2005 California Health and Safety Code Sections 1225-1234 Article 3. Regulations

1225.  The state department shall adopt, and may from time to time
amend or repeal, in accordance with Chapter 4.5 (commencing with
Section 11371) of Part 1 of Division 3 of Title 2 of the Government
Code, such reasonable rules and regulations as may be necessary or
proper to carry out the purposes and intent of this chapter and to
enable the state department to exercise the powers and perform the
duties conferred upon it by this chapter, not inconsistent with any
of the provisions of any statute of this state.  The rules and
regulations for primary care clinics shall be separate and distinct
from the rules and regulations for specialty clinics.
   All regulations relating to licensed clinics in effect on December
31, 1977, which were adopted by the state department, shall remain
in full force and effect until altered, amended, or repealed by the
director.
1226.  (a) The regulations shall prescribe the kinds of services
which may be provided by clinics in each category of licensure and
shall prescribe minimum standards of adequacy, safety, and sanitation
of the physical plant and equipment, minimum standards for staffing
with duly qualified personnel, and minimum standards for providing
the services offered.  These minimum standards shall be based on the
type of facility, the needs of the patients served, and the types and
levels of services provided.
   (b) The Office of Statewide Health Planning and Development, in
consultation with the Community Clinics Advisory Committee, shall
prescribe minimum construction standards of adequacy and safety for
the physical plant of clinics as found in the California Building
Standards Code.
   (c) A city or county, as applicable, shall have plan review and
building inspection responsibilities for the construction or
alteration of buildings described in paragraph (1) and paragraph (2)
of subdivision (b) of Section 1204 and shall apply the provisions of
the latest edition of the California Building Standards Code in
conducting these plan review responsibilities.  For these buildings,
construction and alteration shall include conversion of a building to
a purpose specified in paragraphs (1) and (2) of subdivision (b) of
Section 1204.
   Upon the initial submittal to a city or county by the governing
authority or owner of these clinics for plan review and building
inspection services, the city or county shall reply in writing to the
clinic whether or not the plan review by the city or county will
include a certification as to whether or not the clinic project
submitted for plan review meets the standards as propounded by the
office in the California Building Standards Code.
   If the city or county indicates that its review will include this
certification it shall do all of the following:
   (1) Apply the applicable clinic provisions of the latest edition
of the California Building Standards Code.
   (2) Certify in writing, to the applicant within 30 days of
completion of construction whether or not these standards have been
met.
   (d) If upon initial submittal, the city or county indicates that
its plan review will not include this certification, the governing
authority or owner of the clinic shall submit the plans to the Office
of Statewide Health Planning and Development who shall review the
plans for certification whether or not the clinic project meets the
standards, as propounded by the office in California Building
Standards Code.
   (e) When the office performs review for certification, the office
shall charge a fee in an amount that does not exceed its actual
costs.
   (f) The office of the State Fire Marshal shall prescribe minimum
safety standards for fire and life safety in surgical clinics.
   (g) Notwithstanding subdivision (c), the governing authority or
owner of a clinic may request the office to perform plan review
services for buildings described in subdivision (c).  If the office
agrees to perform these services, after consultation with the local
building official, the office shall charge an amount not to exceed
its actual costs.  The construction or alteration of these buildings
shall conform to the applicable provisions of the latest edition of
the California Building Standards Code for purposes of the plan
review by the office pursuant to this subdivision.
   (h) Regulations adopted pursuant to this chapter establishing
standards for laboratory services shall not be applicable to any
clinic that operates a clinical laboratory licensed pursuant to
Section 1265 of the Business and Professions Code.
1226.1.  (a) A primary care clinic shall comply with the following
requirements regarding health examinations and other public health
protections for individuals working in a primary care clinic:
   (1) An employee working in a primary care clinic who has direct
contact with patients shall have a health examination within six
months prior to employment or within 15 days after employment.  Each
examination shall include a medical history and physical evaluation.
