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Key Concepts: Resident Assessments & Rights

59 key concepts from Title 22, Division 6, Chapter 8, Article 8: Resident Assessments & Rights, for the RCFE Administrator exam. For the searchable, bookmarkable version, use the interactive Study Guide.

Acceptance & Retention: The Aging-in-Place Principle
87455 p. 124
Whether a licensee can accept or retain a resident is governed by the criteria in this chapter (Chapter 8), with the goal of letting residents age in place in the least restrictive environment appropriate for them.
Show Title 22 source text
(a) Acceptance or retention of residents by a licensee shall be in accordance with the criteria specified in this Chapter 8, thereby allowing residents to age in place in the least restrictive environment when appropriate.Part 3, Page 124
Who Can Be Accepted or Retained as a Resident
87455 p. 124
The regulations specifically call out several categories of residents a facility may accept or retain:
  • People capable of managing their own medications.
  • People getting medical care/treatment outside the facility, or from a visiting nurse.
  • People who may need help self-administering medication (per 87465).
  • People who display "behavioral expression" (as defined in 87101).
  • People who may need help managing money.
  • People with a mild, temporary emotional disturbance from a personal loss or move.
  • Bedridden people, as long as 87606's requirements are met.
  • People under 60 whose needs are compatible with, and require the same level of care as, other residents.
  • People diagnosed as terminally ill who are receiving certified hospice services, as long as the facility has a hospice care waiver (87632) and hospice care follows 87633.
Show Title 22 source text
(b) The following persons may be accepted or retained by the licensee: (1) Persons capable of administering their own medications. (2) Persons receiving medical care and treatment outside the facility or who are receiving needed medical care from a visiting nurse. (3) Persons who may need assistance with self-administration of medication as specified in Section 87465, Incidental Medical and Dental Care Services. (4) Persons who display behavioral expression as defined in Section 87101, Definitions. (5) Persons who may need assistance with managing money. (6) Persons with mild temporary emotional disturbance resulting from personal loss or change in living arrangement. (7) Persons who are bedridden provided the requirements of Section 87606 are met. (8) Persons who are under 60 years of age whose needs are compatible with other residents in care, if they require the same amount of care and supervision as do the other residents in the facility. (9) Persons who have been diagnosed as terminally ill and who have obtained the services of hospice, certified in accordance with federal medicare conditions of participation and licensure, provided the licensee has obtained a facility hospice care waiver in accordance with the provisions of Section 87632, Hospice Care Waiver, and hospice care is being provided in accordance with the provisions of Section 87633, Hospice Care for Terminally Ill Residents.Part 3, Page 124
One Reason a Resident Can't Be Accepted or Retained: Active TB
87455 p. 125
A resident can't be accepted or retained if they have active, communicable tuberculosis (among other disqualifying conditions covered elsewhere in this section).
Show Title 22 source text
(c) No resident shall be accepted or retained if any of the following apply: (1) The resident has active communicable tuberculosis.Part 3, Page 125
Conditions for a Terminally Ill Resident's Hospice Waiver
H&S 1569.73(a) p. 125.1
Beyond the facility agreeing to seek a waiver, two more conditions have to be met for a terminally ill resident (or prospective resident) to stay in the facility under a hospice waiver:
  • They have to have obtained services from a hospice that's both certified under federal Medicare rules and separately licensed.
  • In the Department's judgment, the facility has to actually be capable of meeting that person's care/supervision needs, and be in substantial compliance with RCFE regulations overall.
Show Title 22 source text
(2) The terminally ill resident, or the terminally ill person to be accepted as a resident, has obtained the services of a hospice certified in accordance with federal medicare conditions of participation and licensed pursuant to Chapter 8 (commencing with Section 1725) or Chapter 8.5 (commencing with Section 1745).Part 3, Page 125.1
(3) The facility, in the judgment of the department, has the ability to provide care and supervision appropriate to meet the needs of the terminally ill resident or the terminally ill person to be accepted as a resident, and is in substantial compliance with regulations governing the operation of residential care facilities for the elderly.Part 3, Page 125.1
The Four-Step Admission Suitability Process
87456 p. 126
Before accepting a resident, the facility has to go through four steps to evaluate whether they're a good fit:
  • Interview the applicant and their responsible person.
  • Complete a pre-admission appraisal.
  • Get and review a recent medical assessment.
  • Sign the admission agreement.
Show Title 22 source text
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (1) Conduct an interview with the applicant and his responsible person. (2) Perform a pre-admission appraisal. (3) Obtain and evaluate a recent medical assessment. (4) Execute the admissions agreement.Part 3, Page 126
The Pre-Admission Interview
87457 p. 126
Before admission, the prospective resident (and their responsible person, if any) has to be interviewed by the licensee or the staff member responsible for admissions. That interview has to give everyone involved enough information about the facility and its services to make an informed decision, and has to cover the prospective resident's own wishes about admission, their background, specific service needs, medical background, and functional limitations.

No one can be admitted without their own consent (or their responsible person's).
Show Title 22 source text
(a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. (1) Sufficient information about the facility and its services shall be provided to enable all persons involved in the placement to make an informed decision regarding admission. (2) The prospective resident's desires regarding admission, and his/her background, including any specific service needs, medical background and functional limitations shall be discussed.Part 3, Page 126
(b) No person shall be admitted without his/her consent and agreement, or that of his/her responsible person, if any.Part 3, Page 126
What the Suitability Appraisal Has to Document
87457 p. 126
Before admission, the facility has to determine the prospective resident's suitability by appraising their individual service needs against the acceptance/retention criteria in 87455. At minimum, that appraisal has to document:
  • An evaluation of their functional capabilities, mental condition, and social factors (per 87459 and 87462).
  • Whether their safety (or other residents' safety) would be at risk if they're allowed access to certain items covered under 87307 (Personal Accommodations) and 87309 (Storage Space and Access).
Show Title 22 source text
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall document, at a minimum: (A) An evaluation of the prospective resident's functional capabilities, mental condition, and social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. (B) Whether the prospective resident's or other residents' safety would be at risk if the prospective resident is allowed access to any of the items specified in Section 87307, Personal Accommodations and Services and in Section 87309, Storage Space and Access.Part 3, Page 126
Addressing Unmet Needs Found During the Appraisal
87457 p. 127
If the initial appraisal (or a later reappraisal) turns up a resident need that the facility's general services don't cover, the licensee has to get advice from a physician, social worker, or other appropriate consultant to see if the facility can actually meet that need. If it can, the licensee and consultant have to develop a plan of action that includes:
  • Time-bound objectives tied to the resident's specific problems/unmet needs.
  • A plan for meeting those objectives.
  • Who (which individuals or agencies) is responsible for each part of the plan.
  • How progress will be evaluated.
Show Title 22 source text
(2) Except as provided in Section 87638(g)(3), if an initial appraisal or any reappraisal identifies an individual resident service need which is not being met by the general program of facility services, advice shall then be obtained from a physician, social worker, or other appropriate consultant to determine if the needs can be met by the facility. If so, the licensee and the consultant shall develop a plan of action which shall include: (A) Objectives, within a time frame, which relate to the resident's problems and/or unmet needs. (B) Plans for meeting the objectives. (C) Identification of any individuals or agencies responsible for implementing each part of the plan. (D) Method of evaluating progress.Part 3, Page 127
Medical Assessment Timing
87458 p. 127
Before a person can be accepted as a resident, the licensee has to get documentation of a medical assessment (signed by a licensed medical professional and completed within the last year) and keep it in the resident's record. The licensee also has to get an updated medical assessment whenever the Department requires one.
Show Title 22 source text
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.Part 3, Page 127
(b) The licensee shall obtain an updated medical assessment when required by the Department.Part 3, Page 127
Medical Assessment: Disease & Condition Screening
87458 p. 128
The medical assessment's physical exam has to specifically address contagious diseases and any other medical conditions (in addition to tuberculosis and infectious disease, covered separately).
Show Title 22 source text
(C) Contagious diseases. (D) Other medical conditions.Part 3, Page 128
Medical Assessment: History, Medications & Limitations
87458 p. 128
The medical assessment also has to document: prior medical services/history and current status (including height, weight, and blood pressure); current prescribed medications, and whether they should be centrally stored (87465); and any physical limitations affecting the resident's ability to participate in facility programs, including medically necessary diet restrictions.
Show Title 22 source text
(2) Documentation of prior medical services and history and current medical status including, but not limited to height, weight, and blood pressure. (3) A record of current prescribed medications, and an indication of whether the medication should be centrally stored, pursuant to Section 87465, Incidental Medical and Dental Care Services. (4) Identification of physical limitations of the person to determine his/her capability to participate in the programs provided by the licensee, including any medically necessary diet limitations.Part 3, Page 128
Medical Assessment: Ambulatory, Nonambulatory & Bedridden Status
87458 / H&S 1569.72(b) p. 128
The medical assessment has to determine whether the resident is ambulatory, nonambulatory, or bedridden, and specify whether nonambulatory status is based on their physical condition, mental condition, or both.

