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Full text of "California Code of Regulations, (Vol. 30), Title 22, Social Security (Part 3)"

■J^Bl 



Barclays Official 

California 

Code of 
Regulations 



Title 22. Social Security 



Complete Title 

(continued) 



Vol. 30 



THOMSON 

* 

WEST 



Barclays Official California Code of Regulations 

425 Market Street • Fourth Floor • San Francisco, CA 94105 
800-888-3600 



Barclays Official California Code Of Regulations 

revised edition 

This edition of Barclays Official California Code of Regulations, revised on April 1, 1990, has been 
published under the direction of the California Office of Administrative Law which is solely respon- 
sible for its contents. Comments or questions regarding regulations published in this edition should 
be addressed to the State of California, Office of Administrative Law, 300 Capitol Mall, Suite 1250, 
Sacramento, CA 95814, (916) 323-6225. Errors reported will be promptly corrected in subsequent 
supplements. 

OFFICIAL PUBLICATION 

Courts are required to take judicial notice of contents of regulations published in the Official Califor- 
nia Code of Regulations (Gov. Code, § 11344.6). Barclays Official California Code of Regulations, 
as revised April 1, 1990, has been certified by the Office of Administrative Law as the official publi- 
cation of the State of California for this purpose pursuant to title 1, California Code of Regulations, 
section 190. 

CODE SUPPLEMENTS 

Amendments to the official Code are certified weekly by the Office of Administrative Law for publi- 
cation by Barclays. These amendments, when certified and published, become part of the Official 
California Code of Regulations, beginning with Register 90, No. 14, dated April 7, 1990, and include 
all regulations filed with the Secretary of State on or after April 1, 1990. Amendment subscriptions 
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CODE CITATION 

Cite all materials in the Official California Code of Regulations by title number and section number. 
Example: Title 3, California Code of Regulations, section 432 (Short form: Cal. Code Regs., tit. 3, 

§ 432). 

COPYRIGHT NOTICE 

© 2008, State of California. 

This material may not be commercially reproduced or sold in print or electronic forms without 

written permission of Thomson/West. 



Title 22 



Social Security 



Title Table of Contents 



Title 22. Social Security 

Table of Contents 



Division 1. 

Subdivision 1. 

Division 1. 

Part 1. 

Chapter 1 . 
Article 1 . 
Article 2. 

Chapter 2. 
Article 1. 

Article 3. 

Article 4. 



Chapter 3. 


Article 1. 


Article 1.5 


Article 2. 


Article 3. 


Article 4. 


Article 5. 


Article 6. 



Article 7. 



Chapter 4. 
Article 1. 
Article 2. 

Article 3. 
Article 4. 



Page 

Employment Development 
Department 1 

Director of Employment 

Development 3 

Unemployment and Disability 
Compensation 3 

Unemployment Compensation 3 

General Provisions 3 

Policy and Interpretation 3 

General Definitions 3 

Administration 3 

Employment Development 
Department 3 

California Unemployment 

Insurance Appeals Board 9 

Interstate and Federal 

Cooperation 9 

Scope or Coverage 18 

Employment 18 

Employee 20 

Excluded Services 21 

Subject Employers 26 

Elective Coverage 26 

Elections for Financing 

Unemployment Insurance 

Coverage 31 

Financing Unemployment 

Insurance Coverage for 

Public School Employees 33 

Financing Unemployment 

Insurance Coverage for 

Local Public Entity 

Employees 33 

Contributions and Reports 34 

Definitions 34 

"Wages" the Basis of the 

Contribution 34 

Contribution Rates 43 

Reserve Accounts 43 



Page 

Article 5. Transfer of Reserve 

Accounts 45 

Article 6. Records, Reports and 

Contribution Payments 46 

Article 7. Payment of Reported 

Contributions 53 

Article 8. Assessments 53 

Article 9. Refunds and Overpayments 54 

Chapter 5. Unemployment Compensation 

Benefits 54 

Article 1. Eligibility and 

Disqualifications 54 

Article 1.5. Retraining Benefits 94 

Article 2. Computation (Amount and 

Duration) 94 

Article 2.4. Work Sharing Unemployment 

Insurance Benefits 94 

Article 2.7. Irregular or Infrequent Wage 

Payments 96.3 

Article 3. Filing, Determination, and 
Payment of Unemployment 
Compensation Benefit 
Claims 96.4 

Article 4. Overpayments 104.2 

Article 5. Rights of Trainees 106 

Chapter 5.5. Unemployment Compensation for 

State Employees 106 

Chapter 5.6. Unemployment Compensation for 

County Employees 107 

Chapter 5.7. Unemployment Compensation for 
State Higher Education 
Employees 107 

Chapter 6. Financial Provisions 107 

Chapter 7. Collections 1 07 

Chapter 8. Hearing Procedure 109 

Chapter 9. Public Employment Offices 109 

Article 1 . Job Services 109 

Article 2. Appeals 1 10.1 

Chapter 9.5. Employment for Older Workers 1 13 

Chapter 10. Violations 113 



Page i 



Title Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 

Part 2. Disability Compensation 114 Division 2 

Chapter 1 . General Provisions 114 

Chapter 2. Disability Benefits 116 



Article 1 . Eligibility 1 16 

Article 2. Computation (Amount and 

Duration) 118 

Article 3. Determinations of Continuing 

Eligibility 118 

Article 4. Filing, Determination and 
Payment of Disability 
Benefit Claims 118.2 

Article 5. Overpayments 123 

Article 6. Rights of Trainees 123 

Article 7. Rights of Industrially 

Disabled Persons 124 

Chapter 3. Additional Benefits 124 

Chapter 3.5. Prorated Benefits 124 

Chapter 4. Contributions 124 

Chapter 5. Financial Provisions 124 

Article 1 . Disability Fund 124 

Article 2. Disability Administration 

Account 124 

Article 3. Disability Benefit Payment 

Account 124 

Article 4. Extended Liability Account 125 

Article 5. Investments in Buildings 125 

Chapter 6. Voluntary Plans 125 

Chapter 7. Family Temporary Disability 

Insurance 131 

Part 3. Extended Unemployment 

Compensation 1 32.5 



Page 

Work Incentive Programs 132.5 



Chapter 1 . Employment Preparation 

Program 132.5 



General Provisions 132.5 

Extended Duration Benefits 132.5 



Chapter 1. 

Chapter 2. 

Article 1. Eligibility and 

Disqualifications 132.5 

Article 2. Computation (Amount and 

Duration) 132.5 

Article 3. Filing, Determination, and 
Payment of Extended 
Duration Benefit Claims 132.5 

Article 4. Reserve Accounts 132.5 

Article 5. Overpayments 132.5 

Chapter 4. Retraining Benefits 132.5 



Article 1 . Job Search Assistance 132.5 

Article 2. Pilot Payment Component 132.5 

Division 2.5. Withholding Tax on Wages 132.6 

Chapter 1 . General Provisions 1 32.6 

Chapter 2. Withholding and Payment of Tax 148 

Chapter 3. Withholding Exemptions 153 

Chapter 4. Reports, Returns, and 

Statements 154 

Chapter 5. Collections 155 

Division 3. Employment Services Programs 155 



Part 1. 



Employment and Employability 

Services 155 



Chapter 1 . General Provisions and 

Definitions 155 

Chapter 1.5. Employment Training Panel 155 

Article 1 . General Provisions 155 

Article 2. Proposal Process 158.1 

Article 4. Program Operations 158. 11 

Chapter 2. Job Training Partnership Act 

Complaints 158.15 

Article 1 . General Provisions 158.15 

Article 2. Service Delivery Area 

Complaint Procedures 158.16 

Article 3. Procedures for Requests for 
EDD Review or Appeals of 
Service Delivery Area 
Decisions 158.18 

Article 4. Appeals of EDD-Level 

Decisions 158.19 

Chapter 2.5. Youth Employment and 

Development 158.20 

Chapter 2.7. California Work-Site Education 

and Training Act 158.21 

Subdivision 2. California Unemployment 

Insurance Appeals Board 159 

Chapter 1 . General 159 

Chapter 2. Field Operations 163 

Chapter 3. Appellate Operations 170 

Chapter 4. California Unemployment 
Insurance Appeals Board — 
Conflict of Interest Code 172.2 



Page ii 



(7-18-2008) 



Title 22 



Social Security 

Page 

California Department of Part 2. 

Aging 173 

California Department of Aging — 

Conflict of Interest Code 173 Subdivision 1 . 

Title III Programs— Definitions 173 Chapter 1 . 

Title III Programs — PSAs and Article 1 

AAAs 174.1 

Article 2. 
Designation of PSAs and 

AAAs 174.1 . . , _ 

Article 3. 

AAAs General Article 4. 

Responsibilities 174.4 

Area Plans 174.5 _, 

Chapter 2. 

AAA Procurement Procedures . . . 174.9 

Grievance Process 174.12 Chapter 3 

Sanctions 174.13 

Title III Programs— Program and Chapter 4. 

Service Provider Requirements 174.15 

General Requirements for 

Programs and Service Subdivision 2. 

Providers 174.15 

Chapter 1. 
Information and Assistance 174.15 

Multipurpose Senior Centers 174.18 ^, ~ 

Legal Assistance 174.20 

Title III C-Elderly Chapter 2. 1 . 

Nutrition Program 174.20 

Title III Programs— State Subdivision 4. 

Hearings 174.24 

Office of the State Long-Term Chapter 1 . 

Care Ombudsman 174.27 

Long-Term Care Ombudsman Chapter 2. 

Program Provisions 174.27 

Chapter 2.5. 
Ombudsman Duties 174.27 

Violations and Enforcement 174.27 

Planning and Service Areas Chapter 3. 

(PSAs) and Area Agencies on Subchapter 1 . 

Aging (AAAs) 174.28 

Title III Programs— State Subchapter 2. 

Hearings 174.28 Article 1 . 

Department of Social Services — 

Department of Health Article 2 

Services 175 

Department of Social Article 3. 

Services — Manuals of Subchapter 3. 

Policies and Procedures 175 



Title Table of Contents 

Page 

Health and Welfare Agency — 

Department of Health 

Services Regulations 175 

Health and Welfare Agency 175 

Displaced Homemakers 

Programs 1 75 

Definitions 1 75 

Priority for Services for 

Eligible Participants 1 76 

Stipends for Job Training 1 76 

Sliding Fee Schedule: 

Workshops 177 

Health and Welfare Agency — 

Conflict of Interest Code 177 

Safe Drinking Water and Toxic- 
Enforcement Act of 1 986 178 

Hazardous Substance Cleanup 

Arbitration Panel Hearing 

Regulations 201 

Administration 201 

Department of Social Services — 
Conflict of Interest Code 201 

Department of Health Services — 
Conflict of Interest Code 202 

Department of Health Services 

Audits and Appeals 202 

Institutions and Boarding Homes 

for Persons Aged 1 6 and Above 206 

General Provisions and 

Definitions 206 

Licensing Agencies 206 

Maternity Home Care Program: 
Pregnancy Freedom of Choice 

Act 206 

Adoptions Program Regulations 210 

Adoptions Program 

Terminology 210 

General Requirements 213 

Correction, Alteration, 

Translation and Reading of 

Forms 213 

Recruitment — Agency 

Adoptions 217 

Staffing Requirements 219 

Administrative 

Requirements 220 



Division 1.8. 

Chapter I . 

Chapter 2. 
Chapter 3. 

Article 1. 

Article 2. 

Article 3. 
Article 4. 
Article 5. 
Article 6. 

Chapter 4. 
Article 1. 

Article 2. 
Article 3. 
Article 4. 
Article 5. 

Chapter 5. 

Chapter 6. 

Article 1. 

Article 2. 
Article 3. 

Chapter 4. 

Article 7. 
Division 2. 

Part 1. 



Page iii 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 1. Administration of Public and 

Private Agencies 220 

Article 1.1. Unavailability of Verifying 

Documents 221 

Article 2. Content of Case Record 221 

Article 3. Procedures for Post- Adoption 

Services 222 

Article 4. Private Adoption Agency 

Reimbursement Program 225 

Subchapter 4. Procedures for 

Independent Adoptions 226 

Article 1 . Agency Responsibility 226 

Article 2. Placement for Independent 

Adoption 229 

Article 3. Prerequisites to Consent 232 

Article 3.1. Freeing a Child for 

Adoption 238 

Article 4. Accepting Consent 239 

Article 5. Finalization of Adoption 240 

Article 6. Procedures in Denials and 

Commitments 241 

Subchapter 5. Procedures for Agency 

Adoptions 242 

Article 1. Assessment of the Child 242 

Article 2. Freeing a Child for 

Adoption 243 

Article 3. Services for the Birth 

Parents 244 

Article 4. Prerequisites to Accepting a 

Relinquishment 248 

Article 5. Accepting the 

Relinquishment 249 

Article 6. Accepting the Statement of 

Understanding 252 

Article 7. Revocation of 

Relinquishment 260.2 

Article 8. Filing of Relinquishment 260.4 

Article 9. Rescission of 

Relinquishment 260.4 

Article 10. Application to Adopt 260.6 

Article 1 1 . Assessment of the Applicant 260.8 

Article 12. Adoptive Placement 260.12 

Article 13. Completing the Adoption 260.16 

Article 14. Grievance Review 260.18 

Subchapter 6. Procedures for 

Intercountry Adoptions 260.20 



CODE OF REGULATIONS Title 22 

Page 

Article 1. General and Administrative 

Requirements 260.20 

Article 2. Application for the 

Placement of a Child for 

Adoption 260.21 

Article 3. Assessment of the Applicant 260.21 

Article 4. Assessment of the Child 260.24 

Article 5. Background Information on 

the Birth Parents 260.25 

Article 6. Placement 260.25 

Article 7. Supervision of Adoptive 

Placement 260.26 

Article 8. Intercountry Adoption Court 

Report 260.27 

Subchapter 7. Adoption Assistance 
Program/ Aid for the 
Adoption of Children 
(AAP/AAC) 260.28 

Article 1. AAP Case Initiation 260.28 

Article 2. AAP Eligibility 

Requirements 260.29 

Article 3. AAP Payments 260.30 

Article 4. Adoption Assistance Program 

Agreement 260.32 

Article 5. AAP Payment Authorization .... 260.33 

Article 6. AAP Reassessment 260.33 

Article 7. AAP Overpayments 260.34 

Article 8. Notice of Action 260.35 

Article 9. Continuation of Aid for the 

Adoption of Children (AAC) .... 260.35 

Article 10. Documentation of AAP 

Eligibility 260.35 

Article 1 1 . Reimbursement for 

Nonrecurring Adoption 

Expenses 260.36 

Subchapter 8. Adoption of Children with 

Indian Heritage 260.36(a) 

Article 1 . Additional Agency 

Requirements for Adoption 

of Children with Indian 

Heritage 260.36(a) 

Article 2. Certification of Degree of 

Indian Blood (CDIB), Tribal 
Membership Eligibility, and/ 
or Tribal Enrollment 260.36(a) 

Article 3. Background Information 260.37 

Article 4. Information to Parents of a 
Child with Indian Heritage 
Regarding Provisions of the 
ICWA 260.37 



Page iv 



(7-18-2008) 



Title 22 



Social Security 

Page 

Freeing the Indian Child for Article 1. 

Adoption 260.38 Article 2 

Information Transmitted to Article 3 

Applicants in Agency 

Adoptions 260.39 

Article 4. 
Placement and Supervision in 
an Agency Adoption 260.39 Article 5. 

Information Transmitted to 

Petitioners in an Artlcle 6 " 

Independent Adoption 260.39 

Information Transmitted to Article 7. 

the Adoptee 260.40 Article 8. 

Interstate Compact on the Chapter 5. 

Placement of Children 

(1CPC) 260A0 Article 1. 

Definitions and Conditions 260.40 A . , „ 

Article 2. 

Relinquishment Adoptions 260.40 . 

Independent Adoptions 260.41 

Minimum Standards for Facilities Chapter 6. 

for Children 260.43 

Day Nurseries 260.43 

,,. . ru j j r Article 1. 

Minimum Standards lor 

Residential Care Homes for Article 2. 

Adults 260.43 

_ . . „ . Article 3. 

Continuing Care Agreements 260.43 

Article 4. 
Preventive Medical Services 260.43 

California Health Services 

Corps 260.43 Article 6. 

Definitions 260.43 Article 7. 

Eligibility 260.44 Article 8. 

Application 261 Article 9. 

Personnel 261 

Charges and Reimbursements 262 , . , , „ 

fe Article 10. 

Recipient Rights 263 . . , 

v to Article 11. 

Rural Health Services Article 12. 

Development Projects 263 

_, _ . . Chapter 8. 

Definitions 263 

Applicants 264 

Types of Assistance 264 Article 1 . 

Application for Financial Article 2. 

Assistance 264 A . . , ~ 

Article 3. 

Charges and Reimbursements 265 Art'cle 4 

Recipient Rights 265 Article 5. 

Victims of Sexual Assault 266 Chanter 9 

Sickle Cell Screening Program 266 Article 1 . 



Title Table of Contents 

Page 

Definitions 266 

Scope of the Regulations 266 

Approval of a Sickle Cell 

Screening Program 266 

Services 266 

Sickle Cell Screening 

Laboratory Services 266 

Certification of Sickle Cell 

Counselors 266 

Participant Rights 267 

Community Relationship 267 

Assistance to Primary Care 

Clinics 267 

Definitions 267 

Eligibility for Grant 268 

Administration of the Grants 

Program 269 

California Special Supplemental 

Food Program for Women, Infants 

and Children 269 

Definitions 269 

Certification of 

Participants 272 

Nondiscrimination 275 

Fair Hearing Procedures for 
Participants 276 

Supplemental Foods 276 

Nutrition Education 276.1 

Food Delivery System 276.1 

Selection of Local Agencies 288.3 

Administrative Appeal of 

Departmental Decisions 

Affecting Local Agencies 289 

Investigations 290 

Penalties 290 

Records and Reports 290 

Human Immunodeficiency Virus 
(HIV) Testing of Inmates in 
Correctional Facilities 291 

Definitions 291 

Procedures 292 

Appeals Process 295 

Testing Procedures 298.1 

Counseling 298.2 

Tuberculosis Examination 298.3 

Application 298.3 



Article 5. 
Article 6. 

Article 7. 
Article 8. 

Article 9. 
Subchapter 9 

Article 1. 
Article 2. 
Article 3. 

Chapter 4. 



Subchapter 2, 


Chapter 5. 


Chapter 6. 


Subdivision 6. 


Chapter 1. 


Article 1. 


Article 2. 


Article 3. 


Article 4. 


Article 5. 


Article 6. 



Chapter 2. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 

Article 5. 
Article 6. 

Chapter 3. 

Chapter 4. 



Page v 



(7 IS 20UM 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 2. Definitions 298.3 

Article 3. Tuberculosis Examination 298.3 

Article 4. Admission to School 298.3 

Article 5. Records 298.4 

Article 6. Reporting 299 

Article 7. Exclusion from School 299 

Subdivision 7. California Children's Services 299 

Chapter 1 . Definitions 299 

Chapter 2. Administration 302 

Article 1. General Provisions 302 

Article 5. Records and Reports 302.1 

Chapter 3. Application Process 302.1 

Article 1. General Provisions 302.1 

Chapter 4. Medical Eligibility 302.2 

Article 1 . General Provisions 302.2 

Chapter 5. Residential Eligibility 302.7 

Article 1 . General Provisions 302.7 

Chapter 6. Financial Eligibility 302.8 

Article 2. Other Provisions 302.8 

Article 3. CCS Legal Agreement 302.8 

Article 4. Annual Enrollment Fee 302.9 

Article 5. Annual Enrollment Fee 

Collection 302.9 

Chapter 7. Program Benefits 302.9 

Article 3. Diagnostic Services 302.9 

Article 4. Treatment Services 302.10 

Article 6. Authorization for Services 302.10 

Chapter 9. Professional Medical Care 

Providers 302.10 

Article 1 . General Provisions 302.10 

Article 3. Physicians 302.10 

Article 4. Other Health Care 

Professionals 302.11 

Chapter 10. Hospital Providers 302.11 

Article 1. General Provisions 302.11 

Article 4. Special Hospital 303 

Chapter 13. Resolution of Complaints and 
Appeals by CCS Clients or 
Applicants 303 

Article 1. Notice of Action 303 

Article 2. Designated CCS Agency 304 

Article 3. CCS Fair Hearing 304 



CODE OF REGULATIONS Title 22 

Page 

Chapter 14. Other CCS Programs 304.3 

Article 1 . Immunization Adverse 

Reaction Fund 304.3 

Division 2.1 . Department of Rehabilitation 305 

Chapter 1 . Programs for the Blind 305 

Chapter 2. Vocational Rehabilitation 

Programs 305 

Division 3. Health Care Services 307 

Subdivision 1. California Medical Assistance 

Program 307 

Chapter 1 . Introduction 307 

Chapter 2. Determination of Medi-Cal 

Eligibility and Share of Cost 308 

Article 1 . Definitions, Abbreviations 

and Program Terms 308 

Article 2. Administration 317 

Article 3. County of Responsibility for 
Determination of Medi-Cal 
Eligibility 320 

Article 4. Beneficiary Application 

Process 322 Jt^ 

Article 5. Medi-Cal Programs 336.7 ^W 

Article 6. Institutional Status 341 

Article 7. Alienage, Citizenship and 

Residence 342 

Article 8. Responsible Relatives and 

Unit Determination 348 

Article 9. Property 350.3 

Article 10. Income 362.2 

Article 1 1 . Maintenance Need 374 

Article 12. Share of Cost 375 

Article 13. Period of Eligibility 378 

Article 14. Medi-Cal Card Use and 

Issuance 379 

Article 15. Other Health Care Coverage 
and Medicare Buy-In 
Coverage 382 

Article 16. Overpayments, Fraud and 

Improper Utilization 386 

Article 17. Dialysis Medi-Cal Program 386.3 

Article 18. State Administrative 

Hearings 389 

Article 19. Medi-Cal Estate Recovery 390 

Chapter 2.5. Third Party Liability 390 

Article 1. Definitions 390 



Page vi 



(7-18-2008) 



Title 22 



Social Security 
Page 

Estate Recovery 392 Article 4. 

Health Care Services 392.4 

Application and Enrollment 392.4 

General Provisions 394.11 A . . _ 

Article 5. 

Provider Audit Appeals 396.3 

Skilled Nursing Facility and Article 6. 

Intermediate Care Facility Article 7. 

Certification Appeals 
Procedure 402 

Definitions 403 Chapter 4.5. 

Standards for Participation 424 

Scope and Duration of Artlcle l • 

Benefits 436.3 Article 2. 

Scope and Duration of Article 3. 

Supplemental Schedule of 

Benefits 466.1 

Eligibility for Payment 466.1 Chapter 5. 

Payment for Services and Article 1 . 

Supplies 471 Article 2. 

Hospital Inpatient Services Article 3. 

Reimbursement Section 516.4(d)(7) 

Conflict of Interest 516.19 

Article 5. 
Early and Periodic 

Screening, Diagnosis, and Article 6. 

Treatment Program 517 Chapter 5.5. 

Pilot and Demonstration 

Projects 517 

Chapter 6. 

Prepaid Health Plans 517 

General Provisions 517 Article 1. 

^ <?■ ..• Article 2. 

Definitions 517 

Article 3. 
Operational Requirements 520 

Article 4. 
Marketing, Enrollment and 

Disenrollment 528 . . , _ 

Article 5. 

Applications, Contracts and Article 6 

Public Hearings 530 

Chapter 7. 
Conflict of Interest 532 

Emergency Services Claims Article 1. 

Dls P uleS 532 Article! 

Two-Plan Model Managed Care 
Program 538 

Article 3. 
General Provisions 538 

Definitions 538 ™ 

Chapter 8. 

Maximum Enrollment Levels 538.2 



Title Table of Contents 

Page 

Prepaid Health Plan and 

Primary Care Case 

Management Plan Enrollment 

Growth During the 

Transition Period 538.2 

Two-Plan Model 

Requirements 538.2(a) 

Operational Requirements 538.2(c) 

Marketing, Enrollment, 

Assignment, and 

Disenrollment 538.2(j) 

Geographic Managed Care 

Program 538.2(n 

Genera] Provisions 538.2(r) 

Operational Requirements 538.3 

Marketing, Enrollment, 

Assignment, and 

Disenrollment 538.6 

Adult Day Health Care 538.10 

General Provisions 538.10 

Definitions 538.10 

Eligibility, Participation 

and Discharge 539 

Services and Standards 541 

Administration 546 

Payment of Services 551 

Indians and Indian Health 

Service Facilities in Medi-Cal 

Managed Care Programs 552 

Primary Care Case Management 

Plans 552.3 

General Provisions 552.3 

Definitions 552.4 

Operational Requirements 556 

Marketing, Enrollment and 
Disenrollment 565 

Application and Proposal 568.1 

Conflict of Interest 568.3 

Construction/Renovation 
Reimbursement Program 568.4 

Definitions 568.4 

Eligibility for Construction/ 
Renovation Reimbursement 
Program 570 

Standards for Supplemental 
Reimbursement 570 

California Partnership for Long- 
Term Care 571 



• 



Article 2. 

Chapter 3. 
Article 1. 
Article 1.3. 
Article 1.5. 
Article 1.6. 



Article 2. 
Article 3. 
Article 4. 

Article 5. 

Article 6. 

Article 7. 

Article 7.5. 

Article 8. 
Article 10. 



Chapter 3.5. 

Chapter 4. 
Article 1. 
Article 2. 
Article 3. 
Article 4. 

Article 5. 

Article 6. 
Article 7. 

Chapter 4.1. 

Article 1. 
Article 2. 
Article 3. 



Page vii 



(7 IK 200X) 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 1 . Definitions 571 

Article 2. Conditions of Issuer 

Participation 578 

Article 3. Benefits and Provisions for 
Partnership Policies and 
Certificates 584 

Article 4. Premium Provisions 589 

Article 5. Care Management Provider 

Agency Standards 590 

Article 6. Issuer Reporting 

Requirements and Audit 

Information 592 

Chapter 1 1 . Drug Formulary and Medical 

Supplies Listing 596 

Article 1 . Medical Supplies and Medi- 

Cal Drug Formulary 596 

Division 4. Environmental Health 599 

Chapter 1 . Introduction 599 

Article 1 . Definitions 599 

Chapter 2. Regulations for the 

Implementation of the 

California Environmental 

Quality Act 599 

Article 1 . General Requirements and 

Categorical Exemptions 599 

Chapter 3. Water Recycling Criteria 600 

Article 1 . Definitions 600 

Article 2. Sources of Recycled Water 602.1 

Article 3. Uses of Recycled Water 602.1 

Article 4. Use Area Requirements 602.2 

Article 5. Dual Plumbed Recycled Water 

Systems 602.4 

Article 5.1. Groundwater Recharge 602.4 

Article 5.5. Other Methods of Treatment 602.5 

Article 6. Sampling and Analysis 602.5 

Article 7. Engineering Report and 

Operational Requirements 602.5 

Article 8. General Requirements of 

Design 603 

Article 9. Alternative Reliability 
Requirements for Uses 
Permitting Primary 
Effluent 603 



CODE OF REGULATIONS Title 22 

Page 

Article 10. Alternative Reliability 
Requirements for Uses 
Requiring Oxidized, 
Disinfected Wastewater or 
Oxidized, Coagulated, 
Clarified, Filtered, 
Disinfected Wastewater 603 

Article 1 1 . Other Methods of Treatment 604 

Chapter 4. Water Treatment Devices 604 

Article 1 . Definitions 604 

Article 2. Certification Requirements 605 

Article 3. Application Requirements 605 

Article 4. Testing and Testing 

Protocols 606 

Article 5. Product Labeling and Data 

Sheet Requirements 609 

Article 6. Fees 609 

Chapter 12. Safe Drinking Water Project 

Funding 609 

Article 1. Definitions 609 

Article 2. Financing Criteria 610.2 

Article 3. Disadvantaged Communities 610.4 

Article 4. Application Process 610.4 

Article 5. Information to Be Submitted 
Prior to Execution of the 
Funding Agreement 610.6 

Article 6. Design and Construction 610.6 

Article 7. Claims and Loan Repayments 610.6 

Article 8. Consolidation Projects 610.6(a) 

Chapter 13. Operator Certification 610.6(a) 

Article 1 . Definitions 610.6(a) 

Article 2. Operator Certification 

Grades 610.7 

Article 3. Operator Examination 

Criteria and Applications 610.8 

Article 4. Operator Certification 

Criteria and Applications 610.9 

Article 5. Certification Renewals, 
Delinquent Renewals and 
Fees 610.12 

Chapter 14. Water Permits 610.13 

Article 1. Applications 610.13 

Article 3. State Small Water Systems 610.14 

Article 4. Local Primacy Delegation 611 

Chapter 15. Domestic Water Quality and 

Monitoring Regulations 615 

Article 1 . Definitions 615 



Page viii 



(7-18-2008) 



Title 22 



Social Security 
Page 

General Requirements 616.4 Article 4. 

Primary Standards — 

Bacteriological Quality 616.7 

Primary Standards — Inorganic 

Chemicals 616.10 Article 6. 

Trihalomethanes 616.10(c) Article 7. 

Radioactivity 616.10(c) Article 8. 

Primary Standards — Organic 

Chemicals 616.12 Chapter 17. 

Best Available Technologies Article 1 . 

(BAT) 616.15 

Treatment Techniques 616.17 Article 2. 

Secondary Drinking Water 

Standards 616.18 

Special Monitoring . , 

„ t c Article 3. 

Requirements lor 

Unregulated Chemicals 616.20 Articled 

Notification of Water Article 5. 

Consumers and the Article 6. 

Department 616.21 4 ., _ 

* Article 7. 

Records, Reporting and 

Recordkeeping 616.29 ^^ 

Consumer Confidence Report . . . 616.30 

Chapter 17.5. 

Disinfectant Residuals, Article 1 

Disinfection Byproducts, and 

Disinfection Byproduct 

Precursors 616.34 Article 2. 

General Requirements and 

Definitions 616.34 Article 3 ' 

Maximum Contaminant Levels 

for Disinfection Byproducts 

and Maximum Residual 

Disinfectant Levels 616.34 Article 5. 

Monitoring Requirements 616.39 Article 6. 

Compliance Requirements 616.41 

Treatment Technique for Art'H 7 

Control of Disinfection 
Byproduct Precursors 

(DBPP) 616.42 

Article 8. 
Reporting and Recordkeeping 

Requirements 616.44 

California Waterworks Article 9. 

Standards 616.45 

Definitions 616.45 Chapter 18. 

Waivers and Alternatives 616.46 Article 1. 

Permit Requirements 616.46 rh t 1 9 

Water Sources 619 



Title Table of Contents 

Page 

Materials and Installation 

of Water Mains and 

Appurtenances 620 

Disinfection Requirements 621 

Distribution Reservoirs 622 

Additives 622 

Distribution System 

Operation 622.1 

Surface Water Treatment 622.3 

General Requirements and 

Definitions 622.3 

Treatment Requirements, 

Watershed Protection 

Requirements, and 

Performance Standards 622.5 

Monitoring Requirements 622.6(b) 

Design Standards 622.6(b)(3) 

Operation 622.6(b)(3) 

Reporting 622.6(b)(4) 

Watershed Sanitary 

Surveys 622.6(b)(5) 

Public Notification 622.6(b)(5) 

Lead and Copper 622.6(b)(6) 

Genera] Requirements and 

Definitions 622.6(b)(6) 

Requirements According to 

System Size 622.6(c) 

Monitoring for Lead and 

Copper 622.6(0 

Water Quality Parameter 

(WQP) Monitoring 622.6(0 

Corrosion Control 622.6(j> 

Source Water Requirements 

for Action Level 

Exceedances 622.6(k) 

Public Education Program for 

Lead Action Level 

Exceedances 622.6(0 

Lead Service Line 

Requirements for Action 

Level Exceedances 622.6(g) 

Reporting and 

Recordkeeping 622.6(p) 

Drinking Water Additives 622.6(q) 

Requirements 622.6(q) 

Certification of Environmental 
Laboratories 622.6(q) 



Article 2. 
Article 3. 

Article 4. 

Article 4.5. 
Article 5. 
Article 5.5. 

Article 12. 

Article 14. 
Article 16. 

Article 17. 
Article 18. 

Article 19. 

Article 20. 
Chapter 15.5. 

Article 1. 
Article 2. 



Article 3. 
Article 4. 
Article 5. 



Article 6. 

Chapter 16. 

Article 1. 
Article 1.5. 
Article 2. 
Article 3. 



Page ix 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 1. Definitions 622.6(q) 

Article 2. Certification and Amendment 

Process 622.7 

Article 3. Application Process 622.8 

Article 4. Site Visits 622.8 

Article 5. Performance Evaluation 

Testing Process 622.9 

Article 6. Required Test Methods 622.9 

Article 7. Laboratory and Equipment 622.10 

Article 8. Quality Assurance 

Documents 622.10 

Article 9. Laboratory Personnel 622.10 

Article 10. Notification and Reporting 622.11 

Article 11. Reciprocity Agreements 622.12 

Article 12. Subgroups for Fields of 

Testing 622.12 

Article 13. Trade Secrets 622.14 

Article 14. Sale or Transfer of 

Ownership of a Laboratory 622.14 

Article 1 6. National Environmental 
Laboratory Accreditation 
Program (NELAP) 622.15 

Chapter 20. Public Swimming Pools 622.15 

Article 1. Definitions and Scope 622.15 

Article 2. Plans, Construction and 

Inspection 623 

Article 3. Maintenance and Operation 623 

Chapter 21 . Minimum Standards for Permitting 

Medical Waste Facilities 625 

Article 1 . Definitions and Scope 625 

Article 2. General Provisions 626 

Article 3. Medical Waste Treatment 

Facility Permits 626.1 

Article 4. Fees 626.4 

Chapter 22. Safety Regulations for 

Playgrounds 626.4 

Article 1 . Definitions 626.4 

Article 2. General Standards 626.5 

Article 3. Certified Playground Safety 

Inspector Requirements 626.6 

Article 4. Provisions for Child Care 
Centers and Facilities 
Operated for the 
Developmentally Disabled 626.6 



CODE OF REGULATIONS Title 22 

Page 

Division 4.5. Environmental Health Standards 
for the Management of 
Hazardous Waste 627 

Chapter 10. Hazardous Waste Management 

System: General 627 

Article 1 . General 627 

Article 1.5. Conflict of Interest Code 635 

Article 2. Definitions 637 

Article 3. Variances 657 

Chapter 1 1 . Identification and Listing of 

Hazardous Waste 660 

Article 1 . General 660 

Article 2. Criteria for Identifying the 
Characteristics of 
Hazardous Waste 668.3 

Article 3. Characteristics of Hazardous 

Waste 668.3 

Article 4. Lists of Rcra Hazardous 

Wastes 668.6 

Article 4. 1 . Additional Lists of 

Hazardous Wastes 681 

Article 5. Categories of Hazardous 

Waste 681 

Chapter 12. Standards Applicable to 

Generators of Hazardous Waste 692 

Article 1 . Applicability 692 

Article 2. The Manifest 693 

Article 3. Pre-Transport Requirements 694 

Article 4. Recordkeeping and Reporting 698 

Article 5. Exports of Hazardous Waste 699 

Article 6. Imports of Hazardous Waste 702 

Article 7. Farmers 703 

Article 8. Transfrontier Shipments of 
Hazardous Waste for 
Recovery Within the OECD 703 

Chapter 13. Standards Applicable to 

Transporters of Hazardous 

Waste 714 

Article 1. General 714 

Article 2. Compliance with the Manifest 

System and Recordkeeping 715 

Article 3. Hazardous Waste Discharges 718 

Article 4. Regulatory Exemptions for 
Certain Transportation 
Operations 718 

Article 5. Railroad Accident Prevention 
and Immediate Deployment 
(RAPID) Force 720.1 



Page x 



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Title 22 



Social Security 

Page 

Standards for Owners and Chapter 15. 

Operators of Hazardous Waste 

Transfer, Treatment, Storage, 

and Disposal Facilities 720. l 

General 720. l 

Article 1. 
General Facility Standards 720.3 

Article 2. 

Preparedness and Prevention 720.7 . . , n 

v Article 3. 

Contingency Plan and 

Emergency Procedures 720.7 Article 4 

Manifest System, 

Recordkeeping, and Article 5. 

Reporting 720.9 

Water Quality Monitoring and 

Response Programs for Article 6. 

Permitted Facilities 720.14 

Closure and Post-Closure 728 

Article 7. 
Financial Requirements 734 

Article 8. 

Use and Management of Art'cle 9 

Containers 750.18 

Tank Systems 752 Article 10. 

Surface Impoundments 755 Article 1 1 . 

Waste Piles 758.3 Article 12. 

Land Treatment 758.6 Article 13. 

T jf 11 Article 14. 

Landfills 758.10 

Article 15. 

Residuals Repositories 758.12(c) 

Article 16. 

Incinerators 758.12(d) Article 17 

Corrective Action for Waste 

Management Units 758.14 Article 17.5. 

Drip Pads 758.16(d) Article 18. 

Miscellaneous Units 758.18 

Environmental Monitoring and Article 27 

Response Programs for Air, 

Soil, and Soil-Pore Gas for 

Permitted Facilities 758.18(a) Article 28. 

Corrective Action for Solid . . , „ a _ 

TT . Article 28.5. 

Waste Management Units 758.18(d) 

Air Emission Standards for 

Process Vents 758.45 

Air Emission Standards for Article 29. 

Equipment Leaks 758.52 Chapter 16 

Air Emission Standards for 

Tanks, Surface Article 1 

Impoundments, and . 

,-- . /VTilClc J*. 

Containers 758.54(d) 

Containment Buildings 758.54(s) 



Title Table of Contents 

Page 

Interim Status Standards for 

Owners and Operators of 

Hazardous Waste Transfer, 

Treatment, Storage, and 

Disposal Facilities 758.541 u) 

General 758.54m ) 

General Facility Standards 758.54iw i 

Preparedness and 

Prevention 758.54i/.k 1 j 

Contingency Plan and 

Emergency Procedures 758.54(/.x 1 ) 

Manifest System, 

Recordkeeping, and 

Reporting 758.54(/)i3) 

Water Quality Monitoring and 

Response Programs for 

Interim Status Facilities 758.54(/)(8) 

Closure and Post-Closure 758.62 

Financial Requirements 758.69 

Use and Management of 

Containers 758.81 

Tank Systems 758.81 

Surface Impoundments 758.90 

Waste Piles 758.93 

Land Treatment 758.95 

Landfills 758.98 

Incinerators 758.103 

Thermal Treatment 758.104 

Chemical, Physical, and 

Biological Treatment 758.105 

Drip Pads 758.106 

Environmental Monitoring of 

Air and Soil-Pore Gas for 

Interim Status Facilities 758.108 

Air Emission Standards for 

Process Vents 758.112(a) 

Air Emissions Standards for 
Equipment Leaks 758.112(g) 

Air Emission Standards for 

Tanks, Surface 

Impoundments, and 

Containers 758.112(1x1) 

Containment Buildings 758.112(1x23) 

Recyclable Materials (Recyclable 
Hazardous Wastes) 758.ll2(n) 

General 758.ii2(n) 

Generator, Transporter and 

Facility Operator 

Requirements 758.1 I2(n) 



Chapter 14. 



Article 1 . 
Article 2. 
Article 3. 
Article 4. 

Article 5. 

Article 6. 

Article 7. 
Article 8. 
Article 9. 

Article 10. 
Article 1 1 . 
Article 12. 
Article 13. 
Article 14. 
Article 14.5. 
Article 15. 
Article 15.5. 

Article 15.7. 
Article 16. 
Article 17. 



Article 19. 
Article 27. 
Article 28. 
Article 28.5. 

Article 29. 



Page xi 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 3. Requirements for Recyclable 
Materials That Are Placed 
on the Land (Used in a 
Manner That Constitutes 
Disposal) 758.1 l2(o) 

Article 4. Hazardous Wastes and Certain 
Used Oils Regulated as 
Hazardous Waste Fuels 758.1 I2(p) 

Article 5. [Reserved] 758.1 I2(q) 

Article 6. Requirements for Management 

Of Used Oil 758.112(q) 

Article 7. Requirements for Management 
of Spent Lead-Acid Storage 
Batteries 758.1 I2(r) 

Article 8. Hazardous Waste Burned in 
Boilers and Industrial 
Furnaces 758.1 12(s) 

Article 8.5. Requirements for 

Management of Recyclable 

Materials Used in 

Agriculture 758.1 I2(z)( 14) 

Article 9. Requirements for 

Management of Waste 

Elemental Mercury 758.ll2(z)(l5) 

Article 10. Requirements for 

Management of Certain 

Oily Wastes 758.ll2(z)(15) 

Chapter 17. Military Munitions 758.l22(z)(2) 

Chapter 18. Land Disposal 

Restrictions 758.l22(z)(2) 

Article 1 . General 758.l22(z)(2) 

Article 2. Schedule for Land Disposal 
Prohibition and 
Establishment of Treatment 
Standards 758.123 

Article 3. Prohibitions on Land 

Disposal 758.128 

Article 4. Treatment Standards 758.133 

Article 5. Prohibitions on Storage 758.190 

Article 10. Land Disposal Prohibitions — 

Non-RCRA Wastes 758.191 

Article 11. Treatment Standards — Non- 
RCRA Waste Categories 758.191 

Article 12. Incineration Requirements of 

Certain Hazardous Waste 758.192(b) 

Chapter 19. Fees 758.262 

Chapter 20. The Hazardous Waste Permit 

Program 758.271 

Article 1. General Information 758.271 



CODE OF REGULATIONS Title 22 

Page 

Article 2. Permit Application 758.273 

Article 3. Permit Conditions 758.287 

Article 4. Permit Changes and Denials .... 758.289 

Article 5. Expiration and Continuation 

of Permits 758.294 

Article 6. Special Forms of Permits 758.294 

Article 6.5. Standardized Permits 758.300(b) 

Article 7. Interim Status 758.300(d) 

Chapter 2 1 . Procedures for Hazardous Waste 

Permit Decisions 758.304(b) 

Article 1 . General Program 

Requirements 758.304(b) 

Article 2. Specific Procedures 
Applicable to RCRA 
Permits 758.304(h) 

Chapter 22. Enforcement, Inspections, and 

Informant Rewards 758.3040) 

Article 1 . Inspection Authority, 

Designation of Enforcement 
Authority, and Awards 758.304(i) 

Article 2. Delegation of Enforcement 

Order Authority 758.305 

Article 3. Assessment of Administrative 

Penalties 758.306 

Chapter 23. Standards for Universal Waste 

Management 758.306(d) 

Article 1. General 758.306(d) 

Article 2. Standards for Small Quantity 
Handlers of Universal 
Waste 758.306(l)(l) 

Article 3. Standards for Large Quantity 
Handlers of Universal 
Waste 758.306(1)(11) 

Article 4. Standards for Universal 

Waste Transporters 758.306(1X22) 

Article 5. Standards for Destination 

Facilities 758.306(1X25) 

Article 6. Import Requirements 758.306(0(26) 

Article 7. Standards for CRT Material 

Handlers 758.306(1X26) 

Chapter 29. Standards for the Management 

of Used Oil 758.306(1)(32) 

Article 1. Definitions 758.306(0(32) 

Article 2. Applicability 758.306(0(33) 

Article 3. Standards for Used Oil 

Generators 758.306(m) 

Article 4. Standards for Used Oil 

Collection Centers 758.306(n) 



Page xii 



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Title 22 



Social Security 

Page 

Standards for Used Oil Article 5. 

Transporters and Transfer 

Facilities (66279.40) 

[Reserved] 758.306(n) 

Standards for Used Oil 

Recycling Facilities 

(66279.50) [Reserved] 758.306(n) 

[Reserved] 758.306(n) Chapter 45.5. 

[Reserved] 758.306(n) 

[Reserved] 758.306(n) Article 1 . 

Testing Standards and 

Recordkeeping 

Requirements 758.306(n) 

w • • • Chapter 46. 

Waste Minimization 758.315 

Hazardous Waste Source 

Reduction and Management 

Review 758.315 Chapter 47. 

Article 1 
Management of Tanks 758.325 

Best Management Practices for 
Perchlorate Materials 758.329 

General 758.329 Article 2 - 

Alternative Management 

Standards for Treated Wood Chapter 50. 

Waste 758.330(c) Article 1. 

Hazardous Waste Property and 

Border Zone Property 758.330(g) Article 1.5. 

Selection and Ranking Criteria . 

for Hazardous Waste Sites 

Requiring Remedial Action 758.330(h) 

Prohibited Chemical Toilet &P 6F 

Additives 758.333 Article 1 . 

Requirements for Management of 

Fluorescent Light Ballasts Chapter 5 1 .5. 

which Contain Polychlorinated Article 1. 

Biphenyls (PCBs) 758.335 

Additional Requirements for 

Management of Extremely 

Hazardous Wastes 758.336 Chapter 52. 

Hazardous Waste Testing 

Laboratory Certification 758.336 Division 5 

Requirements for Units and 

Facilities Deemed to Have a 

Permit by Rule 758.336 

Permit By Rule 758.336 Chapter 1 . 

[Reserved] 758.338(i) Article 1 . 

[Reserved] 758.338(i) Article 2. 

[Reserved] 758.338(i) Article 3. 



Title Table of Contents 

Page 

Requirements Applicable to 

the Operation of K-l 2 

Schools Hazardous Waste 

Collection. Consolidation, 

and Accumulation Facilities 

(SHWCCAF) Deemed to Have 

a Permit by Rule 758.338iij 

Procurement of Site or Facility 

Cleanup Services 758.342 

Selection Process for 

Private Architectural and 

Engineering Services for 

Sites or Facilities 758.342 

Hazardous Waste Environmental 

Technology Certification 

Program 758.345 

Loan Programs 758.346(a) 

Cleanup Loans and 

Environmental Assistance to 

Neighborhoods Revolving 

Loan Fund 758.346(a) 

Groundwater Remediation 

Loan Program 758.346(h)(2) 

Corrective Action 758.346(j) 

Department of Toxic 

Substances Control 758.346(j) 

Unified Program Agency 

Qualification 758.347 

Corrective Action 

Approach 758.348(e) 

Site Remediation 758.348(c) 

Private Site Management 

Performance Standards 758.348(c) 

Assessment of School Sites 758.355 

Phase I Environmental Site 

Assessments (Proposed New 

and Expanding School 

Sites) 758.355 

Voluntary Registration of 

Environmental Assessors 758.358(a) 

Licensing and Certification of 
Health Facilities, Home Health 
Agencies, Clinics, and Referral 
Agencies 759 

General Acute Care Hospitals 759 

Definitions 759 

License 763 

Basic Services 767 



Article 5. 

Article 6. 

Article 7. 
Article 8. 
Article 9. 
Article 10. 



Chapter 31. 
Article 1. 



Chapter 32. 
Chapter 33. 

Article 1. 
Chapter 34. 

Chapter 39. 
Chapter 40. 

Chapter 41. 
Chapter 42. 

Chapter 43. 

Chapter 44. 
Chapter 45. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 



Page xiii 



(7 IS 2008) 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 4. Supplemental Service 

Approval 774 

Article 5. Special Permit 775 

Article 6. Supplemental Services 776 

Article 7. Administration 798 

Article 8. Physical Plant 808 

Article 9. Regulations Specific to 

Small and Rural Hospitals 814 

Chapter 2. Acute Psychiatric Hospital 815 

Article 1. Definitions 815 

Article 2. License 817 

Article 3. Basic Services 821 

Article 4. Supplemental Service 

Approval 826 

Article 5. Supplemental Services 827 

Article 6. Administration 827 

Article 7. Physical Plant 833 

Chapter 2.5. Certified Nurse Assistant 

Program 837 

Article 1 . Definitions 837 

Article 2. Administration 840 

Article 3. Program Components 841 

Article 4. Continuing Education and In- 
Service Training 845 

Article 5. Adverse Actions and 

Corrective Remedies 847 

Chapter 3. Skilled Nursing Facilities 848 

Article 1 . Definitions 848 

Article 2. License 848.4 

Article 3. Required Services 848.5 

Article 4. Optional Services 853 

Article 5. Administration 859 

Article 6. Physical Plant 867 

Article 7. Violations and Civil 

Penalties 871 

Chapter 3.5. Receivership Management of Long- 
Term Care Facilities 873 

Chapter 4. Intermediate Care Facilities 873 

Article 1 . Definitions 873 

Article 2. License 876.1 

Article 3. Services 881 

Article 4. Administration 901 

Article 5. Physical Plant 906 



CODE OF REGULATIONS Title 22 

Page 

Article 6. Violations and Civil 

Penalties 91 1 

Chapter 4.5. Intermediate Care Facility/ 
Developmentally Disabled- 
Nursing 914 

Chapter 5. Referral Services 914 

Article 1 . Definitions 914 

Article 2. License 915 

Article 3. Administration 950 

Article 4. Services 950 

Article 5. Personnel Requirements 951 

Article 6. General Provisions 952 

Chapter 6. Home Health Agencies 952 

Article 1 . Definitions 952 

Article 2. License 956 

Article 3. Services 959 

Article 4. Administration 962.2 

Article 5. Qualifications for Home 

Health Aide Certification 962.9 

Chapter 7. Primary Care Clinics 962.10 

Article 1 . Definitions 962.10 

Article 2. License 963 

Article 3. Basic Services 964 

Article 4. Drug Distribution 965 

Article 5. Abortion Service 966 

Article 6. Administration 966 

Article 7. Physical Plant 968 

Article 8. Appeals Procedure 969 

Article 9. Birth Services 970 

Chapter 7.1. Specialty Clinics 971 

Article 6. Hemodialyzer Reuse 971 

Chapter 7.2. Psychology Clinics 977 

Article 1 . Definitions 977 

Article 2. License 977 

Article 3. Basic Services 977 

Article 4. Administration 978 

Article 5. Physical Plant 980 

Chapter 8. Intermediate Care Facilities for 

the Developmentally Disabled 981 

Article 1 . Definitions 981 

Article 2. License 985 

Article 3. Services 990 

Article 4. Administration 1006 

Article 5. Physical Plant 1016 



Page xiv 



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Title 22 



Social Security 

Page 

Violations and Civil Division 6. 

Penalties 1020 

Intermediate Care Facilities/ Chapter 1 . 

Developmentally Disabled — Article 1. 

Habilitative 1023 Article 2 

Definitions 1023 Article 3. 

License 1025 Article 4. 

Services 1026 Article 6. 

Administration 1036 Article 7. 

Physical Plant 1042 Article 8. 

Violations and Civil 

Penalties 1044 Chapter 2. 

Psychiatric Health Facilities 1044 Subchapter 1 

Definitions 1044 Article 1 . 

Licensing and Inspection 1047 

Article 2. 
Services 1049 

Article 3. 

Administration 1054 

Article 4. 

Physical Plant 1058.2 . . , _ 

J Article 5. 

Adult Day Health Centers 1058.2 

^ _ . . Article 6. 

Definitions 1058.2 

Article 7. 
License 1061 

Chapter 3. 
Services 1063 

Article 1. 

Administration 1068 

Article 2. 

Physical Plant 1072 . . , - 

Violations 1073 Article 4 

Chemical Dependency Recovery 

Hospital Licensing Regulations 1074 Article 5. 

Definitions 1074 Article 6. 

Article 7. 
Licensing and Inspection 1075 

Article 8. 
Basic Services 1077 

„ . . „ Chapter 3.5. 

Optional Services 1080 

Article 1. 
Administration 1080 

Article 2. 
Physical Plant 1085 . . . « 

Correctional Treatment Centers 1085 Article 4. 

Definitions 1085 

Article 5. 
Licensing and Inspection 1086.3 

Article 6. 

Required Services 1086.4 . . , _ 

Optional Services 1086.13 

Chapter 4. 

Administration 1086.20 . . , , 

Article 1. 

Physical Plant and Safety 1086.27 



Title Table of Contents 

Page 

Licensing of Community Care 
Facilities 1087 

General Licensing Requirements 1087 

General Definitions 1087 

License \im 

Application Procedures KW2 

Administrative Actions 1103 

Continuing Requirements ] 107 

Physical Environment l n u 

Incidental Medical 

Services 1120 

Social Rehabilitation 

Facilities 11 20.4 

Basic Requirements 1 120.4 

General Requirements and 

Definitions 1120.4 

Licensing 1 120.5 

Applications Procedures 1 120.5 

Administrative Actions 1 120.6 

Enforcement Provisions 

(Reserved) 1 120.6 

Continuing Requirements 1 120.6 

Physical Environment 11 20. 11 

Adult Day Programs 1120.12 

General Requirements 1120.12 

Licensing 1120.16 

Application Procedures 1 120.17 

Administrative Actions and 

Inspection Authority 1120.25 

Enforcement Provisions 1 120.26 

Continuing Requirements 1120.28 

Physical Environment 1120.38 

Incidental Medical Services 1120.40 

Adult Day Support Center 1 120.44 

General Requirements 1 120.44 

Licensing (Reserved) 1120.44 

Application Procedures 1 120.44 

Administrative Actions 

(Reserved) 1120.44 

Civil Penalties (Reserved) 1 120.44 

Continuing Requirements 1120.44 

Physical Environment 1 120.46 

Small Family Homes 1 120.46 

General Requirements and 

Definitions ] 1 20.46 



Article 6. 
Chapter 8.5. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 

Chapter 9. 
Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 

Chapter 10. 
Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 

Chapter 1 1 . 

Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 

Chapter 12. 
Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 



Page xv 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 2. Licensing 1 120.47 

Article 3. Application Procedures 1121 

Article 4. Administrative Actions 

(Reserved) 1121 

Article 5. Enforcement Provisions 1121 

Article 6. Continuing Requirements 1121 

Article 7. Physical Environment 1126.1 

Chapter 5. Group Homes 1 126.2 

Article 1. General Requirements and 

Definitions 1126.2 

Article 2. Licensing 1 129 

Article 3. Application Procedures 1 129 

Article 4. Administrative Actions 1131 

Article 5. Enforcement Provisions 1131 

Article 6. Continuing Requirements 1132 

Article 7. Physical Environment 1134.13 

Article 9. Administrator Certification 

Training Programs 1134.14 

Subchapter 1 . Community Treatment 

Facilities 1134.14(c) 

Article 1 . General Requirements and 

Definitions 1134.14(c) 

Article 2. Licensing (Reserved) 1134.14(d) 

Article 3. Application Procedures 1134.14(d) 

Article 4. Administrative Actions 1134.14(d) 

Article 5. Enforcement Provisions 1134.14(e) 

Article 6. Continuing Requirements 1134.14(e) 

Article 7. Physical Environment H34.l4(i) 

Subchapter 2. Care for Children Under 

the Age of Six Years U34.i4(j) 

Article 1 . General Requirements and 

Definitions H34.i4(j) 

Article 3. Application Procedures H34.l4(k) 

Article 6. Continuing Requirements H34.i4(k) 

Article 7. Physical Environment H34.l4(r) 

Subchapter 3. Emergency Intervention in 

Group Homes H34.i4(s) 

Article 1. General Requirements H34.i4(s) 

Article 3. Application Procedures H34.i4(t) 

Article 6. Continuing Requirements 1134.17 

Subchapter 4. Transitional Shelter Care 

Facilities 1134.18 

Article 1 . General Requirements 1134.18 

Article 2. License 1134.19 

Article 3. Application Procedures 1134.19 



CODE OF REGULATIONS Title 22 

Page 

Chapter 6. Adult Residential Facilities 1134.20 

Article 1 . General Requirements and 

Definitions 1134.20 

Article 2. Licensing 1 134.22 

Article 3. Application Procedures 1 134.22 

Article 4. Administrative Actions 

(Reserved) 1134.22 

Article 5. Enforcement Provisions 1134.22 

Article 6. Continuing Requirements 1134.22 

Article 7. Physical Environment 1 140.2(b) 

Article 9. Administrator Certification 

Training Programs 1 140.4 

Chapter 7. Transitional Housing Placement 

Program 1 140.7 

Article 1. General Requirements 1140.7 

Article 2. License Required 1 140.8 

Article 3. Application Procedures 1140.8 

Article 4. Administrative Actions 1 140.11 

Article 5. Enforcement Provisions 

(Reserved) 1140.12 

Article 6. Continuing Requirements 1140.12 

Article 7. Physical Environment 1140.18(a) 

Chapter 7.3. Crisis Nurseries 1140.19 

Article 1 . General Requirements and 

Definitions 1140.19 

Article 2. License Required 1140.22 

Article 3. Application Procedures 1140.25 

Article 4. Administrative Actions 1140.36 

Article 5. Enforcement Provisions 1140.37 

Article 6. Continuing Requirements 1140.40 

Article 7. Physical Environment 1140.56 

Chapter 7.5. Foster Family Homes 1 140.59 

Article 1 . General Requirements and 

Definitions 1 140.59 

Article 2. License 1 140.59 

Article 3. Application Procedures 1141 

Article 4. Administrative Actions 1 144 

Article 6. Continuing Requirements 1146 

Article 7. Physical Environment 1149 

Chapter 8. Residential Care Facilities for 

the Elderly (RCFE) 1149 

Article 1. Definitions and Forms 1149 

Article 2. License 1154 

Article 3. Application Procedures 1158 

Article 4. Operating Requirements 1160 



Page xvi 



(7-18-2008) 



Title 22 



Social Security 

Page 

Physicial Environment and Article 1 . 

Accommodations 1 167 

Background Check 1170 Article 2. 

Personnel 1 174 Article 3. 

Resident Assessments, Article 4. 

Fundamental Services and Article 5. 

Rights 1178 

Chapter 10. 
Resident Records 1180.2(b) 

Food Services 1180.2(c) 

Health-Related Services and r»- ■ ■ -, 

^ ,. . Division 7. 

Conditions l I80.2(i) 

Dementia ll80.2<s) 

Chapter 1. 
Enforcement l I80.2(y) 

Administrative Actions — Article 1 

General H80.2(z)(2) A . , n 

Article 2. 

Administrator Certification . 1 _ 

Training Programs — Vendor 

Information 1180.2(z)(2) 

Article 4. 
Residential Care Facilities for Article 5 

the Chronically 111 H80.2(z)(6) 

Article 6. 
License H80.2(z)(6) 

Definitions 1 1 80.2(z)(6) 

Application Procedures 1180.4 Article 7. 

Administrative Actions 1180.15 Article 8. 

Enforcement Provisions 1180.16 Article 9. 

Artirlf 1 

Continuing Requirements 1180.19 

Physical Environment 1180.25 

Medical and Health Related 

Care 1180.27 

Foster Family Agencies 1 180.37 Chanter 2 

General Requirements and 

Definitions 1 180.37 Article 1 

License 1180.38 Article 2. 

Application Procedures 1180.38 

Certification and Use of Chapter 3. 

Homes 1182 

Administrative Actions 1182.1 Article 1. 

Complaints 1182.2 Article 2. 

Continuing Requirements 1182.2 Article 3. 

Physical Environment 1182.8(a) Article 4. 

Article 5. 
Adoption Agencies 1182.9 

License 1182.9 Article 6 

Administration 1182.10 -,, 

Chapter 4. 

Foster Family Homes 1182.14 Article 1. 



Title Table of Contents 

Page 

General Requirements, 

Definitions, and Forms 1 1 82. 14 

Administrative 1 185 

License/Approval Standards 1 186.8 

Placement 1186.14 

Special Health Care Needs 1186.16 

Regulations Regarding 

Supervision of Life Care 

Contracts 1 186.19 

Health Planning and Facility 
Construction 1191 

Health Planning and Resources 
Development 1191 

Definitions 1 191 

Advisory Health Council 1193 

Area Health Planning 

Agencies 1195 

Office Functions 1 195 

Certificate of Need 1 196 

Hearing Procedure on 

Applications for a 

Certificate of Need 1 198 

Appeals 1199 

Certificate of Exemption 1200 

Terms and Conditions 1200 

Development of Plans 1201 

Review Criteria 1202 

Procedures and Requirements 
Relating to the California 
Environmental Quality Act 1204 

Eminent Domain Procedures for 
Nonprofit Hospitals 1205 

Definitions 1205 

General Provisions and 

Procedures 1 206 

Freestanding Cardiac 

Catheterization Pilot Project 1208 

General Provisions 1208 

Monitoring 1209 

Fees 1210 

Operational Requirement 1210 

Compliance with Other Laws 

and Regulations 1210 

Definitions 1211 

Fire Protection Loans 1211 

Definitions 1211 



Article 5. 

Article 6. 
Article 7. 
Article 8. 

Article 9. 
Article 10. 
Article 1 1 . 

Article 12. 
Article 13. 
Article 14. 

Article 15. 



Chapter 8.5. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 
Article 7. 
Article 8. 

Chapter 8.8. 
Article 1. 

Article 2. 
Article 3. 
Article 4. 

Article 5. 
Article 6. 
Article 7. 
Article 8. 

Chapter 9. 
Article 1. 
Article 2. 

Chapter 9.5. 



Page xvii 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 2. General Provisions 1211 

Chapter 5. Health Facility Construction 

Loan Insurance 1214 

Article 1. Definitions 1214 

Article 2. General Provisions 1216 

Article 3. California Health Facilities 
Construction Loan Insurance 
Program — State Plan 1220 

Article 4. Defaults 1220 

Article 5. Termination of Insurance 1220 

Article 6. Health Facility Construction 

Loan Insurance Fund 1220 

Article 7. California Health Facilities 
Construction Loan Insurance 
Program— State Plan 1220 

Chapter 6. Health Workforce Pilot Project 

Program 1220 

Article 1 . Definitions 1220 

Article 2. Minimum Standards 1221 

Article 3. Application Procedure 1221 

Article 4. Content of Application 1222 

Article 5. Application Review Process 1224 

Article 6. Project Approval 1224 

Article 7. Program Responsibilities 1224 

Article 8. Project Completion/ 

Termination 1225 

Chapter 7. Seismic Structural Safety 

Standards 1226 

Article 1 . General Provisions 1226 

Article 2. Definitions 1226 

Article 3. Approval of Drawings and 

Specifications 1226.1 

Article 4. Fees 1226.2 

Article 5. Approval of Construction 1226.2 

Article 6. Appeals Procedures of the 

Building Safety Board 1227 

Article 7. General Design Requirements 

(Testing and Inspection) 1227 

Article 8. Masonry (Testing and 

Inspection) 1227 

Article 9. Wood (Testing and 

Inspection) 1227 

Article 10. Concrete (Testing and 

Inspection) 1227 

Article 11 . Steel and Iron (Testing and 

Inspection) 1228 



CODE OF REGULATIONS Title 22 

Page 

Article 12. Aluminum (Testing and 

Inspection) 1228 

Article 13. Excavations. Foundations and 
Retaining Walls (Testing 
and Inspections) 1228 

Article 14. Veneer (Testing and 

Inspection) 1228 

Article 15. Masonry or Concrete 

Chimneys, Fireplaces and 

Barbecues (Testing and 

Inspection) 1228 

Article 16. Contracts 1228 

Chapter 8. Clinic Renovation (Construction) 

Grant and Loan Program 1228 

Article 1 . Definitions 1228 

Article 2. Eligibility 1229 

Article 3. Types of Assistance 1229 

Article 4. General Provisions 1229 

Article 5. Application for Funds 1229 

Article 6. Selection Process 1229 

Article 7. Administration 1230 

Chapter 9. Hospital Charges and Fair 

Pricing Policies Reporting 1230 

Article 1 . Hospital Charge Description 

Master Reporting 1230 

Article 2. Hospital Fair Pricing 

Policies Reporting 1231 

Chapter 10. Health Facility Data 1232 

Article 1 . General 1232 

Article 2. Accounting System 

Requirements 1233 

Article 3. Reporting Requirements 1235 

Article 4. Modification, Extension, and 

Appeal Processes 1 236 

Article 5. Collection of Special Fees 1236.2 

Article 6. Public Availability of 

Disclosure Materials 1237 

Article 7. CABG Data Reporting 

Requirements 1237 

Article 8. Patient Data Reporting 

Requirements 1238.7 

Chapter 1 1 . Alzheimer's Disease Institute 

Demonstration Project 1251 

Subchapter 1. Definitions 1251 

Subchapter 2. General Requirements 1263 

Article 1. Institute Administration 1263 

Article 2. Patient Services Management 1267 



Page xviii 



(7-18-2008) 



Title 22 



Social Security 
Page 

Staff 1283 Subchapter 9. 

Environmental Safety and 

Health 1288 Article 1 . 

Physical Plant 1289 Article 2. 

Standards for All Types of Article 3. 

Services 1295 Article 4. 

Monitoring and Compliance 1295 Article 5. 

Skilled Nursing Services 1297 Subchapter 10. 

Definitions 1297 Article 1. 

Designation 1297 Article 2. 

Required Services 1297 Article 3. 

Administration 1301 Article 4. 

Intermediate Care Article 5. 

Services 1301 Subchapter 1 1 . 

Definitions 1301 Article 1. 

Designation 1301 Article 2. 

Services 1302 Article 3. 

Administration 1303 Article 4. 

Outpatient Care Article 5. 

Definitions 1303 Article 6. 

Definitions 1303 Article 7. 

Designation 1304 Subchapter 12. 

Basic Services 1304 

~ _. .. . Article 1. 

Drug Distribution 1305 

A , . . Article 2. 

Administration 1306 

Article 3. 
Day Health Care Services 1306 

Definitions 1306 Article 4 

Designation 1307 Subchapter 13. 

Services 1307 Article 1 

Administration 1309 Article 2. 

Physical Plant 1311 Article 3. 

Social Day Care Services 131 1 Article 4. 

Definitions nil Chapter 12. 

Administration 131 1 

Patient Services 1312 Article 1 . 

Designation 1313 Article 2. 

Home Health Care Article 3 . 

Services 1313 Article 4. 

Definitions 1313 Article 5. 

Designation 1313 Article 6. 

Services 1314 Article 7. 

Administration 1316 Article 8. 

Qualifications for Home Chapter 13. 

Health Aide Certification 1317 



Title Table of Contents 

Page 

In-Home Supportive 

Services 1318 

Definition 1318 

Designation 1318 

Services 1318 

Staff 1319 

Administration 1319 

Respite Care Services 1319 

Definitions 1319 

Training 1320 

Administration 1 320 

Services 1320 

Designation 1320 

Hospice Care Services 1321 

Definitions 1321 

Required Services 1321 

Staff 1322 

Continuity of Care 1323 

Other Services 1324 

Administration 1325 

Designation 1325 

Residential Care 

Services 1 325 

Definitions 1325 

Designation 1325 

Administration and Staffing 
Requirements 1325 

Basic Services 1326 

Referral Services 1329 

Definitions 1329 

Designation 1329 

Administration 1329 

Services 1330 

Postsurgical Recovery Care 
Demonstration Project 1330 

Definitions 1330 

Required Services 1335 

General Requirements 1339 

Administration 1341 

Fees 1345 

Operational Requirements 1345 

Monitoring and Compliance 1345 

Physical Plant 1346.1 

Mobile Cardiac Catheterization 

Pilot Project 1347 



• 



Article 3. 
Article 4. 

Article 5. 
Article 6. 

Article 7. 
Subchapter 3. 

Article 1. 

Article 2. 

Article 3. 

Article 4. 
Subchapter 4. 

Article 1 . 
Article 2. 
Article 3. 
Article 4. 
Subchapter 5. 

Article 1. 

Article 2. 

Article 3. 

Article 4. 

Article 5. 
Subchapter 6. 

Article 1. 

Article 2. 

Article 3. 

Article 4. 

Article 5. 
Subchapter 7. 

Article 1. 

Article 2. 

Article 3. 

Article 4. 
Subchapter 8. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 
Article 5. 



Page xix 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 1 . Definitions 1347 

Article 2. Relationship Between Base 
and Host Hospital During 
Pilot Program Operation 1347 

Article 3. General Provisions 1347 

Article 4. Interim Program Use of 

Mobile Lab When Replacing a 
Hospital Based Cardiac 
Catheterization Laboratory 1348 

Article 5. Monitoring and Record 

Keeping 1348 

Article 6. Fees 1348 

Article 7. Operational Requirement 1348 

Article 8. Compliance with Other Laws 

and Regulations 1348 

Chapter 14. Minority Health Professions 

Education Foundation 1349 

Article 1 . Definitions 1349 

Article 2. General Provisions 1352.3 

Article 3. Scholarships 1352.4 

Article 4. Loan Repayment Program 1 352.6 

Article 5. Registered Nurse Education 

Program 1352.6 

Article 6. Appeals 1352.7 

Article 7. Citizenship and Alien 

Verification Requirements 1352.8 

Chapter 15. Associate Degree Nursing 

Scholarship Program 1352.15 

Chapter 16. Vocational Nurse Scholarship and 

Loan Repayment Program 1352.17 

Article 1 . General Provisions 1352.17 

Article 2. Scholarship Program 

Provisions 1352.18 

Article 3. Loan Repayment Program 

Provisions 1352.20 

Chapter 17. Licensed Mental Health Service 

Provider Education Program 1352.21 

Division 8. Nondiscrimination in State- 
Supported Programs and 
Activities 1353 

Chapter 1 . Purpose, General Definitions and 

General Provisions 1353 



CODE OF REGULATIONS Title 22 

Page 

Article 1 . Purpose and General 

Provisions 1353 

Article 2. General Definitions 1354 

Article 3. Applicability 1354 

Chapter 2. Discriminatory Practices 
Relating to All Groups 
Protected by Article 9.5 1355 

Article 1. General Prohibitions Against 

Discrimination 1355 

Article 2. Mandatory and Permissive 

Remedial Action 1355 

Chapter 3. Discriminatory Practices 

Relating to Specific Groups 

Protected by Article 9.5 1356 

Article 1 . Purpose of This Chapter 1356 

Article 2. Color and Ethnic Group 

Identification 1356 

Article 3. Religion 1356 

Article 4. Age 1356 

Article 5. Sex 1357 

Article 6. Physical or Mental 

Disability 1358 

Chapter 4. Compliance and Enforcement 1359 

Article 1. State Agency Enforcement 

System 1359 

Article 2. Compliance Reports and 

Compliance Information 1360 

Article 3. Information to 

Beneficiaries, the Public, 

Recipients and Employees on 

Rights and 

Responsibilities 1360 

Article 4. Compliance Reviews and 

Complaints 1361 

Article 5. Hearing Process 1362 

Article 6. Sanctions 1363 

Article 7. Enforcement System 
Evaluation and 
Coordination 1363 

Chapter 5. Relationship Between the 

Secretary, DFEH and FEHC 1363 

Article 1 . Incorporation of DFEH and 

FEHC Employment _ 

Discrimination Regulations ^^fc 

by Reference 1363 ^BF 

Article 2. State Agency, DFEH and FEHC 

Roles 1363 



Page xx 



(7-18-2008) 



Title 22 



Social Security 
Page 

Prehospital Emergency Medical Article 2. 

Services 1365 Article 3. 

Emergency Medical Services 

Authority and Commission on Article 4. 

Emergency Medical Services — Article 5. 

Conflict of Interest Code 1365 

Training Standards for Child 

Care Providers 1365 Article 6. 

Definitions 1365 Chapter 3. 

Training Requirements for 

Child Care Providers 1366.2 Article 1 . 

Training Program Approval 1366.2 Article 2. 

Training Program Director Article 3. 

and Instructor 

Requirements 1366.2(a) Article 4. 

Course Hours and Class Article 5. 

Requirements 1366.2(c) Article 6. 

Class Rosters, Course ChaDter 4 

Completion Documents and 

Stickers 1366.2(d) 

Article 1. 
Fees 1366.2(e) 

Article 2. 

First Aid Testing for School Bus Article 3. 

Drivers 1366.3 

Definitions 1366.3 

General 1366.3 Article 4. 

Examination Standards 1366.3 

Article 5. 

First Aid Standards for Public Article 6 

Safety Personnel 1366.3 . . , _ 

J Article 7. 

Definitions 1366.3 » _• , 

Article 8. 

General Training Provisions 1366.4 Article 9 

Training Standards 1366.4 

Training Approval Options 1368 Chapter 5. 

Training Standards and 

Utilization for Use of the Chapter 6. 

Automated External 

Defibrillator by Non-Licensed 

or Non-Certified Personnel 1369 Article 1 

Definitions 1369 Article 2 . 

General Training Provisions 1369 Article 3. 

AED Training Program 

Requirements 1370 Article 4. 

Operational AED Service 

Provider/Vendor Article 5. 

Requirements 1370 _, 

Chapter 7. 

Emergency Medical Article 1 . 

TechnicianI 1371 Article2. 

Definitions 1371 



Title Table of Contents 
Page 

General Provisions 1372 

Program Requirements for EMT- 

I Training Programs 1377 

EMT-I Certification 1380 

Maintaining EMT-I 

Certification and 

Recertification 1380.1 

Record Keeping and Fees 1380.2 

Emergency Medical 

Technician-II 1380.2 

Definitions 1380.2 

General Provisions 1380.3 

Program Requirements for EMT- 

II Training Programs 1382 

Certification 1387 

Operational Requirements 1388 

Record Keeping and Fees 1389 

Emergency Medical Technician- 
Paramedic 1390 

Definitions 1390 

Genera] Provisions 1392 

Program Requirements for 

Paramedic Training 

Programs 1394 

Applications and 

Examinations 1 399 

Licensure 1400 

License Renewal 1402 

System Requirements 1402 

Record Keeping and Fees 1402.2 

Discipline and Reinstatement 

of License 1402.3 

Process for Applicant 

Verification 1402.5 

Process for EMT-I and EMT-II 

Certification Disciplinary 

Action 1402.8 

Definitions 1402.8 

General Provisions 1403 

Evaluation and 

Investigation 1406 

Determination and 

Notification of Action 1406 

Local Responsibilities 1406.2 

Trauma Care Systems 1406.3 

Definitions 1406.3 

Local EMS Agency Trauma 

System Requirements 1408 



Division 9. 

Chapter 1. 

Chapter 1.1. 

Article 1. 
Article 2. 

Article 3. 
Article 4. 

Article 5. 
Article 6. 

Article 7. 
Chapter 1.2. 

Article 1. 
Article 2. 
Article 3. 

Chapter 1.5. 

Article 1. 
Article 2. 
Article 3. 
Article 4. 

Chapter 1.8. 



Article 1. 
Article 2. 
Article 3. 

Article 4. 



Chapter 2. 
Article 1. 



Page xxi 



17 IS 200S) 



Title Table of Contents BARCLAYS CALIFORNIA 

Page 

Article 3. Trauma Center Requirements 1410 

Article 4. Quality Improvement 1414.2 

Article 5. Transfer of Trauma Patients 1414.2 

Chapter 8. Prehospital EMS Aircraft 

Regulations 1414.3 

Article 1 . Definitions 1414.3 

Article 2. General Provisions 1414.4 

Article 3. Personnel 1415 

Article 4. System Operation 1415 

Article 5. Equipment and Supplies, 

Aircraft Specifications 1415 

Chapter 9. Poison Control Center 

Regulations 1416 

Article 1 . Definitions 1416 

Article 2. General Provisions 1416 

Article 3. Designation Process 1416.2 

Chapter 1 1 . EMS Continuing Education 1416.3 

Article 1 . Definitions 1416.3 

Article 2. Approved Continuing 

Education 1416.4 

Article 3. Continuing Education 

Records 1416.4 

Article 4. CE Provider Approval 

Process 1416.5 

Article 5. CE Provider Denial/ 

Disapproval Process 1416.5 

Article 6. CE Providers for EMS 

Personnel 1416.5 

Chapter 12. EMS System Quality 

Improvement 1416.7 

Article 1 . Definitions 1416.7 

Article 2. EMS Service Provider 1416.7 

Article 3. Paramedic Base Hospital 1416.7 

Article 4. Local EMS Agency 1416.8 

Article 5. EMS Authority 1416.8 

Division 10. California Medical Assistance 

Commission 1417 

Chapter 1 . Introduction 1417 

Article 1 . Definitions 141 7 

Article 2. Commission Meetings 1417 

Article 3. Commission Staff 1417 

Chapter 2. Negotiation and Approval of 

Proposed Contracts 1417 



CODE OF REGULATIONS Title 22 

Page 

Chapter 3. Confidentiality of Contract 

Negotiations 1418 

Chapter 4. Conflict of Interest Code 1418 

Division 11. Department of Community 

Services and Development 1421 

Chapter 1 . Community Services Block Grant 

Regulations 1421 

Chapter 2. Low-Income Home Energy 

Assistance Program Regulations 1428 

Chapter 3. Applicant Verification 

Regulations 1428.5 

Chapter 4. Naturalization Services 

Regulations 1428.8 

Chapter 5. Department of Community Services 
and Development — Conflict of 
Interest Code 1428.8 

Division 12. Child Care Facility Licensing 

Regulations 1429 

Chapter 1 . Child Care Center General 

Licensing Requirements 1429 

Article 1 . General Requirements and 

Definitions 1429 

Article 2. Licensing 1431 

Article 3. Application Procedures 1432 

Article 4. Enforcement Provisions 1441 

Article 5. Administrative Actions 1444 

Article 6. Continuing Requirements 1445 

Article 7. Physical Environment 1451 

Subchapter 1 . (Reserved) 1454 

Article 1 . General Requirements and 

Definitions 1454 

Article 2. Licensing 1454 

Article 3. Application Procedure 1454 

Article 4. Administrative Actions 1454 

Article 5. Enforcement Provisions 

(Reserved) 1454 

Article 6. Continuing Requirements 1454 

Article 7. Physical Environment 1456 

Subchapter 2. Infant Care Center 1456 

Article 1 . General Requirements and 

Definitions 1456 

Article 2. Licensing (Reserved) 1456 

Article 3. Application Procedures 

(Reserved) 1456 

Article 4. Enforcement Provisions 

(Reserved) 1456 



Page xxii 



(7-18-2008) 



Title 22 



Social Security 

Page 

Administrative Actions Article 4. 

(Reserved) 1456 

Continuing Requirements 1456 Article 5. 

Physical Environment 1456.4 Article 6. 

School-Age Child Care Article 7. 

Center 1456.6 Subchapter 2. 

General Requirements and 

Definitions 1456.6 Subchapter 3. 

Licensing (Reserved) 1456.6 

Application Procedures 1456.6 

Enforcement Provisions Chapter 2. 

(Reserved) 1456.6 Article 1 . 

Administrative Actions Article 2. 

(Reserved) 1456.6 

Continuing Requirements 1456.6 Article 3. 

Child Care Center for 

Mildly 111 Children 1456.8 Article 4. 

General Requirements and Article 5. 

Definitions 1456.8 Article 6. 

Licensing 1456 - 9 Chapter 3. 

Application Procedures 1456.9 Article 1. 

Administrative Actions Article 2. 

(Reserved) 1456.10 

Enforcement Provisions Chanter 4 

(Reserved) 1456.10 

Continuing Requirements 1456.10 ^, 

fc M Chapter 5. 

Physical Environment 1456.15 

Family Day Care Homes for Chapter 6. 

Children 145617 Article 1. 

General Requirements and Subchapter 6 1 

Definitions 1456.17 

Licensing 1456.18 Article 1. 

Application Procedure 1457 Article 2. 

Enforcement Provisions 1463 

Administrative Actions 1464.1 Article 3. 

Continuing Requirements 1465 Article 4. 

Physical Environment Chapter 7. 

(Reserved) 1466.5 Article 1 . 

~ , ~ . ~ Article 2. 

Department of Child Support 

Services 1467 Article 3. 

Article 4. 
Program Administration 1467 

Operations 1467 Article 5. 

Definitions 1467 

(Reserved) 1472.10(a) Article 6. 

Plans of Cooperation 1472.10(a) Chapter 8. 



Title Table of Contents 

Page 

Standards for Local Program 
Operations (Reserved) 1472.10(b)(1) 

Records Management 1472.10(b)(1) 

Customer Service 1472.10(b)(2) 

Staff Requirements 1472.10(b)(3) 

Fiscal Administration 

(Reserved) 1472.10(b)(4) 

Administrative 

Reporting 1472.10(b)(4) 

Administrative Reports 1472.10(b)(4) 

Case Intake 1472.10(b)(5) 

Definitions 1472.10(b)(5) 

Application and 

Referral 1472.10(b)(6) 

Case Opening 

Requirements 1472.10(b)(6) 

Case Processing 1472.10(b)(7) 

Cooperation 1472.10(b)(8) 

Family Violence 1472.10(b)(9) 

Locate 1472. kxo 

Locate Requirements 1472.10(c) 

Federal Parent Locator 

Service 1472.10(d) 

Establishing Paternity 

(Reserved) 1472.10(c) 

Review and Adjustment of 

Child Support Orders 1472.10(c) 

Enforcement Actions I472.i0(i) 

Definitions 1472. I0(i) 

Immediate Enforcement 

Actions 1472. I0(j) 

Income Withholding Orders . . . 1472. l()(j) 

Medical Support 

Enforcement 1472. iodo 

Real Property Liens 1472. I0(m) 

Credit Reporting 1472. I0(o) 

Interstate Cases 1472. io<p) 

Definitions 1472. i()(p) 

Long Arm Jurisdiction 1472.12 

General Provisions 1472.12 

California As Initiating 

State 1472.14 

California As Responding 

State 1472.16 

Limited Interstate Services 1472.17 

Case Closure 1472.17 



Article 5. 

Article 6. 

Article 7. 

Subchapter 3. 

Article 1. 

Article 2. 
Article 3. 
Article 4. 

Article 5. 

Article 6. 
Subchapter 4. 

Article 1. 

Article 2. 
Article 3. 
Article 4. 

Article 5. 

Article 6. 
Article 7. 

Chapter 3. 

Article 1. 

Article 2. 
Article 3. 
Article 4. 
Article 5. 
Article 6. 
Article 7. 

Division 13. 

Chapter 1 . 

Subchapter 1 

Article 1. 

Article 2. 

Article 3. 



Page xxiii 



Title Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 

Article 1 . Definitions 1472.17 

Article 2. Case Closure 1472.18 

Chapter 9. Collection and Distribution of 

Child Support 1472.20 

Article 1 . Definitions 1472.20 

Article 5. General Requirements 1472.21 

Article 6. Compromise of Assigned 

Arrearages — Family 

Reunification 1472.21 

Chapter 10. Complaint Resolution 1472.23 



Page 

Article 1. Definitions 1472.23 

Article 2. Local Complaint Resolution 

Process 1472.24 

Article 3. State Hearing 1475 

Chapter 1 1 . Quality Control 1483 

Article 1. Performance Measures 1483 

Chapter 12. Automation Requirements 

(Reserved) 1485 

Chapter 13. Conflict of Interest Code 1485 



Page xxiv 



(7-18-2008) 



• 



JSKLm 



Barclays Official 

California 

Code of 
Regulations 



Title 22. Social Security 

Division 5. Licensing and Certification of Health Facilities, Home Health 
Agencies, Clinics, and Referral Agencies 



Vol. 30 



XMOIVISOISI 

* 

WEST 



Barclays Official California Code of Regulations 

425 Market Street • Fourth Floor • San Francisco, CA 94105 
800-888-3600 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Division 5. Licensing and Certification of Health Facilities, 
Home Health Agencies, Clinics, and Referral Agencies 



Table of Contents 



Page 



Page 



Chapter 1 



Article 1. 


Definitions 759 


§70001. 


Meaning of Words. 


§ 70003. 


Hospital. 


§ 70005. 


General Acute Care Hospital. 


§ 70006. 


Acute Psychiatric Care Bed 




Classification. 


§ 70007. 


Alteration. 


§ 70009. 


Autoclaving. 


§70011. 


Basic Services. 


§ 70012. 


Certificate of Exemption. 


§70012.1. 


Certificate of Need. 


§ 70013. 


Child. 


§ 70015. 


Cleaning. 


§ 70016. 


Competency Validation for Patient 




Care Personnel Other Than 




Registered Nurses. 


§70016.1. 


Competency Validation for 




Registered Nurses. 


§ 70017. 


Conservator. 


§70018. 


Critical Burn. 


§ 70019. 


Defined. 


§70021. 


Department. 


§ 70023. 


Director. 


§ 70025. 


Disinfection. 


§ 70027. 


Distinct Part. 


§ 70029. 


Drug Administration. 


§70031. 


Drug Dispensing. 


§ 70033. 


Existing Hospital Building. 


§ 70034. 


General Acute Care Bed 




Classification. 


§ 70035. 


Governing Body. 


§ 70037. 


Guardian. 


§70037.1. 


Human Reproductive Sterilization. 


§ 70038. 


Intermediate Care Bed 




Classification. 


§70041. 


License. 


§ 70042. 


License Category. 


§ 70043. 


Licensee. 


§ 70045. 


Maintenance. 


§ 70046. 


Modernization. 


§ 70047. 


New Construction. 


§ 70048. 


New Special Service. 


§ 70049. 


Nursing Unit. 


§70051. 


Outpatient Service. 


§ 70053. 


Patient. 


§70053.1. 


Patient Care Personnel. 


§ 70053.2. 


Patient Classification System. 


§ 70054. 


Permanently Converted. 


§ 70055. 


Personnel. 


§ 70057. 


Principal Officer. 


§ 70059. 


Restraint. 


§70059.1. 


Rural Area. 


§ 70060. 


Skilled Nursing Care Bed 




Classification. 


§70061. 


Special Permit. 


§ 70062. 


Special Hospital. 


§ 70063. 


Sterilization. 


§ 70065. 


Supervision. 


§ 70067. 


Supplemental Service. 


§ 70069. 


Unit Dose Medication System. 


Article 2. 


License 763 



§70101. 


Inspection of Hospitals. 


§70103. 


License Required. 


§ 70105. 


Application Required. 


§ 70107. 


Content of Application. 


§ 70109. 


Architectural Plans. 


§70110. 


Fee. 


§70111. 


Fee. 


§70113. 


Health Planning Agency Review. 


§70113. 


Projects Requiring a Certificate of 




Need. 


§70113.1. 


•Projects Eligible for a Certificate of 




Exemption. 


§70113.2. 


Projects Not Subject to Review by a 




Voluntary Area Health Planning 




Agency. 


§70113.3. 


Projects Previously Decided by a 




Voluntary Area Health Planning 




Agency. 


§70113.4. 


Exemption Requests for 




Remodeling and Replacement 




Projects. 


§70114. 


Bed Classification. 


§70115. 


Safety, Zoning and Building 




Clearance. 


§70117. 


Issuance, Expiration and Renewal. 


§70119. 


Provisional Licensing of Distinct 




Parts. 


§70121. 


Separate Licenses. 


§ 70123. 


Posting. 


§ 70125. 


Transferability. 


§ 70127. 


Report of Changes. 


§ 70129. 


Program Flexibility. 


§70131. 


Voluntary Suspension of License or 




Licensed Beds. 


§70133. 


Voluntary Cancellation of License. 


§ 70135. 


Revocation or Involuntary 




Suspension of License. 


§ 70136. 


Conviction of Crime: Standards for 




Evaluating Rehabilitation. 


§ 70137. 


Bonds. 


le 3. 


Basic Services 



§70201. Medical Service Definition. 

§ 70203. Medical Service General 

Requirements. 
§ 70205. Medical Service Staff. 

§ 70207. Medical Service Equipment and 

Supplies. 
§ 70209. Medical Service Space. 

§ 70211. Nursing Service General 

Requirements. 
§ 70213. Nursing Service Policies and 

Procedures. 
§ 70214. Nursing Staff Development. 

§ 70215. Planning and Implementing Patient 

Care. 
§ 70217. Nursing Service Staff. 

§70217. Nursing Service Staff. 

§ 70219. Nursing Service Space. 

§ 70221. Surgical Service Definition. 

§ 70223. Surgical Service General 

Requirements. 
§ 70225. Surgical Service Staff. 



Page i 



(7 IS 200K) 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§ 70227. 


Surgical Service Equipment and 




Supplies. 


§ 70229. 


Surgical Service Space. 


§70231. 


Anesthesia Service Definition. 


§ 70233. 


Anesthesia Service General 




Requirements. 


§ 70235. 


Anesthesia Service Staff. 


§ 70237. 


Anesthesia Service Equipment and 




Supplies. 


§ 70239. 


Anesthesia Service Space. 


§70241. 


Clinical Laboratory Service 




Definition. 


§ 70243. 


Clinical Laboratory Service General 




Requirements. 


§ 70245. 


Clinical Laboratory Service Staff. 


§ 70247. 


Clinical Laboratory Service 




Equipment and Supplies. 


§ 70249. 


Clinical Laboratory Service Space. 


§ 70251. 


Radiological Service Definition. 


§ 70253. 


Radiological Service General 




Requirements. 


§ 70255. 


Radiological Service Staff. 


§ 70257. 


Radiological Service Equipment and 




Supplies. 


§ 70259. 


Radiological Service Space. 


§70261. 


Pharmaceutical Service Definition. 


§ 70263. 


Pharmaceutical Service General 




Requirements. 


§ 70265. 


Pharmaceutical Service Staff. 


§ 70267. 


Pharmaceutical Service Equipment 




and Supplies. 


§ 70269. 


Pharmaceutical Service Space. 


§70271. 


Dietetic Service Definition. 


§ 70273. 


Dietetic Service General 




Requirements. 


§ 70275. 


Dietetic Service Staff. 


§ 70277. 


Dietetic Service Equipment and 




Supplies. 


§ 70279. 


Dietetic Service Space. 


Article 4. 


Supplemental Service 




Approval 774 


§70301. 


Supplemental Service Approval 




Required. 


§ 70303. 


Application. 


§ 70305. 


Issuance, Expiration and Renewal. 


§ 70307. 


Program Flexibility. 


§ 70309. 


Revocation or Involuntary 




Suspension of Approval. 


Article 5. 


Special Permit 775 


§70351. 


Special Permit Required. 


§ 70353. 


Application. 


§ 70355. 


Renewal Application. 


§ 70357. 


Issuance, Expiration and Renewal. 


§ 70359. 


Posting. 


§ 70361. 


Transferability. 


§ 70363. 


Program Flexibility. 


§ 70365. 


Voluntary Suspension of Special 




Permit. 


§ 70367. 


Voluntary Cancellation of Special 




Permit. 


§ 70369. 


Revocation or Involuntary 




Suspension of Special Permit. 


Article 6. 


Supplemental Services 776 


§70401. 


Acute Respiratory Care Service 




Definition. 


§ 70403. 


Acute Respiratory Care Service 




General Requirements. 


§ 70405. 


Acute Respiratory Care Service 




Staff. 


§ 70407. 


Acute Respiratory Care Service 




Equipment and Supplies. 


§ 70409. 


Acute Respiratory Care Service 




Space. 


§70411. 


Basic Emergency Medical Service, 




Physician on Duty, Definition. 



§ 70413. 


Basic Emergency Medical Service, 




Physician on Duty, General 




Requirements. 


§70415. 


Basic Emergency Medical Service, 




Physician on Duty, Staff. 


§70417. 


Basic Emergency Medical Service, 




Physician on Duty, Equipment and 




Supplies. 


§ 70419. 


Basic Emergency Medical Service. 




Physician on Duty, Space. 


§70421. 


Bum Center Definition. 


§ 70423. 


Burn Center General Requirements. 


§ 70425. 


Bum Center Staff. 


§ 70427. 


Burn Center Equipment and 




Supplies. 


§ 70429. 


Burn Center Space. 


§70431. 


Cardiovascular Surgery Service 




Definition. 


§ 70433. 


Cardiovascular Surgery Service 




General Requirements. 


§ 70435. 


Cardiovascular Surgery Service 




Staff. 


§ 70437. 


Cardiovascular Surgery Service 




Equipment and Supplies. 


§ 70438. 


Cardiac Catheterization Laboratory 




Service. 


§70438.1. 


Cardiac Catheterization Laboratory 




Service — General Requirements. 


§ 70439. 


Cardiovascular Surgery Service 




Space. 


§ 70441. 


Chronic Dialysis Service Definition. 


§ 70443. 


Chronic Dialysis Service General 




Requirements. 


§ 70445. 


Chronic Dialysis Service Staff. 


§ 70447. 


Chronic Dialysis Service Equipment 




and Supplies. 


§ 70449. 


Chronic Dialysis Service Space. 


§70451. 


Comprehensive Emergency Medical 




Service Definition. 


§ 70453. 


Comprehensive Emergency Medical 




Service General Requirements. 


§ 70455. 


Comprehensive Emergency Medical 




Service Staff. 


§ 70457. 


Comprehensive Emergency Medical 




Service Equipment and Supplies. 


§ 70459. 


Comprehensive Emergency Medical 




Service Space. 


§70461. 


Coronary Care Service Definition. 


§ 70463. 


Coronary Care Service General 




Requirements. 


§ 70465. 


Coronary Care Service Staff. 


§ 70467. 


Coronary Care Service Equipment 




and Supplies. 


§ 70469. 


Coronary Care Service Space. 


§ 70471. 


Dental Service Definition. 


§ 70473. 


Dental Service General 




Requirements. 


§ 70475. 


Dental Service Staff. 


§ 70477. 


Dental Service Equipment and 




Supplies. 


§ 70479. 


Dental Service Space. 


§70481. 


Intensive Care Newborn Nursery 




Service Definition. 


§ 70483. 


Intensive Care Newborn Nursery 




Service General Requirements. 


§ 70485. 


Intensive Care Newborn Nursery 




Service Staff. 


§ 70487. 


Intensive Care Newborn Nursery 




Service Equipment and Supplies. 


§ 70489. 


Intensive Care Newborn Nursery 




Service Space. 


§ 70491. 


Intensive Care Service Definition. 


§ 70493. 


Intensive Care Service General 




Requirements. 


§ 70495. 


Intensive Care Service Staff. 


§ 70497. 


Intensive Care Service Equipment 




and Supplies. 



• 



Page ii 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Page 



Page 



• 



• 



§ 70499. 


Intensive Care Service Space. 


§70501. 


Intermediate Care Service 




Definition. 


§ 70503. 


Intermediate Care Service General 




Requirements. 


§ 70505. 


Nuclear Medicine Service 




Definition. 


§ 70507. 


Nuclear Medicine General 




Requirements. 


§ 70509. 


Nuclear Medicine Service Staff. 


§70511. 


Nuclear Medicine Equipment and 




Supplies. 


§70513. 


Nuclear Medicine Space. 


§70515. 


Occupational Therapy Service 




Definition. 


§70517. 


Occupational Therapy Service 




General Requirements. 


§70519. 


Occupational Therapy Service Staff. 


§ 70521. 


Occupational Therapy Service 




Equipment and Supplies. 


§ 70523. 


Occupational Therapy Service 




Space. 


§ 70525. 


Outpatient Service Definition. 


§ 70527. 


Outpatient Service General 




Requirements. 


§ 70529. 


Outpatient Service Staff. 


§70531. 


Outpatient Service Equipment and 




Supplies. 


§ 70533. 


Outpatient Service Space. 


§ 70535. 


Pediatric Service Definition. 


§ 70537. 


Pediatric Service General 




Requirements. 


§ 70539. 


Pediatric Service Staff. 


§70541. 


Pediatric Service Equipment and 




Supplies. 


§ 70543. 


Pediatric Service Space. 


§ 70545. 


Perinatal Unit Definition. 


§ 70547. 


Perinatal Unit General 




Requirements. 


§ 70549. 


Perinatal Unit Staff. 


§70551. 


Perinatal Unit Equipment and 




Supplies. 


§ 70553. 


Perinatal Unit Space. 


§ 70555. 


Physical Therapy Service 




Definition. 


§ 70557. 


Physical Therapy Service General 




Requirements. 


§ 70559. 


Physical Therapy Service Staff. 


§70561. 


Physical Therapy Service 




Equipment and Supplies. 


§ 70563. 


Physical Therapy Service Space. 


§ 70565. 


Podiatric Service Definition. 


§ 70567. 


Podiatric Service General 




Requirements. 


§ 70569. 


Podiatric Service Staff. 


§ 70571. 


Podiatric Service Equipment and 




Supplies. 


§ 70573. 


Podiatric Service Space. 


§ 70575. 


Psychiatric Unit Definition. 


§ 70577. 


Psychiatric Unit General 




Requirements. 


§ 70579. 


Psychiatric Unit Staff. 


§ 70581. 


Psychiatric Unit Equipment and 




Supplies. 


§ 70583. 


Psychiatric Unit Space. 


§ 70585. 


Radiation Therapy Service 




Definition. 


§ 70587. 


Radiation Therapy Service General 




Requirements. 


§ 70589. 


Radiation Therapy Service Staff. 


§70591. 


Radiation Therapy Service 




Equipment and Supplies. 


§ 70593. 


Radiation Therapy Service Space. 


§ 70595. 


Rehabilitation Center Definition. 


§ 70597. 


Rehabilitation Center General 




Requirements. 


§ 70599. 


Rehabilitation Center Staff. 



§ 70601 . Rehabilitation Center Equipment 

and Supplies. 
§ 70603. Rehabilitation Center Space. 

§ 70605. Renal Transplant Center Definition. 

§ 70607. Renal Transplant Center General 

Requirements. 
§ 70609. Renal Transplant Center Staff. 

§ 7061 1 . Renal Transplant Center Equipment 

and Supplies. 
§ 70613. Renal Transplant Center Space. 

§ 70615. Respiratory Care Service 

Definition. 
§ 70617. Respirator}' Care Service General 

Requirements. 
§ 70619. Respiratory Care Service Staff. 

§ 7062 1 . Respiratory Care Service Equipment 

and Supplies. 
§ 70623. Respiratory Care Service Space. 

§ 70625. Skilled Nursing Service Definition. 

§ 70627. Skilled Nursing Service General 

Requirements. 
§ 70629. Social Service Definition. 

§ 70631. Social Service General 

Requirements. 
§ 70633. Social Service Staff. 

§ 70635. Social Service Equipment and 

Supplies. 
§ 70637. Social Service Space. 

§ 70639. Speech Pathology and/or Audiology 

Service Definition. 
§ 70641 . Speech Pathology and/or Audiology 

Service General Requirements. 
§ 70643. Speech Pathology and/or Audiology 

Service Staff. 
§ 70645. Speech Pathology and/or Audiology 

Service Equipment and Supplies. 
§ 70647. Speech Pathology and/or Audiology 

Service Space. 
§ 70649. Standby Emergency Medical 

Service, Physician on Call, 

Definition. 
§ 70651. Standby Emergency Medical 

Service, Physician on Call, General 

Requirements. 
§ 70653. Standby Emergency Medical 

Service, Physician on Call, Staff. 
§ 70655. Standby Emergency Medical 

Service, Physician on Call, 

Equipment and Supplies. 
§ 70657. Standby Emergency Medical 

Service, Physician on Call, Space. 



e7. 


Administration 798 


§70701. 


Governing Body. 


§ 70703. 


Organized Medical Staff. 


§ 70705. 


Medical Staff, Residents, Interns 




and Students. 


§ 70706. 


Interdisciplinary Practice and 




Responsibility for Patient Care. 


§ 70706.1 


Granting of Nonphysician 




Privileges. 


§ 70706.2 


Standardized Procedures. 


§ 70707. 


Patients' Rights. 


§70707.1 


Criteria for the Performance of 




Sterilization. 


§ 70707.2 


Requirements for Sterilization Other 




Than Emergency Sterilization. 


§ 70707.3 


Informed Consent Process for 




Sterilization. 


§ 70707.4 


Certification of Informed Consent 




for Sterilization. 


§ 70707.5 


Hysterectomy. 


§ 70707.6 


The Additional Requirements for 




Informed Consent Process When 




Specified Federal Funds Are Used. 


§ 70707.7 


Verification of Informed Consent. 


§ 70707.8 


Noncompliance. 



Page 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§ 70707.9. 


Effective Date. 


§ 70708. 


Clinical Research. 


§ 70709. 


Emotional and Attitudinal Support. 


§70711. 


Social Services. 


§70713. 


Use of Outside Resources. 


§70715. 


Nondiscrimination Policies. 


§70717. 


Admission, Transfer and Discharge 




Policies. 


§ 70719. 


Personnel Policies. 


§ 70721. 


Employees. 


§ 70723. 


Employee Health Examinations and 




Health Records. 


§ 70725. 


Employee Personnel Records. 


§ 70727. 


Job Descriptions. 


§ 70729. 


Advertising. 


§70731. 


Alcoholic and/or Tubercular 




Patients. 


§ 70733. 


Records and Reports. 


§ 70735. 


Annual Reports. 


§ 70736. 


Sterilization Reporting 




Requirements. 


§ 70737. 


Reporting. 


§ 70738. 


Infant Security. 


§ 70739. 


Infection Control Program. 


§70741. 


Disaster and Mass Casualty 




Program. 


§ 70743. 


Fire and Internal Disasters. 


§ 70745. 


Fire Safety. 


§ 70746. 


Disruption of Services. 


§ 70747. 


Medical Records Service. 


§ 70749. 


Patient Health Record Content. 


§70751. 


Medical Record Availability. 


§ 70753. 


Transfer Summary. 


§ 70754. 


Special Hospital Transfer 




Agreement. 


§ 70755. 


Patients' Monies and Valuables. 


§ 70757. 


First Aid and Referrals. 


§ 70759. 


Exercise Stress Testing. 


§70761. 


Medical Library. 


§ 70763. 


Medical Photography. 


§ 70765. 


Conference Room. 


icle 8. 


Physical Plant 


§70801. 


Alterations to Existing Buildings or 




New Construction. 


§ 70803. 


Application for Architectural Plan 




Review. 


§ 70805. 


Space Conversion. 


§ 70807. 


Notice to Department. 


§ 70809. 


Patient Accommodations. 


§70811. 


Patient Rooms. 


§70813. 


Patient Property Storage. 


§70815. 


Patient Room Furnishings. 


§70817. 


Provisions for Emptying Bedpans. 


§ 70819. 


Provision for Privacy. 


§ 70821. 


Public Telephone. 


§ 70823. 


Isolation Facilities. 


§ 70825. 


Laundry Service. 


§ 70827. 


Housekeeping. 


§ 70829. 


Morgue. 


§ 70831. 


Central Sterile Supply. 


§ 70833. 


Autoclaves and Sterilizers. 


§ 70835. 


Disinfecting. 


§ 70837. 


General Safety and Maintenance. 


§ 70839. 


Air Filters. 


§70841. 


Emergency Lighting and Power 




System. 


§ 70843. 


Storage and Disposal of Solid 




Wastes. 


§ 70845. 


Solid Waste Containers. 


§ 70847. 


Infectious Waste. 


§ 70849. 


Gases for Medical Use. 


§70851. 


Lighting. 


§ 70853. 


Electrically Sensitive Areas. 


§ 70855. 


Mechanical Systems. 


§ 70857. 


Screens. 


§ 70859. 


Signal Systems. 


§ 70861. 


Storage. 



Page iv 



§ 70863. 


Water Supply and Plumbing. 


§ 70865. 


Ice. 


Article 9. 


Regulations Specific to 




Small and Rural Hospitals 814 


§70901. 


Applicability of Article 9. 


§ 70903. 


Enforcement of Article 9. 


§ 70905. 


Surgical Service General 




Requirements. 


§ 70907. 


Dietetic Service Staff. 


§ 70909. 


Intensive Care Service Space. 


§70911. 


Perinatal Unit Staff. 


§70913. 


Perinatal Unit Space. 


§ 70915. 


Physical Therapy Service General 




Requirements. 


§ 70917. 


Physical Therapy Service 




Equipment and Supplies. 


§ 70919. 


Physical Therapy Service Space. 


§70921. 


Standby Emergency Medical 




Services, Physician on Call, Space. 


§ 70923. 


Conference Room. 


ipter 2. 


Acute Psychiatric Hospital 815 


Article 1. 


Definitions 815 


§71001. 


Meaning of Words. 


§ 71003. 


Hospital. 


§ 71004. 


Acute Psychiatric Care Bed 




Classification. 


§ 71005. 


Acute Psychiatric Hospital. 


§ 71007. 


Alteration. 


§ 71009. 


Autoclaving. 


§71011. 


Basic Services. 


§71012. 


Certificate of Exemption. 


§71012.1 


Certificate of Need. 


§71013. 


Child. 


§71015. 


Cleaning. 


§71017. 


Conservator. 


§71019. 


Defined. 


§71021. 


Department. 


§ 71023. 


Director. 


§ 71025. 


Disinfection. 


§ 71027. 


Distinct Part. 


§ 71029. 


Drug Administration. 


§71031. 


Drug Dispensing. 


§71033. 


Existing Hospital Building. 


§71035. 


Governing Body. 


