Opinion ID: 4556154
Heading Depth: 2
Heading Rank: 1

Heading: Long-Term Care Act

Text: The Long-Term Care Act is a “detailed statutory scheme regulating the standard of care provided by skilled nursing facilities to their patients.” (Kizer v. County of San Mateo (1991) 53 Cal.3d 139, 143 (Kizer); see § 1422, subd. (a) [legislative findings and declarations].) The Act establishes a citation system, an inspection and reporting system, and a provisional licensing mechanism, all of which the Department of Public Health (Department) is charged with administering. (§ 1417.1; see Kizer, at p. 143.) “ ‘Under its licensing authority, the Legislature has mandated standards to ensure quality health care. The regulations establish that what the Legislature and the Department are seeking to impose are measures that protect patients from actual harm, and encourage health care facilities to comply with the applicable regulations and thereby avoid imposition of the penalties.’ ” (Health Facilities, supra, 16 Cal.4th at p. 295, quoting Kizer, at p. 148.) Citations issued by the Department are “classified according to the nature of the violation.” (§ 1424; see also § 1424.5, subd. (a).) Class “A” violations are violations that the Department has determined present an imminent danger or a substantial probability “that death or serious physical harm to patients or residents of the long-term health care facility would result therefrom.” (§ 1424, subd. (d).) Class “AA” violations are Class A violations that are the “direct proximate cause” of a patient’s death. (Id., subd. (c).) Class “B” violations are those that “have a direct or immediate relationship to the health, safety, or security of long-term health care facility patients or 7 JARMAN v. HCR MANORCARE, INC. Opinion of the Court by Chin, J. residents, other than class ‘AA’ or ‘A’ violations.” (Id., subd. (e).) Class “C” violations are violations “relating to the operation or maintenance of a skilled nursing facility which the Department determines has only a minimal relationship to the health, safety or security” of long-term care patients. (Cal. Code Regs., tit. 22, § 72701, subd. (a)(4); see Nevarrez, supra, 221 Cal.App.4th at p. 131.) With respect to the Long-Term Care Act’s inspection and citation process, it operates “to encourage compliance with state mandated standards for patient care and to deter conduct which may endanger the well-being of patients.” (Kizer, supra, 53 Cal.3d at p. 150.) In effect, the scheme “serves to punish by naming and shaming facilities that violate the law.” (State Dept. of Public Health v. Superior Court (2015) 60 Cal.4th 940, 950; cf. § 1422, subd. (a) [legislative finding that inspections are the “most effective means” to implement protective state policy].) Although its authorization of civil penalties (see e.g., §§ 1424, 1424.5, 1425, 1428) has a “punitive or deterrent aspect,” the Long-Term Care Act is nonetheless remedial and its central focus is “preventative.” (Kizer, supra, 53 Cal.3d at pp. 147–148, italics omitted.) With this administrative authority to license and inspect facilities, issue citations, and impose civil penalties, the Department serves as “the primary enforcer of standards of care in the long-term care facilities of this state.” (Health Facilities, supra, 16 Cal.4th at p. 305, fn. 7; see Kizer, supra, 53 Cal.3d at p. 142.)