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 with prohibited health conditions, as defined by the department, to 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.
(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 jointly with the California Department of Aging 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 exempt certified nurse assistants with valid certification from those requirements, 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.begin delete This bill would also authorize the department to develop a certification training program with a standardized test for specified staff.end delete
(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, to 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.
begin insert(7) This bill would make its provisions operative on January 1, 2016.
end insertVote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 1569.23 of the Health and Safety Code
2 is amended to read:
(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.
19(8) Nonpharmacologic, person-centered approaches to dementia
20care.
21(9) Resident admission, retention, and assessment procedures.
P5 1(10) Residents’ rights, and the importance of initial and ongoing
2training for all staff to ensure residents’ rights are fully respected
3and implemented.
4(c) Successful completion of the certification program shall be
5demonstrated by passing a written test and submitting a fee of one
6hundred dollars ($100) to the department for the issuance of a
7certificate of completion.
8(d) The department shall establish by regulation the program
9content, the testing instrument, process for approving certification
10programs, and criteria to be
used for authorizing individuals or
11organizations to conduct certification programs. These regulations
12
shall be developed with the participation of provider organizations
13and other stakeholder groups. The department shall review the test
14annually and update it as necessary to reflect changes in law and
15regulations.
16(e) This section shall apply to all applications for licensure
17unless the applicant provides evidence that he or she has a current
18license for another residential care facility for the elderly which
19was initially licensed prior to July 1, 1989, or has successfully
20completed an approved certification program within the prior five
21years.
22(f) If the applicant is a firm, partnership, association, or
23
corporation, the chief executive officer, or other person serving in
24a like capacity, or the designated administrator of the facility shall
25provide evidence of successfully completing an approved
26certification program.
begin insertSection 1569.23 of the end insertbegin insertHealth and Safety Codeend insert
28begin insert is amended to read:end insert
(a) As a requirement for licensure, the applicant shall
30demonstrate that he or she has successfully completed a
31certification program approved by the department.
32(b) The certification program shall be for a minimum of 40
33hours of classroom instruction and include a uniform core of
34knowledge which shall include all of the following:
35(1) Law, regulations, policies, and procedural standards that
36impact the operations of residential care facilities for the elderly.
37(2) Business operations.
38(3) Management and supervision of staff.
39(4) Psychosocial need of the elderly residents.
40(5) Physical needs for elderly residents.
P6 1(6) Community and support services.
2(7) Use, misuse, and interaction of drugs commonly used by
3the elderly.
4(8) Resident admission, retention, and assessment procedures.
5(c) Successful completion of the certification program shall be
6demonstrated by passing a written test and submitting a fee of one
7hundred dollars ($100) to the department for the issuance of a
8certificate of completion.
9(d) The department shall establish by regulation the program
10content, the
testing instrument, process for approving certification
11programs, and criteria to be used for authorizing individuals or
12organizations to conduct certification programs. These regulations
13shall be developed with the participation of provider organizations.
14(e) This section shall apply to all applications for licensure
15unless the applicant provides evidence that he or she has a current
16license for another residential care facility for the elderly which
17was initially licensed prior to July 1, 1989, or has successfully
18completed an approved certification program within the prior five
19years.
20(f) If the applicant is a firm, partnership, association, or
21corporation, the chief executive officer, or other person serving in
22a like capacity, or the designated administrator of the facility shall
23provide evidence of successfully completing an approved
24certification program.
25(g) This section shall remain in effect only until January 1, 2016,
26and as of that date is repealed, unless a later enacted statute, that
27is enacted before January 1, 2016, deletes or extends that date.
begin insertSection 1569.23 is added to the end insertbegin insertHealth and Safety
29Codeend insertbegin insert, to read:end insert
(a) As a requirement for licensure, the applicant
31shall demonstrate that he or she has successfully completed a
32certification program approved by the department.
33(b) The certification program shall be for a minimum of 100
34hours, of which 80 hours are classroom instruction, and include
35a uniform core of knowledge which shall include all of the
36following:
37(1) Law, regulations, policies, and procedural standards that
38impact the operations of residential care facilities for the elderly.
39(2) Business operations.
40(3) Management and supervision of staff.
P7 1(4) Psychosocial needs of the elderly residents.
2(5) Physical needs of the elderly residents.
3(6) Community and support services.
4(7) Use, misuse, and interaction of drugs commonly used by the
5elderly, and the adverse effects of psychotropic drugs for use in
6controlling the behavior of persons with dementia.
7(8) Nonpharmacologic, person-centered approaches to dementia
8care.
9(9) Resident admission, retention, and assessment procedures.
10(10) Residents’ rights, and the importance of initial and ongoing
11training for all staff to ensure residents’ rights are
fully respected
12and implemented.
