Section 1276.65 Of Article 3. Regulations From California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 3.
1276.65
. (a) For purposes of this section, the following
definitions shall apply:
(1) "Direct caregiver" means a registered nurse, as referred to in
Section 2732 of the Business and Professions Code, a licensed
vocational nurse, as referred to in Section 2864 of the Business and
Professions Code, a psychiatric technician, as referred to in Section
4516 of the Business and Professions Code, and a certified nurse
assistant, as defined in Section 1337.
(2) "Skilled nursing facility" means a skilled nursing facility as
defined in subdivision (c) of Section 1250.
(b) A person employed to provide services such as food
preparation, housekeeping, laundry, or maintenance services shall not
provide nursing care to residents and shall not be counted in
determining ratios under this section.
(c) (1) Notwithstanding any other provision of law, the State
Department of Health Services shall develop regulations that become
effective August 1, 2003, that establish staff-to-patient ratios for
direct caregivers working in a skilled nursing facility. These ratios
shall include separate licensed nurse staff-to-patient ratios in
addition to the ratios established for other direct caregivers.
(2) The department, in developing staff-to-patient ratios for
direct caregivers and licensed nurses required by this section, shall
convert the existing requirement under Section 1276.5 of this code
and Section 14110.7 of the Welfare and Institutions Code for 3.2
nursing hours per patient day of care and shall ensure that no less
care is given than is required pursuant to Section 1276.5 of this
code and Section 14110.7 of the Welfare and Institutions Code.
Further, the department shall develop the ratios in a manner that
minimizes additional state costs, maximizes resident access to care,
and takes into account the length of the shift worked. In developing
the regulations, the department shall develop a procedure for
facilities to apply for a waiver that addresses individual patient
needs except that in no instance shall the minimum staff-to-patient
ratios be less than the 3.2 nursing hours per patient day required
under Section 1276.5 of this code and Section 14110.7 of the Welfare
and Institutions Code.
(d) The staffing ratios to be developed pursuant to this section
shall be 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.
(e) No later than January 1, 2006, and every five years
thereafter, the department shall consult with consumers, consumer
advocates, recognized collective bargaining agents, and providers to
determine the sufficiency of the staffing standards provided in this
section and may adopt regulations to increase the minimum staffing
ratios to adequate levels.
(f) In a manner pursuant to federal requirements, effective
January 1, 2003, every skilled nursing facility shall post
information about staffing levels that includes the current number of
licensed and unlicensed nursing staff directly responsible for
resident care in the facility. This posting shall include staffing
requirements developed pursuant to this section.
(g) (1) Notwithstanding any other provision of law, the department
shall inspect for compliance with this section during state and
federal periodic inspections, including, but not limited to, those
inspections required under Section 1422. This inspection requirement
shall not limit the department's authority in other circumstances to
cite for violations of this section or to inspect for compliance with
this section.
(2) A violation of the regulations developed pursuant to this
section may constitute a class "B," "A," or "AA" violation pursuant
to the standards set forth in Section 1424.
(h) The requirements of this section are in addition to any
requirement set forth in Section 1276.5 of this code and Section
14110.7 of the Welfare and Institutions Code.
(i) Initial implementation of the staffing ratio developed
pursuant to requirements set forth in this section shall be
contingent on an appropriation in the annual Budget Act or another
statute.
(j) In implementing this section, the department may contract as
necessary, on a bid or nonbid basis, for professional consulting
services from nationally recognized higher education and research
institutions, or other qualified individuals and entities not
associated with a skilled nursing facility, with demonstrated
expertise in long-term care. This subdivision establishes an
accelerated process for issuing contracts pursuant to this section
and contracts entered into pursuant to this section shall be exempt
from the requirements of Chapter 1 (commencing with Section 10100)
and Chapter 2 (commencing with Section 10290) of Part 2 of Division 2
of the Public Contract Code.
(k) This section shall not apply to facilities defined in Section
1276.9.