Chapter 8.6. Pediatric Day Health And Respite Care Facilities of California Health And Safety Code >> Division 2. >> Chapter 8.6.
In enacting this chapter, it is the intent of the Legislature
to create, within the state department, a program for licensing
pediatric day health and respite care facilities to serve the needs
of medically fragile and terminally ill children and their families.
As used in this chapter, the following definitions shall
(a) (1) "Pediatric day health and respite care facility" means a
facility that provides an organized program of therapeutic social and
day health activities and services and limited 24-hour inpatient
respite care to medically fragile children 21 years of age or
younger, including terminally ill and technology-dependent patients,
except as provided in paragraph (2) and Section 1763.4.
(2) An individual who is 22 years of age or older may continue to
receive care in a pediatric day health and respite care facility if
the facility receives approval from the state department for a
Transitional Health Care Needs Optional Service Unit pursuant to
Section 1763.4. A patient who previously received services from a
pediatric day health and respite care facility, who is 22 years of
age or older, and who satisfies the requirements of Section 1763.4,
may also receive services in an optional service unit.
(b) "Medically fragile" means having an acute or chronic health
problem that requires therapeutic intervention and skilled nursing
care during all or part of the day. Medically fragile problems
include, but are not limited to, HIV disease, severe lung disease
requiring oxygen, severe lung disease requiring ventilator or
tracheostomy care, complicated spina bifida, heart disease,
malignancy, asthmatic exacerbations, cystic fibrosis exacerbations,
neuromuscular disease, encephalopathies, and seizure disorders.
(c) "Technology-dependent patient" means a person who, from birth,
has a chronic disability, requires the routine use of a specific
medical device to compensate for the loss of use of a life sustaining
body function, and requires daily, ongoing care or monitoring by
(d) "Respite care" means day and 24-hour relief for the parent or
guardian and care for the patient. 24-hour inpatient respite care
includes, but is not limited to, 24-hour nursing care, meals,
socialization, and developmentally appropriate activities. As used in
this chapter, "24-hour inpatient respite care" is limited to no more
than 30 intermittent or continuous whole calendar days per patient
per calendar year.
(e) "Comprehensive case management" means locating, coordinating,
and monitoring services for the eligible patient population and
includes all of the following:
(1) Screening of patient referrals to identify those persons who
can benefit from the available services.
(2) Comprehensive patient assessment to determine the services
(3) Coordinating the development of an interdisciplinary
comprehensive care plan.
(4) Determining individual case cost effectiveness and available
sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the
optimum type, amount, and duration of services provided.
(f) "License" means a basic permit to operate a pediatric day
health and respite care facility. With respect to a health facility
licensed pursuant to Chapter 2 (commencing with Section 1250),
"license" means a special permit authorizing the health facility to
provide pediatric day health and respite care services as a separate
program in a distinct part of the facility.
(g) "State department" means the State Department of Public
(a) The state department shall develop and adopt
regulations for the licensure of, and shall license, pediatric day
health and respite care facilities. The regulations shall include
minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no
later than July 1, 1993.
(b) The state department shall establish within the state
department an advisory committee of experts to assist in the
development of the regulations required pursuant to this section. A
representative of the state department shall act as chairperson of
the committee. The members of the committee shall serve without
compensation, but shall be reimbursed by the state department for all
necessary expenses incurred in the actual performance of their
duties. To the extent sufficient funds have been appropriated in the
Budget Act, the state department may provide staff support to the
committee as the state department deems is necessary for the conduct
of the committee's business. The committee shall meet at the state
director's pleasure until the time that the proposed regulations are
presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision
(b), an entity may be licensed as a pediatric day health and respite
care facility if it meets interim regulations administered by the
state department for congregate living health facilities pursuant to
(d) (1) In addition to the exceptions from regulations described
in subdivision (n) of Section 1267.13, a pediatric day health and
respite care facility shall not be required to conform to the
following regulations contained in Chapter 3 of Division 5 of Title
22 of the California Code of Regulations: 72329.1, 72353, 72359,
72363, 72365, 72371, subdivisions (b) and (c) of Section 72375,
subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2) A pediatric day health and respite care facility shall not be
required to meet the requirements of Section 72367 of Article 3 of
Chapter 3 of Division 5 of Title 22 of the California Code of
Regulations, except that medications brought by or with the patient
on admission to the facility shall not be used unless, after
admission by the facility, the contents of the containers have been
examined and positively identified by a licensed nurse, in accordance
with his or her scope of practice.
