2009 California Health and Safety Code - Section 1336-1336.4 :: Article 8.5. Long-term Care Facility Advance Notification Requirements

1336.  Notwithstanding any other provisions of law, a long-term
health care facility shall give written notice to the affected
patients or to the guardians of the affected patients at least 30
days prior to any change in the status of the license or in the
operation of the facility resulting in the inability of the facility
to care for its patients.
   If patients' placement problems are encountered which cannot be
satisfactorily resolved within this 30-day period, the State
Department of Health Services and the health facility shall agree on
an extension which shall not exceed an additional 60 days.
   The facility shall provide an appropriate team of professional
staff to assist patients and families in obtaining alternative
placement.
   This section shall not apply to actions initiated by the
department to suspend or revoke the license.

1336.1.  (a) After notifying its affected patients, the facility
shall, in response to inquiries made by prospective patients or their
representatives, include notification of the change in the status of
the license or the operation of the facility.
   (b) The facility shall also give oral notification to the office
of the State Long-Term Care Ombudsman of the change in the status of
the license or the operation of the facility at least 30 days prior
to any change in the status of the license or the operation of the
facility.

1336.2.  (a) Before residents are transferred due to any change in
the status of the license or operation of a facility, including a
facility closure or voluntary or involuntary termination of a
facility's Medi-Cal or Medicare certification, the facility shall
take reasonable steps to transfer affected residents safely and
minimize possible transfer trauma by, at a minimum, doing all of the
following:
   (1) Be responsible for ensuring that the resident's attending
physician, if available, or a facility medical director, if
available, completes the medical assessment of the resident's
condition and susceptibility to adverse health consequences,
including psychosocial effects, prior to written notice of transfer
being given to the resident. The assessment shall not be considered
complete unless it provides, in accordance with these assessments,
recommendations for counseling, followup visits, and other
recommended services, by designated health professionals, and for
preventing or ameliorating potential adverse health consequences in
the event of transfer.
   (2) Be responsible for ensuring that the facility nursing staff
and activity director complete an assessment of the social and
physical functioning of the resident based on the relevant portions
of the minimum data set, as described in Section 14110.15 of the
Welfare and Institutions Code, before written notice of transfer is
given to the resident. The assessment shall not be considered
complete unless it provides recommendations for preventing or
ameliorating potential adverse health consequences in the event of
transfer. The assessment may be amended because of a change in the
resident's health care needs. The assessment shall also include a
recommendation for the type of facility that would best meet the
resident's needs.
   (3) Be responsible for evaluating the relocation needs of the
resident including proximity to the resident's representative and
determine the most appropriate and available type of future care and
services for the resident before written notice of transfer is given
to the resident or the resident's representative. The health facility
shall discuss the evaluation and medical assessment with the
resident or the resident's representative and make the evaluation and
assessment part of the medical records for transfer.
   If the resident or resident's representative chooses to make a
transfer prior to completion of assessments, the facility shall
inform the resident or the resident's representative, in writing, of
the importance of obtaining the assessments and followup
consultation.
   (4) At least 30 days in advance of the transfer, inform the
resident or the resident's representative of alternative facilities
that are available and adequate to meet resident and family needs.
   (5) Arrange for appropriate future medical care and services,
unless the resident or resident's representative has otherwise made
these arrangements. This requirement does not obligate a facility to
pay for future care and services.
   (b) The facility shall provide an appropriate team of professional
staff to perform the services required in subdivision (a).
   (c) The facility shall also give written notice to affected
residents or their representatives, advising them of the requirements
in subdivision (a) at least 30 days in advance of transfer. If a
facility is required to give written notice pursuant to Section 1336,
then the notice shall advise the affected resident or resident's
representative of the requirements in subdivision (a). If the
transfer is made pursuant to subdivision (g), the notice shall
include notification to the resident or resident's representative
that the transfer plan is available to the resident or resident's
representative free of charge upon request.
   (d) In the event of a temporary suspension of a facility's license
pursuant to Section 1296, the 30-day notice requirement in
subdivision (c) shall not apply, but the facility shall provide the
relocation services required in subdivision (a) unless the department
provides the services pursuant to subdivision (f).
   (e) The department may make available assistance for the placement
of hard-to-place residents based on the department's determination
of the benefit and necessity of that assistance. A hard-to-place
resident is a resident whose level of care, physical malady, or
behavioral management needs are substantially beyond the norm.
   (f) The department may provide, or arrange for the provision of,
necessary relocation services at a facility, including medical
assessments, counseling, and placement of patients, if the department
determines that these services are needed promptly to prevent
adverse health consequences to patients, and the facility refuses, or
does not have adequate staffing, to provide the services. In these
cases, the facility or the licensee shall reimburse the department
for the cost of providing the relocation services. The department's
participation shall not relieve the facility of any responsibility
under this section. If the department does not provide or arrange for
the provision of the necessary relocation services, and the facility
refuses to provide the relocation services required in subdivision
(a), then the department shall request that the Attorney General's
office or the local district attorney's office seek injunctive relief
and damages in the same manner as provided for in Chapter 5
(commencing with Section 17200) of Part 2 of Division 7 of the
Business and Professions Code.
   (g) If 10 or more residents are likely to be transferred due to
any voluntary or involuntary change in the status of the license or
operation of a facility, including a facility closure or voluntary or
involuntary termination of a facility's Medi-Cal or Medicare
certification, the facility shall submit a proposed relocation plan
for the affected residents to the department for approval at least 15
days prior to the written transfer notification given to any
resident or resident's representative. The plan shall provide for
implementation of the relocation services in subdivision (a) and
shall describe the availability of beds in the area for residents to
be transferred, the proposed discharge process, and the staffing
available to assist in the transfers. The plan shall become effective
upon the date the department grants its approval. The department
shall base its approval of a relocation plan on the standards
specified in this section. The department shall promptly either
approve or reject the plan within 10 working days of receipt from the
facility. If the department rejects the plan, the facility may
resubmit amended relocation plans, each of which the department shall
promptly either approve or reject within 10 working days of receipt
from the facility. Until one plan has been approved by the
department, and until the facility complies with the requirements in
subdivision (a), the facility may not issue a notice of transfer. The
facility shall submit the relocation plan to the local long-term
care ombudsman at the same time the plan is submitted to the
department.
   (h) The resident shall have the right to remain in the facility
for up to 60 days after the approved written notice of the facility's
intent to transfer the resident if an appropriate placement based on
the relocation assessment and relocation recommendations has not
been made. The facility shall be required to maintain an appropriate
level of staffing in order to ensure the well-being of all the
residents as they continue to reside in the facility. The department
shall monitor the facility's staging of transfers, and, if it
determines that the facility's staging of placements is causing a
detrimental impact on those residents being transferred, then the
department shall limit the number of residents being transferred per
day until the department determines that it would be safe to increase
the numbers.

