Title 22 California Code of Regulations Division 5

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1 Title 22 California Code of Regulations Division 5 Title 22 Social Security Title 22 Social Security California Code of Regulations provides information about nurse-to-patient ratios, licensing and certification of health facilities, home health agencies, clinics, and referral agencies.

2 Table of Contents Chapter 1. General Acute Care Hospitals Article 1. Definitions Meaning of Words Hospital General Acute Care Hospital Acute Psychiatric Care Bed Classification Alteration Autoclaving Basic Services Certificate of Exemption Certificate of Need Child Cleaning Competency Validation for Patient Care Personnel Other Than Registered Nurses Competency Validation for Registered Nurses Conservator Critical Burn Defined Department Director Disinfection Distinct Part Drug Administration Drug Dispensing Existing Hospital Building General Acute Care Bed Classification Governing Body Guardian Page 1

3 Human Reproductive Sterilization Intermediate Care Bed Classification License License Category Licensee Maintenance Modernization New Construction New Special Service Nursing Unit Outpatient Service Patient Patient Care Personnel Patient Classification System Permanently Converted Personnel Principal Officer Restraint Rural Area Skilled Nursing Care Bed Classification Special Permit Special Hospital Sterilization Supervision Supplemental Service Unit Dose Medication System Article 2. License Inspection of Hospitals License Required Application Required Page 2

4 Content of Application Architectural Plans Fee Fee Health Planning Agency Review Projects Requiring a Certificate of Need Projects Eligible for a Certificate of Exemption Projects Not Subject to Review by a Voluntary Area Health Planning Agency Projects Previously Decided by a Voluntary Area Health Planning Agency Exemption Requests for Remodeling and Replacement Projects Bed Classification Safety, Zoning and Building Clearance Issuance, Expiration and Renewal Provisional Licensing of Distinct Parts Separate Licenses Posting Transferability Report of Changes Program Flexibility Voluntary Suspension of License or Licensed Beds Voluntary Cancellation of License Revocation or Involuntary Suspension of License Conviction of Crime: Standards for Evaluating Rehabilitation Bonds Article 3. Basic Services Medical Service Definition Medical Service General Requirements Medical Service Staff Medical Service Equipment and Supplies Page 3

5 Medical Service Space Nursing Service General Requirements Nursing Service Policies and Procedures Nursing Staff Development Planning and Implementing Patient Care Nursing Service Staff Nursing Service Space Surgical Service Definition Surgical Service General Requirements Surgical Service Staff Surgical Service Equipment and Supplies Surgical Service Space Anesthesia Service Definition Anesthesia Service General Requirements Anesthesia Service Staff Anesthesia Service Equipment and Supplies Anesthesia Service Space Clinical Laboratory Service Definition Clinical Laboratory Service General Requirements Clinical Laboratory Service Staff Clinical Laboratory Service Equipment and Supplies Clinical Laboratory Service Space Radiological Service Definition Radiological Service General Requirements Radiological Service Staff Radiological Service Equipment and Supplies Radiological Service Space Pharmaceutical Service Definition Pharmaceutical Service General Requirements Pharmaceutical Service Staff Pharmaceutical Service Equipment and Supplies Page 4

6 Pharmaceutical Service Space Dietetic Service Definition Dietetic Service General Requirements Dietetic Service Staff Dietetic Service Equipment and Supplies Dietetic Service Space Article 4. Supplemental Service Approval Supplemental Service Approval Required Application Issuance, Expiration and Renewal Program Flexibility Revocation or Involuntary Suspension of Approval Article 5. Special Permit Special Permit Required Application Renewal Application Issuance, Expiration and Renewal Posting Transferability Program Flexibility Voluntary Suspension of Special Permit Voluntary Cancellation of Special Permit Revocation or Involuntary Suspension of Special Permit Article 6. Supplemental Services Acute Respiratory Care Service Definition Acute Respiratory Care Service General Requirements Acute Respiratory Care Service Staff Acute Respiratory Care Service Equipment and Supplies Acute Respiratory Care Service Space Basic Emergency Medical Service, Physician on Duty, Definition Page 5

