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Key Concepts: Health-Related Services

29 key concepts from Title 22, Division 6, Chapter 8, Article 11: Health-Related Services, for the RCFE Administrator exam. For the searchable, bookmarkable version, use the interactive Study Guide.

Health Practitioner ID & Bedridden Resident Acceptance
87605 / 87606 p. 154
If a licensee employs or allows health care practitioners to treat residents, the facility has to post a visible, prominent notice: "Section 680 of the Business and Professions Code requires health care practitioners to disclose their name and license status on a name tag in at least 18-point type while working in this facility."

Separately, a facility can accept or retain bedridden residents if specific conditions are met: "bedridden" means needing help turning/repositioning in bed, or being unable to transfer to/from bed independently. Whenever a facility accepts or keeps a bedridden resident, it has to notify the fire authority with jurisdiction within 48 hours. (Same 48-hour rule as the Numbers & Deadlines "Notifying the Fire Authority About a Bedridden Resident" card.)
Show Title 22 source text
(c) Licensees who employ or permit health care practitioners to provide care to residents shall post a visible notice in a prominent location that states, "Section 680 of the Business and Professions Code requires health care practitioners to disclose their name and license status on a name tag in at least 18-point type while working in this facility."Part 4, Page 154
(a) Unless otherwise specified, this section applies to licensees who accept or retain residents who are bedridden. The licensee shall be permitted to accept and retain residents who are or shall become bedridden, if all the following conditions are met. Health and Safety Code Section 1569.72(b)(1) provides in part: "(b)(1) ...'bedridden' means either requiring assistance in turning and repositioning in bed, or being unable to independently transfer to and from bed..."Part 4, Page 154
(b) A licensee shall notify the fire authority having jurisdiction within 48 hours of accepting or retaining any person who is bedridden, as specified in Health and Safety Code section 1569.72.Part 4, Page 154
Postural Supports: What's Allowed & Prohibited
87608 p. 156
Based on a resident's appraisal, the facility provides assistance with daily living activities the resident can't do alone, and postural supports (braces, spring-release trays, soft ties, physician-prescribed orthopedic devices) can be used to help with body position, balance, mobility, or independent function: positioning, not restricting, movement.
  • Supports have to fasten in a way the resident can quickly release themselves.
  • A physician's written order for the support has to be kept in the resident's record.
  • If a postural support would change a resident's status to non-ambulatory, the facility needs the appropriate fire clearance (87202) first.
  • Supports can never tie, deprive, or limit the use of a resident's hands or feet. A half-length bed rail for mobility assistance is allowed; full-length bed rails are prohibited, except for hospice residents whose care plan specifically calls for them.
Show Title 22 source text
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. (A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a weakened body part or correction of body parts, are considered postural supports.Part 4, Page 156
(2) Postural supports shall be fastened or tied in a manner that permits quick release by the resident. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. (4) Prior to the use of postural supports that change the ambulatory status of a resident to non-ambulatory, the licensee shall ensure that the appropriate fire clearance, as required by Section 87202, Fire Clearance has been secured.Part 4, Page 156
(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.Part 4, Page 156
Using Home Health Agencies for Incidental Medical Care
87609 p. 157
A licensee can accept or retain residents whose health condition needs incidental medical services, including the conditions covered under 87612 (Restricted Health Conditions).

A licensed home health agency can provide that incidental care as long as: the licensee is in substantial compliance with RCFE law overall, provides the supporting care/supervision the resident still needs, and tells the home health agency which duties facility staff aren't allowed to perform and which regulations apply to the resident's condition. The licensee and agency have to put their respective responsibilities in a written agreement.