13(c) Successful completion of the certification program shall be
14demonstrated by passing a written test and submitting a fee of one
15hundred dollars ($100) to the department for the issuance of a
16certificate of completion.
17(d) The department shall establish by regulation the program
18content, the testing instrument, process for approving certification
19programs, and criteria to be used for authorizing individuals or
20organizations to conduct certification programs. These regulations
21shall be developed with the participation of provider organizations
22and other stakeholder groups. The department shall review the
23test annually and update it as necessary to reflect changes in law
24and regulations.
25(e) This section shall apply to all applications for licensure
26unless the applicant provides
evidence that he or she has a current
27license for another residential care facility for the elderly which
28was initially licensed prior to July 1, 1989, or has successfully
29completed an approved certification program within the prior five
30years.
31(f) If the applicant is a firm, partnership, association, or
32corporation, the chief executive officer, or other person serving
33in a like capacity, or the designated administrator of the facility
34shall provide evidence of successfully completing an approved
35certification program.
36(g) This section shall become operative on January 1, 2016.
Section 1569.371 is added to the Health and Safety
39Code, to read:
(a) No licensee, or officer or employee of the
2licensee, shall discriminate or retaliate in any manner against any
3person receiving the services of the licensee’s residential care
4facility for the elderly, or against any employee of the licensee’s
5facility, on the basis, or for the reason that, the person, employee,
6or any other person dialed or called 911.
7(b) A violation of this section is subject to civil penalty pursuant
8to Section 1569.49.
9(c) This section shall become operative on January 1, 2016.
end insertSection 1569.39 is added to the Health and Safety
12Code, to read:
(a) A residential care facility for the elderly that
14accepts or retains residents with prohibited health conditions, as
15defined by the department, in Section 87615 of Title 22 of the
16California Code of Regulations, shall ensure that residents receive
17home health or hospice services sufficient in scope and hours to
18ensure that residents receive medical care as prescribed by the
19resident’s physician and contained in the resident’s service plan.
20(b) A residential care facility for the elderly that accepts or
21retains residents with restricted health conditions, as defined by
22the department, shall ensure that residents receive medical care as
23prescribed by the
resident’s physician and contained in the
24resident’s service plan by appropriately skilled professionals acting
25within their scope of practice.
26(c) An “appropriately skilled professional” means, for purposes
27of this section, an individual who has training and is licensed to
28perform the necessary medical procedures prescribed by a
29physician. This includes, but is not limited to, a registered nurse,
30licensed vocational nurse, physical therapist, occupational therapist,
31or respiratory therapist. These professionals may include, but are
32not limited to, those persons employed by a home health agency,
33the resident, or a facility, and who are currently licensed in this
34state.
35(d) Failure to meet or arrange to meet the needs of those
36residents who requirebegin delete specialized
healthend delete
begin delete,end delete
37begin insert as specified in the resident’s written record of care, defined
38pursuant to Section 1569.80,end insert or failure to notify the physician of
39a resident’s illness or injury that poses a danger of death or serious
P9 1bodily harm is a licensing violation and subject to civil penalty
2pursuant to Section 1569.49.
3(e) This section shall become operative on January 1, 2016.
end insertSection 1569.62 of the Health and Safety Code is
5amended to read:
(a) The director shall ensure that licensees,
7administrators, and staffs of residential care facilities for the elderly
8have appropriate training to provide the care and services for which
9a license or certificate is issued.
10(b) The department shall develop jointly with the California
11Department of Aging requirements for a uniform core of knowledge
12for the required initial certification and continuing education for
13administrators, and their designated substitutes, and for
14recertification of administrators of residential care facilities for
15the elderly. This knowledge base shall include, as a minimum,
16basic understanding of the psychosocial and
physical care needs
17of elderly persons, applicable laws and regulations, residents’
18rights, and administration. This training shall be developed in
19consultation with individuals or organizations with specific
20expertise in residential care facilities for the elderly or assisted
21living services, or by an outside source with expertise in residential
22care facilities for the elderly or assisted living services.
23(1) The initial certification training for administrators shall
24consist of at least 100 hours.
25(2) The continuing education requirement for administrators is
26at least 60 hours of training during each two-year certification
27period.
28(c) (1) The department shall develop a uniform resident
29assessment
tool to be used by all residential care facilities for the
30elderly. The assessment tool shall, in lay terms, help to identify
31resident needs for service and assistance with activities of daily
32living.
33(2) The departments shall develop a mandatory training program
34
on the utilization of the assessment tool to be given to
35administrators and their designated substitutes.
Section 1569.625 of the Health and Safety Code is
37amended to read:
(a) The Legislature finds that the quality of services
39provided to residents of residential care facilities for the elderly is
40dependent upon the training and skills of staff.
