Subject 111-8-63 RULES AND REGULATIONS FOR ASSISTED LIVING COMMUNITIES
The legal authority for this Chapter is found in O.C.G.A.
§§ 31-2-7
and Chapter 7 of Title 31.
The purpose of these rules and regulations is to establish
the minimum standards for the operation of personal care homes to be licensed
as assisted living communities. Such communities provide assisted living care
to adults who require varying degrees of assistance with the activities of
daily living but who do not require continuous medical or nursing
care.
In these rules, unless the context otherwise requires, the
words, phrases and symbols set forth herein shall mean the following:
| (a) |
"Abuse" means any intentional or grossly
negligent act or series of acts or intentional or grossly negligent omission to
act which causes injury to a resident, including but not limited to, assault or
battery, failure to provide treatment or care, or sexual harassment of the
resident. |
| (b) |
"Activities of daily
living" means bathing, shaving, brushing teeth, combing hair, toileting,
dressing, eating, walking, transferring from place to place, laundering,
cleaning room, managing money, writing letters, shopping, using public
transportation, making telephone calls, grooming, obtaining appointments,
engaging in leisure and recreational activities, or other similar
activities. |
| (c) |
"Administrator"
means the manager designated by the Governing Body as responsible for the
day-to-day management, administration and supervision of the assisted living
community, who may also serve as the on-site manager and responsible staff
person except during periods of his or her own absence. |
| (d) |
"Applicant" means an individual or entity
that submits an application for licensure pursuant to these rules as described
below:
| 1. |
When the assisted living community
is owned by a sole proprietorship, the individual proprietor must be the
applicant for the license, complete the statement of responsibility and serve
as the licensee; |
| 2. |
When the
assisted living community is owned by a partnership, the general partners must
be the applicant for the license, complete the statement of responsibility and
serve as the licensee; |
| 3. |
When the
assisted living community is owned by an association, limited liability company
(LLC) the governing body of the association or LLC must authorize the
application for the license, complete the statement of responsibility and serve
as the licensee; and |
| 4. |
When the
assisted living community is owned by a corporation, the governing body of the
corporation must authorize the application for the license, complete the
statement of responsibility and serve as the licensee. |
|
| (e) |
"Assistive device" means a device that
may restrain movement which has been determined to be required by a licensed
physician, nurse practitioner or physician's assistant working under a protocol
or job description respectively and is applied for protection from injury or to
support or correct the body alignment of the person, for the treatment of a
person's physical condition, and may only be used as a treatment intervention
where a specific written plan of care has been developed and the resident
consents to such use. |
| (f) |
"Assisted
living care" means the specialized care and services provided by an assisted
living community which includes the provision of personal services, the
administration of medications by a certified medication aide and the provision
of assisted self-preservation. |
| (g) |
"Assisted living community" or "community" means a personal care home serving
25 residents or more that is licensed by the department to provide assisted
living care. |
| (h) |
"Assisted
self-preservation" means the capacity of a resident to be evacuated from an
assisted living community to a designated point of safety and within an
established period of time as determined by the Office of Fire Safety
Commissioner. Assisted self-preservation is a function of all of the following:
| 1. |
the condition of the individual, |
| 2. |
the assistance that is available to be
provided to the individual by the staff of the assisted living community;
and |
| 3. |
the construction of the
building in which the assisted living community is housed, including whether
such building meets the state fire safety requirements applicable to an
existing health care occupancy. |
|
| (i) |
"Chemical Restraint" means a
psychopharmacologic drug that is used for discipline or convenience and not
required to treat medical symptoms. |
| (j) |
"Department" means the Department of
Community Health of the State of Georgia operating through the Division of
Healthcare Facility Regulation. |
| (k) |
"Director" means the chief administrator, executive officer or
manager. |
| (l) |
"Disabled individual"
means an individual that has a physical or mental impairment that substantially
limits one or more major life activities and who meets the criteria for a
disability under state or federal law. |
| (m) |
"Employee" means any person, other than a
director, utilized by an assisted living community to provide personal services
to any resident on behalf of the assisted living community or to perform at any
facilities of the assisted living community any duties which involve personal
contact between that person and any paying resident of the assisted living
community. |
| (n) |
"Exploitation" means
an unjust or improper use of another person or the person's property through
undue influence, coercion, harassment, duress, deception, false representation,
false pretense, or other similar means for one's own personal
advantage. |
| (o) |
"Governing Body"
means the owner, the board of trustees or directors, the partnership, the
corporation, the association, the sole proprietorship or the person or group of
persons who maintains and controls the assisted living community and who is
legally responsible for the operation of the community. |
| (p) |
"Health maintenance activities" means
those limited activities that, but for a disability, a person could reasonably
be expected to do for himself or herself. Such activities are typically taught
by a registered professional nurse, but may be taught by an attending
physician, advanced practice registered nurse, physician assistant, or directly
to a patient and are part of ongoing care. Health maintenance activities are
those activities that do not include complex care such as administration of
intravenous medications, central line maintenance, and complex wound care; do
not require complex observations or critical decisions; can be safely performed
and have reasonably precise, unchanging directions; and have outcomes or
results that are reasonably predictable. Health maintenance activities
conducted pursuant to this paragraph shall not be considered the practice of
nursing. |
| (q) |
"Health services"
means the specialized assistance that may be provided by or at the direction of
either licensed healthcare professionals, such as doctors, nurses, physical
therapists or through licensed healthcare programs, such as home health
agencies, hospices and private home care providers to address health needs that
