California RCFEs are not licensed to provide skilled nursing care. A resident who requires G-tube (gastrostomy tube) feeding needs a formal written exception from CDSS before the facility can continue providing that care on-site.
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No. G-tube feeding is considered a skilled nursing service under California law. An RCFE cannot provide this service without a formal written exception approved by CDSS under CCR §87633 and H&SC §1569.73. Providing this care without an exception is a licensing violation.
A hospice waiver applies broadly to a resident enrolled in hospice whose total care needs exceed the RCFE's normal scope. A G-tube exception is specific to a single identified medical procedure. In some cases, both may be needed simultaneously if the resident is also receiving hospice care.
A licensed physician must issue and sign the written order for G-tube feeding. The order should include the indication, formula type, volume, rate, flush schedule, and site care instructions. This order is attached to the exception request submitted to CDSS.
Staff assisting with G-tube care must have documented training and demonstrated competency, as required by CCR §87465. Training records must be on file before the exception is implemented. The exception request should include a summary of which staff are trained and who provided the training.
Processing times vary by regional CDSS office. Submitting a complete, well-documented request with all required attachments typically results in faster review. While waiting for approval, the resident should not receive G-tube care unless a licensed professional from a home health or hospice agency is providing the service directly.