"Bedridden," by the statutory definition, means needing help turning/repositioning in bed, or being unable to transfer to/from bed independently, unless the facility has appropriate staff, mechanical devices, and safety precautions in place to handle it.
Show Title 22 source text
(5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101, Definitions, or bedridden as defined in Health and Safety Code section 1569.72. The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition, or both.Part 3, Page 128
(b)(1) For the purposes of this section, "bedridden" means requiring assistance in turning and repositioning in bed or being unable to independently transfer to and from bed, except in a facility with appropriate and sufficient care staff, mechanical devices, if necessary, and safety precautions, as determined by the director in regulations.Part 3, Page 128
Assessing Functional Capabilities (Activities of Daily Living)
87459 p. 128.1-129
The facility has to assess a person's need for personal assistance by evaluating their ability to perform activities of daily living, including:
  • Bathing
  • Dressing and grooming
  • Toileting
  • Transferring (moving in/out of a bed or chair)
  • Continence
  • Eating
  • Physical condition: specifically vision, hearing, speech, walking (with or without equipment/assistance), dietary limitations, medical history/problems, and need for prescribed medications.
Show Title 22 source text
(a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to:Part 3, Page 128.1
(1) Bathing, including need for assistance: (2) Dressing and grooming, including the need for partial or complete assistance. (3) Toileting, including the need for: (4) Transferring, including the need for assistance in moving in and out of a bed or chair. (5) Continence, including: (6) Eating, including the need for:Part 3, Page 128.1
(7) Physical condition, including: (A) Vision. (B) Hearing. (C) Speech.Part 3, Page 128.1
(D) Walking with or without equipment or other assistance. (E) Dietary limitations. (F) Medical history and problems. (G) Need for prescribed medications.Part 3, Page 129
Assessing Mental Condition
87461 p. 129
To figure out how much supervision a prospective resident needs, the facility has to assess their mental status, specifically checking whether they:
  • Tend to wander.
  • Are confused or forgetful.
  • Are capable of managing their own cash resources.
  • Actively participate in social activities, or are withdrawn.
  • Have a documented history of behavior that could harm themselves or others.
Show Title 22 source text
(a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual: (1) tends to wander; (2) is confused or forgetful; (3) is capable of managing his/her own cash resources; (4) actively participates in social activities or is withdrawn; (5) has a documented history of behaviors which may result in harm to self or others.Part 3, Page 129
Assessing Social Factors
87462 p. 129
The facility has to gather enough information about each person's likes, dislikes, interests, and activities to determine whether the facility's living arrangements will actually suit them, and to suggest which activities they might want to participate in.
Show Title 22 source text
The facility shall obtain sufficient information about each person's likes and dislikes and interests and activities, to determine if the living arrangements in the facility will be satisfactory, and to suggest the program of activities in which the individual may wish to participate.Part 3, Page 129
Reappraisal Cycle & What Counts as a "Significant Change"
87463 p. 130
The pre-admission appraisal has to be updated in writing (as a "reappraisal") as often as needed, or at least once every 12 months, whichever comes first, to capture significant changes and keep the appraisal accurate. (Same 12-month cycle as the Numbers & Deadlines "Reappraisal Cycle" card.)

A "significant change in condition" includes:
  • Physical trauma, like a heart attack or stroke.
  • Changes in cognitive function: thinking, remembering, reasoning, judgment, decision-making.
  • Behavioral expression that could harm the resident or others: unsafe wandering, elopement, hallucinations, poor hazard awareness, poor impulse control.
  • Mental or social trauma, like losing a loved one.
  • Illness or injury that significantly changes health care or dietary needs.
  • Whether the resident's (or others') safety would be at risk with access to items covered under 87307/87309.
Show Title 22 source text
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.Part 3, Page 130
(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. (1) Significant changes in condition, as defined in Section 87101, Definitions, include, but are not limited, to: (A) Physical trauma, such as a heart attack or stroke. (B) Cognitive functions, such as thinking, remembering, reasoning, exercising judgement, and decision-making. (C) Behavioral expression, as defined in Section 87101, Definitions, that may result in harm to self or others, such as unsafe wandering, elopement, hallucinations, lacking in hazard awareness, or lacking in impulse control. (D) A mental or social trauma, such as the loss of a loved one. (E) Illness or injury that results in a significant change in the health care or dietary needs of the resident. (F) Whether the resident's and other residents' safety would be at risk if the resident is allowed to have access to any of the items specified in Section 87307, Personal Accommodations and Services and in Section 87309, Storage Space and Access.Part 3, Page 130
Documenting Behavioral Expression
87463 p. 130
If the licensee sees (or learns of) behavioral expression that has caused or could cause harm to the resident or others, they have to document in the resident's reappraisal:
  • What the behavioral expression looked like.
  • If known, what happened right before it: interactions with others, sudden environment changes, signs of new illness/injury (fever, cough, urinary urgency, limping), overstimulation, or physical sensations the resident couldn't express verbally (fatigue, heat, cold, pain, hunger, thirst, boredom, fear, wanting to walk, needing the toilet).
Show Title 22 source text
(c) If the licensee observes or is made aware of behavioral expression, as defined in Section 87101, that has caused or may cause harm to the resident or others, the licensee shall document all of the following in the resident's reappraisal: (1) A description of the behavioral expression.Part 3, Page 130
(2) If known, identification of events occurring just prior to the behavioral expression including, but not limited to, interactions with other residents or staff, sudden or recent changes in the physical environment, signs of possible new physical illness or injury (such as fever, cough, urinary urgency, or limping), overstimulation (such as from noise or visitors), or physical sensations a resident may not be able to express verbally that may include, but are not limited to, fatigue, heat, cold, pain, hunger, thirst, boredom, fear, wanting to walk, or need for toileting.Part 3, Page 130
Interventions & Specialist Consultation
87463 p. 130.1
The licensee also has to document the interventions planned to reduce risk from a resident's behavioral expression, always using the least restrictive option that fits the resident's individual needs.

