This chapter establishes the licensing and operating standards for Residential Care Facilities for the Elderly (RCFEs) in California, covering application procedures, administrative actions, enforcement, continuing operational requirements, physical environment standards, and incidental medical services. Facility operators must obtain and maintain a license, meet administrator certification requirements, comply with resident rights and care standards, and adhere to physical plant and health condition regulations. The chapter also governs dementia special care advertising and administrator training program approval.
View official sourceRegulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY TABLE OF CONTENTS TITLE 22, DIVISION 6 CHAPTER 8. RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Article 1. Definitions Section General........................................................................................................................ ...................... 87100 Definitions .................................................................................................................... .................... 87101 Definitions - Forms ........................................................................................................................... 87102 Article 2. License License Required ............................................................................................................... ............... 87105 Operation Without a License ............................................................................................................ 87106 Exemption from Licensure....................................................................................................... ......... 87107 Integral Facilities ............................................................................................................ .................. 87108 Limitations - Capacity and Ambulatory Status................................................................................. 87110 Advertisements and License Number ............................................................................................... 87111 False Claims................................................................................................................... ................... 87112 Transferability................................................................................................................ ................... 87113 Continuation of License Under Emergency Conditions/Sale of Property ........................................ 87114 Posting of License............................................................................................................. ................ 87115 Program Flexibility ........................................................................................................................... 87116 Applicant/License Mailing Address.............................................................................................. .... 87117 Nondiscrimination.............................................................................................................. ............... 87118 Renumbered to Section 87716.1 by Manual Letter No. CCL-01-20, effective 10/24/01................. 87124.1 Article 3. Application Procedures Application for License........................................................................................................ ............. 87218 Criminal Record Clearance...................................................................................................... ......... 87219 Fire Clearance ................................................................................................................................... 87220 Plan of Operation .............................................................................................................................. 87222 Disaster and Mass Casualty Plan ...................................................................................................... 87223 Licensing Fees ................................................................................................................. ................. 87224 Commingling of Money........................................................................................................... ......... 87225 Bonding........................................................................................................................ ..................... 87226 CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-05-11 Effective 6/15/05 Page 1 RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations TABLE OF CONTENTS (Continued) Article 3. Application Procedures (Continued) Safeguards for Cash Resources, Personal Property, and Valuables of Residents............................. 87227 Theft and Loss................................................................................................................. .................. 87227.1 Application Review ............................................................................................................. ............. 87228 Capacity ............................................................................................................................................ 87229 Withdrawal of Application ...................................................................................................... ......... 87230 Provisional License............................................................................................................ ............... 87231 Repealed by Manual Letter No. CCL-01-10, effective 6/29/01........................................................ 87233 Repealed by Manual Letter No. CCL-01-10, effective 6/29/01........................................................ 87234 Resubmission of Application.................................................................................................... ........ 87235 Conditions for Forfeiture of a Residential Care Facility for the Elderly License............................. 87236 Article 4. Administrative Actions Section Denial of Initial License...................................................................................................... .............. 87340 Repealed by Manual Letter No. CCL-01-10, effective 6/29/01........................................................ 87341 Revocation or Suspension of License ............................................................................................... 87342 Relocation of Resident - General ...................................................................................................... 87342.1 Licensee Complaints............................................................................................................ ............. 87343 Inspection Authority of the Licensing Agency................................................................................. 87344 Evaluation Visit ............................................................................................................... ................. 87345 Exclusions..................................................................................................................... .................... 87346 Article 5. Enforcement Provisions Serious Deficiencies - Examples................................................................................................ ....... 87451 Deficiencies in Compliance .............................................................................................................. 87452 Follow-Up Visits to Determine Compliance..................................................................................... 87453 Penalties ............................................................................................................................................ 87454 Administrative Review - General ................................................................................................ ..... 87455 Denial or Revocation of License for Failure to Pay Civil Penalties ................................................. 87455.1 Unlicensed Facility Penalties.................................................................................................. .......... 87457 Unlicensed Facility Administrative Appeal...................................................................................... 87458 Article 6. Continuing Requirements Governing Body................................................................................................................. ............... 87560 Reporting Requirements ................................................................................................................... 87561 Finances ............................................................................................................................................ 87562 Administrator - Qualifications and Duties ........................................................................................ 87564 Administrator Certification Requirements....................................................................................... . 87564.2 Administrator Recertification Requirements .................................................................................... 87564.3 CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-05-03 Effective 6/8/05 Page 2 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY TABLE OF CONTENTS (Continued) Article 6. Continuing Requirements (Continued) Section Denial or Revocation of a Certificate .......................................................................................... ..... 87564.4 Forfeiture of a Certificate.................................................................................................... .............. 87564.5 Personnel Requirements - General............................................................................................... ..... 87565 Personnel Records.............................................................................................................. ............... 87566 General........................................................................................................................ ...................... 87567 Admission Agreements........................................................................................................... .......... 87568 Medical Assessment............................................................................................................. ............. 87569 Resident Records ............................................................................................................... ............... 