the assisted living community is not staffed to provide or is not authorized by
law or regulations to provide. |
| (r) |
"Injury" as used in the definition of "abuse" means a wrong or harm caused by
an individual to a resident which is manifested by a physical or behavioral
reaction or change in the appearance or actions of the resident, such as, but
not limited to, reddened or bruised skin not related to routine care, crying,
startling or cowering reaction by the resident and malnutrition or pressure
ulcers for which the facility has not provided proper care. |
| (s) |
"Legal Surrogate" means a duly appointed
person who is authorized to act, within the scope of the authority granted
under the legal surrogate's appointment, on behalf of a resident who is
adjudicated incapacitated. |
| (t) |
"Medical services" means services which may be provided by a person licensed
pursuant to Article II of Chapter 34 of Title 43 of the Official Code of
Georgia Annotated. |
| (u) |
"Memory care
services" means the additional watchful oversight systems and devices that are
required for residents who have cognitive deficits which may impact memory,
language, thinking, reasoning, or impulse control, and which place the
residents at risk of eloping, i.e. engaging in unsafe wandering activities
outside the assisted living community. |
| (v) |
"Memory care unit" means the assisted
living community or specialized unit, thereof, that either holds itself out as
providing additional or specialized care to persons with diagnoses of probable
Alzheimer's Disease or other dementia who may be at risk of engaging in unsafe
wandering activities outside the unit or assisted living community (eloping) or
charges rates in excess of those charged other residents because of cognitive
deficits which may place the residents at risk of eloping. |
| (w) |
"Non-Family Adult" means a resident 18
years of age or older who is not related by blood within the third degree of
consanguinity or by marriage to the person responsible for the management of
the assisted living community or to a member of the governing body. |
| (x) |
"Nursing services" means those services
which may be rendered by a person licensed pursuant to Articles I and 2 of
Chapter 26 of Title 43 of the Official Code of Georgia Annotated. |
| (y) |
"On-site manager" means the administrator
or person designated by the administrator as responsible for carrying out the
day-to-day management, supervision, and operation of the assisted living
community, who may also serve as responsible staff person except during periods
of his or her own absence. |
| (z) |
"Owner" means any individual or any person affiliated with a corporation,
partnership, or association with 10 percent or greater ownership interest in
the business or agency licensed as an assisted living community and who:
| 1. |
purports to or exercises authority of an
owner in the business or agency; |
| 2. |
applies to operate or operates the business or agency; |
| 3. |
maintains an office on the premises of the
assisted living community; |
| 4. |
resides at the assisted living community; |
| 5. |
has direct access to persons receiving
care at the assisted living community; |
| 6. |
provides direct personal supervision of
assisted living community personnel by being immediately available to provide
assistance and direction during the time such assisted living community
services are being provided; or |
| 7. |
enters into a contract to acquire ownership of such a business or
agency. |
|
| (aa) |
"Permit" or
"license" means the authorization granted by the Department to the governing
body to operate an assisted living community. |
| (bb) |
"Personal care home" means any dwelling,
whether operated for profit or not, which undertakes through its ownership or
management to provide or arrange for the provision of housing, food service,
and one or more personal services for two or more adults who are not related to
the owner or administrator by blood or marriage. |
| (cc) |
"Personal Services" includes, but is not
limited to, individual assistance with or supervision of self-administered
medication, assistance, essential activities of daily living such as eating,
bathing, grooming, dressing, toileting, ambulation and transfer. |
| (dd) |
"Proxy caregiver" means an unlicensed
person or a licensed health care facility that has been selected by a disabled
individual or a person legally authorized to act on behalf of such individual
to serve as such individual's proxy caregiver and meets the requirements
contained in the Rules and Regulations for Proxy Caregivers Used in Licensed
Healthcare Facilities, Chapter 111-8-100. |
| (ee) |
"Physical Restraints" are any manual or
physical device, material, or equipment attached or adjacent to the resident's
body that the individual cannot remove easily which restricts freedom or normal
access to one's body. Physical restraints include, but are not limited to, leg
restraints, arm restraints, hand mitts, soft ties or vests, and wheelchair
safety bars. Also included as restraints are assisted living community
practices which function as a restraint, such as tucking in a sheet so tightly
that a bedbound resident cannot move, bedrails, or chairs that prevent rising,
or placing a wheelchair-bound resident so close to a wall that the wall
prevents the resident from rising. Wrist bands or devices on clothing that
trigger electronic alarms to warn staff that a resident is leaving a room do
not, in and of themselves, restrict freedom of movement and should not be
considered as restraints. |
| (ff) |
"Plan of Correction" means the written plan prepared in response to cited rule
violations that identifies by date certain the specific actions that will be
taken by the assisted living community to come into compliance with these
rules. |
| (gg) |
"Representative" means
a person who voluntarily, with the resident's written authorization, acts upon
resident's direction with regard to matters concerning the health and welfare
of the resident, including being able to access personal and medical records
contained in the resident's file and receive information and notices pertaining
to the resident's overall care and condition. This written authorization may
take the form of an advance directive. |
| (hh) |
"Resident" means any non-family adult
who receives or requires assisted living care and resides in the assisted
living community. |
| (ii) |
"Responsible
Staff Person" means the employee designated by the administrator or on-site
manager as responsible for supervising the operation of the assisted living
community during periods of temporary absence of the administrator or on-site
manager. |
| (jj) |
"Self-administration
of medications" or "self-administered medications" means those prescription or
over-the-counter drugs that the resident personally chooses to ingest or apply
where the resident has been assessed and determined to have the cognitive
skills necessary to articulate the need for the medication and generally knows
the times, and physical characteristics of medications to be taken. |
| (kk) |
