Cal. Code Regs. Tit. 22, § 87463 - Reappraisals
(a)
The pre-admission appraisal, as specified in Section
87457, Pre-Admission Appraisal,
shall be updated in writing as frequently as necessary or once every 12 months,
whichever occurs first, to note significant changes in condition, as defined in
Section 87101, Definitions, and to keep
the appraisal accurate. For the purposes of this section, the updated
pre-admission appraisal shall be referred to as the reappraisal.
(b) The reappraisal shall document
significant changes in the resident's physical, mental, cognitive, behavioral,
or functional condition, including those required to be documented as specified
in Section
87466, Observation of the
Resident.
(1) Significant changes in
condition, as defined in Section
87101, Definitions, include, but
are not limited, to:
(A) Physical trauma, such
as a heart attack or stroke.
(B)
Cognitive functions, such as thinking, remembering, reasoning, exercising
judgement, and decision-making.
(C)
Behavioral expression, as defined in Section
87101, Definitions, that may
result in harm to self or others, such as unsafe wandering, elopement,
hallucinations, lacking in hazard awareness, or lacking in impulse
control.
(D) A mental or social
trauma, such as the loss of a loved one.
(E) Illness or injury that results in a
significant change in the health care or dietary needs of the
resident.
(c) If
the licensee observes or is made aware of behavioral expression, as defined in
Section 87101, that has caused or may
cause harm to the resident or others, the licensee shall document all of the
following in the resident's reappraisal:
(1)
A description of the behavioral expression.
(2) If known, identification of events
occurring just prior to the behavioral expression including, but not limited
to, interactions with other residents or staff, sudden or recent changes in the
physical environment, signs of possible new physical illness or injury (such as
fever, cough, urinary urgency, or limping), overstimulation (such as from noise
or visitors), or physical sensations a resident may not be able to express
verbally that may include, but are not limited to, fatigue, heat, cold, pain,
hunger, thirst, boredom, fear, wanting to walk, or need for
toileting.
(3) Interventions to be
implemented to minimize the risks to the health and safety of the resident or
others associated with the resident's behavioral expression. The licensee shall
use the least restrictive intervention to manage the behavioral expression
based on the individual needs of the resident.
(d) If a resident is receiving specialized
services, the licensee shall consult with those care providers in order to
ensure changes in the resident's condition are properly addressed, document
such consultation, and place documentation in the resident's record.
(e) The licensee shall immediately, or as
soon as reasonably possible, bring any significant change in condition, as
defined in Section
87101, Definitions, to the
attention of the appropriate licensed medical professional and if applicable,
other specialized care provider. Documentation of such communication shall be
added to the resident's record and shall include:
(1) Description of the significant change in
condition;
(2) Date and time the
communication occurred and the name of the appropriate licensed medical
professional, and if applicable, other specialized care provider, with whom the
licensee communicated;
(3)
Recommendation, if any, of the appropriate licensed medical professional, and
if applicable, other specialized care provider; and
(4) Change in care to be provided, if
any.
(f) The licensee
shall immediately, or as soon as reasonably possible, communicate with the
resident and, if applicable, the resident's representative, about any
significant change in condition and the recommendation, if any, of the
appropriate licensed medical professional, and if applicable, other specialized
care provider. Documentation of such communication shall be added to the
resident's record.
(g) The licensee
shall ensure corresponding changes are made in the care and supervision
provided to the resident.
(h) The
licensee shall request that all residents receive an annual routine visit with
a licensed medical professional once every twelve months, either in person or
by video appointment.
(1) Documentation of
the annual routine visit, such as a visit summary, shall be added to the
resident's record.
(2)
Documentation of a resident's refusal to receive an annual routine visit, or if
applicable, their representative's refusal on their behalf, shall be added to
the resident's record.
(3) If a
resident refuses to receive an annual routine visit, or if applicable, their
representative refuses an annual routine visit on their behalf, but later
agrees to one, documentation of the annual routine visit shall be added to the
resident's record.
(i)
When there is significant change in condition, as defined in Section
87101, Definitions, or once every
12 months, whichever occurs first, the licensee shall arrange an in-person or
virtual meeting or conference call to share the reappraisal with the resident,
the resident's representative, if applicable, and appropriate facility staff,
as specified in Section
87467, Resident Participation in
Decision Making.
(j) The licensee
shall evaluate staffing needs to ensure that there is a sufficient number of
direct care staff, as specified in Section
87411, Personnel Requirements --
General, to support each resident's physical, social, emotional, safety and
health care needs, as identified in their current appraisal.
Notes
Note: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.1, 1569.156, 1569.2, 1569.31, 1569.312 and 1569.315, Health and Safety Code.
Note: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.1, 1569.156, 1569.2, 1569.31, 1569.312 and 1569.315, Health and Safety Code.
2. Amendment filed 10-17-2024; operative
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