1267.13
. Pursuant to paragraph (3) of subdivision (a) and
subdivision (b) of Section 1265.7, this section shall be effective
until the adoption of permanent regulations. Notwithstanding, the
state department has authority to make reasonable accommodation for
exceptions to the standards in this section, providing the health,
safety, and quality of patient care is not compromised. No exceptions
shall be made for building standards. Prior written approval
communicating the terms and conditions under which the exception is
granted shall be required. Applicants shall request the exception in
writing accompanied by detailed, supporting documentation.
Congregate living health facilities serving persons who are
terminally ill, persons who are catastrophically and severely
disabled, persons who are mentally alert but physically disabled, or
any combination of these persons, shall conform to the following:
(a) Facilities shall obtain and maintain a valid fire clearance
from the appropriate authority having jurisdiction over the facility,
based on compliance with state regulations concerning fire and life
safety, as adopted by the State Fire Marshal.
(b) The State Fire Marshal, with the advice of the State Board of
Fire Services, shall adopt regulations on or before January 1, 1991,
following a public hearing, establishing minimum requirements for the
protection of life and property for congregate living health
facilities serving terminally ill persons, catastrophically and
severely disabled persons, persons who are mentally alert but
physically disabled, or any combination of these persons. These
minimum requirements shall recognize the residential and
noninstitutional setting of congregate living health facilities
serving terminally ill persons, catastrophically and severely
disabled persons, persons who are mentally alert but physically
disabled, or any combination of these persons.
(c) Facilities shall be in a homelike residential setting. Living
accommodations and grounds shall be related to the facility's
function and clientele. Facilities shall provide sufficient space for
comfortable living accommodations and privacy for residents, staff,
and others who may reside in the facility.
(d) Common rooms, including, but not limited to, living rooms,
dining rooms, and dens or other recreation or activity rooms, shall
be provided and shall have sufficient space, separation, or both to
promote and facilitate the program of activities and to prevent these
activities from interfering with other functions. Accommodations
shall ensure adequate space for residents to have visitors and for
privacy during visits, if desired.
(e) Resident bedrooms shall have adequate space to allow easy
passage throughout; permit comfortable usage of furnishings; promote
ease of nursing care; and accommodate use of assistive devices,
including, but not limited to, wheelchairs, walkers, and patient
lifts, when needed.
(f) No room commonly used for other purposes, including, but not
limited to, a hall, stairway, attic, garage, storage area, shed, or
similar detached building, shall be used as a sleeping room for any
resident.
(g) No resident bedroom shall be used as a passageway to another
room, bath, or toilet.
(h) Not more than two residents shall share a bedroom.
(i) Equipment and supplies necessary for personal care and
maintenance of adequate hygiene shall be readily available to all
residents.
(j) Toilets and bathrooms shall be conveniently located. At least
one toilet and washbasin shall be provided per six residents. At
least one bathtub or shower shall be provided per 10 residents.
Individual privacy shall be provided in all toilet, bath and shower
areas. Separate toilet, washbasin, and bathtub or shower
accommodations shall be provided for staff.
(k) Sufficient room shall be available throughout the facility to
accommodate and serve all persons in comfort and safety. The premises
shall be maintained in good repair and shall provide a safe, clean,
and healthful environment.
( l) Facilities shall have equipment and supplies appropriate to
meet the routine and specialized needs of all residents.
(m) All persons shall be protected from hazards throughout the
premises:
(1) Stairways, inclines, ramps, open porches, and other areas of
potential hazard to residents with poor balance or eyesight shall be
made inaccessible unless well lighted and equipped with sturdy hand
railings.
(2) Night lights shall be maintained in hallways and passages to
nonprivate bathrooms.
(3) All indoor and outdoor passageways and stairways shall be kept
free of obstructions.
(4) Fireplaces, woodstoves, and open-faced heaters shall be
adequately screened.
(5) Facilities shall assure the inaccessibility of fishponds,
wading pools, hot tubs, swimming pools, or similar bodies of water or
other areas of potential hazard when not in active use.
