| 1 | | - | Amended IN Senate March 27, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 596Introduced by Senator MenjivarFebruary 20, 2025An act to amend Section Sections 1276.4, 1279.2, and 1280.3 of the Health and Safety Code, relating to health facilities. LEGISLATIVE COUNSEL'S DIGESTSB 596, as amended, Menjivar. Health facilities: administrative penalties.Existing law provides for the licensure of various health facilities, including general acute care hospitals, acute psychiatric hospitals, and special hospitals, by the State Department of Public Health. Existing law requires the department to adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all general acute care hospitals, acute psychiatric hospitals, and special hospitals. Existing law requires the regulations adopted by the department for acute psychiatric hospitals that are not operated by the State Department of State Hospitals to take into account the special needs of the patients served in the psychiatric units.This bill would specify that the adoption of these regulations adopted for acute psychiatric hospitals not operated by the State Department of State Hospitals are deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, and general welfare.Existing law requires these health facilities to report specified adverse events to the department and prescribes the departments response.This bill would require, when the department receives a complaint alleging a violation of the regulations related to nurse-to-patient ratios that does not involve a threat of imminent danger of death or serious bodily harm, the department to commence and complete an inspection within a specified time period.Existing law provides for the licensure of various health facilities, including general acute care hospitals, acute psychiatric hospitals, and special hospitals, by the State Department of Public Health. Existing law requires the department to assess an administrative penalty of $15,000 for the first violation and $30,000 for the second and each subsequent violation if the department determines that a specified health facility has violated nurse-to-patient ratios, as specified. Under existing law, an acute general hospital is not subject to this administrative penalty if the hospital demonstrates it has met specified requirements, including that any fluctuation in required staffing levels was unpredictable and uncontrollable, prompt efforts were made to maintain required staffing levels, and the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. Existing law specifies that multiple violations found on the same inspection survey constitute a single violation for purposes of determining whether the violation was a first, 2nd, or subsequent violation.This bill would require, as part of meeting the above requirements, that the hospital provide the department with documentation that it used and exhausted the on-call list, as defined. The bill would require the on-call list to be at least 10% of the registered nurse staff for the hospital, and require all nurses assigned to an on-call list to possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call. The bill would require the department to treat violations on separate days as separate violations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1276.4 of the Health and Safety Code is amended to read:1276.4. (a) By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The State Department of Public Health shall adopt these regulations in accordance with the departments licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, hospital unit means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department.(b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.(c) Critical care unit as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses.(d) All health facilities licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.(e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area.(f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations.(g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations.(h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.(i) The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room.(j) The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals.(k) The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, and general welfare.(l) The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care.SEC. 2. Section 1279.2 of the Health and Safety Code is amended to read:1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events.SECTION 1.SEC. 3. Section 1280.3 of the Health and Safety Code is amended to read:1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 1 | + | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 596Introduced by Senator MenjivarFebruary 20, 2025 An act to amend Section 1280.3 of the Health and Safety Code, relating to health facilities. LEGISLATIVE COUNSEL'S DIGESTSB 596, as introduced, Menjivar. Health facilities: administrative penalties.Existing law provides for the licensure of various health facilities, including general acute care hospitals, acute psychiatric hospitals, and special hospitals, by the State Department of Public Health. Existing law requires the department to assess an administrative penalty of $15,000 for the first violation and $30,000 for the second and each subsequent violation if the department determines that a specified health facility has violated nurse-to-patient ratios, as specified. Under existing law, an acute general hospital is not subject to this administrative penalty if the hospital demonstrates it has met specified requirements, including that any fluctuation in required staffing levels was unpredictable and uncontrollable, prompt efforts were made to maintain required staffing levels, and the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse.This bill would require, as part of meeting the above requirements, that the hospital provide the department with documentation that it used and exhausted the on-call list, as defined. The bill would require the on-call list to be at least 10% of the registered nurse staff for the hospital, and require all nurses assigned to an on-call list to possess and maintain verified competencies specific to the unit for which they are on call.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1280.3 of the Health and Safety Code is amended to read:1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain verified competencies specific to the unit for which they are on call.(B) Nothing in this paragraph shall be construed to This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) Nothing in this section prohibits This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 46 | | - | The people of the State of California do enact as follows:SECTION 1. Section 1276.4 of the Health and Safety Code is amended to read:1276.4. (a) By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The State Department of Public Health shall adopt these regulations in accordance with the departments licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, hospital unit means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department.