SECTIONS 1275-1289.5 - California Statutes

HEALTH AND SAFETY CODE

SECTION 1275-1289.5

1275. (a) The state department shall adopt, amend, or repeal, in
accordance with Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code and Chapter 4
(commencing with Section 18935) of Part 2.5 of Division 13, any
reasonable rules and regulations as may be necessary or proper to
carry out the purposes and intent of this chapter and to enable the
state department to exercise the powers and perform the duties
conferred upon it by this chapter, not inconsistent with any statute
of this state including, but not limited to, the State Building
Standards Law, Part 2.5 (commencing with Section 18901) of Division
13.
All regulations in effect on December 31, 1973, which were adopted
by the State Board of Public Health, the State Department of Public
Health, the State Department of Mental Hygiene, or the State
Department of Health relating to licensed health facilities shall
remain in full force and effect until altered, amended, or repealed
by the director or pursuant to Section 25 or other provisions of law.
(b) Notwithstanding this section or any other provision of law,
the Office of Statewide Health Planning and Development shall adopt
and enforce regulations prescribing building standards for the
adequacy and safety of health facility physical plants.
(c) The building standards adopted by the State Fire Marshal, and
the Office of Statewide Health Planning and Development pursuant to
subdivision (b), for the adequacy and safety of freestanding physical
plants housing outpatient services of a health facility licensed
under subdivision (a) or (b) of Section 1250 shall not be more
restrictive or comprehensive than the comparable building standards
established, or otherwise made applicable, by the State Fire Marshal
and the Office of Statewide Health Planning and Development to
clinics and other facilities licensed pursuant to Chapter 1
(commencing with Section 1200).
(d) Except as provided in subdivision (f), the licensing standards
adopted by the state department under subdivision (a) for outpatient
services located in a freestanding physical plant of a health
facility licensed under subdivision (a) or (b) of Section 1250 shall
not be more restrictive or comprehensive than the comparable
licensing standards applied by the state department to clinics and
other facilities licensed under Chapter 1 (commencing with Section
1200).
(e) Except as provided in subdivision (f), the state agencies
specified in subdivisions (c) and (d) shall not enforce any standard
applicable to outpatient services located in a freestanding physical
plant of a health facility licensed pursuant to subdivision (a) or
(b) of Section 1250, to the extent that the standard is more
restrictive or comprehensive than the comparable licensing standards
applied to clinics and other facilities licensed under Chapter 1
(commencing with Section 1200).
(f) All health care professionals providing services in settings
authorized by this section shall be members of the organized medical
staff of the health facility to the extent medical staff membership
would be required for the provision of the services within the health
facility. All services shall be provided under the respective
responsibilities of the governing body and medical staff of the
health facility.
(g) For purposes of this section, "freestanding physical plant"
means any building which is not physically attached to a building in
which inpatient services are provided.

1275.1. (a) Notwithstanding any rules or regulations governing
other health facilities, the regulations developed by the State
Department of Mental Health for psychiatric health facilities shall
prevail. The regulations applying to psychiatric health facilities
shall prescribe standards of adequacy, safety, and sanitation of the
physical plant, of staffing with duly qualified licensed personnel,
and of services based on the needs of the persons served thereby.
(b) The regulations shall include standards appropriate for two
levels of disorder:
(1) Involuntary ambulatory psychiatric patients.
(2) Voluntary ambulatory psychiatric patients.
For purposes of this subdivision, "ambulatory patients" shall
include, but not be limited to, deaf, blind, and physically
handicapped persons. Disoriented persons who are not bedridden or
confined to a wheelchair shall also be considered as ambulatory
patients.
(c) The regulations shall not require, but may permit building and
services requirements for hospitals which are only applicable to
physical health care needs of patients that can be met in an
affiliated hospital or in outpatient settings including, but not
limited to, such requirements as surgical, dietary, laboratory,
laundry, central supply, radiologic, and pharmacy.
(d) The regulations shall include provisions for an "open planning"
architectural concept.
(e) The regulations shall exempt from seismic requirements all
structures of Type V and of one-story construction.
(f) Standards for involuntary patients shall include provisions to
allow for restraint and seclusion of patients. Such standards shall
provide for adequate safeguards for patient safety and protection of
patient rights.
(g) The regulations shall provide for the retention by the
psychiatric health facility of a consultant pharmacist, who shall
supervise and review pharmaceutical services within the facility and
perform such other services, including prevention of the unlawful
diversion of controlled substances subject to abuse, as the state
department may by regulation require. Regulations adopted pursuant to
this subdivision shall take into consideration the varying bed sizes
of psychiatric health facilities.

1275.2. (a) Notwithstanding any rules or regulations governing
other health facilities, the regulations adopted by the state
department for chemical dependency recovery hospitals shall prevail.
The regulations applying to chemical dependency recovery hospitals
shall prescribe standards of adequacy, safety, and sanitation of the
physical plant, of staffing with duly qualified personnel, and of
services based on the needs of the persons served thereby.
(b) The regulations shall include provisions for an "open planning"
architectural concept.
(c) Notwithstanding the provisions of Chapter 1 (commencing with
Section 15000) of Division 12.5, the regulations shall exempt from
seismic requirements all freestanding structures of a chemical
dependency recovery hospital. Chemical dependency recovery services
provided as a supplemental service in general acute care beds or
general acute psychiatric beds shall not be exempt from seismic
requirements.
(d) Regulations shall be developed pursuant to this section and
presented for adoption at a public hearing within 180 days of the
effective date of this section.
(e) In order to assist in the rapid development of regulations for
chemical dependency recovery hospitals, the director of the state
department, not later than 30 days after the effective date of this
section, shall convene an advisory committee composed of two
representatives of the State Department of Alcohol and Drug Programs,
two representatives of the State Department of Health Services, one
representative of the Office of Statewide Health Planning and
Development, two persons with experience operating facilities with
alcohol or medicinal drug dependency programs, and any other persons
having a professional or personal nonfinancial interest in
development of such regulations. The members of such advisory
committee who are not state officers or employees shall pay their own
expenses related to participation on the committee. The committee
shall meet at the call of the director until such time as the
proposed regulations are presented for adoption at public hearing.