7 Basic Emergency Medical Service, Physician on Duty, General Requirements Basic Emergency Medical Service, Physician on Duty, Staff Basic Emergency Medical Service, Physician on Duty, Equipment and Supplies Basic Emergency Medical Service, Physician on Duty, Space Burn Center Definition Burn Center General Requirements Burn Center Staff Burn Center Equipment and Supplies Burn Center Space Cardiovascular Surgery Service Definition Cardiovascular Surgery Service General Requirements Cardiovascular Surgery Service Staff Cardiovascular Surgery Service Equipment and Supplies Cardiac Catheterization Laboratory Service Cardiac Catheterization Laboratory Service--General Requirements Cardiovascular Surgery Service Space Chronic Dialysis Service Definition Chronic Dialysis Service General Requirements Chronic Dialysis Service Staff Chronic Dialysis Service Equipment and Supplies Chronic Dialysis Service Space Comprehensive Emergency Medical Service Definition Comprehensive Emergency Medical Service General Requirements Comprehensive Emergency Medical Service Staff Comprehensive Emergency Medical Service Equipment and Supplies Comprehensive Emergency Medical Service Space Coronary Care Service Definition Coronary Care Service General Requirements Coronary Care Service Staff Page 6

8 Coronary Care Service Equipment and Supplies Coronary Care Service Space Dental Service Definition Dental Service General Requirements Dental Service Staff Dental Service Equipment and Supplies Dental Service Space Intensive Care Newborn Nursery Service Definition Intensive Care Newborn Nursery Service General Requirements Intensive Care Newborn Nursery Service Staff Intensive Care Newborn Nursery Service Equipment and Supplies Intensive Care Newborn Nursery Service Space Intensive Care Service Definition Intensive Care Service General Requirements Intensive Care Service Staff Intensive Care Service Equipment and Supplies Intensive Care Service Space Intermediate Care Service Definition Intermediate Care Service General Requirements Nuclear Medicine Service Definition Nuclear Medicine General Requirements Nuclear Medicine Service Staff Nuclear Medicine Equipment and Supplies Nuclear Medicine Space Occupational Therapy Service Definition Occupational Therapy Service General Requirements Occupational Therapy Service Staff Occupational Therapy Service Equipment and Supplies Occupational Therapy Service Space Outpatient Service Definition Outpatient Service General Requirements Page 7

9 Outpatient Service Staff Outpatient Service Equipment and Supplies Outpatient Service Space Pediatric Service Definition Pediatric Service General Requirements Pediatric Service Staff Pediatric Service Equipment and Supplies Pediatric Service Space Perinatal Unit Definition Perinatal Unit General Requirements Perinatal Unit Staff Perinatal Unit Equipment and Supplies Perinatal Unit Space Physical Therapy Service Definition Physical Therapy Service General Requirements Physical Therapy Service Staff Physical Therapy Service Equipment and Supplies Physical Therapy Service Space Podiatric Service Definition Podiatric Service General Requirements Podiatric Service Staff Podiatric Service Equipment and Supplies Podiatric Service Space Psychiatric Unit Definition Psychiatric Unit General Requirements Psychiatric Unit Staff Psychiatric Unit Equipment and Supplies Psychiatric Unit Space Radiation Therapy Service Definition Radiation Therapy Service General Requirements Radiation Therapy Service Staff Page 8

10 Radiation Therapy Service Equipment and Supplies Radiation Therapy Service Space Rehabilitation Center Definition Rehabilitation Center General Requirements Rehabilitation Center Staff Rehabilitation Center Equipment and Supplies Rehabilitation Center Space Renal Transplant Center Definition Renal Transplant Center General Requirements Renal Transplant Center Staff Renal Transplant Center Equipment and Supplies Renal Transplant Center Space Respiratory Care Service Definition Respiratory Care Service General Requirements Respiratory Care Service Staff Respiratory Care Service Equipment and Supplies Respiratory Care Service Space Skilled Nursing Service Definition Skilled Nursing Service General Requirements Social Service Definition Social Service General Requirements Social Service Staff Social Service Equipment and Supplies Social Service Space Speech Pathology and/or Audiology Service Definition Speech Pathology and/or Audiology Service General Requirements Speech Pathology and/or Audiology Service Staff Speech Pathology and/or Audiology Service Equipment and Supplies Speech Pathology and/or Audiology Service Space Standby Emergency Medical Service, Physician on Call, Definition Page 9

