CDSS Survey Process and Handling Type A vs Type B Deficiencies

The CDSS survey process for RCFEs is a critical regulatory mechanism designed to ensure compliance with California Title 22 regulations and protect resident safety. Surveys conducted by the Community Care Licensing Division (CCLD) evaluate facilities for adherence to operational, health, safety, staffing, medication, and resident rights standards.

One of the most serious compliance events an RCFE can face is receiving a Type A or Type B deficiency citation. Understanding the distinction between these categories and how to properly respond is essential for protecting licensure and minimizing regulatory risk.

This article explains the CDSS survey process and provides a structured approach to handling Type A vs Type B deficiencies.

Regulatory Authority

RCFEs are regulated under:

• California Code of Regulations, Title 22, Division 6, Chapter 8

• California Health and Safety Code §§1569 et seq.

• CDSS Community Care Licensing Division enforcement policies

Licensing analysts have statutory authority to inspect, cite, and enforce corrective actions.

The CDSS Survey Process

Types of Surveys

CDSS may conduct several types of inspections:

1. Pre-Licensing Visit

Conducted before issuance of a new RCFE license to verify compliance readiness.

2. Annual or Required Inspection

Routine compliance survey reviewing:

• Resident files

• Medication management

• Staff records

• Training documentation

• Physical plant safety

• Emergency preparedness

3. Complaint Investigation

Triggered by:

• Resident complaints

• Family reports

• Ombudsman referrals

• Law enforcement reports

• Anonymous tips

Complaint surveys often focus narrowly on specific allegations but may expand into broader compliance review.

4. Follow-Up Visit

Conducted to verify correction of previously cited deficiencies.

What Surveyors Evaluate

During a CDSS survey, licensing analysts typically review:

• Admission agreements

• Resident assessments and care plans

• Medication storage and MAR documentation

• Staff training records

• Criminal background clearances

• Hospice coordination

• Disaster drill documentation

• Food service and sanitation

• Personal rights compliance

Surveyors conduct interviews with residents and staff, observe operations, and review documentation.

Understanding Deficiencies

When non-compliance is identified, CDSS issues a deficiency citation. Deficiencies fall into two primary categories:

• Type A Deficiencies

• Type B Deficiencies

The classification depends on the level of risk posed to residents.

Type A Deficiencies

Definition

A Type A deficiency is issued when a violation presents an immediate or substantial threat to the health, safety, or personal rights of residents.

These are considered serious violations.

Examples of Type A Violations

• Unlocked medications accessible to residents

• Retention of a resident with a prohibited health condition

• Failure to report elder abuse

• Lack of fire clearance compliance

• Inadequate supervision resulting in injury

• Staffing levels insufficient to meet resident needs

• Failure to provide emergency care

Type A citations often carry civil penalties.

Civil Penalties for Type A

Penalties may include:

• $150 per day per violation

• Increased penalty amounts for repeated violations

• Immediate correction orders

• Potential license probation

Serious cases may lead to:

• Temporary suspension order

• Exclusion from accepting new residents

• Revocation proceedings

Type B Deficiencies

Definition

A Type B deficiency is issued when a violation does not present immediate danger but still represents non-compliance with Title 22.

These are regulatory violations requiring correction.

Examples of Type B Violations

• Missing staff training documentation

• Incomplete MAR entries

• Missing physician reports

• Failure to post required notices

• Minor documentation errors

• Expired first aid certification

Although less severe than Type A, repeated Type B citations may escalate enforcement scrutiny.

Deficiency Documentation: LIC 809 Form

After the survey, CDSS issues findings on Form LIC 809.

The LIC 809 includes:

• Regulatory citation reference

• Description of violation

• Scope and severity

• Correction deadline

• Civil penalty (if applicable)

Administrators must review this document carefully before signing.

Signing does not indicate agreement; it confirms receipt.

Correction of Deficiencies

Plan of Correction (POC)

Facilities must submit a written Plan of Correction (POC) by the deadline specified.

