California · nursing homes
California nursing home staff requirements: what you have to hold on every person
A California skilled nursing facility has to hold thirty-two dated things on file for the people it employs. Twenty-eight of them are federal and are the same in every state. Four are California's own, and the one that catches most buildings is the yearly TB test, because California never moved to the national approach of testing once and asking questions after.
What California adds
Four things, on top of everything every nursing home in the country already holds. Each one names the section of California law it comes from, so you can read it yourself rather than take our word for it.
| What we track | How often | Where the rule comes from |
|---|---|---|
| A health check when they start, and a TB test every year afterCalifornia is one of only four states that still asks for a yearly test rather than a yearly set of questions. There is no waiver. | Every year. The first one falls within 90 days before their first day, or 7 days after it. | 22 CCR 72535 |
| Forty-eight hours of teaching for every nurse aideThis sits on top of the federal twelve hours, it does not replace them. Twelve a year keeps the certificate alive; the 48 is what renews it. | 48 hours every 2 years, and never fewer than 12 in a single year | Cal. Health & Safety Code 1338.5 |
| Teaching on harassment at workThis is employment law, not a health rule. It reaches every employer with five or more people, so it covers your kitchen and your office as well as the floor. | Every 2 years. Two hours for anyone who supervises, one hour for everybody else. | Cal. Gov. Code 12950.1 |
| Teaching on violence at workAdded by SB 553 and in force since 2024. It comes with a written plan and an incident log, which are building records rather than people records. | Every year | Cal. Labor Code 6401.9 |
What California does not add
Three things are worth saying out loud, because a new director of nursing usually assumes the opposite.
California does not make you re-run a background check on a certified nurse aide. The Live Scan rides on the certificate through CDPH, not on the job, so it does not repeat each time somebody changes employer. What you are keeping is proof the certificate itself is current.
California does not require CPR or first aid for nurse aides in a skilled nursing facility. That is an assisted living rule in this state, and buildings that carry it in a nursing home carry it because they chose to, not because they were told to.
California does not set a state training list beyond the aide hours. The eleven teaching topics further down this page are federal, and they are the same in Fresno as they are in Buffalo.
Where the yearly TB test actually bites
The rest of the country reads the 2019 national guidance, which says test once when somebody starts, then ask about symptoms once a year and teach them what to look for. California kept the test.
That means a building with 90 people has 90 tests to schedule every year, spread across 90 different anniversary dates, and each one has a two-visit shape if it is a skin test rather than a blood draw. It is the single largest recurring date load in a California nursing home, and it is the one that a spreadsheet loses first, because the dates never line up into a season you can plan around.
The practical answer most buildings reach is to move everybody to a blood test and to run them in batches by hire month. That is a choice about how you work, not a rule, and nothing on this page tells you to make it.
What every nursing home in the country holds
These twenty-eight are the same in California as they are everywhere else, and they are most of the job. Each one names a CMS tag, a piece of the federal code, or both. The guides go through the ones that get cited most.
Licences and certificates
| What we track | How often | Where the rule comes from |
|---|---|---|
| A current RN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current LPN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| Nurse aide certification, still active on the state list | When it runs out. Most last a year. | F728 · 42 CFR 483.35(d) |
| A current license for therapy, social work and pharmacy staff | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current administrator license | When it runs out. Most last a year. | F836 · 42 CFR 483.70(a) |
| Proof the food service director is qualified, where no dietitian works full time | When it runs out. Most last 3 years. | F801 · 42 CFR 483.60(a)(2) |
| Proof the activities lead is qualified | When it runs out. Most last 2 years. | F680 · 42 CFR 483.24(c)(2) |
Checks you run on a person
| What we track | How often | Where the rule comes from |
|---|---|---|
| A look at the state nurse aide list before the first shift | Before their first shift, then every 2 years | F729 · 42 CFR 483.35(d)(4) |
| A check for any finding of abuse or neglect against them | Every year | F606 · 42 CFR 483.12(a)(3) |
Health and safety
| What we track | How often | Where the rule comes from |
|---|---|---|
| A first TB check: history, symptoms and a test | Once, in their first two weeks | CDC 2019 via 42 CFR 483.80(a)(2) |
| The hepatitis B shot offered free, and their answer written down | Once, within ten working days of starting | 29 CFR 1910.1030(f) |
| A mask fit test for anyone who wears an N95 | When it runs out. Most last a year. | 29 CFR 1910.134(f) |
| A current CPR card at the healthcare level | When it runs out. Most last 2 years. | F678 · 42 CFR 483.24(a)(3) |
