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重点内容:健康相关服务

来自 Title 22 第6分部第8章「第11条:健康相关服务」的 29 条重点内容中文说明。如需可搜索、可收藏的版本,请使用互动学习指南

医疗从业人员身份标识与卧床住户的接收
87605 / 87606 p. 154
如果许可证持有人雇用或允许医疗保健从业人员为住户提供治疗,设施须张贴醒目、显眼的告示:“《商业与职业法典》第680条要求医疗保健从业人员在本设施工作期间,须在姓名牌上以不小于18号字体标明其姓名及执照状态。”

另外,如满足特定条件,设施可以接收或留住卧床住户——“卧床”指需要他人协助在床上翻身/调整体位,或无法独立完成上下床转移。设施每次接收或留住卧床住户时,都须在48小时内通知有管辖权的消防机关。(与“数字与期限”栏目“关于卧床住户通知消防机关”卡片中48小时的规则相同。)
查看 Title 22 法规原文

法规原文(英文)

(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
体位支持装置:允许与禁止的做法
87608 p. 156
根据住户的评估结果,设施为住户提供其无法独立完成的日常生活活动方面的协助——体位支持装置(支具、弹簧释放托盘、软绑带、医师开具处方的矫形装置)可用于帮助调整体位、平衡、行动能力或独立功能——目的是帮助定位身体,而非限制其活动。
  • 支持装置的固定方式须使住户能够自行快速解开。
  • 须在住户档案中保存医师开具该支持装置的书面医嘱。
  • 如果某项体位支持装置会使住户的状态变为不能自行走动,设施须事先取得相应的消防许可(87202)。
  • 支持装置绝不能捆绑、剥夺或限制住户手脚的使用。允许使用半长床栏以协助行动;除非临终关怀住户的照护计划中特别要求,否则禁止使用全长床栏。
查看 Title 22 法规原文

法规原文(英文)

(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
利用居家健康机构提供附带性医疗照护
87609 p. 157
如果住户的健康状况需要附带性医疗服务(包括87612《受限健康状况》所涵盖的情形),许可证持有人可以接收或留住这类住户。

持证居家健康机构可提供该附带性照护,只要满足以下条件:许可证持有人整体上实质性遵守RCFE相关法规、提供住户仍需要的辅助照护与监督,并告知居家健康机构哪些职责设施员工不得执行,以及适用于该住户状况的相关法规。许可证持有人与该机构须以书面协议明确各自的责任。

使用居家健康机构绝不会扩大许可证持有人本身须提供的照护/监督范围。
查看 Title 22 法规原文

法规原文(英文)

(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
近期存在合规问题的设施需额外获得部门批准
87611 p. 158
在接收或留住具有某些允许健康状况(吸氧、IPPB呼吸机、结肠造口/回肠造口、挛缩,或愈合中的伤口)的住户之前,如果许可证持有人在过去2年内出现过以下任一情形,须先取得部门批准
  • 许可证处于试用期;
  • 被提起行政处分;
  • 召开违规协调会并因此制定了纠正行动计划;或
  • 因受限健康状况住户的直接照护/监督问题收到缺陷通知,且该通知要求在24小时内纠正。
查看 Title 22 法规原文

法规原文(英文)

(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
允许的健康状况照护记录
87611 p. 159
许可证持有人须为每位具有允许健康状况的住户保存一份最新的书面照护记录,内容包括:医师就该状况稳定性出具的文件、该状况所需的服务、干预方式、住户能否自行完成该项操作,以及(若不能)指定的具备适当技能的专业人员是谁;所涉供应商及具备适当技能的专业人员的联系方式;以及紧急联络人信息。
查看 Title 22 法规原文

法规原文(英文)

(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
受限健康状况清单
87612 p. 159-160
许可证持有人可以照护具有以下任一“受限”健康状况/服务需求的住户,每一项均由其各自的具体法规规范:
  • 吸氧治疗(87618)
  • 导尿管照护(87623)
  • 结肠造口/回肠造口照护(87621)
  • 挛缩(87626)
  • 糖尿病(87628)
  • 灌肠、栓剂及/或粪便嵌塞清除(87622)
  • 大小便失禁(87625)
  • 注射(87629)
  • 间歇正压呼吸(IPPB)机使用(87619)
  • 一、二期压力性损伤(87631(a)(3))
  • 伤口护理(87631)
查看 Title 22 法规原文

法规原文(英文)

(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
受限健康状况的一般要求
87613 p. 160
在收住具有受限健康状况的住户之前,许可证持有人须与所有其他照护提供者协调,确保照护的一致性,并确保将协助该住户特殊需求的员工在提供服务之前完成由持证专业人员提供的动手培训(包括一般性程序与针对该住户的具体程序)。