(b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.(c) Critical care unit as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses.(d) All health facilities licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.(e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area.(f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations.(g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations.(h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.(i) The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room.(j) The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals.(k) The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, and general welfare.(l) The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care.SEC. 2. Section 1279.2 of the Health and Safety Code is amended to read:1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events.SECTION 1.SEC. 3. Section 1280.3 of the Health and Safety Code is amended to read:1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 38 | + | The people of the State of California do enact as follows:SECTION 1. Section 1280.3 of the Health and Safety Code is amended to read:1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain verified competencies specific to the unit for which they are on call.(B) Nothing in this paragraph shall be construed to This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) Nothing in this section prohibits This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 62 | | - | 1276.4. (a) By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The State Department of Public Health shall adopt these regulations in accordance with the departments licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, hospital unit means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department.(b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.(c) Critical care unit as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses.(d) All health facilities licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.(e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area.(f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations.(g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations.(h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.(i) The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room.(j) The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals.(k) The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, and general welfare.(l) The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care. |
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| 63 | | - | |
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| 64 | | - | |
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| 65 | | - | |
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| 66 | | - | 1276.4. (a) By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The State Department of Public Health shall adopt these regulations in accordance with the departments licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, hospital unit means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department. |
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| 67 | | - | |
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| 68 | | - | (b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care. |
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| 69 | | - | |
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| 70 | | - | (c) Critical care unit as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses. |
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| 71 | | - | |
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| 72 | | - | (d) All health facilities licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff. |
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| 73 | | - | |
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| 74 | | - | (e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area. |
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| 75 | | - | |
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| 76 | | - | (f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations. |
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| 77 | | - | |
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| 78 | | - | (g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations. |
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| 79 | | - | |
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| 80 | | - | (h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control. |
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| 81 | | - | |
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| 82 | | - | (i) The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room. |
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| 83 | | - | |
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| 84 | | - | (j) The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals. |
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| 85 | | - | |
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| 86 | | - | (k) The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, and general welfare. |
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| 87 | | - | |
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| 88 | | - | (l) The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care. |
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| 89 | | - | |
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| 90 | | - | SEC. 2. Section 1279.2 of the Health and Safety Code is amended to read:1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events. |
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| 91 | | - | |
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| 92 | | - | SEC. 2. Section 1279.2 of the Health and Safety Code is amended to read: |
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| 93 | | - | |
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| 94 | | - | ### SEC. 2. |
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| 95 | | - | |
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| 96 | | - | 1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events. |
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| 97 | | - | |
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| 98 | | - | 1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events. |
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| 99 | | - | |
