2005 California Health and Safety Code Sections 1337-1338.5 Intermediate Care Facilities

1337.  (a) The Legislature finds that the quality of patient care in
skilled nursing and intermediate care facilities is dependent upon
the competence of the personnel who staff its facilities.  The
Legislature further finds that direct patient care in skilled nursing
and intermediate care facilities is currently rendered largely by
certified nurse assistants.  To assure the availability of trained
personnel in skilled nursing and intermediate care facilities, the
Legislature intends that all such facilities in this state
participate in approved training programs established under this
article.  This article shall not apply to intermediate care
facilities/developmentally disabled habilitative which have staff
training programs approved by the State Department of Developmental
Services, general acute care hospitals, acute psychiatric hospitals,
or special hospitals.
   (b) The requirement that certified nurse assistants obtain a
criminal record clearance upon certification and biannually
thereafter shall apply regardless of the setting in which the
certified nurse assistant is employed.
   (c) The department shall develop procedures to ensure that
certified nurse assistants employed by intermediate care facilities
for the developmentally disabled/habilitative and intermediate care
facilities for the developmentally disabled/nursing shall not be
required to obtain multiple criminal record clearances.
   (d) For the purpose of this article:
   (1) "Nurse assistant" means any unlicensed aide, assistant, or
orderly, who performs nursing services directed at the safety,
comfort, personal hygiene, or protection of patients in a skilled
nursing or intermediate care facility.
   (2) "Approved training program" means a program for the training
of nurse assistants that meets the criteria established and approved
under this chapter.
   (3) "Certified nurse assistant" means any person who holds himself
or herself out as a certified nurse assistant and who, for
compensation, performs basic patient care services directed at the
safety, comfort, personal hygiene, and protection of patients, and is
certified as having completed the requirements of this article.
These services shall not include any services which may only be
performed by a licensed person and otherwise shall be performed under
the supervision of a registered nurse, as defined in Section 2725 of
the Business and Professions Code, or a licensed vocational nurse,
as defined in Section 2859 of the Business and Professions Code.
   (4) "State department" means the State Department of Health
Services.
1337.1.  A skilled nursing or intermediate care facility shall adopt
an approved training program that meets standards established by the
state department.  The approved training program shall consist of at
least the following:
   (a) An orientation program to be given to newly employed nurse
assistants prior to providing direct patient care in skilled nursing
or intermediate care facilities.
   (b) (1) A precertification training program consisting of at least
60 classroom hours of training on basic nursing skills, patient
safety and rights, the social and psychological problems of patients,
and resident abuse prevention, recognition, and reporting pursuant
to subdivision (e).  The 60 classroom hours of training may be
conducted within a skilled nursing or intermediate care facility or
in an educational institution.
   (2) In addition to the 60 classroom hours of training required
under paragraph (1), the precertification training program shall
consist of at least 100 hours of supervised and on-the-job training
clinical practice.  The 100 hours may consist of normal employment as
a nurse assistant under the supervision of either the director of
nurse training or a licensed nurse qualified to provide nurse
assistant training who has no other assigned duties while providing
the training.
   (3) At least two hours of the 60 hours of classroom training and
at least four hours of the 100 hours of the supervised clinical
training shall address the special needs of persons with
developmental and mental disorders, including mental retardation,
Alzheimer's disease, cerebral palsy, epilepsy, dementia, Parkinson's
disease, and mental illness.
   (4) In a precertification training program subject to this
subdivision, credit shall be given for the training received in an
approved precertification training program adopted by another skilled
nursing or intermediate care facility.
   (5) This subdivision shall not apply to a skilled nursing or
intermediate care facility that demonstrates to the state department
that it employs only nurse assistants with a valid certification.
   (c) Continuing in-service training to assure continuing competency
in existing and new nursing skills.
   (d) Each facility shall consider including training regarding the
characteristics and method of assessment and treatment of acquired
immune deficiency syndrome (AIDS).
   (e) (1) The approved training program shall include, within the 60
hours of classroom training, a minimum of six hours of instruction
on preventing, recognizing, and reporting instances of resident abuse
utilizing those courses developed pursuant to Section 13823.93 of
the Penal Code, and a minimum of one hour of instruction on
preventing, recognizing, and reporting residents' rights violations.