(e) A pediatric day health and respite care facility shall have a
patient care committee to address quality of care provided in the
facility, including, but not limited to, patient care policies,
pharmacy services, and infection control.
(1) The pediatric day health and respite care facility shall
maintain minutes of every committee meeting and indicate the names of
members present, the date, the length of the meeting, the subject
matter discussed, and any action taken.
(2) The patient care committee shall include the medical director,
dietician, pharmacist, nursing staff, nurse supervisor, center
administrator or director, and other staff as may be required by
facility policies and procedures.
(3) The patient care committee shall meet at least twice per year
or more often if a need or problem is identified by the committee.
(4) The patient care committee shall be responsible for all of the
(A) Reviewing and approving all policies relating to patient care.
Based on reports received from the pediatric day health and respite
care facility's administrator, the committee shall review the
effectiveness of policy implementation and shall make recommendations
to the administrator of the facility for the improvement of patient
care. The committee shall review patient care policies annually and
revise the policies as necessary. The committee's minutes shall list
the policies the committee reviewed.
(B) Infection control in the facility, which shall include, but
not be limited to, establishing, reviewing, monitoring, and approving
policies and procedures for investigating, controlling, and
preventing infections in the facility, and maintaining, reviewing,
and reporting statistics of the number, types, sources, and locations
of infections within the pediatric day health and respite care
(C) Establishing, reviewing, and monitoring the storage and
administration of drugs and biologicals, reviewing and taking
appropriate action based on any findings from a pharmacist hired to
consult with the committee and internal quality assurance reviews,
and recommending improvements of services to the administrator of the
(f) (1) A pediatric day health and respite care facility shall
comply with licensing requirements. The state department may, upon
written request of an applicant or licensee, approve the use of
alternate concepts, methods, procedures, techniques, equipment,
personnel qualifications, or conducting pilot projects, provided
those alternatives are carried out with safe and adequate care for
the patients and with the prior written approval of the state
department. The state department's approval shall provide for the
terms and conditions under which the alternatives are granted. An
applicant's or licensee's written request shall be accompanied by
substantiating evidence supporting the request pursuant to this
(2) The state department's review of written requests submitted
under this subdivision shall consider the unique nature of services
provided to individuals served by the pediatric day health and
respite care facility when compared to the requirements for
congregate living health facilities for individuals requiring
(3) If the state department grants an approval under this
subdivision, a pediatric day health and respite care facility shall
immediately post that approval, or a true copy of that approval,
adjacent to the facility's license.
The annual Licensing and Certification Program fee for a
pediatric day health and respite care facility, as defined in Section
1760.2, shall be set in accordance with Section 1266.
(a) A pediatric day health and respite care facility shall
provide all of the following services:
(6) Developmentally appropriate activities.
(b) Services which may be provided by a pediatric day health and
respite care facility include, but are not limited to, any of the
(1) Physical therapy.
(2) Developmental services.
(3) Occupational and speech therapy.
(4) Educational and psychological services.
(5) Respite care.
(6) Instruction for parents or guardians.
(7) Comprehensive case management, if not otherwise available for
A pediatric day health and respite care facility shall
provide pharmacy services that satisfy all of the following:
(a) (1) Medications shall be supplied to the licensed nursing
personnel of the pediatric day health and respite care facility by
the patient's parent, foster parent, or legal guardian in the
original dispensing container that specifies administration
(2) Medications shall be administered only upon written and signed
orders of the patient's attending physician.
