Cal. Code Regs. Tit. 22, § 72329.1 - Nursing Service - Staff
(a) Nursing service personnel shall be
employed and on duty in at least the number and with the qualifications
determined by the Department to provide the necessary nursing services for
patients admitted for care. The staffing requirementsrequired by this section
are minimum standards only. Skilled nursing facilities shall employ and
schedule additional staff as needed to ensure quality resident care based on
the needs of individual residents and to ensure compliance with all relevant
state and federal staffing requirements. The Department may require a facility
to provide additional staff as set forth in Section
72501(g).
(b) Facilities licensed for 59 or fewer beds
shall have at least one registered nurse or a licensed vocational nurse, awake
and on duty, in the facility at all times, day and night.
(c) Facilities licensed for 60 to 99 beds
shall have at least one registered nurse or licensed vocational nurse, awake
and on duty, in the facility at all times, day and night, in addition to the
director of nursing services. The director of nursing services shall not have
charge nurse responsibilities.
(d)
Facilities licensed for 100 or more beds shall have at least one registered
nurse, awake and on duty, in the facility at all times, day and night, in
addition to the director of nursing services. The director of nursing services
shall not have charge nurse responsibilities.
(e) Nursing stations shall be staffed with
nursing personnel when patients are housed in the nursing unit.
(f) Each facility shall employ sufficient
nursing staff to provide a minimum of 3.2 nursing hours per patient day.
(1) Facilities which provide care for
mentally disordered patients and in which psychiatric technicians provide
patient care shall meet the following standards:
(A) If patients are not certified for special
treatment programs, facilities shall employ sufficient staff to provide a
minimum of 3.2 nursing hours per patient day.
(B) For patients certified for special
treatment programs, facilities shall employ sufficient staff to provide a
minimum of 2.3 nursing hours per patient day for each patient certified to the
special treatment program, exclusive of additional staff required to meet the
staffing standards of the special treatment
program.
(g)
Only direct caregivers as defined in Section
72038 shall be included in the
staff-to-patient ratios. The ratios shall be based on the anticipated
individual patient needs for the activities of each shift and shall be
distributed throughout the day to achieve a minimum of 3.2 nursing hours per
patient day.
(1) Skilled nursing facilities
shall employ and schedule additional staff to ensure patients receive nursing
care based on their needs.
(2) The
calculation of the staff-to-patient ratio shall be based on the daily census of
patients in the skilled nursing facility and not the total number of beds.
Bedholds shall not be included in the calculations of the staff-to-patient
ratio. If the census changes during a 24 hour period, the calculation shall be
based upon the highest number of patients in the facility during the
period.
(3) Unless granted a waiver
pursuant to subsection (j), facilities shall use the following ratios:
(A) On the day shift, the ratio shall be at
least one direct caregiver for every 5 patients or fraction thereof;
(B) On the evening shift, the ratio shall be
at least one direct caregiver for every 8 patients or fraction thereof;
and,
(C) On the night shift, the
ratio shall be at least one direct caregiver for every 13 patients or fraction
thereof.
(D) There shall be one
licensed nurse for every 8 or fewer patients, based on the facility census for
the 24 hour period. These are not in addition to the requirements in
subparagraphs (A) through (C) above, and may be assigned to shifts as required
by the facility, subject to other statutory and regulatory
requirements.
(4) "Day
shift" refers to the 8-hour period during which a facility's patients require
the greatest amount of care. "Evening shift" refers to the 8-hour period when
the facility's patients require more than minimal care. "Night shift" refers to
the 8-hour period during which a facility's patients require the least amount
of care. A facility that uses other than 8-hour shifts for its direct
caregivers shall seek a waiver under subsection (j) to continue that
practice.
(5) A "shift" is defined
as the working period of one direct caregiver, or the full time equivalent of
one direct caregiver, who performs eight hours of nursing services, as defined
in section
72038. Other than time spent on
normal rest periods required by section
11020 of Title 8 of the California
Code of Regulations, or in the in-service training at the facility required by
section 71847, time not spent providing
nursing services, such as that spent at meal periods, may not be included in
calculating a shift. A facility that uses fractions of a shift to meet the
ratios must ensure that the posting required by subsection (i) contains this
information in a form that will enable all interested persons to verify that
the required staffing is provided and the ratios are met.
(6) A citation for a class "AA", class "A" or
class "B" violation may be issued for a violation of this section that meets
the requirements specified in Section
1424
of the Health and Safety Code.
(h) The facility shall retain the staff
assignment record that it employs to comply with subsection (i) for each shift,
the licensing and/or certification status of the staff, and the patient census
for each shift. Records documenting staffing, including staff assignment
records and payroll records, shall be retained for a minimum of three years.
Unless the request is made by Department staff who are present at the facility,
in which case it must be provided immediately, documentation of staffing shall
be provided to the Department within ten days of the Department's request for
the documentation. If the facility is unable to provide the documentation
requested by the Department, it shall cease admitting new patients until it
demonstrates to the Department that it has the staff necessary to provide the
care needed by the patients by submitting the requested documentation. The
facility shall also comply with the provisions of Section
1429.1
of the Health and Safety Code.
(i)
The facility shall post the patient census and staffing information daily. The
posting shall include the actual number of licensed and certified nursing staff
directly responsible for the care of patients for that particular day on each
shift. The facility may use the form it currently uses to comply with the
requirements of section
483.30 of title 42 of the Code of
Federal Regulations, but, in addition to the information the federal regulation
requires it to contain, it shall also designate the patient assignment by
specifying each room and each bed to which each certified nurse assistant is
assigned during his or her shift, and shall additionally specify the assignment
of each licensed nurse and any other direct caregiver not assigned to a
specific room or beds. This posting shall be publicly displayed in a clearly
visible place.
(j) The facility may
request a waiver for the staff-to-patient ratio in accordance with Section
1276.65
of the Health and Safety Code as long as the facility continues to meet the 3.2
nursing hours per patient day requirement.
(1) The facility shall submit a written
request for a waiver with substantiating information to the Department. The
facility shall request the waiver by using the program flexibility procedures
specified in Section
72213, and the Department shall
process the request as required by Section
1276
of the Health and Safety Code.
(2)
The facility shall notify the Department if there has been a change in the
substantiating information. A request for a waiver with substantiating
information included shall be updated and resubmitted
annually.
(k) Staffing
for a distinct part intermediate care unit in a skilled nursing facility:
(1) Units of less than 50 intermediate care
beds shall not be required to provide licensed personnel in addition to those
provided in the skilled nursing facility unless the Department determines
through a written evaluation that additional licensed personnel are necessary
to protect the health and safety of patients.
(2) Units of 50 or more intermediate care
beds shall provide a registered nurse or licensed vocational nurse employed 8
hours on the day shift, 7 days per week in the unit.
(3) For purposes of this section intermediate
care beds that are licensed as such by the Department shall not be included for
establishing licensed nurse staffing as required in subsection (f)(1) if the
unit is used exclusively for intermediate care patients.
(l) Initial implementation of this section
shall be contingent on an appropriation in the annual Budget Act or another
statute, in accordance with Health and Safety Code Section
1276.65(i).
Notes
2. Change without regulatory effect amending section heading and subsection (f)(1) and amending NOTE filed 3-12-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 11).
Note: Authority cited: Sections 1275, 1276.5, 1276.65 and 131200, Health and Safety Code. Reference: Sections 1276, 1276.5, 1276.65, 131050, 131051 and 131052, Health and Safety Code; and Section 14110.7(c), Welfare and Institutions Code.
2. Change without regulatory effect amending section heading and subsection (f)(1) and amending Note filed 3-12-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 11).
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