§71037. 


Guardian. 


§ 71038. 


Intermediate Care Bed 




Classification. 


§71039. 


License. 


§71040. 


License Category. 


§71041. 


Licensee. 


§71043. 


Maintenance. 


§ 71044. 


Modernization. 


§ 71045. 


New Construction. 


§ 71047. 


Nursing Unit. 


§ 71049. 


Outpatient Service. 


§71051. 


Patient. 


§ 71052. 


Permanently Converted. 


§71053. 


Personnel. 


§71055. 


Restraint. 


§ 71056. 


Skilled Nursing Care Bed 




Classification. 


§71057. 


Sterilization. 


§ 71059. 


Supervision. 


§71061. 


Supplemental Service. 


§ 71063. 


Unit Dose Medication System. 


Article 2. 


License 817 


§71101. 


Inspection of Hospitals. 


§71103. 


License Required. 


§71105. 


Application Required. 


§71107. 


Content of Application. 


§71109. 


Architectural Plans. 


§71110. 


Fee. 


§71111. 


Fee 




(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Page 



Page 



§71113. 


Projects Requiring a Certificate of 




Need. 


§71113.1. 


Projects Eligible for a Certificate of 




Exemption. 


§71113.2. 


Projects Not Subject to Review by a 




Voluntary Area Health Planning 




Agency. 


§71113.3. 


Projects Previously Decided by a 




Voluntary Area Health Planning 




Agency. 


§71113.4. 


Exemption Requests for 




Remodeling and Replacement 




Projects. 


§71115. 


Safety, Zoning and Building 




Clearance. 


§71117. 


Issuance. Expiration and Renewal. 


§71119. 


Separate Licenses. 


§71121. 


Posting. 


§71123. 


Transferability. 


§71124. 


Bed Classification. 


§71125. 


Report of Changes. 


§71127. 


Program Flexibility. 


§71129. 


Voluntary Suspension of License or 




Licensed Beds. 


§71131. 


Voluntary Cancellation of License. 


§71133. 


Revocation or Involuntary 




Suspension of License. 


§71134. 


Conviction of Crime: Standards for 




Evaluating Rehabilitation. 


§71135. 


Bonds. 


e3. 


Basic Services 



§71201 
§ 71203 

§ 71205 
§ 71207 

§ 71209 
§71211 

§71213 

§71215 
§71217 

§71219 
§71221 

§ 71223 

§ 71225 

§ 71227 

§ 71229 

§71231 
§ 71233 

§ 71235 
§71237 

§ 71239 
§71241 
§ 71243 

§ 71245 
§ 71247 

§ 71249. 
Article 4. 

§71301. 

§ 71303. 
§ 71305. 



Medical Service Definition. 

Medical Service General 

Requirements. 

Medical Service Staff. 

Medical Service Equipment and 

Supplies. 

Medical Service Space. 

Psychiatric Nursing Service 

Definition. 

Psychiatric Nursing Service General 

Requirements. 

Psychiatric Nursing Service Staff. 

Psychiatric Nursing Service 

Equipment and Supplies. 

Psychiatric Nursing Service Space. 

Psychiatric Rehabilitative Activities 

Service Definition. 

Psychiatric Rehabilitative Activities 

Service General Requirements. 

Psychiatric Rehabilitative Activities 

Service Staff. 

Psychiatric Rehabilitative Activities 

Service Equipment and Supplies. 

Psychiatric Rehabilitative Activities 

Service Space. 

Pharmaceutical Service Definition. 

Pharmaceutical Service General 

Requirements. 

Pharmaceutical Service Staff. 

Pharmaceutical Service Equipment 

and Supplies. 

Pharmaceutical Service Space. 

Dietetic Service Definition. 

Dietetic Service General 

Requirements 

Dietetic Service Staff. 

Dietetic Service Equipment and 

Supplies. 

Dietetic Service Space. 

Supplemental Service 

Approval 

Supplemental Service Approval 

Required. 

Application. 

Issuance, Expiration and Renewal. 



826 



§71307. 


Program Flexibility. 




§71309. 


Revocation or Involuntary 
Suspension of Approval. 




Article 5. 


Supplemental Services 


827 


§71401. 


Requirements for Supplemental 
Services. 




§71403. 


Types of Supplemental Services. 




Article 6. 


Administration 


827 


§71501. 


Governing Body. 




§71503. 


Organized Medical Staff. 




§71505. 


Medical Staff, Residents, Interns 
and Students. 




§71507. 


Patients' Rights. 




§71508. 


Clinical Research. 




§71509. 


Emotional and Attitudinal Support. 




§71511. 


Education of Patients. 




§71513. 


Outside Resource. 




§71515. 


Nondiscrimination Policies. 




§71517. 


Admission. Transfer and Discharge 
Policies. 




§71519. 


Personnel Policies. 




§71521. 


Employees. 




§ 71523. 


Employee Health Examinations and 
Health Records. 




§71525. 


Employee Personnel Records. 




§71527. 


Job Descriptions. 




§71529. 


Advertising. 




§71531. 


Records and Reports. 




§71533. 


Annual Reports. 




§ 71535. 


Reporting. 




§71537. 


Infection Control Program. 




§ 71539. 


Disaster and Mass Casualty 
Program. 




§71541. 


Fire and Internal Disasters. 




§ 71543. 


Fire Safety. 




§71544. 


Disruption of Services. 




§ 71545. 


Restraint of Patients. 




§ 71547. 


Medical Records Service. 




§ 71549. 


Medical Record Content. 




§71551. 


Medical Record Availability. 




§71553. 


Transfer Summary. 




§ 71555. 


Patients' Monies and Valuables. 




§71557. 


First Aid and Referrals. 




§ 71559. 


Medical Library. 




§71561. 


Medical Photography. 




§71563. 


Conference Room. 




Article 7. 


Physical Plant 


833 


§71601. 


Alterations to Existing Buildings or 
New Construction. 




§71603. 


Application for Plan Review. 




§ 71605. 


Space Conversion. 




§71607. 


Notice to Department. 




§ 71609. 


Patient Accommodations. 




§71611. 


Patient Rooms. 




§71613. 


Patient Property Storage. 




§71615. 


Patient Room Furnishings. 




§71617. 


Provisions for Emptying Bedpans. 




§71619. 


Provision for Privacy. 




§71621. 


Public Telephone. 




§71623. 


Isolation Facilities. 




§71625. 


Seclusion Rooms. 




§71627. 


Patient Lounge. 




§ 71629. 


Laundry Service. 




§71631. 


Housekeeping. 




§71633. 


Morgue. 




§ 71635. 


Central Sterile Supply. 




§71637. 


Autoclaves and Sterilizers. 




§71639. 


Disinfecting. 




§71641. 


General Safety and Maintenance. 




§ 71643. 


Air Filters. 




§ 71645. 


Emergency Lighting and Power 
System. 




§ 71647. 


Storage and Disposal of Solid 
Wastes. 




§ 71649. 


Solid Waste Containers. 




§71651. 


Infectious Waste. 





Page 



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Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§71653. 


§ 71655. 


§ 71657. 


§ 71659. 


§71661. 


§ 71663. 


§ 71665. 


§71667. 


Chapter 2.5. 


Article 1. 


§71801. 


§71803. 


§71805. 


§71807. 


§ 71809. 


§71811. 


§71813. 


§71815. 


§71817. 


§71819. 


§71821. 


§71823. 


§71825. 


§71827. 


Article 2. 


§ 71828. 


§71829. 


§71831. 


Article 3. 


§71833. 


§71835. 


§ 71837. 


§ 71839. 


§71841. 



Article 4. 



§71843. 

§71845. 
§71847. 
§ 71849. 



Article 5. 



§71851. 
§ 71853. 

Chapter 3. 

Article 1. 

§ 72001. 
§ 72003. 
§ 72005. 
§ 72007. 
§ 72009. 
§72011. 
§ 72013. 
§ 72015. 
§ 72017. 
§72018. 
§72018.1 
§ 72019. 
§ 72021. 
§ 72023. 
§ 72025. 



Gases for Medical Use. 

Lighting. 

Mechanical Systems. 

Screens. 

Signal Systems. 

Storage. 

Water Supply and Plumbing. 

Ice. 

Certified Nurse Assistant 

Program 837 

Definitions 837 

Agency. 

Clinical Training. 

Continuing Education. 

Core Curriculum. 

Director of Staff Development 

(DSD). 

Gross Negligence. 

Hour. 

Immediate Supervision. 

Incompetence. 

In-Service Training Program. 

Instructor. 

Nursing Facility. 

Public Educational Institution. 

Student Performance Standard. 

Administration 840 

Administrative Policies and 

Procedures. 

Director of Staff Development or 

Instructor. 

Program Flexibility. 

Program Components 841 

Orientation Program. 
Certification Training and 
Competency Evaluation Program. 
Issuance of Certificate. 
Renewal of Unexpired Certificates. 
Fees and Penalties. 

Continuing Education and In- 
Service Training 845 

Provider Identification Training 

Number. 

Continuing Education. 

In-Service Training Program. 

In-Service Training Program and 

Continuing Education Course 

Record of Attendance. 

Adverse Actions and 

Corrective Remedies 847 

Disciplinary Actions and Appeals. 

Program Site Visits. 

Skilled Nursing Facilities 848 

Definitions 848 

Meaning of Words. 

Accredited Record Technician. 

Activity Leader. 

Administrator. 

Alteration. 

Art Therapist. 

Audiologist. 

Authorized Representative. 

Biological. 

Chemical Restraint. 

Consent. 

Conservator. 

Consultant. 

Controlled Drugs. 

Dance Therapist. 



§ 72027. 


Decubitus Ulcer. 


§ 72029. 


Defined. 


§72031. 


Dentist. 


§ 72033. 


Department. 


§ 72035. 


Dietetic Service Supervisor. 


§ 72037. 


Dietitian. 


§ 72038. 


Direct Caregiver. 


§ 72039. 


Director. 


§72041. 


Distinct Part. 


§ 72043. 


Drug. 


§ 72045. 


Drug Administration. 


§ 72047. 


Drug Dispensing. 


§ 72049. 


Fomites. 


§ 72051. 


Guardian. 


§ 72052. 


Informed Consent. 


§ 72053. 


Intermediate Care Bed 




Classification. 


§ 72055. 


Licensed Nurse. 


§ 72057. 


Licensed Psychiatric Technician. 


§ 72059. 


Licensed Vocational Nurse. 


§72061. 


Licensee. 


§ 72063. 


Local Bank. 


§ 72065. 


Mechanically Altered Diet. 


§ 72067. 


Medication. 


§ 72069. 


Music Therapist. 


§72071. 


Narrative Notes. 


§ 72073. 


Nursing Unit. 


§ 72075. 


Occupational Therapist. 


§ 72077. 


Patient. 


§72077.1. 


Patient. 


§72081. 


Pharmacist. 


§ 72082. 


Physical Restraint. 


§ 72083. 


Physical Therapist. 


§ 72085. 


Physician. 


§ 72087. 


Physician's Assistant. 


§ 72089. 


Podiatrist. 


§ 72091. 


Psychologist. 


§ 72092. 


Psychotherapeutic Drug. 


§ 72093. 


Recreation Therapist. 


§ 72095. 


Registered Nurse. 


§ 72097. 


Registered Record Administrator. 


§ 72099. 


Registry Staff. 


§72101. 


Skilled Nursing Care Bed 




Classification. 


§ 72103. 


Skilled Nursing Facility. 


§72105. 


Social Worker. 


§ 72107. 


Speech Pathologist. 


§ 72109. 


Standing Orders. 


§72111. 


Substantial Compliance. 


§72113. 


Supervision. 


§72115. 


Therapeutic Diet. 


§72117. 


Unit Dose Medication System. 


§72119. 


Unit Patient Health Record. 


Article 2. 


License 


§72201. 


Application Required. 


§ 72203. 


Fee. 


§ 72205. 


Safety, Zoning and Building 




Clearance. 


§ 72207. 


Separate Licenses. 


§ 72209. 


Posting. 


§72211. 


Report of Changes. 


§72213. 


Program Flexibility. 


§ 72215. 


Voluntary Suspension of License, 




Service or Licensed Beds. 


§ 72216. 


Conviction of Crime: Standards for 




Evaluating Rehabilitation. 


§ 72217. 


Bonds. 


Article 3. 


Required Services 


§72301. 


Required Services. 


§ 72303. 


Physician Services — General 




Requirements. 


§ 72305. 


Physician Services — Medical 




Director. 


§ 72307. 


Physician Services — Supervision of 



§ 72309. 



Care. 

Nursing Service. 



Page vi 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 





Page 




Page 


§72311. 


Nursing Service — General 


§ 72415. 


Occupational Therapy Service 


§ 72313. 


Nursing Service — Administration of 




Unit— Policies and Procedures. 




Medications and Treatments. 


§ 72417. 


Occupational Therapy Service 


§72315. 


Nursing Service — Patient Care. 




Unit— Staff. 


§ 72317. 


Nursing Service — Standing Orders. 


§ 72419. 


Occupational Therapy Service 


§72319. 


Nursing Service — Restraints and 




Unit — Equipment. 




Postural Supports. 


§72421. 


Occupational Therapy Service 


§72321. 


Nursing Service — Patients with 




Unit — Space. 




Infectious Diseases. 


§ 72423. 


Speech Pathology and/or Audiology 


§ 72323. 


Nursing Service — Cleaning, 




Service Unit — Services. 




Disinfecting and Sterilizing. 


§ 72425. 


Speech Pathology and/or Audiology 


§ 72325. 


Nursing Service — Space. 




Service Unit — Policies and 


§ 72327. 


Nursing Service — Director of 




Procedures. 




Nursing Service. 


§ 72427. 


Speech Pathology and/or Audiology 


§ 72329. 


Nursing Service — Staff. 




Service Unit — Staff. 


§72329.1. 


Nursing Service — Staff. 


§ 72429. 


Speech Pathology and/or Audiology 


§72331. 


Nursing Service-Nurse Assistant 




Service Unit — Equipment. 




Training and Certificate. 


§72431. 


Speech Pathology and/or Audiology 


§ 72333. 


Dietetic Service — General. 




Service Unit — Space. 


§ 72335. 


Dietetic Service — Food Service. 


§ 72433. 


Social Work Service 


§ 72337. 


Dietetic Service — Diet Manual. 




Unit — Services. 


§ 72339. 


Dietetic Service — Therapeutic 


§ 72435. 


Social Work Service Unit — Policies 




Diets. 




and Procedures. 


§72341. 


Dietetic Service — Menus. 


§ 72437. 


Social Work Service Unit — Staff. 


§ 72343. 


Dietetic Service — Food Storage. 


§ 72439. 


Social Work Service 


§ 72345. 


Dietetic — Sanitation. 




Unit — Equipment and Supplies. 


§ 72347. 


Dietetic Service — Cleaning and 


§72441. 


Social Work Service Unit — Space. 




Disinfection of Utensils. 


§ 72443. 


Special Treatment Program Service 


§ 72349. 


Dietetic Service — Equipment and 




Unit — General. 




Supplies. 


§ 72445. 


Special Treatment Program Service 


§72351. 


Dietetic Service — Staff. 




Unit — Services. 


§ 72353. 


Pharmaceutical Service — General. 


§ 72447. 


Special Treatment Program Service 


§ 72355. 


Pharmaceutical 




Unit — Distinct Part. 




Service — Requirements. 


§ 72449. 


Special Treatment Program Service 


§ 72357. 


Pharmaceutical Service — Labeling 




Unit — Program Approval. 




and Storage of Drugs. 


§72451. 


Special Treatment Program Service 


§ 72359. 


Pharmaceutical Service — Stop 




Unit — Program Requirements. 




Orders. 


§ 72453. 


Special Treatment Program Service 


§72361. 


Pharmaceutical Service — Orders for 




Unit — Rights of Patients. 




Drugs. 


§ 72455. 


Special Treatment Program Service 


§ 72363. 


Pharmaceutical Service — Drug 




Unit — Abuse and Corporal 




Order Processing. 




Punishment. 


§ 72365. 


Pharmaceutical Service — Drug 


§ 72457. 


Special Treatment Program Service 




Order Records. 




Unit — Restraint and Seclusion. 


§ 72367. 


Pharmaceutical Service — Personal 


§ 72459. 


Special Treatment Program Service 




Medications. 




Unit — Acceptable Forms of 


§ 72369. 


Pharmaceutical Service — Controlled 




Restraints. 




Drugs. 


§72461. 


Special Treatment Program Service 


§72371. 


Pharmaceutical 




Unit — Orders for Restraint and 




Service — Disposition of Drugs. 




Seclusion. 


§ 72373. 


Pharmaceutical Service — Unit Dose 


§ 72463. 


Special Treatment Program Service 




Medication System. 




Unit — Restrictions on Applying 


§ 72375. 


Pharmaceutical Service — Staff. 




Restraints and Utilizing Seclusion. 


§ 72377. 


Pharmaceutical 


§ 72465. 


Special Treatment Program Service 




Service — Equipment and Supplies. 




Unit— Staff. 


§ 72379. 


Activity Program — General. 


§ 72467. 


Special Treatment Program Service 


§72381. 


Activity Program — Requirements. 




Unit — Program Director. 


§ 72383. 


Activity Program — Activity Plan. 


§ 72469. 


Special Treatment Program Service 


§ 72385. 


Activity Program — Staff. 




Unit — In-Service Education. 


§ 72387. 


Activity Program — Equipment and 


§72471. 


Special Treatment Program Service 




Supplies. 




Unit — Patient Health Records and 


§ 72389. 


Activity Program — Space. 




Plans for Care. 


Article 4. 


Optional Services 853 


§ 72473. 


Special Treatment Program Service 
Unit — Equipment. 


§ 72401. 


Optional Service Units — General. 


§ 72475. 


Special Treatment Program Service 


§ 72403. 


Physical Therapy Service 
Unit — Services. 




Unit — Space. 


§ 72405. 


Physical Therapy Service 


Article 5. 


Administration 859 




Unit — Policies and Procedures. 


§72501. 


Licensee — General Duties. 


§ 72407. 


Physical Therapy Service 


§ 72503. 


Consumer Information to Be 




Unit— Staff. 




Posted. 


§ 72409. 


Physical Therapy Service 


§ 72505. 


Fire Safety. 




Unit — Equipment. 


§ 72507. 


Smoking. 


§72411. 


Physical Therapy Service 


§ 72509. 


Advertising. 




Unit — Space. 


§72511. 


Use of Outside Resources. 


§ 72413. 


Occupational Therapy Service 


§ 72513. 


Administrator. 




Unit — Services. 


§ 72515. 


Admission of Patients. 



Page vii 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§72516 


Standard Admission Agreement. 


§72517 


Staff Development. 


§72519 


Patient Transfer. 


§ 72520 


Bed Hold. 


§ 72521 


Administrative Policies and 




Procedures. 


§ 72523 


Patient Care Policies and 




Procedures. 


§ 72525. 


Required Committees. 


§ 72527 


Patients' Rights. 


§ 72528 


Informed Consent Requirements. 


§ 72529 


Safeguards for Patients' Monies and 




Valuables. 


§72531 


Liability for Rent and Return of 




Rental Advance. 


§ 72533 


Employee Personnel Records. 


§ 72535 


Employees' Health Examination 




and Health Records. 


§ 72537 


Reporting of Communicable 




Diseases. 


§ 72539 


Reporting of Outbreaks. 


§ 72541 


Unusual Occurrences. 


§ 72543 


Patients' Health Records. 


§ 72545 


Admission Records. 


§ 72547 


Content of Health Records. 


§ 72549 


Patient Death Reports. 


§ 72551 


External Disaster and Mass Casualty 




Program. 


§ 72553 


Fire and Internal Disasters. 


§ 72555 


Patient Identification. 


§ 72557 


Equipment and Supplies. 


Article 6. 


Physical Plant 867 


§ 72601 


Alterations to Existing Buildings or 




New Construction. 


§ 72603 


Space Conversion. 


§ 72605 


Notice to Department. 


§ 72607 


Patient Capacity. 


§ 72609 


Patient Rooms. 


§72611 


Special Rooms. 


§ 72613 


Patient's Property Storage and 




Room Furnishings. 


§72615 


Provision for Privacy. 


§ 72617 


Public Telephone. 


§ 72619 


Space and Equipment for 




Autoclaving, Sterilizing and 




Disinfecting. 


§ 72621 


Housekeeping. 


§ 72623 


Laundry. 


§ 72625 


Clean Linen. 


§ 72627 


Soiled Linen. 


§ 72629 


Provisions for Emptying Bedpans. 


§ 72631 


Signal Systems. 


§ 72633 


Utility Rooms. 


§ 72635 


Handrails. 


§ 72637 


General Maintenance. 


§ 72639 


Air Filters. 


§ 72641 


Emergency Lighting and Power 




System. 


§ 72643 


Storage and Disposal of Solid 




Wastes. 


§ 72645 


Solid Waste Containers. 


§ 72647 


Infectious Waste. 


§ 72649 


Gases for Medical Use. 


§ 72651 


Water Supply and Plumbing. 


§ 72653 


Lighting. 


§ 72655 


Maintenance Manual. 


§ 72657 


Mechanical Systems. 


§ 72659 


Screens. 


§ 72661 


Storage. 


§ 72663 


Space. 


§ 72665 


Centralized Services Shared by 




Several Facilities. 


Article 7. 


Violations and Civil 




Penalties 871 


§ 72701 


Definitions. 


§ 72703 


Class "A" Violations — Examples. 



§ 72705. 
§ 72707. 
§ 72709. 
§72711. 
§72713. 



Class "B" Violations — Examples. 

Filing of Names and Addresses. 

Issuance of Citations. 

Penalties. 

Citation Review Conference. 



Chapter 3.5. Receivership Management of Long- 
Term Care Facilities 873 

§ 72801 . Minimum Qualifications for a 

Receiver. 
§ 72803. Receivership Investigation. 

§ 72805. 



Chapter 4. 

Article 1. 

§73001. 
§ 73003. 
§ 73005. 
§ 73007. 
§ 73009. 
§73011. 
§ 73012. 
§73012.1. 
§ 73012.2. 
§ 73013. 
§ 73014. 
§ 73015. 
§ 73017. 
§ 73019. 
§73021. 
§ 73023. 
§ 73025. 
§ 73027. 
§ 73029. 
§73031. 
§ 73033. 
§ 73035. 
§ 73037. 
§ 73039. 
§ 73041. 
§ 73043. 
§ 73045. 
§ 73047. 
§ 73049. 
§ 73049.1. 
§ 73050. 

§73051. 
§ 73053. 
§ 73054. 
§ 73055. 
§ 73057. 
§ 73059. 
§73061. 
§ 73063. 
§ 73064. 
§ 73065. 
§ 73067. 
§ 73069. 
§73071. 
§ 73073. 
§ 73075. 
§ 73077. 
§ 73078. 
§ 73079. 
§ 73080. 
§ 73081. 
§ 73083. 
§ 73085. 
§ 73087. 
§ 73089. 
§ 73090. 
§73091. 
§ 73093. 
§ 73095. 
§ 73097. 
§ 73099. 



Duties of a Receiver. 
Intermediate Care Facilities 



Definitions 



873 
873 



Activity Leader. 

Administrator. 

Alteration. 

Art Therapist. 

Audiologist. 

Autoclaving. 

Certificate of Exemption. 

Certificate of Need. 

Chemical Restraint. 

Cleaning. 

Consent. 

Conservator. 

Consultant. 

Dance Therapist. 

Defined. 

Dentist. 

Department. 

Developmentally Disabled. 

Developmental Specialist. 

Dietitian. 

Director. 

Disinfection. 

Distinct Part. 

Drug Administration. 

Drug Dispensing. 

Existing Facility. 

Guardian. 

Health Facility. 

Infirmary. 

Informed Consent. 

Intermediate Care Bed 

Classification. 

Intermediate Care Facility. 

License. 

License Category. 

Licensee. 

Licensed Psychiatric Technician. 

Licensed Vocational Nurse. 

Long-Term Health Care Facility. 

Maintenance. 

Modernization. 

Music Therapist. 

New Construction. 

New Facility. 

Nursing Unit. 

Occupational Therapist. 

Occupational Therapy Assistant. 

Patient. 

Permanently Converted. 

Pharmacist. 

Physical Restraint. 

Physical Therapist. 

Physical Therapist Assistant. 

Physician. 

Podiatrist. 

Psychologist. 

Psychotherapeutic Drug. 

Recreation Therapist. 

Registered Nurse. 

Restraint. 

Skilled Nursing Facility. 

Social Work Aide. 



Page viii 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Page 



Page 



§73101. 


Social Work Assistant. 


§73103. 


Social Worker. 


§ 73105. 


Special Disability Professional. 


§ 73107. 


Special Disability Worker. 


§73109. 


Speech Pathologist. 


§73111. 


Sterilization. 


§73113. 


Supervision. 


§73115. 


Unit Dose Medication System. 


icle 2. 


License 8 


§73201. 


License Required. 


§ 73203. 


Application Required. 


§ 73205. 


Content of Application. 


§ 73207. 


Architectural Plans. 


§ 73208. 


Fee. 


§ 73209. 


Fee. 


§73211. 


Projects Requiring a Certificate of 




Need. 


§73211.1. 


Projects Eligible for a Certificate of 




Exemption. 


§73211.2. 


Projects Not Subject to Review by a 




Voluntary Area Health Planning 




Agency. 


§73211.3. 


Projects Previously Decided by a 




Voluntary Area Health Planning 




Agency. 


§73211.4. 


Exemption Requests for 




Remodeling and Replacement 




Projects. 


§73213. 


Safety, Zoning and Building 




Clearance. 


§73214. 


Bed Classification. 


§ 73215. 


Issuance, Expiration and Renewal. 


§73217. 


Provisional License. 


§ 73219. 


Separate Licenses. 


§73221. 


Posting. 


§ 73223. 


Transferability. 


§ 73225. 


Report of Changes. 


§ 73227. 


Program Flexibility. 


§ 73229. 


Voluntary Suspension of License, 




Service or Licensed Beds. 


§73231. 


Voluntary Cancellation of License. 


§ 73233. 


Revocation or Involuntary 




Suspension of License. 


§ 73235. 


Temporary Suspension of License. 


§ 73237. 


Pursuing Disciplinary Action to 




Completion. 


§ 73239. 


Reinstatement of Revoked or 




Suspended License. 


§ 73240. 


Conviction of Crime: Standards for 




Evaluating Rehabilitation. 


§73241. 


Bonds. 


icle 3. 


Services 



876.1 



881 



§73301. Required Services. 

§ 73303. Physician Services — General. 

§ 73305. Physician Services — Policies and 

Procedures. 
§ 73307. Physician Services — Equipment and 

Supplies. 
§ 73309. Nursing Service — Defined. 

§ 733 1 1 . Nursing Service — General. 

§ 73313. Nursing Service — Drug 

Administration. 
§ 733 1 5. Nursing Service — Patient Care. 

§ 73317. Nursing Service — Policies and 

Procedures. 
§ 73318. Nursing Service — Nurse Assistant 

Training and Certification. 
§ 733 1 9. Nursing Service— Staff. 

§ 73321. Nursing Service — Equipment and 

Supplies. 
§ 73323. Dietetic Service— Defined. 

§ 73325. Dietetic Service— Food Service. 

§ 73327. Dietetic Service — Policies and 

Procedures. 
§ 73329. Dietetic Service— Diet Manual. 



§73331. 

§ 73333. 
§ 73335. 

§ 73337. 
§ 73339. 
§73341. 

§ 73343. 
§ 73345. 

§ 73347. 
§ 73349. 

§73351. 

§ 73353. 

§ 73355. 

§ 73357. 

§ 73359. 

§73361. 

§ 73363. 

§ 73365. 

§ 73367. 

§ 73369. 

§73371. 

§ 73373. 
§ 73375. 

§ 73377. 
§ 73379. 
§73381. 

§ 73383. 

§ 73385. 
§ 73387. 

§ 73389. 
§73391. 
§ 73393. 

§ 73395. 
§ 73397. 
§ 73399. 
§73401. 
§ 73403. 
§ 73405. 

§ 73407. 

§ 73409. 

§73411. 
§73413. 

§ 73415. 



Dietetic Service — Therapeutic 

Diets. 

Dietetic Service — Menus. 

Dietetic Service — In-Service 

Training. 

Dietetic Service — Food Storage. 

Dietetic Service— Sanitation. 

Dietetic Service — Cleaning and 

Disinfection of Utensils. 

Dietetic Service — Staff. 

Dietetic Service — Equipment and 

Supplies. 

Pharmaceutical Service — General. 

Pharmaceutical Service 

Requirements. 

Pharmaceutical Service — Policies 

and Procedures. 

Pharmaceutical Service — Orders for 

Drugs. 

Pharmaceutical Service — Standing 

Orders. 

Pharmaceutical Service — Stop 

Orders. 

Pharmaceutical Service — Drug 

Order Processing. 

Pharmaceutical Service — Drug 

Order Records. 

Pharmaceutical Service — Personal 

Medications. 

Pharmaceutical Service — Labeling 

and Storage of Drugs. 

Pharmaceutical Service — Controlled 

Drugs. 

Pharmaceutical Service — Disposal 

of Drugs. 

Pharmaceutical Service — Unit Dose 

Medication System. 

Pharmaceutical Service — Staff. 

Pharmaceutical 

Service — Equipment and Supplies. 

Activity Program — Defined. 

Activity Program — Scope. 

Activity Program — Policies and 

Procedures. 

Activity Program — Activity 

Record. 

Activity Program — Staff. 

Activity Program-Equipment and 

Supplies. 

Activity Program-Space. 

Special Disability Services. 

Special Disability 

Services — "Distinct 

Part" — "Program." 

Special Disability 

Services — Program Approval. 

Special Disability 

Services — Program Requirements. 

Special Disability Services — Rights 

of Patients. 

Special Disability Services — Abuse 

and Corporal Punishment. 

Special Disability 

Services— Restraint and Seclusion. 

Special Disability 

Services — Acceptable Forms of 

Restraint. 

Special Disability 

Services — Restrictions on Applying 

Restraints. 

Special Disability Services — Orders 

for Restraint and Seclusion. 

Special Disability Services — Staff. 

Special Disability 

Services — Equipment. 

Special Disability Services — Space. 



Page 



IX 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§73417. 


Special Rehabilitation Program 




Services — Mentally Disordered. 


§ 73419. 


Special Rehabilitation Program 




Services — Staffing. 


§73421. 


Special Rehabilitation Program 




Services — In-Service Training. 


§ 73423. 


Special Rehabilitation Program 




Services — Patient Health Records. 


§ 73425. 


Special Subacute Psychiatric 




Program Services — Mentally 




Disordered. 


§ 73427. 


Special Subacute Psychiatric 




Program Services — Staffing. 


§ 73429. 


Special Subacute Psychiatric 




Program Services — In-Service 




Training. 


§73431. 


Special Subacute Psychiatric 




Program Services — Patient Health 




Records. 


§ 73433. 


Special Program 




Requirements — Developmental ly 




Disabled. 


§ 73435. 


Special Program 




Requirements — Staffing. 


§ 73437. 


Special Program 




Requirements — In-Service 




Training. 


§ 73439. 


Special Program 




Requirements — Patient Health 




Records. 


§73441. 


Application, Issuance, Expiration 




and Renewal. 


§ 73445. 


Optional Service Unit. 


§ 73447. 


Optional Services — Revocation or 




Involuntary Suspension of 




Approval. 


§ 73449. 


Social Work Service Unit. 


§73451. 


Social Work Service Unit — Policies 




and Procedures. 


§ 73453. 


Social Work Service Unit— Staff. 


§ 73455. 


Social Work Service 




Unit — Equipment and Supplies. 


§ 73457. 


Social Work Service Unit — Space. 


§ 73459. 


Physical Therapy Service Unit. 


§ 73461. 


Physical Therapy Service 




Unit — Policies and Procedures. 


§ 73463. 


Physical Therapy Service 




Unit— Staff. 


§ 73465. 


Physical Therapy Service 




Unit — Equipment. 


§ 73467. 


Physical Therapy Service 




Unit — Space. 


§ 73469. 


Occupational Therapy Service Unit. 


§73471. 


Occupational Therapy Service 




Unit — Policies and Procedures. 


§ 73473. 


Occupational Therapy Service 




Unit— Staff. 


§ 73475. 


Occupational Therapy Service 




Unit — Equipment . 


§ 73477. 


Occupational Therapy Service 




Unit — Space. 


§ 73479. 


Speech Pathology and/or Audiology 




Service Unit. 


§73481. 


Speech Pathology and/or Audiology 




Service Unit — Policies and 




Procedures. 


§ 73483. 


Speech Pathology and/or Audiology 




Service Unit — Staff. 


§ 73485. 


Speech Pathology and/or Audiology 




Service Unit — Equipment. 


§ 73487. 


Speech Pathology and/or Audiology 




Service Unit — Space. 


§ 73489. 


Rehabilitation Service Unit. 


§ 73491. 


Rehabilitation Service 




Unit — Policies and Procedures. 


§ 73493. 


Rehabilitation Service Unit — Staff. 



§ 73495. Rehabilitation Service 

Unit — Equipment. 
§ 73497. Rehabilitation Service Unit— Space. 

Article 4. Administration 901 

§ 73501. Licensee — General Duties. 

§ 73502. Consumer Information to Be 

Posted. 
§ 73503. Transfer Agreements. 

§ 73504. Bed Hold. " 

§ 73505. Affiliations. 

§ 73507 Fire Safety. 

§ 73509. Smoking. 

§73511. Administrator. 

§ 73513. Advertising. 

§73515. Inspection Reports. 

§ 73517. Admission of Patients 

§ 73518. Standard Admission Agreement. 

§ 73519. Administrative Policies and 

Procedures. 
§ 73521. Patient Care Policy Committee. 

§ 73523. Patients' Rights. 

§ 73524. Informed Consent Requirements. 

§ 73525. Employees' Health Examinations 

and Health Records. 
§ 73527. Employee Personnel Records. 

§ 73529. Employee Name Badges. 

§ 73531. Patients with Communicable 

Disease. 
§ 73533. Reporting of Communicable 

Disease. 
§73535. Reporting of Outbreaks. 

§ 73537. Occurrence of Unusual Disease. 

§ 73539. Unusual Occurrences. 

§73541. Annual Reports. 

§ 73543. Patients' Health Records. 

§ 73545. Admission Records. 

§ 73547. Content of Health Records. 

§ 73549. Disaster and Mass Casualty 

Program. 
§ 73551. Fire and Internal Disasters. 

§ 73553. Disruption of Services. 

§ 73555. Patient Identification. 

§ 73557. Safeguards for Patients' Monies and 

Valuables. 
§ 73558. Liability for Rent and Return of 

Rental Advance. 



Article 5. 


Physical Plant 


906 


§73601. 


Alterations to Existing Buildings or 
New Construction. 




§ 73603. 


Application for Plan Review. 




§ 73605. 


Space Conversion. 




§ 73607. 


Notice to Department. 




§ 73609. 


Patient Capacity. 




§73611. 


Patient Rooms. 




§ 73613. 


Patients' Property Storage. 




§ 73615. 


Patients' Room Furnishings. 




§ 73617. 


Recreation and Dining Areas. 




§73619. 


Provision for Privacy. 




§73621. 


Public Telephone. 




§ 73623. 


Special Rooms. 




§ 73625. 


Nursing Stations. 




§ 73627. 


Central Supply and Sterilizing. 




§ 73629. 


Utility Rooms. 




§73631. 


Special Systems. 




§ 73633. 


Handrails. 




§ 73635. 


General Maintenance. 




§ 73637. 


Air Filters. 




§ 73639. 


Emergency Lighting and Power 
System. 




§73641. 


Storage and Disposal of Solid 
Waste. 




§ 73643. 


Solid Waste Containers. 




§ 73645. 


Infectious Waste. 




§ 73647. 


Gases for Medical Use. 





Page 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Page 



Page 



§ 73649. 
§73651. 
§ 73653. 
§ 73655. 
§ 73657. 
§ 73659. 
§73661. 
§ 73663. 
§ 73665. 
§ 73667. 
§ 73669. 
§73671. 
§ 73673. 
§ 73675. 
§ 73677. 

§ 73679. 
§73681. 
§ 73683. 

§ 73685. 



Article 6. 



§73701. 
§ 73702. 
§ 73703. 
§ 73705. 
§ 73707. 
§ 73709. 
§73711. 
§ 73713. 
§73715. 
§73717. 
§ 73719. 
§73721. 
§ 73723. 
§ 73725. 
§ 73727. 



Chapter 4.5. 



Chapter 5. 

Article 1. 

§74001. 
§ 74003. 
§ 74005. 
§ 74007. 
§ 74009. 
§74011. 
§ 74013. 
§ 74015. 
§ 74017. 
§74019. 
§ 74021. 
§ 74023. 

Article 2. 

§74101. 
§ 74103. 
§74105. 
§ 74107. 
§ 74108. 
§ 74109. 
§74111. 
§74113. 
§74115. 
§74117. 
§74119. 
§74121. 

§ 74123. 



911 



Water Supply and Plumbing. 

Lighting. 

Maintenance Manual. 

Mechanical Systems. 

Screens. 

Storage. 

Space. 

Linen. 

Laundry 

Laundry Areas. 

Clean Linen. 

Soiled Linen. 

Wash Cloths and Towels. 

Housekeeping. 

Autoclaving, Sterilizing and 

Disinfecting. 

Disinfecting and Sterilizing. 

Provisions for Emptying Bedpans. 

Cleaning, Disinfecting and 

Sterilizing Manual. 

Centralized Services Shared by 

Several Facilities. 

Violations and Civil 

Penalties 

Definitions. 

Class "A" Violations. 

Class "A" Violations — Examples. 

Class "B" Violations. 

Class "B" Violations — Examples. 

Class "C" Violations. 

Filing of Names and Addresses. 

Complaints. 

Issuance of Citations. 

Penalties. 

Review Procedures. 

Informal Conference. 

Posting of Citations. 

Interference with Official Duties. 

Discrimination or Retaliation. 



Intermediate Care Facility/ 
Developmentally Disabled- 
Nursing 914 

Referral Services 914 

Definitions 914 

Agency Manager. 

Client. 

Department. 

Health Facility. 

License. 

Licensed Psychiatric Technician. 

Licensed Vocational Nurse. 

Licensee. 

Patient. 

Referral Agency. 

Registered Nurse. 

Social Worker. 

License 915 

License Required. 

Application Required. 

Content of Application for License. 

Referral Agency — Name. 

Fee. 

Fee. 

Issuance, Expiration and Renewal. 

Separate Licenses. 

Posting. 

Transferability. 

Report of Changes. 

Cancellation or Voluntary 

Suspension of License. 

Revocation or Suspension of 

License. 



§ 74125. 


Civil Penalty. 


§ 74127. 


Pursuing Disciplinary Action to 




Completion. 


§74129. 


Reinstatement — Discipline 




Reduction. 


Article 3. 


Administration 


§74201. 


Agency Manager. 


§ 74203. 


Plan of Operation. 


§ 74205. 


Records. 


§ 74207. 


Facility Records. 


§ 74209. 


Accounting Records. 


§74211. 


Patient Records. 


§74213. 


Personnel Records. 


§74215. 


Fiscal Reports. 


Article 4. 


Services 


§74301. 


Services. 


§ 74303. 


Patient Screening. 


§ 74305. 


Facility Information. 


§ 74307. 


Counseling Procedures. 


§ 74309. 


Referral Services. 


Article 5. 


Personnel Requirements 


§74401. 


Policy Statement. 


§ 74403. 


In-Service Training Policy 




Statement. 


§ 74405. 


Staff Qualifications. 


Article 6. 


General Provisions 


§74501. 


Financial Interest Prohibited. 


§ 74503. 


Fee Schedule. 


§ 74505. 


Payment Terms. 


§ 74507. 


Deposit and Refund Policy. 


§ 74509. 


Re-Referral Fee Prohibited. 


§74511. 


Collection of Duplicate Fees. 


§ 74513. 


Advertisements; 



950 



950 



951 



952 



§ 74515. 



Chapter 6. 



Article 1. 


§ 74600. 


§ 74601. 


§ 74603. 


§ 74605. 


§ 74607. 


§ 74609. 


§74611. 


§ 74613. 


§ 74615. 


§ 74617. 


§ 74619. 


§74621. 


§ 74623. 


§ 74624. 


§ 74625. 


§ 74627. 


§ 74629. 


§74631. 


§ 74633. 


§ 74635. 


§ 74637. 


§ 74639. 


§74641. 


§ 74643. 


§ 74645. 


§ 74647. 


§ 74649. 


§74651. 


§ 74652. 


§ 74653. 


§ 74655. 


§ 74657. 



Misrepresentations. 

Referral of Client to Unlicensed 

Facilities Prohibited. 

Home Health Agencies 952 

Definitions 952 

Home Health Agency. 

Public Agency. 

Private Agency. 

Subdivision. 

Parent and Primary Home Health 

Agency. 

Branch Office. 

Subunit. 

Administrator. 

Audiologist. 

Dentist. 

Department. 

Director. 

Dietitian. 

Home Health Aide. 

Home Health Services. 

License. 

Licensee. 

Licensed Vocational Nurse. 

Occupational Therapist. 

Occupational Therapist Assistant. 

Part-Time or Intermittent Care. 

Patient. 

Physical Therapist. 

Physical Therapist Assistant. 

Physician. 

Podiatrist. 

Public Health Nurse. 

Registered Nurse. 

Skilled Nursing Services Criteria for 

Licensure of Home Health 

Agencies. 

Social Worker. 

Social Work Assistant. 

Speech Pathologist. 



Page xi 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 





Page 




Page 


Article 2. 


License 956 

License Required. 


Article 1. 

§75001. 


Definitions 962.10 


§ 74659. 


Meaning of Words. 


§ 74661. 


Application for License. 


§ 75002. 


Accredited Record Technician. 


§ 74663. 


Special Conditions for License. 


§ 75003. 


Clinic. 


§ 74664. 


Operation of a Home Health 


§75003.1. 


Birth Services. 




Agency Across State Lines. 


§ 75004. 


Dangerous Drug. 


§ 74665. 


Disclosure Clause. 


§ 75005. 


Dental Clinic. 


§ 74667. 


Report of Changes. 


§ 75006. 


Dentist. 


§ 74669. 


Fee. 


§ 75007. 


Drug. 


§74671. 


Issuance, Denial, Expiration and 


§ 75008. 


Drug Administration. 




Renewal. 


§ 75009. 


Drug Dispensing. 


§ 74673. 


Transferability. 


§75009.1. 


High-Risk. 


§ 74675. 


Separate Licenses. 


§ 75010. 


Infectious Wastes. 


§ 74677. 


Availability of License. 


§75011. 


Licensed Nurse. 


§ 74679. 


Voluntary Suspension of License. 


§ 75012. 


Licensed Vocational Nurse. 


§ 74681. 


Voluntary Cancellation of License. 


§ 75013. 


Medical Clinic. 


§ 74683. 


Revocation or Involuntary 


§ 75014. 


Pharmacist. 




Suspension of License. 


§75015. 


Physician. 


§ 74685. 


Pursuing Disciplinary Action to 


§ 75016. 


Physician's Assistant. 




Completion. 


§ 75017. 


Podiatric Clinic. 


§ 74687. 


Reinstatement of Revoked or 


§75018. 


Podiatrist. 




Suspended License. 


§ 75019. 


Registered Nurse. 


§ 74689. 


Program Flexibility. 


§ 75020. 


Registered Record Administrator. 


Article 3. 


Services 959 


Article 2. 


License 963 


§74691. 


Services Provided. 


§ 75021. 


Application Required. 


§ 74693. 


Preventive, Treatment and 


§75021.1. 


Special Permit Required. 




Rehabilitative Services. 


§ 75022. 


Content of Application. 


§ 74695. 


Requirements for Acceptance of 


§ 75023. 


Fees. 




Patients. 


§ 75024. 


Posting. 


§ 74697. 


Plan of Treatment; Plan of Care; 
Plan for Personal Care Services. 


§ 75025. 


Report of Changes. 


§ 74699. 


Summary Report. 


Article 3. 


Basic Services 964 


§74701. 


Orders for Medication and 


§ 75026. 


Basic Services — General 




Treatment. 




Requirements. 


§ 74703. 


Director of Patient Care Services. 


§ 75027. 


Basic Services — Medical Staff. 


§ 74705. 


Nurse Supervisor. 


§ 75028. 


Basic Services — Nursing Staff. 


§ 74707. 


Skilled Nursing Services. 


§ 75029. 


Basic Services — Other Health 


§ 74709. 


Home Health Aide/Personal Care 




Personnel. 




Services Supervision. 


§ 75030. 


Basic Services — Policies and 


§ 74710. 


Personal Care/Home Health Aide 




Procedures. 




Services. 


§ 75031. 


Basic Services — Equipment and 


§74711. 


Therapy Services. 




Supplies. 


§ 74713. 
§ 74715. 


Medical Social Services. 
Diet Counseling Services. 


Article 4. 


Drug Distribution 965 






§ 75032. 


Drug Distribution Service — General 


Article 4. 


Administration 962.2 




Requirements. 


§ 74717. 


Governing Body. 


§ 75033. 


Drug Distribution Service — Policies 


§ 74718. 


Administrator. 




and Procedures. 


§ 74719. 


Services Arranged by Agreement. 


§ 75034. 


Drug Distribution Service — Orders 


§ 74721. 


Written Administrative Policies. 




for Drugs. 


§ 74723. 


Employee's Health Examinations 


§ 75035. 


Drug Distribution 




and Health Records. 




Service — Administration of Drugs. 


§ 74725. 


Reporting of Communicable 


§ 75036. 


Drug Distribution 




Disease. 




Service — Dispensing of Drugs. 


§ 74727. 


Reporting of Outbreaks. 


§ 75037. 


Drug Distribution Service — Storage 


§ 74729. 


Annual Reports. 




of Drugs. 


§74731. 


Patients' Health Records 


§ 75038. 


Drug Distribution Service — Staff. 




Availability. 


§ 75039. 


Drug Distribution 


§ 74733. 


Admission Records. 




Service — Equipment and Supplies. 


§ 74735. 
§ 74737. 


Patient Health Records. 
Professional Advisory Group. 


Article 5. 


Abortion Service 966 


§ 74739. 


Program Evaluation. 


§ 75040. 


Abortion Service — General 


§74741. 


Utilization Review. 




Requirements. 


§ 74742. 


Quality Management. 


§75041. 


Abortion Service — Policies and 


§ 74743. 


Patient Rights. 




Procedures. 


§ 74744. 


Plans of Correction. 


§ 75042. 


Abortion Service — Equipment and 
Supplies. 


Article 5. 


Qualifications for Home 


§ 75043. 


Abortion Service — Staff. 




Health Aide Certification 962.9 


§ 75044. 
Article 6. 


Abortion Service — Space. 


§ 74745. 


Home Health Aide Certification. 


Administration 966 


§ 74747. 


Home Health Aide Training. 


§ 75045. 


Governing Body. 


§ 74749. 


Issuance, Denial, Revocation or 


§ 75046. 


Administrator. 




Suspension of Home Health Aide 


§ 75047. 


Transfer Agreements. 




Certificate. 


§ 75048. 


Service Agreements. 






§ 75049. 


Written Administrative Policies. 


Chapter 7. 


Primary Care Clinics 962.10 


§ 75050. 
»e xii 


Employees. 

(7-18-2008) 


Pai 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 





Page 








Page 


§75051. 


Health Examination and Health 




§ 75204. 


Cleaning. 






Records of Persons Working in the 




§ 75205. 


Performance. 






Clinic. 




§ 75206. 


Disinfection and Storage. 




§ 75052. 


Employee Records. 




§ 75207. 


Disinfectant Rinsing. 




§ 75053. 


Unusual Occurrences. 




§ 75208. 


Quality Assurance Audits. 




§ 75054. 


Patient Health Record Service. 










§ 75055. 


Unit Patient Health Records. 


Chapter 


7.2. 


Psychology Clinics 


977 


§ 75056. 
§ 75057. 


Admission Records. 
Disaster Program. 
Posting of Clinic Schedule. 


Article 1. 


Definitions 


977 


§ 75058. 




§75301. 


Accredited Record Technician. 




§ 75059. 


Quality Assurance Evaluation 




§ 75303. 


Clinic. 






Program. 




§ 75305. 


Psychologist. 










§ 75307. 


Registered Record Administrator. 




Article 7. 


Physical Plant 968 


Article ?.. 


License 


977 


§ 75060. 


Alterations and New Construction. 










§75061. 


Fire Safety. 




§ 75309. 


Application Required. 




§ 75062. 


Maintenance and Operation. 




§75311. 


Content of Application. 




§ 75063. 


Water Supply and Plumbing. 




§ 75313. 


Fees. 




§ 75064. 


Autoclaving and Sterilizing. 




§ 75315. 


Posting. 




§ 75065. 


Disinfecting. 




§ 75317. 


Report of Changes. 




§ 75066. 


Cleaning Equipment and Fixtures. 


Article 3. 


Basic Services 


977 


§ 75067. 


Storage and Disposal of Solid 




§75321. 


Basic Services — General 




§ 75068. 
§ 75069. 


Wastes. 

Solid Waste Containers. 

Infectious Waste. 




§ 75323. 
§ 75325. 


Requirements. 

Basic Services — Psychology Staff. 

Basic Services — Policies and 




§ 75070. 


Gases for Medical Use. 






Procedures. 




§75071. 


Linen and Laundry. 










§ 75072. 


Space Conversion. 


Article 4. 


Administration 


978 


Article 8. 


Appeals Procedure 969 




§ 75327. 
§ 75329. 


Governing Body. 
Administrator. 




§ 75073. 


Appeals Procedure. 




§75331. 


Written Administrative Policies. 




Article 9. 


Birth Services 970 




§ 75333. 
§ 75335. 


Employees. 

Employee Health Examinations and 




§ 75075. 


Birth Services — General 






Health Records. 






Requirements. 




§ 75337. 


Employee Records. 




§ 75077. 


Birth Services — Policies and 




§ 75339. 


Unusual Occurrences. 






Procedures. 




§ 75341. 


Patient Treatment Record Service. 




§ 75079. 


Birth Services — Equipment and 




§ 75343. 


Unit Patient Treatment Records. 






Supplies. 




§ 75345. 


Admission Records. 




§ 75081. 


Birth Services — Staff. 




§ 75347. 


Disaster Program. 




§ 75083. 


Birth Services — Space. 




§ 75349. 
§75351. 


Posting of Clinic Schedule. 
Quality Assurance Evaluation 




Chapter 7.1. 
Article 6. 


Specialty Clinics 97 1 






Program. 
Physical Plant 




Hemodialyzer Reuse 971 


Article 5. 


980 


§ 75172. 


Automated Reuse Machines. 




§ 75353. 


Alterations and New Construction. 




§75173. 


Cleaning. 




§ 75355. 


Fire Safety. 




§ 75174. 


Clearance. 




§ 75357. 


Maintenance and Operation. 




§75175. 


Device History Record. 




§ 75359. 


Water Supply and Plumbing. 




§ 75176. 


Dialysis Facility. 




§75361. 


Cleaning Equipment and Fixtures. 




§75177. 


Dialysis Treatment. 




§ 75363. 


Storage and Disposal of Solid 




§75178. 


Dialyzer. 






Wastes. 




§75178.5. 


Disinfectant Chemical. 




§ 75365. 


Solid Waste Containers. 




§ 75179. 


Disinfectant Rinsing. 




§ 75367. 


Electrical Systems. 




§ 75180. 


Documentation. 




§ 75369. 


Illumination. 




§75181. 


Fiber Bundle Volume. 




§75371. 


Space Conversion. 




§75182. 
§75183. 


Formaldehyde. 
Formaldehyde Disinfectant. 


Chapter 


8. 


Intermediate Care Facilities for 




§75184. 


Label. 






the Developmentally Disabled 


981 


§ 75185. 


Membrane. 










§75186. 


Performance. 


Article 1 . 


Definitions 


981 


§75187. 


PPM. 




§ 76000. 


Statement of Purpose. 




§75188. 


Pyrogen. 




§76001. 


Meaning of Words. 




§75189. 


Record. 




§ 76003. 


Accredited Record Technician. 




§ 75189.5. 


Reprocessing. 




§ 76005. 


Administrator. 




§ 75190. 


Reprocessing Technician. 




§ 76007. 


Advertisement. 




§75191. 


Reuse or Multiple Use. 




§ 76009. 


Alteration. 




§ 75192. 


Reuse Number. 




§76011. 


Art Therapist. 




§75193. 


Ultrafiltration. 




§ 76013. 


Audiologist. 




§ 75194. 


Validation or Process Validation. 




§ 76015. 


Authorized Representative. 




§ 75195. 


Scope and Application. 




§ 76017. 


Autoclaving. 




§75196. 


Contraindications. 




§ 76019. 


Aversive Techniques. 




§ 75197. 


Informed Consent. 




§ 76021. 


Cleaning. 




§75198. 


Record Keeping. 




§ 76023. 


Client. 




§ 75200. 


Facilities. 




§ 76025. 


Clients' Advocate. 




§ 75201. 


Personnel. 




§ 76026. 


Clients' Rights Officer. 




§ 75202. 


Labeling. 




§ 76027. 


Conservator. 




§ 75203. 


Water Quality. 




§ 76029. 


Consultant. 





Page xiii 



(7 IS 200X) 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§76031. 


Controlled Drags. 


§ 76033. 


Dance Therapist. 


§ 76039. 


Decubitus Ulcer. 


§76041. 


Defined. 


§ 76043. 


Dentist. 


§ 76045. 


Department. 


§ 76047. 


Developmental Disability. 


§ 76049. 


Dietetic Service Supervisor. 


§76051. 


Dietitian. 


§ 76053. 


Direct Care Staff. 


§ 76055. 


Director. 


§ 76056. 


Director of Physician Services. 


§ 76057. 


Disinfection. 


§ 76059. 


Distinct Part for the 




Developmentally Disabled. 


§76061. 


Drug. 


§ 76063. 


Drug Administration. 


§ 76065. 


Drug Dispensing. 


§ 76067. 


Generic Agency. 


§ 76069. 


Guardian. 


§76071. 


Headquarters Review and Approval 




Team. 


§ 76073. 


Health Facility. 


§ 76075. 


Health Support Services. 


§ 76077. 


Individual Program Plan. 


§ 76079. 


Intermediate Care Facility for the 




Developmentally Disabled. 


§76081. 


Legend Drug. 


§ 76083. 


License. 


§ 76085. 


License Category. 


§ 76089. 


Licensed Vocational Nurse. 


§76091. 


Licensee. 


§ 76093. 


Living Unit. 


§ 76095. 


Local Bank. 


§ 76097. 


Maintenance. 


§76101. 


Medication. 


§ 76102. 


Modified Diet. 


§ 76103. 


Multidisciplinary Professional Staff. 


§ 76105. 


Music Therapist. 


§ 76107. 


Nurse Assistant. 


§ 76109. 


Occupational Therapist. 


§76111. 


Occupational Therapy Assistant. 


§76115. 


Pharmacist. 


§76117. 


Physical Therapist. 


§76119. 


Physician. 


§76121. 


Physician's Assistant. 


§ 76123. 


Podiatrist. 


§ 76125. 


Postural Supports. 


§ 76127. 


Professional Person in Charge of the 




Facility. 


§ 76129. 


Program Director. 


§ 76130. 


Psychiatric Technician. 


§76131. 


Psychologist. 


§ 76133. 


Psychotropic Drug. 


§76135. 


Qualified Mental Retardation 




Professional. 


§76137. 


Recreation Therapist. 


§76139. 


Registered Nurse. 


§76141. 


Registered Record Administrator. 


§ 76145. 


Rehabilitation Counselor. 


§ 76147. 


Restraint. 


§ 76149. 


Social Worker. 


§76151. 


Speech Pathologist. 


§76153. 


Standing Orders. 


§ 76155. 


Sterilization of Equipment and 




Supplies. 


§ 76159. 


Supervision of Employee. 


§ 76160. 


Therapeutic Diet. 


§76161. 


Training Program for Nurse 




Assistants. 


§ 76165. 


Unit Dose Medication System. 


icle 2. 


License 


§76201. 


License Required. 


§ 76203. 


Application Required. 


§ 76205. 


Content of Application. 


§ 76207. 


Architectural Plans. 


§ 76209. 


Criminal Record Clearance. 



§76211. 


Fee. 


§76213. 


Fire Safety, Zoning and Building 




Clearance. 


§76215. 


Issuance, Expiration and Renewal. 


§76217. 


Provisional License. 


§76219. 


Separate Licenses. 


§76221. 


Posting. 


§ 76223. 


Transferability. 


§ 76225. 


Report of Changes. 


§ 76227. 


Program Flexibility. 


§ 76229. 


Voluntary Suspension of License, 




Service or Licensed Beds. 


§76231. 


Voluntary Cancellation of License. 


§ 76233. 


Revocation or Involuntary 




Suspension of License. 


§ 76235. 


Temporary Suspension of License. 


§ 76237. 


Pursuing Disciplinary Action to 




Completion. 


§ 76239. 


Reinstatement of Revoked or 




Suspended License. 


§ 76240. 


Conviction of Crime: Standards for 




Evaluating Rehabilitation. 


§76241. 


Bonds. 


Article 3. 


Services 


§76301. 


Required Services. 


§ 76303. 


Discharge Planning. 


§ 76305. 


Developmental Program Services. 


§ 76307. 


Developmental Program 



985 



Services — Program Approval for 

Developmental Services. 
§ 76309. Developmental Program 

Services — Facility Program Plan 

Requirements. 
§ 763 1 1 . Developmental Program 

Services — Interdisciplinary Team. 
§ 76313. Developmental Program 

Services — Client Assessment. 
§ 76315. Developmental Program 

Services — Individual Program Plan. 
§76316. Developmental Program 

Services — Grouping Criteria. 
§76317. Developmental Program 

Services — Program Elements. 
§76319. Developmental Program 

Services — Recreational Activities. 
§ 76321. Developmental Program 

Services — Client Mobility. 
§ 76323. Developmental Program 

Services — Health, Hygiene and 

Grooming. 
§ 76325. Developmental Program 

Services — Types of Restraints. 
§ 76327. Developmental Program 

Services — Restraints. 
§ 76329. Developmental Program 

Services — Application of 

Restraints. 
§ 76331. Developmental Program 

Services — Behavior Modification 

Programs. 
§ 76333. Developmental Program 

Services — Client Abuse. 
§ 76335. Developmental Program 

Services — Postural Supports. 
§ 76337. Developmental Program 

Services — Staffing. 
§ 76339. Developmental Program 

Services — Orientation and 

In-Service Training. 
§ 76341. Health Support Services — Physician 

Services. 
§ 76343. Physician Services — Director of 

Physician Services. 
§ 76345. Health Support Services — Nursing 

Services. 
§ 76347. Nursing Services — Administration 

of Medications and Treatments. 



Page xiv 



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Table of Contents 



Page 



Page 



§ 76349. 


Nursing Services — Standing 




Orders. 


§76351. 


Nursing Service — Nurse Assistant 




Training and Certification. 


§ 76355. 


Nursing Services — Staff. 


§ 76357. 


Health Support Services — Dental 




Services. 


§ 76359. 


Dental Services — General 




Requirements. 


§76361. 


Food and Nutrition 




Services — Defined. 


§ 76363. 


Food and Nutrition Services — Food 




Service. 


§ 76365. 


Food and Nutrition 




Services— Policies and Procedures. 


§ 76367. 


Food and Nutrition Services — Diet 




Manual. 


§ 76369. 


Food and Nutrition 




Services — Modified Diets. 


§76371. 


Food and Nutrition 




Services — Therapeutic Diets. 


§ 76373. 


Food and Nutrition 




Services — Menus. 


§ 76375. 


Food and Nutrition 




Services — Orientation and 




In-Service Training. 


§ 76377. 


Food and Nutrition Services — Food 




Storage. 


§ 76379. 


Food and Nutrition 




Services — S anitation . 


§76381. 


Food and Nutrition 




Services — Cleaning and 




Disinfection of Utensils. 


§ 76383. 


Food and Nutrition Services — Staff. 


§ 76385. 


Food and Nutrition 




Services — Equipment and Supplies. 


§ 76387. 


Pharmaceutical Services — General. 


§ 76389. 


Pharmaceutical 




Services — Requirements . 


§76391. 


Pharmaceutical Services — Policies 




and Procedures. 


§ 76393. 


Pharmaceutical Services — Orders 




for Drugs. 


§ 76395. 


Pharmaceutical Services — Stop 




Orders. 


§ 76397. 


Pharmaceutical Services — Drug 




Order Processing. 


§ 76399. 


Pharmaceutical Services — Drug 




Order Records. 


§76401. 


Pharmaceutical Services — Personal 




Medications. 


§ 76403. 


Pharmaceutical Services — Labeling 




and Storage of Drugs. 


§ 76405. 


Pharmaceutical 




Services — Controlled Drugs. 


§ 76407. 


Pharmaceutical Services — Disposal 




of Drugs. 


§ 76409. 


Pharmaceutical Services — Unit 




Dose Medication System. 


§76411. 


Pharmaceutical Services — Staff. 


§76413. 


Pharmaceutical 




Services — Equipment and Supplies. 


Article 4. 


Administration 


§76501. 


Licensee — General Duties. 


§ 76503. 


Consumer Information to Be 




Posted. 


§ 76505. 


Client Transfer Procedures. 


§ 76506. 


Bed Hold. 


§ 76507. 


Use of Outside Resources. 


§ 76509. 


Fire Safety. 


§76511. 


Smoking. 


§76513. 


Administrator. 


§ 76515. 


Advertising. 


§76517. 


Client Brokerage. 


§76519. 


Admission of Clients. 


§76521. 


Policies and Procedures. 


§ 76523. 


Required Committees. 



1006 



§ 76525. 


Clients' Rights. 


§ 76527. 


Clients" Rights — Cause for Denial 




of Clients' Rights. 


§76531. 


Clients' Rights — Complaint 




Procedure. 


§ 76533. 


Clients' Rights — Reports of Clients' 




Rights Denied. 


§ 76535. 


Client's Rights — Access to Denial 




of Rights Information. 


§ 76539. 


Employees' Health Examination 




and Health Records. 


§76541. 


Employee Personnel Records. 


§ 76543. 


Clients with Communicable 




Diseases. 


§ 76545. 


Reporting of Communicable 




Disease. 


§ 76547. 


Reporting of Outbreaks. 


§ 76549. 


Occurrence of Unusual Diseases. 


§76551. 


Unusual Occurrences. 


§ 76553. 


Annual Reports. 


§ 76555. 


Admission Agreement. 


§ 76557. 


Client Records. 


§ 76559. 


Admission Records. 


§76561. 


Content of Records. 


§ 76563. 


External Disaster and Mass Casualty 

Plan. 

Fire and Internal Disasters. 


§ 76565. 


§ 76566. 


Disruption of Services. 


§ 76567. 


Client Identification. 


§ 76569. 


Safeguards for Clients' Monies and 




Valuables. 


§ 76570. 


Liability for Rent and Return of 




Rental Advance. 


§76571. 


Equipment and Supplies. 


icle 5. 


Physical Plant 1016 


§76601. 


Alterations to Existing Buildings or 




New Construction. 


§ 76603. 


Application for Plan Review. 


§ 76605. 


Space Conversion. 


§ 76607. 


Notice to Department. 


§ 76609. 


Client Capacity. 


§76611. 


Client Rooms. 


§ 76613. 


Client Property Storage. 


§ 76615. 


Client Room Furnishings. 


§ 76617. 


Recreation and Dining Areas. 


§ 76619. 


Provision for Privacy. 


§76621. 


Telephone. 


§ 76623. 


Space and Equipment for 




Autoclaving, Sterilizing and 




Disinfecting. 


§ 76625. 


Centralized Services Shared by 




Several Facilities. 


§ 76627. 


Special Rooms. 


§ 76629. 


Housekeeping. 


§76631. 


Laundry. 


§ 76633. 


Linen. 


§ 76635. 


Soiled Linen. 


§ 76637. 


Clean Linen. 


§ 76639. 


Provisions for Emptying Bedpans. 


§76641. 


Client Call Systems. 


§ 76643. 


Utility Rooms. 


§ 76645. 


Handrails. 


§ 76647. 


General Maintenance. 


§ 76649. 


Air Filters. 


§76651. 


Emergency Lighting and Power 




System. 


§ 76653. 


Storage and Disposal of Solid 




Waste. 


§ 76655. 


Solid Waste Containers. 


§ 76657. 


Infectious Waste. 


§ 76659. 


Gases for Medical Use. 


§76661. 


Water Supply and Plumbing. 


§ 76663. 


Lighting. 


§ 76665. 


Maintenance Manual. 


§ 76667. 


Mechanical Systems. 


§ 76669. 


Screens. 


§76671. 


Storage. 



Page xv 



(7- IS 200S) 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§ 76673. 


Space. 


§ 76675. 


Ice. 


§ 76677. 


Cleaning, Disinfecting and 




Sterilizing. 


§ 76679. 


Health Support Area. 


§76681. 


Pest Control Program. 


Article 6. 


Violations and Civil 




Penalties 


§76701. 


Definitions. 


§ 76703. 


Class "A" Violations. 


§ 76705. 


Class "B" Violations. 


§ 76707. 


Class "C" Violations. 


§ 76709. 


Filing of Names and Addresses. 


§76711. 


Complaints. 


§76713. 


Issuance of Citations. 


§ 76715. 


Penalties. 


§76717. 


Review Procedures. 


§76719. 


Informal Conference. 


§76721. 


Posting of Citations. 


§ 76723. 


Interference with Official Duties. 


§ 76725. 


Discrimination or Retaliation. 


Chapter 8.5. 


Intermediate Care Facilities/ 



1020 



Article 1. 



Developmentally Disabled — 
Habilitative 1023 

Definitions 1023 



§ 76800. 


Accredited Record Technician. 


§76801. 


Active Treatment. 


§76801.1. 


Antecedent. 


§ 76802. 


Authorized Representative. 


§ 76803. 


Chemical Restraint. 


§ 76804. 


Client. 


§76804.1. 


Consequence. 


§ 76805. 


Contingent Observation. 


§ 76806. 


Controlled Drugs. 


§ 76807. 


Decubitus Ulcer. 


§ 76808. 


Dietetic Service Supervisor. 


§ 76809. 


Dietitian. 


§ 76810. 


Direct Care Staff. 


§76811. 


Distinct Part. 


§ 76812. 


Drug. 


§ 76813. 


Drug Administration. 


§ 76814. 


Drug Dispensing. 


§76814.1. 


Educator. 


§76815. 


Emergency Intervention Procedures 




for Behavior Control. 


§76816. 


Exclusion Timeout. 


§ 76817. 


Extinction. 


§76818. 


Fines. 


§ 76820. 


Individual Service Plan. 


§76821. 


Legend Drug. 


§ 76822. 


Local Bank. 


§76822.1. 


Medication. 


§ 76823. 


Modified Diet. 


§ 76824. 


Normalization. 


§ 76825. 


Occupational Therapist. 


§ 76826. 


Permanently Converted Beds. 


§ 76827. 


Physical Restraints. 


§ 76828. 


Postural Supports. 


§ 76829. 


Psychotherapeutic Drug. 


§ 76830. 


Qualified Mental Retardation 




Professional (Q.M.R.R). 


§76831. 


Recreation Therapist. 


§ 76832. 


Registered Record Administrator. 


§ 76833. 


Rehabilitation Counselor. 


§ 76835. 


Standing Orders. 


§ 76836. 


Supervision. 


§ 76837. 


Therapeutic Diet. 


§ 76838. 


Token Reinforcers. 


§ 76839. 


Training and Habilitative Service. 


§ 76840. 


Unit Client Record. 


§76841. 


Withdrawal of Social Contact. 


Article 2. 


License 


§ 76844. 


Application Required. 



1025 



§ 76845. 


Criminal Record Clearance. 


§ 76846. 


Fee. 


§ 76847. 


Safety, Zoning and Building 




Clearance. 


§ 76848. 


Expiration of License. 


§ 76849. 


Separate License. 


§ 76850. 


Posting. 


§76851. 


Report of Changes. 


§ 76852. 


Program Flexibility. 


§76852.1. 


Conviction of Crime; Standards for 




Evaluating Rehabilitation. 


§ 76852.2. 


Bonds. 


Article 3. 


Services 


§ 76853. 


Required Services. 


§ 76855. 


Developmental Program Services. 


§ 76856. 


Developmental Program 




Services — Program Approval for 




Developmental Services. 


§ 76857. 


Developmental Program 




Services — Facility Program Plan 




Requirements. 


§ 76858. 


Developmental Program 




Services — Interdisciplinary 




Professional Staff/Team. 


§ 76859. 


Developmental Program 




Services — Client Assessment. 


§ 76860. 


Developmental Program 




Services — Individual Service Plan. 


§76861. 


Developmental Program 




Services — Grouping Criteria. 


§ 76862. 


Developmental Program 




Services — Program Elements. 


§ 76863. 


Developmental Program 




Servi ces — Recreational Activities. 


§ 76864. 


Developmental Program 




Services — Client Mobility. 


§ 76865. 


Developmental Program 




Services — Health, Hygiene and 




Grooming. 


§ 76866. 


Developmental Program 




Services — Types of Restraints. 


§ 76867. 


Developmental Program 




Services — Restrai nts . 


§ 76868. 


Developmental Program 




Services — Application of 




Restraints. 


§ 76869. 


Developmental Program 




Services — Behavior Management 




Program. 


§ 76870. 


Developmental Program 




Services — Client Abuse. 


§76871. 


Developmental Program 




Services — Postural Supports. 


§ 76872. 


Developmental Program 




Services — Staffing. 


§ 76873. 


Developmental Program 




Services — Orientation and 




In-Service Training. 


§ 76874. 


Health Support Services — Physician 




Services. 


§ 76875. 


Health Support Services — Nursing 




Services. 


§ 76876. 


Nursing Services — Administration 




of Medications and Treatments. 


§ 76877. 


Nursing Services — Standing 




Orders. 


§ 76878. 


Nursing Services — Staff. 


§76878.1. 


Equipment and Supplies. 


§ 76879. 


Health Support Services — Dental 




Services. 


§ 76880. 


Dental Services — General 




Requirements. 


§ 76881. 


Food and Nutrition Services. 


§ 76882. 


Food and Nutrition Services — Food 




Services. 


§ 76883. 


Food and Nutrition 




Services — Policies and Procedures. 



Page xvi 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



Page 



Page 



• 



§ 76884. 


Food and Nutrition 




Services — Therapeutic Diet 




Manual. 


§76884.1. 


Food and Nutrition 




Services — Modified Diets. 


§ 76885. 


Food and Nutrition 




Services — Therapeutic Diets. 


§ 76886. 


Food and Nutrition 




Services — Menus. 


§ 76888. 


Food and Nutrition Services — Food 




Storage. 


§ 76889. 


Food and Nutrition 




Services — Sanitation. 


§ 76890. 


Food and Nutrition 




Services — Cleaning and 




Disinfection of Utensils. 


§76891. 


Food and Nutrition Services — Staff. 


§ 76892. 


Food and Nutrition 




Services — Equipment and Supplies. 


§ 76893. 


Pharmaceutical Services — General. 


§ 76894. 


Pharmaceutical 




Services — Requirements . 


§ 76895. 


Pharmaceutical Services — Policies 




and Procedures. 


§ 76896. 


Pharmaceutical Services — Orders 




for Drugs. 


§ 76897. 


Pharmaceutical Services — Stop 




Orders. 


§ 76898. 


Pharmaceutical Services — Drug 




Order Processing. 


§ 76899. 


Pharmaceutical Services — Drug 




Order Records. 


§ 76900. 


Pharmaceutical Services — Personal 




Medications. 


§ 76901. 


Pharmaceutical Services — Labeling 




and Storage of Drugs. 


§ 76902. 


Pharmaceutical 




Services — Controlled Drugs. 


§ 76903. 


Pharmaceutical Services — Disposal 




of Drugs. 


§ 76905. 


Pharmaceutical Services — Staff. 


§ 76906. 


Pharmaceutical 




Services— Equipment and Supplies. 


Article 4. 


Administration 


§ 76907. 


Licensee — General Duties. 


§ 76908. 


Consumer Information to Be 




Posted. 


§ 76909. 


Client Transfer Procedures. 


§76909.1. 


Bed Hold. 


§ 76910. 


Use of Outside Resources. 


§ 76912. 


Smoking. 


§76913. 


Administrator. 


§ 76914. 


Advertising. 


§ 76915. 


Admission of Clients. 


§ 76916. 


Policies and Procedures. 


§ 76917. 


Human Rights Committee. 


§ 76918. 


Client's Rights. 


§ 76919. 


Employees' Health Examination 




and Health Records. 


§ 76920. 


Employee Personnel Records. 


§76921. 


Communicable Disease. 


§ 76922. 


Reporting of Communicable 




Disease. 


§ 76923. 


Unusual Occurrences. 


§ 76924. 


Admission Contract. 


§ 76925. 


Client Record Service. 


§ 76926. 


Admission Records. 


§ 76927. 


Content of Unit Client Record. 


§ 76928. 


External Disaster and Mass Casualty 




Plan. 


§ 76929. 


Fire and Internal Disasters. 


§ 76930. 


Disruption of Services. 


§76931. 


Safeguards for Client's Monies and 




Valuables. 


Article 5. 


Physical Plant 


§ 76933. 


Space Conversion. 



1042 



§ 76935. 


Notice to Department. 


§ 76936. 


Client Capacity. 


§ 76937. 


Client Rooms. 


§ 76939. 


Client Room Furnishings. 


§76941. 


Provision for Privacy. 


§ 76942. 


Telephone. 


§ 76944. 


Housekeeping. 


§ 76945. 


Linen. 


§ 76946. 


Soiled Linen. 


§ 76947. 


Clean Linen. 


§ 76949. 


General Maintenance. 


§ 76950. 


Storage and Disposal of Solid 




Wastes. 


§76951. 


Solid Waste Containers. 


§ 76952. 


Water Supply and Plumbing. 


§ 76953. 


Lighting. 


§ 76954. 


Mechanical Systems. 


§ 76955. 


Screens. 


§ 76956. 


Storage. 


§ 76957. 


Space. 


§ 76959. 


Pest Control Program. 


Article 6. 


Violations and Civil 




Penalties 1044 


§ 76960. 


Definitions. 


§76961. 


Filing of Names and Addresses. 


§ 76962. 


Penalties. 


ipter 9. ] 


Psychiatric Health Facilities 1044 


Article 1. 


Definitions 1044 


§77001. 


Accredited Record Technician. 


§ 77003. 


Authorized Representative. 


§ 77004. 


Clinical Psychologist. 


§ 77004.1. 


Communicable Disease. 


§ 77005. 


Department. 


§ 77007. 


Dietitian. 


§ 77009. 


Director. 


§77010. 


Exclusion Timeout. 


§77011. 


Governing Body. 


§77011.1. 


Infectious Disease. 


§77011.2. 


Licensed Clinical Social Worker. 


§ 77012. 


Licensed Mental Health 




Professional. 


§77012.1. 


Licensed Psychiatric Technician. 


§ 77012.2. 


Licensed Vocational Nurse. 


§ 77013. 


Local Bank. 


§ 77014. 


Marriage, Family and Child 




Counselor. 


§ 77017. 


Mental Health Worker. 


§ 77018. 


On-Call. 


§ 77019. 


Permanently Converted. 


§77021. 


Postural Support. 


§ 77023. 


Psychiatrist. 


§ 77027. 


Registered Record Administrator. 


§ 77028. 


Sanction. 


§ 77029. 


Seclusion. 


§ 77030. 


Structured Outpatient Services. 


§77031. 


Supervision. 


§ 77033. 


Treatment Restraint. 


§ 77035. 


Unit Patient Health Record. 


§ 77036. 


Unusual Occurrences. 


Article 2. 


Licensing and Inspection 1047 


§ 77037. 


Application Required. 


§ 77038. 


Application Procedure for Obtaining 




a License. 


§ 77039. 


Safety, Zoning and Building 




Clearance. 


§77041. 


Issuance, Expiration and Renewal. 


§ 77043. 


Separate License. 


§ 77045. 


Posting of License and Consumer 




Information. 


§ 77047. 


Report of Changes. 


§ 77049. 


Program Flexibility. 


§77051. 


Voluntary Suspension of Licensure 




or Licensed Beds. 


§ 77052. 


Imposition of Sanctions. 



Page xvii 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§ 77052.5. 


Appeal of Sanctions. 


§ 77053. 


Bonds. 


§ 77055. 


Convictions of Crime: Standards for 




Evaluating Rehabilitation. 


Article 3. 


Services 


§ 77059. 


Basic Services. 


§77061. 


Staffing. 


§ 77063. 


Psychiatric, Psychological and 




Counseling Services. 


§ 77065. 


Psychiatric Nursing Services. 


§ 77067. 


Social Services. 


§ 77069. 


Rehabilitation Services. 


§ 77070. 


Structured Outpatient Services 




Program. 


§77071. 


Aftercare Services. 


§ 77073. 


Interdisciplinary Treatment Plan. 


§ 77075. 


Transfer Summary. 


§ 77077. 


Dietetic Services. 


§77079.1. 


Pharmaceutical Services — General. 


§ 77079.2. 


Pharmaceutical 




Services — Requirements. 


§ 77079.3. 


Pharmaceutical Services — Labeling 




and Storage of Drugs. 


§ 77079.4. 


Pharmaceutical Services — Stop 




Orders. 


§ 77079.5. 


Pharmaceutical Services — Orders 




for Drugs. 


§ 77079.6. 


Pharmaceutical Services — Drug 




Order Processing. 


§ 77079.7. 


Pharmaceutical Services — Drug 




Order Records. 


§ 77079.8. 


Pharmaceutical Services — Personal 




Medications. 


§ 77079.9. 


Pharmaceutical 




Services — Controlled Drugs. 


§77079.10. 


Pharmaceutical 




Services — Disposition of Drugs. 


§77079.11. 


Pharmaceutical 




Services — Medication Distribution 




System. 


§ 77079.12. 


Pharmaceutical Services — Staff. 


§ 77079.13. 


Pharmaceutical 




Services — Equipment and Supplies. 


Article 4. 


Administration 


§77081. 


Governing Body. 


§ 77083. 


Organized Clinical Staff. 


§ 77089. 


Affiliation with General Acute Care 




Hospitals. 


§77091. 


Administrator of Business and 




Support Services. 


§ 77093. 


Clinical Director. 


§ 77097. 


Interdisciplinary Treatment Team. 


§ 77099. 


Patients' Rights. 


§77101. 


Types of Restraints and Seclusion. 


§ 77103. 


Behavioral Restraint and Seclusion. 


§ 77104. 


Postural Supports. 


§ 77105. 


Clinical Research. 


§ 77107. 


Education of Patients. 


§ 77109. 


Use of Outside Resources. 


§77111. 


Nondiscrimination Policies. 


§77113. 


Admission Policies. 


§77115. 


Written Administrative Policies. 


§77117. 


Personnel Policies. 


§77119. 


Employee Personnel Records. 


§77121. 


Employee Health Examinations and 




Health Records. 


§ 77123. 


Equipment and Supplies. 


§77125. 


Advertising. 


§ 77127. 


Records and Reports. 


§ 77129. 


Fire and Internal Disasters. 


§77131. 


Fire Safety. 


§77133. 


Disruption of Services. 


§ 77135. 


Patients with Reportable 



1049 



§ 77137. 



Communicable Disease, Physical 
Illness or Physical Injury. 
Unusual Occurrences. 



Page 



xvni 



§77139. 


Health Record Service. 


§77141. 


Health Record Content. 


§ 77143. 


Health Record Availability. 


§ 77145. 


Patients' Monies and Valuables. 


Article 5. 


Physical Plant \058P 


§77147. 


Space Conversion. 


§77151. 


General Maintenance. 


§77153. 


Housekeeping. 


§77155. 


Maintenance Manual. 


apter 10. 


Adult Day Health Centers 1058.2 


Article 1. 


Definitions 1058.2 


§78001. 


Meaning of Words. 


§ 78003. 


Activity Coordinator. 


§ 78005. 


Administrator. 


§ 78007. 


Adult Day Health Care. 


§ 78009. 


Adult Day Health Center. 


§78011. 


Adult Day Health Care County 




Plan. 


§ 78012. 


Adult Day Health Planning Council. 


§78013. 


Adult Day Health Care Review 




Committee. 


§ 78015. 


Advertisement. 


§78017. 


Ambulatory Person. 


§ 78019. 


Art Therapist. 


§78021. 


Authorized Representative. 


§ 78023. 


Basic Program Services. 


§ 78025. 


Cleaning. 


§ 78027. 


Consultant. 


§ 78029. 


Dance Therapist. 


§78031. 


Deficiency. 


§ 78033. 


Dentist. 


§ 78035. 


Department. 


§ 78037. 


Dietitian. 


§ 78039. 


Director. 


§78041. 


Disinfection. 


§ 78043. 


Drug. 


§ 78045. 


Drug Administration. 


§ 78047. 


Health Facility. 


§ 78049. 


Individualized Plan of Care. 


§78051. 


Legal Guardian. 


§ 78053. 


Licensed Capacity. 


§ 78055. 


Licensee. 


§ 78057. 


Licensed Vocational Nurse. 


§ 78059. 


Maintenance. 


§ 78061. 


Medication. 


§ 78063. 


Multidisciplinary Health Team. 


§ 78065. 


Music Therapist. 


§ 78067. 


Occupational Therapist. 


§ 78069. 


Occupational Therapy Aide. 


§78071. 


Occupational Therapy Assistant. 


§ 78073. 


Participant. 


§ 78075. 


Pharmacist. 


§ 78077. 


Physical Therapist. 


§ 78079. 


Physical Therapy Aide. 


§78081. 


Physical Therapy Assistant. 


§ 78083. 


Podiatrist. 


§ 78085. 


Program Aide. 


§ 78087. 


Program Director. 


§ 78089. 


Psychiatrist. 


§78091. 


Psychologist. 


§ 78093. 


Recreation Therapist. 


§ 78094. 


Service Area. 


§ 78095. 


Registered Nurse. 


§ 78097. 


Social Worker. 


§ 78099. 


Social Work Aide. 


§78101. 


Social Work Assistant. 


§ 78103. 


Speech Therapist. 


§ 78105. 


Supervision of Employee. 


Article 2. 


License 1061 


§78201. 


Right to Apply. 


§ 78203. 


License Required. 


§ 78205. 


Content of Application. 


§ 78207. 


Fees. 


§ 78209. 


Public Hearing. 


§ 78213. 


Denial of Initial Application. 




(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 



§ 78215. 
§78217. 
§ 78219. 
§78221. 

§ 78223. 
§ 78225. 
§ 78227. 
§ 78229. 
§78231. 

§ 78233. 



Article 3 



Page 

Inspections. 

Program Flexibility. 

Issuance of License. 

Limitations on Participants 

Admitted. 

Posting of License. 

License Not Transferable. 

New Application Required. 

License Expiration and Renewal. 

Revocation or Suspension of 

License. 

Voluntary Suspension and 

Reinstatement. 

Services 1063 



§78301. 


Basic Program Services; General. 


§ 78303. 


Basic Program Services: 




Assessment. 


§ 78305. 


Basic Program Services: 




Occupational Therapy Services. 


§ 78307. 


Basic Program Services: Physical 




Therapy Services. 


§ 78309. 


Basic Program Services: Speech 




Therapy Services. 


§78311. 


Basic Program Services: Medical 




Services. 


§78313. 


Basic Program Services: Nursing 




Services. 


§78315. 


Nursing Services — Restraints. 


§78317. 


Nursing Services: Medications. 


§ 78319. 


Basic Services: Nutrition Services. 


§ 78321. 


Nutrition Services: Menus. 


§ 78323. 


Nutrition Services: Quality of Food. 


§ 78325. 


Nutrition Services: Food Sanitation. 


§ 78327. 


Nutrition Services: Food Service. 


§ 78329. 


Nutrition Services: Cleaning of 




Utensils. 


§78331. 


Nutrition Services: Supplies and 




Equipment. 


§ 78333. 


Nutrition Services: Staff. 


§ 78335. 


Nutrition Services: Food Storage. 


§ 78337. 


Basic Program Services: Psychiatric 




or Psychological Services. 


§ 78339. 


Basic Program Service: Social 




Services. 


§78341. 


Basic Services. Recreation or 




Planned Social Activities. 


§ 78343. 


Transportation Services. 


§ 78345. 


Basic Program Services — Plan for 




Discharge. 


§ 78347. 


Optional Services. 


icle 4. 


Administration 



§ 78401. Licensee Responsibility. 

§ 78403. Plan of Operation. 

§ 78405. Composition of Governing Board. 

§ 78407. Requirements for Participant 

Admission. 

§ 78409. Fire Clearance. 

§ 78411. Admission and Discharge 

Procedures. 

§ 78413. Employee Requirements. 

§ 78415. Administrator. 

§ 78417. Program Director. 

§ 78419. Staffing Requirements. 

§ 78421. Finances. 

§ 78423. Disaster Plan. 

§ 78425. Transportation Safety. 

§ 78427. Reports. 

§ 78429. Employee Records. 

§ 78431 . Participant Health Records. 

§ 78433. Confidentiality of Information. 

§ 78435. Retention of Records. 

§ 78437. Participant Rights. 

§ 78439. Equipment and Supplies. 

Article 5. Physical Plant 1072 

§78501. Physical Accommodations. 



§ 78503. 
§ 78505. 
§ 78507. 
§ 78509. 
§78511. 
§78513. 

Article 6. 

§78601. 
§ 78603. 
§ 78605. 
§ 78607. 
§ 78609. 

Chapter 11. 



Article 1. 

§ 79001 . 
§ 79005. 
§ 79007. 
§ 79008. 
§ 79009. 
§79011. 
§79013. 
§ 79015. 
§ 79019. 
§79021. 
§ 79023. 
§ 79025. 
§ 79029. 
§ 79033. 
§ 79035. 
§ 79039. 
§79041. 
§ 79049. 
§79051. 
§ 79053. 
§ 79055. 
§ 79057. 
§79061. 
§ 79070. 
§79071. 
§ 79073. 
§ 79075. 
§ 79077. 

Article 2. 

§79101. 
§ 79105. 

§79107. 
§ 79109. 
§79111. 

§79113. 
§79115. 
§79117. 

§79118. 

§79119. 



Page 

General Building Requirements. 

Space Requirements. 

Maintenance and Housekeeping. 

Safety. 

Supplies. 

Solid Waste. 

Violations 1073 

Inspection. 

Deficiencies in Compliance. 

Complaints. 

Deficiencies. 

Inspection Authority. 

Chemical Dependency Recovery 
Hospital Licensing Regulations 1074 

Definitions 1074 

Accredited Record Technician. 

Authorized Representative. 

Biological. 

CDRH. 

Chemical. 

Chemical Dependency. 

Chemical Dependency Counselor. 

Conservator. 

Department. 

Detoxification. 

Dietitian. 

Director. 

Drug. 

Family Therapy. 

Governing Body 

Individual Recovery Plan. 

Licensed Clinical Social Worker. 

Life Experience. 

Medication. 

Outpatient Services. 

Patient. 

Permanently Converted. 

Pharmacist. 

Registered Records Administrator. 

Significant Others. 

Social Worker. 

Supervision. 

Withdrawal Syndrome. 

Licensing and Inspection 1075 

Application Required. 

Safety, Zoning, and Building 

Clearance. 

Issuance, Expiration and Renewal. 

Separate License. 

Posting of License and Consumer 

Information. 

Report of Changes. 

Program Flexibility. 

Voluntary Suspension of License or 

Licensed Beds. 

Conviction of Crime: Standards for 

Evaluating Rehabilitation. 

Bonds. 

1077 



Article 3. 


Basic Services 


§79201. 


Basic Services. 


§ 79203. 


Patient Counseling. 


§ 79205. 


Group Therapy. 


§ 79207. 


Physical Conditioning. 


§ 79209. 


Family Therapy Participation. 


§79211. 


Outpatient Services. 


§ 79213. 


Dietetic Services. 


§ 79215. 


Medication Management. 


§79217. 


Interdisciplinary Treatment Team. 


§ 79219. 


Individual Recovery Plan. 


§79221. 


Staffing. 


Article 4. 


Optional Services 


§79251. 


Optional Services. 


Article 5. 


Administration 



1080 



1080 



Page xix 



Table of Contents 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Page 



Page 



§79301. 


Governing Body. 


§ 79303. 


Medical Staff. 


§ 79307. 


Residents, Interns and Students. 


§ 79309. 


Medical Director. 


§79311. 


Professional Staff. 


§79313. 


Patients' Rights. 


§79315. 


Restraints. 


§79317. 


Postural Supports. 


§79319. 


Transfer Agreement. 


§79321. 


Use of Outside Resources. 


§ 79325. 


Admission Policies. 


§ 79327. 


Personnel Policies. 


§ 79329. 


Communication. 


§79331. 


Employee Health Examinations and 




Health Records. 


§ 79333. 


Employee Personnel Records. 


§ 79337. 


Records and Reports. 


§ 79339. 


Unusual Occurrences. 


§79341. 


Fire and Internal Disasters. 


§ 79345. 


Disruption of Services. 


§ 79347. 


Patient Health Records Service. 


§ 79349. 


Patient Health Record Content. 


§79351. 


Patient Health Record Availability. 


§ 79353. 


Patients' Monies and Valuables. 


§ 79357. 


Professional Literature. 


§ 79359. 


Medical Photography. 


§79361. 


Space Conversion. 


§ 79363. 


Hand Washing. 


§ 79365. 


General Maintenance. 


§ 79367. 


Housekeeping. 


§ 79369. 


Maintenance Manual. 



Article 6. Physical Plant 1085 

Chapter 12. Correctional Treatment Centers 1085 

Article 1. Definitions 1085 

§ 79501. Accredited Record Technician. 

§ 79503. Audiologist. 

§ 79507. Biological. 

§ 79509. Clinical Psychologist. 

§79511. Clinical Restraint. 

§79513. Clinical Seclusion. 

§79515. Communicable Disease. 

§ 79516. Correctional Treatment Center. 

§79517. Decubitus Ulcer. 

§ 79519. Dentist. 

§79521. Department. 

§ 79523. Dietitian. 

§ 79525. Director. 

§ 79527. Drug Administration. 

§ 79529. Drug Dispensing. 

§79531. Governing Body. 

§ 79533. Infectious Disease. 

§ 79534. Informed Consent. 

§ 79535. Inmate. 

§ 79537. Inmate-Patient. 

§ 79539. Licensed Clinical Social Worker. 

§79541. Licensed Vocational Nurse. 

§ 79543. Licensed Marriage, Family, and 

Child Counselor. 

§ 79547. Mental Health Worker. 

§ 79549. Nursing Unit. 

§79551. Occupational Therapist. 

§ 79553. On-Call. 

§ 79555. Outpatient Housing Unit. 

§ 79557. Pharmacist. 

§ 79559. Physical Therapist. 

§ 79561. Physician. 

§ 79563. Podiatrist. 

§ 79564. Psychiatric Mental Health Nurse. 

§ 79565. Psychiatric Technician. 

§ 79567. Psychiatrist. 

§ 79569. Recreation Therapist. 

§79571. Registered Nurse. 

§ 79573. Registered Record Administrator. 

§ 79575. Supervision. 

§ 79577. Treatment Restraint. 



§ 79579. 


Unit Health Records. 


Article 2. 


Licensing and Inspection 1086.3 


§79581. 


Application Required. 


§ 79583. 


Safety, Zoning, and Building 




Clearance. 


§ 79585. 


Issuance, Expiration, and Renewal. 


§ 79587. 


Separate License. 


§ 79589. 


Posting of License and Patient 




Information. 


§79591. 


Report of Changes. 


§ 79593. 


Program Flexibility. 


§ 79595. 


Suspension and Revocation. 


Article 3. 


Required Services 1086.4 


§ 79597. 


Required Services. 


§ 79599. 


Physician Services. 


§79601. 


Physician Services — General 




Requirements. 


§ 79603. 


Physician Services — Policies and 




Procedures. 


§ 79605. 


Physician Service Staff. 


§ 79607. 


Physician Service Space. 


§ 79609. 


Psychiatrist/Psychologist Service. 


§79611. 


Psychiatrist/Psychologist Service 




General Requirements. 


§ 79613. 


Psychiatrist/Psychologist Service 




Staff. 


§ 79615. 


Psychiatrist/Psychologist Service 




Space. 


§ 79625. 


Nursing Service. 


§ 79627. 


Nursing Service General 




Requirements. 


§ 79629. 


Nursing Service — Director of 




Nursing Service. 


§79631. 


Nursing Service — Staff. 


§ 79633. 


Nursing Service — Staff 




Development. 


§ 79635. 


Nursing Service — Administration of 




Medications and Treatments. 


§ 79637. 


Nursing Service — Patient Care. 


§ 79639. 


Nursing Service — Patients with 




Infectious Diseases. 


§79641. 


Nursing Service — Cleaning, 




Disinfecting, and Sterilizing. 


§ 79643. 


Nursing Service — Space. 


§ 79645. 


Pharmaceutical Service. 


§ 79647. 


Pharmaceutical Service — General 




Requirements. 


§ 79649. 


Pharmaceutical Services — Other 




Requirements. 


§79651. 


Pharmaceutical Service — Labeling 




and Storage of Drugs. 


§ 79653. 


Pharmaceutical Service — Stop 




Orders. 


§ 79655. 


Pharmaceutical Service — Orders for 




Drugs. 


§ 79657. 


Pharmaceutical Service — Drug 




Order Processing. 


§ 79659. 


Pharmaceutical Service — Drug 




Order Records. 


§79661. 


Pharmaceutical Service — Personal 




Medications. 


§ 79663. 


Pharmaceutical Service — Controlled 




Drugs. 


§ 79665. 


Pharmaceutical 




Service — Disposition of Drugs. 


§ 79667. 


Pharmaceutical Service — Unit Dose 




Medication System. 


§ 79669. 


Pharmaceutical Service Staff. 


§79671. 


Pharmaceutical 




Service — Equipment and Supplies. 


§ 79673. 


Dental Service. 


§ 79675. 


Dental Service — General 




Requirements. 


§ 79677. 


Dental Service Staff. 


§ 79679. 


Dental Service Equipment and 



Supplies. 



Page xx 



(7-18-2008) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



Table of Contents 





Page 




Page 


§79681. 


Dental Service Space. 


§ 79763. 


Standby Emergency Medical 


§ 79683. 


Dietary Service. 




Services, Physician on Call, 


§ 79685. 


Dietary Service General 




Definition. 




Requirements. 


§ 79765. 


Standby Emergency Medical 


§ 79687. 


Dietary Service Policies and 




Service, Physician on Call, General 




Procedures. 




Requirements. 


§ 79689. 


Dietary Service Therapeutic Diets. 


§ 79767. 


Standby Emergency Medical 


§79691. 


Dietary Service Menus. 




Service, Physician on Call, Staff. 


§ 79693. 


Dietary Service Food Storage. 


§ 79769. 


Standby Emergency Medical 


§ 79695. 


Dietary Service Sanitation. 




Service, Physician on Call, 


§ 79697. 


Dietary Service Cleaning and 




Equipment and Supplies. 




Disinfection of Utensils. 


§79771. 


Standby Emergency Medical 


§ 79699. 


Dietary Service Equipment, Space, 




Service. Physician on Call. Space. 


§79701. 


and Supplies. 
Dietary Service Staff. 


Article 5. 


Administration K)X6.'»0 


Article 4. 


Optional Services 1086.13 


§ 79773. 
§ 79775. 


Governing Body. 
Medical Director. 


§ 79703. 


Optional Services. 


§ 79777. 


Administrator. 


§ 79705. 


Optional Services — Laboratory 


§ 79779. 


Administrative Policies and 




Services. 




Procedures. 


§ 79707. 


Laboratory Service Staff. 


§79781. 


Required Committees. 


§ 79709. 


Laboratory Service — Equipment 


§ 79783. 


Use of Outside Resources. 




and Supplies. 


§ 79785. 


First Aid and Referrals. 


§79711. 


Optional Services — Radiology 


§ 79787. 


Reporting. 




Services. 


§ 79789. 


Patient Transfer. 


§79713. 


Radiology Service General 


§79791. 


Personnel Policies. 




Requirements. 


§ 79793. 


Employee Personnel Records. 


§ 79715. 


Radiology Service Staff. 


§ 79795. 


Employee Health Examinations and 


§79717. 


Radiology Service Equipment and 




Health Records. 




Supplies. 


§ 79797. 


Staff Development. 


§ 79719. 


Radiology Service Space. 


§ 79799. 


Inmate-Patients' Rights. 


§79721. 


Optional Services — Perinatal 


§79801. 


Clinical Restraint, Treatment 




Services. 




Restraint, and Clinical Seclusion. 


§ 79723. 


Perinatal Service General 


§ 79803. 


Health Record Service. 




Requirements. 


§ 79805. 


Inmate-Patient Health Record 


§ 79725. 


Perinatal Service Staff. 




Content. 


§ 79727. 


Perinatal Service Equipment and 


§ 79807. 


Inmate-Patient Health Record 




Supplies. 




Availability. 


§ 79729. 


Optional Services — Outpatient 


§ 79809. 


Transfer Summary. 




Surgical Care. 


§79811. 


Fire and Internal Disasters. 


§79731. 


Outpatient Surgical Care — General 


§79813. 


Custodial Personnel. 




Requirements. 


§79815. 


Inmate-Patient Identification. 


§ 79733. 


Outpatient Surgical Care Staff. 


§79817. 


Equipment and Supplies. 


§ 79735. 


Outpatient Surgical Care Equipment 








and Supplies. 


Article 6. 


Physical Plant and Safety 1086.27 


§ 79737. 


Outpatient Surgical Care Space. 


§79819. 


Alterations to Existing Buildings or 


§ 79739. 


Mental Health Treatment Program. 




New Construction. 


§79741. 


Mental Health Treatment 


§79821. 


Space Conversion and Remodeling. 




Program — General Requirements. 


§ 79823. 


Inmate-Patient Capacity. 


§ 79743. 


Mental Health Treatment 


§ 79825. 


Fire Safety. 




Program — Admission and 


§ 79827. 


Inmate-Patient Rooms. 




Discharge Policies. 


§ 79829. 


Inmate-Patient Room Furnishings. 


§ 79745. 


Mental Health Treatment 


§79831. 


Special Rooms. 




Program — Multidisciplinary 


§ 79833. 


Provision for Emptying Bedpans. 




Treatment Team. 


§ 79835. 


Central Sterile Supply. 


§ 79747. 


Mental Health Treatment 


§ 79837. 


Preparation of Sterile Supplies and 




Program — Individual Treatment 




Equipment. 




Plan. 


§ 79839. 


Call Systems. 


§ 79749. 


Mental Health Treatment 


§79841. 


General Maintenance. 




Program — Services. 


§ 79843. 


Housekeeping. 


§79751. 


Acute Mental Health Care. 


§ 79845. 


Electrical Systems. 


§ 79753. 


Nonacute 24-Hour Mental Health 


§ 79847. 


Storage and Disposal of Solid 




Care. 




Waste. 


§ 79755. 


Mental Health Treatment Program 


§ 79849. 


Solid Waste Containers. 




Staffing — Basic Requirements. 


§79851. 


Medical Waste. 


§ 79757. 


Mental Health Treatment Program 


§ 79853. 


Gases for Medical Use. 




Staffing — Acute Care 


§ 79855. 


Water Supply and Plumbing. 




Requirements. 


§ 79857. 


Lighting. 


§ 79759. 


Mental Health Treatment Program 


§ 79859. 


Heating, Ventilating, and Air 




Staffing — Nonacute Care 




Conditioning. 




Requirements. 


§79861. 


Laundry Service. 


§79761. 


Mental Health Treatment 
Program — Space. 







Page xxi 



(7 IS 2COS) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70016.1 



Division 5. Licensing and Certification of 

Health Facilities, Home Health Agencies, 

Clinics, and Referral Agencies 

(Originally Printed 6-14-75) 



Chapter 1. General Acute Care Hospitals 



Article 1. Definitions 

§ 70001 . Meaning of Words. 

Words shall have their usual meaning unless the context or a definition 
clearly indicates a different meaning. Words used in the present tense in- 
clude the future; words in the singular number include the plural number; 
words in the plural number include the singular number; and words in the 
masculine include the feminine. Shall means mandatory. May means 
permissive. Should means suggested or recommended. 
NOTE: Authority cited for Division 5: Sections 208, 1255. 1266, 1402, 1426, 
38254 and 38255, Health and Safety Code; Sections 7354, 14105 and 14124.5, 
Welfare and Institutions Code. Reference: Sections 1222, 1229, 1250, 1251, 
1251.5, 1252, 1253, 1254, 1255, 1256, 1257, 1265, 1265.5, 1265.7, 1265.8. 1266, 
1267, 1268, 1269, 1270, 1275, 1276, 1277, 1278, 1279, 1280, 1282. 1294, 1295, 
1296, 1297, 1298, 1300, 1315, 1316, 1317, 1318, 1400, 1401, 1402, 1403, 1404, 
1405, 1410, 141 1, 1412, 1417.1, 1418, 1419, 1420, 1421, 1422, 1423, 1424, 1425, 
1426, 1427, 1428, 1429, 1430, 1431, 1432, 1437, 1439, 1729, 1734, 38254, and 
38255, Health and Safety Code; Sections 7354, 14105 and 14124.5, Welfare and 
Institutions Code. 

History 

1 . New Division 5 (Chapters 1 , 2, 3, 4 and 5 (Sections 7000 1-745 1 5, not consecu- 
tive)) filed 6-13-75; effective thirtieth day thereafter (Register 75, No. 24). 

2. Change without regulatory effect of Division 5 heading filed 7-16-87; opera- 
tive 7-16-87 (Register 87, No. 30). 

§ 70003. Hospital. 

Hospital means a general acute care hospital. 

§ 70005. General Acute Care Hospital. 

(a) General acute care hospital means a hospital, licensed by the De- 
partment, having a duly constituted governing body with overall admin- 
istrative and professional responsibility and an organized medical staff 
which provides 24-hour inpatient care, including the following basic ser- 
vices: medical, nursing, surgical, anesthesia, laboratory, radiology, phar- 
macy, and dietary services. 

(b) A general acute care hospital shall not include separate buildings 
which are used exclusively to house personnel or provide activities not 
related to hospital patients. 

NOTE: Authority cited: Section 1250.1(a), Health and Safety Code. Reference: 

Section 1250(a), Health and Safety Code. 

History 

1 . Change without regulatory effect pursuant to section 1 00(b)(3), Title 1 , Califor- 
nia Code of Regulations, repealing subsection (c), filed 4-2-90 (Register 90, 
No. 17). 

§ 70006. Acute Psychiatric Care Bed Classification. 

Acute psychiatric care bed classification means beds designated for 
acute psychiatric, developmentally disabled or drug abuse patients re- 
ceiving 24-hour medical care. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Amendment filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

3. Certificate of Compliance as to filing of 10-5-76 filed 1-31-77 (Register 77, 
No. 6). 

4. Certificate of Compliance as to filing of 1 1-12-76 filed 3-8-77 (Register 77, 
No. 11). 



§ 70007. Alteration. 

Alteration means any change in the construction or configuration oth- 
er than maintenance in an existing building and which does not increase 
the floor or roof area or the volume of enclosed space. 

§ 70009. Autoclaving. 

Autoclaving means the process of sterilization by steam under 
pressure. 

§ 7001 1 . Basic Services. 

Basic services means those essential services required by law for li- 
censure as a hospital including medical, nursing, surgical, anesthesia, 
laboratory, radiology, pharmacy and dietary services. 

§70012. Certificate of Exemption. 

Certificate of Exemption means a document containing Department 
approval for the exemption of a specified project from Certificate ol~ 
Need review. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 11-12-76 as an emergency; effective upon filine (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 7001 2.1 . Certificate of Need. 

Certificate of need means a document containing Department 
approval for a specified project. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§70013. Child. 

History 

1. Repealer filed 1 1-12-76 as an emergency; effective upon filing (Register 76, 
No. 46). 

2. New section filed 1 2-3-76 as an emergency; effective upon filing (Register 76, 
No. 49). 

3. Certificate of Compliance filed 3-8-77 as to filing of 1 1-12-76 (Register 77, 
No. 11). 

4. Reinstatement of section as it existed prior to emergency amendment filed 
12-3-76, by operation of Section 1 1422.1(b), Government Code (Register 77, 
No. 22). 