A written examination report, signed by the person performing the
examination, shall verify that the employee is able to perform his or
her assigned duties.
   (2) At the time of employment, testing for tuberculosis shall
consist of a purified protein derivative intermediate strength
intradermal skin test.  If a positive reaction is obtained from the
skin test, the employee shall be referred to a physician to determine
if a chest X-ray is necessary.  Annual examinations shall be
performed only when medically indicated.
   (3) The clinic shall maintain a health record for each employee
that includes reports of all employment-related health examinations.
These records shall be kept for a minimum of three years following
termination of employment.
   (4) An employee known to have or exhibiting signs or symptoms of a
communicable disease shall not be permitted to work until he or she
submits a physician's certification that the employee is sufficiently
free of the communicable disease to return to his or her assigned
duties.
   (b) Any regulation adopted before January 1, 2004, that imposes a
standard on a primary care clinic that is more stringent than
described in this section is void.
1226.2.  The Community Clinics Advisory Committee provided for in
subdivision (b) of Section 1226 shall meet on an ad hoc basis and
shall be comprised of at least 15 individuals who are employed by, or
under contract to provide service to, a community clinic on a
full-time basis, either directly or as a representative of a clinic
association.  Members of the committee shall be appointed by the
three statewide primary care clinic associations in California that
represent the greatest number of community or free clinic sites.
1226.3.  A primary care clinic may establish compliance with the
minimum construction standards of adequacy and safety for the
physical plant described in subdivision (b) of Section 1226 by
submitting a written certification, as described in Section 5536.26
of the Business and Professions Code, from a licensed architect or a
written statement from a local building department that the
applicable construction, remodeling, alteration, or other applicable
modification of the physical plant is in compliance with these
standards.  No particular form of certification or statement shall be
required by the department.  Any form of statement utilized by a
city or county building department, or certification by a licensed
architect, indicating that the premises conform to the requirements
of the California Building Standards Code, shall be accepted by the
department as sufficient proof of compliance.  Enforcement of
compliance with applicable provisions of the California Building
Standards Code, pursuant to subdivision (b) of Section 1226, shall be
within the exclusive jurisdiction of the local building department.
1226.5.  (a) It is the intent of the Legislature to  establish
seismic safety standards for facilities licensed as surgical clinics
pursuant to this chapter, and for facilities certified for
participation in the federal Medicare program as ambulatory surgical
centers, which accommodate surgical patients under general
anesthesia, but are not required to remain open and usable after an
earthquake to accommodate emergency patients.
   (b) A facility described in subdivision (a) which, after January
1, 1991, anchors fixed medical equipment to the floor or roof of the
facility with a gross operating weight of more than 400 pounds or
anchors fixed medical equipment to the walls or ceiling with a gross
operating weight of more than 20 pounds shall retain the services of
an architect licensed in California, a structural engineer licensed
in California, or a civil engineer registered in California to assure
that the equipment is anchored in such a manner to meet the
requirements of an occupancy importance factor of 1.00, as  set forth
in Title 24 of the California Code of Regulations.
   (c) A facility described in subdivision (a) which retains the
services of an architect or engineer for the anchorage of fixed
medical equipment shall keep available for inspection by the
department for a period of five years following the installation, a
current written certification from the architect or engineer that the
equipment is mounted in accordance with the applicable requirements.
1227.  Any duly authorized officer, employee, or agent of the state
department may upon presentation of proper identification, enter and
inspect any building or premises at any time, with or without advance
notice, to secure compliance with, or to prevent a violation of, any
provision of this chapter or any regulations adopted pursuant to
this chapter.
1228.  (a) Except as provided in subdivision (c), every clinic for
which a license or special permit has been issued shall be
periodically inspected.  The frequency of inspections shall depend
upon the type and complexity of the clinic or special service to be
inspected.  Inspections shall be conducted no less often than once
every three years and as often as necessary to ensure the quality of
care being provided.
