reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 2 - License › Section 72217 - Bonds

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The amount of
				  the Bond required in Section
				  1318
				  of the Health and Safety Code shall be in accordance with the following
				  schedule:
(1)
Total Amount Handled per
								month
Bonds Required
$750 or
								less................................................
$1,000
$751 to
								$1,500...........................................
$2,000
$1,501 to
								$2,500........................................
$3,000
(2) Every
				  further increment of $1,000 or fraction thereof shall require an additional
				  $1,000 on the bond.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72301 - Required Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Skilled nursing facilities shall provide, but shall not be limited to, the
				  following required services: physician, skilled nursing, dietary,
				  pharmaceutical and an activity program.
(b) Skilled nursing facilities caring for
				  patients who are mentally disordered and whose needs for a special treatment
				  program are identified shall also meet the requirements for a special treatment
				  program service.
(c) Skilled
				  nursing facilities providing intermediate care services shall do so in a
				  distinct part separately approved by the Department and shall be in conformity
				  with the licensing regulations for the type of service provided in that
				  distinct part. The facility license shall indicate approval of the distinct
				  part by the Department.
(d) Written
				  arrangements shall be made for obtaining all necessary diagnostic and
				  therapeutic services prescribed by the attending physician, podiatrist,
				  dentist, or clinical psychologist subject to the scope of licensure and the
				  policies of the facility. If the service cannot be brought into the facility,
				  the facility shall assist the patient in arranging for transportation to and
				  from the service location.
(e)
				  Arrangements shall be made for an advisory dentist to participate at least
				  annually in the staff development program for all patient care personnel and to
				  approve oral hygiene policies and practices for the care of patients.
(f) The facility shall ensure that all
				  orders, written by a person lawfully authorized to prescribe, shall be carried
				  out unless contraindicated.
(g) The
				  facility shall make arrangements for a physician or physicians to be available
				  to furnish emergency medical care if the attending physician, or designee, is
				  unavailable. The telephone numbers of those physicians shall be posted in a
				  conspicuous place in the facility.
1. Amendment
					 filed 2-8-83; designated effective 3-2-83 (Register 83, No.
					 7).
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Sections
						1252,
						1276,
						1315,
						1316
						and
						1316.5,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72303 - Physician Services-General Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All persons admitted or accepted for care
				  by the skilled nursing facility shall be under the care of a physician selected
				  by the patient or patient's authorized representative.
(b) Physician services shall mean those
				  services provided by physicians responsible for the care of individual patients
				  in the facility. Physician services shall include but are not limited to:
(1) Patient evaluation including a written
				  report of a physical examination within 5 days prior to admission or within 72
				  hours following admission.
(2) An
				  evaluation of the patient and review of orders for care and treatment on change
				  of attending physicians.
(3)
				  Patient diagnoses.
(4) Advice,
				  treatment and determination of appropriate level of care needed for each
				  patient.
(5) Written and signed
				  orders for diet, care, diagnostic tests and treatment of patients by others.
				  Orders for restraints shall meet the requirements of Section
				  72319(b).
(6) Health record progress notes and other
				  appropriate entries in the patient's health records.
(7) Provision for alternate physician
				  coverage in the event the attending physician is not
				  available.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72305 - Physician Services-Medical Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The facility shall have a medical
				  director who shall be responsible for standards, coordination, surveillance and
				  planning for improvement of medical care in the facility.
(b) The medical director shall:
(1) Act as a liaison between administration
				  and attending physicians.
(2) Be
				  responsible for reviewing and evaluating administrative and patient care
				  policies and procedures.
(3) Act as
				  a consultant to the director of nursing service in matters relating to patient
				  care services.
(4) Be responsible
				  for reviewing employees' preemployment and annual health examination
				  reports.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72307 - Physician Services-Supervision of Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each patient admitted to the skilled
				  nursing facility shall be under the continuing supervision of a physician who
				  evaluates the patient as needed and at least every 30 days unless there is an
				  alternate schedule, and who documents the visits in the patient health
				  record.
(b) Alternate schedules of
				  visits shall be documented in the patient health record with a medical
				  justification by the attending physician. The alternate schedule shall conform
				  with facility policy.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72309 - Nursing Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Nursing service means a service staffed, organized and
					 equipped to provide skilled nursing care to patients on a continuous
