BU 17 – Health Facilities Evaluator Nurses
Weekly Update: Tuesday, July 14, 2020


On Thursday, July 9, 2020, we met with management regarding the notice to shift focus of the Health Facility Evaluator Nurse (HFEN) workforce to infection prevention education in Skilled Nursing Facilities. We also started discussion regarding management’s proposed change to the Duty Statement. Management did agree that the duty statement could have been written more clearly, and management committed to sending us a revised version of the duty statement. They were also open to hearing from members regarding what sections should be revised to be clearer. Although we advocated that a HFEN should be a part of the redrafting, management did not agree.

We understand that some members wanted to listen in on this bargaining session. However, in order to open up bargaining, both sides must be in agreement. Although we made the request, management did not agree. We had three HFENs in attendance for this meeting.

Thank you to everyone who sent us questions and provided so much input. We asked a lot of questions, and management had answers for some of them but not others. Below is a summary of the questions we asked and the responses we received. Kristanna Rivera, Deputy Director of CDPH, answered most of the questions for management’s side.

Q: With the expansion of the responsibilities for infection prevention, does the department expect to alter schedules in any way?

A: HR is not aware of any additional changes. As always, if there is a reason we need to adjust schedules based on workload, we will go through the regular noticing process. 

Q: Regarding the restoration of Alternate Work Week (AWW) schedules, the district offices seem to be doing different things. Some offices never lost their AWW schedules, some offices already went back to AWW schedules, and others are still on the M-F, 8 hour day. What is the status of this? Going back to AWW schedules would be helpful for morale.

A: We thought all DOs did put the AWWs on hold. We are not sure who did go back and who didn’t. All we can say is we will look into it and get back to you.

Q: The notice states “HFENs will be responsible for providing technical assistance, education, and training education on plans of correction and unresolved action items…” What exactly does that mean? Can you walk us through this?

A: We will have to get back to you on that.

Q: Is the expectation that HFENs go into the facilities daily? That’s different than right now.

A: In the course of doing surveys, HFENs are onsite daily sometimes. The HFENs do that now.

Q: There are concerns about increased education around infection control since that is not where their expectation and focus has been in the past. Will the department be providing additional training to HFENs regarding infection control? If the focus of the job is being modified to focus more on infection prevention education and control, how can HFENs be expected to do that if it wasn’t their focus in the academy and it wasn’t a large part of the job before?

A: We will have to get back to you on that. They aren’t training on plans of correction. They are reviewing them and following up to ensure they are correcting deficiencies. 

Q: The notice says that it is necessary to “expand the HFENs infection prevention responsibilities in the SNFs”. What does the department see as the expansion? Wouldn’t this create a conflict of interest since they are telling the facilities what to do?

A: It’s still a compliance role they fulfill. The HFENs have always had responsibility for providing the health facilities with the information on state requirements, and this is no different. With COVID, the requirements are changing. The CDC and OSHA guidance evolves as COVID evolves. We have a greater responsibility to educate them on what those requirements are. If we aren’t informing them or providing information to them, that puts them in a precarious position in terms of compliance.

Q: HFENs are concerned about liability for going in and educating in these facilities due to a potential conflict of interest. 

A: HFENs do serve as an advisor on the requirement parts of their role. I understand that some are stuck on the wording, but our intent is not to change the role. We are not trying to have them work as a consultant, and that’s not the expectation.

Q: We know that HFENs have more of a role educating because of the pandemic, but if you look at the job specifications and the duty statements, it’s more about enforcing the duties, laws, and requirements. The HFEN role is being changed, and how can they do the educating/consulting and the enforcement part as well? Doing education and enforcement doesn’t make sense.

A: That’s not outside of what’s in the scope of the classification. If there is confusion on certain statements, the department is open to providing additional clarity. Part of this was initiated in an effort to get more information on the role. If that’s still not clear, the department is open to figuring out how they will adjust it to be clearer.

Q: The notice states that the anticipated date to start was June 15, 2020, and it will continue for 8-12 months. What does that mean? Why was that time frame picked?

A: The infection prevention piece is based on current COVID conditions. As things evolve, and a vaccine is identified, things may change, which is why we put the 8-12 month duration in it. If there are major changes, we may be prompted to change. The nurses have already been focused on infection prevention for quite some time. We are just documenting that role since site surveys and citations have become the priority.