1275.3. (a) The State Department of Public Health and the State
Department of Developmental Services shall jointly develop and
implement licensing regulations appropriate for intermediate care
facilities/developmentally disabled-nursing and intermediate care
facility/developmentally disabled-continuous nursing.
(b) The regulations adopted pursuant to subdivision (a) shall
ensure that residents of intermediate care facilities/developmentally
disabled-nursing and intermediate care facility/developmentally
disabled-continuous nursing receive appropriate medical and nursing
services, and developmental program services in a normalized, least
restrictive physical and programmatic environment appropriate to
individual resident need.
In addition, the regulations shall do all of the following:
(1) Include provisions for the completion of a clinical and
developmental assessment of placement needs, including medical and
other needs, and the degree to which they are being met, of clients
placed in an intermediate care facility/developmentally
disabled-nursing and intermediate care facility/developmentally
disabled-continuous nursing and for the monitoring of these needs at
regular intervals.
(2) Provide for maximum utilization of generic community resources
by clients residing in a facility.
(3) Require the State Department of Developmental Services to
review and approve an applicant's program plan as part of the
licensing and certification process.
(4) Require that the physician providing the certification that
placement in the intermediate care facility/developmentally
disabled-nursing or intermediate care facility/developmentally
disabled-continuous nursing is needed, consult with the physician who
was the physician of record at the time the person's proposed
placement is being considered by the interdisciplinary team.
(c) Regulations developed pursuant to this section shall include
licensing fee schedules appropriate to facilities which will
encourage their development.
(d) Nothing in this section supersedes the authority of the State
Fire Marshal pursuant to Sections 13113, 13113.5, 13143, and 13143.6
to the extent that these sections are applicable to community care
facilities.

1275.5. (a) The regulations relating to the licensing of hospitals,
heretofore adopted by the Department of Public Health pursuant to
Chapter 2 (commencing with Section 1400) of Division 2, and in effect
immediately prior to July 1, 1973, shall remain in effect and shall
be fully enforceable with respect to any hospital required to be
licensed by this chapter, unless and until the regulations are
readopted, amended, or repealed by the director.
(b) The regulations relating to private institutions receiving or
caring for any mentally disordered persons, mentally retarded
persons, and other incompetent persons, heretofore adopted by the
Department of Mental Hygiene pursuant to Chapter 1 (commencing with
Section 7000) of Division 7 of the Welfare and Institutions Code, and
in effect immediately prior to July 1, 1973, shall remain in effect
and shall be fully enforceable with respect to any facility,
establishment, or institution for the reception and care of mentally
disordered persons, mentally retarded persons and other incompetent
persons, required to be licensed by the provisions of this chapter
unless and until said regulations are readopted, amended, or repealed
by the director.
(c) All regulations relating to the licensing of psychiatric
health facilities heretofore adopted by the State Department of
Health Services, pursuant to authority now vested in the State
Department of Mental Health by Section 5652.5 of the Welfare and
Institutions Code, and in effect immediately preceding September 20,
1988, shall remain in effect and shall be fully enforceable by the
State Department of Mental Health with respect to any facility or
program required to be licensed as a psychiatric health facility,
unless and until readopted, amended, or repealed by the Director of
Mental Health.

1275.6. (a) A health facility licensed pursuant to subdivision (a)
or (b) of Section 1250 may provide in any alternative setting health
care services and programs which may be provided by any other
provider of health care outside of a hospital building or which are
not otherwise specifically prohibited by this chapter. In addition,
the state department and the Office of Statewide Health Planning and
Development shall adopt and enforce standards which permit the
ability of a health facility licensed pursuant to subdivision (a) or
(b) of Section 1250 to use its space for alternative purposes.
(b) In adopting regulations implementing this section, and in
reviewing an application or other request by a health facility
licensed pursuant to subdivision (a) or (b) of Section 1250, pursuant
to Section 1265, and subdivision (b) of Section 1276, relating to
services provided in alternative settings, the state department may
adopt or impose reasonable standards and conditions which promote and
protect patient health, safety, security, and quality of health
care.
(c) Pending the adoption of regulations referred to in subdivision
(b), the state department may condition approval of the alternative
service or alternative setting on reasonable standards consistent
with this section and subdivisions (d) and (e) of Section 1275. The
state department and the Office of Statewide Health Planning and
Development may adopt these standards by mutual agreement with a
health facility proposing a service and may, after consultation with
appropriate professional and trade associations, establish guidelines
for hospitals wishing to institute an alternative service or to
provide a service in an alternative setting. Services provided
outside of a hospital building under this section shall be subject to
the licensing standards, if any, that are applicable to the same or
similar service provided by nonhospital providers outside of a
hospital building. The intent of this subdivision is to assure timely
introduction of safe and efficacious innovations in health care
services by providing a mechanism for the temporary implementation
and evaluation of standards for alternative services and settings and
to facilitate the adoption of appropriate regulations by the state
department.
(d) All health care professionals providing services in settings
authorized by this section shall be members of the organized medical
staff of the health facility to the extent medical staff membership
would be required for the provision of the services within the health
facility. All services shall be provided under the respective
responsibilities of the governing body and medical staff of the
health facility. Nothing in this section shall be construed to repeal
or otherwise affect Section 2400 of the Business and Professions
Code, or to exempt services provided under this section from
licensing standards, if any, established by or otherwise applicable
to, the same or similar service provided by nonhospital providers
outside of a hospital building.
(e) For purposes of this section, "hospital building" shall have
the same meaning as that term is defined in Section 15026.