If a resident is getting specialized services, the licensee has to consult with those care providers to make sure changes in the resident's condition are properly addressed, and document that consultation in the resident's record.
Show Title 22 source text
(3) Interventions to be implemented to minimize the risks to the health and safety of the resident or others associated with the resident's behavioral expression. The licensee shall use the least restrictive intervention to manage the behavioral expression based on the individual needs of the resident.Part 3, Page 130.1
(d) If a resident is receiving specialized services, the licensee shall consult with those care providers in order to ensure changes in the resident's condition are properly addressed, document such consultation, and place documentation in the resident's record.Part 3, Page 130.1
Communicating a Significant Change to the Resident's Doctor
87463 p. 130.1
As soon as reasonably possible, the licensee has to bring any significant change in condition to the attention of the resident's licensed medical professional (and other specialized care provider, if applicable), documenting: what the change was, when/with whom the licensee communicated, any recommendations given, and any resulting change in care.

The licensee also has to communicate the change (and any recommendations) to the resident and their representative, documenting that conversation too, and make sure the resident's actual care and supervision changes accordingly.
Show Title 22 source text
(e) The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition, as defined in Section 87101, Definitions, to the attention of the appropriate licensed medical professional and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include: (1) Description of the significant change in condition; (2) Date and time the communication occurred and the name of the appropriate licensed medical professional, and if applicable, other specialized care provider, with whom the licensee communicated; (3) Recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider; and (4) Change in care to be provided, if any.Part 3, Page 130.1
(f) The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident's record.Part 3, Page 130.1
(g) The licensee shall ensure corresponding changes are made in the care and supervision provided to the resident.Part 3, Page 130.1
Annual Routine Visit Documentation
87463 p. 130.1
The licensee has to request that every resident get a routine visit with a licensed medical professional at least once every 12 months (in person or by video). Whatever happens has to be documented: the visit itself, a refusal by the resident or their representative, or (if they refuse and later change their mind) the visit once it does happen. (Same 12-month cycle as the Numbers & Deadlines "Reappraisal Cycle" card.)
Show Title 22 source text
(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. (2) Documentation of a resident's refusal to receive an annual routine visit, or if applicable, their representative's refusal on their behalf, shall be added to the resident's record. (3) If a resident refuses to receive an annual routine visit, or if applicable, their representative refuses an annual routine visit on their behalf, but later agrees to one, documentation of the annual routine visit shall be added to the resident's record.Part 3, Page 130.1
Sharing the Reappraisal & Evaluating Staffing Needs
87463 p. 131
Whenever there's a significant change in condition, or at least once every 12 months, whichever comes first, the licensee has to arrange an in-person or virtual meeting (or conference call) to share the reappraisal with the resident, their representative, and appropriate facility staff.

The licensee also has to evaluate staffing needs to make sure there's enough direct care staff to support each resident's physical, social, emotional, safety, and health care needs as identified in their current appraisal.
Show Title 22 source text
(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making.Part 3, Page 131
(j) The licensee shall evaluate staffing needs to ensure that there is a sufficient number of direct care staff, as specified in Section 87411, Personnel Requirements -- General, to support each resident's physical, social, emotional, safety and health care needs, as identified in their current appraisal.Part 3, Page 131
Basic Services: Independence & Facility Responsibility
87464 p. 131
Facility services have to continue and promote independence and self-direction for residents as much as possible, encouraging them to participate fully (as their condition allows) in daily living, both in the facility and the community.

"Basic services" are simply the services a facility must provide to get and keep its license, and the admission agreement has to spell out which basic services each resident needs and will receive.

A facility never has to accept a particular resident. But once it does, it's responsible for meeting that resident's needs as identified in the pre-admission appraisal, and providing the basic services described below, directly or through outside resources.
Show Title 22 source text
(a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility and in the community.Part 3, Page 131
(b) As used in this chapter, basic services are those services required to be provided in order to obtain and maintain a license.Part 3, Page 131
(c) The admission agreement shall specify which of the basic services are desired and/or needed by, and will be provided for, each resident.Part 3, Page 131
(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.Part 3, Page 131
SSI/SSP Residents: Basic Services at No Extra Charge
87464 p. 131
If a resident receives SSI/SSP, basic services have to be provided at the basic rate, with no additional charge. That doesn't stop the facility from accepting voluntary contributions from relatives or others on the resident's behalf, and per Social Security Administration guidance, a contribution paid directly to the facility (for something other than food, clothing, or shelter, like care and supervision) doesn't count as the resident's income and won't reduce their SSI/SSP check.
Show Title 22 source text
(e) If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident. (1) This shall not preclude the acceptance by the facility of voluntary contributions from relatives or others on behalf of an SSI/SSP recipient.Part 3, Page 131
(A) The Social Security Administration has interpreted Federal Regulations (20 CFR 416.1102, 416.1103, and 416.1145) to mean that any contribution given directly to the facility on behalf of an SSI/SSP recipient will not count as income (i.e., will not reduce the recipient's SSI/SSP check) if the payment is used for items other than food, clothing or shelter (e.g., care and supervision).Part 3, Page 131
The 7 Basic Services Every Facility Must Provide
87464 / H&S 1569.2(c) p. 132
At minimum, every facility's basic services have to include:
  • Care and supervision, as defined in 87101(c)(3) and Health and Safety Code 1569.2(c): meaning the facility takes on (or promises) ongoing help with daily living activities the resident needs to stay physically/mentally safe, including help with medications, money management, or personal care.
  • Safe, healthful living accommodations and services (87307).
  • Three well-balanced meals and snacks daily, including any doctor-prescribed modified diets (87555).
  • Personal assistance with daily living activities (dressing, eating, bathing, medication help) as identified in the pre-admission appraisal (87608).
  • Regular observation of the resident's physical and mental condition (87466).
  • Arranging for health needs to be met, including transportation (87465).
  • A planned activities program suited to the resident's interests and abilities (87219).
Show Title 22 source text
(f) Basic services shall at a minimum include:Part 3, Page 132
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).Part 3, Page 132
(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident's physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care.Part 3, Page 132
(2) Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services. (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor as a medical necessity, as specified in Section 87555, General Food Service Requirements. (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. (5) Regular observation of the resident's physical and mental condition, as specified in Section 87466, Observation of the Resident. (6) Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. (7) A planned activities program which includes social and recreational activities appropriate to the interests and capabilities of the resident, as specified in Section 87219, Planned Activities.Part 3, Page 132
Incidental Medical & Dental Care: The Facility's Plan
87465 p. 133
Every facility has to have a plan for incidental medical and dental care that encourages routine care and helps residents actually get it. That plan has to cover:
  • Arranging (or helping arrange) medical/dental care that fits each resident's needs.
  • Helping residents get to necessary appointments, including transportation, which can be limited to the nearest facility that can meet the need, provided directly or arranged by the licensee.
  • Helping residents with self-administered medications as needed.
  • Only staff designated by the licensee may assist with self-administration (facility staff generally can't give injections unless separately authorized by law), and that assistance is limited to: medications a physician has authorized for self-administration, medications for a physician-determined temporary/minor illness, and assistance needed because of tremor, failing eyesight, or similar conditions. Assistance never means forcing medication, hiding it in food/drink without consent, or otherwise overriding a resident's right to refuse.
  • When the prescribing physician or the Department asks, the facility has to keep a dosage record for centrally-stored medications.
Show Title 22 source text
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:Part 3, Page 133
(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.Part 3, Page 133
(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service.Part 3, Page 133
(4) The licensee shall assist residents with self-administered medications as needed.Part 3, Page 133
(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. (B) Medications during an illness determined by a physician to be temporary and minor. (C) Assistance required because of tremor, failing eyesight and similar conditions. (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication.Part 3, Page 133
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.Part 3, Page 133
First Aid Privacy, Kit & Infection Control
87465 p. 134
A facility needs adequate privacy for treating minor injuries with first aid, and for physician examinations when needed.

