Cal. Code Regs. Tit. 22, § 81075 - Health-Related Services
(a) The licensee shall ensure that each
client receives necessary first aid and other needed medical or dental
services, including arrangement for and/or provision of transportation to the
nearest available services.
(b)
Clients shall be assisted as needed with self-administration of prescription
and nonprescription medications.
(1) Facility
staff who receive training may assist clients with metered-dose inhalers, and
dry powder inhalers if the following requirements are met:
(A) Facility staff must receive training from
a licensed professional.
1. The licensee
shall obtain written documentation from the licensed professional outlining the
procedures and the names of facility staff who have been trained in those
procedures.
2. The licensee ensures
that the licensed professional reviews staff performance as the licensed
professional deems necessary, but at least once a year.
(B) All staff training shall be documented in
the facility personnel files.
(2) Facility staff, except those authorized
by law, shall not administer injections but staff designated by the licensee
shall be authorized to assist clients with self-administration of injections as
needed.
(3) Assistance with
self-administration does not include forcing a client to take medications,
hiding or camouflaging medications in other substances without the client's
knowledge and consent, or otherwise infringing upon a client's right to refuse
to take a medication.
(4) If the
client's physician has stated in writing that the client is able to determine
and communicate his/her need for a prescription or nonprescription PRN
medication, facility staff shall be permitted to assist the client with
self-administration of their PRN medication.
(5) If the client's physician has stated in
writing that the client 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
client with self-administration, provided all of the following requirements are
met:
(A) There is written direction from a
physician, on a prescription blank, specifying the name of the client, the name
of the medication, all of the information specified in Section
81075(b)(6)(D),
instructions regarding a time or circumstance (if any) when it should be
discontinued, and an indication of when the physician should be contacted for a
medication reevaluation.
(B) Once
ordered by the physician the medication is given according to the physician's
directions.
(C) A record of each
dose is maintained in the client's record. The record shall include the date
and time the PRN medication was taken, the dosage taken, and the client's
response.
(6) If the
client 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 client with self-administration, provided all of the following
requirements are met:
(A) Facility staff
shall contact the client's physician prior to each dose, describe the client's
symptoms, and receive direction to assist the client in self-administration of
that dose of medication.
(B) The
date and time of each contact with the physician, and the physician's
directions, shall be documented and maintained in the client's facility
record.
(C) The date and time the
PRN medication was taken, the dosage taken, and the client's response, shall be
documented and maintained in the client's facility record.
(D) For every prescription and
nonprescription PRN medication for which the licensee provides assistance,
there shall be a signed, dated written order from a physician on a prescription
blank, maintained in the client's file, and a label on the medication. Both the
physician's order and the label shall contain at least all of the following
information:
1. The specific symptoms which
indicate the need for the use of the medication.
2. The exact dosage.
3. The minimum number of hours between
doses.
4. The maximum number of
doses allowed in each 24-hour period.
(c) The isolation room or area specified in
Section 81087(i) shall be
used where separation from others is required.
(d) There shall be privacy for first aid
treatment of minor injuries and for examination or treatment by a physician if
required.
(e) When a client
requires oxygen the licensee is responsible for the following:
(1) Monitoring the client's ongoing ability
to operate and care for the equipment in accordance with the physician's
instructions, or if the client is unable to do so:
(A) Ensuring that an adequate number of
facility staff persons are designated to operate and care for the equipment and
that those staff persons receive.
1. The
licensee shall comply with all of the requirements for training in Sections
81075(b)(1)(A) through
(B).
(2) Ensuring that the following conditions
are met if oxygen equipment is in use:
(A)
The licensee makes a written report to the local fire jurisdiction that oxygen
is in use at the facility.
(B) "No
Smoking - Oxygen in Use" signs shall be posted in appropriate areas.
(C) Smoking is prohibited where oxygen is in
use.
(D) All electrical equipment
is checked for defects that may cause sparks.
(E) Oxygen tanks that are not portable are
secured either in a stand or to the wall.
