Article 5. Enforcement of California Health And Safety Code >> Division 2. >> Chapter 2.35. >> Article 5.
Each licensee shall, within 30 days, after each
appointment as the designated administrator of a nursing home and
after any termination of that appointment, notify the program. Each
notification shall include the name of the administrator, the nursing
home administrator number assigned, the name and address of the
facility or facilities involved, and the date of the appointment or
termination. All information provided pursuant to this section shall
be public information.
The program shall maintain a current list of nursing home
administrators who have been placed on probation or had their
licenses suspended or revoked within the last three years. The
program shall provide the current list of these administrators to
licensed nursing homes and the department district offices every six
months. The current list shall also be available to the general
public upon request.
(a) The program shall maintain a record of enforcement
actions reported to the program, pursuant to Section 1416.12. The
program shall routinely review the citation logs and files of nursing
home administrators whose facilities have received citations from
the department to determine if remedial or disciplinary action
against the administrator is warranted based on the administrator's
involvement or culpability in the citations. Regardless of the
facility's performance record, the program may initiate disciplinary
action against an administrator who violates any statute or
regulation governing licensed nursing home administrators.
(b) Following receipt of reports on temporary suspension orders,
service of an accusation for facility license revocations, or final
decertification of a facility from participation in the Medi-Cal or
Medicare programs, due to failure to meet certification standards,
the program shall make a determination as to whether the evidence
available warrants remedial or disciplinary action against the
administrator or constitutes grounds for denial, suspension, or
revocation pursuant to Section 1416.76.
(c) If the program determines that action against the
administrator is not warranted, the program shall document in the
file the reasons and specific circumstances for not taking remedial
or disciplinary action against the administrator's license.
(d) The program shall consider all of the following prior to
making a determination to initiate disciplinary action:
(1) Any information provided to the program by the administrator
pursuant to this section.
(2) Whether the administrator was in fact the designated
administrator of the facility when the violation occurred, or the
designated administrator of the facility during the period of time
the citation covered.
(3) Whether the administrator should have or could have prevented
the violation or violations that occurred.
(e) Prior to making a final determination to initiate action
against an administrator, the program shall notify the administrator
that the program is considering action and provide the administrator
with an opportunity to show just cause why remedial or disciplinary
action should not be initiated.
(f) If the program determines that grounds for remedial or
disciplinary action exist, the program may initiate either or both of
the following actions, as warranted:
(1) Remedial action, including, but not limited to, a conference
with the administrator, a letter of warning, or both.
(2) Disciplinary action, including, but not limited to, citations,
fines, formal letters of reprimand, probation, denial, suspension,
revocation of the administrator's license, or any combination of
(a) The program shall develop and make available a form
that may be utilized at the nursing home administrator's option to
provide the program with relevant information, documentation, and
background on any actions reported to the program pursuant Section
(b) Any reports received pursuant to Section 1416.12 shall remain
in the administrator's file for five years, unless the program is
notified that the action has been modified or overturned. Any
modification of an action shall be noted and documented in the
(a) It is the responsibility of the nursing home
administrator as the managing officer of the facility to plan,
organize, direct, and control the day-to-day functions of a facility
and to maintain the facility's compliance with applicable laws,
rules, and regulations.
(b) The administrator shall be vested with adequate authority to
comply with the laws, rules, and regulations relating to the
management of the facility.
(c) No licensee shall be cited for any violation caused by any
person licensed pursuant to the Medical Practice Act (Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code) if the person is independent of, and not connected
with, the facility and the licensee shows that he or she has
exercised reasonable care and diligence in notifying these persons of
their duties to the patients in the nursing facility.
(d) The delegation of any authority by a licensee shall not
diminish the responsibilities of that licensee.
(a) Within 24 hours after the nursing home administrator
acquires actual knowledge or credible information that any of the
events specified in subdivision (b) has occurred, the nursing home
administrator shall notify the department's district office for
licensing and certification of that knowledge or information. This
notification may be in written form if it is provided by telephone
facsimile or overnight mail, or by telephone with a written
confirmation within five calendar days. The information provided
pursuant to this subdivision may not be released to the public by the
department unless its release is needed to justify an action taken
by the department or it otherwise becomes a matter of public record.
A violation of this section may result in a citation.
(b) All of the following occurrences shall require notification
pursuant to this section as long as the administrator has actual
knowledge of the occurrence:
(1) The licensee of a facility receives notice that a judgment
lien has been levied against the facility or any of the assets of the
facility or the licensee.