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| 100 | | - | 1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days.(2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1.(b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days.(c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.(d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. (d)(e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report.(e)(f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law.(f)(g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals.(g)(h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals.(h)(i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events. |
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| 101 | | - | |
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| 102 | | - | |
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| 103 | | - | |
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| 104 | | - | 1279.2. (a) (1) In any case in which the department receives a report from a facility pursuant to Section 1279.1, or a written or oral complaint involving a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250, that indicates an ongoing threat of imminent danger of death or serious bodily harm, the department shall make an onsite inspection or investigation within 48 hours or two business days, whichever is greater, of the receipt of the report or complaint and shall complete that investigation within 45 days. |
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| 105 | | - | |
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| 106 | | - | (2) Until the department has determined by onsite inspection that the adverse event has been resolved, the department shall, not less than once a year, conduct an unannounced inspection of any health facility that has reported an adverse event pursuant to Section 1279.1. |
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| 107 | | - | |
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| 108 | | - | (b) In any case in which the department is able to determine from the information available to it that there is no threat of imminent danger of death or serious bodily harm to that patient or other patients, the department shall complete an investigation of the report within 45 days. |
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| 109 | | - | |
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| 110 | | - | (c) If the department does not meet the timeframes established in subdivision (a), the department shall document the extenuating circumstances explaining why it could not meet the timeframes. The department shall provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date. |
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| 111 | | - | |
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| 112 | | - | (d) When the department receives a complaint alleging a violation of the regulations adopted pursuant to Section 1276.4 that does not involve a threat of imminent danger of death or serious bodily harm, the department shall commence an inspection or investigation within 10 business days, and shall complete that investigation within 60 days. |
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| 113 | | - | |
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| 114 | | - | (d) |
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| 115 | | - | |
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| 116 | | - | |
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| 117 | | - | |
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| 118 | | - | (e) The department shall notify the complainant and licensee in writing of the departments determination as a result of an inspection or report. |
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| 119 | | - | |
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| 120 | | - | (e) |
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| 121 | | - | |
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| 122 | | - | |
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| 123 | | - | |
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| 124 | | - | (f) For purposes of this section, complaint means any oral or written notice to the department, other than a report from the health facility, of an alleged violation of applicable requirements of state or federal law or an allegation of facts that might constitute a violation of applicable requirements of state or federal law. |
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| 125 | | - | |
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| 126 | | - | (f) |
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| 127 | | - | |
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| 128 | | - | |
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| 129 | | - | |
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| 130 | | - | (g) The costs of administering and implementing this section shall be paid from funds derived from existing licensing fees paid by general acute care hospitals, acute psychiatric hospitals, and special hospitals. |
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| 131 | | - | |
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| 132 | | - | (g) |
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| 133 | | - | |
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| 134 | | - | |
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| 135 | | - | |
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| 136 | | - | (h) In enforcing this section and Sections 1279 and 1279.1, the department shall take into account the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect the quality of patient care in those hospitals. |
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| 137 | | - | |
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| 138 | | - | (h) |
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| 139 | | - | |
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| 140 | | - | |
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| 141 | | - | |
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| 142 | | - | (i) In preparing the staffing and systems analysis required pursuant to Section 1266, the department shall also report regarding the number and timeliness of investigations of adverse events initiated in response to reports of adverse events. |
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| 143 | | - | |
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| 144 | | - | SECTION 1.SEC. 3. Section 1280.3 of the Health and Safety Code is amended to read:1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 146 | | - | SECTION 1.SEC. 3. Section 1280.3 of the Health and Safety Code is amended to read: |
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| 147 | | - | |
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| 148 | | - | ### SECTION 1.SEC. 3. |