Using a home health agency never expands the scope of care/supervision the licensee itself is required to provide.
Show Title 22 source text
(a) A licensee shall be permitted to accept or retain persons who have a health condition(s) which requires incidental medical services including, but not limited to, the conditions specified in Section 87612, Restricted Health Conditions.Part 4, Page 157
(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (2) The licensee provides the supporting care and supervision needed to meet the needs of the resident receiving home health care. (3) The licensee informs the home health agency of any duties the regulations prohibit facility staff from performing, and of any regulations that address the resident's specific condition(s). (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s).Part 4, Page 157
(c) The use of home health agencies to care for a resident's medical condition(s) does not expand the scope of care and supervision that the licensee is required to provide.Part 4, Page 157
Extra Department Approval for Facilities With Recent Compliance Issues
87611 p. 158
Before accepting or keeping a resident with certain allowable health conditions (oxygen administration, IPPB machine, colostomy/ileostomy, contractures, or healing wounds), a licensee has to get Department approval first if, within the last 2 years, they've had:
  • A probationary license;
  • An administrative action filed against them;
  • A Non-Compliance Conference that resulted in a corrective plan of action; or
  • A notice of deficiency involving direct care/supervision of a restricted-health-condition resident that required correction within 24 hours.
Show Title 22 source text
(a) Prior to accepting or retaining a resident with an allowable health condition as specified in Section 87618, Oxygen Administration - Gas and Liquid; Section 87619, Intermittent Positive Pressure Breathing (IPPB) Machine; Section 87621, Colostomy/Ileostomy; Section 87626, Contractures; or Section 87631, Healing Wounds; licensees who have, or have had, any of the following within the last two years, shall obtain Department approval: (1) Probationary license; (2) Administrative action filed against them; (3) A Non-Compliance Conference as defined in Section 87101(n) that resulted in a corrective plan of action; or (4) A notice of deficiency concerning direct care and supervision of a resident with a health condition specified in Section 87612, Restricted Health Conditions, that required correction within 24 hours.Part 4, Page 158
Record of Care for Allowable Health Conditions
87611 p. 159
The licensee has to keep a current, written record of care for each resident with an allowable health condition, including: physician documentation of the condition's stability, what services it requires, the method of intervention, whether the resident can perform the procedure themselves, and (if not) who the designated appropriately skilled professional is; contact info for any vendors and skilled professionals involved; and emergency contacts.
Show Title 22 source text
(b) The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: (1) Documentation from the physician of the following: (A) Stability of the medical condition(s); (B) Medical condition(s) which require incidental medical services; (C) Method of intervention; (D) Resident's ability to perform the procedure; and (E) An appropriately skilled professional shall be identified who will perform the procedure if the resident needs assistance. (2) The names, address and telephone number of vendors, if any, and all appropriately skilled professionals providing services. (3) Emergency contacts.Part 4, Page 159
The List of Restricted Health Conditions
87612 p. 159-160
A licensee may care for residents with any of these "restricted" health conditions/services, each governed by its own specific regulation:
  • Oxygen administration (87618)
  • Catheter care (87623)
  • Colostomy/ileostomy care (87621)
  • Contractures (87626)
  • Diabetes (87628)
  • Enemas, suppositories, and/or fecal impaction removal (87622)
  • Bowel/bladder incontinence (87625)
  • Injections (87629)
  • Intermittent Positive Pressure Breathing (IPPB) machine use (87619)
  • Stage 1 and 2 pressure injuries (87631(a)(3))
  • Wound care (87631)
Show Title 22 source text
(a) The licensee may provide care for residents who have any of the following restricted health conditions, or who require any of the following health services: (1) Administration of oxygen as specified in Section 87618. (2) Catheter care as specified in Section 87623. (3) Colostomy/ileostomy care as specified in Section 87621. (4) Contractures as specified in Section 87626. (5) Diabetes as specified in Section 87628. (6) Enemas, suppositories, and/or fecal impaction removal as specified in Section 87622. (7) Incontinence of bowel and/or bladder as specified in Section 87625. (8) Injections as specified in Section 87629. (9) Intermittent Positive Pressure Breathing Machine use as specified in Section 87619.Part 4, Page 159
(10) Stage 1 and 2 pressure injuries as specified in Section 87631(a)(3). (11) Wound care as specified in Section 87631.Part 4, Page 160
General Requirements for Restricted Health Conditions
87613 p. 160
Before admitting a resident with a restricted health condition, the licensee has to coordinate with everyone else providing care for consistency, and make sure staff who'll help with the resident's specialized needs complete hands-on training (general and resident-specific) from a licensed professional, before providing services.

If the resident's condition changes, staff have to get any additional training the physician (or their designee) determines is needed. The licensee has to document significant changes in the resident's physical/mental/functional capabilities and immediately report them to the physician and representative.