1275.7. (a) The Legislature makes the following findings and
declarations:
(1) The theft of newborn babies from hospitals is a serious
societal problem that must be addressed.
(2) There is no statutory requirement that hospitals offering
maternity services establish policies and procedures that protect
newborns and their parents from physical harm and emotional distress
resulting from baby thefts.
(3) Societal change has popularized a more open and natural
birthing process, which, unfortunately, increases the risk of thefts
of newborns from hospitals and other health facilities offering
maternity services.
(4) Baby thefts detrimentally affect the emotional and physical
health of newborns and their families.
(5) It is the intent of the Legislature in enacting this chapter
to take reasonable steps toward reducing baby thefts.
(b) On or before July 1, 1991, the state department shall adopt
regulations requiring any hospital or other health facility offering
maternity services to establish written policies and procedures
designed to promote the protection of babies and the reduction of
baby thefts from hospitals or other health facilities offering
maternity services. Those hospitals and facilities shall establish
the policies and procedures no later than 60 days after the
regulations become effective.
(c) The state department shall review the policies and procedures
established by the hospitals and other health facilities, as required
by subdivision (b), to determine compliance with the regulations
adopted by the state department, pursuant to subdivision (b).
(d) Hospitals and other health facilities offering maternity
services shall periodically review their policies and procedures
established pursuant to this section. The review need not occur more
frequently than every two years.

1276. (a) The building standards published in the State Building
Standards Code by the Office of Statewide Health Planning and
Development, and the regulations adopted by the state department
shall, as applicable, prescribe standards of adequacy, safety, and
sanitation of the physical plant, of staffing with duly qualified
licensed personnel, and of services, based on the type of health
facility and the needs of the persons served thereby.
(b) These regulations shall permit program flexibility by the use
of alternate concepts, methods, procedures, techniques, equipment,
personnel qualifications, bulk purchasing of pharmaceuticals, or
conducting of pilot projects as long as statutory requirements are
met and the use has the prior written approval of the department or
the office, as applicable. The approval of the department or the
office shall provide for the terms and conditions under which the
exception is granted. A written request plus supporting evidence
shall be submitted by the applicant or licensee to the department or
office regarding the exception, as applicable.
(c) While it is the intent of the Legislature that health
facilities shall maintain continuous, ongoing compliance with the
licensing rules and regulations, it is the further intent of the
Legislature that the state department expeditiously review and
approve, if appropriate, applications for program flexibility. The
Legislature recognizes that health care technology, practice,
pharmaceutical procurement systems, and personnel qualifications and
availability are changing rapidly. Therefore, requests for program
flexibility require expeditious consideration.
(d) The state department shall, on or before April 1, 1989,
develop a standardized form and format for requests by health
facilities for program flexibility. Health facilities shall
thereafter apply to the state department for program flexibility in
the prescribed manner. After the state department receives a complete
application requesting program flexibility, it shall have 60 days
within which to approve, approve with conditions or modifications, or
deny the application. Denials and approvals with conditions or
modifications shall be accompanied by an analysis and a detailed
justification for any conditions or modifications imposed. Summary
denials to meet the 60-day timeframe shall not be permitted.
(e) Notwithstanding any other provision of law or regulation, the
State Department of Health Services shall provide flexibility in its
pharmaceutical services requirements to permit any state department
that operates state facilities subject to these provisions to
establish a single statewide formulary or to procure pharmaceuticals
through a departmentwide or multidepartment bulk purchasing
arrangement. It is the intent of the Legislature that consolidation
of these activities be permitted in order to allow the more
cost-effective use and procurement of pharmaceuticals for the benefit
of patients and residents of state facilities.

1276.05. (a) The Office of Statewide Health Planning and
Development shall allow any general acute care hospital facility that
needs to relocate services on an interim basis as part of its
approval plan for compliance with Article 8 (commencing with Section
130000) or Article 9 (commencing with Section 130050) in the Alfred
E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Chapter 1
(commencing with Section 129675) of Part 7 of Division 107)
flexibility in achieving compliance with, or in substantial
satisfaction of the objectives of, building standards adopted
pursuant to Section 1276 with regard to the use of interim space for
the provision of hospital services, or both, on a case-by-case basis
so long as public safety is not compromised.
(b) The state department shall allow any facility to which
subdivision (a) applies flexibility in achieving compliance with, or
in substantial satisfaction of, the objectives of licensing
standards, or both, with regard to the use of interim space for the
provision of hospital services, or both, on a case-by-case basis so
long as public safety is not compromised.
(c) Hospital licensees, upon application for program flexibility
under this section, shall provide public notice of the proposed
interim use of space that houses at least one of the eight basic
services that are required in a general acute care hospital in a
manner that is likely to reach a substantial number of residents of
the community served by the facility and employees of the facility.
(d) No request shall be approved under this section for a waiver
of any primary structural system, fire and life safety requirements,
or any requirement with respect to accessibility for persons with
disabilities.
(e) In approving any request pursuant to this section for
flexibility, the office shall consider public comments.
(f) The state department shall establish a unit with two statewide
liaisons for the purposes of the Alfred E. Alquist Hospital
Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing with
Section 129675) of Part 7 of Division 107), to do all of the
following:
(1) Serve as a central resource for hospital representatives on
licensing issues relative to Article 8 or Article 9 in the Alfred E.
Alquist Hospital Facilities Seismic Safety Act of 1983 and provide
licensing information to the public, upon request.
(2) Serve as liaison with the Office of Statewide Health Planning
and Development, the State Fire Marshal, the Seismic Safety
Commission, and other entities as necessary on hospital operational
issues with respect to Article 8 or Article 9 in the Alfred E.
Alquist Hospital Facilities Seismic Safety Act of 1983.
(3) Ensure statewide compliance with respect to licensing issues
relative to hospital buildings that are required to meet standards
established by Article 8 or Article 9 in the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983.
(4) Process requests for program flexibility under subdivision
(a).
(5) Accept and consider public comments on requests for
flexibility.
(g) Each compliance plan, in providing for an interim use of space
in which flexibility is requested, shall identify the duration of
time proposed for the interim use of the space. Upon any amendment of
a hospital's approved compliance plan, any hospital for which a
flexibility plan has been approved pursuant to subdivision (a) shall
provide a copy of the amended plan to the State Department of Health
Services within 30 days.