87570 Register of Residents ........................................................................................................................ 87571 Personal Rights ................................................................................................................................. 87572 Telephones ........................................................................................................................................ 87573 Motor Vehicles Used in Transporting Residents .............................................................................. 87574 Incidental Medical and Dental Care............................................................................................. ..... 87575 Advance Health Care Directives, Requests to Forego Resuscitative Measures, and Do-Not-Resuscitate Forms................................................................................................. ...... 87575.1 Automated External Defibrillators (AEDs) ...................................................................................... 87575.2 Food Services.................................................................................................................. .................. 87576 Personal Accommodations and Services .......................................................................................... 87577 Personal Assistance and Care ........................................................................................................... 87578 Planned Activities ............................................................................................................................. 87579 Personnel - Operations......................................................................................................... ............. 87580 Night Supervision ............................................................................................................................. 87581 Acceptance and Retention Limitations ............................................................................................. 87582 Pre-Admission Appraisal - General .................................................................................................. 87583 Resident Participation in Decisionmaking....................................................................................... . 87583.1 Functional Capabilities ..................................................................................................................... 87584 Mental Condition .............................................................................................................................. 87585 Social Factors................................................................................................................. ................... 87586 Reappraisals ...................................................................................................................................... 87587 Documentation and Support ...................................................................................................... ....... 87588 Eviction Procedures .......................................................................................................................... 87589 Basic Services ................................................................................................................................... 87590 Observation of the Resident.................................................................................................... .......... 87591 Resident Councils ............................................................................................................................. 87592 Requirements for Emergency Adult Protective Services Placements............................................... 87593 Article 7. Physical Environment Alterations to Existing Buildings or New Facilities ......................................................................... 87686 Fire Safety.................................................................................................................... ..................... 87689 Resident and Support Services.................................................................................................. ........ 87690 Maintenance and Operation .............................................................................................................. 87691 Storage Space.................................................................................................................. .................. 87692 CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-13 Effective 9/8/02 Page 3 RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations TABLE OF CONTENTS (Continued) Article 8. Incidental Medical Services Section Health and Safety Protection ................................................................................................... ......... 87700 Prohibited Health Conditions................................................................................................... ......... 87701 Restricted Health Conditions ............................................................................................................ 87701.1 General Requirements for Restricted Health Conditions.................................................................. 8770 1.2 Health Condition Relocation Order .................................................................................................. 87701.3 Resident Request for Review of Health Condition Relocation Order .............................................. 87701.5 Allowable Health Conditions and the Use of Home Health Agencies ............................................. 87702 General Requirements for Allowable Health Conditions ................................................................. 87702.1 Oxygen Administration - Gas and Liquid......................................................................................... 87703 Intermittent Positive Pressure Breathing (IPPB) Machine................................................................ 87704 Colostomy/Ileostomy............................................................................................................ ............ 87705 Enema and/or Suppository and Fecal Impaction Removal ............................................................... 87706 Indwelling Urinary Catheter/Catheter Procedure.............................................................................. 87707 Managed Bowel and Bladder Incontinence ...................................................................................... 87708 Contractures ...................................................................................................................................... 87709 Diabetes....................................................................................................................... ...................... 87710 Injections..................................................................................................................... ...................... 87711 Renumbered to Section 87724 by Manual Letter No. CCL-95-12, effective 11/16/95.................... 87712 Healing Wounds................................................................................................................. ............... 87713 Repealed by Manual Letter No. CCL-92-10, effective 7/21/92........................................................ 87714 Repealed by Manual Letter No. CCL-97-14, effective 6/15/97........................................................ 87715 Hospice Care for Terminally Ill Residents...................................................................................... .. 87716 Facility Hospice Care Waiver................................................................................................... ........ 87716.1 Administrative Review - Incidental Medical Services...................................................................... 87720 Incidental Medical Related Services Exceptions .............................................................................. 87721 Department Review.............................................................................................................. ............. 87722 Care of Persons with Dementia.................................................................................................. ....... 87724 Advertising Dementia Special Care, Programming, and/or Environments....................................... 87725 Training Requirements if Advertising Dementia Special Care, Programming, and/or Environments ............................................................................................... 87725.1 Advertising Dementia Special Care, Programming, and/or Environments as of July 3, 2004 ............................................................................................................................ 87725.2 CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 4 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY TABLE OF CONTENTS (Continued) Article 9. Administrator Certification Training Programs Section Initial Certification Training Program Approval Requirements ....................................................... 87730 Denial of Request for Approval of an Initial Certification Training Program.................................. 87730.1 Revocation of an Initial Certification Training Program .................................................................. 87730.2 Continuing Education Training Program Vendor Requirements...................................................... 87731 Continuing Education Training Program Course Approval Requirements ...................................... 87731.1 Administrative Review of Denial or Revocation of a Request for Approval of a Continuing Education Course............................................................................................. ..... 87731.2 Denial of a Request for Approval of a Continuing Education Training Program............................. 87731.3 Revocation of a Continuing Education Training Program................................................................ 87731. 