Teaching and in-service
| What we track | How often | Where the rule comes from |
|---|---|---|
| Orientation, before they work on their own | Once, in their first week | F940 · 42 CFR 483.95 |
| Teaching on abuse, neglect and dementia care | Every year | F943 · 42 CFR 483.95(c) |
| Teaching on residents' rights | Every year | F942 · 42 CFR 483.95(b) |
| Teaching on stopping infection spreading | Every year | F945 · 42 CFR 483.95(e) |
| Teaching on the quality program | Every year | F944 · 42 CFR 483.95(d) |
| Teaching on the compliance and ethics program, if your company runs five or more buildings | Every year | F946 · 42 CFR 483.95(f) |
| Teaching on mental health and behavior needs | Every year | F949 · 42 CFR 483.95(i) |
| Teaching on talking with residents, for hands-on staff | Every year | F941 · 42 CFR 483.95(a) |
| Teaching on what to do in an emergency | Every year | 42 CFR 483.73(d)(1) |
| Teaching on blood and needle safety | Every year | 29 CFR 1910.1030(g) |
| Teaching on the chemicals they handle | When they start, and again when a new chemical arrives | 29 CFR 1910.1200(h) |
| Twelve hours of teaching for each nurse aide | 12 hours every year, counted from their own start date | F947 · 42 CFR 483.95(g) |
| A written look at how each nurse aide is doing | Every year | F730 · 42 CFR 483.35(d)(7) |
| Teaching on keeping resident information private | When they start, and again whenever your privacy policy changes | 45 CFR 164.530(b)(1) |
Employment paperwork
| What we track | How often | Where the rule comes from |
|---|---|---|
| Form I-9, filled in and kept | Once, in their first three days of work | 8 CFR 274a.2(b)(1)(ii) |
Three more that nearly every building does anyway
These three are not on the tables above, and the reason is narrow: they rest on federal guidance or on a reporting program rather than on a rule with a section number. Almost every nursing home does all three, several state Medicaid programs have made the first one a condition of payment, and a page that called them law would be a page a surveyor would stop trusting.
- A check against the federal list of people barred from Medicare and Medicaid work. Every month. A name that was clear in January can be on it in February, so this is one to run on employees and contractors alike.
- Teaching on the signs of TB. Every year. What the signs are, who is at risk, and what to do about it. Teaching, not a test.
- A flu shot, or their reason for saying no. Every year. Their answer either way, written down. The count of who said yes is what goes in the yearly report.
What you still have to check yourself
Real in California, and not on the tables above, because we could not put a section number next to them without guessing. Guessing at a citation is worse than admitting the gap, because the guess is the thing somebody quotes back.
- Whether any California statute makes you run a Live Scan on staff who hold no certificate at all, such as housekeeping and laundry. We could not find one, and not finding one is not the same as there not being one.
- Your own reading of the CDPH nurse aide and home health aide registry before a first shift. The check is real and every building does it. We have not been able to pin it to a section number, so it is not in the table above.
Where the California rows came from
Read on .
Questions California buildings ask
Does California require an annual TB test for nursing home staff?
Yes. 22 CCR 72535 asks for a health examination within 90 days before the first day of work or 7 days after it, including a TB test, and again every year. Most of the country has moved to the 2019 national approach of one test at hire and a set of questions after that. California has not, so a yearly test on every person is still the answer here.
How many training hours does a California nurse aide need?
Forty-eight hours every two years, with at least twelve of them in each single year. The twelve are also the federal floor, so a building that only counts to twelve is on track for the certificate year by year but short of the renewal total by half.
Do I have to run a new background check on a nurse aide we hire?
For a certified aide, the Live Scan is attached to the certificate through CDPH rather than to the job, so it is not repeated by each employer. What you are checking is that the certificate itself is live. For staff who hold no certificate, we could not find a statute that requires one, which is a question worth putting to your own counsel rather than taking from a web page.
Is harassment training really required in a nursing home?
Yes, and it is not a health rule at all. Cal. Gov. Code 12950.1 reaches every California employer with five or more people, so it covers dietary, housekeeping, maintenance and the office, not only clinical staff. One hour every two years for most people, two hours for anyone who supervises.
What happens if one of these dates runs out?
Nothing happens on the day itself. It becomes a problem the next time somebody asks, and the person who asks is usually a surveyor holding a list of names. A lapsed license or an inactive certificate stops that person working. A late training hour does not stop them working, but it is still a finding, and findings on the same tag in two surveys running are what turn a paperwork problem into a plan of correction.
Where to go next
- How Credolex works in a nursing home
- F947 and F943: required training, the guide behind the tag California leans on
- What Oregon asks for
- What Washington asks for
- What Texas asks for
- Every state we have read so far