None of this affects the resident's right to accept or refuse medical care (87468); if a resident refuses services, the licensee has to immediately notify the physician/designee and representative, and help develop a plan for meeting the resident's needs.
Show Title 22 source text
(a) Prior to admission of a resident with a restricted health condition, the licensee shall: (1) Communicate with all other persons who provide care to that resident to ensure consistency of care for the condition. (2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (A) Training shall include hands-on instruction in both general procedures and resident-specific procedures. (B) Training shall be completed prior to the staff providing services to the resident.Part 4, Page 160
(b) Should the condition of the resident change, all facility staff providing care to that resident shall complete any additional training required to meet the resident's new needs, as determined by the resident's physician or a licensed professional designated by the physician. (c) The licensee shall document any significant occurrences that result in changes in the resident's physical, mental and/or functional capabilities and immediately report these changes to the resident's physician and authorized representative.Part 4, Page 160
(d) A resident's right to receive or reject medical care or services, as specified in Section 87468, Personal Rights, shall not be affected by this section. (1) If a resident refuses medical services the licensee shall immediately notify the resident's physician or licensed professional designated by the physician and the resident's authorized reprehensive, if any, and shall participate in developing a plan for meeting the resident's needs.Part 4, Page 160
Prohibited Health Conditions
87615 p. 161
Some health conditions can never be accommodated; residents with these can't be admitted or retained at all:
  • Stage 3 and 4 pressure injuries.
  • Gastrostomy tubes.
  • Naso-gastric tubes.
  • Staph infection or other serious infection.
  • Needing help with all activities of daily living (total dependence, per 87459).
  • Tracheotomies.
Show Title 22 source text
(a) Persons who require health services or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. (2) Gastrostomy tubes. (3) Naso-gastric tubes. (4) Staphylococcus aureus ("staph") infection or other serious infection. (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. (6) Tracheotomies.Part 4, Page 161
Requesting an Exception for a Prohibited/Restricted Condition
87616 p. 161
If a licensee agrees a resident has a prohibited or restricted health condition, but believes the underlying intent of the law could still be met through some alternative approach, they can submit a written exception request under 87209 (Program Flexibility).
Show Title 22 source text
(a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means.Part 4, Page 161
Department Review of Certain Health Conditions
87617 p. 162
Some health conditions (covered in 87618 through 87631) may need Department review to decide whether a resident can stay in the facility. If the Department flags a resident's condition for review, it tells the licensee what documentation to submit, including physician assessments, the pre-admission appraisal, and copies of prescriptions for incidental medical services/equipment. That documentation has to reach the Department within 10 days.
Show Title 22 source text
(a) Certain health conditions as specified in Sections 87618, Oxygen Administration-Gas and Liquid, through 87631, Healing Wounds, may require review by Department staff to determine if the resident will be allowed to remain in the facility. The Department shall inform the licensee that the health condition of the resident requires review and shall specify documentation which the licensee shall submit to the Department. (1) Documentation shall include, but not be limited to the following: (A) Physician's assessment(s). (B) Pre-admission appraisal. (C) Copies of prescriptions for incidental medical services and/or medical equipment.Part 4, Page 162
(2) The documentation shall be submitted to the Department within 10 days.Part 4, Page 162
Oxygen Administration Requirements
87618 p. 162-163
A facility can accept/retain a resident who needs oxygen gas if the resident can operate the equipment and determine their own need, or if an appropriately skilled professional handles intermittent administration.

The licensee has to monitor the resident's ongoing ability to operate the equipment, arrange a skilled professional if the resident needs assistance, and meet safety requirements: notify the local fire jurisdiction in writing that oxygen is in use, post "No Smoking-Oxygen in Use" signs, prohibit smoking where oxygen is used, check electrical equipment for spark hazards, secure non-portable tanks, keep tubing long enough for movement without being a hazard, use portable oxygen when residents leave their rooms, keep equipment operable, and remove it once no longer needed. Room size has to accommodate the equipment (87307), and staff need to know how to operate it.

Liquid oxygen requires prior approval from the licensing agency, plus the same resident self-sufficiency requirement as gas oxygen.
Show Title 22 source text
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who requires the use of oxygen gas administration under the following circumstances: (1) If the resident is mentally and physically capable of operating the equipment, is able to determine his/her need for oxygen, and is able to administer it him/herself. OR (2) If intermittent oxygen administration is performed by an appropriately skilled professional.Part 4, Page 162
(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. (B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. (C) Smoking shall be prohibited where oxygen is in use. (D) All electrical equipment shall be checked for defects which may cause sparks. (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. (F) Plastic tubing from the nasal canula or mask to the oxygen source shall be long enough to allow the resident movement within his/her room but does not constitute a hazard to the resident or others. (G) Oxygen from a portable source shall be used by residents when they are outside of their rooms. (H) Equipment shall be operable. (I) Equipment shall be removed from the facility when no longer in use by the resident.Part 4, Page 163
(c) The licensee shall be permitted to accept or retain a resident who requires the use of liquid oxygen under the following circumstances: (1) The licensee obtains prior approval from the licensing agency. (2) If the resident is mentally and physically capable of operating the equipment, is able to determine his/her need for oxygen, and is able to administer it him/herself.Part 4, Page 163
IPPB Machine Requirements
87619 p. 164
A facility can accept/retain a resident who needs an Intermittent Positive Pressure Breathing (IPPB) machine if the resident can operate it themselves and knows their own need, or if an appropriately skilled professional operates and cares for the device.