"Self-preservation" means the ability to
respond to an emergency condition, whether caused by fire or otherwise, and
escape the emergency without physical, hands-on assistance from staff. The
resident may move from place to place by walking, either unaided or aided by
prosthesis, brace, cane, crutches, walker or hand rails, or by propelling a
wheelchair. |
| (ll) |
"Staff" means any
person who performs duties in the assisted living community on behalf of the
assisted living community. |
These regulations do not apply to the following
facilities:
| (a) |
boarding homes or
rooming houses which provide no services other than lodging and
meals; |
| (b) |
facilities offering
temporary emergency shelter, such as those for the homeless and victims of
family violence; |
| (c) |
other
facilities, homes or residences licensed by the department which have not been
classified as assisted living communities, e.g. community living arrangements,
personal care homes, hospices, traumatic brain injury facilities; |
| (d) |
facilities providing residential services
for federal, state or local correctional institutions under the jurisdiction of
the criminal justice system; |
| (e) |
charitable organizations providing shelter and other services without charging
any fee to the resident or billing any fee on behalf of the
residents; |
| (f) |
group residences
organized by or for persons who choose to live independently or who manage
their own care and share the cost of services including but not limited to
attendant care, transportation, rent, utilities and food preparation; |
| (g) |
facilities licensed by the Department of
Behavioral Health, Developmental Disabilities and Addictive Diseases;
or |
| (1) |
The governing body of each assisted
living community must submit to the Department an application for a permit in
order to operate. |
| (2) |
The
application for a permit must be made on forms made available by the Department
or in a format acceptable to the Department. |
| (3) |
No application for licensure will be
acted upon by the Department unless it has been determined to be complete and
include all required attachments and fees due the Department as specified in
the Rules and Regulations for General Licensing and Enforcement Requirements,
Chapter 111-8-25. |
| (4) |
Each
application for a permit must be accompanied by an accurate floor plan showing
windows, doors, common areas, and resident room measurements and digital copies
in .jpg format of pictures of the assisted living community's exterior, common
areas and typical resident room. |
| (5) |
The name of the administrator or on-site
manager, who will be working in the assisted living community, if known, must
be included with the application for a permit. If such information is not known
at the time of application, it must be provided to the Department before a
permit will be issued. |
| (6) |
The
ownership of the assisted living community must be fully disclosed in the
application for a permit. In the case of corporations, partnerships, and other
entities recognized by statute, the corporate officers and all other
individuals or family groups owning ten percent or more of the corporate stock
or ownership must be disclosed in the application, as well as the registered
agent for service of process. |
| (7) |
Each application must include documentation of ownership or lease agreement for
the property on which the assisted living community will be operated. |
| (8) |
The filing of an application for
licensure constitutes a representation that the applicant is or will be in
complete control of the community as of a specified date. |
| (9) |
Local zoning and other local requirements
regarding the proper location and establishment of the assisted living
community must be addressed by the applicant with the responsible local
officials. |
| (1) |
The governing
body of each assisted living community must obtain a valid permit from the
Department to provide assisted living care prior to admitting any
residents. |
| (2) |
The permit must be
displayed on the premises in a conspicuous place that is visible to residents
and visitors. |
| (3) |
Permits are not
transferable from one assisted living community or location to
another. |
| (4) |
A permit must be
returned to the Department and is no longer valid when any of the following
events occurs:
| (a) |
The assisted living
community is moved to another location which has not been licensed. |
| (b) |
The ownership of the community
changes. |
| (c) |
The permit is
suspended or revoked. |
|
| (5) |
A separate permit is required for each
assisted living community located on different premises. |
| (6) |
An assisted living community must not
serve more residents than its approved licensed capacity, which is listed on
the face of the permit issued by the Department. |
| (7) |
An assisted living community must provide
assisted living care as authorized by law and these rules. |
| (8) |
An assisted living community must
disclose its licensure classification as an assisted living community in its
marketing materials. |
| (9) |
An
assisted living community must not operate or allow another business to operate
on the premises of the assisted living community where the business intrudes on
the residents' quiet enjoyment and exclusive use of the premises, in any way.
|
| (1) |
The assisted living community must have a
functioning governing body which is responsible for providing the oversight
necessary to ensure that the community operates in compliance with these rules,
the Rules for General Licensing and Enforcement, Chapter 111-8-25, the Rules
for Proxy Caregivers, Chapter 111-8-100, as applicable and other applicable
state laws and regulations. |
| (2) |
The
governing body is responsible for implementing policies, procedures and
practices in the community that support the core values of dignity, respect,
choice, independence and privacy of the residents in a safe environment and in
accordance with these rules. At a minimum, the policies and procedures that are
developed must provide direction for the staff and residents on the following:
| (a) |
the services available in the assisted
living community, including, personal services, assisted living care, memory
care services and any other specialized services such as,,memory care units and
designated proxy caregivers; |
| (b) |
the staffing plan that the community utilizes to ensure that staffing ratios
increase proportionally as the number of residents who require assisted
self-preservation increases; |
| (c) |
admissions, discharges and immediate transfers which ensure that the community
does not admit or retain residents who need more care that the assisted living
community is authorized or capable of providing; |
| (d) |
refunds when a resident is transferred or
discharged; |
| (e) |
training and
ongoing evaluation of staff, including specialized training if designated proxy
caregivers are provided or memory care is offered; |
| (f) |
house rules and their
enforcement; |
| (g) |
protecting the
rights of the residents as set forth in these rules; |
| (h) |
medication management, procurement, the
