Activities of daily living (ADLs) are everyday routines generally involving functional mobility and personal care. Examples include bathing, dressing, toileting and self-feeding.
Frequently Asked Questions
According to Title 22, §87101(a)(6) an "ambulatory person" ". . . means a person who is capable of demonstrating the mental competence and physical ability to leave a building without assistance of any other person or without the use of any mechanical aid in case of an emergency."
Facility licenses reflect the number of ambulatory and non-ambulatory residents a facility is authorized to serve at any one time. Additionally, some facilities may have rooms that only ambulatory residents may occupy, pursuant to the facility's Fire Marshal Clearance.
According to Title 22 a skilled professional (aka a licensed professional (Title 22 §87101(l)(2), or medical professional (Title 22, §87101(m)(1)) refers to a person licensed in California to provide medical care or therapy, or to perform necessary medical procedures, each acting within their individual scope of practice. This includes:
- Physicians/surgeons/physician's assistants,
- RNs/LVNs/Nurse practitioners,
- Physical/occupational/respiratory therapists,
- Psychiatric technicians, etc.
RCFEs are non-medical facilities and are not required to have appropriately skilled professionals on-staff. However, there are stipulations in the regulations that certain types of care can only be provided by appropriately skilled professionals (i.e. administering medications, injections, oxygen, etc.) if the resident is unable to provide the care himself.
CARR advocates that consumers closely review a resident's current and potential care needs in conjunction with what types of care the RCFE can provide, consistent with Title 22 regulations.
According to Title 22,§87101(b)(2) "Basic Services" ". . . means those services required to be provided by the facility in order to obtain and maintain a license and include, in such combinations as may meet the needs of the residents and be applicable to the type of facility to be operated, the following: safe and healthful living accommodations; personal assistance and care; observation and supervision; planned activities; food service; and arrangements for obtaining incidental medical and dental care."
A facility's Admissions Agreement must include Basic Services.
Title 22 §87606 & H&S Code §1569.72(b)(1) : Bedridden means any of the following:
(1) A resident who requires ". . . assistance in turning and repositioning in bed", and is unable to leave a building unassisted under emergency conditions.
(2) A resident who is ". . . unable to independently transfer to and from bed. . ." and is unable to leave a building unassisted under emergency conditions.
Title 22, §87101(c)(2), defines "capacity" as the ". . . maximum number of persons authorized to be provided services at any one time in any licensed facility."
If a facility wishes to change its capacity, it must request a Change in Capacity from CCLD, via a LIC 200. One approved for additional residents, the state issues to the Licensee a new license reflecting the change. The Capacity a facility is licensed for appears on each License (LIC 203). Providing care to more residents than stated on the License is a violation of Title 22, §87204(a).
Title 22, §87101(c)(3): "Care and supervision" means those activities which if provided shall require the facility to be licensed. It includes assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents. "Care and Supervision" shall include, but not be limited to, any one or more of the following activities provided by a person or facility to meet the needs of the resident:
- Assistance in dressing, grooming, bathing and other personal hygiene;
- Assistance with taking medication, as specified in regulation §87465;
- Central storing and distribution of medications;
- Arrangement of and assistance with medical and dental care. (This may include transportation.);
- Maintenance of house rules for the protection of residents;
- Supervision of resident schedules and activities;
- Maintenance and supervision of resident monies or property;
- Monitoring food intake or special diets."
A licensed facility is responsible for ensuring "care and supervision" is available/provided to all residents at all times.
"CCLD" and "CCL" denote Community Care Licensing Division, the state agency residing within Department of Social Services, responsible for licensing and regulating Residential Care Facilities for the Elderly (RCFEs). This website uses the terms interchangeably, except when the terms are used as part of a quoted Title 22 regulation.
Title 22, §87101(c)(11): "Conservator" means a person appointed by the Superior Court pursuant to Probate Code section 1800 et. seq. or Welfare and Institutions Code §5350, to care for the person, or estate, or person and estate, of an adult."
". . . No Licensee or employee of a facility shall . . . (1) accept appointment as guardian or conservator of the person and/or estate of any resident. . .* " (Title 22, §87217(d)(1).
*Except as provided in agreements with continuing care facilities.