4 CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 4.1 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY This Users' Manual is issued as an operational tool. This Manual contains: a) Regulations adopted by the Department of Social Services (DSS) for the governance of its agents, licensees, and/or beneficiaries. b) Regulations adopted by other Stat e Departments affecting DSS programs. c) Statutes from appropriate Codes which govern DSS programs. d) Court decisions; and e) Operational standards by which DSS staff will evaluate performance within DSS programs. Regulations of DSS are printed in gothic type as is this sentence. Handbook material, which includes reprinted statutory material, other department's regulations and examples, is separated from the regulations by double lines and the phrases " HANDBOOK BEGINS HERE ", "HANDBOOK CONTINUES", and "HANDBOOK ENDS HERE" in bold print. Please note that both other departments' regulations and statutes are mandatory, not optional. In addition, please note that as a result of the change to a new computer system revised language in this manual letter and subsequent community care licensing changes will now be identified by.a line in the left margin. Questions relative to this Users' Manual should be directed to your usual program policy office. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-01 Effective 1/1/04 Page 5 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) Article 1. Definitions 87100 GENERAL 87100 The provisions of Chapter 1, Division 6, shall not appl y to the provisions of Chapter 8, Residential Care Facilities for the Elderly (RCFE). NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Section 1569.2, Health and Safety Code. 87101 DEFINITIONS 87101 For purposes of this chapter the following definitions shall apply: (a) (1) Administrator. "Administrator" means the i ndividual designated by the licensee to act in behalf of the licensee in the overall management of the facility. The licensee, if an individual, and the administrator may be one and the same person. (2) Adult. "Adult" means a person who is eighteen (18) years of age or older. (3) “Adult protective services agency” means a c ounty welfare department, as defined in Welfare and Institutions Code Section 15610.13. HANDBOOK BEGINS HERE (A) Welfare and Institutions Code S ection 15610.13 defines “adult protective services agency” to mean a county welfare department, except persons who do not work directly with elders or dependent adults as part of their official duties, including members of support staff and maintenance staff. HANDBOOK ENDS HERE (4) Advance Health Care Directive. "Advance H ealth Care Directive" means a written instruction that relates to the provision of health care wh en the individual is incapacitated. Advance directives include, but are not limited to, a Dura ble Power of Attorney for Health Care, an Individual Health Care Instruction, a Request to Forego Resuscitative Measures, or a Do Not Resuscitate Form. In an advance directive, a person states choices for medical treatment and/or designates who should make treatment choices if the person creating the advance directive should lose decision-making capacity. (5) Allowable Health Condition. "Allowable Hea lth Condition" means any health condition that the licensee is allowed to care for either in accord ance with a specific regulation, or with an exception approved by the licensing agency. Th is includes restricted health conditions as specified in Section 87701.1. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-01-22 Effective 10/25/01 Page 6 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (6) Ambulatory Person. "Ambulatory Person" mean s a person who is capable of demonstrating the mental competence and physical ability to leave a building without assistance of any other person or without the use of any mechanical aid in case of an emergency. (7) Automated External Defibrillator. "Automated External Defibrillator" (AED) means a light- weight, portable device used to administer an electric shock through the chest wall to the heart. Built-in computers assess the patient's heart rhythm, determine whether defibrillation (electrical shock) is needed and then administer the shock. Audible and/or visual prompts guide the user through the process. (8) Applicant. "Applicant" means any individual, fi rm, partnership, association, corporation, county, city, public agency or other government entity th at has made application for a residential care facility for the elderly license, administrator certificate, or special permit. (9) Appropriately Skilled Professional: Means an individual that has training and is licensed to perform the necessary medical procedures prescribed by a physician. This includes but is not limited to the following: Registered Nurse (RN), Licensed Vocational Nurse (LVN), Physical Therapist (PT), Occupational Therapist (OT) and Respiratory Therapist (RT). These professionals may include, but are not limited to, those persons employed by a home health agency, the resident, or facilities and who are currently licensed in California.` (b) (1) Basic Rate. “Basic Rate” means the SSI/ SSP established rate, which does not include that amount allocated for the recipient’s personal and incidental needs. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-13 Effective 9/8/02 Page 6.1 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (2) Basic Services. "Basic Servi ces" means those services required to be provided by the facility in order to obtain and maintain a license and include, in such combinations as may meet the needs of the residents and be applicable to the type of facility to be operated, the following: safe and healthful living accommodations; personal assistan ce and care; observation and supervision; planned activities; food service; and arrangements for obtaining incidental medical and dental care. (c) (1) California Clearance. “California Clearance” means an individual has no felony or misdemeanor convictions reported by the Califor nia Department of Justice. However, the individual may have been arrested with no crim inal conviction, convicted of a minor traffic offnse or adjudicated as a juvenile. (2) Capacity. "Capacity" means that maximum number of persons authorized to be provided services at any one time in any licensed facility. (3) Care and Supervision. "Care and Supervisi on" means those activities which if provided shall require the facility to be licensed. It involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents. "Care and Supervision" shall include, but not be limited to, any one or more of the following activities provided by a person or facility to meet the needs of the residents: (A) Assistance in dressing, grooming, bathing and other personal hygiene; (B) Assistance with taking medication; as specified in Section 87575; (C) Central storing and distribution of medications, as specified in Section 87575; (D) Arrangement of and assistance with medical and dental care. This may include transportation, as specified in Section 87575; (E) Maintenance of house rules for the protection of residents; (F) Supervision of resident schedules and activities; (G) Maintenance and supervision of resident monies or property; (H) Monitoring food intake or special diets. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-14 Effective 8/20/04 Page 7 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (4) Certificate holder. “Certificate holder” means a person who has a current administrator’s certificate issued by the Department regardl ess of whether the person is employed as an administrator in a residential care facility for the elderly. (5) Certified administrator. “Certified administrator” means an administrator who has been issued a residential care facility for the elderly administ rator certificate by the Department and whose certificate is current. (6) Classroom hour. "Classroom Hour" means sixty (60) minutes of classroom instruction with or without a break. It is recommended that no more than twenty (20) minutes of break time be included in every four (4) hours of instruction. No credit is given for meal breaks. (7) Close friend. "Close friend" means a person who is attached to another by feelings of personal regard as indicated by both parties involved. (8) Co-locate. "Co-locate" means that a vendor applicant is approved for more than one program type, i.e., ARF, RCFE, GH, and has received a pproval to teach specific continuing education courses at the same time and at the same location. Co-location is allowed for Continuing Education Training Program vendors only. (9) Community Care Facility. "Community Care Facility" means any facility, place or building providing nonmedical care and supervision, as defined in Section 87101c.(2). (10) Complete request. “Complete request” means the vendor applicant has submitted, and the Department has received, all required information and materials necessary to approve or deny the request for certification program and/or course approval. (11) Conservator. "Conservator" means a person appointed by the Superior Court pursuant to the provisions of Section 1800 et seq. of the Proba te Code or Section 5350 of the Welfare and Institutions Code, to care for the person, or estate, or person and estate, of another. (12) Consultant. "Consultant" means a person pr ofessionally qualified by training and experience to provide expert information on a particular subject. (13) Continuing Care Contract. “Continuing Care C ontract” is defined in Health and Safety Code Section 1771(c)(8). CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-14 Effective 8/20/04 Page 7.1 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 HANDBOOK BEGINS HERE “‘Continuing care contract’ means a contract that includes a continuing care promise made, in exchange for an entrance fee, the payment of pe riodic charges, or both types of payments. A continuing care contract may consist of one agreement or a series of agreements and other writings incorporated by reference.” HANDBOOK ENDS HERE (14) Continuing Education Training Program Ve ndor. “Continuing Education Training Program Vendor” means a vendor approved by the Department to provide continuing education training courses to residential care facility for the elderly administrators and certificate holders to qualify them for renewal of their residential care facility for the elderly administrator certificate. (15) Control of Property. "Control of Property" m eans the right to enter, occupy, and maintain the operation of the facility property within regulatory requirements. Evidence of control of property shall include, but is not limited to, the following: (A) A Grant Deed showing ownership; or (B) The Lease Agreement or Rental Agreement; or (C) A court order or similar document which shows the authority to control the property pending outcome of probate proceeding or estate settlement. (16) Conviction. “Conviction” means: (A) A criminal conviction in California; or (B) Any criminal conviction of another state, federal, military or other jurisdiction, which if committed or attempted in California, would have been punishable as a crime in California. (17) Course. "Course" means eith er, (1) a quarter- or semester-long structured sequence of classroom instruction covering a specific subject, or (2) a one-time seminar, workshop, or lecture of varying duration. (18) Criminal Record Clearance. “Criminal Reco rd Clearance” means an individual has a California clearance and an FBI clearance. