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State of California—Health and Human Services Agency
California Department of Public Health

AFL 07-08
March 23, 2007

Intermediate Care Facility (ICF)/ Developmentally Disabled (DD) - Habilitative
ICF/DD - Nursing

Blood Glucose Testing

The following is information designed to give providers and surveyors an understanding of blood glucose testing applications in the Intermediate Care Facility/Developmentally Disabled-Habilative (ICF/DD-H) and Intermediate Care Facility/Developmentally Disabled-Nursing (ICF/DD-N) facility types.

Effective January 1, 2007, AB 2564 added Section 1265.6 to the Health and Safety Code. This section allows, under specified circumstances, direct care staff employed in ICF/DD-H and N facilities, to be individually trained by registered nurses to attain competency to conduct blood glucose testing for individual consumers, as ordered by the attending physician. 

The registered nurse, within his/her scope of practice, may train direct care staff in an Intermediate Care Facility/Developmentally Disabled-Habilative or Intermediate Care Facility/Developmentally Disabled-Nursing to administer blood glucose testing for an individual residing at the facility who has diabetes, if the following criteria are met:

  1. The blood glucose testing is specifically ordered by the attending physician.
  2. The results of the testing shall be reported to a registered nurse as specified in the physician's order.
  3. Prior to performing the blood glucose testing, the direct care staff shall be trained by the registered nurse to perform the testing and shall demonstrate proficiency in performing the testing while under the immediate supervision of the registered nurse.
  4. Training of direct care staff to perform blood glucose testing shall include, but not be limited to:
    a) An overview of the basic disease process of type I and type II diabetes.
    b) Recognition of the signs and symptoms of hypoglycemia and hyperglycemia.
    c) The role of nutrition management in diabetes.
    d) Diabetes and blood sugar control.
    e) Long-term complications of diabetes.
    f) Specific instruction in utilizing and the use of specific over-the-counter glucose monitoring device that is approved by the FDA, including the cleaning and maintaining the accuracy of the client-specific glucose monitoring device.
    g) Proper infection control practices related to the use of the device, including the handling and disposal of infectious waste.
    h) Recording accurate records of blood glucose readings in the individual client medical record.
  5. Records of blood glucose readings shall be reviewed by the facility registered nurse at least monthly.
  6. A signed written statement shall be prepared by the registered nurse that includes a certification of the direct care staff's competence to perform the testing and that identifies the clients residing at the facility for whom the certification is applicable. This certification shall be placed and maintained in the direct care staff's training record.
  7. The certification of competence to perform the blood glucose testing shall be procedure and client specific, and shall not be transferred between clients residing at the facility or other facilities.
  8. The registered nurse shall be responsible for monitoring and implementing the direct care staff blood glucose testing. At least once every three months, the registered nurse shall observe and confirm the direct care staff person's proficiency in performing the approved testing and shall update the certification. The proficiency determination shall include a determination by the registered nurse that the direct care staff remains proficient in demonstrating the specified method for storage, cleaning and recalibration of the glucose monitoring device.
  9. A registered nurse shall provide continuing in-service education on the management of diabetes and the use of blood glucose monitoring devices not less than once per year and include documentation of the content of the training and the staff who were in attendance.
  10. The facility shall develop a written policy and procedure outlining blood glucose testing for clients residing at the facility that shall include procedures for the training and competency assessment of direct care staff as required by statute.
  11. The facility shall obtain a certificate of waiver pursuant to subdivision (n) of Section 483.460 of Part 42 of the Code of Federal Regulations prior to the implementation of blood glucose testing. The certificate shall be available for inspection by the Department.

It is the responsibly of each facility to assure the health and safety of each consumer under their care. Therefore, the registered nurse shall assume the responsibility for the accuracy of the testing and reporting of results, the overall health care plan and management for the individual consumer with diabetes and report changes in health care status immediately to the attending physician as required by regulation.

Should you have questions about this informative bulletin, please contact Elaine Rawes, RN, Department of Health Services, Licensing and Certification, at (916) 552-8750, or email her at


Original Signed by Kathleen Billingsley, R.N.

Kathleen Billingsley, R.N.
Deputy Director

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