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TITLE22
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Subject: Title 22
ROLE OF THE STATE AND FEDERAL REGULATIONS
One of your very important functions will be to assist your facility
in maintaining compliance to State and Federal Regulations. Facilities
must comply with these regulations in order to be licensed to operate.
Title 22 is the California State Code which contains regulations for
licensing and Certification of health facilities. A copy of these
regulations is located:
______________________________________________________________________
The Department of Health, Education and Welfare also issues
"Standards of Participation" which must be followed if the facility
wishes to participate in the federally funded Medicare program. These
standards are referred to as Federal Regulations. A copy of the
Federal Regulations is located: ADM-D.O.N -OFFICE
______________________________________________________________________
Failure of any facility to comply with these established regulations
can result in any or all of the following:
* Loss of license to operate the facility, resulting in sale or
closure of the facility and transfer of all patients.
* Withdrawnal of state and federal funds which support many of the
patients and pay the expenses of operation of the facility.
* Issuance of violation citations to the facility resulting
in fines/penalties.
* Legal actions filed against the facility and/or individuals
employed by the facility.
The State of California through Title 22 has defined violations and
civil penalties:
* 72701
Definitions
{1} Substantial probability means that the likeihood of an
event is real, real and not imaginary, insignificant or remote.
{2} Serious physical harm means that type of dangerous bodily
injury, illness or condition in which:
[A] A part of the body would be permanently removed,
rendered functionally useless or substantially reduced in
capacity, either temporarily or permanently, and/or
[B] A part of an internal function of the body would be inhibited
in its normal performance to such a degree as to temporarily
or permanently cause a reduction in physical or mental
capacity or shorten life.
*72703
Page 2
Class "A" Violations -- Examples
[A] Each of the following are examples of a class "A" violation
whenever the situation in which it occurs presents an imminent
danger to the patients of the facility or a substantial
probability that death or serious physical harm would result
therefrom:
[1] A violation of Section 72311<a><3>relating to the
notification of the attending physician of any significant
change in a patient's condition.
[2] A violation of Section 72311<a><1>relating to the
unauthorized administration of medications or treatments or both.
[3] A violation of Section 72313<a><2>relating to the
administration of medications, treatments or both, as prescribed
[4] A violation of Section 72313<a><4>relating to the
preparation of medications.
[5] A violation of Section 72313<a><5> relating to the
administration of medications by unauthorized personnel.
[6] A violation of Section 72315<b> relating to the physical
abuse of patients that results in a patient's death or serious
physical harm.
[7] A violation of Section 72631<a> relating to an adequate
emergency call system from patient to staff.
[8] A violation of Section 72321<a><1> relating to adequate
isolation procedures.
[9] A violation of Section 72639<a> relating to maintaining
the facility in a state and sanitary condition.
[10] A violation of Section 72349<d><7> relating to the
capability to serve safe and untainted food.
[11] A violation of Section 72377 relating to the
availability and contents of the emergency drug supply.
[12] A violation of Section 72357 relating to the labeling
and storage of drugs.
[13] A violation of Section 72505 relating to fire safety
measures or procedures.
[14] A violation of Section 72551<e> or 72553<c> relating
to the immediate availability of adequately trained staff
personnel to respond to emergency situations.
[15] A violation of Section 72649<b>relating to the provision
for safe handling and storage of medical gas cylinders.
[16] A violation of Section 72651<d> relating to the
temperature of hot water delivered to plumbing fixtures used by
patients.
72705
Page 3
Class "B" Violations -- Examples
[A] The following are examples of a class "B" violation whenever
the situation in which it occurs has a direct or immediate
relationship to the health, safety or security of a patients:
[1] A violation of Section 72311<a><1> relating to patient
care plans.
[2] A violation of Section 72311<a><3> relating to the
notification of the attending physician of a change
in patients condition.
[3] A violation of Section 72311<a><1> relating to the
unauthorized administration of medications or treatments
or both.
Class "B" Violations -- Examples
[4] A violation of Section 72313 <a><2> relating to the
administration of medications,treatments or both as prescribed.
[5] A violation of Section 72313<a><4> relating to the
preparation of medications.
[6] A violation of Section 72313<a><5> relating to the
administration of medication by unauthorized personnel.
[7] A violation of Section 72315<a> relating to the admission
of patients without an attending physician.
[8] A violation of Section 72315<b> relating to the abuse
of patients.
[9] A violation of Section 72315<d> relating to the personal
hygiene of patients.
[10] A violation of Section 72315<f> relating to the
prevention of decubiti, contractures or deformities.
[11] A violation of Section 72315<i> relating to measures
to prevent and reduce incontinence.
[12] A violation of Section 72317 relating to standing
orders for drugs.
[13] A violation of Section 72319<b><c><d><e><f><g> and <h>
relating to the use of restraints.
[14] A violation of Section 72329 relating to the nursing
staff.
[15] A violation of Section 72335<a> relating to the dietetic
needs of the patients.
[16] A violation of Section 72335<a><7> relating to food
preparation and service.
[17] A violation of Section 72339 relating to therapeutic
diets.
[18] A violation of Section 72343<b> and <c> relating to
storage of food.
[19} A violation of Section 72345 relating to kitchen
sanitation.
[20] A violation of Section 72347<c> or 72653<e> relating
to the cleaning and sanitizing of utensils and dishes.
