Effective January 1, 2026, SB 596 requires CDPH to treat violations of nurse-to-patient ratios on separate days as separate violations. A "day" is a 24-hour period, running from midnight to midnight. If a single nursing shift violates the ratio requirements over two calendar days, CDPH will issue two separate violations to comply with SB 596.
Facilities must document their efforts to ensure compliance with nurse-to-patient staffing ratios. Facilities are not subject to an administrative penalty for violating nurse-to-patient staffing ratios if the hospital demonstrates all of the following:
- Any fluctuation in required staffing levels was unpredictable and uncontrollable.
- Prompt efforts were made to maintain required staffing levels;
- The hospital immediately used and subsequently exhausted the hospital's on-call list of nurses and the charge nurse.
SB 596 defines on-call list as a list comprised of nurses who are scheduled to be on call for the shift and unit where an alleged violation occurred, or nurses who are assigned to a regularly scheduled float pool shift to cover any shortages across one or more specified units. A hospital contacting, or attempting to contact, licensed nurses who are not scheduled to be on call and who are not assigned to a float pool for the unit and shift where an alleged violation occurred shall not be considered as exhausting an on-call list. Hospitals are responsible for providing documentation of the specific nurses and assignments assigned for each unit upon inspection.
Facilities are responsible for following all applicable laws. CDPH's failure to expressly notify facilities of statutory or regulatory requirements does not relieve facilities of their responsibility for following all laws and regulations. Facilities should refer to the full text of all applicable sections of the Health and Safety Code and Title 22 of the California Code of Regulations.
If you have any questions about this AFL, please contact your local district office.
Sincerely,
Original signed by Mandi Posner
Mandi Posner
Deputy Director
Resources:
- AFL 23-27 Nurse-to-Patient Ratios Penalties and Clarification on Unpredictable Situations Affecting Staffing Levels