying
11with the training requirements described in Section 1569.625, shall
12meet the following training requirements for all direct care staff:

13(a) Fifteen hours of resident care orientationbegin delete, end deleteprior to providing
14direct care to residents. All 15 hours shall be devoted to the care
15of persons with dementia. The facility may utilize various methods
16of instruction including, but not limited to, preceptorship,
17mentoring, and other forms of observation and demonstration. The
18orientation time shall be exclusive of any administrative instruction.

19(b) Twelve hours of in-service training per year on the subject
20of providing care and supervision to residents with dementia. This
21training shall be developed in consultation with individuals or
22organizations with specific expertise in dementia care or by an
23outside source with expertise in dementia care. In formulating and
24providing this training, reference may be made to written materials
25and literature on dementia and the care and treatment of persons
26with dementia. This training requirement may be provided at the
27facility or offsite and may include a combination of observation
28and practical application.

29

SEC. 7.  

Section 1569.69 of the Health and Safety Code is
30amended to read:

31

1569.69.  

(a) Each residential care facility for the elderly
32licensed under this chapter shall ensure that each employee of the
33facility who assists residents with the self-administration of
34medications meets the following training requirements:

35(1) In facilities licensed to provide care for 16 or more persons,
36the employee shall complete 32 hours of initial training. This
37training shall consist of 12 hours of hands-on shadowing training,
38which shall be completed prior to assisting with the
39self-administration of medications, and 20 hours of other training
P10   1or instruction, as described in subdivision (f), which shall be
2completed within the first four weeks of employment.

3(2) In facilities licensed to provide care for 15 or fewer persons,
4the employee shall complete 16 hours of initial training. This
5training shall consist of eight hours of hands-on shadowing training,
6which shall be completed prior to assisting with the
7self-administration of medications, and eight hours of other training
8or instruction, as described in subdivision (f), which shall be
9completed within the first two weeks of employment.

10(3) An employee shall be required to complete the training
11requirements for hands-on shadowing training described in this
12subdivision prior to assisting any resident in the self-administration
13of medications. The training and instruction described in this
14subdivision shall be completed, in their entirety, within the first
15two weeks of employment.

16(4) The training shall cover all of the following areas:

17(A) The role, responsibilities, and limitations of staff who assist
18residents with the self-administration of medication, including
19tasks limited to licensed medical professionals.

20(B) An explanation of the terminology specific to medication
21assistance.

22(C) An explanation of the different types of medication orders:
23prescription, over-the-counter, controlled, and other medications.

24(D) An explanation of the basic rules and precautions of
25medication assistance.

26(E) Information on medication forms and routes for medication
27taken by residents.

28(F) A description of procedures for providing assistance with
29the self-administration of medications in and out of the facility,
30and information on the medication documentation system used in
31the facility.

32(G) An explanation of guidelines for the proper storage, security,
33and documentation of centrally stored medications.

34(H) A description of the processes used for medication ordering,
35refills, and the receipt of medications from the pharmacy.

36(I) An explanation of medication side effects, adverse reactions,
37errors, the adverse effects of psychotropic drugs for use in
38controlling the behavior of persons with dementia, and the
39increased risk of death when elderly residents with dementia are
40given antipsychotic medications.

P11   1(5) To complete the training requirements set forth in this
2subdivision, each employee shall pass an examination that tests
3the employee’s comprehension of, and competency in, the subjects
4listed in paragraph (4).

5(6) Residential care facilities for the elderly shall encourage
6pharmacists and licensed medical professionals to use plain English
7when preparing labels on medications supplied to residents. As
8used in this section, “plain English” means that no abbreviations,
9symbols, or Latin medical terms shall be used in the instructions
10for the self-administration of medication.

11(7) The training requirements of this section are not intended
12to replace or supplant those required of all staff members who
13assist residents with personal activities of daily living as set forth
14in Sections 1569.625 and 1569.696.

15(8) The training requirements of this section shall be repeated
16if either of the following occurs:

17(A) An employee returns to work for the same licensee after a
18break of service of more than 180 consecutive calendar days.

19(B) An employee goes to work for another licensee in a facility
20in which he or she assists residents with the self-administration of
21medication.

22(b) Each employee who received training and passed the
23examination required in paragraph (5) of subdivision (a), and who
24continues to assist with the self-administration of medicines, shall
25also complete eight hours of in-service training on
26medication-related issues in each succeeding 12-month period.