1276.1. In setting personnel standards for licensed health
facilities pursuant to Section 1276, the department may set such
standards itself or may adopt them by reference to named
standard-setting organizations. If the department adopts standards
for a category of health personnel by reference to a specified
organization, the department shall either:
(a) List in the regulation the education, training, experience,
examinations, or other requirements set by the specified
organization; or
(b) Retain on file and available for public inspection a listing
of the education, training, experience, examinations, or other
requirements set by the specified organization; or
(c) Have direct statutory authority or requirement to use the
standards of the specified organization.

1276.2. Standards and regulations adopted by the state department
pursuant to Section 1276 shall not require the use of a registered
nurse for the performance of any service or staffing of any position
in freestanding skilled nursing facilities that may lawfully be
performed or staffed by a licensed vocational nurse pursuant to the
Vocational Nursing Practice Act (Chapter 6.5 (commencing with Section
2840) of Division 2 of the Business and Professions Code) and
applicable federal regulations, when a facility is unable to obtain a
registered nurse, except that a licensed vocational nurse employed
in accordance with this section shall be a permanent employee of the
facility. The facility shall make a good faith effort to obtain a
registered nurse prior to determining that it is unable to obtain a
registered nurse for the relevant shift, and this effort shall be
noted in the facility's records. The facility shall make provision
for a registered nurse to be available for consultation and
professional assistance during the hours in which a licensed
vocational nurse is used as provided by this section. The facility
shall maintain a record of the identity and phone number of the
registered nurse that is to be available for consultation and
professional assistance, as required by this section. If the
substitution of a licensed vocational nurse for a registered nurse
occurs more often than seven days per month, the facility shall
obtain program flexibility approval from the state department
pursuant to subdivision (b) of Section 1276. Nothing in this section
shall permit a licensed vocational nurse to act as director of nurses
pursuant to the Vocational Nursing Practice Act. This section
applies to staffing for the evening and night shifts only, except
that if the level of care is determined by the state department to be
inadequate, the state department may require the facility to provide
additional staffing.
This section shall not apply to the Medi-Cal regulations adopted
pursuant to Sections 14114 and 14132.25 of the Welfare and
Institutions Code.

1276.3. (a) The Legislature finds and declares that the citizens of
California are in danger of being injured and killed in the state's
surgical suites and procedural rooms in licensed health facilities,
because of the many intense heat sources present in an oxygen-rich
environment. It is the intent of the Legislature that this section
promote maximum fire and panic safety standards in surgical suites
and procedural rooms in licensed health facilities, and other areas
that pose a danger due to the presence of oxygen, in California.
(b) (1) The state department, shall promote safety by requiring
that licensed health facilities that have surgical suites and
procedural rooms provide information and training in fire and panic
safety in oxygen rich environments, including equipment, safety, and
emergency plans, as part of an orientation for new employees, and
ongoing inservice training.
(2) The licensed health facilities described in paragraph (1)
shall use the fire safety guidelines in oxygen rich environments
published by the Association of Operating Room Nurses or any other
nationally recognized body or organization, and approved by the state
department.
(c) The licensed health facilities described in paragraph (1) of
subdivision (b) shall determine the modality of training and the
number of hours of training required.

1276.4. (a) By January 1, 2002, the State Department of Health
Services shall adopt regulations that establish minimum, specific,
and numerical licensed nurse-to-patient ratios by licensed nurse
classification and by hospital unit for all health facilities
licensed pursuant to subdivision (a), (b), or (f) of Section 1250.
The department shall adopt these regulations in accordance with the
department's licensing and certification regulations as stated in
Sections 70053.2, 70215, and 70217 of Title 22 of the California Code
of Regulations, and the professional and vocational regulations in
Section 1443.5 of Title 16 of the California Code of Regulations. The
department shall review these regulations five years after adoption
and shall report to the Legislature regarding any proposed changes.
Flexibility shall be considered by the department for rural general
acute care hospitals in response to their special needs. As used in
this subdivision, "hospital unit" means a critical care unit, burn
unit, labor and delivery room, postanesthesia service area, emergency
department, operating room, pediatric unit, step-down/intermediate
care unit, specialty care unit, telemetry unit, general medical care
unit, subacute care unit, and transitional inpatient care unit. The
regulation addressing the emergency department shall distinguish
between regularly scheduled core staff licensed nurses and additional
licensed nurses required to care for critical care patients in the
emergency department.
(b) These ratios shall constitute the minimum number of registered
and licensed nurses that shall be allocated. Additional staff shall
be assigned in accordance with a documented patient classification
system for determining nursing care requirements, including the
severity of the illness, the need for specialized equipment and
technology, the complexity of clinical judgment needed to design,
implement, and evaluate the patient care plan and the ability for
self-care, and the licensure of the personnel required for care.
(c) "Critical care unit" as used in this section means a unit that
is established to safeguard and protect patients whose severity of
medical conditions requires continuous monitoring, and complex
intervention by licensed nurses.
(d) All health facilities licensed under subdivision (a), (b), or
(f) of Section 1250 shall adopt written policies and procedures for
training and orientation of nursing staff.
(e) No registered nurse shall be assigned to a nursing unit or
clinical area unless that nurse has first received orientation in
that clinical area sufficient to provide competent care to patients
in that area, and has demonstrated current competence in providing
care in that area.
(f) The written policies and procedures for orientation of nursing
staff shall require that all temporary personnel shall receive
orientation and be subject to competency validation consistent with
Sections 70016.1 and 70214 of Title 22 of the California Code of
Regulations.
(g) Requests for waivers to this section that do not jeopardize
the health, safety, and well-being of patients affected and that are
needed for increased operational efficiency may be granted by the
state department to rural general acute care hospitals meeting the
criteria set forth in Section 70059.1 of Title 22 of the California
Code of Regulations.
(h) In case of conflict between this section and any provision or
regulation defining the scope of nursing practice, the scope of
practice provisions shall control.
(i) The regulations adopted by the department shall augment and
not replace existing nurse-to-patient ratios that exist in regulation
or law for the intensive care units, the neonatal intensive care
units, or the operating room.
(j) The regulations adopted by the department shall not replace
existing licensed staff-to-patient ratios for hospitals operated by
the State Department of Mental Health.
(k) The regulations adopted by the department for health
facilities licensed under subdivision (b) of Section 1250 that are
not operated by the State Department of Mental Health shall take into
account the special needs of the patients served in the psychiatric
units.
( l) The department may take into consideration the unique nature
of the University of California teaching hospitals as educational
institutions when establishing licensed nurse-to-patient ratios. The
department shall coordinate with the Board of Registered Nursing to
ensure that staffing ratios are consistent with the Board of
Registered Nursing approved nursing education requirements. This
includes nursing clinical experience incidental to a work-study
program rendered in a University of California clinical facility
approved by the Board of Registered Nursing provided there will be
sufficient direct care registered nurse preceptors available to
ensure safe patient care.