(2) A financial institution refuses to honor a check or other
instrument issued by the licensee to its employees for a regular
(3) The supplies, including food items and other perishables, on
hand in the facility fall below the minimum specified by any
applicable statute or regulation.
(4) The financial resources of the licensee fall below the amount
needed to operate the facility for a period of at least 45 days based
on the current occupancy of the facility.
(5) The licensee fails to make timely payment of any premiums
required to maintain required insurance policies or bonds in effect,
or any tax lien levied by any government agency.
(a) The program shall establish a system for the issuance
of citations to licensees, examinees, or participants of any program
activity offered or approved by the program. The citations may
contain an order of abatement, an order to pay an administrative fine
assessed by the program chief, or both, where the licensee,
examinee, or participant is in violation of any state or federal
statute or regulation governing licensed nursing home administrators.
(b) The system shall contain all of the following provisions:
(1) Citations shall be in writing and shall describe with
particularity the nature of the violation, including specific
reference to the provision of law determined to have been violated.
(2) Where appropriate, the citation shall contain an order of
abatement fixing reasonable time for abatement of the violation.
(3) (A) Administrative fines assessed by the program shall be
separate from and shall not preclude the levying of any other fines
or any civil or criminal penalty.
(B) In no event shall the administrative fine assessed by the
program be less than fifty dollars ($50) or exceed two thousand five
hundred dollars ($2,500) for each violation. The total assessment
shall not exceed ten thousand dollars ($10,000) for each
investigation or for counts involving fraudulent billings submitted
to insurance companies, Medi-Cal, or Medicare programs.
(4) In assessing a fine, the program shall give due consideration
to the appropriateness of the amount of the fine with respect to
factors such as the gravity of the violation, the good faith effort
of the licensee, examinee, or participant, the unprofessional
conduct, including, but not limited to, incompetence and negligence
in the performance of the duties and responsibilities of an
administrator, the extent to which the cited person has mitigated or
attempted to mitigate any damage or injury caused by his or her
violation, whether the violation was related to patient care, the
history of any previous violations, and other matters as may be
(5) A citation or fine assessment issued pursuant to a citation
shall inform the licensee, examinee, or participant that if he or she
desires a hearing to contest the finding of a violation, the hearing
shall be requested by written notice to the program within 30 days
after the date of issuance of the citation or assessment. A licensee
may, in lieu of contesting a citation pursuant to this section,
transmit to the state department 75 percent of the amount specified
in the citation for each violation within 15 business days after the
issuance of the citation.
(6) Failure of a licensee, examinee, or participant to pay a fine
within 30 days of the date of the assessment, unless the citation is
being appealed, may result in further disciplinary action being taken
by the program. Where a citation is not contested and a fine is not
paid, the full amount of the assessed fine, along with any accrued
penalty interest, shall be added to the fee for renewal of the
license. A license shall not be renewed without payment of the
renewal fee, fine, and accrued interest penalty. A citation may be
issued without the assessment of an administrative fine.
(c) Assessment of administrative fines may be limited to only
particular violations of the applicable licensing act.
Notwithstanding any other provisions of law, where a fine is paid to
satisfy an assessment based on the finding of a violation, payment of
the fine shall be represented as satisfactory resolution of the
matter for purposes of public disclosures. Administrative fines
collected pursuant to this section shall be deposited in the State
Department of Public Health Licensing and Certification Program Fund
established by Section 1266.9.
(a) The program may issue a citation to any person who
holds a license from the program and who violates any statute or
regulation governing licensed nursing home administrators.
(b) Any licensee served with a citation may contest the citation
by appeal to the program within 30 days of service of the citation.
Appeals shall be conducted pursuant to Section 100171.
(c) In addition to requesting a hearing before an administrative
law judge, the licensee may, within 10 days after service of the
citation, notify the department in writing of his or her request for
an informal conference with the department regarding the violations
cited in the citation. At the time of requesting an informal
conference, the licensee shall inform the department whether he or
she shall be represented at the informal conference by legal counsel.
Failure to notify the department of legal representation shall not
result in forfeiture of the right to have legal counsel present.
Unless the request for an informal hearing is made within the 10-day
period, the licensee's right to an informal hearing is deemed waived.
(d) The department shall hold an informal conference with the
licensee and, if applicable, his or her legal counsel or authorized
representatives. At the conclusion of the informal conference the
department may affirm, modify, or dismiss the citation, including any
administrative fine levied, or order of abatement issued.