如果住户的状况发生变化,员工须按医师(或其指定人员)的判断完成所需的额外培训。许可证持有人须记录住户身体/精神/功能能力方面的重大变化,并立即报告给医师及代表。

以上规定均不影响住户接受或拒绝医疗照护的权利(87468)——如果住户拒绝服务,许可证持有人须立即通知医师/其指定人员及代表,并协助制定满足该住户需求的方案。
查看 Title 22 法规原文

法规原文(英文)

(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
禁止的健康状况
87615 p. 161
某些健康状况绝对无法被容纳——具有这些状况的住户完全不得被收住或留住:
  • 三期、四期压力性损伤。
  • 胃造口管。
  • 鼻胃管。
  • 葡萄球菌感染或其他严重感染。
  • 需要他人协助完成全部日常生活活动(依87459属完全依赖状态)。
  • 气管切开术。
查看 Title 22 法规原文

法规原文(英文)

(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
为禁止/受限状况申请例外
87616 p. 161
如果许可证持有人认同某住户具有禁止或受限的健康状况,但认为通过某种替代方式仍可满足法规的根本意图,可依据87209(项目灵活性)提交书面例外申请。
查看 Title 22 法规原文

法规原文(英文)

(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
部门对特定健康状况的审查
87617 p. 162
某些健康状况(见87618至87631)可能需要部门审查,以决定该住户是否可以继续留在设施中。如果部门标记某住户的状况需要审查,会告知许可证持有人须提交哪些文件——包括医师评估、入住前评估,以及附带性医疗服务/设备处方的副本。这些文件须在10天内送达部门。
查看 Title 22 法规原文

法规原文(英文)

(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
吸氧治疗要求
87618 p. 162-163
如果需要吸入氧气的住户能够操作设备并自行判断自己的需求,或由具备适当技能的专业人员进行间歇性给氧,设施可接收/留住该住户。

许可证持有人须持续监测住户操作设备的能力,若住户需要协助须安排具备适当技能的专业人员,并满足以下安全要求:以书面形式通知当地消防管辖机关正在使用氧气、张贴“禁止吸烟——正在使用氧气”标识、在使用氧气的区域禁止吸烟、检查电器设备有无产生火花的隐患、固定非便携式氧气罐、保持导管长度足够方便移动但不构成危险、住户离开房间时使用便携式氧气、保持设备可正常运作,以及在不再需要时移除设备。房间大小须能容纳该设备(87307),员工须懂得如何操作设备。

使用液态氧气须事先获得许可机构批准,并须满足与气态氧气相同的住户自理能力要求。
查看 Title 22 法规原文

法规原文(英文)

(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呼吸机使用要求
87619 p. 164
如果需要使用间歇正压呼吸(IPPB)机的住户能够自行操作设备并知道自身需求,或由具备适当技能的专业人员操作及照护该设备,设施可接收/留住该住户。

许可证持有人须持续监测住户使用设备的能力,若有需要须安排具备适当技能的专业人员协助,保持设备可正常运作并在不再需要时移除,确认房间可容纳该设备,并确保员工懂得如何操作设备。
查看 Title 22 法规原文

法规原文(英文)

(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
结肠造口/回肠造口照护要求
87621 p. 165
如果住户能够完全自行护理其结肠造口或回肠造口(且医师已记录该造口已完全愈合),或由具备适当技能的专业人员予以协助,设施可接收/留住该住户。

须由具备适当技能的专业人员提供该项照护——但造口袋/黏胶可由该专业人员专门指导过的设施员工更换,并须以书面形式记录所委派的内容及被指导人员。该专业人员须至少每月两次审查员工的操作表现(与“数字与期限”栏目“造口照护的监督”卡片相同)。用过的造口袋须依87303(f)(1)丢弃,提供照护时须保护住户隐私。
查看 Title 22 法规原文

法规原文(英文)

(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
粪便嵌塞清除、灌肠与栓剂
87622 p. 166
如果由住户自行操作,或依医嘱由住户本人或具备适当技能的专业人员执行手动粪便嵌塞清除、灌肠或使用栓剂,设施可接收/留住有此类需求的住户。

如果住户需要协助,须由具备适当技能的专业人员执行,提供照护时须保护住户隐私。
查看 Title 22 法规原文

法规原文(英文)

(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
留置导尿管使用要求
87623 p. 166-167
如果住户除插入及冲洗之外能够自行处理留置导尿管的所有其他方面——这两项操作只能由具备适当技能的专业人员依医嘱执行——设施可接收/留住该住户。