§70015. Cleaning. 

Cleaning means the process employed to free a surface from dirt or 
other extraneous material. 

§ 70016. Competency Validation for Patient Care 

Personnel Other Than Registered Nurses. 

Competency validation for patient care personnel other than registered 
nurses is a determination based on an individual's satisfactory perform- 
ance of each specific element of his/her job description, and of the specif- 
ic requirements for the patient care unit in which he or she is employed. 
NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1276, Health and Safety Code. 

HrSTORY 
1. New section filed 1 1-26-96; operative 12-26-96 (Register 96, No. 48). 

§ 7001 6.1 . Competency Validation for Registered Nurses. 

(a) Competency validation for registered nurses is a determination 
based on the satisfactory performance of: 

(1) The statutorily recognized duties and responsibilities of the regis- 
tered nurse, as set forth in Business and Professions Code Section 2725, 
et seq., and regulations promulgated thereunder; and 

(2) The standards required under Section 7021 3(c) which are specific 
to each patient care unit. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 2725, Business and Professions Code; and Section 1276, 
Health and Safety Code. 

History 
1. New section filed 11-26-96; operative 12-26-96 (Register 96, No. 48). 



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§ 70017 



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Title 22 



§70017. Conservator. 

Conservator means a person appointed by the court to take care of the 
person, the property, or both, of a conservatee under Section 5350, et 
seq., of the Welfare and Institutions Code, or under Section 1 701 , et seq., 
of the Probate Code. 

§70018. Critical Burn. 

(a) Critical burn means any one or more of the following types of 
burns: 

(1) Second degree burns exceeding 30 percent of the body surface. 

(2) Third degree burns of the face, hands, feet and/or genitals. 

(3) Third degree burns exceeding 10 percent of the body surface. 

(4) Burns complicated by respiratory tract injury, major soft tissue in- 
jury or fractures. 

(5) Electrical burns. 

(6) Any combination of second and third degree burns which in the ag- 
gregate poses a medical problem equivalent in seriousness to (1 ) through 
(5). 

§70019. Defined. 

Defined means defined in writing. 

§ 70021 . Department. 

Department means the State Department of Health Services. 
NOTE: Authority cited: Sections 208, 1255, 1266, 1275, 1402 and 1426, Health 
and Safety Code; Sections 7354, 14105 and 14124.5, Welfare and Institutions 
Code. Reference: Sections 1222, 1229, 1250, 1251, 1251.5, 1252. 1253. 
1254-1257, 1265, 1265.5, 1265.7-1265.8, 1266-1270, 1275-1280, 1282, 
1294-1298, 1300, 1315-1318, 1400-1405, 1410-1412, 1417.1, 1418-1432, 
1437, 1439, 1729, 1734, 38254 and 38255, Health and Safety Code; Sections 
7354, 14105 and 14124.5, Welfare and Institutions Code. Specific reference: 
Chapter 1252, Statutes of 1977. 

History 

1. Amendment filed 6-30-78 as an emergency; designated effective at 1 1 :59 p.m. 
on 6-30-78 (Register 78, No. 26). 

2. Certificate of Compliance transmitted to O AH 10-27-78; filed 10-31-78 (Reg- 
ister 78, No. 44). 

3. Editorial correction of NOTE (Register 97, No. 50). 

§ 70023. Director. 

Director means the Director of the State Department of Health Ser- 
vices. 

NOTE: Authority cited: Sections 208, 1255, 1266, 1275, 1402 and 1426, Health 
and Safety Code; Sections 7354, 14105 and 14124.5, Welfare and Institutions 
Code. Reference: Sections 1222, 1229, 1250, 1251, 1251.5, 1252-1257, 1265, 
1265.5, 1265.7, 1265.8, 1266-1270, 1275-1280, 1282, 1294-1298, 1300, 
1315-1318, 1400-1405. 1410-1412, 1417.1, 1418-1432, 1437, 1439, 1729, 
1734, 38254 and 38255, Health and Safety Code; Sections 7354, 14105 and 
14124.5, Welfare and Institutions Code. Specific reference: Chapter 1252, Stat- 
utes of 1977. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

3. Amendment filed 6-30-78 as an emergency; designated effective at 1 1 :59 p.m. 
on 6-30-78 (Register 78, No. 26). 

4. Certificate of Compliance transmitted to OAH 10-27-78; filed 10-31-78 (Reg- 
ister 78, No. 44). 

§ 70025. Disinfection. 

Disinfection means the process employed to destroy harmful microor- 
ganisms, but ordinarily not viruses and bacterial spores. 

§ 70027. Distinct Part. 

Distinct part means an identifiable unit accommodating beds and re- 
lated facilities including, but not limited to, contiguous rooms, a wing, 
floor or building that is approved by the Department for a specific pur- 
pose. 

§ 70029. Drug Administration. 

Drug administration means the act in which a single dose of a pre- 
scribed drug or biological is given to a patient by an authorized person 
in accordance with all laws and regulations governing such acts. The 



complete act of administration entails removing an individual dose from 
a previously dispensed properly labeled container, including a unit dose 
container, verifying the dose with the prescribed orders, giving the indi- 
vidual dose to the proper patient and promptly recording the time and 
dose given. 

§ 70031. Drug Dispensing. 

Drug dispensing means the act entailing the interpretation of an order 
for a drug or biological and, pursuant to that order, the proper selection, 
measuring, packaging, labeling and issuance of the drug or biological for 
a patient or for a service unit of the hospital. 

§ 70033. Existing Hospital Building. 

Existing hospital building means an extant structure intended for prop- 
er hospital use. This excludes physician offices contiguous with the hos- 
pital and independent of the hospital as far as ownership. 

§ 70034. General Acute Care Bed Classification. 

(a) "General acute care bed classification" means beds designated for 
burn, coronary, intensive care, medical-surgical, pediatric, perinatal, re- 
habilitation, acute respiratory or tuberculosis patients receiving 24-hour 
medical care. 

(b) Specialized care with respect to special hospitals shall be consid- 
ered to be general acute care. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 1 0-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 

§ 70035. Governing Body. 

Governing body means the person, persons, board of trustees, direc- 
tors or other body in whom the final authority and responsibility is vested 
for conduct of the hospital. 

§ 70037. Guardian. 

Guardian means a person appointed by the court to take care of the per- 
son or the property, or both, of a ward under Section 1400 et seq., of the 
Probate Code. 

§ 70037.1. Human Reproductive Sterilization. 

(a) Human reproductive sterilization means any medical treatment, 
procedure or operation, for the purpose of rendering an individual perma- 
nently incapable of reproducing. 

(b) In this section and in Sections 70707. 1 through 70707.8 and 70736, 
"sterilization" means human reproductive sterilization. 

NOTE: Authority cited: Sections 208, 1275, 1276, Health and Safety Code. Refer- 
ence: Sections 1250 et seq., Health and Safety Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 
22). 

2. Amendment filed 4-17-81; effective thirtieth day thereafter (Register 81, No. 
16). 

§ 70038. Intermediate Care Bed Classification. 

"Intermediate care bed classification" means beds designated for pa- 
tients requiring skilled nursing and supportive care on less than a continu- 
ous basis. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 

§70041. License. 

License means the basic document issued by the Department permit- 
ting the operation of a hospital. This document constitutes the authority 
to receive patients and to perform the services included within the scope 
of these regulations and as specified on the hospital license. 



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§ 70055 



§ 70042. License Category. 

(a) License category means any of the following categories: 

( 1 ) General acute care hospital. 

(2) Acute psychiatric hospital. 

(3) Skilled nursing facility. 

(4) Intermediate care facility. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854. Statutes of 1976. 

History 

1. New section filed 1 1-12-76 as an emersency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance fled 3-8-77 (Register 77, No. 11). 

§ 70043. Licensee. 

Licensee means the person, persons, firm, business trust, partnership, 
association, corporation, political subdivision of the State or other gov- 
ernmental agency within the State to whom a license has been issued. 

§ 70045. Maintenance. 

Maintenance means the upkeep of a building and equipment to pre- 
serve the original functional and operational state. 

§ 70046. Modernization. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 

§ 70047. New Construction. 

(a) New construction means any of the following: 

(1) New buildings. 

(2) Additions to existing buildings. 

(3) Conversions of existing buildings or portions thereof not currently 
licensed as a hospital. 

§ 70048. New Special Service. 

(a) New special service means any special service identified in Section 
7035 1 of this Chapter which is either offered or is intended to be offered 
and which was not approved by the Department prior to September 9, 
1976. Approval of the Department is inferred if one of the following con- 
ditions exist: 

(1) The special service in question has been evaluated by the Depart- 
ment subsequent to July 1 3, 1975 and prior to September 9, 1976 and was 
found to be in compliance with all regulations regarding the service. 

(2) The special service in question was being provided prior to July 1 3 , 
1975, has been provided continuously since that date, and has not been 
inspected and evaluated by the Department for the quality of the service 
provided. Departmental approval in this case can be inferred only until 
such time as the service is evaluated by the Department. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§ 70049. Nursing Unit. 

Nursing unit means a designated patient-care area of the hospital 
which is planned, organized, operated and maintained to function as a 
unit. It includes patient rooms with adequate support facilities, services 
and personnel providing nursing care and necessary management of pa- 
tients. 

§ 70051 . Outpatient Service. 

An outpatient service means an organizational unit of the hospital 
which provides nonemergency health care services to patients. 

§ 70053. Patient. 

(a) Patient means a person who is receiving diagnostic, therapeutic or 
preventive health services or who is under observation or treatment for 
illness or injury or care during and after pregnancy. 



( 1 ) An inpatient means a person who has been formally admitted for 
observation, diagnosis or treatment and who is expected to remain over- 
night or longer. 

(2) An outpatient means a person who has been registered or accepted 
for care but not formally admitted as an inpatient and who does not re- 
main over 24 hours. 

(3) Ambulatory patient means a patient who is capable of demonstrat- 
ing the mental competence and physical ability to leave a building under 
emergency conditions without assistance or supervision of any person. 

(4) Nonambulatory patient means a patient who is unable to leave a 
building unassisted under emergency conditions. It includes, but is not 
limited to, those persons who depend upon mechanical aids such as 
crutches, walkers or wheelchairs, profoundly or severely mentally re- 
tarded persons and shall include blind and totally deaf persons. 

§70053.1. Patient Care Personnel. 

Patient care personnel means hospital personnel, licensed and unli- 
censed, who provide nursing care to patients, including any unlicensed 
personnel who assist with simple nursing procedures. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1276, Health and Safety Code. 

History 
1. New section filed 11-26-96; operative 12-26-96 (Register 96, No. 48). 

§ 70053.2. Patient Classification System. 

(a) Patient classification system means a method for establishing staff- 
ing requirements by unit, patient, and shift that includes: 

(1) A method to predict nursing care requirements of individual pa- 
tients. 

(2) An established method by which the amount of nursing care need- 
ed for each category of patient is validated for each unit and for each shift. 

(3) An established method to discern trends and patterns of nursing 
care delivery by each unit, each shift, and each level of licensed and unli- 
censed staff. 

(4) A mechanism by which the accuracy of the nursing care validation 
method described in (a)(2) above can be tested. This method will address 
the amount of nursing care needed, by patient category and pattern of 
care delivery, on an annual basis, or more frequently, if warranted by the 
changes in patient populations, skill mix of the staff, or patient care deliv- 
ery model. 

(5) A method to determine staff resource allocations based on nursing 
care requirements for each shift and each unit. 

(6) A method by which the hospital validates the reliability of the pa- 
tient classification system for each unit and for each shift. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1276, Health and Safety Code. 

History 
1. New section filed 11-26-96; operative 12-26-96 (Register 96, No. 48). 

§ 70054. Permanently Converted. 

Permanently converted means space which is not available for patient 
accommodation because the facility has converted the patient accommo- 
dation space to some other use and such space could not be reconverted 
to patient accommodation within 24 hours. 

NOTE: Authority cited: Sections 208, 1250, 1250.1. 1251, 1255,and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§ 70055. Personnel. 

(a) Unless otherwise specified in this chapter, the following defini- 
tions shall apply to health care personnel: 

(1) Accredited Record Technician. Accredited record technician 
means a person who is accredited by the American Medical Record Asso- 
ciation. 

(2) Administrator. Administrator means the individual who is ap- 
pointed by the governing body to act in its behalf in the overall manage- 
ment of the hospital. 



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(3) Art Therapist. Art therapist means a person who has a masters de- 
gree in art therapy or in art with emphasis in art therapy, including an ap- 
proved clinical internship from an accredited college or university; or a 
person who is registered or eligible for registration with the American Art 
Therapy Association. 

(4) Audiologist. Audiologist means a person who is licensed as an au- 
diologist by the Board of Medical Examiners. 

(5) Biomedical Equipment Technician. Biomedical equipment techni- 
cian means a person certified by the Association for the Advancement of 
Medical Instrumentation. 

(6) Cardiopulmonary Technologist. Cardiopulmonary technologist 
means a person who is registered by the National Society of Cardiopul- 
monary Technologists. 

(7) Cardiovascular Technologist. Cardiovascular technologist means 
a person who is registered by the National Society of Cardiopulmonary 
Technologists. 

(8) Clinical Laboratory Bioanalyst. Clinical laboratory bioanalyst 
means a person who is licensed as a clinical laboratory bioanalyst by the 
Department. 

(9) Clinical Laboratory Technologist. Clinical laboratory technologist 
means a person who is licensed as a clinical laboratory technologist by 
the Department. 

(10) Consultant. Consultant means a person who is professionally qu- 
alified to provide expert information on a particular subject. 

(11) Dance Therapist. Dance therapist means a person who is regis- 
tered or eligible for registration as a dance therapist registered by the 
American Dance Therapy Association. 

( 1 2) Dentist. Dentist means a person who is licensed as a dentist by the 
Board of Dental Examiners. 

(13) Dietitian. Dietitian means a person who is registered or eligible 
for registration as a registered dietitian by the American Dietetic Associ- 
ation. 

(14) Learning Disability Specialist. Learning disability specialist 
means a person who has a master's degree in learning disabilities from 
an accredited university. 

(15) Licensed Psychiatric Technician. Licensed psychiatric techni- 
cian means a person who is licensed as a licensed psychiatric technician 
by the Board of Vocational Nurse and Psychiatric Technician Examin- 
ers. 

(16) Licensed Vocational Nurse. Licensed vocational nurse means a 
person who is licensed as a licensed vocational nurse by the Board of Vo- 
cational Nurse and Psychiatric Technician Examiners. 

(17) Mental Health Worker. Mental health worker means an unli- 
censed person who through experience, in-service training or formal 
education is qualified to participate in the care of the psychiatric patient. 

(18) Music Therapist. Music therapist means a person who is regis- 
tered or eligible for registration as a registered music therapist by the Na- 
tional Association for Music Therapy. 

(19) Nurse Anesthetist. Nurse anesthetist means a registered nurse 
who is certified as a nurse anesthetist by the American Association of 
Nurse Anesthetists. 

(20) Occupational Therapist. Occupational therapist means a person 
who is certified or eligible for certification as an occupational therapist 
registered by the American Occupational Therapy Association. 

(21) Occupational Therapy Assistant. Occupational therapy assistant 
means a person who is certified or eligible for certification as a certified 
occupational therapy assistant by the American Occupational Therapy 
Association. 

(22) Orthotist and Prosthetist. Orthotist and prosthetist means a person 
who is certified or eligible for certification by the American Board of Ort- 
hotists and Prosthetists Certification, Washington, D.C. 

(23) Pharmacist. Pharmacist means a person who is licensed as a phar- 
macist by the Board of Pharmacy. 

(24) Physical Therapist. Physical therapist means a person licensed as 
a registered physical therapist by the Physical Therapy Examining Com- 
mittee of the Board of Medical Examiners. 



(25) Physical Therapist Assistant. Physical therapist assistant means 
a person who is approved as a physical therapist assistant by the Physical 
Therapy Examining Committee of the Board of Medical Examiners. 

(26) Physician. Physician means a person licensed as a physician and 
surgeon by the Board of Medical Examiners or by the Board of Osteo- 
pathic Examiners. 

(27) Podiatrist. Podiatrist means a person who is licensed as a podia- 
trist by the Board of Medical Examiners. 

(28) Psychiatrist. Psychiatrist means a person who is licensed as a phy- 
sician and surgeon by the Board of Medical Examiners or the Board of 
Osteopathic Examiners and who is certified or eligible for certification 
by the American Board of Psychiatry and Neurology or who has special- 
ized training and/or experience in psychiatry. 

(29) Psychologist. Psychologist means a person who is licensed as a 
psychologist by the Board of Medical Examiners. 

(30) Pulmonary Technologist. Pulmonary technologist means a per- 
son who is registered by the National Society of Cardiopulmonary Tech- 
nologists. 

(31) Radiologic Technologist. Radiologic technologist means a per- 
son other than a licentiate of the healing arts who has been issued a certifi- 
cate by the Department to engage in diagnostic radiologic technology 
without limitations as to procedures or areas of application and under the 
supervision of a certified X-ray supervisor and operator. 

(32) Recreation Therapist. Recreation therapist means a person who 
is certified or eligible for certification as a registered recreator with spe- 
cialization in therapeutic recreation by the California Board of Park and 
Recreation Personnel or the National Therapeutic Recreation Society. 

(33) Registered Nurse. 

(A) Registered nurse means a person licensed by the Board of Regis- 
tered Nursing. 

(B) Nurse Midwife. Nurse midwife means a registered nurse certified 
under Article 2.5, Chapter 6 of the Business and Professions Code. 

(34) Registered Record Administrator. Registered record administra- 
tor means a person who is registered by the American Medical Record 
Association. 

(35) Respiratory Therapist. Respiratory therapist means a person who 
is registered or eligible for registration as a respiratory therapist by the 
American Association for Respiratory Therapy or the National Board for 
Respiratory Therapy. 

(36) Respiratory Therapy Technician. Respiratory therapy technician 
means a person who is certified or eligible for certification as a respirato- 
ry therapy technician by the American Association for Respiratory Ther- 
apy or the National Board for Respiratory Therapy. 

(37) Social Worker. Social worker means a person who is licensed as 
a clinical social worker by the Board of Behavioral Science Examiners. 

(38) Social Work Assistant. Social work assistant means a person with 
a baccalaureate in the social sciences or related fields and who receives 
supervision, consultation and in-service training from a social worker. 

(39) Social Work Aide. Social work aide means a staff person with 
orientation, on-the-job training and supervision from a social worker or 
a social work assistant. 

(40) Speech Pathologist. Speech pathologist means a person who is li- 
censed as a speech pathologist by the Board of Medical Examiners. 

(41) Therapeutic Radiologic Technologist. Therapeutic radiologic 
technologist means a person other than a licentiate of the healing arts who 
has been issued a certificate by the Department to engage in therapeutic 
radiologic technology without limitation as to procedures or areas of 
application and under the supervision of a certified X-ray supervisor and 
operator. 

(42) Vocational Rehabilitation Counselor. Vocational rehabilitation 
counselor means a person who has a master's degree in rehabilitation 
counseling, or a master' s degree in a related area plus training and skill 
in the vocational rehabilitation process or has a baccalaureate degree and 
has worked under the direct supervision of a person with the above quali- 
fications. 



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§ 70101 



(43) X-ray Technician. X-ray technician means a person who has 
been issued a limited permit by the Department to engage in diagnostic 
or therapeutic radiologic technology in certain specific categories under 
the supervision of a certified X-ray supervisor and operator. 

(44) Physician's Assistant. Physician's assistant means a person certi- 
fied as such by the Physician's Assistant Examining Committee of the 
California Board of Medical Quality Assurance. 

NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (a)(33) and new subsection (a)(44) filed 3-13-80; 
effective thirtieth day thereafter (Register 80, No. 1 1). 

2. Change without regulatory effect amending subsection (a)(23) and Notk filed 
6-16-2000 pursuant to section 100, title 1, California Code of Regulations 
(Register 2000, No. 24). 



§ 70057. Principal Officer. 

Principal officer means the officer designated by an organization who 
has legal authority and responsibility to act for and in behalf of that orga- 
nization. 

§ 70059. Restraint. 

Restraint means controlling a patient's physical activity in order to 
protect the patient or others from injury by seclusion or mechanical de- 
vices. 



§70059.1. Rural Area. 

For the purposes of Health and Safety Code, Section 1250.8(b)(4)(A), 
"rural area" means any area which is located more than 30 miles or 30 
minutes driving distance from the city hall for any metropolitan area with 
a population of 150,000 or more. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1250.8, Health and Safety Code. 

History 

1 . New section filed 1 1-1 6-95 as an emergency; operative 1 1-16-95 (Register 95, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 3-15-96 
or emergency language will be repealed by operation of law on the following 
day. 

2. Certificate of Compliance as to 1 1-16-95 order, including amendment of sec- 
tion and Note, transmitted to OAL 3-15-96 and filed 4-12-96 (Register 96, 
No. 15). 



§ 70060. Skilled Nursing Care Bed Classification. 

"Skilled nursing care bed classification" means beds designated for 
patients requiring skilled nursing care on a continuous and extended ba- 
sis. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 1 0-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 



§ 70061. Special Permit. 

Special permit means the document issued by the Department which 
constitutes the authority to perform those supplemental services which 
are identified as special services in Section 70351. 

§ 70062. Special Hospital. 

"Special hospital" means a hospital which provides special services in 
cither rehabilitation, maternity, or dentistry, and which meets all of the 
requirements for a general acute care hospital, except that it is not re- 
quired to provide surgical or anesthesia services. 



NOTE: Authority cited: Sections 208 and 1250, Health and Safety Code. Refer- 
ence: ACR 67, Chapter 83, Statutes of 1977. 

History 
1. New section filed 7-28-78; effective thirtieth day thereafter (Register 78, 30. 

§ 70063. Sterilization. 

Sterilization means a process employed to destroy all living organ- 
isms. 

§ 70065. Supervision. 

(a) Supervision means to instmct an employee or subordinate in his 
duties and to oversee or direct his work, but does not necessarily require 
the immediate presence of the supervisor. 

(b) Direct supervision means that the supervisor shall be present in the 
same building as the person being supervised and available for consulta- 
tion and/or assistance. 

(c) Immediate supervision means that the supervisor shall be physical- 
ly present while a task is being performed. 

Supplemental service means an organized inpatient or outpatient ser- 
vice which is not required to be provided by law or regulation. 

§ 70067. Supplemental Service. 

Supplemental service means an organized inpatient or outpatient ser- 
vice which is not required to be provided by law or regulation. 

§ 70069. Unit Dose Medication System. 

Unit dose medication system means a system in which single dosage 
units of drugs are prepackaged and prelabeled in accordance with all 
applicable laws and regulations governing these practices. The system 
shall also comprise, but not be limited to, all equipment and appropriate 
records necessary and used in making the dose available to the patient in 
an accurate and safe manner. A pharmacist shall be in charge of and re- 
sponsible for the system. 

Article 2. License 

§ 701 01 . Inspection of Hospitals. 

(a) The Department shall inspect and license hospitals. 

(b) Any officer, employee or agent of the Department may, upon pre- 
sentation of proper identification, enter and inspect any building or prem- 
ises at any reasonable time to secure compliance with, or to prevent a vio- 
lation of, any provision of these regulations. 

(c) All hospitals for which a license has been issued shall be inspected 
periodically by a representative or representatives appointed by the De- 
partment. Inspections shall be conducted as frequently as necessary, but 
not less than once every two years, to assure that quality care is being pro- 
vided. During the inspection, the representative or representatives of the 
Department shall offer such advice and assistance to the hospital as is ap- 
propriate. For hospitals of 100 licensed bed capacity or more, the inspec- 
tion team shall include at least a physician, registered nurse and persons 
experienced in hospital administration and sanitary inspections. 

(d) The Department may provide consulting services upon request to 
any hospital to assist in the identification or correction of deficiencies or 
the upgrading of the quality of care provided by the hospital. 

(e) The Department shall notify the hospital of all deficiencies of com- 
pliance with these regulations and the hospital shall agree with the De- 
partment upon a plan of corrections which shall give the hospital a rea- 
sonable time to correct such deficiencies. If at the end of the allotted time, 
as revealed by repeat inspection, the hospital has failed to correct the defi- 
ciencies, the Director may take action to revoke or suspend the license. 

(f) Reports on the results of each inspection of a hospital shall be pre- 
pared by the inspector or inspection team and shall be kept on file in the 
Department along with the plan of correction and hospital comments. 
The inspection report may include a recommendation for reinspection. 
All inspection reports, lists of deficiencies and plans of correction shall 
be open to public inspection without regard to which body performs the 
inspection. 

(g) The Department shall have the authority to contract for outside per- 
sonnel to perform inspections of hospitals as the need arises. The Depart- 



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merit, when feasible, shall contract with nonprofit, professional organi- 
zations which have demonstrated the ability to carry out the provisions 
of this section. Such organizations shall include, but not be limited to, the 
California Medical Association Committee on Medical Staff Surveys 
and participants in the Consolidated Hospital Survey Program. 

§ 70103. License Required. 

(a) No person, firm, partnership, association, corporation, political 
subdivision of the state or other governmental agency shall establish, op- 
erate or maintain a hospital, or hold out, represent, or advertise by any 
means that it operates a hospital, without first obtaining a license from 
the Department. 

(b) The provisions of this article do not apply to any facility conducted 
by and for the adherents of any well-recognized church or religious de- 
nomination for the purpose of providing facilities for the care or treat- 
ment of the sick who depend upon prayer or spiritual means for healing 
in the practice of the religion of such church or denomination. 

§70105. Application Required. 

(a) A verified application shall be forwarded to the Department when- 
ever any of the following circumstances occur: 

( 1 ) Construction of a new or replacement facility or addition to an ex- 
isting facility. 

(2) Increase or decrease of licensed bed capacity. 

(3) Added service or change from one service to another. 

(4) Change of ownership. 

(5) Change of name of hospital. 

(6) Change of license category. 

(7) Change of location of the hospital. 

(8) Change of bed classification. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76. No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§ 701 07. Content of Application. 

(a) Any person, firm, partnership, association, corporation, political 
subdivision of the state, state agency or other governmental agency desir- 
ing to obtain a license shall file with the Department an application on 
forms furnished by the Department. The application shall contain the fol- 
lowing information: 

( 1 ) Name of applicant and, if an individual, verification that the appli- 
cant has attained the age of 18 years. 

(2) Type of facility to be operated and types of services for which ap- 
proval is requested. 

(3) Location of the hospital. 

(4) Name of person in charge of the hospital. 

(5) If the applicant is an individual, satisfactory evidence that the 
applicant is of reputable and responsible character. 

(6) If applicant is a firm, association, organization, partnership, busi- 
ness trust, corporation or company, satisfactory evidence that the mem- 
bers or shareholders thereof and the person in charge of the hospital for 
which application for license is made are of reputable and responsible 
character. 

(7) If the applicant is a political subdivision of the State or other gov- 
ernmental agency, satisfactory evidence that the person in charge of the 
hospital for which application for license is made is of reputable and re- 
sponsible character. 

(8) If the applicant is a partnership, the name and principal business 
address of each partner. 

(9) If the applicant is a corporation, the name and principal business 
address of each officer and director of the corporation; and for nonpublic 
corporations, the name and business address of each stockholder owning 
10 percent or more of the stock and any corporate member who has re- 
sponsibility in the operation of the hospital. 

(10) Copy of the current organizational chart. 



(11) Certificate of Need or a Certificate of Exemption from the Depart- 
ment if required by Chapter 1, Division 7 of this title. 

( 1 2) Such other information or documents as may be required by the 
Department for the proper administration and enforcement of the licens- 
ing law and requirements. 

History 

1. Amendment filed 1 1-12-76 as an emersency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1 ). 

3. Amendment of subsection (a)(l 1 ) filed 5-25-77; effective thirtieth day thereaf- 
ter (Register 77, No. 22). 

§ 70109. Architectural Plans. 

Applications submitted for proposed construction of new hospitals or 
additions to licensed hospitals shall include architectural plans and speci- 
fications. Information contained in such applications shall be on file in 
the Department and available to interested individuals and community 
agencies. 

§70110. Fee. 

(a) Each application for a license shall be accompanied by the pre- 
scribed fee. 

(b) The annual fee for license to operate a hospital, the term for which 
commences at any time during the calendar year 1975, when the applica- 
tion is filed upon change of ownership, change of location or renewal of 
a license shall be that specified in the following schedule: 

Capacity Requested Fee 

1—49 inclusive $150.00 plus 0.0185 of 1 percent 

of the gross operating costs for 
the last fiscal year ending on or 
before December 31,1 974. 

50-99 inclusive $300.00 plus 0.0185 of 1 percent 

of the gross operating costs of the 
last fiscal year ending on or 
before December 31, 1974. 

100 and over $425.00 plus 0.0185 of 1 percent 

of the gross operating costs for 
the last fiscal year ending on or 
before December 3 1 , 1974. 

(c) The annual fee for a license to operate a hospital which is being li- 
cense for the first time, the term for which commences at any time during 
the calendar year 1975, shall be that specified in the following schedule: 

Capacity Requested Fee 

1—49 inclusive $200.00 

50-99 inclusive $300.00 

100 and over $800.00 

(d) No fee shall be refunded to the applicant if the application is with- 
drawn or if the application is denied by the Department. 

(e) An additional fee of $25.00 shall be paid for processing any change 
of name. However, no additional fee shall be charged for any change of 
name, which is processed upon a renewal application or upon an applica- 
tion filed because of a change of ownership. 

(f) Fees for licenses which cover periods in excess of 12 months shall 
be prorated on the basis of the number of months to be licensed divided 
by 12 months. 

(g) Fees shall be waived for any facility conducted, maintained or op- 
erated by this state or any state department, authority, bureau, commis- 
sion or officer or by the Regents of the University of California or by a 
local hospital district, city or county. 

NOTE: Authority cited: Sections 208 (a), 1266, Health and Safety Code. Refer- 
ence: Section 1266, Health and Safety Code. 

History 

1. New section filed 1-30-80: effective thirtieth day thereafter (Register 80, 
No. 5). 

§70111. Fee. 

(a) Each application for a license shall be accompanied by the pre- 
scribed fee. The license fee under this section shall be effective January 
1, 1979. 

(b) The fee for a license to operate a hospital which is being licensed 
for the first time, or upon a change of ownership or change of location 
shall be that specified in the following schedule: 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70117 



• 



• 



Capacity Requested Fee 

1-49 inclusive $293.00 

50-99 inclusive $439.00 

100 and over $1,172.00 

(c) The fee for a license to operate a hospital upon a renewal of a li- 
cense during the year 1979 shall be that specified in the following sched- 
ule: 

Capacity Requested Fee 

1-49 inclusive $200.00 plus 0.01232 of 1 percent 

of gross operating costs for the 
last complete fiscal year of the 
hospital. 

50-99 inclusive $399.00 plus 0.01232 of 1 percent 

of the gross operating costs of the 
last complete fiscal year of the 
hospital 

100 and over $567.00 plus 0.01232 of 1 percent of 

the gross operating costs for the 
last complete fiscal year of the 
hospital 

(d) No fee shall be refunded to the applicant if the application is with- 
drawn or if the application is denied by the Department. 

(e) Fees for licenses which cover periods in excess of 12 months shall 
be prorated on the basis of the total number of months to be licensed di- 
vided by 12 months. 

(f) Fees shall be waived for any facility conducted, maintained or oper- 
ated by this state or any state department, authority, bureau, commission 
or officer, or by the Regents of the University of California, or by a local 
hospital district, city or county. 

NoiK: Authority cited: Sections 1275, and 1729 Health and Safety Code. Refer- 
ence: Sections 1266, and 1729, Health and Safety Code. 

History 

1. Amendment of subsections (a), (b), and (c) filed 10-8-76; effective thirtieth day 
thereafter (Register 76, No. 41). 

2. Amendment of subsections (a), (b) and (c) filed 1^1-77; effective thirtieth day 
thereafter (Register 77, No. 2). 

3. Amendment of subsections (a), (b), (c), (e), and (f) filed 1 1-8-78; effective thir- 
tieth day thereafter (Register 78, No. 45). 

4. Amendment of subsections (a), (b), and (c), and repealer of subsection (g) filed 
5-2-79; effective thirtieth day thereafter (Register 79, No. 18). 

§ 701 1 3. Health Planning Agency Review. 

History 

1 . Repealer filed 12-3-76 as an emergency ; effective upon filing (Register 76, No. 
49). 

2. Reinstatement of section as it existed prior to emergency repealer filed 1 2-3-76 
as to filing of 6-13-75 by operation of Section 11422.1(b), Government Code 
(Register 77, No. 22). 

3. Repealer filed 3-31-78; effective thirtieth day thereafter (Register 78, No. 13). 

§ 7011 3. Projects Requiring a Certificate of Need. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference Chapter 854, Statutes of 1976. 

History 
1. Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 701 13.1. Projects Eligible for a Certificate of Exemption. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 701 13.2. Projects Not Subject to Review by a Voluntary 
Area Health Planning Agency. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 701 13.3. Projects Previously Decided by a Voluntary 
Area Health Planning Agency. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255. and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 



History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 701 1 3.4. Exemption Requests for Remodeling and 
Replacement Projects. 

NOTE: Authority cited: Sections 208. 1250, 1250.1, 1251, 1255. and 1268. Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1. Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77. No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 701 1 4. Bed Classification. 

(a) Each hospital shall notify the Department on forms supplied by the 
Department of bed classifications as defined in Sections 70006, 70034, 
70038 and 70060 within 30 days of the effective date of this section. For 
hospitals not reporting within the 30-day period, the Department will 
classify the beds based on the latest information in the Department files. 

(b) After the above notification has been received by the Department 

or the Department has classified the beds, no further reclassification of 

beds shall take place until on or after January 1, 1977. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 

§ 70115. Safety, Zoning and Building Clearance. 

(a) Architectural plans shall not be approved and a license shall not be 
originally issued to any hospital which does not conform to: the regula- 
tions in this chapter; state requirements on seismic safety, fire and life 
safety and environmental impact; and local fire safety, zoning and build- 
ing ordinances. Evidence of such compliance shall be presented in writ- 
ing to the Department. 

(b) It shall be the responsibility of the licensee to maintain the hospital 
in a safe structural condition. If the Department determines that an evalu- 
ation of the structural condition of a hospital building is necessary, the 
licensee may be required to submit a report by a licensed structural engi- 
neer which shall establish a basis for eliminating or correcting the struc- 
tural conditions which are found to be hazardous to occupants. 

§ 70117. Issuance, Expiration and Renewal. 

(a) Upon verification of compliance with the licensing requirements, 
the Department shall issue the applicant a license. 

(b) If the applicant is not in compliance with the laws or regulations, 
the Department shall deny the applicant a license and shall immediately 
notify the applicant in writing. Within 20 days of receipt of the Depart- 
ment's notice, the applicant may present his written petition for a hearing 
to the Department. The Department shall set the matter for hearing within 
30 days after receipt of the petition in proper form. The proceedings shall 
be conducted in accordance with Chapter 5 (commencing with Section 
1 1500) of Part 1 of Division 3 of Title 2 of the Government Code. 

(c) Each initial license shall expire at midnight, one year from the date 
of issue. A renewal license: 

( 1 ) May be issued for a period not to exceed two years if the holder of 
the license has been found not to have been in violation of any statutory 
requirements, regulations or standards during the preceding license peri- 
od. 

(2) Shall reflect the number of beds that meet construction and opera- 
tional requirements and shall not include beds formerly located in patient 
accommodation space which has been permanently converted. 

(3) Shall not be issued if the hospital is liable for and has not paid the 
special fees required by Section 90417, Chapter 1, Division 7, of this 
Title. 

(d) The Department shall mail an application form for renewal of li- 
cense to the licensee at least 45 days prior to expiration of a license. 
Application for renewal, accompanied by the necessary fees, shall be 
filed with the Department annually and not less than ten days prior to the 
expiration date. Failure to make a timely renewal application shall result 
in expiration of the license. 



Page 765 



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§ 70119 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



History 

1. Amendment of subsection (c) filed 1 1-1 2-76 as an emergency; effective upon 
filing (Register 76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 701 19. Provisional Licensing of Distinct Parts. 

(a) The initial license, issued by the Department to an applicant when 
the hospital includes a distinct part which will function as a skilled nurs- 
ing or intermediate care service, shall include a separate provisional au- 
thorization for the distinct part. The provisional authorization for the dis- 
tinct part service shall terminate six months from the date of issuance. 
The Department shall give the distinct part, and supporting elements of 
the hospital, a full and complete inspection within 30 days prior to termi- 
nation of the provisional authorization. A regular authorization will be 
included in the license if the hospital and distinct part meet all applicable 
requirements for licensure. If the hospital does not meet the requirements 
for licensure but has made substantial progress toward meeting such re- 
quirements, as determined by the Department, the initial provisional li- 
cense shall be renewed for six months. If the Department determines that 
there has not been substantial progress toward meeting licensure require- 
ments at the time of the first full inspection provided by this section, or 
if the 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 such requirements, no further license shall be issued. 

(b) An applicant who has been denied provisional licensing may con- 
test such denial by filing a statement of issues, as provided in Section 
1 1 504 of the Government Code: The proceedings to review such denial 
shall be conducted pursuant to the provisions of Chapter 5 (commencing 
with Section 1 1500), Part 1, Division 3, Title 2, of the Government Code. 

§ 701 21 . Separate Licenses. 

Separate licenses shall be required for hospitals which are maintained 
on separate premises even though they are under the same management. 
This does not apply to outpatient departments or clinics of hospitals des- 
ignated as such which are maintained and operated on separate premises. 
Separate licenses shall not be required for separate buildings on the same 
grounds or adjacent grounds. 

§70123. Posting. 

The license, or a true copy thereof, shall be posted conspicuously in 
a prominent location within the licensed premises and accessible to pub- 
lic view. 

§70125. Transferability. 

Licenses are not transferable. The licensee shall notify the Department 
in writing at least 30 days prior to the effective date of any change of own- 
ership. A new application for license shall be submitted by the prospec- 
tive new owner. 

§ 70127. Report of Changes. 

(a) The licensee shall notify the Department in writing any time a 
change of stockholder owning ten percent or more of the non-public cor- 
porate stock occurs. Such notice shall include the name and principal 
mailing address of the new stockholder. 

(b) Each licensee shall notify the Department in writing within ten 
days prior to any change of the mailing address of the licensee. Such no- 
tice shall include the new mailing address of the licensee. 

(c) Any change in the principal officer shall be reported in writing 
within ten days by the licensee to the Department. Such notice shall in- 
clude the name and principal business address of such officer. 

§ 70129. Program Flexibility. 

(a) All hospitals shall maintain continuous compliance with the licens- 
ing requirements. These requirements do not prohibit the use of alternate 
concepts, methods, procedures, techniques, equipment, personnel quali- 
fications or the conducting of pilot projects provided such exceptions are 
carried out with the provisions for safe and adequate care and with the 
prior written approval of the Department. Such approval 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. 

(b) Hospitals which by reason of remoteness are unable to comply with 
provisions of the regulations for basic services and perinatal or pediatric 
services, shall submit a written request to the Department for exception. 
In reviewing such request, special attention may be required regarding 
qualifications of medical staff and personnel. 

(c) Special exceptions may be granted under this section for hospitals 
required to provide services and accommodations for persons who may 
have dangerous propensities necessitating special precautions, personnel 
with special qualifications, locked accommodations, special protection 
for windows, type and location of lighting and plumbing fixtures, signal 
systems, control switches, beds and other furnishings. This applies to 
psychiatric units and detention facilities where added protection is neces- 
sary for patients, staff members and members of the public. 

(d) Any approval of the Department granted under this section or a true 
copy thereof, shall be posted immediately adjacent to the facility's li- 
cense that is required to be posted by Section 70123. 

History 
1. Editorial correction of subsection (b) (Register 95, No. 44). 

§ 70131. Voluntary Suspension of License or Licensed 
Beds. 

(a) Upon written request, a licensee may request that his license or li- 
censed beds be put in suspense. The Department may approve the request 
for a period not to exceed 12 months. 

(b) Any license or portion thereof which ha been temporarily sus- 
pended by the Department pursuant to this section shall remain subject 
to all renewal requirements of an active license, including the payment 
of license renewal fees, during the period of temporary suspension. 

(c) Any license suspended pursuant to this section may be reinstated 
by the Department within 12 months of the date of suspension upon re- 
ceipt of an application and evidence showing compliance with licensing 
operational requirements in effect at the time of reinstatement. If the li- 
cense is not reinstated within the 12 month period, the license shall expire 
automatically and shall not be subject to reinstatement. 

§ 70133. Voluntary Cancellation of License. 

(a) The licensee shall notify the Department in writing as soon as pos- 
sible and in all cases at least 30 days prior to the desired effective date of 
cancellation of the license. 

(b) Any license voluntarily cancelled pursuant to this section may be 
reinstated by the Department within 12 months of the date of voluntary 
cancellation upon receipt of an application along with evidence showing 
compliance with operational and construction licensing requirements. 

§ 70135. Revocation or Involuntary Suspension of 
License. 

(a) Pursuant to provisions of Chapter 5 (commencing with Section 
1 1500), Part 1 , Division 3, of Title 2, Government Code, the Department 
may suspend or revoke any license issued under the provisions of Chap- 
ter 2 (commencing with Section 1250), Division 2, Health and Safety 
Code, upon any of the following grounds. 

(1) Violation by the licensee of any of the provisions of Chapter 2 
(commencing with Section 1250), Division 2, Health and Safety Code, 
or the regulations promulgated by the Department. 

(2) Aiding, abetting or permitting the violation of any provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, or the regulations promulgated by the Department. 

(3) Conduct inimical to the public health, morals, welfare or safety of 
the people of the State of California in the maintenance and operation of 
the premises or services for which a license is issued. 

(b) The license of any hospital against which special fees are required 
by Section 90417, Chapter 1, Division 7, of this Title shall be revoked, 
after notice of hearing, if it is determined by the Department that the fees 
required were not paid within the time prescribed. 



• 



• 



Page 766 



Register 96, No. 48; 11-29-96 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70211 



(c) The Director may temporarily suspend any license prior to any 
hearing when, in his opinion, such action is necessary to protect the pub- 
lic welfare. 

( 1 ) The Director shall notify the licensee of the temporary suspension 
and the effective date thereof and at the same time shall serve such licen- 
see with an accusation. 

(2) Upon receipt of a notice of defense by the licensee, the Director 
shall set the matter for hearing within 1 5 days. The hearing shall be held 
as soon as possible but no later than 30 days after receipt of such notice. 

(3) The temporary suspension shall remain in effect until such time as 
the hearing is completed and the Director has made a final determination. 

(4) If the Director fails to make a final determination within 60 days 
after the original hearing has been completed, the temporary suspension 
shall be deemed vacated. 

(5) If the provisions of Chapter 2 (commencing with Section 1250), 
Division 2, Health and Safety Code, or the regulations promulgated by 
the Director are violated by a licensee which is a group, corporation or 
other association, the Director may suspend the license of such organiza- 
tion or may suspend the license as to any individual person within such 
organization who is responsible for such violation. 

(d) The withdrawal of an application for a license shall not deprive the 
Department of its authority to institute or continue a proceeding against 
the applicant for the denial of the license upon any ground provided by 
law or to enter an order denying the license upon any such ground, unless 
the Department consents in writing to such withdrawal. 

(e) The suspension, expiration or forfeiture of a license issued by the 
Department shall not deprive the Department of its authority to institute 
or continue a proceeding against the license upon any ground provided 
by law or to enter an order suspending or revoking a license or otherwise 
taking disciplinary action against the licensee on any such ground. 
NOTE: Authority cited: Section 208(a), Health and Safety Code. Reference: Sec- 
tion 1296, Health and Safety Code. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

3. Amendment of subsection (c)(2) filed 7-25-79; effective thirtieth day thereafter 
(Register 79, No. 30). 

§ 70136. Conviction of Crime: Standards for Evaluating 
Rehabilitation. 

When considering the denial, suspension or revocation of a license 
based on the conviction of a crime in accordance with Section 1265.1 or 
1294 of the Health and Safety Code, the following criteria shall be con- 
sidered in evaluating rehabilitation: 

( 1 ) The nature and the seriousness of the crime(s) under consideration. 

(2) Evidence of conduct subsequent to the crime which suggests re- 
sponsible or irresponsible character. 

(3) The time which has elapsed since commission of the crime(s) or 
conduct referred to in subdivision (1) or (2). 

(4) The extent to which the applicant has complied with any terms of 
parole, probation, restitution, or any other sanction lawfully imposed 
against the applicant. 

(5) Any rehabilitation evidence submitted by the applicant. 

NOTE: Authority cited: Sections 208(a), 1265.2 and 1275, Health and Safety 
Code. Reference: Sections 1265.1, 1265.2 and 1294, Health and Safety Code. 

History 
1. New section filed 9-13-84; effective thirtieth day thereafter (Register 84, No. 
37). 

§70137. Bonds. 

(a) Each licensee shall file or have on file with the Department a bond 
issued by a surety company admitted to do business in this State if the li- 
censee is handling or will handle money in the amount of $25 or more per 
patient or $500 or more for all patients in any month. 

( 1 ) The amount of the bond shall be according to the following sched- 
ule: 



Amount Handled Bond Required 

$750 or less SI. 000 

$751 to $1,500 S2.000 

$1,501 to $2,500 $3,000 

(2) Every further increment of S 1 ,000 or fraction thereof shall require 
an additional $1,000 on the bond. 

(b) Each application for an original license or renewal of license shall 
be accompanied by an affidavit on a form provided by the Department. 
The affidavit shall state whether the licensee handles or will handle 
money of patients and the maximum amount of money to be handled for 
any patient and for all patients in any month. 

(c) No licensee shall either handle money of a patient or handle 
amounts greater than those stated in the affidavit submitted by him with- 
out first notifying the Department and filing a new or revised bond if re- 
quired. 

Article 3. Basic Services 

§ 70201 . Medical Service Definition. 

Medical service means those preventive, diagnostic and therapeutic 
measures performed by or at the request of members of the organized 
medical staff. 

§ 70203. Medical Service General Requirements. 

(a) A committee of the medical staff shall be assigned responsibility 
for: 

( 1 ) Recommending to the governing body the delineation of medical 
privileges. 

(2) Developing, maintaining and implementing written policies and 
procedures in consultation with other appropriate health professionals 
and administration. Policies shall be approved by the governing body. 
Procedures shall be approved by the administration and medical staff 
where such is appropriate. 

(3) Developing and instituting, in conjunction with members of the 
medial staff and other hospital services, a continuing cardiopulmonary 
resuscitation training program. 

(4) Determining what emergency equipment and supplies should be 
available in all areas of the hospital. 

(b) The responsibility and accountability of the medical service to the 
medical staff and administration shall be defined. 

(c) The following shall be available to all patients in the hospital: 

(1) Electrocardiographic testing. 

(2) Pulmonary function testing. 

(3) Intermittent positive pressure breathing apparatus. 

(4) Cardiac monitoring capability. 

(5) Suction. 

(d) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70205. Medical Service Staff. 

A physician shall have overall responsibility for the medical service. 
This physician shall be certified or eligible for certification in internal 
medicine by the American Board of Internal Medicine. If such an inter- 
nist is not available, a physician, with training and experience in internal 
medicine, shall be responsible for the service. 

§ 70207. Medical Service Equipment and Supplies. 

There shall be adequate equipment and supplies maintained related to 
the nature of the needs and the services offered. 

§ 70209. Medical Service Space. 

There shall be adequate space maintained to meet the needs of the ser- 
vice. 

§ 7021 1 . Nursing Service General Requirements. 

(a) The nursing service shall be organized, staffed, equipped, and 
supplied, including furnishings and resource materials, to meet the needs 
of patients and the service. 



Page 767 



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§ 70213 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(b) The nursing service shall be under the direction of an administrator 
of nursing services who shall be a registered nurse with the following 
qualifications: 

( 1 ) Master's degree in nursing or a related field with at least one year 
of experience in administration; or 

(2) Baccalaureate degree in nursing or a related field with at least two 
years of experience in nursing administration; or 

(3) At least four years of experience in nursing administration or su- 
pervision, with evidence of continuing education directly related to the 
job specifications. 

(c) It shall be designated in writing by the hospital administrator that 
the administrator of nursing services has authority, responsibility and ac- 
countability for the nursing service within the facility. 

( 1 ) The internal structure and accountability of the nursing service, in- 
cluding identification of nursing service units and committees, shall be 
defined in writing. 

(2) The relationship between the nursing service and administration, 
organized medical staff and other departments shall be defined in writ- 
ing. Such definition of relationship shall be developed in cooperation 
with respective departments. Administrative, medical staff, and other 
hospital committees that address issues affecting nursing care shall in- 
clude registered nurses, including those who provide direct patient care. 
Licensed vocational nurses may serve on those committees. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 3-13-80; effective thirtieth day thereafter (Register 80, No. 
11). 

2. Repealer and new section, and amendment of Notf. filed 1 1-26-96; operative 
12-26-96 (Register 96, No. 48). 



§ 70213. Nursing Service Policies and Procedures. 

(a) Written policies and procedures for patient care shall be developed, 
maintained and implemented by the nursing service. 

( 1 ) Policies and procedures which involve the medical staff shall be 
reviewed and approved by the medical staff prior to implementation. 

(2) Policies and procedures of other departments which contain re- 
quirements for the nursing service shall be reviewed and approved by the 
nursing service prior to implementation. 

(3) The nursing service shall review and revise policies and procedures 
every three years, or more often if necessary. 

(4) The hospital administration and the governing body shall review 
and approve all policies and procedures that relate to the nursing service 
every three years or more often, if necessary. 

(b) Policies and procedures shall be based on current standards of nurs- 
ing practice and shall be consistent with the nursing process which in- 
cludes: assessment, nursing diagnosis, planning, intervention, evalua- 
tion, and, as circumstances require, patient advocacy. 

(c) Policies and procedures which contain competency standards for 
staff performance in the delivery of patient care shall be established, im- 
plemented, and updated as needed for each nursing unit, including stan- 
dards for the application of restraints. Standards shall include the ele- 
ments of competency validation for patient care personnel other than 
registered nurses as set forth in Section 70016, and the elements of com- 
petency validation for registered nurses as set forth in Section 70016.1. 
At least annually, patient care personnel shall receive a written perform- 
ance evaluation. The evaluation shall include, but is not limited to, mea- 
suring individual performance against established competency stan- 
dards. 

(d) Policies and procedures that require consistency and continuity in 
patient care, incorporating the nursing process and the medical treatment 
plan, shall be developed and implemented in cooperation with the medi- 
cal staff. 

(e) Policies and procedures shall be developed and implemented 
which establish mechanisms for rapid deployment of personnel when 
any labor intensive event occurs which prevents nursing staff from pro- 



viding attention to all assigned patients, such as multiple admissions or 
discharges, or an emergency health crisis. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 1276, Health and Safety Code. 

History 

1 . Amendment of section headine and section, and new Note filed 1 1-26-96: op- 
erative 12-26-96 (Register 96, No. 48). 



§70214. Nursing Staff Development. 

(a) There shall be a written, organized in-service education program 
for all patient care personnel, including temporary staff as described in 
subsection 70217(m). The program shall include, but shall not be limited 
to, orientation and the process of competency validation as described in 
subsection 70213(c). 

( 1 ) All patient care personnel, including temporary staff as indicated 
in subsection 70217(m). shall receive and complete orientation to the 
hospital and their assigned patient care unit before receiving patient care 
assignments. Orientation to a specific unit may be modified in order to 
meet temporary staffing emergencies as described in subsection 
70213(e). 

(2) All patient care personnel, including temporary staff as described 
in subsection 70217(m), shall be subject to the process of competency 
validation for their assigned patient care unit or units. Prior to the comple- 
tion of validation of the competency standards for a patient care unit, pa- 
tient care assignments shall be subject to the following restrictions: 

(A) Assignments shall include only those duties and responsibilities 
for which competency has been validated. 

(B) A registered nurse who has demonstrated competency for the pa- 
tient care unit shall be responsible for nursing care as described in subsec- 
tions 70215(a) and 70217(h)(3), and shall be assigned as a resource nurse 
for those registered nurses and licensed vocational nurses who have not 
completed competency validation for that unit. 

(C) Registered nurses shall not be assigned total responsibility for pa- 
tient care, including the duties and responsibilities described in subsec- 
tions 70215(a) and 70217(h)(3), until all the standards of competency for 
that unit have been validated. 

(3) The duties and responsibilities of patient care personnel who may 
be temporarily re-directed from their assigned units are subject to the re- 
strictions in (A), (B), and (C) of subsection (a)(2) above. 

(4) Orientation and competency validation shall be documented in the 
employee's file and shall be retained for the duration of the individual's 
employment. 

(5) A rural General Acute Care Hospital, as defined in Health and 
Safety Code Section 1250(a), may apply for program flexibility pursuant 
to Section 70129 of this Chapter, to meet the requirements of subsections 
70214(a)(1) through (4) above, by alternate means. 

(b) The staff education and training program shall be based on current 
standards of nursing practice, established standards of staff performance 
as specified in subsection 70213(c) above, individual staff needs and 
needs identified in the quality assurance process. 

(c) The administrator of nursing services shall be responsible for see- 
ing that all nursing staff receive mandated education as specified in sub- 
section (a) of this Section. 

(d) All staff development programs shall be documented by: 

( 1 ) A record of the title, length of course in hours, and objectives of the 
education program presented. 

(2) Name, title, and qualifications of the instructor or the title and type 
of other educational media. 

(3) A description of the content. 

(4) A date, a record of the instructor, process, or media and a list of at- 
tendees. 

(5) Written evaluation of course content by attendees. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Sections 1250(a) and 1276, Health and Safety Code. 

History 
1. New section filed 1 1-26-96; operative 12-26-96 (Register 96, No. 48). 



Page 768 



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Licensing and Certification of Health Facilities and Referral Agencies 



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§ 70215. Planning and Implementing Patient Care. 

(a) A registered nurse shall directly provide: 

( 1 ) Ongoing patient assessments as defined in the Business and Profes- 
sions Code, Section 2725(d). Such assessments shall be performed, and 
the findings documented in the patient's medical record, for each shift, 
and upon receipt of the patient when he/she is transferred to another pa- 
tient care area. 

(2) The planning, supervision, implementation, and evaluation of the 
nursing care provided to each patient. The implementation of nursing 
care may be delegated by the registered nurse responsible for the patient 
to other licensed nursing staff, or may be assigned to unlicensed staff, 
subject to any limitations of their licensure, certification, level of vali- 
dated competency, and/or regulation. 

(3) The assessment, planning, implementation, and evaluation of pa- 
tient education, including ongoing discharge teaching of each patient. 
Any assignment of specific patient education tasks to patient care person- 
nel shall be made by the registered nurse responsible for the patient. 

(b) The planning and delivery of patient care shall reflect all elements 
of the nursing process: assessment, nursing diagnosis, planning, inter- 
vention, evaluation and, as circumstances require, patient advocacy, and 
shall be initiated by a registered nurse at the time of admission. 

(c) The nursing plan for the patient's care shall be discussed with and 
developed as a result of coordination with the patient, the patient's fami- 
ly, or other representatives, when appropriate, and staff of other disci- 
plines involved in the care of the patient. 

(d) Information related to the patient's initial assessment and 
reassessments, nursing diagnosis, plan, intervention, evaluation, and pa- 
tient advocacy shall be permanently recorded in the patient's medical re- 
cord. 

NOTK: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: Section 2725(d), Business and Professions Code; and Section 1276, 
Health and Safety Code. 

History 
1 . Repealer and new section, and new Note filed 1 1-26-96; operative 12-26-96 
(Register 96, No. 48). 

Amendments to section 70217 were adopted on an emergency 
basis and became operative 11-12-2004. The emergency 
amendments were subsequently readopted twice, effective 
3-15-2005 and 7-14-2005. These amendments were enjoined 
from implementation and enforcement by the Superior Court 
for Sacramento County in the case of California Nurses 
Association v. Schwarzenegger etal, Case No. 04CS01725. As 
a result of the injunction, the version of the regulation adopted 
on 9-26-2003 and operative 1-1-2004 remained in effect. 
California Nurses Association v. Schwarzenegger et ai, has 
been resolved; no certificate of compliance was submitted for 
the emergency action and the emergency amendments were 
repealed by operation of law. 

§ 7021 7. Nursing Service Staff. 

NOTE: Authority cited: Sections 1275, 1276.4 and 100275(a), Health and Safety 
Code. Reference: Sections 1250(a), 1276, 1276.4, 1797.58 and 1790.160, Health 
and Safety Code. 

History 

1. Repealer and new section, and new Note filed 1 1-26-96; operative 12-26-96 
(Register 96, No. 48). 

2. Amendment of section and Note filed 9-26-2003; operative 1-1-2004 (Regis- 
ter 2003, No. 39). 

3. Amendment of subsections (a), (a)( 1 1 ) and (d), new subsections (e) and (s), sub- 
section relettering and amendment of newly designated subsection (r) filed 
1 1-12-2004 as an emergency; operative 1 1-12-2004 (Register 2004, No. 46). 
A Certificate of Compliance must be transmitted to OAL by 3-14-2005 or 
emergency language will be repealed by operation of law on the following day. 

4. Amendment of subsections (a), (a)( 1 1 ) and (d), new subsections (e) and (s), sub- 
section relettering and amendment of newly designated subsection (r) refiled 
3-10-2005 as an emergency; operative 3-15-2005 (Register 2005, No. 10). A 



Certificate of Compliance must be transmitted to OAL by 7-1 3-2005 or emer- 
gency language will be repealed by operation of law on the following day. 

5. Amendment of subsections (a), (a)( 1 1 ) and (d), new subsections (e) and (s), sub- 
section relettering and amendment of newly designated subsection (r) rciiled 
7-1 1-2005 as an emergency; operative 7-14-2005 (Register 2005, No. 28). A 
Certificate of Compliance must be transmitted to OAL by 1 1 -1 4-2005 or emer- 
gency language will be repealed by operation of law on the following day. 

6. Addition of explanatory Note (Register 2005, No. 33). 

7. Repealed by operation of Government Code section 1 1 346. 1 ( g) (Register 2005, 
No. 47). 

§ 7021 7. Nursing Service Staff. 

(a) Hospitals shall provide staffing by licensed nurses, within the 
scope of their licensure in accordance with the following nurse-to- 
patient ratios. Licensed nurse means a registered nurse, licensed voca- 
tional nurse and, in psychiatric units only, a licensed psychiatric techni- 
cian. Staffing for care not requiring a licensed nurse is not included 
within these ratios and shall be determined pursuant to the patient classi- 
fication system. 

No hospital shall assign a licensed nurse to a nursing unit or clinical 
area unless that hospital determines that the licensed nurse has demon- 
strated current competence in providing care in that area, and has also re- 
ceived orientation to that hospital's clinical area sufficient to provide 
competent care to patients in that area. The policies and procedures of the 
hospital shall contain the hospital's criteria for making this determina- 
tion. 

Licensed nurse-to-patient ratios represent the maximum number of 
patients that shall be assigned to one licensed nurse at any one time. "As- 
signed" means the licensed nurse has responsibility for the provision of 
care to a particular patient within his/her scope of practice. There shall 
be no averaging of the number of patients and the total number of li- 
censed nurses on the unit during any one shift nor over any period of time. 
Only licensed nurses providing direct patient care shall be included in the 
ratios. 

Nurse Administrators, Nurse Supervisors, Nurse Managers, and 
Charge Nurses, and other licensed nurses shall be included in the calcula- 
tion of the licensed nurse-to-patient ratio only when those licensed 
nurses are engaged in providing direct patient care. When a Nurse Ad- 
ministrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other li- 
censed nurse is engaged in activities other than direct patient care, that 
nurse shall not be included in the ratio. Nurse Administrators, Nurse Su- 
pervisors, Nurse Managers, and Charge Nurses who have demonstrated 
current competence to the hospital in providing care on a particular unit 
may relieve licensed nurses during breaks, meals, and other routine, ex- 
pected absences from the unit. 

Licensed vocational nurses may constitute up to 50 percent of the li- 
censed nurses assigned to patient care on any unit, except where regis- 
tered nurses are required pursuant to the patient classification system or 
this section. Only registered nurses shall be assigned to Intensive Care 
Newborn Nursery Service Units, which specifically require one regis- 
tered nurse to two or fewer infants. In the Emergency Department, only 
registered nurses shall be assigned to triage patients and only registered 
nurses shall be assigned to critical trauma patients. 

Nothing in this section shall prohibit a licensed nurse from assisting 
with specific tasks within the scope of his or her practice for a patient as- 
signed to another nurse. "Assist" means that licensed nurses may provide 
patient care beyond their patient assignments if the tasks performed are 
specific and time-limited. 

(1) The licensed nurse-to-patient ratio in a critical care unit shall be 
1 :2 or fewer at all times. "Critical care unit" means a nursing unit of a gen- 
eral acute care hospital which provides one of the following services: an 
intensive care service, a burn center, a coronary care service, an acute re- 
spiratory service, or an intensive care newborn nursery service. In the in- 
tensive care newborn nursery service, the ratio shall be 1 registered 
nurse: 2 or fewer patients at all times. 

(2) The surgical service operating room shall have at least one regis- 
tered nurse assigned to the duties of the circulating nurse and a minimum 
of one additional person serving as scrub assistant for each patient-occu- 
pied operating room. The scrub assistant may be a licensed nurse, an op- 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



erating room technician, or other person who has demonstrated current 
competence to the hospital as a scrub assistant, but shall not be a physi- 
cian or other licensed health professional who is assisting in the perfor- 
mance of surgery. 

(3) The licensed nurse-to-patient ratio in a labor and delivery suite of 
the perinatal service shall be 1 :2 or fewer active labor patients at all times. 
When a licensed nurse is caring for antepartum patients who are not in 
active labor, the licensed nurse-to-patient ratio shall be 1:4 or fewer at 
all times. 

(4) The licensed nurse-to-patient ratio in a postpartum area of the per- 
inatal service shall be 1 :4 mother-baby couplets or fewer at all times. In 
the event of multiple births, the total number of mothers plus infants as- 
signed to a single licensed nurse shall never exceed eight. For postpartum 
areas in which the licensed nurse's assignment consists of mothers only, 
the licensed nurse-to-patient ratio shall be 1 :6 or fewer at all times. 

(5) The licensed nurse-to-patient ratio in a combined Labor/Delivery/ 
Postpartum area of the perinatal service shall be 1 :3 or fewer at all times 
the licensed nurse is caring for a patient combination of one woman in 
active labor and a postpartum mother and infant The licensed nurse-to- 
patient ratio for nurses caring for women in active labor only, antepartum 
patients who are not in active labor only, postpartum women only, or 
mother-baby couplets only, shall be the same ratios as stated in subsec- 
tions (3) and (4) above for those categories of patients. 

(6) The licensed nurse-to-patient ratio in a pediatric service unit shall 
be 1 :4 or fewer at all times. 

(7) The licensed nurse-to-patient ratio in a postanesthesia recovery 
unit of the anesthesia service shall be 1 :2 or fewer at all times, regardless 
of the type of anesthesia the patient received. 

(8) In a hospital providing basic emergency medical services or com- 
prehensive emergency medical services, the licensed nurse-to-patient 
ratio in an emergency department shall be 1 :4 or fewer at all times that 
patients are receiving treatment. There shall be no fewer than two li- 
censed nurses physically present in the emergency department when a 
patient is present. 

At least one of the licensed nurses shall be a registered nurse assigned 
to triage patients. The registered nurse assigned to triage patients shall be 
immediately available at all times to triage patients when they arrive in 
the emergency department. When there are no patients needing triage, 
the registered nurse may assist by performing other nursing tasks. The 
registered nurse assigned to triage patients shall not be counted in the li- 
censed nurse-to-patient ratio. 

Hospitals designated by the Local Emergency Medical Services 
(LEMS ) Agency as a "base hospital", as defined in section 1 797.58 of the 
Health and Safety Code, shall have either a licensed physician or a regis- 
tered nurse on duty to respond to the base radio 24 hours each day. When 
the duty of base radio responder is assigned to a registered nurse, that reg- 
istered nurse may assist by performing other nursing tasks when not re- 
sponding to radio calls, but shall be immediately available to respond to 
requests for medical direction on the base radio. The registered nurse as- 
signed as base radio responder shall not be counted in the licensed nurse- 
to-patient ratios. 

When licensed nursing staff are attending critical care patients in the 
emergency department, the licensed nurse-to-patient ratio shall be 1:2 
or fewer critical care patients at all times. A patient in the emergency de- 
partment shall be considered a critical care patient when the patient meets 
the criteria for admission to a critical care service area within the hospital. 

Only registered nurses shall be assigned to critical trauma patients in 
the emergency department, and a minimum registered nurse-to-critical 
trauma patient ratio of 1 : 1 shall be maintained at all times. A critical trau- 
ma patient is a patient who has injuries to an anatomic area that : (1) re- 
quire life saving interventions, or (2) in conjunction with unstable vital 
signs, pose an immediate threat to life or limb. 

(9) The licensed nurse-to-patient ratio in a step-down unit shall be 1 :4 
or fewer at all times. Commencing January 1 , 2008, the licensed nurse- 
to-patient ratio in a step-down unit shall be 1 :3 or fewer at all times. A 
"step down unit" is defined as a unit which is organized, operated, and 
maintained to provide for the monitoring and care of patients with moder- 



ate or potentially severe physiologic instability requiring technical sup- 
port but not necessarily artificial life support. Step-down patients are 
those patients who require less care than intensive care, but more than 
that which is available from medical/surgical care. "Artificial life sup- 
port" is defined as a system that uses medical technology to aid, support, 
or replace a vital function of the body that has been seriously damaged. 
"Technical support" is defined as specialized equipment and/or person- 
nel providing for invasive monitoring, telemetry, or mechanical ventila- 
tion, for the immediate amelioration or remediation of severe pathology. 

( 1 0) The licensed nurse-to-patient ratio in a telemetry unit shall be 1:5 
or fewer at all times. Commencing January 1 , 2008, the licensed nurse- 
to-patient ratio in a telemetry unit shall be 1 :4 or fewer at all times. "Te- 
lemetry unit" is defined as a unit organized, operated, and maintained to 
provide care for and continuous cardiac monitoring of patients in a stable 
condition, having or suspected of having a cardiac condition or a disease 
requiring the electronic monitoring, recording, retrieval, and display of 
cardiac electrical signals. "Telemetry unit" as defined in these regula- 
tions does not include fetal monitoring nor fetal surveillance. 

(11) The licensed nurse-to-patient ratio in medical/surgical care units 
shall be 1:6 or fewer at all times. Commencing January 1, 2005, the li- 
censed nurse-to-patient ratio in medical/surgical care units shall be 1:5 
or fewer at all times. A medical/surgical unit is a unit with beds classified 
as medical/surgical in which patients, who require less care than that 
which is available in intensive care units, step-down units, or specialty 
care units receive 24 hour inpatient general medical services, post-surgi- 
cal services, or both general medical and post-surgical services. These 
units may include mixed patient populations of diverse diagnoses and di- 
verse age groups who require care appropriate to a medical/surgical unit. 

(12) The licensed nurse-to-patient ratio in a specialty care unit shall 
be 1:5 or fewer at all times. Commencing January 1, 2008, the licensed 
nurse-to-patient ratio in a specialty care unit shall be 1 :4 or fewer at all 
times. A specialty care unit is defined as a unit which is organized, oper- 
ated, and maintained to provide care for a specific medical condition or 
a specific patient population. Services provided in these units are more 
specialized to meet the needs of patients with the specific condition or 
disease process than that which is required on medical/surgical units, and 
is not otherwise covered by subdivision (a). 

(13) The licensed nurse-to-patient ratio in a psychiatric unit shall be 
1 :6 or fewer at all times. For purposes of psychiatric units only, "licensed 
nurses" also includes licensed psychiatric technicians in addition to li- 
censed vocational nurses and registered nurses. Licensed vocational 
nurses, licensed psychiatric technicians, or a combination of both, shall 
not exceed 50 percent of the licensed nurses on the unit. 

(14) Identifying a unit by a name or term other than those used in this 
subsection does not affect the requirement to staff at the ratios identified 
for the level or type of care described in this subsection. 

(b) In addition to the requirements of subsection (a), the hospital shall 
implement a patient classification system as defined in Section 70053.2 
above for determining nursing care needs of individual patients that re- 
flects the assessment, made by a registered nurse as specified at subsec- 
tion 70215(a)(1), of patient requirements and provides for shift-by-shift 
staffing based on those requirements. The ratios specified in subsection 
(a) shall constitute the minimum number of registered nurses, licensed 
vocational nurses, and in the case of psychiatric units, licensed psychiat- 
ric technicians, who shall be assigned to direct patient care. Additional 
staff in excess of these prescribed ratios, including non-licensed staff, 
shall be assigned in accordance with the hospital's documented patient 
classification system for determining nursing care requirements, consid- 
ering factors that include the severity of the illness, the need for special- 
ized equipment and technology, the complexity of clinical judgment 
needed to design, implement, and evaluate the patient care plan, the abil- 
ity for self-care, and the licensure of the personnel required for care. The 
system developed by the hospital shall include, but not be limited to, the 
following elements: 

(1) Individual patient care requirements. 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70223 



• 



• 



(2) The patient care delivery system. 

(3) Generally accepted standards of nursing practice, as well as ele- 
ments reflective of the unique nature of the hospital's patient population. 

(c) A written staffing plan shall be developed by the administrator of 
nursing service or a designee, based on patient care needs determined by 
the patient classification system. The staffing plan shall be developed and 
implemented for each patient care unit and shall specify patient care re- 
quirements and the staffing levels for registered nurses and other licensed 
and unlicensed personnel. In no case shall the staffing level for licensed 
nurses fall below the requirements of subsection (a). The plan shall in- 
clude the following: 

( 1 ) Staffing requirements as determined by the patient classification 
system for each unit, documented on a day-to-day, shift-by-shift basis. 

(2) The actual staff and staff mix provided, documented on a day-to- 
day, shift-by-shift basis. 

(3) The variance between required and actual staffing patterns, docu- 
mented on a day-to-day, shift-by-shift basis. 

(d) In addition to the documentation required in subsections (c)(1) 
through (3) above, the hospital shall keep a record of the actual registered 
nurse, licensed vocational nurse and licensed psychiatric technician as- 
signments to individual patients by licensure category, documented on 
a day-to-day, shift-by-shift basis. The hospital shall retain: 

( 1 ) The staffing plan required in subsections (c)(1) through (3) for the 
time period between licensing surveys, which includes the Consolidated 
Accreditation and Licensing Survey process, and 

(2) The record of the actual registered nurse, licensed vocational nurse 
and licensed psychiatric technician assignments by licensure category 
for a minimum of one year. 

(e) The reliability of the patient classification system for validating 
staffing requirements shall be reviewed at least annually by a committee 
appointed by the nursing administrator to determine whether or not the 
system accurately measures patient care needs. 

(f) At least half of the members of the review committee shall be regis- 
tered nurses who provide direct patient care. 

(g) If the review reveals that adjustments are necessary in the patient 
classification system in order to assure accuracy in measuring patient 
care needs, such adjustments must be implemented within thirty (30) 
days of that determination. 

(h) Hospitals shall develop and document a process by which all inter- 
ested staff may provide input about the patient classification system, the 
system's required revisions, and the overall staffing plan. 

(i) The administrator of nursing services shall not be designated to 
serve as a charge nurse or to have direct patient care responsibility, except 
as described in subsection (a) above. 

(j) Registered nursing personnel shall: 

(1) Assist the administrator of nursing service so that supervision of 
nursing care occurs on a 24-hour basis. 

(2) Provide direct patient care. 

(3) Provide clinical supervision and coordination of the care given by 
licensed vocational nurses and unlicensed nursing personnel. 

(k) Each patient care unit shall have a registered nurse assigned, pres- 
ent and responsible for the patient care in the unit on each shift. 

(/) A rural General Acute Care Hospital as defined in Health and Safety 
Code Section 1250(a), may apply for and be granted program flexibility 
for the requirements of subsection 70217(i) and for the personnel re- 
quirements of subsection (j)(l) above. 

(m) Unlicensed personnel may be utilized as needed to assist with sim- 
ple nursing procedures, subject to the requirements of competency vali- 
dation. Hospital policies and procedures shall describe the responsibility 
of unlicensed personnel and limit their duties to tasks that do not require 
licensure as a registered or vocational nurse. 

(n) Nursing personnel from temporary nursing agencies shall not be 
responsible for a patient care unit without having demonstrated clinical 
and supervisory competence as defined by the hospital's standards of 



staff performance pursuant to the requirements of subsection 70213(c) 
above. 

(0) Hospitals which utilize temporary nursing agencies shall have and 
adhere to a written procedure to orient and evaluate personnel from these 
sources. Such procedures shall require that personnel from temporary 
nursing agencies be evaluated as often, or more often, than staff 
employed directly by the hospital. 

(p) All registered and licensed vocational nurses utilized in the hospi- 
tal shall have current licenses. A method to document current licensure 
shall be established. 

(q) The hospital shall plan for routine fluctuations in patient census. 
If a healthcare emergency causes a change in the number of patients on 
a unit, the hospital must demonstrate that prompt efforts were made to 
maintain required staffing levels. A healthcare emergency is defined for 
this purpose as an unpredictable or unavoidable occurrence at unsched- 
uled or unpredictable intervals relating to healthcare delivery requiring 
immediate medical interventions and care. 

NOTE: Authority cited: Sections 1275, 1276.4 and 100275(a), Health and Safety 
Code. Reference: Sections 1250(a), 1276, 1276.4, 1797.58 and 1790.160, Health 
and Safety Code. 

History 

1 . Restoration of text as it existed priorto 1 1-12-2004 and addition of explanatory 
Note (Register 2005, No. 33). 

2. Editorial correction implementing restoration of text as it existed prior to 
1 1-12-2004 (Register 2005, No. 36). 

§ 70219. Nursing Service Space. 

(a) Space and components for nurses' stations and utility rooms shall 
comply with the requirements set forth in California Code of Regula- 
tions, Title 24, Part 2, Section 420A.14, California Building Code, 1995. 

(b) Office space shall be provided for the administrator of nursing ser- 
vices and for the other needs of the service. 

NOTE: Authority cited: Sections 100275(a) and 1275, Health and Safety Code. 
Reference: CCR, Title 24, Section 420A.14, California Building Code; and Sec- 
tions 1276, Health and Safety Code. 

History 
1. Repealer and new section, and new Note-: filed 1 1-26-96; operative 12-26-96 
(Register 96, No. 48). 

§ 70221. Surgical Service Definition. 

Surgical service means the performance of surgical procedures with 
the appropriate staff, space, equipment and supplies. 

§ 70223. Surgical Service General Requirements. 

(a) Hospitals shall maintain at least the number of operating rooms in 
ratio to licensed bed capacity as follows: 

Licensed Bed Capacity Number of Operating Rooms 

Less than 25 One 

25 to 99 Two 

100 or more Three 

For each additional 100 beds or major fractions thereof, at least one 
additional operating room shall be maintained, unless approved to the 
contrary by the Department. 

(1) Required operating rooms are in addition to special operating 
rooms, cystoscopy rooms and fracture rooms which are provided by the 
hospital. 

(2) Beds in a distinct part skilled nursing service, intermediate care ser- 
vice or psychiatric unit shall be excluded from calculating the number of 
operating rooms required. 

(b) A committee of the medical staff shall be assigned responsibility 
for: 

(1) Recommending to the governing body the delineation of surgical 
privileges for individual members of the medical staff. A current list of 
such privileges shall be kept in the files of the operating room supervisor. 

(2) Development, maintenance and implementation of written policies 
and procedures in consultation with other appropriate health profession- 
als and administration. Policies shall be approved by the governing body. 
Procedures shall be approved by the administration and medical staff 
where such is appropriate. 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(3) Determining what emergency equipment and supplies shall be 
available in the surgery suite. 

(4) Determining which operative procedures require an assistant sur- 
geon or assistants to the surgeon. 

(c) The responsibility and the accountability of the surgical service to 
the medical staff and administration shall be defined. 

(d) Prior to commencing surgery the person responsible for adminis- 
tering anesthesia, or the surgeon if a general anesthetic is not to be admin- 
istered, shall verify the patient's identity, the site and side of the body to 
be operated on, and ascertain that a record of the following appears in the 
patient's medical record: 

(1) An interval medical history and physical examination performed 
and recorded within the previous 24 hours. 

(2) Appropriate screening tests, based on the needs of the patient, ac- 
complished and recorded within 72 hours prior to surgery. 

(3) An informed consent, in writing, for the contemplated surgical pro- 
cedure. 

(e) The requirements of (d), above, do not preclude rendering emer- 
gency medical or surgical care to a patient in dire circumstances. 

(0 A register of operations shall be maintained including the following 
information for each surgical procedure performed: 

( 1 ) Name, age, sex and hospital admitting number of the patient. 

(2) Date and time of the operation and the operating room number. 

(3) Preoperative and postoperative diagnosis. 

(4) Name of surgeon, assistants, anesthetists and scrub and circulating 
assistant. 

(5) Surgical procedure performed and anesthetic agent used. 

(6) Complications, if any, during the operation. 

(g) All anatomical parts, tissues and foreign objects removed by opera- 
tion shall be delivered to a pathologist designated by the hospital and a 
report of his findings shall be filed in the patient's medical record. 

(h) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

(i) The requirements in this section do not apply to special hospitals 
unless the special hospital provides this service. 

History 
1 . New subsection (i) filed 7-28-78; effective thirtieth day thereafter (Register 78, 

No. 30). 

§ 70225. Surgical Service Staff. 

(a) A physician shall have overall responsibility for the surgical ser- 
vice. This physician shall be certified or eligible for certification in sur- 
gery by the American Board of Surgery. If such a surgeon is not avail- 
able, a physician, with additional training and experience in surgery shall 
be responsible for the service. 

(b) One or more surgical teams consisting of physicians, registered 
nurses and other personnel shall be available at all times. 

(c) A registered nurse with training and experience in operating room 
techniques shall be responsible for the nursing care and nursing manage- 
ment of operating room service. 

(d) There shall be sufficient nursing personnel so that one person is not 
serving as circulating assistant for more than one operating room. 

(e) There shall be evidence of continuing education and training pro- 
grams for the nursing staff. 



NOTE: Authority cited: Sections 1275, 1276.4 and 100275(a), Health and Safety 
Code. Reference: Sections 1276 and 1276.4. Health and Safety Code. 

History 

1. Repealer of subsection (g) filed 6-15-89 as an emergency; operative 6-15-89 
(Register 89, No. 25). A Certificate of Compliance must be transmitted to OAL 
within 120 days or subsection (g) will be reinstated as it existed prior to the 
emergency on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Repealer of subsection (g) refiled 11-16-89 as an emergency; operative 
1 1-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 1 20 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

5. Repealer of subsection (d). subsection relettering and amendment of Notk filed 
9-26-2003; operative 1-1-2004 (Register 2003. No. 39). 

§ 70227. Surgical Service Equipment and Supplies. 

(a) There shall be adequate and appropriate equipment and supplies 
maintained related to the nature of the needs and the services offered, in- 
cluding at least the following monitoring equipment and supplies: 

( 1 ) Cardiac monitor, with a pulse rate meter, for each patient receiving 
a general anesthetic. 

(2) D. C. defibrillator. 

(3) Electrocardiographic machine. 

(4) Oxygen and respiratory rate alarms. 

(5) Appropriate supplies and drugs for emergency use. 

§ 70229. Surgical Service Space. 

(a) Hospitals shall maintain operating rooms as follows: 

( 1 ) Operating rooms shall have a minimum floor dimension of 5 .4 me- 
ters ( 1 8 feet) and shall contain not less than 30 square meters (324 square 
feet) of floor area. 

(2) Cast rooms, fracture rooms and cystoscopic rooms, if provided, 
shall have a minimum floor area of 17 square meters (180 square feet), 
no dimension of which shall be less than three (3) meters (1 1 feet) net. 

§ 70231 . Anesthesia Service Definition. 

Anesthesia service means the provision of anesthesia of the type and 
in the manner required by the patient's condition with appropriate staff, 
space, equipment and supplies. A postanesthesia recovery unit is a spe- 
cific area in a hospital, staffed and equipped to provide specialized care 
and supervision of patients during the immediate postanesthesia period. 

§ 70233. Anesthesia Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. The policies and proce- 
dures shall include provision for at least: 

(1) Preanesthesia evaluation of the patient by an individual qualified 
to administer anesthesia as a licensed practitioner in accordance with his 
or her scope of licensure. Persons providing preanesthesia evaluations 
shall appropriately document pertinent information relative to the choice 
of anesthesia and the surgical or obstetrical procedure anticipated. 



[The next page is 771.] 



Page 770.2 



Register 2005, No. 47; 11-25-2005 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70243 



• 



(2) Review of the patient's condition immediately prior to induction 
of anesthesia. 

(3) Safety of the patient during the anesthetic period. 

(4) Recording of all events taking place during the induction of, main- 
tenance of and emergence from anesthesia, including the amount and du- 
ration of all anesthetic agents, other drugs, intravenous fluids and blood 
or blood fractions. 

(5) Recording of postanesthetic visits that include at least one note de- 
scribing the presence or absence of complications related to anesthesia. 

(b) The responsibility and the accountability of the anesthesia service 
to the medical staff and administration shall be defined. 

(c) Rules for the safe use of nonflammable and flammable anesthetic 
agents which conform with the rules of the State Fire Marshal and Section 
70849 shall be adopted. 

(d) Periodically, an appropriate committee of the medical staff shall 
evaluate the service provided and make appropriate recommendations to 
the executive committee of the medical staff and administration. 

(e) The requirements in this section do not apply to special hospitals 
unless the special hospital provides this service. 

NOTh: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code; and Section 2725, Business and Pro- 
fessions Code. 

History 

1 . New subsection (e) filed 7-28-78; effective thirtieth day thereafter (Reeister 78, 
No. 30). 

2. Amendment of subsection (a)( 1) and adoption of Note filed 4-15-93; operative 
5-17-93 (Register 93, No. 16). 

§ 70235. Anesthesia Service Staff. 

(a) A physician shall have overall responsibility for the anesthesia ser- 
vice. His responsibility shall include at least the: 

( 1 ) Availability of equipment, drugs and parenteral fluids necessary 
for administering anesthesia and for related resuscitative efforts. 

(2) Development of regulations concerning anesthetic safety. 

(3) Operation of the postanesthesia service. 

(b) Anesthesia care shall be provided by physicians or dentists with 
anesthesia privileges, nurse anesthetists, or appropriately supervised 
trainees in an approved educational program. 

(c) Anesthesia staff shall be available or on call at all times. 

(d) A registered nurse with training and experience in postanesthesia 
nursing care shall be responsible for the nursing care and nursing man- 
agement in the postanesthesia recovery unit. 

(e) There shall be sufficient licensed nurses assigned to meet the needs 
of the patients. 

(f) Nurses assistants, where provided, shall not be assigned patient 
care duties unless under the direct supervision of a licensed nurse. 

§ 70237. Anesthesia Service Equipment and Supplies. 

(a) There shall be adequate and appropriate equipment for the delivery 
of anesthesia and postanesthesia recovery care. 

(1) The anesthetist shall check the readiness, availability, and cleanli- 
ness of all equipment used prior to the administration of the anesthetic 
agents. 

(2) At least the following equipment shall be provided in the postanes- 
thesia recovery room: 

(A) Cardiac monitor, with pulse rate meter, in the ratio of 1 monitor 
for each two (2) patients. 

(B) D. C. defibrillator. 

(C) Mechanical positive pressure breathing apparatus. 

(D) Stripchart electrocardiographic recorder. 

(E) Sphygmomanometer. 

(F) Crash cart, or equivalent, with appropriate supplies and drugs for 
emergency use. 

§ 70239. Anesthesia Service Space. 

(a) Postanesthesia recovery unit shall maintain the following spaces as 
required in Section T 17-314, Title 24, California Administrative Code: 



( 1 ) Floor area of at least 7.5 square meters (80 square feet) per bed ex- 
clusive of the spaces listed below in (2) through (6). 

(2) Space for a nurses' control desk, charting space, locked medicine 
cabinet, refrigerator and handwashing lavatory not requiring direct con- 
tact of the hands for operation. 

(3) A utility space including a rim-flush clinic sink and countertop 
work space at least one meter (3 feet) long. Clean and dirty areas shall be 
separated. 

(4) Storage space for clean linen. 

(5) Storage space for soiled linen. 

(6) Storage space for supplies and equipment. 

(7) Air Conditioning. 

(b) The postanesthesia recovery unit is classified as an electrically sen- 
sitive area and shall meet grounding requirements in Section 70853. 

(c) Beds in the postanesthesia recovery unit shall not be included in the 
licensed bed capacity of the hospital. 

§ 70241 . Clinical Laboratory Service Definition. 

Clinical laboratory service means the performance of clinical labora- 
tory tests with appropriate staff, space, equipment and supplies. 

§ 70243. Clinical Laboratory Service General 
Requirements. 

(a) Clinical laboratories shall be operated in conformance with the 
California Business and Professions Code, Division 2, Chapter 3 (Sec- 
tions 1200 to 1322, inclusive) and the California Administrative Code, 
Title 1 7, Chapter 2, Subchapter 1 , Group 2 (Sections 1 030 to 1 057, inclu- 
sive). 

(b) All hospitals shall maintain clinical laboratory services and equip- 
ment for routine laboratory work, such as urinalysis, complete blood 
counts, blood typing, cross matching and such other tests as are required 
by these regulations. 

(c) All hospitals shall maintain or make provision for clinical laborato- 
ry services for performance of tests in chemistry, microbiology, serolo- 
gy, hematology, pathology and such other tests as are required by these 
regulations. 

(d) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(e) The responsibility and the accountability of the clinical laboratory 
service to the medical staff and administration shall be defined. 

(f) The director of the clinical laboratory shall assure that: 

(1) Examinations are performed accurately and in a timely fashion. 

(2) Procedures are established governing the provision of laboratory 
services for outpatients. 

(3) Laboratory systems identify the patient, test requested, date and 
time the specimen was obtained, the time the request reached the labora- 
tory, the time the laboratory completed the test and any special handling 
which was required. 

(4) Procedures are established to ensure the satisfactory collection of 
specimens. 

(5) A communications system to provide efficient information ex- 
change between the laboratory and related areas of the hospital is estab- 
lished. 

(6) A quality control system within the laboratory designed to ensure 
medical reliability of laboratory data is established. The results of control 
tests shall be readily available in the hospital. 

(7) Reports of all laboratory examinations are made a part of the pa- 
tient's medical record as soon as is practical. 

(8) No laboratory procedures are performed except on the order of a 
person lawfully authorized to give such an order. 

(g) Tissue specimens shall be examined by a physician who is certified 
or eligible for certification in anatomical and/or clinical pathology by the 
American Board of Pathology or possesses qualifications which are 
equivalent to those required for certification. Oral specimens may be ex- 



Page 771 



Register 96, No. 48; 11-29-96 



§ 70245 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



amined by a dentist who is certified or eligible for certification as an oral 
pathologist by the American Board of Oral Pathology. A record of his 
findings shall become a part of the patient's medical record. 

( 1 ) A tissue file shall be maintained at the hospital or the principal of- 
fice of the consulting pathologist. 

(h) The use, storage and disposal of radioactive materials shall comply 
with the California Radiation Control Regulations, Subchapter 4, Chap- 
ter 5, Title 17, California Administrative Code. 

(i) Where the hospital depends on outside blood banks, there shall be 
a written agreement governing the procurement, transfer and availability 
of blood. 

(j) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 
NOTE: Authority cited: Sections 208(a) and 1275. Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Amendment of subsection (f) filed 3-13-80; effective thirtieth day thereafter 

(Register 80, No. 1 1 ). 

§ 70245. Clinical Laboratory Service Staff. 

(a) A physician shall have overall responsibility for the clinical labora- 
tory service. This physician shall be certified or eligible for certification 
in clinical pathology and/or pathologic anatomy by the American Board 
of Pathology. If such a pathologist is not available on a full-time or regu- 
lar part-time weekly basis, a physician or a licensed clinical laboratory 
bioanalyst who is available on a full-time or regular part-time basis may 
administer the clinical laboratory. In this circumstance, a pathologist, qu- 
alified as above, shall provide consultation at suitable intervals to assure 
high quality service. 

(b) There shall be a physician, clinical laboratory bioanalyst or clinical 
laboratory technologist on duty or on call at all times to assure the avail- 
ability of emergency laboratory services. 

(c) There shall be sufficient staff with adequate training and experi- 
ence to meet the needs of the service being offered. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1 . Repealer of subsection (d) filed 6-15-89 its an emergency; operative 6-15-89 
(Register 89, No. 25). A Certificate of Compliance must be transmitted to OAL 
within 120 days or subsection (d) will be reinstated as it existed prior to the 
emergency on 10-13-89. 

2. Certificate of Compliance as to 6-15-89 order transmitted to OAL on 10-13-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Repealer of subsection (d) refiled 11-16-89 as an emergency; operative 
1 1-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 1 20 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70247. Clinical Laboratory Service Equipment and 
Supplies. 

(a) There shall be sufficient equipment and supplies maintained to per- 
form the laboratory services being offered. 

(b) The hospital shall maintain blood storage facilities in conformance 
with the provisions of Section 1002(g), Article 10, Group 1, Subchapter 
1, Chapter 2, Title 17, California Administrative Code. Such facilities 
shall be inspected at appropriately short intervals each day of the week 
to assure these requirements are being fulfilled. 

§ 70249. Clinical Laboratory Service Space. 

(a) Adequate laboratory space a determined by the Department shall 
be maintained. 

(b) If tests on outpatients are to be performed, outpatient access to the 
laboratory shall not traverse a nursing unit. 

§ 70251. Radiological Service Definition. 

Radiological service means the use of X-ray, other external ionizing 
radiation, and/or thermography, and/or ultra sound in the detection, diag- 



nosis and treatment of human illnesses and injuries with appropriate 
staff, space, equipment and supplies. Ultra sound although properly the 
province of physical medicine, may be considered part of the radiological 
service. 

§ 70253. Radiological Service General Requirements. 

(a) All hospitals shall maintain a diagnostic radiological service. 

(b) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(c) The responsibility and the accountability of the radiological ser- 
vice to the medical staff and administration shall be defined. 

(d) The use, storage and shielding of all radiation machines and radio- 
active materials shall comply with the California Radiation Control Reg- 
ulations, Subchapter 4, Chapter 5, Title 17, California Administrative 
Code. 

(e) All persons operating or supervising the operation of X-ray ma- 
chines shall comply with the requirements of the Radiologic Technology 
Regulations, Subchapter 4.5, Chapter 5, Title 17, California Administra- 
tive Code. 

(f) Diagnostic radiological services may be performed on the order of 
a person lawfully authorized to give such an order. 

(g) Reports of radiological service examinations shall be filed in the 
patient's medical record and maintained in the radiology unit. 

(h) X-ray films or reproductions thereof, shall be retained for the same 
period of time as is required for other parts of the patient's medical re- 
cord. 

(i) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70255. Radiological Service Staff. 

(a) A physician shall have overall responsibility for the radiological 
service. This physician shall be certified or eligible for certification by 
the American Board of Radiology. If such a radiologist is not available 
on a full-time or regular part-time basis, a physician, with training and 
experience in radiology, may administer the service. In this circum- 
stance, a radiologist, qualified as above, shall provide consultation ser- 
vices at suitable intervals to assure high quality service. 

(b) Sufficient certified radiologic technologists shall be employed to 
meet the needs of the service being offered. 

(c) There shall be at least one person on duty or on call at all times capa- 
ble of operating radiological equipment. 

§ 70257. Radiological Service Equipment and Supplies. 

(a) There shall be sufficient equipment and supplies maintained to ade- 
quately perform the radiological services that are offered in the hospital. 
As a minimum, the following equipment shall be available: 

( 1 ) At least one radiographic and fluoroscopic unit. On and after Janu- 
ary 1 , 1977, fluoroscopic units shall be equipped with image intensifiers. 

(2) Film processing equipment. 

(b) Proper resuscitative and monitoring equipment shall be immedi- 
ately available. 

§ 70259. Radiological Service Space. 

(a) There shall be sufficient space maintained to adequately provide 
radiological services. This shall include but not be limited to the follow- 
ing: 

( 1 ) A separate X-ray room large enough to accommodate the neces- 
sary radiographic equipment and to allow easy maneuverability of 
stretchers and wheelchairs. 

(2) Toilet facilities located adjacent to or in the immediate vicinity. 

(3) Dressing room facilities for patients. 

(4) Film processing area. 

(5) Sufficient storage space for all the necessary X-ray equipment, 
supplies and for exposed X-ray film and copies of reports. 



• 



Page 772 



Register 96, No. 48; 11-29-96 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70263 



• 



(6) Suitable area for viewing and reporting of radiographic examina- 
tions. 

(b) If X-ray examinations are to be performed on outpatients, outpa- 
tient access to the radiological spaces shall not traverse a nursing unit. 

§ 70261. Pharmaceutical Service Definition. 

Pharmaceutical service means the procuring, manufacturing, com- 
pounding, dispensing, distributing, storing and administering of drugs, 
biologicals and chemicals by appropriate staff which has adequate space, 
equipment and supplies. Pharmaceutical services also include the provi- 
sion of drug information to other health professionals and patients. 

§ 70263. Pharmaceutical Service General Requirements. 

(a) All hospitals having a licensed bed capacity of 100 or more beds 
shall have a pharmacy on the premises licensed by the California Board 
of Pharmacy. Those hospitals having fewer than 100 licensed beds shall 
have a pharmacy license issued by the Board of Pharmacy pursuant to 
Section 4029 or 4056 of the Business and Professions Code. 

(b) The responsibility and the accountability of the pharmaceutical 
service to the medical staff and administration shall be defined. 

(c) A pharmacy and therapeutics committee, or a committee of equiva- 
lent composition, shall be established. The committee shall consist of at 
least one physician, one pharmacist, the director of nursing service or her 
representative and the administrator or his representative. 

( 1 ) The committee shall develop written policies and procedures for 
establishment of safe and effective systems for procurement, storage, 
distribution, dispensing and use of drugs and chemicals. The pharmacist 
in consultation with other appropriate health professionals and adminis- 
tration shall be responsible for the development and implementations of 
procedures. Policies shall be approved by the governing body. Proce- 
dures shall be approved by the administration and medical staff where 
such is appropriate. 

(2) The committee shall be responsible for the development and main- 
tenance of a formulary of drugs for use throughout the hospital. 

(d) There shall be a system maintained whereby no person other than 
a pharmacist or an individual under the direct supervision of a pharmacist 
shall dispense medications for use beyond the immediate needs of the pa- 
tients. 

(e) There shall be a system assuring the availability of prescribed med- 
ications 24 hours a day. 

(f) Supplies of drugs for use in medical emergencies only shall be im- 
mediately available at each nursing unit or service area as required. 

(1) Written policies and procedures establishing the contents of the 
supply procedures for use, restocking and sealing of the emergency drug 
supply shall be developed. 

(2) The emergency drug supply shall be stored in a clearly marked por- 
table container which is sealed by the pharmacist in such a manner that 
a seal must be broken to gain access to the drugs. The contents of the con- 
tainer shall be listed on the outside cover and shall include the earliest ex- 
piration date of any drugs within. 

(3) The supply shall be inspected by a pharmacist at periodic intervals 
specified in written policies. Such inspections shall occur no less fre- 
quently than every 30 days. Records of such inspections shall be kept for 
at least three years. 

(g) No drugs shall be administered except by licensed personnel au- 
thorized to administer drugs and upon the order of a person lawfully au- 
thorized to prescribe or furnish. This shall not preclude the administra- 
tion of aerosol drugs by respiratory therapists. The order shall include the 
name of the drug, the dosage and the frequency of administration, the 
route of administration, if other than oral, and the date, time and signature 
of the prescriber or furnisher. Orders for drugs should be written or trans- 
mitted by the prescriber or furnisher. Verbal orders for drugs shall be giv- 
en only by a person lawfully authorized to prescribe or furnish and shall 
be recorded promptly in the patient's medical record, noting the name of 
the person giving the verbal order and the signature of the individual re- 
ceiving the order. The prescriber or furnisher shall countersign the order 
within 48 hours. 



(1) Verbal orders for administration of medications shall be received 
and recorded only by those health care professionals whose scope of li- 
censure authorizes them to receive orders for medication. 

(2) Medications and treatments shall be administered as ordered, 
(h) Standing orders for drugs may be used for specified patents when 

authorized by a person licensed to prescribe. A copy of standing orders 
for a specific patient shall be dated, promptly signed by the prescriber and 
included in the patient's medical record. These standing orders shall: 

(1) Specify the circumstances under which the drug is to be adminis- 
tered. 

(2) Specify the types of medical conditions of patients for whom the 
standing orders are intended. 

(3) Be initially approved by the pharmacy and therapeutics committee 
or its equivalent and be reviewed at least annually by that committee. 

(4) Be specific as to the drug, dosage, route and frequency of adminis- 
tration. 

(i) An individual prescriber may notify the hospital in writing of his 
own standing orders, the use of which is subject to prior approval and pe- 
riodic review by the pharmacy and therapeutics committee or its equiva- 
lent. 

(j) The hospital shall develop policies limiting the duration of drug 
therapy in the absence of the preserver's specific indication of duration 
of drug therapy or under other circumstances recommended by the phar- 
macy and therapeutics committee or its equivalent and approved by the 
executive committee of the medical staff. The limitations shall be estab- 
lished for classes of drugs and/or individual drug entities. 

(k) If drugs are supplied through a pharmacy, orders for drugs shall be 
transmitted to the pharmacy either by written prescription of the prescrib- 
er, by an order form which produces a direct copy of the order or by an 
electronically reproduced facsimile. When drugs are not supplied 
through a pharmacy, such information shall be made available to the hos- 
pital pharmacist. 

(/) Medications shall not be left at the patient's bedside unless the pre- 
scriber so orders. Such bedside medications shall be kept in a cabinet, 
drawer or in possession of the patient. Drugs shall not be left at the bed- 
side which are listed in Schedules II, III and IV of the Federal Compre- 
hensive Drug Abuse Prevention and Control Act of 1970 as amended. If 
the hospital permits bedside storage of medications, written policies and 
procedures shall be established for the dispensing, storage and records of 
use, of such medications. 

(m) Medications brought by or with the patient to the hospital shall not 
be administered to the patient unless all of the following conditions are 
met: 

(1) The drugs have been ordered by a person lawfully authorized to 
give such an order and the order entered in the patient's medical record. 

(2) The medication containers are clearly and properly labeled. 

(3) The contents of the containers have been examined and positively 
identified, after arrival at the hospital, by the patient's physician or the 
hospital pharmacist. 

(n) The hospital shall establish a supply of medications which is acces- 
sible without entering either the pharmacy or drug storage room during 
hours when the pharmacist is not available. Access to the supply shall be 
limited to designated registered nurses. Records of drugs taken from the 
supply shall be maintained and the pharmacist shall be notified of such 
use. The records shall include the name and strength of the drug, the 
amount taken, the date and time, the name of the patient to whom the drug 
was administered and the signature of the registered nurse. The pharma- 
cist shall be responsible for maintenance of the supply and assuring that 
all drugs are properly labeled and stored. The drug supply shall contain 
that type and quantity of drugs necessary to meet the immediate needs of 
patients as determined by the pharmacy and therapeutics committee. 

(o) Investigational drug use shall be in accordance with applicable 
state and federal laws and regulations and policies adopted by the hospi- 
tal. Such drugs shall be used only under the direct supervision of the prin- 
cipal investigator, who shall be a member of the medical staff and be re- 
sponsible for assuring that informed consent is secured from the patient. 



Page 772.1 



Register 2000, No. 24; 6-16-2000 



§ 70265 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Basic information concerning the dosage form, route of administration, 
strength, actions, uses, side effects, adverse effects, interactions and 
symptoms of toxicity of investigational drugs shall be available at the 
nursing station where such drugs are being administered and in the phar- 
macy. The pharmacist shall be responsible for the proper labeling, stor- 
age and distribution of such drugs pursuant to the written order of the in- 
vestigator. 

(p) No drugs supplied by the hospital shall be taken from the hospital 
unless a prescription or medical record order has been written for the 
medication and the medication has been properly labeled and prepared 
by the pharmacist in accordance with state and federal laws, for use out- 
side of the hospital. 

(q) Labeling and storage of drugs shall be accomplished to meet the 
following requirements: 

( 1 ) Individual patient medications, except those that have been left at 
the patient's bedside, may be returned to the pharmacy for appropriate 
disposition. 

(2) All drug labels must be legible and in compliance with state and 
federal requirements. 

(3) Drugs shall be labeled only by persons legally authorized to pre- 
scribe or dispense or under the supervision of a pharmacist. 

(4) Test agents, germicides, disinfectants and other household sub- 
stances shall be stored separately from drugs. 

(5) External use drugs in liquid, tablet, capsule or powder form shall 
be segregated from drugs for internal use. 

(6) Drugs shall be stored at appropriate temperatures. Refrigerator 
temperature shall be between 2.2°C (36°F) and 7.7°C (46°F) and room 
temperature shall be between 15°C (59°F) and 30°C (86°F). 

(7) Drugs shall be stored in an orderly manner in well-lighted cabinets, 
shelves, drawers or carts of sufficient size to prevent crowding. 

(8) Drugs shall be accessible only to responsible personnel designated 
by the hospital, or to the patient as provided in 70263 (1) above. 

(9) Drugs shall not be kept in stock after the expiration date on the label 
and no contaminated or deteriorated drugs shall be available for use. 

( 1 0) Drugs maintained on the nursing unit shall be inspected at least 
monthly by a pharmacist. Any irregularities shall be reported to the direc- 
tor of nursing service and as required by hospital policy. 

(11) Discontinued individual patient's drugs not supplied by the hos- 
pital may be sent home with the patient. Those which remain in the hospi- 
tal after discharge that are not identified by lot number shall be destroyed 
in the following manner: 

(A) Drugs listed in Schedules II, III or IV of the Federal Comprehen- 
sive Drug Abuse Prevention and Control Act of 1970, as amended, shall 
be destroyed in the presence of two pharmacists or a pharmacist and a 
registered nurse employed by the hospital. The name of the patient, the 
name and strength of the drug, the prescription number, the amount de- 
stroyed, the date of destruction and the signatures of the witnesses re- 
quired above shall be recorded in the patient' s medical record or in a sep- 
arate log. Such log shall be retained for at least three years. 

(B) Drugs not listed under Schedules II, III or IV of the Federal Com- 
prehensive Drug Abuse Prevention and Control Act of 1970, as 
amended, shall be destroyed in the presence of a pharmacist. 

(r) The pharmacist shall develop and implement written quality con- 
trol procedures for all drugs which are prepackaged or compounded in 
the hospital including intravenous solution additives. He shall develop 
and conduct an in-service training program for the professional staff to 
assure compliance therewith. 

(s) The pharmacist shall be consulted on proper methods for repackag- 
ing and labeling of bulk cleaning agents, solvents, chemicals and poisons 
used throughout the hospital. 



(t) Periodically, the pharmacy and therapeutics committee, or its 
equivalent, shall evaluate the services provided and make appropriate 
recommendations to the executive committee of the medical staff and ad- 
ministration. 

NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276, Health and Safety Code. 

History 

1 . Amendment of subsection (m) filed 3-13-80; effective thirtieth day thereafter 
(Register 80, No. 11). 

2. Amendment of subsection (g), new subsections (g)(1) and (e)(2). and amend- 
ment of NOTP. filed 1 1-26-96: operative 12-26-96 (Register 96, No. 48). 

3. Change without regulatory effect amending subsection (a) and Noth filed 
6-16-2000 pursuant to section 100, title 1, California Code of Regulations 
(Register 2000, No. 24). 

§ 70265. Pharmaceutical Service Staff. 

A pharmacist shall have overall responsibility for the pharmaceutical 
service. He shall be responsible for the procurement, storage and distri- 
bution of all drugs as well as the development, coordination, supervision 
and review of pharmaceutical services in the hospital. Hospitals with a 
limited permit shall employ a pharmacist on at least a consulting basis. 
Responsibilities shall be set forth in a job description or agreement be- 
tween the pharmacist and the hospital. The pharmacist shall be responsi- 
ble to the administrator and shall furnish him written reports and recom- 
mendations regarding the pharmaceutical services within the hospital. 
Such reports shall be provided no less often than quarterly. 