1276.5. (a) The department shall adopt regulations setting forth
the minimum number of equivalent nursing hours per patient required
in skilled nursing and intermediate care facilities, subject to the
specific requirements of Section 14110.7 of the Welfare and
Institutions Code. However, notwithstanding Section 14110.7 or any
other provision of law, commencing January 1, 2000, the minimum
number of actual nursing hours per patient required in a skilled
nursing facility shall be 3.2 hours, except as provided in Section
1276.9.
(b) (1) For the purposes of this section, "nursing hours" means
the number of hours of work performed per patient day by aides,
nursing assistants, or orderlies plus two times the number of hours
worked per patient day by registered nurses and licensed vocational
nurses (except directors of nursing in facilities of 60 or larger
capacity) and, in the distinct part of facilities and freestanding
facilities providing care for the developmentally disabled or
mentally disordered, by licensed psychiatric technicians who perform
direct nursing services for patients in skilled nursing and
intermediate care facilities, except when the skilled nursing and
intermediate care facility is licensed as a part of a state hospital,
and except that nursing hours for skilled nursing facilities means
the actual hours of work, without doubling the hours performed per
patient day by registered nurses and licensed vocational nurses.
(2) Concurrent with implementation of the first year of rates
established under the Medi-Cal Long Term Care Reimbursement Act of
1990 (Article 3.8 (commencing with Section 14126) of Chapter 7 of
Part 3 of Division 9 of the Welfare and Institutions Code), for the
purposes of this section, "nursing hours" means the number of hours
of work performed per patient day by aides, nursing assistants,
registered nurses, and licensed vocational nurses (except directors
of nursing in facilities of 60 or larger capacity) and, in the
distinct part of facilities and freestanding facilities providing
care for the developmentally disabled or mentally disordered, by
licensed psychiatric technicians who performed direct nursing
services for patients in skilled nursing and intermediate care
facilities, except when the skilled nursing and intermediate care
facility is licensed as a part of a state hospital.
(c) Notwithstanding Section 1276, the department shall require the
utilization of a registered nurse at all times if the department
determines that the services of a skilled nursing and intermediate
care facility require the utilization of a registered nurse.
(d) (1) Except as otherwise provided by law, the administrator of
an intermediate care facility/developmentally disabled, intermediate
care facility/developmentally disabled habilitative, or an
intermediate care facility/developmentally disabled--nursing shall be
either a licensed nursing home administrator or a qualified mental
retardation professional as defined in Section 483.430 of Title 42 of
the Code of Federal Regulations.
(2) To qualify as an administrator for an intermediate care
facility for the developmentally disabled, a qualified mental
retardation professional shall complete at least six months of
administrative training or demonstrate six months of experience in an
administrative capacity in a licensed health facility, as defined in
Section 1250, excluding those facilities specified in subdivisions
(e), (h), and (i).

1276.6. Each facility shall certify, under penalty of perjury and
to the best of their knowledge, on a form provided by the department,
that funds received pursuant to increasing the staffing ratio to
3.2, as provided for in Section 1276.5, were expended for this
purpose. The facility shall return the form to the department within
30 days of receipt by the facility.

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.

1276.7. (a) (1) On or before May 1, 2001, the department shall
determine the need, and provide subsequent recommendations, for any
increase in the minimum number of nursing hours per patient day in
skilled nursing facilities. The department shall analyze the
relationship between staffing levels and quality of care in skilled
nursing facilities. The analysis shall include, but not be limited
to, all of the following:
(A) A determination of average staffing levels in this state.
(B) A review of facility expenditures on nursing staff, including
salary, wages, and benefits.
(C) A review of other states' staffing requirements as relevant to
this state.
(D) A review of available research and reports on the issue of
staffing levels and quality of care.
(E) The number of Medi-Cal beds in a facility.
(F) The corporate status of the facility.
(G) Information on compliance with both state and federal
standards.
(H) Work force availability trends.
(2) The department shall prepare a report on its analysis and
recommendations and submit this report to the Legislature, including
its recommendations for any staffing increases and proposed
timeframes and costs for implementing any increase.
(b) It is the intent of the Legislature to establish sufficient
staffing levels required to provide quality skilled nursing care. It
is further the intent of the Legislature to increase the minimum
number of direct care nursing hours per patient day in skilled
nursing facilities to 3.5 hours by 2004 or to whatever staffing
levels the department determines are required to provide California
nursing home residents with a safe environment and quality skilled
nursing care.

