Cal. Code Regs. Tit. 22, § 87465 - Incidental Medical and Dental Care Services
(a) A plan for incidental medical and dental
care shall be developed by each facility. The plan shall encourage routine
medical and dental care and provide for assistance in obtaining such care, by
compliance with the following:
(1) The
licensee shall arrange, or assist in arranging, for medical and dental care
appropriate to the conditions and needs of residents.
(2) The licensee shall provide assistance in
meeting necessary medical and dental needs. This includes transportation which
may be limited to the nearest available medical or dental facility which will
meet the resident's need. In providing transportation the licensee shall do so
directly or make arrangements for this service.
(3) When residents require prosthetic
devices, vision and hearing aids, the staff shall be familiar with the use of
these devices, and shall assist such persons with their utilization as
needed.
(4) The licensee shall
assist residents with self-administered medications as needed.
(5) Facility staff, except those authorized
by law, shall not administer injections, but staff designated by the licensee
may assist persons with self-administration as needed. Assistance with
self-administered medications shall be limited to the following:
(A) Medications usually prescribed for
self-administration which have been authorized by the person's
physician.
(B) Medications during
an illness determined by a physician to be temporary and minor.
(C) Assistance required because of tremor,
failing eyesight and similar conditions.
(D) Assistance with self-administration does
not include forcing a resident to take medications, hiding or camouflaging
medications in other substances without the resident's knowledge and consent,
or otherwise infringing upon a resident's right to refuse to take a
medication.
(6) When
requested by the prescribing physician or the Department, a record of dosages
of medications which are centrally stored shall be maintained by the
facility.
(7) There shall be
adequate privacy for first aid treatment of minor injuries and for examination
by a physician if required.
(8) If
a facility has no medical unit on the grounds, a complete first aid kit shall
be maintained and be readily available in a specific location in the facility.
The kit shall be a general type approved by the American Red Cross, or shall
contain at least the following:
(A) A current
edition of a first aid manual approved by the American Red Cross, the American
Medical Association or a state or federal health agency.
(B) Sterile first aid dressings.
(C) Bandages or roller bandages.
(D) Scissors.
(E) Tweezers.
(F) Thermometers.
(9) The licensee shall ensure that infection
control practices are maintained in the facility as specified in Section
87470, Infection Control
Requirements.
(b) If the
resident's physician has stated in writing that the resident is able to
determine and communicate his/her need for a prescription or nonprescription
PRN medication, facility staff shall be permitted to assist the resident with
self-administration of his/her PRN medication.
(c) If the resident's physician has stated in
writing that the resident is unable to determine his/her own need for
nonprescription PRN medication, but can communicate his/her symptoms clearly,
facility staff designated by the licensee shall be permitted to assist the
resident with self-administration, provided all of the following requirements
are met:
(1) There is written direction from
a physician, on a prescription blank, specifying the name of the resident, the
name of the medication, all of the information specified in Section
87465(e),
instructions regarding a time or circumstance (if any) when it should be
discontinued, and an indication of when the physician should be contacted for a
medication reevaluation.
(2) Once
ordered by the physician the medication is given according to the physician's
directions.
(3) A record of each
dose is maintained in the resident's record. The record shall include the date
and time the PRN medication was taken, the dosage taken, and the resident's
response.
(d) If the
resident is unable to determine his/her own need for a prescription or
nonprescription PRN medication, and is unable to communicate his/her symptoms
clearly, facility staff designated by the licensee, shall be permitted to
assist the resident with self-administration, provided all of the following
requirements are met:
(1) Facility staff shall
contact the resident's physician prior to each dose, describe the resident's
symptoms, and receive direction to assist the resident in self-administration
of that dose of medication.
(2) The
date and time of each contact with the physician, and the physician's
directions, shall be documented and maintained in the resident's facility
record.
(3) The date and time the
PRN medication was taken, the dosage taken, and the resident's response shall
be documented and maintained in the resident's facility record.
(e) For every prescription and
nonprescription PRN medication for which the licensee provides assistance there
shall be a signed, dated written order from a physician on a prescription
blank, maintained in the resident's file, and a label on the medication. Both
the physician's order and the label shall contain at least all of the following
information.
(1) The specific symptoms which
indicate the need for the use of the medication.
(2) The exact dosage.
(3) The minimum number of hours between
doses.
(4) The maximum number of
doses allowed in each 24-hour period.