(3) The pediatric day health and respite care facility shall not
order medications from a pharmacy or take delivery of medications
from a pharmacy.
(4) The pediatric day health and respite care facility shall not
accept a patient into the facility if the patient's medications have
expired or are scheduled to expire during the patient's stay at the
(b) (1) Physician orders shall be current and maintained in the
patient's medical record at the pediatric day health and respite care
facility. Verbal orders from the attending physician for services to
be rendered at the facility may be received and recorded by licensed
nursing personnel in the patient's medical record at the facility
and shall be signed by the attending physician within 30 working
(2) Medications shall not be administered to a patient unless the
facility first verifies that the medication was ordered by a
physician. Verification may be obtained by contacting the physician's
office or by being provided with a copy of the physician's order for
(c) The pediatric day health and respite care facility shall
maintain records of medication administered for at least one year,
unless a longer period is required by state or federal law. The
records of medication administered shall be a part of the patient's
plan of care.
(d) The pediatric day health and respite care facility may treat
changes in the patient's condition, such as new onset pain, nausea,
diarrhea, infections, or other similar changes, in accordance with
the patient's plan of care if the patient has been prescribed
medications to treat these anticipated symptoms, and the treatment
does not present a risk to the health and safety of themselves, other
patients, staff, or other individuals with whom the patient may come
into contact. A patient who presents with symptoms that are not
anticipated or planned for in the plan of care shall not remain in
(e) Other requirements as specified in subdivision (a) of Section
72375, and subdivision (a) of Section 72377, of Article 3 of Chapter
3 of Division 5 of Title 22 of the California Code of Regulations.
(f) Only licensed nursing personnel, acting in accordance with
their scope of practice, may accept, inspect the condition of medical
containers, and record the receipt and the return of all medications
in a pediatric day health and respite care facility. The facility
shall comply with Section 72313 of Title 22 of the California Code of
Regulations with regard to the administration of medication.
(g) A pediatric day health and respite care facility shall comply
with all applicable state and federal laws regarding the labeling
condition of medication containers.
(a) A pediatric day health and respite care facility may
establish admission criteria based upon the compatibility of the
developmental needs of the persons served and the facility's ability
to meet those needs. All admission criteria established by the
facility shall be approved by the state department.
(b) A child accepted for care in a pediatric day health and
respite care facility shall satisfy all of the following criteria:
(1) Be medically stable, as determined by the child's attending
physician and surgeon.
(2) Be under the care of a physician and surgeon who approves the
plan of care.
(3) Have current immunization records unless medically
contraindicated as stated by the child's attending physician and
surgeon at the time of admission and pose no significant risk of
infection to others in the facility.
(4) Have the consent of the parent or legal guardian for the
A pediatric day health and respite care facility may
implement policies and procedures that prohibit smoking by patients,
parents, staff, visitors, or consultants within the facility or on
the premises, if the prohibition is clearly stated in the admission
agreement, and notices are posted at the facility.
Pediatric day health and respite care facilities shall be
(a) Pediatric day health and respite care facilities shall
meet the same fire safety standards adopted by the State Fire Marshal
that apply to community care facilities, as defined in Section 1502,
of similar size and with clients of similar age and ambulatory
status. No other state or local requirements relating to fire safety
shall apply to these facilities and the requirements in this section
shall be uniformly enforced by state and local fire authorities.
(b) Pediatric day health and respite care facilities shall meet
the same seismic safety standards that apply to community care
facilities, as defined in Section 1502, of similar size and with
clients of similar age and ambulatory status. No additional state or
local requirements relating to seismic safety shall apply to these
A pediatric day health and respite care facility of six
beds or less shall be considered a residential use of property for
purposes of any zoning ordinance or law related to the residential
use of property. This section does not prohibit any city, county, or
other local public entity from placing restrictions on building
heights, setback, lot dimensions, or placement of signs of a
pediatric day health and respite care facility as long as those
restrictions are identical to those applied to single-family
A pediatric day health and respite care facility shall
conspicuously post the license, or a true copy thereof, in a location
accessible to public view.
