Type A vs. Type B citations, explained

The current Facility Evaluation Report (form LIC 809, 9/23) says there are two types of deficiencies. In CDSS's words:

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety or personal rights of persons in care.
• Type B deficiencies are violations that, without correction, could become a risk to the health, safety or personal rights of persons in care. Type B also covers recordkeeping violations that could affect clients' care or the protection of their resources, and violations that could affect services clients need.

Put simply, Type A is about immediate risk and Type B is about potential risk. A deficiency written up on a report is what the state counts as a citation; the forms speak of "cited deficiencies."

The complaint report form (LIC 9099, 12/16), which predates the current LIC 809, also describes a Type C category for violations with no immediate or potential impact where the licensee is in substantial compliance. The current LIC 809 lists only Type A and Type B.

ARFs follow both the general licensing rules in Title 22, Chapter 1 (§80000 and following) and the ARF rules in Chapter 6 (§85000 and following). Section 80001 defines a deficiency as any failure to comply with the Community Care Facilities Act (Health and Safety Code §1500 and following) or its regulations, and a serious deficiency as one that presents an immediate or substantial threat to the physical health, mental health or safety of clients.

Section 80051 lists regulations that, if not complied with, nearly always result in a serious deficiency. The list includes:

• limits on capacity or the ambulatory status of clients (§80010)
• criminal record clearance (§80019) and fire clearance (§80020)
• clients' personal rights (§80072)
• storing and dispensing medications (§80075)
• food storage, preparation and service (§80076)
• safety of client accommodations, hot water temperature and toilet facilities (§80087, §80088)

Whether a particular finding is marked Type A or Type B is decided by the evaluator based on the risk it presents.

Under §80052, before a visit ends the licensee or person in charge meets with the evaluator to discuss any deficiencies and jointly develop a plan for correcting each one. The written notice must cite the rule, describe the problem and where it happened, and set a correction date.

• In setting the date, the evaluator considers the potential hazard, how many clients are affected, and what equipment or staff are needed.
• The date generally may not be more than 30 calendar days after the notice, unless the evaluator determines it cannot be fully corrected in that time.
• When an immediate penalty applies, the evaluator requires correction within 24 hours.

Section 80053 adds that a follow-up visit is conducted within ten working days after the correction date, unless the licensee has shown the deficiency was corrected. No penalty is assessed without a follow-up visit.

Civil penalties for ARFs are set by Health and Safety Code §1548 and Title 22 §80054. In general terms:

• a deficiency that is not corrected by its due date carries a daily penalty until it is corrected;
• some violations carry an immediate penalty when cited, including ones that result in a client's sickness, injury or death;
• repeating a violation of the same regulation subsection within 12 months brings a larger immediate penalty.

The amounts are set in law and can change, so check the current statute before relying on any figure. The LIC 809 also explains that a licensee can request a review of a deficiency or penalty in writing within 15 business days.

• Totals cover the facility's whole history. A long-licensed, larger home may have more citations simply because it has had more visits.
• Look at what was cited. A Type A for supervision or medications deserves a closer read than a Type B for a missing form.
• Look for repeats. The same problem cited again suggests it wasn't fixed at the root.
• Read the report itself. The count can't tell you whether the problem was corrected, and some reports list deficiencies that were fixed on the spot.

You can narrow Facility Search to facilities with no Type A citations, or see those that have them, and the Deficiency Finder finds facilities cited under a specific Title 22 section.