					 basis.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72311 - Nursing Service-General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Nursing service shall include, but not be
				  limited to, the following:
(1) Planning of
				  patient care, which shall include at least the following:
(A) Identification of care needs based upon
				  an initial written and continuing assessment of the patient's needs with input,
				  as necessary, from health professionals involved in the care of the patient.
				  Initial assessments shall commence at the time of admission of the patient and
				  be completed within seven days after admission.
(B) Development of an individual, written
				  patient care plan which indicates the care to be given, the objectives to be
				  accomplished and the professional discipline responsible for each element of
				  care. Objectives shall be measurable and time-limited.
(C) Reviewing, evaluating and updating of the
				  patient care plan as necessary by the nursing staff and other professional
				  personnel involved in the care of the patient at least quarterly, and more
				  often if there is a change in the patient's condition.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72313 - Nursing Service-Administration of Medications and Treatments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Medications and
				  treatments shall be administered as follows:
(1) No medication or treatment shall be
				  administered except on the order of a person lawfully authorized to give such
				  order.
(2) Medications and
				  treatments shall be administered as prescribed.
(3) Tests and taking of vital signs, upon
				  which administration of medications or treatments are conditioned, shall be
				  performed as required and the results recorded.
(4) Preparation of doses for more than one
				  scheduled administration time shall not be permitted.
(5) All medications and treatments shall be
				  administered only by licensed medical or licensed nursing personnel with the
				  following exceptions:
(A) Students in the
				  healing arts professions may administer medications and treatments only when
				  the administration or medications and treatments is incidental to their course
				  of study as approved by the professional board or organization legally
				  authorized to give such approval.
(B) Unlicensed persons may, under the direct
				  supervision of licensed nursing or licensed medical personnel, during training
				  or after completion of training and demonstrated evidence of competence,
				  administer the following:
1. Medicinal
				  shampoos and baths.
2. Laxative
				  suppositories and laxative enemas.
3. Nonlegend topical ointments, creams,
				  lotions and solutions when applied to intact skin surfaces. Unlicensed persons
				  shall not administer any medication associated with treatment of eyes, ears,
				  nose, mouth, or genitourinary tract.
(6) Medications shall be administered as soon
				  as possible, but no more than two hours after doses are prepared, and shall be
				  administered by the same person who prepares the doses for administration.
				  Doses shall be administered within one hour of the prescribed time unless
				  otherwise indicated by the prescriber.
(7) Patients shall be identified prior to
				  administration of a drug or treatment.
(8) Drugs may be administered in the absence
				  of a specific duration of therapy on a licensed prescriber's new drug order if
				  the facility applies its stop-order policy for such drugs. The prescriber shall
				  be contacted prior to discontinuing therapy as established by stop-order
				  policy.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72315 - Nursing Service-Patient Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) No patient shall be admitted or accepted
				  for care by a skilled nursing facility except on the order of a
				  physician.
(b) Each patient shall
				  be treated as individual with dignity and respect and shall not be subjected to
				  verbal or physical abuse of any kind.
(c) Each patient, upon admission, shall be
				  given orientation to the skilled nursing facility and the facility's services
				  and staff.
(d) Each patient shall
				  be provided care which shows evidence of good personal hygiene, including care
				  of the skin, shampooing and grooming of hair, oral hygiene, shaving or beard
				  trimming, cleaning and cutting of fingernails and toenails. The patient shall
				  be free of offensive odors.
(e)
				  Each patient shall be encouraged and/or assisted to achieve and maintain the
				  highest level of self-care and independence. Every effort shall be made to keep
				  patients active, and out of bed for reasonable periods of time, except when
				  contraindicated by orders of a licensed health care practitioner acting within
				  the scope of his or her professional licensure.
(f) Each patient shall be given care to
				  prevent formation and progression of decubiti, contractures and deformities.
				  Such care shall include:
(1) Changing position
				  of bedfast and chairfast patients with preventive skin care in accordance with
				  the needs of the patient.
(2)
				  Encouraging, assisting and training in self-care and activities of daily
				  living.
(3) Maintaining proper body
				  alignment and joint movement to prevent contractures and deformities.
(4) Using pressure-reducing devices where
				  indicated.
(5) Providing care to
				  maintain clean, dry skin free from feces and urine.
(6) Changing of linens and other items in
				  contact with the patient, as necessary, to maintain a clean, dry skin free from
				  feces and urine.
(7) Carrying out
				  of physician's orders for treatment of decubitus ulcers. The facility shall
				  notify the physician, when a decubitus ulcer first occurs, as well as when
				  treatment is not effective, and shall document such notification as required in
				  Section 72311(b).
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72317 - Nursing Service-Standing Orders