(f) Emergency care requirements shall include
the following:
(1) The name, address, and
telephone number of each resident's physician and dentist shall be readily
available to that resident, the licensee, and facility staff.
(2) The name, address and telephone number of
each emergency agency to be called in the event of an emergency, including but
not limited to the fire department, crisis center or paramedical unit or
medical resource, shall be posted in a location visible to both staff and
residents.
(3) The name and
telephone number of an ambulance service shall be readily
available.
(g) The
licensee shall immediately telephone 9-1-1 if an injury or other circumstance
has resulted in an imminent threat to a resident's health including, but not
limited to, an apparent life-threatening medical crisis except as specified in
Sections 87469(c)(2), (c)(3), or
(c)(4).
(h) The following requirements shall apply to
medications which are centrally stored:
(1)
Medications shall be centrally stored under the following circumstances:
(A) The preservation of medicines requires
refrigeration, if the resident has no private refrigerator.
(B) Any medication is determined by the
physician to be hazardous if kept in the personal possession of the person for
whom it was prescribed.
(C) Because
of potential dangers related to the medication itself, or due to physical
arrangements in the facility and the condition or the habits of other persons
in the facility, the medications are determined by either a physician, the
administrator, or Department to be a safety hazard to
others.
(2) Centrally
stored medicines shall be kept in a safe and locked place that is not
accessible to persons other than employees responsible for the supervision of
the centrally stored medication.
(3) Each container shall carry all of the
information specified in (6)(A) through (E) below plus expiration date and
number of refills.
(4) All
centrally stored medications shall be labeled and maintained in compliance with
state and federal laws. No persons other than the dispensing pharmacist shall
alter a prescription label.
(5)
Each resident's medication shall be stored in its originally received
container. No medications shall be transferred between containers.
(6) The licensee shall be responsible for
assuring that a record of centrally stored prescription medications for each
resident is maintained for at least one year and includes:
(A) The name of the resident for whom
prescribed.
(B) The name of the
prescribing physician.
(C) The drug
name, strength and quantity.
(D)
The date filled.
(E) The
prescription number and the name of the issuing pharmacy.
(F) Instructions, if any, regarding control
and custody of the medication.
(i) Prescription medications which are not
taken with the resident upon termination of services, not returned to the
issuing pharmacy, nor retained in the facility as ordered by the resident's
physician and documented in the resident's record nor disposed of according to
the hospice's established procedures or which are otherwise to be disposed of
shall be destroyed in the facility by the facility administrator and one other
adult who is not a resident. Both shall sign a record, to be retained for at
least three years, which lists the following:
(1) Name of the resident.
(2) The prescription number and the name of
the pharmacy.
(3) The drug name,
strength and quantity destroyed.
(4) The date of
destruction.
(j) In all
facilities licensed for sixteen (16) persons or more, one or more employees
shall be designated as having primary responsibility for assuring that each
resident receives needed first aid and needed emergency medical services and
for assisting residents as needed with self-administration of medications. The
names of the staff employees so responsible and the designated procedures shall
be documented and made known to all residents and staff.
Notes
2. Amendment of subsection (g) filed 4-7-2015; operative 7-1-2015 (Register 2015, No. 15).
3. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) filed 2-7-2022 as an emergency; operative 2-7-2022 (Register 2022, No. 6). A Certificate of Compliance must be transmitted to OAL by 8-8-2022 or emergency language will be repealed by operation of law on the following day.
4. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 8-8-2022 as an emergency; operative 8-8-2022 (Register 2022, No. 32). A Certificate of Compliance must be transmitted to OAL by 11-7-2022 or emergency language will be repealed by operation of law on the following day.
5. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 11-7-2022 as an emergency; operative 11-7-2022 (Register 2022, No. 45). A Certificate of Compliance must be transmitted to OAL by 2-6-2023 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 11-7-2022 order transmitted to OAL 2-3-2023 and filed 3-20-2023 (Register 2023, No. 12).
Note: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.1, 1569.2, 1569.31, 1569.312 and 1569.73, Health and Safety Code.
2. Amendment of subsection (g) filed 4-7-2015; operative
3. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) filed 2-7-2022 as an emergency; operative
4. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 8-8-2022 as an emergency; operative
5. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 11-7-2022 as an emergency; operative
6. Certificate of Compliance as to 11-7-2022 order transmitted to OAL 2-3-2023 and filed
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