Assisted Living in California

Agency: Department of Social Services, Community Care Licensing Divisio
Phone: (916) 651-3456
Website: www.ccld.ca.gov

An RCFE is a voluntarily chosen housing arrangement where 75 percent of the residents are 60 years of age or older and where varying levels of care and supervision are provided, as agreed to at the time of admission or as determined at subsequent times of reappraisal. Any resident age 18-59 must have needs compatible with other residents

Facility Scope of Care:
An RCFE provides care and supervision to its residents, including assistance with activities of daily living (ADLs), observation and reassessment, and, when appropriate, selfreleasing postural supports. Residents with the following conditions or in need of the following incidental medical services may be admitted or retained as long as the applicable statutes and regulations are followed, and those procedures and services requiring a nurse or physical therapist are provided by an appropriately skilled professional: administration of oxygen, catheter care, colostomy/ileostomy care, contractures, diabetes, enemas/suppositories, incontinence, injections, intermittent positive pressure breathing machines, stage I and II dermal ulcers, and wound care. Dementia and hospice care may be provided if statutory and regulatory requirements are met.

Move-In/Move-Out Requirements:
Residents may not be admitted or retained if they have active communicable tuberculosis; require 24-hour skilled nursing or intermediate care; have a mental disorder resulting in ongoing behavior that would upset the general resident group; would require a greater amount of care and supervision than the other residents; or cannot generally benefit from the program services available in the facility. A facility may issue a 30-day notice to a resident for: nonpayment of the rate for basic services within 10 days of due date; failure to comply with state or local law; failure to comply with general facility policies; a need not previously identified if it is determined after a reappraisal that a facility is unable to meet that new need; or if there is a change in the use of the facility. The department may grant a three-day eviction notice if sufficient evidence supports the licensee's assertion that the resident poses a threat to himself or others.

Resident Assessment:
Residents must be assessed prior to move in, including an evaluation of functional capacity, mental condition, and social factors. While no standardized form is required, an assessment form is available at www.ccld.ca.gov. The appraisal must be updated at least once a year or upon significant change in condition. A comprehensive physician report is also considered part of the resident assessment tool and must be updated upon significant change in a resident's condition.

Medication Management:
Facility staff, unless he/she is an appropriately skilled professional acting within his/her scope of practice, may not administer medications to residents, but may assist them with the self-administration of medications

Physical Plant Requirements:
The regulations allow for private or semi-private resident rooms. Resident rooms must be furnished by the licensee or resident and be of sufficient size to allow for mobility of the resident and equipment.

Residents Allowed Per Room:
A maximum of two residents is allowed per resident bedroom.

Life Safety:
Prior to licensure, each licensee must secure and maintain an appropriate facility fire clearance approved by the fire authority having jurisdiction. To obtain a fire clearance, the licensee must meet standards established by the State Fire Marshal and the local fire authority having jurisdiction for the protection of life and property against fire. For example, RCFEs licensed for seven or more residents must have sprinklers. (In California, sprinkler systems should meet National Fire Protection Association standards.) All RCFEs must have smoke detectors. In addition, each licensee must have a current, written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event of a disaster or an emergency. The emergency disaster plan must be posted prominently in the facility and be available to emergency responders.

Alzheimer's Unit Requirements:
RCFEs may admit residents who are diagnosed by a physician as having dementia if certain requirements are met, including an annual medical assessment, adequate supervision, enhanced physical plant safety requirements, and an appropriate activity program. Use of egress alert devices, delayed egress, and locked facility doors and perimeters are also allowed if specified additional requirements are met. Delayed egress and locked doors/perimeters require special fire clearances, and are only allowed with prior approval from CCLD. Resident and/or responsible person consent is also required prior for use of delayed egress devices or locked facility doors.

Staff Training for Alzheimer's Care:
All staff who care for residents with dementia must receive training in dementia care. There are additional training requirements for direct care staff who work in a facility where the licensee advertises, promotes, or otherwise holds him/herself out as providing special care, programming, and /or environments for residents with dementia or related disorders. These direct care staff must receive six hours of dementia care orientation within the first four weeks of employment and at least eight hours of dementia care in-service training per year.

Staffing Requirements:
Facility personnel must be sufficient at all times to provide the services necessary to meet resident needs. In RCFEs caring for 16 or more residents, there must be awake night staff. In facilities with dementia residents, there must be an adequate number of direct care staff to support each resident's physical, social, emotional, safety, and health care needs as identified in his/her current appraisal. In facilities with fewer than 16 residents, there must be at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal, or observation to require awake night supervision.

Staff Education Training:
All staff must have on-the-job training or related experience in the job assigned to them. Staff who assist residents with personal ADLs must receive at least 10 hours of initial training within the first four weeks of employment and at least four hours annually thereafter. All trainings must be documented and retained in facility files/records. Food service and activity directors in facilities with a capacity of 16 or more must have specified experience and education or training. Staff providing direct care to residents shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Each RCFE shall provide training in recognizing and reporting elder and dependent adult abuse, as prescribed by the California Department of Justice. Prior to the admission of a resident with a restricted health condition, the licensee shall ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional to meet those needs. Training shall include hands-on instruction in both general procedures and resident-specific procedures. Staff shall have knowledge and the ability to recognize and respond to problems and shall contact the physician, appropriately skilled professional, and/or vendor as necessary. Direct care staff who assist residents with the self-administration of medication in RCFEs, excluding licensed health care professionals, must meet specified medication training requirements. In facilities licensed to provide care for 15 or fewer persons, direct care staff shall complete six hours of initial training, which includes two hours of hands-on shadowing training. In facilities licensed to provide care for 16 or more persons, the employee shall complete 16 hours of initial training, which includes eight hours of hands-on shadowing training. Direct care staff must pass an exam and complete additional training in each succeeding 12-month period. The training material and exam must be developed by or in consultation with a licensed nurse, pharmacist, or physician. Facilities licensed for 16 or more residents are also required to maintain documentation that demonstrates that a consultant pharmacist or nurse has reviewed the facility's medication program and procedures at least twice a year

Medicaid Policy and Reimbursements:
California's Assisted Living Waiver (ALW) was renewed for five years effective March 1, 2009 by the Centers for Medicare & Medicaid Services. The program is open to interested providers in the following counties: Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, and Riverside. The ALW enrolls eligible beneficiaries residing in skilled nursing facilities or the community and places them in RCFEs. As of February 2011, the ALW was enrolling beneficiaries in Los Angeles, Sacramento, San Joaquin, Riverside, and San Bernardino Counties. The ALW anticipates enrolling beneficiaries in Sonoma and Fresno Counties, beginning in 2011. Additional information may be found at http://www.dhcs.ca.gov/services/ltc/pages/ALWPP.aspx.