The licensee has to monitor the resident's ongoing ability to use the equipment, arrange skilled-professional assistance if needed, keep the equipment operable and remove it once no longer needed, confirm the room can accommodate it, and make sure staff know how to operate it.
Show Title 22 source text
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who requires the use of an IPPB machine under the following circumstances: (1) If the resident is mentally and physically capable of operating his/her own equipment and is able to determine his/her own need. OR (2) If the device is operated and cared for by an appropriately skilled professional.Part 4, Page 164
(b) In addition to Section 87611(b), the licensee shall be responsible for the following: (1) Monitoring of the resident's ongoing ability to operate the equipment in accordance with the physician's orders. (2) Ensuring that the procedure is administered by an appropriately skilled professional should the resident require assistance. (3) Ensuring that the use of the equipment meets the following requirements: (A) Equipment shall be operable. (B) Equipment shall be removed from the facility when no longer in use by the resident. (4) Determining that room size can accommodate equipment in accordance with Section 87307(a)(2)(A). (5) Ensuring that facility staff have knowledge of and ability in the operation of the equipment.Part 4, Page 164
Colostomy/Ileostomy Care Requirements
87621 p. 165
A facility can accept/retain a resident with a colostomy or ileostomy if the resident can fully care for it themselves (and a physician has documented it's completely healed), or if an appropriately skilled professional assists.

An appropriately skilled professional has to provide the care, though the ostomy bag/adhesive can be changed by facility staff the professional has specifically instructed, with written documentation of what was delegated and to whom. The professional has to review staff performance at least twice a month (same as the Numbers & Deadlines "Oversight of Ostomy Care" card). Used bags get discarded per 87303(f)(1), and privacy is required whenever care is provided.
Show Title 22 source text
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a colostomy or ileostomy under the following circumstances: (1) If the resident is mentally and physically capable of providing all routine care for his/her ostomy, and the physician has documented that the ostomy is completely healed. OR (2) If assistance in the care of the ostomy is provided by an appropriately skilled professional.Part 4, Page 165
(b) In addition to Section 87611(b), the licensees shall be responsible for the following: (1) Ensuring that ostomy care is provided by an appropriately skilled professional. (A) The ostomy bag and adhesive may be changed by facility staff who have been instructed by the professional. (B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed. (C) The professional shall review the procedures and techniques no less than twice a month. (2) Ensuring that used bags are discarded as specified in Section 87303(f)(1). (3) Privacy shall be afforded when ostomy care is provided.Part 4, Page 165
Fecal Impaction Removal, Enemas & Suppositories
87622 p. 166
A facility can accept/retain a resident needing manual fecal impaction removal, enemas, or suppositories if it's self-administered by the resident, or administered per physician's orders by the resident or an appropriately skilled professional.

If the resident needs assistance, an appropriately skilled professional has to perform it, and privacy is required whenever care is provided.
Show Title 22 source text
(a) The licensee shall be permitted to accept or retain a resident who requires manual fecal impaction removal, enemas, or use of suppositories under the following circumstances: (1) Self care by the resident. (2) Manual fecal impaction removal, enemas, and/or suppositories shall be permitted if administered according to physician's orders by either the resident or an appropriately skilled professional.Part 4, Page 166
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Ensuring that the administration of enemas or suppositories or manual fecal impaction removal is performed by an appropriately skilled professional should the resident require assistance. (2) Privacy shall be afforded when care is being provided.Part 4, Page 166
Indwelling Urinary Catheter Requirements
87623 p. 166-167
A facility can accept/retain a resident with an indwelling catheter if the resident can handle everything except insertion and irrigation themselves; those two specifically can only be performed by an appropriately skilled professional under physician's orders.