11 Standby Emergency Medical Service, Physician on Call, General Requirements Standby Emergency Medical Service, Physician on Call, Staff Standby Emergency Medical Service, Physician on Call, Equipment and Supplies Standby Emergency Medical Service, Physician on Call, Space Article 7. Administration Governing Body Organized Medical Staff Medical Staff, Residents, Interns and Students Interdisciplinary Practice and Responsibility for Patient Care Granting of Nonphysician Privileges Standardized Procedures Patients' Rights Criteria for the Performance of Sterilization Requirements for Sterilization Other Than Emergency Sterilization Informed Consent Process for Sterilization Certification of Informed Consent for Sterilization Hysterectomy The Additional Requirements for Informed Consent Process When Specified Federal Funds Are Used Verification of Informed Consent Noncompliance Effective Date Clinical Research Emotional and Attitudinal Support Social Services Use of Outside Resources Nondiscrimination Policies Admission, Transfer and Discharge Policies Personnel Policies Page 10

12 Employees Employee Health Examinations and Health Records Employee Personnel Records Job Descriptions Advertising Alcoholic and/or Tubercular Patients Records and Reports Annual Reports Sterilization Reporting Requirements Reporting Infant Security Infection Control Program Disaster and Mass Casualty Program Fire and Internal Disasters Fire Safety Disruption of Services Medical Records Service Patient Health Record Content Medical Record Availability Transfer Summary Special Hospital Transfer Agreement Patients' Monies and Valuables First Aid and Referrals Exercise Stress Testing Medical Library Medical Photography Conference Room Article 8. Physical Plant Alterations to Existing Buildings or New Construction Application for Architectural Plan Review Page 11

13 Space Conversion Notice to Department Patient Accommodations Patient Rooms Patient Property Storage Patient Room Furnishings Provisions for Emptying Bedpans Provision for Privacy Public Telephone Isolation Facilities Laundry Service Housekeeping Morgue Central Sterile Supply Autoclaves and Sterilizers Disinfecting General Safety and Maintenance Air Filters Emergency Lighting and Power System Storage and Disposal of Solid Wastes Solid Waste Containers Infectious Waste Gases for Medical Use Lighting Electrically Sensitive Areas Mechanical Systems Screens Signal Systems Storage Water Supply and Plumbing Ice Page 12

14 Article 9. Regulations Specific to Small and Rural Hospitals Applicability of Article Enforcement of Article Surgical Service General Requirements Dietetic Service Staff Intensive Care Service Space Perinatal Unit Staff Perinatal Unit Space Physical Therapy Service General Requirements Physical Therapy Service Equipment and Supplies Physical Therapy Service Space Standby Emergency Medical Services, Physician on Call, Space Conference Room Chapter 2. Acute Psychiatric Hospital Article 1. Definitions Meaning of Words Hospital Acute Psychiatric Care Bed Classification Acute Psychiatric Hospital Alteration Autoclaving Basic Services Certificate of Exemption Certificate of Need Child Cleaning Conservator Defined Department Director Page 13

15 Disinfection Distinct Part Drug Administration Drug Dispensing Existing Hospital Building Governing Body Guardian Intermediate Care Bed Classification License License Category Licensee Maintenance Modernization New Construction Nursing Unit Outpatient Service Patient Permanently Converted Personnel Restraint Skilled Nursing Care Bed Classification Sterilization Supervision Supplemental Service Unit Dose Medication System Article 2. License Inspection of Hospitals License Required Application Required Content of Application Architectural Plans Page 14

