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Adult and Senior Care Updates - August 2004

COMMUNITY CARE LICENSING ADULT & SENIOR CARE UPDATE

This is our third Adult and Senior Care Update for 2004. It also marks the eleventh year of our efforts to keep the residential care community informed about licensing programs and services. The Updates continue to be an important method for sharing information. We appreciate your support in sharing these Updates with those in your organization and others interested in adult and senior care issues.

REGULATION PACKAGES

The following regulation packages for adult and senior care facilities are currently in process or completed. If you have questions about any of the proposed regulations, please contact our Policy Development Bureau, at (916) 324-4312. For copies of the proposed regulations or more information about hearing schedules, contact the Department's Office of Regulations Development at (916) 657-2586 or visit their website at www.dss.cahwnet.gov/ord/default.htm. Please note that depending on the version of software that you are currently using, it might be necessary to press your control key to activate the hyperlinks found throughout this document.

Health-Related Conditions in Residential Care Facilities for the Elderly: These regulations became effective June 10, 2004, and permit licensees to provide care for certain health related conditions, without prior approval from the licensing agency.

Some of the changes to the regulations include:

  • Definition of the terms "Licensed Professional" and "Non-Compliance Conference."
  • Removal of the licensing approval requirement for use of postural supports and bed rails under specified conditions.
  • Update of Handbook (Section 87691(f)(2)) to reflect current law for disposal of contaminated needles.
  • Removal of liquid oxygen from list of prohibited health conditions.
  • Care requirements for Restricted Health Conditions are added to Section 87701.2(a) through (d)(1). These sections specify safeguards to accept or retain a resident with restricted health conditions.
  • Licensees with serious compliance issues must continue to obtain prior Departmental approval.
  • Removes need for prior licensing approval for gas oxygen administration by an appropriately skilled professional, and removes seven foot tubing length restriction. Adds requirements for acceptance or retention of a resident who requires liquid oxygen.
  • Allows an appropriately skilled professional to operate and care for a resident who requires use of an Intermittent Positive Pressure Breathing (IPPB) machine, without prior licensing approval. As a result of testimony, nebulizer, added to this section in the initial emergency regulations, is removed. Nebulizer devices are passive and much simpler than IPPB machines and therefore are not subject to the same requirements.
  • Allows an appropriately skilled professional to care for a resident who requires ostomy care without prior licensing approval; and, allows trained facility staff to change the ostomy bag and adhesive without prior licensing approval.
  • Allows care and/or supervision of contractures by an appropriately skilled professional without prior licensing approval.
  • Removes the requirement for prior licensing approval when the resident requires care for a healing wound by or under the supervision of an appropriately skilled professional. In addition, it allows an appropriately skilled professional, such as a Registered Nurse to diagnose the stage of the pressure sore. Insertion of eye drops following cataract surgery is removed from this section. Assistance with insertion of eye drops following cataract surgery can be safely done by facility staff that routinely assists with administration of medication and eye drops for other medical reasons.

Contact your Licensing Program Analyst or the local licensing office if you have questions. You may review the regulations at: www.dss.cahwnet.gov/getinfo/pdf/f090322r.PDF.

Dementia Regulations for Residential Care Facilities for the Elderly (RCFEs): These regulations became effective July 3, 2004. They address necessary safeguards for residents with dementia, while maximizing their independence. Licensees of facilities that advertise or promote dementia special care, programming, and/or environments must include a brief narrative description about the special features of their facility in their plan of operation. In addition, new training requirements were added for direct care staff working for licensees who advertise or promote specialized dementia care, programming, and/or environments. Direct care staff in these facilities shall complete six hours of resident care orientation within the first four weeks of employment. Direct care staff hired as of July 3, 2004, must complete eight hours of in-service training on serving residents with dementia within 12 months of that date and in each succeeding 12-month period.

Section 87725(b) specifies procedures for licensees who will no longer advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders. All licensees must meet those requirements by October 31, 2004. Also, Section 87725.2 provides additional timelines for licensees who were already advertising or promoting dementia special care, programming, and/or environments as of July 3, 2004, and who will continue to do so. Individuals licensed after July 3, 2004, will not need the additional timelines provided in Section 87725.2.

Records Removal and Reproduction Regulations: These proposed regulations clarify and delineate the Department's authority to inspect, audit, and copy client or facility records upon demand during normal business hours; and to remove them if necessary for copying. They also contain safeguards to prohibit the removal of health-related records (unless duplicate information is available); establish standards for the removal and return of records; and cut across facility categories. These regulations will enhance the Department's ability to protect the health and safety of clients/residents in care. The public hearing on the proposed regulations took place on June 16, 2004 in Sacramento. We are currently responding to the public testimony received and evaluating whether any changes need to be made to the regulations. If there are no significant changes to the regulations, we anticipate them being submitted to the Office of Administrative Law in September 2004.