1336.3.  (a) In the event of an emergency, such as earthquake, fire,
or flood which threatens the safety or welfare of patients in a
facility, the facility shall do all of the following:
   (1) Notify, as soon as possible, family members, patients'
guardians, the state department, and the ombudsperson for that
facility of the emergency and the steps that the facility plans to
take for the patient's welfare.
   (2) Provide the services set forth in subdivision (a) of Section
1336.2 if further relocation of the patient is necessary.
   (3) Undertake prompt medical assessment of, and provide counseling
as needed to, patients whose further relocation is not necessary but
who have suffered or may suffer adverse health consequences due to
the emergency or sudden transfer.
   (b) Each facility shall adopt a written emergency preparedness
plan and shall make that plan available to the state department upon
request. The plan shall comply with the requirements in this section
and the state department's Contingency Plan for Licensed Facilities.
The facility, as part of its emergency preparedness planning, shall
seek to enter into reciprocal or other agreements with nearby
facilities and hospitals to provide temporary care for patients in
the event of an emergency. The facility shall report to the state
department the name of any facility or hospital which fails or
refuses to enter into such agreements and the stated reason for that
failure or refusal.
   Section 1336.2 shall not apply in the event of transfers made
pursuant to an emergency preparedness plan. In any event, however,
the facility shall provide the notice and services described in
subdivisions (a) to (c), inclusive.

1336.4.  Failure to comply with the requirements in Sections 1336 to
1336.3, inclusive, shall be subject to issuance of citations and
imposition of civil penalties pursuant to Chapter 2.4 (commencing
with Section 1417), and Sections 72701 and following of the
California Administrative Code.