Cal. Code Regs. Tit. 22, § 74709 - Home Health Aide/Personal Care Services Supervision
(a) When an agency provides or arranges for
home health aide services for a patient in conjunction with skilled nursing
services, the services shall be given in accordance with a written plan of
treatment or plan of care and the case shall be supervised by a registered
nurse.
(1) If the patient receives skilled
nursing care, the registered nurse shall perform the supervisory visit
described in (a)(2) of this section, unless the registered nurse, in the
exercise of professional judgment, delegates this task to a licensed vocational
nurse. The registered nurse shall provide the initial assessment of the patient
and the care environment. If the patient is not receiving skilled nursing care,
but is receiving another skilled service (e.g. physical therapy, occupational
therapy, or speech-pathology services), the initial assessment or evaluation
and supervision may be provided by the appropriate therapist, when within his
or her scope of practice. The supervisor nurse shall be responsible for:
(A) Assigning home health aides to a case in
accordance with the plan of treatment or plan of care as required in subsection
(a).
(B) Providing written
instructions for patient care.
(2) If the patient receives skilled care, the
registered nurse (or another professional described in paragraph (a)(1) of this
section) shall make an on-site visit to the patient's home no less frequently
than every two weeks. The home health agency shall develop and implement
policies and procedures for those circumstances when the home health agency
requires on-site supervisory visits to be conducted jointly with the home
health aide present (e.g. when joint visits are part of a performance
evaluation).
(A) When a licensed vocational
nurse is delegated supervision of home health aide services that are provided
in conjunction with skilled nursing services, a registered nurse shall make the
on-site supervisory visit to the patient's home at least every three months, to
observe the patient and patient care environment.
(3) If the home health aide/personal care
services are provided to a patient who is not receiving skilled nursing care,
physical or occupational therapy or speech-language pathology services, the
registered nurse or, when delegated, the licensed vocational nurse, shall make
a supervisory visit to the patient's home no less frequently than every 62
days. Regular supervisory visits shall occur while the home health aide is
providing patient care and shall include verification that the plan of
treatment, plan of care, or plan for personal care services is being followed
appropriately.
(A) When a licensed vocational
nurse is delegated supervision of home health aide/personal care services (when
the patient is only receiving these services), the registered nurse shall at
least alternate on-site supervisory visits to the patient's home with the
licensed vocational nurse, to observe the patient and the patient care
environment.
(4) If home
health aide/personal care services are provided by an individual who is not an
employee of the primary home health agency, the primary home health agency
shall be responsible for the overall quality of care provided by the aide, and
provide for supervision of the aide, including referral of any concerns to the
appropriate agency or organization when care problems are
observed.
(b) When a
licensed vocational nurse is delegated supervision of home health aide/personal
care services, a registered nurse shall retain responsibility for supervision
of licensed and unlicensed personnel providing such services.
(c) Registered nurses who are assigned to
supervise the case when a licensed vocational nurse has been delegated
supervision of home health aide patient care, or registered nurses who
supervise home health aide care, may also be assigned to provide direct
services for agency patients.
(d)
Nothing in this section shall be construed as permitting a physical therapy
aide, as defined in Title 16, Section
1399, California Code of
Regulations, to perform the functions of a home health aide, unless the
physical therapy aide meets the definition of a home health aide. Physical
therapy aides who are not certified as home health aides may not substitute for
home health aides when home health aides are required by a plan of treatment or
plan of care. Nothing in this section shall require a physical therapist to
supervise home health aides in the same manner as physical therapy aides. Home
health aide services shall comply with applicable state law.
(e) Home health agencies participating in the
Medicare and or Medi-Cal program shall meet applicable federal
requirements.
Notes
2. Amendment of section heading, section and NOTE refiled 8-14-95 as an emergency; operative 8-14-95 (Register 95, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-12-95 or emergency language will be repealed by operation of law on the following day.
3. Amendment of section heading, section and NOTE refiled 12-12-95 as an emergency; operative 12-12-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-10-96 or emergency language will be repealed by operation of law on the following day.
4. Amendment of section heading, section and NOTE refiled 4-11-96 as an emergency; operative 4-11-96 (Register 96, No. 15). A Certificate of Compliance must be transmitted to OAL by 8-9-96 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-28-95 order transmitted to OAL 8-7-96 and disapproved 9-19-96 (Register 96, No. 38).
6. Amendment of section heading, section and NOTE filed 9-19-96 as an emergency; operative 9-19-96 (Register 96, No. 38). A Certificate of Compliance must be transmitted to OAL by 1-17-97 or emergency language will be repealed by operation of law on the following day.
7. Editorial correction of HISTORY 6 (Register 97, No. 3).
8. Amendment of section heading, section and NOTE refiled 1-16-97 as an emergency; operative 1-16-97 (Register 97, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-16-97 or emergency language will be repealed by operation of law on the following day.
9. Amendment of section heading, section and NOTE refiled 5-15-97 as an emergency; operative 5-15-97 (Register 97, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-12-97 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 5-15-97 order, including amendment of section heading, section and NOTE, transmitted to OAL 8-26-97 and filed 10-8-97 (Register 97, No. 41).
Note: Authority cited: Sections 1734 and 100275, Health and Safety Code. Reference: Sections 1727(c), 1727.5(a), 1727.5(c), 1727.5(f) and 1734, Health and Safety Code.
2. Amendment of section heading, section and Note refiled 8-14-95 as an emergency; operative 8-14-95 (Register 95, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-12-95 or emergency language will be repealed by operation of law on the following day.
3. Amendment of section heading, section and Note refiled 12-12-95 as an emergency; operative 12-12-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-10-96 or emergency language will be repealed by operation of law on the following day.
4. Amendment of section heading, section and Note refiled 4-11-96 as an emergency; operative 4-11-96 (Register 96, No. 15). A Certificate of Compliance must be transmitted to OAL by 8-9-96 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-28-95 order transmitted to OAL 8-7-96 and disapproved 9-19-96 (Register 96, No. 38).
6. Amendment of section heading, section and Note filed 9-19-96 as an emergency; operative 9-19-96 (Register 96, No. 38). A Certificate of Compliance must be transmitted to OAL by 1-17-97 or emergency language will be repealed by operation of law on the following day.
7. Editorial correction of History 6 (Register 97, No. 3).
8. Amendment of section heading, section and Note refiled 1-16-97 as an emergency; operative 1-16-97 (Register 97, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-16-97 or emergency language will be repealed by operation of law on the following day.
9. Amendment of section heading, section and Note refiled 5-15-97 as an emergency; operative 5-15-97 (Register 97, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-12-97 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 5-15-97 order, including amendment of section heading, section and Note, transmitted to OAL 8-26-97 and filed 10-8-97 (Register 97, No. 41).
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