   (2) A minimum of four hours of instruction on preventing,
recognizing, and reporting instances of resident abuse, including
instruction on preventing, recognizing, and reporting residents'
rights violations, shall be included within the total minimum hours
of continuing education or in-service training required and in effect
for certified nursing assistants.
1337.2.  (a) An applicant for certification as a certified nurse
assistant shall comply with each of the following:
   (1) Be at least 16 years of age.
   (2) Have successfully completed a training program approved by the
department, which includes an examination to test the applicant's
knowledge and skills related to basic patient care services.
   (3) Obtain a criminal record clearance pursuant to Section 1338.5.
   (b) The state department may establish procedures for issuing
certificates which recognize certification programs in other states
and countries.
   (c) Upon written application, criminal record clearance pursuant
to Section 1338.5, and documentation of passing an appropriate
competency examination, the state department may issue a certificate
to any applicant who possesses a valid state license as either a
licensed vocational nurse or a registered nurse issued by any other
state or foreign country, and who, in the opinion of the state
department, has the qualifications specified in this article.
   (d) Upon written application, criminal record clearance pursuant
to Section 1338.5, and documentation of passing an appropriate
examination, the state department may issue a certificate to any
applicant who has completed the fundamentals of nursing courses in a
school for registered nurses, approved by the Board of Registered
Nursing, or in a school for licensed vocational nurses, approved by
the Board of Vocational Nurse and Psychiatric Technician Examiners,
which are substantially equivalent to the certification training
program specified in this article.
   (e) Every person certified as a nurse assistant under this article
may be known as a "certified nurse assistant" and may place the
letters CNA after his or her name when working in a licensed health
facility.  An individual working independently, providing personal
care services, may not advertise or represent himself or herself as a
certified nurse assistant.
   (f) Any person holding a nurse assistant certificate issued by the
state department prior to January 1, 1988, may continue to hold
himself or herself out as a certified nurse assistant until January
1, 1991.  Thereafter, it shall be unlawful for any person not
certified under this article to hold himself or herself out to be a
certified nurse assistant.  Any person willfully making any false
representation as being a certified nurse assistant is guilty of a
misdemeanor.
   (g) Any person who violates this article is guilty of a
misdemeanor and, upon a conviction thereof, shall be punished by
imprisonment in the county jail for not more than 180 days, or by a
fine of not less than twenty dollars ($20) nor more than one thousand
dollars ($1,000), or by both such fine and imprisonment.
1337.3.  (a) The state department shall prepare and maintain a list
of approved training programs for nurse assistant certification.  The
list shall include training programs conducted by skilled nursing or
intermediate care facilities, as well as local agencies and
education programs.  In addition, the list shall include information
on whether a training center is currently training nurse assistants,
their competency test pass rates, and the number of nurse assistants
they have trained.  Clinical portions of the training programs may be
obtained as on-the-job training, supervised by a qualified director
of staff development or licensed nurse.
   (b) It shall be the duty of the state department to inspect a
representative sample of training programs.  The state department
shall protect consumers and students in any training program against
fraud, misrepresentation, or other practices that may result in
improper or excessive payment of funds paid for training programs.
In evaluating a training center's training program, the state
department shall examine each training center's trainees' competency
test passage rate, and require each program to maintain an average 60
percent test score passage rate to maintain its participation in the
program.  The average test score passage rate shall be calculated
over a two-year period.  If the state department determines that any
training program is not complying with regulations or is not meeting
the competency passage rate requirements, notice thereof in writing
shall be immediately given to the program.  If the program has not
been brought into compliance within a reasonable time, the program
may be removed from the approved list and notice thereof in writing
given to it.  Programs removed under this article shall be afforded
an opportunity to request reinstatement of program approval at any
time.  The state department's district offices shall inspect
facility-based centers as part of their annual survey.
   (c) Notwithstanding Section 1337.1, the approved training program
shall consist of at least the following:
   (1) A 16-hour orientation program to be given to newly employed
nurse assistants prior to providing direct patient care, and
consistent with federal training requirements for facilities
participating in the Medicare or medicaid programs.
