Residents' safety, your license, your building.

Administrator certification and caregiver hours

Keep training records by employee. They back up the staffing answers on your application, and they are what you will reach for if a fall or medication claim comes in. California sets the hours by statute.

Administrator certificate (H&S 1569.616)

• The administrator completes a department-approved certification program before employment, and the licensee notifies the department within 30 days of any change in administrators.
• The program is at least 80 hours of coursework, including at least 60 hours of interactive instruction, followed by a department exam of at least 100 questions passed within 60 days of finishing the program.
• The certificate renews every two years with 40 hours of continuing education. No more than half may be self-paced, and at least 8 hours must cover serving clients with dementia.
• A certificate not renewed within four years of expiring can only be restored by completing the certification program again and passing any test then required.

Direct care staff (H&S 1569.625)

• Staff who help residents with personal activities of daily living need 40 hours of training.
• The first 20 hours come before working independently with residents, including 6 hours on dementia care and 4 hours on postural supports, restricted health conditions and hospice care.
• The other 20 hours, including 6 more on dementia care, are due within the first four weeks of employment.
• Every year after that, 20 more hours, of which 8 are dementia care and 4 cover postural supports, restricted health conditions and hospice care.

Certified nurse assistants, LVNs and RNs are outside those hours, but they still get 8 hours on resident characteristics, records and facility procedures before giving direct care. CNAs also take 12 hours of dementia training and the annual 20 hours.

What to read for in an RCFE policy

Abuse exclusions and claims-made retroactive dates matter in an RCFE policy just as they do for a home care agency; I walk through that reading on home health care insurance and abuse and molestation insurance. Three points are particular to a residential care home:

• Defense costs against the floor. IRMI notes that defense within limits, where defense payments reduce the limit, is more common in professional liability than in general liability. If the form you are relying on for the 1569.605 minimum works that way, read it knowing a long defense draws down the limit you are counting toward the minimum.
• One aggregate, several homes. 1569.605 applies to every RCFE. If one policy covers more than one home, read whether the $3,000,000 aggregate is shared or applies at each home. IRMI describes the CGL general aggregate as the most payable in an annual policy period for most covered losses; once paid out, it is exhausted.
• Residents' belongings. Under H&S 1569.152, a facility that fails to make reasonable efforts to safeguard resident property must reimburse or replace stolen or lost property at its then current value, with the theft and loss program in 1569.153 as the measure. IRMI describes the care, custody or control exclusion, common to several liability forms, as eliminating coverage for damage to property in the insured's care, custody or control. Read how your forms treat property you hold for residents.

For how the two main liability forms split the work, see professional vs. general liability.