27(c) The requirements set forth in subdivisions (a) and (b) do not
28apply to persons who are licensed medical professionals.

29(d) Each residential care facility for the elderly that provides
30employee training under this section shall use the training material
31and the accompanying examination that are developed by, or in
32consultation with, a licensed nurse, pharmacist, or physician. The
33licensed residential care facility for the elderly shall maintain the
34following documentation for each medical consultant used to
35develop the training:

36(1) The name, address, and telephone number of the consultant.

37(2) The date when consultation was provided.

38(3) The consultant’s organization affiliation, if any, and any
39educational and professional qualifications specific to medication
40management.

P12   1(4) The training topics for which consultation was provided.

2(e) Each person who provides employee training under this
3section shall meet the following education and experience
4requirements:

5(1) A minimum of five hours of initial, or certified continuing,
6education or three semester units, or the equivalent, from an
7accredited educational institution, on topics relevant to medication
8management.

9(2) The person shall meet any of the following practical
10experience or licensure requirements:

11(A) Two years of full-time experience, within the last four years,
12as a consultant with expertise in medication management in areas
13covered by the training described in subdivision (a).

14(B) Two years of full-time experience, or the equivalent, within
15the last four years, as an administrator for a residential care facility
16for the elderly, during which time the individual has acted in
17substantial compliance with applicable regulations.

18(C) Two years of full-time experience, or the equivalent, within
19the last four years, as a direct care provider assisting with the
20self-administration of medications for a residential care facility
21for the elderly, during which time the individual has acted in
22substantial compliance with applicable regulations.

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

24(3) The licensed residential care facility for the elderly shall
25maintain the following documentation on each person who provides
26employee training under this section:

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

28(B) Information on the topics or subject matter covered in the
29training.

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

31(f) Other training or instruction, as required in paragraphs (1)
32and (2) of subdivision (a), may be provided offsite, and may use
33various methods of instruction, including, but not limited to, all
34of the following:

35(1) Lectures by presenters who are knowledgeable about
36medication management.

37(2) Video recorded instruction, interactive material, online
38training, and books.

39(3) Other written or visual materials approved by organizations
40or individuals with expertise in medication management.

P13   1(g) Residential care facilities for the elderly licensed to provide
2care for 16 or more persons shall maintain documentation that
3demonstrates that a consultant pharmacist or nurse has reviewed
4the facility’s medication management program and procedures at
5least twice a year.

6(h) Nothing in this section authorizes unlicensed personnel to
7directly administer medications.

8

SEC. 8.  

Section 1569.696 is added to the Health and Safety
9Code
, to read:

10

1569.696.  

(a) All residential care facilities for the elderly that
11serve residents with postural supports, as described in Section
1287608 of Title 22 of the California Code of Regulations, or
13restricted health conditions or health services, as described in
14Section 87612 of Title 22 of the California Code of Regulations,
15or who receive hospice services, as described in Section 87633 of
16Title 22 of the California Code of Regulations, in addition to
17complying with the training requirements in Section 1569.625,
18shall meet the following training requirements for all direct care
19staff:

20(1) Fifteen hours of training on the care, supervision, and special
21needs of those residents, prior to providing direct care to residents.
22The facility may utilize various methods of instruction, including,
23but not limited to, preceptorship, mentoring, and other forms of
24observation and demonstration. The orientation time shall be
25exclusive of any administrative instruction.

26(2) Twelve hours thereafter of in-service training per year on
27the subject of serving those residents.

28(b) This training shall be developed in consultation with
29individuals or organizations with specific expertise in the care of
30those residents described in subdivision (a). In formulating and
31providing this training, reference may be made to written materials
32and literature. This training requirement may be provided at the
33facility or offsite and may include a combination of observation
34and practical application.

35

SEC. 9.  

No reimbursement is required by this act pursuant to
36Section 6 of Article XIII B of the California Constitution because
37the only costs that may be incurred by a local agency or school
38district will be incurred because this act creates a new crime or
39infraction, eliminates a crime or infraction, or changes the penalty
40for a crime or infraction, within the meaning of Section 17556 of
P14   1the Government Code, or changes the definition of a crime within
2the meaning of Section 6 of Article XIII B of the California
3Constitution.



O

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