   (2) (A) A certification training program consisting of at least 60
classroom hours of training on basic nursing skills, patient safety
and rights, the social and psychological problems of patients, and
elder abuse recognition and reporting pursuant to subdivision (e) of
Section 1337.1.  The 60 classroom hours of training may be conducted
within a skilled nursing facility, an intermediate care facility, or
an educational institution.
   (B) In addition to the 60 classroom hours of training required
under subparagraph (A), the certification program shall also consist
of 100 hours of supervised and on-the-job training clinical practice.
  The 100 hours may consist of normal employment as a nurse assistant
under the supervision of either the director of staff development or
a licensed nurse qualified to provide nurse assistant training who
has no other assigned duties while providing the training.
   (3) At least two hours of the 60 hours of classroom training and
at least four hours of the 100 hours of the supervised clinical
training shall address the special needs of persons with
developmental and mental disorders, including mental retardation,
Alzheimer's disease, cerebral palsy, epilepsy, dementia, Parkinson's
disease, and mental illness.
   (d) The state department, in consultation with the State
Department of Education and other appropriate organizations, shall
develop criteria for approving training programs, that includes
program content for orientation, training, inservice and the
examination for testing knowledge and skills related to basic patient
care services and shall develop a plan that identifies and
encourages career ladder opportunities for certified nurse
assistants.  This group shall also recommend, and the department
shall adopt, regulation changes necessary to provide for patient care
when facilities utilize noncertified nurse assistants who are
performing direct patient care.  The requirements of this subdivision
shall be established by January 1, 1989.
   (e) On or before January 1, 2004, the state department, in
consultation with the State Department of Education, the American Red
Cross, and other appropriate organizations, shall do the following:
   (1) Review the current examination for approved training programs
for certified nurse assistants to ensure the accurate assessment of
whether a nurse assistant has obtained the required knowledge and
skills related to basic patient care services.
   (2) Develop a plan that identifies and encourages career ladder
opportunities for certified nurse assistants, including the
application of on-the-job post-certification hours to educational
credits.
   (f) A skilled nursing or intermediate care facility shall
determine the number of specific clinical hours within each module
identified by the state department required to meet the requirements
of subdivision (d), subject to subdivisions (b) and (c).  The
facility shall consider the specific hours recommended by the state
department when adopting the certification training program required
by this chapter.
   (g) This article shall not apply to a program conducted by any
church or denomination for the purpose of training the adherents of
the church or denomination in the care of the sick in accordance with
its religious tenets.
   (h) The Chancellor of the California Community Colleges shall
provide to the state department a standard process for approval of
college credit.  The state department shall make this information
available to all training programs in the state.
1337.4.  Every skilled nursing or intermediate care facility shall
designate a licensed nurse as a director of staff development who
shall be responsible for the management of the approved training
program.
1337.5.  (a) Approved training programs shall be conducted during
the normal working hours of the nurse assistant unless the nurse
assistant receives at least the normal hourly wage for any additional
time spent in the training program.
   (b) On or after September 1, 1978, only the following persons may
be employed by a skilled nursing facility or intermediate care
facility as a nurse assistant:
   (1) A certified nurse assistant.
   (2) A nurse assistant hired on a temporary basis who has been
employed less than a maximum total of three months in skilled nursing
facilities or intermediate care facilities, including the current
period of employment.
   (3) A nurse assistant who, within three months of the date of
employment, is enrolled in an approved certification training program
which requires completion not more than six months from the date of
employment; provided, that the employing facility  may apply to the
state department for an extension of the deadline under this
paragraph for enrollment in a certification training program if the
facility has a contract to obtain the training from an educational
institution, approved by the facility, which operates on a semester
basis and cannot enroll nursing assistant students except at semester
intervals;  and the delayed enrollment will not postpone completion
of certification training beyond nine months from the date of
employment.
1337.6.  (a) Certificates issued under this article shall be renewed
every two years and renewal shall be conditional upon the occurrence
of all of the following:
   (1) The certificate holder submitting documentation of completion
of 48 hours of in-service training every two years obtained through
an approved training program or taught by a director of staff
development for a licensed skilled nursing or intermediate care
facility that has been approved by the state department, or by
individuals or programs approved by the state department. At least 12
of the 48 hours of in-service training shall be completed in each of
the two years. Twenty-four of the 48 hours of in-service training
may be obtained through an online computer training program approved
by the Licensing and Certification Division of the state department.
