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Adult and Senior Care Update - May 2004
COMMUNITY CARE LICENSING ADULT & SENIOR CARE UPDATE
This is our second 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. 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 (Waivers and Exceptions): These regulations became effective on January 1, 2004. They eliminate the requirement for the licensee to obtain approval from the licensing agency to provide specified routine care for certain health related conditions. These regulations were filed on an emergency basis. Under the emergency procedure, the regulations became effective prior to the public hearing. Modifications were made to the regulations based on comments received at the February 11, 2004, public hearing. The changes consist of a definition of a "licensed professional", removal of "nebulizers" from the list of restricted health conditions and other minor grammatical changes. The 15-day re-notice ended on April 26, 2004. No additional testimony was received and no further amendments are being made to these regulations. The regulations have been submitted to the Office of Administrative Law for review. It is anticipated that the final regulations will become effective in early July 2004.
Records Removal and Reproduction Regulations: These proposed regulations clarify and delineate the Department's authority to inspect, audit, and copy client/resident 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 these proposed regulations will be held on June 16, 2004, at 10:00 a.m. in the first floor auditorium at 744 P Street in Sacramento.
Dementia Regulations for Residential Care Facilities for the Elderly (RCFEs): These regulations address necessary safeguards for residents with dementia, while maximizing their independence. The regulations also implement the provisions of Assembly Bill 1753, (Chapter 434, Statutes of 2000). This statute adds training requirements for direct care staff working for licensees who advertise or promote specialized dementia care/programming and/or environments. In addition, licensees of these facilities must include a brief narrative description about the special features of their facility in their plan of operation. The Department made the regulatory changes to meet the "clarity" standard of Government Code Section 11349.1. The required 15-day re-notice ended on April 1, 2004 with no public comments received. The regulations were resubmitted to the Office of Administrative Law on April 21, 2004. It is anticipated that these regulations will become effective in early July 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. We anticipate this package to be ready for processing by this summer.
Age Exceptions for Adult Residential Facilities: We are developing emergency regulations to eliminate the need for a licensee to request an exception when a client reaches 60 years of age. The criteria will be based upon a percentage between the capacity and census of the facility. We anticipate this package to be ready for processing by this summer.
ADULT AND ELDER ABUSE RECOGNITION AND REPORTING TRAINING
A recent survey conducted by the local Ombudsman in the Sacramento and surrounding areas, indicates that many licensees are not meeting the mandate to ensure that all staff are trained on the recognition and reporting of dependent adult and/or elder abuse. Legislation passed in 1999 and 2001 requires Adult Community Care Facilities (Adult Residential Facility, Adult Day Care, Adult Day Support Center and Social Rehabilitation Facility) and Residential Care Facilities for the Elderly (RCFEs) to provide minimal core training to facility staff on recognizing and reporting elder and dependent adult abuse. The law further requires that the training provided to staff, must be the curriculum provided by the Department of Justice (DOJ).
The DOJ is responsible for the development and distribution of the training materials, which includes a training curriculum and videotape. All new employees must receive this training within 60 days of their first day of employment. Newly licensed facilities will receive this training material directly from DOJ and staff training must be completed within six months of the beginning date of operation.
Licensees who need another copy of the materials, or who have not received training materials within 60 days of initial licensure, should contact the Crime Prevention Unit within the DOJ at (916) 324-7863 to request this material.
As part of the facility visit, Licensing Program Analysts will review the personnel files for documentation that the abuse reporting material has been reviewed by staff. In addition, each staff should complete the SOC 341A, acknowledging the employee's responsibility and rights regarding abuse reporting.