1276.8. Notwithstanding any other provision of law, including, but
not limited to, Section 1276, the following shall apply:
(a) As used in this code, "respiratory care practitioner,"
"respiratory therapist," "respiratory therapy technician," and
"inhalation therapist" mean a respiratory care practitioner certified
under the Respiratory Care Practice Act (Chapter 8.3 (commencing
with Section 3700) of Division 2 of the Business and Professions
Code).
(b) The definition of respiratory care services, respiratory
therapy, inhalation therapy, or the scope of practice of respiratory
care, shall be as described in Section 3702 of the Business and
Professions Code.
(c) Respiratory care may be performed in hospitals, ambulatory or
in-home care, and other settings where respiratory care is performed
under the supervision of a medical director in accordance with the
prescription of a physician and surgeon. Respiratory care may also be
provided during the transportation of a patient, and under any
circumstances where an emergency necessitates respiratory care.
(d) In addition to other licensed health care practitioners
authorized to administer respiratory care, a certified respiratory
care practitioner may accept, transcribe, and implement the written
and verbal orders of a physician and surgeon pertaining to the
practice of respiratory care.

1276.9. (a) A special treatment program service unit distinct part
shall have a minimum 2.3 nursing hours per patient per day.
(b) For purposes of this section, "special treatment program
service unit distinct part" means an identifiable and physically
separate unit of a skilled nursing facility or an entire skilled
nursing facility that provides therapeutic programs to an identified
mentally disordered population group.
(c) For purposes of this section, "nursing hours" means the number
of hours of work performed per patient day by aides, nursing
assistants, or orderlies, plus two times the number of hours worked
per patient day by registered nurses and licensed vocational nurses
(except directors of nursing in facilities of 60 or larger capacity),
and, in the distinct part of facilities and freestanding facilities
providing care for the developmentally disabled or mentally
disordered, by licensed psychiatric technicians who perform direct
nursing services for patients in skilled nursing and intermediate
care facilities, except when the skilled nursing and intermediate
care facility is licensed as a part of a state hospital.
(d) A special treatment program service unit distinct part shall
also have an overall average weekly staffing level of 3.2 hours per
patient per day, calculated without regard to the doubling of nursing
hours, as described in paragraph (1) of subdivision (b) of Section
1276.5, for the special treatment program service unit distinct part.
(e) The calculation of the overall staffing levels in these
facilities for the special treatment program service unit distinct
part shall include staff from all of the following categories:
(1) Certified nurse assistants.
(2) Licensed vocational nurses.
(3) Registered nurses.
(4) Licensed psychiatric technicians.
(5) Psychiatrists.
(6) Psychologists.
(7) Social workers.
(8) Program staff who provide rehabilitation, counseling, or other
therapeutic services.

1277. (a) No license shall be issued by the state department unless
it finds that the premises, the management, the bylaws, rules and
regulations, the equipment, the staffing, both professional and
nonprofessional, and the standards of care and services are adequate
and appropriate, and that the health facility is operated in the
manner required by this chapter and by the rules and regulations
adopted hereunder.
(b) Notwithstanding any provision of Part 2 (commencing with
Section 5600) of Division 5 of, or Division 7 (commencing with
Section 7100) of, the Welfare and Institutions Code or any other law
to the contrary, except Sections 2072 and 2073 of the Business and
Professions Code, the licensure requirements for professional
personnel, including, but not limited to, physicians and surgeons,
dentists, podiatrists, psychologists, marriage and family therapists,
pharmacists, registered nurses, and clinical social workers in the
state and other governmental health facilities licensed by the state
department shall not be less than for those professional personnel in
health facilities under private ownership. Persons employed as
psychologists and clinical social workers, while continuing in their
employment in the same class as of January 1, 1979, in the same state
or other governmental health facility licensed by the state
department, including those persons on authorized leave, but not
including intermittent personnel, shall be exempt from the
requirements of this subdivision. Additionally, the requirements of
this subdivision may be waived by the state department solely for
persons in the professions of psychology, marriage and family therapy
or clinical social work who are gaining qualifying experience for
licensure in such profession in this state. A waiver granted pursuant
to this subdivision shall not exceed three years from the date the
employment commences in this state in the case of psychologists, or
four years from commencement of the employment in this state in the
case of marriage and family therapists and clinical social workers,
at which time licensure shall have been obtained or the employment
shall be terminated except that an extension of a waiver of licensure
for marriage and family therapists and clinical social workers may
be granted for one additional year, based on extenuating
circumstances determined by the department pursuant to subdivision
(e). For persons employed as psychologists, clinical social workers,
or marriage and family therapists less than full time, an extension
of a waiver of licensure may be granted for additional years
proportional to the extent of part-time employment, as long as the
person is employed without interruption in service, but in no case
shall the waiver of licensure exceed six years in the case of
clinical social workers and marriage and family therapists or five
years in the case of psychologists. However, this durational
limitation upon waivers shall not apply to active candidates for a
doctoral degree in social work, social welfare, or social science,
who are enrolled at an accredited university, college, or
professional school, but these limitations shall apply following
completion of this training. Additionally, this durational limitation
upon waivers shall not apply to active candidates for a doctoral
degree in marriage and family therapy who are enrolled at a school,
college, or university, specified in subdivision (b) of Section
4980.36 of, or subdivision (b) of Section 4980.37 of, the Business
and Professions Code, but the limitations shall apply following
completion of the training. A waiver pursuant to this subdivision
shall be granted only to the extent necessary to qualify for
licensure, except that personnel recruited for employment from
outside this state and whose experience is sufficient to gain
admission to a licensing examination shall nevertheless have one year
from the date of their employment in California to become licensed,
at which time licensure shall have been obtained or the employment
shall be terminated, provided that the employee shall take the
licensure examination at the earliest possible date after the date of
his or her employment, and if the employee does not pass the
examination at that time, he or she shall have a second opportunity
to pass the next possible examination, subject to the one-year limit
for marriage and family therapists and clinical social workers, and
subject to a two-year limit for psychologists.
(c) A special permit shall be issued by the state department when
it finds that the staff, both professional and nonprofessional, and
the standards of care and services are adequate and appropriate, and
that the special services unit is operated in the manner required in
this chapter and by the rules and regulations adopted hereunder.
(d) The state department shall apply the same standards to state
and other governmental health facilities that it licenses as it
applies to health facilities in private ownership, including
standards specifying the level of training and supervision of all
unlicensed practitioners. Except for psychologists, the department
may grant an extension of a waiver of licensure for personnel
recruited from outside this state for one additional year, based upon
extenuating circumstances as determined by the department pursuant
to subdivision (e).
(e) The department shall grant a request for an extension of a
waiver based on extenuating circumstances, pursuant to subdivisions
(b) and (d), if any of the following circumstances exist:
(1) The person requesting the extension has experienced a recent
catastrophic event which may impair the person's ability to qualify
for and pass the license examination. Those events may include, but
are not limited to, significant hardship caused by a natural
disaster, serious and prolonged illness of the person, serious and
prolonged illness or death of a child, spouse, or parent, or other
stressful circumstances.
(2) The person requesting the extension has difficulty speaking or
writing the English language, or other cultural and ethnic factors
exist which substantially impair the person's ability to qualify for
and pass the license examination.
(3) The person requesting the extension has experienced other
personal hardship which the department, in its discretion, determines
to warrant the extension.