A pediatric day health and respite care facility shall not
be subject to architectural plan review or field inspection by the
Office of Statewide Health Planning and Development. However, as part
of the application for licensure, an applicant shall submit evidence
of compliance with local building code requirements. In addition,
the physical environment shall be adequate to provide the level of
care and service required by the clients of the facility as
determined by the state department.
Sections 1761.2, 1761.4, and 1761.8 do not prohibit the
use of alternate space utilization, new concepts of design, treatment
techniques, equipment and alternate finish materials, or other
flexibility, if written approval is granted by the local building
(a) In order to obtain a license under the provisions of this
chapter to establish, conduct, or maintain a pediatric day health
and respite care facility, a person, entity, political subdivision of
the state, or governmental agency shall file with the state
department a verified application on a form prescribed, prepared, and
furnished by the state department, containing information as may be
required by the state department for the proper administration and
enforcement of this chapter.
(b) The state department shall initiate an initial licensing
inspection of a Transitional Health Care Needs Optional Service Unit
within 60 days of receipt of a completed application.
(a) If a pediatric day health and respite care facility or
an applicant for a license has not been previously licensed, the
state department shall issue a provisional license to the facility
only as provided in this section.
(b) The state department shall not issue a provisional license
unless, after an onsite survey by the state department, the state
department finds that the pediatric day health and respite care
facility is in substantial compliance with the requirements of this
(c) A provisional license to operate a pediatric day health and
respite care facility shall terminate six months from the date of
issuance, or the date that the state department is able to conduct a
full and complete inspection, whichever is later.
(d) Within 30 days prior to the termination of a provisional
license, the state department shall give the facility a full and
complete inspection, and, if the facility meets all applicable
requirements for licensure, a regular license shall be issued. If the
facility does not meet the requirements for licensure but has made
substantial progress towards meeting the requirements, as determined
by the state department, the initial provisional license shall be
renewed for six months.
(e) If the state department determines that there has not been
substantial progress towards meeting licensure requirements at the
time of the first full inspection provided by this section, or, if
the state department determines upon its inspection made within 30
days of the termination of a renewed provisional license that there
is lack of full compliance with the requirements, the state
department shall not issue a further license.
(f) If an applicant for a provisional license to operate a
pediatric day health and respite care facility has been denied
provisional licensing by the state department, the applicant may
contest the denial by filing a request for a hearing pursuant to
(g) The state department shall not apply less stringent criteria
when granting a provisional license pursuant to this section than it
applies when granting a permanent license.
(a) A license issued under this chapter shall expire 12
months from the date of its issuance. The licensee shall pay a fee,
not to exceed the reasonable regulatory cost to the state department,
to the state department annually, not less than 30 days prior to
expiration date, subject to the state department mailing the notice
of renewal in accordance with subdivision (b).
(b) (1) At least 45 days prior to the expiration of a license
issued pursuant to this chapter, the state department shall mail a
notice for renewal to the licensee.
(2) A license renewal shall be submitted with the necessary fee in
accordance with subdivision (a). A license shall be deemed renewed
upon payment of the necessary fee, commencing from the license's
expiration date. If the requirements of this section are satisfied,
the state department shall issue a license to the facility by the
expiration date of the license to ensure the provider remains in good
standing. The facility's license shall be mailed within 15 calendar
days after the date the state department receives the renewal fee.
Every pediatric day health and respite care facility for
which a license has been issued shall be periodically inspected by a
duly authorized representative of the state department. Reports of
each inspection shall be prepared by the representative upon forms
prepared and furnished by the state department and filed with the
state department. The inspection shall be for the purpose of ensuring
that the pediatric day health and respite care facility is complying
with the provisions of this chapter and the rules and regulations of
the state department.
The state department may deny an application for, or
suspend or revoke a license issued under the provisions of this
chapter in the manner provided in Section 1763 upon, any of the
(a) A serious violation by the licensee of any of the provisions
of this chapter, of any other law, or of the rules and regulations
promulgated under this chapter that jeopardizes the health and safety
(b) Aiding, abetting, or permitting the commission of any illegal
(c) Willful omission or falsification of a material fact in the
application for a license.