   (2) (A) A vendor of online programs for continuing education shall
ensure that each online course contains all of the following:
   (i) An interactive portion where the participants receive
feedback, through online communication, based on input from the
participant.
   (ii) Required use of a personal identification number or personal
identification information to confirm the identity of the
participant.
   (iii) A final screen displaying a printable statement, to be
signed by the participant, certifying that the identified participant
completed the course. The vendor shall obtain a copy of the final
screen statement with the original signature of the participant prior
to the issuance of a certificate of completion. The signed statement
of completion shall be maintained by the vendor for a period of
three years and shall be made available to the department upon
demand.
   (B) The department may approve online programs for continuing
education that do not meet the requirements of subparagraph (A) if
the vendor demonstrates to the department's satisfaction that,
through advanced technology, the course and the course delivery meet
the other requirements of this section.
   (3) The certificate holder obtaining a criminal record clearance.
   (b) Certificates issued under this article shall expire on the
certificate holder's birthday. If the certificate is renewed more
than 30 days after its expiration, the certificate holder, as a
condition precedent to renewal, shall also pay the delinquency fee
prescribed by this article.
   (c) To renew an unexpired certificate, the certificate holder
shall, on or before the certificate expiration date, apply for
renewal on a form provided by the state department, pay the renewal
fee prescribed by this article, and submit documentation of the
required in-service training.
   (d) The state department shall give written notice to a
certificate holder 90 days in advance of the renewal date and, 90
days in advance of the expiration of the fourth year that a renewal
fee has not been paid, and shall give written notice informing the
certificate holder, in general terms, of the provisions of this
article. Nonreceipt of the renewal notice does not relieve the
certificate holder of the obligation to make a timely renewal.
Failure to make a timely renewal shall result in expiration of the
certificate.
   (e) Except as otherwise provided in this article, an expired
certificate may be renewed at any time within two years after its
expiration on the filing of an application for renewal on a form
prescribed by the state department, and payment of the renewal fee in
effect on the date the application is filed, and documentation of
the required in-service education.
   Renewal under this article shall be effective on the date on which
the application is filed, on the date when the renewal fee is paid,
or on the date on which the delinquency fee is paid, whichever occurs
last. If so renewed, the certificate shall continue in effect until
the date provided for in this article, when it shall expire if it is
not again renewed.
   (f) If a certified nurse assistant applies for renewal more than
two years after the expiration, the certified nurse assistant shall
complete an approved 75-hour competency evaluation training program
and competency evaluation program. If the certified nurse assistant
demonstrates in writing to the state department's satisfaction why
the certified nurse assistant cannot pay the delinquency fee, then
the state department on a case-by-case basis shall consider waiving
the delinquency fee. A suspended certificate is subject to expiration
and shall be renewed as provided in this article, but this renewal
does not entitle the certificate holder, while the certificate
remains suspended, and, until it is reinstated, to engage in the
certified activity, or in any other activity or conduct in violation
of the order or judgment by which the certificate was suspended.
   (g) A revoked certificate is subject to expiration as provided in
this article, but it cannot be renewed. If reinstatement of the
certificate is approved by the state department, the certificate
holder, as a condition precedent to reinstatement, shall pay a
reinstatement fee in an amount equal to the renewal fee in effect on
the date the application for reinstatement is filed, plus the
delinquency fee, if any, accrued at the time of its revocation.
   (h) Except as provided in subdivision (i), a certificate that is
not renewed within four years after its expiration cannot be renewed,
restored, reissued, or reinstated except upon completion of a
certification program unless deemed otherwise by the state department
if all of the following conditions are met:
   (1) No fact, circumstance, or condition exists that, if the
certificate was issued, would justify its revocation or suspension.
   (2) The person pays the application fee provided for by this
article.
   (3) The person takes and passes any examination that may be
required of an applicant for a new certificate at that time, that
shall be given by an approved provider of a certification training
program.
   (i) A certified nurse assistant whose certificate has expired
after two years may have his or her certificate renewed if he or she
pays a training application fee, completes 75 hours in an approved
competency evaluation training program, passes a competency test, and
obtains a criminal background clearance prior to the renewal. The
department shall develop a training program for these previously
certified individuals.
