§ 87705 — Care of Persons With Dementia

(a)  This section applies to the care of residents diagnosed with dementia. Mild cognitive impairment, as defined in Section 87101, Definitions, is not considered to be dementia.

(b)  Licensees shall be responsible for the following:

  (1)  Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation:

    (A)  Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living;

    (B)  Recognizing symptoms that may create or aggravate behavioral expression, as defined in Section 87101, Definitions, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and

    (C)  Recognizing the effects of medications commonly used to reduce behavioral expression.

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      Health and Safety Code section 1569.625(c) specifies in pertinent part:

      "The training shall include, but not be limited to, all of the following:

        (7)  Dementia care, including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia.

        (8)  The special needs of persons with Alzheimer's disease and dementia, including nonpharmacologic, person-centered approaches to dementia care."

      Health and Safety Code section 1569.626(a) specifies in pertinent part:

      "All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff:

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        (1)  Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment.  All 12 hours shall be devoted to the care of persons with dementia.

        (2)  Eight hours of in-service training per year on the subject of serving residents with dementia."

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  (2)  For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal, or observation, to require awake night supervision. This requirement is in addition to requirements specified in Section 87415, Night Supervision.

(c)  With the prior written approval of the resident or conservator and provided such devices do not violate the resident's rights as specified in Section 87468.1 Personal Rights of Residents in All Facilities, the licensee may use egress alert and location tracking devices as needed to ensure resident safety.

(d)  The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions.

(e)  Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements:

  (1)  The licensee shall notify the licensing agency immediately after determining the date that the device will be installed.

  (2)  The licensee shall ensure that the fire clearance includes approval of delayed egress devices.

  (3)  Facility staff shall attempt to redirect a resident at risk for elopement who may be attempting to leave the facility without violating Section 87468.1, Personal Rights of Residents in All Facilities.

  (4)  Residents who continue to indicate a desire to leave the facility following redirection shall be permitted to do so with staff supervision.

  (5)  Facility staff shall ensure the continued safety of residents if they wander away from the facility without violating Sections 87468.1, Personal Rights of Residents in All Facilities and Section 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities.

  (6)  For each incident of elopement, as defined in Section 87101, Definitions, the licensee shall report the incident to:

    (A)  The resident's representative, if applicable, immediately upon becoming aware of the incident. A written report shall also be provided to the resident's representative as specified in Section 87211, Reporting Requirements. Documentation of the report shall be added to the resident's record.

    (B)  The licensing agency Officer of the Day, by telephone, e-mail, fax, or hand-delivery no later than the next working day following the incident. If reported by telephone, a written report shall also be submitted to the licensing agency as specified in Section 87211, Reporting Requirements. The report shall be added to the resident's record.

  (7)  Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents, including staff needed to escort residents who need supervision to leave the facility.

(f)  Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements:

  (1)  Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates.

  (2)  The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates.

  (3)  Facility staff shall attempt to redirect a resident at risk for elopement who may be attempting to leave the facility without violating Section 87468.1, Personal Rights of Residents in All Facilities.

  (4)  The licensee shall maintain either of the following documents in the resident's record, depending on the resident's conservatorship status:

    (A)  Court order showing the conservator's legal authority to place the conservatee in a facility with locked exterior doors or perimeter fence gates, for each resident who has been conserved under the Probate Code or the Lanterman-Petris-Short Act; or

    (B)  A written statement signed by each non-conserved resident that states the resident understands that the facility has locked exterior doors or perimeter fence gates and that the resident voluntarily consents to such upon admission.

  (5)  Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely.

  (6)  Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents.

NOTE:  Authority cited:  Sections 1569.30 and 1569.698, Health and Safety Code.  Reference:  Sections 1569.2, 1569.31, 1569.312, 1569.698, 1569.699 and 13131, Health and Safety Code.