(F) Plastic tubing from the nasal cannula
(mask) to the oxygen source is long enough to allow the client movement within
his/her room but does not constitute a hazard to the client or
others.
(G) Clients use oxygen from
a portable source when they are outside of their rooms or when walking in a day
care setting.
(H) Equipment is
operable.
(I) Facility staff have
knowledge and ability to operate and care for the oxygen equipment.
(J) Equipment is removed from the facility
when no longer in use by the client.
(f) Staff responsible for providing direct
care and supervision shall receive training in first aid from persons qualified
by agencies including but not limited to the American Red Cross.
(g) If the facility has no medical unit on
the grounds, first aid supplies shall be maintained and be readily available in
a central location in the facility.
(1) The
supplies shall include 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)
Adhesive tape.
(E)
Scissors.
(F) Tweezers.
(G) Thermometers.
(H) Antiseptic
solution.
(h)
There shall be at least one person capable of and responsible for communicating
with emergency personnel in the facility at all times. The following
information shall be readily available:
(1)
The name, address and telephone number of each client's physician and dentist,
and other medical and mental health providers, if any.
(2) The name, address and telephone number of
each emergency agency, including but not limited to the fire department, crisis
center or paramedical unit. There shall be at least one medical resource
available to be called at all times.
(3) The name and telephone number of an
ambulance service.
(i)
When a client requires prosthetic devices, or vision or hearing aids, the staff
shall be familiar with the use of these devices and aids and shall assist the
client with their utilization as needed.
(j) Medications shall be centrally stored
under the following circumstances:
(1)
Preservation of the medication requires refrigeration.
(2) Any medication determined by the
physician to be hazardous if kept in the personal possession of the client for
whom it was prescribed.
(3) Because
of physical arrangements and the condition or the habits of persons in the
facility, the medications are determined by either the administrator or by the
licensing agency to be a safety hazard.
(k) The following requirements shall apply to
medications which are centrally stored:
(1)
Medication 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.
(2) Each
container shall identify the items specified in Section
81075(k)(7)(A) through
(G) below.
(3) All medications shall be labeled and
maintained in compliance with label instructions and state and federal
laws.
(4) No person other than the
dispensing pharmacist shall alter a prescription label.
(5) Each client's medication shall be stored
in its originally received container.
(6) No medications shall be transferred
between containers.
(7) The
licensee shall ensure the maintenance, for each client, of a record of
centrally stored prescription medications which is retained for at least one
year and includes the following:
(A) The name
of the client for whom prescribed.
(B) The name of the prescribing
physician.
(C) The drug name,
strength and quantity.
(D) The date
filled.
(E) The prescription number
and the name of the issuing pharmacy.
(F) Expiration date.
(G) Number of refills.
(H) Instructions, if any, regarding control
and custody of the medication.
(l) Prescription medications which are not
taken with the client upon termination of services, or which are not to be
retained shall be destroyed by the facility administrator, or a designated
substitute, and one other adult who is not a client.
(1) Both shall sign a record, to be retained
for at least one year, which lists the following:
(A) Name of the client.
(B) The prescription number and the name of
the pharmacy.
(C) The drug name,
strength and quantity destroyed.
(D) The date of
destruction.
(m) The facility administrator shall ensure
the development and implementation of a plan which insures assistance is
provided to the clients in meeting their medical and dental needs.
(n) The facility administrator shall ensure
the isolation of a client suspected of having a contagious or infectious
disease and shall ensure that a physician is contacted to determine suitability
of the client's retention in the facility.
(o) For each client that the licensee
determines there is a need, a licensee shall develop an individual
medication-management plan provided all of the following conditions are met:
(1) The licensee has obtained a signed
determination by a licensed medical professional that a client is able to hold,
manage, and safeguard his/her own medications pursuant to Section
81069(e).
(2) The licensee shall ensure that the
client's medications are stored so that they are inaccessible to other clients
in the facility.