A skilled professional handles bag/tubing changes (though facility staff can empty the bag once instructed, with written documentation of the delegation). The professional has to review staff performance as often as necessary, but at least annually (same as the "Oversight of Catheter and Contracture Care" card). Waste is disposed of per 87303(f)(1), and privacy is maintained during care.
Show Title 22 source text
(a) The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (1) If the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation. (A) Irrigation shall only be performed by an appropriately skilled professional in accordance with the physician's orders. (B) A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders.Part 4, Page 166
(2) Ensuring that the bag and tubing are changed by an appropriately skilled professional should the resident require assistance. (A) The bag may be emptied by facility staff who receive instruction from an appropriately skilled professional. (B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed. (C) The licensee shall ensure that the professional reviews staff performance as often as necessary, but at least annually. (3) Ensuring that waste materials shall be disposed of as specified in Section 87303(f)(1). (4) Privacy shall be maintained when care is provided.Part 4, Page 167
Managed Incontinence Requirements
87625 p. 167-168
A facility can accept/retain a resident with manageable bowel/bladder incontinence if it can be handled through self-care, a structured retraining program, scheduled toileting, or incontinence care products.

The facility has to: offer scheduled toileting assistance/reminders rather than just diapering when a resident could benefit; check incontinent residents regularly (including overnight); keep them clean, dry, and free of odor; have bowel/bladder programs designed by an appropriately skilled professional experienced with elderly patients, who also trains staff and periodically re-assesses effectiveness; regularly check skin exposed to urine/stool for breakdown; maintain privacy during care; never withhold fluids to control incontinence; and never catheterize a resident just for the facility's convenience.
Show Title 22 source text
(a) The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances: (1) The condition can be managed with any of the following: (A) Self care by the resident. (B) A structured bowel and/or bladder retraining program to assist the resident in restoring a normal pattern of continence. (C) A program of scheduled toileting at regular intervals. (D) The use of incontinent care products.Part 4, Page 167
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Ensuring that residents who can benefit from scheduled toileting are assisted or reminded to go to the bathroom at regular intervals rather than being diapered.Part 4, Page 167
(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. (4) Ensuring that bowel and/or bladder programs are designed by an appropriately skilled professional with training and experience in care of elderly persons with bowel and/or bladder dysfunction... (9) Ensuring that fluids are not withheld to control incontinence. (10) Ensuring that an incontinent resident is not catheterized to control incontinence for the convenience of the licensee.Part 4, Page 168
Contractures Requirements
87626 p. 168-169
A facility can accept/retain a resident with contractures if the contractures don't severely affect functional ability, and either the resident can care for them alone or an appropriately skilled professional provides the care/supervision.

Physician/physical-therapist-prescribed range-of-motion or other exercises are performed by an appropriately skilled professional or by facility staff the professional has trained (with written documentation of that training). The professional has to review staff performance as often as necessary, but at least annually.
Show Title 22 source text
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has contractures under the following circumstances: (1) If the contractures do not severely affect functional ability and the resident is able to care for the contractures by him/herself. OR (2) If the contractures do not severely affect functional ability and care and/or supervision is provided by an appropriately skilled professional.Part 4, Page 168
(b) In addition to Section 87611(b), the licensee shall be responsible for the following: (1) Ensuring that range of motion or other exercise(s), if prescribed by the physician or physical therapist, are performed by an appropriately skilled professional or by facility staff who receive instruction from an appropriately skilled professional. (2) Ensuring that prior to facility staff performing range of motion or other prescribed exercises, there shall be written documentation by the appropriately skilled professional, outlining instruction on the procedures and the names of the facility staff receiving instruction. (3) Ensuring that the professional reviews staff performance as often as necessary, but at least annually.Part 4, Page 169
Diabetes Requirements
87628 p. 169
A facility can accept/retain a resident with diabetes if they can test their own glucose and administer their own medication (oral or injected), or have it administered by an appropriately skilled professional.

The licensee has to help with self-administered medication (87465), keep enough medicine/testing supplies/syringes/needles on hand and properly stored (87465(c)), dispose of syringes/needles per 87303(f)(2), and provide physician-prescribed modified diets (87555(b)(7)).
Show Title 22 source text
(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional.Part 4, Page 169
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Assisting residents with self-administered medication as specified in Section 87465, Incidental Medical and Dental Care Services. (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c). (3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2). (4) Providing modified diets as prescribed by a resident's physician as specified in Section 87555(b)(7).Part 4, Page 169
Healing Wounds Requirements
87631 p. 170
A facility can accept/retain a resident with a healing wound when care is performed by (or supervised by) an appropriately skilled professional, when the wound resulted from surgery and care follows the surgeon's directions, or when it's a stage 1/2 pressure injury diagnosed and cared for by a physician or appropriately skilled professional (with all care documented in the resident's file).

