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Key Concepts: Enforcement

15 key concepts from Title 22, Division 6, Chapter 8, Article 13: Enforcement, for the RCFE Administrator exam. For the searchable, bookmarkable version, use the interactive Study Guide.

The Licensing Agency's Inspection Authority
87755 p. 190
Any properly identified officer, employee, or agent of the licensing agency can enter and inspect an entire facility's premises at any time, with or without advance notice, after stating why they're there.

The licensee has to arrange for private interviews with any resident or staff member, and make all facility-operation records available for examination. The agency can also inspect, audit, and copy resident/facility records during normal business hours, with any removal subject to the same protections covered in 87412(f), 87506(d), and 87508(b).
Show Title 22 source text
(a) Any duly authorized officer, employee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premises of any place providing services at any time, with or without advance notice.Part 4, Page 190
(b) The licensee shall ensure that provisions are made for private interviews with any resident or any staff member; and for the examination of all records relating to the operation of the facility.Part 4, Page 190
(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b).Part 4, Page 190
Annual Visit Triggers & Complaint Response Timing
H&S 1569.33 / 1569.35(c) p. 195
The Department has to do an annual unannounced visit whenever any of these apply: the license is on probation; a compliance plan requires it; an accusation is pending against the licensee; a facility needs an annual visit as a condition of federal funding; or the Department needs to verify someone ordered out of the facility is actually gone.

Facilities not covered by one of those triggers still get an unannounced visit to at least 20% of facilities every year, and no facility ever goes more than 5 years without a visit. Complaint-triggered inspections happen within 10 days of the complaint (unless the visit would interfere with the investigation itself). (Same figures as the "How Often Facilities Get Inspected" card.)
Show Title 22 source text
(1) When a license is on probation. (2) When the terms of agreement in a facility compliance plan require an annual evaluation. (3) When an accusation against a licensee is pending. (4) When a facility requires an annual visit as a condition of receiving federal financial participation. (5) In order to verify that a person who has been ordered out of the facility for the elderly by the department is no longer at the facility.Part 4, Page 195
(c) The department shall conduct annual unannounced visits to no less than 20 percent of facilities not subject to an evaluation under subdivision (b)... (d) Under no circumstance shall the department visit a residential care facility for the elderly less often than once every five years."Part 4, Page 195
Health and Safety Code section 1569.35(c) provides in part: "(c) Upon receipt of a complaint, ...the department shall make a preliminary review and...an onsite inspection within 10 days after receiving the complaint except where the visit would adversely affect the licensing investigation or the investigation of other agencies, including, but not limited to, law enforcement agencies..."Part 4, Page 195
Evaluation Visits & When a Deficiency Notice Issues
87756 p. 196
Every facility gets evaluated per the same standard covered in the previous card (H&S 1569.33). Beyond that, the licensing agency can make any number of other visits it deems necessary to check compliance.

If, during a routine visit, evaluation, or complaint investigation, the evaluator finds a deficiency, they issue a notice of deficiency, unless the deficiency is minor and gets corrected right there during the visit.
Show Title 22 source text
(a) Every residential care facility for the elderly shall be evaluated as specified in Health and Safety Code section 1569.33.Part 4, Page 196
(b) Any number of other visits may be made to a facility for various purposes as determined to be necessary by the licensing agency to determine compliance with applicable laws and regulations. (c) When a routine visit, evaluation or investigation of a complaint is conducted and the evaluator determines that a deficiency exists, the evaluator shall issue a notice of deficiency, unless the deficiency is minor and corrected during the visit.Part 4, Page 196
Serving & Writing Up a Notice of Deficiency
87756 p. 197
Before finishing a visit/evaluation/investigation, the evaluator meets with the licensee/administrator/operator to discuss deficiencies found and develop a correction plan (included in the notice). The notice gets served by personal delivery, or by leaving it with the person in charge and mailing a copy to the licensee if the licensee isn't present; and if anyone refuses to accept it, that refusal gets noted, a copy left at the facility, and another copy mailed to the licensee.