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| 150 | | - | 1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 152 | | - | 1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 153 | | - | |
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| 154 | | - | 1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation. For purposes of this subdivision, the department shall treat violations on separate days as separate violations.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain maintain, in writing, verified competencies specific to the unit for which they are on call.(B) This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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| 54 | + | 1280.3. (a) Commencing on the effective date of the regulations adopted pursuant to this section, the director may assess an administrative penalty against a licensee of a health facility licensed under subdivision (a), (b), or (f) of Section 1250 for a deficiency constituting an immediate jeopardy violation as determined by the department up to a maximum of seventy-five thousand dollars ($75,000) for the first administrative penalty, up to one hundred thousand dollars ($100,000) for the second subsequent administrative penalty, and up to one hundred twenty-five thousand dollars ($125,000) for the third and every subsequent violation. An administrative penalty issued after three years from the date of the last issued immediate jeopardy violation shall be considered a first administrative penalty so long as the facility has not received additional immediate jeopardy violations and is found by the department to be in substantial compliance with all state and federal licensing laws and regulations. The department shall have full discretion to consider all factors when determining the amount of an administrative penalty pursuant to this section.(b) Except as provided in subdivision (c), for a violation of this chapter or the rules and regulations promulgated thereunder that does not constitute a violation of subdivision (a), the department may assess an administrative penalty in an amount of up to twenty-five thousand dollars ($25,000) per violation. This subdivision shall also apply to violation of regulations set forth in Article 1 (commencing with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or the rules and regulations promulgated thereunder.The department shall promulgate regulations establishing the criteria to assess an administrative penalty against a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250. The criteria shall include, but need not be limited to, the following:(1) The patients physical and mental condition.(2) The probability and severity of the risk that the violation presents to the patient.(3) The actual financial harm to patients, if any.(4) The nature, scope, and severity of the violation.(5) The facilitys history of compliance with related state and federal statutes and regulations.(6) Factors beyond the facilitys control that restrict the facilitys ability to comply with this chapter or the rules and regulations promulgated thereunder.(7) The demonstrated willfulness of the violation.(8) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring.(c) The department shall not assess an administrative penalty for minor violations.(d) The regulations shall not change the definition of immediate jeopardy as established in this section.(e) The regulations shall apply only to incidents occurring on or after the effective date of the regulations.(f) (1) Notwithstanding subdivision (a), if the department determines that a health facility licensed under subdivision (a), (b), or (f) of Section 1250 has violated a regulation adopted pursuant to Section 1276.4, the department shall assess an administrative penalty of fifteen thousand dollars ($15,000) for the first violation and thirty thousand dollars ($30,000) for the second and each subsequent violation. For purposes of this subdivision, multiple violations found on the same inspection survey shall constitute a single violation for purposes of determining whether the violation was a first, second, or subsequent violation.(2) A violation occurring more than three years after the date of the last violation shall be treated as a first violation.(3) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this subdivision by means of an All Facilities Letter (AFL) or similar instruction.(4) (A) Notwithstanding paragraph (1), a general acute care hospital shall not be subject to an administrative penalty under that paragraph if the hospital demonstrates to the satisfaction of the department all of the following:(i) That any fluctuation in required staffing levels was unpredictable and uncontrollable.(ii) Prompt efforts were made to maintain required staffing levels.(iii) In making those efforts, the hospital immediately used and subsequently exhausted the hospitals on-call list of nurses and the charge nurse. To demonstrate that it has satisfied this requirement, the hospital shall provide the department with documentation that it used and exhausted the on-call list. As used in this clause, on-call list means a documented list of nurses who are officially scheduled to be on call for a shift outside their regularly scheduled shifts. To qualify as an on-call list for purposes of this paragraph, the on-call list shall be at least 10 percent of the registered nurse staff for the hospital. All nurses assigned to an on-call list shall possess and maintain verified competencies specific to the unit for which they are on call.(B) Nothing in this paragraph shall be construed to This paragraph does not affect the obligation of a general acute care hospital to maintain proper staffing levels as prescribed in Section 70217 of Title 22 of the California Code of Regulations.(5) Nothing in this section prohibits This section does not prohibit the department from issuing an administrative penalty for a staffing violation pursuant to this section and an administrative penalty for any resulting harm pursuant to subdivision (a).(g) If the licensee disputes a determination by the department regarding the alleged deficiency or alleged failure to correct a deficiency, or regarding the reasonableness of the proposed deadline for correction or the amount of the penalty, the licensee may, within 10 working days, request a hearing pursuant to Section 131071. Penalties shall be paid when all appeals have been exhausted and the departments position has been upheld.(h) For purposes of this section, immediate jeopardy means a situation in which the licensees noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient.(i) In enforcing subdivision (a) and paragraph (1) of subdivision (f), the department shall take into consideration the special circumstances of small and rural hospitals, as defined in Section 124840, in order to protect access to quality care in those hospitals. |
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