Source: https://rcfereform.org/faq-page/114
Timestamp: 2019-04-21 17:00:02+00:00

Document:
Title 22, §87101(v)1) a "vendor" means a CCLD-approved ". . . institution, association, individual(s), or other entity that assumes full responsibility or control over a [CCLD]-approved Initial Certification Training Program or a Continuing Education Training Program."
A waiver, per Title 22, §87101(w)(1), allows for ". . . variance to a specific regulation based on a facility-wide need or circumstance which is not typically tied to a specific resident or staff persons. Requests for waivers are made to the licensing agency, in advance, by an applicant or Licensee. "
The most common waiver requested is a hospice waiver. When a facility requests a hospice waiver, it is requesting permission to accept, or retain any resident, at any time in the future, who may require hospice services. The facility must submit a written request for a waiver. Typically, Community Care Licensing (CCL) will approve the waiver if the facility is determined, through a case management visit, to be in substantial compliance.
A waiver is in contrast to an "exception" , which is a variance from the regulations based on a unique need or circumstance of a specific resident or staff person. An exception cannot be transferred or applied to any other individual.
According to Title 22, §87101(s)(9), "substantial compliance" means the absence of any deficiencies which would threaten the physical health, mental health, safety and/or welfare of the residents.
Throughout our reviews, CARR found that "substantial compliance" was a subjective, rather than objective, designation. This, we concluded, was due to the discretionary nature with which the regulations are enforced. For example, one Licensing Program Analyst (LPA) may deem a water temperature or food service violation, if corrected at the time of visit, as not worthy of a deficiency, where as another LPA may cite the deficiency regardless of whether the deficiency was corrected on-the-spot.
Licensing Program Analysts, or LPAs, are the employees of Community Care Licensing Division (CCLD) responsible for licensing, evaluating, and investigating Residential Care Facilities for the Elderly (RCFEs). They conduct site visits and, in the presence of deficiencies, have the authority to issue citations and civil penalties.
Title 22, §87101(r)(6) defines "responsible person" as the ". . . individual or individuals, including a relative, health care surrogate decision maker or placement agency, who assist the resident in placement, or assume varying degrees of responsibility for the resident's well-being."
According to Title 22, §87101(n)(2), a non-ambulatory person "means a person who is unable to leave a building unassisted under emergency conditions. It includes, but is not limited to, those persons who depend upon mechanical aids such as crutches, walkers and wheelchairs. It also includes persons who are unable, or likely to be unable, to respond physically or mentally to an oral instruction relating to fire danger and, unassisted, take appropriate action relating to such danger."
Residents with dementia, and bedridden residents are considered non-ambulatory. A facility's license reflects the number of ambulatory and non-ambulatory residents a facility may serve at any one time. Additionally, some facility rooms may not be cleared to house non-ambulatory residents per the Fire Marshal.
Title 22, §87101 (l)(1) and H&SC §1569.2(g) defines "license" to ". . . mean a basic permit to operate a residential care facility for the elderly."
The license should be posted prominently in every facility, demonstrating Community Care Licensing's (CCLD's) care parameters approved by the state.
Title 22, §87101 (l)(3) " 'Licensee' means the individual, firm, partnership, corporation, association, or county having the authority and responsibility for the operation of a licensed facility."
The Licensee's name appears on each License.
The Licensee is the individual, partnership or corporation that has the authority and responsibility for the operation of the licensed RCFE. To become a Licensee, the individual or 'legal entity' must attend the mandatory orientations, and successfully complete the application process. The License to operate an RCFE is issued in the name of the Licensee.
According to the regulations, the Licensee may, or may not, act as the administrator of the RCFE. It is very common in smaller facilities (1-6 bed facilities), for the Licensee to also act as the Administrator. In larger facilities, an Administrator is usual hired by the Licensee. The individual serving as the Administrator of an RCFE must meet the educational and experience requirements of Title 22.
Title 22, §87101(h)(1), defines "healing wounds include cuts, stage one and two dermal ulcers [bedsores] as diagnosed by a physician, and incisions that are being treated by an appropriate skilled professional with the affected area returning to its normal state."
Healing wounds are sometimes referred to as 'decubitus ulcers," "pressure sores," or "bed sores."
Title 22, §87101(t)(2), defines "transfer trauma" ". . . means the consequences of the stress and emotional shock caused by an abrupt, involuntary relocation of a resident from one facility to another."
(1) A resident who requires ". . . assistance in turning and repositioning in bed", and is unable to leave a building unassisted under emergency conditions.
(2) A resident who is ". . . unable to independently transfer to and from bed. . ." and is unable to leave a building unassisted under emergency conditions.
RCFEs caring for residents receiving hospice services must meet specific qualifications as stipulated in Title 22, §87633. Providing Hospice Care.
(2) If assistance in the care of the ostomy is provided by an appropriately skilled professional.
(3) Privacy is afforded when care is provided.
(4) The used bags are discarded appropriately.
Additionally, the bag and adhesive may be changed by facility staff who have been instructed by the appropriately skilled professional. The facility must maintain written documentation provided by the appropriately skilled professional, outlining the instruction of the procedures delegated, and the names of the facility staff who have been instructed. The appropriately skilled professional shall review the procedures and techniques no less than twice a month.
Title 22, §87101(e)(6) "exception" ". . .means a variance from a specific regulation based on the unique need or circumstances of a specific resident or staff person." An exception cannot be transferred or applied to any other individual. Requests for exceptions are made to CCLD by the Licensee.