P10 1(b) The current training requirements for staff of residential care
2facilities for the elderly are insufficient to meet the range of care
3needs of the residents of those facilities. It is the intent of the
4Legislature in enacting this section to ensure that direct care staff
5have the knowledge and proficiency to carry out the tasks of their
6jobs.
7(c) The department shall adopt regulations to require staff
8members
of residential care facilities for the elderly who assist
9residents with personal activities of daily living to receive
10appropriate training. This training shall consist of 40 hours of
11training within the first four weeks of employment, at least 24
12hours of which shall be completed prior to providing direct care
13to residents, and 20 hours annually thereafter. This training shall
14be administered on the job, or in a classroom setting, or any
15combination of the two. The department shall establish the subject
16matter required for this training. This training shall be developed
17in consultation with individuals or organizations with specific
18expertise in residential care facilities for the elderly or assisted
19living services, or by an outside source with expertise in residential
20care facilities for the elderly or assisted living services, as defined
21in Section 1771.
22(d) The training shall include, but not be limited to, the
23following:
24(1) Physical limitations and needs of the elderly.
25(2) Importance and techniques for personal care services.
26(3) Residents’ rights.
27(4) Policies and procedures regarding medications.
28(5) Use, misuse, and interaction of drugs commonly used by
29the elderly, and the adverse effects of psychotropic drugs for use
30in controlling the behavior of persons with dementia.
31(6) The special needs of persons with Alzheimer’s disease and
32dementia, including nonpharmacologic
person-centered approaches
33to dementia care.
34(7) Psychosocial needs of the elderly.
35(8) This subdivision shall not apply to certified nurse assistants,
36certified pursuant to Section 1337.2, except that certified nurse
37assistants with valid certification shall receive eight hours of
38trainingprior to providing direct care to residents, on resident
39characteristics, resident records, and facility practices and
40procedures.
P11 1(e) The department may develop a certification training program
2with a standardized test for staff pursuant to this section and
3Sections 1569.626, 1569.69, and 1569.696.
Section 1569.626 of the Health and Safety Code is
5amended to read:
All residential care facilities for the elderly that
7advertise or promote special care, special programming, or a special
8environment for persons with dementia, in addition to complying
9with the training requirements described in Section 1569.625, shall
10meet the following training requirements for all direct care staff:
11(a) Fifteen hours of resident care orientationprior to providing
12direct care to residents. All 15 hours shall be devoted to the care
13of persons with dementia. The facility may utilize various methods
14of instruction including, but not limited to, preceptorship,
15mentoring, and other forms of observation and demonstration. The
16orientation time shall be
exclusive of any administrative instruction.
17(b) Twelve hours of in-service training per year on the subject
18of providing care and supervision to residents with dementia. This
19training shall be developed in consultation with individuals or
20organizations with specific expertise in dementia care or by an
21outside source with expertise in dementia care. In formulating and
22providing this training, reference may be made to written materials
23and literature on dementia and the care and treatment of persons
24with dementia. This training requirement may be provided at the
25facility or offsite and may include a combination of observation
26and practical application.
Section 1569.69 of the Health and Safety Code is
28amended to read:
(a) Each residential care facility for the elderly
30licensed under this chapter shall ensure that each employee of the
31facility who assists residents with the self-administration of
32medications meets the following training requirements:
33(1) In facilities licensed to provide care for 16 or more persons,
34the employee shall complete 32 hours of initial training. This
35training shall consist of 12 hours of hands-on shadowing training,
36which shall be completed prior to assisting with the
37self-administration of medications, and 20 hours of other training
38or instruction, as described
in subdivision (f), which shall be
39completed within the first four weeks of employment.
P12 1(2) In facilities licensed to provide care for 15 or fewer persons,
2the employee shall complete 16 hours of initial training. This
3training shall consist of eight hours of hands-on shadowing training,
4which shall be completed prior to assisting with the
5self-administration of medications, and eight hours of other training
6or instruction, as described in subdivision (f), which shall be
7completed within the first two weeks of employment.
8(3) An employee shall be required to complete the training
9requirements for hands-on shadowing training described in this
10subdivision prior to assisting any resident in the self-administration
11of medications. The training and instruction described in this
12subdivision
shall be completed, in their entirety, within the first
13two weeks of employment.
14(4) The training shall cover all of the following areas:
15(A) The role, responsibilities, and limitations of staff who assist
16residents with the self-administration of medication, including
17tasks limited to licensed medical professionals.
18(B) An explanation of the terminology specific to medication
19assistance.
20(C) An explanation of the different types of medication orders:
21prescription, over-the-counter, controlled, and other medications.
22(D) An explanation of the basic rules and precautions of
23medication assistance.
24(E) Information on medication forms and routes for medication
25taken by residents.