§ 70267. Pharmaceutical Service Equipment and Supplies. 

(a) There shall be adequate equipment and supplies for the provision 
of pharmaceutical services within the hospital. 

(b) Reference materials containing monographs on all drugs in use in 
the hospital shall be available in each nursing unit. Such monographs 
must include information concerning generic and brand names, if appli- 
cable, available strengths and dosage forms and pharmacological data in- 
cluding indications, side effects, adverse effects and drug interactions. 

§ 70269. Pharmaceutical Service Space. 

(a) Adequate space shall be available at each nursing station for the 
storage of drugs and preparation of medication doses. 

(b) All spaces and areas used for the storage of drugs shall be lockable 
and accessible to authorized personnel only. 

§ 70271. Dietetic Service Definition. 

Dietetic service means providing safe, satisfying and nutritionally ad- 
equate food for patients with appropriate staff, space, equipment and sup- 
plies. 

§ 70273. Dietetic Service General Requirements. 

(a) The dietetic service shall provide food of the quality and quantity 
to meet the patient's needs in accordance with physicians' orders and, to 
the extent medically possible, to meet the Recommended Daily Dietary 
Allowances, 1974 Edition, adopted by the Food and Nutrition Board of 
the National Research Council of the National Academy of Sciences, 
2107 Constitution Avenue, Washington, DC 20418, and the following: 

(1) Not less than three meals shall be served daily. 

(2) Not more than 14 hours shall elapse between the evening meal and 
breakfast of the following day. 

(3) Nourishment or between meal feedings shall be provided as re- 
quired by the diet prescription and shall be offered to all patients unless 
counterordered by the physician. 

(4) Patient food preferences shall be respected as much as possible and 
substitutes shall be offered through use of a selective menu or substitutes 
from appropriate food groups. 

(5) When food is provided by an outside food service, all applicable 
requirements herein set forth shall be met. The hospital shall maintain ad- 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70275 



equate space, equipment and staple food supplies to provide patient food 
service in emergencies. 

(b) Policies and procedures shall be developed and maintained in con- 
sultation with representatives of the medical staff, nursing staff and ad- 
ministration to govern the provision of dietetic services. Policies shall be 
approved by the medical staff, administration and governing body. Pro- 
cedures shall be approved by the medical staff and administration. 

(c) The responsibility and the accountability of the dietetic service to 
the medical staff and administration shall be defined. 

(d) A current diet manual approved by the dietitian and the medical 
staff shall be used as the basis for diet orders and for planning modified 
diets. Copies of the diet manual shall be available at each nursing station 
and in the dietetic service area. 

(e) Therapeutic diets shall be provided as prescribed by a person law- 
fully authorized to give such an order and shall be planned, prepared and 
served with supervision and/or consultation from the dietitian. Persons 
responsible for therapeutic diets shall have sufficient knowledge of food 
values to make appropriate substitutions when necessary. 

(0 A current profile card shall be maintained for each patient indicat- 
ing diet, likes, dislikes and other pertinent information concerning the pa- 
tient's dietary needs. 

(g) Menus. 

( 1 ) Menus for regular and routine modified diets shall be written at 
least one week in advance, dated and posted in the kitchen at least three 
days in advance. 

(2) If any meal served varies from the planned menu, the change shall 
be noted in writing on the posted menu in the kitchen. 

(3) Menus shall provide a variety of foods in adequate amounts at each 
meal. 

(4) Menus should be planned with consideration for cultural and reli- 
gious background and food habits of patients. 

(5) A copy of the menu as served shall be kept on file for at least 30 
days. 

(6) Records of food purchased shall be kept available for one year. 

(7) Standardized recipes, adjusted to appropriate yield, shall be main- 
tained and used in food preparation. 

(h) Food shall be prepared by methods which conserve nutritive value, 
flavor and appearance. Food shall be served attractively at appropriate 
temperatures and in a form to meet individual needs. 

(i) Nutritional Care. 

( 1 ) Nutritional care shall be integrated in the patient care plan. 

(2) Observations and information pertinent to dietetic treatment shall 
be recorded in patient's medical records by the dietitian. 

(3) Pertinent dietary records shall be included in patient's transfer dis- 
charge record to ensure continuity of nutritional care. 

(j) In-service training shall be provided for all dietetic service person- 
nel and a record of subject areas covered, date and duration of each ses- 
sion and attendance lists shall be maintained. 

(k) Food Storage. 

(1) Food storage areas shall be clean at all times. 

(2) Dry or staple items shall be stored at least 30 cm (12 inches) above 
the floor, in a ventilated room, not subject to sewage or waste water back- 
flow, or contamination by condensation, leakage, rodents or vermin. 

(3) All readily perishable foods or beverages capable of supporting 
rapid and progressive growth of microorganisms which can cause food 
infections or food intoxication shall be maintained at temperatures of 7°C 
(45°F) or below, or at 60°C ( 140°F) or above, at all times, except during 
necessary periods of preparation and service. Frozen food shall be stored 
at-18°C(0°F)orbelow. 

(4) There shall be a reliable thermometer in each refrigerator and in 
storerooms used for perishable food. 

(5) Pesticides, other toxic substances and drugs shall not be stored in 
the kitchen area or in storerooms for food and/or food preparation equip- 
ment and utensils. 



(6) Soaps, detergents, cleaning compounds or similar substances shall 
not be stored in food storerooms or food storage areas. 
(/) Sanitation. 

(1) All kitchens and kitchen areas shall be kept clean, free from litter 
and rubbish and protected from rodents, roaches, flies and other insects. 

(2) All utensils, counters, shelves and equipment shall be kept clean, 
maintained in good repair and shall be free from breaks, corrosions, open 
seams, cracks and chipped areas. 

(3) Plasticware, china and glassware that is unsightly, unsanitary or 
hazardous because of chips, cracks or loss of glaze shall be discarded. 

(4) Ice which is used in connection with food or drink shall be from a 
sanitary source and shall be handled and dispensed in a sanitary manner. 

(5) Kitchen wastes that are not disposed of by mechanical means shall 
be kept in leakproof, nonabsorbent, tightly closed containers and shall be 
disposed of as frequently as necessary to prevent a nuisance or unsightli- 
ness. 

(m) All utensils used for eating, drinking and in the preparation and 
serving of food and drink shall be cleaned and disinfected or discarded 
after each usage. 

( 1 ) Gross food particles shall be removed by scraping and prerinsing 
in running water. 

(2) The utensils shall be thoroughly washed in hot water with a mini- 
mum temperature of 43°C ( 1 10°F), using soap or detergent, rinsed in hot 
water to remove soap or detergent and disinfected by one of the following 
methods or an equivalent method approved by the Department: 

(A) Immersion for at least two minutes in clean water at 77°C ( 1 80°F). 

(B) Immersion for at least 30 seconds in clean water at 82°C ( 180°F). 

(C) Immersion in water containing bactericidal chemical as approved 
by the Department. 

(3) After disinfection the utensils shall be allowed to drain and dry in 
racks or baskets on nonabsorbent surfaces. Drying cloths shall not be 
used. 

(4) Results obtained with dishwashing machines shall be equal to 
those obtained by the methods outlined above and all dishwashing ma- 
chines shall meet the requirements contained in Standard No. 3 as 
amended in April 1965 of the National Sanitation Foundation, P.O. Box 
1468, Ann Arbor, MI 48106. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Amendment of subsection (e) filed 3-13-80; effective thirtieth day thereafter 
(Register 80, No. 11). 

§ 70275. Dietetic Service Staff. 

(a) A registered dietitian shall be employed on a full-time, part-time 
or consulting basis. Part-time or consultant services shall be provided on 
the premises at appropriate times on a regularly scheduled basis and of 
sufficient duration and frequency to provide continuing liaison with 
medical and nursing staffs, advice to the administrator, patient counsel- 
ing, guidance to the supervisor and staff of the dietetic service, approval 
of all menus and participation in development or revision of dietetic poli- 
cies and procedures and in planning and conducting in-service education 
programs. 

(b) If a registered dietitian is not employed full-time, a full-time per- 
son who has completed a dietetic supervisor's training program meeting 
the requirements of Essentials of an Acceptable Program of Dietetic As- 
sistant Education, revised June, 1974, by the American Dietetic Associ- 
ation, 430 North Michigan Avenue, Chicago, IL 606 1 1 , shall be 
employed to be responsible for the operation of the food service. This 
program or its equivalent shall be required on and after July 1 , 1 977. 

(c) Sufficient dietetic service personnel shall be employed, oriented, 
trained and their working hours scheduled to provide for the nutritional 
needs of the patients and to maintain the dietetic service areas. If dietetic 
service employees are assigned duties in other service areas, those duties 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



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shall not interfere with the sanitation, safety or time required for dietetic 
work assignments. 

(d) Current work schedules by job titles and weekly duty schedules 
shall be posted in the dietetic service area. 

(e) A record shall be maintained of the number of persons by job title 
employed full or part-time in dietetic services and the number of hours 
each works weekly. 

(f) Hygiene of Dietetic Service Staff. 

(1) Dietetic service personnel shall be trained in basic food sanitation 
techniques, shall be clean, wear clean clothing, including a cap and/or a 
hair net and shall be excluded from duty when affected by skin infection 
or communicable diseases. Beards and mustaches which are not closely 
cropped and neatly trimmed shall be covered. 

(2) Employee's street clothing stored in the kitchen area shall be in a 
closed area. 

(3) Kitchen sinks shall not be used for handwashing. Separate hand- 
washing facilities with soap, running water and individual towels shall 
be provided. 

(4) Persons other than dietetic personnel shall not be allowed in the 
kitchen area unless required to do so in the performance of their duties. 

§ 70277. Dietetic Service Equipment and Supplies. 

(a) Equipment of the type and in the amount necessary for the proper 
preparation, serving and storing of food and for proper dishwashing shall 
be provided and maintained in good working order. 

( 1 ) The dietetic service area shall be ventilated in a manner that will 
maintain comfortable working conditions, remove objectionable odors 
and fumes and prevent excessive condensation. 

(2) Equipment necessary for preparation and maintenance of menus, 
records and references shall be provided. 

(3) Fixed and mobile equipment in the dietetic service area shall be lo- 
cated to assure sanitary and safe operation and shall be of sufficient size 
to handle the needs of the hospital. 

(b) Food Supplies. 

( 1 ) At least one week' s supply of staple foods and at least two (2) days 
supply of perishable foods shall be maintained on the premises. Supplies 
shall be appropriate to meet the requirements of the menu. 

(2) All food shall be of good quality and procured from sources ap- 
proved or considered satisfactory by federal, state and local authorities. 
Food in unlabeled, rusty, leaking, broken containers or cans with side 
seam dents, rim dents or swells shall not be accepted or retained. 

(3) Milk, milk products and products resembling milk shall be pro- 
cessed or manufactured in milk product plants meeting the requirements 
of Division 15 of the California Food and Agricultural Code. 

(4) Milk may be served in individual containers, the cap or seal of 
which shall not be removed except in the presence of the patient. Milk 
may be served from a dispensing device which has been approved for 
such use. Milk served from an approved device shall be dispensed direct- 
ly into the glass or other container from which the patient drinks. 

(5) Catered foods and beverages from a source outside the hospital 
shall be prepared, packed, properly identified, stored and transported in 
compliance with these regulations and other applicable federal, state and 
local codes as determined by the Department. 

(6) Foods held in refrigerated or other storage areas shall be appropri- 
ately covered. Food which was prepared and not served shall be stored 
appropriately, clearly labeled and dated. 

(7) Hermetically sealed foods or beverages served in the hospital shall 
have been processed in compliance with applicable federal, state and lo- 
cal codes. 

§ 70279. Dietetic Service Space. 

(a) Adequate space for the preparation and serving of food shall be 
provided. Equipment shall be placed so as to provide aisles of sufficient 
width to permit easy movement of personnel, mobile equipment and sup- 
plies. 



(b) Well ventilated food storage areas of adequate size shall be pro- 
vided. 

(c) A minimum of .057 cubic meters (two cubic feet) of usable refrig- 
erated space per bed shall be maintained for the storage of frozen and 
chilled foods. 

(d) Adequate space shall be maintained to accommodate equipment, 
personnel and procedures necessary for proper cleaning and sanitizing of 
dishes and other utensils. 

(e) Where employee dining space is provided, a minimum of 1.4 
square meters (15 square feet) of floor area per person served, including 
serving area, shall be maintained. 

(f) Office or other suitable space shall be provided for the dietitian or 
dietetic service supervisor for privacy in interviewing personnel, con- 
ducting other business related to dietetic service and for the preparation 
and maintenance of menus and other necessary reports and records. 

Article 4. Supplemental Service Approval 

§ 70301 . Supplemental Service Approval Required. 

(a) Any licensee desiring to establish or conduct, or who holds out, 
represents or advertises by any means the provision of a supplemental 
service, shall obtain prior approval from the Department or a special per- 
mit if required by Section 70351. 

(b) The provisions of this Article shall apply only to any supplemental 
service for which a special permit is not required. 

(c) Any licensee who offers a supplemental service for which approval 
is now required under these regulations is authorized to continue furnish- 
ing such service without obtaining approval until the Department in- 
spects and evaluates the quality of the service and determines whether 
such service meets the requirements for the service contained in these 
regulations. If the Department determines that the service meets such re- 
quirements, it shall notify the licensee in writing. If the Department deter- 
mines that the service does not meet the requirements, it shall so notify 
the licensee of all deficiencies of compliance with these regulations and 
the hospital shall agree with the Department upon a plan of corrections 
which shall give the hospital a reasonable time to correct such deficien- 
cies. If at the end of the allotted time, as revealed by repeat inspection, 
the hospital has failed to correct the deficiencies, the licensee shall cease 
and desist all holding out, advertising or otherwise representing that it 
furnishes such recognized service. 

§ 70303. Application. 

Any licensee desiring approval for a supplemental service shall file 
with the Department an application on forms furnished by the Depart- 
ment. 

§ 70305. Issuance, Expiration and Renewal. 

(a) The Department shall list on the hospital license each supplemental 
service for which approval is granted. 

(b) If the applicant is not in compliance with the laws and regulations, 
the Department shall deny the applicant approval and shall immediately 
notify the applicant in writing. Within 20 days of receipt of the Depart- 
ment's notice, the applicant may present his written petition for a hearing 
to the Department. The Department shall set the matter for hearing within 
30 days after receipt of the petition in proper form. The proceedings shall 
be conducted in accordance with Chapter 5 (commencing with Section 
1 1500) of Part 1 of Division 3 of Title 2 of the Government Code. 

(c) Each supplemental service approval shall expire on the date of ex- 
piration of the hospital license. A renewal of the approval may be issued 
for a period not to exceed two years if the holder of the approval has been 
found not to have been in violation of any statutory requirements, regula- 
tions or standards during the preceding approval period. 

§ 70307. Program Flexibility. 

(a) All hospitals shall maintain continuous compliance with the 
supplemental service requirements. These requirements do not prohibit 
the use of alternate concepts, methods, procedures, techniques, equip- 



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§ 70363 



ment, personnel qualifications or the conducting of pilot projects pro- 
vided such exceptions are carried out with the prior written approval of 
the Department. Such approval 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 Depart- 
ment. 

(b) Any approval granted by the Department pursuant to this section, 
or a true copy thereof, shall be posted immediately adjacent to the facil- 
ity's license required to be posted by Section 70123. 

§ 70309. Revocation or Involuntary Suspension of 
Approval. 

(a) Pursuant to provisions of Chapter 5 (commencing with Section 
1 1500) Part I, Division 3, Government Code, the Department may sus- 
pend or revoke the approval of a supplemental service issued under the 
provisions of Chapter 2 (commencing with Section 1250), Division 2, 
Health and Safety Code, upon any of the following grounds: 

( 1 ) Violation by the licensee of any provisions of Chapter 2 (com- 
mencing with Section 1250), Division 2, Health and Safety Code, or of 
the supplemental service regulations promulgated by the Department. 

(2) Aiding, abetting or permitting the violation of any provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, or of any supplemental service regulations promulgated by the 
Department. 

(3) Conduct inimical to the public health, morals, welfare or safety of 
the people of the State of California in the maintenance and operation of 
a supplemental service. 

(b) The Director may temporarily suspend any supplemental service 
approval prior to any hearing when, in his opinion, such action is neces- 
sary to protect the public welfare. 

( 1 ) The Director shall notify the licensee of the temporary suspension 
and the effective date thereof and at the same time shall serve such licens- 
ee with an accusation. 

(2) Upon receipt of a notice of contest by the licensee, the Director 
shall set the matter for hearing within 30 days after receipt of such notice. 

(3) The temporary suspension shall remain in effect until such time as 
the hearing is completed and the Director has made a final determination. 

(4) If the Director fails to make a final determination within 60 days 
after the original hearing has been completed, the temporary suspension 
shall be deemed vacated. 

(5) If the provisions of Chapter 2 (commencing with Section 1250), 
Division 2, Health and Safety Code, or the supplemental service regula- 
tions promulgated by the Director are violated by a licensee which is a 
group, corporation or other association, the Director may suspend the ap- 
proval of such organization or may suspend the approval as to any indi- 
vidual person within such organization who is responsible for such viola- 
tion. 

(c) The withdrawal of an application for approval shall not deprive the 
Department of its authority to institute or continue a proceeding against 
the applicant for the denial of the approval upon any group provided by 
law or to enter an order denying the approval upon any such ground, un- 
less the Department consents in writing to such withdrawal. 

(d) The suspension, expiration or forfeiture of an approval issued by 
the Department shall not deprive the Department of its authority to insti- 
tute or continue a proceeding against the licensee upon any ground pro- 
vided by law or to enter an order suspending or revoking approval or 
otherwise taking disciplinary action against the licensee on any such 
ground. 

(e) A licensee whose approval has been revoked or suspended may pe- 
tition the Department for reinstatement or reduction of penalty after a pe- 
riod of not less than one year has elapsed from the effective date of the 
decision or from the date of the denial of a similar petition. 



Article 5. Special Permit 

§ 70351 . Special Permit Required. 

(a) Any licensee desiring to establish or conduct, or who holds out, 
represents or advertises by any means, the performance of a special ser- 
vice shall obtain a special permit from the Department. 

(b) The following supplemental services are also special services for 
which a special permit is required: 

(1) Basic emergency medical service. 

(2) Burn center. 

(3) Cardiovascular surgery service. 

(4) Chronic dialysis unit. 

(5) Comprehensive emergency medical service. 

(6) Intensive care newborn nursery service. 

(7) Psychiatric unit. 

(8) Radiation therapy service. 

(9) Renal transplant center. 

History 

1. Amendment filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§ 70353. Application. 

Any licensee desiring to obtain a special permit shall file with the De- 
partment an application on forms furnished by the Department. Such oth- 
er information or documents as may be required for the proper adminis- 
tration and enforcement of the licensing law and requirements shall be 
submitted with the application. 

§ 70355. Renewal Application. 

The licensee shall submit renewal applications as required by the De- 
partment. 

§ 70357. Issuance, Expiration and Renewal. 

(a) Upon verification of compliance with the supplemental service re- 
quirements for any service which is a special service, the Department 
shall issue a special permit except that no special permit shall be issued 
for new special services for which there is no valid, subsisting, and unex- 
pired Certificate of Need or Certificate of Exemption. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 70359. Posting. 

The special permit, or a true copy thereof, shall be posted conspicuous- 
ly in a prominent location within the licensed premises and accessible to 
public view. 

§ 70361 . Transferability. 

Special permits are not transferable. The licensee shall notify the De- 
partment in writing at least 30 days prior to the effective date of any 
change of ownership. A new application for special permit shall be sub- 
mitted by the prospective new owner. 

§ 70363. Program Flexibility. 

(a) All hospitals shall maintain continuous compliance with the spe- 
cial permit requirements. These requirements do not prohibit the use of 
alternate concepts, methods, procedures, techniques, equipment, person- 
nel qualifications or the conducting of pilot projects provided such ex- 
ceptions are carried out with the prior written approval of the Depart- 
ment. Such approval shall provide for the terms and conditions under 
which the exception is granted. A written request plus supporting evi- 
dence shall be submitted by the applicant or licensee to the Department. 



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(b) Any approval granted by the Department pursuant to this section, 
or a taie copy thereof, shall be posted immediately adjacent to the facil- 
ity's license required to be posted by Section 70123. 

§ 70365. Voluntary Suspension of Special Permit. 

(a) Upon written request and good cause, a licensee may request that 
a special permit be put in suspense. The Department may approve the re- 
quest for a period not to exceed 12 months. 

(b) Any special permit which has been temporarily suspended by the 
Department pursuant to this section shall remain subject to all renewal 
requirements of an active special permit, including the payment of re- 
newal fees, during the period of temporary suspension. 

(c) Any special permit suspended pursuant to this section may be rein- 
stated by the Department within 12 months of the date of suspension 
upon receipt of an application and evidence showing compliance with 
supplemental service requirements in effect at the time of reinstatement. 
If the special permit is not reinstated within the 1 2-month period, the spe- 
cial permit shall expire automatically. 

§ 70367. Voluntary Cancellation of Special Permit. 

(a) The licensee shall notify the Department in writing as soon as pos- 
sible and in all cases at least 30 days prior to the effective date of cancella- 
tion of a special permit. 

(b) Any special permit cancelled pursuant to this section may be rein- 
stated by the Department on receipt of an application along with evidence 
showing compliance with supplemental service requirements. 

§ 70369. Revocation or Involuntary Suspension of Special 
Permit. 

(a) Pursuant to provisions of Chapter 5 (commencing with Section 
1 1 500), Part I, Division 3, Title 2, Government Code, the Department 
may suspend or revoke any special permit issued under the provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, upon any of the following grounds: 

( 1 ) Violation by the licensee of any provisions of Chapter 2 (com- 
mencing with Section 1250), Division 2, Health and Safety Code, or of 
the supplemental service regulations promulgated by the Department. 

(2) Aiding, abetting or permitting the violation of any provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, or supplemental service regulations promulgated by the Depart- 
ment. 

(3) Conduct inimical to the public health, morals, welfare or safety of 
the people of the State of California in the maintenance and operation of 
a supplemental service. 

(b) The Director may temporarily suspend any special permit prior to 
any hearing when, in his opinion, such action is necessary to protect the 
public welfare. 

(1 ) The Director shall notify the licensee of the temporary suspension 
and the effective date thereof and at the same time shall serve such licens- 
ee with an accusation. 

(2) Upon receipt of a notice of contest by the licensee, the Director 
shall set the matter for hearing within 30 days after receipt of such notice. 

(3) The temporary suspension shall remain in effect until such time as 
the hearing is completed and the Director has made a final determination. 

(4) If the Director fails to make a final determination within 60 days 
after the original hearing has been completed, the temporary suspension 
shall be deemed vacated. 

(5) If the provisions of Chapter 2 (commencing with Section 1250), 
Division 2, Health and Safety Code, or the regulations promulgated by 
the Director are violated by a licensee which is a group, corporation or 
other association, the Director may suspend the special permit of such or- 
ganization or may suspend the special permit as to any individual person 
within such organization who is responsible for such violation. 

(c) The withdrawal of an application for a special permit shall not de- 
prive the Department of its authority to institute or continue a proceeding 
against the applicant for the denial of the special permit upon any group 



provided by law or to enter an order denying the special permit upon any 
such ground, unless the Department consents in writing to such with- 
drawal. 

(d) The suspension, expiration or forfeiture of a special permit issued 
by the Department shall not deprive the Department of its authority to in- 
stitute or continue a proceeding against the licensee upon any ground 
provided by law or to enter an order suspending or revoking a special per- 
mit or otherwise taking disciplinary action against the licensee on any 
such ground. 

(e) A person whose special permit has been revoked or suspended may 
petition the Department for reinstatement or reduction of penalty after a 
period of not less than one year has elapsed from the effective date of the 
decision or from the date of the denial of a similar petition. 

Article 6. Supplemental Services 

§ 70401 . Acute Respiratory Care Service Definition. 

Acute Respiratory Care Service means an intensive care unit in which 
there are specially trained nursing and supportive personnel and the nec- 
essary diagnostic, monitoring and therapeutic equipment to provide spe- 
cialized medical and nursing care to patients with acute respiratory prob- 
lems. 

§ 70403. Acute Respiratory Care Service General 
Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and accountability of the acute respiratory care 
service to the medical staff and administration shall be defined. 

(c) The unit shall be used primarily for the care of patients with acute 
respiratory failure. The unit should contain at least four (4) beds and 
should treat 1 00 or more patients per year. 

(d) Data relating to admissions, mortality and morbidity shall be kept 
and reviewed by an appropriate committee of the medical staff at least 
quarterly. 

(e) The hospital shall have the capability to perform blood gas analysis 
and electrolyte determinations at all times. 

(f) The unit shall be located to prevent through traffic. 

(g) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70405. Acute Respiratory Care Service Staff. 

(a) A physician shall have overall responsibility for the acute respira- 
tory care service. When possible this physician shall be certified or eligi- 
ble for certification in pulmonary disease by the American Board of In- 
ternal Medicine or be certified or eligible for certification by the 
American Board of Anesthesiology. If such specialists are not available, 
a physician who is certified or eligible for certification as an internist by 
the American Board of Internal Medicine with interest and experience in 
acute respiratory care may direct and coordinate the service. 

(b) A minimum of one other physician experienced in acute respirato- 
ry care shall be available to the unit. 

(c) Consultants in the specialities of medicine and surgery shall be 
available to the unit. 

(d) A registered nurse with at least six months nursing experience in 
the care of acute respiratory failure patients shall be responsible for the 
nursing care and nursing management of the unit. 

(e) A registered nurse:patient ratio shall be 1:4 or fewer on all shifts. 

(f) Sufficient other licensed nursing personnel who have experience 
in acute respiratory care nursing shall provide additional support in a total 
nurse:patient ratio of 1:2 or fewer on each shift. 



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§ 70415 



(g) Sufficient respiratory therapists and/or respiratory therapy techni- 
cians to provide support for resuscitation and maintenance of the me- 
chanical ventilators in a ratio of 1 :4 or fewer on each shift. 

(h) A physical therapist and a social worker should be available on a 
regular basis. 

§ 70407. Acute Respiratory Care Service Equipment and 
Supplies. 

(a) Equipment and supplies shall include at least: 

(1) Vertically adjustable beds with immediately removable head- 
boards with trendelenburg position capability. 

(2) Bed scales. 

(3) One pressure cycle respirator for each bed and one volume-cycle 
respirator for each four beds. 

(4) Endotracheal tubes and tracheostomy sets. 

(5) Patient lift. 

(6) Respiratory and cardiac monitoring for each bed. 

(7) Crash cart or equivalent. 

(8) Spriometry equipment. 

(9) Resuscitative equipment. 

(10) DC defibrillator. 

(11) Self-inflating bag and attached mask at each bed. 

(b) An acute respiratory care unit is classified as an electrically sensi- 
tive area and shall meet the requirements of Section 70853 of these regu- 
lations. 

§ 70409. Acute Respiratory Care Service Space. 

(a) In addition to the construction requirements in Section T17-316, 
Title 24, California Administrative Code, the following shall be met: 

( 1 ) Beds in the acute respiratory care service shall be included in the 
total licensed bed capacity of the hospital. 

(2) Each bed area shall contain at least 1 2.2 square meters ( 1 32 square 
feet) of floor space with no dimension less than 3.3 meters ( 1 1 feet) and 
with 1 .2 meters (4 feet) of clearance at both sides and at the foot of the 
bed with a minimum of 2.4 meters (8 feet) between beds. 

(3) 1.2 meters (4 feet) of floor space shall be provided around nurses' 
desks and utility areas. 

(4) All beds shall be placed in relation to the nurses' station or work 
area to obtain maximum observation of the patients. 

§ 7041 1 . Basic Emergency Medical Service, Physician on 
Duty, Definition. 

Basic emergency medical service, physician on duty, means the provi- 
sion of emergency medical care in a specifically designated area of the 
hospital which is staffed and equipped at all times to provide prompt care 
for any patient presenting urgent medical problems. 

§ 70413. Basic Emergency Medical Service, Physician on 
Duty, General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the emergency medi- 
cal service to the medical staff and administration shall be defined. 

(c) The emergency medical service shall be so located in the hospital 
as to have ready access to all necessary services. 

(d) A communications system employing telephone, radiotelephone 
or similar means shall be in use to establish and maintain contact with the 
police department, rescue squads and other emergency services of the 
community. 

(e) The emergency medical service shall have a defined emergency 
and mass casualty plan in concert with the parent hospital's capabilities 
and the capabilities of the community served. 

(F) The hospital shall require continuing education of all emergency 
medical service personnel. 



(g) Medical records shall be maintained on all patients presenting 
themselves for emergency medical care. These shall become part of the 
patient's hospital medical record. Past hospital records shall be available 
to the emergency medical service. 

(h) An emergency room log shall be maintained and shall contain at 
least the following information related to the patient: name, date, time 
and means of arrival, age, sex, record number, nature of complaint, dis- 
position and time of departure. The name of those dead on arrival shall 
be entered in the log. 

(i) All medications furnished to patients through the emergency ser- 
vice shall be provided by a pharmacist or an individual lawfully autho- 
rized to prescribe. Such medications shall be properly labeled and all re- 
quired records shall be maintained in accordance with state and federal 
laws. 

(j) Each Basic Emergency Medical Service shall be identified to the 
public by an exterior sign, clearly visible from public thoroughfares. The 
wording of such signs shall state: BASIC EMERGENCY MEDICAL 
SERVICE, PHYSICIAN ON DUTY. 

(k) Standardized emergency nursing procedures shall be developed by 
an appropriate committee of the medical staff. 

(/) A list of referral services shall be available in the basic emergency 
service. This list shall include the name, address and telephone number 
of the following: 

( 1 ) Police department. 

(2) Antivenin service. 

(3) Burn center. 

(4) Drug abuse center. 

(5) Poison control information center. 

(6) Suicide prevention center. 

(7) Director of the State Department of Health or his designee. 

(8) Local health department. 

(9) Clergy. 

(10) Emergency psychiatric service. 

(11) Chronic dialysis service. 

(12) Renal transplant center. 

(13) Intensive care newborn nursery. 

(14) Emergency maternity service. 

(15) Radiation accident management service. 

(16) Ambulance transport and rescue service. 

(17) County coroner or medical examiner. 

(m) The hospital shall have the following service capabilities: 

(1) Intensive care service with adequate monitoring and therapeutic 
equipment. 

(2) Laboratory service with the capability of performing blood gas 
analysis and electrolyte determinations. 

(3) Radiological service shall be capable of providing the necessary 
support for the emergency service. 

(4) Surgical services shall be immediately available for life-threaten- 
ing situations. 

(5) Postanesthesia recovery service. 

(6) The hospital shall have readily available the services of a blood 
bank containing common types of blood and blood derivatives. Blood 
storage facilities shall be in or adjacent to the emergency service. 

(n) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70415. Basic Emergency Medical Service, Physician on 
Duty, Staff. 

(a) A physician trained and experienced in emergency medical ser- 
vices shall have overall responsibility for the service. He or his designee 
shall be responsible for: 

(1) Implementation of established policies and procedures. 

(2) Providing physician staffing for the emergency services 24 hours 
a day who are experienced in emergency medical care. 



Page 777 



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(3) Development of a roster of specialty physicians available for con- 
sultation at all times. 

(b) All physicians, dentists and podiatrists providing services in the 
emergency room shall be members of the organized medical staff. 

(c) A registered nurse qualified by education and/or training shall be 
responsible for the nursing care within the service. 

(d) A registered nurse trained and experienced in emergency nursing 
care shall be on duty at all times. 

(e) There shall be sufficient other licensed nurses and skilled personnel 
as required to support the services offered. 

§ 70417. Basic Emergency Medical Service, Physician on 
Duty, Equipment and Supplies. 

All equipment and supplies necessary for life support shall be avail- 
able, including but not limited to, airway control and ventilation equip- 
ment, suction devices, cardiac monitor defibrillator, pacemaker 
capability, apparatus to establish central venous pressure monitoring, in- 
travenous fluids and administration devices. 



§ 70419. Basic Emergency Medical Service, Physician on 
Duty, Space. 

(a) The following space provisions and designations shall be provided: 

( 1 ) Treatment room. 

(2) Cast room. 

(3) Nursing station. 

(4) Medication room. 

(5) Public toilets. 

(6) Observation room. 

(7) Staff support rooms including toilets, showers and lounge. 

(8) Waiting room. 

(9) Reception area. 

(b) Observation beds in the emergency medical service shall not be 
counted in the total licensed bed capacity of the hospital. 

§ 70421 . Burn Center Definition. 

Burn center means an intensive care unit in which there are specially 
trained physicians, nursing and supportive personnel and the necessary 
monitoring and therapeutic equipment needed to provide specialized 
medical and nursing care to burned patients. 

§ 70423. Burn Center General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the burn center service 
to the medical staff and administration shall be defined. 

(c) The burn center shall be used solely for the care of patients with 
burns or similar and related conditions. The center shall contain at least 
four (4) beds and should treat fifty (50) or more patients per year. 

(d) If clinical or laboratory research projects are conducted, they shall 
be reviewed annually by an appropriate research committee. 

(e) Data relating to admission, morbidity and mortality shall be kept 
and reviewed by an appropriate committee of the medical staff at least 
quarterly. 

(f) The hospital shall have the capability to perform necessary labora- 
tory studies including blood gas analysis and electrolyte determinations 
twenty-four (24) hours a day. 

(g) A photograph shall be taken of all burns upon admission and upon 
discharge of the patient. 

(h) The center shall be located to prevent through traffic. 
(i) Respiratory care service and rehabilitation service shall be avail- 
able to and associated with the burn center. 



(j) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70425. Burn Center Staff. 

(a) A physician shall have responsibility for the burn service. This phy- 
sician shall be certified or eligible for certification by the American 
Board of Surgery or American Board of Plastic Surgery and should be a 
member of the American Bum Association. 

(b) At least two (2) surgeons, experienced in bum therapy and certified 
or eligible for certification by the American Board of Surgery or the 
American Board of Plastic Surgery shall be responsible for the supervi- 
sion and performance of bum care. 

(c) Continuous in-house physician coverage shall be provided. 

(d) Consultants in the specialties of medicine and surgery shall be 
available to the center. These specialties shall include, but not be limited 
to: anesthesia, dermatology, pediatrics, psychiatry, orthopedics, otolary- 
ngology, ophthalmology, nephrology, pulmonary medicine and 
pathology. 

(e) A registered nurse with at least six months' nursing experience in 
the treatment of bum patients in a bum center, and with evidence of con- 
tinuing education in burn care, shall be responsible for the nursing care 
and nursing management of the bum center. 

(f) A registered nurse with at least three months' nursing experience 
in the treatment of bum patients in a bum center shall be on duty on each 
shift. 

(g) Sufficient other nursing personnel shall be provided. 

(h) Psychiatrists, physical therapists, occupational therapists and so- 
cial workers shall be available on a regular basis to provide needed care 
and consultation. 

§ 70427. Burn Center Equipment and Supplies. 

(a) Equipment and supplies available to the bum center shall include 
at least: 

(1) Vertically adjustable beds. 

(2) Circular rotating electric beds or equivalent. 

(3) A suitable patient weighing device. 

(4) Ventilators. 

(5) Respiratory and cardiac monitoring equipment. 

(6) Cardiopulmonary resuscitation cart. 

§ 70429. Burn Center Space. 

(a) The following spaces, services and equipment shall be provided: 

(1) Nurses' station as defined in Title 24, California Administrative 
Code, Section Tl 7-306. 

(2) Utility rooms as defined in Title 24, California Administrative 
Code, Section T 17-308. 

(3) Storage space for clean linen. 

(4) Storage space for soiled linen. 

(5) Air conditioning system as required in Section T17-104. 

(6) A piped air/oxygen system and a piped suction system providing 
outlets at each bed. 

(7) Window area sufficient to provide patients with an awareness of 
the outdoors. 

(8) Cubicle curtains or other means of assuring visual privacy for each 
patient. 

(9) A treatment room. 

(10) A fully equipped operating room within the hospital. 

(11) Bathing facilities for patients. 

(12) Storage space for equipment and supplies. 

(13) Waiting area adjacent to the center. 

(b) Beds located in the bum center shall be included in the total li- 
censed bed capacity of the hospital. 

§ 70431 . Cardiovascular Surgery Service Definition. 

Cardiovascular surgery service means the performance of laboratory 
procedures for obtaining physiologic, pathologic and angiographic data 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70437 



on patients, and cardiovascular operative procedures, each supported by 
appropriate staff, space, equipment and supplies. It is the intent of this 
definition that the two aspects of this service shall not exist separately. 

§ 70433. Cardiovascular Surgery Service General 
Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. These policies and pro- 
cedures shall include provision for at least: 

(1 ) Definitions of qualifications of physicians for privileges to per- 
form cardiovascular laboratory catheterization procedures and/or sur- 
gery. 

(2) Regular review of case management, both preoperatively and post- 
operatively. 

(3) Collection, processing and retrieval of data on all patients to in- 
clude at least: diagnosis, procedure performed, pathophysiologic, angio- 
graphic, morbidity and mortality data. 

(4) Recommendations regarding equipment used, procedures per- 
formed and staffing patterns in the catheterization laboratory and cardio- 
vascular surgery units. 

(b) The responsibility and the accountability of the service to the medi- 
cal staff and administration shall be defined. 

(c) An adequate service base shall support the provision of these ser- 
vices. Recommended minimums are: 

( 1 ) 260 cardiac catheterizations per year. 

(2) 150 cardiovascular procedures requiring extra corporeal bypass 
per year. 

(d) The cardiovascular surgical service shall be available at all times 
for emergencies. 

(e) Supportive diagnostic services with trained personnel shall be 
available and include, where appropriate, electrocardiography, vector- 
cardiography, exercise stress testing, cardiac pacemaker station, echo- 
cardiography, phonocardiography and pulse tracings. 

(0 An intensive care service with respiratory care capabilities shall be 
provided by the hospital. 

(g) An animal laboratory is recommended as support for the cardiovas- 
cular surgery service. 

(h) A cardiac rehabilitation program should be integrated with the car- 
diovascular surgery service for early identification of the patient who can 
profit thereby. 

(i) All persons operating or supervising the operation of X-ray ma- 
chines shall comply with the requirements of the Radiologic Technology 
Regulations, Subchapter 4.5, Chapter 5, Title 17, California Administra- 
tive Code. 

(j) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70435. Cardiovascular Surgery Service Staff. 

(a) Cardiovascular catheterization laboratory. 

( 1 ) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification in cardiology by 
either the American Board of Internal Medicine or the American Board 
of Pediatrics or have equivalent experience and training. He shall be re- 
sponsible for: 

(A) Implementing established policies and procedures. 

(B) Supervision and training of all personnel, including in-service 
training and continuing education. 

(C) Assuring proper safety, function, maintenance and calibration of 
all equipment. 

(D) Maintaining a record of all angiographic procedures performed. 

(2) A physician who is certified or eligible for certification by the 
American Board of Radiology with special training or experience in car- 



diovascular radiology shall be available to the cardiovascular surgery 
service staff. 

(3) Two persons (registered nurses or cardiovascular technicians) 
shall assist during the performance of all cardiac catheterization proce- 
dures. These personnel shall be trained in the use of all instruments and 
equipment and shall be supervised by a physician. 

(4) A biomedical engineer shall be available for consultation as re- 
quired. 

(5) An electronic technician shall be available where required, 
(b) Cardiovascular operative service. 

(1) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification by the American 
Board of Thoracic Surgery or the American Board of Surgery with train- 
ing and experience in cardiovascular surgery. He shall be responsible for: 

(A) Implementing established policies and procedures. 

(B) Training and supervising the nurses and technicians in special 
techniques. 

(C) Training and supervising the clinical perfusionists. 

(2) A minimum of three surgeons shall constitute a surgical team for 
the performance of all cardovascular operative procedures which require 
extracorporeal bypass. At least one surgeon must meet the requirements 
outlined in subparagraph (b) ( 1 ) above. 

(3) Anesthesia for cardiovascular procedures shall be administered by 
a physician who is certified or eligible for certification by the American 
Board of Anesthesiology. 

(4) A physician who is certified or eligible for certification in cardiolo- 
gy by the American Board of Internal Medicine should be a member of 
the surgical team and should assist in monitoring the patient. 

(5) Clinical perfusionists shall operate the extracorporeal equipment 
under the immediate supervision of the cardiovascular surgeon or car- 
diologist. 

§ 70437. Cardiovascular Surgery Service Equipment and 
Supplies. 

(a) Cardiovascular catheterization laboratory equipment and supplies 
shall include but not be limited to: 

(1) X-ray machine 

(2) Image intensifier. 

(3) Pulse generator. 

(4) Camera. 

(5) Spot film device. 

(6) Videotape viewing equipment of fluoroscopic procedures. 

(7) Magnetic tape recording and playback equipment. 

(8) Motor driven cardiac table. 

(9) Cinefluorography and radiography equipment. 

(10) Monitoring and recording equipment. 

(11) Pressure transducers. 

(12) Equipment for determining cardiac output. 

(13) Equipment for exercising patients during procedures. 

(14) Equipment for determining oxygen saturation, hemoglobin, 
blood gas analysis and pH. 

(15) Appropriate cardiac catheters and accessory equipment. 

(16) Resuscitation equipment. 

(b) Cardiovascular operating room equipment and supplies shall in- 
clude but not be limited to: 

(1) Monitoring and recording equipment for: 

(A) Electrocardiograms. 

(B) Pressures. 

(C) Coronary blood flow. 

(D) Cardiac output. 

(E) Patient temperature. 

(2) Blood gas analyzer. 

(3) Heart-lung machine with oxygenator. 

(4) Device for rapid cooling and heating of the patient. 

(5) DC defibrillator. 

(6) Magnetic tape recording equipment. 



Page 779 



Register 90, Nos. 14-19; 5-11-90 



§ 70438 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(7) Suction outlets, piped in air and oxygen and tanks of gas including 
mixtures of oxygen and carbon dioxide. 

(8) All other necessary equipment and supplies as required in an oper- 
ating room. 

§ 70438. Cardiac Catheterization Laboratory Service. 

Cardiac catheterization laboratory service shall be organized to per- 
form laboratory procedures for obtaining physiologic, pathologic and an- 
giographic data on patients with cardiovascular disease. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1255 and 1255.5. Health and Safety Code. 

History 
1. New section filed 8-2-85 as an emergency; effective upon filing (Register 85. 
No. 31 ). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on ] 2-2-85. 

§ 70438.1 . Cardiac Catheterization Laboratory 
Service — General Requirements. 

The cardiac catheterization laboratory service may be approved in a 
general acute care hospital which does not provide cardiac surgery pro- 
vided the following requirements are met: 

(a) The hospital shall maintain a current written transfer agreement as 
specified in Section 1255 of the Health and Safety Code, which shall in- 
clude all of the following: 

( 1 ) Provisions for emergency and routine transfer of patients. 

(2) Provisions which specify that cardiac surgery staff and facilities 
shall be immediately available to the patient upon notification of an 
emergency. 

(3) Provisions which specify that the cardiac catheterization laborato- 
ry staff shall have responsibility for arranging transportation to the re- 
ceiving hospitals. 

(b) Only the following diagnostic procedures shall be performed in the 
catheterization laboratory: 

( 1 ) Right heart catheterization and angiography. 

(2) Right and left heart catheterization and angiography. 

(3) Left heart catheterization and angiography. 

(4) Coronary angiography. 

(5) Electrophysiology studies. 

(6) Myocardial biopsy. 

(c) The hospital shall comply with all of the requirements of Sections 
70433(a), (b), (c)(1), (e), (i), (j), 70435a) and 70437(a). 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1255 and 1255.5, Health and Safety Code. 

History 

1. New section filed 8-2-85 as an emergency; effective upon filing (Register 85, 
No. 31 ). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 12-2-85. 

2. Certificate of Compliance including amendment transmitted to OAL 1 1-22-85 
and filed 12-12-85 (Register 85, No. 50). 

§ 70439. Cardiovascular Surgery Service Space. 

(a) Catheterization laboratory space shall include: 

( 1 ) A minimum floor area of 40 square meters (450 square feet) for the 
procedure room. 

(2) A minimum floor area of 9 square meters ( 1 00 square feet) for each 
of the following: 

(A) Control, monitoring and recording equipment. 

(B) X-ray power and controls. 

(C) Work room. 

(D) Dressing rooms for doctors and nurses. 

(b) Cardiovascular surgery space shall include: 

(1) Operating rooms that comfortably accommodate 12 persons and 
all necessary equipment with a minimum floor area of 60 square meters 
(650 square feet). 

(2) Work room. 

(3) Pump work room. 

(4) Adequate storeroom. 



§ 70441. Chronic Dialysis Service Definition. 

Chronic dialysis service means a specialized unit of a hospital for the 
treatment of patients with end-stage renal disease who manifest the accu- 
mulation of excessive nitrogenous waste products. The scope of services 
includes hemodialysis per se and may include peritoneal dialysis or other 
means for removing toxic or excessive waste products from the blood. 
The service includes supervision of patients undergoing home dialysis. 

§ 70443. Chronic Dialysis Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and the administration. Policies shall be ap- 
proved by the governing body. Procedures shall be approved by the ad- 
ministration and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the chronic dialysis 
service to the medical staff and administration shall be defined. 

(c) The hospital shall: 

( 1 ) Have two or more dialysis stations. A minimum of five dialysis ses- 
sions per week should be performed at each station. 

(2) Work in cooperation with other facilities providing care for pa- 
tients with end-stage renal disease. 

(3) Make chronic dialysis services available to patients with end-stage 
renal disease referred from other facilities which do not provide chronic 
dialysis serviced. 

(4) Participate in the development and use of a registry of prospective 
recipient patients. 

(5) Participate in kidney procurement, preservation and transport pro- 
gram. 

(6) Review all patients with end-state renal disease to determine the 
appropriateness of their treatment modality, including self-dialysis, 
home dialysis and renal transplantation and cooperate with other facili- 
ties for the timely transfer of medical data. 

(d) The hospital shall provide directly: 

(1) Respiratory therapy. 

(2) Twenty-four hour laboratory capability of performing, as a mini- 
mum, the following determinations: C.B.C., B.U.N., creatinine, platelet 
count, blood typing and cross matching, blood gas analysis, blood pH, 
serum glucose, electrolytes, coagulation tests, spinal fluid examination 
and urinalysis. 

(3) Chronic dialysis on an outpatient basis. 

(4) Angiography. 

(e) The hospital shall provide directly or by arrangement: 

(1) Immunofluorescence studies. 

(2) Electron microscopy 

(3) Microbiological studies for rickettsiae, fungi, bacteria and viruses. 

(4) Tissue culture. 

(5) Outpatient services. 

(6) Self-dialysis training program. 

(7) Home-dialysis training program. 

(8) Transplantation evaluation of patients with end-stage renal dis- 
ease. 

(9) Renal transplantation. 

(10) Nuclear medicine service. 

(f) There shall be a separate designated area as needed for patients un- 
dergoing chronic dialysis who are known to be hepatitis B surface anti- 
gen positive. 

(g) The particular requirements for patients on chronic dialysis shall 
be accommodated in the disaster and fire plans of the hospital, 

(h) There shall be inservice training and continuing education for all 
medi-cal, nursing and other personnel. 

(i) There shall be a written hepatitis control program. 

(j) Periodically, a committee of the medical staff shall evaluate the ser- 
vices provided and make appropriate recommendations to the executive 
committee of the medical staff and administration. 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70453 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1 . Amendment of subsections (f) and (i) filed 6-15-89 as an emergency; operative 
6- 1 5-89 (Register 89, No. 25). A Certificate of Compliance must be transmitted 
to OAL within 120 days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment of subsections (f) and (i) refiled 1 1-16-89 as an emergency; opera- 
tive 1 1 -1 6-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 1 20 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 11-16-89 order including nonsubstantive 
chanse of subsections (f) and (i) transmitted to OAL 3-1 5-90 and filed 4-16-90 
(Register 90, No. 17). 

§ 70445. Chronic Dialysis Service Staff. 

(a) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification by the American 
Board of Internal Medicine or the American Board of Pediatrics and shall 
have a minimum of one year's training or experience in the care of pa- 
tients with end-stage renal disease. 

(b) Surgeons performing the vascular access procedures shall be certi- 
fied or eligible for certification by the American Board of Surgery and 
shall have a minimum of one year's training or experience in vascular 
surgery. 

(c) Children being treated for end-stage renal disease shall be under 
the care of a physician who is certified or eligible for certification by the 
American Board of Pediatrics. 

(d) Where appropriate, the hospital shall provide timely evaluation 
and consultation by the following specialists: 

( 1 ) Physicians certified or eligible for certification in cardiology, en- 
docrinology, infectious disease or hematology by the American Board of 
Internal Medicine. 

(2) A physician certified or eligible for certification in neurology by 
the American Board of Psychiatry and Neurology. 

(3) A physician certified or eligible for certification in psychiatry by 
the American Board of Psychiatry and Neurology. 

(4) A physician certified or eligible for certification in orthopaedic sur- 
gery by the American Board of Orthopaedic Surgery. 

(5) A physician certified or eligible for certification by the American 
Board of Pathology. 

(6) A physician certified or eligible for certification by the American 
Board of Urology. 

(e) There shall be a registered nurse responsible for the nursing service 
who has had at least 12 months' general nursing experience or six 
months' experience in the care of patients with end-stage renal disease. 

(f) There shall be sufficient other licensed nurses and skilled personnel 
to provide the required patient care. 

(g) A dietitian shall provide diet management and counseling to meet 
the needs of patients with end-stage renal disease. 

(h) A social worker shall provide social service and counseling to meet 
the needs of patients with end-stage renal disease. 

§ 70447. Chronic Dialysis Service Equipment and 
Supplies. 

(a) Equipment and supplies shall include at least: 

(1) A dialysis machine or equivalent (with appropriate monitoring 
equipment) for each bed or station. 

(2) Dialysis equipment appropriate for pediatric patients, if treated. 

§ 70449. Chronic Dialysis Service Space. 

(a) There shall be a minimum of 10 square meters (110 square feet) of 
floorspace per bed or station. 

(b) The following areas shall be provided and maintained: 

( 1 ) Patient waiting area. 

(2) Conference room. 

(3) Nurses' station. 

(4) Segregated area for home dialysis training, if provided. 

(5) Machine storage room. 

(6) Supplies storage room. 



(7) Utility room. 

(c) Beds in the chronic dialysis service, unless used for stay of over 24 
hours, shall not be included in the total licensed bed capacity of the hospi- 
tal. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (b) filed 6-15-89 as an emergency; operative 
6- 1 5-89 (Register 89. No. 25). A Certificate of Compliance must be transmitted 
to OAL within 120 days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0- -1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment of subsection (b) refiled 1 1-16-89 as an emergency: operative 
11-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 1 20 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15- 90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70451 . Comprehensive Emergency Medical Service 
Definition. 

Comprehensive Emergency medical service means the provision of 
diagnostic and therapeutic services for unforeseen physical and mental 
disorders which, if not promptly treated, would lead to marked suffering, 
disability or death. The scope of services is comprehensive with in-house 
capabilities for managing all medical situations on a definitive and con- 
tinuing basis. 

§ 70453. Comprehensive Emergency Medical Service 
General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the emergency medi- 
cal service to the medical staff and administration shall be defined. 

(c) The emergency medical service shall be so located in the hospital 
as to have ready access to all necessary services. 

(d) A communications system employing telephone, radiotelephone 
or similar means shall be in use to establish and maintain contact with the 
police department, rescue squads and other emergency services of the 
community. 

(e) The emergency medical service shall have a defined emergency 
and mass casualty plan in concert with the hospital's capabilities and the 
capabilities of the community served. 

(f) The hospital shall require continuing education of all emergency 
medical service personnel. 

(g) Medical records shall be maintained on all patients presenting 
themselves for emergency medical care. These shall become part of the 
patient's hospital medical record. Past hospital records shall be available 
to the emergency medical service. 

(h) An emergency room log shall be maintained and shall contain at 
least the following information relating to the patient: name, date, time 
and means of arrival, age, sex, record number, nature of complaint, dis- 
position and time of departure. The name of those dead on arrival shall 
also be entered in the log. 

(i) All medications furnished to patients through the emergency ser- 
vice shall be provided by a pharmacist or an individual lawfully autho- 
rized to prescribe. Such medications shall be properly labeled and all re- 
quired records shall be maintained in accordance with state and federal 
laws. 

(j) Each comprehensive emergency medical service shall be identified 
to the public by an exterior sign, clearly visible from public thorough- 
fares. The wording of such signs shall state: COMPREHENSIVE 
EMERGENCY MEDICAL SERVICE PHYSICIAN ON DUTY. 

(k) Standardized emergency nursing procedures shall be developed by 
an appropriate committee of the medical staff. 



Page 781 



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§ 70455 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(/) A list of referral services shall be available in the emergency center. 
This list shall include the name, address and telephone number of the fol- 
lowing: 

( 1 ) Police department. 

(2) Antivenin service. 

(3) Drug abuse center. 

(4) Poison control information center. 

(5) Suicide prevention center. 

(6) Director of State Department of Health or his designee. 

(7) Local health department. 

(8) Clergy. 

(9) County coroner or medical examiner. 

(m) The hospital shall have the following additional services which 
shall be continuously staffed in a manner that permits the performance 
of all required functions: 

( 1 ) Chronic dialysis service. 

(2) Burn center. 

(3) Respiratory care service. 

(4) Intensive care newborn nursery. 

(5) Coronary care service. 

(6) Intensive care service. 

(7) Pediatric service. 

(8) Psychiatric unit. 

(9) Cardiovascular surgery service. 

(10) Postanesthesia recovery unit. 

(n) The radiological service shall have the capability of performing 
contrast studies including angiography in addition to its usual capabili- 
ties. 

(0) The clinical laboratory shall be capable of performing blood gas 
analysis, pH, serum electrolytes and other procedures appropriate for 
emergency medical care. 

(p) Surgical services shall be immediately available for life-threaten- 
ing situations. 

(q) The hospital shall have readily available the service of a blood bank 
containing common types of blood and blood derivatives. Blood storage 
facilities shall be in or adjacent to the emergency service. 

(r) There shall be affiliation of the emergency medical service with a 
medical school. 

(s) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70455. Comprehensive Emergency Medical Service Staff. 

(a) A full-time physician trained and experienced in emergency medi- 
cal service shall have overall responsibility for the service. The physician 
or her or his designee shall be responsible for: 

( 1 ) Implementation of established policies and procedures. 

(2) Providing continuous staffing with physicians trained and experi- 
enced in emergency medical service. Such physicians shall be assigned 
to and be located in the emergency service area 24 hours a day. 

(3) Providing experienced physicians in specialty categories to be 
available in-house 24 hours a day. Such specialities include but are not 
limited to medicine, surgery, anesthesiology, orthopedics, neurosurgery, 
pediatrics and obstetrics-gynecology. 

(A) The most senior resident in any of the specialities may be consid- 
ered an experienced physician. 

(4) Maintenance of a roster of specialty physicians immediately avail- 
able for consultation and/or assistance. 

(5) Assurance of continuing education for all emergency service staff 
including physicians, nurses and other personnel. 

(b) All physicians, dentists and podiatrists providing services in the 
emergency room shall be members of the organized medical staff. 

(c) A registered nurse qualified by education and/or training shall be 
responsible for nursing care within the service. 

(d) All registered nurses shall have training and experience in emer- 
gency lifesaving and life support procedures. 



(e) A registered nurse trained and experienced in emergency nursing 
care shall be on duty at all times. 

(f) There shall be sufficient licensed nurses and other skilled personnel 
on duty as required to support the services. 

NOTE: Authority cited: Sections 1252, 1255(c). 1275, 1276.4 and 100275(a), 
Health and Safety Code. Reference: Section 1250(a), Health and Safety Code. 

History 

1. Amendment of subsection (a), new subsection (e), subsection reletterins and 
new Notk filed 9-26-2003: operative 1-1-2004 (Register 2003, No. 39). 

§ 70457. Comprehensive Emergency Medical Service 
Equipment and Supplies. 

All equipment and supplies necessary for life support shall be avail- 
able, including but not limited to: airway control and ventilation equip- 
ment, suction devices, cardiac monitor, defibrillators, pacemaker capa- 
bility, apparatus to establish central nervous system monitoring and 
administration devices. 

§ 70459. Comprehensive Emergency Medical Service 
Space. 

(a) The following space provisions and designations shall be provided: 

( 1 ) Treatment rooms. 

(2) Cast rooms. 

(3) Operating room fully equipped. 

(4) Intensive care in or adjoining the emergency medical service area. 

(5) Nursing station. 

(6) Medication room. 

(7) Clean and dirty utility room. 

(8) X-ray spaces. 

(9) Laboratory facilities. 

(10) Staff support rooms including toilets, showers, lounge and sleep- 
ing area. 

(11) Public toilets. 

(12) Observation room. 

(13) Police and press room. 

(14) Waiting room. 

(15) Reception area. 

(b) Observation beds in the emergency medical service shall not be 
counted in the total licensed bed capacity of the hospital. 

§ 70461 . Coronary Care Service Definition. 

Coronary care service means an intensive care unit in which there are 
specially trained nursing and supportive personnel with necessary diag- 
nostic, monitoring and therapeutic equipment needed to provide special- 
ized medical and nursing care to patients suspected of or having signifi- 
cant coronary artery disease, heart failure or dysrhythmia. 

§ 70463. Coronary Care Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. The policies and proce- 
dures shall include but not be limited to: 

(1) Admission, transfer and discharge policies. 

(2) Staffing requirements. 

(3) Routine procedures. 

(4) Emergency procedures. 

(b) The responsibility and the accountability of the coronary care ser- 
vice to the medical staff and administration shall be defined. 

(c) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Repealer of subsection (a)(5) filed 6-15-89 as an emergency; operative 
6-1 5-89 (Register 89, No. 25). A Certificate of Compliance must be transmitted 
to OAL within 120 days or subsection (a)(5) will be reinstated its it existed prior 
to the emergency on 10—13—89. 

2. Certificate of Compliance as to 6-15-89 order transmitted to OAL on 10-13-89 
and disapproved by OAL, on 1 1-13-89 (Register 89, No. 46). 



Page 782 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70483 



3. Repealer of subsection (a)(5) refiled 11-16-89 as an emergency: operative 
11-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 120 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70465. Coronary Care Service Staff. 

(a) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification in cardiovascular 
disease by the American Board of Internal Medicine. If such a cardiolo- 
gist is not available, a physician certified or eligible for certification in 
internal medicine by the American Board of Internal Medicine, with 
training and experience in cardiovascular disease, may administer the 
service. In this circumstance, a cardiologist, qualified as above, shall pro- 
vide consultation at such frequency as to assure high quality service. The 
physician in charge shall be responsible for: 

( 1 ) Implementation of established policies and procedures. 

(2) Development of a system for assuring physician coverage. 

(3) Conducting education programs in coronary care for physicians. 

(4) Assuring there is a continuing education program for nursing per- 
sonnel in coronary care. 

(5) Final decision regarding admissions to and discharges from unit. 

(b) A registered nurse with training and experience in coronary care 
nursing shall be responsible for the nursing care and nursing manage- 
ment of the service. 

(c) All licensed nurses shall have had training and experience in coro- 
nary care nursing. 

(d) There shall be not less than two nursing personnel physically pres- 
ent in the coronary care unit when a patient is present. At least one of the 
nursing personnel shall be a registered nurse. 

(e) The licensed nurse:patient ratio shall be 1:2 or fewer at all times. 
Licensed vocational nurses may constitute up to 50 percent of the li- 
censed nurses. 

§ 70467. Coronary Care Service Equipment and Supplies. 

The equipment and supplies required in Section 70497 for intensive 
care units shall be provided. 

§ 70469. Coronary Care Service Space. 

The space requirements in Section 70499 for intensive care units shall 
be provided. 

§ 70471 . Dental Service Definition. 

Dental services means the provision of diagnostic, preventive or cor- 
rective procedures performed by dentists with appropriate staff, space, 
equipment and supplies. 

§ 70473. Dental Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the dental service to 
the medical staff and administration shall be defined. 

(c) A physician member of the medical staff shall be responsible for 
the care of any medical problem arising during the hospitalization of den- 
tal patients. 

(d) There shall be a well-defined plan for oral health care, based on 
patient need, the size of the hospital and the type of service provided. 

(e) There shall be a well-organized plan for emergency dental care. 

(f) There shall be a record of all dental services provided to the patient 
and this shall be made a part of the patient's medical record. 

(g) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 



§ 70475. Dental Service Staff. 

(a) A dentist shall have overall responsibility for the dental service. 

(b) The dental service shall be staffed by a sufficient number of dentist 
members of the medical staff along with auxiliary personnel to render 
proper dental care. 

(c) If dental hygienists, dental assistants or dental laboratory techni- 
cians are employed, they shall work under the supervision of the director 
of the dental service. 

§ 70477. Dental Service Equipment and Supplies. 

(a) There shall be sufficient equipment, instruments and supplies 
maintained to meet the needs of the services offered. 

(b) There shall be equipment for sterilization of instruments and sup- 
plies. 

(c) The following materials shall be available for immediate use wher- 
ever dental treatment is provided: 

( 1 ) Oxygen. 

(2) Appropriate drugs. 

(3) Resuscitation equipment. 

(d) The hospital library shall contain an adequate selection of dental 
texts, periodicals and the "Index to Dental Literature." 

(e) Radiographic equipment shall meet the requirements of Chapter 5, 
Part 1, Title 17, California Administrative Code. 

§ 70479. Dental Service Space. 

(a) There shall be adequate space maintained for the dental service. 

(b) There shall be facilities for dental radiography. 

§ 70481 . Intensive Care Newborn Nursery Service 
Definition. 

An intensive care newborn nursery service means the provision of 
comprehensive and intensive care for all contingencies of the newborn 
infant. Infant transport services are an indispensable part of an intensive 
care newborn nursery service. 

§ 70483. Intensive Care Newborn Nursery Service General 
Requirements. 

(a) An intensive care newborn nursery service shall provide: 

(1) Comprehensive care for all life-threatening or disability-produc- 
ing situations. 

(2) Consultation service to referring perinatal units. 

(3) Infant transport services between perinatal units and the intensive 
care newborn nursery. 

(4) A transport team consisting of at least a physician and registered 
nurse or respiratory therapist. 

(5) Continuing education for staff of the intensive care newborn nurs- 
ery as well as referring perinatal units. 

(6) Review an evaluation of service programs of perinatal units. 

(b) There shall be written policies and procedures developed and 
maintained by the person responsible for the service in consultation with 
other appropriate health professionals and administration. Procedures 
shall be approved by the medical staff and administration where such is 
appropriate. Such policies and procedures shall include but not be limited 
to: 

( 1 ) Relationships to other services in the hospital. 

(2) Admission to the intensive care newborn nursery. 

(3) Consultation to perinatal units. 

(4) Infection control and relationship to the hospital infection commit- 
tee. 

(5) Transfer of infants to and from perinatal units. 

(6) Provision for family-centered infant care by parent or surrogate. 

(7) Prevention and treatment of neonatal hemorrhagic disease. 

(8) Visiting privileges. 

(9) Resuscitation of the newborn. 

( 1 0) Administering and monitoring of oxygen and respiratory therapy. 

(11) Transfusion. 

( 1 2) PKU screening 



Page 783 



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§ 70485 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(13) Rhesus (Rh) hemolytic disease identification, reporting and pre- 
vention. 

( 14) Management of hyperbilirubinemia. 

(15) Discharge and continuity of care with referral to community sup- 
portive services. 

(16) Pediatric-pathologic-radiologic conferences. 

(17) Routine and special care of the infant. 

(18) Handwashing technique. 

(19) Individual bassinet technique. 

(20) Gavage feedings. 

(21) Intravenous therapy. 

(22) Formula preparation and storage. 

(23) Respiratory care procedures. 

(c) The responsibility and the accountability of the intensive care new- 
born nursery service to the medical staff and administration shall be de- 
fined. 

(d) The hospital laboratory shall have the capability of performing 
blood gas analyses, pH and microtechniques. 

(e) Infants with diarrhea of the newborn as defined in section 2564, 
Title 17, California Code of Regulations, or who have draining lesions 
shall be isolated. 

(f) Infants suspected of having airborne infections shall be separated 
from other infants in the nursery. 

(g) All infections shall be reported to the hospital infection control 
committee promptly. 

(h) Social services shall be available. 

(i) There shall be discharge planning and provisions for follow-up 
care. 

(j) Oxygen shall be administered to newborn infants only on the writ- 
ten order of a physician. The order shall include the concentration (vol- 
ume percent) or desired arterial partial pressure of oxygen and be re- 
viewed, modified or discontinued after 24 hours. 

(k) The intensive care newborn nursery is considered an electrically 
sensitive area and shall meet the requirements of section 70853 of these 
regulations. 

(1) An air-conditioned transport vehicle shall be provided which has 
an intercommunication system between the driver and the transport team 
and radio communication between the transport team and the intensive 
care newborn nursery. 

(m) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated is it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70485. Intensive Care Newborn Nursery Service Staff. 

(a) A physician shall have overall responsibility for the service. The 
physician shall be certified or eligible for certification by the American 
Board of Pediatrics and have additional training and experience in neon- 
tology. 

( 1 ) The pediatrician shall be responsible for: 

(A) Providing in-hospital pediatric service. 

(B) Maintaining working relationships with referring perinatal units. 

(C) Providing for joint staff conferences and continuing education of 
respective medical specialties. 

(D) Providing transport team availability at all times. 



(2) A physician who is certified or eligible for certification by the 
American Board of Anesthesiology shall be available to the service. 

(3) A surgeon experienced in neonatal surgery and a pediatric cardiol- 
ogist shall be available to the service. 

(b) A registered nurse who has had training and experience in intensive 
care of the newborn shall be responsible for the nursing care in the inten- 
sive care newborn nursery. 

(c) A registered nurse trained in intensive care of the newborn shall be 
on duty on each shift. 

(d) A ratio of one registered nurse to two or fewer intensive care infants 
shall be maintained. 

(e) There shall be evidence of continuing education and training pro- 
grams for the nursing staff in intensive care newborn nursing. 

(f) A registered nurse trained in intensive care of the newborn shall be 
available to serve on the transport team. 

(g) A respiratory therapist trained in the respiratory care of the new- 
bom shall be available to the service. 

§ 70487. Intensive Care Newborn Nursery Service 
Equipment and Supplies. 

(a) The intensive care newborn nursery shall include at least the fol- 
lowing: 

( 1 ) A separate bassinet or equivalent for each infant. 

(2) Enclosed storage unit for clean supplies. 

(3) Diaper receptacles with a cover, foot control and disposable liner. 

(4) A hamper with a disposable liner for soiled linen. 

(5) A wall thermometer and hygrometer. 

(6) Accurate beam scales or the equivalent. 

(7) Thermostatically controlled incubators or radiant heating devices 
to maintain proper ambient temperature. 

(8) Two oxygen and one compressed air outlets per infant station with 
regulating devices and administration equipment. 

(9) Resuscitation equipment and supplies to include at least: 

(A) Glass trap suction device with catheter or a device which serves 
this function. 

(B) Pharyngeal airways, assorted sizes. 

(C) Laryngoscope, including a blade for premature infants. 

(D) Endotracheal catheters, assorted sizes with malleable stylets. 

(E) Arterial catheters, assorted sizes. 

(F) Ventilatory assistance bag and infant mask. 

(G) Bulb syringe. 
(H) Stethoscope. 

(I) Syringes, needles and appropriate drugs. 

(10) Suction equipment. 

(1 1) DC defibrillator (within the hospital). 

(12) Cardiac monitor. 

( 1 3) Blanket warmer. 

(14) Blood gas analyzer (within the hospital). 

(15) Umbilical blood vessel catheterization tray. 

(16) Portable incubator with power pack to provide continuous tem- 
perature control and monitoring. 

(17) Ventilatory equipment designed for the care of newborn infants. 

(18) Ten or more electrical outlets for each infant bed equivalent. 

(19) One handwashing sink with controls not requiring direct contact 
of the hand for operation (wrist or elbow blade handle are not acceptable) 
for each four bassinets. 

(b) Infant transport equipment shall include at least the following: 

(1) Infant transport incubator with self-contained power supply to 
maintain a neutral thermal environment. 

(2) Oxygen supply with fail-safe monitor humidifier. 

(3) Oxygen analyzer. 

(4) Compressed air supply. 

(5) Temperature monitoring equipment. 

(6) Cardiopulmonary monitoring equipment. 

(7) Suction device. 

(8) Infusion pump. 



Page 784 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70497 



(9) Resuscitation equipment and supplies. 

(10) Intravenous fluids and supplies. 

§ 70489. Intensive Care Newborn Nursery Service Space. 

(a) Sufficient floor area shall be provided so that there is at least 7.2 
square meters (80 square feet) per bassinet. 

(b) A work room or control station shall be maintained which shall pro- 
vide for handwashing, gowning and charting. 

(c) There shall be 100 foot candles of light at each bassinet. 

(d) A waiting room shall be maintained adjacent to the intensive care 
newborn nursery. 

(e) A treatment area with temperature control. 

(0 Bassinets in the intensive care newborn nursery shall be included 
in the total licensed bed capacity of the hospital. 

§ 70491 . Intensive Care Service Definition. 

An intensive care service is a nursing unit in which there are specially 
trained nursing and supportive personnel and diagnostic, monitoring and 
therapeutic equipment necessary to provide specialized medical and 
nursing care to critically ill patients. 

§ 70493. Intensive Care Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. Policies and procedures 
shall include, but not be limited to: 

( 1 ) Admission, discharge and transfer policies. 

(2) Staffing requirements. 

(3) Routine procedures. 

(4) Emergency procedures. 

(b) The responsibility and the accountability of the intensive care ser- 
vice to the medical staff and administration shall be defined. 

(c) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

(d) Intensive care units are classified as electrically sensitive areas and 
shall meet the requirements of section 70853 of these regulations. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Repealer of subsection (a)(5) filed 6-15-89 as an emergency; operative 
6-1 5-89 (Register 89, No. 25). A Certificate of Compliance must be transmitted 
to OAL within 120 days or subsection (a)(5) will be reinstated is it existed prior 
to the emergency on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Repealer of subsection (a)(5) refiled 11-16-89 as an emergency; operative 
1 1-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 
mitted to OAL within 1 20 days or the section will be reinstated as it existed prior 
to the emergency on 3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70495. Intensive Care Service Staff. 

(a) A physician with training in critical care medicine shall have over- 
all responsibility for the intensive care service. This physician or his des- 
ignated alternate shall be responsible for: 

(1) Implementation of established policies and procedures. 

(2) Development of a system for assuring physician coverage. 

(3) Final decision regarding admissions to and discharges from the 
unit. 

(4) Assuring there is continuing education for the medical staff and 
nursing personnel. 

(b) A registered nurse with training and experience in intensive care 
nursing shall be responsible for the nursing care and nursing manage- 
ment of the intensive care unit when a patient is present. 



(c) All licensed nurses shall have training and experience in intensive 
care nursing. 

(d) There shall be not less than two nursing personnel physically pres- 
ent in the intensive care unit when a patient is present. At least one of the 
nursing personnel shall be a registered nurse. 

(e) The nurse:patient ratio shall be 1 :2 or fewer at all times. Licensed 
vocational nurses may constitute up to 50 percent of the licensed nurses. 

(f) An inhalation therapist, physical therapist and other supportive ser- 
vice staff shall be available depending upon the requirements of the ser- 
vice. 

§ 70497. Intensive Care Service Equipment and Supplies. 

(a) In addition to the construction requirements of Section T17-316, 
Title 24, California Administrative Code, the following requirements 
shall be met: 

( 1 ) Individual bed area lighting which is controlled by a dimmer in the 
patient care unit shall be provided. Special lights should be provided for 
patient examinations. 

(2) Isolated power systems, if installed, shall be provided with a con- 
tinuously operating line isolation monitor to warn of possible leakage or 
faulty current. The monitor shall contain a red signal lamp and audible 
warning signal activated when total current reaches a value of two (2) 
milliamperes. All other receptacles shall be located at least 2.4 meters (8 
feet) away. 

(3) A minimum of four (4) duplex or eight (8) single receptacles shall 
be provided at the head of each bed and served by at least two separate 
circuits used for no other purpose. 

(b) General equipment shall include but not be limited to: 

(1) Electrocardiographic oscilloscopic monitor with writer at each 
bed. If a central nurses' station is equipped with a writer, a writer is not 
required at each bedside. 

(2) DC defibrillator. 

(3) Positive pressure breathing apparatus. 

(4) Oxygen mask with accessory equipment. 

(5) Transvenous cardiac pacemaker. 

(6) Emergency cart containing drugs and emergency supplies. 

(7) Sterile trays for parenteral therapy. 

(8) Tracheostomy tray. 

(9) Thoracentesis tray. 

(10) Venesection tray. 

(11) Irrigation equipment. 

(12) Intravenous fluids and plasma expanders or plasma. 

(13) Refrigerated storage for drugs and biologicals. 

(14) Laryngoscope and cuffed endotracheal tubes. 

(15) Equipment for blood gas analysis, immediately available. 

(c) Other equipment that is to be provided at each bed unless otherwise 
indicated: 

(1) Devices for holding intravenous solutions. 

(2) Wall clock with sweep second hand visible to each patient. 

(3) Wall-mounted interval clock with sweep second hand which may 
be activated at time of cardiac arrest. 

(4) A sphygmomanometer. 

(5) Two oxygen outlets or a single outlet with a "Y" connection with 
sufficient oxygen delivery capability. 

(6) One air outlet. 

(7) Two piped suction inlets or a single inlet with a "Y" connection 
with sufficient suction capability. 

(d) An intercommunication system shall be provided which includes 
the following: 

( 1 ) A call outlet at each bed which communicates to the nurses' control 
desk. 

(2) An intercommunication system connected to the nearest continu- 
ously staffed nurses' station, which will enable the nurse or physician to 
contact the nearby unit without leaving the intensive care unit. 



Page 785 



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§ 70499 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(3) An alarm system or other method for summoning physicians or 
cardiac arrest teams. 

§ 70499. Intensive Care Service Space. 

(a) In addition to the construction requirements in Section T17-316, 
Title 24, the following requirement shall be met: 

( 1 ) An intensive care unit shall consist of not less than four (4) nor 
more than twelve (12) patient beds, including at least one isolation room. 
Multiple, interconnected units may be approved by the Department. 

(2) Beds in the intensive care unit shall be included in the total licensed 
bed capacity. 

(3) Each patient bed area shall contain at least 1 1 .9 square meters (132 
square feet) with no dimension less than 3.3 meters ( 1 1 feet) and with 1 .2 
meters (4 feet) of clearance at each side and the foot of the bed and with 
a minimum 2.4 meters (8 feet) between beds. 

(4) 1.2 meters (4 feet) shall be provided around the nurses' desk. 

(5) All beds shall be placed in relation to the nurses' station or work 
area to obtain maximum observation of patients. 

(6) A visitor's waiting area nearby to the unit shall be provided. 

§ 70501 . Intermediate Care Service Definition. 

Intermediate care service means the provision of inpatient care to pa- 
tients who have need for skilled nursing supervision and supportive care 
but who do not require continuous skilled nursing care. 

§ 70503. Intermediate Care Service General Requirements. 

(a) The regulations for Intermediate Care Facilities, Chapter 4, Divi- 
sion 5, Title 22, California Administrative Code, shall be met with the 
following exceptions: 

( 1 ) The administrator of the hospital does not need to possess a license 
as a nursing home administrator and his services may be shared between 
the hospital and the intermediate care service. 

(2) The functions of the director of nurses may be shared between the 
hospital and the intermediate care service. The registered nurse require- 
ment, referred to as the director of the nursing service in Section 73323 
of the regulations for Intermediate Care Facilities, shall be met. 

(b) There shall be written policies and procedures relating to the trans- 
fer of patients between the hospital and intermediate care service that are 
approved by the medical staff. 

(c) The intermediate care services shall be provided in a distinct part. 

§ 70505. Nuclear Medicine Service Definition. 

Nuclear medicine service means those measures using internal radio- 
nuclides for the diagnosis and treatment of patients, employing specially 
trained personnel and providing appropriate space, equipment and sup- 
plies. 

§ 70507. Nuclear Medicine General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the nuclear medicine 
service to the medical staff and administration shall be defined. 

(c) The storage, use and disposal of radionuclides shall meet the safety 
standards of California Radiation Control Regulations, Subchapter 4, 
Chapter 5, Title 17, California Administrative Code. 

(d) Nuclear medicine patients shall be subject to periodic followup on 
completion of their treatment in coordination with the referring physi- 
cian. 

(e) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make recommendations to the execu- 
tive committee of the medical staff and administration. 

§ 70509. Nuclear Medicine Service Staff. 

(a) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification by the appropriate 



specialty board, as follows: the conjoint American Board of Nuclear 
Medicine or one of its parent boards: American Board of Radiology, 
American Board of Pathology or American Board of Internal Medicine. 

(b) Where appropriate, technologists with training and experience in 
handling radionuclides in either of the three disciplines of radiology, nu- 
clear medicine or pathology shall be employed in sufficient number to 
accomplish the mission of the service. 

(c) A radiological physicist should be available to the nuclear medi- 
cine service. 

§ 7051 1 . Nuclear Medicine Equipment and Supplies. 

Equipment and supplies shall be sufficient to meet the needs of the pa- 
tients and the scope of services offered. 

§70513. Nuclear Medicine Space. 

The space required will be dependent upon services offered. Where ra- 
diotherapy is provided from a radionuclide source, construction require- 
ments shall meet the standards of Subchapter 4, Chapter 5, Title 17, Cali- 
fornia Administrative Code and Part 6, Division Tl 7, Part 6, Subchapter 
4, Chapter 5, Title 24, California Administrative Code. 

§ 70515. Occupational Therapy Service Definition. 

(a) Occupational therapy services means those services provided to a 
patient by or under the supervision of an occupational therapist with ap- 
propriate staff, space, equipment and supplies. These services are used 
to restore the functional capacity of those individuals whose abilities to 
cope with tasks of daily living are threatened or impaired by developmen- 
tal deficits, the aging process, physical illness or injury or psychosocial 
disabilities. Occupational therapy services include but are not limited to: 

(1) Providing the physician with an initial evaluation of the patient's 
level of function by diagnostic and prognostic testing. 

(2) Intervention in acute stages of illness or injury to minimize or pre- 
vent disfunction. 

(3) Use of professionally selected self-care skills, daily living tasks 
and tests and therapeutic exercises to improve function. 

(4) Training in the performance of tasks modified to the patient's level 
of physical and emotional tolerance. 

(5) Provision of preventive and corrective equipment to promote func- 
tion and to prevent deformity. 

(6) Reevaluating the patient as changes occur and modifying treatment 
goals consistent with these changes. 

(7) Psychological conditioning of the patient to prepare him for reentry 
and integration into his community. 

(8) Use of tests to determine patient's ability in areas of concentration, 
attention, thought organization, preception and problem solving. 

(9) Prevocational evaluation through the use of specific tasks to deter- 
mine the patient's potential for vocational performance. 

§ 70517. Occupational Therapy Service General 
Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the occupational thera- 
py service to the medical staff and administration shall be defined. 

(c) Occupational therapy shall be given only on the signed order of a 
person lawfully authorized to give such an order. 

(d) Patients shall be evaluated by the occupational therapist and a treat- 
ment program shall be established to include the modalities, the frequen- 
cy and duration of treatments. This program and any modifications shall 
be approved in writing by the referring physician. 

(e) Signed notes shall be entered into the record each time occupation- 
al therapy service has been performed. 

(f) Progress notes shall be written and signed at least weekly by the oc- 
cupational therapist and summarized upon completion of the treatment 
program. 



• 



Page 786 



Register 90, Nos. 14-19; 5-11-90 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70527 



(g) Occupational therapy staff shall be involved in orientation and in- 
service training of hospital employees. 

(h) There shall be staff representation at the multidisciplinary confer- 
ences in order to plan and review patient treatment. 

(i) Procedures shall be established for outpatient treatment, home vis- 
its and referrals to appropriate community agencies. 

(j) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70519. Occupational Therapy Service Staff. 

(a) An occupational therapist shall have overall responsibility for the 
service. 

(b) The occupational therapy director shall be responsible for the coor- 
dination of activity therapies which may include but not be limited to rec- 
reation, dance, art, music, poetry and drama. 

(c) There shall be sufficient staff to meet the needs of the patients and 
scope of the services offered. The staff shall consist of occupational ther- 
apist^) and may additionally consist of occupational therapy assistants, 
occupational therapy aides and other supportive personnel. 

(d) The occupational therapist shall supervise treatment rendered by 
aides and occupational therapy assistants. When occupational therapy 
aides are providing treatment, an occupational therapist shall provide di- 
rect supervision of the treatment rendered. 

§ 70521 . Occupational Therapy Service Equipment and 
Supplies. 

(a) There shall be sufficient equipment and supplies appropriate to the 
needs of the services offered. In addition there shall be: 

( 1 ) A telephone. 

(2) A handwashing sink in the treatment area. 

(3) Equipment made accessible to patients in wheelchairs, on crutches, 
or when using other adaptive equipment. This shall include but not be 
limited to: 

(A) Adequate width of door openings. 

(B) Toilets with grab bars on both sides of the commode. 

(C) Over-sink mirrors. 

(D) Drinking fountains. 

(E) Adjustable tables. 

§ 70523. Occupational Therapy Service Space. 

(a) Adequate space shall be maintained for the equipment and supplies 
necessary to provide occupational therapy service. The minimum floor 
area for occupational therapy service shall be 28 square meters (300 
square feet), no dimension of which shall be less than 4 meters ( 1 2 feet). 

(b) Office space, separate from the treatment area, shall be provided. 

(c) There shall be adequate ventilation and lighting, and sufficient 
power outlets, both 1 10 V and 220 V, for equipment. 

(d) Floor finishes shall be of a nonslip variety to minimize hazard. 

(e) Architectural barriers, as defined by the American National Stan- 
dards, Al 17.1, 1961 (reaffirmed 1971), including thresholds and stair- 
ways shall be provided with alternate means of access such as ramps. 

(f) Suitable waiting space shall be provided. 

§ 70525. Outpatient Service Definition. 

Outpatient service means the rendering of nonemergency health care 
services to patients who remain in the hospital less than 24 hours with the 
appropriate staff, space, equipment and supplies. 

§ 70527. Outpatient Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the outpatient service 
to the medical staff and administration shall be defined. 



(c) If outpatient surgery is performed, the written policies and proce- 
dures shall make provision for at least the following: 

( 1 ) The types of operative procedures that may be performed. 

(2) Types of anesthesia that may be used. 

(3) Preoperative evaluation of the patient, meeting the same standards 
as apply to inpatient surgery. 

(4) Informed operative consent. 

(5) The delivery of all anatomical parts, tissues and foreign objects re- 
moved to a pathologist designated by the hospital and a report of findings 
to be filed in the patient's medical record. 

(6) Written preoperative instructions to patients covering: 

(A) Applicable restrictions upon food and drugs before surgery. 

(B) Any special preparations to be made by the patient. 

(C) Any postoperative requirements. 

(D) An understanding that admission to the hospital may be required 
in the event of an unforeseen circumstance. 

(7) Examination of each patient by a licensed practitioner whose scope 
of licensure permits prior to discharge. 

(d) A medical record shall be maintained for each patient receiving 
care in the outpatient service. The completed medical record shall in- 
clude the following, if applicable: 

(1) Identification sheet to include but not be limited to the following 
patient information: 

(A) Name. 

(B) Address. 

(C) Identification number (if applicable). 

1. Hospital number. 

2. Social Security. 

3. Medicare. 

4. Medi-Cal. 

(D) Age. 

(E) Sex. 

(F) Marital status. 

(G) Religious preference. 
(H) Date and time of arrival. 

(1) Date and time of departure. 

(J) Name, address and telephone number of person or agency responsi- 
ble for the patient. 

(K) Initial diagnostic impression. 
(L) Discharge or final diagnosis. 

(2) Medical history including: 

(A) Immunization record. 

(B) Screening tests. 

(C) Allergy record. 

(D) Nutritional evaluation. 

(E) Neonatal history for pediatric patients. 

(3) Physical examination report. 

(4) Consultation reports. 

(5) Clinical notes including dates and time of visits. 

(6) Treatment and instructions, including: 

(A) Notations of prescriptions written. 

(B) Diet instaictions, if applicable. 

(C) Self-care instructions. 

(7) Reports of all laboratory tests performed. 

(8) Reports of all X-ray examinations performed. 

(9) Written record of preoperative and postoperative instructions. 

( 1 0) Operative report on outpatient surgery including preoperative and 
postoperative diagnosis, description of findings, techniques used and tis- 
sue removed or altered, if appropriate. 

(11) Anesthesia record including preoperative diagnosis, if anesthesia 
is administered. 

(12) Pathology report, if tissue or body fluid was removed. 

(13) Clinical data from other providers. 

(14) Referral information from other agencies. 

(15) All consent forms. 



Page 787 



Register 93, No. 16; 4-16-93 



§ 70529 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(e) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1275, Health and Safety Code; and Section 2725, Business and Pro- 
fessions Code. 

History 
1 . Amendment of subsection (c)(7) and adoption of Note filed 4-1 5-93; operative 

5-17-93 (Register 93, No. 16). 

§ 70529. Outpatient Service Staff. 

(a) The outpatient service shall have a person designated to direct and 
coordinate the service. 

(b) All physicians, dentists and podiatrists providing services in the 
outpatient unit shall be members of the organized medical staff. All other 
health care professionals providing services in outpatient settings shall 
meet the same qualifications as those professionals providing services in 
inpatient services. 

(c) A registered nurse shall be responsible for the nursing service in the 
outpatient service. 

(d) There shall be sufficient nursing and other personnel to provide the 

scope of services offered. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (b) and adoption of Note filed 4-15-93; operative 
5-17-93 (Register 93, No. 16). 

§ 70531 . Outpatient Service Equipment and Supplies. 

There shall be sufficient and appropriate equipment and supplies re- 
lated to the scope and nature of the anticipated needs and services. 

§ 70533. Outpatient Service Space. 

(a) The number of examination and treatment rooms shall be adequate 
in relation to the volume and nature of work performed. 

(b) Waiting areas shall be readily accessible to patients and personnel. 
Rest rooms, drinking fountain and a public telephone shall be provided. 

(c) Laboratory, radiology and pharmacy services shall be readily 
available to the outpatient service. 

(d) If outpatient surgery is performed in the outpatient service area, the 
basic facilities shall include: 

(1) Appropriately equipped and staffed operating room and postanes- 
thesia recovery area. 

(2) Appropriate means of control against the hazards of infection, elec- 
trical or mechanical failure, fire and explosion. 

(3) Provision for sterilizing equipment and supplies and for maintain- 
ing sterile technique. 

(4) Appropriate equipment and instrumentation for anesthesia, emer- 
gency cardiopulmonary resuscitation and other life support systems. 

(5) The operating room shall be so located that it does not directly con- 
nect with a corridor used for general through traffic. Entry and exit shall 
be controlled with respect to personnel, patients and materials handling. 

(6) Construction of the operating room shall be in conformity with pro- 
visions of Division T17, Title 24, California Administrative Code. 

(e) If beds are provided in the outpatient unit, they shall not be included 
in the licensed bed capacity. 

(1) Inpatients shall not be allowed to occupy an outpatient bed. 

(2) Outpatients shall not be allowed to remain over 24 hours in outpa- 
tient beds. 

§ 70535. Pediatric Service Definition. 

Pediatric service means the observation, diagnosis and treatment (in- 
cluding preventive treatment) of children and their illnesses, injuries, dis- 
eases and disorders by appropriate staff, space, equipment and supplies. 

§ 70537. Pediatric Service General Requirements. 

(a) There shall be written policies and procedures developed and main- 
tained by the person responsible for the service in consultation with other 
appropriate health professionals and administration. These policies and 



procedures shall be based upon the standards and recommendations of 
the American Academy of Pediatrics (Care of Children in Hospitals, 
1971). Policies shall be approved by the governing body. Procedures 
shall be approved by the medical staff and administration where such is 
appropriate. These policies and procedures shall include but not be lim- 
ited to: 

(1) Admission policies. 

(2) Visiting privileges and parent participation. 

(3) Accidents. 

(4) Patient emergencies. 

(5) Reporting of child abuse or neglect. 

(6) Consultation requirements. 

(7) Infection control and isolation procedures. 

(8) Drug reactions and interactions. 

(b) The responsibility and the accountability of the pediatric service 
to the medical staff and administration shall be defined. 

(c) A pediatric nursing unit shall be provided if the hospital has eight 
or more licensed pediatric beds. 

(d) Patients beyond the age of 13 shall not be admitted to or cared for 
in spaces approved for pediatric beds unless approved by the pediatrician 
in unusual circumstances and the reason documented in the patient's 
medical record. 

(e) An activity program appropriate to the needs of the patients and the 
scope of the service shall be provided. Participation in such program shall 
be with the approval of the attending physician. The activity program 
shall be under the direction of a designated member of the hospital staff. 

(f) The hospital shall inform the parent or guardian as soon as possible 
of any accident affecting the child. 

(g) Periodically, an appropriate committee of the medial staff shall 
evaluate the services provide and make appropriate recommendations to 
the executive committee of the medical staff and administration. 

§ 70539. Pediatric Service Staff. 

(a) A physician shall have overall responsibility for the pediatric ser- 
vice. This physician shall be certified or eligible for certification by the 
American Board of Pediatrics. If such a pediatrician is not available, a 
physician with training and experience in pediatrics may administer the 
service. In this circumstance, a pediatrician, qualified as above, shall pro- 
vide consultation at a frequency which will assure high quality service. 

(b) A registered nurse who has had training and experience in pediatric 
nursing shall be responsible for the nursing care and nursing manage- 
ment in the pediatric service. 

(c) In addition to the above, there shall be a registered nurse present 
on each shift with responsibility for patient care. 

(d) There shall be sufficient other staff to provide adequate care. 

(e) There shall be evidence of continuing education and training for the 
nursing staff in pediatric nursing. 

§ 70541 . Pediatric Service Equipment and Supplies. 

Sufficient equipment and supplies shall be provided to adequately care 
for pediatric patients. This shall include a full range of sizes and modifi- 
cations suitable for use with infants and small children. 

§ 70543. Pediatric Service Space. 

(a) Beds in the pediatric unit, including bassinets, cribs and youth 
beds, shall be included in the total licensed bed capacity of the hospital. 

(b) The rooms for pediatric patients shall be located to provide ade- 
quate observation by nursing and other personnel. 

(c) Rooms for infants under the age of three years shall be separate 
from those of older children. 

(d) A private room shall be available for any pediatric patient in need 
of physical separation as defined by the infection control committee. 

(e) An examination and treatment room shall be located in or adjacent 
to the pediatric unit. 

(f) A play area of sufficient size should be provided. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



Page 788 



Register 93, No. 16; 4-16-93 



Title 22 Licensing and Certification of Health Facilities and Referral Agencies § 70543 

HISTORY 3. Amendment of subsection (d) refiled 1 1-16-89 as an emergency; operative 

1. Amendment of subsection (d) filed 6-15-89 as an emergency; operative 11-16-89 (Register 89, No. 46). A Certificate of Compliance must be trans- 

6-15-89 (Register 89, No. 25). A Certificate Of Compliance must be trans- mitted to OAL within 120 days or the section will be reinstated as it existed prior 

mitted to OAL within 120 days or emergency language will be repealed on to the emergency on 3-16-90. 

10-13-89. 4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 

2.CertificateofComplianceasto6-15-89ordertransmittedtoOALon 10-13-89 and filed 4-16-90 (Register 90, No. 17). 

and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 



[The next page is 789.] 



Page 788.1 Register 93, No. 16; 4-lfi-93 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70549 



§ 70545. Perinatal Unit Definition. 

A perinatal unit means a maternity and newborn service of the hospital 
for the provision of care during pregnancy, labor, delivery, postpartum 
and neonatal periods with appropriate staff, space, equipment and sup- 
plies. 

§ 70547. Perinatal Unit General Requirements. 

(a) A perinatal unit shall provide: 

( 1 ) Care for the patient during pregnancy, labor, delivery and the post- 
partum period. 

(2) Care for the normal infant and the infant with abnormalities which 
usually do not impair function or threaten life. 

(3) Care for mothers and infants needing emergency or immediate life 
support measures to sustain life up to 1 2 hours or to prevent major disabil- 
ity. 

(4) Formal arrangements for consultation and/or transfer of an infant 
to an intensive care newborn nursery, or a mother to a hospital with the 
necessary services, for problems beyond the capability of the perinatal 
unit. 

(b) There shall be written policies and procedures developed and 
maintained by the person responsible for the service in consultation with 
other appropriate health professionals and administration. These policies 
and procedures shall reflect the standards and recommendations of the 
American College of Obstetricians and Gynecologists "Standard for Ob- 
stetric-Gynecologic Hospital Services," 1 969, and the American Acade- 
my of Pediatrics "Hospital Care of Newborn Infants," 1971. Policies 
shall be approved by the governing body. Procedures shall be approved 
by the medical staff and administration where such is appropriate. Such 
policies and procedures shall include but not be limited to: 

(1) Relationships to other services in the hospital. 

(2) Admission policies, including infants delivered prior to admission 
and infants transferred from an intensive care newborn nursery. 

(3) Arrangements for maternity patient overflow. 

(4) Consultation from an intensive care newborn nursery. 

(5) Infection control and relationship to the hospital infection commit- 
tee. 

(6) Transfer of mothers to appropriate care services and/or infants to 
and from an intensive care newborn nursery. 

(7) Provision, where deemed necessary, for family centered perinatal 
care, including rooming-in and care of infants by parent or surrogate. 

(8) Prevention and treatment of neonatal hemorrhagic disease. 

(9) Care of the premature or low birth weight infant. 

(10) Visiting privileges. 

(11) Resuscitation of newborn. 

( 1 2) Administering and monitoring of oxygen and respiratory therapy. 

(13) Transfusion. 

(14) PKU screening. 

(15) Rhesus (Rh) hemolytic disease identification, reporting and pre- 
vention. 

( 1 6) Management of hyperbilirubinemia. 

(17) Induction of labor and administration of oxytocic drugs. 

(18) Provision for parent education regarding childbirth, child care 
and family planning. 

(19) Discharge and continuity of care with referral to community sup- 
portive services. 

(20) Obstetric-pediatric-pathologic-radiologic conferences. 

(21) Patient identification system. 

(22) Care routines for the mother and infant. 

(23) Handwashing technique. 

(24) Individual bassinet technique. 

(25) Credo treatment of eyes of newborn. 

(26) Breast feeding. 

(27) Gavage feedings. 

(28) Formula preparation and storage. 

(c) The responsibility and the accountability of the perinatal service to 
the medical staff and administration shall be defined. 



(d) The hospital laboratory should have the capability of performing 
blood gas analyses. pH and microtechniques. 

(e) The hospital shall have the capability for operative delivery includ- 
ing caesarean section at all times. 

(f) The Infection Control Committee shall develop and implement po- 
licies for the management, including physical separation from other in- 
fants, of infants with diarrhea of the newborn or draining lesions. 

(g) All infections shall be reported to the hospital infection control 
committee promptly. 

(h) All persons in the delivery room shall wear clean gowns, caps and 
masks during a delivery. 

(i) Oxygen shall be administered to newborn infants only on the writ- 
ten order of a physician. The order shall include the concentration (vol- 
ume percent) or desired arterial partial pressure of oxygen and be re- 
viewed, modified, or discontinued after 24-hours. 

(j) All patients shall be attended by a physician or licensed nurse when 
under the effect of anesthesia or regional analgesia, when in active labor, 
during delivery or in the immediate postpartum period. 

(k) Rooming-in should be permitted if requested by the family. 

(1) Smoking shall be prohibited in delivery rooms and nurseries. 

(m) The delivery room is considered an electrically sensitive area and 
shall meet the requirements of section 70853 of these regulations. 

(n) Periodically, an appropriate committee of the medical staff shall 

evaluate the services provided and make appropriate recommendations 

to the executive committee of medical staff and administration. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0- 1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 
120days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order including amendment of sub- 
section (f) transmitted to OAL 3-15-90 and filed 4-16-90 (Register 90, No. 
17). 

5. Editorial correction of subsection (a) (Register 95, No. 25). 

§ 70549. Perinatal Unit Staff. 

(a) A physician shall have overall responsibility of the unit. This physi- 
cian shall be certified or eligible for certification by the American Board 
of Obstetrics and Gynecologists or the American Board of Pediatrics. If 
a physician with one of the above qualifications is not available, a physi- 
cian with training and experience in obstetrics and gynecology or pediat- 
rics may administer the service. In this circumstance, a physician with the 
above qualifications shall provide consultation at a frequency which will 
assure high quality service. He shall be responsible for: 

(1) Providing continuous obstetric, pediatric, anesthesia, laboratory 
and radiologic coverage. 

(2) Maintaining working relationships with intensive care newborn 
nursery. 

(3) Providing for joint staff conferences and continuing education of 
respective medical specialities. 

(b) A physician who is certified or eligible for certification by the 
American Board of Pediatrics shall be responsible for the nursery. 

(c) There shall be one registered nurse on duty on each shift assigned 
to the labor and delivery suite. In addition, there shall be sufficient trained 
personnel to assist the family, monitor and evaluate labor and assist with 
the delivery. 

(d) There shall be one registered nurse on duty for each shift assigned 
to the antepartum and postpartum areas. In addition, there shall be suffi- 
cient trained personnel to assess and provide care, assist the family and 
provide family education. 

(e) A registered nurse who has had training and experience in neonatal 
nursing shall be responsible for the nursing care in the nursery. 



Page 789 



Register 95, No. 25; 6-23-95 



§ 70551 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(1) A registered nurse trained in infant resuscitation shall be on duty 
on each shift. 

(2) A ratio of one licensed nurse to eight or fewer infants shall be main- 
tained for normal infants. 

(f) There shall be evidence of continuing education and training pro- 
grams for the nursing staff in perinatal nursing and infection control. 

§ 70551. Perinatal Unit Equipment and Supplies. 

(a) General equipment shall include at least the following: 

(1) Amniocentesis tray. 

(2) DC defibrillator immediately available. 

(3) Blanket warmer. 

(4) Solutions and supplies for intravenous fluids, blood, plasma and 
blood substitutes or fractions. 

(b) A fetal heart rate monitor should be available. 

(c) Labor rooms shall contain at least the following equipment: 

(1) Oxygen and suction outlets. 

(2) A labor bed with adjustable side rails. 

(3) Foot stool. 

(4) One or more comfortable chairs. 

(5) Handwashing facilities. 

(6) Toilet and handwashing facilities shall be in or immediately adja- 
cent to labor room and shall be shared by no more than two patients. 

(7) Adjustable examination light. 

(8) Sphygmomanometer. 

(9) Regular and fetal stethoscope. 

(d) Delivery rooms shall have at least the following equipment: 

( 1 ) Adjustable delivery table. 

(2) Surgical light. 

(3) Equipment for inhalation anesthesia and regional analgesia. 

(4) Clock with sweep second hand. 

(5) An elapsed time clock. 

(6) Emergency supplies such as packings, syringes, needles and drugs. 

(7) Emergency call button. 

(8) Provision for oxygen and suction for mother and infant. 

(9) Thermostatically controlled incubator or radiant heating device. 

(10) Sterile one percent silver nitrate and irrigating solutions for pro- 
phylactic Crede treatment of the eyes. 

(11) Sterile clamps or ties for umbilical cord. 

(12) Resuscitation equipment and supplies to include at least: 

(A) Glass trap suction device with catheter. 

(B) Pharyngeal airways, assorted sizes. 

(C) Laryngoscope, including a blade for premature infants. 

(D) Endotracheal catheters, assorted sizes with malleable stylets. 

(E) Arterial catheters, assorted sizes. 

(F) Ventilatory assistance bag and infant mask. 

(G) Bulb syringe. 
(H) Stethoscope. 

(I) Syringes, needles and appropriate drugs. 

(e) Nursery equipment shall include at least the following: 

( 1 ) A separate bassinet for each infant made of easily cleanable materi- 
al such as metal or clear plastic. 

(2) Enclosed storage unit for clean supplies for each infant. 

(3) Diaper receptacles with a cover, foot control and disposable liner. 

(4) A hamper with a disposable liner for soiled linen. 

(5) A wall thermometer and hygrometer. 

(6) Accurate beam scales or the equivalent. 

(7) Thermostatically controlled incubators or radiant heating devices 
to maintain proper ambient temperature. 

(8) Oxygen and compressed air supply, regulating devices and admin- 
istration equipment. 

(9) Resuscitation equipment as required in delivery rooms. 

(10) Suction equipment. 

(1 1) At least one duplex electrical outlet for every two bassinets. 



(12) One handwashing sink with controls not requiring direct contact 
of the hands for operation (wrist or elbow blade handles are not accept- 
able) for each six bassinets. 

§ 70553. Perinatal Unit Space. 

(a) General: 

( 1 ) A storage room for supplies and equipment used in labor and deliv- 
ery areas shall be maintained. 

(2) Dressing room for staff personnel should be provided. 

(b) Labor rooms: 

(1 ) At least one labor room, having a minimum of 9.3 square meters 
(100 square feet) of floor space shall be provided. 

(2) Labor room beds shall not be included in the licensed bed capacity 
of the hospital. 

(3) A labor room shall contain no more than two beds. 

(c) Delivery rooms: 

(1 ) Delivery rooms shall be provided which are used for no other pur- 
pose. The operating room may serve as the delivery room in rural area 
hospitals having a licensed bed capacity of 25 or less. 

(2) Delivery rooms shall have a minimum floor area of 30 square me- 
ters (324 square feet) with no dimension less than 5.5 meters (18 feet). 

(d) Nurseries: 

(1) Sufficient floor area shall be provided so that there is at least 2.3 
square meters (25 square feet) per bassinet with at least 1 meter (3 feet) 
between bassinets. 

(2) A workroom or control station shall be maintained which shall pro- 
vide for handwashing, gowning and charting. 

(3) There shall be 100 foot candles of light at each bassinet. 

(4) Bassinets in the normal newborn nursery are not included in the to- 
tal licensed bed capacity of the hospital. 

§ 70555. Physical Therapy Service Definition. 

(a) Physical therapy service means those services to a patient by or un- 
der the supervision of a physical therapist to achieve and maintain the 
highest functional level with appropriate staff, space, equipment and sup- 
plies. Physical therapy services include but are not limited to: 

(1) Providing the physician with an initial written evaluation of the pa- 
tient's rehabilitation potential. 

(2) Applying muscle, nerve, joint and functional ability tests. 

(3) Treating patients to relieve pain, develop or restore function. 

(4) Assisting patients to achieve and maintain maximum performance 
using physical means such as exercise, massage, heat, sound, water, 
light, ice, and electricity. 

§ 70557. Physical Therapy Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the physical therapy 
service to the medical staff and administration shall be defined. 

(c) Physical therapy shall be given only on the signed order of a person 
lawfully authorized to give such an order. 

(d) When physical therapy is ordered, the patient shall be evaluated by 
the physical therapist and a treatment program shall be established to in- 
clude the modalities, frequency and duration of treatments. This program 
and any modifications shall be approved by the person who signed the 
order for service. 

(e) Signed notes shall be entered into the record each time physical 
therapy service has been performed. 

(f) Progress notes shall be written and signed at least weekly by the 
physical therapist and summarized upon completion of the treatment pro- 
gram. 

(g) Physical therapy service staff shall be involved in orientation and 
in-service training of hospital employees. 



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Title 22 Licensing and Certification of Health Facilities and Referral Agencies § 70557 

(h) There shall be written techniques for cleaning and culturing of hy- to the executive committee of the medical staff and administration, 
drotherapy equipment. NOTE: Authority cited: Section 208(a) and 1 275, Health and Safety Code. Refer- 



(i) Procedures shall be established for outpatient treatment, home vis- ence: Section 1276 < Health and Saf fy_ Code 
; and referrals to appropriate community agencies, 
(j) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 



its and referrals to appropriate community agencies. r , . ,,.,,,„„, „ . . . , , 

... T-. . ,. ,, . . ,- , ,. . , r r i 11 1. Amendment or subsections (c) and (d) riled 3-13-80; effective thirtieth day 

(j) Periodically, an appropriate committee ot the medical staff shall thereafter ( Register 80 No in 



History 
thereafter (Register 80, No. 11). 