   (b) (1) During inspections, representatives of the department
shall offer any advice and assistance to the clinic as they deem
appropriate.  The department may contract with local health
departments for the assumption of any of the department's
responsibilities under this chapter.  In exercising this authority,
the local health department shall conform to the requirements of this
chapter and to the rules, regulations, and standards of the
department.
   (2) The department shall reimburse local health departments for
services performed pursuant to this section, and these payments shall
not exceed actual cost.  Reports of each inspection shall be
prepared by the representative conducting it upon forms prepared and
furnished by the department and filed with the department.
   (c) This section shall not apply to any of the following:
   (1) A rural health clinic.
   (2) A primary care clinic accredited by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), the Accreditation
Association for Ambulatory Health Care (AAAHC), or any other
accrediting organization recognized by the department.
   (3) An ambulatory surgical center.
   (4) An end stage renal disease facility.
   (5) A comprehensive outpatient rehabilitation facility that is
certified to participate either in the Medicare program under Title
XVIII (42 U.S.C.  Sec. 1395 et seq.) of the federal Social Security
Act, or the medicaid program under Title XIX (42 U.S.C. Sec. 1396 et
seq.) of the federal Social Security Act, or both.
   (d) Notwithstanding paragraph (2) of subdivision (c), the
department shall retain the authority to inspect a primary care
clinic pursuant to Section 1227, or as necessary to ensure the
quality of care being provided.
1229.  The state department shall notify any clinic of all
deficiencies in its compliance with the provisions of this chapter or
the rules and regulations adopted hereunder, which are discovered or
confirmed by inspection, and the clinic shall agree with the state
department upon a plan of correction which shall give the clinic a
reasonable time to correct such deficiencies.  During such allotted
time, a list of deficiencies and the plan of correction shall be
conspicuously posted in a clinic location accessible to public view.
If at the end of the allotted time, as provided in the plan of
correction, the clinic has failed to correct the deficiencies, the
state department shall assess the licensee a civil penalty not to
exceed fifty dollars ($50) per day, until the state department finds
the clinic in compliance.  In such case, the state department may
also initiate action against the clinic to revoke or suspend the
license.  Nothing in this chapter shall be deemed to prohibit a
clinic which is unable to correct the deficiencies, as specified in a
plan of corrections, for reasons beyond its control from voluntarily
surrendering its license pursuant to Section 1245 prior to the
assessment of any civil penalty or the initiation of any revocation
or suspension proceeding.
1229.1.  No notification of deficiency, civil or criminal penalty,
fine, sanction, or denial, suspension, or revocation of licensure,
may be imposed against a primary care clinic, or any person acting on
behalf of the clinic, for a violation of a regulation, as defined in
Section 11342.600 of the Government Code, including every rule,
regulation, order, or standard of general application, or the
amendment, supplement, or revision of any rule, regulation, order, or
standard adopted by a state agency to implement, interpret, or make
specific the law enforced or administered by it, or to govern its
procedure, unless the regulation has been adopted pursuant to Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code.
1230.  Reports on the results of each inspection shall be kept on
file in the state department along with the plan of correction and
clinic comments.  The inspection report may include a recommendation
for reinspection.  All inspection reports, lists of deficiencies, and
plans of correction shall be public records open to public
inspection.
1231.  (a) All clinics shall maintain compliance with the licensing
requirements.  These requirements shall not, however, prohibit the
use of alternate concepts, methods, procedures, techniques, space,
equipment, personnel qualifications, or the conducting of pilot
projects, provided these exceptions are carried out with provision
for safe and adequate patient care and with prior written approval of
the department.  A written request and substantiating evidence
supporting the request shall be submitted by the applicant or
licensee to the state department.  Where a licensee submits a single
program flexibility request and substantiating evidence on behalf of
more than one similarly situated primary care clinic, the department
may approve the program flexibility request as to each of the primary
care clinics identified in the request.  The department shall
approve or deny any request within 60 days of submission.  This
approval shall be in writing and shall provide for the terms and
conditions under which the exception is granted.  A denial shall be
in writing and shall specify the basis therefor.