A compliant POC should include:

1. Immediate corrective action taken

2. Systemic change implemented

3. Monitoring process to prevent recurrence

4. Person responsible for oversight

5. Completion date

Generic or vague POCs often trigger rejection.

Timelines

• Type A deficiencies often require immediate correction or very short timelines.

• Type B deficiencies usually allow up to 10 calendar days unless otherwise specified.

Failure to correct within the timeframe may result in additional penalties.

Handling Type A Deficiencies Strategically

When a Type A citation is issued:

1. Correct Immediately

Take corrective action before the surveyor leaves if possible.

2. Document Thoroughly

Maintain:

• Incident reports

• Staff retraining documentation

• Updated policies

• Photographic evidence (if applicable)

3. Conduct Root Cause Analysis

Determine whether violation was:

• Isolated human error

• System failure

• Policy gap

• Staffing deficiency

CDSS expects systemic correction, not superficial fixes.

4. Implement Monitoring System

Establish:

• Monthly audits

• Supervisor review checklists

• Training refreshers

Demonstrating ongoing oversight strengthens compliance posture.

Handling Type B Deficiencies Strategically

Type B deficiencies should not be minimized. They signal operational weaknesses.

Recommended steps:

1. Correct documentation gaps immediately

2. Update policies if outdated

3. Re-educate staff

4. Conduct internal audit to identify similar issues

Multiple Type B citations across surveys may indicate patterns of non-compliance.

Public Posting Requirements

Type A citations must often be:

• Posted in a visible area

• Made available to residents and families

Deficiencies may also appear on public licensing reports.

Transparency impacts facility reputation.

Appeal Process

Facilities may appeal citations if they believe findings are inaccurate.

The appeal process generally involves:

• Written dispute submission

• Supporting documentation

• Possible administrative review

Appeals must be timely and fact-based.

Strategic review by regulatory consultants or legal counsel is recommended before initiating an appeal.

Repeat Violations and Escalation

Repeated deficiencies may result in:

• Increased civil penalties

• Compliance conference

• Conditional license

• Mandatory compliance plan

• Revocation proceedings

CDSS tracks violation history.

Facilities with recurring issues face greater enforcement intensity.

Best Practices to Prepare for CDSS Surveys

1. Conduct Quarterly Internal Mock Surveys

Audit:

• Resident files

• Medication logs

• Staff credentials

• Emergency drills

2. Maintain Survey Binder

Include:

• Administrator certificate

• Staff roster

• Training logs

• Disaster plan

• Incident log

• Infection control plan

3. Train Staff on Survey Protocol

Staff should:

• Answer truthfully

• Provide documents promptly

• Avoid speculation

4. Review Prior LIC 809 Reports

Analyze patterns and prevent recurrence.

Risk Management Considerations

CDSS survey findings can affect:

• Insurance underwriting

• Investor due diligence

• Change of ownership approvals

• Public perception

• Referral relationships

Facilities with strong compliance histories are more attractive for acquisition and partnerships.

Conclusion

The CDSS survey process for California RCFEs is structured, documentation-driven, and risk-focused. Understanding the distinction between Type A and Type B deficiencies is essential for protecting licensure and maintaining operational stability.

Type A deficiencies represent immediate threats and carry serious enforcement consequences. Type B deficiencies reflect regulatory non-compliance but still require prompt and systemic correction.

Proactive compliance systems, internal audits, and structured plans of correction significantly reduce exposure to penalties and licensing instability.

Effective RCFE administrators treat surveys as ongoing readiness exercises, not isolated events.

URL References:

California Department of Social Services – Community Care Licensing
https://www.cdss.ca.gov/inforesources/community-care-licensing

RCFE Regulations – Title 22
https://www.cdss.ca.gov/Portals/9/Regs/rcfe_regs.pdf

California Health and Safety Code – RCFE
https://leginfo.legislature.ca.gov

California Long-Term Care Ombudsman
https://aging.ca.gov/programs-and-services/long-term-care-ombudsman