[The next page is 79 1 . 



Page 790.1 Register 95, No. 25; 6-23-95 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70577 



• 



§ 70559. Physical Therapy Service Staff. 

(a) A physical therapist shall have overall responsibility for the physi- 
cal therapy service. 

(b) There shall be sufficient staff to meet the needs of the patients and 
scope of the services offered. The staff shall consist of physical therapists 
and may additionally consist of physical therapist assistants, physical 
therapy aides and other supportive personnel. 

(c) The physical therapist shall supervise treatment rendered by aides 
and assistants. When physical therapy aides are providing treatment, a 
physical therapist shall provide direct supervision of the treatment ren- 
dered. 

§ 70561 . Physical Therapy Service Equipment and 
Supplies. 

(a) There shall be sufficient equipment and supplies appropriate to the 
needs and the services offered. In addition there shall be: 

( 1 ) A telephone. 

(2) A handwashing sink in the treatment area. 

(3) Equipment accessible to patients in wheelchairs, on crutches, or 
when using other adaptive equipment. This shall include but not be lim- 
ited to: 

(A) Adequate width of door openings. 

(B) Toilets with grab bars on both sides of the commode. 

(C) Over sink mirrors. 

(D) Drinking fountains. 

(E) Adjustable tables. 

§ 70563. Physical Therapy Service Space. 

(a) Adequate space shall be maintained for the equipment and supplies 
necessary to provide physical therapy service. The minimum floor area 
for physical therapy service shall be 28 square meters (300 square feet), 
no dimension of which shall be less than 4 meters (12 feet). 

(b) Office space, separate from the treatment area, shall be provided. 

(c) Floor finishes shall be of a nonslip variety to minimize hazard. 

(d) Architectural barriers as defined in Specifications for Making 
Buildings and Facilities Accessible and Usable by the Physically Handi- 
capped, A— 1 17.1 1961 (reaffirmed 1971) by the American National 
Standards Institute, Inc., 1430 Broadway, New York, NY 10018, shall 
have alternate means of access such as ramps. 

(e) A suitable waiting area shall be provided. 

§ 70565. Podiatric Service Definition. 

Podiatric service means the diagnosis and treatment of disorders of the 
foot by podiatrists with the appropriate staff, space, equipment and sup- 
plies. 

§ 70567. Podiatric Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the podiatric service 
to the medical staff and administration shall be defined. 

(c) A physician member of the medical staff shall be responsible for 
the care of any medical problem arising during the hospitalization of po- 
diatric patients. 

(d) There shall be a record of all podiatric services provided for the pa- 
tient and this shall be made a part of the patient's medical record. 

(e) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70569. Podiatric Service Staff. 

A podiatrist shall have overall responsibility for the service. 



§ 70571 . Podiatric Service Equipment and Supplies. 

There shall be sufficient equipment, instruments, and supplies for the 
scope of services provided. 

§ 70573. Podiatric Service Space. 

There shall be adequate space maintained to meet the needs of the ser- 
vice. 

§ 70575, Psychiatric Unit Definition. 

A psychiatric unit means a service, department or division of a hospital 
which is organized, staffed and equipped to provide inpatient and outpa- 
tient care for mentally disordered or other patients referred to in Division 
5 (commencing with Section 5000) or Division 6 (commencing with 
6000) of the Welfare and Institutions Code. 

§ 70577. Psychiatric Unit General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the psychiatric service 
to the medical staff and administration shall be defined. 

(c) The psychiatric unit shall be used for patients with he diagnosis of 
a mental disorder requiring hospital care. For purposes of these regula- 
tions "mental disorder" is defined as any psychiatric illness or disease, 
whether functional or of organic origin. 

(d) Medical services. 

(1) Psychiatrists or clinical psychologists within the scope of their li- 
censure and subject to the rules of the facility, shall be responsible for the 
diagnostic formulation for their patients and the development and imple- 
mentation of each patient's treatment plan. 

(2) Medical examinations shall be performed as often as indicated by 
the medical needs of the patient as determined by the patient's attending 
psychiatrist. Reports of all medical examinations shall be on file in the 
patient's medical record. 

(3) A psychiatrist shall be available at all times for psychiatric emer- 
gencies. 

(4) An appropriate committee of the medical services shall: 

(A) Identify and recommend to administration the equipment and sup- 
plies necessary for emergency medical problems. 

(B) Develop a plan for handling and/or referral of patients with emer- 
gency medical problems. 

(C) Determine the circumstances under which electroconvulsive ther- 
apy may be administered. 

(D) Develop guidelines for the administration of a drug when given in 
unusually high dosages or for purposes other than those for which the 
drug is customarily used. 

(e) Psychological services shall be provided by clinical psychologists 
within the scope of their licensure and subject to the provisions of Section 
1316.5 of the Health and Safety Code. 

(1) Facilities which permit clinical psychologists to admit patients 
shall do so only if there are staff physicians who will provide the neces- 
sary medical care to the patients. 

(2) Only staff physicians shall assume responsibility for those aspects 
of patient care which may be provided only by physicians. 

(f) Provision shall be made for the rendering of social services by so- 
cial workers at the request of a patient's attending physician. 

(g) Therapeutic activity program. 

(1 ) Every unit shall provide and conduct organized programs of thera- 
peutic activities in accordance with the interests, abilities and needs of 
the patients. 

(2) Individual evaluation and treatment plans which are correlated 
with the total therapeutic program shall be developed and recorded for 
each patient. 

(h) Education. 

(1) No hospital shall accept children of school age who are educable 
or trainable and who are expected to be a patient in the unit for one month 



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§ 70579 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



or longer unless an educational or training program can be made avail- 
able for such children in accordance with their needs and conditions. 

(2) Educational programs provided in the facility shall follow those 
programs established by law, and shall be under the direction of teachers 
with California teaching credentials. 

(3) If children attend community schools, supervision to and from 
school shall be provided in accordance with the needs and conditions of 
the patients. 

(4) Transportation to and from school shall be provided where indi- 
cated. 

(i) The medical records of all patients admitted to the unit shall contain 
a legal authorization for admission. Release of information or medical re- 
cords concerning any patient shall be only as authorized under the provi- 
sions contained in Article 7 (commencing with Section 5325; and Sec- 
tion 5328 in particular) Part 1, Division 5 of the Welfare and Institutions 
Code. 

(j) Restraint of patients. 

( 1 ) Restraint shall be used only when alternative methods are not suffi- 
cient to protect the patient or others from injury. 

(2) Patients shall be placed in restraint only on the written order of the 
physician. This order shall include the reason for restraint and the type 
of restraint to be used. In a clear case of emergency, a patient may be 
placed in restraint at the discretion of a registered nurse and a verbal or 
written order obtained thereafter. If a verbal order is obtained it shall be 
recorded in the patient's medical record and be signed by the physician 
on his next visit. 

(3) Patients in restraint by seclusion or mechanical means shall be ob- 
served at intervals not greater than 15 minutes. 

(4) Restraints shall be easily removable in the event of fire or other 
emergency. 

(5) Record of type of restraint including time of application and re- 
moval shall be in the patient's medical record. 

(k) Patients' rights. 

(1) All patients shall have rights which include, but are not limited to, 
the following: 

(A) To wear his own clothes, to keep and use his own personal posses- 
sions including his toilet articles; and to keep and be allowed to spend a 
reasonable sum of his own money for canteen expenses and small pur- 
chases. 

(B) To have access to individual storage space for his private use. 

(C) To see visitors each day. 

(D) To have reasonable access to telephones, both to make and receive 
confidential calls. 

(E) To have ready access to letter writing materials, including stamps, 
and to mail and receive unopened correspondence. 

(F) To refuse shock treatment. 

(G) To refuse lobotomy. 

(H) To be informed of the provisions of law regarding complaints and 
of procedures for registering complaints confidentially, including but not 
limited to, the address and telephone number of the complaint receiving 
unit of the Department. 

(1) All other rights as provided by law or regulations. 

(2) The physician who has overall responsibility for the unit or his de- 
signee, may for good cause, deny a person any of the rights specified in 
( 1 ) above, except those rights specified in subsections (F), (G) and (I) 
above and the rights under subsection (F) may be denied only under the 
conditions specified in Section 5326.4, Welfare and Institutions Code. 
The denial, and the reasons therefor, shall be entered in the patient's med- 
ical record. 

(3) These rights, written in English and Spanish, shall be prominently 
posted. 

(/) Psychiatric unit staff shall be involved in orientation and in-service 
training of hospital employees. 

(m) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1255, 1276 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83. No. 7). 

2. Amendment of subsection (d)( 1 ) filed 1 1-1-85 as an emergency; effective upon 
filing (Register 85, No. 44). A Certificate of Compliance must be transmitted 
to OAL within 120 days or emergency language will be repealed on 3-3-86. 

3. Certificate of Compliance transmitted to OAL 2-28-86 and filed 3-26-86 
(Register 86, No. 13). 

4. Change without regulatory effect amending subsection (e), repealing subsec- 
tions (e)(l)-(2), amending subsection 0X-) ar >d amending Noti; filed 
3-24-2005 pursuant to section 100, title 1, California Code of Regulations 
(Register 2005, No. 12). 

5. Change without regulatory effect amending subsection (e), adding new subsec- 
tions (e)( 1 )-(2) and amending subsection (j)(2) and Notf. filed 4-20-2006 pur- 
suant to section 100, title 1 , California Code of Regulations (Register 2006, No. 
16). 

§ 70579. Psychiatric Unit Staff. 

(a) If a psychiatrist is not the administrative director of the psychiatric 
unit, a psychiatrist who is certified or eligible for certification in psychia- 
try by the American Board of Psychiatry and Neurology, shall be respon- 
sible for the medical care and services of the unit, including all those acts 
of diagnosis, treatment, or prescribing or ordering of drugs which may 
only be performed by a licensed physician. 

(b) A clinical psychologist shall be available on a full-time, part-time 
or consulting basis. The clinical psychologist shall function on such 
terms and conditions as the facility shall establish. 

(c) A registered nurse with two years experience in psychiatric nursing 
shall be responsible for the nursing care and nursing management of the 
psychiatric unit. 

(d) There shall be registered nurses with training and experience in 
psychiatric nursing on duty in the unit at all times. 

(e) There shall be sufficient nursing staff, including registered nurses, 
licensed vocational nurses, licensed psychiatric technicians and mental 
health workers to meet the needs of the patients. 

(0 A qualified therapist should be employed to conduct the therapeutic 
activity program. Therapists that may be involved in the program include 
occupational, music, art, dance and recreation therapist. 

(g) A social worker shall be employed on a full-time, regular part- 
time or consulting basis. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1255, 1276 and 1316.5, Health and Safety Code. 

History 
1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§ 70581 . Psychiatric Unit Equipment and Supplies. 

(a) Sufficient equipment and supplies shall be provided to meet the 
needs of the patients, including that necessary for the rehabilitative thera- 
py program. 

(b) Resuscitative and cardiac monitoring equipment shall be in or 
readily available to the unit. 

§ 70583. Psychiatric Unit Space. 

(a) A psychiatric unit shall meet the following space requirements: 

(1) Consultation room for interviewing patients. 

(2) Facilities for physical examination and a treatment room for medi- 
cal procedures. 

(3) At least one observation room for acutely disturbed patients. This 
room shall have facilities for visual observation and be located near the 
nursing station and a bathroom. 

(4) Separate dining room. 

(5) Facilities for occupational therapy. 

(6) Indoor and outdoor facilities for therapeutic activities. 

(7) A separate nursing station for the psychiatric unit. No beds for pa- 
tients on the unit shall be located more than 90 feet away from the nursing 
station. 

(8) Windows, modified to prevent patients from leaving the unit by 
way of a window. 

(9) There shall be a principal entrance to the unit which could be 
locked if necessary. 



• 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70595 



(b) A unit which treats children of school age over a substantial period 
of time (one month or more) shall have physical facilities for an educa- 
tional program, such as a classroom and an office for the teacher. 

(c) Beds in a psychiatric unit shall be counted in the total licensed bed 
capacity of the hospital. 

§ 70585. Radiation Therapy Service Definition. 

Radiation therapy service means the use of external ionizing radiation 
including X-rays and teletherapy and brachytherapy using sealed 
sources of radioactive material in the treatment of human illnesses with 
appropriate staff, space, equipment and supplies. 

§ 70587. Radiation Therapy Service General 
Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the radiation therapy 
service to the medical staff and administration shall be defined. 

(c) Radiation therapy shall be given only under the direction of a radi- 
ation therapist. 

(d) All cancer cases accepted for curative radiation shall have adequate 
histologic substantiation of diagnosis unless convincing alternative evi- 
dence for diagnosis is presented. 

(e) Documentation of the initial evaluation, treatment plan, dosimetry, 
and clinical, technical and follow-up notes shall be maintained. 

(f) Adequate communication shall be maintained with referring physi- 
cians. 

(g) There should be periodic review of case management, complica- 
tions and treatment results. 

(h) There shall be a tumor board, a tumor registry, and/or cancer com- 
mittee in which the radiation therapy staff shall participate, 
(i) There shall be provided: 

( 1 ) Continuing radiological physics support for radiation therapy in 
cancer management. 

(2) Calibration and operation of radiation therapy equipment accord- 
ing to California Radiation Control Regulations, Subchapter 4, Chapter 
5, Title 17, California Administrative Code. 

(3) Appropriate radiation treatment localization, simulation and veri- 
fication. 

(4) Isodose treatment planning with complex analyses generated in ap- 
propriate cases. 

(5) Treatment record quality control through independent review of 
records of patients undergoing treatment. The record shall be signed by 
the reviewer. 

(6) Radiation protection for patients and staff in accordance with re- 
quirements of California Radiation Control Regulations, Subchapter 4, 
Chapter 5, Title 17, California Administrative Code. 

(j) Periodic follow-up of patients following completion of treatment 
shall be coordinated with the referring physician. 

(k) The hospital shall have on file and open to inspection by the De- 
partment evidence of any and all affiliations currently in effect. These 
may include but are not limited to: 

( 1 ) Joint directorship and/or physician collaboration and coordination 
among several institutions. 

(2) Interhospital collaboration for professional and administrative 
management. 

(/) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70589. Radiation Therapy Service Staff. 

(a) A physician shall have overall responsibility for the service. This 
physician shall be certified or eligible for certification in therapeutic radi- 
ology by the American Board of Radiology or be certified or eligible for 



certification in radiology by the American Board of Radiology and have 
two (2) years of additional full-time experience in radiation therapy. 

(b) In remote communities where the population and number of cancer 
cases are insufficient to require a full-time radiation therapist, a general 
radiologist may provide radiation treatment of limited scope for those pa- 
tients whose transportation to larger centers would be undesirable. He 
shall have an established mechanism to provide the consultation, physics 
and treatment planning support and referral availability of a radiation 
therapist. 

(c) Other personnel who shall be available full-time, part-time or on 
a consultative basis, depending upon the activity of the department are: 

(1) A radiological physicist who is either certified in radiological 
physics or in therapeutic radiological physics by the American Board of 
Radiology. 

(2) A dosimetrist (treatment plan technologist) who is a qualified and 
experienced radiation therapy technologist with a minimum of one year 
of additional clinical training in dosimetry under the direction of an expe- 
rienced dosimetrist and a physicist. 

(3) A certified therapeutic radiological technologist. 

(4) Appropriate support personnel including licensed nurses, where 
patient load requires. 

§ 70591 . Radiation Therapy Service Equipment and 
Supplies. 

(a) Equipment and supplies shall include: 

(1) Megavoltage (supervoltage) treatment unit capable of delivering 
x or gamma rays of effective energy 500 KeV or more and conforming 
to the requirements of California Radiation Control Regulations, Sub- 
chapter 4, Chapter 5, Title 17, California Administrative Code. 

(2) Access to medium voltage or superficial treatment unit delivering 
500 KeV or less, but otherwise having the same functional characteristics 
as the above megavoltage units and conforming to the requirements of 
California Radiation Control Regulations, Subchapter 4, Chapter 5, Title 
17, California Administrative Code. 

(3) Access to brachytherapy equipment which shall meet the require- 
ments of California Radiation Control Regulations, Subchapter 4, Chap- 
ter 5, Title 17, California Administrative Code. 

(4) Appropriate examination room equipment. 

(5) Emergency trays and medications. 

(6) Access to radiation measurement and calibration equipment in- 
cluding a calibration constancy instrument and access to a secondary 
standard dose meter. 

§ 70593. Radiation Therapy Service Space. 

(a) Rooms accommodating radiation therapy machines shall be of ade- 
quate size to permit easy use of stretcher patients. Shielding of the rooms 
shall meet the requirements of California Radiation Control Regulations, 
Subchapter 4, Chapter 5, Title 17, California Administrative Code. 

(b) Sufficient examination rooms of adequate size. 

(c) Patient reception, waiting and dressing areas with conveniently lo- 
cated toilets shall be provided. 

(d) Space sufficient for medical and physics staff functions shall be 
provided. 

Rehabilitation center means a functional unit for the provision of those 
rehabilitation services that restore an ill or injured person to the highest 
level of self-sufficiency or gainful employment of which he is capable 
in the shortest possible time, compatible with his physical, intellectual 
and emotional or psychological capabilities and in accord with planned 
goals and objectives. 

§ 70595. Rehabilitation Center Definition. 

Rehabilitation center means a functional unit for the provision of those 
rehabilitation services that restore an ill or injured person to the highest 
level of self-sufficiency or gainful employment of which he is capable 
in the shortest possible time, compatible with his physical, intellectual 
and emotional or psychological capabilities and in accord with planned 
goals and objectives. 



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Title 22 



§ 70597. Rehabilitation Center General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. These policies and pro- 
cedures shall include but not be limited to: 

(1) Goals and objectives. 

(2) General eligibility and admission criteria. 

(3) Geographic area to be served. 

(4) Scope of services to be provided. 

(5) Rehabilitation staff eligibility requirements. 

(6) Relationships between the hospital and other health facilities in the 
community. 

(7) Sources and forms used for referral of patients. 

(b) The responsibility and the accountability of the rehabilitation ser- 
vice to the medical staff and administration shall be defined. 

(c) As a minimum, physical therapy, occupational therapy and speech 
therapy shall be provide and the requirements for these individual ser- 
vices, as stated elsewhere in these regulations, shall be met. 

(d) There shall be preadmission patient screening done by an appropri- 
ate individual who may be the director of the service or his designee. 
Such screening shall include but not be limited to: 

(1) Medical review. 

(2) Rehabilitative potential evaluation. 

(3) Review of future placement resources. 

(e) An outpatient service shall be part of the rehabilitation center. This 
service shall provide continuity of care to patients who have completed 
inpatient rehabilitation care and will provide comprehensive, integrated 
care for patients not requiring hospitalization. This service shall have 
available all of the resources of the rehabilitation center. 

( 1 ) A coordinated system of patient scheduling and appointments that 
serves to minimize waiting time shall be established. 

(2) An outpatient medical record shall be maintained for each patient 
receiving care in the outpatient service. The completed medical record 
shall include the information required for treatment of all hospital outpa- 
tients (Section 70367). 

(f) There shall be a written utilization review plan that outlines the: 

( 1 ) Organization and composition of the utilization review committee, 
which shall include at least two physicians who shall be responsible for 
the utilization review functions. 

(2) Requirement that the committee shall meet at least once each 
month. 

(3) Selection of cases, both inpatient and outpatient, for review on a 
scientifically selected basis. 

(4) Summary of the number and types of cases reviewed and the find- 
ings on each. 

(5) Actions to be taken by the rehabilitation center based on the find- 
ings and recommendations of the utilization review committee. 

(g) Staff conferences shall be held regularly and include representa- 
tion and participation by all disciplines involved in the program to assist 
in the organization and coordination of services offered. 

(h) Patient case conferences shall be held regularly to determine need 
for modification of treatment plans. 

( 1 ) There shall be a case conference plan and written minutes of each 
case conference held. 

(2) One member of the rehabilitation service team shall be designated 
as the patient service coordinator. 

(i) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70599. Rehabilitation Center Staff. 

(a) A physician experienced in rehabilitation medicine shall have 
overall responsibility for the service. 



(b) A registered nurse with training and at least one year of experience 
in rehabilitation nursing shall be responsible for nursing care and nursing 
management of rehabilitation services. 

(c) Sufficient registered nurses experienced in rehabilitation nursing 
shall be employed to meet the needs of the service. 

(d) Other personnel experienced in rehabilitation shall be provided to 
meet the needs of the service and shall include but not be limited to the 
following: 

(1) Full-time physical therapists. 

(2) Full-time occupational therapists. 

(3) Speech pathologists. 

(4) The following personnel shall be available on a consultation or re- 
ferral basis: 

(A) Audiologist. 

(B) Orthotist. 

(C) Prosthetist. 

(D) Vocational rehabilitation counselor. 

(E) Recreational therapist. 

(F) Psychiatrist. 

(G) Psychologist. 

(H) Registered nurse with public health nursing certificate. 
(I) Learning disability specialist. 
(J) Social worker. 

§ 70601 . Rehabilitation Center Equipment and Supplies. 

(a) There shall be sufficient equipment and supplies to fulfill the needs 
of the services provided. 

(b) The equipment shall be of a type, quantity and quality that will pro- 
vide safe and effective patient care. 

§ 70603. Rehabilitation Center Space. 

(a)Rehabilitation beds shall be in a designated area of the hospital and 
shall be included in the licensed bed capacity of the hospital. 

(b) The following structural features shall be provided in the rehabili- 
tation service area: 

(1) Flooring in rehabilitation areas, while selected for appearance, du- 
rability and ease of cleaning and maintenance, shall also be selected and 
maintained to minimize slipping hazards. 

(2) Architectural barriers as defined in Specifications for Making 
Buildings and Facilities Accessible and Usable by the Physically Handi- 
capped, A-117.1 1961 (reaffirmed 1971) by the American National 
Standards Institute, Inc., 1430 Broadway, New York, NY 10018, shall 
have alternate means of access such as ramps. 

(3) Sturdy handrails shall be provided on both sides of ramps and stairs 
in areas used by physically handicapped patients. 

(4) Grab bars on both sides of toilets and supports shall be provided 
in patient bathrooms so that physically disabled patients may use toilet, 
handwashing and bathing facilities with minimal or no assistance. 

(5) Doors and doorways. 

(A) Doors to be used by ambulatory and wheelchair patients shall be 
at least 1 . 1 meters (three feet, eight inches) wide. Doors 0.9 meter (three 
feet) wide may be permitted at individual toilet rooms adjacent to patient 
bedrooms. 

(B) Thresholds at doorways shall be flush with the floor. 

(C) There should be at least two doors of entry and exit from group ac- 
tivity areas, i.e., craft and workshops. All such exit doors shall be 
equipped with panic bars. 

(D) Doors shall not obstruct wheelchair patients' access to toilets and 
other patient areas. 

(6) Bathing facilities. 

(A) Bathtubs shall be of standard height. There shall be access on both 
sides and one end of bathtub to allow personnel to work on either side or 
end of tub. 

(B) Shower stalls shall have minimum dimensions of at least 1 .2 me- 
ters (four feet), be equipped with handrails and curtains and be designed 
for easy accessibility. The floor shall be sloped to provide drainage. 



• 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70609 



(7) There shall be at least one training toilet area in each patient unit 
with minimum dimensions of 1.5 meters (five feet) and 1.8 meters (six 
feet). 

(8) Drinking fountains shall be located conveniently in nursing units, 
treatment areas and the lobby. Fountains shall be usable by wheelchair 
patients. 

(9) Telephones shall be accessible to and usable by wheelchair pa- 
tients. 

(10) All rooms shall contain a minimum of 10 square meters (1 10 
square feet) of usable floor space per bed with greater space provided for 
special needs such as circ-o-lectric beds. 

(11) Beds of adjustable height, preferably electrically operated, ade- 
quate to the needs of the service shall be provided. Beds shall be adjust- 
able to the heights of wheelchair seats for use in patient transfer. 

(12) A mirror with overhead light, so arranged as to be easily usable 
by handicapped patients in wheelchairs, shall be provided in patient 
rooms. 

(13) Dining and lounge or recreation area. 

(A) Space for group dining shall be provided in a minimum amount of 
at least 2 square meters (20 square feet) per licensed bed for adults and/or 
children beyond the crib age. 

(B) Space for group recreation or patients lounge shall be provided in 
the same space ratio as the dining area. 

(C) Dining and recreation areas shall be equipped with appropriate 
height tables to accommodate patients in wheelchairs. 

(14) Suitable space shall be provided for staff conferences, patient 
evaluation and progress reports. 

(15) Classroom space. 

(16) An examining room equipped with furnishings, equipment and 
supplies adjacent or readily accessible to the office of the physician in 
charge of the outpatient service. 

( 1 7) A waiting room area with coat or locker space, drinking fountain, 
telephone and men and women toilet facilities in or adjacent to the reha- 
bilitation outpatient service area. 

(18) Access to an outside area to be used in therapeutic procedures for 
patients. 

§ 70605. Renal Transplant Center Definition. 

Renal transplant center means a specialized unit of a hospital for the 
treatment of patients with end-stage renal disease who manifest the accu- 
mulation of excessive nitrogenous waste products. The scope of services 
offered is comprehensive and includes acute dialysis, renal transplanta- 
tion and may include peritoneal dialysis or other means for removing tox- 
ic or excessive waste products from the blood. 

§ 70607. Renal Transplant Center General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and the administration. Policies shall be ap- 
proved by the governing body. Procedures shall be approved by the ad- 
ministration and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the renal transplant 
center to the medical staff and administration shall be defined. 

(c) The hospital shall: 

( 1 ) Perform a sufficient number of transplants per annum to demon- 
strate a capability to perform with high quality. Fifteen (15) transplants 
should be performed per annum. 

(2) Offer both living related donor and cadaver donor transplant ser- 
vices. 

(3) Contribute to a coordinated system of care by arrangements with 
other facilities providing care for patients with end-stage renal disease. 

(4) Make renal transplant services available to patients with end-stage 
renal disease referred from facilities that do not provide renal transplant 
services. 

(5) Participate in the development and use of a registry of prospective 
recipient patients. 



(6) Participate in kidney procurement, preservation and transport pro- 
gram. 

(7) Cooperate with other facilities for the timely transfer of medical 
data on patients with end-stage renal disease. 

(d) There shall be a written hepatitis control program incorporating the 
recommendations of Report 33, January 1971, of the Hepatitis Surveil- 
lance Program of the Center for Disease Control, Public Health Services, 
Atlanta. GA 30333. 

(e) There shall be in-service training and continuing education for all 
medical, nursing and other personnel. 

(f) The particular requirements for renal transplant and acute dialysis 
patients shall be accommodated in the disaster and fire plans of the hospi- 
tal. 

(g) The hospital shall provide directly: 

(1) Inpatient acute dialysis. 

(2) Respiratory therapy. 

(3) Angiography. 

(4) Nuclear medicine. 

(5) Twenty-four hour laboratory capability of performing, as a mini- 
mum, the following determinations: C.B.C., B.U.N., creatinine, platelet 
count, blood typing and cross matching, blood gas analysis, blood pH, 
electrolytes, serum glucose, coagulation tests, spinal fluid examination, 
and urinalysis. 

(6) Immunofluorescence studies. 

(h) The hospital shall provide directly or by arrangement: 

(1) Microbiological studies for rickettsiae, fungi, bacteria and viruses. 

(2) Electron microscopy. 

(3) Outpatient follow-up care of patients with renal transplants. 

(4) Tissue culture. 

(5) Tissue typing and immunologic testing. 

(6) Cadaver kidney preservation. 

(7) Chronic dialysis. 

(i) Periodically, a committee of the medical staff shall evaluate the ser- 
vices provided and make appropriate recommendations to the executive 
committee of the medical staff and administration. 

§ 70609. Renal Transplant Center Staff. 

(a) A physician shall have overall responsibility for the center. This 
physician shall be certified or eligible for certification by the American 
Board of Surgery, American Board of Urology, American Board of Inter- 
nal Medicine or American Board of Pediatrics and shall have a minimum 
of one year's training or experience in the care of patients with renal 
transplantation. 

(b) The surgeons performing the transplantation procedures shall be 
certified or eligible for certification by the American Board of Surgery 
or American Board of Urology and shall have at least one year's training 
or experience in renal transplantation. 

(c) Children (13 years of age or under) receiving transplant services 
shall be under the care of a physician who is certified or eligible for certi- 
fication by the American Board of Pediatrics. 

(d) Where appropriate, the hospital shall provide timely evaluation 
and consultation for its patients with renal transplants by the following 
specialists: 

(1 ) Physicians certified or eligible for certification in cardiology, en- 
docrinology, hematology, or infectious disease by the American Board 
of Internal Medicine. 

(2) A physician certified or eligible for certification in neurology by 
the American Board of Psychiatry and Neurology. 

(3) A physician certified or eligible for certification in psychiatry by 
the American Board of Psychiatry and Neurology. 

(4) A physician certified or eligible for certification in orthopaedic sur- 
gery by the American Board of Orthopaedic Surgery. 

(5) A physician certified or eligible for certification by the American 
Board of Pathology. 

(6) A physician certified or eligible for certification by the American 
Board of Urology. 



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(e) There shall be a registered nurse responsible for the nursing service 
who has had at least 12 months' general nursing experience or six 
months' experience in the care of patients with renal transplants. 

(f) There shall be sufficient other licensed nurses and skilled personnel 
to provide the required patient care. 

(g) A dietician shall provide diet management and counseling to meet 
the needs of patients with renal transplants. 

(h) A social worker shall provide the social services and counseling 
needs of patients with renal transplants. 

§ 7061 1 . Renal Transplant Center Equipment and 
Supplies. 

(a) Equipment and supplies shall include at least the following if 
chronic dialysis is provided: 

(1) A dialysis machine or equivalent (with appropriate monitoring 
equipment) for each bed or station. 

(2) Dialysis equipment appropriate for pediatric patients, if treated. 

(3) Cardiac monitoring equipment. 

(4) Resuscitative equipment. 

§ 70613. Renal Transplant Center Space. 

(a) There shall be a minimum of 10 square meters (1 10 square feet) of 
floor space per bed. Beds in the renal transplant center shall be included 
in the total licensed bed capacity of the hospital. 

(b) The following areas shall be provided and maintained if chronic 
dialysis is provided: 

( 1 ) Patient waiting area. 

(2) Conference room. 

(3) Nurses' station. 

(4) Isolation room. 

(5) Segregated area for home dialysis training. 

(6) Machine storage room. 

(7) Supplies storage room. 

(8) Utility room. 

§ 70615. Respiratory Care Service Definition. 

(a) Respiratory care service means those diagnostic and therapeutic 
procedures for ventilatory support and associated services to patients 
with appropriate staff, space, equipment and supplies. These diagnostic 
and therapeutic procedures include but are not limited to: 

( 1 ) Measurement of pulmonary function testing and blood gas analy- 
ses. 

(2) Procedures to reverse or prevent further physiological abnormali- 
ties. 

(3) Treatment or prevention of airway problems of respiratory therapy 
origin. 

(4) Positive pressure ventilatory therapy. 

(5) Respiratory monitoring. 

(6) Cardiopulmonary resuscitation. 

(7) Physical therapy of the chest including bronchial drainage and per- 
cussion. 

(8) Patient instruction. 

(9) Care of the intubated and tracheostomy patient. 

(10) Constant consideration of infection control. 

§ 70617. Respiratory Care Service General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the respiratory care 
service to the medical staff and administration shall be defined. 

(c) There shall be clear delineation as to who may perform the various 
procedures, under what circumstances and under whose supervision, 
with the important undesirable side effects noted if an emergency arises. 

(d) All services shall be provided on the order of a person lawfully au- 
thorized to give such an order and shall specify the type, frequency of 



treatment, the dose and type of medication, appropriate dilution ratios 
and which diagnostic procedures are requested. 

(e) A copy of the order shall be available within the respiratory care 
files in addition to the patient's health record. 

(f) Diagnostic studies and treatment modalities shall be recorded in the 
patient's medical record including the type of diagnostic or therapeutic 
procedures, the dates and times of their occurrence and their effects in- 
cluding any adverse reactions. 

(g) Normal range and acceptable deviations from normal will be clear- 
ly delineated. Reactions outside the acceptable usual disease range shall 
be brought to the attention of the referring physician and the nursing ser- 
vice. 

(h) Respiratory care staff shall be involved in orientation and in-ser- 
vice training of hospital employees. 

(i) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 
NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1 . Amendment of subsections (d) and (e) filed 3-13-80; effective thirtieth day 

thereafter (Register 80, No. 11). 

§ 7061 9. Respiratory Care Service Staff. 

(a) A physician shall have overall responsibility for the service. This 
physician should be certified or eligible for certification by the American 
Board of Internal Medicine or the American Board of Anesthesiology. 
His responsibilities shall include: 

(1) Coordinating with other services. 

(2) Making services available. 

(3) Assuring the quality of respiratory care personnel. 

(4) Developing measures to control nosocomial infections. 

(b) The day-to-day operation of the service shall be under the immedi- 
ate supervision of a technical director who shall be a respiratory therapist, 
respiratory therapy technician, cardiopulmonary or pulmonary technolo- 
gist or a registered nurse with specialized training and/or advanced expe- 
rience in respiratory care, who shall be responsible for: 

(1) Supervising the clinical application of respiratory care. 

(2) Supervising the technical procedures used in pulmonary function 
testing and blood gas analysis. 

(3) Supervising the maintenance of equipment. 

(4) Assuring that national and local safety standards are met. 

(c) Other personnel may include registered nurses, licensed vocational 
nurses and physical therapists trained in respiratory care, respiratory 
therapists, respiratory therapy technicians, cardiopulmonary or pulmo- 
nary technologists and students. 

§ 70621 . Respiratory Care Service Equipment and 
Supplies. 

(a) There shall be sufficient types and quantity of equipment to provide 
the appropriate inhalation of the several gases, aerosols and such other 
modalities required for the anticipated nature and variety of procedures. 

(b) Equipment shall be calibrated in accordance with manufacturer's 
instructions and records of such calibrations shall be kept. 

§ 70623. Respiratory Care Service Space. 

(a) There shall be sufficient space maintained for: 

(1) Storage of necessary equipment. 

(2) Work areas for cleaning, sterilizing and repairing equipment. 

(3) Pulmonary function studies and blood gas analysis, if performed 
in the unit. 

(4) Office space. 

§ 70625. Skilled Nursing Service Definition. 

Skilled nursing service means the provision of skilled nursing care and 
supportive care to patients whose primary need is for the availability of 
skilled nursing care on a long-term basis. There is provision for 24-hour 



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Licensing and Certification of Health Facilities and Referral Agencies 



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• 



• 



inpatient care and as a minimum includes medical, nursing, dietary, phar- 
maceutical services and an activity program. 

§ 70627. Skilled Nursing Service General Requirements. 

(a) The regulations for Skilled Nursing Facilities, Chapter 3, Division 
5, Title 22, California Administrative Code, shall be met with the follow- 
ing exceptions: 

( 1 ) The administrator of the hospital does not need to possess a license 
as a nursing home administrator and his services may be shared between 
the hospital and the skilled nursing service. 

(2) The functions of the director of nurses may be shared between the 
hospital and the skilled nursing service. The registered nurse require- 
ment, referred to as director of the nursing service, in Section 72323 of 
regulations for Skilled Nursing Facilities. 

(b) There shall be written policies and procedures relating to the trans- 
fer of patients between the hospital and skilled nursing service that are 
approved by the medical staff. 

(c) The skilled nursing service shall be provided in a distinct part. 

§ 70629. Social Service Definition. 

Social service means assisting patients and their families to under- 
stand and cope with the emotional and social problems which affect their 
health status, with appropriately organized staff, space, equipment and 
supplies, problems of patients. 

§ 70631. Social Service General Requirements. 

(a) The social service to be provided shall be planned and developed 
in consultation with the administration, medical staff, nursing staff and 
other staff as appropriate. 

(b) The responsibility and the accountability of the social service to ad- 
ministration and medical staff shall be defined. 

(c) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(d) When the patient receives social service appropriate entries and 
progress notes shall be included in the patient's medical record. 

(e) Social service staff shall be involved in orientation and in-service 
training of the staff to assist in identifying social and emotional problems 
of patients. 

(f) Periodically, an appropriate committee of the medical staff shall 
evaluate the service provided and make appropriate recommendations to 
the executive committee of the medical staff and administration. 

§ 70633. Social Service Staff. 

(a) A social worker shall have overall responsibility for the service. 

(b) The social service staff shall be sufficient in number and qualifica- 
tions to effectively provide the service needed. Such personnel may in- 
clude social work assistants, social work aides and support staff. 

§ 70635. Social Service Equipment and Supplies. 

Equipment and supplies shall be provided as needed for performance 
of social service. 

§ 70637. Social Service Space. 

There shall be sufficient office space and privacy for interviewing and 
conducting social service. 

§ 70639. Speech Pathology and/or Audiology Service 
Definition. 

Speech pathology and/or audiology service means diagnostic evalua- 
tion, screening, testing and rehabilitation services for individuals with 
speech, hearing and/or language disorders with appropriate staff, space, 
equipment and supplies. 



§ 70641 . Speech Pathology and/or Audiology Service 
General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and accountability of the speech pathology and/ 
or audiology service to the medical staff and administration shall be de- 
fined. 

(c) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70643. Speech Pathology and/or Audiology Service 
Staff. 

(a) A speech pathologist, audiologist or otolaryngologist shall have 
overall responsibility for the service. 

(b) There shall be sufficient trained staff to meet the needs of the pa- 
tients and the scope of the services provided. 

(c) All unlicensed personnel shall work under the direct supervision 
of a speech pathologist or audiologist. 

(d) There shall be arrangements for consultation with the patient's 
physician, a physician who is certified or eligible for certification by the 
American Board of Otolaryngology or other physician specialists as 
deemed appropriate. 

§ 70645. Speech Pathology and/or Audiology Service 
Equipment and Supplies. 

(a) At least the following equipment shall be provided: 

(1) An appropriate clinical audiometer. 

(2) Diagnostic tests and materials. 

(3) Other equipment and materials deemed necessary by the person 
having overall responsibility for the service. 

(b) Audiometric equipment shall be calibrated in accordance with 
Standard S-3.6, 1969, Specifications for Audiometer, of the American 
National Standards Institute, Inc., 1430 Broadway, New York, NY 
10018. Evidence of such calibration shall be available on request. 

§ 70647. Speech Pathology and/or Audiology Service 
Space. 

(a) There shall be at least one two-room testing suite that meets Stan- 
dard S— 3.1, 1960 (R-1971), Criteria for Background Noise in Audiome- 
ter Rooms, of the American National Standards Institute, Inc., 1430 
Broadway, New York, NY 10018. 

(b) There shall be the space necessary for the tables and chairs to con- 
duct interviews, consultations, treatment and to accommodate patients in 
wheelchairs or on stretchers. 

§ 70649. Standby Emergency Medical Service, Physician 
on Call, Definition. 

Standby emergency medical service, physician on call, means the pro- 
vision of emergency medical care in a specifically designated area of the 
hospital which is equipped and maintained at all times to receive patients 
with urgent medical problems and capable of providing physician service 
within a reasonable time. 

§ 70651 . Standby Emergency Medical Service, Physician 
on Call, General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The responsibility and the accountability of the emergency medi- 
cal service to the medical staff and administration shall be defined. 

(c) There shall be a roster of names of physicians and their telephone 
numbers who are available to provide emergency service. 



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(d) A communication system employing telephones, radiotelephone 
or similar means shall be in use to establish and maintain contact with the 
police department, rescue squads and other emergency services of the 
community. 

(e) The emergency medical service shall have a defined emergency 
and mass casualty plan in concert with the hospital's capabilities and the 
capabilities of the community served. 

(0 The hospital shall require continuing education of all emergency 
medical service personnel. 

(g) Medical records shall be maintained on all patients presenting 
themselves for emergency medical care. These shall become part of the 
patient's hospital medical record. Past hospital records shall be available 
to the emergency medical service. 

(h) An emergency room log shall be maintained and shall contain at 
least the following information relating to the patient: name, date, time 
and means of arrival, age, sex, record number, nature of complaint, dis- 
position and time of departure. The name of those dead on arrival shall 
also be entered in the log. 

(i) Each standby emergency medical service shall be identified to the 
public by an exterior sign, clearly visible from public thoroughfares. The 
wording of such signs shall state STANDBY EMERGENCYMEDICAL 
SERVICE, PHYSICIAN ON CALL. 

(j) Standardized emergency nursing procedures shall be developed by 
an appropriate committee of the medical staff. 

(k) A list of referral services shall be available in the emergency ser- 
vice. This list shall include the name, address and telephone number of 
the following: 

( 1 ) Police department 

(2) Blood bank 

(3) Antivenin service 

(4) Burn center 

(5) Drug abuse center 

(6) Poison control information center 

(7) Suicide prevention center 

(8) Director of the State Department of Health or his designee 

(9) Local health department 

(10) Clergy 

(11) Emergency psychiatric service 

(12) Chronic hemodialysis service 

(13) Renal transplant center 

(14) Intensive care newborn nursery 

(15) Emergency maternity service 

(16) Radiation accident management service 

(17) Ambulance transport and rescue services 

(18) County coroner or medical examiner 

(1) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 70653. Standby Emergency Medical Service, Physician 
on Call, Staff. 

(a) A physician shall have overall responsibility for the service. He or 
his designee shall be responsible for: 

(1) Implementation of established policies and procedures. 

(2) Development of a system for assuring physician coverage on call 
24 hours a day to the emergency medical service. 

(3) Assurance that physician coverage is available within a reasonable 
length of time, relative to the patient's illness or injury. 

(4) Development of a roster of specialty physicians available for con- 
sultation at all times. 

(5) Assurance of continuing education for the medical and nursing 
staff. 

(b) All physicians, dentists and podiatrists providing services in the 
emergency room shall be members of the organized medical staff. 

(c) A registered nurse shall be immediately available within the hospi- 
tal at all times to provide emergency nursing care. 



(d) There shall be sufficient other personnel to support the services of- 
fered. 

§ 70655. Standby Emergency Medical Service, Physician 
on Call, Equipment and Supplies. 

All equipment and supplies necessary for life support shall be avail- 
able. Equipment shall include, but need not be limited to, airway control 
and ventilation equipment, suction devices, cardiac monitor defibrilla- 
tor, intravenous fluids and administering devices and including blood ex- 
panders. 

§ 70657. Standby Emergency Medical Service, Physician 
on Call, Space. 

(a) The following space provisions and designations shall be met: 

( 1 ) Designated emergency room area 

(2) Reception area 

(3) Observation room 

(b) Observation beds in the emergency medical service shall not be 
counted in the total licensed bed capacity of the hospital. 

Article 7. Administration 

§ 70701. Governing Body. 

(a) The governing body shall: 

(1) Adopt written bylaws in accordance with legal requirements and 
its community responsibility which shall include but not be limited to 
provision for: 

(A) Identification of the purposes of the hospital and the means of ful- 
filling them. 

(B) Appointment and reappointment of members of the medical staff. 

(C) Appointment and reappointment of one or more dentists, podia- 
trists, and/or clinical psychologists to the medical staff respectively, 
when dental, podiatric, and/or clinical psychological services are pro- 
vided. 

(D) Formal organization of the medical staff with appropriate officers 
and bylaws. 

(E) Membership on the medical staff which shall be restricted to physi- 
cians, dentists, podiatrists, and clinical psychologists competent in their 
respective fields, worthy in character and in professional ethics. No hos- 
pital shall discriminate with respect to employment, staff privileges or 
the provision of professional services against a licensed clinical psychol- 
ogist within the scope of his/her licensure, or against a licensed physician 
and surgeon or podiatrist on the basis of whether the physician and sur- 
geon or podiatrist holds an M.D., D.O. or D.P.M. degree. Wherever staff- 
ing requirements for a service mandate that the physician responsible for 
the service be certified or eligible for certification by an appropriate 
American medical board, such position may be filled by an osteopathic 
physician who is certified or eligible for certification by the equivalent 
appropriate American Osteopathic Board. 

(F) Self-government by the medical staff with respect to the profes- 
sional work performed in the hospital, periodic meetings of the medical 
staff to review and analyze at regular intervals their clinical experience 
and requirement that the medical records of the patients shall be the basis 
for such review and analysis. 

(G) Preparation and maintenance of a complete and accurate medical 
record for each patient. 

(2) Appoint an administrator whose qualifications, authority and du- 
ties shall be defined in a written statement adopted by the governing 
body. 

(3) The Department shall be notified in writing whenever a change of 
administrator occurs. 

(4) Provide appropriate physical resources and personnel required to 
meet the needs of the patients and shall participate in planning to meet 
the health needs of the community. 

(5) Take all reasonable steps to conform to all applicable federal, state 
and local laws and regulations, including those relating to licensure, fire 
inspection and other safety measures. 



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(6) Provide for the control and use of the physical and financial re- 
sources of the hospital. 

(7) Require that the medical staff establish controls that are designed 
to ensure the achievement and maintenance of high standards of profes- 
sional ethical practices including provision that all members of the medi- 
cal staff be required to demonstrate their ability to perform surgical and/ 
or other procedures competently and to the satisfaction of an appropriate 
committee or committees of the staff, at the time of original application 
for appointment to the staff and at least every two years thereafter. 

(8) Assure that medical staff by-laws, rates and regulations are subject 
to governing body approval, which approval shall not be withheld unrea- 
sonably. 

(9) These by-laws shall include an effective formal means for the 
medical staff, as a liaison, to participate in the development of all hospital 
policy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

2. Editorial correction of subsection (a)(7) filed 8-31-83; effective thirtieth day 
thereafter (Register 83, No. 36). 

§ 70703. Organized Medical Staff. 

(a) Each hospital shall have an organized medical staff responsible to 
the governing body for the adequacy and quality of the medical care ren- 
dered to patients in the hospital. 

( 1 ) The medical staff shall be composed of physicians and, where den- 
tal or podiatric services are provided, dentists or podiatrists. 

(2) Where clinical psychological services are provided, clinical psy- 
chologists may be appointed to the medical staff subject to the by-laws, 
rules and regulation of the hospital. 

(b) The medical staff, by vote of the members and with the approval 
of the governing body, shall adopt written by-laws which provide formal 
procedures for the evaluation of staff applications and credentials, ap- 
pointments, reappointments, assignment of clinical privileges, appeals 
mechanisms and such other subjects or conditions which the medical 
staff and governing body deem appropriate. The medical staff shall abide 
by and establish a means of enforcement of its by-laws. Medical staff by- 
laws, rules and regulations shall not deny or restrict within the scope of 
their licensure, the voting right of staff members or assign staff members 
to any special class or category of staff membership, based upon whether 
such staff members hold an M.D., D.O., D.P.M., OR D.D.S. degree or 
clinical psychology license. 

(c) The medical staff shall meet regularly. Minutes of each meeting 
shall be retained and filed at the hospital. 

(d) The medical staff by-laws, rules, and regulations shall include, but 
shall not be limited to, provision for the performance of the following 
functions: executive review, credentialing, medical records, tissue re- 
view, utilization review, infection control, pharmacy and therapeutics, 
and assisting the medical staff members impaired by chemical dependen- 
cy and/or mental illness to obtain necessary rehabilitation services. 
These functions may be performed by individual committees, or when 
appropriate, all functions or more than one function my be performed by 
a single committee. Reports of activities and recommendations relating 
to these functions shall be made to the executive committee and the gov- 
erning body as frequently as necessary and at least quarterly. 

(e) The medical staff shall provide in its by-laws, rules and regulations 
for appropriate practices and procedures to be observed in the various de- 
partments of the hospital. In this connection the practice of division of 
fees, under any guise whatsoever, shall be prohibited and any such divi- 
sion of fees shall be cause for exclusion from the staff. 

(f) The medical staff shall provide for availability of staff physician for 
emergencies among the in-hospital population in the event that the at- 
tending physician or his alternate is not available. 

(g) The medical staff shall participate in a continuing program of pro- 
fessional education. The results of retrospective medical care evaluation 



shall be used to determine the continuing education needs. Evidence of 
participation in such programs shall be available. 

(h) The medical staff shall develop criteria under which consultation 
will be required. These criteria shall not preclude the requirement for 
consultations on any patient when the director of the service, chairman 
of a department or the chief of staff determines a patient will benefit from 
such consultation. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83: designated effective 3-2-83 (Register 83, No. 7). 

2. Amendment of subsection (d) filed 10-3-88; operative 1 1-2-88 (Register 88, 
No. 41). 

3. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

4. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0- 1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No 46). 

5. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

6. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70705. Medical Staff, Residents, Interns and Students. 

(a) The hospital shall not permit any physician, dentist, podiatrist, or 
clinical psychologist or any medical, dental, podiatric or clinical psy- 
chology resident, intern or student to perform any service for which a li- 
cense, certificate of registration or other form of approval is required un- 
less such person is licensed, registered, approved or is exempted 
therefrom under the provisions of the State Medical Practice Act, the 
State Dental Practice Act, the State Podiatric Practice Act, or the State 
Psychology Licensing Law and, further, unless such services are per- 
formed under the direct supervision of licensed practitioner whenever so 
required by law. 

(b) If patient care is provided by residents, interns and medical stu- 
dents, such care shall be in accordance with the provisions of a program 
approved by and in conformity with: the Council on Education of the 
American Medical Association, the American Osteopathic Association 
Board of Trustees through the Committee on postdoctoral training and 
the Bureau of Professional Education, the American Dental Association, 
the American Podiatry Association, or the Education and Training Board 
of the American Psychological Association and/or the residency training 
programs of the respective specialty boards. 

(c) Except in an emergency, all other patient care by interns, house of- 
ficers, residents or persons with equivalent titles, not provided as speci- 
fied in subdivision (b) of this section, must be provided by a practitioner 
with a current license to practice in California. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§ 70706. Interdisciplinary Practice and Responsibility for 
Patient Care. 

(a) In any facility where registered nurses will perform functions re- 
quiring standardized procedures pursuant to Section 2725 of the Busi- 
ness and Professions Code, or in v/hich licensed or certified healing arts 
professionals who are not members of the medical staff will be granted 
privileges pursuant to Section 70706. 1 there shall be a Committee on In- 
terdisciplinary Practice established by and accountable to the Governing 
Body, for establishing policies and procedures for interdisciplinary med- 
ical practice. 

(b) The Committee on Interdisciplinary Practice shall include, as a 
minimum, the director of nursing, the administrator or designee and an 
equal number of physicians appointed by the Executive Committee of the 
medical staff, and registered nurses appointed by the director of nursing. 
Licensed or certified health professionals other than registered nurses 
who are performing or will perform functions as in (a) above shall be in- 
cluded in the Committee. 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(c) The Committee on Interdisciplinary Practice shall establish written 
policies and procedures for the conduct of its business. Policies and pro- 
cedures shall include but not be limited to: 

(1) Provision for securing recommendations from members of the 
medical staff in the medical specialty, or clinical field of practice under 
review, and from persons in the appropriate nonmedical category who 
practice in the clinical field or specialty under review. 

(2) Method for the approval of standardized procedures in accordance 
with Sections 2725 of the Business and Professions Code in which affir- 
mative approval of the administrator of designee and a majority of the 
physician members and a majority of the registered nurse members 
would be required and that prior to such approval, consultation shall be 
obtained from facility staff in the medical and nursing specialties under 
review. 

(3) Providing for maintaining clear lines of responsibility of the nurs- 
ing service for nursing care of patients and of the medical staff for medi- 
cal services in the facility. 

(4) Intended line of approval for each recommendation of the Commit- 
tee. 

NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 3-13-80; effective thirtieth day thereafter (Register 80, No. 
11). 

§ 70706.1. Granting of Nonphysician Privileges. 

(a) Registered Nurses. The Committee on Interdisciplinary Practice 
shall be responsible for recommending policies and procedures for the 
granting of expanded role privileges to registered nurses, whether or not 
employed by the facility, to provide for the assessment, planning, and di- 
rection of the diagnostic and therapeutic care of a patient in a licensed 
health facility. These policies and procedures will be administered by the 
Committee on Interdisciplinary Practice which shall be responsible for 
reviewing credentials and making recommendations for the granting 
and/or rescinding of such privileges. 

(b) Physician's Assistant. A physician's assistant who practices in a 
licensed facility shall be supervised by a physician approved by the Divi- 
sion of Allied Health Professions of the Board of Medical Quality Assur- 
ance who is a member of the active medical staff of that facility. Physi- 
cian' s assistants shall apply to and be approved by the Executive 
Committee of the medical staff of the facility in which the physician's as- 
sistant wishes to practice. 

NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 3-13-80; effective thirtieth day thereafter (Register 80, No. 
11). 

§ 70706.2. Standardized Procedures. 

(a) The Committee on Interdisciplinary Practice shall be responsible 
for: 

( 1 ) Identifying functions and/or procedures which require the formu- 
lation and adoption of standardized procedures under Section 2725 of the 
Business and Professions Code in order for them to be performed by reg- 
istered nurses in the facility, and initiating the preparation of such stan- 
dardized procedures in accordance with this section. 

(2) The review and approval of all such standardized procedures cov- 
ering practice by registered nurses in the facility. 

(3) Recommending policies and procedures for the authorization of 
employed staff registered nurses to perform the identified functions and/ 
or procedures. These policies and procedures may be administered by the 
Committee on Interdisciplinary Practice or by delegation to the director 
of nursing. 

(b) Each standardized procedure shall: 

(1) Be in writing and show date or dates of approval including approv- 
al by the Committee on Interdisciplinary Practice. 



(2) Specify the standardized procedure functions which registered 
nurses are authorized to perform and under what circumstances. 

(3) State any specific requirements which are to be followed by regis- 
tered nurses in performing all or part of the functions covered by the par- 
ticular standardized procedure. 

(4) Specify any experience, training or special education requirements 
for performance of the functions. 

(5) Establish a method for initial and continuing evaluation of the com- 
petence of those registered nurses authorized to perform the functions. 

(6) Provide for a method of maintaining a written record of those per- 
sons authorized to perform the functions. 

(7) Specify the nature and scope of review and/or supervision required 
for the performance of the standardized procedure functions; for exam- 
ple, if the function is to be performed only under the immediate supervi- 
sion of a physician, that limitation must be clearly stated. If physician su- 
pervision is not required, that fact should be clearly stated. 

(8) Set forth any specialized circumstances under which the registered 
nurse is to communicate immediately with a patient's physician concern- 
ing the patient's condition. 

(9) State any limitations on settings or departments within the facility 
where the standardized procedure functions may be performed. 

(10) Specify any special requirements for procedures relating to pa- 
tient recordkeeping. 

(11) Provide fo periodic review of the standardized procedure. 

(c) If nurses have been approved to perform procedures pursuant to a 
standardized procedure, the names of the nurses so approved shall be on 
file in the office of the director of nursing. 

NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 3-13-80; effective thirtieth day thereafter (Register 80, No. 

11). 

§ 70707. Patients' Rights. 

(a) Hospitals and medical staffs shall adopt a written policy on pa- 
tients' rights. 

(b) A list of these patients' rights shall be posted in both Spanish and 
English in appropriate places within the hospital so that such rights may 
be read by patients. This list shall include but not be limited to the pa- 
tients' rights to: 

(1) Exercise these rights without regard to sex, economic status, edu- 
cational background, race, color, religion, ancestry, national origin, sex- 
ual orientation or marital status, or the source of payment for care. 

(2) Considerate and respectful care. 

(3) Knowledge of the name of the physician who has primary responsi- 
bility for coordinating the care and the names and professional relation- 
ships of other physicians and nonphysicians who will see the patient. 

(4) Receive information about the illness, the course of treatment and 
prospects for recovery in terms that the patient can understand. 

(5) Receive as much information about any proposed treatment or pro- 
cedure as the patient may need in order to give informed consent or to re- 
fuse this course of treatment. Except in emergencies, this information 
shall include a description of the procedure or treatment, the medically 
significant risks involved in this treatment, alternate courses of treatment 
or nontreatment and the risks involved in each and to know the name of 
the person who will carry out the procedure or treatment. 

(6) Participate actively in decisions regarding medical care. To the ex- 
tent permitted by law, this includes the right to refuse treatment. 

(7) Full consideration of privacy concerning the medical care pro- 
gram. Case discussion, consultation, examination and treatment are con- 
fidential and should be conducted discreetly. The patient has the right to 
be advised as to the reason for the presence of any individual. 

(8) Confidential treatment of all communications and records pertain- 
ing to the care and the stay in the hospital. Written permission shall be 
obtained before the medical records can be made available to anyone not 
directly concerned with the care. 

(9) Reasonable responses to any reasonable requests made for service. 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70707.3 



(10) Leave the hospital even against the advice of physicians. 

(11) Reasonable continuity of care and to know in advance the time 
and location of appointment as well as the identity of persons providing 
the care. 

(12) Be advised if hospital/personal physician proposes to engage in 
or perform human experimentation affecting care or treatment. The pa- 
tient has the right to refuse to participate in such research projects. 

(13) Be informed of continuing health care requirements following 
discharge from the hospital. 

(14) Examine and receive an explanation of the bill regardless of 
source of payment. 

(15) Know which hospital rules and policies apply to the patient' s con- 
duct while a patient. 

(16) Have all patients* rights apply to the person who may have legal 
responsibility to make decisions regarding medical care on behalf of the 
patient. 

(17) Designate visitors of his/her choosing, if the patient has decision- 
making capacity, whether or not the visitor is related by blood or mar- 
riage, unless: 

(A) No visitors are allowed. 

(B) The facility reasonably determines that the presence of a particular 
visitor would endanger the health or safety of a patient, a member of the 
health facility staff, or other visitor to the health facility, or would signifi- 
cantly disrupt the operations of the facility. 

(C) The patient has indicated to the health facility staff that the patient 
no longer wants this person to visit. 

(18) Have the patient's wishes considered for purposes of determining 
who may visit if the patient lacks decision-making capacity and to have 
the method of that consideration disclosed in the hospital policy on visita- 
tion. At a minimum, the hospital shall include any person living in the 
household. 

(19) This section may not be construed to prohibit a health facility 
from otherwise establishing reasonable restrictions upon visitation, in- 
cluding restrictions upon the hours of visitation and number of visitors. 

(c) A procedure shall be established whereby patient complaints are 
forwarded to the hospital administration for appropriate response. 

(d) All hospital personnel shall observe these patients' rights. 
NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (b) filed 3-13-80; effective thirtieth day thereafter 
(Register 80, No. 11). 

2. Amendment of subsection (b)(1), new subsections (b)(17)-(b)(19), and amend- 
ment of Note filed 1-30-97; operative 3-1-97 (Register 97, No. 5). 

§ 70707.1 . Criteria for the Performance of Sterilization. 

(a) A sterilization shall be performed only if the following conditions 
are met: 

( 1 ) The individual is at least 1 8 years old at the time the consent is ob- 
tained, or the individual is under 18 and: 

(A) Has entered into a valid marriage, whether or not such marriage 
was terminated by dissolution; or 

(B) Is on active duty with the United States armed services; or 

(C) Is over 15 years old, lives apart from his or her parents or guard- 
ian^) manages, his or her own financial affairs; or 

(D) Has received a declaration of emancipation pursuant to Section 64 
of the Civil Code. 

(2) The individual is able to understand the content and nature of the 
informed consent process as specified in 70707.3. 

(3) The individual has voluntarily given informed consent in accor- 
dance with all the requirements prescribed in Sections 70707.1 through 
70707.6. 

(4) At least 30 days, but not more than 180 days, have passed between 
the date of informed consent and the date of the sterilization, except in 
the following Instances. 



(A) Sterilization may be performed at the time of emergency abdomi- 
nal surgery if the following requirements are met: 

1 . The written informed consent to be sterilized was given at least 30 
days before the individual intended to be sterilized. 

2. At least 72 hours have passed after written informed consent to be 
sterilized was given. 

(B) Sterilization may be performed at the time of premature delivery 
if the following requirements are met: 

1 . The written informed consent was given at least 30 days before the 
expected date of the delivery. 

2. At least 72 hours have passed after written informed consent to be 
sterilized was given. 

(C) The patient voluntarily requests in writing that the procedure be 
performed in less than 30 days. However, in no case shall a sterilization 
be performed in less than 72 hours following the signing of the consent 
form. 

NOTE: Authority cited: Sections 208, 1 275, 1276, Health and Safety Code. Refer- 
ence: Sections 1250et seq., Health and Safety Code; Sections 25.6, 25.7, 34.6, and 
63, Civil Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 
22). 

2. Repealer and new section filed 4-1 7-8 1 ; effective thirtieth day thereafter (Reg- 
ister 81, No. 16). 

§ 70707.2. Requirements for Sterilization Other Than 
Emergency Sterilization. 

NOTE: Authority cited: Sections 208, 1 275, 1276, Health and Safety Code. Refer- 
ence: Sections 1250 et seq., Health and Safety Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 

22). 

2. Repealer filed 4-17-81 ; effective thirtieth day thereafter (Register 81, No. 16). 

§ 70707.3. Informed Consent Process for Sterilization. 

(a) An individual has given informed consent only if: 

(1) The person who obtained consent for the sterilization procedure: 

(A) Offered to answer any questions the individual to be sterilized may 
have concerning the procedure. 

(B) Provided the individual with a copy of the consent form and the 
booklet on sterilization published by the Department. 

(C) Provided orally all of the following to the individual to be steril- 
ized: 

1 . Advice that the individual is free to withhold or withdraw consent 
to the procedure at any time before the sterilization without affecting the 
right to future care or treatment and without loss or withdrawal of any 
federally funded program benefits to which the individual might be 
otherwise entitled. 

2. A full description of available alternative methods of family plan- 
ning and birth control. 

3. Advice that the sterilization procedure is considered to be irrevers- 
ible. 

4. A thorough explanation of the specific sterilization procedure to be 
performed. 

5. A full description of the discomforts and risks that may accompany 
or follow the performing of the procedure, including an explanation of 
the type and possible effects of any anesthetic to be used. 

6. A full description of the benefits or advantages that may be expected 
as a result of the sterilization. 

7. Approximate length of hospital stay. 

8. Approximate length of time for recovery. 

9. Financial cost to the patient. 

10. Information that the procedure is established or new. 

11. Advice that the sterilization will not be performed for at least 30 
days, except under the circumstances specified in Section 70707. 1 . 

12. The name of the physician performing the procedure. If another 
physician is to be substituted, the patient shall be notified, prior to admin- 



Page 801 



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§ 70707.4 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



istering pre-anesthetic medication of the physician's name and the rea- 
son for the change in physician. 

(2) Suitable arrangements were made to ensure that the information 
specified in (a)(1) was effectively communicated to any individual who 
is blind, deaf, or otherwise handicapped. 

(3) An interpreter was provided if the individual to be sterilized did not 
understand the language used on the consent form or the language used 
by the person obtaining consent. 

(4) The individual to be sterilized was permitted to have a witness of 
the individual's choice present when consent was obtained. 

(5) The sterilization operation was requested without fraud, duress, or 
undue influence. 

(6) The consent form requirements of Section 70707.4 were met. 

(b) Informed consent may not be obtained while the individual to be 
sterilized is: 

( 1 ) In labor or within 24 hours postpartum or postabortion. 

(2) Seeking to obtain or obtaining an abortion. 

(A) Seeking to obtain means that period of time during which the abor- 
tion decision and the arrangement for the abortion are being made. 

(B) Obtaining an abortion means that period of time during which the 
individual is undergoing the abortion procedure, including any period 
during which preoperative medication is administered. 

(3) Under the influence of alcohol or other substances that affect the 
individual's state of awareness. 

(c) The informed consent process may be conducted either by a physi- 
cian or by the physician's designee. 

(d) A copy of the signed consent form shall be: 

( 1 ) Provided to the patient. 

(2) Retained by the physician and the hospital in the patient's medical 
records. 

(e) No person shall by reason of mental retardation alone be prevented 

from consenting to sterilization under this section. 

NOTE: Authority cited: Sections 208(a), 1275, and 1276, Health and Safety Code. 
Reference: Section 1250, Health and Safety Code. 

History 

1 . New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 

22). 

2. Repealer and new section filed 4-17-8 1 ; effective thirtieth day thereafter (Reg- 
ister 81, No. 16). 

3. New subsections (b)(2)(A) and (B) filed 7-1-83; effective thirtieth day thereaf- 
ter (Register 83, No. 27). 



§ 70707.4. Certification of Informed Consent for 
Sterilization. 

(a) The Consent Form, provided by the Department in English and 
Spanish, shall be the only approved form and shall be signed and dated 
by the: 

( 1 ) Individual to be sterilized. 

(2) Interpreter, if one is provided. 

(3) Person who obtained the consent. 

(4) Physician who performed the sterilization procedure, or an alter- 
nate physician. 

(b) The person securing consent shall certify, by signing the Consent 
Form, that he or she: 

(1) Advised the individual to be sterilized before the individual to be 
sterilized signed the Consent Form, that no federal benefits may be with- 
drawn because of the decision not to be sterilized. 

(2) Explained orally the requirements for informed consent to the indi- 
vidual to be sterilized as set forth on the Consent Form and in Section 
70707.3. 

(3) Determined to the best of his/her knowledge and belief that the in- 
dividual to be sterilized appeared to understand the content and nature of 
the informed consent process as specified in 70707.3 and knowingly and 
voluntarily consented to be sterilized. 

(c) The physician performing the sterilization, or an alternate physi- 
cian shall certify, by signing the Consent Form, that: 



( 1 ) The physician or an alternate physician, shortly before the per- 
formance of the sterilization, advised the individual to be sterilized that 
federal benefits shall not be withheld or withdrawn because of a decision 
not to be sterilized. 

(2) The physician or an alternate physician explained orally the re- 
quirements for informed consent as set forth on the Consent Form. 

(3) To the best of the physician's or an alternate physician's knowl- 
edge and belief, the individual to be sterilized appeared to knowingly and 
voluntarily consent to be sterilized. 

(4) At least 30 days have passed between the date of the individual's 
signature on the Consent Form and the date upon which the sterilization 
was performed, except in the following instances: 

(A) Sterilization may be performed at the time of emergency abdomi- 
nal surgery if the physician: 

1 . Certifies that the written informed consent to be sterilized was given 
at least 30 days before the individual intended to be sterilized. 

2. Certifies that at least 72 hours have passed after written informed 
consent to be sterilized was given. 

3. Describes the emergency on the Consent Form. 

(B) Sterilization may be performed at the time of premature delivery 
if the physician certifies that: 

1 . The written informed consent was given at least 30 days before the 
expected date of the delivery. The physician shall state the expected date 
of the delivery on the Consent Form. 

2. At least 72 hours have passed after written informed consent to be 
sterilized was given. 

(C) The patient voluntarily requests in writing that the procedure be 
performed in less than 30 days. However, in no case shall a sterilization 
be performed in less than 72 hours following the signing of the Consent 
Form. 

(d) The interpreter, if one is provided, shall certify that he or she: 

( 1 ) Transmitted the information and advice presented orally to the in- 
dividual to be sterilized. 

(2) Read the Consent Form and explained its contents to the individual 
to be sterilized. 

(3) Determined to the best of his/her knowledge and belief that the in- 
dividual to be sterilized understood that the interpreter told the individu- 
al. 

(e) The person who obtains consent shall provide the individual to be 
sterilized with a copy of the booklet on sterilization, provided by the De- 
partment in English and Spanish before obtaining consent. 

(f) For the purposes of this section, shortly before means a period with- 
in 72 hours prior to the time the patient receives any preoperative medica- 
tion. 

NOTE: Authority cited: Sections 208(a), 1275 and 1276, Health and Safety Code. 
Reference: Section 1250, Health and Safety Code. 

History 

1 . New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 

22). 

2. Repealer and new section filed 4-17-81 ; effective thirtieth day thereafter (Reg- 
ister 81, No. 16). 

3. Amendment of subsections (a)(4) and (c) filed 7-1-83; effective thirtieth day 
thereafter (Register 83, No. 27). 

§ 70707.5. Hysterectomy. 

(a) Except for a previously sterile woman, a hysterectomy may be per- 
formed or arranged for by a physician only if: 

(1) The person who secures the authorization to perform the hysterec- 
tomy has informed the individual and the individual's representatives, if 
any, orally and in writing, that the hysterectomy will render the individu- 
al permanently sterile. 

(2) The individual and the individual's representative, if any, has 
signed a written acknowledgement of receipt of the information in (1). 

(3) The individual has been informed of the rights to consultation with 
a second physician. 

(b) A copy of the signed statement shall be: 
(1) Provided to the patient. 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70715 



• 



(2) Retained by the physician and the hospital in the patient's medical 
records. 

(c) For previously sterile women the physician shall discuss with the 
patient her pre-existing sterility and certify in the patient's health record 
that the individual was previously sterile and the cause of sterility. 
NOTE: Authority cited: Sections 208, 1275 and 1276, Health and Safety Code. 
Reference: Sections 1275, 1276 and 1294, Health and Safety Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 
22). 

2. Repealer and new section filed 4-17-8 1 ; effective thirtieth day thereafter (Reg- 
ister 81, No. 16). 

3. Amendment of subsection (a) and new subsection (c) filed 2-25-86; effective 
thirtieth day thereafter (Register 86, No. 9). 

§ 70707.6. The Additional Requirements for Informed 
Consent Process When Specified Federal 
Funds Are Used. 

Pursuant to Title 22, California Administrative Code Sections 5 1 1 63 
and 5 1 305. 1 through 5 1 305.7 the following Additional Requirements for 
Informed Consent Process shall be met When Specified Federal Funds 
are Used: 

(a) When Medi-Cal funds are used: 

( 1 ) Sterilization shall be performed only if the following conditions are 
met: 

(A) The individual is at least twenty-one years old at the time consent 
is obtained. 

(B) The individual is not a mentally incompetent individual. 

(C) The individual is not an institutionalized individual. 

(2) A hysterectomy shall not be covered if: 

(A) Performed solely for the purpose of rendering an individual per- 
manently sterile. 

(B) There is more than one purpose to the procedure, and the hysterec- 
tomy would not be performed except for the purpose of rendering the in- 
dividual permanently sterile. 

(3) The hospital may not honor any request that the sterilization be per- 
formed earlier than 30 days as may non-Medi-Cal patients under Sec- 
tions 70707. 1(4)(C) and 70707.4(4)(C). 

(b) For the purposes of this section the following definitions apply: 

(1) Mentally incompetent individual means an individual who has 
been declared mentally incompetent by a Federal, State, or local court of 
competent jurisdiction for any purpose, unless the individual has been 
declared competent for purposes which include the ability to consent to 
sterilization. 

(2) Institutionalized individual means an individual who is: 

(A) Involuntarily confined or detained, under a civil or criminal stat- 
ute, in a correctional or rehabilitative facility, including a mental hospital 
or other facility for the care and treatment of mental illness. 

(B) Confined, under a voluntary commitment, in a mental hospital or 
other facility for the care and treatment of mental illness. 

NOTE: Authority cited: Sections 208, 1275, 1276. Health and Safety Code. Refer- 
ence: Sections 1250 et seq. , Health and Safety Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 
22). 

2. Repealer and new section filed 4-17-8 1 ; effective thirtieth day thereafter (Reg- 
ister 81, No. 16). 

§ 70707.7. Verification of Informed Consent. 

(a) For the purposes of the hospital in complying with these regula- 
tions, signature of the patient, physician, physician's designee (if any) 
and auditor-witness (if applicable) on the Sterilization Consent Docu- 
ment shall be sufficient evidence that the informed consent procedure has 
taken place. 

NOTE: Authority cited: Sections 208, 1275, 1276. Health and Safety Code. Refer- 
ence: Sections 1250 et seq. , Health and Safety Code. 

History 
1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 

22). 



2. Amendment filed 4-17-81 ; effective thirtieth day thereafter (Register 81 , No. 
16). 

§ 70707.8. Noncompliance. 

Noncompliance with Sections 70707.1 through 70707.7 may result in 
a revocation or an involuntary suspension of the hospital's license as de- 
lineated in Section 70135. 

The facility shall report to the Board of Medical Quality Assurance the 
name of any physician who performs a sterilization procedure which was 
not in compliance with Sections 70707. 1 through 70707.7 of this chapter. 

NOTE: Authority cited: Sections 208, 1 275, 1276, Health and Safety Code. Refer- 
ence: Sections 1250 et seq. , Health and Safety Code. 

History 
1. New section filed 5-21-11; effective thirtieth day thereafter (Register 77, No. 

22). 

§ 70707.9. Effective Date. 

NOTE: Authority cited: Sections 208, 1275 and 1276, Health and Safety Code. 
Reference: Sections 1250 et seq., Health and Safety Code. 

History 

1. New section filed 6-27-77 as an emergency; effective upon filing (Register 77, 
No. 27). 

2. Amendment filed 8-3-77 as an emergency; effective upon filing (Register 77, 
No. 32). 

3. Certificate of Compliance filed 1 1-30-77 (Register 77, No. 49). 

4. Repealer filed 4-17-81 ; effective thirtieth day thereafter (Register 81, No. 16). 

§ 70708. Clinical Research. 

Research projects involving human subjects shall have the prior ap- 
proval of a broadly represented committee which shall assure maximum 
patient safety and understanding. 

§ 70709. Emotional and Attitudinal Support. 

Hospitals shall have a written plan for the provision of those compo- 
nents of total patient care that relate to the spiritual, emotional and attitu- 
dinal health of the patient, patients' families, visitors designated by pa- 
tients pursuant to Section 70707(b)(17) and hospital personnel. 

NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276. Health and Safety Code. 

History 
1 . Amendment of section and new Note filed 1-30-97; operative 3-1-97 (Regis- 
ter 97, No. 5). 

§ 7071 1 . Social Services. 

(a) Hospitals shall have a written plan for providing social services to 
those patients with social problems. This service may be provided 
through: 

(1) An organized social service within the hospital, or 

(2) A social worker employed on a part-time basis, or 

(3) Social work consultant services from a community agency. 

§ 7071 3. Use of Outside Resources. 

If a hospital does not employ a qualified professional person to render 
a specific service to be provided by the hospital, there shall be arrange- 
ments for such a service through a written agreement with an outside re- 
source — which meets the standards and requirements of these regula- 
tions. The responsibilities, functions, objectives and terms of agreement, 
including financial arrangements and charges of each such outside re- 
source, shall be delineated in writing and signed by an authorized repre- 
sentative of the hospital and the person or the agency providing the ser- 
vice. The agreement shall specify that the hospital retains professional 
and administrative responsibility for the services rendered. The outside 
resource, when acting as a consultant, shall apprise the administrator of 
recommendations, plans for implementation and continuing assessment 
through dated and signed reports which shall be retained by the adminis- 
trator for follow-up action and evaluation of performance. 

§ 70715. Nondiscrimination Policies. 

(a) No hospital shall discriminate against any person based on sex, 
race, color, religion, ancestry or national origin, except as provided here- 
in. This provision shall apply to the appointment of the medical staff, hir- 
ing of hospital employees and the admission, housing or treatment of pa- 
tients. 



Page 803 



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§ 70717 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(b) Any bona fide nonprofit religious, fraternal or charitable organiza- 
tion which can demonstrate to the satisfaction of the Department that its 
primary or substantial purpose is not to evade this section may establish 
admission policies limiting or giving preference to their own members 
or adherents. Such policies shall not be construed as a violation of the first 
paragraph of this section. Any admission of nonmembers or nonadhere- 
nts shall be subject to the first paragraph of this subsection. 

(c) No hospital which permits sterilization operations for contracep- 
tive purposes nor any member of its medical staff shall require of the pa- 
tient any special nonmedical qualifications which are not imposed upon 
individuals seeking other types of operations. Prohibited nonmedical 
qualifications shall include, but not be limited to, age, marital status and 
number of natural children. This prohibition does not affect requirements 
relating to the physical or mental condition of the patient, physician 
counselling of the patient or existing law pertaining to individuals below 
the age of majority. 

§ 70717. Admission, Transfer and Discharge Policies. 

(a) Each hospital shall have written admission, transfer and discharge 
policies which encompass the types of clinical diagnoses for which pa- 
tients may be admitted, limitations imposed by law or licensure, staffing 
limitations, rules governing emergency admissions, advance deposits, 
rates of charge for care, charges for extra services, terminations of ser- 
vices, refund policies, insurance agreements and other financial consid- 
erations, discharge of patients and other related functions. 

(b) Hospitals offering emergency and/or outpatient services shall 
make available, upon request of a patient, a schedule of hospital charges. 

(c) Patients shall be admitted only upon the order and under the care 
of a member of the medical staff of the hospital who is lawfully autho- 
rized to diagnose, prescribe and treat patients. The patient's condition 
and provisional diagnosis shall be established at time of admission by the 
member of the medical staff who admits the patient, subject to the rules 
and regulations of the hospital, and the provisions of Section 70705(a). 

( 1 ) Patients admitted to the hospital for podiatric services shall receive 
the same basic medical appraisal as patients admitted for other services. 
This shall include the performance and recording of the findings in the 
health record of an admission history and physical examination which 
shall be performed by persons lawfully authorized to do so by their re- 
spective practice acts. 

(d) Within 24 hours after admission, or immediately before, every pa- 
tient shall have a complete history and physical examination performed 
providing the condition of the patient permits. 

(e) No mentally competent adults shall be detained in a hospital 
against their will. Emancipated minors shall not be detained in a hospital 
against their will. Unemancipated minors shall not be detained against 
the will of their parents or legal guardians. In those cases where law per- 
mits unemancipated minors to contract for medical care without the con- 
sent of their parents or legal guardians, the minors shall not be detained 
in the hospital against their will. This provision shall not be construed to 
preclude or prohibit attempts to persuade a patient to remain in the hospi- 
tal in the patient's own interest nor the detention of mentally disordered 
patients for the protection of themselves or others under the provisions 
of the Lanterman-Petris-Short Act (Welfare and Institutions Code, Sec- 
tion 5000, et seq.,) if the hospital has been designated by the county as 
a treatment facility pursuant to said act nor to prohibit minors legally ca- 
pable of contracting for medical care from assuming responsibility for 
their discharge. However, in no event shall a patient be detained solely 
for nonpayment of a hospital bill. 

(f) No patient shall be transferred or discharged solely for the purposes 
of effecting a transfer from a hospital to another health facility unless: 

(1) Arrangements have been made in advance for admission to such 
health facility. 

(2) A determination has been made by the patient's physician that such 
a transfer or discharge would not create a medical hazard to the patient. 

(3) The patient or the person legally responsible for the patient has 
been notified, or attempts have been made over the 24-hour period prior 



to the patient's transfer and the legally responsible person cannot be 
reached. 

(g) Minors shall be discharged only to the custody of their parents or 
legal guardians or custodians, unless such parents or guardians shall 
otherwise direct in writing. This provision shall not be construed to pre- 
clude minors legally capable of contracting for medical care from assum- 
ing responsibility for themselves upon discharge. 

(h) Each patient upon admission shall be provided with a wristband 
identification tag or other means of identification unless the patient's 
condition will not permit such identification. Minimum information shall 
include the name of the patient, the admission number and the name of 
the hospital. 

(i) No patients shall be admitted routinely to a distinct part of a hospital 
unless it is appropriate for the level of care required by those patients. 

(j) Patients with critical burns shall be treated in a burn center unless 
transfer of the patient to the burn center is contraindicated in the judg- 
ment of the attending physician. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1285, 1315 and 1316.5, Health and Safety Code. 

History 

1. Amendment of subsection (d) filed 3-13-80; effective thirtieth day thereafter 
(Register 80, No. 11). 

2. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

3. Change without regulatory effect amending subsections (c) and (f)(2) and 
amending Notk filed 3-24-2005 pursuant to section 100, title 1, California 
Code of Regulations (Register 2005, No. 12). 

4. Change without regulatory effect amending subsections (c) and (f)(2) and Note 
filed 4-20-2006 pursuant to section 100, title 1 , California Code of Regulations 
(Register 2006, No. 16). 

§70719. Personnel Policies. 

(a) Each hospital shall adopt written personnel policies concerning 
qualifications, responsibilities and conditions of employment for each 
type of personnel, which shall be available to all personnel. Such policies 
shall include but not be limited to: 

( 1 ) Wage scales, hours of work and all employee benefits. 

(2) A plan for orientation of all personnel to policies and objectives of 
the hospital and for on-the-job training where necessary. 

(3) A plan for at least an annual evaluation of employee performance. 

(b) Personnel policies shall require that employees and other persons 
working in or for the hospital familiarize themselves with these and such 
other regulations as are applicable to their duties. 

(c) Hospitals shall furnish written evidence of a plan for growth and 
development of the hospital staff through: 

( 1 ) Designation of a staff member qualified by training and experience 
who shall be responsible for staff education. 

(2) Reference material relevant to the services provided by the hospital 
which shall be readily accessible to the staff. 

§ 70721 . Employees. 

(a) The hospital shall recruit qualified personnel and provide initial 
orientation of new employees, a continuing in-service training program 
and competent supervision designed to improve patient care and em- 
ployee efficiency. 

(b) If language or communication barriers exist between hospital staff 
and a significant number of patients, arrangements shall be made for in- 
terpreters or for the use of other mechanisms to insure adequate commu- 
nications between patients and personnel. 

(c) The hospital shall designate a member of the staff as a patient dis- 
charge planning coordinator. 

(d) All employees of the hospital having patient contact, including stu- 
dents, interns and residents, shall wear an identification tag bearing their 
name and vocational classification. 

(e) Appropriate employees shall be given training in methods of hospi- 
tal infection control and cardiopulmonary resuscitation. 

(f) Uniform rules shall be established for each classification of em- 
ployees concerning the conditions of employment. A written statement 
of all such rules shall be provided each employee upon commencing em- 
ployment. 



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§ 70723 



• 



§ 70723. Employee Health Examinations and Health 
Records. 

(a) Personnel evidencing signs or symptoms indicating the presence 
of an infectious disease shall be medically screened prior to having pa- 
tient contact. Those employees determined to have infectious potential 
as defined by the Infection Control Committee shall be denied or re- 
moved from patient contact until it has been determined that the individu- 
al is no longer infectious. 

(b) A health examination, performed by a person lawfully authorized 
to perform such an examination, shall be required as a requisite for em- 
ployment and must be performed within one week after employment. 
Written examination reports, signed by the person performing the exami- 
nation, shall verify that employees are able to perform assigned duties. 

( 1 ) Initial examination for tuberculosis shall include a tuberculin skin 
test using the Mantoux method using a 5 Tuberculin Unit dose of PPD 



tuberculin stabilized with Tween-80, the result of which is read and re- 
corded in millimeters of induration. If the result is positive, a chest film 
shall be obtained. A skin test need not be done on a person with a docu- 
mented positive reaction to PPD but a baseline chest X-ray shall be ob- 
tained. 

(2) Policies and Procedures that address the identification, employ- 
ment utilization and medical referral of persons with positive skin tests 
including those who have converted from negative to positive shall be 
written and implemented. 

(3) An annual skin test for tuberculosis shall be performed on those in- 
dividuals with a previously documented negative tuberculin skin test. If 
an individual with a previously documented negative skin test has a sub- 
sequent positive reaction, a chest X-ray shall be obtained. 

(4) Less frequent testing for tuberculosis, but never less than every 
four years, may be adopted as hospital policy when documented in wrii- 



[The next page is 805.] 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 70738 



ing as approved by the Infection Control Committee, the medical staff 
and the health officer of the health jurisdiction in which the facility is lo- 
cated. 

(c) Employee health records shall be maintained by the hospital and 
shall include the records of all required health examinations. Such re- 
cords shall be kept a minimum of three years following termination of 
employment. 

(d) Personnel shall be made aware of recommended vaccinations for 
preventable diseases that can be prevented by vaccination. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1 . Amendment of subsection (b) filed 3-13-80; effective thirtieth day thereafter 
(Register 80, No. 11). 

2. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

3 . Certificate of Compliance as to 6- 1 5-89 order transmitted to OAL on 1 0- 1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

4. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

5. Certificate of Compliance as to 1 1-16-89 order including amendment of sub- 
sections (a), (b) and (d) transmitted to OAL 3-15-90 and filed 4-16-90 (Regis- 
ter 90, No. 17). 

§ 70725. Employee Personnel Records. 

All hospitals shall maintain personnel records of all employees. Such 
records shall be retained for at least three years following termination of 
employment. The record shall include the employee's full name, Social 
Security number, the license or registration number, if any, brief resume 
of experience, employment classification, date of beginning employ- 
ment and date of termination of employment. Records of hours and dates 
worked by all employees during at least the most recent six -month period 
shall be kept on file at the place of employment. 

§ 70727. Job Descriptions. 

Job descriptions detailing the functions of each classification of em- 
ployee shall be written and shall be available to all personnel. 

§ 70729. Advertising. 

No hospital shall make or disseminate any false or misleading state- 
ment or advertise by any manner or means any false claims regarding ser- 
vices provided by the hospital. 

§ 70731 . Alcoholic and/or Tubercular Patients. 

(a) Any licensee who holds out or advertises, by any means, the capa- 
bility of providing specialized treatment of alcoholics and/or tubercular 
patients shall: 

( 1 ) Establish a distinct part for each type of patient treated. 

(2) Obtain Department approval. 

§ 70733. Records and Reports. 

(a) Each hospital shall maintain copies of the following applicable 
documents on file in the administrative offices of the hospital: 

(1) Articles of incorporation or partnership agreement. 

(2) Bylaws or rules and regulations of the governing body. 

(3) Bylaws and rules and regulations of the medical staff. 

(4) Minutes of the meetings of the governing body and the medical 
staff. 

(5) Reports of inspections by local, state and federal agents. 

(6) All contracts, leases and other agreements required by these regu- 
lations. 

(7) Patient admission roster. 

(8) Reports of unusual occurrences for the preceding two years. 

(9) Personnel records. 

(10) Policy manuals. 

(11) Procedure manuals 



(12) Minutes and reports of the hospital Infection Control Committee. 

(13) Any other records deemed necessary for the direct enforcement 
of these regulations by the Department. 

(b) The records and reports mentioned or referred to above shall be 
made available for inspection by any duly authorized officer, employee 
or agent of the Department. 

§ 70735. Annual Reports. 

All hospitals shall submit annual reports to the Department on forms 
supplied by the Department and by the date specified on the form. 

§ 70736. Sterilization Reporting Requirements. 

(a) All hospitals performing tubal ligations, vasectomies, and hyster- 
ectomies shall submit to the Department a quarterly report containing the 
following information: 

( 1 ) The total number of such sterilizations performed, including diag- 
noses and types of procedures employed. 

(2) The number and type of such sterilizations performed by each phy- 
sician on the medical staff preserving the anonymity of the physicians 
and patient. 

(3) Demographic and medical data as required by the Department. 
NOTE: Authority cited: Sections 208. 1275. 1276, Health and Safety Code. Refer- 
ence: Sections 1250 et seq. , Health and Safety Code. 

History 

1. New section filed 5-27-77; effective thirtieth day thereafter (Register 77, No. 

22). 

§ 70737. Reporting. 

(a) Reportable Disease or Unusual Occurrences. All cases of report- 
able diseases shall be reported to the local health officer in accordance 
with Section 2500, Article 1, Subchapter 4, Chapter 4, Title 17, Califor- 
nia Administrative Code. Any occurrence such as epidemic outbreak, 
poisoning, fire, major accident, disaster, other catastrophe or unusual oc- 
currence which threatens the welfare, safety or health of patients, person- 
nel or visitors shall be reported as soon as reasonably practical, either by 
telephone or by telegraph, to the local health officer and to the Depart- 
ment. The hospital shall furnish such other pertinent information related 
to such occurrences as the local health officer or the Department may re- 
quire. 

(b) Testing for Phenylketonuria. Hospitals to which maternity patients 
or infants 30 days of age or under may be admitted shall comply with the 
requirements governing testing for phenylketonuria (PKU) contained in 
Section 6500 of Title 17, California Administrative Code. 

(c) Rhesus (Rh) Hemolytic Disease of the Newborn. Hospitals to 
which maternity patients may be admitted shall comply with the require- 
ments for the determination and reporting of the rhesus (Rh) blood type 
of maternity patients and the reporting of rhesus (Rh) hemolytic disease 
of the newborn contained in Section 65 1 of Title 1 7, California Admin- 
istrative Code. 

(d) Child Placement. Hospitals shall report to the Department on forms 
supplied by them, within 48 hours, the name and address of any person 
other than a parent or relative by blood or marriage, or the name and ad- 
dress of the organization or institution into whose custody a child is given 
on discharge from the hospital. The release of children for adoption shall 
be in conformity with the state law regulating adoption procedure. 

§ 70738. Infant Security. 

Written policies and procedures shall be adopted and implemented to 
accurately identify infants and to protect infants from removal from the 
facility by unauthorized persons. The policies and procedures shall be re- 
viewed and updated by the facility every two years. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. New section filed 1-24-90 as an emergency; operative 1-24-90 (Register 90, 
No. 5). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 5-24-90. 

2. Certificate of Compliance as to 1 -24-90 order transmitted to OAL 5-24-90 and 
filed 6-21-90 (Register 90, No. 33). 



Page 805 



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§ 70739 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§ 70739. Infection Control Program. 

(a) A written hospital infection control program for the surveillance, 
prevention and control of infections shall be adopted and implemented. 
The program shall include policies and procedures that: 

(1) Define and require methods to handle all patients, all blood and 
body fluids and all materials that are soiled with blood and/or body fluids 
from all patients. The methods prescribed shall be designed to reduce the 
risk of transmission of potentially infectious etiologic agents from pa- 
tient to patient and between patient and healthcare worker. The methods 
shall include handwashing, the use of gloves, the use of other barriers, the 
handling of needles/sharps and the disposal of materials that are soiled 
with or contain blood and/or body fluids. 

(2) Define practices to reduce the risk of transmission of airborne in- 
fectious etiologic agents including tuberculosis and addressing the as- 
signment of rooms and/or roommates. 

(3) Provide for and document the education of all personnel. 

(A) Each new employee shall receive training appropriate to his/her 
job classification and work activities to acquaint him/her with infection 
control policies and procedures of the healthcare facility. 

(B) Training material shall be kept current and conform to new infor- 
mation pertaining to the prevention and control of infectious diseases. 
Revised training material shall be presented to all healthcare workers. 

(4) Provide a plan for the surveillance and control of nosocomial infec- 
tions including procedures for the investigation and management of out- 
breaks. 

(5) Define the equipment, instruments, utensils and disposable materi- 
als that are to be identified as biohazardous. 

(b) The oversight of the infection surveillance, prevention and control 
program shall be vested in a multi-disciplinary committee which shall 
include representatives from the medical staff, administration, nursing 
department and infection control personnel. This committee shall pro- 
vide advice on all proposed construction and shall be responsible for the 
provision of current, updated information on infection control policy and 
procedures for the facility. 

(c) Hospitals having a licensed bed capacity of 200 or more shall have 
a full-time infection control employee who shall coordinate the activities 
of the program. 

(d) Hospitals having a licensed bed capacity of 199 or less shall have 
a designated part-time infection control employee who shall coordinate 
activities of the program. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-15-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order including amendment of sub- 
sections (a)-(d) transmitted to OAL 3-15-90 and filed 4-16-90 (Register 90, 

No. 17). 



§ 70741 . Disaster and Mass Casualty Program. 

(a) A written disaster and mass casualty program shall be developed 
and maintained in consultation with representatives of the medical staff, 
nursing staff, administration and fire and safety experts. The program 
shall be in conformity with the California Emergency Plan of October 1 0, 
1972 developed by the State Office of Emergency Services and the Cali- 
fornia Emergency Medical Mutual Aid Plan of March 1974 developed 
by the Office of Emergency Services, Department of Health. The pro- 
gram shall be approved by the medical staff and administration. A copy 
of the program shall be available on the premises for review by the De- 
partment. 



(b) The program shall cover disasters occurring in the community and 
widespread disasters. It shall provide for at least the following: 

(1) Availability of adequate basic utilities and supplies, including gas, 
water, food and essential medical and supportive materials. 

(2) An efficient system of notifying and assigning personnel. 

(3) Unified medical command. 

(4) Conversion of all usable space into clearly defined areas for effi- 
cient triage, for patient observation and for immediate care. 

(5) Prompt transfer of casualties, when necessary and after prelimi- 
nary medical or surgical services have been rendered, to the facility most 
appropriate for administering definite care. 

(6) A special disaster medical record, such as an appropriately de- 
signed tag, that accompanies the casualty as he is moved. 

(7) Procedures for the prompt discharge or transfer of patients already 
in the hospital at the time of the disaster who can be moved without jeop- 
ardy. 

(8) Maintaining security in order to keep relatives and curious persons 
out of the triage area. 

(9) Establishment of a public information center and assignment of 
public relations liaison duties to a qualified individual. Advance arrange- 
ments with communications media will be made to provide organized 
dissemination of information. 

(c) The program shall be brought up-to-date, at least annually, and all 
personnel shall be instructed in its requirements. There shall be evidence 
in the personnel files, e.g., orientation checklist or elsewhere, indicating 
that all new employees have been oriented to the program and procedures 
within a reasonable time after commencement of their employment. 

(d) The disaster plan shall be rehearsed at least twice a year. There shall 
be a written report and evaluation of all drills. The actual evacuation of 
patients to safe areas during the drill is optional. 

§ 70743. Fire and Internal Disasters. 

(a) A written fire and internal disaster program, incorporating evacua- 
tion procedures, shall be developed with the assistance of fire, safety and 
other appropriate experts. A copy of the program shall be available on the 
premises for review by the Department. 

(b) The written program shall include at least the following: 

(1) Plans for the assignment of personnel to specific tasks and respon- 
sibilities. 

(2) Instructions relating to the use of alarm systems and signals. 

(3) Information concerning methods of fire containment. 

(4) Systems for notification of appropriate persons. 

(5) Information concerning the location of fire fighting equipment. 

(6) Specification of evacuation routes and procedures. 

(7) Other provisions as the local situation dictates. 

(c) Fire and internal disaster drills shall be held at least quarterly for 
each shift of hospital personnel and under varied conditions. The actual 
evacuation of patients to safe areas during a drill is optional. 

(d) The evacuation plan shall be posted throughout the facility and 
shall include at least the following: 

(1) Evacuation routes. 

(2) Location of fire alarm boxes. 

(3) Location of fire extinguishers. 

§ 70745. Fire Safety. 

All hospitals shall be maintained in conformity with the regulations 
adopted by the State Fire Marshal for the prevention of fire and for the 
protection of life and property against fire and panic. All hospitals shall 
secure and maintain a clearance relative to fire safety from the State Fire 
Marshal. 

§ 70746. Disruption of Services. 

(a) Each hospital shall develop a written plan to be used when a discon- 
tinuance or disruption of services occurs. 

(b) The administrator shall be responsible for informing the Depart- 
ment, via telephone, immediately upon being notified of the intent of the 
discontinuance or disruption of services or upon the threat of a walkout 



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§ 70751 



of a substantial number of employees, or earthquake, fire, power outage 
or other calamity that causes damage to the facility or threatens the safety 
or welfare of patients or clients. 

§ 70747. Medical Records Service. 

(a) The hospital shall maintain a medical record service which shall be 
conveniently located and adequate in size and equipment to facilitate the 
accurate processing, checking, indexing and filing of all medical records. 

(b) The medical records service shall be under the supervision of a reg- 
istered records administrator or accredited records technician. The regis- 
tered record administrator or accredited record technician shall be as- 
sisted by such qualified personnel as are necessary for the conduct of the 
service. 

§ 70749. Patient Health Record Content. 

(a) Each inpatient medical record shall consist of at least the following 
items: 

(1) Identification sheets which include but are not limited to the fol- 
lowing: 

(A) Name. 

(B) Address on admission. 

(C) Identification number (if applicable). 

1 . Social Security. 

2. Medicare 

3. Medi-Cal 

(D) Age. 

(E) Sex. 

(F) Martial status. 

(G) Religion. 

(H) Date of admission. 

(1) Date of discharge. 

(J ) Name, address and telephone number of person or agency responsi- 
ble for patient. 

(K) Name of patient's admitting physician. 
(L) Initial diagnostic impression. 
(M) Discharge or final diagnosis. 

(2) History and physical examination. 

(3) Consultation reports. 

(4) Order sheet including medication, treatment and diet orders. 

(5) Progress notes including current or working diagnosis. 

(6) Nurses' notes which shall include but not be limited to the follow- 
ing: 

(A) Concise and accurate record of nursing care administered. 

(B) Record of pertinent observations including psychosocial and 
physical manifestations as well as incidents and unusual occurrences, 
and relevant nursing interpretation of such observations. 

(C) Name, dosage and time of administration of medications and treat- 
ment. Route of administration and site of injection shall be recorded if 
other than by oral administration. 

(D) Record of type of restraint and time of application and removal. 
The time of application and removal shall not be required for soft tie re- 
straints used for support and protection of the patient. 

(7) Vital sign sheet. 

(8) Reports of all laboratory tests performed. 

(9) Reports of all X-ray examinations performed. 

(10) Consent forms, when applicable. 

(11) Anesthesia record including preoperative diagnosis, if anesthesia 
has been administered. 

(12) Operative report including preoperative and postoperative diag- 
nosis, description of findings, technique used, tissue removed or altered, 
if surgery was performed. 

(13) Pathological report, if tissue or body fluid was removed. 

( 14) Labor record, if applicable. 

(15) Delivery record, if applicable. 



(16) A discharge summary which shall briefly recapitulate the signifi- 
cant findings and events of the patient's hospitalization, his condition on 
discharge and the recommendations and arrangements for future care. 
NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Amendment filed 3-13-80; effective thirtieth day thereafter (Register 80, 

No. 11). 

§ 70751. Medical Record Availability. 

(a) Records shall be kept on all patients admitted or accepted for treat- 
ment. All required patient health records, either as originals or accurate 
reproductions of the contents of such originals, shall be maintained in 
such form as to be legible and readily available upon the request of: 

( 1 ) The admitting physician. 

(2) The nonphysician granted privileges pursuant to Section 70706. 1. 

(3) The hospital or its medical staff or any authorized officer, agent or 
employee of either. 

(4) Authorized representatives of the Department. 

(5) Any other person authorized by law to make such a request. 

(b) The medical record, including X-ray films, is the property of the 
hospital and is maintained for the benefit of the patient, the medical staff 
and the hospital. The hospital shall safeguard the information in the re- 
cord against loss, defacement, tampering or use by unauthorized persons. 

(c) Patient records including X-ray films or reproduction thereof shall 
be preserved safely for a minimum of seven years following discharge 
of the patient, except that the records of unemancipated minors shall be 
kept at least one year after such minor has reached the age of 1 8 years and, 
in any case, not less than seven years. 

(d) If a hospital ceases operation, the Department shall be informed 
within 48 hours of the arrangements made for safe preservation of patient 
records as above required. 

(e) If ownership of a licensed hospital changes, both the previous li- 
censee and the new licensee shall, prior to the change of ownership, pro- 
vide the Department with written documentation that: 

(1) The new licensee will have custody of the patients' records upon 
transfer of the hospital and that the records are available to both the new 
and former licensee and other authorized persons; or 

(2) Arrangements have been made for the safe preservation of patient 
records, as above required, and that the records are available to both the 
new and former licensees and other authorized persons. 

(f) Medical records shall be filed in an easily accessible manner in the 
hospital or in an approved medical record storage facility off the hospital 
premises. 

(g) Medical records shall be completed promptly and authenticated or 
signed by a physician, dentist or podiatrist within two weeks following 
the patient's discharge. Medical records may be authenticated by a signa- 
ture stamp or computer key, in lieu of a physician's signature, only when 
that physician has placed a signed statement in the hospital administra- 
tive offices to the effect that he is the only person who: 

(1) Has possession of the stamp or key. 

(2) Will use the stamp or key. 

(h) Medical records shall be indexed according to patient, disease, op- 
eration and physician. 

(i) By July 1, 1976 a unit medical record system shall be established 
and implemented with inpatient, outpatient and emergency room records 
combined. 

(j) The medical record shall be closed and a new record initiated when 
a patient is transferred to a different level of care within a hospital which 
has a distinct part skilled nursing or intermediate care service. 
NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Amendment of subsection (a) filed 3-13-80; effective thirtieth day thereafter 

(Register 80, No. 11). 



Page 807 



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§ 70753 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§ 70753. Transfer Summary. 

A transfer summary shall accompany the patient upon transfer to a 
skilled nursing or intermediate care facility or to the distinct part skilled 
nursing or intermediate care service unit of the hospital. The transfer 
summary shall include essential information relative to the patient's 
diagnosis, hospital course, medications, treatments, dietary requirement, 
rehabilitation potential, known allergies and treatment plan and shall be 
signed by the physician. 

§ 70754. Special Hospital Transfer Agreement. 

A special hospital shall have an effective written agreement with a 
general acute care hospital in the same geographic area for the provision 
of surgical and anesthesia services and any other service which may be 
required and which the special hospital does not provide. 
NOTE: Authority cited: Section 208 and 1 250, Health and Safety Code. Reference: 
ACR 67, Chapter 83, Statutes of 1977. 

History 
1. New section filed 7-28-78; effective thirtieth day thereafter (Register 78, No. 

30). 



§ 70755. Patients' Monies and Valuables. 

(a) No licensee shall use patients' monies or valuables as his own or 
mingle them with his own. Patients' monies and valuables shall be sepa- 
rate, intact and free from any liability the licensee incurs in the use of his 
own or the institutions' funds and valuables. 

(b) Each licensee shall maintain adequate safeguards and accurate re- 
cords of patients' monies and valuables entrusted to his care. 

( 1 ) Records of patients' monies which are maintained as a drawing ac- 
count shall include a control account for all receipts and expenditures, an 
account for each patient and supporting vouchers filed in chronological 
order. Each account shall be kept current with columns for debits, credits 
and balance. 

(2) Records of patients' monies and other valuables entrusted to the 
licensee for safekeeping shall include a copy of the receipt furnished to 
the patient or to the person responsible for the patient. 

(c) Patients' monies not kept in the hospital shall be deposited in a de- 
mand trust account in a local bank authorized to do business in California, 
the deposits of which are insured by the Federal Deposit Insurance Cor- 
poration. A county hospital may deposit such funds with the county trea- 
surer. 

(d) When the amount of money entrusted to a licensee for patients ex- 
ceeds $500, all money in excess of $500 shall be deposited in a demand 
trust account as specified in (c) above, unless a fireproof safe is provided 
on the premises for the protection of monies and valuables. If a fireproof 
safe is kept and the licensee desires the protection accorded by Civil Code 
Section 1860, he shall give notice as provided by that section. 

(e) Upon discharge of the patient, all refunds due and all money and 
valuables of that patient which have been entrusted to the licensee shall 
be surrendered to the patient or the person responsible for the patient in 
exchange for a signed receipt. Money and valuables kept within the hos- 
pital must be surrendered upon demand and those kept in a demand trust 
account or with the county treasurer must be made available within three 
normal banking days. 

(f) Following the death of a patient, except in a coroner or medical ex- 
aminer' s case, all money and valuables of that patient which have been 
entrusted to the licensee shall be surrendered to the person responsible 
for the patient, the executor or the administrator of the estate in exchange 
for a signed receipt, within 30 days. Immediate written notice of the death 
of a patient without an agent or known heirs shall be given to the public 
administrator of the county as specified by Section 1 145 of the Probate 
Code. 

(g) Upon change of ownership of a hospital, a written verification by 
a public accountant of all patients' monies which are being transferred 
to the custody of the new owners shall be obtained by the new owner in 
exchange for a signed receipt. 



§ 70757. First Aid and Referrals. 

(a) If a hospital does not maintain an emergency medical service, its 
employees shall exercise reasonable care to determine whether an emer- 
gency exists, render necessary lifesaving first aid and shall direct the per- 
sons seeking emergency care to the nearest hospital which can render the 
needed services and shall assist the persons seeking emergency care in 
obtaining such services, including transportation services, in every way 
reasonable under the circumstances. 

(b) Hospitals not providing emergency medical service shall not ad- 
vertise or make any other representation to the public that may convey 
or connote the availability of such service. The posting of signs to desig- 
nate entrances for use by outpatients and ambulances such as ambulance 
entrance, referred patients, outpatient service or other words of similar 
connotation is not prohibited. Such hospitals may represent to the public 
in any form or manner and only in its entirety, the phrase first aid and re- 
ferral service. 

§ 70759. Exercise Stress Testing. 

