§ 51215.8. Pediatric Subacute Care Unit.
22 CA ADC § 51215.8Barclays Official California Code of Regulations
22 CCR § 51215.8
§ 51215.8. Pediatric Subacute Care Unit.
(a) A pediatric subacute care unit means an identifiable unit of a certified nursing facility licensed as a skilled nursing facility and meeting the standards for participation as a provider under the Medi-Cal program set forth in this section, accommodating beds including contiguous rooms, a wing, a floor, or a building that is approved by the Department for such purpose. In addition to the requirements set forth in this section, a facility providing pediatric subacute care unit services shall comply with all of the licensing requirements set forth in Title 22, Division 5, otherwise applicable to licensure as a skilled nursing facility.
(f) The facility shall provide for a comprehensive developmental assessment for each pediatric subacute care patient who is under 36 months of age. The assessment shall be performed by a qualified professional with training and expertise specific to the assessment of, and program planning for, infant and child development. The professional who performs the developmental assessment shall:
(h) In accordance with (j)(3) of this Section, the facility shall work with the Local Education Agency in the development and implementation of an Individual Education Plan (IEP) for each pediatric subacute care patient who is 36 months of age and older. The facility shall incorporate those activities identified in the IEP, as appropriate, into the patient's comprehensive nursing care plan. To facilitate continuity of services, the facility shall obtain instruction from the Local Education Agency for the pediatric subacute direct patient care unit staff in performing activities in the IEP when the child is not in a formal educational session.
(i) In accordance with (j)(3) and (j)(4) of this section, the facility shall work with the Regional Center, as defined in Title 17, California Code of Regulations, Section 54302(a)(43) or the Local Education Agency Provider, as defined in Title 22, California Code of Regulations, Section 51190.2, in the development and implementation of an Individual Family Service Plan (IFSP), as specified in Government Code Section 95020, for each pediatric subacute patient who is under 36 months of age. The facility shall incorporate those identified activities in the IFSP, as appropriate, into the patient's comprehensive nursing plan. To facilitate continuity of services, the facility shall obtain instruction from the Regional Center or Local Education Agency Provider for the pediatric subacute unit staff in performing activities in the IFSP.
(j) Each pediatric subacute care unit shall designate a person or persons as the Service Coordinator whose time is equal, in hours, to one full-time position for every 20 patients. This position shall be dedicated to the pediatric subacute care unit and be separate from the nurse staffing hours required by (k) of this section. The Service Coordinator(s) shall be either a registered nurse or individual with a baccalaureate degree in social work who possesses the knowledge and ability to assess the current needs of each pediatric subacute patient and the available resources in the facility and community to meet those needs. The Service Coordinator's activities shall include, but not be limited to:
(3) Referral to and collaboration with Early Intervention Programs as described in the Individuals with Disabilities Education Act, 20 United States Code, Section 1400, et seq., Early Intervention Program, 20 United States Code, Section 1471, and with Special Education Programs, as described in the California Education Code, Section 56000 et seq.;
(k) Pediatric subacute care units shall define, implement, and maintain a system for determining patient requirements for nursing care based on patient needs with goals that are time limited, as demonstrated in each patient's comprehensive care plan. Nursing personnel shall be sufficient to assure prompt recognition of any untoward change in patient condition, and to facilitate appropriate nursing, medical or other appropriate intervention. The pediatric subacute care unit shall utilize nursing staff in at least the following minimum ratios: a minimum daily average of 5.0 actual unduplicated licensed nursing hours per patient day, and 4.0 actual certified nurse aide hours per patient day.
(2) A minimum of one registered nurse per shift, not including the unit's head nurse/nurse manager, unless at least 80% of the time of that nurse is spent in direct patient care. In such a case, the remaining 20% of time of that nurse shall be spent in managerial duties for the pediatric subacute unit.
(B) Proof of completion, within two months of employment, of at least 40 hours of direct employee specific preceptorship, provided by a registered nurse meeting the qualifications specified in Section 51215.8(m), designed to promote the licensed nurse's clinical competency in providing nursing services to the types of pediatric patients with technology dependency for whom the facility provides care. The preceptorship may be provided during the licensed nurse's normal working tour of duty.
(r) In complying with the staff development requirements specified in Section 72517(a)(1), the facility shall focus on the nursing care and developmental needs of pediatric patients for whom it provides care. The facility shall maintain documentation of compliance with this section and provide it upon request by the Department.
(t) The pediatric subacute care unit shall utilize a licensed Respiratory Care Practitioner to provide a minimum of 3.0 hours per patient day to each ventilator dependent patient, and a minimum of 2.0 hours per patient day to each non-ventilator dependent patient, of medically necessary respiratory care services, when provided under the order of a person lawfully authorized to give such an order, and according to each pediatric subacute beneficiary's assessment and care plan. A licensed Respiratory Care Practitioner shall be present in the nursing facility 24 hours a day and may have assigned duties outside the pediatric subacute care unit.
(u) Each facility providing pediatric subacute services shall provide for the consultant services of a registered dietician with demonstrated background and/or clinical experience in pediatric nutrition. The pediatric registered dietician shall provide a comprehensive nutrition assessment within seven working days of the child's admission to the pediatric subacute unit followed by development and implementation of a nutrition care plan in accordance with accepted pediatric nutrition standards of care.
Credits
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Section 14132.25, Welfare and Institutions Code.
History
1. New section filed 4-13-94 as an emergency; operative 4-1-94. Emergency adoption submitted to OAL for printing only pursuant to section 4, AB 36 (chapter 1030, Statutes of 1993) (Register 94, No. 15).
2. Certificate of Compliance as to 4-13-94 order including amendment of section transmitted to OAL 9-26-94 and filed 10-20-94 (Register 94, No. 42).
3. Editorial correction of History 1 and 2 (Register 95, No. 14).
4. Amendment of section and Note filed 6-30-97 as an emergency; operative 6-30-97 (Register 97, No. 27). A Certificate of Compliance must be transmitted to OAL by 10-28-97 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 6-30-97 order transmitted to OAL 10-22-97 and filed 11-26-97 (Register 97, No. 48).
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 22, § 51215.8, 22 CA ADC § 51215.8
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