A Criminal Record Clearance, Title 22, §87101 (c)(18) ". . .means an individual has a California clearance [through the California Department of Justice] and a FBI clearance." All Licensees, employees, volunteers and individuals (other than residents) residing in the facility must be fingerprinted and cleared before having a presence in a Residential Care Facility for the Elderly (RCFE).
According to Title 22, §87101(d)(2), "deficiency" ". . . means any failure to comply with any provision of the Residential Care Facilities Act for the Elderly and regulations adopted by the Department pursuant to the Act."
Title 22, §87101(d)(4) defines "dementia" to mean ". . . the loss of intellectual function (such as thinking, remembering, reasoning, exercising judgment and making decisions) and other cognitive functions, sufficient to interfere with an individual's ability to perform activities of daily living or to carry out social or occupational activities. Dementia is not a disease itself, but rather a group of symptoms that may accompany certain conditions or diseases, including Alzheimer's Disease. Symptoms may include changes in personality, mood and/or behavior. Dementia is irreversible when caused by disease or injury, but may be reversible when caused by depression, drugs, alcohol, or hormone/vitamin imbalances."
There is a regulatory difference between Licensees providing care of residents with dementia (Title 22, Section 87705), and Licensees who "advertise, promote, or otherwise hold themselves out as providing special care, programming and/or environments for residents with dementia (Title 22, Section 87706). Also, not all facilities are approved by the state to provide dementia care; CARR's review of 354 files revealed that Licenses (LIC 203) issued by CCLD frequently do not state whether a facility provides Dementia care. If it is unclear from the License whether Dementia care is provided, the consumer should ask for clarification.
The state once required Dementia waivers before Licensees could care for residents with dementia; Dementia Waivers are no longer required.
Title 22, §87101(d)(9), a "Do-Not-Resuscitate" or DNR Form ". . . means the pre-hospital do-not-resuscitate forms developed by the California Emergency Medical Services Authority. . ." [and others.] "These forms, when properly completed by the resident or (in certain instances) a resident's Health Care Surrogate Decision Maker and, by a physician, alert pre-hospital emergency medical services personnel to the resident's wish to forego resuscitative measures in the event of the resident's cardiac or respiratory arrest."
Review the resident's file to validate the resident's signed DNR is in the file, and verify the facility knows its responsibility to immediately provide the DNR to emergency responders.
As defined by Title 22, §87101(e)(1), an "egress alert device" means ". . . a wrist band or other device which may be worn by a resident or carried on a resident's person, which triggers a visual or auditory alarm when the resident leaves the facility building or grounds."
Per Title 22, §87101(f)(2), "Federal Bureau of Investigation (FBI) clearance" ". . . means an individual has no felony or misdemeanor convictions reported by the Federal Bureau of Investigation. The individual may also have been arrested with no criminal conviction, convicted of a minor traffic offense or adjudicated as a juvenile."
Receiving an FBI clearance is a component of receiving a Criminal Record Clearance, required for Licensees, employees, volunteers, and other individuals (who are not residents) residing in the facility, prior to having a presence in the facility.
Title 22, §87101(h)(1), defines "healing wounds include cuts, stage one and two dermal ulcers [bedsores] as diagnosed by a physician, and incisions that are being treated by an appropriate skilled professional with the affected area returning to its normal state."
Healing wounds are sometimes referred to as 'decubitus ulcers," "pressure sores," or "bed sores."
The home page of the Hospice Foundation of America describes Hospice as a ". . . special concept of care designed to provide comfort, pain relief and support to residents and their families when a life-limiting illness no longer responds to cure-oriented treatments. This type of care neither prolongs life nor hastens death, but rather has the goal to improve the quality of a resident's last days (or months) by offering comfort and dignity." Source: http://www.hospicefoundation.org
RCFEs caring for residents receiving hospice services must meet specific qualifications as stipulated in Title 22, §87633. Providing Hospice Care.
Pursuant to Title 22, §87101(f)(1), a "facility hospice care waiver" means ". . . a waiver from the limitation on retention of residents who require more care and supervision than other residents and residents who are bedridden other than for temporary illness." This ". . . waiver granted by [CCLD] will permit the retention in a facility of a designated maximum number of terminally ill residents who are receiving hospice services from a hospice agency." The ". . . waiver will apply only to those residents who are receiving hospice care in compliance with a hospice care plan meeting the requirements. . ." of Title 22, §87633.
