Senate Bill No. 911

Introduced by Senator Block

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 introduced, Block. Residential care facilities for the elderly.

(1) Existing law, the California Residential Care Facilities for the Elderly Act, provides for the licensure 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.

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

This bill would change the minimum hours of classroom instruction to 80 hours 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.

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

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 or specialized health conditions 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 specialized 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 least 8 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 if they demonstrate to the department that it only employs certified nurse assistants with valid certification, provided that certified nurse assistants receive 8 hours of training within the first 10 days of employment on resident characteristics, plans of care, resident records, and facility practices and procedures.

(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 within the first 4 weeks of employment 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 residents within the first 6 weeks of employment. This bill also would require 12 hours of in-service training per year on the subject of serving those residents.

(6) 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.  

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

1569.23.  

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

(b) The certification program shall be for a minimum of begin delete 40 end delete begin insert 80 end insert
hours of classroom instruction and include a uniform core of
knowledge which shall include all of the following:

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

(2) Business operations.

(3) Management and supervision of staff.

(4) Psychosocial need of the elderly residents.

(5) Physical needs for elderly residents.

(6) Community and support services.

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

begin insert

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

end insert begin delete

(8)

end delete

begin insert (9) end insert  Resident admission, retention, and assessment procedures.

begin insert

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

end insert

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

(d) The department shall establish by regulation the program
content, the testing instrument, process for approving certification
programs, and criteria to be used for authorizing individuals or
organizations to conduct certification programs. These regulations
shall be developed with the participation of provider organizations.

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

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

SEC. 2.  

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

1569.371.  

No licensee, or officer or employee of the licensee,
shall discriminate or retaliate in any manner 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.

SEC. 3.  

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

1569.39.  

(a) A residential care facility for the elderly that
accepts or retains residents with restricted or specialized health
conditions, as defined by the department to include, at a minimum,
bedridden, contractures, decubitus ulcers, healing wounds, or
receipt of hospice services, shall employ a registered nurse on a
full-time or part-time basis, as appropriate, to oversee the care
provided to those residents.

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

SEC. 4.  

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

1569.62.  

(a) The director shall 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.

(b) The department shall develop begin delete jointly with the Department
of Aging, with input from provider organizations, end delete requirements
for a uniform core of knowledge begin delete within end delete begin insert for end insert the required begin delete 20 hours
of end delete begin insert initial certification and end insert continuing education for administrators,
and their designated substitutes, and for recertification of
administrators of residential care facilities for the elderly. This
knowledge base shall include, as a minimum, basic understanding
of the psychosocial and physical care needs of elderly persons begin insert ,
applicable laws and regulations, residents’ rights, end insert and
administration. begin delete The end delete begin insert This training shall be developed in consultation
with individuals or organizations with specific expertise in
residential care facilities for the elderly or assisted living services,
or by an outside source with expertise in residential care facilities
for the elderly or assisted living services. end insert

begin insert (1) end insert begin insert   end insert begin insert The initial certification training for administrators shall
consist of at least 80 hours. end insert

begin insert

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

end insert

begin insert (c) end insert begin insert   end insert begin insert (1) end insert begin insert   end insert begin insert The end insert department shall develop begin delete jointly with the Department
of Aging, with input from provider organizations, end delete a uniform
resident assessment tool to be used by all residential care facilities
for the elderly. The assessment tool shall, in lay terms, help to
identify resident needs for service and assistance with activities
of daily living.

begin delete

The

end delete

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

SEC. 5.  

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

1569.625.  

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

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

begin delete

(b)

end delete

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

begin delete

(c)

end delete

begin insert (d) end insert  The training shall include, but not be limited to, the
following:

(1) Physical limitations and needs of the elderly.

(2) Importance and techniques for personal care services.

(3) Residents’ rights.

(4) Policies and procedures regarding medications.

begin insert

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

end insert begin insert

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

end insert begin delete

(5)

end delete

begin insert (7) end insert  Psychosocial needs of the elderly.

begin insert

(8) This subdivision shall not apply to a residential care facility
for the elderly that demonstrates to the department that the facility
employs only certified nurse assistants with valid certification,
pursuant to Section 1337.2, except that certified nurse assistants
with valid certification shall receive eight hours of training within
the first 10 days of employment on resident characteristics, resident
records, and facility practices and procedures.

end insert

SEC. 6.  

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

1569.626.  

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

(a)  begin delete Six end delete begin insert Fifteen end insert hours of resident care orientation within the first
four weeks of employment. All begin delete six end delete begin insert 15 end insert hours shall be devoted to
the care of persons with dementia. The facility may utilize various
methods of instruction including, but not limited to, preceptorship,
mentoring, and other forms of observation and demonstration. The
orientation time shall be exclusive of any administrative instruction.

(b)  begin delete Eight end delete begin insert Twelve end insert hours of in-service training per year on the
subject of begin delete serving end delete begin insert providing care and supervision to end insert residents with
dementia. This training shall be developed in consultation with
individuals or organizations with specific expertise in dementia
care or by an outside source with expertise in dementia care. In
formulating and providing this training, reference may be made
to written materials and literature on dementia and the care and
treatment of persons with dementia. begin delete This training requirement may
be satisfied in one day or over a period of time. end delete This training
requirement may be provided at the facility or offsite and may
include a combination of observation and practical application.

SEC. 7.  

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

1569.69.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(2) The date when consultation was provided.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SEC. 8.  

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

1569.696.  

(a) All residential care facilities for the elderly that
serve residents with postural supports, as described in Section
87608 of Title 22 of the California Code of Regulations, or
restricted health conditions or health services, as described in
Section 87612 of Title 22 of the California Code of Regulations,
or who receive hospice services, as described in Section 87633 of
Title 22 of the California Code of Regulations, in addition to
complying with the training requirements in Section 1569.625,
shall meet the following training requirements for all direct care
staff:

(1) Fifteen hours of training on the care, supervision, and special
needs of those residents within the first six weeks of employment.
The facility may utilize various methods of instruction, including,
but not limited to, preceptorship, mentoring, and other forms of
observation and demonstration. The orientation time shall be
exclusive of any administrative instruction.

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

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

SEC. 9.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B 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 XIII B of the California
Constitution.