The written notice of deficiency has to include: the specific statute/regulation violated; a factual description of exactly how and where the violation occurred; the correction plan developed at the meeting; and a date by which each deficiency must be corrected.
Show Title 22 source text
(d) Prior to completion of a visit, evaluation or investigation, the evaluator shall meet with the licensee, administrator, operator, or other person in charge of the facility to discuss any deficiencies noted. At the meeting, a plan for correcting each deficiency shall be developed and included in the notice of deficiency. Prior to completion of the visit, the evaluator shall serve the notice of deficiency on the licensee by either: (1) Personal delivery to the licensee, or (2) If the licensee is not at the facility site, leaving the notice with the person in charge of the facility and also mailing a copy to the licensee. (3) If the licensee or the person in charge of the facility refuses to accept the notice, a notation of the refusal shall be written on the notice and a copy left at the facility. (A) Under such circumstances, a copy of the notice shall also be mailed to the licensee.Part 4, Page 197
(e) The notice of deficiency shall be in writing and shall include: (1) A reference to the statute or regulation upon which the deficiency is premised. (2) A factual description of the nature of the deficiency fully stating the manner in which the licensee failed to comply with specified statute or regulation, and the particular place or area of the facility in which it occurred. (3) The plan developed, as specified in (d) above, for correcting each deficiency. (4) A date by which each deficiency shall be corrected.Part 4, Page 197
Correction Deadlines: Serious vs. Non-Serious Deficiencies
87756 p. 198
The evaluator can require correction within 24 hours, specifying that date on the notice, whenever penalties are being assessed under 87761(c)-(e); this 24-hour deadline applies specifically to serious deficiencies.

Otherwise, the standard correction deadline is no more than 30 calendar days after the notice is served, unless the evaluator determines the deficiency genuinely can't be fully corrected that fast (in which case the notice specifies what has to happen within those first 30 days to begin the fix); this 30-day window applies to non-serious deficiencies. (Same figures as the "Deadlines for Fixing a Cited Deficiency" card.)
Show Title 22 source text
(B) The evaluator shall require correction of the deficiency within 24 hours and shall specify on the notice the date by which the correction must be made whenever penalties are assessed pursuant to Sections 87761(c), (d) and (e).Part 4, Page 198
(C) The date for correcting a deficiency shall not be more than 30 calendar days following service of the notice of deficiency, unless the evaluator determines that the deficiency cannot be completely corrected in 30 calendar days. If the date for correcting the deficiency is more than 30 days following service of the notice of deficiency the notice shall specify action which must be taken within 30 calendar days to begin correction.Part 4, Page 198
License Complaints & Serious Deficiency Examples, Intro
87757 / 87758 p. 198
Every licensee has the right (without fear of retaliation) to bring a complaint to the Department or licensing agency about a licensing representative's alleged misapplication or capricious enforcement of the regulations, or about a substantial disagreement over how the RCFE Act or regulations should be applied.

Separately, the regulations give examples of what typically counts as a serious deficiency: violations where noncompliance poses an immediate or substantial threat to residents' physical health, mental health, or safety, starting with 87355 (criminal record clearance).
Show Title 22 source text
(a) Each licensee shall have the right, without prejudice, to bring to the attention of the Department or the licensing agency, or both, any alleged misapplication or capricious enforcement of regulations by any licensing representative, or any substantial differences in opinion as may occur between the licensee and any licensing representative concerning the proper application of the Residential Care Facilities for the Elderly Act or of these regulations.Part 4, Page 198
(a) Regulations including, but not limited to, the following may result in serious deficiencies when a failure to comply presents an immediate or substantial threat to the physical health, mental health, or safety of the residents: (1) Section 87355 relating to criminal record clearance.Part 4, Page 198
The Full List of Serious Deficiency Examples
87758 p. 199
The rest of the regulation's serious-deficiency examples list:
  • 87202: fire clearance
  • 87204: capacity/resident type limitations
  • 87311: telephone service
  • 87455(c)(1),(2),(4) or 87615: communicable disease, inpatient-care needs, prohibited health conditions
  • 87204(b): nonambulatory residents
  • 87468(a)(3): resident rights
  • 87608(a): restraints
  • 87307(d)(3)-(7) or (e): accommodation safety
  • 87555(b)(24),(25),(27): food storage/prep/service
  • 87465(b)(3): medical/dental care
  • 87465(c): storing/dispensing medications
  • 87303(e)(2): hot water temperature
  • 87303(e)(4)-(6): toilet/handwashing/bathing accommodations
  • 87303(f)(1)-(2): solid waste/syringe/needle disposal
  • 87415: night supervision
  • 87638: forwarding a resident's relocation-order review request
Show Title 22 source text
(2) Section 87202 relating to fire clearance. (3) Section 87204 relating to limitations on the number or types of facility residents. (4) Section 87311 relating to telephone service. (5) Sections 87455(c)(1) or (2), or (4), or Section 87615 relating to persons with communicable diseases, persons requiring inpatient health care, persons who are bedridden, or persons with a prohibited health condition. (6) Section 87204(b) relating to nonambulatory residents. (7) Section 87468(a)(3) relating to resident rights. (8) Section 87608(a) relating to restraints.Part 4, Page 199
(9) Sections 87307(d)(3) through (7) or (e) relating to safety of resident accommodations. (10) Section 87555(b)(24), (25), or (27) relating to storage, preparation and service of food. (11) Section 87465(b)(3) relating to medical and dental care of residents. (12) Section 87465(c) relating to storing and dispensing medications. (13) Section 87303(e)(2) relating to hot water temperature. (14) Section 87303(e)(4), (5), or (6) relating to toilet, handwashing and bathing accommodations. (15) Section 87303(f)(1) or (2) relating to storage and disposal of solid wastes, syringes and needles. (16) Section 87415 relating to night supervision. (17) Section 87638 relating to licensees forwarding to the Department a resident's request for review by an interdisciplinary team of a health condition relocation order.Part 4, Page 199
Follow-Up Visit Timing & Standard Penalty
87759 / 87761 p. 200
A follow-up visit happens within 10 working days after the correction deadline, unless the licensee has already demonstrated the fix was made, and no penalty can be assessed without one. (Same window as the "Follow-Up Inspection Timing" card.)