(e) The licensee does not waive his or her request for a hearing
to contest a citation by requesting an informal conference. If the
citation is dismissed after the informal conference, the request for
a hearing on the matter of the citation shall be deemed to be
withdrawn. If the citation, including any administrative fine levied
or order of abatement, is modified or affirmed, the citation shall be
upheld and the licensee shall, within 15 working days from the date
the citation review conference decision was rendered, notify the
director or the director's designee that he or she wishes to appeal
the decision through the procedures set forth in Section 100171.
(a) The time allowed for abatement of violation shall
begin the first day after the order of abatement has been served or
received. If a licensee who has been issued an order of abatement is
unable to complete the correction within the time set forth in the
citation because of conditions beyond his or her control after the
exercise of reasonable diligence, the licensee may request from the
program an extension of time in which to complete the correction. The
request shall be in writing and made within the time set for
(b) An order of abatement shall either be personally served upon
the licensee or mailed by certified mail, return receipt requested.
(c) When an order of abatement is not contested, or if the order
is appealed and the licensee does not prevail, failure to abate the
violation cited within the time specified in the citation shall
constitute a violation and failure to comply with the order of
abatement. Where a licensee has failed to correct a violation within
the time specified in the citation the department shall assess the
licensee a civil penalty in the amount of fifty dollars ($50) for
each day that the violation continues beyond the date specified in
the citation. If the licensee disputes a determination by the
department regarding alleged failure to correct a violation or
regarding the reasonableness of the proposed deadline for correction,
the licensee may request an informal conference to contest the
(d) Any unpaid administrative fine shall begin accruing a
7-percent interest penalty on the unpaid balance due. This interest
shall continue to accrue until the administrative fine and interest
are paid in full.
The program may deny, or may suspend or revoke, a license
upon any of the following grounds:
(a) Gross negligence.
(c) The conviction of any crime involving dishonesty or which is
substantially related to the qualifications, functions, or duties of
a nursing home administrator. A conviction following a plea of nolo
contendere is deemed to be a conviction within the meaning of this
(d) Using fraud or deception in applying for a license or in
taking the examination provided for in this chapter.
(e) Treating or attempting to treat any physical or mental
condition without being currently licensed to do so.
(f) Violating Section 650 of the Business and Professions Code,
any provision of this chapter, or any rule or regulation of the
program adopted pursuant to this chapter.
(g) Lack of any qualification requirement for the license.
(h) Failure to report under Section 1416.60 to the program,
without just cause.
(a) The program may deny a nursing home administrator
applicant or licensee, a license, based on one of the following
(1) Conviction of a crime. A conviction within the meaning of this
section means a plea or verdict of guilty or a conviction following
a plea of nolo contendere. The program may take action following the
establishment of a conviction after the time for appeal has elapsed,
or the judgment of conviction has been affirmed on appeal, or when an
order granting probation is made suspending the imposition of
sentence, irrespective of a subsequent order under Section 1203.4 of
the Penal Code.
(2) Commits any act involving dishonesty, fraud, or deceit with
the intent to substantially benefit himself or herself or another, or
substantially injure another.
(3) Commits any act which, if done by a licentiate, would be
grounds for suspension or revocation of license. The program may deny
a license pursuant to this subdivision only if the crime or act is
substantially related to the qualifications, functions, or duties of
a nursing home administrator.
(b) Notwithstanding any other provision of this chapter, no person
shall be denied a license solely on the basis that he or she has
been convicted of a felony if he or she has obtained a certificate of
rehabilitation under Section 4852.01 of the Penal Code, or that he
or she has been convicted of a misdemeanor and has met all applicable
requirements of the criteria of rehabilitation developed by the
program pursuant to subdivision (f).
(c) The program may deny a nursing home administrator license on
the ground that the applicant knowingly made a false statement of
fact required to be revealed in the application for the license.
(d) The program may suspend or revoke a license on the ground that
the applicant or licensee has been convicted of a crime, as defined
in paragraph (1) of subdivision (a), if the crime is substantially
related to the qualifications, functions, or duties of a nursing home
(e) The program shall develop criteria to use to determine whether
a crime or act is substantially related to the qualifications,
functions, or duties of a nursing home administrator, and shall use
the criteria when considering the denial, suspension, or revocation
of a license.
(f) The program shall develop criteria to be used by the program
to evaluate the rehabilitation of a person when considering the
denial, suspension, or revocation of a license under this section.
(g) The program shall take into account all competent evidence of
rehabilitation furnished by the applicant or licensee pursuant to the
evaluation process set forth in subdivision (f).
The program may deny, or may suspend or revoke, a nursing
home administrator license or participation in specific training
program areas under this chapter upon any of the following grounds:
(a) Misappropriation of funds or property of the facility, the
patients, or of others.