If there's no on-site medical unit, the facility has to keep a complete, readily available first aid kit: either a general American Red Cross-approved kit, or one containing at minimum: a current first aid manual (Red Cross, AMA, or a state/federal health agency edition), sterile dressings, bandages/roller bandages, scissors, tweezers, and thermometers.

The licensee also has to maintain infection control practices per 87470.
Show Title 22 source text
(7) There shall be adequate privacy for first aid treatment of minor injuries and for examination by a physician if required.Part 3, Page 134
(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. (B) Sterile first aid dressings. (C) Bandages or roller bandages. (D) Scissors. (E) Tweezers. (F) Thermometers.Part 3, Page 134
(9) The licensee shall ensure that infection control practices are maintained in the facility as specified in Section 87470, Infection Control Requirements.Part 3, Page 134
Assisting With PRN Medication
87465 p. 134
If a resident's physician has said in writing the resident can determine and communicate their own need for a PRN (as-needed) medication (prescription or not), staff can help them self-administer it.

If the physician has instead said the resident can't determine their own need for a nonprescription PRN medication but can clearly communicate their symptoms, designated staff can still help them self-administer it, but only if specific written-order requirements are met.
Show Title 22 source text
(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.Part 3, Page 134
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:Part 3, Page 134
PRN Medication When a Resident Can't Determine Need Themselves
87465 p. 135
If a resident can't determine their own need for a PRN medication and can't clearly communicate symptoms, designated staff can still help them self-administer it, but only if:
  • Staff contact the resident's physician before each dose, describe the symptoms, and get direction to proceed.
  • Each physician contact (date, time, and directions given) is documented in the resident's record.
  • Each dose taken (date, time, dosage, and the resident's response) is documented in the resident's record.
Show Title 22 source text
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: (1) Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. (2) The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record.Part 3, Page 135
When Medications Must Be Centrally Stored
87465 p. 136
Medications have to be centrally stored (rather than kept by the resident) if:
  • They need refrigeration and the resident has no private fridge.
  • A physician determines the medication is hazardous if kept in the resident's personal possession.
  • A physician, the administrator, or the Department determines the medication (or the facility's physical layout, or another resident's condition/habits) creates a safety hazard to others.
Show Title 22 source text
(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator. (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed. (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others.Part 3, Page 136
How Centrally Stored Medications Must Be Handled
87465 p. 136
Centrally stored medication rules:
  • Kept in a safe, locked place accessible only to employees responsible for supervising it.
  • Each container has to carry all the required label information (name, prescribing physician, drug/strength/quantity, fill date, prescription number/pharmacy, control instructions) plus expiration date and refill count.
  • Labels have to comply with state/federal law; only the dispensing pharmacist can alter a prescription label.
  • Each resident's medication stays in its original container, never transferred to a different one.
Show Title 22 source text
(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. (3) Each container shall carry all of the information specified in (6)(A) through (E) below plus expiration date and number of refills. (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.Part 3, Page 136
Medication Records: What Must Be Tracked
87465 p. 136
The licensee has to keep a record of each resident's centrally stored prescription medications for at least 1 year, including at minimum: the resident's name, the prescribing physician's name, and the drug's name, strength, and quantity. (Same 1-year retention as the Numbers & Deadlines "Medication and Destruction Records" card.)
Show Title 22 source text
(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity.Part 3, Page 136
Destroying Unused Medications
87465 p. 137
Prescription medications that aren't taken with the resident when services end, returned to the pharmacy, retained per the physician's documented order, or disposed of under hospice procedures have to be destroyed at the facility by the administrator and one other adult who isn't a resident. Both sign a record, retained for at least 3 years, listing the resident's name, the prescription number/pharmacy, the drug name/strength/quantity destroyed, and the destruction date.
Show Title 22 source text
(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident's physician and documented in the resident's record nor disposed of according to the hospice's established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: (1) Name of the resident. (2) The prescription number and the name of the pharmacy. (3) The drug name, strength and quantity destroyed. (4) The date of destruction.Part 3, Page 137
Designated First Aid Staff
87465 p. 137
In facilities licensed for 16 or more residents, one or more employees have to be specifically designated as responsible for making sure residents get needed first aid and emergency medical services, and for helping with self-administered medications. Who's responsible, and the procedures involved, have to be documented and made known to all residents and staff.
Show Title 22 source text
(j) In all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents as needed with self-administration of medications. The names of the staff employees so responsible and the designated procedures shall be documented and made known to all residents and staff.Part 3, Page 137
Regularly Observing Residents for Changes
87466 p. 137
The licensee has to make sure residents are regularly observed for changes in physical, mental, emotional, and social functioning, and that appropriate help is given when observation reveals an unmet need. If something like unusual weight gain/loss or a decline in mental or physical health is observed, the licensee has to document it and bring it to the attention of the resident's physician and responsible person, if any.
Show Title 22 source text
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.Part 3, Page 137
The Initial Care-Planning Meeting
87467 p. 138
Prior to, or within 2 weeks of, a resident's admission, the licensee has to arrange a meeting with the resident, their representative (if any), appropriate facility staff, a home health agency representative (if any), and any other appropriate parties, to prepare a written record of the care the resident will receive and their preferences about facility services. (Same 2-week window as the Numbers & Deadlines "Care Planning Meeting" card.)
Show Title 22 source text
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility.Part 3, Page 138
Personal Rights: Privately vs. Publicly Operated Facilities
87468 p. 138
Residents have personal rights spelled out in 87468.1 (rights in all facilities) and 87468.2 (additional rights in privately operated facilities), as applicable. The distinction:
  • A "privately operated facility" is licensed to an individual, firm, partnership, association, or corporation.
  • A "publicly operated facility" is licensed to a city, county, or other government entity.
Show Title 22 source text
(a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (1) "Privately operated facility" means a residential care facility for the elderly that is licensed to an individual, firm, partnership, association, or corporation. (2) "Publicly operated facility" means a residential care facility for the elderly that is licensed to a city, county, or other government entity.Part 3, Page 138
Personal Rights Notice at Admission Agreement Signing
87468 p. 139
When the admission agreement is signed, the resident and their representative have to be personally advised of, and given a copy of:
  • Their personal rights under 87468.1/87468.2, with both the resident and representative signing a copy, which goes in the resident's record.
  • A nondiscrimination notice (specific required wording protecting against discrimination based on actual/perceived sexual orientation, gender identity, gender expression, or HIV status, with Ombudsman complaint-filing information), also signed and filed in the resident's record.
Show Title 22 source text
(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities or and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record.Part 3, Page 139
(2) A nondiscrimination notice. (A) The notice shall read "[Name of facility] does not discriminate and does not permit discrimination, including, but not limited to, bullying, abuse, or harassment, on the basis of actual or perceived sexual orientation, gender identity, gender expression, or HIV status, or based on association with another individual on account of that individual's actual or perceived sexual orientation, gender identity, gender expression, or HIV status. You may file a complaint with the Office of the State Long-Term Care Ombudsman [provide contact information] if you believe that you have experienced this kind of discrimination."Part 3, Page 139
Posting Personal Rights & Nondiscrimination Info
87468 p. 139
Licensees also have to prominently post personal rights, the nondiscrimination notice, and complaint information somewhere accessible to residents, representatives, and the public, including posting the applicable personal rights from 87468.1/87468.2.
Show Title 22 source text
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility.Part 3, Page 139
Posting Rights in Other Languages & Confidential Language List
87468 p. 139.1
Licensees have to post personal rights, the nondiscrimination notice, and complaint information in English, and also in any other language that at least 5% of residents can only read. (Same 5% threshold as the Numbers & Deadlines "Translating Resident Rights Notices" card.)