1278. Any officer, employee, or agent of the state department may,
upon presentation of proper identification, enter and inspect any
building or premises at any reasonable time to secure compliance
with, or to prevent a violation of, any provision of this chapter.

1278.5. (a) The Legislature finds and declares that it is the
public policy of the State of California to encourage patients,
nurses, members of the medical staff, and other health care workers
to notify government entities of suspected unsafe patient care and
conditions. The Legislature encourages this reporting in order to
protect patients and in order to assist those accreditation and
government entities charged with ensuring that health care is safe.
The Legislature finds and declares that whistleblower protections
apply primarily to issues relating to the care, services, and
conditions of a facility and are not intended to conflict with
existing provisions in state and federal law relating to employee and
employer relations.
(b) (1) No health facility shall discriminate or retaliate, in any
manner, against any patient, employee, member of the medical staff,
or any other health care worker of the health facility because that
person has done either of the following:
(A) Presented a grievance, complaint, or report to the facility,
to an entity or agency responsible for accrediting or evaluating the
facility, or the medical staff of the facility, or to any other
governmental entity.
(B) Has initiated, participated, or cooperated in an investigation
or administrative proceeding related to, the quality of care,
services, or conditions at the facility that is carried out by an
entity or agency responsible for accrediting or evaluating the
facility or its medical staff, or governmental entity.
(2) No entity that owns or operates a health facility, or which
owns or operates any other health facility, shall discriminate or
retaliate against any person because that person has taken any
actions pursuant to this subdivision.
(3) A violation of this section shall be subject to a civil
penalty of not more than twenty-five thousand dollars ($25,000). The
civil penalty shall be assessed and recovered through the same
administrative process set forth in Chapter 2.4 (commencing with
Section 1417) for long-term health care facilities.
(c) Any type of discriminatory treatment of a patient by whom, or
upon whose behalf, a grievance or complaint has been submitted,
directly or indirectly, to a governmental entity or received by a
health facility administrator within 180 days of the filing of the
grievance or complaint, shall raise a rebuttable presumption that the
action was taken by the health facility in retaliation for the
filing of the grievance or complaint.
(d) (1) There shall be a rebuttable presumption that
discriminatory action was taken by the health facility, or by the
entity that owns or operates that health facility, or that owns or
operates any other health facility, in retaliation against an
employee, member of the medical staff, or any other health care
worker of the facility, if responsible staff at the facility or the
entity that owns or operates the facility had knowledge of the
actions, participation, or cooperation of the person responsible for
any acts described in paragraph (1) of subdivision (b), and the
discriminatory action occurs within 120 days of the filing of the
grievance or complaint by the employee, member of the medical staff
or any other health care worker of the facility.
(2) For purposes of this section, discriminatory treatment of an
employee, member of the medical staff, or any other health care
worker includes, but is not limited to, discharge, demotion,
suspension, or any unfavorable changes in, or breach of, the terms or
conditions of a contract, employment, or privileges of the employee,
member of the medical staff, or any other health care worker of the
health care facility, or the threat of any of these actions.
(e) The presumptions in subdivisions (c) and (d) shall be
presumptions affecting the burden of producing evidence as provided
in Section 603 of the Evidence Code.
(f) Any person who willfully violates this section is guilty of a
misdemeanor punishable by a fine of not more than twenty thousand
dollars ($20,000).
(g) An employee who has been discriminated against in employment
pursuant to this section shall be entitled to reinstatement,
reimbursement for lost wages and work benefits caused by the acts of
the employer, and the legal costs associated with pursuing the case,
or to any remedy deemed warranted by the court pursuant to this
chapter or any other applicable provision of statutory or common law.
A health care worker who has been discriminated against pursuant to
this section shall be entitled to reimbursement for lost income and
the legal costs associated with pursuing the case, or to any remedy
deemed warranted by the court pursuant to this chapter or other
applicable provision of statutory or common law. A member of the
medical staff who has been discriminated against pursuant to this
section shall be entitled to reinstatement, reimbursement for lost
income resulting from any change in the terms or conditions of his or
her privileges caused by the acts of the facility or the entity that
owns or operates a health facility or any other health facility that
is owned or operated by that entity, and the legal costs associated
with pursuing the case, or to any remedy deemed warranted by the
court pursuant to this chapter or any other applicable provision of
statutory or common law.
(h) The medical staff of the health facility may petition the
court for an injunction to protect a peer review committee from being
required to comply with evidentiary demands on a pending peer review
hearing from the member of the medical staff who has filed an action
pursuant to this section, if the evidentiary demands from the
complainant would impede the peer review process or endanger the
health and safety of patients of the health facility during the peer
review process. Prior to granting an injunction, the court shall
conduct an in camera review of the evidence sought to be discovered
to determine if a peer review hearing, as authorized in Section 805
and Sections 809 to 809.5, inclusive, of the Business and Professions
Code, would be impeded. If it is determined that the peer review
hearing will be impeded, the injunction shall be granted until the
peer review hearing is completed. Nothing in this section shall
preclude the court, on motion of its own or by a party, from issuing
an injunction or other order under this subdivision in the interest
of justice for the duration of the peer review process to protect the
person from irreparable harm.
(i) For purposes of this section, "health facility" means any
facility defined under this chapter, including, but not limited to,
the facility's administrative personnel, employees, boards, and
committees of the board, and medical staff.
(j) This section shall not apply to an inmate of a correctional
facility or juvenile facility of the Department of Corrections and
Rehabilitation, or to an inmate housed in a local detention facility
including a county jail or a juvenile hall, juvenile camp, or other
juvenile detention facility.
(k) This section shall not apply to a health facility that is a
long-term health care facility, as defined in Section 1418. A health
facility that is a long-term health care facility shall remain
subject to Section 1432.
(l) Nothing in this section shall be construed to limit the
ability of the medical staff to carry out its legitimate peer review
activities in accordance with Sections 809 to 809.5, inclusive, of
the Business and Professions Code.
(m) Nothing in this section abrogates or limits any other theory
of liability or remedy otherwise available at law.