use of certified medication aides and professional oversight provided for such
services; |
| (i) |
health and hygiene
issues for residents and staff relating to infection control, work policies and
return to work policies, food borne illnesses and reportable
diseases; |
| (j) |
the investigation and
reporting of abuse, neglect, exploitation of residents, residents' wandering
away from the community, accidents, injuries and changes in residents'
conditions to required parties; |
| (k) |
discipline procedures for handling acts committed by staff which are
inconsistent with the policies of the assisted living community; |
| (l) |
emergency preparedness, drills and
evacuation requirements; |
| (m) |
quality assurance review mechanisms, including resident and family feedback to
determine opportunities for improving care; |
| (n) |
the use of volunteers and their
orientation regarding resident's rights and basic safety precautions; |
| (o) |
the specific use of proxy caregivers
allowed within the community and the oversight of proxy caregivers the
community requires or provides in accordance with Georgia law, these rules and
the rules for proxy caregivers, Chapter 111-8-100; and |
| (p) |
the safety and security precautions that
will be employed by the assisted living community to protect residents from
harm by other residents, designated proxy caregivers, and other individuals,
not employed by the community who routinely come into the community. |
|
| (3) |
The governing body must
designate an administrator or on-site manager as responsible for the overall
management of the assisted living community and for carrying out the rules and
policies adopted by the governing body. |
| (4) |
The governing body must ensure that the
Department has current emergency contact information consisting of name, e-mail
contact for notifications to the licensed community, physical addresses, and
phone numbers for the governing body and the administrator or on-site manager
of the assisted living community. |
| (5) |
The governing body must take appropriate
measures within its control, to protect the residents from criminal activity
occurring in the assisted living community. |
| (6) |
The governing body must not allow persons
who are not residents of the assisted living community to live on the premises
if they are listed on the National Sex Offender Registry. |
| (7) |
No member of the governing body,
administration, or staff of the assisted living community or an affiliated
assisted living community or family members of the governing body or any staff
may serve as the legal surrogate or representative of a resident. |
| (8) |
Where the governing body, a member of the
governing body's family or a staff member of the assisted living community or
an affiliated assisted living community serves as the representative payee of a
resident, the individual or entity must be covered by a surety bond. |
| (1) |
Each community must have a full-time
administrator to provide day-to-day leadership to the community. The
administrator must meet the following qualifications:
| (a) |
The individual must be 21 years of age or
older, and |
| (b) |
The individual must
satisfy at least one of the following educational criteria:
| 1. |
a bachelor's degree from an accredited
college or university plus 1 year's experience in a health or aging related
setting; |
| 2. |
an associate's degree
from an accredited college or university, plus 2 years' experience working in a
personal care, health or aging related setting, including 1 year in a
leadership or supervisory position; |
| 3. |
a license as a nursing home
administrator; |
| 4. |
certification by
a nationally recognized educational provider or license issued by another state
as a nursing home administrator or an assisted living facility administrator
where the curriculum addresses in detail the knowledge and skills necessary to
manage a nursing home or an assisted living community; or |
| 5. |
a GED or HS diploma and a total 4 years
experience working in a licensed personal care home or other health-related
setting which has included at least 2 years supervisory experience. |
|
|
| (2) |
The administrator
is responsible for ensuring that the policies and procedures are effective and
enforced to ensure compliance with these rules and community policies and
procedures. |
| (3) |
Each assisted
living community must have a separate administrator or on-site manager who
works under the supervision of the administrator. |
| (4) |
The administrator or on-site manager must
designate qualified staff as responsible staff to act on his or her behalf and
to carry out his or her duties in the absence of the administrator or on-site
manager. |
| (5) |
Residents must not be
allowed to function or be counted as staff. |
| (6) |
Staff must be assigned duties consistent
with their positions, training, experiences, and the requirements of Rule
111-8-63-.09. |
| (7) |
The administrator is responsible for
ensuring that the assisted living community has an effective quality assurance
program which includes at least the following:
| (a) |
investigating resident incidents which
result in injuries or death in order to identify and implement opportunities
for improvement in care; |
| (b) |
implementing changes made to support improved care, such as those necessary to
minimize illness outbreaks and eliminate identified rule violations; |
| (c) |
monitoring staff performance to ensure
that care and services are being delivered safely and in accordance with these
rules and community policies; and |
| (d) |
obtaining and using feedback from the
residents and representatives, at least annually, on the quality of services
provided by the community and opportunities for improvement of services.
|
|
| (1) |
The on-site manager and responsible
staff persons must be at least 21 years of age and responsible for supervising
the provision of care by all other staff. No staff person under the age
of 18 is permitted to work in the assisted living community unless there is
direct line-of-sight supervision being provided by the administrator, on-site
manager or a responsible staff person or the staff member is at least 17 years
of age and has successfully completed a vocational technical training track as
a nursing assistant through a Georgia high school. |
| (2) |
Initial Training for All
Staff. The administrator or on-site manager must ensure that any person
working in the assisted living community as staff, receives training within the
first 60 days of employment on the following:
| (a) |
residents' rights and identification of
conduct constituting abuse, neglect or exploitation of a resident and reporting
requirements to include the employee's receipt of a copy of the Long-Term Care
Facility Resident Abuse Reporting Act as outlined in O.C.G.A. § 31-8-81et
seq.; |
| (b) |
general
infection control principles including importance of hand hygiene in all
settings and attendance policies when ill; |
| (c) |
training necessary to carry out assigned
job duties; and |
| (d) |
emergency
preparedness. |
|
| (3) |
Initial Training for Staff Providing Hands-On Personal Services.