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-14 Effective 8/20/04 Page 7.2 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (d) (1) Day. "Day" means calendar day unless otherwise specified. (2) Deficiency. "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. (3) Delayed Egress Device. "Delayed Egress Devi ce" means a special egress-control device of the time delay type as specified in Health and Safety Code Section 1569.699(a). HANDBOOK BEGINS HERE (A) Health and Safety Code Section 1569.699(a) reads: When approved by the person responsible for enforcement as described in Section 13146, exit doors in facilities classified as Group R, Division 2 facilities under the California Building Standards Code, licensed as residential care facilities for the elderly, and housing clients with Alzheimer's di sease or dementia, may be equipped with approved listed special egress-control devi ces of the time-delay type, provided the building is protected throughout by an approved automatic sprinkler system and an approved automatic smoke-detection system. The devices shall conform to all of the following requirements: (1) Automatic deactivation of the egress-c ontrol device upon activation of either the sprinkler system or the detection system. (2) Automatic deactivation of the egress-control device upon loss of electrical power to any one of the following: The egress-control device; the smoke- detection system; exit illumination as required by Section 1012 of the California Building Code. (3) Be capable of being deactivated by a signal from a switch located in an approved location. HANDBOOK CONTINUES CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-01-04 Effective 3/12/01 Page 8 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 HANDBOOK CONTINUES (4) Initiate an irreversible process that will deactivate the egress-control device whenever a manual force of not more than 15 pounds (66.72N) is applied for two seconds to the panic bar or other door-latching hardware. The egress- control device shall deactivate within an approved time period not to exceed a total of 15 seconds, except that the pe rson responsible for enforcement as described in Section 13146 may approve a delay not to exceed 30 seconds in residential care facilities for the elderly serving patients with Alzheimer's disease. The time delay established for each egress-control device shall not be field adjustable. (5) Actuation of the panic bar or other door-latching hardware shall activate an audible signal at the door. (6) The unlatching shall not require more than one operation. (7) A sign shall be provided on the door located above and within 12 inches (305mm) of the panic bar or other door-latching hardware reading: KEEP PUSHING, THIS DOOR WILL OPEN IN ____ SECONDS, ALARM WILL SOUND. Sign letters shall be at least one inch (25mm) in height and shall have a stroke of not less than 1/8 inch (3.3mm). (8) Regardless of the means of deactivati on, relocking of the egress-control device shall be by manual means only at the door. HANDBOOK ENDS HERE (4) Dementia. "Dementia" means the loss of intellectual function (such as thinking, remembering, reasoning, exercising judgement 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. (5) Department. "Department" is defined in Health and Safety Code, Section 1569.2(b). CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 8.1 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 HANDBOOK BEGINS HERE "Department" means the State Department of Social Services. HANDBOOK ENDS HERE (6) Dietitian. "Dietitian" means a person who is elig ible for registration by the American Dietetic Association. (7) Direct care staff. “Direct care staff” means the licensee, and/or those individuals employed by the licensee, who provide direct care to the residents, including, but not limited to, assistance with activities of daily living. (8) Director. "Director" is defined in Health and Safety Code, Section 1569.2(c). HANDBOOK BEGINS HERE "Director" means the Director of the State Department of Social Services. HANDBOOK ENDS HERE (9) Do-Not-Resuscitate (DNR) Form. "Do-Not-R esuscitate Form" means the pre-hospital do-not- resuscitate forms developed by the California Emergency Medical Services Authority and by other local emergency medical services agencies. These forms, when properly completed by a resident or (in certain instances) a resident's Health Care Surrogate Decision Maker, and by a physician, alert pre-hospital emergency medical services personnel to the resident's wish to forego resuscitative measures in the event of the resident's cardiac or respiratory arrest. (10) Documentation. "Documentation" mean s written supportive information including but not limited to the Licensing Report (Form LIC 809). (e) (1) Egress Alert Device."Egress Alert Device" means a wrist band or other device which may be worn by a resident or carried on a resident's person, which triggers a visual or auditory alarm when the resident leaves the facility building or grounds. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-14 Effective 8/20/04 Page 8.2 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (2) Elderly Person. "Elderly Person" means, for purposes of admission into a residential care facility for the elderly, a person who is sixty (60) years of age or older. (3) Emergency Approval to Operate. "Emergency Approval to Operate" (EAO) means a temporary approval to operate a facility for no more than 60 days pending the issuance or denial of a license by the licensing agency. (4) Evaluator. "Evaluator" means any person who is a duly authorized officer, employee or agent of the Department including any officer, employee or agent of a county or other public agency authorized by contract to license community care facilities. (5) Evidence of Licensee's Death. "Evidence of Li censee's Death" shall include, but is not limited to, a copy of the death certificate, obituary noti ce, certification of death from the decedent's mortuary, or a letter from the attending physician or coroner's office verifying the death of the licensee. (6) Exception. "Exception" means a variance to a specific regulation based on the unique needs or circumstances of a specific resident or staff pe rson. Requests for exceptions are made to the licensing agency by an applicant or licensee. They may be granted for a particular facility, resident or staff person, but cannot be transferred or applied to other individuals. (7) Existing Facility. "Existing Facility" means any facility operating under a valid license on the date of application for a new license. (f) (1) Facility Hospice Care Waiver. "Facility Hospice Care Waiver" means a waiver from the limitation on retention of residents who require more care and supervision than other residents and residents who are bedridden other than for a temporary illness. The Hospice Care Waiver granted by the Department will permit the rete ntion in a facility of a designated maximum number of terminally ill residents who are receiving hospice services from a hospice agency. The Facility Hospice Care Waiver will apply only to those residents who are receiving hospice care in compliance with a hospice care plan meeting the requirements of Section 87716. (2) Federal Bureau of Investigation (FBI) Clearan ce. “Federal Bureau of Investigation Clearance” means an individual has no felony or misdemeanor convictions reported by the FBI. The individual may also have been arrested with no criminal conviction, convicted of a minor traffic offense or adjudicated as a juvenile. (g) (1) Guardian. "Guardian" means a person a ppointed by the Superior Court pursuant to the provisions of Section 1500 et seq. of the Probate Code to care for the person, or person and estate, of another. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 9 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (h) (1) Healing wounds include cuts, stage one and two dermal ulcers 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. They may involve breaking or laceration of the skin and usually damage to the underlying tissues. (2) Health Care Provider. "Health Care Provider" means those persons described in Probate Code Section 4615: "a person who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or practice of a profession." CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 9.1 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (3) Health Care Surrogate Decision Maker. "H ealth Care Surrogate Decision Maker" means an individual who participates in health care decision making on behalf of an incapacitated resident. Health care surrogate decision maker may be formally appointed (e.g., by the resident in a Durable Power of Attorney for Health Care or by a court in a conservatorship proceeding) or, in the absence of a formal appointment, may be recognized by virtue of a relationship with the resident (e.g., the resident's next of kin). The licensee or any staff member of the facility shall not be appointed health care surrogate decision maker. (4) Health Condition Relocation Order. "Health Condition Relocation Order" means written notice by the Department to a licensee requiring the relocation of a resident from a residential care facility for the elderly because the resident h as a health condition which cannot be cared for within the limits of the license, requires inpatient care in a health facility or has a prohibited health condition as specified in Section 87701. (5) Home Economist. "Home Economist" means a person who holds a baccalaureate or higher degree in home economics and who specialized in either food and nutrition or dietetics. (6) Hospice or Hospice Agency. "Hospice or Hospice Agency" means an entity which provides hospice services to terminally ill persons, is Medi care certified for hospice, and holds either a Hospice license or a Home Hea lth Agency license from the California Department of Health Services. Any organizations, appropriately skilled professionals, or other professional persons or entities that are subcontracted by the hospice or hospice agency for the provision of specified hospice services to the resident are included within the definition. The hospice agency providing services in an RCFE shall not subcontract with the licensee or any facility staff for the provision of services. (7) Hospice Care Plan. "Hospice Care Plan" mean s the hospice agency's written plan of care for a terminally ill resident. The hospice shall retain overall responsibility for the development and maintenance of the plan and quality of hospice services delivered. (i) (1) Immediate Need. "Immediate Need" means a situation where prohibiting the operation of the facility would be detrimental to a resident's physical health, mental health, safety, or welfare. Examples of immediate need include but are not limited to: (A) A change in facility location when resi dents are in need of services from the same operator at the new location; (B) A change of facility ownership when r esidents are in need of services from the new operator. