California Legislature—2013–14 Regular Session

Assembly Bill No. 1996

Introduced by Assembly Member Brown

February 20, 2014

An act to amend Sections 1420 and 1422 of the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL’S DIGEST

AB 1996, as introduced, Brown. Long-term health care facilities: quality of care.

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the licensure and regulation of health facilities, including, but not limited to, long-term health care facilities, as defined.

Existing law requires inspection of a long-term health care facility at least once every 2 years.

This bill instead would require inspection at least once every year and would delete obsolete references to a health facility inspection pilot program.

Existing law authorizes the appointment of a temporary manager or receiver to operate a long-term health facility if certain conditions exist.

This bill would authorize the inspector to refer the matter for appointment of a temporary manager or receiver under those provisions if he or she finds that conditions at the facility indicate the need for the appointment.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1420 of the Health and Safety Code is
amended to read:

1420.  

(a) (1) Upon receipt of a written or oral complaint, the
state department shall assign an inspector to make a preliminary
review of the complaint and shall notify the complainant within
two working days of the receipt of the complaint of the name of
the inspector. Unless the state department determines that the
complaint is willfully intended to harass a licensee or is without
any reasonable basis, it shall make an onsite inspection or
investigation within 10 working days of the receipt of the
complaint. In any case in which the complaint involves a threat of
imminent danger of death or serious bodily harm, the state
department shall make an onsite inspection or investigation within
24 hours of the receipt of the complaint. In any event, the
complainant shall be promptly informed of the state department’s
proposed course of action and of the opportunity to accompany
the inspector on the inspection or investigation of the facility. Upon
the request of either the complainant or the state department, the
complainant or his or her representative, or both, may be allowed
to accompany the inspector to the site of the alleged violations
during his or her tour of the facility, unless the inspector determines
that the privacy of any patient would be violated thereby.

(2) When conducting an onsite inspection or investigation
pursuant to this section, the state department shall collect and
evaluate all available evidence and may issue a citation based
upon, but not limited to, all of the following:

(A) Observed conditions.

(B) Statements of witnesses.

(C) Facility records.

(3) Within 10 working days of the completion of the complaint
investigation, the state department shall notify the complainant
and licensee in writing of the department’s determination as a
result of the inspection or investigation.

begin insert

(4) In addition, if the inspection demonstrates that conditions
exist indicating the need for appointment of a temporary manager
or receiver pursuant to Article 8 (commencing with Section 1325)
of Chapter 2, the inspector shall immediately refer the matter to
the director along with his or her findings and recommendations.

end insert

(b) Upon being notified of the state department’s determination
as a result of the inspection or investigation, a complainant who
is dissatisfied with the state department’s determination, regarding
a matter which would pose a threat to the health, safety, security,
welfare, or rights of a resident, shall be notified by the state
department of the right to an informal conference, as set forth in
this section. The complainant may, within five business days after
receipt of the notice, notify the director in writing of his or her
request for an informal conference. The informal conference shall
be held with the designee of the director for the county in which
the long-term health care facility which is the subject of the
complaint is located. The long-term health care facility may
participate as a party in this informal conference. The director’s
designee shall notify the complainant and licensee of his or her
determination within 10 working days after the informal conference
and shall apprise the complainant and licensee in writing of the
appeal rights provided in subdivision (c).

(c) If the complainant is dissatisfied with the determination of
the director’s designee in the county in which the facility is located,
the complainant may, within 15 days after receipt of this
determination, notify in writing the Deputy Director of the
Licensing and Certification Division of the state department, who
shall assign the request to a representative of the Complainant
Appeals Unit for review of the facts that led to both determinations.
As a part of the Complainant Appeals Unit’s independent
investigation, and at the request of the complainant, the
representative shall interview the complainant in the district office
where the complaint was initially referred. Based upon this review,
the Deputy Director of the Licensing and Certification Division
of the state department shall make his or her own determination
and notify the complainant and the facility within 30 days.

(d) Any citation issued as a result of a conference or review
provided for in subdivision (b) or (c) shall be issued and served
upon the facility within three working days of the final
determination, unless the licensee agrees in writing to an extension
of this time. Service shall be effected either personally or by
registered or certified mail. A copy of the citation shall also be
sent to each complainant by registered or certified mail.

(e) A miniexit conference shall be held with the administrator
or his or her representative upon leaving the facility at the
completion of the investigation to inform him or her of the status
of the investigation. The department shall also state the items of
noncompliance and compliance found as a result of a complaint
and those items found to be in compliance, provided the disclosure
maintains the anonymity of the complainant. In any matter in which
there is a reasonable probability that the identity of the complainant
will not remain anonymous, the state department shall also notify
the facility that it is unlawful to discriminate or seek retaliation
against a resident, employee, or complainant.