16 Fee Fee Projects Requiring a Certificate of Need Projects Eligible for a Certificate of Exemption Projects Not Subject to Review by a Voluntary Area Health Planning Agency Projects Previously Decided by a Voluntary Area Health Planning Agency Exemption Requests for Remodeling and Replacement Projects Safety, Zoning and Building Clearance Issuance, Expiration and Renewal Separate Licenses Posting Transferability Bed Classification Report of Changes Program Flexibility Voluntary Suspension of License or Licensed Beds Voluntary Cancellation of License Revocation or Involuntary Suspension of License Conviction of Crime: Standards for Evaluating Rehabilitation Bonds Article 3. Basic Services Medical Service Definition Medical Service General Requirements Medical Service Staff Medical Service Equipment and Supplies Medical Service Space Psychiatric Nursing Service Definition Psychiatric Nursing Service General Requirements Page 15

17 Psychiatric Nursing Service Staff Psychiatric Nursing Service Equipment and Supplies Psychiatric Nursing Service Space Psychiatric Rehabilitative Activities Service Definition Psychiatric Rehabilitative Activities Service General Requirements Psychiatric Rehabilitative Activities Service Staff Psychiatric Rehabilitative Activities Service Equipment and Supplies Psychiatric Rehabilitative Activities Service Space Pharmaceutical Service Definition Pharmaceutical Service General Requirements Pharmaceutical Service Staff Pharmaceutical Service Equipment and Supplies Pharmaceutical Service Space Dietetic Service Definition Dietetic Service General Requirements Dietetic Service Staff Dietetic Service Equipment and Supplies Dietetic Service Space Page 16

18 Chapter 1. General Acute Care Hospitals Meaning of Words Article 1. Definitions Words shall have their usual meaning unless the context or a definition clearly indicates a different meaning. Words used in the present tense include the future; words in the singular number include the plural number; words in the plural number include the singular number; and words in the masculine include the feminine. Shall means mandatory. May means permissive. Should means suggested or recommended Hospital Hospital means a general acute care hospital General Acute Care Hospital (a) General acute care hospital means a hospital, licensed by the Department, having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. (b) A general acute care hospital shall not include separate buildings which are used exclusively to house personnel or provide activities not related to hospital patients Acute Psychiatric Care Bed Classification Acute psychiatric care bed classification means beds designated for acute psychiatric, developmentally disabled or drug abuse patients receiving 24-hour medical care Alteration Alteration means any change in the construction or configuration other than maintenance in an existing building and which does not increase the floor or roof area or the volume of enclosed space Autoclaving Autoclaving means the process of sterilization by steam under pressure Basic Services Basic services means those essential services required by law for licensure as a hospital including medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy and dietary services Certificate of Exemption Certificate of Exemption means a document containing Department approval for the exemption of a specified project from Certificate of Need review. Page 17

19 Certificate of Need Certificate of need means a document containing Department approval for a specified project Child HISTORY 1. Repealer filed as an emergency; effective upon filing (Register 76, No. 46). 2. New section filed as an emergency; effective upon filing (Register 76, No. 49). 3. Certificate of Compliance filed as to filing of (Register 77, No. 11). 4. Reinstatement of section as it existed prior to emergency amendment filed , by operation of Section (b), Government Code (Register 77, No. 22) Cleaning Cleaning means the process employed to free a surface from dirt or other extraneous material Competency Validation for Patient Care Personnel Other Than Registered Nurses Competency validation for patient care personnel other than registered nurses is a determination based on an individual's satisfactory performance of each specific element of his/her job description, and of the specific requirements for the patient care unit in which he or she is employed Competency Validation for Registered Nurses (a) Competency validation for registered nurses is a determination based on the satisfactory performance of: (1) The statutorily recognized duties and responsibilities of the registered nurse, as set forth in Business and Professions Code Section 2725, et seq., and regulations promulgated thereunder; and (2) The standards required under Section 70213(c) which are specific to each patient care unit Conservator Conservator means a person appointed by the court to take care of the person, the property, or both, of a conservatee under Section 5350, et seq., of the Welfare and Institutions Code, or under Section 1701, et seq., of the Probate Code Critical Burn (a) Critical burn means any one or more of the following types of burns: (1) Second degree burns exceeding 30 percent of the body surface. (2) Third degree burns of the face, hands, feet and/or genitals. (3) Third degree burns exceeding 10 percent of the body surface. Page 18

