The CNA scope of practice in California is defined by Health and Safety Code sections 1337 through 1338.5 and Title 22 of the California Code of Regulations, and it draws a firm line: you may provide hands-on personal care, take and record vital signs, assist with mobility and feeding, apply non-sterile dressings to intact skin, and document your observations, all under the supervision of a licensed nurse. You may not give medications, perform anything invasive, assess patients, or make clinical decisions. Crossing that line can cost you your certification and, in some cases, bring criminal charges.
What You Can Do
Title 22 and the related regulations spell out the nursing activities a CNA is permitted to carry out. They include personal care and comfort measures, feeding, vital signs, measuring intake and output, assistance with activities of daily living, toileting assistance, bladder and bowel retraining, applying non-sterile dry dressings to intact skin, and applying over-the-counter ointments or lotions to intact skin.1Cornell Law School. California Code of Regulations Title 15, 3999.325 – Nursing Scope of Service Communicating with the patient is on the same list, which matters: emotional support and companionship are part of the job, not extras.
Vital signs sit at the center of daily CNA work. You take and record blood pressure, pulse, respiration rate, and temperature. You do not interpret those readings. What you do is recognize when something looks off and report it to the supervising nurse promptly. Early reporting of a change in condition is one of the most valuable things you do on any shift.
Mobility assistance is the other big category. You help patients transfer between beds and wheelchairs, reposition bedridden patients to prevent pressure injuries, and support walking to maintain strength and circulation. Training programs are required to cover proper body mechanics for these tasks, both to protect patients and to protect you.2New York State Department of Health. Nurse Aide Training Program and Certification
Feeding Safely
When you feed a patient with swallowing difficulties, you follow the diet plan ordered by a licensed professional. That may mean thickened liquids or pureed foods. Position the patient upright with the head of the bed at least 30 degrees, keep the chin tucked to reduce aspiration risk, and stop feeding immediately if the patient begins coughing, choking, or showing distress. You do not decide on your own to change a diet consistency or modify food texture. That is a licensed provider’s call.
Support Tasks Around the Facility
Beyond direct care, CNAs change bed linens, restock supplies, and keep patient areas clean and hazard-free. Infection control is woven through all of it. Skilled nursing facilities are required to maintain infection prevention programs that cover cleaning and disinfection of the environment and resident care equipment, with clear protocols for who cleans what.3California Department of Public Health (CDPH). Establishing an Effective Infection Prevention and Control Program in SNF You sanitize wheelchairs, walkers, and other mobility aids and make sure reusable equipment such as blood pressure cuffs and thermometers is cleaned and stored properly between patients. You may also transport lab specimens or non-controlled medications under supervision, following facility handling guidelines.
What You Cannot Do
This is where scope-of-practice trouble usually starts. California law prohibits CNAs from performing any task that requires clinical judgment, assessment, or intervention beyond their training.
- Medication administration. CNAs cannot give medications to patients. Unlike some states with formal Medication Aide certification programs, California does not authorize CNAs to administer medications independently. Some private schools offer “medication aide” courses, but completing one does not change your legal scope under California law.
- Invasive procedures. You cannot perform anything that breaks the skin or enters the body. Inserting catheters, drawing blood, administering tube feedings, and performing wound care beyond applying a simple non-sterile dry dressing to intact skin are all off-limits.1Cornell Law School. California Code of Regulations Title 15, 3999.325 – Nursing Scope of Service
- Clinical decisions. You cannot diagnose conditions, develop treatment plans, or make independent care decisions. Even adjusting a patient’s oxygen flow rate or modifying their diet requires a licensed professional’s order.
- Assessment and evaluation. Patient assessment, care planning, and evaluation belong to the registered nurse and should not be delegated to a CNA. Your role is to observe and report, not to assess.
When a Nurse Asks You to Do Something Outside Your Scope
It happens. A busy nurse may ask you to flush a catheter, change a sterile dressing, or give a patient their medication “just this once.” The answer is no, every time. You are individually responsible for staying within your scope regardless of who directs you otherwise. Decline respectfully, explain why, and if the request persists, document it and report it to the charge nurse or supervisor. A licensed nurse who delegates inappropriately is also violating their own professional standards.
Proper delegation requires that the task be appropriate, that the patient’s circumstances be stable, that the CNA have the right training, that clear instructions be given, and that adequate supervision be available. If any of those elements is missing, the delegation is improper and you are not obligated to accept it.
The Supervision You Must Work Under
CNAs are not independent practitioners in California. You work under the supervision of a licensed nurse, either an RN or an LVN. In skilled nursing facilities, staffing rules are specific. Facilities with 59 or fewer beds must have at least one RN or LVN awake and on duty at all times, day and night. Facilities with 60 to 99 beds need at least one RN or LVN on duty around the clock in addition to the director of nursing services. Facilities with 100 or more beds must have at least one RN on duty at all times in addition to the director of nursing services.4Legal Information Institute. California Code of Regulations Title 22, 72329.1 – Nursing Service – Staff
The reason is straightforward. A licensed professional must always be available for clinical decision-making and to respond when a CNA observes something that needs a higher level of intervention. In acute care hospitals, CNAs are typically assigned to specific nurses who oversee their work.