须由具备适当技能的专业人员负责更换导尿袋/导管(不过经指导后,设施员工可以清空导尿袋,并须以书面形式记录该委派内容)。该专业人员须视需要而定,但至少每年一次审查员工的操作表现(与“导尿管及挛缩照护的监督”卡片相同)。废弃物须依87303(f)(1)处置,护理期间须保护住户隐私。
查看 Title 22 法规原文

法规原文(英文)

(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
可控性失禁管理要求
87625 p. 167-168
如果住户的大小便失禁状况可以通过自理、结构化的重新训练计划、定时如厕,或失禁护理用品加以管理,设施可接收/留住该住户。

设施须做到:对能够受益于定时如厕的住户提供协助/提醒,而非直接使用尿布;定期检查失禁住户(包括夜间);保持其清洁、干燥、无异味;由具备照护老年患者经验的具备适当技能的专业人员设计大小便失禁管理方案,并由该专业人员培训员工及定期重新评估方案效果;定期检查接触尿液/粪便的皮肤有无破损;护理期间保护隐私;不得为控制失禁而限制住户饮水;且绝不能仅为设施方便而对住户实施导尿以控制失禁。
查看 Title 22 法规原文

法规原文(英文)

(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
挛缩照护要求
87626 p. 168-169
如果挛缩未严重影响住户的功能能力,且住户能够自行护理该挛缩,或由具备适当技能的专业人员提供照护/监督,设施可接收/留住有挛缩的住户。

经医师/物理治疗师开具的关节活动度训练或其他运动,须由具备适当技能的专业人员执行,或由经该专业人员指导(并以书面形式记录该培训)的设施员工执行。该专业人员须视需要而定,但至少每年一次审查员工的操作表现。
查看 Title 22 法规原文

法规原文(英文)

(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
糖尿病照护要求
87628 p. 169
如果患有糖尿病的住户能够自行进行血糖检测并自行给药(口服或注射)——或由具备适当技能的专业人员为其给药,设施可接收/留住该住户。

许可证持有人须协助自我给药(87465),保持并妥善存放足量的药物/检测用品/注射器/针头(87465(c)),依87303(f)(2)处置注射器/针头,并提供住户医师开具的特殊饮食(87555(b)(7))。
查看 Title 22 法规原文

法规原文(英文)

(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
愈合中的伤口护理要求
87631 p. 170
如果护理由具备适当技能的专业人员执行(或在其监督下进行)、伤口系手术所致且护理遵循外科医师的指示,或该伤口为经医师或具备适当技能的专业人员诊断及护理的一、二期压力性损伤(所有护理均记录在住户档案中),设施可接收/留住具有愈合中伤口的住户。

根据本条款,皮肤撕裂伤不属于愈合中的伤口。
查看 Title 22 法规原文

法规原文(英文)

(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
取得临终关怀照护豁免
87632 p. 171
要接收/留住正在接受临终关怀服务的绝症住户,许可证持有人须向部门取得设施临终关怀照护豁免——须以书面形式提出申请,说明(除其他事项外)设施希望在任一时刻容纳的绝症住户最大人数,并确认将与临终关怀机构就照护计划达成协议。

除非设施能证明自己确实有能力满足绝症住户的照护/监督需求,并愿意在临终关怀照护计划要求时增派照护人员,否则部门不会批准该豁免。一旦批准,该豁免会附带条款/条件,以保护该绝症住户及设施内其他所有住户——包括须由该住户(或其医疗保健代理决策人)在入住时签署一份书面申请,同意其在接受临终关怀服务期间被接收/留住。
查看 Title 22 法规原文

法规原文(英文)

(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
临终关怀豁免的通知与部门回应
87632 p. 171.1
一旦设施获得豁免,须在开始为某住户提供临终关怀服务(或收住已在接受临终关怀服务的住户)后5个工作日内以书面形式通知部门。(与“临终关怀豁免批准与通知时限”卡片中5天的规则相同。)

就豁免申请本身而言,部门须在收到符合要求的申请后30天内以书面形式回复——批准/拒绝该申请,或标记为缺项(说明缺少的内容及补交期限;逾期未补交则自动视为拒绝)。
查看 Title 22 法规原文

法规原文(英文)

(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
绝症住户的临终关怀照护:条件与照护计划
87633 p. 172-173
如果满足以下条件,设施可以让绝症住户在设施内接受临终关怀服务:许可证持有人已取得临终关怀照护豁免、在所有适用要求及豁免条款方面保持实质性合规,且每位住户(或其医疗保健代理决策人)分别与经州许可、通过Medicare认证的临终关怀机构单独签约——而非由许可证持有人代为签约。