Q: We acknowledge that we are in a pandemic, but what was the purpose in changing the duty statement for all the HFENs?

A: It’s been a while since the duty statement was updated and the Center for Healthcare Quality (CHCQ) has been going through process improvement initiatives. They have a performance improvement team to improve operations and the way they do the work. Through some of those activities, they found that there could be improvement. For example, through the recruitment process, they were finding some things weren’t as clear to candidates applying to the positions about the work being done, so they wanted better clarity to the work performed.

Q: Who made the changes to the duty statement?

A: CHCQ management with their personnel liaison group. Afterwards, proposed duty statements are then sent to HR to ensure they are not exceeding the class specifications.  

Q: Is management willing to add a HFEN to the group that does changes to the duty statement?

A: Not at this time. Management is responsible for assigning work and drafting duty statements. It’s not a requirement to include staff in drafting the duty statements, and it’s within management’s rights to do so without input. There are feedback loops in process such as the all-staff calls.

Q: The notice says the HFENs primary focus would be infection control, but the duty statement says the primary responsibility is enforcement. Which one is it?

A: I shouldn’t have said primary focus, they provide greater detail on the infection activities. There is more emphasis on infection prevention in the second paragraph of essential functions in the duty statement. In their jobs as they go out and do these surveys, it is the department’s intent to focus more on infection control.

Q: So, the primary focus of HFENs is still enforcement?

A: Yes.

Q: Why did management add the word “environmental” to the third sentence under job summary, which starts with “Primary responsibility for uniform application and enforcement…?”

A: We aren’t sure. We will have to get back to you on that.

Q: The proposed duty statement states “extensive local and statewide travel will be required”. Does this mean HFENs will be required to travel more outside of their current geographic areas and do more statewide travel?

No. The intent was to document what HFENs are currently doing.

Q: Language was added that ” this position may require overnight stays, evening, weekends, and holiday surveys”. When the pandemic first started and we were working with DSS, the requirement was to be available on weekends. Is the intent here to change what HFENs are currently doing with their schedules?

A: No. This has always been the requirement on survey work, and it’s been in the job posting that “extensive travel may be required” along with other aspects of the job.  It says “may” because it depends on the assignment.

Q: Does the proposed duty statement mean that HFENs must have a valid driver’s license now?

A: No. A driver’s license is not a condition of employment for HFENs. But, if they are driving to get to surveys, they need to have a valid license, a good driving record, and drive safely regardless of whether they are using their own vehicle, a state vehicle, or a rental. If they don’t have a license, but have someone that can drop them off or use public transit, that is within the scope of what they can do to get to the assignment. 

Q: Why was the last sentence under job summary added that HFENs “will be required to wear appropriate Personal Protective Equipment (PPE) such as mask, gown, gloves, safety glasses or face shield during site visits to healthcare facilities?”

A: This could have been worded differently. We were trying to say that appropriate PPE for the particular site will be required. 

Q: Will the department be supplying PPE?

A: Yes.

Q: How often will HFENs get the supplies of PPE? How does management intend to send out the appropriate PPE to the HFENs? They are going to facilities now and going to the office to replace a mask doesn’t sound very efficient.

A: We don’t know. The district offices usually handle that. We will have to get back to you on that.

Q: When will nurses be able to get fit-tested for the N-95?

A: CHCQ is working on a contract for fit testing and the medical clearance required for the other notice regarding COVID testing. We will get back to you on a timeline.

Q: What if someone fails the fit test? What’s the plan then? What will they be equipped with?

A: We will have to look at alternative masks such as the PAPRs.

Q: How will management ensure that HFENs have proper supplies of PPE? We have had issues with PPE for many months now. The notice also adds mention of safety glasses and face shields.

A: It depends on the situation of what PPE is required. CHCQ says they have sufficient PPE for all circumstances. But it’s different depending on what activity is required. It’s different for COVID testing than it is for going into the SNFs.

Q: Does management’s PPE plan include sanitizing of N95s and other PPE equipment?

A: We don’t know. We will have to get back to you on that.

Q: On the duty statement, why did management remove the checkmark under “special requirements” for Conflict of Interest (COI)?

A: Under the “special requirement” section of the duty statement, the box for conflict of interest should have been checked on the new duty statement. That was a mistake on our part.

