(

a) The Legislature finds and declares that it is the public policy of this state to ensure that long-term health care facilities provide the highest level of care possible. The Legislature further finds that inspections are the most effective means of furthering this policy. It is not the intent of the Legislature by the amendment of subdivision (

b) enacted by

Chapter of the Statutes of to reduce in any way the resources available to the department for inspections, but rather to provide the department with the greatest flexibility to concentrate its resources where they can be most effective. It is the intent of the Legislature to create a survey process that includes state-based survey components and that determines compliance with federal and California requirements for certified long-term health care facilities.

It is the further intent of the Legislature to execute this inspection in the form of a single survey process, to the extent that this is possible and permitted under federal law. The inability of the state to conduct a single survey in no way exempts the state from the requirement under this

section that state-based components be inspected in long-term health care facilities as required by law. (b)

(1) Notwithstanding

Section or any other law, without providing notice of these inspections, the department, in addition to any inspections conducted pursuant to complaints filed pursuant to

Section 1419, shall conduct inspections of each skilled nursing facility at least once every months and all other long-term care facilities at least once every months, and as often as necessary to ensure the health, safety, and security of patients in long-term health care facilities. Facilities that have been issued a class “AA,” class “A,” or class “B” citation within the past months shall be inspected annually. The department shall vary the cycle in which inspections of long-term health care facilities are conducted to reduce the predictability of the inspections.

(2) Inspections and investigations of long-term health care facilities that are certified by the Medicare Program or the Medicaid program shall determine compliance with federal standards and California statutes and regulations to the extent that California statutes and regulations provide greater protection to residents, or are more precise than federal standards, as determined by the department. Notwithstanding any other law, the department, without taking regulatory action pursuant to

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, may implement, interpret, or make specific this paragraph by means of an All Facilities Letter (AFL) or similar instruction. Prior to issuing an AFL or similar instruction, the department shall consult with interested parties and shall inform the appropriate committees of the Legislature. The department shall also post the AFL or similar instruction on its internet website so that any person may observe which California laws and regulations provide greater protection to its residents or are more precise than federal standards.

This subdivision is not intended to change existing statutory or regulatory requirements governing the care provided to long-term health care facility residents.

(3) In order to ensure maximum effectiveness of inspections conducted pursuant to this article, the department shall identify all state law standards for the staffing and operation of long-term health care facilities. Costs of the additional survey and inspection activities required by

Chapter of the Statutes of shall be included as Licensing and Certification Program activities for the purposes of calculating fees in accordance with

Section 1266. (

c) Except as otherwise provided in subdivision (b), the department shall conduct unannounced direct patient care inspections to inspect physician and surgeon services, nursing services, pharmacy services, dietary services, and activity programs of all the long-term health care facilities. Facilities evidencing repeated serious problems in complying with this

chapter or a history of poor performance, or both, shall be subject to periodic unannounced direct patient care inspections during the inspection year. The direct patient care inspections shall assist the department in the prioritization of its efforts to correct facility deficiencies. (

d) A long-term health care facility shall report to the department any changes in the nursing home administrator or the director of nursing services within calendar days of the changes. (

e) Within days after the receipt of notice of a change in the nursing home administrator or the director of nursing services, the department may conduct an abbreviated inspection of the long-term health care facilities. (

f) If a change in a nursing home administrator occurs and the Board of Nursing Home Administrators notifies the department that the new administrator is on probation or has had their license suspended within the previous three years, the department shall conduct an abbreviated survey of the long-term health care facility employing that administrator within days of notification.