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 10 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (2) Initial Certification Training Program Vendor. “Initial Certification Training Program Vendor” means a vendor approved by the Department to provide the initial forty (40) hour certification training program to persons who do not possess a valid residential care facility for the elderly administrator certificate. (3) Initial Vendor Application. "Initial Vendor A pplication" means the application form, LIC 9141, used to request approval from the Department to become a vendor for the first time. (4) Instruction: Means to furnish an individual w ith knowledge or to teach, give orders, or direction of a process or procedure. (5) Interdisciplinary Team. "Interdisciplinary Team " means a team that shall assist the Department in evaluating the need for relocating a resident of a residential care facility for the elderly when the resident has requested a review of the Department's health-condition relocation order. This team shall consist of the Department's nurse consultant and a social worker, designated by the Department, with experience in the needs of the elderly. Persons selected for an interdisciplinary team review shall not have been involved in the initial decision to issue a relocation order for the resident in question. (j) (Reserved) (k) (Reserved) (l) (1) License. "License" is defined in Health and Safety Code Section 1569.2(g). HANDBOOK BEGINS HERE (A) Health and Safety Code Section 1569.2(g) reads: "License" means a basic permit to operate a residential care facility for the elderly. HANDBOOK ENDS HERE CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 10.1 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (2) Licensed Professional. “Licensed Professional” means a person who is licensed in California to provide medical care or therapy. This includ es physicians and surgeons, physician assistants, nurse practitioners, registered nurses, licensed vocational nurses, psychiatric technicians, physical therapists, occupational therapists and respiratory therapists, who are operating within his/her scope of practice. (3) Licensee. "Licensee" means the individual, firm, partnership, corporation, association or county having the authority and responsibility for the operation of a licensed facility. (4) Licensing Agency. "Licensing Agency" means a st ate, county or other public agency authorized by the Department to assume specified licensing, approval or consultation responsibilities pursuant to Section 1569.13 of the Health and Safety Code. (m) (1) Medical Professional. “Medical Professional” means an individual who is licensed or certified in California to perform the necessary medical proce dures within his/her scope of practice. This includes, but is not limited to, Medical Doctor (MD), Registered Nurse (RN) and Licensed Vocational Nurse (LVN). (2) Mild Cognitive Impairment. “Mild cognitive impairment” (MCI) refers to people whose cognitive abilities are in a “conditional state” between normal aging and dementia. Normal age- related memory changes can include forgetting a person’s name or the location of an object, however, individuals with MCI have difficulty with short-term memory loss. MCI is a state in which at least one cognitive function, usually short-term memory, is impaired to an extent that is greater than would be anticipated in the normal aging process. MCI is characterized by short- term memory problems, but no other symptoms of dementia (e.g., problems with language, judgement, changes in personality or behavior) that affect a person’s daily functioning. Individuals with MCI may experience some difficulty with intellectually demanding activities, but lack the degree of cognitive and functional impairment required to meet diagnostic criteria for dementia. (n) (1) New Facility. "New Facility" means any f acility applying for an initial license whether newly constructed or previously existing for some other purpose. (2) Nonambulatory Person. "Nonambulatory Pers on" 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. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 11 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (3) Non-Compliance Conference. “Non-Complian ce Conference” means a meeting initiated by the Department that takes place between the licensing agency and the licensee to afford the licensee an opportunity to correct licensing violations other than those that pose an immediate danger to residents and that may result in a corrective plan of action. Its purpose is to review the existing deficiencies and to impress upon the licensee the seriousness of the situation prior to the agency requesting administrative action to revoke the license. The Department may initiate administrative action without a non-compliance conference. (4) Nutritionist. "Nutritionist" means a person holding a master's degree in food and nutrition, dietetics, or public health nutrition, or who is employed by a county health department in the latter capacity. (o) (Reserved) (p) (1) Physician. "Physician" means a person li censed as a physician and surgeon by the California Board of Medical Examiners or by the California Board of Osteopathic Examiners. (2) Placement Agency. "Placement Agency" as de fined in Health and Safety Code Section 1569.47(a), means any county welfare department, county social services department, county mental health department, county public guardian, general acute care hospital discharge planner or coordinator, state-funded program or private agency providing placement or referral services, and regional center for persons with developmental disabilities which is engaged in finding homes or other places for the placement of elderly persons for temporary or permanent care. (3) "PRN Medication" (pro re nata) means an y nonprescription or prescription medication which is to be taken as needed. (4) Provision or Provide. Whenever any regulation specifies that provision be made for or that there be provided any service, personnel or other require ment, it means that if the resident is not capable of doing so himself, the licensee shall do so directly or present evidence satisfactory to the licensing agency of the particular arrangement by which another provider in the community will do so. (5) Provisional License. "Provisional License" mean s a temporary, nonrenewable license, issued for a period not to exceed twelve months which is issued in accordance with the criteria specified in Section 87231. (q) (Reserved) CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 12 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (r) (1) Rehabilitation. “Rehabilitation” means the effo rt to reestablish good character since the date of the last conviction, including, but not limited to, education, counseling or therapy, training, stable employment, restitution, remorse, changes in lifestyle, or community service. (2) Relative. "Relative" means spouse, parent, ste pparent, son, daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, ne phew, first cousin or any such person denoted by the prefix "grand" or "great", or the spouse of any of the pe rsons specified in this definition, even if the marriage has been terminated by death or dissolution. (3) Renewal Vendor Application. "Renewal Vendor Application" means the application form, LIC 9141, used to request approval from the Departme nt to continue another two (2) years as an approved vendor. (4) Request to Forego Resuscitative Measures. A "Request to Forego Resuscitative Measures" is defined in Probate Code Section 4753(b). CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-14 Effective 8/20/04 Page 12.1 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 HANDBOOK BEGINS HERE (A) Probate Code Section 4753(b) reads: A "request to forego resuscitative measures" shall be a written document, signed by the individual, or a legally recognized surrogate health care decisionmaker and a physician and surgeon, that directs a health care provider to forego resuscitative measures. For the purpose of this section, a "request to fo rego resuscitative measures" shall include a prehospital "do not resuscitate" form as developed by the Emergency Medical Services Authority or other substantially similar form. A request to forego resuscitative measures may also be evidenced by a medallion engraved with the words "do not resuscitate" or the letters "DNR", a patient identifica tion number, and a 24-hour toll-free telephone number, issued by a person pursuant to an agreement with the Emergency Medical Services Authority. HANDBOOK ENDS HERE (5) Residential Care Facility for the Elderly. "R esidential Care Facility for the Elderly" means a housing arrangement chosen voluntarily by the resident, the resident's guardian, conservator or other responsible person; where 75 percent of the residents are sixty years of age or older and where varying levels of care and supervision are provided, as agreed to at time of admission or as determined necessary at subsequent times of reappraisal. Any younger residents must have needs compatible with other residents. (6) Responsible Person. "Respons ible Person" means that 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. (7) Room and Board. "Room and Board" means a living arrangement where care and supervision is neither provided nor available. (s) (1) Serious Deficiency. "Serious Deficiency" m eans any deficiency that presents an immediate or substantial threat to the physical health, mental health, or safety of the residents or clients of a community care facility. (2) Shall. "Shall" means mandatory. "May" means permissive. