California Regulatory Compliance Resources for Residential Care Facilities

Residential care facilities for the elderly in California may not admit or retain individuals who require certain levels of care or have specific conditions. These prohibited conditions include:

• Individuals who require 24-hour skilled nursing or intermediate care.
• Individuals needing care for Stage III or IV dermal ulcers. Care for Stage I and II dermal ulcers is permitted if self-care or licensed professional care is provided.
• Individuals needing care for Gastrostomies, Nasogastric tubes, or Tracheostomies.
• Individuals requiring Treatment for staph or other serious infections.
• Individuals who require assistance with all activities of daily living (ADLs).
• Individuals who have a communicable disease.
• Individuals who are bedridden and cannot get out of bed. However, residents who will be bedridden for more than 14 days may be retained if the facility notifies the Department of Social Services that the condition is temporary and the building meets specified fire safety standards.
• Individuals who have a mental disorder resulting in ongoing disruptive behavior that would upset other residents.
• Individuals with Dementia, unless the facility meets specific requirements for dementia care. Facilities may admit residents diagnosed with dementia if specified requirements are met, including an annual medical assessment, adequate supervision, enhanced physical plant safety features, and an appropriate activity program.

It is also noted that individuals with specified health conditions requiring incidental medical services may be admitted and retained if either the resident provides self-care or a licensed professional provides care. This list includes, but is not limited to: administration of oxygen; catheter care; colostomy/ileostomy care; diabetes; enemas, suppositories, and/or fecal impaction removal; care for bowel and/or bladder incontinence; injections; and treatment of Stage I and II dermal ulcers. Residents who are capable of administering their own medications, receiving medical care outside the facility, needing only reminders or assistance with self-administered medication due to forgetfulness or physical limitations, have cognitive impairment, mild dementia, or a mild temporary emotional disturbance may also be admitted or retained.

Several kinds of documentation are required for residential care facilities for the elderly in California. These include:

• Resident Agreements (Admission Agreement): These agreements must be signed by the resident and his/her responsible party within 7 days of admission. They must include information about basic and optional services, service rates, payment provisions, and refund policies, facility policies, and eviction and discharge criteria.
• Pre-Admission Appraisal: A pre-admission appraisal of all applicants is required prior to move-in. This appraisal evaluates the applicant’s functional capacity (measured by the ability to perform ADLs), mental condition, and social factors to determine their suitability for admission.
• Physician Medical Evaluation: A medical evaluation conducted by a physician is required before admission. This evaluation must include the resident’s diagnoses, current status, medications and treatments, and prescribed diets. Both the medical evaluation and the resident appraisal must be updated when a significant change occurs in the resident’s condition and as needed to maintain an accurate record of the resident’s needs.
• Plan of Operation: This is required for specialized facilities that market themselves as providing special care. For facilities admitting residents with dementia, this plan must include the program philosophy, pre-admission and ongoing assessment processes, admission information (areas where special care is provided, services available, and procedures to review the plan), activity programs, staff qualifications and training, building design features, resident change in condition policies, and procedures to review the program’s effectiveness.
• Staff Training and Qualifications: Documentation regarding the training and qualifications of staff is required. This includes records of initial and ongoing training for staff.
• Facility Documentation: Facilities must maintain documentation regarding medications, food service, incident reports (if applicable), and compliance with fire and safety standards.
• Background Checks and Fingerprint Clearances: Documentation showing background checks and fingerprint clearances for staff and volunteers is required. All facility staff must have a fingerprint clearance prior to their physical presence in the facility, and this clearance must be received by the licensing agency before issuing a license. Private paid personal assistants hired by residents must also have a criminal background clearance.

Residential care facilities for the elderly in California must meet specific staffing requirements.

• General Staffing Requirements. : Every facility must have a certified administrator who manages the facility according to the rules; this person may also be the licensee. A designee must be assigned when the administrator is not available. Facilities must also employ direct care staff to provide personal care services and supervision. Appropriately skilled professionals (such as a licensed nurse) may be hired to provide services like medication administration and incidental medical services if needed. Facilities must employ sufficient staff to deliver services required by residents. The licensing agency determines the maximum number of residents based on factors including the licensee’s skills, family residing on-site, building features, and staff availability.
• Awake Night Staffing: Requirements for awake staff during the night depend on the facility’s resident count.
  • For 1–16 residents: Staff must be available in the facility.
  • For 16–100 residents: At least 1 awake staff is required.
  • For 101–200 residents: 1 awake staff is required, and 1 staff member must be on call.
  • For more than 200 residents: There must be 1 awake staff and 1 on call, plus 1 additional awake staff for each 100 residents over 200.
  • Specifically for dementia care facilities with fewer than 16 residents, at least 1 awake night staff person is required if any resident with dementia is determined through assessment to require awake night supervision.
• Staff Training CA- 5. : All personnel must receive on-the-job training or have relevant experience in areas such as housekeeping, sanitation, providing necessary resident care and supervision (including communication skills), assisting with prescribed medications, recognizing early signs of illness, and knowledge of community resources. Staff who assist residents with ADLs must receive at least 10 hours of initial training within the first four weeks of employment and at least 4 additional hours annually. Staff assisting with self-administration of medications must complete coursework and pass an examination (16 hours training for facilities licensed for 16+ residents, 6 hours for those licensed for 15 or fewer), including hands-on shadowing and instruction developed with a licensed medical professional. They also require 4 hours of annual in-service training on medication-related issues. All staff caring for residents with dementia must receive dementia care training, including 6 hours of orientation and 8 hours of annual in-service training on topics like common behavioral problems, communication skills, promoting dignity, and end-of-life care. Before admitting a resident with a restricted health condition, relevant direct care staff must complete training provided by a licensed professional to meet the resident’s needs.
• Background Checks: Criminal background checks and fingerprint clearances are required for staff and volunteers.