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Adult and Senior Care Update - February 2004

COMMUNITY CARE LICENSING ADULT & SENIOR CARE UPDATE

This is our first 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.

UPDATE ON GOVERNOR SCHWARZENEGGER'S EXECUTIVE ORDER

As you may be aware, Executive Order (EO) S-2-03, in part, provided for a freeze and reassessment of regulatory actions pending on November 17, 2003. The Governor's Office issued a subsequent memo dated December 8, 2003, which provided additional information and guidance on the effect of the EO. Specifically, the December 8, 2003 memo states, "The Order…does not apply to new regulatory actions commenced subsequent to November 17, 2003. New regulatory actions are those noticed for the first time under Government Code 11346.4 after November 17, 2003, or emergency regulations adopted for the first time by the agency after November 17, 2003." The Department was able to receive approval to move forward with the regulatory packages already in process.

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 become effective prior to the public hearing. The regulations are effective for 120 days.

A public hearing was held on February 11, 2004, in Sacramento. We are currently responding to the testimony we received.

Hospice Regulations for Adult Residential Facilities (ARF): These regulations permit licensees to request a waiver from the Department to allow a client diagnosed with a terminal illness to receive hospice care services in an Adult Residential Facility. These regulations are effective as of January 16, 2004, and provide consistency between the ARF licensing category and RCFEs in the area of hospice care services.

Records Removal and Reproduction Regulations: These regulations will clarify and establish the Department's authority to inspect, audit, and copy client/resident or facility records during normal business hours. They will also permit licensing staff to remove records if necessary for copying. Safeguards will prohibit the removal of emergency or health-related information (unless duplicate information is available), and standards will be established for the safe removal and timely return of records to facilities.

These regulations will apply to all facility categories and will enhance the Department's ability to protect the health and safety of clients/residents in care. The public hearing will take place in Sacramento within the next few months, and revisions to the regulations will be made as necessary in response to public testimony.

Fire and Life Safety Emergency Regulations: These regulations will clarify requirements for smoke detectors and fire extinguishers in residential care facilities and child care centers; will set standards for emergency drills; and will make related regulations consistent across facility categories. We are continuing to work with the State Fire Marshal's (SFM) office to refine the draft regulations and to avoid any conflicts with existing codes and regulations. The SFM must approve the regulations before they can be submitted to the Office of Administrative Law. As we indicated previously, these are emergency regulations that will take effect immediately upon approval by the Office of Administrative Law. The public hearing will be held thereafter and necessary revisions based upon testimony will be made.

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. On January 22, 2004, the Office of Administrative Law notified the Department of the disapproval of the regulation package because of a failure to follow required regulatory procedures and to comply with the "clarity" standard of Government Code Section 11349.1. The Department is in the process of making the necessary regulatory changes. These changes are substantive and require an additional 15-day renotice. The Department has a May 21, 2004, deadline to submit these regulations to the Office of Administrative Law for approval.

Secured Perimeters in Adult Day Care Facilities and Adult Day Support Centers: These regulations implement Senate Bill (SB) 1361 (Chapter 729, Statutes of 1998) that adds Section 1531.2 to the Health and Safety Code to permit licensees of Adult Day Programs to install secured perimeter fences or delayed egress devices of the time-delay type on exit doors. The State Fire Marshal (SFM) developed regulations to allow the use of secured perimeter fences and/or special egress control devices in adult facilities providing day care. The regulations were scheduled to be heard again in January 2004. The State Fire Marshal was unable to obtain an exemption for the proposed/pending regulation package prior to the California Building Standards Commission meeting scheduled for January 7, 2004, and therefore requested the regulation package be withdrawn. We cannot introduce regulations until the SFM adopts new regulatory requirements. You will be kept informed in future updates on the status of this package.

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 in early Spring.

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 the percentage to the facility's census.

BLOOD-GLUCOSE MONITORING IN RESIDENTIAL CARE FACILITIES FOR THE ELDERLY

There has been some confusion regarding who can administer a finger-stick test to a diabetic resident of a Residential Care Facility for the Elderly (RCFE) for the purposes of blood-glucose monitoring. Only a licensed health-care professional can administer the finger-stick test to a diabetic resident of an RCFE because the California Medical Board has determined that administration of the test is a medical procedure. However, facility staff may assist a diabetic resident of an RCFE with self-administration of the finger-stick test, including steadying the resident's hand or helping the resident read the manufacturer's instructions. Assistance does not include actually pressing the resident's finger or hand down on the device to prick the skin.

In addition, staff of an RCFE may perform a glucometer reading without an exception as long as they are properly trained to perform the reading. However, although facility staff may read the number on a blood-glucose testing device for a resident, they cannot interpret the number. Facility staff cannot monitor a health condition, make a determination on the amount of medication required based on a reading, or make any other medical decision based on the reading.

CHANGE IN LICENSING FEES

Assembly Bill (AB) 1752, Chapter 225, Statutes of 2003, amended Health and Safety Code section 1523.1, 1568.05 and 1569.105 to reflect an increase in licensing fees. The increase in fees based on facility type and capacity became effective August 4, 2003.

RESIDENTIAL CARE FACILITIES UNDER THE FAIR LABOR STANDARDS ACT -
U.S. DEPARTMENT OF LABOR FACT SHEET #44

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 Visits to Employers. This Fact Sheet provides general information about the laws enforced by the Wage and Hour Division. 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 #44 at the following address: www.dol.gov/esa/regs/compliance/whd/whdfs44.htm for those requirements, please contact the Department of Industrial Relations at www.dir.ca.gov or call (800) 963-9424 for employer consultation services.

NEW FACILITY SEARCH FEATURE ON THE CCLD WEBSITE

The Community Care licensing Division website has changed. Now someone can order a statewide list for any category. This was not possible previously. People can still also sort by city, county or zip code.

OMBUDSMAN POSTER REQUIREMENTS

Welfare and Institutions Code (W & I Code) Section 9718 requires that the Ombudsman poster be placed in a conspicuous location in all Residential Care Facilities for the Elderly. The poster notifies residents, family members, friends and facility staff of the local Ombudsman Program telephone number and of the toll-free CRISIS Line number. The poster and other information can be obtained by contacting the ombudsman program serving the county in which your facility is located.

LICENSED 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 Office locations 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