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 13 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (3) Significant Other. “Significant Other” means a person, including a person of the same gender, with whom a resident was sharing a partnership prior to his/her placement in a Residential Care Facility for the Elderly (RCFE). The partnership involves two adults who have chosen to share one another’s lives in an intimate and committed relationship of mutual caring. (4) Simplified Exemption. “Simplified Ex emption” means an exemption granted on the Department’s own motion, as authorized in Health and Safety Code Section 1569.17(c)(4), if the individual’s criminal history meets specific criteria established by Department regulation. (5) Singular-Plural. Whenever in these regulations the singular is used, it can include the plural. (6) Social Worker. "Social Worker" means a pe rson who has a graduate degree from an accredited school of social work or who has equivalent qualifications as determined by the Department. (7) SSI/SSP. "SSI/SSP" means the Supplemental Security Income/State Supplemental Program. (8) Standard Precautions. See “Universal Precautions.” (9) Substantial Compliance. "Substantial Complian ce" means the absence of any deficiencies which would threaten the physical health, mental health , safety or welfare of the residents. Such deficiencies include, but are not limited to, those deficiencies referred to in Section 87451 and the presence of any uncorrected serious deficiencies for which civil penalties could be assessed. (10) Supervision. “Supervision” means to oversee or direct the work of an individual or subordinate but does not necessarily require the immediate presence of the supervisor. (t) (1) Terminally Ill Resident. "Terminally Ill Resident" means that the resident has a prognosis by his/her attending physician that the resident's life expectancy is six months or less if his/her illness or condition runs its normal course. (2) Transfer trauma. "Transfer trauma" means th e consequences of the stress and emotional shock caused by an abrupt, involuntary relocation of a resident from one facility to another. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 13.1 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (u) (1) Universal Precautions. “Universal Precaution s” means an approach to infection control that treats all human blood and body fluids as if they are infectious. Generally, universal precautions consist of regular hand washing after coming in to contact with another person’s body fluids (mucous, saliva, urine, etc.) and includes use of gloves when handling blood or body fluids that contain blood. Specifically, universal precautions consist of the following four basic infection control guidelines: (A) Hand washing - Staff should wash their hands in the following situations, but not limited to these situations: 1. After assisting with incontinent care or wiping a resident’s nose. 2. Before preparing or eating food. 3. After using the toilet. 4. Before and after treating or bandaging a cut. 5. After wiping down surfaces, cleaning spills, or any other housekeeping. 6. After being in contact with any body fl uids from another person, even if they wore gloves during contact with body fluids. (B) Gloves 1. Use gloves only one time, for one incident or resident. (i) Air dry the hands or dry the hands on a single-use paper towel prior to putting on a new pair of gloves. (ii) Dispose of used gloves immediately after use. 2. Staff should always wear gloves in the following situations, but not limited to these situations: (i) When they come into contact with blood or body fluids. (ii) When they have cuts or scratches on their hands. (iv) When administering first aid for a cut, a bleeding wound, or a bloody nose. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 14 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (C) Cleaning with a disinfectant - Staff should clean with a disinfectant: 1. On all surfaces and in the resident’s room and on an “as needed” basis on any surface that has come into contact with blood. 2. Such as a basic bleach solution, made fresh daily by mixing 1/4 cup household liquid chlorine bleach in one gallon of tap water, or one tablespoon bleach in one quart of water. (D) Proper disposal of infectious materials - St aff should dispose of infectious materials by placing them in a plastic trash bag, tying the bag with a secure tie, and disposing of it out of reach of residents and children. (2) "Unlicensed Residential Facility for the Elderly" means a facility as defined in Health and Safety Code Section 1569.44. HANDBOOK BEGINS HERE (A) Health and Safety Code Section 1569.44 provides in part: A facility shall be deemed to be an "unlicensed residential care facility for the elderly" and "maintained and operated to provide resi dential care" if it is unlicensed and not exempt from licensure, and any one of the following conditions is satisfied: (1) The facility is providing care and supervis ion, as defined by this chapter or the rules and regulations adopted pursuant to this chapter. (2) The facility is held out as, or represented as, providing care and supervision, as defined by this chapter or the rules a nd regulations adopted pursuant to this chapter. (3) The facility accepts or retains residents who demonstrate the need for care and supervision, as defined by this chapte r or the rules and regulations adopted pursuant to this chapter. (4) The facility represents itself as a licensed residential facility for the elderly. HANDBOOK ENDS HERE CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-03-05 Effective 7/16/03 Page 14.1 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87101 (Cont.) 87101 DEFINITIONS (Continued) 87101 (B) A facility which is "providing care and s upervision" as defined in Section 87101c.(2) includes, but is not limited to, one in which individual has been placed by a placement agency or family members. (C) A facility which is "held out as or re presented as providing care and supervision" includes, but is not limited to: (1) A facility whose license has been revoked or denied, but the individual continues to provide care for the same or different clients with similar needs. (2) A facility where change of ownership has occurred and the same clients are retained. (3) A licensed facility that moves to a new location. (4) A facility which advertises as providing care and supervision. (D) A facility which "accepts or retains residents who demonstrate the need for care and supervision" includes, but is not limited to: (1) A facility with residents requiring care and supervision, even though the facility is providing board and room only, or board only, or room only. (2) A facility where it is apparent that care and supervision are being provided by virtue of the client's needs being met. (v) (1) Vendor. “Vendor” means a Department-approved institution, association, individual(s), or other entity that assumes full responsibility or control over a Department-approved Initial Certification Training Program and/or a Continuing Education Training Program. (2) Vendor applicant. “Vendor applicant” means an y institution, association, individual(s), or other entity that submits a request for approval of an Initial Certification Training Program and/or a Continuing Education Training Program. (3) Voluntary. "Voluntary" means resulting from free will. (w) (1) Waiver. "Waiver" means a variance to a specific regulation based on a facility-wide need or circumstance which is not typically tied to a specific resident or staff person. Requests for waivers are made to the licensing agency, in advance, by an applicant or licensee. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-01-04 Effective 3/12/01 Page 15 87101 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87101 DEFINITIONS (Continued) 87101 (x) (Reserved) (y) (Reserved) (z) (Reserved) NOTE: Authority cited: Sections 1569.23, 1569.30, 1569.616, and 1569.698, Health and Safety Code. Reference: 42 CFR 418.3; Sections 1569.1, 1569.2, 1569.5, 1569.10, 1569.145, 1569.15, 1569.153, 1569.157, 1569.158, 1569.17, 1569.19, 1569.191, 1569.193, 1569.20, 1569.21, 1569.23, 1569.31, 1569.312, 1569.33, 1569.38, 1569.44, 1569.47, 1569.54, 1569.616, 1569.626, 1569.699, 1569.73, 1569.74, 1569.82, 1797.196, and 1771, Health and Safety Code; Section 15610.13, Welfare and Institutions Code; and Sections 1800, 4615, 4650, and 4753, Probate Code. 87102 DEFINITIONS - FORMS 87102 The following forms, which are incorporated by reference, apply to the regulations in Title 22, Division 6, Chapter 8 (Residential Care Facilities for the Elderly). (a) LIC 9139 (2/01) - Renewal of Continuing Educa tion Course Approval, Administrator Certification Program. (b) LIC 9140 (6/01) - Request for Course Approval, Administrator Certification Program. (c) LIC 9141 (5/01) - Vendor Application/Rene wal, Administrator Certification Program. (d) PUB 325 (3/99) – Your Right To Make Decisions About Medical Treatment. (e) Core of Knowledge Guidelines (6/01/ 01) - RCFE 40-Hour Initial Certification. NOTE: Authority cited: Section 1569.30, Health a nd Safety Code. Refere nce: Sections 1530 and 1569.616(i), Health and Safety Code; and Section 15376, Government Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 15.1 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87106 (Cont.) Article 2. License 87105 LICENSE REQUIRED 87105 (a) Pursuant to Health and Safety Code, Secti on 1569.10, any individual or legal entity providing or intending to provide care and supervision to the elderly in a residential facility shall obtain a current valid license pursuant to the provisions of this chapte r. This shall not require an adult residential facility to relocate a resident who becomes 60, nor to change licensing category, provided that the resident's needs remain compatible with those of other residents, and the licensing agency has approved an exception request. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.10, 1569.44 and 1569.45, Health and Safety Code. 87106 OPERATION WITHOUT A LICENSE 87106 (a) An unlicensed facility as defined in Section 87101u.