(n) Facilities serving persons who are terminally ill,
catastrophically and severely disabled, mentally alert but physically
disabled, or any combination of these persons, shall, in addition to
the requirements of this chapter and until specific regulations
governing their operation are filed, conform to regulations contained
in Chapter 3 of Division 5 of Title 22 of the California Code of
Regulations of April 1, 1988, with the exception of the following
sections or portions of sections: 72007, 72053, 72073, subdivision
(a) of Section 72077, 72097, 72099, 72103, 72203, subdivision (a) of
Section 72205, 72301, 72305, subdivision (a) of Section 72325, 72327,
72329, 72331, 72337, subdivisions (b), (g), and (h) of Section
72351, 72353, subdivision (a) of Section 72367, 72373, subdivision
(b) of Section 72375, 72401, 72403, 72405, 72407, 72409, 72411,
72413, 72415, 72417, 72419, 72421, 72423, 72425, 72427, 72429, 72431,
72433, 72435, 72437, 72439, 72441, 72443, 72445, 72447, 72449,
72451, 72453, 72455, 72457, 72459, 72461, 72463, 72465, 72467, 72469,
72471, 72473, 72475, 72503, paragraph (2) of subdivision (a) of
Section 72513, 72520, 72535, 72555, 72557, subdivisions (a) and (b)
of Section 72601, subdivision (d) of Section 72607, subdivisions (a)
and (d) of Section 72609, 72611, 72615, 72617, 72629, 72631, 72633,
72635, subdivisions (b), (c), and (d) of Section 72639, 72641, and
72665.
(o) (1) Facilities serving persons who are terminally ill,
catastrophically and severely disabled, mentally alert but physically
disabled, or any combination of these persons, shall have an
administrator who is responsible for the day-to-day operation of the
facility. The administrator may be either a licensed registered
nurse, a nursing home administrator, or the licensee. The
administrator shall be present at the facility a sufficient number of
hours to ensure the smooth operation of the facility. If the
administrator is also the registered nurse fulfilling the duties
specified in paragraph (2), the administrator shall not be
responsible for more than one facility. In all other circumstances,
the administrator shall not be responsible for more than three
facilities with an aggregate total of 75 beds and these facilities
shall be within one hour's surface travel time of each other.
(2) (A) For each congregate living health facility of more than
six beds serving persons who are terminally ill, catastrophically and
severely disabled, mentally alert but physically disabled, or any
combination of these persons, there shall be, at a minimum, a
registered nurse or licensed vocational nurse awake and on duty at
all times. A registered nurse shall be awake and on duty eight hours
a day, five days a week.
(B) For each congregate living health facility of six or fewer
beds serving persons who are terminally ill, catastrophically and
severely disabled, mentally alert but physically disabled, or any
combination of these persons, a registered nurse shall visit each
patient at least twice a week for approximately two hours, or more as
patient care requires.
(C) For all congregate living health facilities serving persons
who are terminally ill, catastrophically and severely disabled,
mentally alert but physically disabled, or any combination of these
persons, a registered nurse shall be available for consultation and
able to come into the facility within 30 minutes, if necessary, when
no registered nurse is on duty. In addition, certified nurse
assistants, or persons with similar training and experience as
determined by the department, shall be awake and on duty in the
facility in at least the following ratios: facilities with six beds
or less, one per shift; facilities with 7 to 12 beds, two per shift;
facilities with 13 to 25 beds, three per day and evening shifts and
two per nocturnal shift. No nursing services personnel shall be
assigned housekeeping or dietary duties.
(3) Notwithstanding the provisions of this subdivision, the
facility shall provide appropriately qualified staff in sufficient
numbers to meet patient care needs.
(4) 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 department may require a facility to provide
additional professional, administrative, or supportive personnel
whenever the state department determines through a written
evaluation, that additional personnel are needed to provide for the
health and safety of patients.
(5) All staff members shall receive orientation regarding care
appropriate for the patients' diagnoses and individual resident
needs. Orientation shall include a minimum of 16 hours during the
first 40 hours of employment.
(6) Nothing in this chapter shall prevent the use of volunteers;
however, volunteers shall not be used as substitutes for the
personnel required in the above sections. Volunteers providing
patient care services shall:
(A) Be provided clearly defined roles and written job
descriptions.
(B) Receive orientation and training equivalent to that provided
paid staff.
(C) Possess education and experience equal to that required of
paid staff performing similar functions.
(D) Conform to the facility's policies and procedures.
(E) Receive periodic performance evaluations.
(p) The interim standards prescribed by this section shall become
inoperative upon the filing of the regulations with the Secretary of
State.