(f) For purposes of this section, “complaint” means any oral or
written notice to the state department, other than a report from the
facility of an alleged violation of applicable requirements of state
or federal law or any alleged facts that might constitute such a
violation.

SEC. 2.  

Section 1422 of the Health and Safety Code is amended
to read:

1422.  

(a) The Legislature finds and declares that it is the public
policy of this state to ensure that long-term health care facilities
provide the highest level of care possible. The Legislature further
finds that inspections are the most effective means of furthering
this policy. It is not the intent of the Legislature by the amendment
of subdivision (b) enacted by Chapter 1595 of the Statutes of 1982
to reduce in any way the resources available to the state department
for inspections, but rather to provide the state department with the
greatest flexibility to concentrate its resources where they can be
most effective. It is the intent of the Legislature to create a survey
process that includes state-based survey components and that
determines compliance with federal and California requirements
for certified long-term health care facilities. It is the further intent
of the Legislature to execute this inspection in the form of a single
survey process, to the extent that this is possible and permitted
under federal law. The inability of the state to conduct a single
survey in no way exempts the state from the requirement under
this section that state-based components be inspected in long-term
health care facilities as required by law.

(b) (1)  begin delete (A) end delete begin delete   end delete Notwithstanding Section 1279 or any other
provision of law, without providing notice of these inspections,
the department, in addition to any inspections conducted pursuant
to complaints filed pursuant to Section 1419, shall conduct
inspections annually, except with regard to those facilities which
have no class “AA,” class “A,” or class “B” violations in the past
12 months. The state department shall also conduct inspections as
may be necessary to ensure the health, safety, and security of
patients in long-term health care facilities. Every facility shall be
inspected at least once every begin delete two years end delete begin insert year end insert . The department shall
vary the cycle in which inspections of long-term health care
facilities are conducted to reduce the predictability of the
inspections.

begin delete

(B)

end delete

begin insert (2) end insert  Inspections and investigations of long-term health care
facilities that are certified by the Medicare Program or the Medicaid
Program shall determine compliance with federal standards and
California statutes and regulations to the extent that California
statutes and regulations provide greater protection to residents, or
are more precise than federal standards, as determined by the
department. Notwithstanding any other provision of law, the
department may, without taking regulatory action pursuant to
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
3 of Title 2 of the Government Code, implement, interpret, or make
specific this paragraph by means of an All Facilities Letter (AFL)
or similar instruction. Prior to issuing an AFL or similar instruction,
the department shall consult with interested parties and shall inform
the appropriate committees of the Legislature. The department
shall also post the AFL or similar instruction on its Web site so
that any person may observe which California laws and regulations
provide greater protection to its residents or are more precise than
federal standards. Nothing in this subdivision is intended to change
existing statutory or regulatory requirements governing the care
provided to long-term health care facility residents.

begin delete

(C)

end delete

begin insert (3) end insert  In order to ensure maximum effectiveness of inspections
conducted pursuant to this article, the department shall identify all
state law standards for the staffing and operation of long-term
health care facilities. Costs of the additional survey and inspection
activities required by Chapter 895 of the Statutes of 2006 shall be
included as Licensing and Certification Program activities for the
purposes of calculating fees in accordance with Section 1266.

begin delete

(2) The state department shall submit to the federal Department
of Health and Human Services on or before July 1, 1985, for review
and approval, a request to implement a three-year pilot program
designed to lessen the predictability of the long-term health care
facility inspection process. Two components of the pilot program
shall be (A) the elimination of the present practice of entering into
a one-year certification agreement, and (B) the conduct of
segmented inspections of a sample of facilities with poor inspection
records, as defined by the state department. At the conclusion of
the pilot project, an analysis of both components shall be conducted
by the state department to determine effectiveness in reducing
inspection predictability and the respective cost benefits.
Implementation of this pilot project is contingent upon federal
approval.

end delete

(c) Except as otherwise provided in subdivision (b), the state
department shall conduct unannounced direct patient care
inspections at least annually to inspect physician and surgeon
services, nursing services, pharmacy services, dietary services,
and activity programs of all the long-term health care facilities.
Facilities evidencing repeated serious problems in complying with
this chapter or a history of poor performance, or both, shall be
subject to periodic unannounced direct patient care inspections
during the inspection year. The direct patient care inspections shall
assist the state department in the prioritization of its efforts to
correct facility deficiencies.

(d) All long-term health care facilities shall report to the state
department any changes in the nursing home administrator or the
director of nursing services within 10 calendar days of the changes.

(e) Within 90 days after the receipt of notice of a change in the
nursing home administrator or the director of nursing services, the
state department may conduct an abbreviated inspection of the
long-term health care facilities.

(f) If a change in a nursing home administrator occurs and the
Board of Nursing Home Administrators notifies the state
department that the new administrator is on probation or has had
his or her license suspended within the previous three years, the
state department shall conduct an abbreviated survey of the
long-term health care facility employing that administrator within
90 days of notification.