(1) is in violation of Section 1569.10, 1569.44, and/or 1569.45 of the Health and Safety Code unless the facility is exempted from licensure under Section 87107(a). (b) If the facility is alleged to be in violati on of Section 1569.10 and/or 1569.44 and/or 1569.45 of the Health and Safety Code, the licensing agency shall conduct a site visit and/or evaluation of the facility pursuant to Health and Safety Code Section 1569.35. HANDBOOK BEGINS HERE (1) Health and Safety Code S ection 1569.35(c) provides in part: Upon receipt of a complaint, other than a complaint alleging denial of a statutory right of access to a residential care facility for the elderly, the department shall make a preliminary review and, unless the department determines that the complaint is willfully intended to harass a licensee or is without any reasonable basis, it shall make an onsite inspection within 10 days after receiving the complaint. In either event, the complainant shall be promptly informed of the department's proposed course of action. HANDBOOK ENDS HERE CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-91-34 Effective 5/28/91 Page 16 87106 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87106 OPERATION WITHOUT A LICENSE (Continued) 87106 (c) If the facility is operating without a license, the li censing agency shall issue a Notice of Operation in Violation of Law, and shall refer the case for criminal prosecution and/or civil proceedings. (d) The licensing agency shall issue an immediat e civil penalty pursuant to Sections 87310 and 1569.485 of the Health and Safety Code. HANDBOOK BEGINS HERE (1) Section 1569.485 of the Health a nd Safety Code provides in part: Notwithstanding any other provision of this chapter, any person who violates Section 1569.10 or 1569.44, or both, may be assessed by the department an immediate civil penalty in the amount of two hundred dollars ($200) per day of violation. The civil penalty shall be imposed if an unlicensed facility is operated and the operator refuses to seek licensure or the licensure application is de nied and the operator continues to operate the unlicensed facility. HANDBOOK ENDS HERE (e) Sections 87106(c) and (d) shall be applied in an y combination deemed appropriate by the licensing agency. (f) The licensing agency shall notify the appropriate local or state Ombudsman, placement, or adult protective service agency if either of the following conditions exist: (1) There is an immediate threat to the residents' health and safety. (2) The facility does not submit an application for licensure within 15 calendar days of being served a Notice of Operation in Violation of Law. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.10, 1569.19, 1569.335, 1569.35, 1569.40, 1569.405, 1569.41, 1569.42, 1569.43, 1569.44, 1569.45, 1569.47, 1569.485 and 1569.495, Health and Safety Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-89-04 Issued 7/1/89 Page 17 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87107 (Cont.) 87107 EXEMPTION FROM LICENSURE 87107 (a) The following shall be allowed to operate without being licensed as a residential care facility for the elderly: (1) Any health facility, as defined by Health and Safety Code Section 1250. (2) Any clinic, as defined by Hea lth and Safety Code Section 1202. (3) Any facility conducted by and for the adherent s of any well-recognized church or religious denomination for the purpose of providing facilities for the care or treatment of the sick who depend on prayer or spiritual means for healing in the practice of the religion of such church or denomination. Such facilities shall be limited to those facilities or portions thereof which substitute prayer for medical/nursing services which would otherwise be provided for or required by residents in a health facility, as defined by Section 1200 or 1250 of the Health and Safety Code. (4) Any house, institution, hotel or other similar place that supplies board and room only, or room only, or board only, if no element of care and/or supervision, as defined by this chapter, is provided, made available, or contractually promised, such as in a life care agreement or program agreement with a facility. However, this shall not preclude care and/or supervision provided for brief and irregular periods of time for reasons such as temporary illnesses or emergencies provided that such is determined to be minor and temporary and does not require twenty-four (24) hours supervision of the resident(s). (5) Recovery houses or other similar facilities providing group living arrangements for persons recovering from alcoholism or drug addicti on where the facility provides no care and supervision. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-89-04 Issued 7/1/89 Page 18 87107 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87107 EXEMPTION FROM LICENSURE (Continued) 87107 (6) Any alcoholism recovery facility as defined by Section 11834.11 of the Health and Safety Code relating to alcohol programs. HANDBOOK BEGINS HERE Health and Safety Code Section 11834.11 provides in part: (A) An "alcoholism recovery facility" means any facility place or building which is maintained and operated to provide 24-hour residential nonmedical alcoholism recovery services exclusively for individuals whose involvement in services is related primarily to an alcohol problem. HANDBOOK ENDS HERE (7) Any care and supervision of persons by a fam ily member. For purposes of this section “family member” means any spouse, by marriage or otherwise, child or stepchild, by natural birth or by adoption, parent, brother, sister, half-brother, half-sister, parent-in-law, brother-in-law, sister-in- law, nephew, niece, aunt, uncle, first cousin, or any person denoted by the prefix “grand” or “great”, or the spouse of any of these persons, even if the marriage has been terminated by death or dissolution. (8) Any arrangement for the care and supervision of a person or persons from only one family by a close friend who is not a licensee or current employee of a Residential Care Facility for the Elderly or of an Adult Residential Facility, and whose friendship pre-existed a provider/recipient relationship, and all of the following conditions are met: (A) The care and supervision is provided in a home or residence chosen by the recipient, regardless of who owns the home or residence. (B) The arrangement is not of a business nature, in that the provider does not represent himself or herself as being in the business of provision of care, and any compensation that may be paid to the provider is only for the value of the services rendered. (C) The arrangement occurs and continues only as long as the needs for care and supervision of the recipient are being adequately met. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 19 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87107 87107 EXEMPTION FROM LICENSURE (Continued) 87107 (9) Any housing project for elderly or disabled individuals that meets federal requirements as specified in Health and Safety Code Section 1569.145(g). HANDBOOK BEGINS HERE (A) Health and Safety Code Section 1569.145(g) provides: “Any housing for elderly or disabled persons, or both, that is approved and operated pursuant to Section 202 of Public Law 86-372 (12 U.S.C.A. Sec. 1701q), or Section 811 of Public Law 101- 625 (42 U.S.C.A. Sec 8013), or whose mortgage is insured pursuant to Section 236 of Public Law 90-448 (12 U.S.C.A. Sec. 1715z), or that receives mortgage assistance pursuant to Section 221d(3) of Public Law 87-70 (12 U.S.C.A. Sec.17151), where supportive services are made available to residents at their option, as long as the project owner or operator does not contract for or provide the supportive services. The project owner or operator may coordinate, or help residents gain access to, the supportive services, either directly, or through a service coordinator.” HANDBOOK ENDS HERE (10) Any similar facility as determined by the Director. NOTE: Authority cited: Sections 1569.145 and 1569.30, Health and Safety Code. Reference: Sections 1505, 1569.145, and 11834.02, Health and Safety Code; and Grimes v. CDSS (1999) 70 Cal.App.4th 1065. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 19.1 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87111 (Cont.) 87108 INTEGRAL FACILITIES 87108 (a) Upon written application, the licensing agency may issue a single license to integral facilities conducting multiple, related programs which would otherwise require separate licenses provided all of the following requirements are met: (1) Separate buildings or portions of the facility shall be integral components of a single program. (2) All components of the program shall be managed by the same licensee. (3) All components of the program shall be conducted at a single site. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Section 1569.30, Health and Safety Code. 87110 LIMITATIONS -- CAPACITY AND AMBULATORY STATUS 87110 (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. (b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.2, 1569.31 and 1569.312, Health and Safety Code. 87111 ADVERTISEMENTS AND LICENSE NUMBER 87111 (a) In accordance with Health and Safety Code S ections 1569.68 and 1569.681, licensees shall reveal each facility license number in all public advertisements, including Internet, or correspondence. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 20 This page is intentionally left blank. Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87111 87111 ADVERTISEMENTS AND LICENSE NUMBER (Continued) 87111 HANDBOOK BEGINS HERE (1) Health and Safety Code, Section 1569.681 provides: (a) Each residential care facility for the elderl y licensed under this chapter shall reveal its license number in all advertisements, publi cations, or announcements made with the intent to attract clients or residents. (b) Advertisements, publications, or announcements subject to the requirements of subdivision (a) referred to herein include, but are not limited to, those contained in the following: (1) Newspaper or magazine. (2) Consumer report. (3) Announcement of intent to commence business. (4) Telephone directory yellow pages. (5) Professional or service directory. (6) Radio or television commercial. (2) Health and Safety Code, Section 1569.68 provides: All residential care facilities shall be required to include their current license number in any public advertisement or correspondence. HANDBOOK ENDS HERE (b) Licensees who operate more than one facility and use a common advertisement for these facilities shall be required to list each facility license number in acco rdance with Health and Safety Code Sections 1569.681 and 1569.68. NOTE: Authority cited: Section 1569.30, Health a nd Safety Code. Referen ce: Sections 1569.68 and 1569.681, Health and Safety Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 21 87112 RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87112 FALSE CLAIMS 87112 No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. NOTE: Authority cited: Section 1569.30, Health a nd Safety Code. Referen ce: Sections 1569.30 and 1569.44, Health and Safety Code. 87113 TRANSFERABILITY 87113 (a) The license shall not be transferable. (b) The licensee shall notify the licensing agency and a ll residents receiving services, or their responsible persons, in writing as soon as possible and in all cases at least sixty (60) days prior to the effective date that any change in ownership of the facility occu rs as required by