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Standing orders shall not be used in skilled nursing
					 facilities.
Note: Authority cited: Sections
						208(a)and
												1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72321 - Nursing Service-Patients with Infectious Diseases

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Patients with infectious diseases shall
				  not be admitted to or cared for in the facility unless the following
				  requirements are met:
(1) A patient suspected
				  of or diagnosed as having an infectious or reportable communicable disease or
				  being in a carrier state who the attending officer determines is a potential
				  danger, shall be accommodated in a room, vented to the outside, and provided
				  with a separate toilet, handwashing facility, soap dispenser and individual
				  towels.
(2) There shall be:
(A) Separate provisions for handling
				  contaminated linens.
(B) Separate
				  provisions for handling contaminated dishes.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72323 - Nursing Service-Cleaning, Disinfecting and Sterilizing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each facility shall adopt a written
				  manual on cleaning, disinfecting and sterilizing procedures. The manual shall
				  include procedures to be used in the care of utensils, instruments, solutions,
				  dressings, articles and surfaces and shall be available for use by facility
				  personnel. All procedures shall be carried out in accordance with the
				  manual.
(b) Each facility shall
				  make provisions for the cleaning and disinfecting of contaminated articles and
				  surfaces which cannot be sterilized.
(c) Bedside equipment including but not
				  limited to washbasins, emesis basins, bedpans and urinals shall be sanitized
				  only by one of the following methods:
(1)
				  Submersion in boiling water for a minimum of 30 minutes.
(2) Autoclaving at 15 pounds pressure and
				  121°C (250) for 20 minutes.
(3)
				  Gas sterilization.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72325 - Nursing Service-Space

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An office or other suitable space shall
				  be provided for the director of nursing service.
(b) A nursing station shall be maintained in
				  each nursing unit or building.
(c)
				  Each nursing station shall have a cabinet, a desk, space for records, a
				  bulletin board, a telephone and a specifically designated and well illuminated
				  medication storage compartment with a lockable door. If a separate medication
				  room is maintained, it shall have a lockable door and a sink with water
				  connections for care of equipment and for handwashing.
(d) If a refrigerator is provided in a
				  nursing station, the refrigerator shall meet the following standards:
(1) Be located in a clean area not subject to
				  contamination by human waste.
(2)
				  Maintain temperatures at or below 7°C (45°F) for chilling.
(3) Maintain the freezer at minus 18°C
				  (0°F).
(4) Contain an accurate
				  thermometer at all times.
(5) If
				  foods are retained in the refrigerator, they shall be covered and clearly
				  identified as to contents and date initially covered.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72327 - Nursing Service-Director of Nursing Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The director of nursing service shall be
				  a registered nurse and shall be employed eight hours a day, on the day shift
				  five days a week.
(b) The director
				  of nursing service shall have at least one year of experience in nursing
				  supervision within the last five years.
(c) The director of nursing service shall
				  have, in writing, administrative authority, responsibility and accountability
				  for the nursing services within the facility and serve only one facility in
				  this capacity at any one time.
Note: Authority cite: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72329 - Nursing Service - Staff

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Nursing service personnel shall be employed and on duty in at least the number
				  and with the qualifications determined by the Department to provide the
				  necessary nursing services for patients admitted for care. The Department may
				  require a facility to provide additional staff as set forth in Section
				  72501(g).
(b) Facilities licensed for 59 or fewer beds
				  shall have at least one registered nurse or a licensed vocational nurse, awake
				  and on duty, in the facility at all times, day and night.
(c) Facilities licensed for 60 to 99 beds
				  shall have at least one registered nurse or licensed vocational nurse, awake
				  and on duty, in the facility at all times, day and night, in addition to the
				  director of nursing services. The director of nursing service shall not have
				  charge nurse responsibilities.
(d)
				  Facilities licensed for 100 or more beds shall have at least one registered
				  nurse, awake and on duty, in the facility at all times, day and night, in
				  addition to the director of nursing service. The director of nursing service
				  shall not have charge nurse responsibilities.
(e) Nursing stations shall be staffed with
				  nursing personnel when patients are housed in the nursing unit.
(f) Each facility shall employ sufficient
				  nursing staff to provide a minimum daily average of 3.0 nursing hours per
				  patient day.
(1) Facilities which provide care
				  for mentally disordered patients and in which psychiatric technicians provide
				  patient care shall meet the following standards:
(A) If patients are not certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum daily average of 3.0 nursing hours per patient day.
(B) For patients certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum daily average of 2.3 nursing hours per patient day for each patient
				  certified to the special treatment program, exclusive of additional staff
				  required to meet the staffing standards of the special treatment
				  program.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72329.1 - Nursing Service - Staff