   (b) Substantiating evidence of a shortage of a specific health
care professional that is submitted in support of a request for
utilization of alternatives to personnel requirements contained in
regulations adopted under this chapter may include documentation that
the clinic is located in a geographic area that is either deemed
under federal law, or designated by the Office of Statewide Health
Planning and Development, as a medically underserved area, a health
professional shortage area, or as serving, in whole or in part, a
medically underserved population.
   (c) If after investigation the department determines that a clinic
granted a waiver pursuant to this section is operating in a manner
contrary to the terms or conditions of the waiver, the director shall
immediately revoke the waiver as to that clinic site.
1231.5.  The department may grant to a PACE program, as defined in
Chapter 8.75 (commencing with Section 14590) of Part 3 of Division 9
of the Welfare and Institutions Code, exemptions from the provisions
contained in this chapter in accordance with the requirements of
Section 100315.
1232.  No clinic which permits sterilization operations for
contraceptive purposes to be performed therein, nor the medical staff
of such clinic, shall require the individual upon whom such a
sterilization operation is to be performed to meet any special
nonmedical qualifications, which are not imposed on individuals
seeking other types of operations in the clinic.  Such prohibited
nonmedical qualifications shall include, but not be limited to, age,
marital status, and number of natural children.
   Nothing in this section shall prohibit requirements relating to
the physical or mental condition of the individual or affect the
right of the attending physician to counsel or advise his patient as
to whether or not sterilization is appropriate.  This section shall
not affect existing law with respect to individuals below the age of
majority.
1233.  A surgical clinic may restrict use of its facilities to
members of the medical staff of the surgical clinic and other
physicians and surgeons approved by the medical staff to practice at
the clinic.
1233.5.  By June 30, 1995, a licensed clinic board of directors and
its medical director shall establish and adopt written policies and
procedures to screen patients for purposes of detecting spousal or
partner abuse.  The policies shall include procedures to accomplish
all of the following:
   (a) Identifying, as part of its medical screening, spousal or
partner abuse among patients.
   (b) Documenting in the medical record patient injuries or
illnesses attributable to spousal or partner abuse.
   (c) Providing to patients who exhibit signs of spousal or partner
abuse a current referral list of private and public community
agencies that provide, or arrange for, the evaluation, counseling,
and care of persons experiencing spousal or partner abuse, including,
but not limited to, hot lines, local battered women's shelters,
legal services, and information about temporary restraining orders.
   (d) Designating licensed clinical staff to be responsible for the
implementation of these guidelines.
   It is the intent of the Legislature that clinics, for purposes of
satisfying the requirements of this section, adopt guidelines similar
to those developed by the American Medical Association regarding
domestic violence detection and referral.  The Legislature recognizes
that while guidelines evolve and change, the American Medical
Association's guidelines may serve, at this time, as a model for
clinics to follow.
1234.  (a) Smoking shall not be permitted in patient areas of a
clinic except those rooms designated for occupancy exclusively by
smokers.
   (b) Clearly legible signs shall either:
   (1) State that smoking is unlawful and be conspicuously posted by,
or on behalf of, the owner or manager of such clinic, in all areas
of a clinic where smoking is unlawful.
   (2) Identify "smoking permitted" areas, and be posted by, or on
behalf of, the owner or manager of such clinic, only in areas of a
clinic where smoking is lawfully permitted.
   If "smoking permitted" signs are posted, there shall also be
conspicuously posted, near all major entrances, clearly legible signs
stating that smoking is unlawful except in areas designated "smoking
permitted."
   (c) This section shall not apply to skilled nursing facilities,
intermediate care facilities, and intermediate care facilities for
the developmentally disabled.