At the Department's request (and immediately if asked during an inspection), the licensee has to provide a confidential, always-current list of residents and the language(s) each one reads.
Show Title 22 source text
(d) Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language.Part 3, Page 139.1
(e) At the request of the Department, and immediately if the request is made during an inspection, a licensee shall provide the Department with a confidential list of residents that includes the language(s) read by each resident, which is to be kept confidential to the extent permitted by law. This list shall be maintained in an accurate and current status at all times.Part 3, Page 139.1
Personal Rights in All Facilities: Dignity, Safety & Freedom
87468.1 p. 139.1
Every resident, in every facility, has the right to:
  • Be treated with dignity in relationships with staff, other residents, and everyone else.
  • Safe, healthful, comfortable accommodations, furnishings, and equipment.
  • Be free from punishment, humiliation, intimidation, abuse, or other punitive actions, including withholding a resident's money or interfering with eating, sleeping, or elimination.
  • Be informed of complaint procedures, including how to reach the Department's complaint unit, Community Care Licensing Division, and the long-term care ombudsman.
  • Freely attend religious services/activities of their choice (in or outside the facility) and receive visits from their spiritual advisor, always on a purely voluntary basis.
  • Leave the facility at any time and never be locked in, though house rules like locking doors at night for safety, or barring windows against intruders (with Department permission), are still allowed.
Show Title 22 source text
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents' money or interfering with daily living functions such as eating, sleeping, or elimination. (4) To be informed by the licensee of the provisions of law regarding complaints and of procedures for confidentially registering complaints, including, but not limited to, the address and telephone number for the complaint receiving unit of the Department, and how to contact the Community Care Licensing Division of the California Department of Social Services, and the long-term care ombudsman regarding grievances in regard to the facility. (5) To have the freedom to attend religious services or activities of their choice either in or outside the facility and to have visits from the spiritual advisor of their choice. Attendance at religious services, either in or outside the facility, shall be on a completely voluntary basis. (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department.Part 3, Page 139.1
More Rights: Facility Visits & Representative Communication
87468.1 p. 139.2
Residents also have the right to:
  • Visit the facility before moving in, along with their representatives.
  • Have their representatives regularly informed of care/service activities, including ongoing evaluations, as appropriate.
  • Have communications from their representatives to the licensee answered promptly and appropriately.
  • Be informed of the licensee's visiting/communication policy, which has to be posted where residents and families can see it, and designed to actively encourage family involvement.
Show Title 22 source text
(7) To visit the facility prior to residence along with their representatives. (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. (9) To have communications to the licensee from their representatives answered promptly and appropriately. (10) To be informed of the licensee's policy concerning visits and other communications with residents, according to Health and Safety Code section 1569.313.Part 3, Page 139.2
Health and Safety Code section 1569.313 provides: "Each residential care facility for the elderly shall state, on its client information form or admission agreement, and on its patient's rights form, the facility's policy concerning family visits and other communication with resident clients and shall promptly post notice of its visiting policy at a location in the facility that is accessible to residents and families. The facility's policy concerning family visits and communication shall be designed to encourage regular family involvement with the resident client and shall provide ample opportunities for family participation in activities at the facility."Part 3, Page 139.2
More Rights: Visitors, Possessions, Communication & Autonomy
87468.1 p. 139.2
Rounding out the rights guaranteed in every facility:
  • Private visits during reasonable hours, without prior notice, from visitors including ombudspersons and advocates, as long as it doesn't infringe on other residents' rights.
  • Wear their own clothes, keep and use their own possessions (including toiletries), and keep/spend their own money.
  • Access to individual storage space for private use.
  • Reasonable phone access for private calls (the licensee can require reimbursement for long-distance charges).
  • Send and receive unopened mail promptly.
  • Accept or refuse medical care or other services.
  • Get help exercising the right to vote.
  • Move out of the facility.
Show Title 22 source text
(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. (12) To wear their own clothes; to keep and use their own personal possessions, including their toilet articles; and to keep and be allowed to spend their own money. (13) To have access to individual storage space for private use. (14) To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. (15) To send and receive unopened correspondence in a prompt manner. (16) To receive or reject medical care or other services. (17) To receive assistance in exercising the right to vote. (18) To move from the facility.Part 3, Page 139.2
Protected From Discriminatory Actions
87468.1 p. 139.3
No licensee or facility staff can take certain actions against a resident, including doing so wholly or partly because of a resident's actual or perceived sexual orientation, gender identity, gender expression, or HIV status. Prohibited actions include:
  • Denying admission, transfer, or refusing to transfer a resident within or between facilities, or discharging/evicting a resident.
  • Where rooms are gender-assigned, assigning a transgender resident's room contrary to their gender identity (unless the resident themselves requests it).
  • Prohibiting or harassing a resident's use of a restroom matching their gender identity, including demanding ID to enter.
Show Title 22 source text
(b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection. A licensee or facility staff may not take any of the following actions, which also includes taking these actions wholly or partially on the basis of the actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status, of a resident: (1) Deny admission to a facility, transfer or refuse to transfer a resident within the facility or to another facility, or discharge or evict a resident from a facility.Part 3, Page 139.3
(3) Where rooms are assigned by gender, assign, reassign, or refuse to assign, a room to a resident who is transgender other than according to the resident's gender identity, unless at the request of the resident who is transgender.Part 3, Page 139.3
(4) Prohibit a resident from using, or harass a resident who seeks to use or uses, a restroom available to others of the same gender identity, regardless of whether the resident is making a gender transition or appears to be gender-nonconforming. Harassment includes, but is not limited to, requiring a resident to show identity documents to gain entrance to a restroom available to other persons of the same gender identity.Part 3, Page 139.3
Additional Rights in Privately Operated Facilities: Privacy Through Care Planning
87468.2 p. 139.5
On top of the rights that apply everywhere, residents in privately operated facilities also have the right to:
  • A reasonable level of personal privacy: in accommodations, medical treatment, personal care, visits, communications, phone calls, internet use, and family/resident group meetings.
  • Keep their records and personal information confidential, approving any release except as legally required.
  • Be encouraged and helped in exercising their rights as citizens and residents, free from interference, coercion, discrimination, or retaliation.
  • Care and supervision that meets their needs, delivered by adequately staffed, qualified, competent personnel.
  • Food of sufficient quality and quantity to meet their nutritional needs.
  • Make their own daily-life choices in the facility.
  • Fully participate in planning their own care: attending and taking part in care meetings, involving people of their choice, and getting the information/support needed to make informed decisions.
Show Title 22 source text
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. (2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. (3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. (5) To be served food of the quality and quantity necessary to meet their nutritional needs. (6) To make choices concerning their daily lives in the facility. (7) To fully participate in planning their care, including the right to attend and participate in meetings or communications regarding care and services to be provided, according to Health and Safety Code section 1569.80 and involve persons of their choice in this planning. The licensee shall provide necessary information and support to ensure that residents direct the planning of their care to the maximum extent possible, and are enabled to make informed decisions and choices.Part 3, Page 139.5
Care Plan Review Cycle & Freedom From Abuse
H&S 1569.80 p. 139.6
The written care record from the initial planning meeting has to be reviewed (and revised if needed) at least once every 12 months, or sooner if there's a significant change in condition, whichever comes first. (Same 12-month cycle as the "Reappraisal Cycle" and "Care Planning Meeting" cards.)