26(F) A description of procedures for providing assistance with
27the self-administration of medications in and out of the facility,
28and information on the medication documentation system used in
29the facility.
30(G) An explanation of guidelines for the proper storage, security,
31and documentation of centrally stored medications.
32(H) A description of the processes used for medication ordering,
33refills, and the receipt of medications from the pharmacy.
34(I) An explanation of medication side effects, adverse reactions,
35errors,
the adverse effects of psychotropic drugs for use in
36controlling the behavior of persons with dementia, and the
37increased risk of death when elderly residents with dementia are
38given antipsychotic medications.
39(5) To complete the training requirements set forth in this
40subdivision, each employee shall pass an examination that tests
P13 1the employee’s comprehension of, and competency in, the subjects
2listed in paragraph (4).
3(6) Residential care facilities for the elderly shall encourage
4pharmacists and licensed medical professionals to use plain English
5when preparing labels on medications supplied to residents. As
6used in this section, “plain English” means that no abbreviations,
7symbols, or Latin medical terms shall be used in the instructions
8for the self-administration of
medication.
9(7) The training requirements of this section are not intended
10to replace or supplant those required of all staff members who
11assist residents with personal activities of daily living as set forth
12in Sections 1569.625 and 1569.696.
13(8) The training requirements of this section shall be repeated
14if either of the following occurs:
15(A) An employee returns to work for the same licensee after a
16break of service of more than 180 consecutive calendar days.
17(B) An employee goes to work for another licensee in a facility
18in which he or she assists residents with the self-administration of
19medication.
20(b) Each employee who received training and passed the
21examination required in paragraph (5) of subdivision (a), and who
22continues to assist with the self-administration of medicines, shall
23also complete eight hours of in-service training on
24medication-related issues in each succeeding 12-month period.
25(c) The requirements set forth in subdivisions (a) and (b) do not
26apply to persons who are licensed medical professionals.
27(d) Each residential care facility for the elderly that provides
28employee training under this section shall use the training material
29and the accompanying examination that are developed by, or in
30consultation with, a licensed nurse, pharmacist, or physician. The
31licensed residential care facility for the elderly shall maintain the
32following documentation
for each medical consultant used to
33develop the training:
34(1) The name, address, and telephone number of the consultant.
35(2) The date when consultation was provided.
36(3) The consultant’s organization affiliation, if any, and any
37educational and professional qualifications specific to medication
38management.
39(4) The training topics for which consultation was provided.
P14 1(e) Each person who provides employee training under this
2section shall meet the following education and experience
3requirements:
4(1) A minimum of five hours of initial, or
certified continuing,
5education or three semester units, or the equivalent, from an
6accredited educational institution, on topics relevant to medication
7management.
8(2) The person shall meet any of the following practical
9experience or licensure requirements:
10(A) Two years of full-time experience, within the last four years,
11as a consultant with expertise in medication management in areas
12covered by the training described in subdivision (a).
13(B) Two years of full-time experience, or the equivalent, within
14the last four years, as an administrator for a residential care facility
15for the elderly, during which time the individual has acted in
16substantial compliance with applicable regulations.
17(C) Two years of full-time experience, or the equivalent, within
18the last four years, as a direct care provider assisting with the
19self-administration of medications for a residential care facility
20for the elderly, during which time the individual has acted in
21substantial compliance with applicable regulations.
22(D) Possession of a license as a medical professional.
23(3) The licensed residential care facility for the elderly shall
24maintain the following documentation on each person who provides
25employee training under this section:
26(A) The person’s name, address, and telephone number.
27(B) Information on the
topics or subject matter covered in the
28training.
29(C) The time, dates, and hours of training provided.
30(f) Other training or instruction, as required in paragraphs (1)
31and (2) of subdivision (a), may be provided offsite, and may use
32various methods of instruction, including, but not limited to, all
33of the following:
34(1) Lectures by presenters who are knowledgeable about
35medication management.
36(2) Video recorded instruction, interactive material, online
37training, and books.
38(3) Other written or visual materials approved by organizations
39or individuals with expertise in medication management.
P15 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.
begin insertSection 1569.62 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
9amended to read:end insert
(a) The director shall ensure that licensees,
11administrators, and staffs of residential care facilities for the elderly
12have appropriate training to provide the care and services for which
13a license or certificate is issued.
14(b) The department shall develop jointly with the Department
15of Aging, with input from provider organizations, requirements
16for a uniform core of knowledge within the required 20 hours of
17continuing education for administrators, and their designated
18substitutes, and for recertification of administrators of residential
19care facilities for the elderly. This knowledge base shall include,
20as a minimum, basic understanding of the psychosocial and
21physical care needs of elderly persons and administration. The
22department shall develop jointly with the Department of Aging,
23with
input from provider organizations, 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
27 living.