Q: On the duty statement, why did management add under Travel – “Mandatory – minimum of 50%”?

A: The previous duty statement already states “extensive travel will be required”. There is no different expectation regarding travel for HFENs. This relates to feedback from new candidates not realizing how much travel was required. We wanted to be clear what the existing HFENs were already doing. The 50% was an average of how much travel we believe HFENs do now.

Q: Do any of these changes affect mileage and travel rules?

A: No. The travel and mileage rules haven’t changed.

Q: For the travel, some HFENs use state cars.  How are they sanitizing? Are there enough state vehicles for the travel they are currently doing? How does management ensure they are maintained?

A: I can check/confirm where we are right now. I don’t know if there is sanitation of the state cars. That’s under DGS, and I’m not sure of their protocols.  We can see what information we can get from DGS. I thought that if it’s a DGS car, they are responsible for maintenance. I need to find out who is the point person on this at all the district offices.

Q: Some HFENs have been told that if state vehicles are available, the HFENs are expected to take it or rent a car, and that the last resort is to use their own vehicle. Is that your understanding?

A: We can check on that because I thought that had changed and employees could now use their personal vehicle if they want to. Let us get back to you on that. 

Q: Does the department have any other expectations of duties they will be doing?  If a HFEN has a certain number of facilities and there is an increased emphasis on infection prevention, what should the HFEN do differently?

A: Probably more contact based on COVID activity, may have more frequent contact on infection prevention and what the requirements are. On a regular basis (and HFENs can speak to this), they are providing them information on requirements and operation of them. The frequency of contact may not be as much as it is now.  Right now, we’re having surges in positive COVID, and that’s impacting various facilities and SNFs, and there’s a higher demand for that infection prevention. The last thing they need is to care for possible COVID and then they have an outbreak. Providing support for the facilities.

Q: We don’t fully understand the second paragraph of the proposed duty statement, under essential functions. It makes it sound like there would be more travel and more time in the facilities. We already enforce, investigate complaints, and we already get complaints about readmission to facilities with COVID. We need more explanation of what this means. Does this paragraph mean that HFENs need to be spending more time in the facilities?

A: We will have to get back to you on that. This paragraph was expanded although the end sentence is the same. There was more information added in there as far as compliance oversights that the HFENs have and in particular related to the infection prevention type activities related to COVID. With COVID, there’s a lot more involved in infection control activities in the compliance roles we play.

Q: Can you clarify what “providing consistent feedback, instruction, and education” means?

A: Yes. Will get back to you on that.

Q: The second paragraph under essential functions states that the “incumbent will not only address infection control but will also provide quality and safety oversight to SNFs and other healthcare facilities”. What does “quality and safety oversight” mean specifically?

A: It’s really compliance focused, so the wording can be adjusted.

Q: Will the HFENs get baseline testing? This is a big concern for nurses.

A: We are looking into it now because everyone in the health facilities is required to be tested because it puts us in an inconsistency to have them go in without being tested. But, we are not at the point of finalizing that yet. If we get to the point of putting a plan together, we will definitely send you a notice on that.

Q: Does the department plan on hiring more HFENs? They are being stretched thin on all the areas they are expected to perform. 

A: I think we just got some BCP positions and some are HFENs. Of course, we’d be looking at filling them and distributing them throughout the state based on the surveys at the district offices. We assess the surveyed workload in the offices. I can’t recall, but I understand there were some BCP positions in our last July 1.

Q: Since the HFENs and CDPH in general have been in the middle of dealing with this pandemic, has the department thought about providing an incentive or extra pay due to the hazards of this job right now? It would help morale dramatically.

A: We are in conversations with CalHR and not just for HFENs. We have a lot of people going into challenging environments, and we are trying to figure out the best way to recognize that. All I can say is that it’s something we are aware of and that we’re looking into it.


Management and our Union are working on dates for a follow-up meeting regarding this notice. We will also send out the revised proposed duty statement when we receive it from management. At the next meeting, we also hope to talk about the notice regarding COVID testing. We did not have enough time to get to that notice in the meeting held on Thursday, July 9th.

Please continue to email us at unit17@seiu1000.org with your questions or concerns. We will be submitting a follow-up information request to management.

You can also send management directly your ideas of areas of the duty statement that need to be clarified.