Proceedings for the denial, suspension, or revocation of
licenses, or denial or withdrawal of approval under this chapter
shall be conducted in accordance with Section 131071. The suspension,
expiration, or forfeiture by operation of law of a license issued by
the state department, its suspension, forfeiture, or cancellation by
order of the state department or by order of a court, or its
surrender without the written consent of the state department, shall
not deprive the state department of its authority to institute or
continue a disciplinary proceeding against the licensee upon any
ground provided by law or to enter an order suspending or revoking
the license or otherwise taking disciplinary action against the
licensee on any of those grounds.
The state department has authority to make reasonable
accommodation for exceptions to the standards in this chapter if the
health, safety, and quality of patient care is not compromised. Prior
written approval communicating the terms and conditions under which
the exception is granted shall be required. An applicant shall
request an exception in writing accompanied by detailed supporting
(a) For purposes of this chapter, the following definitions
(1) "Distinct part" means an identifiable unit accommodating beds
or patient space, including, but not limited to, contiguous beds or
patient space, a wing, floor, or building approved by the state
department for a specific purpose.
(2) "Older children" means patients who are 18 to 21 years of age,
(3) "Transitional Health Care Needs Optional Service Unit" or
"optional service unit" means a functional unit of a pediatric day
health and respite care facility that is organized, staffed, and
equipped to provide care to individuals who are 22 years of age or
(A) Patients receiving care in the optional service unit shall be
in age-appropriate groupings as provided for in the pediatric day
health and respite care facility's policies and procedures. Older
children are not precluded from being cared for in the same optional
service unit as the patients who are 22 years of age or older. If a
pediatric day health and respite care facility proposes to provide
care to older children in the optional service unit, the facility
shall have policies, procedures, equipment, and supplies to meet the
needs of those patients. Patients who are 15 to 17 years of age,
inclusive, may also be considered for care in the optional service
unit if the pediatric day health and respite care facility obtains an
individual age waiver from the regional center, with the concurrence
of the department. A pediatric day health and respite care facility
is not required to operate an optional service unit.
(B) In order to continue receiving care in the pediatric day
health and respite care facility, patients who are 22 years of age or
older shall have a developmental age of 18 years of age or younger,
as evidenced by the patient's Individual Education Plan (IEP),
Regional Center Assessment, physician's assessment, or other
assessment using a standardized assessment tool that is nationally
recognized in the field. A patient who previously received services
from a pediatric day health and respite care facility, who is 22
years of age or older, and who satisfies the requirements of this
subparagraph may also receive services in an optional service unit.
(b) An optional service unit shall be subject to the approval of
the state department. A pediatric day health and respite care
facility desiring approval for an optional service unit shall file an
application on forms furnished by the state department. The state
department shall list on the facility license each optional service
for which approval is granted.
(c) Except as provided in subparagraph (A) of paragraph (3) of
subdivision (a), care for patients who are 22 years of age or older
shall be provided in a distinct part of the pediatric day health and
respite care facility or optional service unit, separate from the
area where care is provided to patients who are 21 years of age or
younger. The facility shall establish and implement policies and
procedures for determining the age ranges of patients who are cared
for in the optional service unit. These policies and procedures shall
include, but not be limited to, consideration of the patient's
chronological age, developmental age, and size, and shall reflect the
needs of individual patients through a comprehensive assessment.
(d) The pediatric day health and respite care facility shall
ensure that its staffing and equipment are sufficient to provide
services to patients who are 22 years of age or older.
(e) A Transitional Health Care Needs Optional Service Unit shall
have written policies and procedures for the management of the
service. The policies and procedures shall be established and
implemented by the patient care policy committee described in Section
(f) (1) The state department may review and approve the policies
and procedures for an optional service unit.
(2) The State Department of Developmental Services and the
regional centers may review the policies and procedures for an
optional service unit.