Residents also have the right to be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal/mental/physical/sexual abuse; to raise grievances and recommend changes without retaliation (with the licensee responding promptly); and to contact the Department and/or the long-term care ombudsman about grievances, with their contact info posted somewhere easily accessible.
Show Title 22 source text
(c) The written record described in subdivision (a) shall be reviewed, and, if necessary, revised, at least once every 12 months, or upon a significant change in the resident's condition, as defined by regulations, whichever occurs first. The review shall take place at a meeting coordinated by the facility, and attended by the resident, the resident's representative, if any, an appropriate member or members of the facility's staff, and, if the resident is receiving home health services in the facility, a representative from the home health agency involved.Part 3, Page 139.6
(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. (9) To present grievances and recommend changes in policies, procedures, and services to the facility staff, management, and governing authority, and to any other person without restraint, coercion, discrimination, reprisal, or other retaliatory actions. The licensee shall respond to residents' grievances and recommendations promptly. (10) To contact the State Department of Social Services, the long-term care ombudsman, or both, regarding grievances in regard to the licensee.Part 3, Page 139.6
Posted Info & Being Informed of Facility Rules
W&I 9718 / 87468.2 p. 139.7
Every long-term care facility has to post, somewhere conspicuous, the name, address, and phone number of the local ombudsman office (and the nearest approved organization), plus a brief description of the services they provide.

Residents also have the right to be fully informed, at or before admission, of all the rules governing their conduct and responsibilities at the facility, acknowledged in writing. Any facility rule has to be reasonable and can't violate a resident's rights or other applicable laws.
Show Title 22 source text
Welfare and Institutions Code section 9718 provides: "Every long-term care facility, as defined in subdivision (b) of Section 9701, shall post in a conspicuous location a notice of the name, address, and phone number of the office and the nearest approved organization, and a brief description of the services provided by the office and the approved organization. The form of the notice shall be approved by the office."Part 3, Page 139.7
(11) To be fully informed, prior to or at the time of admission, of all rules that govern resident conduct and responsibilities while living at the facility, as evidenced by the resident's written acknowledgement. All rules established by a licensee shall be reasonable and not violate any rights in this section or other applicable laws or regulations, according to Health and Safety Code section 1569.885.Part 3, Page 139.7
Rate Increases: Notice & No Lump-Sum Assessments
H&S 1569.885 / 1569.655 p. 139.8
Every admission agreement has to attach a statement of resident's rights that includes information on reporting known/suspected elder and dependent adult abuse.

Residents have the right to a comprehensive fee-schedule description in their admission agreement, plus written notice of rate increases: at least 60 days in advance, explaining the amount, reason, and added costs (same 60-day rule as the Numbers & Deadlines "Rate Increase Notice" card).