28The departments shall develop a mandatory training program
29on the utilization of the assessment tool to be given to
30administrators and their designated substitutes.
31(c) This section shall remain in effect only until January 1, 2016,
32and as of that date is repealed, unless a later enacted statute, that
33is enacted before January 1, 2016, deletes or extends that date.
begin insertSection 1569.62 is added to the end insertbegin insertHealth and Safety
35Codeend insertbegin insert, to read:end insert
(a) The director shall ensure that licensees,
37administrators, and staff of residential care facilities for the elderly
38have appropriate training to provide the care and services for
39which a license or certificate is issued.
P16 1(b) The department shall develop jointly with the California
2Department of Aging requirements for a uniform core of knowledge
3for the required initial certification and continuing education for
4administrators, and their designated substitutes, and for
5recertification of administrators of residential care facilities for
6the elderly. This knowledge base shall include, as a minimum,
7basic understanding of the psychosocial and physical care needs
8of elderly persons, applicable laws and regulations, residents’
9rights, and administration. This training shall be developed in
10consultation with
individuals or organizations with specific
11expertise in residential care facilities for the elderly or assisted
12living services, or by an outside source with expertise in residential
13care facilities for the elderly or assisted living services.
14(1) The initial certification training for administrators shall
15consist of at least 100 hours.
16(2) The continuing education requirement for administrators is
17at least 60 hours of training during each two-year certification
18period.
19(c) (1) The department shall develop a uniform resident
20assessment tool to be used by all residential care facilities for the
21elderly. The assessment tool shall, in lay terms, help to identify
22resident needs for service and assistance with activities of daily
23living.
24(2) The departments shall develop a mandatory training
25program on the utilization of the assessment tool to be given to
26administrators and their
designated substitutes.
27(d) This section shall become operative on January 1, 2016.
begin insertSection 1569.625 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
29amended to read:end insert
(a) The Legislature finds that the quality of services
31provided to residents of residential care facilities for the elderly is
32dependent upon the training and skills of staff. It is the intent of
33the Legislature in enacting this section to ensure that direct-care
34staff have the knowledge and proficiency to carry out the tasks of
35their jobs.
36(b) The department shall adopt regulations to require staff
37members of residential care facilities for the elderly who assist
38residents with personal activities of daily living to receive
39appropriate training. This training shall consist of 10 hours of
40training within the first four weeks of employment and four hours
P17 1annually thereafter. This training shall be administered on the job,
2or in a classroom setting, or any combination of the two. The
3
department shall establish, in consultation with provider
4organizations, the subject matter required for this training.
5(c) The training shall include, but not be limited to, the
6following:
7(1) Physical limitations and needs of the elderly.
8(2) Importance and techniques for personal care services.
9(3) Residents’ rights.
10(4) Policies and procedures regarding medications.
11(5) Psychosocial needs of the elderly.
begin insert
12(d) This section shall remain in effect only until January 1, 2016,
13and as of that date is repealed, unless a later enacted statute, that
14is enacted before January 1, 2016, deletes or extends that date.
begin insertSection 1569.625 is added to the end insertbegin insertHealth and Safety
16Codeend insertbegin insert, to read:end insert
(a) The Legislature finds that the quality of services
18provided to residents of residential care facilities for the elderly
19is dependent upon the training and skills of staff.
20(b) The current training requirements for staff of residential
21care facilities for the elderly are insufficient to meet the range of
22care needs of the residents of those facilities. It is the intent of the
23Legislature in enacting this section to ensure that direct care staff
24have the knowledge and proficiency to carry out the tasks of their
25jobs.
26(c) The department shall adopt regulations to require staff
27members of residential care facilities for the elderly who assist
28residents with personal activities of daily living to receive
29appropriate training. This training shall consist of 40 hours of
30training within
the first four weeks of employment, at least 24
31hours of which shall be completed prior to providing direct care
32to residents, and 20 hours annually thereafter. This training shall
33be administered on the job, or in a classroom setting, or any
34combination of the two. The department shall establish the subject
35matter required for this training. This training shall be developed
36in consultation with individuals or organizations with specific
37expertise in residential care facilities for the elderly or assisted
38living services, or by an outside source with expertise in residential
39care facilities for the elderly or assisted living services, as defined
40in Section 1771.
P18 1(d) The training shall include, but not be limited to, the
2following:
3(1) Physical limitations and needs of the elderly.
4(2) Importance and techniques for personal care services.
5(3) Residents’ rights.
6(4) Policies and procedures regarding medications.
7(5) Use, misuse, and interaction of drugs commonly used by the
8elderly, and the adverse effects of psychotropic drugs for use in
9controlling the behavior of persons with dementia.
10(6) The special needs of persons with Alzheimer’s disease and
11dementia, including nonpharmacologic person-centered
12approaches to dementia care.
