California residential care facilities for the elderly (RCFEs) face significant changes to their resident reappraisal requirements starting on January 1, 2025. These changes, resulting from updates to Title 22, Section 87463 of the California Code of Regulations, establish new standards for when and how RCFEs must evaluate their residents.

Annual Requirements Expanded

The regulatory changes make clear that RCFEs must perform reappraisals when residents experience “significant” changes in condition, but at least once every 12 months. Under the updated regulations, a “significant” change is one that impacts a resident’s physical, cognitive, behavioral, or functional condition such that it requires an alteration of services. This includes changes from trauma, illness, or injury affecting health needs, changes in cognitive abilities or decision-making capacity, and “behavioral expressions” that may cause harm to self or others. Following each reappraisal, RCFEs must arrange a meeting to discuss results, either in-person, virtually, or via conference call, with staff members, the resident, and the resident’s representative(s).

RCFEs must now also request that all residents, not just those with a physician’s diagnosis of dementia, have a routine annual visit, either in person or via video, with a licensed medical professional. The RCFE must document either the completed visit or the resident’s refusal in the resident’s record.

Enhanced Documentation and Notification Protocols

The new regulations provide more detailed requirements for documentation and communication. When documenting behavioral expressions, RCFEs must include:

• A description of the behavior;
• Any known triggering events; and
• Required interventions, emphasizing the least restrictive options.

Before finalizing a reappraisal, RCFEs must promptly contact the resident’s physician and any specialized service providers about significant changes. The RCFE must document, in the resident’s record, the date and time of the contact with the provider, descriptions of any significant changes, recommendations received, and any changes to the resident’s care plan. RCFEs must then inform the resident and legal representative(s) about these changes and recommendations.

Looking Ahead

These updates to Section 87463 provide clearer guidance while likely increasing oversight from the California Department of Social Services. RCFEs should review and update their reappraisal processes before the January 1, 2025 effective date to ensure full compliance with these new requirements.