1279. (a) Every health facility for which a license or special
permit has been issued shall be periodically inspected by the
department, or by another governmental entity under contract with the
department. The frequency of inspections shall vary, depending upon
the type and complexity of the health facility or special service to
be inspected, unless otherwise specified by state or federal law or
regulation. The inspection shall include participation by the
California Medical Association consistent with the manner in which it
participated in inspections, as provided in Section 1282 prior to
September 15, 1992.
(b) Except as provided in subdivision (c), inspections shall be
conducted no less than once every two years and as often as necessary
to ensure the quality of care being provided.
(c) For a health facility specified in subdivision (a), (b), or
(f) of Section 1250, inspections shall be conducted no less than once
every three years, and as often as necessary to ensure the quality
of care being provided.
(d) During the inspection, the representative or representatives
shall offer such advice and assistance to the health facility as they
deem appropriate.
(e) For acute care hospitals of 100 beds or more, the inspection
team shall include at least a physician, registered nurse, and
persons experienced in hospital administration and sanitary
inspections. During the inspection, the team shall offer advice and
assistance to the hospital as it deems appropriate.
(f) The department shall ensure that a periodic inspection
conducted pursuant to this section is not announced in advance of the
date of inspection. An inspection may be conducted jointly with
inspections by entities specified in Section 1282. However, if the
department conducts an inspection jointly with an entity specified in
Section 1282 that provides notice in advance of the periodic
inspection, the department shall conduct an additional periodic
inspection that is not announced or noticed to the health facility.
(g) Notwithstanding any other provision of law, the department
shall inspect for compliance with provisions of state law and
regulations during a state periodic inspection or at the same time as
a federal periodic inspection, including, but not limited to, an
inspection required under this section. If the department inspects
for compliance with state law and regulations at the same time as a
federal periodic inspection, the inspection shall be done consistent
with the guidance of the federal Centers for Medicare and Medicaid
Services for the federal portion of the inspection.
(h) The department shall emphasize consistency across the state
and its district offices when conducting licensing and certification
surveys and complaint investigations, including the selection of
state or federal enforcement remedies in accordance with Section
1423. The department may issue federal deficiencies and recommend
federal enforcement actions in those circumstances where they provide
more rigorous enforcement action.

1279.1. (a) A health facility licensed pursuant to subdivision (a),
(b), or (f) of Section 1250 shall report an adverse event to the
department no later than five days after the adverse event has been
detected, or, if that event is an ongoing urgent or emergent threat
to the welfare, health, or safety of patients, personnel, or
visitors, not later than 24 hours after the adverse event has been
detected. Disclosure of individually identifiable patient information
shall be consistent with applicable law.
(b) For purposes of this section, "adverse event" includes any of
the following:
(1) Surgical events, including the following:
(A) Surgery performed on a wrong body part that is inconsistent
with the documented informed consent for that patient. A reportable
event under this subparagraph does not include a situation requiring
prompt action that occurs in the course of surgery or a situation
that is so urgent as to preclude obtaining informed consent.
(B) Surgery performed on the wrong patient.
(C) The wrong surgical procedure performed on a patient, which is
a surgical procedure performed on a patient that is inconsistent with
the documented informed consent for that patient. A reportable event
under this subparagraph does not include a situation requiring
prompt action that occurs in the course of surgery, or a situation
that is so urgent as to preclude the obtaining of informed consent.
(D) Retention of a foreign object in a patient after surgery