A skin tear does not count as a healing wound under this section.
Show Title 22 source text
(a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. (2) When the wound is the result of surgical intervention and care is performed as directed by the surgeon. (3) Residents with a stage one or two pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional. (A) The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional. (B) All aspects of care performed by the medical professional and facility staff shall be documented in the resident's file. (b) A skin tear is not a healing wound.Part 4, Page 170
Getting a Hospice Care Waiver
87632 p. 171
To accept/retain terminally ill residents receiving hospice care, a licensee needs a facility hospice care waiver from the Department, requesting it in writing, specifying (among other things) the maximum number of terminally ill residents the facility wants at any one time, and confirming an agreement will be reached with the hospice agency covering the care plan.

The Department won't approve a waiver unless the facility demonstrates it can actually meet terminally ill residents' care/supervision needs, and is willing to add care staff if the hospice care plan requires it. If granted, the waiver comes with terms/conditions to protect the terminally ill resident and everyone else in the facility, including a written request, signed by the resident (or their health care surrogate) at admission, agreeing to be accepted/retained while receiving hospice services.
Show Title 22 source text
(1) Specification of the maximum number of terminally ill residents which the facility wants to have at any one time.Part 4, Page 171
(4) A statement by the licensee that an agreement with the hospice agency will be entered into regarding the care plan for the terminally ill resident to be accepted and/or retained in the facility. The agreement with hospice shall design and provide for the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the licensee.Part 4, Page 171
(c) No waiver request will be approved unless the facility demonstrates the ability to meet the care and supervision needs of terminally ill residents, and states a willingness to provide additional care staff if required by the hospice care plan.Part 4, Page 171
(d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: (1) A written request shall be signed by each terminally ill resident or prospective resident upon admission, or by the resident's or prospective resident's health care surrogate decision maker to allow for his or her acceptance or retention in the facility while receiving hospice services.Part 4, Page 171
Hospice Waiver Notification & Department Response
87632 p. 171.1
Once a facility has a waiver, it has to notify the Department in writing within 5 working days of starting hospice care for a resident (or admitting a resident already on hospice). (Same 5-day rule as the "Hospice Waiver Approval and Notification Timelines" card.)

On the waiver request itself, the Department has to respond in writing within 30 days of receiving an acceptable request: either approving/denying it, or flagging it as deficient (describing what's missing and the deadline to fix it; missing that deadline results in automatic denial).
Show Title 22 source text
(2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice.Part 4, Page 171.1
(e) Within 30 days of receipt of an acceptable request for a hospice care waiver, the Department shall notify the applicant or licensee, in writing of one of the following: (1) The request has been approved or denied. (2) The request is deficient, describing additional information required for the request to be acceptable and a time frame for submitting this information.Part 4, Page 171.1
Hospice Care for Terminally Ill Residents: Conditions & Care Plan
87633 p. 172-173
A facility can let terminally ill residents receive hospice care on-site if: the licensee has a hospice care waiver, stays in substantial compliance with all applicable requirements and the waiver's terms, and each resident (or their health care surrogate) individually contracts with a state-licensed, Medicare-certified hospice agency, not the licensee contracting on their behalf.