(b) Using fraud, deception, or misrepresentation in applying for
the AIT Program, the examination for licensure, or any other program
functions provided for in this chapter.
(c) Procuring a nursing home license by fraud, deception, or
(d) Impersonating any applicant or acting as a proxy for an
applicant in an examination.
(e) Impersonating any licensed nursing home administrator.
(f) Treating or attempting to treat any physical or mental
condition without having a valid license to do so.
(g) Violating Section 650 of the Business and Professions Code,
any provisions of this chapter, or any rule or regulation of the
program adopted pursuant to this chapter.
(h) Lack of any qualification requirement for a license,
participation in the AIT Program or preceptor program.
(i) A pattern of failure to report changes under Section 1416.60
to the program without just cause.
(j) Failure to comply with this chapter or the laws, rules, and
regulations relating to health facilities.
(k) The commission of any dishonest, corrupt, or fraudulent act or
any act of physical or mental, including sexual, abuse of any person
in connection with the administration of, or any patient in, a
( l) Violation by the licensee of any of the provisions of this
chapter or of the rules and regulations promulgated under this
(m) Aiding, abetting, or conspiring with another person to violate
provisions of this chapter or of the rules and regulations
promulgated under this chapter.
(n) Violation of the examination security agreement.
(a) The program may place a nursing home administrator
license on probation in lieu of formal action to suspend or revoke
the license if the department determines that probation is the
appropriate action. Upon successful completion of the probation
period, the license shall be restored to regular status.
(b) The probationary license shall be based upon an agreement
entered into between the licensee and the program that specifies
terms and conditions of licensure during the probationary period. The
terms and conditions shall be related to matters, including, but not
limited to, work performance, rehabilitation, training, counseling,
progress reports, and treatment programs.
(c) The term of the probationary license shall not exceed two
years. If the licensee successfully completes the term of probation,
as determined by the department, no further action shall be taken
upon the allegations that were the basis for the probationary
license. If the licensee fails to comply with the terms and
conditions of the probationary license agreement, the department may
proceed with a formal action to suspend or revoke the license.
Upon the determination to deny application for licensure
for grounds specified in Section 1416.77, the program shall
immediately notify the applicant in writing by certified mail. A
petition for an administrative hearing must be received by the
program within 20 business days of receipt of notification. Upon
receipt, the department shall set the matter for administrative
hearing, pursuant to procedures specified in Section 100171.
(a) Proceedings to suspend or revoke licensure for grounds
specified in Section 1416.77 shall be conducted in accordance with
Section 100171. In the event of conflict between this chapter and
Section 100171, Section 100171 shall prevail.
(b) (1) The program may temporarily suspend any license prior to
any hearing if the action is necessary to protect the public welfare.
The program shall notify the licensee of the temporary suspension
and the effective date. Upon receipt of a notice of defense by the
licensee, the department shall set the matter within 15 days. The
administrative hearing conducted in accordance with Section 100171
shall be held as soon as possible but not later than 30 days after
receipt of the notice. The temporary suspension shall remain in
effect until the hearing is completed and the department has made a
final determination on the merits. However, the temporary suspension
shall be deemed vacated if the department fails to make a final
determination on the merits of the action within 60 days after the
original hearing has been completed. If the provisions of this
chapter or the rules or regulations promulgated by the director are
violated by a licensee, the director may suspend the license for the
(2) If the program determines that the temporary suspension shall
become an actual suspension, the department shall specify the period
of the suspension, not to exceed two years. The program may determine
that the suspension shall be stayed, and place the licensee on
probation for a period that shall not exceed two years.
(c) The program may suspend or revoke a license prior to any
hearing when immediate action is necessary in the judgment of the
director to protect the public welfare. Proceedings for immediate
revocation shall be conducted in accordance with Section 100171. The
department shall set the matter for hearing within 15 days and hold
the administrative hearing as soon as possible but not later than 30
calendar days from receipt of the request for a hearing. A written
hearing decision upholding or setting aside the action shall be sent
by certified mail to the licenseholder within 30 calendar days of the
Whenever any person has engaged, or is about to engage, in
any acts or practices that constitute, or will constitute, a
violation of this chapter, the superior court in and for the county
in which those acts or practices take place, or are about to take
place, may issue an injunction or other appropriate order,
restraining the conduct, on application of the program, to the
Attorney General, or the district attorney.
If any provision of this chapter, or the application
thereof to any person or circumstance, is held invalid, that
invalidity shall not affect other provisions or applications of this
chapter that can be given effect without the invalid provision or
application, and to this end the provisions of this chapter are
declared to be severable.