In addition to the initial training required of all staff in paragraph (2)
above, the administrator must ensure that staff hired to provide hands-on
personal services to residents receive training within the first 60 days of
employment which includes the following:
| (a) |
current certification in emergency first aid except where the staff person is a
currently licensed health care professional; |
| (b) |
current certification in cardiopulmonary
resuscitation where the training course required return demonstration of
competency; |
| (c) |
medical and social
needs and characteristics of the resident population, including special needs
of residents with dementia; |
| (d) |
residents' rights and the provision of care to residents that is individualized
and helpful; and |
| (e) |
training
specific to assigned job duties, such as, but not limited to, permissible
assistance with medications, contraindications for medications that must be
brought to the attention of appropriate individuals, assisting residents in
transferring, ambulation, proper food preparation, proper performance of health
maintenance activities if serving as a designated proxy caregiver and
responding appropriately to dementia-related behaviors. |
|
| (4) |
Trained Staff Present. At
least one staff person who has completed the minimum training requirements of
Rule 111-8-63-.09(2)(a) through (d) and (3)(a) through (e) above must be
present in the assisted living community at all times any residents are present
to provide necessary oversight and assistance to staff providing hands-on
personal services who have not completed the training, to ensure that care and
services are delivered safely and in accordance with these rules. |
| (5) |
Training Hours Required During
First Year of Employment. All staff offering hands-on personal services
to the residents, including the administrator or on-site manager, must
satisfactorily complete a total of at least twenty-four (24) hours of
continuing education within the first year of employment as a direct care
worker. Staff providing hands-on personal services in a specialized memory care
unit, must have 8 hours training related specifically to dementia care,
included in their 24 hours of first-year employment training. The courses
offered must be relevant to assigned job duties and include such topics as
cardiopulmonary resuscitation and first aid certifications, utilizing standard
precautions in working with aging residents, working with residents with
Alzheimer's or other cognitive impairments, working with persons who have
developmental disabilities or persons who have mental illness, providing social
and recreational activities, understanding legal issues, performing necessary
physical maintenance, fire safety, housekeeping activities, recognizing and
reporting abuse, neglect and exploitation, preparing and serving food safely,
preserving the dignity and rights of residents receiving care to make
meaningful choices, providing and documenting medication assistance, or other
topics as determined necessary by the Department to support
compliance. |
| (6) |
Ongoing Staff
Training. Beginning with the second year of employment, staff providing
hands-on personal services must have a minimum of sixteen (16) hours of
job-related continuing education as referenced in paragraph 111-8-63-.09(5)
above annually. For staff providing hands-on personal services in the memory
care unit, at least two hours of the ongoing continuing education required each
year must be devoted specifically to training relevant to caring for residents
with dementia. |
| (7) |
Training
Records. The community must maintain documentation reflecting course
content, instructor qualifications, agenda and attendance rosters for all
trainings provided. |
| (8) |
Proxy
Caregiver Training. An assisted living community employing proxy
caregivers must provide training to the proxy caregivers in accordance with the
Rules and Regulations for Use of Proxy Caregivers, Chapter 111-8-100 subject to
the limitation that only certified medication aides may administer medications
on behalf of the community. |
| (9) |
Hospice Training. The assisted living community shall ensure that
any medication aide(s) who will be administering liquid morphine to any hospice
patient(s) residing in the community receive adequate training from a licensed
hospice on the safe and proper administration of liquid morphine prior to such
administration and on an annual basis thereafter. The community shall maintain
documentation of all training provided. |
| (10) |
Staff Health Examinations and
Screenings. The administrator, on-site manager, and each employee must
have received a tuberculosis screening and a physical examination by a licensed
physician, nurse practitioner or physician's assistant within twelve months
prior to providing care to the residents. The physical examination must be
sufficiently comprehensive to assure that the employee is physically qualified
to work and free of diseases communicable within the scope of employment.
Follow-up examinations must be conducted by a licensed physician, nurse
practitioner or physician's assistant for each administrator or staff person to
determine readiness to return to work following a significant illness or
injury. Health information, screenings, assessments and medical releases
regarding each staff member must be retained in a readily retrievable format by
the assisted living community and made available for review and/or copying by
Department representatives upon request. |
| (11) |
Criminal History Background Checks
for Owners Required. The owner of the business or agency applying for
the license must comply with the requirements of the Rules and Regulations for
Criminal Background Checks, Chapter 111-8-12. |
| (12) |
Criminal History Background Checks
for Director, Administrator and Onsite Manager Required. Prior to
serving as a director, administrator or onsite manager of an assisted living
community, the community must obtain a satisfactory fingerprint records check
determination for the person to be hired in compliance with the Rules and
Regulations for Criminal Background Checks, Chapter 111-8-12. |
| (13) |
Criminal History Background Checks
for Direct Access Employees Required. Prior to serving as a direct
access employee, the community must obtain a satisfactory fingerprint records
check determination for the person to be hired in compliance with the Rules and
Regulations for Criminal Background Checks, Chapter 111-8-12. |
| (14) |
The administrator or on-site manager
must obtain an employment history for each employee and maintain documentation
in the employee's file. If the potential employee has no prior employment
history, then the assisted living community must retain documentation of a
satisfactory personal reference check. |
| (15) |
Personnel files must be maintained in
the assisted living community for each employee and for three years following
the employee's departure or discharge. These files must be available for
inspection by departmental staff but must be maintained to protect the
confidentiality of the information contained in them from improper disclosure.
The files must include the following:
| (a) |
evidence of a satisfactory fingerprint record check determination, if
applicable; |
| (b) |
report of physical
examination completed by a licensed physician, nurse practitioner or
physician's assistant, and a TB screening completed within the 12 months
preceding the date of hire; |
| (c) |
evidence of trainings, skills competency determinations and recertifications as
required by these rules and, if applicable, the Rules for Proxy Caregivers,
Chapter 111-8-100; |
| (d) |
employment
history, including previous places of work, employers and telephone contacts
with previous employers; |
| (e) |
supporting documentation reflecting that the employee has the basic
qualifications as represented, e.g. documentation of good standing by nursing
board, no findings of abuse, neglect or exploitation entered against the
individual in the nurse aide registry, satisfactory report of motor vehicle
driving record where the employee may be transporting residents; and |
| (f) |
written evidence of satisfactory initial
and annual work performance reviews for unlicensed staff providing hands-on
personal care. Where the unlicensed staff perform specialized tasks, such as
health maintenance activities, assistance with medications or medication
administration, such performance reviews must include the satisfactory
completion of skills competency checklists as specified in applicable rules.