Hospice waivers are frequently posted near the facility license. A facility's license should also accurately reflect the number of state-approved hospice waivers.
Title 22, §87101 (l)(1) and H&SC §1569.2(g) defines "license" to ". . . mean a basic permit to operate a residential care facility for the elderly."
The license should be posted prominently in every facility, demonstrating Community Care Licensing's (CCLD's) care parameters approved by the state.
Title 22, §87101 (l)(3) " 'Licensee' means the individual, firm, partnership, corporation, association, or county having the authority and responsibility for the operation of a licensed facility."
The Licensee's name appears on each License.
Licensing Program Analysts, or LPAs, are the employees of Community Care Licensing Division (CCLD) responsible for licensing, evaluating, and investigating Residential Care Facilities for the Elderly (RCFEs). They conduct site visits and, in the presence of deficiencies, have the authority to issue citations and civil penalties.
A full description of their duties is available at : http://www.ccld.ca.gov/Res/pdf/LPA-Residential.pdf
According to Title 22, §87101(n)(2), a non-ambulatory person "means a person who is unable to leave a building unassisted under emergency conditions. It includes, but is not limited to, those persons who depend upon mechanical aids such as crutches, walkers and wheelchairs. It also includes persons who are unable, or likely to be unable, to respond physically or mentally to an oral instruction relating to fire danger and, unassisted, take appropriate action relating to such danger."
Residents with dementia, and bedridden residents are considered non-ambulatory. A facility's license reflects the number of ambulatory and non-ambulatory residents a facility may serve at any one time. Additionally, some facility rooms may not be cleared to house non-ambulatory residents per the Fire Marshal.
Title 22, §87101(s)(2) states that "'may' means permissive."
Under Title 22, §87101(p)3), PRN (pro re nata) medication ". . . means any non-prescription or prescription medication which is to be taken 'as needed'." This prescribing protocol ('as needed') contrasts with other prescribing protocols, i.e every 12 hours, or three times a day, with meals.
Title 22, §87101(r)(5) defines a "Residential Care Facility for the Elderly" (RCFE), as ". . . a housing arrangement chosen voluntarily by the resident, the resident's guardian, conservator or other responsible person; where 75% of the residents are sixty years of age or older and where varying levels of care and supervision are provided, as agreed to at time of admission or as determined necessary at subsequent times of reappraisal. Any younger residents must have needs compatible with other residents.
Title 22, §87101(r)(6) defines "responsible person" as the ". . . individual or individuals, including a relative, health care surrogate decision maker or placement agency, who assist the resident in placement, or assume varying degrees of responsibility for the resident's well-being."
Title 22, Section 87101(d)(7) defines "direct care staff" to mean ". . . the Licensee, or those individuals employed by the Licensee, who provide direct care to the residents, including but not limited to, assistance with activities of daily living."
Caregivers are direct care staff.
Title 22, §87101(t)(2), defines "transfer trauma" ". . . means the consequences of the stress and emotional shock caused by an abrupt, involuntary relocation of a resident from one facility to another."
Title 22, Section 87101(u)(1) defines "universal precautions" as ". . . an approach to infection control that treats all human blood and body fluids [mucous, saliva, urine, etc.] as if they were infectious."
Title 22, §87101(v)1) a "vendor" means a CCLD-approved ". . . institution, association, individual(s), or other entity that assumes full responsibility or control over a [CCLD]-approved Initial Certification Training Program or a Continuing Education Training Program."
Title 22, §87101(v)(3), "'voluntary' means resulting from free will."
A waiver, per Title 22, §87101(w)(1), allows for ". . . variance to a specific regulation based on a facility-wide need or circumstance which is not typically tied to a specific resident or staff persons. Requests for waivers are made to the licensing agency, in advance, by an applicant or Licensee. "
The most common waiver requested is a hospice waiver. When a facility requests a hospice waiver, it is requesting permission to accept, or retain any resident, at any time in the future, who may require hospice services. The facility must submit a written request for a waiver. Typically, Community Care Licensing (CCL) will approve the waiver if the facility is determined, through a case management visit, to be in substantial compliance.
A waiver is in contrast to an "exception" , which is a variance from the regulations based on a unique need or circumstance of a specific resident or staff person. An exception cannot be transferred or applied to any other individual.