   (j) Certificate holders shall notify the department within 60 days
of any change of address. Any notice sent by the department shall be
effective if mailed to the current address filed with the
department.
   (k) Certificate holders that have been certified as both nurse
assistants pursuant to this article and home health aides pursuant to
Chapter 8 (commencing with Section 1725) of Division 2 shall renew
their certificates at the same time on one application.
1337.7.  (a) Fees shall be submitted along with nurse assistant
applications and certificate renewal applications.  The state
department shall collect fees according to the following schedule:
   (1) The training application fee shall be fifteen dollars ($15).
   (2) The renewal fee for certified nurse assistants shall be no
more than twenty dollars ($20).
   (3) The renewal fee for persons who are certified as both nurse
assistants and home health aides shall be no more than twenty dollars
($20).
   (4) The delinquency fee for late renewals is ten dollars ($10).
   (5) The duplicate fee for lost certificates is five dollars ($5).
   (b) The penalty for submitting insufficient funds or any
fictitious check, draft, or order on any bank or depository for
payment of any fee to the state department shall be ten dollars
($10).
1337.8.  (a) The state department shall investigate complaints
concerning misconduct by certified nurse assistants and may take
disciplinary action pursuant to Section 1337.9.
   (b) The state department shall maintain a registry that includes
the certification status of all certified nurse assistants, including
the status of any proposed or completed disciplinary actions.
   (c) Long-term health care facilities, as defined in Section 1418,
that hire certified nursing assistants shall consult the state
department's registry prior to hiring these individuals or placing
them in direct contact with patients.
1337.9.  (a) (1) The state department may deny an application for,
initiate an action to suspend or revoke a certificate for, or deny a
training and examination application for a nurse assistant.
   (2) The state department shall deny a training and examination
application and deny, suspend, or revoke a certificate issued under
this article if the applicant or certificate holder has been
convicted of a violation or attempted violation of any one or more of
the following Penal Code provisions:  Section 187, subdivision (a)
of Section 192, Section 203, 205, 206, 207, 209, 210, 210.5, 211,
220, 222, 243.4, 245, 261, 262, or 264.1, Sections 265 to 267,
inclusive, Section 273a, 273d, 273.5, or 285, subdivisions (c), (d),
(f), and (g) of Section 286, Section 288, subdivisions (c), (d), (f),
and (g) of Section 288a, Section 288.5, 289, 289.5, 368, 451, 459,
470, 475, 484, or 484b, Sections 484d to 484j, inclusive, Section
487, 488, 496, 503, 518, or 666, unless any of the following applies:
   (A) The person was convicted of a felony and has obtained a
certificate of rehabilitation under Chapter 3.5 (commencing with
Section 4852.01) of Title 6 of Part 3 of the Penal Code and the
information or accusation against him or her has been dismissed
pursuant to Section 1203.4 of the Penal Code.
   (B) The person was convicted of a misdemeanor and the information
or accusation against him or her has been dismissed pursuant to
Section 1203.4 or 1203.4a of the Penal Code.
   (C) The certificate holder was convicted of a felony or a
misdemeanor, but has previously disclosed the fact of each conviction
to the department, and the department has made a determination in
accordance with law that the conviction does not disqualify the
applicant from certification.
   (D) The person was convicted of a misdemeanor violation of Section
488 or 496, is requesting a renewal of their certificate, and has
had no subsequent convictions in the last five years.  This paragraph
shall become inoperative on August 1, 2001.
   (b) An application or certificate shall be denied, suspended, or
revoked upon conviction in another state of an offense that, if
committed or attempted in this state, would have been punishable as
one or more of the offenses set forth in subdivision (a), unless
evidence of rehabilitation comparable to the certificate of
rehabilitation or dismissal of a misdemeanor set forth in paragraph
(1) or (2) of subdivision (a) is provided.
   (c) The state department may deny an application or deny, suspend,
or revoke a certificate issued under this article for any of the
following:
   (1) Unprofessional conduct, including, but not limited to,
incompetence, gross negligence, unless due to circumstances beyond
the nurse assistant's control, physical, mental, or verbal abuse of
patients, or misappropriation of property of patients or others.