13(7) Psychosocial needs of the elderly.
14(8) This subdivision shall not apply to certified nurse assistants,
15certified pursuant to Section 1337.2, except that certified nurse
16assistants with valid certification shall receive eight hours of
17training prior to providing direct care to residents, on resident
18characteristics, resident records, and facility practices and
19procedures.
20(e) This section shall become operative on January 1, 2016.
begin insertSection 1569.626 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
22amended to read:end insert
All residential care facilities for the elderly that
24advertise or promote special care, special programming, or a special
25environment for persons with dementia, in addition to complying
26with the training requirements described in Section 1569.625, shall
27meet the following training requirements for all direct care staff:
28(a) Six hours of resident care orientation within the first four
29weeks of employment. All six hours shall be devoted to the care
30of persons with dementia. The facility may utilize various methods
31of instruction including, but not limited to, preceptorship,
32mentoring, and other forms of observation and demonstration. The
33orientation time shall be exclusive of any administrative instruction.
34(b) Eight hours of in-service training per year on the subject of
35serving
residents with dementia. This training shall be developed
36in consultation with individuals or organizations with specific
37expertise in dementia care or by an outside source with expertise
38in dementia care. In formulating and providing this training,
39reference may be made to written materials and literature on
40dementia and the care and treatment of persons with dementia.
P19 1This training requirement may be satisfied in one day or over a
2period of time. This training requirement may be provided at the
3facility or offsite and may include a combination of observation
4and practical application.
5(c) This section shall remain in effect only until January 1, 2016,
6and as of that date is repealed, unless a later enacted statute, that
7is enacted before January 1, 2016, deletes or extends that date.
begin insertSection 1569.626 is added to the end insertbegin insertHealth and Safety
9Codeend insertbegin insert, to read:end insert
All residential care facilities for the elderly that
11advertise or promote special care, special programming, or a
12special environment for persons with dementia, in addition to
13complying with the training requirements described in Section
141569.625, shall meet the following training requirements for all
15direct care staff:
16(a) Fifteen hours of resident care orientation prior to providing
17direct care to residents. All 15 hours shall be devoted to the care
18of persons with dementia. The facility may utilize various methods
19of instruction including, but not limited to, preceptorship,
20mentoring, and other forms of observation and demonstration.
21The orientation time shall be exclusive of any administrative
22instruction.
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(c) This section shall become operative on January 1, 2016.
begin insertSection 1569.69 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
35amended to read:end insert
(a) Each residential care facility for the elderly
37licensed under this chapter shall ensure that each employee of the
38facility who assists residents with the self-administration of
39medications meets the following training requirements:
P20 1(1) In facilities licensed to provide care for 16 or more persons,
2the employee shall complete 16 hours of initial training. This
3training shall consist of eight hours of hands-on shadowing training,
4which shall be completed prior to assisting with the
5self-administration of medications, and eight hours of other training
6or instruction, as described in subdivision (f), which shall be
7completed within the first two weeks of employment.
8(2) In facilities licensed to
provide care for 15 or fewer persons,
9the employee shall complete six hours of initial training. This
10training shall consist of two hours of hands-on shadowing training,
11which shall be completed prior to assisting with the
12self-administration of medications, and four hours of other training
13or instruction, as described in subdivision (f), which shall be
14completed within the first two weeks of employment.
15(3) An employee shall be required to complete the training
16requirements for hands-on shadowing training described in this
17subdivision prior to assisting any resident in the self-administration
18of medications. The training and instruction described in this
19subdivision shall be completed, in their entirety, within the first
20two weeks of employment.
21(4) The training shall cover all of the following areas:
22(A) The role,
responsibilities, and limitations of staff who assist
23residents with the self-administration of medication, including
24tasks limited to licensed medical professionals.
25(B) An explanation of the terminology specific to medication
26assistance.
27(C) An explanation of the different types of medication orders:
28prescription, over-the-counter, controlled, and other medications.
29(D) An explanation of the basic rules and precautions of
30medication assistance.
31(E) Information on medication forms and routes for medication
32taken by residents.
33(F) A description of procedures for providing assistance with
34the self-administration of medications in and out of the facility,
35and information on the medication
documentation system used in
36the facility.
37(G) An explanation of guidelines for the proper storage, security,
38and documentation of centrally stored medications.
39(H) A description of the processes used for medication ordering,
40refills, and the receipt of medications from the pharmacy.
P21 1(I) An explanation of medication side effects, adverse reactions,
2and errors.
3(5) To complete the training requirements set forth in this
4subdivision, each employee shall pass an examination that tests
5the employee’s comprehension of, and competency in, the subjects
6listed in paragraph (4).