REQUIREMENTS WHEN THERE IS A CHANGE OF ADMINISTRATOR
A provider association recently posed the question about what licensees need to submit when there is a change of administrator. The reporting requirements section of the regulations states the licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following: 1) Name and residence and mailing addresses of the new administrator; 2) Date he/she assumed his/her position; and 3) Description of his/her background and qualifications, including documentation of required education and administrator certification, a photocopy of the documentation is acceptable. In addition to the written notification the following documentation is required:
- LIC 308 Designation of Administrative Responsibility
- LIC 500 Personnel Report - specifying the administrator's work hours
- LIC 501 Personnel Record
- Copy of the Administrator Certificate (applicable to Adult Residential & Residential Care Facilities for the Elderly)
- A criminal record clearance that is associated to the facility where they will be working. This is required prior to the administrator's employment or presence in the facility (Licensees can use the LIC 9182 to request a criminal record clearance transfer). Please note that if the administrator has previously been granted a criminal record exemption to work, you must use the LIC 9188 to request a transfer of the criminal record exemption transfer.
- For corporate licensees, a copy of the board resolution. If not available at the time of the change, the written notification must include the date of the next board meeting and the resolution must be sent to the licensing office after the board adopts the resolution.
A memorandum was distributed to the regional and local unit managers about this process. Copies of the LIC forms can be found on the CCLD website at www.ccld.ca.gov . If you have any questions, please contact your Licensing Program Analyst or your local licensing office.
SENIOR CARE PROGRAM OFFICE RELOCATION & NEW UNIT MANAGER
The Statewide Senior Care Program Office has officially moved from San Bruno to Sacramento. Their new address is: 744 P Street, MS 10-90, Sacramento, CA 95814. The telephone and fax numbers are included in the attached senior care telephone list. The Senior Care Program now shares office space with the Continuing Care Contracts Branch. The two programs have been merged under Ben Partington, Statewide Senior Care Program Administrator.
The Senior Care Program is pleased to announce that Lisa Schoenthal has been appointed to the position of Local Unit Manager in the San Bruno Regional Office. Lisa has worked for Community Care Licensing Division as a Licensing Program Analyst and as an analyst in the Technical Support Program. Lisa is a welcomed addition to the Regional Office management team.
NEWS BRIEFS
- The Sierra-Cascade Licensing Office located in Fresno has recently changed their telephone numbers. Please refer to the attached telephone list for the new contact numbers.
- The American Heart Association recently announced new guidelines aimed at preventing heart disease in women. Go to www.americanheart.org
- Elderly U. S. patients are prescribed improper medications in about one out of every 12 physician visits, according to a Center for Disease Control study published recently in the Archives of Internal Medicine. The study, which examined patient data from hospital outpatient departments, and physician offices from 1995 to 2000, found that elderly patients were prescribed improper medications about 8% of the time, or in an estimated 16.7 million physician visits. According to the study, physicians were more likely to prescribe improper medications when they prescribed more than one treatment. Go to http://archinte.ama-assn.org/cgi/content/abstract/164/3/305 for more information.
- May 2004 has been proclaimed, "Older Californians Month." This year's theme, "Aging Well, Living Well," highlights the importance of healthy living through good nutrition and proper exercise. "Life expectancy in California is longer than that of the nation as a whole," said State Aging Director Lynda Terry. "California's older adults are living longer, healthier and more productive lives." We must not become complacent. An estimated 37 percent of older Californians still lead a sedentary lifestyle, resulting in increased physical and mental health risks."
Governor Arnold Schwarzenegger joined Director Terry in recognizing California's seniors by proclaiming May 2004 as "Older Californians Month." "We honor our older Californians whose vast contributions forged our state infrastructure, protected our natural wonders, developed our education system and built the foundation for our powerful economy," proclaimed Schwarzenegger. "Throughout the month of May, we pay tribute to their enriching contributions and the knowledge and perspective they have imparted on younger generations."
California is home to approximately five million residents 60 years of age and older. That number is expected to increase to nine million by 2020 and will represent more than 20 percent of California's total population. Recent studies also indicate that the average life span in California is 78.8 years of age, nearly one year longer than that of people living in other states. In 1965, the federal government recognized the value of the country's seniors and passed the Older Americans Act, which initiated many programs designed to help seniors. "We will continue working to make California a community for all ages, while encouraging wellness among seniors by assisting them in remaining independent at home and living independent lives in their communities," added Terry. For more information about "Older Californians Month," visit this link for Governor Schwarzenegger's Website
CRIMINAL BACKGROUND CHECK PROCEDURES
There have been questions raised recently regarding responsibilities of licensees when they choose not to request an exemption on behalf of a prospective employee who has a criminal record. Licensees are reminded that if they elect not to request a criminal record exemption for an employee/prospective employee, they must provide him/her with the Individual Exemption Request Letter . The individual then has the right to proceed with an exemption request on their own behalf. Without this exemption, the individual cannot work in, live in, or be associated with the facility.