   (2) Conviction of a crime substantially related to the
qualifications, functions, and duties of a certified nurse assistant,
irrespective of a subsequent order under Section 1203.4, 1203.4a, or
4852.13 of the Penal Code, where the state department determines
that the applicant or certificate holder has not adequately
demonstrated that he or she has been rehabilitated and will present a
threat to the health, safety, or welfare of patients.
   (3) Conviction for, or use of, any controlled substance as defined
in Division 10 (commencing with Section 11000), or any dangerous
drug, as defined in Section 4022 of the Business and Professions
Code, or alcoholic beverages, to an extent or in a manner dangerous
or injurious to the certified nurse assistant, any other person, or
the public, to the extent that this use would impair the ability to
conduct, with safety to the public, the practice authorized by a
certificate.
   (4) Procuring a certified nurse assistant certificate by fraud or
misrepresentation or mistake.
   (5) Making or giving any false statement or information in
conjunction with the application for issuance of a nurse assistant
certificate or training and examination application.
   (6) Impersonating any applicant, or acting as proxy for an
applicant, in any examination required under this article for the
issuance of a certificate.
   (7) Impersonating another certified nurse assistant, a licensed
vocational nurse, or a registered nurse, or permitting or allowing
another person to use a certificate for the purpose of providing
nursing services.
   (8) Violating or attempting to violate, directly or indirectly, or
assisting in or abetting the violating of, or conspiring to violate
any provision or term of, this article.
   (d) In determining whether or not to deny the application for
licensure or renewal pursuant to subdivision (c), the department
shall take into consideration the following factors as evidence of
good character and rehabilitation:
   (1) The nature and seriousness of the conduct or crime under
consideration and its relationship to their employment duties and
responsibilities.
   (2) Activities since conviction, including employment or
participation in therapy or education, that would indicate changed
behavior.
   (3) The time that has elapsed since the commission of  the conduct
or offense referred to in paragraph (1) or (2) and the number of
offenses.
   (4) The extent to which the person has complied with any terms of
parole, probation, restitution, or any other sanction lawfully
imposed against the person.
   (5) Any rehabilitation evidence, including character references,
submitted by the person.
   (6) Employment history and current employer recommendations.
   (7) Circumstances surrounding the commission of the offense that
would demonstrate the unlikelihood of repetition.
   (8) The granting by the Governor of a full and unconditional
pardon.
   (9) A certificate of rehabilitation from a superior court.
   (e) When the state department determines that a certificate shall
be suspended, the state department shall specify the period of actual
suspension.  The state department may determine that the suspension
shall be stayed, placing the certificate holder on probation with
specified conditions for a period not to exceed two years.  When the
state department determines that probation is the appropriate action,
the certificate holder shall be notified that in lieu of the state
department proceeding with a formal action to suspend the
certification and in lieu of an appeal pursuant to subdivision (h),
the certificate holder may request to enter into a diversion program
agreement.  A diversion program agreement shall specify terms and
conditions related to matters, including, but not limited to, work
performance, rehabilitation, training, counseling, progress reports,
and treatment programs.  If a certificate holder successfully
completes a diversion program, no action shall be taken upon the
allegations that were the basis for the diversion agreement.  Upon
failure of the certificate holder to comply with the terms and
conditions of an agreement, the state department may proceed with a
formal action to suspend or revoke the certification.
   (f) A plea or verdict of guilty, or a conviction following a plea
of nolo contendere shall be deemed a conviction within the meaning of
this article.  The state department may deny an application or deny,
suspend, or revoke a certification based on a conviction as provided
in this article when the judgment of conviction is entered or when
an order granting probation is made suspending the imposition of
sentence.
   (g) Upon determination to deny an application or deny, revoke, or
suspend a certificate, the state department shall notify the
applicant or certificate holder in writing by certified mail of all
of the following:
   (1) The reasons for the determination.
   (2) The applicant's or certificate holder's right to appeal the
determination if the determination was made under subdivision (c).
   (h) (1) Upon written notification that the state department has
determined that an application shall be denied or a certificate shall
be denied, suspended, or revoked under subdivision (c), the
applicant or certificate holder may request an administrative hearing
by submitting a written request to the state department within 20
business days of receipt of the written notification.  Upon receipt
of a written request, the state department shall hold an
administrative hearing pursuant to the procedures specified in
Section 100171, except where those procedures are inconsistent with
this section.
