Source: https://rcfereform.org/faq/Frequently-Asked-Questions-19
Timestamp: 2017-04-27 18:36:06
Document Index: 732373904

Matched Legal Cases: ['§87415', '§87303', '§87101', '§87618', '§87608', '§87217', '§87217', '§87101']

Frequently Asked Questions | Consumer Advocates For RCFE Reform
Night Supervision Title 22, §87415
The Licensee must designate the following number of people to assist in caring for residents in the event of an emergency between the hours of 10 pm and 6 am:
For facilities with 16 or fewer residents, one employee must be on the premise but need not be awake.
For facilities with 16 to 100 residents, a total of two employees must be available. At least one person shall be on the premises and awake. Another employee shall be on call, and be capable of responding within 10 minutes.
For facilities with 101 to 200, a total of three employees must be available. One employee must be on the premise and awake. Another employee on the premise but on call. And still another, on call and capable of responding within 10 minutes.
For every additional 100 residents (or fraction thereof), an additional employee must be on the premise and awake.
In facilities that require a signal system (Title 22, §87303), at least one employee must be located to enable an immediate response to the signal. If the signal system is visual only, this employee must be awake.
Non-ambulatory Person 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.
Oxygen Administration-Gas and Liquid: Restricted Health Condition Title 22 §87618
A facility may accept or retain a resident who requires the use of oxygen GAS if:
(1) the resident is mentally and physically capable of operating the equipment, is able to determine his/her need for oxygen, and is able to administer it him/herself *; OR
(2) intermittent oxygen administration is performed by an appropriately skilled professional.
*The facility is responsible for continuously monitoring the resident's ongoing ability to operate the equipment in accordance with the physician's orders.
Since a licensed professional is not required per regulation to be onsite 24/7 in an RCFE, in some cases the ability of a facility to guarantee intermittent administration and assistance by a skilled professional may be difficult. The regulations do, however, require that the facility staff have knowledge of, and the ability to operate the oxygen equipment. But they are not allowed to assist the resident, per the regulations; only an appropriate skilled professional is allowed to provide this assistance. In addition to the administration of oxygen, Title 22 includes the following requirements as they pertain to the oxygen equipment:
(1) The facility shall submit a written report to the local fire jurisdiction notifying them oxygen is in use at the facility.
(2) "No Smoking-Oxygen in Use" signs shall be posted in appropriate areas.
(3) Smoking shall be prohibited where oxygen is in use.
(4) Oxygen tanks that are not portable must be secured in a stand or to a wall.
(5) Plastic tubing from the nasal canula or mask to the oxygen shall be long enough to allow movement by the resident but not constitute a hazard to the resident or others.
(There are special conditions if oxygen tubing exceeds 7 feet in length. Refer to Title 22 or contact CARR if you require detailed information.)
(6) Oxygen from a portable source shall be used by residents when they are outside their rooms.
(7) Equipment shall be operable.
(8) Equipment shall be removed when no longer in use.
(9) Room size should be appropriate to accommodate all equipment.
A facility may accept or retain a resident who requires the use of LIQUID oxygen if:
(1) The licensee obtains prior approval from the licensing agency; AND
(2) If the resident is mentally and physically capable of operating the equipment, is able to determine his/her need for oxygen, and is able to administer it him/herself.
The regulations do not speak to a resident remaining in an RCFE if he requires assistance with liquid oxygen. Even if a licensed skilled professional is available to assist, it is not clear that the regulations allow this type of assistance. If this could be an issue for your resident, contact CCLD for regulatory clarification. Payment Options for Assisted Living in California Assisted living services in California are almost entirely private pay. Though, there is some governmental assistance available for seniors meeting certain eligibility criteria. Below you will find brief descriptions regarding payment options & links to additional information.
Personal Resource Options Include:
Personal Income/Savings/Assets
Reverse Mortgages: Reverse Mortgages are a special type of home loan that lets homeowners (62 and older) convert the equity in their home into cash. Free information is available from the U.S Department of Housing & Urban Development at or by calling The National Council on Aging at (800) 510-0301. Here the phone is answered by individuals offering counseling on reverse mortgages, providing answers to the following questions:
The cost associated
Other options that may be available
Long-Term Care Insurance: The following link will direct you to California’s Department of Insurance – Consumers: Long-Term Care Insurance (2008). This document contains a thorough overview of long-term care insurance and answers the most pertinent questions you need to get your research started:
What is LTC & who can benefit from it?
How to choose a qualified agent?
Questions to ask before purchase.
Rules that apply to agents, benefits & policies, etc.
In California only 3 categories of LTC insurance are sold, here they are listed and described.
Additional resources - Including HICAP, the Health Insurance Counseling & Advocacy Program This organization provides free counseling on LTC insurance & Medicare & Medicare Supplement Policies. Consumers should call 1(800) 434-0222 to find the local HICAP project operating in their community.