20 (4) Burns complicated by respiratory tract injury, major soft tissue injury or fractures. (5) Electrical burns. (6) Any combination of second and third degree burns which in the aggregate poses a medical problem equivalent in seriousness to (1) through (5) Defined Defined means defined in writing Department Department means the State Department of Health Services Director Director means the Director of the State Department of Health Services Disinfection Disinfection means the process employed to destroy harmful microorganisms, but ordinarily not viruses and bacterial spores Distinct Part Distinct part means an identifiable unit accommodating beds and related facilities including, but not limited to, contiguous rooms, a wing, floor or building that is approved by the Department for a specific purpose Drug Administration Drug administration means the act in which a single dose of a prescribed drug or biological is given to a patient by an authorized person in accordance with all laws and regulations governing such acts. The complete act of administration entails removing an individual dose from a previously dispensed properly labeled container, including a unit dose container, verifying the dose with the prescriber's orders, giving the individual dose to the proper patient and promptly recording the time and dose given Drug Dispensing Drug dispensing means the act entailing the interpretation of an order for a drug or biological and, pursuant to that order, the proper selection, measuring, packaging, labeling and issuance of the drug or biological for a patient or for a service unit of the hospital Existing Hospital Building Existing hospital building means an extant structure intended for proper hospital use. This excludes physician offices contiguous with the hospital and independent of the hospital as far as ownership. Page 19

21 General Acute Care Bed Classification (a) General acute care bed classification means beds designated for burn, coronary, intensive care, medical-surgical, pediatric, perinatal, rehabilitation, acute respiratory or tuberculosis patients receiving 24-hour medical care. (b) Specialized care with respect to special hospitals shall be considered to be general acute care Governing Body Governing body means the person, persons, board of trustees, directors or other body in whom the final authority and responsibility is vested for conduct of the hospital Guardian Guardian means a person appointed by the court to take care of the person or the property, or both, of a ward under Section 1400 et seq., of the Probate Code Human Reproductive Sterilization (a) Human reproductive sterilization means any medical treatment, procedure or operation, for the purpose of rendering an individual permanently incapable of reproducing. (b) In this section and in Sections and 70736, sterilization means human reproductive sterilization Intermediate Care Bed Classification Intermediate care bed classification means beds designated for patients requiring skilled nursing and supportive care on less than a continuous basis License License means the basic document issued by the Department permitting the operation of a hospital. This document constitutes the authority to receive patients and to perform the services included within the scope of these regulations and as specified on the hospital license License Category (a) License category means any of the following categories: (1) General acute care hospital. (2) Acute psychiatric hospital. (3) Skilled nursing facility. (4) Intermediate care facility Licensee Licensee means the person, persons, firm, business trust, partnership, association, corporation, political subdivision of the State or other governmental agency within the State to whom a license has been issued. Page 20

22 Maintenance Maintenance means the upkeep of a building and equipment to preserve the original functional and operational state Modernization NOTE: Authority cited: Sections 208, 1250, , 1251, 1255, and 1268, Health and Safety Code. Reference: Chapter 854, Statutes of HISTORY 1. Repealer filed ; effective thirtieth day thereafter (Register 77, No. 22) New Construction (a) New construction means any of the following: (1) New buildings. (2) Additions to existing buildings. (3) Conversions of existing buildings or portions thereof not currently licensed as a hospital New Special Service (a) New special service means any special service identified in Section of this Chapter which is either offered or is intended to be offered and which was not approved by the Department prior to September 9, Approval of the Department is inferred if one of the following conditions exist: (1) The special service in question has been evaluated by the Department subsequent to July 13, 1975 and prior to September 9, 1976 and was found to be in compliance with all regulations regarding the service. (2) The special service in question was being provided prior to July 13, 1975, has been provided continuously since that date, and has not been inspected and evaluated by the Department for the quality of the service provided. Departmental approval in this case can be inferred only until such time as the service is evaluated by the Department Nursing Unit Nursing unit means a designated patient-care area of the hospital which is planned, organized, operated and maintained to function as a unit. It includes patient rooms with adequate support facilities, services and personnel providing nursing care and necessary management of patients Outpatient Service An outpatient service means an organizational unit of the hospital which provides nonemergency health care services to patients. Page 21

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