Where exercise stress testing is performed, there shall be appropriate 
monitoring and resuscitative equipment and persons trained in cardio- 
pulmonary resuscitative techniques physically present. 

§ 70761 . Medical Library. 

(a) Each hospital shall maintain a medical library consistent with the 
needs of the hospital. 

(b) The medical library shall be located in a convenient location, and 
its contents shall be organized, easily accessible and available through 
authorized personnel at all times. 

(c) The library shall contain modern textbooks in basic sciences and 
other current textbooks, journals and magazines pertinent to the clinical 
services maintained in the hospital. 

§ 70763. Medical Photography. 

The hospital shall have a policy regarding the obtaining of consent for 
medical photography. 

§ 70765. Conference Room. 

Suitable space for conferences shall be provided in the hospital. 

Article 8. Physical Plant 

§ 70801 . Alterations to Existing Buildings or New 
Construction. 

(a) Alterations to existing buildings licensed as hospitals or new con- 
structions shall be in conformance with Chapter 1, Division T17, Part 6, 
Title 24, California Administrative Code. 

(b) Hospitals licensed and in operation prior to the effective date of 
changes in these regulations shall not be required to institute corrective 
alterations or construction to comply with such changes except where 
specifically required or where the Department determines that a definite 
hazard to health and safety exists. Any hospital for which preliminary or 
working drawings and specifications have been approved by the Depart- 
ment prior to the effective date of changes to these regulations shall not 
be required to comply with such changes provided substantial, actual 
construction is commenced within one year after the effective date of 
such changes. 

§ 70803. Application for Architectural Plan Review. 

(a) Drawings and specifications for alterations to existing buildings or 
new construction shall be submitted to the Department for approval and 
shall be accompanied by an application for plan review on forms fur- 
nished by the Department. The application shall: 

( 1 ) Identify and describe the work to be covered by the plan review for 
which the application is made. 

(2) Describe the land on which the proposed work is to be done, by lot, 
block, tract or house and street address or similar description that will 
readily identify and definitely locate the proposed building or work. 

(3) Show the present and proposed use or occupancy of all parts of the 
building or buildings. 



Page 808 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70825 



(4) State the number of square meters (feet) of floor area involved in 
new construction and in alterations. 

(5) Give such other information as may be required by the Department 
for unusual design circumstances. 

(6) Be signed by the person designing the work or the owner of the 
work. 

(b) The application for plan review shall also include a written state- 
ment that a description of the proposed work has been submitted to the 
Area Comprehensive Health Planning Agency approved by the State Ad- 
visory Health Council pursuant to Section 437.7 of the Health and Safety 
Code. 

§ 70805. Space Conversion. 

Spaces approved for specific uses at the time of licensure shall not be 
converted to other uses without the written approval of the Department. 

§ 70807. Notice to Department. 

The licensee shall notify the Department in writing not later than ten 
days after the date when construction of a new hospital is commenced or 
when construction involving an increase in bed capacity or change of ser- 
vices of an existing hospital is commenced. 

§ 70809. Patient Accommodations. 

(a) No hospital shall have more patients or beds set up for overnight 
use by patients than the approved licensed bed capacity except in the case 
of justified emergency when temporary permission may be granted by 
the Director or his designee. Beds not used for overnight stay such as la- 
bor room beds, recovery beds, beds used for admission screening or beds 
used for diagnostic purposes in X-ray or laboratory departments are not 
included in the approved licensed bed capacity. 

(b) Five percent of a facility's total licensed bed capacity may be used 
for a classification other than that designated on the license. Upon appli- 
cation to the Director and a showing that seasonal fluctuations justify, the 
Director may grant the use of an additional five percent of the beds for 
other than the classified use. 

(c) Patients shall not be housed in areas which have not been approved 
by the Department for patient housing and which have not been granted 
a fire clearance by the State Fire Marshal, except as provided in para- 
graph (a) above. 

(d) The number of licensed beds shown on a license shall not exceed 
the number of beds for which the facility meets applicable construction 
and operational requirements. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 7081 1 . Patient Rooms. 

(a) Patients shall be accommodated only in rooms with the following 
minimum floor area: 

(1) Single rooms: 10.2 square meters (1 10 square feet) of floor area, 
except for private rooms in pediatric units which shall have at least 9.3 
square meters (100 square feet). 

(2) Multi-patient rooms: 7.4 square meters (80 square feet) of floor 
area per bed with one meter (three feet) between beds, except in special- 
ized units. 

(b) Each patient room shall be labeled with a number, letter or combi- 
nation of the two for identification. 

(c) Patient rooms which are approved for ambulatory patients only 
shall not accommodate nonambulatory patients. Before patients are ac- 
commodated in ambulatory sections, they shall demonstrate that they are 
ambulatory, and this shall be noted in the patient's medical record. The 
hospital shall transfer patients from the ambulatory section when their 
condition becomes nonambulatory. The ambulatory status of patients 
shall be demonstrated upon request of the Department. 

(d) Patient rooms approved for use by ambulatory patients only shall 
be identified as follows: the words Reserved for Ambulatory Patients, in 
letters at least one and one-half centimeters (one-half inch) high shall be 



posted on the outside of the door or on the wall alongside the door where 
they are visible to persons entering the room. 

(e) Except in rooms approved by the Department for detention and for 
psychiatric patients, patients' rooms shall not be kept locked when occu- 
pied. 

(f) Any exit door, corridor or perimeter fence may be locked for egress 
only upon the written approval of the Department. 

§ 70813. Patient Property Storage. 

Patients shall be provided with closet or locker space for clothing, toi- 
let articles and other personal belongings. Bedside tables or the equiva- 
lent shall be provided for each patient. 

§ 70815. Patient Room Furnishings. 

A bed with a suitable mattress and a chair shall be provided for each 
patient. In hospitals all beds, except cribs and bassinets, shall be adjust- 
able. 

§ 70817. Provisions for Emptying Bedpans. 

Bedpans shall be emptied and cleaned in utility rooms or in toilets ad- 
joining patients' rooms when such toilets are equipped with flushing at- 
tachments and vacuum breakers. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 1 0-1 3-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 120 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 7081 9. Provision for Privacy. 

A method of assuring visual privacy for each patient shall be main- 
tained in patient rooms and in tub, shower and toilet rooms. 

§ 70821 . Public Telephone. 

Each floor accommodating patients shall have a telephone installed 
for patient use. Such telephones shall be readily accessible to patients 
who are limited to wheel chairs and stretchers. This may not be required 
in separate buildings having six (6) or fewer beds which are restricted to 
occupancy by ambulatory patients. 

§ 70823. Isolation Facilities. 

A private room shall be available for any patient in need of physical 
separation as defined by the infection control committee. Private toilet 
facilities shall be immediately adjacent to this room. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-15-89 order transmitted to OAL on 1 0-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-1 5-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70825. Laundry Service. 

(a) Laundry and linen. 

(1) An adequate supply of clean linen shall be provided for at least 
three complete bed changes for the hospital's licensed bed capacity. 

(2) There shall be written policies and procedures developed and im- 
plemented pertaining to the handling, storage, transportation and pro- 
cessing of linens. 



Page 809 



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§ 70827 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(3) If the hospital operates its own laundry, such laundry shall be: 

(A) Located in such relationship to other areas that steam, odors, lint 
and objectionable noises do not reach patient or personnel areas. 

(B) Well-lighted and ventilated and adequate in size for the needs of 
the hospital and for the protection of employees. 

(C) Maintained in a sanitary manner and kept in good repair. 

(D) Not part of a storage area. 

(4) Hospital linens shall be washed according to the following method: 
All linens shall be washed using an effective soap or detergent and 

thoroughly rinsed to remove soap or detergent and soil. Linens shall be 
exposed to water at a minimum temperature of 7 1 °C ( 1 60°F) for at least 
24 minutes during the washing process. 

(5) Separate rooms shall be maintained in the hospital for storage of 
clean linen and for storage of soiled linen. Linen storage rooms shall not 
be used for any other purpose. Storage shall not be permitted in attic 
spaces, corridors or plenums (air distribution chambers) of air condition- 
ing or ventilating systems. 

(6) Handwashing and toilet facilities for laundry personnel shall be 
provided at locations convenient to the laundry. 

(7) Soiled and clean linen carts shall be so labeled and provided with 
covers made of washable materials which shall be laundered or suitably 
cleaned daily. Linen carts used for the storage or transportation of dirty 
linen shall be washed before being used for the storage and transportation 
of clean linen. 

(8) If the hospital does not maintain a laundry service, the commercial 
laundry utilized shall meet the standards of this section. 

(b) Soiled linen. 

( 1 ) Soiled linen shall be handled, stored and processed in a safe manner 
that will prevent the spread of infection and will assure the maintenance 
of clean linen. 

(2) Policies and procedures shall be developed and implemented per- 
taining to linen soiled with chemotherapeutic agents or radioactive sub- 
stances. 

(3) Soiled linen shall be sorted in a separate enclosed room by a person 
instructed in methods of protection from contamination. This person 
shall not have responsibility for immediately handling clean linen until 
protective attire worn in the soiled linen area is removed and hands are 
washed. 

(4) Soiled linen shall be bagged or covered for transport. 

(5) If chutes are used for transporting soiled linen, the chutes shall be 
maintained in a clean, sanitary state. 

(c) Clean linen. 

(1) Persons processing clean linen shall be dressed in clean garments 
at all times while on duty shall not handle soiled linen. 

(2) Clean linen from a commercial laundry shall be delivered to the 
hospital completely wrapped and delivered to a designated clean area. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (a) filed 10-15-85; effective thirtieth day thereafter 
(Register 85, No. 42). 

2. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

3 . Certificate of Compliance as to 6- 1 5-89 order transmitted to OAL on 1 0- 1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

4. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 120 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

5. Certificate of Compliance as to 11-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 



§ 70827. Housekeeping. 

(a) Each hospital shall make provision for the routine cleaning of ar- 
ticles and surfaces such as furniture, floors, walls, ceilings, supply and 
exhaust grills and lighting fixtures with a detergent/disinfectant. 



(b) There shall be written policies and procedures developed and im- 
plemented to include but not be limited to the following: 

(1) Cleaning of occupied patient areas, nurses' stations, work areas, 
halls, entrances, storage areas, rest rooms, laundry, pharmacy, offices, 
etc. 

(2) Cleaning of specialized areas such as nursery, operating and deliv- 
ery rooms. 

(3) Cleaning of isolation areas. 

(4) Cleaning of kitchen and associated areas. 

(5) Cleaning of walls and ceilings. 

(6) Terminal cleaning of patient unit upon discharge of patient. 

(c) Housekeeping cleaning supplies and equipment provided. 

(d) Housekeeping personnel shall maintain the interior of the hospital 
in a safe, clean, orderly, attractive manner free from offensive odors. One 
person shall be designated to be in charge of the housekeeping service. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 1 0-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 120 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70829. Morgue. 

(a) Hospitals with a licensed bed capacity of 50 or more shall maintain 
a well-ventilated morgue with autopsy facilities unless adequate morgue 
and autopsy facilities are available in the local community. 

(b) Hospitals with a licensed bed capacity of 100 or more shall main- 
tain a well-ventilated morgue with autopsy facilities. 

(c) Refrigerated compartments shall be maintained if human remains 
are held unembalmed. The air temperature shall not be higher than 7°C 
(45°F). 

§ 70831 . Central Sterile Supply. 

(a) Each hospital shall provide, prepare, sterilize and store sufficient 
sterile supplies and medical and surgical equipment and shall dispense 
them to all services in the hospital. The operation of this service shall be 
carried out in an area designated, equipped and staffed for this purpose. 

(b) A person shall be designated to be in charge of the central sterile 
supply. 

(c) There shall be written procedures developed and maintained per- 
taining to the cleaning, preparation, disinfection and sterilization of uten- 
sils, instruments, solutions, dressings and other articles. 

(d) There shall be effective separation of soiled or contaminated sup- 
plies and equipment from the clean and sterilized supplies and equip- 
ment. 

(e) Sterile supplies and equipment shall be stored in clean cabinets, 
cupboards or other satisfactory spaces. An orderly system of rotation of 
supplies shall be used so that supplies stored first will be used first. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 6-15-89 as an emergency; operative 6-15-89 (Register 89, 
No. 25). A Certificate of Compliance must be transmitted to OAL within 120 
days or emergency language will be repealed on 10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Amendment refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 
89, No. 46). A Certificate of Compliance must be transmitted to OAL within 1 20 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 



Page 810 



Register 90, Nos. 32-37; 9-14-90 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70845 



§ 70833. Autoclaves and Sterilizers. 

(a) Autoclaves and sterilizers shall be maintained in operating condi- 
tion at all times. 

(b) Instructions for operating autoclaves and sterilizers shall be posted 
in the area where the autoclaves and sterilizers are located. 

(c) Written procedures shall be developed, maintained and available 
to personnel responsible for sterilization of supplies and equipment that 
include, but are not limited to the following: 

( 1 ) Time, temperature and pressure for sterilizing the various bundles, 
packs, dressings, instruments, solutions, etc. 

(2) Cleaning, packaging, storing and issuance of supplies and equip- 
ment. 

(3) Dating and outdating of materials sterilized. 

(4) Loading of the sterilizer. 

(5) Daily checking of recording and indicating thermometers and fil- 
ing for one year of recording thermometer charts. 

(6) Monthly bacteriological test, the bacterial organism used and filing 
for one year of the test results. 

(7) Length of aeration time for materials gas-sterilized. 

§ 70835. Disinfecting. 

NOTE: Authority cited: Sections 208 (a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Repealer flied 6-15-89 as an emergency; operative 6-15-89 (Register 89, No. 
25). A Certificate of Compliance must be transmitted to OAL within 120 days 
or the section will be reinstated as it existed prior to the emergency on 
10-13-89. 

2. Certificate of Compliance as to 6-1 5-89 order transmitted to OAL on 10-1 3-89 
and disapproved by OAL on 1 1-13-89 (Register 89, No. 46). 

3. Repealer refiled 1 1-16-89 as an emergency; operative 1 1-16-89 (Register 89, 
No. 46). A Certificate of Compliance must be transmitted to OAL within 120 
days or the section will be reinstated as it existed prior to the emergency on 
3-16-90. 

4. Certificate of Compliance as to 1 1-16-89 order transmitted to OAL 3-15-90 
and filed 4-16-90 (Register 90, No. 17). 

§ 70837. General Safety and Maintenance. 

(a) The hospital shall be clean, sanitary and in good repair at all times. 
Maintenance shall include provision and surveillance of services and 
procedures for the safety and well-being of patients, personnel and visi- 
tors. 

(b) Hospital buildings and grounds shall be maintained free of such en- 
vironmental pollutants and such nuisances as may adversely affect the 
health or welfare of patients to the extent that such conditions are within 
the reasonable control of the hospital. 

(c) All hospitals shall maintain in operating condition all buildings, 
fixtures and spaces in the numbers and types as specified in construction 
requirements under which the hospital or unit was first licensed. 

(d) A written manual on maintenance of heating, air conditioning and 
ventilation systems shall be adopted by each hospital and a maintenance 
log shall be maintained. 

(e) Equipment provided must meet any and all applicable California 
Occupational Safety and Health Act requirements in effect as of the time 
of purchase. All portable electrical equipment using 110-120 volt 60 
hertz current shall be equipped with a three-wire grounded power cord 
with an Underwriters Laboratories approved hospital grade three-prong 
plug. The cord grip shall be an integral part of the plug. 

(f) All gauging and measuring equipment shall be regularly calibrated 
as specified by the manufacturer and records of such testing kept for at 
least two years. 

§ 70839. Air Filters. 

(a) The licensee shall be responsible for regular inspection, cleaning 
or replacement of all filters installed in heating, air conditioning and ven- 
tilating systems, as necessary to maintain the systems in normal operat- 
ing condition. The efficiency of the replacement filters shall be equal to 
the efficiency rating of the replaced filters. 



(b) A written record of inspection, cleaning or replacement including 
static pressure drop shall be regularly maintained and available for in- 
spection. The record shall include a description of the filters originally 
installed, the American Society of Heating, Refrigeration and Air Condi- 
tioning Engineers (ASHRAE) atmospheric dust spot test efficiency rat- 
ing and the criteria established by the manufacturer or supplier to deter- 
mine when replacement or cleaning is necessary. 

(c) Following filter replacement or cleaning, the installation shall be 
visually inspected for torn media and bypass in filter frames by means of 
a flashlight or equivalent, both with fans in operation and stopped. Tears 
in filter media and bypass in filter frames shall be eliminated in accor- 
dance with the manufacturer's directions and as required by the Depart- 
ment. 

(d) Where filter maintenance is performed by an equipment service 
company, a certification shall be provided to the licensee that the require- 
ments listed in Section 70839 (a) and (b) have been accommodated. 

(e) If filter maintenance as required in Section 70839 (a) and (b) is per- 
formed by employees of the hospital, a written record shall be maintained 
by the licensee. 

§ 70841 . Emergency Lighting and Power System. 

(a) Auxiliary lighting and power facilities shall be readily available at 
all times. 

(1) The emergency lighting and power system shall be maintained in 
operating condition to provide automatic restoration of power for emer- 
gency circuits within ten seconds after normal power failure. 

(2) Emergency generators installed in hospitals shall be tested under 
load conditions for at least 30 minutes at intervals of not more than 7 days. 

(b) The licensee shall provide and maintain an emergency electrical 
system in compliance with Section E702-7 and E702-20, Part 3, Title 
24, California Administrative Code. The system shall serve all lighting, 
signals, alarms and equipment required to permit continued operation of 
all necessary functions of the hospital for a minimum of 24 hours. 

(c) The Department may require the licensee to submit a report of eval- 
uation of the emergency electrical system by a registered electrical engi- 
neer to substantiate compliance with Subarticle E702-7, Part 3, Title 24, 
California Administrative Code. Essential engineering data, including 
load calculations, assumptions and tests and, where necessary, plans and 
specifications acceptable to the Department shall be included in the re- 
port. 

(d) Where alteration of the emergency electrical system is determined 
to be necessary, the work shall comply with Sections E702-20 and 
E702-24, Part 3, Title 24, California Administrative Code. 

(e) A written record of inspection, performance, exercising period and 
repairs shall be maintained and available. 

§ 70843. Storage and Disposal of Solid Wastes. 

(a) Solid wastes shall be stored and eliminated in a manner to preclude 
the transmission of communicable disease. These wastes shall not be a 
nuisance or a breeding place for insects or rodents nor be a food source 
for either. 

(b) Solid waste containers shall be stored and located in a manner that 
will protect against odors. 

(c) Syringes and needles shall be disposed of safely as biohazardous 
waste in puncture proof containers. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Certificate of Compliance as to 11-16-89 order including amendment of sub- 
section (c) transmitted to OAL 3-15-90 and filed 4-16-90 (Register 90, No. 
17). 

§ 70845. Solid Waste Containers. 

(a) All containers, except movable bins used for storage of solid 
wastes, shall have tight-fitting covers in good repair, external handles 
and be leakproof and rodent proof. 



Page 811 



Register 90, Nos. 32-37; 9-14-90 



§ 70847 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(b) Movable bins, when used for storing or transporting solid wastes 
from the premises, shall have approval of the local health department and 
meet the following requirements: 

( 1 ) Have tight-fitting covers. 

(2) Be in good repair. 

(3) Be leakproof. 

(4) Be rodent proof unless stored in a room or screened enclosure. 

(c) All containers receiving putrescible wastes shall be emptied at least 
every four days, or more often if necessary. 

(d) Solid waste containers, including movable bins, shall be thorough- 
ly washed and cleaned each time they are emptied unless soil contact sur- 
faces have been completely protected from contamination by disposable 
liners, bags or other devices removed with the waste. Each movable bin 
should provide for suitable access and a drainage device to allow com- 
plete cleaning at the storage area. 

NOTE: Authority cited: Sections 208(a) and 1 254, Health and Safety Code. Refer- 
ence: Sections 1250, 1275 and 25157.3. Health and Safety Code. 

History 

1 . Repealer of subsection (e) filed 12-30-83 as an emergency; effective upon fil- 
ing (Register 84, No. 3). A Certificate of Compliance must be transmitted to 
OAL within 120 days or emergency language will be repealed on 4-29-84. 

2. Certificate of Compliance transmitted to OAL 4-30-84 and withdrawn 
5-30-84 (Register 84. No. 24). 

3. Repealer of subsection (e) filed 5-30-84 as an emergency; effective upon filing 
(Register 84, No. 24). A Certificate of Compliance must be transmitted to OAL 
within 120 days or emergency language will be repealed on 9-27-84. 

4. Certificate of Compliance transmitted to OAL 9-26-84 and filed 10-16-84 
(Register 84, No. 42). 

§ 70847. Infectious Waste. 

Infectious waste, as defined in Health and Safety Code Section 
25 1 1 7.5, shall be handled and disposed of in accordance with the Hazard- 
ous Waste Control Law, Chapter 6.5, Division 20, Health and Safety 
Code (beginning with Section 25 100) and the regulations adopted there- 
under (beginning with Section 66100 of this Title). 
NOTE: Authority cited: Sections 208, 1254, 25150 and 25157.3, Health and Safety 
Code. Reference: Sections 1250, 251 17 and 251 17.5, Health and Safety Code. 

History 

1 . Repealer and new section filed 1 2-30-83 as an emergency; effective upon filing 
(Register 84, No. 3). A Certificate of Compliance must be transmitted to OAL 
within 120 days or emergency language will be repealed on 4-29-84. 

2. Certificate of Compliance transmitted to OAL 4-30-84 and withdrawn 
5-30-84 (Register 84, No. 24). 

3. Repealer and new section filed 5-30-84 as an emergency; effective upon filing 
(Register 84, No. 24). A Certificate of Compliance must be transmitted to OAL 
within 1 20 days or emergency language will be repealed on 9-27-84. 

4. Certificate of Compliance transmitted to OAL 9-26-84 and filed 10-16-84 
(Register 84, No. 42). 

§ 70849. Gases for Medical Use. 

(a) Provision shall be made for safe handling and storage of medical 
gas cylinders. 

(b) Transfer of gas by hospital personnel from one cylinder to another 
is prohibited except when approved by the Department. 

(c) Gases for medical use include carbon dioxide, cyclopropane, ethy- 
lene, helium, nitrous oxide, oxygen, helium-oxygen mixtures and car- 
bon dioxide-oxygen mixtures. 

(d) All anesthesia machines and related equipment shall be so con- 
structed that connections for different gases are not interchangeable. 

This requirement shall be accomplished by installing permanent fit- 
tings as indicated below: 

(1) Yoke connections of anesthesia machines and flush outlet valves 
for small compressed gas cylinders (Style E and smaller) shall conform 
with the pin index safety system contained in pamphlet B57.1 Com- 
pressed Gas Cylinder Valve Outlet and Inlet Connections, 1965 Edition, 
by the American National Standards Institute, Inc., 1430 Broadway, New 
York, NY 10018. 

(2) Valve outlet connections for large cylinders (Style F and larger) for 
oxygen and nitrous oxide shall conform with the standards contained in 
pamphlet B57. 1 , Compressed Gas Cylinder Valve Outlet and Inlet Con- 



nections, 1965 Edition, by the American National Standards Institute, 
Inc., 1430 Broadway, New York, NY 10018. Standard connection No. 
540 shall be used with oxygen cylinders and standard connection No. 
1320 shall be used with nitrous oxide cylinders. Cylinders for medical 
gases, other than oxygen and nitrous oxide, used with anesthesia ma- 
chines shall be limited to Style E and smaller. 

(3) Removable exposed threaded connections, where employed in 
medical gas piping systems and equipment used in conjunction with re- 
suscitators and oxygen therapy apparatus, shall be provided with nonin- 
terchangeable connections which conform with pamphlet V-5, Diame- 
ter-Index Safety System. May 1970 printing, by the Compressed Gas 
Association, Inc., 500 Fifth Avenue, New York, NY 10036. 

(4) Station outlets from piped oxygen and nitrous oxide systems shall 
conform with the standards contained in bulletin NFPA No. 56°F, Non- 
flammable Medical Gas Systems, 1973, by the National Fire Protection 
Association, 470 Atlantic Avenue, Boston, MA 02210. 

(5) Removable connection hoses from station outlets or cylinders to 
yokes of anesthesia machines shall be fitted with permanently connected 
fittings to match the standards listed above in paragraphs ( 1 ), (2), (3) and 
(4). 

(e) The piped oxygen or nitrous oxide system(s) shall be tested in ac- 
cordance with the National Fire Protection Association Bulletin NFPA 
No. 56F, referred to above, and a written report shall be maintained in 
each of the following instances: 

(1) Upon completion of initial installation. 

(2) Whenever changes are made to a system. 

(3) Whenever the integrity of a system has been breached. 

(4) At least annually. 

(f) Oxygen Equipment. 

(1) Vaporizer bottles shall be sterilized after each use. 

(2) Only sterile fluids shall be used in vaporizer bottles. 

(3) Vaporizer bottles shall be changed at least every 24 hours. 

§70851. Lighting. 

(a) All rooms, attics, basements, passageways and other spaces shall 
be illuminated. 

(b) Adequate illumination shall be maintained for the comfort of pa- 
tients and personnel. 

(c) All patient rooms shall have a minimum of 30 foot candles of light 
delivered to reading or working surfaces and not less than 10 foot candles 
of light in the remainder of the room. 

(d) All corridors, storerooms, stairways, ramps, exits and entrances 
shall have a minimum of five foot candles of light measured in the darkest 
corner. 

(e) Except in closets, storage spaces, attic spaces, equipment rooms 
and similar areas, lighting fixtures shall have suitable enclosures to con- 
trol fixture brightness and to prevent accidental breakage. Where ex- 
posed lamp fixtures are permitted, suitable guards shall be maintained in 
locations where breakage could be hazardous to personnel. 

(f) Emergency lighting facilities shall be maintained for use during 
electrical power failure. In addition, flashlights shall be available at all 
times. Open flame lights shall not be used. 

§ 70853. Electrically Sensitive Areas. 

(a) Electrically sensitive patient areas are those areas of the hospital 
where patients with invasive instrumentation (that can provide electrical- 
ly conductive pathways directly to the heart) are usually located. These 
patients are particularly vulnerable to accidental electrocution from con- 
tact with equipment or other conducting surfaces bearing electrical po- 
tentials that would not normally be considered hazardous. These patient 
care areas must be provided with additional electrical safeguards. Such 
areas include but are not limited to: 

(1) Coronary care units. 

(2) Intensive care units. 

(3) Cardiac catheterization laboratories. 

(4) Operating rooms. 

(5) Portions of emergency rooms. 



Page 812 



Register 90, Nos. 32-37; 9-14-90 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 70865 



(6) Postoperative recovery rooms. 

(b) All circuits serving electrically sensitive patient care areas shall 
have equipotential bonding. 

(c) Each patient bed shall be served by receptacles from two separate 
circuits and, as a minimum, one of the circuits shall be from a separate 
emergency power source. A portion of the receptacles should be located 
other than at the head of the bed. 

(d) All circuits from the same source shall be in the same phase. 

(e) To protect instrumented patients who are vulnerable to electric 
shock hazards, all conducting surfaces, that are or could be located within 
six feet of a patient shall be tested regularly and shown to meet the re- 
quirements set forth below. The measurements shall be made using a 
standard test load to simulate the conducting pathway provided by the pa- 
tient. The standard test load and test conditions shall meet the require- 
ments in Safe Current Limits: AAMI Safety Standard for Electromedical 
Apparatus, published April 1 974 by the Association for the Advance- 
ment of Medical Instrumentation, 1500 Wilson Boulevard, Suite 417, 
Arlington, VA 22209. 

( 1 ) Electromedical equipment with patient leads or other connections 
intended to be attached directly to the heart or to an invasive conductive 
pathway to the heart or great vessels shall be provided with special elec- 
trically isolated leads or connections by optical coupling or some other 
technical provision. The current limits for such an isolated patient con- 
nection shall not exceed 20 microamperes at the patient end of the lead 
and shall not exceed 10 microamperes at the junction between the patient 
lead and the equipment. 

(2) The current limit for electromedical equipment with an electrical 
or conductive patient contact, other than defined in (1) above, shall not 
exceed 50 microamperes. 

(3) The limit for currents arising from metal parts associated with elec- 
tromedical equipment, other than the cases defined in (1 ) and (2) above, 
shall not exceed 1 00 microamperes. 

(0 All electrical service outlets and grounding circuits shall be in- 
spected at least quarterly. 

( 1 ) Records of this inspection shall include at least the following infor- 
mation: 

(A) Confirmation that the contact tension of each blade of each wall 
receptacle is not less than 225 grams (8 oz.) per blade. 

(B) Confirmation of the presence and correct polarity of the hot and 
neutral connections in each wall receptacle. 

(C) Verification of the continuity of the grounding circuit in each wall 
receptacle. 

(D) Physical condition of each receptacle. 

(E) Physical condition of any male plugs and line cords of equipment 
in use in the areas at the time of each inspection. 

(F) Verification that the resistance between all exposed metal surfaces 
and each patient reference grounding point, or a selected wall receptacle 
ground, is less than 0.15 ohms. 

(g) All portable (minor movable) electromedical equipment that is 
used in electrically sensitive patient areas shall be included in an appro- 
priate preventive maintenance program. 

( 1 ) Records of the maintenance shall include at least the following in- 
formation. These measurements and inspections shall be made at least 
once every three months. 

(A) Determination of the leakage current levels for all electrically 
powered diagnostic, monitoring or therapeutic equipment, including 
electrically powered beds. 

(B) Verification of the integrity of the power cords, including continu- 
ity of the conductors and adequacy of the strain relief device. 

§ 70855. Mechanical Systems. 

Heating, air conditioning and ventilating systems shall be maintained 
in operating condition to provide a comfortable temperature and to meet 
the new construction requirements in effect at the time plans were ap- 
proved for the facility. 



§ 70857. Screens. 

To protect against insects, screens of 6 mesh per centimeter (16 mesh 
per inch) shall be provided on doors and openable windows. Screen doors 
shall be of a type approved by the State Fire Marshal. 

§ 70859. Signal Systems. 

(a) A call system shall be maintained in operating order in all nursing 
units. Call systems shall be maintained to provide visible and audible sig- 
nal communication between nursing personnel and patients. The mini- 
mum requirements are: 

( 1 ) A call station or stations providing extension cords to each patient 
bed. These extension cords shall be readily accessible to patients. 

(2) A visible signal in the corridor above the door of each patient room. 

(3) An audible signal and light indicating the room from which the call 
originates shall be located at the nurses" stations. Alternate systems must 
be approved in writing by the Department. 

(b) The call system shall be provided in each patient's toilet room, 
bathroom and shower room in locations easily accessible to the patients. 
Electric shock hazard shall be eliminated by grounding or by an equally 
effective method. 

(c) The call systems shall be designed to require resetting at the calling 
station unless a two-way voice communication component is included 
in the system. 

§70861. Storage. 

(a) All hospitals shall maintain general storage space of at least 1 .9 
square meters (20 square feet) per bed in addition to specialized storage 
space. 

(b) Storage is not permitted in plenums (air distribution chambers) of 
air conditioning or ventilation systems. 

§ 70863. Water Supply and Plumbing. 

(a) Water for human consumption from an independent source shall 
be subjected to bacteriological analysis by the local health department, 
State Department of Health or a licensed commercial laboratory at least 
every three (3) months. A copy of the most recent laboratory report shall 
be available for inspection. 

(b) Plumbing and drainage facilities shall be maintained in compliance 
with Part 5, Title 24, California Administrative Code, Basic Plumbing 
Requirements. Drinking water supplies shall comply with Group 4, Sub- 
chapter 1 , Chapter 5, Division Tl 7, Part 6, of Title 24, California Admin- 
istrative Code. 

(c) Backflow preventers (vacuum breakers) shall be maintained in op- 
erating condition where required by Section T17-210(c), Division T17, 
Part 6, Title 24, California Administrative Code. 

(d) For hot water used by patients, there shall be temperature controls 
to automatically regulate the temperature between 40.5°C (105°F) and 
48.9°C (120°F). 

(e) Hot water at a minimum temperature of 82.2°C (180°F) shall be 
maintained at the final rinse section of dishwashing facilities unless alter- 
nate methods are approved by the Department. 

(f) Taps delivering water at 5].6°C (125°F) or higher shall be identi- 
fied prominently by warning signs with letters 5 cm (2 inches) high. 

(g) Grab bars shall be maintained for each toilet, bathtub and shower 
used by patients, where required in Section Tl 7-2 12(b), Division T17, 
Part 6, of Title 24, California Administrative Code. 

(h) As a minimum, toilet, handwashing and bathing facilities shall be 
maintained in operating condition in the number and types specified in 
construction requirements in effect at the time the building or unit was 
constructed. 

§ 70865. Ice. 

Ice which is used in connection with food or drink shall be from a sani- 
tary source and shall be handled and dispensed in a sanitary manner. 
NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



Page 813 



Register 90, Nos. 32-37; 9-14-90 



§ 70901 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



History 
1. Certificate of Compliance as to 1 1-16-89 order including amendment trans- 
mitted to OAL 3-15-90 and filed 4-16-90 (Register 90, No. 17). 



Article 9. 



Regulations Specific to Small and 
Rural Hospitals 



§ 70901 . Applicability of Article 9. 

Regulations found in Article 9 are applicable to all small and rural hos- 
pitals as defined in Health and Safety Code Section 442.2(c). 

NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 

l. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70903. Enforcement of Article 9. 

Each regulation in Article 9 provides an alternative for a specific regu- 
lation or regulations found elsewhere in Chapter l . Preceding or included 
in each section in Article 9 is the number of the section it will modify or 
replace. 

NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70905. Surgical Service General Requirements. 

Section 70223 shall apply as written with the following exception: 
Hospitals with a licensed bed capacity of 25 or more but less than 50 shall 
only be required to maintain one operating room. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1 . New section filed 2-26-90 as an emergency: operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70907. Dietetic Service Staff. 

Section 70275 shall be replaced by the following: 

(a) A registered dietitian shall be employed on a full-time, part-time 
or consulting basis for approval of all menus and participation in devel- 
opment or revision of dietetic policies and procedures and in planning 
and conducting in-service education programs. 

(b) Sufficient dietetic service personnel shall be employed, oriented, 
trained and their working hours scheduled to provide for the nutritional 
needs of the patients and to maintain the dietetic service areas. If dietetic 
service employees are assigned duties in other service areas, those duties 
shall not interfere with the sanitation, safety or time required for dietetic 
work assignments. 

(c) A record shall be maintained of the number of persons by job title 
employed full or part-time in dietetic services and the number of hours 
each works weekly. 

(d) Hygiene of Dietetic Service Staff. 

(1) Dietetic service personnel shall be trained in basic food sanitation 
techniques, shall be clean, wear clean clothing, including a cap and/or a 
hair net and shall be excluded from duty when affected by skin infection 
or communicable diseases. Beards and mustaches which are not closely 
cropped and neatly trimmed shall be covered. 

(2) Employee's street clothing stored in the kitchen area shall be in a 
closed area. 



(3) Kitchen sinks shall not be used for handwashing. Separate hand- 
washing facilities with soap, running water and individual towels shall 
be provided. 

(4) Persons other than dietetic personnel shall not be allowed in the 
kitchen area unless required to do so in the performance of their duties. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 

1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 



§ 70909. Intensive Care Service Space. 

Section 70499 shall apply as written with the following exceptions: an 
intensive care unit may consist of less than four (4) but shall not consist 
of less than two (2) patient beds; an isolation room is not required. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 



§ 7091 1 . Perinatal Unit Staff. 

Section 70549 shall be replaced by the following: 

(a) A physician shall have overall responsibility of the unit. This physi- 
cian shall be certified or eligible for certification by the American Board 
of Obstetrics and Gynecologists or the American Board of Pediatrics. If 
a physician with one of the above qualifications is not available, a physi- 
cian with training and experience in obstetrics and gynecology or pediat- 
rics may administer the service. In this circumstance, a physician with the 
above qualifications shall provide consultation at a frequency which will 
assure high quality service. The physician responsible for the unit shall 
be responsible for: 

(1) Providing continuous obstetric, pediatric, anesthesia, laboratory 
and radiologic coverage. 

(2) Maintaining working relationships with intensive care newborn 
nursery. 

(3) Providing for joint staff conferences and continuing education of 
respective medical specialties. 

(b) A physician who has training and experience in newborn care shall 
be responsible for the nursery. 

(c) There shall be one registered nurse trained in infant resuscitation 
on duty on each shift assigned to the labor and delivery suite. In addition, 
there shall be sufficient trained personnel to assist the family, provide 
family education, monitor and evaluate labor, assist with the delivery and 
assist the patient during the post-partum period. 

(d) If the hospital has a nursery, a registered nurse who has had training 
and experience in neonatal nursing shall be responsible for the nursing 
care in the nursery. 

(1) A registered nurse trained in infant resuscitation shall be on duty 
on each shift. 

(2) A ratio of one licensed nurse to eight or fewer infants shall be main- 
tained for normal infants. 

(e) There shall be evidence of continuing education and training pro- 
grams for the nursing staff in perinatal nursing and infection control. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 

1 . New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 



Page 814 



Register 90, Nos. 32-37; 9-14-90 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§71011 



§ 70913. Perinatal Unit Space. 

Section 70553 shall apply as written with the following exception: The 
operating room may serve as the delivery room in hospitals having a li- 
censed bed capacity of 50 or less. 

NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70915. Physical Therapy Service General Requirements. 

Section 70557 shall apply as written with the following exception: 
Procedures for outpatient treatment, home visits and referrals to appro- 
priate community agencies need only be established if such resources are 
available. 

NOTK: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70917. Physical Therapy Service Equipment and 
Supplies. 

Section 70561 shall apply as written with the following exception: Ad- 
justable tables shall not be required if a suitable alternative is available. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70919. Physical Therapy Service Space. 

Section 70563 shall not apply. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 

1 . New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70921. Standby Emergency Medical Services, Physician 
on Call, Space. 

Section 70657 shall apply as written with the following exceptions: 
The reception area may be a multi-purpose area and the observation 
room need not be dedicated solely for that purpose. 
NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 
1 . New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 
emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 

§ 70923. Conference Room. 

Section 70765 shall be modified as follows: A hospital shall either pro- 
vide suitable space for conferences within the facility or shall otherwise 
provide access to suitable space for conferences. 

NOTE: Authority cited: Sections 442.3 and 442.6, Health and Safety Code. Refer- 
ence: Section 442.3, Health and Safety Code. 

History 

1. New section filed 2-26-90 as an emergency; operative 2-26-90 (Register 90, 
No. 9). A Certificate of Compliance is not required to be transmitted and this 



emergency regulation remains in force and effect pursuant to Health and Safety 
Code Sections 442.3(b) and 442.6(e). Issuing agency: Office of Statewide 
Health Planning and Development. 



Chapter 2. Acute Psychiatric Hospital 



Article 1. Definitions 

§ 71 001 . Meaning of Words. 

Words shall have their usual meaning unless the context or a definition 
clearly indicates a different meaning. Words used in the present tense in- 
clude the future; words in the singular number include the plural number; 
words in the plural number include the singular number and words in the 
masculine include the feminine. Shall means mandatory. May means 
permissive. Should means suggested or recommended. 

§71003. Hospital. 

Hospital, where used in these regulations means an acute psychiatric 
hospital. 

§ 71004. Acute Psychiatric Care Bed Classification. 

Acute psychiatric care bed classification means beds designated for 
acute psychiatric, developmentally disabled or drug abuse patients re- 
ceiving 24-hour medical care. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255, and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

3. Certificate of Compliance as to filing of 10-5-76 filed 1-31-77 (Register 77, 
No. 6). 

4. Certificate of Compliance as to filing of 1 1-12-76 filed 3-8-77 (Register 77, 
No. 11). 

§ 71005. Acute Psychiatric Hospital. 

(a) Acute psychiatric hospital means a hospital having a duly consti- 
tuted governing body with overall administrative and professional re- 
sponsibility and an organized medical staff which provides 24-hour in- 
patient care for mentally disordered, incompetent or other patients 
referred to in Division 5 (commencing with section 5000) or Division 6 
(commencing with section 6000) of the Welfare and Institutions Code, 
including the following basic services: medical, nursing, rehabilitative, 
pharmacy and dietary services. 

(b) An acute psychiatric hospital shall not include separate buildings 
which are used exclusively to house personnel or provide activities not 
related to hospital patients. 

NOTE: Authority cited: Section 1250.1(e), Health and Safety Code. Reference: 
Section 1250(b), Health and Safety Code. 

History 

1 . Change without regulatory effect pursuant to section 100(b)(3), Title 1 , Califor- 
nia Code of Regulations, repealing subsection (c), filed 4-2-90 (Register 90, 
No. 17). 

§71007. Alteration. 

Alteration means any work other than maintenance in an existing 
building and which does not increase the floor or roof area or the volume 
of enclosed space. 

§71009. Autoclaving. 

Autoclaving means the process of sterilization by steam under pres- 
sure. 

§ 71 01 1 . Basic Services. 

Basic services means those essential services required by law for li- 
censure as a hospital including medical, nursing, rehabilitative, pharma- 
cy and dietary services. 



Page 815 



Register 90, Nos. 32-37; 9-14-90 



§ 71012 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§71012. Certificate of Exemption. 

Certificate of Exemption means a document containing Department 
approval for the exemption of a specified project from Certificate of 
Need review. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251. 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 1 1-12-76 as an emergency; effective upon filing (Reaister 

76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§ 71 01 2.1 . Certificate of Need. 

Certificate of Need means a document containing Department approv- 
al for a specified project. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251. 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§71013. Child. 

Child means a person who is 13 years of age or under. 

§71015. Cleaning. 

Cleaning means the process employed to free a surface from dirt or 
other extraneous material. 

§71017. Conservator. 

Conservator means a person appointed by the court to take care of the 
person or the property, or both, of a conservatee under Section 5350, et 
seq., of the Welfare and Institutions Code or under Section 1701, et seq., 
of the Probate Code. 

§71019. Defined. 

Defined means written. 

§71021. Department. 

Department means the State Department of Health Services. 
NOTE: Authority cited: Sections 208, 1255, 1266, 1275, 1402 and 1426, Health 
and Safety Code; Sections 7354, 14105 and 14124.5, Welfare and Institutions 
Code. Reference: Sections 1222. 1229, 1250, 1251, 1251.5, 1252-1257, 1265, 
1265.5, 1265.7, 1265.8, 1266-1270, 1275-1280, 1282, 1294-1298, 1300, 
1315-1318, 1400-1405, 1410-1412, 1417.1, 1418-1432, 1437, 1439, 1729, 
1734, 38254 and 38255, Health and Safety Code; Sections 7354, 14105 and 
14124.5, Welfare and Institutions Code. Specific reference: Chapter 1252, Stat- 
utes of 1977. 

History 

1 . Amendment filed 6-30-78 as an emergency; designated effective at 1 1 :59 p.m. 
on 6-30-78 (Register 78, No. 26). 

2. Certificate of Compliance transmitted to OAH 10-27-78; filed 10-31-78 (Reg- 
ister 78, No. 44). 

§71023. Director. 

Director means the Director of the State Department of Health Ser- 
vices. 

NOTE: Authority cited: Sections 208, 1255, 1266, 1275, 1402 and 1426, Health 
and Safety Code; Sections 7354, 14105 and 14124.5, Welfare and Institutions 
Code. Reference: Sections 1222, 1229, 1250, 1251, 1251.5, 1252, 1253-1257, 
1265, 1265.5, 1265.7, 1265.8, 1266-1270, 1275-1280, 1282, 1294-1298, 1300, 
1315, 1316-1318, 1400-1405, 1410-1412, 1417.1, 1418-1432, 1437, 1439, 
1729, 1734, 38254 and 38255, Health and Safety Code; Sections 7354, 14105 and 
14124.5, Welfare and Institutions Code. Specific reference: Chapter 1252, Stat- 
utes of 1977. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

3. Amendment filed 6-30-78 as an emergency; designated effective at 1 1 :59 p.m. 
on 6-30-78 (Register 78, No. 26). 

4. Certificate of Compliance transmitted to OAH 10-27-78; filed 10-31-78 (Reg- 
ister 78, No. 44). 



§71025. Disinfection. 

Disinfection means the process employed to destroy harmful microor- 
ganisms but ordinarily not viruses and bacterial spores. 

§71027. Distinct Part. 

Distinct part means an identifiable unit accommodating beds and re- 
lated facilities including but not limited to contiguous rooms, a wing, 
floor or building that is approved by the Department for a specific pur- 
pose. 

§71029. Drug Administration. 

Drug administration means the act in which a single dose of a pre- 
scribed drug or biological is given to a patient by an authorized person 
in accordance with all laws and regulations governing such acts. The 
complete act of administration entails removing an individual dose from 
a previously labeled container, including a unit dose container, verifying 
the dose with the preserver's orders, giving the individual dose to the 
proper patient and promptly recording the time and dose given. 

§ 71031. Drug Dispensing. 

Drug dispensing means the act entailing the interpretation of an order 
for a drug or biological and, pursuant to that order, the proper selection, 
measuring, packaging, labeling and issuance of the drug or biological for 
a patient or for a service unit of the hospital. 

§ 71033. Existing Hospital Building. 

Existing hospital building means an extant structure intended for prop- 
er hospital use. This excludes physician offices contiguous with the hos- 
pital and independent of the hospital as far as ownership. 

§ 71035. Governing Body. 

Governing body means the person, persons, board of trustees, direc- 
tors or other body in whom the authority and responsibility is vested for 
conduct of the hospital. 

§71037. Guardian. 

A guardian means a person appointed by the court to take care of the 
person or the property, or both, of a ward under Section 1400, et seq., of 
the Probate Code. 

§ 71038. Intermediate Care Bed Classification. 

"Intermediate care bed classification" means beds designated for pa- 
tients requiring skilled nursing and supportive care on less than a continu- 
ous basis. 

NOTE: Authority cited: Sections 208 and 1 250. 1 , Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 

§71039. License. 

License means a basic document issued by the Department permitting 
the operation of a hospital. This document constitutes the authority to re- 
ceive patients and to perform the services included within the scope of 
these regulations and as specified on the hospital license. 

§71040. License Category. 

(a) License category means any of the following categories: 

(1) General acute care hospital. 

(2) Acute psychiatric hospital. 

(3) Skilled nursing facility. 

(4) Intermediate care facility. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§71041. Licensee. 

Licensee means the person, persons, firm, partnership, association, 
corporation, political subdivision of the State or other governmental 
agency within the State to whom a license has been issued. 



• 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 71051 



§71043. Maintenance. 

Maintenance means the upkeep of a building and equipment to pre- 
serve the original functional and operational state. 

§71044. Modernization. 

NOTE: Authority cited: Sections 208. 1250. 1250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§71045. New Construction. 

(a) New construction means any of the following: 

( 1 ) New buildings. 

(2) Additions to existing buildings. 

(3) Conversion of existing buildings or portions thereof not currently 
licensed as a hospital. 

§71047. Nursing Unit. 

Nursing unit means a designated patient care area of the hospital which 
is planned, organized, operated and maintained to function as a unit. It 
includes bedrooms with adequate supporting facilities, services and per- 
sonnel providing nursing care and necessary management of patients. 



§ 71 049. Outpatient Service. 

An outpatient service means an organizational unit of the hospital 
which provides nonemergency health care services to patients. 

§71051. Patient. 

(a) Patient means a person who is receiving diagnostic or preventive 
health services or who is under observation or treatment for illness or in- 
jury or care during and after pregnancy. 

(1) Inpatient. An inpatient means a person who has been formally ad- 
mitted for observation, diagnosis or treatment and who is expected to re- 
main overnight or longer. 

(2) Outpatient. An outpatient means a person who has been registered 
or accepted for care but not formally admitted as an inpatient and who 
does not remain over 24 hours. 

(3) Ambulatory. Ambulatory means a patient who is capable of dem- 
onstrating the mental competence and physical ability to leave a building 
without assistance or supervision of any person under emergency condi- 
tions. 

(4) Nonambulatory. Nonambulatory means a patient who is unable to 
leave a building unassisted under emergency conditions. It includes, but 
is not limited to, those persons who depend upon mechanical aids such 



[The next page is 817. 



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Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§71101 



as crutches, walkers or wheelchairs, profoundly or severely mentally re- 
tarded persons and shall include totally deaf persons. 

§71052. Permanently Converted. 

Permanently converted means space which is not available for patient 
accommodation because the facility has converted the patient accommo- 
dation space to some other use and such space could not be reconverted 
to patient accommodation within 24 hours. 

NOTH: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1. New section filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 1 1). 

§71053. Personnel. 

(a) Unless otherwise specified in this chapter, the following defini- 
tions shall apply to health care personnel: 

( 1 ) Accredited Record Technician. 

Accredited record technician means a person who is accredited by the 
American Medical Record Association. 

(2) Administrator. Administrator means the individual who is ap- 
pointed by the governing body to act in its behalf in the overall manage- 
ment of the hospital. 

(3 ) Art Therapist. Art therapist means a person who has a master' s de- 
gree in art therapy or in art with emphasis in art therapy, including an ap- 
proved clinical internship from an accredited college or university; or a 
person who is registered or eligible for registration with the American Art 
Therapy Association. 

(4) Consultant. Consultant means a person who is professionally qual- 
ified to provide expert information on a particular subject. 

(5) Dance Therapist. Dance therapist means a person who is registered 
or eligible for registration as a dance therapist registered by the American 
Dance Therapy Association. 

(6) Dietitian. Dietitian means a person who is registered or eligible by 
registration as a registered dietitian by the American Dietetic Associ- 
ation. 

(7) Licensed Psychiatric Technician. Licensed psychiatric technician 
means a person who is licensed as a licensed psychiatric technician by 
the Board of Vocational Nurse and Psychiatric Technician Examiners. 

(8) Licensed Vocational Nurse. Licensed vocational nurse means a 
person who is licensed as a licensed vocational nurse by the Board of Vo- 
cational Nurse and Psychiatric Technician Examiners. 

(9) Mental Health Worker. Mental health worker means an unlicensed 
person who through experience, in-service training or formal education 
is qualified to participate in the care of the psychiatric patient. 

(10) Music Therapist. Music therapist means a person who is regis- 
tered or eligible for registration as a registered music therapist by the Na- 
tional Association for Music Therapy. 

(11) Occupational Therapist. Occupational therapist means a person 
who is certified or eligible for certification as an occupational therapist 
registered by the American Occupational Therapy Association. 

(12) Occupational Therapy Assistant. Occupational therapy assistant 
means a person who is certified or eligible for certification as a certified 
occupational therapy assistant by the American Occupational Therapy 
Association. 

(13) Pharmacist. Pharmacist means a person who is licensed as a phar- 
macist by the Board of Pharmacy. 

(14) Physician. Physician means a person licensed as a physician and 
surgeon by the Board of Medical Examiners or by the Board of Osteo- 
pathic Examiners. 

(15) Psychologist. Psychologist means a person who is licensed as a 
psychologist by the Board of Medical Examiners. 

( 1 6) Psychiatrist. Psychiatrist means a person who is licensed as a phy- 
sician and surgeon by the Board of Medical Examiners or the Board of 
Osteopathic Examiners and who has specialized training and/or experi- 
ence in psychiatry. 



(17) Recreation Therapist. Recreation therapist means a person who 
is certified or eligible for certification as a registered recreator with spe- 
cialization in therapeutic recreation by the California Board of Park and 
Recreation personnel or the National Therapeutic Recreation Society. 

(18) Registered Nurse. Registered nurse means a person who is li- 
censed by the Board of Registered Nursing. 

(19) Registered Record Administrator. Registered record administra- 
tor means a person who is registered or eligible for registration as a regis- 
tered record administrator by the American Medical Record Association. 

(20) Social Worker. Social worker means a person who is licensed as 
a clinical social worker by the Board of Behavioral Science Examiners. 
NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276, Health and Safety Code. 

History 
1. Change without regulatory effect amending subsection (a)( 13) and adding new 
NOTEfiled 6-1 6-2000 pursuant to section 1 00, title 1 , California Code of Regu- 
lations (Register 2000, No. 24). 

§71055. Restraint. 

Restraint means controlling a patient's physical activity in order to 
protect the patient or others from injury by seclusion, medication or me- 
chanical devices. 

§ 71056. Skilled Nursing Care Bed Classification. 

"Skilled nursing care bed classification" means beds designated for 
patients requiring skilled nursing care on a continuous and extended ba- 
sis. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 10-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-3 1-77 (Register 77, No. 6). 

§71057. Sterilization. 

Sterilization means a process employed to destroy all living organ- 
isms. 

§71059. Supervision. 

(a) Supervision means to instruct an employee or subordinate in his 
duties and to oversee or direct his work but does not necessarily require 
the immediate presence of the supervisor. 

(b) Direct supervision means that the supervisor shall be present in the 
same building as the person being supervised and available for consulta- 
tion and/or assistance. 

(c) Immediate supervision means that the supervisor shall be physical- 
ly present while a task is being performed. 

§ 71 061 . Supplemental Service. 

Supplemental service means an organized inpatient or outpatient ser- 
vice which is not required to be provided by law or regulation. 

§ 71063. Unit Dose Medication System. 

Unit dose medication system means a system in which single dosage 
units of drugs are prepackaged and prelabeled in accordance with all 
applicable laws and regulations governing these practices. The system 
shall also comprise, but not be limited to, all equipment and appropriate 
records necessary and used in making the dose available to the patient ac- 
curately and safely. A pharmacist shall be in charge and responsible for 
the system. 

Article 2. License 

§ 71 1 01 . Inspection of Hospitals. 

(a) The Department shall inspect and license hospitals. 

(b) Any officer, employee or agent of the Department may, upon pre- 
sentation of proper identification, enter and inspect any building or prem- 
ise at any reasonable time to secure compliance with, or to prevent a vio- 
lation of, any provision of these regulations. 

(c) All hospitals for which a license has been issued shall be inspected 
periodically by a representative or representatives appointed by the De- 



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§ 71103 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



partment. Inspections shall be conducted as frequently as necessary, but 
not less than once every two years, to assure that quality care is being pro- 
vided. During the inspection, the representative or representatives of the 
Department shall offer such advice and assistance to the hospital as is ap- 
propriate. For hospitals of 1 00 licensed bed capacity or more, the inspec- 
tion team shall include at least a physician, registered nurse and persons 
experienced in hospital administration and sanitary inspections. 

(d) The Department may provide consulting services upon request to 
any hospital to assist in the identification or correction of deficiencies or 
the upgrading of the quality of care provided by the hospital. 

(e) The Department shall notify the hospital of all deficiencies of com- 
pliance with these regulations and the hospital shall agree with the De- 
partment upon a plan of corrections which shall give the hospital a rea- 
sonable time to correct such deficiencies. If at the end of the allotted time, 
as revealed by repeat inspection, the hospital has failed to correct the defi- 
ciencies, the Director may take action to revoke or suspend the license. 

(f) Reports on the results of each inspection of a hospital shall be pre- 
pared by the inspector or inspection team and shall be kept on file in the 
Department along with the plan of correction and hospital comments. 
The inspection report may include a recommendation for reinspection. 
All inspection reports, lists of deficiencies and plans of correction shall 
be open to public inspection without regard to which body performs the 
inspection. 

(g) The Department shall have the authority to contract for outside per- 
sonnel to perform inspections of hospitals as the need arises. The Depart- 
ment, when feasible, shall contract with nonprofit, professional organi- 
zations which have demonstrated the ability to carry out the provisions 
of this section. Such organizations shall include, but not be limited to, the 
California Medical Association Committee on Medical Staff Surveys 
and participants in the Consolidated Hospital Survey Program. 

§ 71 1 03. License Required. 

(a) No person, firm, partnership, association, corporation, political 
subdivision of the State or other governmental agency shall establish, op- 
erate or maintain a hospital, or hold out, represent or advertise by any 
means that it operates a hospital without first obtaining a license from the 
Department. 

(b) The provisions of this article do not apply to any facility conducted 
by and for the adherents of any well recognized church or religious de- 
nomination for the purpose of providing facilities for the care or treat- 
ment of the sick who depend upon prayer or spiritual means for healing 
in the practice of the religion of such church or denomination. 

§ 711 05. Application Required. 

(a) A verified application shall be forwarded to the Department when- 
ever any of the following circumstances occur: 

( 1 ) Construction of a new or replacement facility or addition to an ex- 
isting facility. 

(2) Increase or decrease of licensed bed capacity. 

(3) Added service or change from one service to another. 

(4) Change of ownership. 

(5) Change of name of hospital. 

(6) Change of license category. 

(7) Change of location of the hospital. 

(8) Change of bed classification. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 71 1 07. Content of Application. 

(a) Any person, firm, partnership, association, corporation, political 
subdivision of the State, state agency or other governmental agency de- 
siring to obtain a license shall file with the Department an application on 
forms furnished by the Department. The application shall contain the fol- 
lowing: 



( 1 ) Name of applicant, and if an individual, verification that the appli- 
cant has attained the age of 1 8 years. 

(2) Type of facility to be operated and types of services for which ap- 
proval is requested. 

(3) Location of the hospital. 

(4) Name of person in charge of the hospital. 

(5) If the applicant is an individual, satisfactory evidence that the 
applicant is of reputable and responsible character. 

(6) If applicant is a firm, association, organization, partnership, busi- 
ness trust, corporation or company, satisfactory evidence that the mem- 
bers or shareholders thereof and the person in charge of the hospital for 
which application for license is made are of reputable and responsible 
character. 

(7) If the applicant is a political subdivision of the State or other gov- 
ernmental agency, satisfactory evidence that the person in charge of the 
hospital for which application for license is made is of reputable and re- 
sponsible character. 

(8) If the applicant is a partnership, the name and principal business 
address of each partner. 

(9) If the applicant is a corporation, the name and principal business 
address of each officer and director of the corporation; and for nonpublic 
corporations the name and business address of each stockholder owning 
five percent or more of the stock and any corporate member who has re- 
sponsibility in the operation of the hospital. 

(10) Copy of the current organizational chart. 

(1 1) Certificate of Need or a Certificate of Exemption from the Depart- 
ment if required by Chapter 1 , Division 1 , Division 7 of this title. 

(12) Such other information or documents as may be required by the 
Department for the proper administration and enforcement of the licens- 
ing law and requirements. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

3. Amendment of subsection (a)(l 1) filed 5-25-77; effective thirtieth day thereaf- 
ter (Register 77, No. 22). 

§ 71 1 09. Architectural Plans. 

Applications submitted for proposed construction of new hospitals or 
additions to licensed hospitals shall include architectural plans and speci- 
fications. Information contained in such applications shall be on file in 
the Department and available to interested individuals and community 
agencies. 

§71110. Fee. 

(a) Each application for a license shall be accompanied by the pre- 
scribed fee. 

(b) The annual fee for a license to operate a hospital, the term for which 
commences at any time during the calendar year 1975, when the applica- 
tion is filed upon a change of ownership, change of location or renewal 
of a license shall be that specified in the following schedule: 

Capacity Requested Fee 

1-49 $150.00 plus 0.0185 of 1 percent 

of the gross operating costs for the 
last fiscal year ending on or 
before December 31, 1974 

50-99 inclusive $300.00 plus 0.0185 of 1 percent 

of the gross operating costs for the 
last fiscal year ending on or 
before December 31,1 974 

100 and over $425,00 plus 0.0185 of 1 percent 

of the gross operating costs for 
the last fiscal year ending on or 
before December 31,1 974. 

(c) The annual fee for a license to operate a hospital which is being li- 
censed for the first time, the term for which commences at any time dur- 
ing the calendar year 1975, shall be that specified in the following sched- 
ule: 



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Licensing and Certification of Health Facilities and Referral Agencies 



§71117 



Capacity Requested Fee 

1-49 inclusive $200.00 

50-99 inclusive $300.00 

100 and over $800.00 

(d) no fee shall be refunded to the applicant if the application is with- 
drawn or if the application is denied by the Department. 

(e) An additional fee of $25.00 shall be paid for processing any change 
of name. However, no additional fee shall be charged for any change of 
name, which is processed upon a renewal application or upon an applica- 
tion filed because of a change of ownership. 

(f) Fees for licenses which cover periods in excess of 12 months shall 
be prorated on the basis of the number of months to be licensed divided 
by 1 2 months. 

(g) Fees shall be waived for any facility conducted, maintained or op- 
erated by this state or any state department, authority, bureau, commis- 
sion or officer or by the Regents of the University of California or by a 
local hospital district, city or county. 

NOTE: Authority cited: Sections 208 (a), 1266, Health and Safety Code. Refer- 
ence: Section 1266, Health and Safety Code. 

History 
1. New section filed 1-30-80; effective thirtieth day thereafter (Register 80, No. 

5). 

§71111. Fee 

(a) Each application for a license shall be accompanied by the pre- 
scribed fee. The license fee under this section shall be effective January 
l, 1979. 

(b) The fee for a license to operate a hospital which is being licensed 

for the first time, or upon a change of ownership or change of location 

shall be that specified in the following schedule: 

Capacity Requested Fee 

1-49 inclusive $293.00 

50-99 inclusive $439.00 

100 and over $1,172.00 

(c) The fee for a license to operate a hospital upon a renewal of a li- 
cense during the year 1 979 shall be that specified in the following sched- 
ule: 

Capacity Requested Fee 

1-49 inclusive $200.00 plus 0.01232 of 1 percent 

of gross operating costs for the last 
complete fiscal year of the hospital 

50-99 inclusive $399.00 plus 0.01232 of 1 percent 

of gross operating costs for the last 
complete fiscal year of the hospital 

100 and over $567.00 plus 0.01232 of 1 percent 

of gross operating costs for the last 
complete fiscal year of the hospital 

(d) No fee shall be refunded to the applicant if the application is with- 
drawn or if the application is denied by the Department. 

(e) Fees for licenses which cover periods in excess of 12 months shall 
be prorated on the basis of the total number of months to be licensed di- 
vided by 12 months. 

(0 Fees shall be waived for any facility conducted, maintained or oper- 
ated by this State or any state department, authority, bureau, commission 
or officer or by the Regents of the University of California or by a local 
hospital district, city or county. 

NOTE: Authority cited: Sections 1275, and 1729, Health and Safety Code. Refer- 
ence: Sections 1266, and 1729, Health and Safety Code. 

History 

1 . Amendment of subsections (a), (b), and (c) filed 10-8-76; effective thirtieth day 
thereafter (Register 76, No. 41). 

2. Amendment of subsections (a), (b), and (c) filed 1-4-77; effective thirtieth day 
thereafter (Register 77, No. 2). 

3. Amendment filed 1 1-8-78; effective thirtieth day thereafter (Register 78, No. 
45). 

4. Amendment of subsections (a), (b), (c), and (f) filed 5-2-79; effective thirtieth 
day thereafter (Register 79, No. 18). 

§ 71 1 13. Projects Requiring a Certificate of Need. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 



History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 71 1 1 3.1 . Projects Eligible for a Certificate of Exemption. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255 and 1268. Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 

1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 71 1 1 3.2. Projects Not Subject to Review by a Voluntary 
Area Health Planning Agency. 

NOTE: Authority cited: Sections 208. 1 250, 1 250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77. No. 11. 

§ 71113.3. Projects Previously Decided by a Voluntary 
Area Health Planning Agency. 

NOTE: Authority cited: Sections 208, 1250, 1250.1, 1251, 1255 and 1268, Health 
and Safety Code. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 1 1 . 

§ 71 1 1 3.4. Exemption Requests for Remodeling and 
Replacement Projects. 

NOTE: Authority cited: Sections 208, 1 250, 1250.1, 1251, 1255 and 1268, Health 
and Safety Cod. Reference: Chapter 854, Statutes of 1976. 

History 
1 . Repealer filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22). 
For prior history, see Register 77, No. 11. 

§ 71 1 1 5. Safety, Zoning and Building Clearance. 

(a) Architectural plans shall not be approved and a license shall not be 
originally issued to any hospital which does not conform to: the regula- 
tions in this chapter; state requirements on seismic safety, fire and life 
safety and environmental impact ajid local fire safety, zoning and build- 
ing ordinances. Evidence of such compliance shall be presented in writ- 
ing to the Department. 

(b) It shall be the responsibility of the licensee to maintain the hospital 
in a safe structural condition. If the Department determines that an evalu- 
ation of the structural condition of a hospital building is necessary, the 
licensee may be required to submit a report by a licensed structural engi- 
neer which shall establish a basis for eliminating or correcting the struc- 
tural conditions which may be hazardous to occupants. 

§ 71 1 1 7. Issuance, Expiration and Renewal. 

(a) Upon verification of compliance with the licensing requirements, 
the Department shall issue the applicant a license. 

(b) If the applicant is not in compliance with the laws or regulations, 
the Department shall deny the applicant a license and shall immediately 
notify the applicant in writing. Within 20 days of receipt of the Depart- 
ment's notice, the applicant may present his written petition for a hearing 
to the Department. The Department shall set the matter for hearing within 
30 days after receipt of the petition in proper form. 

(c) Each initial license shall expire at midnight, one year from the date 
of issue. A renewal license: 

(1 ) May be issued for a period not to exceed two years if the holder of 
the license has been found not to have been in violation of any statutory 
requirements, regulations or standards during the preceding license peri- 
od. 

(2) Shall reflect the number of beds that meet construction and opera- 
tional requirements and shall not include beds formerly located in patient 
accommodation space which has been permanently converted. 

(3) Shall not be issued if the hospital is liable for and has not paid the 
special fees required by Section 90417, Chapter 1, Division 7, of this 
Title. 

(d) The Department shall mail an application for renewal of license 
form to the licensee at least 45 days prior to expiration of a license. Appli- 



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cation for renewal, accompanied by the necessary fees, shall be filed with 
the Department annually not less than ten days prior to the expiration 
date. Failure to make a timely renewal shall result in expiration of the li- 
cense. 

History 

1. Amendment of subsection (c) filed 1 1-12-76 as an emergency; effective upon 
filing (Register 76. No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). (Next pase is 
1964.3) 

§ 71 1 1 9. Separate Licenses. 

Separate licenses shall be required for hospitals which are maintained 
on separate premises even though they are under the same management. 
This does not apply to outpatient departments or clinics of hospitals des- 
ignated as such which are maintained and operated on separate premises. 
Separate licenses shall not be required for separate buildings on the same 
grounds or adjacent grounds. 

§71121. Posting. 

The license, or a true copy thereof, shall be posted conspicuously in 
a prominent location within the licensed premises and accessible to pub- 
lic view. 

§71123. Transferability. 

Licenses are not transferable. The licensee shall notify the Department 
in writing at least 30days prior to the effective date of any change of own- 
ership. A new application for license shall be submitted by the prospec- 
tive new owner. 

§ 71 1 24. Bed Classification. 

(a) Each hospital shall notify the Department on forms supplied by the 
Department of bed classifications as defined in Sections 71004, 71038 
and 71056 within 30 days of the effective date of this section. For hospi- 
tals not reporting within the 30-day period, the Department will classify 
the beds based on the latest information in the Department files. 

(b) After the above notification has been received by the Department 
or the Department has reclassified the beds, no further reclassification of 
beds shall take place until on or after January 1 , 1 977. 

NOTE: Authority cited: Sections 208 and 1250.1, Health and Safety Code. Refer- 
ence: Chapter 854, Statutes of 1976. 

History 

1 . New section filed 1 0-5-76 as an emergency; effective upon filing (Register 76, 
No. 41). 

2. Certificate of Compliance filed 1-31-77 (Register 77, No. 6). 

§ 71 1 25. Report of Changes. 

(a) The licensee shall notify the Department in writing any time a 
change of stockholder owning ten percent or more of the nonpublic cor- 
porate stock occurs. Such writing shall include the name and principal 
mailing address of the new stockholder(s). 

(b) Each licensee shall notify the Department in writing within ten 
days prior to any change of the mailing address of the licensee. Such writ- 
ing shall include the new mailing address of the licensee. 

(c) Any change in the principal officer shall be reported in writing 
within ten days by the licensee to the Department. Such writing shall in- 
clude the name and principal business address of such officer. 

§ 71 1 27. Program Flexibility. 

(a) All hospitals shall maintain continuous compliance with the licens- 
ing requirements. These requirements do not prohibit the use of alternate 
concepts, methods, procedures, techniques, equipment, personnel quali- 
fications or the conducting of pilot projects provided such exceptions are 
carried out with the provisions for safe and adequate care and with the 
prior written approval of the Department. Such approval 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. 

(b) Special exceptions may be granted under this section for hospitals 
required to provide services and accommodations for persons who may 
have dangerous propensities necessitating special precautions, personnel 



with special qualifications, locked accommodations, special protection 
for windows, type and location of lighting and plumbing fixtures, signal 
systems, control switches, beds and other furnishing. This applies to psy- 
chiatric units and detention facilities where added protection is necessary 
for patients, staff members and members of the public. 

(c) Any approval of the Department granted under this section, or a 
true copy thereof, shall be posted immediately adjacent to the facility's 
license that is required to be posted by Section 71121. 

§ 71 129. Voluntary Suspension of License or Licensed 
Beds. 

(a) Upon written request, a licensee may request that his license or li- 
censed beds be put in suspense. The Department may approve the request 
for a period not to exceed 1 2 months. 

(b) Any license or portion thereof which has been temporarily sus- 
pended by the Department pursuant to this section shall remain subject 
to all renewal requirements of an active license, including the payment 
of license renewal fees, during the period of temporary suspension. 

(c) Any license suspended pursuant to this section may be reinstated 
by the Department within 12 months of the date of suspension upon re- 
ceipt of an application and evidence showing compliance with licensing 
operational requirements in effect at the time of reinstatement. If the li- 
cense is not reinstated within the 12-month period, the license shall ex- 
pire automatically and shall not be subject to reinstatement. 

§ 71 1 31 . Voluntary Cancellation of License. 

(a) The licensee shall notify the Department in writing as soon as pos- 
sible and in all cases at least 30 days prior to the desired effective date of 
cancellation of the license. 

(b) Any license voluntarily cancelled pursuant to this section may be 
reinstated by the Department on receipt of an application along with evi- 
dence showing compliance with operational licensing requirements. 

§ 71 133. Revocation or Involuntary Suspension of 
License. 

(a) Pursuant to provisions of Chapter 5 (commencing with Section 
11500), Part I, Division 3, Title 2, Government Code, the Department 
may suspend or revoke any license issued under the provisions of Chap- 
ter 2 (commencing with Section 1250), Division 2, Health and Safety 
Code, upon any of the following grounds. 

(1) Violation by the licensee of any of the provisions of Chapter 2 
(commencing with Section 1250), Division 2, Health and Safety Code, 
or the regulations promulgated by the Department. 

(2) Aiding, abetting or permitting the violation of any provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, or the regulations promulgated by the Department. 

(3) Conduct inimical to the public health, morals, welfare or safety of 
the people of the State of California in the maintenance and operation of 
the premises or services for which a license is issued. 

(b) The license of any hospital against which special fees are required 
by Section 90417, Chapter 1, Division 7, of this Title shall be revoked, 
after notice of hearing, if it is determined by the Department that the fees 
required were not paid within the time prescribed. 

(c) The Director may temporarily suspend any license prior to any 
hearing when, in his opinion, such action is necessary to protect the pub- 
lic welfare. 

(1) The Director shall notify the licensee of the temporary suspension 
and the effective date thereof and at the same time shall serve such licens- 
ee with an accusation. 

(2) Upon receipt of a notice of defense by the licensee, the Director 
shall set the matter for hearing within 15 days. The hearing shall be held 
as soon as possible but no later than 30 days after receipt of such notice. 

(3) The temporary suspension shall remain in effect until such time as 
the hearing is completed and the Director has made a final determination. 

(4) If the Director fails to make a final determination within 60 days 
after the original hearing has been completed, the temporary suspension 
shall be deemed vacated. 



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§ 71203 



(5) If the provisions of Chapter 2 (commencing with Section 1250), 
Division 2, Health and Safety Code, or the regulations promulgated by 
the Director are violated by a licensee which is a group, corporation or 
other association, the Director may suspend the license of such organiza- 
tion or may suspend the license as to any individual person within such 
organization who is responsible for such violation. 

(d) The withdrawal of an application for a license shall not deprive the 
Department of its authority to institute or continue a proceeding against 
the applicant for the denial of the license upon any ground provided by 
law or to enter an order denying the license upon any such ground, unless 
the Department consents in writing to such withdrawal. 

(e) The suspension, expiration, or forfeiture of a license issued by the 
Department shall not deprive the Department of its authority to institute 
or continue a proceeding against the licensee upon any ground provided 
by law or to enter an order suspending or revoking a license or otherwise 
taking disciplinary action against the licensee on any such ground. 
NOTE: Authority cited: Section 208(a), Health and Safety Code. Reference: Sec- 
tion 1296, Health and Safety Code. 

History 

1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

3. Amendment of subsection (c)(2) filed 7-25-79; effective thirtieth day thereafter 
(Register 79, No. 30). 

§ 71 134. Conviction of Crime: Standards for Evaluating 
Rehabilitation. 

When considering the denial, suspension or revocation of a license 
based on the conviction of a crime in accordance with Section 1265.1 or 
1294 of the Health and Safety Code, the following criteria shall be con- 
sidered in evaluating rehabilitation: 

( 1 ) The nature and the seriousness of the crime(s) under consideration. 

(2) Evidence of conduct subsequent to the crime which suggests re- 
sponsible or irresponsible character. 

(3) The time which has elapsed since commission of the crime(s) or 
conduct referred to in subdivision (1) or (2). 

(4) The extent to which the applicant has complied with any terms of 
parole, probation, restitution, or any other sanction lawfully imposed 
against the applicant. 

(5) Any rehabilitation evidence submitted by the applicant. 

NOTE: Authority cited: Sections 208(a), 1265.2 and 1275, Health and Safety 
Code. Reference: Sections 1265.1, 1265.2 and 1294, Health and Safety Code. 

History 
1. New section filed 9-13-84; effective thirtieth day thereafter (Register 84, No. 
37). 

§71135. Bonds. 

(a) Each licensee shall file or have on file with the Department a bond 
issued by a surety company admitted to do business in this State if the li- 
censee is handling or will handle money in the amount of $25 or more per 
patient or $500 or more for all patients in any month. 

( 1 ) The amount of the bond shall be according to the following sched- 
ule: 

Amount Handled Bond Required 

S750 or less $1,000 

$751 to $1,500 $2,000 

51,501 to $2,500 $3,000 

(2) Every further increment of $ 1 ,000 or fraction thereof shall require 
an additional $1,000 on the bond. 

(b) Each application for an original license or renewal of license shall 
be accompanied by an affidavit on a form provided by the Department. 
The affidavit shall state whether the licensee handles or will handle 
money of patients and the maximum amount of money to be handled for 
any patient and for all patients in any month. 

(c) No licensee shall either handle money of a patient or handle 
amounts greater than those stated in the affidavit submitted by him with- 
out first notifying the Department and filing a new or revised bond if re- 
quired. 



Article 3. Basic Services 

§ 71 201 . Medical Service Definition. 

Medical service means those medically and professionally directed 
services for the diagnosis, therapeutic management and treatment of 
mentally disordered patients. For purposes of these regulations, "mental 
disorder" is defined as any psychiatric illness or disease, whether func- 
tional or of organic origin. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§ 71203. Medical Service General Requirements. 

(a) The medical service shall consist of the following organized and 
staffed elements: 

(1) Psychiatric component. 

(A) Psychiatrists or clinical psychologists within the scope of their li- 
censure and subject to the rules of the facility, shall be responsible for the 
diagnostic formulation for their patients and the development and imple- 
mentation of each patient's treatment plan. 

(B) A psychiatrist shall be available at all times for psychiatric emer- 
gencies. 

(2) General medicine component. 

(A) All incidental medical services necessary for the care and support 
of patients shall be provided by in-house staff or through the use of out- 
side resources in accordance with Section 71513 of these regulations. 

(B) Incidental medical services include but are not limited to: 

1 . General medicine and surgery. 

2. Dental. 

3. Radiological. 

4. Laboratory. 

5. Anesthesia. 

6. Podiatry. 

7. Physical therapy. 

8. Speech pathology. 

9. Audiology. 

(3) Psychological component. 

(A) Psychological service shall be provided by clinical psychologists 
within the scope of his/her licensure and subject to the provisions of Sec- 
tion 1316.5 of the Health and Safety Code. 

(B) Facilities which permit clinical psychologists to admit patients 
shall do so only if there are staff physicians who will provide the neces- 
sary medical care for the patients. 

(C) Only staff physicians shall assume responsibility for those aspects 
of patient care which may be provided only by physicians. 

(4) Social service component. 

(A) Social service shall be provided by social workers under the direc- 
tion of the medical staff. 

(b) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(c) The responsibility and the accountability of the medical service to 
the medical staff and administration shall be defined. 

(d) An appropriate committee of the medical service shall: 

(1) Identify and recommend to administration the equipment and sup- 
plies necessary for coping with emergency medical problems. 

(2) Develop a plan for handling and/or referral of patients with emer- 
gency medical problems. 

(3) Determine the circumstances under which electroconvulsive ther- 
apy may be administered. 

(4) Develop guidelines for the administration of drugs when given in 
unusually high dosages or when given for purposes other than those for 
which the drug is customarily used. 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(e) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

2. Amendment filed 1 1-1-85 as an emergency; effective upon filing (Register 85, 
No. 44). A Certificate of Compliance must he transmitted to OAL within 120 
days or emergency language will be repealed on 3-3-86. 

3. Certificate of Compliance transmitted to OAL 2-28-86 and filed 3-26-86 
(Register 86, No. 13). 

4. Change without regulatory effect repealing subsection (a)(3)(B), relettering and 
amending former subsection (a)(3)(C) to (a)(3)(B) and amending Notk filed 
3-24-2005 pursuant to section 100, title 1, California Code of Regulations 
(Register 2005, No. 12). 

5. Change without regulatory effect adding subsection (a)(3)(B), relettering sub- 
sections and amending newly designated subsection (a)(3)(C) and Noti- filed 
4-20-2006 pursuant to section 100, title 1, California Code of Regulations 
(Register 2006, No. 16). 

§ 71 205. Medical Service Staff. 

(a) A physician shall have overall responsibility for the medical ser- 
vice. 

(b) Psychiatric component. 

(1 ) A psychiatrist shall coordinate the psychiatric services provided. 

(2) There shall be sufficient psychiatrists on the staff to meet the needs 
of the patients. 

(c) General medical component. 

(1) A physician shall coordinate the general medical component. 

(2) This physician shall have training and/or experience sufficient to 
coordinate the incidental medical services. 

(d) Psychological component. 

( 1 ) One or more psychologists shall be employed on a full-time, regu- 
lar part-time or consulting basis. 

(e) Social service component. 

( 1 ) One or more social workers shall be employed on a full-time, regu- 
lar part-time or consulting basis. 

§ 71207. Medical Service Equipment and Supplies. 

There shall be adequate equipment and supplies maintained related to 
the nature of the needs and the services offered. 

§ 71 209. Medical Service Space. 

There shall be adequate space maintained to meet the needs of the ser- 
vice. 

§ 71 21 1 . Psychiatric Nursing Service Definition. 

Psychiatric nursing service means the performance of those services 
directed toward meeting the objectives of an individual planned thera- 
peutic program supervised and coordinated by a registered nurse in con- 
junction with the treatment plan, nursing care and other health profes- 
sional care. 

§ 71213. Psychiatric Nursing Service General 
Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the director of nursing in consultation with other appropriate health 
professionals and administration. Policies shall be approved by the gov- 
erning body. Procedures shall be approved by the administration and 
medical staff where such is appropriate. 

(b) The responsibility and the accountability of the nursing service to 
the medical staff and hospital administration shall be defined. 

(c) There shall be a written organized staff education program which 
shall include orientation and in-service education and training. 

(1) There shall be written objectives, plans for implementation and an 
evaluation mechanism. 

(d) There shall be a written patient care plan developed for each patient 
in coordination with the total mental health team. This plan shall include 
goals, problems/needs and approach and shall be available to all mem- 
bers of the mental health team. 



(e) There shall be a written nursing audit procedure and evidence that 
audit procedures are in effect. 

(0 There shall be a method for determining staffing requirements 
based on assessment of patient needs. This assessment shall take into 
consideration at least the following: 

(1 ) The ability of the patient to care for himself. 

(2) His degree of illness. 

(3) Requirements for special nursing activities. 

(4) Skill level of personnel required in his care. 

(5) Placement of the patient in the nursing unit. 

(g) There shall be documentation of the methodology used in making 
staffing determinations. Such documentation shall be part of the records 
of the nursing service and be available for review. 

(h) There shall be a written staffing pattern which shall show: 

(1) Total numbers of staff including full-time and full-time equiva- 
lents. 

(2) The available nursing care hours for each nursing unit. 

(3) The categories of staff available for patient care. 

(i) There shall be a record retained for six months of the written staff- 
ing pattern available for review by the Department at any given time. 

§ 71 21 5. Psychiatric Nursing Service Staff. 

(a) The psychiatric nursing service shall be under the direction of a reg- 
istered nurse who shall meet at least the following qualifications: 

(1 ) Master's degree in psychiatric nursing or related field with experi- 
ence in administration; or 

(2) Baccalaureate degree in nursing or related field with experience in 
psychiatric nursing and two years of experience in nursing administra- 
tion; or 

(3) Four years of experience in nursing administration or supervision 
and with experience in psychiatric nursing. 

(b) The director of nurses shall not be designated to serve as charge 
nurse. 

(c) Sufficient registered nursing personnel shall be provided to: 

(1) Assist the director of nurses for evening and night services and 
when necessary for day services. 

(2) Give direct nursing care based on patient need. 

(3) Have a registered nurse on duty at all times. 

(4) Plan, supervise and coordinate care given by licensed vocational 
nurses, licensed psychiatric technicians and other mental health workers. 

(d) Each nursing unit shall have a registered nurse, licensed vocational 
nurse or licensed psychiatric technician on duty at all times. 

(e) Licensed vocational nurses and licensed psychiatric technicians 
may be utilized as needed to assist registered nurses in ratios appropriate 
to patient needs. 

(t) Mental health workers may be utilized as needed to assist with nurs- 
ing procedures. 

§ 71217. Psychiatric Nursing Service Equipment and 
Supplies. 

There shall be adequate and appropriate equipment and supplies re- 
lated to the scope and nature of the needs anticipated and the services of- 
fered. 

§ 71219. Psychiatric Nursing Service Space. 

Office space shall be provided for the director of nurses. 

§ 71 221 . Psychiatric Rehabilitative Activities Service 
Definition. 

Psychiatric rehabilitative activities service means that rehabilitative 
service medically prescribed, professionally directed and supervised, to 
evaluate and treat the patient. Therapists as used in Section 71221 
through 71229 may include occupational, music, art, dance and recre- 
ation therapists. 

§ 71223. Psychiatric Rehabilitative Activities Service 
General Requirements. 

(a) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 71233 



• 



priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(b) The policies and procedures shall include but not be limited to: 

(1) Treatment goals and objectives. 

(2) Scope of service. 

(3) Standards of practice. 

(4) Arrangements for continuity of care upon discharge. 

(c) The responsibility and the accountability of the psychiatric rehabil- 
itative activities service to the medical staff and administration shall be 
defined. 

(d) Patients shall be evaluated and a treatment program shall be estab- 
lished and modified with the concurrence of the referring physician. 

(e) Signed progress notes shall be entered into the patient's medical re- 
cord by the therapist at least weekly. A summary note shall be written 
upon completion of the treatment program. 

(f) Meetings and conferences with other members of the mental health 
team shall be held in order to plan, review and coordinate patient treat- 
ment programs. 

(g) There shall be regularly scheduled in-service training for all levels 
of staff. 

(h) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration. 

§ 71 225. Psychiatric Rehabilitative Activities Service Staff. 

(a) A therapist shall have overall responsibility for the psychiatric re- 
habilitative activities service. This person shall have had at least two 
years' experience in the care of acute psychiatric patients. 

(b) There shall be a sufficient number of therapists to carry out the 
scope of services offered. Nonprofessional assistants and volunteers 
shall work under the direct supervision of a therapist. 

(c) A sufficient number of appropriate personnel shall be provided for 
the safety of the patients. 

§ 71 227. Psychiatric Rehabilitative Activities Service 
Equipment and Supplies. 

(a) There shall be sufficient equipment and supplies appropriate to the 
needs of the psychiatric rehabilitative activities services offered. In addi- 
tion, there shall be: 

( 1 ) A telephone. 

(2) A handwashing sink in the treatment area. 

(3) Drinking fountain. 

(4) Toilet facilities. 

§ 71229. Psychiatric Rehabilitative Activities Service 
Space. 

(a) Adequate space shall be maintained for the necessary equipment 
to provide psychiatric rehabilitative activity services. 

(b) There shall be indoor and outdoor patient areas provided. 

(c) There shall be an activities room and a patient lounge separate from 
the patient's dining room. 

(d) There shall be office space separate from the activities area. 

(e) When outpatients are treated, there shall be a waiting area pro- 
vided. 

(f) Where children are accepted for treatment, space appropriate for 
children's use shall be provided. 

§ 71 231 . Pharmaceutical Service Definition. 

Pharmaceutical service means the procuring, manufacturing, com- 
pounding, dispensing, distributing, storing and administering of drugs, 
biologicals and chemicals by appropriate staff, which has adequate 
space, equipment and supplies. Pharmaceutical services also include the 
provision of drug information to other health professionals and patients. 

§ 71233. Pharmaceutical Service General Requirements. 

(a) All hospitals having 1 00 beds or more shall have a pharmacy on the 
premises licensed by the California Board of Pharmacy. Those hospitals 



having less than 100 beds shall have a pharmacy license issued by the 
Board of Pharmacy pursuant to Section 4029 or 4056 of the Business and 
Professions Code. 

(b) The responsibility and the accountability of the pharmaceutical 
service to the medical staff and administration shall be defined. 

(c) A pharmacy and therapeutics committee shall be established. The 
committee shall consist of at least one physician, one pharmacist, the di- 
rector of nursing service or her representative and the administrator or his 
representative. 

(1) The committee shall develop written policies and procedures for 
establishment of safe and effective systems of procurement, storage, dis- 
tribution, dispensing and use of drugs and chemicals. The pharmacist, in 
consultation with other appropriate health professionals and administra- 
tion shall be responsible for the development and implementation of pro- 
cedures. Policies shall be approved by the governing body. Procedures 
shall be approved by the administration and medical staff where such is 
appropriate. 

(2) The committee shall be responsible for the development mainte- 
nance of a formulary of drugs for use throughout the hospital. 

(d) There shall be a system maintained whereby no person other than 
a pharmacist or an individual under the direct supervision of a pharmacist 
shall dispense medications for use beyond the immediate needs of the pa- 
tient. 

(e) There shall be a system assuring the availability of prescribed med- 
ications 24 hours a day. 

(f) Supplies of drugs for use in medical emergencies only shall be im- 
mediately available at each nursing unit or service area as required. 

(1) Written policies and procedures establishing the contents of the 
supply, procedures for use, restocking and sealing of the emergency drug 
supply shall be developed. 

(2) The emergency drug supply shall be stored in a clearly marked por- 
table container which is sealed by the pharmacist in such a manner that 
a seal must be broken to gain access to the drugs. The contents of the con- 
tainer shall be listed on the outside cover and shall include the expiration 
earliest date or lot number of any drugs within. 

(3) The supply shall be inspected by a pharmacist at periodic intervals 
specified in written policies. Such inspections shall occur no less fre- 
quently than every 30 days. Records of such inspections shall be kept for 
at least three years. 

(g) No drugs shall be administered except by licensed personnel au- 
thorized to administer drugs and upon the order of a person legally autho- 
rized to prescribe. The order shall include the name of the drug, the dos- 
age, the frequency of administration, the route of administration if other 
than oral, and the date, time and signature of the prescriber. Orders for 
drugs should be written by the prescriber. Verbal orders for drugs shall 
be given only to a registered nurse or licensed pharmacist by a person le- 
gally authorized to prescribe and shall be recorded promptly in the pa- 
tient's medical record, noting the name of the person giving the verbal 
order and the signature of the individual receiving the order. The pre- 
scriber shall countersign the order within 48 hours. 

(h) Standing orders for drugs may be used for specified patients when 
authorized by a person licensed to prescribe. These standing orders shall: 

( 1 ) Specify the circumstances under which the drug is to be adminis- 
tered. 

(2) Specify the types of medical conditions of patients for whom the 
standing orders are intended. 

(3) Be initially approved by the pharmacy and therapeutics committee 
or its equivalent and be reviewed at least annually by that committee. 

(4) Be specific as to the drug, dosage, route and frequency of adminis- 
tration. 

(5) A copy of standing orders for a specific patient shall be dated, 
promptly signed by the physician and included in the patient's medical 
record. 

(i) An individual prescriber may notify the hospital in writing of his 
own standing orders, the use of which is subject to prior approval and pe- 



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Title 22 



riodic review by the pharmacy and therapeutics committee or its equiva- 
lent. 

(j) The hospital shall develop policies limiting the duration of drug 
therapy in the absence of the prescriber's specific indication of duration 
of therapy or under other circumstances recommended by the pharmacy 
and therapeutics committee or its equivalent and approved by the execu- 
tive committee of the medical staff. The limitations shall be established 
for classes of drugs and/or individual drug entities. 

(k) If drugs are supplied through a pharmacy, orders for drugs shall be 
transmitted to the pharmacy either by written prescription of the prescrib- 
er, by an order form which produces a direct copy of the order or by an 
electronically reproduced facsimile. When drugs are not supplied 
through a pharmacy, such information shall be made available to the hos- 
pital pharmacist. 

(/) No medications shall be left at the patient's bedside. 

(m) Medications brought by or with the patient to the hospital shall not 
be administered to the patient unless all of the following conditions are 
met: 

(1) The drugs have been ordered by the patient's attending physician 
and the order entered in the patient's medical record. 

(2) The medication containers are clearly and properly labeled. 

(3) The contents of the containers have been examined and positively 
identified, after arrival at the hospital, by the patient's physician or the 
hospital pharmacist. 

(n) The hospital shall establish a supply of medications which is acces- 
sible without entering the pharmacy during hours when the pharmacist 
is not available. Access to the supply shall be limited to designated regis- 
tered nurses. Records of drugs taken from the supply shall be maintained 
and the pharmacist shall be notified of such use. The records shall include 
the name and strength of the drug, the amount taken, the date and time, 
the name of the patient to whom the drug was administered and the signa- 
ture of the registered nurse. The pharmacist shall be responsible for main- 
tenance of the supply and assuring that all drugs are properly labeled and 
stored. The drug supply shall contain that type and quantity of drugs nec- 
essary to meet the immediate needs of patients as determined by the phar- 
macy and therapeutics committee. 

(0) Investigational drug use shall be in accordance with applicable 
state and federal laws and regulations and policies adopted by the hospi- 
tal. Such drugs shall be used only under the direct supervision of the prin- 
cipal investigator, who shall be a member of the medical staff and be re- 
sponsible for assuring that informed consent is secured from the patient. 
Basic information concerning the dosage form, route of administration, 
strength, actions, uses, side effects, adverse effects, interactions and 
symptoms of toxicity of investigational drugs shall be available at the 
nursing station where such drugs are being administered and in the phar- 
macy. The pharmacist shall be responsible for the proper labeling, stor- 
age and distribution of such drugs pursuant to the written order of the in- 
vestigator. 

(p) No drugs supplied by the hospital shall be taken from the hospital 
unless a prescription or medical record order has been written for the 
medication and the medication has been properly labeled and prepared 
by the pharmacist in accordance with state and federal laws, for use out- 
side of the hospital. 

(q) Labeling and storage of drugs shall be accomplished to meet the 
following requirements: 

( 1 ) Individual patient medications may be returned to the pharmacy 
provided that lot control is maintained if the drugs are to be reissued. 

(2) All drug labels must be legible and in compliance with state and 
federal requirements. 

(3) All labeling of drugs shall be performed by one legally authorized 
to prescribe or dispense or under the supervision of a pharmacist. 

(4) Test agents, germicides, disinfectants and other household sub- 
stances shall be stored separately from drugs. 

(5) External use drugs in liquid, tablet, capsule or powder form shall 
be segregated from drugs for internal use. 



(6) Drugs shall be stored at appropriate temperatures. Refrigerator 
temperature shall be from 2.2°C (36°F) to 7.7°C (46°F) and room tem- 
perature shall be between 15°C (59°F) and 30°C (86°F). 

(7) Drugs shall be stored in an orderly manner in well lighted cabinets, 
shelves, drawers or carts of sufficient size to prevent crowding. 

(8) Drugs shall be accessible only to responsible personnel designated 
by the hospital. 

(9) Drugs shall not be kept in stock after the expiration date on the label 
and no contaminated or deteriorated daig shall be available for use. 

(10) Drugs maintained on the nursing unit shall be inspected at least 
monthly by a pharmacist. Any irregularities shall be reported to the direc- 
tor of nursing services and as required by hospital policy. 

(11) Discontinued individual patient's drugs not supplied by the hos- 
pital may be sent home with the patient. Those which remain in the hospi- 
tal after discharge that are not identified by a lot number shall be de- 
stroyed in the following manner: 

(A) Drugs listed in Schedules II, III or IV of the Federal Comprehen- 
sive Drug Abuse Prevention and Control Act of 1970, as amended, shall 
be destroyed in the presence of two pharmacists or a pharmacist and a 
registered nurse employed by the hospital. The name of the patient, the 
name and strength of the drug, the prescription number, the amount de- 
stroyed, the date of destruction and the signatures of the witnesses re- 
quired above shall be recorded in the patient's medical record or in a sep- 
arate log. Such a log shall be retained for at least three years. 

(B) Drugs not listed under Schedules II, III or IV of the Federal Com- 
prehensive Drag Abuse Prevention and Control Act of 1970, as 
amended, shall be destroyed in the presence of pharmacist or registered 
nurse. The name of the patient, the name and strength of the drug, the pre- 
scription number if applicable, the amount destroyed, the date of destruc- 
tion and the signatures of two witnesses shall be recorded in the patient's 
medical record or in a separate log. Such a log shall be retained for at least 
three years. 

(r) The pharmacist shall develop and implement written quality con- 
trol procedures for all drugs which are prepackaged or compounded in 
the hospital, including intravenous solution additives. He shall also de- 
velop and implement written quality control procedures for intravenous 
solution additives and shall establish a training program of physicians 
and registered nurses to assure compliance therewith. 

(s) The pharmacist shall be consulted on proper methods for repackag- 
ing and labeling of bulk cleaning agents, solvents, chemicals and poisons 
used throughout the hospital. 

(t) Periodically, an appropriate committee of the medical staff shall 
evaluate the services provided and make appropriate recommendations 
to the executive committee of the medical staff and administration 
NOTE: Authority cited: Sections 1275 and 100275, Health and Safety Code. Ref- 
erence: Section 1276, Health and Safety Code. 

History 
1 . Change without regulatory effect amending subsection (a) and adding new 
Note filed 6-16-2000 pursuant to section 1 00, title 1 , California Code of Regu- 
lations (Register 2000, No. 24). 

§ 71235. Pharmaceutical Service Staff. 

A pharmacist shall have overall responsibility for the pharmaceutical 
service. He shall be responsible for the procurement, storage and distri- 
bution of all drugs as well as the development, coordination, supervision 
and review of pharmaceutical services in the hospital. Hospitals with a 
limited pharmacy permit shall employ a pharmacist on at least a consult- 
ing basis. Responsibilities shall be set forth in a job description or agree- 
ment between the pharmacist and the hospital. The pharmacist shall be 
responsible to the administrator and shall furnish him written reports and 
recommendations regarding the pharmaceutical services within the hos- 
pital. Such reports shall be provided no less often than quarterly. 

§ 71237. Pharmaceutical Service Equipment and Supplies. 

(a) There shall be adequate equipment and supplies for the provision 
of pharmaceutical service within the hospital. 



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• 



(b) Reference materials containing monographs on all drugs in use in 
the hospital shall be available in each nursing unit. Such monographs 
must include information concerning generic and brand names, if appli- 
cable, available strengths and dosage forms and pharmacological data in- 
cluding indications, side effects, adverse effects and ding interactions. 

§ 71239. Pharmaceutical Service Space. 

(a) Adequate space shall be available at each nursing station for the 
storage of drugs and preparation of medication doses. 

(b) All spaces and areas used for the storage of drugs shall be lockable. 

§ 71 241 . Dietetic Service Definition. 

Dietetic service means providing safe, satisfying and nutritionally ad- 
equate food for patients with appropriate staff, space, equipment and sup- 
plies. 

§ 71243. Dietetic Service General Requirements 

(a) The dietetic service shall provide food of the quality and quantity 
to meet the patient's need in accordance with physicians' orders and, to 
the extent medically possible, to meet the Recommended Daily Dietary 
Allowance, 1 974 Edition, adopted by the Food and Nutrition Board of the 
National Research Council of the National Academy of Sciences, 2107 
Constitution Avenue, Washington, DC 20418, and the following: 

( 1 ) Not less than three meals shall be served daily. 

(2) Not more than 14 hours shall elapse between the evening meal and 
breakfast of the following day. 

(3) Nourishment or between meal feedings shall be provided as re- 
quired by the diet prescription and shall be offered to all patients unless 
counterordered by the physician. 

(4) Patient food preferences shall be respected as much as possible and 
substitutes shall be offered through use of a selective menu or substitutes 
from appropriate food groups. 

(5) Where desirable, table service should be provided for all who can 
and wish to eat at a table. Tables of appropriate height shall be provided 
for patients in wheelchairs. 

(6) When food is provided by an outside commercial food service, all 
applicable requirements herein set forth shall be met. The hospital shall 
maintain adequate space, equipment and staple food supplies to provide 
patient food service in emergencies. 

(b) Written policies and procedures shall be developed and maintained 
by the person responsible for the service in consultation with other appro- 
priate health professionals and administration. Policies shall be approved 
by the governing body. Procedures shall be approved by the administra- 
tion and medical staff where such is appropriate. 

(c) The responsibility and the accountability of the dietetic service to 
the medical staff and hospital administration shall be defined. 

(d) A current diet manual approved by the dietitian and the medical 
staff shall be used as the basis for diet orders and for planning modified 
diets. Copies of the diet manual shall be available at each nursing station 
and in the dietetic service area. 

(e) Therapeutic diets shall be provided as prescribed by the attending 
physician and shall be planned, prepared and served with supervision 
and/or consultation from the dietitian. Persons responsible for therapeu- 
tic diets shall have sufficient knowledge of food values to make appropri- 
ate substitutions when necessary. 

(f) A current profile card shall be maintained for each patient indicat- 
ing diet, likes, dislikes and other pertinent information concerning the pa- 
tient' s dietary needs. 

(g) Menus. 

(1) Menus for regular and routine modified diets shall be written at 
least one week in advance, dated and posted in the kitchen at least three 
days in advance. 

(2) If any meal served varies from the planned menu, the change shall 
be noted in writing on the posted menu in the kitchen. 

(3) Menus shall provide a variety of foods in adequate amounts at each 
meal. 



(4) Menus shall be planned with consideration for cultural and reli- 
gious background and the food habits of patients. 

(5) A copy of the menu as served shall be kept on file for at least 30 
days. 

(6) Records of food purchased shall be kept available for one year. 

(7) Standardized recipes, adjusted to appropriate yield, shall be main- 
tained and used in food preparation. 

(h) Food shall be prepared by methods which conserve nutritive value, 
flavor and appearance. Food shall be served attractively at appropriate 
temperatures and in a form to meet individual needs. 

(i) Nutritional Care. 

(1) Nutritional care shall be integrated in the patient care plan. 

(2) Observations and information pertinent to dietetic treatment shall 
be recorded in patient's medical records by the dietitian. 

(3) Pertinent dietary records shall be included in patient's transfer dis- 
charge record to ensure continuity of nutritional care. 

(j) In-service training shall be provided for all dietetic service person- 
nel and a record of subject areas covered, date and duration of each ses- 
sion, and attendance lists shall be maintained. 

(k) Food Storage. 

(1) Food storage areas shall be clean at all times. 

(2) Dry or staple items shall be stored at least 30 cm (12 inches) above 
the floor, in a ventilated room, not subject to sewage or waste water back- 
flow, or contamination by condensation, leakage, rodents or vermin. 

(3) All readily perishable foods or beverages capable of supporting 
rapid and progressive growth f microorganisms which can cause food in- 
fections or food intoxication shall be maintained at temperatures of 7°C 
(45°F) or below, or at 60°C (140°F) or above, at all times except during 
necessary periods of preparation and service. Frozen food shall be stored 
at-18°C(0°F)orbelow. 

(4) There shall be a reliable thermometer in each refrigerator and in 
storerooms used for perishable food. 

(5) Pesticides, other toxic substances and drugs shall not be stored in 
the kitchen area or in storerooms for food and/or food preparation equip- 
ment and utensils. 

(6) Soaps, detergents, cleaning compounds or similar substances shall 
not be stored in food storerooms or food storage areas. 

(/) Sanitation. 

(1) All kitchens and kitchen areas shall be kept clean, free from litter 
and rubbish and protected from rodents, roaches, flies or other insects. 

(2) AH utensils, counters, shelves and equipment shall be kept clean, 
maintained in good repair and shall be free from breaks, corrosions, open 
seams, cracks and chipped areas. 

(3) Plasticware, china and glassware that is unsightly, unsanitary or 
hazardous because of chips, cracks or loss of glaze shall be discarded. 

(4) Ice which is used in connection with food or drink shall be from a 
sanitary source and shall be handled and dispensed in a sanitary manner. 

(5) Kitchen wastes that are not disposed of by mechanical means shall 
be kept in leakproof, nonabsorbent, tightly closed containers and shall be 
disposed of as frequently as necessary to prevent a nuisance or unsightli- 
ness. 

(m) All utensils used for eating, drinking and in the preparation and 
serving of food and drink shall be cleaned and disinfected after each 
usage. 

(1) Gross food particles shall be removed by scraping and prerinsing 
in running water. 

(2) The utensils shall be thoroughly washed in hot water with a mini- 
mum temperature of 43°C (1 10°F), using soap or detergent, rinsed in hot 
water to remove soap or detergent and disinfected by one of the following 
methods or an equivalent method approved by the Department: 

(A) Immersion for at least two minutes in clean water at 77°C ( 1 70°F). 

(B) Immersion for at least 30 seconds in clean water at 82°C ( 1 80°F). 

(C) Immersion in water containing bactericidal chemical as approved 
by the Department. 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(3) After disinfection the utensils shall be allowed to drain and dry in 
racks or baskets on nonabsorbent surfaces. Drying cloths shall not be 
used. 

(4) Results obtained with dishwashing machines shall be equal to 
those obtained by the methods outlined above and all dishwashing ma- 
chines shall meet the requirements contained in Standard No. 3 as 
amended in April 1965 of the National Sanitation Foundation, P.O. Box 
1468, Ann Arbor, MI 94106. 

§ 71 245. Dietetic Service Staff. 

(a) Registered dietitian shall be employed on a full-time, part-time or 
consulting basis. Part-time or consultant services shall be provided on the 
premises at appropriate times on a regularly scheduled basis and of suffi- 
cient duration and frequency to provide continuing liaison with medical 
and nursing staffs, advice to the administrator, patient counseling, guid- 
ance to the supervisor and staff of the dietetic service, approval of all me- 
nus and participation in development or revision of dietetic policies and 
procedures as in planning and conducting in-service education pro- 
grams. 

(b) If a registered dietitian is not employed full-time person who has 
completed a dietetic supervisor's training program meeting the require- 
ments of Essentials of an Acceptable Program of Dietetic Assistant Edu- 
cation, revised June, 1974, by the American Dietetic Association, 430 
North Michigan Avenue, Chicago, IL 6061 1 , shall be employed to be re- 
sponsible for the operation of the food service. This program or its equiv- 
alent shall be required on and after July 1, 1977. 

(c) Sufficient dietetic service personnel shall be employed, oriented, 
trained and their working hours scheduled to provide for the nutritional 
needs of the patients and to maintain the dietetic service areas. If dietetic 
service employees are assigned duties in other service areas, those duties 
shall not interfere with the sanitation, safety or time required for dietetic 
work assignments. 

(d) Current work schedules by job titles and weekly duty schedules 
shall be posted in the dietetic service area. 

(e) A record shall be maintained of the number of persons by job title 
employed full or part-time in dietetic services and the number of hours 
each works weekly. 

(0 Hygiene of Dietetic Staff. 

