Citations issued pursuant to this chapter shall be classified according to the nature of the violation and shall indicate the classification on the face thereof. (a) In determining the amount of the civil penalty, all relevant facts shall be considered, including, but not limited to, the following: (1) The probability and severity of the risk that the violation presents to the residentâs mental and physical condition. (2) The residentâs medical condition. (3) The residentâs mental condition and the residentâs history of mental disability or disorder. (4) The good faith efforts exercised by the facility to prevent the violation from occurring. (5) The licenseeâs history of compliance with regulations. (b) Relevant facts considered by the department in determining the amount of the civil penalty shall be documented by the department on an attachment to the citation and available in the public record. This requirement shall not preclude the department or a facility from introducing facts not listed on the citation to support or challenge the amount of the civil penalty in any proceeding set forth in Section 1428. (c) (1) Class âAAâ violations are violations that meet the criteria for a class âAâ violation and that the department determines to have been a substantial factor in the death of a resident of a long-term health care facility. Except as provided in Section 1424.5, a class âAAâ citation is subject to a civil penalty in the amount of not less than five thousand dollars ($5,000) and not exceeding twenty-five thousand dollars ($25,000) for each citation. In any action to enforce a citation issued under this subdivision, the department shall prove all of the following: (A) The violation was a substantial factor in the death of a resident. A substantial factor is more than a remote or trivial factor, but is not required to be the only cause of harm. (B) The death resulted from an occurrence of the nature that the regulation was designed to prevent. (C) The resident suffering the death was among the class of persons for whose protection the regulation was adopted. (2) If the department meets this burden of proof, the licensee shall have the burden of proving that the licensee did what might reasonably be expected of a long-term health care facility licensee, acting under similar circumstances, to comply with the regulation. If the licensee sustains this burden, then the citation shall be dismissed. (3) Except as provided in Section 1424.5, for each class âAAâ citation within a 12-month period that has become final, the department shall consider the suspension or revocation of the facilityâs license in accordance with Section 1294. For a third or subsequent class âAAâ citation in a facility within that 12-month period that has been sustained, the department shall commence action to suspend or revoke the facilityâs license in accordance with Section 1294. (d) (1) Class âAâ violations are violations that the department determines present either (1) imminent danger that death or serious harm to the residents of the long-term health care facility would result therefrom, or (2) substantial probability that death or serious physical harm to residents of the long-term health care facility would result therefrom. A physical condition or one or more practices, means, methods, or operations in use in a long-term health care facility may constitute a class âAâ violation. The condition or practice constituting a class âAâ violation shall be abated or eliminated immediately, unless a fixed period of time, as determined by the department, is required for correction. Except as provided in Section 1424.5, a class âAâ citation is subject to a civil penalty in an amount not less than one thousand dollars ($1,000) and not exceeding ten thousand dollars ($10,000) for each citation. (2) If the department establishes that a violation occurred, the licensee shall have the burden of proving that the lic
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