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Nursing service personnel shall be
				  employed and on duty in at least the number and with the qualifications
				  determined by the Department to provide the necessary nursing services for
				  patients admitted for care. The staffing requirementsrequired by this section
				  are minimum standards only. Skilled nursing facilities shall employ and
				  schedule additional staff as needed to ensure quality resident care based on
				  the needs of individual residents and to ensure compliance with all relevant
				  state and federal staffing requirements. The Department may require a facility
				  to provide additional staff as set forth in Section
				  72501(g).
(b) Facilities licensed for 59 or fewer beds
				  shall have at least one registered nurse or a licensed vocational nurse, awake
				  and on duty, in the facility at all times, day and night.
(c) Facilities licensed for 60 to 99 beds
				  shall have at least one registered nurse or licensed vocational nurse, awake
				  and on duty, in the facility at all times, day and night, in addition to the
				  director of nursing services. The director of nursing services shall not have
				  charge nurse responsibilities.
(d)
				  Facilities licensed for 100 or more beds shall have at least one registered
				  nurse, awake and on duty, in the facility at all times, day and night, in
				  addition to the director of nursing services. The director of nursing services
				  shall not have charge nurse responsibilities.
(e) Nursing stations shall be staffed with
				  nursing personnel when patients are housed in the nursing unit.
(f) Each facility shall employ sufficient
				  nursing staff to provide a minimum of 3.2 nursing hours per patient day.
(1) Facilities which provide care for
				  mentally disordered patients and in which psychiatric technicians provide
				  patient care shall meet the following standards:
(A) If patients are not certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum of 3.2 nursing hours per patient day.
(B) For patients certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum of 2.3 nursing hours per patient day for each patient certified to the
				  special treatment program, exclusive of additional staff required to meet the
				  staffing standards of the special treatment
				  program.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72329.2 - Nursing Service - Staff

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each facility, except those skilled
				  nursing facilities that are a distinct part of a general acute care facility or
				  a state-owned hospital or developmental center, shall employ sufficient nursing
				  staff to provide a minimum of 3.5 direct care service hours per patient day,
				  except as set forth in Health and Safety Code section
				  1276.9.
				  Skilled nursing facilities shall provide a minimum of 2.4 certified nurse
				  assistant hours per patient day to meet the requirements of this subdivision.
(1) Facilities that are a distinct part of a
				  general acute care facility or a state-owned hospital or developmental center
				  shall continue to meet the standard set forth in Health and Safety Code section
				  1276.5.
(2) Facilities which provide care for persons
				  with mental health disorders and in which psychiatric technicians provide
				  patient care shall meet the following standards:
(A) For patients not certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum of 3.5 direct care service hours per patient day.
(B) For patients certified for special
				  treatment programs, facilities shall employ sufficient staff to provide a
				  minimum of 2.3 nursing hours per patient day for each patient certified to the
				  special treatment program, exclusive of additional staff required to meet the
				  staffing standards of the special treatment
				  program.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72331 - Nursing Service-Nurse Assistant Training and Certificate. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, No. 46). A
					 Certificate of Compliance must be transmitted to OAL by 11-13-91 or emergency
					 repeal will be reinstated by operation of law on the following
					 day.
2. Repealer refiled 11-14-91 as an emergency; operative
					 11-13-91 (Register 92, No. 8). A Certificate of Compliance must be transmitted
					 to OAL 3-12-92 or emergency language will be repealed by operation of law on
					 the following day.
3. Editorial correction of HISTORY 2. filed and
					 repealer refiled 5-6-92 as an emergency; operative 5-6-92 (Register 92, No.
					 20). A Certificate of Compliance must be transmitted to OAL 9-3-92 or emergency
					 language will be repealed by operation of law on the following
					 day.
4. Certificate of Compliance as to 5-6-92 order transmitted to
					 OAL 8-27-92 and filed 10-9-92 (Register 92, No.
					 41).
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Sections
						1137.7
						through
						1338.3,
						1439.1
						through
						1439.8
						and
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72333 - Dietetic Service-General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Dietetic service" means a service organized, staffed and
					 equipped to assure that food service to patients is safe, appetizing and
					 provides for their nutritional needs.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72335 - Dietetic Service-Food Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The dietetic service shall provide food
				  of the quality and quantity to meet each patient's needs in accordance with the
				  physicians' orders and to meet the "Dietary Reference Intakes: The Essential
				  Guide to Nutrient Requirements" (2006) by the National Research Council of the
				  National Academy of Sciences, Institute of Medicine, hereby incorporated by
				  reference, and the following:
(1) Not less
				  than 3 meals shall be served daily and with not more than a 14-hour span
				  between the last meal and the first meal of the following day.
(2) Between-meal feeding shall be provided as
				  required by the diet order. Bedtime nourishments shall be offered to all
				  patients unless contraindicated.
(3) Patient food preferences shall be adhered
				  to as much as possible and substitutes for all food refused shall be from
				  appropriate food groups. Condiments such as salt, pepper or sugar shall be
				  available at each meal unless contraindicated by the diet order.
(4) Table service shall be provided for all
				  patients who can and wish to eat at a table. Tables of appropriate height shall
				  be provided for patients in wheelchairs.
(5) No food ordered for the facility shall be
				  diverted or taken from the facility. No rebates shall be received or allowed to
				  the facility or its owners, directors, officers or employees from any
				  commercial food source.
(6) When
				  food is provided by an outside resource, the facility shall ensure that all
				  federal, state and local requirements are met. The facility shall maintain a
				  written plan, adequate space, equipment and food supplies to provide patients'
				  food service in emergencies.
(7)
				  Recipes for all items that are prepared for regular and therapeutic diets shall
				  be available and used to prepare attractive and palatable meals, in which
				  nutritive values, flavor and appearance are conserved. Food shall be served
				  attractively, at appropriate temperatures with appropriate eating utensils and
				  in a form to meet individual needs.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72337 - Dietetic Service-Diet Manual