   (2) A hearing under this section shall be conducted within 60 days
of the receipt of the written request of the applicant or
certificate holder submitted pursuant to paragraph (1) by a hearing
officer or administrative law judge designated by the director at a
location, other than the work facility, convenient to the applicant
or certificate holder unless the applicant or certificate holder
agrees to an extension.  The hearing shall be tape recorded and a
written decision shall be sent by certified mail to the applicant or
certificate holder within 30 calendar days of the hearing.  Except as
specified in subdivision (i), the effective date of an action to
revoke or suspend a certificate shall be specified in the written
decision, or if no administrative hearing is timely requested, the
effective date shall be 21 business days from written notification of
the department's determination to revoke or suspend.
   (i) The state department may revoke or suspend a certificate prior
to any hearing when immediate action is necessary in the judgment of
the director to protect the public welfare.  Notice of this action,
including a statement of the necessity of immediate action to protect
the public welfare, shall be sent in accordance with subdivision
(g).  If the certificate holder requests an administrative hearing
pursuant to subdivision (h), the state department shall hold the
administrative hearing as soon as possible but not later than 30
calendar days from receipt of the request for a hearing.  A written
hearing decision upholding or setting aside the action shall be sent
by certified mail to the certificate holder within 30 calendar days
of the hearing.
   (j) Upon the expiration of the term of suspension, he or she shall
be reinstated by the state department and shall be entitled to
resume practice unless it is established to the satisfaction of the
state department that the person has practiced as a certified nurse
assistant in this state during the term of suspension.  In this
event, the state department shall revoke the person's certificate.
   (k) Upon a determination to deny an application or deny, revoke,
or suspend a certificate, the state department shall notify the
employer of the applicant and certificate holder in writing of that
determination, and whether the determination is final, or whether a
hearing is pending relating to this determination.  If a licensee or
facility is required to deny employment or terminate employment of
the employee based upon notice from the state that the employee is
determined to be unsuitable for employment under this section, the
licensee or facility shall not incur criminal, civil, unemployment
insurance, workers' compensation, or administrative liability as a
result of that denial or termination.
1338.  (a) The state department shall, through the Medi-Cal program,
provide rate adjustments to skilled nursing or intermediate care
facilities for the portion of additional costs attributable to the
requirements of Sections 1337.1, 1337.  3, and 1337.5 with respect to
Medi-Cal patients.  The portion of such additional costs
attributable to Medi-Cal shall be the same as the ratio of Medi-Cal
patients to total patients in the facility.  Such rate adjustments
shall also include provisions for an increase in wages for nurse
assistants who receive certificates pursuant to Section 1337.3 and a
continuing wage differential between certified and uncertified nurse
assistants thereafter.
   (b) On and after September 1, 1978, the rate adjustments specified
in subdivision (a) shall not be paid to any skilled nursing facility
or intermediate care facility which has not received approval of the
state department for an approved training program that meets the
standards and requirements of Section 1337.1, unless the facility has
had an application for such approval on file with the state
department on or before August 1, 1978, which has not been approved
or rejected.  However, payment of such rate adjustments to facilities
with applications on file with the state department on or before
August 1, 1978, which have not received action by the state
department, shall cease upon rejection of the application.
   Within one week after the effective date of this article the state
department shall notify all skilled nursing facilities or
intermediate care facilities, which have not filed an application
with the state department for approval of an approved training
program, of the requirements of this subdivision.
   (c) Facilities granted an exemption by the state department prior
to the effective date of this section pursuant to subsection (i) of
Section 51510 or subsection (h) of Section 51511 of Title 22 of the
California Administrative Code shall be entitled to continuance of
such exemption unless and until the facility ceases to meet any of
the eligibility criteria which are specified in such regulations on
the effective date of this section.
1338.1.  The state department shall assign sufficient qualified
employees to supervise and evaluate training programs required by
this article.