7(6) Residential care facilities for the elderly shall encourage
8pharmacists and licensed medical professionals to use
plain English
9when preparing labels on medications supplied to residents. As
10used in this section, “plain English” means that no abbreviations,
11symbols, or Latin medical terms shall be used in the instructions
12for the self-administration of medication.
13(7) The training requirements of this section are not intended
14to replace or supplant those required of all staff members who
15assist residents with personal activities of daily living as set forth
16in Section 1569.625.
17(8) The training requirements of this section shall be repeated
18if either of the following occurs:
19(A) An employee returns to work for the same licensee after a
20break of service of more than 180 consecutive calendar days.
21(B) An employee goes to work for another licensee in a facility
22in
which he or she assists residents with the self-administration of
23medication.
24(b) Each employee who received training and passed the
25examination required in paragraph (5) of subdivision (a), and who
26continues to assist with the self-administration of medicines, shall
27also complete four hours of in-service training on
28medication-related issues in each succeeding 12-month period.
29(c) The requirements set forth in subdivisions (a) and (b) do not
30apply to persons who are licensed medical professionals.
31(d) Each residential care facility for the elderly that provides
32employee training under this section shall use the training material
33and the accompanying examination that are developed by, or in
34consultation with, a licensed nurse, pharmacist, or physician. The
35licensed residential care facility for the elderly shall
maintain the
36following documentation for each medical consultant used to
37develop the training:
38(1) The name, address, and telephone number of the consultant.
39(2) The date when consultation was provided.
P22 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.
P23 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(i) This section shall remain in effect only until January 1, 2016,
13and as of that date is repealed, unless a later enacted statute, that
14is enacted before January 1, 2016, deletes or extends that date.
begin insertSection 1569.69 is added to the end insertbegin insertHealth and Safety
16Codeend insertbegin insert, to read:end insert
(a) Each residential care facility for the elderly
18licensed under this chapter shall ensure that each employee of the
19facility who assists residents with the self-administration of
20medications meets all of the following training requirements:
21(1) In facilities licensed to provide care for 16 or more persons,
22the employee shall complete 32 hours of initial training. This
23training shall consist of 12 hours of hands-on shadowing training,
24which shall be completed prior to assisting with the
25self-administration of medications, and 20 hours of other training
26or instruction, as described in subdivision (f), which shall be
27completed within the first four weeks of employment.
28(2) In
facilities licensed to provide care for 15 or fewer persons,
29the employee shall complete 16 hours of initial training. This
30training shall consist of eight hours of hands-on shadowing
31training, which shall be completed prior to assisting with the
32self-administration of medications, and eight hours of other
33training or instruction, as described in subdivision (f), which shall
34be completed within the first two weeks of employment.
35(3) An employee shall be required to complete the training
36requirements for hands-on shadowing training described in this
37subdivision prior to assisting any resident in the self-administration
38of medications. The training and instruction described in this
39subdivision shall be completed, in their entirety, within the first
40two weeks of employment.
P24 1(4) The training shall cover all of the following areas:
2(A) The role, responsibilities, and limitations of staff who assist
3residents with the self-administration of medication, including
4tasks limited to licensed medical professionals.
5(B) An explanation of the terminology specific to medication
6assistance.
7(C) An explanation of the different types of medication orders:
8prescription, over-the-counter, controlled, and other medications.
9(D) An explanation of the basic rules and precautions of
10medication assistance.
11(E) Information on medication forms and routes for medication
12taken by residents.
13(F) A description of procedures for providing assistance with
14the self-administration of medications in and out of the facility,
15and
information on the medication documentation system used in
16the facility.
17(G) An explanation of guidelines for the proper storage, security,
18and documentation of centrally stored medications.
19(H) A description of the processes used for medication ordering,
20refills, and the receipt of medications from the pharmacy.
21(I) An explanation of medication side effects, adverse reactions,
22errors, the adverse effects of psychotropic drugs for use in
23controlling the behavior of persons with dementia, and the
24increased risk of death when elderly residents with dementia are
25given antipsychotic medications.
26(5) To complete the training requirements set forth in this
27subdivision, each employee shall pass an examination that tests
28the employee’s comprehension of, and
competency in, the subjects
29listed in paragraph (4).
30(6) Residential care facilities for the elderly shall encourage
31pharmacists and licensed medical professionals to use plain
32English when preparing labels on medications supplied to
33residents. As used in this section, “plain English” means that no
34abbreviations, symbols, or Latin medical terms shall be used in
35the instructions for the self-administration of medication.
36(7) The training requirements of this section are not intended
37to replace or supplant those required of all staff members who
38assist residents with personal activities of daily living as set forth
39in Sections 1569.625 and 1569.696.
P25 1(8) The training requirements of this section shall be repeated
2if either of the following occur:
3(A) An
employee returns to work for the same licensee after a
4break of service of more than 180 consecutive calendar days.