须由临终关怀机构为每位绝症住户制定书面临终关怀照护计划,并在临终关怀服务开始前,由许可证持有人与住户(或其代理决策人)共同确认同意,随后由许可证持有人与临终关怀机构双方全面落实执行。该计划须在设施内保持最新,内容包括:临终关怀机构/医师的联系方式(含24小时紧急联络电话);临终关怀机构将提供的服务及其类型/频率;住户在临终关怀机构中的主要联系人,以及设施方主要/备用照护人员;以及许可证持有人自身职责的说明——包括药物及其他物质的储存/处理程序,以及由临终关怀机构员工中哪位(以姓名或职务指明)负责管制及监督第II类至第V类管制药物(设施员工仍可在无临终关怀人员在场的情况下协助住户自我服药)。
查看 Title 22 法规原文

法规原文(英文)

(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
报告临终关怀服务中断情况
87633 p. 175
除87211规定的标准报告要求外,只要绝症住户的临终关怀服务因死亡以外的任何原因(如拒绝接受临终关怀照护或被临终关怀机构中止服务)而中断或终止,许可证持有人须单独向部门报告;此外还须报告任何偏离住户临终关怀照护计划的情形,或任何威胁到住户健康/安全的其他事件。
查看 Title 22 法规原文

法规原文(英文)

(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
临终关怀照护的室友知情确认
87633 p. 176
如果某住户将与被接收/留住以接受临终关怀照护的住户同住一室,该室友(或其代表)须签署一份声明,确认知悉该临终关怀住户打算在此设施内接受照护直至生命终结,并自愿同意允许临终关怀护理人员及该住户的支持网络(家人、朋友、神职人员等)进入共用居住空间。如果该室友之后以口头或书面方式撤回该同意,许可证持有人须做出能够充分满足该临终关怀住户需求的其他安排。
查看 Title 22 法规原文

法规原文(英文)

(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
部门下令迁移的依据与初步通知
87637 p. 176.1
如果住户的健康状况超出设施许可范围可照护的限度、需要住院式医疗机构照护,或属于87455(c)/87615规定的禁止状况,部门会下令许可证持有人将该住户迁移安置。

此时,部门会向许可证持有人发出书面通知,下令迁移并说明住户有权申请跨学科团队审查(87638)——同时将同一份通知/信息发送给该住户及其负责人(如有)。
查看 Title 22 法规原文

法规原文(英文)

(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
通知细节与迁移计划要求
87637 p. 177
如果住户没有负责人,通知则改为发送给其代表收款人(如有),部门同时会致电通知州长期照护监察员。通知中还须说明许可证持有人可以申请行政审查,或请求部门批准/恢复某项例外或豁免,以便让该住户继续留在设施内。

除非设施许可证已被吊销,许可证持有人须制定一份书面迁移计划,尽量减轻转移可能带来的压力,内容须包括:具体的开始及完成日期(可允许立即迁移,但不得超过30天——与“健康状况迁移计划期限”卡片相同);通知住户/负责人的具体日期;以及许可证持有人将如何协助确定合适的迁移安置地点,并在实际搬迁前确认新设施在法律上确实能够满足该住户的需求。
查看 Title 22 法规原文

法规原文(英文)

(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
提交、执行与豁免迁移计划
87637 p. 178
迁移计划须在部门LIC 809报告所设定的期限内以书面形式提交给部门。许可证持有人须遵守已批准计划中的一切内容——与任何其他人订立的私下协议都不能免除其应负的这一责任,或免除其为减轻住户压力而须采取一切必要措施的义务。

如果部门认定住户因设施无法处理的健康状况而处于紧迫危险之中,会下令立即迁移——在这种情况下,完全不需要提交书面迁移计划。
查看 Title 22 法规原文

法规原文(英文)

(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
申请对迁移令的审查
87638 p. 179
住户(或其负责人)可以请求部门的跨学科团队审查并重新考虑某项健康状况迁移令。如果住户没有负责人,可由长期照护监察员及/或其代表收款人代为提出该审查请求。

住户/负责人须在收到该迁移令后3个工作日内,向许可证持有人提交一份书面、签名并注明日期的审查请求(与“申诉健康状况迁移令”卡片中的时限相同)。许可证持有人随后须在住户提出请求后10个工作日内,向部门提交所需的支持文件。
查看 Title 22 法规原文

法规原文(英文)

(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
部门作出决定的期限与审查权的限制
87638 p. 180
部门须在住户被告知需要迁移后的30天内,以书面形式并说明理由,告知住户(及其负责人)跨学科团队的决定(与同名卡片中的时限相同)。

不过,该审查权也有实际限制。它不能
  • 推翻部门为保护住户自身健康/安全而作出的迁移必要性认定(87612(a))。
  • 适用于87224项下的驱逐。
  • 创设本流程之外的、要求州听证或其他任何行政审查的权利。
  • 适用于设施许可证已依87775(c)被临时吊销的情形。
查看 Title 22 法规原文

法规原文(英文)

(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