Documenting and Reporting
Accurate record-keeping is a legal obligation. Title 22 requires CNAs to document vital signs, intake and output, and observations about a patient’s condition.5Cornell Law School. California Code of Regulations Title 22, 71835 – Certification Training and Competency Evaluation Program Entries must be timely, legible, and accurate. If you make an error on paper, draw a single line through the mistake and initial the correction; never scratch out, white out, or rewrite an entry. For electronic health records, use only your own login credentials. Sharing logins is a common HIPAA problem and can result in discipline even if no patient data was compromised.
Document what you observed and what you did, not what you think it means. If a patient’s condition concerns you, report it verbally to the supervising nurse and record the observation itself. Nursing assessments, diagnoses, and physician orders are not yours to document. Falsifying records or failing to document can lead to certification revocation and legal liability.
Mandated Reporting of Abuse
Every CNA in California is a mandated reporter under Welfare and Institutions Code section 15630. If you suspect or witness abuse, neglect, or exploitation of a patient in a long-term care facility, you are legally required to report it. Timelines depend on severity:6California Department of Justice. Mandated Reporter Flow Chart
- Physical abuse with serious bodily injury: call 911 immediately, and submit a written report to the Long-Term Care Ombudsman and law enforcement within 2 hours.
- Physical abuse without serious injury: report to the LTC Ombudsman immediately or as soon as practically possible, and submit a written report to the Ombudsman and law enforcement within 24 hours.
- Non-physical abuse (emotional, financial, or other): report to the LTC Ombudsman immediately or as soon as practically possible, and submit a written report within 24 hours.
Failing to report is itself a violation. The clock starts when you observe, learn of, or reasonably suspect abuse. “I wasn’t sure” is not a defense; the law requires reporting of suspected abuse, not just confirmed abuse. Federal regulations also require that every resident in a long-term care facility be treated with respect and dignity, with rights to refuse treatment, to personal privacy during care and communications, and to confidentiality of medical records.7eCFR. Requirements for States and Long Term Care Facilities If a patient refuses a bath or a meal, document the refusal and notify the nurse. You do not force care.
What Happens If You Step Outside Your Scope
The California Department of Public Health investigates complaints against CNAs, including allegations of abuse, neglect, unprofessional conduct, and scope-of-practice violations. If a complaint is substantiated, CDPH can impose disciplinary action ranging from probation (called “diversion”) to suspension of up to 24 months to full revocation of your certification.8California Department of Public Health (CDPH). How to Report Misconduct or Abuse
For substantiated findings of abuse, neglect, or misappropriation of property, the finding is placed on the State Nurse Aide Registry under federal regulations. Once that happens, you are prohibited from working in any capacity at a facility certified for Medicare or Medicaid funding, which covers most nursing homes and hospitals in the state.9eCFR. 42 CFR 483.156 – Registry of Nurse Aides That finding effectively ends a CNA career.
Criminal exposure is separate from the administrative process. Practicing medicine or nursing without a license violates California Business and Professions Code section 2052, a “wobbler” offense. Prosecutors can charge it as a misdemeanor (up to one year in county jail and a $1,000 fine) or a felony (up to three years in prison and a $10,000 fine), depending on the circumstances and whether a patient was harmed. If your unauthorized actions injure a patient, civil negligence lawsuits are also possible, and your employer’s liability insurance will not cover tasks outside your scope.
Your Right to Appeal
If CDPH proposes to suspend or revoke your certification, you can challenge it. CDPH must mail written notice at least 20 business days before the action takes effect, explaining the charges and the supporting evidence. You then have 15 business days from receiving that notice to request an informal hearing, and CDPH must hold the hearing within 5 business days of a timely request.10Cornell Law School. California Code of Regulations Title 22, 71851 – Disciplinary Actions and Appeals One limitation: if you have already been convicted in court for the underlying conduct, you are not eligible for the informal hearing process. Miss the 15-business-day window and the proposed action takes effect as scheduled.
Keeping Your Certification Active
California CNA certification runs on a two-year cycle. To renew, you must complete at least 48 hours of in-service training or continuing education units during each two-year period, with a minimum of 12 hours per year.11California Department of Public Health (CDPH). CNA Renewal Application Federal rules add a work requirement: if you go 24 consecutive months without performing any nursing or nursing-related work for pay, you lose active status on the registry and must pass a new competency evaluation to become recertified.9eCFR. 42 CFR 483.156 – Registry of Nurse Aides
Keep documentation of every continuing education course and your employment dates. At renewal you will need to show both the training hours and proof of work in an aide capacity during the certification period. Missing a renewal deadline does not automatically erase your certification, but working with an expired credential exposes you to discipline and puts your employer at risk of regulatory violations.