Such reviews must be conducted by staff or contractors qualified by education,
training and experience to assess that the assigned duties are being performed
in accordance with these rules and accepted health and safety
standards. |
|
| (16) |
Where the
assisted living community permits a resident to hire his or her own
companion-sitter, proxy caregiver to perform health maintenance activities or
aide of any sort, the assisted living community must require assurance that the
companion-sitter, proxy caregiver or aide so hired is familiar with emergency
evacuation routes and has documentation reflecting compliance with the
provisions of the Rules for Proxy Caregivers, Chapter 111-8-100, as
applicable. |
| (17) |
The administrator,
on-site manager, and staff persons must not be under the influence of alcohol
or other controlled substances while engaged in any work-related activity on
behalf of the assisted living community. |
| (18) |
The community must maintain a minimum
on-site staff to resident ratio of one awake direct care staff person per 15
residents during waking hours and one awake direct care staff person per 25
residents during non-waking hours where the residents have minimal care needs.
However, the assisted living community must staff above these minimum on-site
staff ratios to meet the specific residents' ongoing health, safety and care
needs.
| (a) |
Staff, such as cooks and
maintenance staff, who do not receive on-going direct care training and whose
job duties do not routinely involve the oversight or delivery of direct
personal care to the residents, must not be counted towards these minimum
staffing ratios. Personnel who work for another entity, such as a private home
care provider, hospice, etc. or private sitters cannot be counted in the staff
ratios for the assisted living community. |
| (b) |
At least one administrator, on-site
manager, or a responsible staff person must be on the premises 24 hours per day
providing supervision whenever residents are present. |
| (c) |
Residents must be supervised consistent
with their needs. |
|
| (19) |
Sufficient staff time must be provided by the assisted living community such
that each resident:
| (a) |
receives services,
treatments, medications and diet as prescribed; |
| (b) |
receives proper care to prevent decubitus
ulcers and contractures; |
| (c) |
is
kept comfortable and clean; |
| (d) |
is
treated with dignity, kindness, and consideration and respect; |
| (e) |
is protected from avoidable injury and
infection; |
| (f) |
is given prompt,
unhurried assistance if she or he requires help with eating; |
| (g) |
is given assistance, if needed, with
daily hygiene, including baths and oral care; and |
| (h) |
is given assistance in transferring and
assisted self-preservation when needed. |
|
| (20) |
All persons, including the administrator
or on-site manager, who offer direct care to the residents on behalf of the
assisted living community, must maintain an awareness of each resident's normal
appearance and must intervene, as appropriate, if a resident's state of health
appears to be in jeopardy. |
| (21) |
All
assisted living communities must develop and maintain accurate staffing plans
that take into account the specific needs of the residents and monthly work
schedules for all employees, including relief workers, showing planned and
actual coverage for each day and night. The assisted living community must
retain the completed staff schedules for a minimum of one year. |
| (22) |
Staff must wear employee identification
badges which are readily visible with abbreviations for professional/special
credentials displayed on the badges, if any. |
| (1) |
The records required by these rules and
other records maintained in the normal course of the business of the community
must be available for inspection and review by properly identified
representatives of the Department. |
| (2) |
Where the Department identifies rule
violations, the assisted living community will receive a written report of
inspection. If the assisted living community disagrees with the facts and
conclusions stated in the inspection report, it must submit its written
statement explaining its disagreement and any evidence supporting the
disagreement to the Department within 10 days of the receipt of the written
inspection report. Where the Department concurs with the written statement of
the assisted living community, it will issue a revised inspection report to the
assisted living community. |
| (3) |
Within 10 days of receipt of the written report of inspection, the assisted
living community must develop a written plan for correcting any rule violations
identified. The plan of correction must identify the specific actions that the
assisted living community will take by date certain to come into compliance
with each rule for which a deficient practice was identified. |
| (4) |
A copy of the most recent inspection
report and plan of correction must be displayed in the assisted living
community in a location that is routinely used by the community to communicate
information to residents and visitors. Additionally, if the community maintains
a website, it shall post a web link in a prominent location on the main page of
the website that provides access to copies of all inspection reports and plans
of correction from the previous 18 months. When the Department develops a
website for receiving plans of correction electronically and notifies the
community of the appropriate internet address, the community also must file its
plan of correction electronically on the Department's website within 10 days of
receipt of the report of inspection. |
| (5) |
The assisted living community must take
the corrective actions necessary to achieve compliance with the
rules. |
| (6) |
The assisted living
community must complete and maintain an accurate and current licensed
residential care profile on file with the Department when the Department makes
available a system for the submission and collection of such information
electronically. |
| (7) |
The assisted
living community must provide services that are consistent with the information
reported on its licensed residential care profile, its license and these
rules. |
| (8) |
The assisted living
community's marketing materials must be consistent with its licensure
classification as an assisted living community, the information reported on its
licensed residential care profile, and these rules. |
| (9) |
Only an assisted living community
licensed pursuant to these rules may hold itself out as offering assisted
living care. |
| (1) |
An assisted living community shall be
designed, constructed, arranged, and maintained so as to provide for all of the
following:
| (a) |
health, safety, and well-being
of the residents; |
| (b) |
independence,
privacy and dignity of the residents; and |
| (c) |
safe access of all residents with varying
degrees of functional impairments to living, dining and activity areas within
the assisted living community. |
|
| (2) |
An assisted living community which
undergoes major structural renovation or is first constructed after the
effective date of these rules must be designed and constructed in compliance
with applicable state and local building and fire codes. |
| (3) |
The assisted living community must have
