Bill Text: CA SB911 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Residential care facilities for the elderly.

Spectrum: Strong Partisan Bill (Democrat 10-1)

Status: (Passed) 2014-09-28 - Chaptered by Secretary of State. Chapter 705, Statutes of 2014. [SB911 Detail]

Download: California-2013-SB911-Amended.html

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BILL NUMBER: SB 911	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 27, 2014
	AMENDED IN SENATE  MARCH 4, 2014

INTRODUCED BY   Senator Block
   (Coauthor: Senator Correa)
   (Coauthors: Assembly Members Ammiano, Brown, Chávez, Skinner,
Ting, Wieckowski, and Yamada)

                        JANUARY 23, 2014

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



	LEGISLATIVE COUNSEL'S DIGEST


   SB 911, as amended, Block. Residential care facilities for the
elderly.
   (1) Existing law, the California Residential Care Facilities for
the Elderly Act, provides for the licensure and regulation of
residential care facilities for the elderly by the State Department
of Social Services. A person who violates the act is guilty of a
misdemeanor and subject to civil penalty and suspension or revocation
of license.
   Existing law requires an applicant for a license to complete, at a
minimum, a 40-hour certification program approved by the department
that includes instruction in a uniform code of knowledge, and to pass
a written test.
   This bill would change the minimum hours of classroom instruction
to 100 hours, of which 80 hours are classroom instruction, and would
add additional topics to the uniform code of knowledge, including,
but not limited to, the adverse effects of psychotropic drugs for use
in controlling the behavior of persons with dementia. The bill would
also require the department to annually review the test and update
it as necessary to reflect changes in the law and regulations.
   This bill would require that no licensee, or officer or employee
of the licensee, shall discriminate or retaliate against any person
receiving the services of the licensee's residential care facility
for the elderly, or against any employee of the licensee's facility,
on the basis, or for the reason that, the person, employee, or any
other person dialed or called 911.
   This bill would require a residential care facility for the
elderly that accepts or retains residents with  restricted or
 prohibited health conditions  , as   defined
by the department,  to  employ a registered nurse on a
full-time or part-time basis, as appropriate, to oversee the care
provided to those residents. A residential care facility for the
elderly that accepts or retains residents with restricted or
prohibited health conditions would be required to have a registered
nurse on call 24 hours per day, as specified.   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  a residential care facility for the
elderly from these training requirements if the facility demonstrates
to the department that it only employs  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. This bill would also authorize the
department to develop a certification training program with a
standardized test for specified staff.
   (4) Existing law requires all direct care staff of a residential
care facility for the elderly, which advertises or promotes special
care, programming, or environment for persons with dementia, receive
6 hours of resident care orientation within the first 4 weeks of
employment and 8 hours of in-service training per year.
   This bill would increase that training to 15 hours of resident
care orientation, prior to providing direct care to residents, and 12
hours of in-service training per year on the subject of providing
care and supervision to residents with dementia.
   (5) Existing law requires that employees who assist residents with
the self-administration of medications at a licensed residential
care facility for the elderly, which provides care for 16 or more
persons, complete 16 hours of initial training, consisting of 8 hours
of hands-on shadowing training and 8 hours of other training or
instruction, to be completed within the first 2 weeks of employment.
If that facility provides care for 15 or fewer persons, employees are
required to complete 6 hours of initial training, consisting of 2
hours of hands-on shadowing training and 4 hours of other training or
instruction, to be completed within the first 2 weeks of employment.

   This bill would require employees at a licensed residential care
facility for the elderly that provides care for 16 or more persons,
 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.
   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 100 hours,
of which 80 hours are 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, and the adverse effects of psychotropic drugs for use in
controlling the behavior of persons with dementia.
   (8) Nonpharmacologic, person-centered approaches to dementia care.

   (9) Resident admission, retention, and assessment procedures.
   (10) Residents' rights, and the importance of initial  and
 ongoing training for all staff to ensure residents' rights are
fully respected and implemented.
   (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
and other stakeholder groups. The department shall review the test
annually and update it as necessary to reflect changes in law and
regulations.
   (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.  (a) 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.
   (b) A violation of this section is subject to civil penalty
pursuant to Section 1569.49.
  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 
prohibited 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.  
department, in Section 87615 of Title 22 of the California Code of
  Regulations, shall ensure that residents receive home
health or hospice services sufficient in scope and hours to ensure
that residents receive medical care as prescribed by the resident's
physician and contained in the resident's service plan. 

   (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.  
   (b) A residential care facility for the elderly that accepts or
retains residents with restricted health conditions, as defined by
the department, shall ensure that residents receive medical care as
prescribed by the resident's physician and contained in the resident'
s service plan by appropriately skilled professionals acting within
their scope of practice.  
   (c) An "appropriately skilled professional" means, for purposes of
this section, an individual who has training and is licensed to
perform the necessary medical procedures prescribed by a physician.
This includes, but is not limited to, a registered nurse, licensed
vocational nurse, physical therapist, occupational therapist, or
respiratory therapist. These professionals may include, but are not
limited to, those persons employed by a home health agency, the
resident, or a facility, and who are currently licensed in this
state.  
   (d) Failure to meet or arrange to meet the needs of those
residents who require specialized health services, or failure to
notify the physician of a resident's illness or injury that poses a
danger of death or serious bodily harm is a licensing violation and
subject to civil penalty pursuant to Section 1569.49. 
  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  jointly with the California
Department of Aging  requirements for a uniform core of
knowledge for the required initial certification and 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, applicable laws and regulations, residents' rights,
and administration. 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.
   (1) The initial certification training for administrators shall
consist of at least 100 hours.
   (2) The continuing education requirement for administrators is at
least 60 hours of training during each two-year certification period.

   (c) (1) The department shall develop 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.
   (2) The 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.
   (b) 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 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.
   (c) 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 40 hours of
training within the first four weeks of employment, at least 24 
hours  of which shall be completed prior to providing direct
care to residents, and 20 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 the subject
matter required for this training. 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.
   (d) 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. 
   (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.  
   (5) Use, misuse, and interaction of drugs commonly used by the
elderly, and the adverse effects of psychotropic drugs for use in
controlling the behavior of persons with dementia. 
   (6) The special needs of persons with Alzheimer's disease and
dementia, including nonpharmacologic person-centered approaches to
dementia care.
   (7) Psychosocial needs of the elderly.
   (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   certified nurse assistants  , 
certified  pursuant to Section 1337.2, except that certified
nurse assistants with valid certification shall receive eight hours
of training  ,  prior to providing direct care to
residents, on resident characteristics, resident records, and
facility practices and procedures.
   (e) The department may develop a certification training program
with a standardized test for staff pursuant to this section and
Sections 1569.626, 1569.69, and 1569.696.
  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) Fifteen hours of resident care orientation  ,
 prior to providing direct care to residents. All 15 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) Twelve hours of in-service training per year on the subject of
providing care and supervision to 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. 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 32 hours of initial training. This
training shall consist of 12 hours of hands-on shadowing training,
which shall be completed prior to assisting with the
self-administration of medications, and 20 hours of other training or
instruction, as described in subdivision (f), which shall be
completed within the first four weeks of employment.
   (2) In facilities licensed to provide care for 15 or fewer
persons, the employee shall complete 16 hours of initial training.
This training shall consist of eight hours of hands-on shadowing
training, which shall be completed prior to assisting with the
self-administration of medications, and eight 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,
errors, 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.
   (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
Sections 1569.625 and 1569.696.
   (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
eight 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, prior to providing direct care to
residents. 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.