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A current therapeutic diet manual, approved by the
					 dietitian and the patient care policy committee, shall be readily available to
					 dietetic personnel and licensed healthcare practitioners acting within the
					 scope of their professional licensure or certification. It shall be reviewed
					 annually and revised at least every five years.
1. Amendment
					 of section and NOTE filed 3-3-2010; operative 4-2-2010 (Register 2010, No.
					 10).
Note: Authority cited: Sections
						1275,
						100275
						and
						131200,
						Health and Safety Code. Reference: Sections
						1276,
						1316.5,
						131050,
						131051
						and
						131052,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72339 - Dietetic Service-Therapeutic Diets

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Therapeutic diets shall be provided for each patient as
					 prescribed and shall be planned, prepared and served with supervision and/or
					 consultation from the dietitian. Persons responsible for therapeutic diets
					 shall have sufficient knowledge of food values to make appropriate
					 substitutions when necessary.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72341 - Dietetic Service-Menus

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Menus for regular and therapeutic diets
				  shall be written at least one week in advance, dated and posted in the kitchen
				  at least one week in advance.
(b)
				  All menus shall be approved by the dietitian.
(c) If any meal served varies from the
				  planned menu, the change and the reason for the change shall be noted in
				  writing on the posted menu in the kitchen.
(d) Menus shall provide a variety of foods
				  and indicate standard portions at each meal. Menus shall be varied for the same
				  day of consecutive weeks. If a cycle menu is used, the cycle shall be of no
				  less than three weeks duration and shall be revised quarterly.
(e) Menus shall be adjusted to include
				  seasonal commodities.
(f) Menus
				  shall be planned with consideration of cultural background and food habits of
				  patients.
(g) A copy of the menu as
				  served shall be kept on file for at least 30 days.
(h) Itemized records of food purchases shall
				  be kept for one year and available for review by the Department. Food purchases
				  invoices are acceptable provided they list amounts and types of foods
				  purchased.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72343 - Dietetic Service-Food Storage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Food storage areas shall be clean at all
				  times.
(b) All foods or food items
				  not requiring refrigeration shall be stored above the floor, on shelves, racks,
				  dollies or other surfaces which facilitate thorough cleaning, in a ventilated
				  room, not subject to sewage or wastewater backflow or contamination by
				  condensation, leakage, rodents or vermin. All packaged food, canned foods, or
				  food items stored shall be kept clean and dry at all times.
(c) All readily perishable foods or beverages
				  shall be maintained at temperatures of 7°C (45°F) or below, or at
				  60°C (140°F) or above, at all times, except during necessary periods of
				  preparation and service. Frozen foods shall be stored at minus 18°C
				  (0°F) or below at all times. There shall be an accurate thermometer in each
				  refrigerator and freezer and in storerooms used for perishable foods. All foods
				  stored in walk-in refrigerators and freezers shall be stored above the floor on
				  shelves, racks, dollies or other surfaces that facilitate thorough
				  cleaning.
(d) Pesticides and other
				  toxic substances and drugs shall not be stored in the kitchen area or in
				  storerooms for food or food preparation equipment and utensils.
(e) Soaps, detergents, cleaning compounds or
				  similar substances shall be stored in separate storage areas.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72345 - Dietetic-Sanitation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All kitchens
				  and kitchen areas shall be kept clean, free from litter and rubbish and
				  protected from rodents, roaches, flies and other insects.
(b) All utensils, counters, shelves and
				  equipment shall be kept clean, maintained in good repair and shall be free from