Separately, licensees can never charge a nonrecurring lump-sum assessment: unexpected costs that would otherwise trigger one instead have to be rolled into the monthly rate and spread out (amortized) over 12 months.
Show Title 22 source text
(e) The statement of resident's rights attached to admissions agreements by a residential care facility for the elderly shall include information on the reporting of suspected or known elder and dependent adult abuse, as set forth in Section 1569.889."Part 3, Page 139.8
(12) To receive in the admission agreement a comprehensive description of the method for evaluating residents' service needs and the fee schedule for the items and services, and to receive written notice of any rate increases according to Health and Safety Code sections 1569.655 and 1569.884.Part 3, Page 139.8
(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident.Part 3, Page 139.8
(b) No licensee shall charge nonrecurring lump-sum assessments. The notification requirements contained in subdivision (a) shall apply to increases specified in this subdivision. For purposes of this subdivision, "nonrecurring lump-sum assessments" mean rate increases due to unavoidable and unexpected costs that financially obligate the licensee. In lieu of the lump-sum payment, all increases in rates shall be to the monthly rate amortized over a 12-month period. The prohibition against a lump-sum assessment shall not apply to charges for specific goods or services provided to an individual resident.Part 3, Page 139.8
What the Admission Agreement Must Cover
H&S 1569.884 p. 139.9
Every admission agreement has to include:
  • A description of items/services covered by a single fee (like a monthly room-and-board fee).
  • A description and fee schedule for anything not covered by that single fee, plus a monthly itemized statement of separate charges.
  • Separate charges only if authorized by the agreement, with any newly available services/charges disclosed and a signed acceptance/refusal statement attached.
  • How third-party services (ancillary, health, medical) tied to the resident's care plan are arranged, accessed, monitored, restricted, and paid for.
  • Billing/payment policies, the conditions for rate increases (1569.655), the visit/communication policy (1569.313), and the refund policy for advance fees after a resident's death (1569.652).
Show Title 22 source text
Health and Safety Code section 1569.884 provides: "The admission agreement shall include all of the following: (a) A comprehensive description of any items and services provided under a single fee, such as a monthly fee for room, board, and other items and services. (b) A comprehensive description of, and the fee schedule for, all items and services not included in a single fee. In addition, the agreement shall indicate that the resident shall receive a monthly statement itemizing all separate charges incurred by the resident. (c) A facility may assess a separate charge for an item or service only if that separate charge is authorized by the admission agreement. If additional services are available through the facility to be purchased by the resident that were not available at the time the admission agreement was signed, a list of these services and charges shall be provided to the resident or the resident's representative. A statement acknowledging the acceptance or refusal to purchase the additional services shall be signed and dated by the resident or the resident's representative and attached to the admission agreement. (d) An explanation of the use of third-party services within the facility that are related to the resident's service plan, including, but not limited to, ancillary, health, and medical services, how they may be arranged, accessed, and monitored, any restrictions on third-party services, and who is financially responsible for the third-party services. (e) A comprehensive description of billing and payment policies and procedures. (f) The conditions under which rates may be increased pursuant to Section 1569.655. (g) The facility's policy concerning family visits and other communication with residents, pursuant to Section 1569.313. (h) The facility's policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident's death, pursuant to Section 1569.652."Part 3, Page 139.9
More Rights: Retention Limits, Room Notice, Records Access & Eviction Protection
87468.2 p. 139.10
Additional resident rights:
  • Be told in writing, at or before admission, of any resident-retention limitations set by the state or the licensee.
  • Reasonable accommodation of individual needs/preferences, unless it would endanger the resident or others.
  • Reasonable accommodation of room and roommate preferences.
  • Written notice of any room change at least 30 days in advance, unless the resident agrees, it's needed to fill a vacant bed, or it's an emergency. (Same 30-day rule as the Numbers & Deadlines "Room Change Notice" card.)
  • Prompt access to review their records, with photocopies provided within 2 business days at no more than the community-standard cost. (Same window as the "Providing Copies of Records" card.)
  • Protection from involuntary transfer, discharge, or eviction, except for reasons state law/regulations actually permit.
Show Title 22 source text
(13) To be informed in writing prior to or at the time of admission, of any resident retention limitations set by the state or licensee, including any limitations or restrictions on the licensee's ability to meet residents' needs. (14) To reasonable accommodation of their individual needs and preferences in all aspects of life in the facility, except when accommodation would endanger the health or safety of the individual resident or other residents. (15) To reasonable accommodation of their preferences concerning room and roommate choices. (16) To written notice of any room changes at least 30 days in advance unless a room change is agreed to by the resident, required to fill a vacant bed, or necessary due to an emergency.Part 3, Page 139.10
(19) To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. (20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents.Part 3, Page 139.10
Advance Directives, Independent Living & Resident Councils
87468.2 p. 139.11
Residents have the right to:
  • Written information on establishing an advance health care directive, and the facility's policy on honoring one: facilities can't condition care on whether someone has one, and have to educate staff and provide written information about it at admission.
  • Be encouraged toward independent living through the planned activities program (87219).
  • Organize and take part in a resident council.
Show Title 22 source text
(22) To receive written information on the right to establish an advance health care directive and the licensee's written policies on honoring an advance health care directive according to Health and Safety Code section 1569.156.Part 3, Page 139.11
Health and Safety Code section 1569.156 provides: "(a) A residential care facility for the elderly shall do all of the following: (1) Not condition the provision of care or otherwise discriminate based on whether or not an individual has executed an advance directive... (2) Provide education to staff on issues concerning advance directives. (3) Provide written information, upon admission, about the right to make decisions concerning medical care... (4) Provide written information about policies of the facility regarding the implementation of the rights described in paragraph (3)."Part 3, Page 139.11
(23) To be encouraged to develop and maintain their fullest potential for independent living through participation in activities designed and implemented for this purpose, according to Section 87219. (24) To organize and participate in a resident council established according to Health and Safety Code section 1569.157.Part 3, Page 139.11
Resident Council Rules
H&S 1569.157 p. 139.12
On request from 2 or more residents, the facility has to help establish and maintain a resident council, made up of residents, though others (family, advocates, ombudsman reps, staff) can join meetings if the council invites them. The council can recommend ways to improve daily life/care and protect resident rights. If it submits written concerns, the facility has to respond in writing within 14 calendar days (same as the family council rule).

If a facility has a resident council and a licensed capacity of 16 or more, it has to appoint a staff liaison, provide a meeting room, and post meeting info centrally.
Show Title 22 source text
(a) Every licensed residential care facility for the elderly, at the request of two or more residents, shall assist the residents in establishing and maintaining a single resident council at the facility. The resident council shall be composed of residents of the facility. Family members, resident representatives, advocates, long-term care ombudsman program representatives, facility staff, or others may participate in resident council meetings and activities at the invitation of the resident council.Part 3, Page 139.12
(b) A resident council may, among other things, make recommendations to facility administrators to improve the quality of daily living and care in the facility and to promote and protect residents' rights.Part 3, Page 139.12
(c) If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days.Part 3, Page 139.12
(f)(2) If a facility has a resident council and a licensed capacity of 16 or more, the facility shall appoint a designated staff liaison to assist the resident council, make a room available for resident council meetings, and post meeting information in a central location readily accessible to residents, relatives, and resident representatives.Part 3, Page 139.12
No Interference With Councils & Theft Reimbursement
H&S 1569.157 / 1569.152 p. 139.13
A facility can't willfully interfere with a resident council forming, meeting, or taking part in inspections; interference includes retaliating against a participant, refusing to publicize meetings or provide space, or ignoring the council's written requests.

Separately, if a facility fails to make reasonable efforts to safeguard resident property, it has to reimburse the resident for, or replace, stolen or lost property at current value. The facility is presumed to have made reasonable efforts if it has clear, convincing evidence it met each theft-and-loss-program requirement (though residents can still challenge that presumption in court).
Show Title 22 source text
(g) A facility shall not willfully interfere with the formation, maintenance, or promotion of a resident council, or its participation in the regulatory inspection process. For the purposes of this subdivision, willful interference shall include, but not be limited to, discrimination or retaliation in any way against an individual as a result of his or her participation in a resident council, refusal to publicize resident council meetings or provide appropriate space for either meetings or a bulletin board, or failure to respond to written requests by the resident council in a timely manner.Part 3, Page 139.13
(a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. The facility shall be presumed to have made reasonable efforts to safeguard resident property if the facility has shown clear and convincing evidence of its efforts to meet each of the requirements specified in Section 1569.153. The presumption shall be a rebuttable presumption, and the resident or the resident's representative may pursue this matter in any court of competent jurisdiction.Part 3, Page 139.13
Occasional Theft Doesn't Mean an Inadequate Program
H&S 1569.152(c) p. 139.14
The Department can't conclude a facility's theft-and-loss program is inadequate just because theft or loss happened there occasionally; an isolated incident, on its own, doesn't prove the program is deficient.
Show Title 22 source text
(c) The department shall not determine that a facility's program is inadequate based solely on the occasional occurrence of theft or loss in a facility."Part 3, Page 139.14
Property Inventory, Surrender & Theft Documentation
H&S 1569.153 p. 139.15
As part of the theft-and-loss program, facilities have to:
  • Create a written personal property inventory at admission, in ink, witnessed and dated, updated as items are added/removed at the resident's/family's written request.
  • Inventory and surrender belongings at discharge (signed receipt) or after death (to the authorized representative, signed receipt), with immediate written notice to the county public administrator if heirs can't/won't claim the property.
  • Document theft-control efforts at least semiannually, reviewed by the administrator (and resident council, when feasible).
  • Mark property for identification when feasible (including engraving dentures, tagging prosthetics).
  • Report thefts worth $100+ to law enforcement within 36 hours.
Show Title 22 source text
(d) A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident's behalf.Part 3, Page 139.15
(e) Inventory and surrender of the resident's personal effects and valuables upon discharge to the resident or authorized representative in exchange for a signed receipt. (f) Inventory and surrender of personal effects and valuables following the death of a resident to the authorized representative in exchange for a signed receipt. Immediate written notice to the public administrator of the county upon the death of a resident whose heirs are unable or unwilling to claim the property as specified in Chapter 20 (commencing with Section 1140) of Division 3 of the Probate Code.Part 3, Page 139.15
(g) Documentation, at least semiannually, of the facility's efforts to control theft and loss, including the review of theft and loss documentation and investigative procedures and results of the investigation by the administrator and, when feasible, the resident council. (h) Establishment of a method of marking, to the extent feasible, personal property items for identification purposes upon admission and, as added to the property inventory list, including engraving of dentures and tagging of other prosthetic devices.Part 3, Page 139.15
(i) Reports to the local law enforcement agency within 36 hours when the administrator of the facility has reason to believe resident property with a then current value of one hundred dollars ($100) or more has been stolen. Copies of those reports for the preceding 12 months shall be made available to the State Department of Social Services and law enforcement agencies.Part 3, Page 139.15
Secured Storage & Financial Affairs Protections
H&S 1569.153 / 87468.2 p. 139.16
Facilities have to maintain a secured area where residents can request their property be kept safe, and provide a lock for a resident's bedside drawer/cabinet on request (at the resident's expense), though the administrator can still access locked areas when needed.