The standard penalty for an uncorrected serious deficiency is $50/day per violation, capped at $150/day. (Same as "Standard Penalty Amounts.")
Show Title 22 source text
(a) A follow-up visit shall be conducted within 10 working days following the latest date of correction specified in the notice of deficiency, unless the licensee has demonstrated that the deficiency was corrected as required in the notice of deficiency. No penalty shall be assessed unless a follow-up visit is conducted.Part 4, Page 200
(a) A penalty of $50 per day, per cited violation, shall be assessed for all serious deficiencies that are not corrected by the date specified in the notice of deficiency, up to a maximum of $150 per day.Part 4, Page 200
Immediate $150/Day Penalty for Sickness, Injury, or Death
87761 p. 201
If a deficiency actually resulted in a resident's sickness, injury, or death, the penalty jumps immediately to $150 per day, regardless of the standard $50/day rule. (Same as "Standard Penalty Amounts.")

Note: the official regulation text itself reads "sickness, injury of death"; an apparent drafting typo in the source document. The excerpt below is quoted exactly as printed for citation accuracy; the intended (and correct) meaning is "sickness, injury, or death."
Show Title 22 source text
(c) Notwithstanding Section 87761(a) above, an immediate penalty of $150 per day shall be assessed for any of the following: (1) Sickness, injury of death of a client has occurred as a result of the deficiency.Part 4, Page 201
Requesting a Review of a Deficiency, Penalty, or Relocation Notice
87763 p. 202
A licensee (or their representative) can request, in writing, a review of a notice of deficiency, notice of penalty, and/or health condition relocation order, but the request must go in within 10 working days of receiving the notice or order. The review is conducted by a higher-level staff person, not the same evaluator who issued the original notice. (Same 10-working-day window as the "Appealing a Citation" card.)
Show Title 22 source text
(a) A licensee or his/her representative may request in writing a review of a notice of deficiency, notice of penalty and/or health condition relocation order within 10 working days of receipt of the notice or order. This review shall be conducted by a higher level staff person other than the evaluator who issued the notice of deficiency, notice of penalty, and/or health condition relocation order.Part 4, Page 202
Suspension of New Admissions: Grounds, Notice & Lifting the Order
87764 p. 202.1-202.2
The Department can order a facility to stop accepting new admissions in two situations: (1) a cited deficiency presents a direct and immediate risk to residents' health, safety, or personal rights and the licensee doesn't fix it right away, or (2) the facility has failed to pay an assessed civil penalty after exhausting the administrative review process.

The Department serves written notice the same way deficiency notices are served (personal delivery, or leaving it with a designated person plus mailing a copy, with a refusal-to-accept noted if that happens). The notice has to state the statutes/regulations violated, the effective date, the correction terms, and a factual description of the risk (or of the unpaid-penalty situation).