				  breaks, corrosion, open seams, cracks and chipped areas.
(c) Plastic ware, china and glassware that
				  cannot be sanitized or are hazardous because of chips, cracks or loss of glaze
				  shall be discarded.
(d) Ice which
				  is used in connection with food or drink shall be from a sanitary source and
				  shall be handled and dispensed in a sanitary manner.
(e) Kitchen wastes that are not disposed of
				  by mechanical means shall be kept in clean, leakproof, nonabsorbent, tightly
				  closed containers and shall be disposed of as frequently as necessary to
				  prevent a nuisance or unsightliness.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72347 - Dietetic Service-Cleaning and Disinfection of Utensils

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All utensils used for eating, drinking
				  and in the preparation and serving of food and drink shall be cleaned and
				  disinfected or discarded after each usage.
(b) Gross food particles shall be removed by
				  careful scraping and prerinsing in running water.
(c) Utensils not washed by mechanical means
				  shall be placed in hot water with a minimum temperature of 43°C
				  (110°F), washed using soap or detergent, rinsed in hot water to remove soap
				  or detergent and disinfected by one of the following methods or equivalent, as
				  approved by the Department:
(1) Immersion for
				  at least two minutes in clean water at 77°C (170°F).
(2) Immersion for at least 30 seconds in
				  clean water at 83°C (180°F).
(3) Immersion in water containing
				  bactericidal chemical as approved by the Department.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72349 - Dietetic Service-Equipment and Supplies

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Equipment of the type and in the amount
				  necessary for the proper preparation, serving and storing of food and for
				  proper dishwashing shall be provided and maintained in good working
				  order.
(b) Fixed and mobile
				  equipment in the dietetic service area shall be located to assure sanitary and
				  safe operation and shall be of sufficient size to handle the needs of the
				  facility.
(c) The dietetic service
				  area shall be ventilated in a manner that will maintain comfortable working
				  conditions, remove objectionable odors, fumes and prevent excessive
				  condensation.
(d) Food supplies
				  shall meet the following standards:
(1) At
				  least one week's supply of staple foods and at least two days' supply of
				  perishable foods shall be maintained on the premises. Food supplies shall meet
				  the requirements of the weekly menu including the therapeutic diets
				  ordered.
(2) All food shall be of
				  good quality and procured from sources approved or considered satisfactory by
				  federal, state or local authorities. Food in unlabeled, rusty, leaking, broken
				  containers or cans with side seam dents, rim dents or swells shall not be
				  retained or used.
(3) Milk, when
				  served as a beverage, shall be pasteurized Grade A or certified unless
				  otherwise prescribed by the physician's diet order. Milk, milk products and
				  products resembling milk shall be processed or manufactured in milk product
				  plants meeting the requirements of Division 15 of the California Food and
				  Agricultural Code. Powdered milk shall not be used as a beverage but may be
				  used in cooking.
(4) Milk shall be
				  served in individual containers or from a dispensing device which has been
				  approved for such use, by the local health department or from the original
				  container. Milk shall be dispensed directly into the glass or other container
				  from which the patient drinks.
(5)
				  Catered foods and beverages from a source outside the licensed facility shall
				  be prepared, packed, properly identified, stored and transported in compliance
				  with these regulations and other applicable federal, state and local
				  codes.
(6) Foods held in
				  refrigerated or other storage areas shall be covered. Liquids and food which
				  are prepared and not served shall be tightly covered, stored appropriately,
				  clearly labeled and dated. A written procedure shall be established and
				  followed for the safe use of leftover foods.
(7) Spoiled or contaminated food shall not be
				  served.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72351 - Dietetic Service - Staff