handrails, doorways and corridors which accommodate mobility devices, such as
walkers, wheel chairs and crutches or canes as the residents may require for
their safety. |
| (4) |
Assisted living
communities serving persons dependent upon wheelchairs for mobility must
provide at least two (2) exits from the community which are remote from each
other and wheelchair accessible. |
| (5) |
Common Areas. The assisted
living community must have common areas which meet the following requirements:
| (a) |
The assisted living community must have
separate and distinct living room(s) which are conveniently located within easy
walking distance of each resident's private living space, available for the
residents' informal use at any time and not requiring any resident to leave the
building to use. |
| (b) |
The assisted
living community must have living rooms large enough to accommodate the
residents without crowding. The rooms must be comfortably and attractively
furnished. |
| (c) |
The assisted living
community must have areas in the community for use by residents and visitors
which afford them privacy. |
| (d) |
The
assisted living community must have a kitchen and a comfortable dining area
which are properly equipped and adequate in size for the number of residents
being served. |
| (e) |
All stairways and
ramps must have sturdy and securely fastened handrails, not less than 30 inches
nor more than 34 inches above the center of the tread. Exterior stairways,
decks and porches must have handrails on the open sides. |
| (f) |
Floor coverings must be intact and
securely fastened to the floor and free of hazards that might cause
tripping. |
| (g) |
All areas of the
assisted living community, including hallways and stairs must provide
sufficient ambient lighting such that the residents may move about safely and
objects may be easily observed by the residents. In addition, appropriate task
lighting necessary for more visually demanding activities such as reading,
knitting or preparing food must also be provided for resident use. |
| (h) |
The assisted living community must
provide laundering facilities on the premises for residents' personal
laundry. |
| (i) |
An assisted living
community which provides laundry services for the residents must have a storage
area that is used for clean laundry that is separate from the dirty
laundry. |
| (j) |
Common areas, such as
living, dining, activity, laundry or other multi-purpose rooms, or hallways
must not be used as sleeping accommodations for residents, family or
staff. |
|
| (6) |
Bedrooms or Private Living Spaces. The assisted living community must
have bedrooms or private living spaces for the residents which meet the
following requirements:
| (a) |
Bedrooms or
private living spaces assigned to individual residents must have at least 80
square feet of usable floor space per resident with no more than two residents
sharing the private living space. Usable floor space is defined as that floor
space under a ceiling at least seven feet in height. However, licensed personal
care homes approved prior to or on February 6, 1981 to operate with bedrooms
with a minimum of 70 square feet of usable floor space per resident which have
continuously operated since that date seeking licensure as assisted living
communities, may continue to use the minimum 70 square feet standard. Where an
assisted living community operating under this exception has its permit
revoked, changes ownership, changes location, or undergoes extensive
renovations, or for any other reason surrenders its permit, this exception
regarding the minimum square footage is no longer available. |
| (b) |
The resident's private living space must
be self-contained and separated from halls, corridors and other rooms by floor
to ceiling walls and must not be used as a passageway or corridor by others to
access other parts of the assisted living community. |
| (c) |
The resident's private living space must
have at least one window opening through an exterior wall of the assisted
living community. |
| (d) |
Each sleeping
room must have a secondary exit. This secondary exit may be a door or a window
usable for escape. |
| (e) |
A room must
not be used as a bedroom or private living space where more than one-half the
room height is below ground level. Bedrooms or private living spaces which are
partially below ground level must have adequate natural light and ventilation
and have two useful means of egress. Control of dampness must be
assured. |
| (f) |
Doorways of bedrooms
or private living spaces occupied by residents must be equipped with
side-hinged permanently mounted doors equipped with positively latching
hardware which will insure opening of the door by a single motion, such as
turning a knob or by pressing with normal strength on a latch. For bedrooms or
private living spaces which have locks on doors, both the occupant and staff
must be provided with keys to assure easy entry and exit. |
|
| (7) |
Bathing and Toileting
Facilities. The assisted living community must provide bathing and
toileting facilities that meet the accessibility needs of the residents and the
following requirements:
| (a) |
At least one
toilet and lavatory must be provided for each four residents' use based on the
licensed capacity of the assisted living community. |
| (b) |
At least one bathing or showering
facility must be provided for each eight residents based on the licensed
capacity of the assisted living community. Assisted living communities serving
residents who are dependent on wheel chairs or walkers, for mobility must have
fully accessible bathrooms available for these residents. |
| (c) |
There must be at least one toilet and
lavatory provided on each floor where residents have bedrooms. |
| (d) |
There must be a separate toilet and
lavatory for the staff's use that is not counted in the minimum ratio of
toilets and lavatories required for residents. |
| (e) |
Grab bars and nonskid surfacing or strips
must be properly installed in all showers and bath areas. |
| (f) |
Bathrooms and toilet facilities must have
working exhaust fans vented to the outside or windows that are screened and
open to the outside easily. |
| (g) |
Toilets, bathtubs and showers must provide for individual privacy. |
|
| (8) |
Electrical
Inspection. An applicant to operate an assisted living community must
submit evidence of a satisfactory inspection of the electrical service of the
assisted living community by a qualified electrician within no more than six
months prior to the date of filing the application for a permit However, where
the applicant holds a personal care home permit for the premises at the time of
the application to become an assisted living community, no new electrical
inspection is required unless renovation or repair work has been done since the
last electrical inspection. Electrical service must be maintained in a safe
condition at all times. The Department may require a re-inspection of the
electrical service at any time renovation or repair work is done in the
assisted living community or there is a request for a change in capacity or
there is reason to believe that a risk to residents exists. |
| (9) |
Fire Safety. The assisted
living community must have an effective fire safety program for the benefit of
the residents which takes into account the unique needs of the residents being
served.
