If you plan to move a family member to a nursing home, you need to understand what government agencies regulate them. If your loved one is already in a nursing home and you suspect abuse or neglect, you might need to contact one or more agencies to lodge a complaint. When you need help with California nursing home regulations, the Silva Injury Law legal team is here to help. Contact us today.
How Are Nursing Homes Regulated in California?
Several different branches of government govern nursing homes. Here is a look at some agencies responsible for California nursing home regulations.
California Department of Health
Any nursing home in California must have a valid license from the California Department of Public Health (DPH) and meet all standards for nursing homes. If the home accepts Medi-Cal or Medicare, they must have federal certification. Most nursing homes accept payments from government programs, so almost all facilities have federal and state certifications.
Nursing homes can be certified at different levels. Many are skilled nursing facilities (SNFs), but there are other types, such as intermediate care facilities (ICF).
Evaluators or surveyors visit nursing homes for routine inspections and investigate complaints. The inspectors also do follow-up visits to ensure any problems identified are corrected. This process involves speaking to some residents about the level of care they receive.
Department of Health Care Services
The Department of Health Care Services (DHCS) administers Medi-Cal. This government agency creates regulations related to nursing home qualifications to participate in the Medi-Cal program. It also makes regulations for individuals applying for financial assistance.
When nursing homes send their bills, DHCS reviews and decides the appropriate payment for long-term care. The agency also investigates allegations of Medi-Cal fraud in nursing homes.
California Attorney General
The California Attorney General’s office prosecutes elder neglect and abuse. If there’s an allegation of Medi-Cal fraud, their office will prosecute that too.
Regulations for Residential Care Facilities for the Elderly (RCFEs)
Several agencies oversee licensing and regulations for Residential Care Facilities for the Elderly in California. RCFEs include assisted living, memory care, and continuing care retirement communities (CCRCs). The priority here is to promote independence and self-direction as much as possible, as these are residential, non-medical communities and facilities.
The Community Care Licensing Division (CCLD), California Department of Social Services, and Continuing Care Contracts Branch are all responsible for regulating and licensing these facilities under the RCFE Act.
Reporting Nursing Home Abuse and Fraud
If there’s a problem at a facility, it’s often best to try to use available dispute remedies before reporting to DPH. However, you can still file a complaint with DPH, especially if it involves something serious.
Start by contacting your local long-term care ombudsperson office in the county where the nursing home is located. Its function is to help resolve issues and answer questions when patients have concerns over their rights and care. The ombudsman has no power over the nursing home, but they can help resolve some problems.
If there’s no resolution, you can file a complaint with the correct Department of Public Health District Office that oversees the involved nursing home. If you’re concerned about finding the right office, file a complaint using the Cal Health Find Database. When you file your complaint on this website, DPH will forward the complaint to the correct District Office.
Individuals can also report suspected elder abuse or Medi-Cal fraud to the California Attorney General’s office by calling the hotline, filling out an online form, or sending a written complaint.
Nursing Home Regulations and Patients’ Rights
All residents of nursing homes in California have residents’ rights. These rights are established by federal and state law. Nursing homes can’t decide to ignore them. If you believe a nursing home is violating your or a family member’s rights, it’s time to take action.
Contact a Lawyer Today
Understanding what to do and what agencies to file complaints with can be complicated. Fortunately, you don’t have to go through the process alone. The skilled legal team at Silva Injury Law is here to help. Attorney Michael Joe Silva is a former prosecutor for Merced County and is well-versed in the regulatory side of nursing homes in California. We’re here for you when you need someone to advocate for your rights or those of a loved one in a nursing home. Contact our office today to schedule an initial consultation to learn more.
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