( 1 ) Dietetic service personnel shall be trained in basic food sanitation 
techniques, shall be clean, wear clean clothing, including a cap and/or a 
hair net and shall be excluded from duty when affected by skin infection 
or communicable diseases. Beards and mustaches which are not closely 
cropped and neatly trimmed shall be covered. 

(2) Employees' street clothing stored in the kitchen shall be in a closed 
area. 

(3) Kitchen sinks shall not be used for handwashing. Separate hand- 
washing facilities with soap, running water and individual towels shall 
be provided. 

(4) Persons other than dietetic personnel shall not be allowed in the 
kitchen area unless required to do so in the performance of their duties. 

§ 71 247. Dietetic Service Equipment and Supplies. 

(a) Equipment of the type and in the amount necessary for the proper 
preparation, serving and storing of food and for proper dishwashing shall 
be provided and maintained in good working order. 

( 1 ) The dietetic service area shall be ventilated in a manner that will 
maintain comfortable working conditions, remove objectionable odors 
and fumes and prevent excessive condensation. 

(2) Equipment necessary for preparation and maintenance of menus, 
records and references shall be provided. 

(3) Fixed and mobile equipment in the dietetic service area shall be lo- 
cated to assure sanitary and safe operation and shall be of sufficient size 
to handle the needs of the hospital. 

(b) Food Supplies. 

( 1 ) At least one week' s supply of staple foods and at least two (2) days 
supply of perishable foods shall be maintained on the premises. Supplies 
shall be appropriate to meet the requirements of the menu. 



(2) All food shall be of good quality and procured from sources ap- 
proved or considered satisfactory by federal, state and local authorities. 
Food in unlabeled, rusty, leaking, dented or broken containers, or cans 
with side seam dents, rim dents or swells shall not be accepted or retained. 

(3) Milk, milk products and products resembling milk shall be pro- 
cessed or manufactured in milk product plants meeting the requirements 
of Division 15 of the California Food and Agricultural Code. 

(4) Milk may be served in individual containers, the cap or seal of 
which shall not be removed except in the presence of the patient. Milk 
may be served from a dispensing device which has been approved for 
such use. Milk served from an approved device shall be dispensed direct- 
ly into the glass or other container from which the patient drinks. 

(5) Catered foods and beverages from a source outside the hospital 
shall be prepared, packed, properly identified, stored and transported in 
compliance with these regulations and other applicable federal, state and 
local codes as determined by the Department. 

(6) Food held in refrigerated or other storage areas shall be appropri- 
ately covered. Food which was prepared and not served shall be stored 
appropriately, clearly labeled and dated. 

(7) Hermetically sealed foods or beverages served in the hospital shall 
have been processed in compliance with applicable federal, state and lo- 
cal codes. 

§ 71 249. Dietetic Service Space. 

(a) Adequate space for the preparation and serving of food shall be 
provided. Equipment shall be placed so as to provide aisles of sufficient 
width to permit easy movement of personnel, mobile equipment and sup- 
plies. 

(b) Well ventilated food storage areas of adequate size shall be pro- 
vided. 

(c) A minimum of 0.057 cubic meters (two cubic feet) of usable refrig- 
erated space per bed shall be maintained for the storage of frozen and 
chilled foods. 

(d) Adequate space shall be maintained to accommodate equipment, 
personnel and procedures necessary for proper cleaning and sanitizing of 
dishes and other utensils. 

(e) Where employee dining space is provided, a minimum of 1.4 
square meters (15 square feet) of floor area per person served, including 
serving area, shall be maintained. 

(f) Office or other suitable space shall be provided for the dietitian or 
dietetic service supervisor for privacy in interviewing personnel, con- 
ducting other business related to dietetic service and for the preparation 
and maintenance of menus and other necessary reports and records. 

Article 4. Supplemental Service Approval 

§ 71 301 . Supplemental Service Approval Required. 

(a) Any licensee desiring to establish or conduct, or who holds out, 
represents or advertises by any means, the provision of a supplemental 
service, shall obtain prior approval from the Department, or a special per- 
mit if required by Section 70401 . 

(b) The provisions of this Article shall apply only to any supplemental 
service for which a special permit is not required. 

(c) Any licensee who offers a supplemental service for which approval 
is now required under these regulations, is authorized to continue fur- 
nishing such service without obtaining approval until the Department in- 
spects and evaluates the quality of the service and determines whether 
such service meets the requirements for the service contained in these 
regulations. If the Department determines that the service meets such re- 
quirements, it shall notify the licensee in writing. If the Department deter- 
mines that the service does not meet the requirements, it shall so notify 
the licensee of all deficiencies of compliance with these regulations and 
the hospital shall agree with the Department upon a plan of corrections 
which shall give the hospital a reasonable time to correct such deficien- 
cies. If at the end of the allotted time, as revealed by repeat inspection, 
the hospital has failed to correct the deficiencies, the licensee shall cease 



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§ 71501 



and desist all holding out, advertising or otherwise representing that it 
furnishes such recognized service. 

§71303. Application. 

Any licensee desiring approval for a supplemental service shall file 
with the Department an application on forms furnished by the Depart- 
ment. 

§ 71305. Issuance, Expiration and Renewal. 

(a) The Department shall list on the hospital license each supplemental 
service for which approval is granted. 

(b) If the applicant is not in compliance with the laws and regulations, 
the Department shall deny the applicant approval and shall immediately 
notify the applicant in writing. Within 20 days of receipt of the Depart- 
ment's notice, the applicant may present his written petition for a hearing 
to the Department. The Department shall set the matter for hearing within 
30 days after receipt of the petition in proper form. The proceedings shall 
be conducted in accordance with Chapter 5 (commencing with Section 
1 1500) of Part 1 of Division 3 of Title 2 of the Government Code. 

(c) Each supplemental service approval shall expire on the date of ex- 
piration of the hospital license. A renewal of the approval may be issued 
for a period not to exceed two years if the holder of the approval has been 
found not to have been in violation of any statutory requirements, regula- 
tions or standards during the preceding approval period. 

§ 71307. Program Flexibility. 

(a) All hospitals shall maintain continuous compliance with the 
supplemental service requirements. These requirements do not prohibit 
the use of alternate concepts, methods, procedures, techniques, equip- 
ment, personnel qualifications or the conducting of pilot projects pro- 
vided such exceptions are carried out with the prior written approval of 
the Department. Such approval 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 Depart- 
ment. 

(b) Any approval granted by the Department pursuant to this Section, 
or a true copy thereof, shall be posted immediately adjacent to the facil- 
ity's license required to be posted by Section 71121. 

§ 71309. Revocation or Involuntary Suspension of 
Approval. 

(a) Pursuant to provisions of Chapter 5 (commencing with Section 
1 1500), Part I, Division 3, Government Code, the Department may sus- 
pend or revoke the approval of a supplemental service issued under the 
provisions of Chapter 2 (commencing with Section 1250), Division 2, 
Health and Safety Code, upon any of the following grounds: 

(1) Violation by the licensee of any provisions of Chapter 2 (com- 
mencing with Section 1 250), Division 2, Health and Safety Code, or of 
the supplemental service regulations promulgated by the Department. 

(2) Aiding, abetting or permitting the violation of any provisions of 
Chapter 2 (commencing with Section 1 250), Division 2, Health and Safe- 
ty Code, or of any supplemental service regulations promulgated by the 
Department. 

(3) Conduct inimical to the public health, morals, welfare or safety of 
the people of the State of California in the maintenance and operation of 
a supplemental service. 

(b) The Director may temporarily suspend any supplemental service 
approval prior to any hearing when, in his opinion, such action is neces- 
sary to protect the public welfare. 

( 1 ) The Director shall notify the licensee of the temporary suspension 
and the effective date thereof and at the same time shall serve such licens- 
ee with an accusation. 

(2) Upon receipt of a notice of contest by the licensee, the Director 
shall set the matter for hearing within 30 days after receipt of such notice. 

(3) The temporary suspension shall remain in effect until such time as 
the hearing is completed and the Director has made a final determination. 



(4) If the Director fails to make a final determination within 60 days 
after the original hearing has been completed, the temporary suspension 
shall be deemed vacated. 

(5) If the provisions of Chapter 2 (commencing with Section 1250), 
Division 2, Health and Safety Code, or the supplemental service regula- 
tions promulgated by the Director are violated by a licensee which is a 
group, corporation or other association, the Director may suspend the ap- 
proval of such organization or may suspend the approval as to any indi- 
vidual person within such organization who is responsible for such viola- 
tion. 

(c) The withdrawal of an application for approval shall not deprive the 
Department of its authority to institute or continue a proceeding against 
the applicant for the denial of the approval upon any group provided by 
law or to enter an order denying the approval upon any such ground, un- 
less the Department consents in writing to such withdrawal. 

(d) The suspension, expiration or forfeiture of an approval issued by 
the Department shall not deprive the Department of its authority to insti- 
tute or continue a proceeding against the licensee upon any ground pro- 
vided by law or to enter an order suspending or revoking approval or 
otherwise taking disciplinary action against the licensee on any such 
ground. 

(e) A licensee whose approval has been revoked or suspended may pe- 
tition the Department for reinstatement or reduction of penalty after a pe- 
riod of not less than one year has elapsed from the effective date of the 
decision or from the date of the denial of a similar petition. 

Article 5. Supplemental Services 

§ 71 401 . Requirements for Supplemental Services. 

When a supplemental service is provided, the requirements for that 
service in Article 3 and 6, Chapter 1 , Division 5, Title 22, California Ad- 
ministrative Code, shall be met. 

§ 71403. Types of Supplemental Services. 

(a) Supplemental services include but are not limited to: 

(1) Anesthesia Service. 

(2) Clinical Laboratory Service. 

(3) Intensive Care Service. 

(4) Intermediate Care Service. 

(5) Outpatient Service. 

(6) Radiological Service. 

(7) Skilled Nursing Service. 

Article 6. Administration 

§ 71501. Governing Body. 

(a) The governing body shall: 

(1) Adopt written bylaws in accordance with legal requirements and 
its community responsibility which shall include but not be limited to 
provision for: 

(A) Identification of the purposes of the hospital and the means of ful- 
filling them. 

(B) Appointment and reappointment of members of the medical staff. 

(C) Appointment and reappointment of one or more dentists, podia- 
trists, and/or clinical psychologists to the medical staff respectively when 
dental, podiatric, and/or clinical psychological services are provided. 

(D) Formal organization of the medical staff with appropriate officers 
and bylaws. 

(E) Membership on the medical staff which shall be restricted to physi- 
cians, dentists, podiatrists and clinical psychologists competent in their 
respective fields, worthy in character and in professional ethics. No hos- 
pital shall discriminate with respect to employment, staff privileges or 
the provision of professional services against a licensed clinical psychol- 
ogist within the scope of his/her licensure, or against a licensed physician 
and surgeon or podiatrist on the basis of whether the physician and sur- 
geon or podiatrist holds an M.D., D.O. or D.P.M. degree. Wherever staff- 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



ing requirements lor a service mandate that the physician responsible for 
the service be certified or eligible for certification by an appropriate 
American Medical Board, such position may be filled by an osteopathic 
physician who is certified or eligible for certification by the equivalent 
appropriate American Osteopathic Board. 

(F) Self government by the medical staff with respect to the profes- 
sional work performed in the hospital, regular and periodic meetings of 
the medical staff to review and analyze their clinical experience, and re- 
quirement that the medical records of the patients shall be the basis for 
such review and analysis. 

(G) The preparation and maintenance of a complete and accurate med- 
ical record for each patient. 

(2) Appoint an administrator whose qualifications, authority and du- 
ties shall be defined in a written statement adopted by the governing 
body. The Department shall be notified in writing whenever a change of 
administrator occurs. 

(3) Provide appropriate physical resources and personnel required to 
meet the needs of the patients and shall participate in planning to meet 
the mental health needs of the community. 

(4) Take all reasonable steps to conform to all applicable federal, state 
and local laws and regulations, including those relating to licensure, fire 
inspection and other safety measures. 

(5) Provide for the control and use of the physical and financial re- 
sources of the hospital. 

(6) Require that the medical staff establish controls that are designed 
to ensure the achievement and maintenance of high standards of profes- 
sional ethical practices including provision that all members of the medi- 
cal staff be required to demonstrate their ability to perform surgical and/ 
or other procedures competently to the satisfaction of an appropriate 
committee or committees of the staff, at the time of original application 
for appointment to the staff and at least every two years thereafter. 

(7) Assure that medical staff bylaws, rules and regulations are subject 
to governing body approval, which approval shall not be withheld unrea- 
sonably. These bylaws shall include an effective formal means for the 
medical staff, as a liaison, to participate in the development of all hospital 
policy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

2. Editorial correction of subsection (a)(6) filed 8-31-83; effective thirtieth day 
thereafter (Register 83, No. 36). 

§ 71503. Organized Medical Staff. 

(a) Each hospital shall have an organized medical staff responsible to 
the governing body for the fitness, adequacy and quality of the medical 
care rendered to patients in the hospital. 

(b) Medical staff membership. 

( 1 ) The medical staff shall be composed of physicians and, where den- 
tal or podiatric services are provided, dentists or podiatrists. 

(2) When clinical psychological services are provided, clinical psy- 
chologists may be appointed to the medical staff subject to the bylaws, 
rules and regulations of the hospital. 

(c) The medical staff, by vote of the members and with the approval 
of the governing body, shall adopt written bylaws which provide formal 
procedures for the evaluation of staff applications and credentials, ap- 
pointments, reappointments, assignment of clinical privileges, appeals 
mechanisms and such other subjects or conditions which the medical 
staff and governing body deem appropriate. The medical staff shall abide 
by and establish a means of enforcement of its bylaws. Medical staff by- 
laws, rules and regulations shall not deny or restrict, within the scope of 
their licensure, the voting rights of staff members or assign staff members 
to any special class or category of staff membership, based upon whether 
such staff members hold an M.D., D.O. or D.P.M. degree or clinical psy- 
chology license. 

(d) The medical staff shall meet regularly. Minutes of each meeting 
shall be retained and filed at the hospital. 



(e) The medical staff bylaws, rules, and regulations shall include, but 
shall not be limited to, provision for the performance of the following 
functions: executive review, credentialing, medical records, tissue re- 
view, utilization review, infection control, pharmacy and therapeutics, 
and assisting the medical staff members impaired by chemical dependen- 
cy and/or mental illness to obtain necessary rehabilitation services. 
These functions may be performed by individual committees, or when 
appropriate, all functions or more than one function may be performed 
by a single committee. Reports of activities and recommendations relat- 
ing to these functions shall be made to the executive committee and the 
governing body as frequently as necessary and at least quarterly. 

(f) The medical staff shall provide in its bylaws, rules and regulations 
for appropriate practices and procedures to be observed in the various de- 
partments of the hospital. In this connection, the practice of division of 
fees, under any guise whatsoever, shall be prohibited and any such divi- 
sion of fees shall be cause for exclusion from the staff. 

(g) The medical staff shall provide for availability of a staff physician 
for emergencies among the in-hospital population in the event that the 
attending physician or his alternate is not available. 

(h) The medical staff shall participate in a continuing program of pro- 
fessional education. The results of retrospective medical care evaluation 
shall be used to determine the continuing education needs. Evidence of 
participation in such programs shall be available. 

(i) The medical staff shall provide at least one physician to participate 
as a member of the hospital infection control committee. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

2. Amendment of subsection (e) filed 10-3-88; operative 1 1-2-88 (Register 88, 
No. 41). 

§ 71505. Medical Staff, Residents, Interns and Students. 

(a) The hospital shall not permit any physician, dentist, podiatrist or 
clinical psychologist or any medical, dental, podiatric or clinical psy- 
chology resident, intern or student to perform any service for which a li- 
cense, certificate of registration or other form of approval is required un- 
less such person is licensed, registered, approved or is exempted 
therefrom under the provisions of the State Medical Practice Act, the 
State Dental Practice Act or the State Psychology Licensing Law and, 
further, unless such services are performed under the direct supervision 
of a licensed practitioner whenever so required by law. 

(b) If patient care is provided by residents, interns and medical stu- 
dents, such care shall be in accordance with the provisions of a program 
approved by and in conformity with: the Council on Education of the 
American Medical Association, the American Osteopathic Association 
Board of Trustees through the Committee on postdoctoral training and 
the Bureau of Professional Education, the American Dental Association, 
the American Podiatry Association or the Education and Training Board 
of the American Psychological Association, and/or the residency train- 
ing programs of the respective specialty boards. 

(c) Except in an emergency, all other patient care by interns, house of- 
ficers, residents or persons with equivalent titles, not provided as speci- 
fied in subdivision (b) of this section, must be provided by a practitioner 
with a current license to practice in California. 

NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 
1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§71507. Patients' Rights. 

(a) All patients shall have rights which include, but are not limited to 
the following: 

(1 ) To wear his own clothes, to keep and use his own personal posses- 
sions including his toilet articles; and to keep and be allowed to spend a 
reasonable sum of his own money for canteen expenses and small pur- 
chases. 

(2) To have access to individual storage space for his private use. 

(3) To see visitors each day. 



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(4) To have reasonable access to telephones, both to make and receive 
confidential calls. 

(5) To have ready access to letter writing materials, including stamps, 
and to mail and receive unopened correspondence. 

(6) To refuse shock treatment. 

(7) To refuse psychosurgery as defined in Section 5325, Welfare and 
Institutions Code. 

(8) To be informed of the provisions of law regarding complaints and 
of procedures for registering complaints confidentially, including but not 
limited to, the address and telephone number of the complaint receiving 
unit of the Department. 

(9) All other rights as provided by law or regulation. 

(b) The physician who has overall responsibility for the service or his 
designee, may for good cause, deny a person any of the rights specified 
in (a) above, except those rights specified in subsection (7) and (9) above 
and the rights under subsection (6) may be denied only under the condi- 
tions specified in Section 5326.7, Welfare and Institutions Code. The de- 
nial, and the reasons therefore, shall be entered in the patient's medical 
record. 

(c) These rights, written in English and Spanish, shall be prominently 
posted. 

(d) There shall be a procedure established whereby patient complaints 
are forwarded to hospital administration. Knowledge of this procedure 
shall be readily available to patients. The hospital administration shall, 
in all cases, acknowledge to the patient their receipt of his complaint. Ad- 
ditional follow-up of the complaint and response to the patient shall be 
handled as is appropriate. 

History 
1. Editorial correction of subsection (b) (Register 80, No. 40). 

§71508. Clinical Research. 

Research projects involving human subjects shall have the prior ap- 
proval of a broadly represented committee which shall assure maximum 
patient safety and understanding. 

§ 71509. Emotional and Attitudinal Support. 

Hospitals shall have a written plan for the provision of those compo- 
nents of total patient care that relate to the spiritual, emotional and attitu- 
dinal needs of the patient, patients' families and hospital personnel. 

§ 71 51 1 . Education of Patients. 

(a) Where patients of school age expected to remain in the hospital for 
30 days or more, the local school district shall be contacted to arrange for 
education, wherever appropriate. 

(b) A hospital may operate its own educational program for patients 
in the school age group in consultation and cooperation with the local 
school district. 

§ 71513. Outside Resource. 

If a hospital does not employ a qualified professional person to render 
a specific service to be provided by the hospital, there shall be arrange- 
ments for such a service through a written agreement with an outside re- 
source which meets the standards and requirements of these regulations. 
The responsibilities, functions, and objectives, and the terms of agree- 
ment, including financial arrangements and charges, of each such outside 
resource shall be delineated in writing and signed by an authorized repre- 
sentative of the hospital and the person or the agency providing the ser- 
vice. The agreement shall specify that the hospital retains professional 
and administrative responsibility for the services rendered. The outside 
resource, when acting as a consultant, shall apprise the administrator of 
recommendations, plans for implementation and continuing assessment 
through dated, signed reports which shall be retained by the administrator 
for follow-up action and evaluation of performance. 

§71515. Nondiscrimination Policies. 

(a) No hospital shall discriminate against any person based on sex, 
race, color, religion, ancestry or national origin, except as provided here- 
in. This provision shall apply to the appointment of the medical staff, hir- 



ing of hospital employees and the admission, housing or treatment of pa- 
tients. 

(b) Any bona fide nonprofit religious, fraternal or charitable organiza- 
tion, which can demonstrate to the satisfaction of the Department that its 
primary or substantial purpose is not to evade this section, may establish 
admission policies limiting or giving preference to their own members 
or adherents. Such policies shall not be construed as a violation of the first 
paragraph of this section. Any admission of nonmembers or nonadher- 
ents shall be subject to the first paragraph of this subsection. 

(c) No hospital which permits sterilization operations for contracep- 
tive purposes nor any member of its medical staff shall require of the pa- 
tient any special nonmedical qualifications which are not imposed upon 
individuals seeking other types of operations. Prohibited nonmedical 
qualifications shall include, but not be limited to, age, marital status and 
number of natural children. This prohibition does not affect requirements 
relating to the physical or mental condition of the patient, physician 
counseling of the patient or existing law pertaining to individuals below 
the age of majority. 

§ 71517. Admission, Transfer and Discharge Policies. 

(a) Each hospital shall have written admission, transfer and discharge 
policies which encompass the types of diagnoses for which patients may 
be admitted, limitations imposed by law or licensure, staffing limitations, 
rules governing emergency admissions, policies concerning advance de- 
posits, rates of charge for care, charges for extra services, terminations 
of services, refund policies, insurance agreements and other financial 
considerations, discharge of patients and other related functions. 

(b) Patients shall be admitted only upon the order and under the care 
of a member of the medical staff of the hospital who is lawfully autho- 
rized to diagnose, prescribe and treat patients. The patient's condition 
and provisional diagnosis shall be established at time of admission by the 
member of the medical staff who admits the patient subject to the rules 
and regulations of the hospital, and the provisions of Section 71505(a). 

(c) Within 24 hours after admission or immediately before, every pa- 
tient shall have a complete history and physical examination and psy- 
chiatric evaluation performed by persons lawfully authorized by their re- 
spective practice acts to perform such examinations providing the 
condition of the patient permits. Each patient shall have a complete psy- 
chological evaluation performed by a physician and surgeon or clinical 
psychologist consistent with the medical staff bylaws, and providing the 
condition of the patient permits. 

(d) No mentally competent adult, shall be detained in a hospital against 
his will. An emancipated minor shall not be detained in a hospital against 
his will. An unemancipated minor shall not be detained against the will 
of his parent or legal guardian. In those cases where law permits an un- 
emancipated minor to contract for medical care without the consent of his 
parent or guardian, he shall not be detained in the hospital against his will. 
This provision shall not be construed to preclude or prohibit attempts to 
persuade a patient to remain in the hospital in his own interest, nor the 
temporary detention of a mentally disturbed patient for the protection of 
himself or others under the provisions of the Lanterman-Petris-Short 
Act (Welfare and Institutions Code, Section 5000 et seq.) if the hospital 
has been designated by the county as a treatment facility pursuant to said 
act, nor to prohibit a minor legally capable of contracting for medical care 
from assuming responsibility for his discharge. However, in no event 
shall a patient be detained solely for nonpayment of his hospital bill. 

(e) No inpatient shall be transferred or discharged for purposes of ef- 
fecting a transfer, from a hospital to another health facility, unless ar- 
rangements have been made in advance for admission to such health fa- 
cility and the person legally responsible for the patient has been notified 
or attempts over a 24-hour period have been made and a responsible per- 
son cannot be reached. A transfer or discharge shall not be carried out if, 
in the opinion of the patient's physician such transfer or discharge would 
create a medical hazard. 

(f) A minor shall be discharged only to the custody of his or her parent 
or to his legal guardian or custodian, unless such parent or guardian shall 
otherwise direct in writing. This provision shall not be construed to pre- 



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BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



elude a minor legally capable of contracting for medical care from as- 
suming responsibility for himself upon discharge. 

(g) Each patient upon admission shall be provided with a wristband 
identification tag or other means of identification unless the patient's 
condition will not permit such identification. Minimum information shall 
include the name of the patient, hospital admission number and the name 
of the hospital. 

(h) Involuntary admission to the hospital shall be in conformity with 
the provisions of the Lanterman-Petris-Short Act (Welfare and Institu- 
tions Code, Section 5000 et seq.). 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1315, 1316 and 1316.5. Health and Safety Code. 

History 

1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83. No. 7). 

2. Change without regulatory effect amending subsections (b) and (e) and amend- 
ing Notk filed 3-24-2005 pursuant to section 100, title 1, California Code of 
Regulations (Register 2005, No. 12). 

3. Change without regulatory effect amending subsections (b) and (e) and Note 
filed 4-20-2006 pursuant to section 1 00, title 1 , California Code of Regulations 
(Register 2006, No. 16). 

§71519. Personnel Policies. 

(a) Each hospital shall adopt written personnel policies concerning 
qualifications, responsibilities and conditions of employment for each 
type of personnel, which shall be available to all personnel. Such policies 
shall include but not be limited to: 

( 1 ) Wage scales, hours of work and all employee benefits. 

(2) A plan for orientation of all personnel to policies and objectives of 
the hospital and for on-the-job training where necessary. 

(3) A plan for at least an annual evaluation of employee performance. 

(b) Personnel policies shall require that employees and other persons 
working in or for the hospital familiarize themselves with these and such 
other regulations as are applicable to their duties. 

(c) Hospitals shall furnish evidence of a plan for growth and develop- 
ment of the hospital staff through: 

( 1 ) Designation of a staff member qualified by training and experience 
who shall be responsible for staff education. 

(2) Reference material, relevant to the services provided by the hospi- 
tal, which shall be readily accessible to the staff. 

§71521. Employees. 

(a) The hospital shall recruit qualified personnel and provide initial 
orientation of new employees, a continuing in-service training program 
and competent supervision designed to improve patient care and em- 
ployee efficiency. 

(b) If language or communication barriers exist between hospital staff 
and a significant number of patients, arrangements shall be made for in- 
terpreters or for the use of other mechanisms to insure adequate commu- 
nications between patients and personnel. 

(c) The hospital shall designate a member of the staff as a patient dis- 
charge planning coordinator. 

(d) All employees of the hospital, having patient contact, including 
students, interns and residents, shall wear an identification tag bearing 
their name and vocational classification. 

(e) All appropriate employees shall be given training in methods of 
hospital infection control. 

(f) Uniform rules shall be established for each classification of em- 
ployees concerning the conditions of employment. A written statement 
of all such roles shall be provided each employee upon commencing em- 
ployment. 

§ 71523. Employee Health Examinations and Health 
Records. 

(a) Personnel employed in health facilities who will have contact di- 
rectly or indirectly with patients shall be free from symptoms indicating 
the presence of infectious diseases. 

(b) A health examination performed under the direction of a physician 
shall be required as a requisite for employment and must be performed 
within one week after employment. Written examination reports signed 
by the physician which verify that employees are able to perform as- 



signed duties shall be maintained. Repeat examinations shall be per- 
formed whenever necessary to ascertain that employees are free from 
symptoms indicating the presence of infectious disease and are able to 
perform their assigned duties. Upon initial examination, and at least an- 
nually, the employee shall have a skin test for tuberculosis using Purified 
Protein Derivatives intermediate strength or a chest X-ray. Positive reac- 
tion to the skin test shall be followed by a 35.56 cm x 43. 18 cm (14" x 
17") chest X-ray. 

(c) Employee health records shall be maintained by the hospital and 
shall include the records of all required health examinations. Such re- 
cords shall be kept a minimum of three years following termination of 
employment. 

(d) Employees known to have or evidencing symptoms of infectious 
disease shall be removed from contact with patients. 

§ 71525. Employee Personnel Records. 

All hospitals shall maintain personnel records of all employees. Such 
records shall be retained for at least three years following termination of 
employment. The record shall include the employee's full name. Social 
Security number, the license or registration number, if any, brief resume 
of experience, employment classification, date of beginning employ- 
ment and date of termination of employment. Records of hours and dates 
worked by all employees during at least the most recent six-month period 
shall be kept on file at the place of employment. 

§ 71527. Job Descriptions. 

Job descriptions detailing the functions of each classification of em- 
ployee shall be written and shall be available to all personnel. 

§71529. Advertising. 

No hospital shall make or disseminate any false or misleading state- 
ment, or advertise by any manner or means any false claims regarding 
services provided by the hospital. 

§ 71 531 . Records and Reports. 

(a) Each hospital shall maintain copies of the following applicable 
documents on file in the administrative offices of the hospital: 

( 1 ) Articles of incorporation or partnership agreement. 

(2) Bylaws and rules and regulations of the governing body. 

(3) Bylaws and rules and regulations of the medical staff. 

(4) Minutes of the meetings of the governing body and the medical 
staff. 

(5) Reports of inspections by local, state and federal agencies. 

(6) All contracts, leases and other agreements required by these regu- 
lations. 

(7) Patient admission roster. 

(8) Reports of unusual occurrences for the preceding two years. 

(9) Personnel records. 

(10) Policy manuals. 

(11) Procedure manuals. 

( 1 2) Minutes and reports of the hospital infection control committee. 

(13) Any other records deemed necessary for the direct enforcement 
of these regulations by the Department. 

(b) The records and reports mentioned or referred to above shall be 
made available for inspection by any duly authorized officer, employee 
or agent of the Department. 

§71533. Annual Reports. 

All hospitals shall submit annual reports to the Department, on forms 
supplied by the Department and by the date specified on the form. 

§71535. Reporting. 

(a) Reportable Diseases or Unusual Occurrences. All cases of report- 
able diseases shall be reported to the local health officer in accordance 
with Section 2500, Article 1, Subchapter 1, Chapter 4, Title 17, Califor- 
nia Administrative Code. Any occurrence such as epidemic outbreak, 
poisoning, fire, major accident, disaster, other catastrophe or unusual oc- 
currence which threatens the welfare, safety or health of patients, person- 
nel or visitors shall be reported as soon as reasonably practical, either by 
telephone or by telegraph, to the local health officer and to the Depart- 



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§ 71545 



ment. The hospital shall furnish such other pertinent information related 
to such occurrences as the local health officer of the Department may re- 
quire. 

(b) Testing for Phenylketonuria. If a maternity patient is admitted the 
hospital shall comply with the requirements governing testing for phe- 
nylketonuria (PKU) contained in Section 6500 of Title 1 7, California Ad- 
ministrative Code. 

(c) Rhesus (Rh) Hemolytic Disease of the Newborn. All hospitals to 
which maternity patients may be admitted shall comply with the require- 
ments for the determination and reporting of the rhesus (Rh) blood type 
of maternity patients and the reporting of rhesus (Rh) hemolytic disease 
of the newborn as contained in Section 6510 of Title 17, California Ad- 
ministrative Code. 

(d) Child Placement. The release of children for adoption shall be in 
conformity with the state law regulating adoption procedure. Hospitals 
shall report to the Department on forms supplied by them, within 48 
hours, the name and address of any person other than a parent or relative 
by blood or marriage, or the name and address of the organization or insti- 
tution into whose custody a child is given on discharge from the hospital. 

§ 71537. Infection Control Program. 

(a) A written hospital infection control program shall be adopted. The 
program shall conform to the guidelines contained in Infection Control 
in the Hospital, 1974, published by the American Hospital Association, 
840 North Lake Shore Drive, Chicago, IL 6061 1. 

(b) A copy of the plan shall be available for review by the Department. 

(c) There shall be a system of reporting of possibly acquired hospital 
infections to the infection control committee. 

(d) The program shall be reviewed, evaluated and updated annually by 
the infection control committee. A report of this review shall be available 
to the Department. 

§ 71539. Disaster and Mass Casualty Program. 

(a) A written disaster and mass casualty program shall be developed 
and maintained in consultation with representatives of the medical staff, 
nursing staff, administration and fire and safety experts. The program 
shall be in conformity with the California Emergency Plan of October 10, 
1972 developed by the State Office of Emergency Services and the Cali- 
fornia Emergency Medical Mutual Aid Plan of March 1974 developed 
by the Office of Emergency Services, Department of Health. The pro- 
gram shall be approved by the medical staff and administration. A copy 
of the program shall be available on the premises for review by the De- 
partment. 

(b) The program shall cover local disasters occurring in the communi- 
ty and widespread disasters. It shall provide for at least the following: 

(1) Availability of adequate basic utilities and supplies, including gas, 
water, food and essential medical and supportive materials. 

(2) An efficient system of notifying and assigning personnel. 

(3) Unified medical command. 

(4) Conversion of all usable space into clearly defined areas for effi- 
cient triage, for patient observation and for immediate care. 

(5) Prompt transfer of casualties, when necessary and after prelimi- 
nary medical or surgical services have been rendered, to the facility most 
appropriate for administering definitive care. 

(6) A special disaster medical record, such as an appropriately de- 
signed tag, that accompanies the casualty as he is moved. 

(7) Procedures for the prompt discharge or transfer of patients, already 
in the hospital who can be moved without jeopardy. 

(8) Maintaining security in order to keep relatives and curious persons 
out of the triage area. 

(9) Establishment of a public information center and assignment of 
public relations liaison duties to a qualified individual. Advance arrange- 
ments with communications media will be made to provide organized 
dissemination of information. 

(c) The program shall be brought up-to-date, at least annually, and all 
personnel shall be instructed in its requirements. There shall be evidence 
in the personnel files, e.g., orientation checklist or elsewhere, indicating 



that all new employees have been oriented to the program and procedures 
within a reasonable time after commencement of their employment. 

(d) The disaster plan shall be rehearsed at least twice a year. There shall 
be a written report and evaluation of all drills. The actual evacuation of 
patients to safe areas during the drill is optional. 

§ 71 541 . Fire and Internal Disasters. 

(a) A written fire and internal disaster program, incorporating evacua- 
tion procedures, shall be developed with the assistance of fire, safety and 
other appropriate experts. A copy of the program shall be available on the 
premises for review by the Department. 

(b) The written program shall include at least the following: 

( 1 ) Plans for the assignment of personnel to specific tasks and respon- 
sibilities. 

(2) Instructions relating to the use of alarm systems and signals. 

(3) Information concerning methods of fire containment. 

(4) Systems for notification of appropriate persons. 

(5) Information concerning the location of fire fighting equipment. 

(6) Specification of evacuation routes and procedures. 

(7) Other provisions as the local situation dictates. 

(c) Fire and internal disaster drills shall be held at least quarterly, for 
each shift of hospital personnel and under varied conditions. The actual 
evacuation of patients to safe areas during a drill is optional. 

(d) The evacuation plan shall be posted throughout the facility and 
shall include at least the following: 

(1) Evacuation routes. 

(2) Location of fire alarm boxes. 

(3) Location of fire extinguishers. 

§71543. Fire Safety. 

All hospitals shall be maintained in conformity with the regulations 
adopted by the State Fire Marshal for the prevention of fire and for the 
protection of life and property against fire and panic. All hospitals shall 
secure and maintain a clearance relative to fire safety from the State Fire 
Marshal. 

§ 71 544. Disruption of Services. 

(a) Each hospital shall develop a written plan to be used when a discon- 
tinuance or disruption of services occurs. 

(b) The administrator shall be responsible for informing the Depart- 
ment, via telephone, immediately upon being notified of the intent of the 
discontinuance or disruption of services or upon the threat of a walkout 
of a substantial number of employees, or earthquake, fire, power outage 
or other calamity that causes damage to the facility or threatens the safety 
or welfare of patients or clients. 

§ 71 545. Restraint of Patients. 

(a) Restraint shall be used only when alternative methods are not suffi- 
cient to protect the patient or others from injury. 

(b) Patients shall be placed in restraint only on the written order of the 
physician. This order shall include the reason for restraint and the type 
of restraint to be used. In a clear case of emergency, a patient may be 
placed in restraint at the discretion of a registered nurse and a verbal or 
written order obtained thereafter. If a verbal order is obtained it shall be 
recorded in the patient's medical record and be signed by the physician 
on his next visit. 

(c) Patients in restraint by seclusion or mechanical means shall be ob- 
served at intervals not greater than 15 minutes. 

(d) Restraints shall be easily removable in the event of fire or other 
emergency. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1255, 1276 and 1316.5, Health and Safety Code. 

History 

1. Change without regulatory effect amending subsection (b) and adding Noth 
filed 3-24-2005 pursuant to section 1 00, title 1 , California Code of Regulations 
(Register 2005, No. 12). 

2. Change without regulatory effect amending subsection (b) and Noth filed 
4-20-2006 pursuant to section 100, title 1, California Code of Regulations 
(Register 2006, No. 16). 



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§ 71547. Medical Records Service. 

(a) The hospital shall maintain a medical record service which shall be 
conveniently located and adequate in size and equipment to facilitate the 
accurate processing, checking, indexing and filing of all medical records. 

( b) The medical records service shall be under the supervision of a reg- 
istered record administrator or accredited records technician. The regis- 
tered record administrator or accredited records technician shall be as- 
sisted by such qualified personnel as are necessary for the conduct of the 
service. 

(c) Policies and procedures shall be established to ensure the confiden- 
tiality of patient health information, in accordance with applicable laws 
and regulations. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. New subsection (c) filed 2-8-83; designated effective 3-2-83 (Register 83, 

No. 7). 

§ 71549. Medical Record Content. 

(a) Each inpatient medical record shall consist of at least the following: 
( 1 ) Identification sheets to include but not be limited to the following: 

(A) Name. 

(B) Address on admission. 

(C) Identification number (if applicable). 

1. Hospital admission number. 

2. Social Security number. 

3. Medicare number. 

4. Medi-Cal number. 

(D) Age. 

(E) Sex. 

(F) Marital status. 

(G) Legal status. 
(H) Religion. 

(1) Date of admission. 
(J) Date of discharge. 

(K) Name, address and telephone number of person or agency respon- 
sible for patient. 

(L) Name of patient's medical staff member responsible for care. 
(M) Initial diagnostic impression. 
(N) Discharge or final diagnosis. 
(O) Disposition. 

(2) Psychiatric history and physical examination. 

(3) Legal authorization for admission. 

(4) Consultation reports, including neurologic examination. 

(5) Order sheet including medication, treatment and diet orders. 

(6) Treatment plan. 

(7) Progress notes including current or working diagnosis, the com- 
plaints of others regarding the patient, as well as the patient's comments. 

(8) Nurses' notes which shall include but not be limited to the follow- 
ing: 

(A) Concise and accurate record of nursing care provided. 

(B) Record of pertinent observation of the patient and the response to 
treatment. 

(C) Name, dosage and time of administration of medications and treat- 
ment. Route of administration and site of injection shall be recorded, if 
other than by oral administration. 

(D) Record of type of restraint, including time of application and re- 
moval. 

(9) Vital sign sheet, including weight record. 

(10) Reports of all laboratory tests performed. 

(11) Reports of all X-ray examinations performed. 

(12) Consent forms, when applicable. 

(13) Anesthesia record including preoperative diagnosis, if anesthesia 
has been administered. 

(14) Operative report including preoperative and postoperative diag- 
nosis, description of findings, technique used, tissue removed or altered, 
if surgery was performed. 



(15) Pathological report, if tissue or body fluid was removed. 

(16) Labor record, if applicable. 

(17) Delivery record, if applicable. 

( 1 8) A discharge summary which shall briefly recapitulate the signifi- 
cant findings and events of the patient's hospitalization, the patient's 
condition on discharge and the recommendation and arrangements for 
future care. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1316.5, Health and Safety Code. 

History 
1. Amendment filed 2-8-83: designated effective 3-2-83 (Register 83, No. 7). 

§ 71551. Medical Record Availability. 

(a) Records shall be kept on all patients admitted or accepted for treat- 
ment. All required records, either as originals or accurate reproductions 
of the contents of such originals, shall be maintained in such form as to 
be legible and readily available upon the request of: the attending physi- 
cian; the hospital or its medical staff or any authorized officer, agent or 
employee of either; authorized representatives of the Department; or any 
other person authorized by law to make such a request. 

(b) The medical record, including X-ray film, is the property of the 
hospital and is maintained for the benefit of the patient, the medical staff 
and the hospital. The hospital shall safeguard the information in the re- 
cord against loss, defacement, tampering or use by unauthorized persons. 

(c) Patient records including X-ray film or reproductions thereof shall 
be preserved safely for a minimum of seven years following discharge 
of the patient, except that the records of unemancipated minors shall be 
kept at least one year after such minor has reached the age of 1 8 years and, 
in any case, not less than seven years. 

(d) If a hospital ceases operation, the Department shall be informed 
within 48 hours of the arrangements made for safe preservation of patient 
records as above required. 

(e) If ownership of a licensed hospital changes, both the previous li- 
censee and the new licensee shall, prior to the change of ownership, pro- 
vide the Department with written documentation that: 

(1) The new licensee will have custody of the patients' records upon 
transfer of the hospital, and that the records are available to both the new 
and former licensee and other authorized persons; or 

(2) Arrangements have been made for the safe preservation of patient 
records, as required above, and that the records are available to both the 
new and former licensees and other authorized persons. 

(f) Medical records shall be filed in an easily accessible manner in the 
hospital or in an approved medical record storage facility off the hospital 
premises. 

(g) Medical records shall be completed promptly an authenticated or 
signed by a physician, dentist, podiatrist or clinical psychologist within 
two weeks following the patient's discharge. Medical records may be au- 
thenticated by a signature stamp or computer key, in lieu of a physician's 
signature, only when that physician has placed a signed statement in the 
hospital administrative office to the effect that he/she is the only person 
who: 

(1) Has possession of the stamp or key. 

(2) Will use the stamp or key. 

(h) Medical records shall be indexed according to patient, diagnoses 
and physician. 

(i) By July 1, 1976 a unit medical record system shall be established 
and implemented with inpatient, outpatient and emergency room records 
combined. 

(j) The medical record shall be closed and a new record initiated when 
a patient is transferred to a different level of care within a hospital which 
has a distinct part skilled nursing or intermediate care service. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§71553. Transfer Summary. 

A transfer summary shall accompany the patient upon transfer to a 
skilled nursing or intermediate care facility or to the skilled nursing long- 
term unit of the hospital. The transfer summary shall include essential in- 



Page 832 



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Title 22 Licensing and Certification of Health Facilities and Referral Agencies § 71555 

formation relative to the patient's diagnosis, hospital course, medica- rate, intact and free from any liability the licensee incurs in the use of his 

tions, treatments, dietary requirement, rehabilitation potential, known own or the institution's funds and valuables. 

allergies and treatment plan and shall be signed by the physician. (b) Each licensee shall maintain adequate safeguards and accurate re- 
cords of patients' monies and valuables entrusted to his care. 

§ 71555. Patients' Monies and Valuables. (1) Records, of patients' monies which are maintained as a drawing ac- 

(a) No licensee shall use patients' monies or valuables as his own or count, shall include a control account for all receipts and expenditures, 

mingle them with his own. Patients' monies and valuables shall be sepa- an account for each patient and supporting vouchers filed in chronolog- 



• 



[The next page is 833.] 



Page 832.1 Register 2006, No. 16; 4-21 -2006 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71609 



• 



ical order. Each account shall be kept current with columns for debits, 
credits and balance. 

(2) Records of patients' monies and other valuables entrusted to the 
licensee for safekeeping shall include a copy of the receipt furnished to 
the patient or to the person responsible for the patient. 

(c) Patients' monies not kept in the hospital shall be deposited in a de- 
mand taist account in a local bank authorized to do business in California, 
the deposits of which are insured by the Federal Deposit Insurance Cor- 
poration. A county hospital may deposit such funds with the county trea- 
surer. 

(d) When the amount of money entrusted to a licensee for patients ex- 
ceeds $500, all money in excess of $500 shall be deposited in a demand 
trust account as specified in (c), above, unless a fireproof safe is provided 
on the premises for the protection of monies and valuables. If a fireproof 
safe is kept and the licensee desires the protection accorded by Civil Code 
Section 1860, he shall give notice as provided by that section. 

(e) Upon discharge of a patient, all refunds due and all money and 
valuables of that patient which have been entrusted to the licensee shall 
be surrendered to the patient or the person responsible for the patient in 
exchange for a signed receipt. Money and valuables kept within the hos- 
pital must be surrendered upon demand and those kept in a demand trust 
account or with the county treasurer shall be made available within three 
normal banking days. 

(f) Following the death of a patient, except in a coroner or medical ex- 
aminers case, all money and valuables of that patient which have been 
entrusted to the licensee shall be surrendered to the person responsible 
for the patient, the executor or the administrator of the estate in exchange 
for a signed receipt, within 30 days. Immediate written notice of the death 
of a patient without an agent or known heirs shall be given to the public 
administrator of the county as specified by Section 1 145, of the Probate 
Code. 

(g) Upon change of ownership of a hospital, a written verification by 
a public accountant of all patients' monies which are being transferred 
to the custody of the new owners shall be obtained by the new owner in 
exchange for a signed receipt. 

§ 71 557. First Aid and Referrals. 

(a) If a hospital subject to the provisions of this chapter does not main- 
tain an emergency medical service, its employees shall nevertheless ex- 
ercise reasonable care to determine whether an emergency exists, render 
necessary life saving first aid and shall direct the persons seeking emer- 
gency care to the nearest hospital which can render the needed services 
and shall assist the persons seeking emergency care in obtaining such ser- 
vices, including transportation services, in every way reasonable under 
the circumstances. 

(b) Hospitals not providing emergency medical service shall not ad- 
vertise or make any other representation to the public that may convey 
or connote the availability of such service. The posting of signs to desig- 
nate entrances for use by outpatients and ambulances such as ambulance 
entrance, referred patients, outpatient service or other words of similar 
connotation is not prohibited. Such hospitals may represent to the public 
in any form or manner, and only in its entirety, the phrase first aid and 
referral service. 

§71559. Medical Library. 

(a) Each hospital shall maintain a medical library consistent with the 
needs of the hospital. 

(b) The medical library shall be located in a convenient location, and 
its contents shall be organized, easily accessible and available through 
authorized personnel at all times. 

(c) The library shall contain current textbooks, journals and magazines 
pertinent to the clinical services maintained in the hospital. 

§ 71 561 . Medical Photography. 

The hospital shall have a policy regarding the obtaining of consent for 
medical photography. 



§71563. Conference Room. 

A conference room shall be provided in the hospital. 

Article 7. Physical Plant 

§ 71 601 . Alterations to Existing Buildings or New 
Construction. 

(a) Alterations to existing buildings licensed as hospitals or new con- 
struction shall be in conformance with Chapter l. Division 17, Part 6, 
Title 24, California Administrative Code. 

(b) Hospitals licensed and in operation prior to the effective date of 
changes in these regulations shall not be required to institute corrective 
alterations or construction to comply with such changes except where 
specifically required or where the Department determines that a definite 
hazard to health and safety exists. Any hospital for which preliminary or 
working drawings and specifications have been approved by the Depart- 
ment prior to the effective date of changes to these regulations shall not 
be required to comply with such changes provided substantial, actual 
construction is commenced within one year after the effective date of 
such changes. 

§ 71603. Application for Plan Review. 

(a) Drawings and specifications for alterations to existing buildings or 
new construction shall be submitted to the Department for approval and 
shall be accompanied by an application for plan review on forms fur- 
nished by the Department. The application shall: 

( 1 ) Identify and describe the work to be covered by the plan review for 
which the application is made. 

(2) Describe the land on which the proposed work is to be done, by lot, 
block, tract or house and street address or similar description that will 
readily identify and definitely locate the proposed building or work. 

(3) Show the present and proposed use or occupancy of all parts of the 
building or buildings. 

(4) State the number of square meters (square feet) of floor area in- 
volved in new construction and in alterations. 

(5) Give such other information as may be required by the Department 
for unusual design circumstances. 

(6) Be signed by the person designing the work or the owner of the 
work. 

(b) The application for plan review shall also include a written state- 
ment that a description of the proposed work has been submitted to the 
Area Comprehensive Health Planning Agency approved by the State Ad- 
visory Health Council pursuant to Section 437.7 of the Health and Safety 
Code. 

§ 71605. Space Conversion. 

Spaces approved for specific uses at the time of licensure shall not be 
converted to other uses without the written approval of the Department. 

§ 71 607. Notice to Department. 

The licensee shall notify the Department in writing not later than ten 
days after the date when construction of a new hospital is commenced or 
when construction involving an increase in bed capacity or change of ser- 
vices of an existing hospital is commenced. 

§ 71 609. Patient Accommodations. 

(a) No hospital shall have more patients or beds set up for overnight 
use by patients than the approved licensed bed capacity except in the case 
of justified emergency when temporary permission may be granted by 
the Director or his designee. Beds not used for overnight stay such as la- 
bor room beds, recovery beds, beds used for admission screening or beds 
used for diagnostic purposes in X-ray or laboratory departments are not 
included in the approved licensed bed capacity. 

(b) Five percent of a facility's total licensed bed capacity may be used 
for a classification other than that designated on the license. Upon appli- 
cation to the Director and a showing that seasonal fluctuations justify, the 
Director may grant the use of an additional five percent of the beds for 
other than the classified use. 



Page 833 



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§ 71611 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(c) Patients shall not be housed in areas which have not been approved 
by the Department for patient housing and which have not been granted 
a fire clearance by the State Fire Marshal, except as provided in para- 
graph (a) above. 

(d) The number of licensed beds shown on a license shall not exceed 
the number of beds for which the facility meets applicable construction 
and operational requirements. 

History 

1. Amendment filed 1 1-12-76 as an emergency; effective upon filing (Register 
76, No. 46). 

2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11). 

§ 71 61 1 . Patient Rooms. 

(a) Patients shall be accommodated only in rooms with the following 
minimum floor area: 

( 1 ) Single rooms: 1 0.2 square meters (110 square feet) of floor area ex- 
cept for private rooms in pediatric units which shall have at least 9.3 
square meters (100 square feet). 

(2) Multipatient rooms: 7.4 square meters (80 square feet) of floor area 
per bed with one meter (three feet) between beds, except in specialized 
units. 

(b) Each patient room shall be labeled with a number, letter or combi- 
nation of the two for identification. 

(c) Patient rooms which are approved for ambulatory patients only 
shall not accommodate nonambulatory patients. Before patients are ac- 
commodated in ambulatory sections, they shall demonstrate that they are 
ambulatory, and this shall be noted in the patient's medical record. The 
hospital shall transfer patients from the ambulatory section when their 
condition becomes nonambulatory. The ambulatory status of patients 
shall be demonstrated upon request of the Department. 

(d) Patient rooms approved for use by ambulatory patients only shall 
be identified as follows: the words reserved for ambulatory patients, in 
letters at least one and one-half centimeters (one-half inch) high, shall 
be posted on the outside of the door or on the wall alongside the door 
where they are visible to persons entering the room. 

(e) Except for rooms approved by the Department for detention of psy- 
chiatric patients, patients' rooms shall not be kept locked when occupied. 

(f) The decision of maintaining locked wards shall be made by the 
staff, depending upon the needs of the patient(s). 

(g) Where patients are kept in locked wards or rooms, adequate staff 
must be available to assure safe and quick egress of the patients. 

(h) Where the safety of the patient and others are of appropriate con- 
cern because of the condition of the patient, windows shall either be inac- 
cessible to the patient or glazed with unbreakable materials. 

§ 71 61 3. Patient Property Storage. 

Patients shall be provided with closet or locker space for clothing, toi- 
let articles and other personal belongings. Where appropriate, bedside 
tables or equivalent shall also be provided. 

§ 71615. Patient Room Furnishings. 

A bed with a suitable mattress and a chair shall be provided for each 
patient. 

§ 71617. Provisions for Emptying Bedpans. 

(a) Bedpans shall be cleaned in utility rooms or bedpan cleaning 
rooms, unless toilets adjoining patients' rooms are used for cleaning bed- 
pans, in which case such toilets shall be equipped with bedpan flushing 
attachments and vacuum breakers. Bedpans shall not be cleaned in bath- 
tubs, handwashing sinks or laundry tubs. 

(b) Bedpan covers shall not be used interchangeably. 

§ 71 61 9. Provision for Privacy. 

A method of assuring privacy for each patient shall be maintained in 
patient rooms and in tub, shower and toilet rooms. 

§ 71 621 . Public Telephone. 

A telephone shall be available for patient use. 



§71623. Isolation Facilities. 

At least one single bed special room shall be provided for the isolation 
of a single patient at a ratio of one special room for each 50 beds or major 
fraction thereof. At least one special room shall be provided. 

§ 71625. Seclusion Rooms. 

Where provided, seclusion rooms shall be designed and equipped to 
ensure the safety of the patient. 

§71627. Patient Lounge. 

Adequate space and equipment shall be provided for patient use for so- 
cial activities. 

§71629. Laundry Service. 

(a) Laundry and linen. 

(1) An adequate supply of clean linen shall be provided for at least 
three complete bed changes for the hospital's full bed capacity. 

(2) There shall be written procedures developed and maintained per- 
taining to the handling, storage, transportation and processing of linens. 

(3) If the hospital operates its own laundry, such laundry shall be: 

(A) Located in such relationship to other areas that steam, odors, lint 
and objectionable noises do not reach patient or personnel areas. 

(B) Well lighted and ventilated and adequate in size for the needs of 
the hospital and for the protection of employees. 

(C) Maintained in a sanitary manner and in good repair. 

(D) Not part of a storage area. 

(4) Hospital linens shall be washed according to the following method: 
All linens shall be washed using an effective soap or detergent and 

thoroughly rinsed to remove soap or detergent and soil. Linens shall be 
exposed to water at a minimum temperature of 71°C (160°F) for at least 
24 minutes during the washing process, or a lower temperature of 60°C 
(140°F.) for 24 minutes may be utilized if the linens are subsequently 
passed through a flatwork ironer at 1 1 0- 1 1 5 feet per minute at a tempera- 
ture of 300°F. or a tumbler dryer at a temperature of 180°F. 

(5) Separate rooms shall be maintained in the hospital for storage of 
clean linen and for storage of soiled linen. Linen storage rooms shall be 
adequate in size for the needs of the hospital and shall not be used for any 
other purpose. Storage shall not be permitted in attic spaces, corridors or 
plenums (air distribution chambers) of air conditioning or ventilating 
systems. 

(6) Handwashing and toilet facilities for laundry personnel shall be 
provided at locations convenient to the laundry. 

(7) Soiled and clean linen carts shall be so labeled and provided with 
covers made of washable materials which shall be laundered daily or suit- 
ably cleaned daily. 

(8) If the hospital does not maintain a laundry service, the commercial 
laundry utilized shall meet the standards of this section. 

(b) Soiled linen. 

(1) Laundry shall be handled, stored and processed in a manner that 
will prevent the spread of infection and will assure the maintenance of 
clean linen. 

(2) Each of the following classes of laundry shall be separately trans- 
ported, stored and washed: 

(A) Linen from isolation rooms. 

(B) All radioactive contaminated linen. 

(C) Linen from pathology. 

(3) Soiled linen shall be sorted in a separate enclosed room by a person 
instructed in methods of protection from contamination. This person 
shall not have responsibility for immediately handling clean linen. 

(4) Soiled linen shall be stored and transported in a closed container 
which does not permit airborne contamination of corridors and areas oc- 
cupied by patients, and precludes the cross-contamination of clean linen. 

(5) If soiled linen is transported in wheeled containers such convey- 
ances shall not be used for transporting clean linen. Carts or conveyances 
and their contents shall be covered during the transportation process. 

(6) If chutes are used for transporting soiled linen, the chutes shall be 
maintained in a clean, sanitary state. 



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Licensing and Certification of Health Facilities and Referral Agencies 



§ 71641 



• 



(c) Clean Linen. 

( 1 ) Clean linen shall be sorted, handled and transported in such a man- 
ner as to prevent cross-contamination. 

(2) Clean linen carts shall be used only for the purpose of transporta- 
tion or storage of clean linen. 

(3) Persons processing clean linen shall be dressed in clean garments 
at all times while on duty and shall not handle soiled linen. 

(4) Clean linen from a commercial laundry shall be delivered to the 
hospital completely wrapped and delivered to a designated clean area. 

(5) Clean linen in patient care units shall be stored in clean, ventilated 
closets, rooms or alcoves, used for that purpose only. Corridors shall not 
be used for storage of linen. 

(6) If clean linen is stored in the laundry area, it shall be stored in a 
room separate from the sorting room, laundry room or soiled linen room. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 

1. Amendment of subsection (a) filed 10-15-85; effective thirtieth day thereafter 
(Register 85, No. 42). 



§ 71 631 . Housekeeping. 

(a) Each hospital shall make provision for the routine cleaning of ar- 
ticles and surfaces such as furniture, floors, walls, ceilings, supply and 
exhaust grills and lighting fixtures. 

(b) There shall be written routines and procedures developed and 
maintained to include but not be limited to the following: 

( 1 ) Daily cleaning of patient areas, nurses' stations, work areas, halls, 
entrances, storage areas, restrooms, laundry, pharmacy, offices, etc. 

(2) Daily cleaning of specialized areas. 

(3) Daily cleaning of isolation areas. 

(4) Daily cleaning of kitchen and associated areas. 

(5) Weekly cleaning of such things as radiators, clocks, pictures, venti- 
lators, curtains, draperies, etc. 

(6) Monthly and as necessary cleaning of walls and ceilings. 

(7) Terminal cleaning of patient unit upon discharge of patient. 

(c) There shall be sufficient housekeeping cleaning supplies and 
equipment provided. 

( 1 ) Housekeeping cleaning supplies, other than in bulk, and equipment 
shall be stored in housekeeping rooms. 

(2) A detergent germicide shall be used for all cleaning and dusting 
purposes. 

(3) Mop heads shall be removable and changed at least daily. 

(d) There shall be sufficient housekeeping personnel to maintain the 
interior of the hospital in a safe, clean, orderly, attractive manner and free 
from offensive odors. 

(e) A person qualified by experience and training shall be designated 
to be in charge of housekeeping service. 

§71633. Morgue. 

(a) Hospitals with a licensed bed capacity of 50 or more shall maintain 
a well ventilated morgue with autopsy facilities, unless adequate morgue 
and autopsy facilities are available in the local community. 

(b) Hospitals with a licensed bed capacity of 200 or more shall main- 
tain a well ventilated morgue with autopsy facilities. 

(c) Refrigerated compartments shall be maintained if human remains 
are held unembalmed. The air temperature shall not be higher than 7°C 
(45°F). 

§ 71635. Central Sterile Supply. 

(a) Each hospital shall provide, prepare, sterilize and store sufficient 
sterile supplies and medical and surgical equipment and shall dispense 
them to all services in the hospital. The operation of this service shall be 
carried out in an area designated, equipped and staffed for this purpose. 

(b) A person qualified by training and experience, recommended by 
the infection control committee shall be designated to be in charge of the 



central sterile supply. Liaison with the infection control committee shall 
be maintained through that person's membership on the committee. 

(c) There shall be written procedures developed and maintained per- 
taining to the cleaning, preparation, disinfection and sterilization of uten- 
sils, instruments, solutions, dressings and other articles. 

(d) There shall be effective separation of soiled or contaminated sup- 
plies and equipment from the clean and sterilized supplies and equip- 
ment. 

(e) Sterile supplies and equipment shall be stored in clean cabinets, 
cupboards or other satisfactory spaces. An orderly system of rotation of 
supplies shall be used so that supplies stored first will be used first. 

§ 71637. Autoclaves and Sterilizers. 

(a) Autoclaves and sterilizers shall be maintained in operating condi- 
tion at all times. 

(b) Instructions for operating autoclaves and sterilizers shall be posted 
in the area where the autoclaves and sterilizers are located. 

(c) Written procedures shall be developed, maintained and available 
to personnel responsible for sterilization of supplies and equipment that 
include, but are not limited to the following: 

(1) Time, temperature and pressure for sterilizing the various bundles, 
packs, dressings, instruments, solutions, etc. 

(2 Cleaning, packaging, storing and issuance of supplies and equip- 
ment. 

(3) Dating and outdating of material sterilized. 

(4) Loading of the sterilizer. 

(5) Daily checking of recording and indicating thermometers and fil- 
ing for one year of recording thermometer charts. 

(6) Monthly bacteriological test, the bacterial organism used and filing 
for one year of the test results. 

(7) Length of aeration time for materials gas sterilized. 

§71639. Disinfecting. 

(a) Each hospital shall make provision for the cleaning and disinfec- 
tion of contaminated articles and surfaces which cannot be sterilized. 

(b) Thermometers should be disinfected for at least ten minutes with 
70 percent ethyl alcohol or 99 percent isopropyl alcohol with 0.2 percent 
iodine. 

(c) Written procedures shall be developed and maintained for the dis- 
infection of articles and surfaces. 

§ 71 641 . General Safety and Maintenance. 

(a) The hospital shall be clean, sanitary, and in good repair at all times. 
Maintenance shall include provision and surveillance of services and 
procedures for the safety and well-being of patients, personnel and visi- 
tors. 

(b) Hospital buildings and grounds shall be maintained free of such en- 
vironmental pollutants and such nuisances as may adversely affect the 
health or welfare of patients to the extent that such conditions are within 
the reasonable control of the hospital. 

(c) All hospitals shall maintain in operating condition all buildings, 
fixtures and spaces in the numbers and types as specified in construction 
requirements under which the hospital or unit was first licensed. 

(d) A written manual on maintenance of heating, air conditioning and 
ventilation systems shall be adopted by each hospital and a maintenance 
log shall be maintained. 

(e) Equipment provided must meet any and all applicable California 
Occupational Safety and Health Act requirements in effect as of the time 
of purchase. All portable electrical equipment using 110-120 volt 60 
hertz current shall be equipped with a three-wire grounded power cord 
with an Underwriters Laboratories approved hospital grade three-prong 
plug. The cord grip shall be an integral part of the plug. 

(f) All gauging and measuring equipment shall be regularly calibrated 
as specified by the manufacturer and records of such testing kept lor at 
least two years. 



Page 835 



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§ 71643 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§71643. Air Filters. 

(a) The licensee shall be responsible for regular inspection, cleaning 
or replacement of all filters installed in heating, air conditioning and ven- 
tilating systems, as necessary to maintain the systems in normal operat- 
ing condition. The efficiency of the replacement filters shall be equal to 
the efficiency rating of the replaced filters. 

(b) A written record of inspection, cleaning or replacement including 
static pressure drop shall be regularly maintained and available for in- 
spection. The record shall include a description of the filters originally 
installed, the American Society of Heating, Refrigeration, and Air Con- 
ditioning Engineers (ASHRAE) atmospheric dust spot test efficiency rat- 
ing and the criteria established by the manufacturer or supplier to deter- 
mine when replacement or cleaning is necessary. 

(c) Following filter replacement or cleaning, the installation shall be 
visually inspected for torn media and bypass in filter frames by means of 
a flashlight or equivalent, both with fans in operation and stopped. Tears 
in filter media and bypass in filter frames shall be eliminated in accor- 
dance with the manufacturer's directions and as required by the Depart- 
ment. 

(d) Where filter maintenance is performed by an equipment service 
company, a certification shall be provided to the licensee that the require- 
ments listed in Section 71643 (a) and (b) have been accommodated. 

(e) If filter maintenance as required in Section 71643 (a) and (b) is per- 
formed by employees of the hospital, a written record shall be maintained 
by the licensee. 

§ 71645. Emergency Lighting and Power System. 

(a) Auxiliary lighting and power facilities shall be readily available at 
all times. 

( 1 ) The emergency lighting and power system shall be maintained in 
operating condition to provide automatic restoration of power for emer- 
gency circuits within ten seconds after normal power failure. 

(2) Emergency generators installed in hospitals shall be tested under 
load conditions for at least 30 minutes at intervals of not more than seven 
days. 

(b) The licensee shall provide and maintain an emergency electrical 
system in compliance with Section E702-7 and E7 02-20, Part 3, Title 
24, California Administrative Code. The system shall serve all lighting, 
signals, alarms and equipment required to permit continued operation of 
all necessary functions of the hospital for a minimum of 24 hours. 

(c) The Department may require the licensee to submit a report of eval- 
uation of the emergency electrical systems by a registered electrical engi- 
neer to substantiate compliance with Subarticle E702-7, Part 3, Title 24, 
California Administrative Code. Essential engineering data, including 
load calculations, assumptions and tests, and where necessary, plans and 
specifications acceptable to the Department, shall be included in the re- 
port. 

(d) Where alteration of the emergency electrical system is determined 
to be necessary, the work shall comply with Sections E702-20 and 
E702-24, Part 3, Title 24, California Administrative Code. 

(e) A written record of inspection, performance, exercising period and 
repairs shall be maintained and available. 

§ 71647. Storage and Disposal of Solid Wastes. 

(a) Solid wastes shall be stored and eliminated in a manner to preclude 
the transmission of communicable disease. These wastes shall not be a 
nuisance or provide a breeding place for insects or rodents nor shall it be 
a food source for either. 

(b) Solid waste containers shall be stored and located in a manner that 
will protect against odors. 

(c) Syringes and needles, before being discarded into waste contain- 
ers, shall be rendered unusable. 

§71649. Solid Waste Containers. 

(a) All containers, except movable bins used for storage of solid 
wastes, shall have tight-fitting covers in good repair, external handles 
and be leakproof and rodent proof. 



(b) Movable bins, when used for storing or transporting solid wastes 
from the premises, shall meet the following requirements: 

( 1 ) Have tight-fitting covers approved by the local health department 
and kept closed when not being loaded. 

(2) Be in good repair. 

(3) Be leakproof. 

(4) Be rodent proof unless stored in a room or screened enclosure. 

(c) All containers receiving putrescible wastes shall be emptied at least 
every four days, or more often if necessary. 

(d) Solid waste containers, including movable bins, shall be thorough- 
ly washed and cleaned each time they are emptied unless soil contact sur- 
faces have been completely protected from contamination by disposable 
liners, bags or other devices removed with the waste. Each movable bin 
may provide for suitable access and a drainage device to allow complete 
cleaning at the storage area. 

NOTE: Authority cited: Sections 208 (a) and 1254 Health and Safety Code. Refer- 
ence: Sections 1250 and 25157.3, Health and Safety Code. 

History 

1. Repealer of subsection (e) filed 12-30-83 as an emergency; effective upon fil- 
ing (Register 84, No. 3). A Certificate of Compliance must be transmitted to 
OAL within 1 20 days or emergency language will be repealed on 4-29-84. 

2. Certificate of Compliance transmitted to OAL 4-30-84 and withdrawn 
5-30-84 (Register 84, No. 24). 

3. Repealer of subsection (e) filed 5-30-84 as an emergency; effective upon filing 
(Register 84, No. 24). A Certificate of Compliance must be transmitted to OAL 
within 120 days or emergency language will be repealed on 9-27-84. 

4. Certificate of Compliance transmitted to OAL 9-26-84 and filed 10-16-84 
(Register 84, No. 42). 

§ 71 651 . Infectious Waste. 

Infectious waste, as defined in Health and Safety Code Section 
25 1 1 7.5, shall be handled and disposed of in accordance with the Hazard- 
ous Waste Control Law, Chapter 6.5, Division 20, Health and Safety 
Code (beginning with Section 25100) and the regulations adopted there- 
under (beginning with Section 66100 of this Title). 
NOTE: Authority cited: Sections 208, 1 254, 25 1 50 and 25 1 57.3, Health and Safety 
Code. Reference: Sections 1250, 251 17 and 251 17.5, Health and Safety Code. 

History 

1 . Repealer and new section filed 1 2-30-83 as an emergency ; effective upon filing 
(Register 84, No. 3). A Certificate of Compliance must be transmitted to OAL 
within 120 days or emergency language will be repealed on 4-29-84. 

2. Certificate of Compliance transmitted to OAL 4-30-84 and withdrawn 
5-30-84 (Register 84, No. 24). 

3. Repealer and new section filed 5-30-84 as an emergency; effective upon filing 
(Register 84, No. 24). A Certificate of Compliance must be transmitted to OAL 
within 120 days or emergency language will be repealed on 9-27-84. 

4. Certificate of Compliance transmitted to OAL 9-26-84 and filed 10-16-84 
(Register 84, No. 42). 

§ 71 653. Gases for Medical Use. 

(a) Provision shall be made for safe handling and storage of medical 
gas cylinders. 

(b) Transfer of gas by hospital personnel from one cylinder to another 
is prohibited except when approved by the Department. 

(c) Gases for medical use include carbon dioxide, cyclopropane, ethy- 
lene, helium, nitrous oxide, oxygen, helium-oxygen mixtures and car- 
bon dioxide-oxygen mixtures. 

(d) All anesthesia machines and related equipment shall be so con- 
structed that connections for different gases are not interchangeable. 

These requirements shall be accomplished by installing permanent fit- 
tings as indicated below: 

(1) Yoke connections of anesthesia machines and flush outlet valves 
for small compressed gas cylinders (Style E and smaller) shall conform 
with the pin index and safety system contained in pamphlet B57 . 1 , Com- 
pressed Gas Cylinder Valve Outlet and Inlet Connections, 1965 Edition, 
by the American National Standards Institute, Inc., 1430 Broadway, New 
York, NY 10018. 

(2) Valve outlet connections for large cylinders (Style F and larger) for 
oxygen and nitrous oxide shall conform with the standards contained in 
pamphlet B57.1, Compressed Gas Cylinder Valve Outlet and Inlet Con- 
nections, 1965 Edition, by the American National Standards Institute, 



Page 836 



(4-1-90) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71801 



Inc., 1430 Broadway, New York, NY 10018. Standard connection No. 
540 shall be used with oxygen cylinders and standard connection 1 320 
shall be used with nitrous oxide cylinders. Cylinders for medical gases, 
other than oxygen and nitrous oxide used with anesthesia machines, shall 
be limited to Style E and smaller. 

(3) Removable exposed threaded connections, where employed in 
medical gas piping systems and equipment used in conjunction with re- 
suscitators and oxygen therapy apparatus, shall be provided with nonin- 
terchangeable connections which conform with pamphlet V-5, Diame- 
ter-Index Safety System, May 1 970 printing, by the Compressed Gas 
Association, Inc., 500 Fifth Avenue, New York, NY 10036. 

(4) Station outlets from piped oxygen and nitrous oxide systems shall 
conform with the standards contained in bulletin NFPA No. 56F, Non- 
flammable Medical Gas Systems, 1973, by the National Fire Protection 
Association, 470 Atlantic Avenue, Boston, MA 02210. 

(5) Removable connection hoses from station outlets or cylinders to 
yokes of anesthesia machines shall be fitted with permanently connected 
fittings to match the standards listed above in paragraphs ( 1 ), (2), (3) and 
(4). 

(e) The piped oxygen or nitrous oxide system(s) shall be tested in ac- 
cordance with the National Fire Protection Association bulletin, NFPA 
No. 56F, referred to above, and a written report shall be maintained in 
each of the following instances. 

( 1 ) Upon completion of initial installation. 

(2) Whenever changes are made to a system. 

(3) Whenever the integrity of a system has been breached. 

(4) At least annually. 

(f) Oxygen Equipment. 

( 1 ) Vaporizer bottles shall be sterilized after each use. 

(2) Only sterile fluid shall be used in vaporizer bottles. 

(3) Vaporizer bottles shall be changed at least every 24 hours. 

§71655. Lighting. 

(a) All rooms, attics, basements, passageways and other spaces shall 
be illuminated. 

(b) Adequate illumination shall be maintained for the comfort of pa- 
tients and personnel. 

(c) All patient rooms shall have a minimum of 30 foot candles of light 
delivered to reading or working surfaces and not less than 10 foot candles 
of light in the remainder of the room. 

(d) All corridors, storerooms, stairways, ramps, exits and entrances 
shall have a minimum of five foot candles of light measured in the darkest 
corner. 

(e) Except in closets, storage spaces, attic spaces, equipment rooms 
and similar areas, lighting fixtures shall have suitable enclosures to con- 
trol fixture brightness and to prevent accidental breakage. Where ex- 
posed lamp fixtures are permitted, suitable guards shall be maintained in 
locations where breakage could be hazardous to personnel. 

(f) Emergency lighting facilities shall be maintained for use during 
electrical power failure. In addition, flashlights shall be available at all 
times. Open flame lights shall not be used. 

§ 71657. Mechanical Systems. 

Heating, air conditioning, and ventilating systems shall be maintained 
in operating condition to provide a comfortable temperature and to meet 
the new construction requirements in effect at the time plans were ap- 
proved for the hospital. 

§71659. Screens. 

To protect against flies and other insects, screens of 6 mesh per centi- 
meter (16 mesh per inch) shall be provided on doors and openable win- 
dows. Screen doors shall be of a type approved by the State Fire Marshal. 

§ 71 661 . Signal Systems. 

(a) Where bed patients are cared for, a call system shall be maintained 
in operating order in all nursing units. Call systems shall be maintained 



to provide visible and audible signal communication between nursing 
personnel and patients. The minimum requirements are: 

( 1 ) A visible signal in the corridor above the door of each patient room. 

(2) An audible signal and light indicating the room from which the call 
originates shall be located at the nurses' stations. Alternate systems must 
be approved in writing by the Department. 

(b) The nurses' call systems shall be designed to require resetting at 
the calling station where the call originates unless a two-way voice com- 
munication component is included in the system. 

§71663. Storage. 

(a) All hospitals shall maintain general storage space of at least l .9 
square meters (20 square feet) per bed in addition to specialized storage 
space. 

(b) Storage is not permitted in plenums (air distribution chambers) of 
air conditioning or ventilation systems. 

§ 71 665. Water Supply and Plumbing. 

(a) Water for human consumption from an independent source shall 
be subjected to bacteriological analysis by the local health department. 
State Department of Health or a licensed commercial laboratory at least 
every three (3) months. A copy of the most recent laboratory report shall 
be available for inspection. 

(b) Plumbing and drainage facilities shall be maintained in compliance 
with Part 5, Title 24, California Administrative Code, Basic Plumbing 
Requirements. Drinking water supplies shall comply with Group 4, Sub- 
chapter 1, Chapter 5, Division T 17, Part 6, Title 24, California Adminis- 
trative Code. 

(c) Backflow preventers (vacuum breakers) shall be maintained in op- 
erating condition where required by Section T17-210 (c), Division T17, 
Part 6, Title 24, California Administrative Code. 

(d) For hot water used by patients, there shall be temperature controls 
to automatically regulate the temperature between 40.5°C. (105°F) and 
48.9°C(120°F). 

(e) Hot water at a minimum temperature of 82.2°C (180°F) shall be 
maintained at the final rinse section of dishwashing facilities unless alter- 
nate methods are approved by the Department. 

(f) Taps delivering water at 51.60°C (125°F) or higher shall be identi- 
fied prominently by warning signs with letters 5 cm (2 inches) high. 

(g) Grab bars are not required for each toilet, bathtub and shower ex- 
cept where both are appropriate to patient care and supervised by person- 
nel. 

(h) As a minimum, toilet, handwashing and bathing facilities shall be 
maintained in operating condition in the number and types specified in 
construction requirements in effect at the time the building or unit was 
constructed. 

(i) Overhead pipes and ducts shall not be exposed in such manner as 
to endanger the patient directly or indirectly. 

§71667. Ice. 

Ice which is used in connection with food or drink shall be from a sani- 
tary source and shall be handled and dispensed in a sanitary manner. Bac- 
teriological testing shall be performed at least monthly and reports there- 
of shall be on file in the laboratory. 



Chapter 2.5. 



Certified Nurse Assistant 
Program 



Article 1. Definitions 

§71801. Agency. 

Agency means a private school, organization or individual approved 
by the Department to provide a continuing education course and a certifi- 
cation training program for nurse assistants. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1 and 1337.3(a), Health and Safety Code. 



Page 837 



Register 92, No. 41; 10-9-92 



§ 71803 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



History 

1 . New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted toOAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-L2-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§71803. Clinical Training. 

Clinical training means that portion of the orientation program and the 
certification training program which includes instruction and demonstra- 
tion on a patient of patient care skills by a Director of Staff Development 
or other instructor and a return demonstration of competence in these 
skills by the student. 

NOTE: Authority cited; Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71805. Continuing Education. 

Continuing education means provision of structured courses for certi- 
fied nurse assistants by an agency, a public educational institution, or in 
a health care setting other than the nursing facility where the certified 
nurse assistant is employed. 

NOTE. Authority cited: Sections 208(a), 1275, 1337.1 and 1338.3, Health and 
Safety Code. Reference: Sections 1337.1 and 1337.6, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 71807. Core Curriculum. 

Core curriculum means a description of each category of study within 
a program which covers the minimum knowledge and skills required for 
nurse assistants and builds on their knowledge in a logical and methodi- 
cal manner. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3(d), Health and Safety Code. 

History 
1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 

No. 46). A Certificate of Compliance must be transmitted to OAL by 11- 13-91 

or emergency language will be repealed by operation of law on the following 

day. 



2. New section refiled 11-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71 809. Director of Staff Development (DSD). 

Director of Staff Development (DSD) means a licensed nurse, ap- 
proved by the Department, who meets the qualification requirement as 
stated in section 7 1 829 and is employed by or under contract with a nurs- 
ing facility. 

NOTE: Authority cited: Sections 208.(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1 and 1337.4, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 71 81 1 . Gross Negligence. 

Gross negligence means the failure of a person to exercise any care, 
or the exercise of so little care that it is apparent that the person is indiffer- 
ent to the consequences of his or her conduct and to the welfare of others. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.8(d)(1), Health and Safety Code and CALJIC No. 
8.92 (4th ed. 1979). 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 11-14-91 as an emergency; operative 1 1-1 3-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§71813. Hour. 

Hour means fifty (50) minutes of participation in an organized learn- 
ing experience. Each hour of classroom theory shall be accepted as one 
(1) hour of certification training, in-service training or continuing educa- 
tion. 

NOTE: Authority cited: Sections 208(a), 13275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.3(c) and 1337.6(a), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 



Page 838 



Register 92, No. 41; 10-9-92 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71827 



§ 71 81 5. Immediate Supervision. 

Immediate Supervision means that a supervisor shall not only be in the 
same building but shall also be present while the person being supervised 
demonstrates the clinical skills. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3(c), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 



§ 71 81 7. Incompetence. 

Incompetence means that a certified nurse assistant does not possess 
or fails to exercise that knowledge and/or skill possessed and exercised 
by a reasonable certified nurse assistants under similar circumstances. 
NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1(c) and 1337.8(d), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, Not 41). 



§ 71 81 9. In-Service Training Program. 

In-service training program means a Department-approved structure 
program established for certified nurse assistants and provided by a nurs- 
ing facility employer of nurse assistants. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1(c) and 1337.6(a), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 11-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 



§71821. Instructor. 

Instructor means a licensed nurse employed by an agency or public 
educational institution who, when teaching a certification training pro- 
gram, meets the Department's qualifications for a Director of Staff De- 
velopment. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.3 and 1337.4, Health and Safety Code. 



History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1 - 1 3 91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3 -12- 92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 71823. Nursing Facility. 

Nursing facility means a skilled nursing facility, an intermediate care 
facility, an intermediate care facility/developmentally disabled or an in- 
termediate care facility/developmentally disabled-nursing. This defini- 
tion has a specific application to this chapter only and it is not intended 
to replace the statutory definition of "skilled nursing facility" or any oth- 
er definition of a health facility in Health and Safety Code section 
1250(c). 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337(a), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency: operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 71825. Public Educational Institution. 

Public educational institution means a community college, university, 
a regional occupation center, a high school, an adult education center, ac- 
credited school of professional nursing or accredited school of vocational 
nursing whose certified nurse assistant training programs have been ap- 
proved by the Department of Health Services or the Department of Con- 
sumer Affairs and offered by the Department of Education. 
NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1 - 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71 827. Student Performance Standard. 

Student performance standard means a standard which is used as a 
method of measuring student learning. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337 and 1337.3, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1 - 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 



Page 839 



Register 92, No. 41; 10-9-92 



§ 71828 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of section 
heading and text transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, 
No. 41). 



Article 2. Administration 

§ 71828. Administrative Policies and Procedures. 

(a) Each nursing facility, agency or public educational institution pro- 
viding nurse assistant training shall develop and implement written ad- 
ministrative and management policies to govern the administrative and 
management of the training program, the director of staff development 
and instructors. Such policies shall be reviewed annually and revised as 
often as the nursing facility, agency or public educational institution de- 
termines necessary. A copy of the written policies shall be made avail- 
able upon request to the Department. 

(b) Policies shall include but not be limited to: 

(1) Job descriptions detailing qualifications, duties, responsibilities, 
and limitations for the licensed nurse program director and the instruc- 
tors. 

(2) An organizational chart showing the person in charge of the pro- 
gram, the lines of authority, responsibility, communication, staff assign- 
ments, and schedules. 

(3) The method of monitoring instructors by the individual responsible 
for the training program. 

(4) The ratio of students to instructor(s) for the clinical training, not to 
exceed a ratio of one (1) instructor to fifteen (15) students. 

(5) How student absenteeism and makeup classes will be handled. 

(c) No nursing facility shall permit students to practice their clinical 
skills training or have contact with patients unless they have been 
screened and there is no indication they have been convicted of crimes 
defined in sections 220, 243.4, 261 , 264. 1 , 273a, 288, 289, and 368 of the 
Penal Code. 

(d) No nursing facility, agency, or public institution shall make or dis- 
seminate false or misleading statements or advertisements regarding 
training provided. 

(e) No nursing facility, agency, or public institution shall make a claim 
that completion of their program may lead to a student receiving a nurse 
assistant certification unless the nursing facility, agency, or public insti- 
tution provides a nurse assistant training program approved by the De- 
partment. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337 and 1337.3, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 11-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tion (c) transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71 829. Director of Staff Development or Instructor. 

(a) Each nursing facility, agency or public educational institution pro- 
viding nurse assistant training shall be responsible for hiring qualified 



staff and shall submit a resume to the Department reflecting the qualifica- 
tions of a Director of Staff Development or Instructor who must be ap- 
proved by the Department. In nursing facilities a licensed nurse who 
meets the qualifications in this section may provide the training in place 
of the DSD when the DSD is absent due to illness or vacation or when 
the DSD has terminated employment. In the latter instance the facility 
must show evidence of recruitment efforts. A copy of the resume must 
be kept on file at the facility or agency. The Department shall be notified 
within thirty (30) calendar days following the employment of a new Di- 
rector of Staff Development or Instructor. 

(1) Submission of a resume shall be deemed to occur on the date the 
resume is received by the Department. 

(2) A resume shall be considered complete when it clearly addresses 
all the qualifications required by this section. 

(b) The Department shall inform the facility, agency or public institu- 
tion, within thirty (30) calendar days of receipt of the resume that it is 
complete and accepted or that it is deficient and what specific informa- 
tion or documentation is required to complete the resume. 

(c) The Department's maximum time period to approve a resume for 
an Instructor or Director of Staff Development shall be sixty (60) calen- 
dar days, from the receipt of the initial application to the final decision 
regarding the resume. To prevent delays, the Department may provide 
telephone approvals whenever possible. Telephone approvals shall be 
followed by written confirmations. 

(d) The nursing facility, agency or public educational institution is re- 
sponsible for assuring that the Director of Staff Development or Instruc- 
tor who teaches the certification training program meets either of the fol- 
lowing qualification requirements: 

( 1 ) One ( 1 ) year of experience as a licensed nurse providing direct pa- 
tient care in a long term care facility in addition to one ( 1 ) year of experi- 
ence planning, implementing and evaluating educational programs in 
nursing; or 

(2) Two years of full time experience as a licensed nurse, at least one 
year of which must be in the provision of direct patient care in a nursing 
facility. Within six (6) months of employment and prior to teaching a cer- 
tification program, the Director of Staff Development or Instructor shall 
obtain a minimum of twenty-four (24) hours of continuing education 
courses in planning, implementing and evaluation educational programs 
in nursing. These must either be courses approved by the Board of Regis- 
tered Nursing or courses administered by an accredited educational insti- 
tution. A transcript of successfully completed courses shall be sent to the 
Department and shall be used as a basis for approval of the qualifications 
of the Director of Staff Development or Instmctor. A copy of the tran- 
script shall be kept on file at the nursing facility, agency or public educa- 
tional institution. 

(e) Depending on the number of beds, nursing facilities which provide 
only an orientation program and in-service program must employ or con- 
tract with a Director of Staff Development according to the minimum 
number of hours specified in Column A. Nursing facilities which also 
have a certification program shall employ or contract with a Director of 
Staff Development according to the minimum number of hours specified 
in Column B. The Department may require a facility to proved additional 
staff in accordance with 22 CCR section 72501(g). 

Column A Column B 

Number of Beds Required Hours Number of Beds Required Hours 
Per Month Per Week 

100 or more 93 100 or more 40 

60-99 54 60-99 30 

1-59 26 1-59 20 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 

Code. Reference: Section 1337.4, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency, operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 



Page 840 



Register 92, No. 41; 10-9-92 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71833 



2. New section refiled 1 1-14-91 as an emergency: operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tions (a) and (d)( l)-(2) transmitted to OAL 8-27-92 and filed 10-9-92 (Regis- 
ter 92, No. 41). 



§ 71 831 . Program Flexibility. 

(a) Although facilities, agencies and public educational institutions 
are required to comply with sections 7 1 801 through 7 1 853, these require- 
ments shall not prohibit the use of alternate concepts, methods, proce- 
dures, techniques or personnel qualifications in the provision of nurse as- 
sistant training programs provided such exceptions are carried out 
without reduction in the quality of nurse assistant training, the quality of 
patient care in the facility or the ability of the certification training pro- 
gram to prepare nurse assistants for certification. Such exceptions may 
only be carried out with the prior written approval of the Department 
which shall provide for the terms and conditions under which the excep- 
tion is granted. A written request and substantiating evidence supporting 
the request shall be submitted by the applicant or licensee to the Depart- 
ment. 

(b) Submission of a request for program flexibility must be made in the 
format and on a form developed by the Department. Form DHS 5000, 
5/92, is hereby incorporated by reference. Submission of the program 
flexibility request shall be deemed to occur on the date the request is re- 
ceived by the Department. This form can be obtained by writing to the 
Department at the address specified in Section 71833(b). 

(c) A request is considered complete when the facility, agency or pub- 
lic institution has fully described how it intends to meet the regulatory re- 
quirement in an alternate manner. 

(d) The Department shall inform the facility, agency, or public institu- 
tion within thirty (30) calendar days of receipt of a request for flexibility 
that the request is complete and accepted for consideration or that the re- 
quest is deficient and what specific information or documentation is re- 
quired to complete the request. 

(e) The Department shall within sixty (60) days of a completed re- 
quest, notify the facility, agency or public institution in writing, of the 
Department's decision regarding the request. 

(f) The Department's time frames for processing a program flexibility 
request from the day a complete request is received are as follows: 



(1) 


Minimum . . 


30 days. 


(2) 


Median 


45 days. 


(3) 


Maximum . . 


60 days. 



NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1338.3 and 1276, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1—1 3— 
91 or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-LZ-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tions (a) and (b) and new subsection (f) transmitted to OAL 8-27-92 and filed 
10-9-92 (Register 92, No. 41). 



Article 3. Program Components 

§71833. Orientation Program. 

(a) An orientation program shall be provided by each nursing facility. 
Each nursing facility must submit for the Department's approval a writ- 
ten plan describing its orientation program. Facilities which already have 
a written plan approved by the Department shall be required to only sub- 
mit changes for approval when these occur. To be considered complete, 
any new program plan shall include the following: 

(1) An orientation schedule indicating the time, date of presentation 
and the number of hours in which orientation is provided. 

(2) A lesson plan which includes a student performance standard and 
a detailed outline of content for each lesson. The topic content must pro- 
vide the Department with adequate detail (i.e., method, technique and 
procedure(s)) to discern what is taught. The lesson plan must describe the 
method of teaching, and the method of evaluating the students' knowl- 
edge and clinical skills. 

(3) Core curriculum. 

(b) New orientation program plans or changes to those plans shall be 
submitted to the Department for approval at the following address: De- 
partment of Health Services, Licensing and Certification Program, Nurse 
Assistant Certification Unit, 1800 Third Street, Suite 200, P.O. Box 
942732, Sacramento, CA 94234-7320. 

(c) Upon receipt of the program plan, the Department shall inform the 
applicant in writing within 30 days of the date received whether the pro- 
gram plan is complete and accepted for consideration or that the request 
is deficient and what specific information or documentation is required 
to be changed or added. 

(d) The Department' s time frames for approving or denying a program 
plan from the date a complete application is received are as follows: 

(1) Minimum .. 30 days. 

(2) Median .... 60 days. 

(3) Maximum . . 90 days. 

(e) Certified and noncertified nurse assistants shall receive sixteen 
( 1 6) documented hours of orientation. The orientation shall be completed 
during the first forty (40) hours of employment. 

(1) The first eight (8) hours of orientation shall be conducted prior to 
providing direct patient care. Orientation related to the following facili- 
ty-specific subjects shall be provided at the facility where the certified 
or noncertified nurse assistant is to be employed: 

(A) A tour of the nursing facility, including a description of the patient 
population, description of the daily routine for patients and demonstra- 
tion of the use of equipment including the call cord and intercommunica- 
tion system. 

(B) Instruction in the prevention and management of a catastrophe and 
other unusual occurrences, including but not limited to emergency proce- 
dures related to fire and disaster preparedness. 

(C) Introduction to basic patient care which includes supervised clini- 
cal training prior to a patient care assignment. This training shall be the 
responsibility of the Director of Staff Development or other licensed 
nurse who is free of other responsibilities during the time he/she is pro- 
viding the clinical training. 

(2) The remaining eight (8) hours of the orientation program shall be 
presented within the next thirty-two (32) hours of employment. Facili- 
ties which are under common ownership or belong to one corporation 
may provide this portion of the orientation in a central location other than 
the one where the nurse assistant is employed. During this final eight (8) 
hours of orientation, the following topics must be included: 

(A) Administrative structure. 

1. Organization of staff. 

2. Services offered. 

3. The role of nurse assistants, including job description, team ap- 
proach, attitudes and approaches to patients. 



Page 841 



Register 95, No. 44; 11-3-95 



§ 71835 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



4. Personnel policies, including appearance and grooming. 

(B) The facility's philosophy of patient care. 

(C) Patients' rights. 

(D) Legal and ethical considerations of health care. 

(E) Patient care policies and procedures including but not limited to 
bathing, bedmaking, transfer techniques, positioning and turning. 

(F) Patient comfort and patient environment. 

(G) The role of Federal and State regulations in the provision of care. 
(H) Instruction in the relief of choking. 

(0 After completing sixteen (1 6) hours of orientation and prior to be- 
ginning a certification program, noncertified nurse assistants shall pro- 
vide patient care only in areas of skill where they have received orienta- 
tion and training and have demonstrated that they are competent through 
performance evaluations completed and signed by the Director of Staff 
Development or Instructor. 

(g) A licensed nurse shall be responsible for the written evaluation of 
each clinical skill demonstrated by noncertified nurse assistants and shall 
determine their ability to provide patient care. During the evaluation, the 
licensed nurse shall be free from other responsibilities. 
NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tions (a) and (a)(2), new subsections (b)-(d) and relettering of former subsection 
(b) to (e), amendment of subsections (e)(1) and (e)(2)(E), relettering of former 
subsections (c) and (d) to (t) and (g), abd repealer of subsections (e) and (f) trans- 
mitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71835. Certification Training and Competency Evaluation 
Program. 

(a) A certification training program shall be conducted either directly 
by a nursing facility or through an agreement with another nursing facil- 
ity, agency or public educational institution approved by the Department. 
All providers of certification training and competency evaluation pro- 
grams shall meet both state and federal requirements. 

(b) When a nursing facility provides the certification training program 
through another nursing facility, agency or public educational institu- 
tion, there shall be a written agreement signed and dated by the autho- 
rized representatives of each party. Agencies and public institutions 
which use nursing facilities as a clinical skills training site for certifica- 
tion training shall keep a record of each student, the date and the time of 
the training and the name of the qualified instructor. Agencies and public 
institutions must develop the training schedule with the nursing facility 
and provide the above record to the nursing facility. The agency, public 
educational institution or nursing facility providing the training must re- 
tain these records for a period of four (4) years starting from the date each 
class begins. 

(c) A contractor who provides certification training for a nursing facil- 
ity by agreement shall be responsible for the program in its entirety. This 
shall include furnishing the staff to teach theory and supervise the clinical 
training of the program. Nursing facilities shall only contract with De- 
partment approved training programs. 

(d) Credit for portions of another California approved certification 
training program completed within the previous two years shall be given. 
To receive credit for the portion(s) of a training program received in 
another state or country, a nursing assistant must request the provider in 



the other state or country to submit an original transcript of the course(s) 
to the Department at the address specified in Section 71833(b). 

( 1 ) Starting from the date the Department receives a request for ap- 
proval, the applicant shall be informed within 30 days whether the re- 
quest is complete and accepted for filing or whether the request is defi- 
cient and what specific information is needed. A complete request is one 
that includes an original transcript. 

(2) Starting from the date a completed request is received, the Depart- 
ment will make a decision whether to approve or disapprove it within 90 
days. The Department's time frames for acting on a request for credit are 
as follows: 

(A) Minimum . . 30 days. 

(B) Median 60 days. 

(C) Maximum . . 90 days. 

(e) The nursing facility, school or agency shall maintain evidence that 
all health professionals involved in the training program are currently li- 
censed, registered or certified in their area of expertise. 

(f) Each student enrolled in a certification training program or compe- 
tency evaluation program shall have a health examination prior to partici- 
pating in segments of the program which involve contact with patients 
in a nursing facility. 

(1) This examination shall include: 

(A) A medical history and physical examination. 

(B) A purified protein derivative, intermediate strength intradermal 
skin test for tuberculosis, unless medically contraindicated. If a positive 
reaction is obtained, a chest x-ray shall be taken, unless medically con- 
traindicated. 

(2) A report, signed by the physician, physician's assistant or nurse 
practitioner, shall be provided to the nursing facility. This report shall in- 
dicate that the student does not have any health condition that would 
create a hazard to himself, fellow employees, or patients. 

(g) A licensed nurse (or nurses) in a nursing facility may assist the Di- 
rector of Staff Development in the supervision of students during clinical 
training. Such nurse(s) shall have no other duties while supervising stu- 
dents for the one hundred (100) hours of clinical training. The 100 hours 
of supervised clinical training shall be conducted between the hours of 
6:00 a.m. and 8:00 p.m. 

(h) Application shall be made by the nursing facility, agency or public 
educational institution to the Department for approval of a certification 
training program. 

(1) Submission of an application shall be considered complete when 
all of the information required under subsection (i) of this section has 
been received by the Department. 

(2) The Department's maximum time period for processing an appli- 
cation for a certification training program, from the receipt of initial 
application to the final decision regarding the application shall be ninety 
(90) days. 

(3) No training shall commence until the nursing facility, agency, or 
public institution receives approval from the Department. 

(i) Applications shall contain a sample of four (4) lesson plans which 
address four (4) different topics in a module specified in section 
71835(n). Each lesson plan must include: 

( 1 ) The student performance standard. 

(2) An outline of content to be provided for that particular lesson with 
adequate detail (i.e., method, technique, procedure) to discern what is 
taught. 

(3) The method of evaluating knowledge and demonstrable skills. 

(4) A sample of the skills return demonstration record used for each 
trainee which shall include: 

(A) A listing of the duties and skills the nurse assistant must learn. 

(B) Space to record the date when the nurse assistant performs this 
duty or skill. 

(C) Space to note satisfactory or unsatisfactory performance. 

(D) Space to record the initials and title of the licensed nurse evaluator. 



Page 842 



Register 95, No. 44; 11-3-95 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71835 



• 



(j) The program shall be finished and/or a competency evaluation must 
be successfully completed within four (4) months of employment. 

(k) Each nursing facility, agency or public educational institution shall 
submit a request for the Department's review and approval thirty (30) 
days prior to a change in core curriculum content, training hours or con- 
tracted services. 

(/) All records regarding the program shall be kept available for the De- 
partment's inspection for a period of four years from the date the Depart- 
ment approves it. All records pertaining to individuals who have success- 
fully completed the program shall be available for the Department's 
inspection for period of four (4) years from the date of enrollment. Re- 
cords of students who have not successfully completed the program may 
be discarded. 

(m) A certification training program shall consist of at least the follow- 
ing: 

(1) One hundred (100) hours of clinical training under the immediate 
supervision of the Director of Staff Development or Instructor. The train- 
ing shall include demonstration by the Instructor or Director of Staff De- 
velopment of basic patient care skills based upon the theory and clinical 
instruction presented in classroom. Return demonstrations by the student 
are also required and shall be under the immediate supervision of the In- 
structor or Director of Staff Development or other licensed nurse who has 
no other responsibilities while supervising students. During clinical 
training and demonstration of skills, there shall be no more than fifteen 
(15) students assigned to each instructor at any time. Clinical training 
shall take place in a nursing facility and shall be conducted in conjunction 
with classroom instruction. To be counted toward 100 hours of clinical 
training, the successful performance of a nurse assistant must be verified 
by the Instructor or the Director of Staff Development. 

(2) A minimum of fifty (50) hours of classroom instruction shall be 
conducted in either a nursing facility, an agency or a public educational 
institution. 

(n) The Department's criterion for approving certification training 
programs shall be that each program shallow include one hundred (100) 
hours of supervised clinical training and fifty (50) hours of theory, as spe- 
cified in the modules and hours stated below. It is not necessary that the 
modules be presented in the same sequence, as long as the content and 
hours are the same. Specific theory hours assigned to each module are 
mandatory. Specific clinical hours for each module are recommended. 
Prior to any direct contact with a patient, at least a total of 1 6 hours of 
training shall be provided in the following areas: 

(1) Communications and interpersonal skills. 

(2) Infection control. 

(3) Safety and emergency procedures including the Heimlich maneu- 
ver. 

(4) Promoting the independence of patients. 

(5) Respecting the rights of patients. 



(1) Module 1. Introduction. 

(A) Role and responsibilities of the Certified 
Nurse Assistant. 

(B) Title 22, division 5, California Code of 
Regulations, overview. 

(C) Requirements for nurse assistant certification. 

(D) Professionalism. 

(E) Ethics and confidentiality. 

(2) Module 2, Patients' Rights. 



Theory 
Hours 



Clinical 
Hours 



Theory 


Clinical 


Hours 


Hours 


2 






1 



Each nursing assistant applicant shall be instructed in patients' right as specified 
in title 22, California Code of Regulations section 72527 and in sections 1599.1, 
1599.2, and 1599.3 of the Health and Safety Code and in Title 42, Code of Federal 
Regulations Part 483 , Sections 483 . 1 0, 483 . 1 2, 483 . 1 3 and 483 . 1 5. The provisions 
of these sections are incorporated by reference into this regulation. 



(3) Module 3. Interpersonal skills. 

(A) Communications. 

(B) Defense mechanisms. 

(C) Sociocultural factors. 

(D) Attitudes toward illness and health care. 

(E) Family interaction 







(4) Module 4. Prevention and Management 
of Catastrophe and Unusual Occurrences. 

A) Emergency. 

B) General safety rules. 

C) Fire and disaster plans. 

D) Roles and procedures for Certified Nurse Assistants. 

E) Patient safety. 

5) Module 5. Body Mechanics. 

A) Basic rules of body mechanics. 

B) Transfer techniques. 

C) Ambulation. 

D) Proper use of body mechanics 
and positioning techniques. 

6) Module 6. Medical and Surgical Asepsis. 

A) Micro-organisms. 

B) Universal precautions for infection control in- 
cluding methods to handle patients, and all materials 

hat are soiled with blood and/or body fluids from pa- 
ients. The methods prescribed shall be designed to 
reduce the risk of transmission of potentially infec- 
ious etiologic agents from patient to patient and be- 
ween patients and healthcare workers. 

C) Basic principles of asepsis. 

7) Module 7. Weights and Measures. 

A) The metric system. 

B) Weight, length and liquid volume. 

C) Military time i.e. a twenty-four (24) hour clock. 

8) Module 8. Patient Care Skill. 

A) Bathing and medicinal baths which includes sub- 
stances such as bran, oatmeal, starch, sodium bicar- 
bonate, epsom salts, pine products, tar, sulfur, potas- 
sium permanganate or salt. 

B) Dressing. 

C) Oral hygiene. 

D) Hair care, hair shampoo, medicinal shampoo, 
nail care and shaving. 

E) Prosthetic devices. 

F) Skin care including prevention of decubitus ulcers. 

G) Elimination needs. 

H) Bowel and bladder retraining. 

I) Weighing and measuring the patient. 

9) Module 9. Patient Care Procedures. 

A) Collection of specimens, including stool, urine 
and sputum. 

B) Care of patients with tubing to include but not be 
imited to urinary, gastric, oxygen and intravenous. 

This care does not include inserting, suctioning or 

changing the tubes. 

C) Intake and output. 

D) Bedmaking. 

E) Cleansing enemas and laxative 
suppositories. 

F) Admission, transfer and discharge. 

G) Bandages and nonsterile dry dressings, including 
he application of nonlegend topical ointments to in- 
act skin surfaces. 

10) Module 10. Vital Signs. 

A) Purpose of vital signs. 

B) Factors affecting vital signs. 

C) Normal ranges. 

D) Methods of measurement. 

E) Temperature, pulse, respiration. 

F) Blood pressure. 

G) Abnormalities. 
H) Recording. 

1 1) Module 11. Nutrition. 

A) Proper nutrition. 

B) Feeding techniques. 

C) Diet therapy. 

12) Module 12. Emergency Procedures. 

A) Signs and symptoms of distress. 

B) Immediate and temporary intervention. 

C) Emergency codes. 

13) Module 13. Long-Term Care Patient. 

A) Needs of persons with developmental and mental 
disorders including mental retardation, Alzheimer's 
disease, cerebral palsy, epilepsy, dementia and men- 

al illness. 

B) Introduction to anatomy and physiology. 

C) Physical and behavioral needs and changes. 

D) Community resources available. 

E) Psychological, social and recreational needs. 



14 



44 



Page 843 



Register 95, No. 44; 11-3-95 



§ 71837 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



Theory Clinical 
Hours Hours 

(F) Common diseases and disorders including signs 

and symptoms. 

(14) Module 14. Rehabilitative Nursing. 2 4 

(A) Promoting patients' potential. 

(B) Devices and equipment. 

(C) Activities of daily living. 

(D) Family interactions. 

(H) Complication of inactivity. 

(F) Ambulation. 

(G) Range of Motion. 

(15) Module 15. Observation and Charting. 4 4 

(A) Observation of patients and reporting responsibility. 

(B) Patient care plan. 

(C) Patient care documentation. 

(D) Legal issues of charting. 

(E) Medical terminology and abbreviations. 

(16) Module 16. DeatrTand Dying. 2 

(A) Stages of grief. 

(B) Emotional and spiritual needs of the patient 
and family. 

(C) Rights of the dying patient. 

(D) Signs of approaching death. 

(E) Monitoring of the patient. 

(F) Post mortem care. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.3 and 1337.6, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3—12—92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tions (a), (b) and (d), new subsections (d)(l)-(d)(2)(C), amendment of subsec- 
tions (f)(1)(B), (f)(2), (i), (i)(l), (1), (m)(l ), and (n), new subsections (n)(l)-(5), 
and amendment of (2), (8)(A), (9)(A)-(B), (13)(A) of Table and Note trans- 
mitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

5. Editorial corrections (Register 95, No. 44). 

§ 71 837. Issuance of Certificate. 

(a) The Director of Staff Development or Instructor shall notify the 
Department in writing of those individuals who have completed the certi- 
fication training program and have successfully passed examinations 
testing the knowledge and skills related to the basic patient care modules 
identified in section 71 835(n). Those who have not passed the examina- 
tion may be given two more opportunities to take the examination and 
pass. Notification of those who passed shall be sent no later than ten (10) 
working days following the examinations. 

(b) No part-time or full-time nurse assistant shall be employed as a 
nurse assistant by a facility beyond four months unless he or she is certi- 
fied. 

(c) Every person applying for, holding or to whom a certificate is is- 
sued, shall file hi s or her present mailing address with the Department and 
shall notify the Department of any change therein. Applicants shall use 
the Department's form 283B, dated 5/92, and instructions revised on 
7-16-92. This form and instructions are herein incorporated by refer- 
ence. They can be obtained from the address shown below. The applica- 
tion and subsequent correspondence shall be mailed to the same address: 

Department of Health Services 

Licensing and Certification 

Nurse Assistant Certification Section 

714/744 P Street 

P.O. Box 942732 

Sacramento, CA 94234-7320 

(d) Starting from the date the Department receives the application for 
the certificate, the Department shall inform the applicant within 30 days 
whether the application is complete or whether it is deficient. If it is defi- 



cient the Department shall inform the applicant what specific areas need 
to be changed or what information needs to be added. Applications are 
considered complete when applicants indicate they are at least 1 6 years 
old, have paid the fee when required by Section 7184t(a)(l ), are on the 
Department's records as having successfully completed an approved 
training program and have passed the examination. 