1338.2.  (a) The state department shall convene a work group to
develop recommendations to the department on ways to expand the
availability of training programs and certified nurse assistants
available for hire in the state.  The work group shall investigate,
but not be limited to investigating, all of the following:
   (1) Work-based learning programs for students in the regional
occupational programs in the state.
   (2) Utilization of apprenticeships.
   (3) Promotional programs for training centers and certified nurse
assistant jobs.
   (4) Utilization of expanded data resources.
   (b) The recommendations required by subdivision (a) shall be
submitted by the work group to the state department on or before July
1, 2001.
   (c) The work group shall consist of, but not be limited to, all of
the following:
   (1) A representative from the State Department of Education.
   (2) Nurse-Assistant training center representatives.
   (3) A director of staff development for a long-term health care
facility.
   (4) A publisher of nurse assistant training and competency
curricula.
   (5) An industry representative.
   (6) A currently certified nurse assistant.
   (7) A consumer representative.
   (8) A labor union representative.
   (9) A representative of the American Red Cross.
   (10) The Chancellor of the California Community Colleges.
   (11) A representative from the Office of Statewide Health Planning
and Development.
   (12) A registered nurse and a licensed vocational nurse, both of
whom are currently providing long-term care nursing services.
1338.3.  The State Director of Health Services may adopt emergency
regulations pursuant to Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 3 of the Government Code to
implement this article.  The adoption of the regulations shall be
deemed to be an emergency and necessary for the immediate
preservation of the public peace, health, or safety.  Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code, emergency regulations  adopted by
the State Department of Health Services in order to implement this
article shall not be subject to the review and approval of the Office
of Administrative Law.  These regulations shall become effective
immediately upon filing with the Secretary of State.
1338.5.  (a) (1) A criminal record clearance shall be conducted for
all nurse assistants by the submission of fingerprint cards to the
state department for processing at the Department of Justice.  This
criminal record clearance shall be completed prior to issuing or
renewing a certificate.  Applicants shall be responsible for any
costs associated with rolling the fingerprint cards.  The fee to
cover the processing costs of the Department of Justice, not
including the costs associated with rolling the fingerprint cards,
shall not exceed thirty-two dollars ($32) per card.
   (2) (A) Upon enrollment in a training program for nurse assistant
certification, and prior to direct contact with residents, a
candidate for training shall submit a training and examination
application and the fingerprint cards to the state department to
receive a criminal record review through the Department of Justice.
Submission of the fingerprints to the Federal Bureau of Investigation
shall be at the discretion of the state department.
   (B) New nurse assistant applicants who are unemployed and unable
to pay the fee charged by the Department of Justice pursuant to
paragraph (1) of subdivision (a) due to financial hardship may
request a waiver for a period not to exceed six months.  The request
for waiver shall be made in writing at the time the fingerprint card
is submitted for processing.  The applicant shall agree to pay the
fee within six months of employment.  The failure to pay the fee
within the six-month period shall result in the inactivation of the
applicant's certificate until the fee is paid in full.
   (b) Upon receipt of the fingerprints, the Department of Justice
shall notify the state department of the criminal record information,
as provided for in this subdivision.  If no criminal record
information has been recorded, the Department of Justice shall
provide the state department with a statement of that fact.  If the
fingerprints are illegible, the Department of Justice shall, within
15 calendar days from receipt of the fingerprints, notify the state
department of that fact.
   (c) The department shall respond to the applicant and employer
within 30 days from the date of receipt of the fingerprint cards.
   (d) The use of fingerprint live-scan technology implemented by the
Department of Justice by the year 1999 shall be used by the
Department of Justice to generate timely and accurate positive
fingerprint identification prior to nurse assistant certification.
   (e) The state department shall develop procedures to ensure that
any licensee, direct care staff, or certificate holder for whom a
criminal record has been obtained pursuant to this section or Section
1265.5 or 1736 shall not be required to obtain multiple criminal
record clearances.
   (f) If the department receives a fingerprint card from a certified
nursing assistant 60 days prior to the expiration of the certified
nursing assistant's certification and the department has received no
response from the Department of Justice, or if the department is
experiencing a delay in processing the renewal of the certified
nursing assistant's certification at the time of the expiration of
the certified nursing assistant's certification, the department may
extend the expiration of the certified nursing assistant's
certification for 60 days.  This provision shall expire August 1,
2001.