The suspension takes effect immediately upon notice, and the facility can't admit new residents while it's in effect (admission agreements signed before the order don't count as new admissions). The suspension stays in effect until the Department confirms all cited deficiencies are corrected (with a follow-up visit within 10 business days of the correction deadline if correction isn't otherwise demonstrated) or, for the unpaid-penalty scenario, until the penalty is paid. Once cleared, the Department has to notify the licensee within 2 business days that the suspension is lifted. (Same figures as "Suspension of New Admissions: Timelines.")
Show Title 22 source text
(a) The Department may order a suspension of new admissions for a facility, as specified in Health and Safety Code Section 1569.545, in either of the following circumstances: (1) When a facility is cited for a deficiency that presents a direct and immediate risk to the health, safety, or personal rights of a resident or residents of the facility and the licensee fails to correct the deficiency immediately. (2) When a facility has failed to pay a civil penalty (or penalties) assessed by the Department after the facility has exhausted the administrative review process specified in Health and Safety Code Section 1569.49.Part 4, Page 202.1
(b) The Department shall serve written notice to the licensee of the order of suspension of new admissions according to the following: (1) Personal delivery to the licensee at the facility site. (2) If the licensee is not at the facility site, the notice shall be left with a person designated in the facility file to accept licensing reports. Under such circumstances, a copy of the notice shall also be mailed to the licensee. (3) If the licensee or designated person refuses to accept the notice, a notation of the refusal shall be written on the notice and the notice shall be left at the facility. Under such circumstances, a copy of the notice, which includes a notation of the refusal, shall also be mailed to the licensee.Part 4, Page 202.1
(c) The notice of the order of suspension of new admissions shall include the following: (1) Citation of statutes and regulations alleged to be violated. (2) The date the order is effective. (3) Terms of the order, including plans of correction for any deficiency cited. (4) (A) In the case of a suspension pursuant to subsection (a)(1), a factual description of the nature of the deficiency fully stating the manner in which the deficiency presents a direct and immediate risk to the health, safety, or personal rights of a resident or residents of the facility.Part 4, Page 202.1
(e) The order of the Department imposing the suspension of new admissions is effective immediately upon notice. The facility shall not admit new residents while the suspension is in effect. (1) For purposes of this section, any admission agreement signed prior to the effective date of the order of suspension of new admissions is not considered a new admission.Part 4, Page 202.2
(f) The suspension of new admissions for a facility shall remain in effect until the Department determines: (1) In the case of a suspension pursuant to subsection (a)(1), the facility has demonstrated to the Department the correction of all deficiencies identified in the notice. If the facility does not demonstrate to the Department the correction of all deficiencies identified in the notice, the Department shall conduct a follow–up visit to determine compliance within ten (10) business days following the latest date of correction specified in the notice.Part 4, Page 202.2
(g) Once the Department has determined that the violation (or violations) has been corrected or fine (or fines) has been paid, as specified in subsection (f), the Department shall notify the licensee immediately, but no later than two (2) business days following the determination, of the order to remove the suspension of new admissions.Part 4, Page 202.2
Appealing a Suspension of New Admissions
87765 p. 202.3
A licensee can appeal a suspension-of-new-admissions order by requesting a written review within 10 business days of receiving the order. The Deputy Director of the Community Care Licensing Division (or their designee) conducts that review. (Same window as "Suspension of New Admissions: Timelines.")
Show Title 22 source text
(a) A licensee or their representative may appeal the decision of the Department to suspend new admissions by requesting, in writing, a review of the order of suspension of new admissions within ten (10) business days of receipt of the order. This review shall be conducted by the Deputy Director of the Community Care Licensing Division or their designee.Part 4, Page 202.3
Unlicensed Facility Penalty: The Initial $100/Day Trigger
87768 p. 203
Operating an unlicensed facility draws a $100 per day, per resident penalty if the operator hasn't submitted a completed license application within 15 calendar days of the Notice of Operation in Violation of Law. (Same figures as the "Operating Without a License" card.)
Show Title 22 source text
(a) A penalty of $100 per day per resident shall be assessed for the operation of an unlicensed facility under either of the following conditions: (1) The operator has not submitted a completed application for licensure within 15 calendar days of issuance of the Notice of Operation in Violation of Law pursuant to Section 87106.Part 4, Page 203
Unlicensed Operation That Continues After an Application Is Denied
87768 p. 204
If a facility's license application gets denied but it keeps operating anyway, the facility has to cease operating within 10 calendar days of the denial notice being mailed (or received, whichever happens first), regardless of whether an appeal is pending. (Same 10-day figure as "Operating Without a License.")
Show Title 22 source text
(2) Unlicensed operation continued after denial of the initial application. (A) Notwithstanding any appeal action, facility operation must cease within 10 calendar days of the mailing of the notice of denial or upon receipt of the denial notice by the operator, whichever occurs first.Part 4, Page 204
Appealing an Unlicensed-Facility Penalty Assessment
87769 p. 205
An unlicensed operator can appeal a penalty assessment, but must do so within 10 working days of being served the assessment. If the facility hasn't stopped operating, the $200/day penalty keeps accruing throughout the appeal. (Same window as "Appealing an Unlicensed-Facility Penalty.")
Show Title 22 source text
(a) An unlicensed operator or his/her representative shall have the right to appeal the penalty assessment within 10 working days after service of the penalty assessment. (1) If the unlicensed facility operation has not ceased, the $200 per day penalty shall continue to accrue during the appeal process.Part 4, Page 205

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