[21] A violation of Section 72349<d> relating to food supplies
[22] A violation of Section 72351 relating to dietetic
personnel.
[23] A violation of Section 72351<g> relating to the hygiene
of dietetic. personnel.
[24] A violation of Section 72355 relating to obtaining drugs
on a 24-hour basis.
[25] A violation of Section 72357 relating to the labeling
and storage of drugs.
Page 4
[26] A violation of Section 72361 relating to drugs orders.
[27] A violation of Section 72377 relating to emergency
drugs supply.
[28] A violation of Section 72319<b> relating to the
unauthorized use of restraint or seclusion.
[29] A violation of Section 72459 relating to the restraint
and seclusion of patients.
[30] A violation of Section 72329<a> relating to the
adequacy of staff.
[31] A violation of Section 72505 relating to fire safety.
[32] A violation of Section 72507<a>,<b>or <d> relating
to patients smoking.
[33] A violation of Section 72535<a> or <b> relating to
employee's health examinations.
Class "B" Violations -- Examples
[34] A violation of Section 72547 relating to patients records
[35] A violation of Section 72501 relating to the reporting
of unusual occurrences.
[36] A violation of Section 72551<a> relating to the written
disaster program.
[37] A violation of Section 72551<c> relating to instructing
staff in the disaster plan.
[38] A violation of Section 72551<e> relating to the rehearsal
of the disaster program.
[39] A violation of Section 72553 relating to the
fire program.
[40] A violation of Section 72553<c> relating to fire drills.
[41] A violation of Section 72553<d> relating to evacuation
plan.
[42] A violation of Section 72557 relating to patient care
equipment.
[43] A violation of Section 72607<a>,<b> or <c> relating to
the housing of patients.
[44] A violation of Section 72615 relating to patient privacy.
[45] A violation of Section 72619 relating to autoclaving.
[46] A violation of Section 72619<b><1><A> relating to
equipping of autoclave.
[47] A violation of Section 72621 relating to housekeeping.
[48] A violation of Section 72623<a> or <b>, 72625 or 72627
relating to laundry and linen service.
[49] A violation of Section 72637 relating to general
maintenance.
Page 5
[50] A violation of Section 72641<a>,<b><<d> or <e> relating
emergency power.
[51] A violation of section 72643 or 72645<a>,<b>,<d> or <e>
relating to the storage and disposal of solid waste.
[52] A violation of Section 72647 relating to
infectious waste.
[5g to grab bars.
[58] A violation of Section 72653 relating to lighting.
[59] A violation of Section 72657 relating to mechanical
systems.
-NOTES-
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Page 6
Facilities are usually survey or inspected by members of the Health
Department annually --- some more frequently. These inspections are
called routine inspections. A law was passed recently which allows
facilities with a good record to be evaluated every two years.
Facilitiy may also be surveyed or inspected when complaints are
made about the facility and /or its operation. You will need to
understand your responsibility when participating in the survey
process. Title 22 states:
72725
Interference with Official Duties
<a> Any duly authorized officer, employee or agent of the
Department may enter and inspect any facility, including, but not
limited to, interviewing patients and reviewing records at any time.
Inspections conducted pursuant to complaints filed with the
Department shall be conducted in such a manner as to ensure
maximum effectiveness.
No advance notice shall be given of any inspection unless previously
and specifically authorized by the Director or required by federal
law.
<b> No licensee oe employee of any skilled nursing facility
shall:
<1> Willfully prevent, interfere with or attempt to
impede in any way the work of any duly authorized
representative of the Department in the lawful
enforcement of his inspection duties.
<2> Willfully prevent or attempt to prevent any
such representative from examining any relevant books
or records in the conduct of his inspection duties.
<3> Willfully prevent or interfere with any such
representative in the preserving of evidence of any
violation of these regulations.
Page 7
The best ways for you to participate in the survey process is to
know your regulations and to do all you can to maintain your area
of responsibility in continuing compliance with these regulations.
Make sure you report promptly special problems/situations that
jeopardize compliance to your immediate Nursing Supervisor,
Director of Nursing and/ or Administrator.
Review the last survey report issued to your facility.
The survey report is posted [ ]
Take corrective action to eliminate deficiencies identified so that
"repeat" deficiencies will not occur.
The facility is due for the next routine survey in [ ]
Don't panic when surveyors arrive in the facility.
Make sure your staff knows there is a survey in progress and monitor
their performance carefully. Make rounds and verify that your area
of responsibility is ready for inspection. Sometimes the presence of
surveyors causes disruption of normal routines, so close supervision
is needed to keep patient care routines as normal as possible.
Greet surveyors with courtesy and respect. Answer questions
concisely and accurately. If you are unsure of something, ask for
assistance from your immediate Nursing Supervisor. A surveyor's
primary responsibility is to gather, validate and interpret data
in reference to established standards spelled out in the regulations
Developing good working relationships with your surveyors
benefits everyone.
Surveyors frequently offer constructive suggestions to help solve
problems identified. If problems are identified, avoid becoming
defensive or argumentative -- the surveyors do not generally write
the regulations, they simply enforce them.
Most will work cooperatively with facilities toward the common goal
of improved patient care.
The best way to have a "good survey" is to provide care in
compliance with the regulations and accepted standards of nursing
practice every day. When you do this you protect your patients,
your staff and your facility.
Page 8
Title 22
________________________________I have received and reviewed information on the
Role of State and Federal Regulations Title 22.