Section 87465 - Incidental Medical and Dental Care Services(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service.(3) When residents require prosthetic devices, vision and hearing aids, the staff shall be familiar with the use of these devices, and shall assist such persons with their utilization as needed.(4) The licensee shall assist residents with self-administered medications as needed.(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician.(B) Medications during an illness determined by a physician to be temporary and minor.(C) Assistance required because of tremor, failing eyesight and similar conditions.(D) Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication.(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.(7) There shall be adequate privacy for first aid treatment of minor injuries and for examination by a physician if required.(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency.(B) Sterile first aid dressings.(C) Bandages or roller bandages.(9) The licensee shall ensure that infection control practices are maintained in the facility as specified in Section 87470, Infection Control Requirements.(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation.(2) Once ordered by the physician the medication is given according to the physician's directions.(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:(1) Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication.(2) The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record.(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record.(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (1) The specific symptoms which indicate the need for the use of the medication.(3) The minimum number of hours between doses.(4) The maximum number of doses allowed in each 24-hour period.(f) Emergency care requirements shall include the following:(1) The name, address, and telephone number of each resident's physician and dentist shall be readily available to that resident, the licensee, and facility staff.(2) The name, address and telephone number of each emergency agency to be called in the event of an emergency, including but not limited to the fire department, crisis center or paramedical unit or medical resource, shall be posted in a location visible to both staff and residents.(3) The name and telephone number of an ambulance service shall be readily available.(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident's health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator.(B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed.(C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others.(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.(3) Each container shall carry all of the information specified in (6)(A) through (E) below plus expiration date and number of refills.(4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label.(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed.(B) The name of the prescribing physician.(C) The drug name, strength and quantity.(E) The prescription number and the name of the issuing pharmacy.(F) Instructions, if any, regarding control and custody of the medication.(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident's physician and documented in the resident's record nor disposed of according to the hospice's established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: (1) Name of the resident.(2) The prescription number and the name of the pharmacy.(3) The drug name, strength and quantity destroyed.(4) The date of destruction.(j) In all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents as needed with self-administration of medications. The names of the staff employees so responsible and the designated procedures shall be documented and made known to all residents and staff.Cal. Code Regs. Tit. 22, § 87465
1. Change without regulatory effect renumbering former section 87575 to new section 87465, including amendment of section heading, section and NOTE, filed 3-5-2008 pursuant to section 100, title 1, California Code of Regulations (Register 2008, No. 10).
2. Amendment of subsection (g) filed 4-7-2015; operative 7-1-2015 (Register 2015, No. 15).
3. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) filed 2-7-2022 as an emergency; operative 2-7-2022 (Register 2022, No. 6). A Certificate of Compliance must be transmitted to OAL by 8-8-2022 or emergency language will be repealed by operation of law on the following day.
4. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 8-8-2022 as an emergency; operative 8-8-2022 (Register 2022, No. 32). A Certificate of Compliance must be transmitted to OAL by 11-7-2022 or emergency language will be repealed by operation of law on the following day.
5. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 11-7-2022 as an emergency; operative 11-7-2022 (Register 2022, No. 45). A Certificate of Compliance must be transmitted to OAL by 2-6-2023 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 11-7-2022 order transmitted to OAL 2-3-2023 and filed 3-20-2023 (Register 2023, No. 12). Note: Authority cited: Section 1569.30, Health and Safety Code. Reference: Sections 1569.1, 1569.2, 1569.31, 1569.312 and 1569.73, Health and Safety Code.
1. Change without regulatory effect renumbering former section 87575 to new section 87465, including amendment of section heading, section and Note, filed 3-5-2008 pursuant to section 100, title 1, California Code of Regulations (Register 2008, No. 10).
2. Amendment of subsection (g) filed 4-7-2015; operative 7/1/2015 (Register 2015, No. 15).
3. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) filed 2-7-2022 as an emergency; operative 2/7/2022 (Register 2022, No. 6). A Certificate of Compliance must be transmitted to OAL by 8-8-2022 or emergency language will be repealed by operation of law on the following day.
4. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 8-8-2022 as an emergency; operative 8/8/2022 (Register 2022, No. 32). A Certificate of Compliance must be transmitted to OAL by 11-7-2022 or emergency language will be repealed by operation of law on the following day.
5. Repealer of former subsection (a)(3), subsection renumbering and new subsection (a)(9) refiled 11-7-2022 as an emergency; operative 11/7/2022 (Register 2022, No. 45). A Certificate of Compliance must be transmitted to OAL by 2-6-2023 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 11-7-2022 order transmitted to OAL 2-3-2023 and filed 3/20/2023 (Register 2023, No. 12).