California nursing home responsiveness requirements

A long-term health care facility must report every incident of alleged or suspected resident abuse to CDPH immediately or within 24 hours; failure to do so is a class 'B' violation, and the duty is on top of, not in place of, the mandated-reporter duties of Welfare & Institutions Code § 15630.

A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the department immediately, or within 24 hours.

Mandated reporters who suspect abuse in a long-term care facility must give a verbal report to local law enforcement within two hours and a written report within 24 hours to the long-term care ombudsman, local law enforcement and the state licensing agency; the narrow exception for resident-on-resident abuse by a resident with diagnosed dementia and no serious bodily injury requires only a 24-hour written report to the ombudsman and local law enforcement.

In all other instances, immediately or as soon as practically possible, but no longer than two hours, the reporter shall submit a verbal report of the known, suspected, or alleged instance of abuse to the local law enforcement agency, and shall submit a written report to all of the following agencies within 24 hours: (I) The long-term care ombudsman. (II) The local law enforcement agency. (III) The corresponding state licensing agency.

Unusual occurrences that threaten the welfare, safety or health of patients, personnel or visitors must be reported by the facility within 24 hours, by telephone confirmed in writing, to both the local health officer and CDPH, with the incident report retained on file for one year.

Occurrences such as epidemic outbreaks, poisonings, fires, major accidents, death from unnatural causes or other catastrophes and unusual occurrences which threaten the welfare, safety or health of patients, personnel or visitors shall be reported by the facility within 24 hours either by telephone (and confirmed in writing) or by telegraph to the local health officer and the Department. An incident report shall be retained on file by the facility for one year.

A skilled nursing facility must arrange for backup physicians to furnish emergency medical care whenever the attending physician or designee is unavailable, and must post those physicians' telephone numbers conspicuously in the facility.

The facility shall make arrangements for a physician or physicians to be available to furnish emergency medical care if the attending physician, or designee, is unavailable. The telephone numbers of those physicians shall be posted in a conspicuous place in the facility.

Physician services required of a skilled nursing facility expressly include arranging alternate physician coverage for when the attending physician is not available.

Provision for alternate physician coverage in the event the attending physician is not available.

Every skilled nursing facility must keep at least one licensed nurse awake and on duty around the clock — an RN or LVN in facilities of 99 beds or fewer, and an RN in facilities of 100 or more beds, in each case in addition to the director of nursing services for facilities of 60 beds or more.

Facilities licensed for 59 or fewer beds shall have at least one registered nurse or a licensed vocational nurse, awake and on duty, in the facility at all times, day and night. … Facilities licensed for 100 or more beds shall have at least one registered nurse, awake and on duty, in the facility at all times, day and night, in addition to the director of nursing services.

Free-standing skilled nursing facilities must staff to a minimum of 3.5 direct care service hours per patient day, of which at least 2.4 hours must be certified nurse assistant hours — a state minimum with no federal counterpart.

Each facility, except those skilled nursing facilities that are a distinct part of a general acute care facility or a state-owned hospital or developmental center, shall employ sufficient nursing staff to provide a minimum of 3.5 direct care service hours per patient day, except as set forth in Health and Safety Code section 1276.9. Skilled nursing facilities shall provide a minimum of 2.4 certified nurse assistant hours per patient day to meet the requirements of this subdivision.

Nursing staff must promptly notify the attending licensed healthcare practitioner of admissions, sudden adverse changes, unusual occurrences, medication errors and similar events; every notification attempt must be charted with the time, method of communication and the name of the person acknowledging contact, and if the practitioner is not readily available emergency care must be obtained under § 72301(g) — the closest California analog to a duty to reach and be reached by telephone.

All attempts to notify licensed healthcare practitioners … 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 licensed healthcare practitioner … or his or her designee is not readily available, emergency medical care shall be provided as outlined in Section 72301(g).

Enumerated California patients' rights include reasonable access to telephones with the ability to make and receive confidential calls, and the right to associate and communicate privately with persons of the patient's choice and to send and receive personal mail unopened; the facility must adopt written policies implementing these rights and make them available to the patient and the public.

To have reasonable access to telephones and to make and receive confidential calls.

A physical-plant requirement that a telephone meeting California Building Standards Code (Title 24) section E702-32 be installed for patient use, and that the nurses' station telephone expressly does not satisfy that requirement.

A telephone shall be installed to meet the requirements of Section E702-32 of Title 24. … The telephone at the nurses station shall not be considered as meeting the requirements of this section.

Each facility must adopt and follow a written external disaster and mass casualty program developed with county and local planning offices, and the plan must include an evacuation plan carrying current emergency telephone numbers for physicians, health facilities, the fire department and local EMS agencies, plus procedures for recalling off-duty personnel, a chart of lines of authority, patient-relocation records, and a designated public relations liaison for releasing information.

An evacuation plan, including evacuation routes, emergency phone numbers of physicians, health facilities, the fire department and local emergency medical services agencies and arrangements for the safe transfer of patients after evacuation.

A nurses' signal (call) system meeting California Building Standards Code (Title 24) section E702-30 must be maintained in operating order, and detachable extension cords must be readily accessible to patients at all times.

(a) A nurses' signal system shall be maintained in operating order as required by Section E702-30 of Title 24. (b) Detachable extension cords shall be readily accessible to patients at all times.

Skilled nursing facilities (health facilities under § 1250(c)) must develop, implement and comply with a written patient safety plan, including a multidisciplinary patient safety committee that reviews reported patient safety events, monitors corrective action, recommends preventive measures, and reviews and revises the plan at least annually, plus an anonymous-capable event reporting system open to staff, patients and visitors. Commencing January 1, 2026 and biennially thereafter, the plan must also be submitted to CDPH's Licensing and Certification Division; failure to adopt, update or submit it carries a fine of up to $5,000.

A health facility, as defined in subdivision (a), (b), (c), or (f) of Section 1250, shall develop, implement, and comply with a patient safety plan for the purpose of improving the health and safety of patients and reducing preventable patient safety events.