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  dietitian shall be employed on a full-time, part-time or consulting basis.
				  Part-time or consultant services shall be provided on the premises at
				  appropriate times on a regularly scheduled basis. A written record of the
				  frequency, nature and duration of the consultant's visits shall be
				  maintained.
(b) If a dietitian is
				  not employed full-time, a full-time dietetic services supervisor shall be
				  employed to be responsible for the operation of the food service. The dietetic
				  supervisor may also cook, provided sufficient time is allowed for managerial
				  responsibilities.
(c) Sufficient
				  staff shall be employed, oriented, trained and their working hours scheduled to
				  provide for the nutritional needs of the patients and to maintain the dietetic
				  service areas. If dietetic service employees are assigned duties in other
				  services, those duties shall not interfere with the sanitation, safety or time
				  required for dietetic work assignments.
(d) Current work schedules by job titles and
				  weekly time schedules by job titles shall be posted.
(e) Dietetic service personnel shall be
				  trained in basic food sanitation techniques, wear clean clothing, and a cap or
				  a hair net, and shall be excluded from duty when affected by skin infection or
				  communicable diseases. Beards and mustaches which are not closely cropped and
				  neatly trimmed shall be covered.
(f) Employees' street clothing stored in the
				  kitchen shall be in a closed area separate from food or items used in food
				  service.
(g) Kitchen sinks shall
				  not be used for handwashing. Separate handwashing facilities with soap, running
				  water and individual towels shall be provided.
(h) Persons other than dietetic service
				  personnel shall not be allowed in the kitchen areas unless required to do so in
				  the performance of their duties.
(i) Smoking shall not be permitted in kitchen
				  areas.
1. Change
					 without regulatory effect amending section heading and subsection (b) and
					 amending NOTE filed 3-12-2013 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2013, No. 11).
Note: Authority cited: Sections
						1275
						and
						131200,
						Health and Safety Code. Reference: Sections
						1276,
						131050,
						131051
						and
						131052,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72353 - Pharmaceutical Service-General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Arrangements shall be made to assure that
				  pharmaceutical services are available to provide patients with prescribed drugs
				  and biologicals.
(b) Dispensing,
				  labeling, storage and administration of drugs and biologicals shall be in
				  conformance with state and federal laws.
(c) If a pharmacy is located on the premises,
				  the pharmacy shall be licensed by the California State Board of Pharmacy and
				  approved by the Department. The pharmacy shall not serve the general public
				  unless a separate public entrance or a separate public serving window is
				  utilized. Pharmacies located on the licensed premises of skilled nursing
				  facilities shall be opened for inspection upon the request of an authorized
				  Department representative.
(d) The
				  facility shall not accept money, goods or services free or below cost from any
				  pharmacist or pharmacy as compensation or inducement for referral of business
				  to any pharmacy.
Note: Authority cited: Sections
						208(a)
						and
						1275,
						Health and Safety Code. Reference: Section
						1276,
						Health and Safety Code; Sections
						650
						and
						651,
						Business and Professions Code.
California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72355 - Pharmaceutical Service-Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Pharmaceutical service shall include, but
				  is not limited to, the following:
(1)
				  Obtaining necessary drugs including the availability of 24-hour prescription
				  service on a prompt and timely basis as follows:
(A) Drugs ordered "Stat" that are not
				  available in the facility emergency drug supply shall be available and
				  administered within one hour of the time ordered during normal pharmacy hours.
				  For those hours during which the pharmacy is closed, drugs ordered "Stat" shall
				  be available and administered within two hours of the time ordered. Drugs
				  ordered "Stat" which are available in the emergency drug supply shall be
				  administered immediately.
(B)
				  Anti-infectives and drugs used to treat severe pain, nausea, agitation,
				  diarrhea or other severe discomfort shall be available and administered within
				  four hours of the time ordered.
(C)
				  Except as indicated above, all new drug orders shall be available on the same
				  day ordered unless the drug would not normally be started until the next
				  day.
(D) Refill of prescription
				  drugs shall be available when needed.