MEDICATIONS GUIDE - California

1 COMMUNITY CARE LICENSING DIVISION ADVOCACY AND TECHNICAL SUPPORT RESOURCE GUIDE MEDICATIONS GUIDE Residential Care Facilities for the Elderly MEDICATIONS FOR SENIOR CARE FACILITIES TSP 2016-03 (version 09/30/2016) PAGE 1 All Residential Care Facilities for the Elderly (RCFEs) licensed by the California Department of Social Services (Department), Community Care Licensing Division (CCLD) must comply with the medication regulations in Title 22 of the California Code of Regulations (22 CCR) and the Health and Safety Code (HSC). Medication management represents an area of great responsibility .

2 If not managed per physician orders and in compliance with statutory and regulatory requirements, MEDICATIONS intended to assist with a resident's health maintenance may place an individual's health and safety at risk. This GUIDE is meant to help providers understand the regulations for medication management but is not a substitute for the actual regulations and statutes governing the operation of a licensed RCFE. The following information provides regulatory and statutory requirements as well as suggestions for best practices to provide additional safeguards in the management of MEDICATIONS in an RCFE.

3 The provided appendix contains exact regulation and statutory language for the sections related to medication management in licensed RCFEs. This GUIDE is not an exhaustive treatment of the subject. If you have additional questions, you should consult with your Regional Office. GENERAL REQUIREMENTS RCFE licensees must ensure the following with regard to medication assistance: Licensees are required to assist residents with self-administration of MEDICATIONS as needed, as specified in Title 22 section 87465(a)(5). Assistance with self-administration of MEDICATIONS is limited to those MEDICATIONS usually prescribed for self-administration which have been authorized by the resident s physician and MEDICATIONS prescribed during an illness determined by the physician to be temporary and minor, as specified in Title 22 section 87465(a)(6)(A) and (B).

4 Assistance with self-administration of MEDICATIONS can also include when a resident needs assistance due to tremor, failing eyesight and similar conditions, as specified in Title 22 section 87465(a)(6)(C). In This Resource GUIDE Plan of Operation 2 Incidental Medical and Dental Care Services 2 PRN MEDICATIONS 11 OTC/Nonprescription MEDICATIONS 14 Ear/Eye Drops and Nasal Sprays 15 Narcotics 16 Observation of the Resident 18 Psychotropic Medication 18 Injectable MEDICATIONS 21 Hospice / Hospice Care Waiver 23 Medication Training Requirements 24 Addressing Behavioral Issues 25 Medical Marijuana 26 Appendix 29 COMMUNITY CARE LICENSING DIVISION ADVOCACY AND TECHNICAL SUPPORT RESOURCE GUIDE MEDICATIONS FOR SENIOR CARE FACILITIES TSP 2016-03 (version 09/30/2016)

5 PAGE 2 Assistance with self-administration of MEDICATIONS 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, as specified in Title 22 section 87465(a)(6)(D). Each employee of the facility who assists residents with the self-administration of MEDICATIONS must meet all of the following initial training, testing and annual training requirements specified in Health and Safety Code section Training is designed to ensure staff understands the following: The role, responsibilities, and limitations of staff assigned to assist residents with the self-administration of medication, including tasks limited to licensed medical professionals.

6 The guidelines for the proper storage, security, and documentation of centrally stored MEDICATIONS . Medication side effects, adverse reactions, errors, the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia, and the increased risk of death when elderly residents with dementia are given antipsychotic MEDICATIONS . Below are common scenarios in the care of residents with medication needs. The scenarios are practices commonly used by providers to comply with medication-related regulations and statutes. Plan of Operation (22 CCR 87208) Scenario: Description of Regulations: Best Practices: Licensee designates staff to handle medication Follow the written policies and procedures provided in the facility s Department-approved plan of operation for the functions of these designated staff.

7 Train all staff responsible for MEDICATIONS as described in the facility s Department-approved plan of operation. Verify and document staff training and competence in these areas. For specific information on training, please see the Medication Training Section on page 24. Review the plan of operation on a regular basis. Revise policies and procedures as needed and submit to Department for approval. Incidental Medical and Dental Care Services (22 CCR 87465) Scenario: Description of Regulations: Best Practices: Resident arrives with medication Ensure a physician authorization is provided for each prescription and nonprescription PRN medication that facility staff will provide assistance to the resident.

8 Contact the prescribing physician (s) to ensure their awareness of all MEDICATIONS currently taken by the resident. Inspect each label to ensure the medication is prescribed for the resident and the medication has not expired. COMMUNITY CARE LICENSING DIVISION ADVOCACY AND TECHNICAL SUPPORT RESOURCE GUIDE MEDICATIONS FOR SENIOR CARE FACILITIES TSP 2016-03 (version 09/30/2016) PAGE 3 Incidental Medical and Dental Care Services (22 CCR 87465) Scenario: Description of Regulations: Best Practices: Resident arrives with medication, Maintain a log of centrally stored MEDICATIONS for each resident.

9 The LIC 622 is available for this purpose. Retain on file a copy of the prescriptions for centrally stored MEDICATIONS in the resident s file. Keep centrally stored MEDICATIONS in a safe and locked place that is not accessible to others. Conduct a count of pills received. This will assist with documenting when refills are to be ordered. Review the amount of refills remaining on the prescription and ensure that the medication is refilled if needed. If no refills are available, contact the physician for further instructions. Ensure medication which is not centrally stored is kept in a safe and locked place by the resident.

10 Discuss MEDICATIONS with the resident and the responsible party/authorized representative, if any (if the resident has consented or if the responsible person/ authorized representative has the power of attorney for health care or is the conservator). Have physician routinely review and approve a list of all MEDICATIONS taken by the resident and verify dispensing instructions. Make sure the primary care physician is aware of MEDICATIONS prescribed to a resident by any specialists. Have the administrator review the MEDICATIONS and the dispensing instructions with staff.