When an employee/prospective employee has a criminal record, the Community Care Licensing Division Caregiver Background Check Bureau sends two letters. The first letter is addressed to the licensee and asks if the licensee wants to request an exemption on behalf of the individual. The second letter (Individual Exemption Request) is sent to the employee/prospective employee in care of the facility address. If the licensee chooses to request an exemption on behalf of the individual, the licensee is to check the yes box on page two of the Exemption Needed Letter, sign and send the information to begin the exemption request process. If the licensee does not want to request an exemption on behalf of the individual, he/she is to check the no box, sign and return the second page of the letter. In that situation, the individual is disassociated from the facility and cannot be present in a licensed facility. If the individual seeks an exemption for him/herself and is approved for an exemption, the exemption may be transferred to any licensee who wishes to hire him/her. (Note: Foster Family Agency Certified Home foster parents are not eligible to apply for an Individual Exemption).
TRANSFER OF CRIMINAL RECORD EXEMPTIONS
Some licensees are requiring individuals who have already obtained a criminal record exemption to go through the fingerprint process again. Doing so is unnecessary, expensive and will significantly delay the exemption transfer. Prior to allowing individuals who have a current exemption to work in a new facility, the licensee must request that the exemption be transferred by completing the Criminal Record Exemption Transfer Form (LIC 9188) and sending the completed form to their Community Care Licensing Division Regional Office. The Regional Office will forward the LIC 9188 to the Caregiver Background Check Bureau for processing. This form is available on-line at: www.dss.cahwnet.gov/forms/english/LIC9188.PDF.
RESIDENTIAL CARE FACILITIES UNDER THE FAIR LABOR STANDARDS ACT - U.S. DEPARTMENT OF LABOR FACT SHEET #23
The United States (U.S.) Department of Labor, Wage and Hour Division is responsible for the administration of the Fair Labor Standards Act (FLSA) in the area of wages and compensation. In a joint effort with the Wage and Hour Division, each of our updates feature one in a series of fact sheets providing general information on various topics. Enclosed is a fact sheet entitled Overtime Pay Requirements of the FLSA. Additional information can be obtained from the Department of Labor website at www.dol.gov or by calling their toll-free information service number, (866) 889-5627. Please review Fact Sheet #23 at the following address: www.dol.gov/esa/regs/compliance/whd/whdfs23.htm .
USE OF MANAGEMENT COMPANIES AS CO-LICENSEES
Licensing staff have noticed an increase in the number of licensees who have signed contracts with management companies to operate or help operate their facilities. Section 1569.10 of the Health and Safety Code requires that any entity, such as a person, firm, partnership, association, or corporation which contracts to operate or manage a residential facility for the elderly must hold a valid license to do so.
Although the relationship between an applicant/licensee and a management company is not the same as a partnership, the management company is still required to be included on the licensee application. A copy of the contract between the licensee/applicant and the management company must be submitted with the application for licensure.
If a management company is hired to manage a licensed facility, an "abbreviated" application is usually all that is required. However, failure to add management companies to licenses as co-licensees could result in civil penalty assessments of up to $200 per day. If you have questions regarding management companies and their licensing requirements, please contact your local Senior Care Program Regional Office.
THE WEST NILE VIRUS IN CALIFORNIA
With summer fast approaching, the news media have highlighted the health threats posed by the West Nile virus (WNV). WNV is a disease transmitted to humans by infected mosquitoes. Licensees are reminded to drain any standing water to prevent mosquitoes from breeding, and should install or repair screens to prevent mosquitoes from coming indoors. A WNV guideline for long-term care facilities is on the California Department of Health Services website at www.dhs.ca.gov .
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,
DAVE DODDS
Deputy Director
Community Care Licensing Division
Enclosures