The California Department of Health issued an All Facilities Letter (AFL) to clarify nursing staff-to-patient ratios regulations for skilled nursing facilities (SNFs). The letter states that the minimum number of actual nursing hours per patient in a SNF should be 3.2 hours, except for special treatment program service unit distinct parts. The AFL requires the development of staff-to-patient ratios for direct caregivers and licensed nurses to ensure that no less care is given than 3.2 nursing hours per patient day of care. New sections were added to Title 22 to define terms, create three 8-hour shifts for nurse-to-patient staffing, describe documentation and posting requirements, and specify the procedure to obtain a waiver for established staffing per shift for SNFs. The initial implementation of this section is contingent on an appropriation in the annual Budget Act or another statute. The Licensing and Certification (L&C) Program staff will continue to determine a facility's compliance with the 3.2 hours of nursing services per patient day in accordance with existing L&C policies and procedures.

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