Residents also have the right to manage their own financial affairs. A licensee can't require residents to deposit personal funds with them, and, except in approved continuing care agreements, a licensee (or their spouse, domestic partner, relative, or employee) can never:
  • Serve as a resident's guardian or conservator.
  • Act as a representative payee without the resident's documented written consent.
  • Serve as a resident's agent under a power of attorney.
  • Become a joint tenant with a resident on any account.
Show Title 22 source text
(j) Maintenance of a secured area for residents' property which is available for safekeeping of resident property upon the request of the resident or the resident's responsible party. Provide a lock for the resident's bedside drawer or cabinet upon request of and at the expense of the resident, the resident's family, or authorized representative. The facility administrator shall have access to the locked areas upon request.Part 3, Page 139.16
(26) To manage their financial affairs. A licensee shall not require residents to deposit their personal funds with the licensee. Except as provided for in approved continuing care agreements, a licensee, or a spouse, domestic partner, relative, or employee of a licensee, shall not do any of the following: (A) Accept appointment as a guardian or conservator of the person or estate of a resident. (B) Become or act as a representative payee for any payments made to a resident, without the written and documented consent of the resident or the resident's representative. (C) Serve as an agent for a resident under any general or special power of attorney. (D) Become or act as a joint tenant on any account with a resident.Part 3, Page 139.16
Personal Possessions, Nondiscrimination & Family Councils
87468.2 / H&S 1569.158 p. 139.17
Residents have the right to keep, access, and use their own possessions (including toiletries) and money, unless a statute/regulation limits it.

Facilities can't discriminate against an applicant or resident based on sex, race, color, religion, national origin, marital status, domestic partner status, ancestry, or actual/perceived sexual orientation or gender identity.

Residents' family, friends, and representatives also have the right to organize a family council. Facilities can't prohibit one from forming, and have to let it meet in a common room during mutually agreed hours, independently, without facility staff, unless the council invites them.
Show Title 22 source text
(27) To keep, have access to, and use their own personal possessions, including toilet articles, and to keep and be allowed to spend their own money, unless limited by statute or regulation.Part 3, Page 139.17
(b) A licensed residential care facility for the elderly shall not discriminate against a person seeking admission or a resident based on the person's or resident's sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.Part 3, Page 139.17
Health and Safety Code section 1569.158 provides: "(a) A residential care facility for the elderly shall not prohibit the formation of a family council. When requested by a member of the resident's family or the resident representative, a family council shall be allowed to meet in a common meeting room of the facility during mutually agreed upon hours. (b) Facility policies on family councils shall in no way limit the right of residents and participants in a family council to meet independently with outside persons, including members of nonprofit or government organizations or with facility personnel during nonworking hours."Part 3, Page 139.17
Family Council Response & New-Resident Notice
H&S 1569.158 p. 139.18
If a family council submits written concerns or recommendations, the facility has to respond in writing within 14 calendar days (same as the resident council rule).

If a facility doesn't have a family council, it has to give new residents' families/representatives written information about their right to form one at admission, and, with the council's permission, can share the designated representative's contact info with the long-term care ombudsman program on request.
Show Title 22 source text
(f) If a family council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to the concerns or recommendations within 14 calendar days.Part 3, Page 139.18
(2) If a facility does not have a family council, the facility shall provide, upon admission of a new resident, written information to the resident's family or resident representative of their right to form a family council. (3) Upon request, and with the permission of the family council, the facility shall share the name and contact information of the designated representative of the family council with the long-term care ombudsman program.Part 3, Page 139.18
Advance Directive Information at Admission
87469 p. 140
At admission, the facility has to give every resident (and their representative/responsible person) written information about the right to make medical care decisions, including the Department's approved brochure and a copy of 87469(b)-(d).

Residents are allowed to keep a Request to Forego Resuscitative Measures, an Advance Health Care Directive, and/or a Do-Not-Resuscitate (DNR) form in their facility file.
Show Title 22 source text
(a) Upon admission, a facility shall provide each resident, and representative or responsible person of each resident, with written information about the right to make decisions concerning medical care. This information shall include, but not be limited to, the Department's approved brochure entitled "Your Right To Make Decisions About Medical Treatment," PUB 325, (3/12) and a copy of Sections 87469(b), (c) and (d) of the regulations.Part 3, Page 140
(b) Residents shall be permitted to have a Request to Forego Resuscitative Measures, an Advance Health Care Directive and/or a Do-Not-Resuscitate (DNR) Form in their facility file.Part 3, Page 140
Emergency Response Exception for Hospice Residents
87469 p. 141
If a resident with an advance directive/resuscitation-request form on file has a medical emergency, staff normally call 911 or hand the form to a physician/nurse present. But there's a specific exception: for a terminally ill resident on hospice who has completed the form under H&S 1569.73(c), and whose life-threatening emergency is directly tied to the expected course of their terminal illness, the facility can notify the hospice agency instead of calling 911. Emergencies unrelated to the terminal illness still require an immediate 911 call.
Show Title 22 source text
(c) If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following:Part 3, Page 141
(3) Specifically for a terminally ill resident that is receiving hospice services and has completed an advance directive and/or request regarding resuscitative measures form pursuant to Health and Safety Code section 1569.73(c), and is experiencing a life-threatening emergency as displayed by symptoms of impending death that is directly related to the expected course of the resident's terminal illness, the facility may immediately notify the resident's hospice agency in lieu of calling emergency response (9-1-1). For emergencies not directly related to the expected course of the resident's terminal illness, the facility staff shall immediately telephone emergency response (9-1-1).Part 3, Page 141

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