A written hospice care plan has to be developed by the hospice agency for each terminally ill resident, agreed to by the licensee and resident (or surrogate) before hospice services start, and fully implemented by both the licensee and the hospice. That plan has to be kept current in the facility, including: hospice/physician contact info (with 24-hour emergency numbers); the services the hospice will provide, including type/frequency; the resident's primary hospice contact and primary/alternate facility caregiver; and a description of the licensee's own responsibilities, including procedures for storing/handling medications and other substances, and who (by name or role) on the hospice staff controls and supervises Schedule II-V controlled drugs (facility staff can still help with self-medication without hospice staff present).
Show Title 22 source text
(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. (2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act... all other requirements of Chapter 8... and with all terms and conditions of the waiver.Part 4, Page 172
(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident's hospice agency, and agreed to by the licensee and the resident, or prospective resident, or the resident's or prospective resident's Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s).Part 4, Page 173
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (2) A description of the services to be provided in the facility by the hospice agency including but not limited to the type and frequency of services to be provided.Part 4, Page 173
(4) A description of the area of licensee's responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. (A) The plan shall specify all procedures to be implemented by the licensee regarding the storage and handling of medications or other substances, and the maintenance and use of medical supplies, equipment, or appliances. (B) The plan shall specify, by name or job function, the licensed health care professional on the hospice agency staff who will control and supervise the storage and administration of all controlled drugs (Schedule II - V) for the hospice client. Facility staff can assist hospice residents with self-medications without hospice personnel being present.Part 4, Page 173
Reporting Hospice Service Interruptions
87633 p. 175
Beyond the standard 87211 reporting requirements, the licensee has to separately report to the Department whenever a terminally ill resident's hospice services are interrupted or discontinued for any reason other than death (like refusing hospice care or being discharged from it), and also has to report any deviation from the resident's hospice care plan or other incident threatening any resident's health/safety.
Show Title 22 source text
(g) In addition to the reporting requirements specified in Section 87211, Reporting Requirements, the licensee shall submit a report to the Department when a terminally ill resident's hospice services are interrupted or discontinued for any reason other than the death of the resident, including refusal of hospice care or discharge from hospice. The licensee shall also report any deviation from the resident's hospice care plan, or other incident, which threatens the health and safety of any resident.Part 4, Page 175
Roommate Acknowledgment for Hospice Care
87633 p. 176
If a resident will share a room with someone accepted/retained for hospice care, the roommate (or their representative) has to sign a statement acknowledging that the hospice resident intends to receive care there for the rest of their life, and voluntarily agreeing to give hospice caregivers and the resident's support network (family, friends, clergy, etc.) access to the shared space. If the roommate later withdraws that agreement (verbally or in writing), the licensee has to make alternative arrangements that fully meet the hospice resident's needs.
Show Title 22 source text
(5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. (A) If the roommate withdraws the agreement verbally or in writing, the licensee shall make alternative arrangements which fully meet the needs of the hospice resident.Part 4, Page 176
Grounds for a Department-Ordered Relocation & Initial Notice
87637 p. 176.1
If a resident's health condition can't be cared for within the facility's license limits, needs inpatient health-facility care, or is a prohibited condition under 87455(c)/87615, the Department orders the licensee to relocate them.

When that happens, the Department gives the licensee written notice ordering the relocation and explaining the resident's right to an interdisciplinary team review (87638), and sends that same notice/information to the resident and their responsible person, if any.
Show Title 22 source text
(a) If a resident has a health condition which cannot be cared for within the limits of the license, requires inpatient care in a health facility, or has a health condition prohibited by Section 87455(c) or Section 87615, Prohibited Health Conditions, the Department shall order the licensee to relocate the resident.Part 4, Page 176.1
(b) When the Department orders the relocation of a resident, the following shall apply: (1) The Department shall give written notice to the licensee ordering the relocation of the resident and informing the licensee of the resident's right to an interdisciplinary team review of the relocation order as specified in Section 87638, Resident Request for Review of Health Condition Relocation Order. Notice of the health condition relocation order and information about the right to request an interdisciplinary team review of the relocation order shall be given to the resident, by the Department, and sent to the resident's responsible person, if any.Part 4, Page 176.1
Notice Details & Relocation Plan Requirements
87637 p. 177
If the resident has no responsible person, notice goes to their representative payee (if any) instead, and the Department also phones the State Long-Term Care Ombudsman. The notice also has to explain that the licensee can request an administrative review, or ask the Department to grant/reinstate an exception or waiver to keep the resident in the facility.

Unless the facility's license is suspended, the licensee has to prepare a written relocation plan minimizing transfer-trauma stress, including: specific start/completion dates (immediate relocation allowed, but capped at 30 days, same as the "Health Condition Relocation Plan Deadline" card); a specific date for notifying the resident/responsible person; and how the licensee will help identify an acceptable relocation site, confirming the new facility can legally meet the resident's needs before any move happens.
Show Title 22 source text
(A) If the resident has no responsible person, as defined in Section 87101, the relocation order shall be sent to the representative payee, if any. In such cases, the Department shall also notify the State Long-Term Care Ombudsman of the relocation order by telephone. (B) The notice shall advise that the licensee may request an administrative review of the health condition relocation order, and may request that an exception or waiver be granted or reinstated by the Department to allow retention of the resident in the facility.Part 4, Page 177
(2) The licensee shall prepare a written relocation plan in any instance where the Department does not suspend the facility license. The plan shall contain all necessary steps to be taken to reduce stress to the resident which may result in transfer trauma, and shall include but not be limited to: (A) A specific date for beginning and a specific date for completion of the process of safely relocating the resident. The time frame for relocation may provide for immediate relocation but shall not exceed 30 days. (B) A specific date when the resident and the resident's responsible person, if any, shall be notified of the need for relocation.Part 4, Page 177
(D) The method by which the licensee shall participate in the identification of an acceptable relocation site with the resident and the responsible person, if any. The licensee shall advise the resident and/or the responsible person that if the resident is to be moved to another residential care facility for the elderly, a determination must be made that the resident's needs can be legally met in the new facility before the move is made. If the resident's needs cannot be legally met in the new facility, the resident must be moved to a facility licensed to provide the necessary care.Part 4, Page 177
Submitting, Following & Skipping the Relocation Plan
87637 p. 178
The relocation plan has to be submitted in writing to the Department within the time set by the Department's LIC 809 report. The licensee has to comply with everything in the approved plan; no side contract with anyone else can excuse them from that responsibility or from taking all necessary steps to reduce the resident's stress.

