Citation Review Conferences
California law requires the Department to use a citation system with civil penalties to enforce violations of statutory and regulatory requirements by long-term care (LTC) health facilities, which include skilled nursing facilities, intermediate care facilities (ICF), ICF-Developmentally Disabled, ICF-Developmentally Disabled Habilitative, ICF-Developmentally Disabled Nursing, and congregate living health facilities. Statutory and regulatory requirements govern the care and services provided by LTC health facilities by establishing standards for medical/nursing care, resident/client rights, diet/nutrition, pharmacy, activities, social services, and physical plant. Generally, citations classify the severity of a LTC health facilities’s violation of the requirements, as AA citations ($25,000 to $100,000 penalty); A citations ($2,000 to $20,000) and B citations ($100 to $1,000), but there are certain rare types of citations with various penalties that may also be issued to LTC health facilites.
The citation review conference (CRC) is an informal proceeding that is requested by the cited LTC health facility that desires to contest a citation. An independent hearing officer presides over the CRC to make a determination whether to uphold, modify or dismiss the citation or the assessed civil penalty. The CRCs are held in the various Licensing and Certification (L&C) district offices. The CRC participants include: the LTC health facility, representatives of L&C’s district office, the complainant and his/her designated representative, the patient’s designated health care provider; a personal attorney and any representative of the Office of the State Long-Term Care Ombudsman. In advance, all permissible participants are informed, in writing, of the location, time, day and date of the CRC.
During any presentation at the CRC, the participants are protected from any other party’s cross-examination. The participants are relatively free from interruption, except possible clarifying questioning from the impartial hearing officer. The CRC proceeds as follows:
- The hearing officer circulates an attendance sheet and convenes the CRC with an introduction of all participants.
- The L&C district office representative reads the citation narrative and provides evidence to support the alleged violations.
- The LTC health facility makes its argument by providing witnesses, asserting facts, submitting documents or raising technical issues about the alleged violation, citation level and/or civil penalty.
- The L&C district office representative is provided an opportunity to rebut the LTC health facility’s argument.
- The other parties attending the CRC are provided an opportunity to make statements or present any evidence pertaining to the citation, as desired.
- When all parties have completed the presentation of their information and any rebuttal, the hearing officer makes a closing statement to conclude the CRC.
- The hearing officier analyzes the information obtained from the CRC and makes findings based on whether there is a preponderance of the evidence to support one or more violations of the requirements. If so, the hearing officer determines whether the violation(s) meet the statutory definition of the citation level, whether five specific criteria were used to determine the amount of the civil penalty, and whether any technical issues have merit.
- The hearing officer prepares a written decision discussing these findings and how it supports the final determination. The written decision must be distributed within 30 days to all required CRC participants.