Health and Safety Code Section 1569.191(a)(1). (c) In all other instances, including a change in licen see, type of license, or location of the facility, the licensee shall notify the licensing agency and all r esidents receiving services, or their responsible persons, in writing as soon as possible and in all cases at least thirty (30) days prior to the effective date of that change. (d) In the case of change of ownership or licensee a new application for license shall be submitted by the prospective new licensee. NOTE: Authority cited: Sections 1569.30 and 1569.30(a), Health and Safety Code. Reference: Sections 1569.11 and 1569.191, Health and Safety Code. 87114 CONTINUATION OF LICENSE UNDER EMERGENCY 87114 CONDITIONS/SALE OF PROPERTY (a) The licensing agency may consent to a change of location and continuation of the existing license of any facility for a reasonable period of time when th e change is requested because of the accidental destruction of the licensed premises or similar emergency conditions, so long as the new location or place of performance conforms to building, fire and life safety standards. (b) In the event of a licensee's death, an adult who has control of the property, and had been designated by the licensee as the party responsible to continue operation of the facility upon a licensee’s death shall: CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-12 Effective 7/3/04 Page 22 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87114 (Cont.) 87114 CONTINUATION OF LICENSE UNDER EMERGENCY 87114 CONDITIONS/SALE OF PROPERTY (Continued) (1) notify the Department by the next working day of the licensee’s death; (2) inform the Department within 5 working days if the designee decides not to apply for licensure. (A) If the designee decides not to apply, the Department will help the designee develop and implement a relocation plan for facility residents. (c) The Department may permit a designee to conti nue operation of a previously licensed facility, and grant an Emergency Approval to Operate (EAO) to a facility for up to 60 days pending issuance or denial of a license, provided the following requirements of Section 1569.193 of the Health and Safety Code are met: (1) The designee notifies the Department during th e next working day following the death of the licensee, that he/she will continue to operate the facility. (2) A notarized designation of the adult, authori zed by the licensee, to continue operation of the facility in the event of the licensee’s death, was filed by the licensee with the Department. (A) The notarized statement was signed by th e designee, and indicated acceptance of the designation. (B) The notarized statement contains, or is accompanied by a declaration under penalty of perjury, regarding any criminal convictions of the designee. (3) The designee is able to operate the fac ility to the satisfaction of the Department. (4) The designee files an application for licensu re, and provides a copy of the licensee’s death certificate, obituary notice, certification of death from the decedent’s mortuary, or a letter from the attending physician or coroner’s office verifying the death of the licensee, within 20 calendar days of the licensee’s death. (5) The applicant who is issued an EAO shall pe rform all the duties, functions, and responsibilities required of a licensee. (A) Failure to comply with licensing la ws and regulations under Section 87114(b) as determined by the licensing agency, shall r esult in the denial of the application for license. This denial shall also constitute termination of the EAO. (B) The licensing agency shall provide written notification of the denial and this notice shall be effective immediately upon receipt. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 23 87114 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87114 CONTINUATION OF LICENSE UNDER EMERGENCY 87114 CONDITIONS/SALE OF PROPERTY (Continued) (d) The Department shall determine, within 60 days, af ter receipt of the completed application, whether a license will be issued. (e) Following receipt of a completed application, the designee shall not be considered to be operating an unlicensed facility while the Department decides whether to grant the license. (f) In the event of the sale and transfer of property a nd business, the applicant (buyer) shall be issued an EAO if the applicant (buyer) complies with Section 1569.191 of the Health and Safety Code. HANDBOOK BEGINS HERE (1) Health and Safety Code, Section 1569.191 provides in part: (a) Notwithstanding Section 1569.19, in the even t of a sale of a licensed facility where the sale will result in a new license being issued, the sale and transfer of property and business shall be subject to both of the following: (1) The licensee shall provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 60 days prior to the transfer of property or business, or at the time that a bona- fide offer is made, whichever period is longer. HANDBOOK CONTINUES CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 24 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87114 (Cont.) 87114 CONTINUATION OF LICENSE UNDER EMERGENCY 87114 CONDITIONS/SALE OF PROPERTY (Continued) HANDBOOK CONTINUES (2) The licensee shall, prior to entering in to an admission agreement, inform all residents, or their legal representatives, admitted to the facility after notification to the department, of the licensee's intent to sell the property or business. (b) Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter. (1) The seller shall notify, in writing, a pr ospective buyer of the necessity to obtain a license, as required by this chapter, if the buyer's intent is to continue operating the facility as a residential care facility for the elderly. The seller shall send a copy of this written notice to the licensing agency. (2) The prospective buyer shall submit an application for a license, as specified in Section 1569.15, within five days of the acceptance of the offer by the seller. (c) No sale of the facility shall be permitte d until 60 days have elapsed from the date upon which notice has been provided pursuant to paragraphs (1) and (2) of subdivision (a). (d) The department shall give priority to applications for licensure which are submitted pursuant to this section in order to ensure timely transfer of the property and business. The department shall make a decision within 60 days after a complete application is submitted on whether to issue a license pursuant to Section 1569.15. (e) If the parties involved in the transfer of the property and business fully comply with this section then the transfer may be completed and the buyer shall not be considered to be operating an unlicensed facility while the department makes final determination on the application for licensure. HANDBOOK ENDS HERE CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 25 87114 (Cont.) RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87114 CONTINUATION OF LICENSE UNDER EMERGENCY 87114 CONDITIONS/SALE OF PROPERTY (Continued) (g) "A bona-fide offer", as specified in Health a nd Safety Code Section 1569.191(a)(1), shall mean a proposal by the buyer to purchase the facility with definite terms in writing communicated to the seller and accompanied by a cash deposit. NOTE: Authority cited: Sections 1569.30, Health and Safety Code. Reference: Sections 1569. 1, 1569.15, 1569.191, 1569.193, and 1569.30, Health and Safety Code. 87115 POSTING OF LICENSE 87115 The license shall be posted in a prominent location in the licensed facility accessible to public view. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Section 1569.30, Health and Safety Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-02-08 Effective 8/22/02 Page 26 Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87116 87116 PROGRAM FLEXIBILITY 87116 (a) The use of alternate concepts, programs, services , procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conduct of experimental or demonstration projects shall not be prohibited by these regulations provided that: (1) Such alternatives shall be carried out w ith provisions for safe and adequate services. (2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency by the applicant or licensee. (3) Prior written approval of the licensing agency shall be received. (A) In determining the merits of each requ est, the licensing agency shall use as guidelines the standards utilized or recommended by well-recognized state and national organizations as appropriate. (B) The licensing agency shall provide written approval or denial. (b) Unless prior written approval of the licensing agen cy is received, all community care facilities shall maintain continuous compliance with the licensing regulations. NOTE: Authority cited: Section 1569.30, Health a nd Safety Code. Referen ce: Sections 1569.30 and 1569.31, Health and Safety Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-89-04 Issued 7/1/89 Page 27 87117 RESIDENTIAL CARE FACILITIES FOR THE ELDERLY Regulations 87117 APPLICANT/LICENSEE MAILING ADDRESS 87117 The applicant or licensee shall file his/her mailing addr ess, in writing, with the licensing agency and shall notify the agency, in writing, of any change within 10 calendar days. NOTE: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.15, 1569.20, 1569.22, 1569.30 and 1569.51, Health and Safety Code. 87118 NONDISCRIMINATION 87118 (a) Any adult shall be permitted to apply for a license re gardless of age, sex, race, religion, color, political affiliation, national origin, disability, marital status, actual or perceived sexual orientation, or ancestry. (b) All licensed facilities shall receive persons on a nondiscriminatory basis according equal treatment and services without regard to race, color, religion, national origin, actual or perceived sexual orientation or ancestry. (c) An exception shall be made in the case of any bona fide nonprofit religious, fraternal or charitable organization which can demonstrate to the satisfaction of the Department or the licensing agency that its primary or substantial purpose is not to evade this section. (1) It may establish reception policies limiting or givi ng preference to its own members or adherents, provided, however, such membership is nondiscriminatory and such policies shall not be construed as a violation of this section. (2) Any reception of nonmembers or nonadherents sh all be subject to the requirements of this section. NOTE: Authority cited: Section 1569.30, Health a nd Safety Code. Referen ce: Sections 1569.30 and 1569.31, Health and Safety Code; and Section 51, Civil Code. CALIFORNIA-DSS-MANUAL-CCL MANUAL LETTER NO. CCL-04-03 Effective 1/9/04 Page 28