5(B) An employee goes to work for another licensee in a facility
6in which he or she assists residents with the self-administration
7of medication.
8(b) Each employee who received training and passed the
9examination required in paragraph (5) of subdivision (a), and who
10continues to assist with the self-administration of medicines, shall
11also complete eight hours of in-service training on
12medication-related issues in each succeeding 12-month period.
13(c) The requirements set forth in subdivisions (a) and (b) do not
14apply to persons who are licensed medical professionals.
15(d) Each residential care facility for the elderly that provides
16employee
training under this section shall use the training material
17and the accompanying examination that are developed by, or in
18consultation with, a licensed nurse, pharmacist, or physician. The
19licensed residential care facility for the elderly shall maintain the
20following documentation for each medical consultant used to
21develop the training:
22(1) The name, address, and telephone number of the consultant.
23(2) The date when consultation was provided.
24(3) The consultant’s organization affiliation, if any, and any
25educational and professional qualifications specific to medication
26management.
27(4) The training topics for which consultation was provided.
28(e) Each person who provides employee training
under this
29section shall meet the following education and experience
30requirements:
31(1) A minimum of five hours of initial, or certified continuing,
32education or three semester units, or the equivalent, from an
33accredited educational institution, on topics relevant to medication
34management.
35(2) The person shall meet any of the following practical
36experience or licensure requirements:
37(A) Two years of full-time experience, within the last four years,
38as a consultant with expertise in medication management in areas
39covered by the training described in subdivision (a).
P26 1(B) Two years of full-time experience, or the equivalent, within
2the last four years, as an administrator for a residential care
3facility for the elderly, during which time the individual has
acted
4in substantial compliance with applicable regulations.
5(C) Two years of full-time experience, or the equivalent, within
6the last four years, as a direct care provider assisting with the
7self-administration of medications for a residential care facility
8for the elderly, during which time the individual has acted in
9substantial compliance with applicable regulations.
10(D) Possession of a license as a medical professional.
11(3) The licensed residential care facility for the elderly shall
12maintain the following documentation on each person who provides
13employee training under this section:
14(A) The person’s name, address, and telephone number.
15(B) Information on the topics or subject matter
covered in the
16training.
17(C) The times, dates, and hours of training provided.
18(f) Other training or instruction, as required in paragraphs (1)
19and (2) of subdivision (a), may be provided offsite, and may use
20various methods of instruction, including, but not limited to, all
21of the following:
22(1) Lectures by presenters who are knowledgeable about
23medication management.
24(2) Video recorded instruction, interactive material, online
25training, and books.
26(3) Other written or visual materials approved by organizations
27or individuals with expertise in medication management.
28(g) Residential care facilities for the elderly licensed to
provide
29care for 16 or more persons shall maintain documentation that
30demonstrates that a consultant pharmacist or nurse has reviewed
31the facility’s medication management program and procedures at
32least twice a year.
33(h) Nothing in this section authorizes unlicensed personnel to
34directly administer medications.
35(i) This section shall become operative on January 1, 2016.
Section 1569.696 is added to the Health and Safety
38Code, to read:
(a) All residential care facilities for the elderly that
40serve residents with postural supports, as described in Section
P27 187608 of Title 22 of the California Code of Regulations, or
2restricted health conditions or health services, as described in
3Section 87612 of Title 22 of the California Code of Regulations,
4or who receive hospice services, as described in Section 87633 of
5Title 22 of the California Code of Regulations, in addition to
6complying with the training requirements in Section 1569.625,
7shall meet the following training requirements for all direct care
8staff:
9(1) Fifteen hours of training on the care, supervision, and special
10needs of those
residents, prior to providing direct care to residents.
11The facility may utilize various methods of instruction, including,
12but not limited to, preceptorship, mentoring, and other forms of
13observation and demonstration. The orientation time shall be
14exclusive of any administrative instruction.
15(2) Twelve hours thereafter of in-service training per year on
16the subject of serving those residents.
17(b) This training shall be developed in consultation with
18individuals or organizations with specific expertise in the care of
19those residents described in subdivision (a). In formulating and
20providing this training, reference may be made to written materials
21and literature. This training requirement may be provided at the
22facility or offsite and may include a combination of observation
23and
practical application.
24(c) This section shall become operative on January 1, 2016.
end insertNo reimbursement is required by this act pursuant to
27Section 6 of Article XIII B of the California Constitution because
28the only costs that may be incurred by a local agency or school
29district will be incurred because this act creates a new crime or
30infraction, eliminates a crime or infraction, or changes the penalty
31for a crime or infraction, within the meaning of Section 17556 of
32the Government Code, or changes the definition of a crime within
33the meaning of Section 6 of Article XIII B
of the California
34Constitution.
O
96