(e) The Department shall make a decision whether or not to issue a cer- 
tificate within 90 days from the date the Department receives a completed 
application. The Department's time frames for acting on an application 
are as follows: 

(1) Minimum .. 30 days. 

(2) Median .... 60 days. 

(3) Maximum . . 90 days. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.2 and 1337.4, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-LZ-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tions (a)-(d) and new subsections (e)-(e)(3) transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 71839. Renewal of Unexpired Certificates. 

(a) Certified nurse assistants shall submit a certification renewal appli- 
cation, an application fee and verification of the required in-service 
training every two (2) years. 

(b) Submission of an application for renewal shall be deemed to occur 
on the date the application is received by the Department. 

(1) Starting from the date the Department receives an application for 
a renewed certificate, the applicant shall be informed within 30 days 
whether the application is complete and accepted for filing or that the 
application is deficient and what specific information is needed. 

(2) An application is considered complete when the correct fee is re- 
ceived and the accompanying documentation verifies completion of re- 
quired twenty- four (24) hours of in-service training or continuing edu- 
cation per year for a total of forty-eight (48) hours within the two (2) year 
renewal period. The in-service training and continuing education shall 
include multiple topics. 

(3) Starting from the date a completed application is received, the De- 
partment will make a decision whether to approve or disapprove it within 
90 days. The Department's time frames for acting on an application for 
renewal are as follows: 

(A) Minimum . . 30 days. 

(B) Median 60 days. 

(C) Maximum . . 90 days. 

(c) California, out-of-state, and foreign academic nursing courses 
given in accredited postsecondary institutions, out-of-state nursing-re- 
lated courses approved for in-service training or continuing education by 
licensing agencies of other states, providers approved by the California 
Board of Registered Nursing and courses given by nationally recognized 
health associations shall be approved if the Department determines them 
to be equivalent for meeting the requirements for an in-service training 
program or continuing education program. Only original documents and 
transcripts from out-of-state or foreign schools will be accepted by the 
Department for equivalency consideration. These documents must come 
directly from the institution or agency where the course(s) were pro- 
vided. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.2 and 1337.6, Health and Safety Code. 



Page 844 



Register 95, No. 44; 11-3-95 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71845 



History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including new subsection (b)(1) 
and renumbering of following subsection with amendment, repealer of subsec- 
tion (b)(2), new subsections (b)(3)-(b)(3)(C), and amendment of subsection (c) 
transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 



§ 71 841 . Fees and Penalties. 

(a) Each individual shall submit a fee for the issuance and renewal of 
certificates, replacement of certificates and penalties for late filings of re- 
newals. 

(1) The application for certification fee shall be fifteen dollars 
($15.00). 

(2) The renewal fee shall be twenty dollars ($20.00). 

(3) The Delinquency fee shall be ten dollars ($10.00). 

(4) The duplicate fee for lost certificates shall be five dollars ($5.00). 

(b) Payment by mail for the required fee shall be by personal check, 
cashiers check, certified check or money order. The penalty for submit- 
ting insufficient funds or any fictitious check shall be a fine often dollars 
($10.00) in addition to any adverse action imposed pursuant to Health 
and Safety Code section 1337.8. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.7, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tion (a)(1) transmitted to OAL 8-27-92 and filed 10^9-92 (Register 92, No. 
41). 



Article 4. Continuing Education and 
In-Service Training 



§ 71 843. Provider Identification Training Number. 

(a) A provider identification training number shall be issued to all ex- 
isting nursing facilities who have an in-service training program. 

(b) A provider identification training number shall be issued in accor- 
dance with the time frames indicated in Sections 7 1 845(b) and 7 1 847(c). 
This number shall be issued to each new program provider at the time of 
course approval and prior to the provider offering a in-service training 
program or continuing education course to a certified nurse assistant for 
credit. 

(c) If two (2) or more providers cosponsor a course, only one (1) pro- 
vider identification number shall be used for that course and the provider 
whose number is used shall assume full responsibility for the course. 

(d) The provider identification training number is not transferable. 
NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3(d), Health and Safety Code. 



History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 11-14-91 as an emergency; operative 1 1-13-91 (Register 
92. No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tion (b) transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41 ). 

§71845. Continuing Education. 

(a) Continuing education may be offered by an individual, partnership, 
corporation, association, governmental entity, agency or public educa- 
tional institution approved by the Department. 

(b) Application for approval of new and renewal of existing continuing 
education programs shall be submitted to the Department at the address 
specified in Section 71833(b). 

(1) Starting from the date the Department receives an application for 
a continuing education program, the applicant shall be informed within 
30 days whether the application is complete and accepted for filing or that 
the application is deficient and what specific information is needed. 

(2) An application shall be considered complete when received by the 
Department with all the requirements in subsection (c) included. 

(3) Starting from the date a completed application is received, the De- 
partment will make a decision, whether to approve or disapprove it with- 
in 90 days. The Department's time frames for acting on an application for 
approval of a continuing education program are as follows: 

(A) Minimum . . 30 days. 

(B) Median .... 60 days. 

(C) Maximum . . 90 days. 

(c) Application for approval of an initial continuing education pro- 
grams shall include the following: 

(1) A course title, course outline, core curriculum and lesson plan(s). 
Lesson plans shall include student performance standards and an outline 
of content to be provided for each particular lesson. Lesson plans must 
provide the Department with adequate detail (i.e., method, technique, 
procedure) to discern what is being taught. Plans must also include the 
method of evaluating the results of the training. Course content shall be 
designed to enhance knowledge and skills acquired during the basic cer- 
tification training. 

(2) The number of hours scheduled for presentation. 

(3) A sample of an evaluation tool. 

(d) Approved providers of continuing education shall maintain the 
program and attendance records of all students for period of four (4) years 
from the starting date of each class. The records shall be immediately ac- 
cessible upon request. 

(e) Authorization to participate as a continuing education provider 
shall be revoked if it is found that the program is not being conducted in 
accordance with the approved plan or in accordance with this chapter. 
The provider may submit a new application after ninety (90) days follow- 
ing revocation if deficiencies have been corrected. 

(f) Providers shall request Departmental approval whenever changes 
are made to the program as originally approved. 

(g) Providers shall submit a request for Department review and ap- 
proval not later than thirty (30) days prior to a change in the program and 
within thirty (30) days following a change in staff. 

(h) A nurse instructor shall hold a current valid license to practice as 
a licensed nurse. 

(i) A consultant who is instructing in a health area which requires a li- 
cense, must be currently licensed, registered or certified in his or her area 
of expertise. 

(j) Continuing Education Credit. 



Page 845 



Register 95, No. 44; 11-3-95 



§ 71847 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



( 1 ) One ( 1 ) hour of classroom theory shall be accepted as one ( 1 ) hour 
of continuing education credit. 

(2) Three (3) hours in course related clinical training shall be accepted 
as one (1) hour of continuing education credit. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference": Sections 1337.1(c) and 1337.6(a), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1 - 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment of subsec- 
tion (b), new subsection (b)(1) and renumbering and amendment of following 
subsection, repealer of subsection (b)(2), new subsections (b)(3)-(b)(3)(C), 
amendment of subsections (c)( 1 ) and (d), repealer of subsections (e)( 1 )-(2) and 
reletterine of following subsections, and amendment of subsections (f), (g), and 
(i) transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 

§ 71847. In-Service Training Program. 

(a) Each facility shall complete a performance review of every nurse 
assistant employed by the facility at least once every 1 2 months and must 
provide regular in-service training based on the outcome of these re- 
views. 

(b) In-service training programs shall take place in a nursing facility. 
Such facility shall have a written plan describing its in-service training 
program. 

(c) Applications for approval and renewal of written plans for in-ser- 
vice training programs shall be submitted to the Department for approval 
at the address specified in Section 71833(b). 

( 1 ) Starting from the date the Department receives an application for 
an in-service training program, the applicant shall be informed within 30 
days whether the application is complete and accepted for filing or that 
the application is deficient and what specific information is needed. 

(2) An application shall be considered complete when received by the 
Department with all the requirements in subsections (d), (e) and (f) of this 
section included. 

(3) Starting from the date a completed application is received, the De- 
partment will make a decision whether to approve or disapprove it within 
90 days. The Department's time frames for acting on an application for 
approval of an in-service training program are as follows: 

(A) Minimum . . 30 days. 

(B) Median .... 60 days. 

(C) Maximum . . 90 days. 

(d) Each application for approval or renewal of an in-service training 
program shall include: 

(1) A three (3) month in-service schedule. 

(2) A course title, course outline, core curriculum and lesson plan(s). 
The lesson plan must include student performance standards and a de- 
scription of topics included which provides the Department with ade- 
quate detail (i.e., method, technique, procedure) to discern what is taught. 
The lesson plan must describe the method of teaching and the method of 
evaluating the results of the training. 

(3) The number of hours for presentation and presentation dates. 

(4) The method to evaluate learning when audio/video tapes or films 
are used. 

(e) Each nursing facility shall include a schedule to demonstrate how 
it will make available twenty-four (24) hours of varied in-service train- 
ing annually. The in-service training shall include multiple subjects. 

(1) In-service training program sessions shall be made available to all 
employed certified nurse assistants who shall receive at least the normal 
hourly wage for attending the program. 



(f) The content of the in-service training program shall enhance 
knowledge and skills learned in the certification training program and 
shall also address areas of weakness as determined by a nurse assistant's 
performance reviews, areas of special needs of the patients, including 
those with cognitive needs, and areas wherein the facility received defi- 
ciencies related to patient care following the last licensing survey. Sub- 
jects may include, but are not limited to: 

( 1 ) Working with patients who have special problems such as blind- 
ness, deafness, confusion or communication disabilities. 

(2) Bladder and bowel training and management. 

(3) Signs, symptoms and probable causes of patient distress with pro- 
cedures to be followed for alleviating distress and emergency procedures 
for the relief of choking. 

(4) Psychosocial aspects of aging and/or chronic illness as relevant to 
the individual, family and community. 

(5) Patient care elements including planning and organizing work 
while individualizing patient care; testing urine for sugar and acetone; 
measuring blood pressure and administering nonmedicated enemas. 

(6) Nursing care relevant to body systems including, but not limited 
to, fractures, diabetes, cardiac disorders, dementia, cerebrovascular acci- 
dents, arthritis, pulmonary disorders and infectious diseases including 
Acquired Immune Deficiency Syndrome (AIDS). 

(7) Nutritional needs of patients and related nursing interventions. 

(8) Oral hygiene. 

(9) Patient care conferences and patient care plans involving the pa- 
tient and the patient's family. 

(10) Improving skills in observation, reporting and recording of pa- 
tient information. 

(11) Developing effective relationships and means of intervention on 
behalf of the patients. 

(12) Social and recreational needs of the patient. 

(13) Working with the dying patient and the family. 

( 1 4) Environmental safety including fire and accident prevention. 

(15) Universal precautions for infection control including methods to 
handle all patients and all materials that are soiled with blood and/or body 
fluids from all patients. The methods prescribed shall be developed to re- 
duce the risk of transmission of potentially infectious etiologic agents 
from patients and between patients and health care workers. 

(16) Patients' rights and civil rights. 

(17) Disaster preparedness. 

(18) Sensory deprivation and stimulation. 

(19) Maintenance of healthy skin: prevention of skin breakdown, body 
positioning and range of motion. 

(20) Use of adaptive equipment relevant to nutrition and physical dys- 
function. 

(21) Safeguarding patients' personal property through compliance 
with the facility's theft and loss prevention program. 

(g) In-service training programs shall describe what staff needs were 
assessed, how the program plan will meet those needs, how the plan will 
be implemented and how staff learning will be assessed. 

(h) Each nursing facility shall submit a renewal request for the Depart- 
ment' s review and approval every two years and not later than thirty (30) 
days prior to a change in core curriculum content or training hours or 
thirty (30) days following a change in program staff. 

(i) A nursing facility shall keep all records of in-service training pro- 
grams on file for a period of four years starting from the date the first 
classes were offered. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1(c), 1337.1(d), 1337.3, 1337.5(a) and 
1337.6(a), Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-9 1 
or emergency language will be repealed by operation of law on the following 
day. 



Page 846 



Register 95, No. 44; 11-3-95 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 71853 



2. New section refiled 1 1-14-9] as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No! 41 ). 

§ 71849. In-Service Training Program and Continuing 
Education Course Record of Attendance. 

(a) The nursing facility, agency or public educational institution shall 
provide each certified nurse assistant with a record of the in-service 
training program or continuing education course he or she has com- 
pleted. The record shall include: 

(1) The individual's name and nurse assistant certification number. 

(2) The title of the program. 

(3) The date and hours attended. 

(4) The name, address and telephone number of the organization or in- 
dividual providing the training. 

(5) The name, professional title and signature of the Director of Staff 
Development or Instructor. 

(6) The provider identification training number issued by the Depart- 
ment. 

(7) The following statement: "This record shall be retained by the cer- 
tified nurse assistant for a period of four (4) years starting from the date 
of enrollment." 

(b) The orientation program in a nursing facility and the certification 
training program shall not be claimed by the certified nurse assistant as 
in-service or continuing education credit. 

(c) Credit shall not be claimed for partial completion of in-service or 
continuing education by the certified nurse assistant. 

(d) Nursing facilities may plan joint in-service classes and continuing 
education courses and share community resources as long as one provid- 
er can be identified as fully responsible. Each participating facility, 
agency or public educational institution shall retain in-service or contin- 
uing education class records of instructors, class schedules and partici- 
pating students for a period of four (4) years from the date each class 
starts. These records shall be kept available for Departmental review. 
NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Sections 1337.1 and 1337.6, Health and Safety Code. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Amendment of subsections (a)(7) and (d) transmitted to OAL 8-27-92 and filed 
10-9-92 (Register 92, No. 41). 



Article 5. Adverse Actions and 
Corrective Remedies 

§ 71 851 . Disciplinary Actions and Appeals. 

(a) The Department shall take disciplinary action against certified 
nurse assistants in accordance with the specifications in section 1337.8 
of the Health and Safety Code. 

(b) When determining whether to revoke, deny, suspend, or place on 
probation the certificate of a certified nurse assistant, the Department 
shall consider at least the following criteria: 



(1) The individual's total criminal record. 

(2) The nature and severity of the act(s) or crime(s) under consider- 
ation. 

(3) Evidence of any act(s) or crimes committed subsequent to the 
act(s) or crime(s) under consideration. 

(4) The time that has elapsed since commission of the act(s) or crime 
referred to in subsections (1) and (2) of this regulation. 

(5) The extent to which the applicant has complied with any terms of 
parole, probation, restitution or any other sanctions lawfully imposed 
against the applicant. 

(6) Evidences, if any, of rehabilitation submitted by the applicant. 

(c) At least twenty (20) business days prior to the effective date of the 
action, the Department shall mail the certified nurse assistant a written 
notice of the proposed action. The Department shall send this notice by 
certified mail to the most recent address on record and shall indicate the 
reasons for such action, and shall include a copy of the charges and mate- 
rial upon which the action is based and an explanation of the right to re- 
spond either verbally or in writing to a Departmental representative at an 
informal hearing. Persons convicted in a court of law are not eligible for 
the informal hearing process. The informal hearing shall be held at a loca- 
tion designated by the Department. The nurse assistant must submit a re- 
quest for an informal hearing within fifteen (15) business days of receipt 
of the notice of the effective date of an action to suspend or revoke his 
or her certificate. The Department shall conduct the informal hearing 
within five (5) business days of receipt of a timely request for a hearing. 

(d) Any certified nurse assistant may forego the informal hearing pro- 
cess and proceed directly to a formal administrative hearing by writing 
to the Department's Nurse Assistant Certification section within 20 cal- 
endar days of receipt of the Department's notice of adverse action. 

(e) The Department must issue a written decision to the individual by 
certified mail within five (5) business days after close of the informal 
hearing. The decision must notify the individual of his or her right to an 
appeal pursuant to chapter 5 (commencing with section 1 1500) of part 1 
of division 3 of title 2 of the Government Code if the individual is dissa- 
tisfied with the decision. The nurse assistant must submit his/her appeal 
to the Department's Licensing and Certification Program, Nurse Assis- 
tant Certification section, at the address provided in section 71837(c) 
within twenty (20) business days of the decision. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1 337.8, Health and Safety Code, Skelly vs. State Person- 
nel Board (197 '5) 15 Cal3d 194. 

History 

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 1 3-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Amendment of subsection (c) transmitted to OAL 8-27-92 and filed 10-9-92 
(Register 92, No. 41). 



§ 71 853. Program Site Visits. 

When the Department makes a site visit and finds that the program or 
provider is out of compliance with this chapter or the provider's own po- 
licies and procedures, the nursing facility, agency or public educational 
institution must implement corrective action. Unless a different time pe- 
riod is specified, the facility, agency or public educational institution 
shall make the corrections within sixty (60) days of the notice of noncom- 
pliance or its program will be disapproved. Providers of programs which 
are brought back into compliance may apply for reinstatement to the De- 
partment's Nurse Assistant Certification Unit. 

NOTE: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety 
Code. Reference: Section 1337.3(b), Health and Safety Code. 



Page 847 



Register 95, No. 44; 11-3-95 



§ 72001 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



History 

1. New section filed 7-16-91 as an emergency: operative 7-16-91 (Register 91, 
No. 46). A Certificate of Compliance must be transmitted to OAL by 1 1- 13-91 
or emergency language will be repealed by operation of law on the following 
day. 

2. New section refiled 1 1-14-91 as an emergency; operative 1 1-13-91 (Register 
92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 
or emergency language will be repealed by operation of law on the following 
day. 

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an 
emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Com- 
pliance must be transmitted to OAL 9-3-92 or emergency language will be re- 
pealed by operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted 
to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41). 



Chapter 3. Skilled Nursing Facilities 



Article 1. Definitions 

§ 72001 . Meaning of Words. 

Words shall have their usual meaning unless the context or a definition 
clearly indicates a different meaning. Words used in the present tense in- 
clude the future; words in the singular number include the plural number; 
words in the plural number include the singular number. Shall means 
mandatory. May means permissive. Should means suggested and recom- 
mended. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Repealer of Chapter 3 (Articles 1-6, Sections 72001-7272, not consecutive) 
and new Chapter 3 (Articles 1-7, Sections 72001-72713, not consecutive) filed 
2-19-82; effective thirtieth day thereafter (Register 82, No. 8). For prior histo- 
ry, see Registers 81, No. 43; 80, No. 5; 79, No. 49; 79, No. 30; 79, No. 18; 79, 
No. 15; 79, No. 5; 79, No. 3; 78, No. 51; 78, No. 45: 78, No. 44; 78, No. 26; 77, 
No. 52; 77, No. 44; 77, No. 27; 77, No. 22; 77, No. 1 1; 77, No. 6; 77, No. 2; 76, 
No. 51 ; 76, No. 46; 76, No. 41; and 76, No. 34. 

§ 72003. Accredited Record Technician. 

Accredited record technician means a person who is accredited as such 
by the American Medical Record Association. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72005. Activity Leader. 

Activity leader means a person qualified by training and/or experience 
to develop and implement an activity program. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72007. Administrator. 

Administrator means a person licensed as a nursing home administra- 
tor by the California Board of Examiners of Nursing Home Administra- 
tors or a person who has a state civil service classification or a state career 
executive appointment to perform that function in a state facility. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72009. Alteration. 

Alteration means any construction work other than maintenance in an 
existing building which does not increase the floor area or roof area or 
the volume of enclosed space. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§72011. Art Therapist. 

Art therapist means a person who has a master's degree in art therapy 
or in art education or psychology with major course work in art, art thera- 
py, including an approved clinical internship in art therapy from an ac- 
credited college or university, and a person who is registered or eligible 
for registration as such with the American Art Therapy Association. 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§72013. Audiologist. 

Audiologist means a person licensed as such by the California Board 
of Medical Quality Assurance or a person who has a master's degree in 
the field and is authorized to practice under the supervision of a licensed 
audiologist as outlined in Section 2530.5(0, Chapter 5.3, of the Business 
and Professions Code. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72015. Authorized Representative. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. Repealer filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§72017. Biological. 

Biological means a product, vims, serum, toxin, antitoxin or analo- 
gous product derived from living matter applicable to the prevention, 
treatment or cure of disease or injuries in humans. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§72018. Chemical Restraint. 

Chemical restraint means a drug used to control behavior and used in 
a manner not required to treat the patient's medical symptoms. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§72018.1. Consent. 

Consent means the voluntary agreement by a patient or a representa- 
tive of an incapacitated patient to receive an identified treatment or pro- 
cedure. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§72019. Conservator. 

Conservator means a person appointed by a court to take care of the 

person, the property or both of the conservatee under Section 5350 et 

seq., of the Welfare and Institutions Code or under Section 1800 et seq., 

of the Probate Code. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72021 . Consultant. 

Consultant means a qualified person who gives professional advice or 
service, with or without remuneration. 

NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72023. Controlled Drugs. 

Controlled drugs means those drugs covered under the Federal Com- 
prehensive Drug Abuse Prevention Control Act of 1970, as amended, or 
the California Uniform Controlled Substances Act. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72025. Dance Therapist. 

Dance therapist means a person who has a master's degree in dance 
therapy, including an approved clinical internship from an accredited 
college or university, or a person who is registered or eligible for registra- 
tion as such by the American Dance Therapy Association. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72027. Decubitus Ulcer. 

Decubitus ulcer means an ulceration of skin and underlying tissue 
caused by pressure. 



Page 848 



Register 95, No. 44; 11-3-95 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 72055 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72029. Defined. 

Defined means explained in writing. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§72031. Dentist. 

Dentist means a person licensed as such by the California Board of 
Dental Examiners. 

NOTE: Authority cited: Sections 208(a) and J 275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72033. Department. 

Department means the California Department of Health Services or its 

designee. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1257 and 1276, Health and Safety Code. 

§ 72035. Dietetic Service Supervisor. 

Dietetic service supervisor means a person who meets one of the fol- 
lowing requirements: 

(a) Is a qualified dietitian. 

(b) Has a bachelor's degree with major studies in food and nutrition, 
dietetics, or food management and has one year of experience in the di- 
etetic service of a health care institution. 

(c) Is a graduate of a dietetic technician or dietetic assistant training 
program approved by the American Dietetic Association. 

(d) Is a graduate of a state-approved program that provides 90 or more 
hours of classroom instruction in food service supervision. 

(e) Has training experience in food service supervision and manage- 
ment in a military service equivalent in content to (c) or (d) of the above. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72037. Dietitian. 

Dietitian means a person who is registered or eligible for registration 
as such by the American Dietetic Association. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276 and 1276.1, Health and Safety Code. 

§ 72038. Direct Caregiver. 

"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 of the Health and Safety Code, while actually providing care to pa- 
tients. A person serving as the director of nursing services in a facility 
with 60 or more licensed beds cannot be a direct caregiver. 

Initial implementation of this section shall be contingent on an ap- 
propriation in the annual Budget Act or another statute, in accordance 
with Health and Safety Code Section 1276.65(1). 

NOTE: Authority cited: Sections 1250, 1276.65, 100275 and 131200, Health and 
Safety Code. Reference: Sections 1276.65 and 131051, Health and Safety Code. 

History 

1 . New section filed 1 1-8-2007 as an emergency; operative pursuant to Health and 
Safety Code section 1276.65(i) (Register 2007, No. 45). This regulatory action 
is deemed an emergency exempt from OAL review and was filed with the Secre- 
tary of State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate 
of Compliance must be transmitted to OAL by 5-6-2008 or emergency lan- 
guage will be repealed by operation of law on the following day. 

2. New section refiled 5-6-2008 as an emergency; operative pursuant to Health 
and Safety Code section 1276.65(i) (Register 2008, No. 19). This regulatory ac- 
tion is deemed an emergency exempt from OAL review and was filed with the 
Secretary of State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Cer- 
tificate of Compliance must be transmitted to OAL by 1 1-3-2008 or emergency 
language will be repealed by operation of law on the following day. 

§ 72039. Director. 

Director means the director of the California Department of Health 
Services. 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 101. Health and Safety Code. 

§72041. Distinct Part. 

Distinct part means an identifiable unit accommodating beds includ- 
ing but not limited to contiguous rooms, a wing, floor or building that is 
approved by the Department for a specific purpose. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1250.1 and 1276, Health and Safety Code. 

§ 72043. Drug. 

(a) Drug means a medication. 

(b) Legend daig means any of the following: 

(1) Any drug labeled with the statement "Caution: Federal Law pro- 
hibits dispensing without prescription" or words of similar import 

(2) Any dangerous drug under Section 421 1 of the Business and Pro- 
fessions Code. 

(c) Psychotropic drug means a medication used to modify behavior. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72045. Drug Administration. 

Drug administration means the act in which a single dose of a pre- 
scribed drug or biological is given to a patient. The complete act of ad- 
ministration entails removing an individual dose from a container (in- 
cluding a unit dose container), verifying the dose with the preserver's 
orders, giving the individual dose to the patient and promptly recording 
the time and dose given. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72047. Drug Dispensing. 

Drug dispensing means the act entailing the interpretation of a pre- 
scription order for a drug or biological and the proper selection, measur- 
ing, packaging, labeling and issuance of the drug or biological for a pa- 
tient. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72049. Fomites. 

Fomites means an object, or an article of clothing or material that is not 
in itself contaminated but is able to harbor pathogenic microorganisms 
which may by that means be transmitted to others. 
NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Sections 1275 and 1276, Health and Safety Code. 

§72051. Guardian. 

Guardian means a person appointed by the court to take care of the per- 
sons or the property, or both, of a ward under Section 1 500 et seq., of the 
Probate Code. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72052. Informed Consent. 

Informed consent means the voluntary agreement of a patient or a rep- 
resentative of an incapacitated patient to accept a treatment or procedure 
after receiving information in accordance with Sections 72527(a)(5) and 
72528. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code; and Cobbs v. Grant (1972) 8 Cal.3d 
229. 

History 
1. New section filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§ 72053. Intermediate Care Bed Classification. 

Intermediate care bed classification means beds designated for pa- 
tients requiring skilled nursing and supported care on less than a continu- 
ous basis. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1250, 1250.1 and 1276, Health and Safety Code. 

§ 72055. Licensed Nurse. 

Licensed nurse means a registered nurse or licensed vocational nurse 
as defined. 



Page 848.1 



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§ 72057 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72057. Licensed Psychiatric Technician. 

Licensed Psychiatric Technician means a person licensed as such by 
the California Board of Vocational Nurse and Psychiatric Technician Ex- 
aminers. 

NOTE: Authority cited: Sections 208(a) and 1275. Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72059. Licensed Vocational Nurse. 

Licensed Vocational Nurse means a person licensed as such by the 
California Board of Vocational Nurse and Psychiatric Technician Ex- 
aminers. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§72061. Licensee. 

Licensee means the person, persons, firm, partnership, association, or- 
ganization, company, corporation, business trust, political subdivision of 
the state, or other governmental agency to whom a license has been is- 
sued. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1251, Health and Safety Code. 

§ 72063. Local Bank. 

Local bank means the bank or branch of that bank which is in the vicin- 
ity of the facility. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1318, Health and Safety Code. 

§ 72065. Mechanically Altered Diet. 

Mechanically altered diet means a diet altered in texture. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72067. Medication. 

Medication means any chemical compound, remedy or noninfectious 
biological substance, the action of which is not solely mechanical, which 
may be administered to patients by any route as an aid in the diagnosis, 
treatment, or prevention of disease or other abnormal condition, for relief 
of pain or suffering, or to control or improve any psychological or patho- 
logical condition. Products which contain medications but which are pri- 
marily used for cosmetic or other nonmedication purposes are not medi- 
cations as defined above. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72069. Music Therapist. 

Music therapist means a person who has a bachelor's degree in music 
therapy and who is registered or eligible for registration as such with the 
National Association for Music Therapy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72071 . Narrative Notes. 

Narrative notes means a written record which relates, reports or re- 
views facts about a patient and which includes but is not limited to obser- 
vations, patients' reactions to care and response to treatment. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276 of the Health and Safety Code. 

§ 72073. Nursing Unit. 

Nursing unit means a designated patient care area of a facility which 
is planned, organized, operated and maintained to function as a unit. It 
includes patients' rooms with adequate support accommodations, ser- 
vices and personnel providing nursing care and necessary management 
of patients. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72075. Occupational Therapist. 

(a) Occupational therapist means a person who is a graduate of an oc- 
cupational therapy curriculum accredited jointly by the Council on Medi- 



cal Education of the American Medical Association and the American 
Occupational Therapy Association, and who is registered or who is eligi- 
ble for registration by the American Occupational Therapy Association, 
(b) Occupational therapy assistant means a person who is certified or 
eligible for certification as such by the American Occupational Therapy 
Association. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72077. Patient. 

(a) Patient means a person admitted to a skilled nursing facility for ob- 
servation, diagnosis or treatment. 

(b) Ambulatory patient means a patient who is able to leave a building 
unassisted under emergency conditions. 

(c) Nonambulatory patient means a patient who is unable to leave a 
building unassisted under emergency conditions. 

( 1 ) The term nonambulatory patient includes, but is not limited to, per- 
sons who depend upon mechanical aids such as crutches, walkers, and 
wheelchairs, and shall include profoundly or severely mentally retarded 
persons. 

(d) This section shall become inoperative upon the operative date of 
Section 72077.1. 

NOTE: Authority cited: Sections 1250, 1275, 1276.65, 100275 and 131200, Health 
and Safety Code. Reference: Sections 1276, 1276.65, 13131 and 131051, Health 
and Safety Code. 

History 

1 . New subsection (d) and amendment of Note filed 1 1-8-2007 as an emergency; 
operative 1 1-8-2007 (Register 2007, No. 45). This regulatory action is deemed 
an emergency exempt from OAL review and was filed with the Secretary of 
State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate of 
Compliance must be transmitted to OAL by 5-6-2008 or emergency language 
will be repealed by operation of law on the following day. 

2. New subsection (d) and amendment of Note refiled 5-6-2008 as an emergency; 
operative 5-6-2008 (Register 2008, No. 19). This regulatory action is deemed 
an emergency exempt from OAL review and was filed with the Secretary of 
State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate of 
Compliance must be transmitted to OAL by 1 1-3-2008 or emergency language 
will be repealed by operation of law on the following day. 

§72077.1. Patient. 

(a) Patient, or resident, means a person admitted to a skilled nursing 
facility for observation, diagnosis or treatment. 

(b) Ambulatory patient means a patient who is able to leave a building 
unassisted under emergency conditions. 

(c) Nonambulatory patient means a patient who is unable to leave a 
building unassisted under emergency conditions. 

( 1 ) The term nonambulatory patient includes, but is not limited to, per- 
sons who depend upon mechanical aids such as crutches, walkers, and 
wheelchairs, and shall include profoundly or severely mentally retarded 
persons. 

(d) Initial implementation of this section shall be contingent on an ap- 
propriation in the annual Budget Act or another statute, in accordance 
with Health and Safety Code Section 1276.65(i). 

NOTE: Authority cited: Sections 1250, 1275, 1276.65, 100275 and 131200, Health 
and Safety Code. Reference: Sections 1276.65, 13131 and 131051, Health and 
Safety Code. 

History 

1 . New section filed 1 1-8-2007 as an emergency; operative pursuant to Health and 
Safety Code section 1276.65(i) (Register 2007, No. 45). This regulatory action 
is deemed an emergency exempt from OAL review and was filed with the Secre- 
tary of State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate 
of Compliance must be transmitted to OAL by 5-6-2008 or emergency lan- 
guage will be repealed by operation of law on the following day. 

2. New section refiled 5-6-2008 as an emergency; operative pursuant to Health 
and Safety Code section 1 276.65(i) (Register 2008, No. 19). This regulatory ac- 
tion is deemed an emergency exempt from OAL review and was filed with the 
Secretary of State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Cer- 
tificate of Compliance must be transmitted to OAL by 1 1-3-2008 or emergency 
language will be repealed by operation of law on the following day. 

§72081. Pharmacist. 

Pharmacist means a person licensed as such by the California Board 
of Pharmacy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 



Page 848.2 



Register 2008, No. 19; 5-9-2008 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 72109 



§ 72082. Physical Restraint. 

For the purposes of informed consent, physical restraint means any 
physical or mechanical device or material attached or adjacent to a pa- 
tient's body that the patient cannot remove easily, which has the effect 
of restricting the patient's freedom of movement. Physical restraint does 
not include the use of the least restrictive immobilization reasonably nec- 
essary to administer necessary treatment of a therapeutic, non-continu- 
ous nature, such as a single injection of antibiotics, and where the immo- 
bilization is removed upon the administration of such treatment. This 
exception shall not include immobilizations for continuously adminis- 
tered treatments such as intravenous therapy. 

NOTE: Authority cited: Sections 208(a) and 1 275. Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§ 72083. Physical Therapist. 

(a) Physical therapist means a person licensed as such by the Califor- 
nia Board of Medical Quality Assurance. 

(b) Physical therapist assistant means a person who is approved as 
such by the Physical Therapy Examining Committee of the California 
Board of Medical Quality Assurance. 

(c) Physical therapist aide means a person who, under the direct super- 
vision of the registered physical therapist, assists with physical therapy 
care. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72085. Physician. 

(a) Physician means a person licensed as a physician and surgeon by 
the California Board of Medical Quality Assurance or by the Board of 
Osteopathic Examiners. 

(b) Attending physician means the physician chosen by the patient or 
the patient' s representative to be responsible for the medical treatment of 
the patient in the facility. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

History 
1 . Editorial correction of subsection (b) (Register 95, No. 44). 

§ 72087. Physician's Assistant. 

Physician's assistant means a person who is certified as such by the 
Physician's Assistant Examining Committee of the California Board of 
Medical Quality Assurance. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72089. Podiatrist. 

Podiatrist means a person licensed as such by the California Board of 
Medical Quality Assurance. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72091 . Psychologist. 

(a) Psychologist means a person licensed as such by the California 
Board of Medical Quality Assurance. 

(b) Clinical psychologist means a psychologist licensed by the Board 
of Medical Quality Assurance who ( 1 ) possesses an earned doctorate de- 
gree in psychology from an educational institution meeting the criteria 
of Subdivision (b) of Section 2914 of the Business and Professions Code 
and (2) has at least two years of clinical experience in a multidisciplinary 
facility licensed or operated by this or another state or by the United 
States to provide health care, or, is listed in the latest edition of the Na- 
tional Register of Health Services Providers in Psychology, as adopted 
by the Council for the National Register of Health Service Providers in 
Psychology. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276, 1276.1, and 1316.5, Health and Safety Code. 

§ 72092. Psychotherapeutic Drug. 

Psychotherapeutic drug means a medication to control behavior or to 
treat thought disorder processes. 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1. New section filed 5-27-92; operative 5-27-92 (Register 92, No. 22). 

§ 72093. Recreation Therapist. 

Recreation therapist means a person with specialization in therapeutic- 
recreation and who is registered or eligible for registration as such by the 
California Board of Park and Recreation Personnel or the National Ther- 
apeutic Recreation Society. 

NOTE: Authority cited: Sections 208(a) and 1 275. Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72095. Registered Nurse. 

Registered Nurse means a person licensed as such by the California 

Board of Registered Nursing. 

NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72097. Registered Record Administrator. 

Registered record administrator means a person who is registered as 
such by the American Medical Record Association. 

NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72099. Registry Staff. 

Registry staff means staff personnel provided by a placement service 
on a temporary or on a day-to-day basis, in a facility. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72101. Skilled Nursing Care Bed Classification. 

Skilled nursing care bed classification means beds designated for pa- 
tients requiring skilled nursing care on a continuous and extended basis. 
NOTE: Authority cited: Sections 208 and 1250.1, Health ad Safety Code. Refer- 
ence: Sections 1250 and 1250.1, Health and Safety Code. 

§ 72103. Skilled Nursing Facility. 

Skilled nursing facility means a health facility or a distinct part of a 
hospital which provides continuous skilled nursing care and supportive 
care to patients whose primary need is for availability of skilled nursing 
care on an extended basis. It provides 24-hour inpatient care and, as a 
minimum, includes physician, skilled nursing, dietary, pharmaceutical 
services and an activity program. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1250 and 1276, Health and Safety Code. 

§72105. Social Worker. 

(a) Clinical social worker means a person who is licensed as such by 
the California Board of Behavioral Science Examiners. 

(b) Social work assistant means a person with a baccalaureate degree 
in the social sciences or related fields and who receives supervision, con- 
sultation and in-service training from a social worker. 

(c) Social work aide means a staff person with orientation, on-the-job 
training, and who receives supervision from a social worker or social 
work assistant. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§72107. Speech Pathologist. 

Speech pathologist means a person licensed as such by the California 
Board of Medical Quality Assurance or a person who has a master's de- 
gree in the field and is authorized to practice under the supervision of a 
licensed speech pathologist as outlined in Section 2530.5(f), Chapter 5.3, 
of the Business and Professions Code. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1276 and 1276.1, Health and Safety Code. 

§ 72109. Standing Orders. 

Standing orders means those written orders which are used or intended 
to be used in the absence of a prescriber' s specific order for a specific pa- 
tient. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



Page 848.3 



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§ 72111 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§ 721 1 1 . Substantial Compliance. 

Substantial compliance means conformity to regulations by a licensee 
to such an extent that patient safety, welfare and quality of care are as- 
sured. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1268.5, 1276 and 1437, Health and Safety Code. 

§72113. Supervision. 

(a) Supervision means to instruct an employee or subordinate in their 
duties and to oversee or direct work, but does not necessarily require the 
immediate presence of the supervisor. 

(b) Direct supervision means that the supervisor shall be present in the 
same building as the person being supervised, and available for consulta- 
tion and assistance. 

(c) Immediate supervision means that the supervisor shall be physical- 
ly present while a task is being performed by the person being supervised. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 721 1 5. Therapeutic Diet. 

Therapeutic diet means any diet modified from a regular diet in a man- 
ner essential to the treatment or control of a particular disease or illness. 
NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276 of the Health and Safety Code. 

§ 721 17. Unit Dose Medication System. 

Unit dose medication system means a system in which single dosage 
units of drugs are prepackaged and prelabeled in accordance with all 
applicable laws and regulations governing these practices and are made 
available separated as to patient and by dosage time. The system shall 
also comprise, but not be limited to, all equipment and appropriate re- 
cords deemed necessary to make the dose available to the patient in an 
accurate and safe manner. A pharmacist shall be in charge of and respon- 
sible for the system. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1275 and 1276, Health and Safety Code. 

§ 721 19. Unit Patient Health Record. 

Unit patient health record means a record that organizes all informa- 
tion on the care and treatment rendered to a patient in a facility. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

Article 2. License 

§ 72201 . Application Required. 

(a) Whenever either of the following circumstances occur, verified 
application for a new license completed on forms furnished by the De- 
partment shall be submitted to the Department. 

(1) Establishment of a skilled nursing facility. 

(2) Change of ownership. 

(b) Whenever any of the following circumstances occur, the licensee 
shall submit to the Department a verified application for a corrected li- 
cense completed on forms furnished by the Department. 

(1) Construction of new or replacement skilled nursing facility. 

(2) Increase in licensed bed capacity. 

(3) Change of name of facility. 

(4) Change of licensed category. 

(5) Change of location of facility. 

(6) Change in bed classification. 

(7) Addition or deletion of any special or optional units listed in Ar- 
ticle 4. 

NOTE: Authority cited: Sections 208(a), 1254 and 1275, Health and Safety Code. 
Reference: Sections 1254, 1265 and 1267.5, Health and Safety Code. 

§ 72203. Fee. 

(a) Each application for a license shall be accompanied by the pre- 
scribed fee. The annual license fee under this section shall be effective 
for the calendar year of 1979. 



(1) The annual fee for a license to operate a skilled nursing facility 
which is being licensed for the first time or upon a change of ownership, 
change of location or renewal of license shall be that specified in the fol- 
lowing schedule: 

Capacity Requested Fee 

1-49 inclusive $948 plus $13 per licensed bed 

50-99 inclusive $1,186 plus $13 per licensed bed 

1 00 and over inclusive $1 ,540 plus $1 3 per licensed bed 

(2) No fee shall be refunded to the applicant if the application is with- 
drawn or if the application is denied by the Department. 

(3) An additional fee of $25.00 shall be paid for processing any change 
of name. However, no additional fee shall be charged for any change of 
name which is processed upon a renewal application or upon application 
filed because of a change of ownership. 

(b) Application fees for licenses which cover periods in excess of 12 
months shall be prorated on the basis of the total number of months to be 
licensed divided by 12 months. (Example: 18 months divided by 12 
equals 1.5 times the application fee specified in the fee schedule.) 

(c) Applications for provisional licenses (for six-month periods) shall 
be subject to the full amount of the fee specified in the fee schedule. If 
upon the expiration of the provisional license a second provisional (six- 
month period) license is to be issued, the licensee shall receive credit for 
the unused portion of the fee collected and no additional fee will be re- 
quired of the licensee. 

If a regular license is issued upon the expiration of the first provisional 
license, the unused portion of the fee collected for the provisional license 
shall be credited against the annual fee required for the regular license. 
If neither a second provisional or a regular license is to be issued to the 
applicant, there will be no refund or any portion of the fee paid for the 
provisional license. 

(d) When there is an increase in licensed bed capacity or a change of 
classification of licensure, license fees already paid that year shall be 
credited against the total fee due for the new bed capacity. 

NOTE: Authority cited: Section 1275, Health and Safety Code. Reference: Sec- 
tions 1266 and 1276, Health and Safety Code. 

§ 72205. Safety, Zoning and Building Clearance. 

(a) A license shall not be issued to any skilled nursing facility which 
does not conform to the State Fire Marshal' s requirements on fire and life 
safety and the state requirements on environmental impact and to local 
fire safety, zoning and building ordinances. Evidence of such com- 
pliances shall be presented in writing to the Department. 

(b) The licensee shall maintain the skilled nursing facility in a safe 
structural condition. If the Department determines in a written report sub- 
mitted to the licensee that an evaluation of the structural condition of a 
skilled nursing facility building is necessary, the licensee may be re- 
quired to submit a report by a licensed structural engineer which shall es- 
tablish a basis for elimination or correcting the structural conditions 
which may be hazardous to occupants. The licensee shall eliminate or 
correct any hazardous conditions. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1265.8 and 1276, Health and Safety Code. 

§ 72207. Separate Licenses. 

Separate licenses shall be required for skilled nursing facilities which 
are maintained on separate premises even though they are under the same 
management. Separate licenses shall not be required for separate build- 
ings on the same grounds or adjacent grounds. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1251, Health and Safety Code. 

§ 72209. Posting. 

The license or a true copy thereof shall be conspicuously posted in a 
location accessible to public view within the facility. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1253 and 1276, Health and Safety Code. 

§ 7221 1 . Report of Changes. 

(a) The licensee shall notify the Department in writing of any changes 
in the information provided pursuant to Sections 1265 and 1267.5, 
Health and Safety Code, within 10 days of such changes. This notifica- 



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tion shall include information and documentation regarding such 
changes. 

(b) When a change of administrator occurs, the Department shall be 
notified within 10 days in writing by the licensee. Such writing shall in- 
clude the name and license number of the new administrator. 

(c) Each licensee shall notify the Department within 1 days in writing 
of any change of the mailing address of the licensee. Such writing shall 
include the new mailing address of the licensee. 

(d) When a change in the principal officer of a corporate licensee 
(chairman, president or general manager) occurs the Department shall be 
notified within 10 days in writing by the licensee. Such writing shall in- 
clude the name and business address of such officer. 

(e) Any decrease in licensed bed capacity of the facility shall require 
notification by letter to the Department and shall result in the issuance of 
a corrected license. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1265 and 1267.5, Health and Safety Code. 

§72213. Program Flexibility. 

(a) All skilled nursing facilities shall maintain compliance with the li- 
censing requirements. These requirements do not prohibit the use of al- 
ternate concepts, methods, procedures, techniques, equipment, person- 
nel qualifications or the conducting of pilot projects, provided such 
exceptions are carried out with the provisions for safe and adequate care 
and with the prior written approval of the department. Such approval 
shall provide for the terms and conditions under which the exception is 
granted. A written request and substantiating evidence supporting the re- 
quest shall be submitted by the applicant or licensee to the Department. 

(b) Any approval of the Department granted under this Section, or a 

true copy thereof, shall be posted immediately adjacent to the facility's 

license. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1268, Health and Safety Code. 

§ 72215. Voluntary Suspension of License, Service or 
Licensed Beds. 

(a) Any license, or portion thereof, which has been suspended for a pe- 
riod of time approved by the Department shall remain subject to all re- 
newal requirements of an active license, including the payment of license 
renewal fees during the period of suspension. 

(b) If the license is not reinstated during the period of approved sus- 
pension, the license shall expire automatically and shall not qualify for 
reinstatement; however, an application may be submitted for a new li- 
cense. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1300, Health and Safety Code. 

§ 72216. Conviction of Crime: Standards for Evaluating 
Rehabilitation. 

When considering the denial, suspension or revocation of a license 
based on the conviction of a crime in accordance with Section 1265. 1 or 
1294 of the Health and Safety Code, the following criteria shall be con- 
sidered in evaluating rehabilitation: 

( 1 ) The nature and the seriousness of the crime(s) under consideration. 

(2) Evidence of conduct subsequent to the crime which suggests re- 
sponsible or irresponsible character. 

(3) The time which has elapsed since commission of the crime(s) or 
conduct referred to in subdivision (1) or (2). 

(4) The extent to which the applicant has complied with any terms of 
parole, probation, restitution, or any other sanction lawfully imposed 
against the applicant. 

(5) Any rehabilitation evidence submitted by the applicant. 

NOTE: Authority cited: Sections 208(a), 1265.2 and 1275, Health and Safety 
Code. Reference: Sections 1265.1, 1265.2 and 1294, Health and Safety Code. 

History 
1. New section filed 9-13-84; effective thirtieth day thereafter (Register 84, No. 
37). 



§72217. Bonds. 

(a) The amount of the Bond required in Section 1 3 1 8 of the Health and 
Safety Code shall be in accordance with the following schedule: 

( 1 ) Total Amount Handled per month Bonds Required 

$750 or less $1,000 

$751 to $1,500 S2.000 

$1,501 to $2,500 S3.000 

(2) Every further increment of $ 1 ,000 or fraction thereof shall require 
an additional $1,000 on the bond. 

(b) Each application for an original license or renewal of license shall 
be accompanied by an affidavit on a form provided by the Department. 
The affidavit shall state whether the license handles or will handle money 
of patients and the maximum amount of money to be handled for: 

( 1 ) Any patient. 

(2) All patients in any month. 

(c) No licensee shall either handle money of a patient or handle 
amounts greater than those stated in the affidavit submitted by him with- 
out first notifying the Department and filing a new or revised bond if re- 
quested. 

(d) Charges for the surety company bond to handle patient monies 

shall not be paid out of those monies. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1318, Health and Safety Code. 

Article 3. Required Services 

§ 72301 . Required Services. 

(a) Skilled nursing facilities shall provide, but shall not be limited to, 
the following required services: physician, skilled nursing, dietary, phar- 
maceutical and an activity program. 

(b) Skilled nursing facilities caring for patients who are mentally dis- 
ordered and whose needs for a special treatment program are identified 
shall also meet the requirements for a special treatment program service. 

(c) Skilled nursing facilities providing intermediate care services shall 
do so in a distinct part separately approved by the Department and shall 
be in conformity with the licensing regulations for the type of service pro- 
vided in that distinct part. The facility license shall indicate approval of 
the distinct part by the Department. 

(d) Written arrangements shall be made for obtaining all necessary 
diagnostic and therapeutic services prescribed by the attending physi- 
cian, podiatrist, dentist, or clinical psychologist subject to the scope of 
licensure and the policies of the facility. If the service cannot be brought 
into the facility, the facility shall assist the patient in arranging for trans- 
portation to and from the service location. 

(e) Arrangements shall be made for an advisory dentist to participate 
at least annually in the staff development program for all patient care per- 
sonnel and to approve oral hygiene policies and practices for the care of 
patients. 

(f) The facility shall ensure that all orders, written by a person lawfully 
authorized to prescribe, shall be carried out unless contraindicated. 

(g) The facility shall make arrangements for a physician or physicians 
to be available to furnish emergency medical care if the attending physi- 
cian, or designee, is unavailable. The telephone numbers of those physi- 
cians shall be posted in a conspicuous place in the facility. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1252, 1276, 1315, 1316 and 1316.5, Health and Safety Code. 

History 
1. Amendment filed 2-8-83; designated effective 3-2-83 (Register 83, No. 7). 

§ 72303. Physician Services — General Requirements. 

(a) Physician services shall mean those services provided by physi- 
cians responsible for the care of individual patients in the facility. All per- 
sons admitted or accepted for care by the skilled nursing facility shall be 
under the care of a physician selected by the patient or patient's autho- 
rized representative. 

(b) Physician services shall include but are not limited to: 



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( 1 ) Patient evaluation including a written report of a physical examina- 
tion within 5 days prior to admission or within 72 hours following admis- 
sion. 

(2) An evaluation of the patient and review of orders for care and treat- 
ment on change of attending physicians. 

(3) Patient diagnoses. 

(4) Advice, treatment and determination of appropriate level of care 
needed for each patient. 

(5) Written and signed orders for diet, care, diagnostic tests and treat- 
ment of patients by others. Orders for restraints shall meet the require- 
ments of Section 723 19(b). 

(6) Health record progress notes and other appropriate entries in the 
patient's health records. 

(7) Provision for alternate physician coverage in the event the attend- 
ing physician is not available. 

(c) Nonphysician practitioners may be permitted to render those medi- 
cal services which they are legally authorized to perform. Nonphysician 
practitioners means any of the following: 

(1 ) Physicians' assistants working under the responsibility and super- 
vision of a physician approved as a supervisor by the Board of Medical 
Quality Assurance and performing only those selected diagnostic and 
therapeutic tasks identified in Title 1 6, California Administrative Code, 
Chapter 13, Subchapter 3, Article 5. 

(2) Registered nurses may perform patient care services utilizing 
"Standardized Procedures" which have been approved by the medical 
staff, or by the medical director if there is no organized medical staff, the 
registered nurse and the administrator as authorized in the Business and 
Professions Code, Chapter 5, Article 2, Section 2725. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code; and Valdivia, etal. v. Cow, U.S. Dis- 
trict Court for the Eastern District of California, Case No. CIV S-90-1226. 

History 
1. Amendment of subsection (b)(5) and Note filed 5-25-95; operative 6-26-95 
(Register 95, No. 21). 

§ 72305. Physician Services — Medical Director. 

(a) The facility shall have a medical director who shall be responsible 
for standards, coordination, surveillance and planning for improvement 
of medical care in the facility. 

(b) The medical director shall: 

(1) Act as a liaison between administration and attending physicians. 

(2) Be responsible for reviewing and evaluating administrative and pa- 
tient care policies and procedures. 

(3) Act as a consultant to the director of nursing service in matters re- 
lating to patient care services. 

(4) Be responsible for reviewing employees' preemployment and an- 
nual health examination reports. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72307. Physician Services — Supervision of Care. 

(a) Each patient admitted to the skilled nursing facility shall be under 
the continuing supervision of a physician who evaluates the patient as 
needed and at least every 30 days unless there is an alternate schedule, 
and who documents the visits in the patient health record. 

(b) Alternate schedules of visits shall be documented in the patient 
health record with a medical justification by the attending physician. The 
alternate schedule shall conform with facility policy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72309. Nursing Service. 

Nursing service means a service staffed, organized and equipped to 
provide skilled nursing care to patients on a continuous basis. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 7231 1 . Nursing Service — General 

(a) Nursing service shall include, but not be limited to, the following: 



( 1 ) Planning of patient care, which shall include at least the following: 

(A) Identification of care needs based upon an initial written and con- 
tinuing assessment of the patient's needs with input, as necessary, from 
health professionals involved in the care of the patient. Initial asses- 
sments shall commence at the time of admission of the patient and be 
completed within seven days after admission. 

(B) Development of an individual, written patient care plan which in- 
dicates the care to be given, the objectives to be accomplished and the 
professional discipline responsible for each element of care. Objectives 
shall be measurable and time-limited. 

(C) Reviewing, evaluating and updating of the patient care plan as nec- 
essary by the nursing staff and other professional personnel involved in 
the care of the patient at least quarterly, and more often if there is a change 
in the patient's condition. 

(2) Implementing of each patient's care plan according to the methods 
indicated. Each patient's care shall be based on this plan. 

(3) Notifying the attending physician promptly of: 

(A) The admission of a patient. 

(B) Any sudden and/or marked adverse change in signs, symptoms or 
behavior exhibited by a patient. 

(C) An unusual occurrence involving a patient, as defined in Section 
72541. 

(D) A change in weight of five pounds or more within a 30-day period 
unless a different stipulation has been stated in writing by the patient's 
physician. 

(E) Any untoward response or reaction by a patient to a medication or 
treatment. 

(F) Any error in the administration of a medication or treatment to a 
patient which is life threatening and presents a risk to the patient. 

(G) The facility's inability to obtain or administer, on a prompt and 
timely basis, drugs, equipment, supplies or services as prescribed under 
conditions which present a risk to the health, safety or security of the pa- 
tient. 

(b) All attempts to notify physicians shall be noted in the patient's 
health record including the time and method of communication and the 
name of the person acknowledging contact, if any. If the attending physi- 
cian or his designee is not readily available, emergency medical care 
shall be provided as outlined in Section 72301(g). 

(c) Licensed nursing personnel shall ensure that patients are served the 

diets as prescribed by attending physicians. 

NOTE: Authority cited: Section 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72313. Nursing Service — Administration of Medications 
and Treatments. 

(a) Medications and treatments shall be administered as follows: 

( 1 ) No medication or treatment shall be administered except on the or- 
der of a person lawfully authorized to give such order. 

(2) Medications and treatments shall be administered as prescribed. 

(3) Tests and taking of vital signs, upon which administration of medi- 
cations or treatments are conditioned, shall be performed as required and 
the results recorded. 

(4) Preparation of doses for more than one scheduled administration 
time shall not be permitted. 

(5) All medications and treatments shall be administered only by li- 
censed medical or licensed nursing personnel with the following excep- 
tions: 

(A) Students in the healing arts professions may administer medica- 
tions and treatments only when the administration or medications and 
treatments is incidental to their course of study as approved by the profes- 
sional board or organization legally authorized to give such approval. 

(B) Unlicensed persons may, under the direct supervision of licensed 
nursing or licensed medical personnel, during training or after comple- 
tion of training and demonstrated evidence of competence, administer 
the following: 

1 . Medicinal shampoos and baths. 



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§ 72319 



2. Laxative suppositories and laxative enemas. 

3. Nonlegend topical ointments, creams, lotions and solutions when 
applied to intact skin surfaces. Unlicensed persons shall not administer 
any medication associated with treatment of eyes, ears, nose, mouth, or 
genitourinary tract. 

(6) Medications shall be administered as soon as possible, but no more 
than two hours after doses are prepared, and shall be administered by the 
same person who prepares the doses for administration. Doses shall be 
administered within one hour of the prescribed time unless otherwise in- 
dicated by the prescriber. 

(7) Patients shall be identified prior to administration of a daig or treat- 
ment. 

(8) Drugs may be administered in the absence of a specific duration of 
therapy on a licensed prescriber' s new daig order if the facility applies 
its stop-order policy for such drugs. The prescriber shall be contacted 
prior to discontinuing therapy as established by stop-order policy. 

(b) No medication shall be used for any patient other than the patient 
for whom it was prescribed. 

(c) The time and dose of the drug or treatment administered to the pa- 
tient shall be recorded in the patient's individual medication record by the 
person who administers the drug or treatment. Recording shall include 
the date, the time and the dosage of the medication or type of the treat- 
ment. Initials may be used, provided that the signature of the person ad- 
ministering the medication or treatment is also recorded on the medica- 
tion or treatment record. 

(d) Oxygen equipment shall be maintained as follows: 

( 1 ) Humidifier bottles on oxygen equipment shall be changed and ster- 
ilized at least every 24 hours. 

(2) Only sterile distilled, demineralized or de-ionized water shall be 
used in humidifier bottles. 

N()TK: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72315. Nursing Service— Patient Care. 

(a) No patient shall be admitted or accepted for care by a skilled nurs- 
ing facility except on the order of a physician. 

(b) Each patient shall be treated as individual with dignity and respect 
and shall not be subjected to verbal or physical abuse of any kind. 

(c) Each patient, upon admission, shall be given orientation to the 
skilled nursing facility and the facility's services and staff. 

(d) Each patient shall be provided care which shows evidence of good 
personal hygiene, including care of the skin, shampooing and grooming 
of hair, oral hygiene, shaving or beard trimming, cleaning and cutting of 
fingernails and toenails. The patient shall be free of offensive odors. 

(e) Each patient shall be encouraged and/or assisted to achieve and 
maintain the highest level of self-care and independence. Every effort 
shall be made to keep patients active, and out of bed for reasonable peri- 
ods of time, except when contraindicated by physician's orders. 

(0 Each patient shall be given care to prevent formation and progres- 
sion of decubiti, contractures and deformities. Such care shall include: 

( 1 ) Changing position of bedfast and chairfast patients with preventive 
skin care in accordance with the needs of the patient. 

(2) Encouraging, assisting and training in self-care and activities of 
daily living. 

(3) Maintaining proper body alignment and joint movement to prevent 
contractures and deformities. 

(4) Using pressure-reducing devices where indicated. 

(5) Providing care to maintain clean, dry skin free from feces and 
urine. 

(6) Changing of linens and other items in contact with the patient, as 
necessary, to maintain a clean, dry skin free from feces and urine. 

(7) Carrying out of physician's orders for treatment of decubitus ul- 
cers. The facility shall notify the physician, when a decubitus ulcer first 
occurs, as well as when treatment is not effective, and shall document 
such notification as required in Section 7231 1(b). 

(g) Each patient requiring help in eating shall be provided with assis- 
tance when served, and shall be provided with training or adaptive equip- 



ment in accordance with identified needs, based upon patient assessment, 
to encourage independence in eating. 

(h) Each patient shall be provided with good nutrition and with neces- 
sary fluids for hydration. 

(i) Measures shall be implemented to prevent and reduce incontinence 
for each patient and shall include: 

( 1 ) Written assessment by a licensed nurse to determine the patient's 
ability to participate in a bowel and/or bladder management program. 
This is to be initiated within two weeks after admission of an incontinent 
patient. 

(2) An individualized plan, in addition to the patient care plan, for each 
patient in a bowel and/or bladder management program. 

(3) A weekly written evaluation in the progress notes by a licensed 
nurse of the patient's performance in the bowel and/or bladder manage- 
ment program. 

(j) Fluid intake and output shall be recorded for each patient as follows: 

( 1 ) If ordered by the physician. 

(2) For each patient with an indwelling catheter: 

(A) Intake and output records shall be evaluated at least weekly and 
each evaluation shall be included in the licensed nurses' progress notes. 

(B ) After 30 days the patient shall be reevaluated by the licensed nurse 
to determine further need for the recording of intake and output. 

(k) The weight and length of each patient shall be taken and recorded 
in the patient's health record upon admission, and the weight shall be tak- 
en and recorded once a month thereafter. 

(/) Each patient shall be provided visual privacy during treatments and 
personal care. 

(m) Patient call signals shall be answered promptly. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence; Section 1275, Health and Safety Code. 

§ 72317. Nursing Service — Standing Orders. 

Standing orders shall not be used in skilled nursing facilities. 

NOTE: Authority cited: Sections 208(a)and 1 275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72319. Nursing Service — Restraints and Postural 
Supports. 

(a) Written policies and procedures concerning the use of restraints 
and postural supports shall be followed. 

(b) Restraints shall only be used with a written order of a physician or 
other person lawfully authorized to prescribe care. The order must speci- 
fy the duration and circumstances under which the restraints are to be 
used. Orders must be specific to individual patients. In accordance with 
Section 72317, there shall be no standing orders and in accordance with 
Section 72319(i)(2)(A), there shall be no P.R.N, orders for physical re- 
straints. 

(c) The only acceptable forms of physical restraints shall be cloth 
vests, soft ties, soft cloth mittens, seat belts and trays with spring release 
devices. Soft ties means soft cloth which does not cause abrasion and 
which does not restrict blood circulation. 

(d) Restraints of any type shall not be used as punishment, as a substi- 
tute for more effective medical and nursing care, or for the convenience 
of staff. 

(e) No restraints with locking devices shall be used or available for use 
in a skilled nursing facility. 

(f) Seclusion, which is defined as the placement of a patient alone in 
a room, shall not be employed. 

(g) Restraints shall be used in such a way as not to cause physical inju- 
ry to the patient and to insure the least possible discomfort to the patient. 

(h) Physical restraints shall be applied in such a manner that they can 
be speedily removed in case of fire or other emergency, 
(i) The requirements for the use of physical restraints are: 
(1) Treatment restraints may be used for the protection of the patient 
during treatment and diagnostic procedures such as, but not limited to, 
intravenous therapy or catheterization procedures. Treatment restraints 
shall be applied for no longer than the time required to complete the treat- 
ment. 



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(2) Physical restraints for behavior control shall only be used on the 
signed order of a physician or other person lawfully authorized to pre- 
scribe care, except in an emergency which threatens to bring immediate 
injury to the patient or others. In such an emergency an order may be re- 
ceived by telephone, and shall be signed within 5 days. Full documenta- 
tion of the episode leading to the use of the physical restraint, the type of 
the physical restraint used, the length of effectiveness of the restraint time 
and the name of the individual applying such measures shall be entered 
in the patient's health record. 

(A) Physical restraints for behavioral control shall only be used with 
a written order designed to lead to a less restrictive way of managing, and 
ultimately to the elimination of, the behavior for which the restraint is 
applied. There shall be no PRN orders for behavioral restraints. 

(B) Each patient care plan which includes the use of physical restraint 
for behavior control shall specify the behavior to be eliminated, the meth- 
od to be used and the time limit for the use of the method. 

(C) Patients shall be restrained only in an area that is under supervision 
of staff and shall be afforded protection from other patients who may be 
in the area. 

(j) When drugs are used to restrain or control behavior or to treat a dis- 
ordered thought process, the following shall apply: 

( 1 ) The specific behavior or manifestation of disordered thought pro- 
cess to be treated with the drug is identified in the patient's health record. 

(2) The plan of care for each patient specifies data to be collected for 
use in evaluating the effectiveness of the drugs and the occurrence of ad- 
verse reactions. 

(3) The data collected shall be made available to the prescriber in a 
consolidated manner at least monthly. 

(4) PRN orders for such drugs shall be subject to the requirements of 
this section. 

(k) "Postural support" means a method other than orthopedic braces 
used to assist patients to achieve proper body position and balance. Pos- 
tural supports may only include soft ties, seat belts, spring release trays 
or cloth vests and shall only be used to improve a patient's mobility and 
independent functioning, to prevent the patient from falling out of a bed 
or chair, or for positioning, rather than to restrict movement. These meth- 
ods shall not be considered restraints. 

( 1 ) The use of postural support and the method of application shall be 
specified in the patient's care plan and approved in writing by the physi- 
cian or other person lawfully authorized to provide care. 

(2) Postural supports shall be applied: 

(A) Under the supervision of a licensed nurse. 

(B) In accordance with principles of good body alignment and with 
concern for circulation and allowance for change of position. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code; and Valdivia, etal. v. Cove, U.S. Dis- 
trict Court for the Eastern District of California, Case No. CIV S-90-1226. 

History 
1. Amendment of subsection (b) and Note filed 5-25-95; operative 6-26-95 
(Register 95, No. 21). 



§ 72321 . Nursing Service — Patients with Infectious 
Diseases. 

(a) Patients with infectious diseases shall not be admitted to or cared 
for in the facility unless the following requirements are met: 

(1) A patient suspected of or diagnosed as having an infectious or re- 
portable communicable disease or being in a carrier state who the attend- 
ing officer determines is a potential danger, shall be accommodated in a 
room, vented to the outside, and provided with a separate toilet, hand- 
washing facility, soap dispenser and individual towels. 

(2) There shall be: 

(A) Separate provisions for handling contaminated linens. 

(B) Separate provisions for handling contaminated dishes. 

(b) The facility shall adopt, observe and implement written infection 
control policies and procedures. These policies and procedures shall be 
reviewed at least annually and revised as necessary. 



(c) The following shall be available in each nurse's station: 

(1) The facility's infection control policies and procedures. 

(2) Name, address and telephone numbers of local health officers. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72323. Nursing Service — Cleaning, Disinfecting and 
Sterilizing. 

(a) Each facility shall adopt a written manual on cleaning, disinfecting 
and sterilizing procedures. The manual shall include procedures to be 
used in the care of utensils, instruments, solutions, dressings, articles and 
surfaces and shall be available for use by facility personnel. All proce- 
dures shall be carried out in accordance with the manual. 

(b) Each facility shall make provisions for the cleaning and disinfect- 
ing of contaminated articles and surfaces which cannot be sterilized. 

(c) Bedside equipment including but not limited to washbasins, emesis 
basins, bedpans and urinals shall be sanitized only by one of the follow- 
ing methods: 

( 1 ) Submersion in boiling water for a minimum of 30 minutes. 

(2) Autoclaving at 15 pounds pressure and 121°C (250) for 20 min- 
utes. 

(3) Gas sterilization. 

(d) Chemicals shall not be used as a substitute for the methods speci- 
fied in (c) above. 

(e) Electronic thermometers shall be cleaned and disinfected accord- 
ing to the manufacturer's instructions. Glass thermometers shall be 
cleaned and disinfected for at least 10 minutes with 70 percent ethyl alco- 
hol or 90 percent isopropyl alcohol with 0.2 percent iodine. Oral and rec- 
tal thermometers shall be stored separately in clean, labeled containers 
with fitted lids. 

(f) Individual patient care supply items designed and identified by the 
manufacturer to be disposable shall not be reused. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72325. Nursing Service — Space. 

(a) An office or other suitable space shall be provided for the director 
of nursing service. 

(b) A nursing station shall be maintained in each nursing unit or build- 
ing. 

(c) Each nursing station shall have a cabinet, a desk, space for records, 
a bulletin board, a telephone and a specifically designated and well illu- 
minated medication storage compartment with a lockable door. If a sepa- 
rate medication room is maintained, it shall have a lockable door and a 
sink with water connections for care of equipment and for handwashing. 

(d) If a refrigerator is provided in a nursing station, the refrigerator 
shall meet the following standards: 

(1) Be located in a clean area not subject to contamination by human 
waste. 

(2) Maintain temperatures at or below 7°C (45°F) for chilling. 

(3) Maintain the freezer at minus 18°C (0°F). 

(4) Contain an accurate thermometer at all times. 

(5) If foods are retained in the refrigerator, they shall be covered and 

clearly identified as to contents and date initially covered. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72327. Nursing Service — Director of Nursing Service. 

(a) The director of nursing service shall be a registered nurse and shall 
be employed eight hours a day, on the day shift five days a week. 

(b) The director of nursing service shall have at least one year of expe- 
rience in nursing supervision within the last five years. 

(c) The director of nursing service shall have, in writing, administra- 
tive authority, responsibility and accountability for the nursing services 
within the facility and serve only one facility in this capacity at any one 
time. 

NOTE: Authority cite: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



Page 848.8 



Register 2008, No. 19; 5-9-2008 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 72329.1 



§ 72329. Nursing Service— Staff. 

(a) Nursing service personnel shall be employed and on duty in at least 
the number and with the qualifications determined by the Department to 
provide the necessary nursing services for patients admitted for care. The 
Department may require a facility to provide additional staff as set forth 
in Section 72501(g). 

(b) Facilities licensed for 59 or fewer beds shall have at least one regis- 
tered nurse or a licensed vocational nurse, awake and on duty, in the facil- 
ity at all times, day and night. 

(c) Facilities licensed for 60 to 99 beds shall have at least one regis- 
tered nurse or licensed vocational nurse, awake and on duty, in the facil- 
ity at all times, day and night, in addition to the director of nursing ser- 
vices. The director of nursing service shall not have charge nurse 
responsibilities. 

(d) Facilities licensed for 100 or more beds shall have at least one reg- 
istered nurse, awake and on duty, in the facility at all times, day and night, 
in addition to the director of nursing service. The director of nursing ser- 
vice shall not have charge nurse responsibilities. 

(e) Nursing stations shall be staffed with nursing personnel when pa- 
tients are housed in the nursing unit. 

(f) Each facility shall employ sufficient nursing staff to provide a mini- 
mum daily average of 3.0 nursing hours per patient day. 

( 1 ) Facilities which provide care for mentally disordered patients and 
in which licensed psychiatric technicians provide patient care shall meet 
the following standards: 

(A) If patients are not certified for special treatment programs, facili- 
ties shall employ sufficient staff to provide a minimum daily average of 
3.0 nursing hours per patient day. 

(B) For patients certified for special treatment programs, facilities 
shall employ sufficient staff to provide a minimum daily average of 2.3 
nursing hours per patient day for each patient certified to the special treat- 
ment program, exclusive of additional staff required to meet the staffing 
standards of the special treatment program. 

(g) Staffing for a distinct part intermediate care unit in a skilled nursing 
facility: 

(1) Units of less than 50 intermediate care beds shall not be required 
to provide licensed personnel in addition to those provided in the skilled 
nursing facility unless the Department determines through a written eval- 
uation that additional licensed personnel are necessary to protect the 
health and safety of patients. 

(2) Units of 50 or more intermediate care beds shall provide a regis- 
tered nurse or licensed vocational nurse employed 8 hours on the day 
shift, 7 days per week in the unit. 

(3 ) For purposes of this section intermediate care beds that are licensed 
as such by the Department shall not be included for establishing licensed 
nurse staffing as required in Section 72329(f)( 1 ) if the unit is used exclu- 
sively for intermediate care patients. 

(h) This section shall become inoperative upon the operative date of 
Section 72329.1. 

NOTK: Authority cited: Sections 1275, 1276.5, 1276.65 and 131200, Health and 
Safety Code. Reference: Sections 1276, 1276.5, 1276.65 and 1 3 1 05 1 , Health and 
Safety Code; and Section 14110.7(c), Welfare and Institutions Code. 

History 

1. Amendment of subsection (f) filed 9-23-85 as an emergency; effective upon 
filing (Register 85, No. 39). A Certificate of Compliance must be transmitted 
to OAL within 120 days or emergency language will be repealed on 1-21-86. 

2. Certificate of Compliance transmitted to OAL 1-17-86 and filed 2-10-86 
(Register 86, No. 7). 

3. New subsection (h) and amendment of Notk filed 1 1-8-2007 as an emergency; 
operative 1 1-8-2007 (Register 2007, No. 45). This regulatory action is deemed 
an emergency exempt from OAL review and was filed with the Secretary of 
State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate of 
Compliance must be transmitted to OAL by 5-6-2008 or emergency language 
will be repealed by operation of law on the following day. 

4. New subsection (h) and amendment of Noth refiled 5-6-2008 as an emergency; 
operative 5-6-2008 (Register 2008, No. 19). This regulatory action is deemed 
an emergency exempt from OAL review and was filed with the Secretary of 
State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Certificate of 
Compliance must be transmitted to OAL by 1 1-3-2008 or emergency language 
will be repealed by operation of law on the following day. 



§ 72329.1 . Nursing Service—Staff. 

(a) Nursing service personnel shall be employed and on duty in at least 
the number and with the qualifications determined by the Department to 
provide the necessary nursing services for patients admitted for care. The 
Department may require a facility to provide additional staff as set forth 
in Section 72501(g). 

(b) Facilities licensed for 59 or fewer beds shall have at least one regis- 
tered nurse or a licensed vocational nurse, awake and on duty, in the facil- 
ity at all times, day and night. 

(c) Facilities licensed for 60 to 99 beds shall have at least one regis- 
tered nurse or licensed vocational nurse, awake and on duty, in the facil- 
ity at all times, day and night, in addition to the director of nursing ser- 
vices. The director of nursing services shall not have charge nurse 
responsibilities. 

(d) Facilities licensed for 100 or more beds shall have at least one reg- 
istered nurse, awake and on duty, in the facility at all limes, day and night. 
in addition to the director of nursing services. The director of nursing ser- 
vices shall not have charge nurse responsibilities. 

(e) Nursing stations shall be staffed with nursing personnel when pa- 
tients are housed in the nursing unit. 

(0 Each facility shall employ sufficient nursing staff to provide a mini- 
mum of 3.2 nursing hours per patient day. 

(1) Facilities which provide care for mentally disordered patients and 
in which licensed psychiatric technicians provide patient care shall meet 
the following standards: 

(A) If patients are not certified for special treatment programs, facili- 
ties shall employ sufficient staff to provide a minimum of 3.2 nursing 
hours per patient day. 

(B) For patients certified for special treatment programs, facilities 
shall employ sufficient staff to provide a minimum of 2.3 nursing hours 
per patient day for each patient certified to the special treatment program. 
exclusive of additional staff required to meet the staffing standards of the 
special treatment program. 

(g) Only direct caregivers as defined in Section 72038 shall be in- 
cluded in the staff-to-patient ratios. The ratios shall be based on the an- 
ticipated individual patient needs for the activities of each shift and shall 
be distributed throughout the day to achieve a minimum of 3.2 nursing 
hours per patient day. The ratios for nursing hours per patient day in a 
skilled nursing facility shall be as follows: 

( 1 ) The licensed nurse-to-patient ratio shall be at least one licensed 
nurse to 30 patients or fewer. At no time shall one licensed nurse be re- 
sponsible for more than 30 patients. Skilled nursing facilities shall 
employ and schedule additional staff to ensure patients receive nursing 
care based on their needs. 

(2) In addition to the ratio for licensed nurses, the certified nurse assis- 
tant-to-patient ratio shall be at least one certified nurse assistant to 1 5 pa- 
tients or fewer. At no time shall one certified nurse assistant be responsi- 
ble for more than 15 patients. 

(3) The calculation of the staff-to-patient ratio shall be based on the 
daily census of patients in the skilled nursing facility and not the total 
number of beds. Bedholds shall not be included in the calculations of the 
staff-to-patient ratio. 

(4) In the event that a patient is admitted or readmitted to the skilled 
nursing facility, the calculation shall be adjusted to take the additional pa- 
tient into account. 

(5) Unless granted a waiver pursuant to subsection (j), facilities shall 
use the following ratios: 

(A) On the day shift, the ratio shall be at least one licensed nurse for 
every 20 patients or fraction thereof, and one certified nurse assistant for 
every 9 patients or fraction thereof; 

(B) On the evening shift, the ratio shall be at least one licensed nurse 
for every 25 patients or fraction thereof, and one certified nurse assistant 
for every 10 patients or fraction thereof; and, 

(C) On the night shift, the ratio shall be at least one licensed nurse for 
every 30 patients or fraction thereof, and one certified nurse assistant for 
every 15 patients or fraction thereof. 



Page 848.9 



Register 2008, No. 19; 5-9-2008 



§ 72331 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



(6) A citation for a class "AA", class "A" or class "B" violation may 
be issued for a violation of this section that meets the requirements speci- 
fied in Section 1 424 of the Health and Safety Code. 

(h) Documentation of Daily Staffing: 

( 1 ) Upon any increase of patient census, the facility shall document its 
compliance with subsection (g). 

(2) The facility shall retain the staff assignment record that it employs 
to comply with subsection (i) for each shift, the licensing and/or certifica- 
tion status of the staff, and the patient census for each shift. Records docu- 
menting staffing, including staff assignment records and payroll records, 
shall be retained for a minimum of three years. Unless the request is made 
by Department staff who are present at the facility, in which case it must 
be provided immediately, documentation of staffing shall be provided to 
the Department within ten days of the Department's request for the docu- 
mentation. If the facility is unable to provide the documentation re- 
quested by the Department, it shall cease admitting new patients until it 
demonstrates to the Department that it has the staff necessary to provide 
the care needed by the patients by submitting the requested documenta- 
tion. The facility shall also comply with the provisions of Section 1429. 1 
of the Health and Safety Code. 

(i) The facility shall post the patient census and staffing information 
daily. The posting shall include the actual number of licensed and certi- 
fied nursing staff directly responsible for the care of patients for that par- 
ticular day on each shift. The facility may use the form required by sec- 
tion 483.30 of title 42 of the Code of Federal Regulations, but it shall also 
designate the patient assignment by specifying each room and each bed 
to which each certified nurse assistant and licensed nurse is assigned dur- 
ing his or her shift. This posting shall be publicly displayed in a clearly 
visible place. 

(j) The facility may request a waiver for the staff-to-patient ratio in 
accordance with Section 1 276.65 of the Health and Safety Code as long 
as the facility continues to meet the 3.2 nursing hours per patient day re- 
quirement. 

(1) The facility shall submit a written request for a waiver with sub- 
stantiating information to the Department. The facility shall request the 
waiver by using the program flexibility procedures specified in Section 
72213, and the Department shall process it as required by Section 1276 
of the Health and Safety Code. 

(2) The facility shall notify the Department if there has been a change 
in the substantiating information. A request for a waiver with substantiat- 
ing information included shall be updated and resubmitted annually. 

(k) Staffing for a distinct part intermediate care unit in a skilled nursing 
facility: 

( 1 ) Units of less than 50 intermediate care beds shall not be required 
to provide licensed personnel in addition to those provided in the skilled 
nursing facility unless the Department determines through a written eval- 



uation that additional licensed personnel are necessary to protect the 
health and safety of patients. 

(2) Units of 50 or more intermediate care beds shall provide a regis- 
tered nurse or licensed vocational nurse employed 8 hours on the day 
shift, 7 days per week in the unit. 

(3) For purposes of this section intermediate care beds that are licensed 
as such by the Department shall not be included for establishing licensed 
nurse staffing as required in subsection (f )( 1 ) if the unit is used exclusive- 
ly for intermediate care patients. 

(/) Initial implementation of this section shall be contingent on an ap- 
propriation in the annual Budget Act or another statute, in accordance 
with Health and Safety Code Section 1276.65(i). 

NOTE: Authority cited: Sections 1275, 1276.5, 1276.65 and 131200, Health and 
Safety Code. Reference: Sections 1276, 1276.5. 1276.65 and 131051, Health and 
Safety Coce; and Section 141 10.7(c), Welfare and Institutions Code. 

History 

1 . New section filed 1 1 -8-2007 as an emergency; operative pursuant to Health and 
Safety Code section 1276.65(i) (Register 2007, No. 45). This regulatory action 
is deemed an emergency exempt from OAL review and was filed with the Secre- 
tary of State pursuant to Chapter 684. Statutes of 2001 (AB 1075). A Certificate 
of Compliance must be transmitted to OAL by 5-6-2008 or emergency lan- 
guage will be repealed by operation of law on the following day. 

2. New section refiled 5-6-2008 as an emergency; operative pursuant to Health 
and Safety Code section 1276.65(i) (Register 2008, No. 19). This regulatory ac- 
tion is deemed an emergency exempt from OAL review and was filed with the 
Secretary of State pursuant to Chapter 684, Statutes of 2001 (AB 1075). A Cer- 
tificate of Compliance must be transmitted to OAL by 1 1 -3-2008 or emergency 
language will be repealed by operation of law on the following day. 

§ 72331 . Nursing Service-Nurse Assistant Training and 
Certificate. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Sections 1137.7 through 1338.3, 1439.1 through 1439.8 and 1276, Health 
and Safety Code. 

History 

1. Repealer filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, No. 
46). A Certificate of Compliance must be transmitted to OAL by 1 1-13-91 or 
emergency repeal will be reinstated by operation of law on the following day. 

2. Repealer refiled 11-14-91 as an emergency; operative 11-13-91 (Register 92, 
No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 or 
emergency language will be repealed by operation of law on the following day. 

3. Editorial correction of History 2. filed and repealer refiled 5-6-92 as an emer- 
gency; operative 5-6-92 (Register 92, No. 20). A Certificate of Compliance 
must be transmitted to OAL 9-3-92 or emergency language will be repealed by 
operation of law on the following day. 

4. Certificate of Compliance as to 5-6-92 order transmitted to OAL 8-27-92 and 
filed 10-9-92 (Register 92, No. 41). 

§ 72333. Dietetic Service— General. 

"Dietetic service" means a service organized, staffed and equipped to 
assure that food service to patients is safe, appetizing and provides for 
their nutritional needs. 



[The next page is 849.] 



Page 848.10 



Register 2008, No. 19; 5-9-2008 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 72347 



• 



NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72335. Dietetic Service — Food Service. 

(a) The dietetic service shall provide food of the quality and quantity 
to meet each patient's needs in accordance with the physicians' orders 
and to meet "The Recommended Daily Dietary Allowance," the most 
current edition, adopted by the Food and Nutrition Board of the National 
Research Council of the National Academy of Sciences, and the follow- 
ing: 

( 1 ) Not less than 3 meals shall be served daily and with not more than 
a 14-hour span between the last meal and the first meal of the following 
day. 

(2) Between-meal feeding shall be provided as required by the diet or- 
der. Bedtime nourishments shall be offered to all patients unless con- 
traindicated. 

(3) Patient food preferences shall be adhered to as much as possible 
and substitutes for all food refused shall be from appropriate food groups. 
Condiments such as salt, pepper or sugar shall be available at each meal 
unless contraindicated by the diet order. 

(4) Table service shall be provided for all patients who can and wish 
to eat at a table. Tables of appropriate height shall be provided for patients 
in wheelchairs. 

(5) No food ordered for the facility shall be diverted or taken from the 
facility. No rebates shall be received or allowed to the facility or its own- 
ers, directors, officers or employees from any commercial food source. 

(6) When food is provided by an outside resource, the facility shall en- 
sure that all federal, state and local requirements are met. The facility 
shall maintain a written plan, adequate space, equipment and food sup- 
plies to provide patients' food service in emergencies. 

(7) Recipes for all items that are prepared for regular and therapeutic 
diets shall be available and used to prepare attractive and palatable meals, 
in which nutritive values, flavor and appearance are conserved. Food 
shall be served attractively, at appropriate temperatures with appropriate 
eating utensils and in a form to meet individual needs. 

(b) A current profile card shall be maintained for each patient, indicat- 
ing diet order, likes, dislikes, allergies to foods, diagnosis and instruc- 
tions or guidelines to be followed in the preparation and serving of food 
for the patient. 

(c) All regular and therapeutic diets shall be prescribed by a person 
lawfully authorized to give such an order. Verbal orders may be received 
and recorded by a qualified dietitian and shall be signed by the prescriber 
within five days. 

NOTH: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72337. Dietetic Service— Diet Manual. 

A current therapeutic diet manual, approved by the dietitian and the 
patient care policy committee, shall be readily available to the attending 
physician, nursing and dietetic personnel. It shall be reviewed annually 
and revised at least every five years. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72339. Dietetic Service — Therapeutic Diets. 

Therapeutic diets shall be provided for each patient as prescribed and 
shall be planned, prepared and served with supervision and/or consulta- 
tion from the dietitian. Persons responsible for therapeutic diets shall 
have sufficient knowledge of food values to make appropriate substitu- 
tions when necessary. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72341 . Dietetic Service — Menus. 

(a) Menus for regular and therapeutic diets shall be written at least one 
week in advance, dated and posted in the kitchen at least one week in ad- 
vance. 

(b) All menus shall be approved by the dietitian. 



(c) If any meal served varies from the planned menu, the change and 
the reason for the change shall be noted in writing on the posted menu in 
the kitchen. 

(d) Menus shall provide a variety of foods and indicate standard por- 
tions at each meal. Menus shall be varied for the same day of consecutive 
weeks. If a cycle menu is used, the cycle shall be of no less than three 
weeks duration and shall be revised quarterly. 

(e) Menus shall be adjusted to include seasonal commodities. 

(f) Menus shall be planned with consideration of cultural background 
and food habits of patients. 

(g) A copy of the menu as served shall be kept on file for at least 30 
days. 

(h) Itemized records of food purchases shall be kept for one year and 
available for review by the Department. Food purchases invoices are ac- 
ceptable provided they list amounts and types of foods purchased. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72343. Dietetic Service — Food Storage. 

(a) Food storage areas shall be clean at all times. 

(b) All foods or food items not requiring refrigeration shall be stored 
above the floor, on shelves, racks, dollies or other surfaces which facili- 
tate thorough cleaning, in a ventilated room, not subject to sewage or 
wastewater backflow or contamination by condensation, leakage, ro- 
dents or vermin. All packaged food, canned foods, or food items stored 
shall be kept clean and dry at all times. 

(c) All readily perishable foods or beverages shall be maintained at 
temperatures of 7°C (45°F) or below, or at 60°C ( 140°F) or above, at all 
times, except during necessary periods of preparation and service. Fro- 
zen foods shall be stored at minus 1 8°C (0°F) or below at all times. There 
shall be an accurate thermometer in each refrigerator and freezer and in 
storerooms used for perishable foods. All foods stored in walk-in refrig- 
erators and freezers shall be stored above the floor on shelves, racks, dol- 
lies or other surfaces that facilitate thorough cleaning. 

(d) Pesticides and other toxic substances and drugs shall not be stored 
in the kitchen area or in storerooms for food or food preparation equip- 
ment and utensils. 

(e) Soaps, detergents, cleaning compounds or similar substances shall 
be stored in separate storage areas. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72345. Dietetic— Sanitation. 

(a) All kitchens and kitchen areas shall be kept clean, free from litter 
and rubbish and protected from rodents, roaches, flies and other insects. 

(b) All utensils, counters, shelves and equipment shall be kept clean, 
maintained in good repair and shall be free from breaks, corrosion, open 
seams, cracks and chipped areas. 

(c) Plastic ware, china and glassware that cannot be sanitized or are 
hazardous because of chips, cracks or loss of glaze shall be discarded. 

(d) Ice which is used in connection with food or drink shall be from a 
sanitary source and shall be handled and dispensed in a sanitary manner. 

(e) Kitchen wastes that are not disposed of by mechanical means shall 
be kept in clean, leakproof, nonabsorbent, tightly closed containers and 
shall be disposed of as frequently as necessary to prevent a nuisance or 
unsightliness. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72347. Dietetic Service— Cleaning and Disinfection of 
Utensils. 

(a) All utensils used for eating, drinking and in the preparation and 
serving of food and drink shall be cleaned and disinfected or discarded 
after each usage. 

(b) Gross food particles shall be removed by careful scraping and pre- 
rinsing in running water. 

(c) Utensils not washed by mechanical means shall be placed in hot 
water with a minimum temperature of 43 °C (1 10°F). washed using soap 



Page 849 



(4-1-90) 



§ 72349 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



or detergent, rinsed in hot water to remove soap or detergent and disin- 
fected by one of the following methods or equivalent, as approved by the 
Department: 

( 1 ) Immersion for at least two minutes in clean water at 77°C ( 1 70°F). 

(2) Immersion for at least 30 seconds in clean water at 83°C ( 1 80°F). 

(3) Immersion in water containing bactericidal chemical as approved 
by the Department. 

(d) After disinfection the utensils shall be allowed to drain and dry in 
racks or baskets on nonabsorbent surfaces. Drying cloths shall not be 
used. 

(e) Results obtained with dishwashing machines shall be equal to those 
obtained by the methods outlined above and all dishwashing machines 
shall meet the requirements contained in Standard No. 3, as amended in 
April 1965, of the National Sanitation Foundation. Hot water at a mini- 
mum temperature of 83°C (180°F), shall be maintained at the manifold 
of the final rinse. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72349. Dietetic Service — Equipment and Supplies. 

(a) Equipment of the type and in the amount necessary for the proper 
preparation, serving and storing of food and for proper dishwashing shall 
be provided and maintained in good working order. 

(b) Fixed and mobile equipment in the dietetic service area shall be lo- 
cated to assure sanitary and safe operation and shall be of sufficient size 
to handle the needs of the facility. 

(c) The dietetic service area shall be ventilated in a manner that will 
maintain comfortable working conditions, remove objectionable odors, 
fumes and prevent excessive condensation. 

(d) Food supplies shall meet the following standards: 

(1) At least one week's supply of staple foods and at least two days' 
supply of perishable foods shall be maintained on the premises. Food 
supplies shall meet the requirements of the weekly menu including the 
therapeutic diets ordered. 

(2) All food shall be of good quality and procured from sources ap- 
proved or considered satisfactory by federal, state or local authorities. 
Food in unlabeled, rusty, leaking, broken containers or cans with side 
seam dents, rim dents or swells shall not be retained or used. 

(3) Milk, when served as a beverage, shall be pasteurized Grade A or 
certified unless otherwise prescribed by the physician's diet order. Milk, 
milk products and products resembling milk shall be processed or man- 
ufactured in milk product plants meeting the requirements of Division 15 
of the California Food and Agricultural Code. Powdered milk shall not 
be used as a beverage but may be used in cooking. 

(4) Milk shall be served in individual containers or from a dispensing 
device which has been approved for such use, by the local health depart- 
ment or from the original container. Milk shall be dispensed directly into 
the glass or other container from which the patient drinks. 

(5) Catered foods and beverages from a source outside the licensed fa- 
cility shall be prepared, packed, properly identified, stored and trans- 
ported in compliance with these regulations and other applicable federal, 
state and local codes. 

(6) Foods held in refrigerated or other storage areas shall be covered. 
Liquids and food which are prepared and not served shall be tightly cov- 
ered, stored appropriately, clearly labeled and dated. A written procedure 
shall be established and followed for the safe use of leftover foods. 

(7) Spoiled or contaminated food shall not be served. 

NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72351 . Dietetic Service— Staff . 

(a) A dietitian shall be employed on a full-time, part-time or consult- 
ing basis. Part-time or consultant services shall be provided on the prem- 
ises at appropriate times on a regularly scheduled basis. A written record 
of the frequency, nature and duration of the consultant's visits shall be 
maintained. 



(b) If a dietitian is not employed full-time, a full-time person who is 
a graduate of a state approved course that provides 90 or more hours of 
classroom instruction in food supervision shall be employed to be re- 
sponsible for the operation of the food service. The dietetic supervisor 
may also cook, provided sufficient time is allowed for managerial re- 
sponsibilities. 

(c) Sufficient staff shall be employed, oriented, trained and their work- 
ing hours scheduled to provide for the nutritional needs of the patients 
and to maintain the dietetic service areas. If dietetic service employees 
are assigned duties in other services, those duties shall not interfere with 
the sanitation, safety or time required for dietetic work assignments. 

(d) Current work schedules by job titles and weekly time schedules by 
job titles shall be posted. 

(e) Dietetic service personnel shall be trained in basic food sanitation 
techniques, wear clean clothing, and a cap or a hair net, and shall be ex- 
cluded from duty when affected by skin infection or communicable dis- 
eases. Beards and mustaches which are not closely cropped and neatly 
trimmed shall be covered. 

(f) Employees' street clothing stored in the kitchen shall be in a closed 
area separate from food or items used in food service. 

(g) Kitchen sinks shall not be used for handwashing. Separate hand- 
washing facilities with soap, running water and individual towels shall 
be provided. 

(h) Persons other than dietetic service personnel shall not be allowed 
in the kitchen areas unless required to do so in the performance of their 
duties. 

(i) Smoking shall not be permitted in kitchen areas. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72353. Pharmaceutical Service — General. 

(a) Arrangements shall be made to assure that pharmaceutical services 
are available to provide patients with prescribed drugs and biologicals. 

(b) Dispensing, labeling, storage and administration of drugs and bio- 
logicals shall be in conformance with state and federal laws. 

(c) If a pharmacy is located on the premises, the pharmacy shall be li- 
censed by the California State Board of Pharmacy and approved by the 
Department. The pharmacy shall not serve the general public unless a 
separate public entrance or a separate public serving window is utilized. 
Pharmacies located on the licensed premises of skilled nursing facilities 
shall be opened for inspection upon the request of an authorized Depart- 
ment representative. 

(d) The facility shall not accept money, goods or services free or below 
cost from any pharmacist or pharmacy as compensation or inducement 
for referral of business to any pharmacy. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code; Sections 650 and 651, Business and 
Professions Code. 

§ 72355. Pharmaceutical Service — Requirements. 

(a) Pharmaceutical service shall include, but is not limited to, the fol- 
lowing: 

(1) Obtaining necessary drugs including the availability of 24-hour 
prescription service on a prompt and timely basis as follows: 

(A) Drugs ordered "Stat" that are not available in the facility emergen- 
cy drug supply shall be available and administered within one hour of the 
time ordered during normal pharmacy hours. For those hours during 
which the pharmacy is closed, drugs ordered "Stat" shall be available and 
administered within two hours of the time ordered. Drugs ordered "Stat" 
which are available in the emergency drug supply shall be administered 
immediately. 

(B) Anti-infectives and drugs used to treat severe pain, nausea, agita- 
tion, diarrhea or other severe discomfort shall be available and adminis- 
tered within four hours of the time ordered. 

(C) Except as indicated above, all new drug orders shall be available 
on the same day ordered unless the drug would not normally be started 
until the next day. 

(D) Refill of prescription drugs shall be available when needed. 



• 



Page 850 



(4-1-90) 



Title 22 



Licensing and Certification of Health Facilities and Referral Agencies 



§ 72369 



(2) Dispensing of drugs and biologicals. 

(3) Monitoring the drug distribution system which includes ordering, 
dispensing and administering of medication. 

(4) Provision of consultative and other services furnished by pharma- 
cists which assist in the development, coordination, supervision and re- 
view of the pharmaceutical services within the facility. 

NOTK: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72357. Pharmaceutical Service — Labeling and Storage of 
Drugs. 

(a) Containers which are cracked, soiled or without secure closures 
shall not be used. Drug labels shall be legible. 

(b) All drugs obtained by prescription shall be labeled in compliance 
with state and federal laws governing prescription dispensing. No person 
other than the dispenser of the drug shall alter any prescription label. 

(c) Nonlegend drugs shall be labeled in conformance with state and 
federal food and drug laws. 

(d) Test reagents, germicides, disinfectants and other household sub- 
stances shall be stored separately from drugs and shall not be accessible 
to patients. 

(e) External use drugs in liquid, tablet, capsule or powder form shall 
be stored separately from drugs for internal use. 

(f) Drugs shall be stored in appropriate temperatures. Drugs required 
to be stored at room temperature shall be stored at a temperature between 
15°C (59°F) and 30°C (86°F). Drugs requiring refrigeration shall be 
stored in a refrigerator between 2°C (36°F) and 8°C (46°F). When drugs 
are stored in the same refrigerator with food, the drugs shall be kept in 
a closed container clearly labeled "drugs." 

(g) Drugs shall be stored in an orderly manner in cabinets, drawers or 
carts of sufficient size to prevent crowding. 

(h) Dose preparation and administration areas shall be well-lighted. 

(i) Drugs shall be accessible only to personnel designated in writing 
by the licensee. 

(j) Storage of nonlegend drugs at the bedside shall meet the following 
conditions: 

( 1 ) The manner of storage shall prevent access by other patients. Lock- 
able drawers or cabinets need not be used unless alternate procedures, in- 
cluding storage on a patient' s person or in an unlocked drawer or cabinet 
are ineffective. 

(2) The facility shall record in the patient health record the bedside 
medications used by the patient, based on observation by nursing person- 
nel and/or information supplied by the patient. 

(3) The quantity of each drug supplied to the patient for bedside stor- 
age shall be recorded in the health record each time the drug is so 
supplied. 

(k) Storage of legend drugs at the bedside shall meet the conditions of 
72357(j) and shall in addition: 

( 1 ) Be specifically ordered by the prescriber of the drugs, and 

(2) Be limited to sublingual or inhalation forms of emergency drugs. 
(/) Drugs shall not be kept in stock after the expiration date on the label 

and no contaminated or deteriorated drugs shall be available for use. 

(m) The drugs of each patient shall be kept and stored in their original- 
ly received containers. No drug shall be transferred between containers. 

(n) Discontinued drug containers shall be marked, or otherwise identi- 
fied, to indicate that the drug has ben discontinued, or shall be stored in 
a separate location which shall be identified solely for this purpose. Dis- 
continued drugs shall be disposed of within 90 days of the date the drug 
order was discontinued, unless the drug is reordered within that time. 
NOTH: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Sections 1418.5 and 1276, Health and Safety Code. 

§ 72359. Pharmaceutical Service — Stop Orders. 

Written policies shall be established and implemented limiting the du- 
ration of new drug orders in the absence of a prescriber' s specific indica- 
tion for duration of therapy. The prescriber shall be contacted for new or- 
ders prior to the termination time established by the policy. Such policies 
shall include all categories of drugs. 

NOTH: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



§ 72361 . Pharmaceutical Service — Orders for Drugs. 

(a) No drugs shall be administered except upon the order of a person 
lawfully authorized to prescribe for and treat human illness. 

(b) All daig orders shall be written, dated, and signed by the person 
lawfully authorized to give such an order. The name, quantity or specific 
duration of therapy, dosage and time or frequency of administration of 
the drag, and the route of administration if other than oral shall be speci- 
fied. "P.R.N." order shall also include the indication for use of a drug. 

(c) Verbal orders for drugs and treatments shall be received only by 
licensed nurses, psychiatric technicians, pharmacists, physicians, physi- 
cian's assistants from their supervising physicians only, and certified re- 
spiratory therapists when the orders relate specifically to respiratory 
care. Such orders shall be recorded immediately in the patient's health 
record by the person receiving the order and shall include the date and 
time of the order. The order shall be signed by the prescriber within five 
days. 

(d) The signing of orders shall be by signature or a personal computer 
key. Signature stamps shall not be used. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72363. Pharmaceutical Service — Drug Order Processing. 

Signed orders for drugs shall be transmitted to the issuing pharmacy 
within 48 hours, either by written prescription of the prescriber or by an 
order form which produces a direct copy of the order or by an electroni- 
cally reproduced facsimile. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72365. Pharmaceutical Service — Drug Order Records. 

Facilities shall maintain a record which includes, for each drug or- 
dered by prescription, the name of the patient, the drug name, and 
strength, the date ordered, the date and amount received and the name of 
the issuing pharmacy. The records shall be kept at least one year. 
NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72367. Pharmaceutical Service — Personal Medications. 

(a) Medications brought by or with the patient on admission to the fa- 
cility shall not be used unless the contents of the containers have been ex- 
amined and positively identified after admission by the patient's physi- 
cian or a pharmacist retained by the facility. 

(b) The facility may use drugs transferred from other licensed health 
facilities or those drugs dispensed or obtained after admission from any 
licensed or governmental pharmacy and may accept the delivery of those 
drugs by any agent of the patient or pharmacy without the necessity of 
identification by a physician or pharmacist. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72369. Pharmaceutical Service — Controlled Drugs. 

(a) Drugs listed in Schedules II. Ill and IV of the Federal Comprehen- 
sive Drug Abuse Prevention and Control Act of 1 970 shall not be accessi- 
ble to other than licensed nursing, pharmacy and medical personnel des- 
ignated by the licensee. Drugs listed in Schedule II of the above Act shall 
be stored in a locked cabinet or a locked drawer separate from noncon- 
trolled drugs unless they are supplied on a scheduled basis as part of a unit 
dose medication system. 

(b) Separate records of use shall be maintained on all Schedule II 
drugs. Such records shall be maintained accurately and shall include the 
name of the patient, the prescription number, the drug name, strength and 
dose administered, the date and time of administration and the signature 
of the person administering the drug. Such records shall be reconciled at 
least daily and shall be retained at least one year. If such drugs are 
supplied on a scheduled basis as part of a unit dose medication system, 
such records need not be maintained separately. 

(c) Drug records shall be maintained for drugs listed in Schedules III 
and IV of the above Act in such a way that the receipt and disposition of 
each dose of any such drug may be readily traced. Such records need not 
be separate from other medication records. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 



Page 851 



Register 95, Nos. 1-3; 1 -20-95 



§ 72371 



BARCLAYS CALIFORNIA CODE OF REGULATIONS 



Title 22 



§ 72371. Pharmaceutical Service — Disposition of Drugs. 

(a) Drugs which have been dispensed for individual patient use and are 
labeled in conformance with State and Federal law for outpatient use 
shall be furnished to patients on discharge on the orders of the discharg- 
ing physician. If the physician's discharge orders do not include provi- 
sions for drug dispositions, drugs shall be furnished to patients unless: 

( 1 ) The discharging physician specifies otherwise or, 

(2) The patient leaves or is discharged without a physician's order or 
approval or, 

(3) The patient is discharged to a general acute care hospital, acute psy- 
chiatric hospital, or acute care rehabilitation hospital or, 

(4) The drug was discontinued prior to discharge or, 

(5) The labeled directions for use are not substantially the same as most 
current orders for the drug in the patient's health record. 

(b) A record of the drugs sent with the patient shall be made in the pa- 
tient's health record. 

(c) Patient's drugs supplied by prescription which have been discon- 
tinued and those which remain in the facility after discharge of the patient 
shall be destroyed by the facility in the following manner: 

(1) Drugs listed in Schedules II, III or IV of the Federal Comprehen- 
sive Drug Abuse Prevention and Control Act of 1970 shall be destroyed 
by the facility in the presence of a pharmacist and a registered nurse 
employed by the facility. The name of the patient, the name and strength 
of the drug, the prescription number, the amount destroyed, the date of 
destruction and the signatures of the witnesses required above shall be 
recorded in the patient's health record or in a separate log. Such log shall 
be retained for at least three years. 

(2) Drugs not listed under Schedules II, III or IV of the Federal Com- 
prehensive Drug Abuse Prevention and Control Act of 1970 shall be de- 
stroyed by the facility in the presence of a pharmacist or licensed nurse. 
The name of the patient, the name and strength of the drug, the prescrip- 
tion number if applicable, the amount destroyed, the date of destruction 
and the signatures of the person named above and one other person shall 
be recorded in the patient's health record or in a separate log. Such log 
shall be retained for at least three years. 

(d) Unless otherwise prohibited under applicable federal or state laws, 
individual patient drugs supplied in sealed containers may be returned, 
if unopened, to the issuing pharmacy for disposition provided that: 

( 1 ) No drugs covered under the Federal Comprehensive Drug Abuse 
Prevention and Control Act of 1970 are returned. 

(2) All such drugs are identified as to lot or control number. 

(3) The signatures of the receiving pharmacist and a registered nurse 
employed by the facility are recorded in a separate log which lists the 
name of the patient, the name, strength, prescription number (if applica- 
ble), the amount of the drug returned and the date of return. The log must 
be retained for at least three years. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

History 
1 . Change without regulatory effect relettering duplicate subsection (c) to (d) filed 
1-1 1-95 pursuant to section 100, title 1 , California Code of Regulations (Regis- 
ter 95, No. 2). 

§ 72373. Pharmaceutical Service — Unit Dose Medication 
System. 

In facilities utilizing a unit dose medication system, there shall be at 
least a 24-hour supply of all patient medications on hand at all times, ex- 
cept those drugs which are to be discontinued within the 24-hour period. 
Drugs that are part of a unit dose medication system shall not exceed a 
48-hour supply. 

NOTE: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72375. Pharmaceutical Service — Staff. 

(a) Facilities shall retain a consulting pharmacist who devotes a suffi- 
cient number of hours during a regularly scheduled visit, for the purpose 
of coordinating, supervising and reviewing the pharmaceutical service 
committee, or its equivalent, at least quarterly. The report shall include 



a log or record of time spent in the facility. There shall be a written agree- 
ment between the pharmacist and the facility which includes duties and 
responsibilities of both. 

(b) A pharmacist shall serve on the pharmaceutical service committee 
and the patient care policy committee. 

(c) A pharmacist shall review the drug regimen of each patient at least 
monthly and prepare appropriate reports. The review of the drug regimen 
of each patient shall include all drugs currently ordered, information con- 
cerning the patient's condition relating to drug therapy, medication ad- 
ministration records, and where appropriate, physician's progress notes, 
nurse's notes, and laboratory test results. The pharmacists shall be re- 
sponsible for reporting, in writing, irregularities in the dispensing and ad- 
ministration of drugs and other matters relating to the review of the drug 
regimen to the administrator and director of the nursing service. 
NOTE: Authority cited: Sections 208(a) and 1 275, Health and Safety Code. Refer- 
ence: Section 1276, Health and Safety Code. 

§ 72377. Pharmaceutical Service — Equipment and 
Supplies. 

(a) There shall be adequate equipment and supplies necessary for the 
provision of pharmaceutical services within the facility including at least 
the following: 

( 1 ) Refrigerator with an accurate thermometer. 

(