If the Department decides the resident is in imminent danger because of a health condition the facility can't handle, it orders immediate relocation, and in that case, no written relocation plan is required at all.
Show Title 22 source text
(3) The relocation plan shall be submitted in writing to the Department within the time set forth in the LIC 809 (Rev. 5/88) Licensing Report by the Department that the resident requires health services that the facility cannot legally provide.Part 4, Page 178
(6) The licensee shall comply with all terms and conditions of the approved plan. No written or oral contract with any other person shall release the licensee from the responsibility specified in this section or Section 87223, Relocation of Residents, for relocating a resident who has a health condition(s) which cannot be cared for in the facility and/or which requires inpatient care in a licensed health facility, nor from taking all necessary actions to reduce stress to the resident.Part 4, Page 178
(7) In cases where the Department determines that the resident is in imminent danger because of a health condition(s) which cannot be cared for in the facility or which requires inpatient care in a licensed health facility, the Department shall order the licensee to immediately relocate the resident. (A) No written relocation plan is necessary in cases of immediate relocation.Part 4, Page 178
Requesting a Review of a Relocation Order
87638 p. 179
A resident (or their responsible person) can request that the Department's interdisciplinary team review and reconsider a health condition relocation order. If the resident has no responsible person, the Long-Term Care Ombudsman and/or their representative payee can request the review on their behalf.

The resident/responsible person has 3 working days from receiving the order to submit a written, signed, dated review request to the licensee (same window as the "Appealing a Health Condition Relocation Order" card). The licensee then has 10 working days from the resident's request to submit the required supporting documentation to the Department.
Show Title 22 source text
(a) A resident, or the resident's responsible person, if any, shall be permitted to request a review and determination of the Department's health condition relocation order by the interdisciplinary team. (1) If the resident has no responsible person, as defined in Section 87101, the Long-Term Care Ombudsman and/or the resident's representative payee, if any, shall be permitted to submit a request for review and determination on behalf of the resident.Part 4, Page 179
(b) The resident, or the resident's responsible person, if any, shall have three (3) working days, from receipt of the relocation order, to submit to the licensee a written, signed and dated request for a review and determination by the interdisciplinary team.Part 4, Page 179
(e) Within ten (10) working days from the date of the resident's review request, the licensee shall submit to the Department the documentation specified in Section 87638(g) to complete the resident's review request.Part 4, Page 179
Department's Determination Deadline & Limits on the Review Right
87638 p. 180
The Department has to tell the resident (and responsible person) in writing, with reasons, what the interdisciplinary team decided, within 30 days of the resident being notified they need to relocate (same window as the existing card of the same name).

That review right has real limits, though. It does not:
  • Undo a Department determination that relocation is needed to protect the resident's own health/safety (87612(a)).
  • Apply to evictions under 87224.
  • Create a right to a state hearing or any other administrative review beyond this specific process.
  • Apply if the facility's license has been temporarily suspended under 87775(c).
Show Title 22 source text
(h) The Department shall inform the resident and/or the resident's responsible person, if any, in writing, of the interdisciplinary team's determination and the reason for that determination not more than 30 days after the resident or his/her responsible person, if any, is notified of the need to relocate.Part 4, Page 180
(i) The resident's right to a review of a health condition relocation order issued by the Department shall not: (1) Nullify a determination by the Department that the resident must be relocated in order to protect the resident's health and safety as specified in Section 87612(a). (2) Apply to eviction under Section 87224, Eviction Procedures. (3) Imply a right to a state hearing or any other administrative review beyond that set forth in this section. (4) Apply if the facility license has been temporarily suspended as specified in Section 87775(c).Part 4, Page 180

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