Government Assistance Options Include:
Veterans Benefits: For free information, call The Department of Veteran Affairs at 1-800-827-1000] California Regional Offices. Another good resource appears to be VeteranAid. Supplemental Security Income (SSI): Supplemental Security Income, also known as SSI, is a benefit paid to qualifying blind, disabled, or 65+ year old individuals having fewer than $2,000 in assets. As of 2011, the monthly rate for RCFEs from SSI funds is $982/month. The maximum SSI a qualifying elder can receive is $1,100. (SEE ALSO SSI FAQ)
Not all RCFEs accept SSI clients. However, after admission, a facility cannot evict a resident for non-payment should the resident's wealth diminish and they be approved for SSI. The resident must be retained and cared for at the lower SSI rate making the original rate contained in the Admissions Agreement void. The Assisted Living Waiver Pilot Program (ALW): Under the ALW program, Medicaid pays for services in assisted living for eligible seniors at a tiered reimbursement rate. While SSI is used to cover the cost of room & board. The program is currently only available in the following counties- Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino and Riverside Counties. The number of waiver slots available in each county is limited. Individuals applying must be deemed nursing home eligible. For here more on this program, or contact the state office directly at (916) 552-9105.
Medicare: Medicare does not cover services in assisted living facilities.
Notes in italics represent the views and/or experience of CARR regarding this topic.
Postural Supports Title 22 §87608.
The following regulations pertain to postural supports:
(1) Supports shall be limited to devices used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of a bed, a chair, etc. Included here are physician-prescribed orthopedic devices (braces or casts) used for support of a weakened body part or correction of body parts.
(2) Supports shall be fastened or tied in a manner that permits quick release by the resident.
(3) A written order from a physician indicating the need for the support shall be maintained in the resident's record, and if necessary CCLD may require additional documentation to verify the order.
(4) If the use of the support changes the ambulatory status of a resident to non-ambulatory, the licensee shall ensure that the appropriate fire clearance has been secured prior to the use of the support.
(5) Under no circumstances shall postural supports include tying, depriving or limiting the used of a resident's hands or feet.
(6) Bed rails that extend from the head half the length of the bed and are used only for assistance with mobility shall be allowed.
(7) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and who have a hospice care plan that specifies the need for full bed rails.
Power of Attorney: Can a Licensee accept appointment for a resident? Title 22, §87217(d)(1)-(4)
"No Licensee or employee shall*:
(1) accept appointment as a guardian or conservator of the person and/or estate of any resident,
(2) accept any general or special power of attorney for any resident,
(3) become substitute payee for any payments made to any resident [unless involving Social Security monies & licensee is representative payee], or
(4) become the joint tenant on any account specified in §87217(h) with a resident. *except as provided in approved continuing care agreements.
PRN Medication Under Title 22, §87101(p)3), PRN (pro re nata) medication ". . . means any non-prescription or prescription medication which is to be taken 'as needed'." This prescribing protocol ('as needed') contrasts with other prescribing protocols, i.e every 12 hours, or three times a day, with meals.
Public file: What information is contained in a facility's? On this website, CARR has provided relevant information found in the public file on licensed facilities in San Diego and Imperial Counties. CARR collected this information from the public files housed at Community Care Licensing Division (CCLD). These files are physically available at the state's offices for all to view. If you choose to review a file at CCLD you will first have to submit, either in person, or over the phone, a California Public Records Act (CPRA) Request, specifically requesting a file by facility name. Under the CPRA, they must respond to your request within 10 days.
Each file at CCL has two components: A Public File and a Confidential File. The state will only provide you the Public File, not the Confidential File. In the PUBLIC FILE, there are two sections: the application section (the left side of the file) and the compliance section (the right side of the file). APPLICATION SECTION: The documents supplied in this section are windows into the operation and business of the facility. Documents in this section include the contact information of all Licensees (whether individuals or business entities), the License, Delegation, bonding status, the fire marshal clearance for the building and their authorized capacity, the expected operating costs and revenue of the facility, promised staffing levels, etc. For many facilities in CARR's facility database, most of these documents are provided as of the last time the file was reviewed. For other facilities, our database is not nearly as complete. As file surveillance continues, CARR's database will expand to include many of these documents. COMPLIANCE SECTION: The documents in this section serve as the record of the communication between CCLD and the facility/Licensee. The two most important document types are the LIC 809- Facility Evaluations, and the LIC 9099 - Complaint Investigations. Also included in this section are Communication Logs, Civil Penalty Assessments and Invoices, any other correspondence and Long-term Care Ombudsman evaluations.
CARR considers the LIC809 and LIC9099 documents to be the most important among those in its document database. These documents are the windows you have regarding how well the Licensee complies with the regulations. From these documents you can infer quality-of-care based on the types and frequency of deficiencies cited. If you don't have time to read any other documents about a facility, please read the LIC809s and LIC9099s for the facility you are interested in. If you need more information regarding certain documents in the file, please take a look at the Understanding California's Oversight & Regulation section and/or Understanding CCLDs Forms in our FAQ section or contact us. Public file: Why review prior to placement? Moving from one's home into the care of others is a very complex transition. And while a welcoming smile, glossy brochure and 20-minute tour of featured amenities may give you and your loved one the reassurance you need to embark on this difficult transition, what you really need to make this transition safely and successfully, is the facts. Familiarizing yourself with a facility's history through review of the public file, or the documents from the public file offered on this site, can help bring into focus the entire picture. Of particular interest to any consumer is a detailed review of the inspection (LIC 809) reports, and the complaint documents (LIC 9099). A facility's file suggests a facility's weaknesses, strengths, any reoccurring challenges, a Licensees' level of responsibility, and the overall oversight of the facility. In This Section