Title 22, §87101(c)(2), defines "capacity" as the ". . . maximum number of persons authorized to be provided services at any one time in any licensed facility."
If a facility wishes to change its capacity, it must request a Change in Capacity from CCLD, via a LIC 200. One approved for additional residents, the state issues to the Licensee a new license reflecting the change. The Capacity a facility is licensed for appears on each License (LIC 203). Providing care to more residents than stated on the License is a violation of Title 22, §87204(a).
According to Title 22, §87101(d)(2), "deficiency" ". . . means any failure to comply with any provision of the Residential Care Facilities Act for the Elderly and regulations adopted by the Department pursuant to the Act."
A licensee must give 30 days written notice delivered in person or via mail to the resident and/or resident's responsible party. Three (3) day evictions (aka expedited evictions) are possible with approval from the Department. Approval for an expedited eviction will only be granted if the Department finds good cause. Good cause exists if the facility can prove the resident is engaging in behaviors threatening to the well-being of other residents.
2) Failure of a resident to comply with state or local law after a written notice of the alleged violation has been issued from the appropriate authorities. The violation must be deemed as one that affects the well-being of other residents. For example, a driving violation would not be grounds for eviction unless the resident was responsible for driving other residents.
3) Failure of a resident to comply with the written policies of the facility. These policies must be contained in the signed admissions agreement. Said policies must be in place for the purpose of making communal living possible.
4) If a resident is deemed through a reappraisal to be no longer appropriate for the facility. While the licensee can conduct the reappraisal (§87463), they must bring any significant changes in a resident's condition to the attention of the resident's physician, family and responsible party and must arrange a meeting to include all parties. It has been noted that some facilities attempt to misuse this section as an opportunity to dump a difficult or high-needs resident. If the facility should have reasonably predicted the resident's current condition during the admissions process and admitted them in spite of, than the facility remains responsible for providing the necessary care. For example, if the resident is admitted with a diagnosis of dementia and begins to wander, it is the facility's responsibility to properly address this behavior. They cannot seek the remedy of eviction since this is not a change in condition but rather a behavior that should have been anticipated by the licensee given the resident's diagnosis of dementia.
Should a reappraisal determine that the resident has a developed a prohibited health condition (link) then the facility may request a waiver to retain the resident or the resident will need to be moved to a higher level of care.
Note to consumer: LPAs are not medical professionals and are, therefore, limited in their ability to determine whether or not a facility is truly qualified for a waiver that expands the scope of care of a facility. CARR recommends families discuss with a trusted physician or nurse, the specific requirements and attention necessary to ensure the health of a medically-compromised resident living in a non-medical environment. Additionally, families’ continued vigilance is paramount in all circumstances surrounding changes in conditions.
5) A change in the use of the facility.
Residents have the right to file a complaint regarding evictions. Residents and/or their families can contact the local Community Care Licensing Office. The Department is mandated to investigate a complaint within 10 days. Click here for a list of Program Offices and contact information.
Should a resident remain after the effective date of the eviction, then the facility must file an unlawful detainer action with the superior court and get a written judgment signed by a judge to have the resident evicted. Only a sheriff or sheriff's deputy is authorized to physically evict a resident. A licensee is not authorized to take any physical action to remove the resident and/or their belongings from the facility or deny them access.
During the 30 days and after (should the resident remain) it is still the facility's responsibility to provide uninterrupted care and services to the resident.
More information on enforcement of these polices can be found in CANHR's archive.
Title 22, §87101(d)(4) defines "dementia" to mean ". . . the loss of intellectual function (such as thinking, remembering, reasoning, exercising judgment and making decisions) and other cognitive functions, sufficient to interfere with an individual's ability to perform activities of daily living or to carry out social or occupational activities. Dementia is not a disease itself, but rather a group of symptoms that may accompany certain conditions or diseases, including Alzheimer's Disease. Symptoms may include changes in personality, mood and/or behavior. Dementia is irreversible when caused by disease or injury, but may be reversible when caused by depression, drugs, alcohol, or hormone/vitamin imbalances."
There is a regulatory difference between Licensees providing care of residents with dementia (Title 22, Section 87705), and Licensees who "advertise, promote, or otherwise hold themselves out as providing special care, programming and/or environments for residents with dementia (Title 22, Section 87706). Also, not all facilities are approved by the state to provide dementia care; CARR's review of 354 files revealed that Licenses (LIC 203) issued by CCLD frequently do not state whether a facility provides Dementia care. If it is unclear from the License whether Dementia care is provided, the consumer should ask for clarification.
The state once required Dementia waivers before Licensees could care for residents with dementia; Dementia Waivers are no longer required.
Prior to accepting any residents, the licensee must notify CCLD and obtain an appropriate fire clearance for the clients the RCFE plans to serve.
All facilities must maintain an appropriate fire clearance approved by the fire department having jurisdiction over the area the facility is located in.
The request (STD 850) for Fire Marshal Clearance (FMC) is forwarded to the local Fire Marshal Office, or Fire Protection Jurisdiction. The agency then schedules a tour of the facility, and notes any approvals or special conditions on the body of the STD 850. The completed document is signed by the agency and returned to CCLD for its action. Fire clearances are required for non-ambulatory, hospice and bedridden resident acceptance and retention.

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