California Code of Regulations
Title 22 - Social Security
Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies
Chapter 6 - Home Health Agencies
Article 3 - Services
Section 74709 - Home Health Aide/Personal Care Services Supervision

Universal Citation: 22 CA Code of Regs 74709

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) When an agency provides or arranges for home health aide services for a patient in conjunction with skilled nursing services, the services shall be given in accordance with a written plan of treatment or plan of care and the case shall be supervised by a registered nurse.

(1) If the patient receives skilled nursing care, the registered nurse shall perform the supervisory visit described in (a)(2) of this section, unless the registered nurse, in the exercise of professional judgment, delegates this task to a licensed vocational nurse. The registered nurse shall provide the initial assessment of the patient and the care environment. If the patient is not receiving skilled nursing care, but is receiving another skilled service (e.g. physical therapy, occupational therapy, or speech-pathology services), the initial assessment or evaluation and supervision may be provided by the appropriate therapist, when within his or her scope of practice. The supervisor nurse shall be responsible for:
(A) Assigning home health aides to a case in accordance with the plan of treatment or plan of care as required in subsection (a).

(B) Providing written instructions for patient care.

(2) If the patient receives skilled care, the registered nurse (or another professional described in paragraph (a)(1) of this section) shall make an on-site visit to the patient's home no less frequently than every two weeks. The home health agency shall develop and implement policies and procedures for those circumstances when the home health agency requires on-site supervisory visits to be conducted jointly with the home health aide present (e.g. when joint visits are part of a performance evaluation).
(A) When a licensed vocational nurse is delegated supervision of home health aide services that are provided in conjunction with skilled nursing services, a registered nurse shall make the on-site supervisory visit to the patient's home at least every three months, to observe the patient and patient care environment.

(3) If the home health aide/personal care services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy or speech-language pathology services, the registered nurse or, when delegated, the licensed vocational nurse, shall make a supervisory visit to the patient's home no less frequently than every 62 days. Regular supervisory visits shall occur while the home health aide is providing patient care and shall include verification that the plan of treatment, plan of care, or plan for personal care services is being followed appropriately.
(A) When a licensed vocational nurse is delegated supervision of home health aide/personal care services (when the patient is only receiving these services), the registered nurse shall at least alternate on-site supervisory visits to the patient's home with the licensed vocational nurse, to observe the patient and the patient care environment.

(4) If home health aide/personal care services are provided by an individual who is not an employee of the primary home health agency, the primary home health agency shall be responsible for the overall quality of care provided by the aide, and provide for supervision of the aide, including referral of any concerns to the appropriate agency or organization when care problems are observed.

(b) When a licensed vocational nurse is delegated supervision of home health aide/personal care services, a registered nurse shall retain responsibility for supervision of licensed and unlicensed personnel providing such services.

(c) Registered nurses who are assigned to supervise the case when a licensed vocational nurse has been delegated supervision of home health aide patient care, or registered nurses who supervise home health aide care, may also be assigned to provide direct services for agency patients.

(d) Nothing in this section shall be construed as permitting a physical therapy aide, as defined in Title 16, Section 1399, California Code of Regulations, to perform the functions of a home health aide, unless the physical therapy aide meets the definition of a home health aide. Physical therapy aides who are not certified as home health aides may not substitute for home health aides when home health aides are required by a plan of treatment or plan of care. Nothing in this section shall require a physical therapist to supervise home health aides in the same manner as physical therapy aides. Home health aide services shall comply with applicable state law.

(e) Home health agencies participating in the Medicare and or Medi-Cal program shall meet applicable federal requirements.

1. Amendment of section heading, section and NOTE filed 4-28-95 as an emergency; operative 4-28-95 (Register 95, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-28-95 or emergency language will be repealed by operation of law on the following day.
2. Amendment of section heading, section and NOTE refiled 8-14-95 as an emergency; operative 8-14-95 (Register 95, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-12-95 or emergency language will be repealed by operation of law on the following day.
3. Amendment of section heading, section and NOTE refiled 12-12-95 as an emergency; operative 12-12-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-10-96 or emergency language will be repealed by operation of law on the following day.
4. Amendment of section heading, section and NOTE refiled 4-11-96 as an emergency; operative 4-11-96 (Register 96, No. 15). A Certificate of Compliance must be transmitted to OAL by 8-9-96 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-28-95 order transmitted to OAL 8-7-96 and disapproved 9-19-96 (Register 96, No. 38).
6. Amendment of section heading, section and NOTE filed 9-19-96 as an emergency; operative 9-19-96 (Register 96, No. 38). A Certificate of Compliance must be transmitted to OAL by 1-17-97 or emergency language will be repealed by operation of law on the following day.
7. Editorial correction of HISTORY 6 (Register 97, No. 3).
8. Amendment of section heading, section and NOTE refiled 1-16-97 as an emergency; operative 1-16-97 (Register 97, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-16-97 or emergency language will be repealed by operation of law on the following day.
9. Amendment of section heading, section and NOTE refiled 5-15-97 as an emergency; operative 5-15-97 (Register 97, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-12-97 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 5-15-97 order, including amendment of section heading, section and NOTE, transmitted to OAL 8-26-97 and filed 10-8-97 (Register 97, No. 41).

Note: Authority cited: Sections 1734 and 100275, Health and Safety Code. Reference: Sections 1727(c), 1727.5(a), 1727.5(c), 1727.5(f) and 1734, Health and Safety Code.

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