(3) The licensee
shall ensure that facility staff responsible for educating and/or assisting the
client with regard to storing and managing his/her own medications have
received training from a licensed professional sufficient to meet the needs of
the client, consistent with the Needs and Services Plan. The licensed
professional must be authorized by law to administer medications, including,
but not limited to, a registered nurse, licensed vocational nurse or
psychiatric technician.
(A) This training
shall include hands-on instruction in both general and client-specific
procedures; and shall consist of, but not necessarily be limited to, the
following:
1. General properties of the
medication(s) the client is taking;
2. The specific reason(s) the client is
taking the medication(s);
3. Proper
administration of the medication(s), including dosage information and potential
side effects and drug interactions;
4. Packaging/storage of the medication(s),
including how to use pill boxes and medication organizers; and
5. Any other information necessary to ensure
that the needs of the client are met.
(B) The licensee shall obtain from the
licensed professional documentation outlining the information contained in the
training and the names of facility staff who completed the training.
(C) The licensee or designee shall review and
document staff performance annually.
(D) The training shall be completed prior to
facility staff providing services to the client as part of the client's
individual medication-management plan.
(E) All training shall be documented in
facility personnel files.
(4) The licensee shall ensure that a log is
maintained each time medication is taken by the client with the following
information:
(A) Medication name and dosage
(e.g.: Amoxicillin, 250mg)
(B)
Dosage times and instructions (e.g.: 3 times per day with meals)
(C) Time medication was given
(D) A current total count of the number of
servings contained in the bottle or package shall be documented, in terms of
measure or numerical count, for all medication that is within the facility upon
bringing the medication into the facility and after each dose taken by the
client.
(E) Initials of staff
verifying information in 81075(o)(4)(A) through (D) above.
(5) The licensee shall ensure that the
written individual medication-management plan is designed to provide staff
support and encourage client independence, assist the client in holding,
managing, and safeguarding all of his/her own medications consistent with
California Code of Regulations, Title 9, Sections 532.1(c) and (g).
(6) The individual medication-management plan
shall be included in the client's written treatment/rehabilitation plan, which
is part of the client's Needs and Services Plan, as specified in Section
81068.2(b)(3).
(7) The client's progress in meeting the
goals outlined in his/her individual medication-management plan shall be
assessed and documented in the client's file as frequently as necessary, but at
least weekly for the first month, and at least monthly thereafter.
(8) The client's individual
medication-management plan shall include provisions for terminating the
client's participation in the plan if the client demonstrates that he/she is
not capable of safely storing and managing his/her own medications.
(9) Notwithstanding Sections
81075(k)(5) and
(k)(6), a client may transfer to and
temporarily store his/her own medication(s) in a pill box or medication
organizer for no more than one week at a time, as part of the client's
individual medication-management plan.
(p) Facility staff shall not transfer
medication(s) from its originally received container to a pill box or
medication organizer for a client, but shall supervise or assist the client as
needed with this task.
(q) The
licensee shall ensure that the client's pill box is up to date and contains the
correct and most current prescribed medication(s).
Notes
2. Editorial correction of printing error in subsection (c) (Register 91, No. 32).
3. Change without regulatory amending section and NOTE filed 1-5-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 2).
4. Amendment of subsection (b)(5)(A) and new subsections (o)-(q) filed 9-7-2017; operative 9-7-2017 pursuant to Government Code section 11343.4(b)(3) (Register 2017, No. 36).
Note: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 5670 and 5671, Welfare and Institutions Code; and Sections 1501, 1502, 1502(a)(7), 1507, 1530 and 1531, Health and Safety Code.
2. Editorial correction of printing error in subsection (c) (Register 91, No. 32).
a1 The reorganization of Chapter 2 is printed as a repealer and adoption for clarity.
3. Change without regulatory amending section and Note filed 1-5-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 2).
4. Amendment of subsection (b)(5)(A) and new subsections (o)-(q) filed 9-7-2017; operative
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