Pressure Sores - Stage I and Stage II: Allowable Health Conditions

Understanding Facility Practices

Title 22 §87631

Stage I and Stage II pressures sores (aka bedsores) are medical conditions allowed to be treated within a Residential Care Facility for the Elderly (RCFE).  They are listed under Healing Wounds in Title 22.  The regulations are summarized below.   RCFEs are allowed to accept and/or retain residents with a healing wound under the following circumstances:

(1) Care for healing wounds is performed by or under the supervision of an appropriately skilled professional.

(2) Stage I or II pressure sores must be diagnosed by an appropriately skilled professional. 

(a) The resident must receive care for the pressure sore from an appropriately skilled professional.

(b) All aspects of care performed by the medical professional and facility staff shall be documented in the resident's file.

Since RCFEs are non-medical facilities, and therefore not required to have an appropriately skilled professional on-staff, bedsores pose a serious challenge for facilities and their residents.  Bedsores can escalate to life-threatening condition if not given proper attention.  

Mini-Primer on Bedsores (aka Decubitus Ulcers):

(A) Bedsores are skin ulcers that develop from pressure when people lie in bed or sit in a chair for long periods of time.  Infrequent rotation and repositioning of elderly persons who have difficulty moving independently is a primary cause.  Those individuals with diabetes are at a greater risk of developing bedsores due to poor circulation.  And anything but meticulous incontinence care can threaten skin integrity which can lead to skin deterioration and/or pressure sores.

(B) A Stage I bedsore is when the affected skin looks red and may feel warm to the touch.  The area may also burn, hurt or itch.  A Stage II bedsore is when the affected skin is more damaged, which can result in an open sore that looks like an abrasion or a blister.  The skin around the wound may be discolored and very painful.

(C) Prompt identification and treatment of these wounds is imperative to increase the likelihood of recovery. 

(D) Prior to placement, knowing the following may be helpful:

  • The facility's access to an appropriately skilled professional

  • The facility's policy and history as it pertains to bedsores and incontinence care. See LIC 809s & LIC 9099s.

  • The facility's staffing ratio and the competency of the staff (could they identify the warning signs)

  • Does the facility excel at keeping residents active, mobile, and comfortable?

ADDITIONAL RESOURCES: (illustrations of bedsore stages)

See these sections inside …


Keep in touch with what’s happening in California about assisted living and RCFE legislation and related items.