Category Consolidation for Adult Day Programs: We are consolidating the General Licensing Requirements, Adult Day Care and Adult Day Support Center Regulations into a single category called Adult Day Programs to comply with Senate Bill 1982, Chapter 773, Statutes of 2002. The regulations were submitted to the Office of Regulations Development on July 12, 2004. We will inform you in future updates about the date and location of the public hearing.

Age and Postural Support Exceptions for Adult Residential Facilities: These regulations will eliminate the need for a licensee to request an exception when a client reaches 60 years of age and for the use of a postural support. The criteria for retaining a resident who has reached the age of 60 will be based upon a percentage between the capacity and census of the facility. This regulation package will also remove those approval/exception requirements under specified conditions. The licensee will have to meet the same regulatory conditions required by the approval/exception process. We will report in future updates about the progress of these regulations.

DON'T LEAVE PEOPLE IN CARS UNATTENDED

Each year around 200 people die as a result of a heat wave in some part of the country. Surprisingly, most are over 50 years of age. High blood pressure, heart or blood vessel problems, poorly working sweat glands, kidney disease, being overweight or underweight, lack of water consumption, and various prescription medications are all factors that put you at risk for heat exhaustion or heat stroke. A heat stroke is serious, and can be fatal, so medical help must be summoned right away. The signs of a stroke include:

  • Fainting
  • Change in behavior including confusion, being grouchy, staggering, acting strangely
  • A strong rapid pulse or a slow weak pulse
  • Flushed dry skin
  • A lack of sweat to cool the body.

Remember the temperature inside a car is hotter than outside temperatures and can climb very rapidly. For example, on a 93-degree day, the inside of a car can reach 125 degrees Fahrenheit in 20 minutes or less. Please be safe and do not leave dependent adults unattended in a vehicle; this is particularly important during the hot summer months. This happens frequently to children and pets also. Ask yourself if you could remain in the car with the doors locked and windows rolled up and the answer will be no. For more information about heat exhaustion please contact the National Institute of Health (NIH) at 1-800-222-2225, or visit their website at: www.nia.nih.gov. The NIH has free information on health and aging.

OUTBREAKS OF THE STOMACH FLU IN LONG-TERM CARE FACILITIES

Over the past two years there have been an increasing number of outbreaks of acute viral gastroenteritis (often called the "stomach flu") in long-term care facilities. In response, the California Department of Health Services (CDHS) has developed guidelines for controlling these outbreaks. With Fall just around the corner, these guidelines have been adapted for use by licensed residential community care facilities ( click here to view attachment ). Licensees are encouraged to follow the guidelines-which are considered "best practices"-to the extent possible. If you have questions or comments, please contact Jon Rosenberg ( jrosenbe@dhs.ca.gov ) or Chris Cahill ( ccahill@dhs.ca.gov ) by e-mail, or at (510) 540-2566. For a more detailed version of the guidelines, please see the CDHS web site at: www.dhs.ca.gov/ps/dcdc/disb/pdf/Gastroenteritis%20Outbreaks%20Report.pdf .

THE WEST NILE VIRUS IN CALIFORNIA

The West Nile Virus (WNV), a disease transmitted to humans by infected mosquitoes, continues to be a very real health threat in California. Licensees are reminded again to drain any standing water to prevent mosquitoes from breeding, and to install or repair screens to prevent mosquitoes from coming indoors. Review the WNV facts with your staff and residents found on the California Department of Health Services' web site at www.dhs.ca.gov/ps/dcdc/disb/pdf/LTCFs%20WNV%205-24-04.pdf .

RESIDENTIAL CARE STATISTICS

Enclosed are the most recent statistics on licensed Adult and Senior Care facilities and capacities. Further breakouts by category and location are available. Please direct your requests to Jeff Hiratsuka, Chief of the Central Operations Branch, at (916) 322-4875.

SUMMARY

If you have questions about items included in this Update or suggestions for future topics, please contact Cathleen McCoy, Chief of the Technical Assistance and Policy Branch, or me at (916) 657-2346. Also, please visit our website at www.ccld.ca.gov to obtain copies of Updates, office locations, provider letters, regulations, or to learn more about licensing services.

Sincerely,

Original signed by M. Mills
MARTHA MILLS
Interim Deputy Director
Community Care Licensing Division

Enclosures