| (a) |
The assisted living community must
comply with applicable fire and safety rules published by the Office of the
Safety Fire Commissioner. |
| (b) |
The
assisted living community must comply with applicable local ordinances that
specifically address fire safety. |
| (c) |
The assisted living community is required
to obtain a repeat fire safety inspection if at any time the physical plant
undergoes substantial repair, renovation or additions. |
| (d) |
Where the Department has reason to
believe, based on the number of residents requiring assisted self-preservation
and staffing patterns that an assisted living community may not be able to
evacuate all of the residents to a designated point of safety within an
established period of time as determined by the Office of the Safety Fire
Commissioner, the Department may either require the assisted living community
to conduct an immediate fire safety drill or make a referral for a new
compliance determination to the Office of the State Fire
Commissioner. |
|
| (10) |
Water and Sewage. The assisted living community's water and sewage
systems must meet applicable federal, state, and local regulations. |
| (11) |
Outdoor Spaces. Assisted
living communities must provide or have conveniently located access to outdoor
spaces for the use of the residents and access to parking spaces for the use of
residents and visitors. Such outdoor spaces may include solaria, porches,
balconies, roof decks, gardens or patios. |
| (1) |
The assisted living community must
provide furnishings throughout the assisted living community for the use of the
residents that are maintained in good condition, intact, and
functional. |
| (2) |
The assisted living
community must provide a name plate, or other identification, outside the
resident's bedroom or personal living space that marks the area as the personal
living space of the particular resident(s), unless the resident specifically
requests no identification markers to be used. |
| (3) |
Each resident's bedroom or private living
space must have an adequate closet or wardrobe. |
| (4) |
Each resident's bedroom or private living
space must have working lighting fixtures sufficient for reading and other
resident activities. |
| (5) |
If the
community provides the furnishings, each resident's bedroom or private living
space must have a bureau or dresser or the equivalent and at least one
comfortable chair per resident in each bedroom or private living
space. |
| (6) |
Each resident bedroom
must have a mirror appropriate for grooming unless the resident or resident's
representative explicitly requests to have the mirror removed. |
| (7) |
Each resident's bedroom or private living
space must have a waste basket unless the resident or resident's representative
specifically requests to have it removed. |
| (8) |
The assisted living community must allow
the resident to personalize the bedroom or private living space as the resident
chooses by permitting the resident to use personal furniture so long as such
furnishings do not pose a threat to the health or safety of the other
residents. The assisted living community must provide the resident with
assistance in mounting or hanging pictures on bedroom walls. |
| (9) |
Each resident must have an individual bed
which is at least 36-inches wide and 72-inches long with comfortable springs
and mattress, clean and in good condition. Where a particular resident is very
tall, the assisted living community must provide an extra-long mattress. The
mattress must not be less than five-inches thick, or four-inches, if of a
synthetic construction. Roll-a-ways, cots, double-decks, stacked bunks,
hide-a-beds and studio couches are not to be provided by the assisted living
community in lieu of standard beds. However, residents who prefer to furnish
their own living units may choose to use different-sized beds in lieu of
standard twin-size beds. |
| (10) |
The
assisted living community must make available for each resident who requires
linen service an adequate supply of clean linens which includes, at a minimum,
two sheets, pillow, pillowcase, blanket, bedspread, towels and wash cloth. If
the resident requires more blankets for comfort, the assisted living community
must provide them. |
| (11) |
The
assisted living community must change and launder linens for each resident at
least weekly or more often unless the resident specifically declines the linen
service. Whether or not the resident declines linen services, the assisted
living community must maintain an adequate supply of spare linens on hand to
accommodate the needs of the residents. |
| (12) |
At least one current calendar and
working clock must be placed in the common living area of each assisted living
community. |
| (1) |
The interior and exterior of the assisted
living community must be kept clean, in good repair and maintained free of
unsanitary or unsafe conditions which might pose a health or safety risk to the
residents and staff. |
| (2) |
Where the
assisted living community includes private living space for persons who are not
receiving services as residents of the assisted living community, the
maintenance of the private living space must comply with fire safety codes and
not threaten the health or safety of the residents. |
| (3) |
The assisted living community must
maintain wall-type electric outlets and working lamps or light fixtures
throughout the assisted living community in good working order and which are
safe for the intended use. The assisted living community must provide necessary
light bulbs. |
| (4) |
Refrigeration and
cooking appliances must be properly installed, maintained in accordance with
manufacturer's recommendations and kept clean. Where metal hoods or canopies
are provided, they must be equipped with filters which are maintained in an
efficient condition and kept clean at all times. |
| (5) |
Space heaters must not be used, except
during an emergency situation after obtaining specific written approval of the
fire safety authority having jurisdiction over the assisted living
community. |
| (6) |
Fire screens and
protective devices must be used with fireplaces, stoves and heaters. |
| (7) |
Each assisted living community must be
protected with sufficient functioning smoke detectors, powered by house
electrical service with battery back-up, which when activated, must initiate an
alarm which is audible in the sleeping rooms. |
| (8) |
Each assisted living community must have
charged 5 lb. or more multipurpose ABC fire extinguishers available for use
throughout the community as required by state or local fire codes, whichever is
more stringent. These fire extinguishers shall be checked and tagged annually
by a licensed fire extinguisher company to assure the extinguishers remain in
operable condition. |
| (9) |
Each
assisted living community must have a working doorbell or doorknocker which is
audible to staff inside at all times. |
| (10) |
Exterior doors must be equipped with
locks which do not require keys to open them from the inside. |
| (11) |
Entrances and exits, sidewalks, and
escape routes must be maintained free of any hazards such as refuse, equipment,
furniture, ice, snow, debris or any other impediments to ensure complete and
immediate entry and exit in the case of fire or other emergency. |
| (12) |
The assisted living community must have
its name and house number displayed so as to be easily visible from the
street. |
| (13) |
The assisted living
community must store and safeguard poisons, caustics, and other dangerous
materials in safe areas and separate from food preparation and storage areas,
and medication storage areas. |
| (14) |
Heated water must be made available by the assisted living community to the
residents for their usage and must be comfortable to the touch but must not
exceed 120 degrees Fahrenheit (F.). |
| (15) |
Where the assisted living community
provides transportation to the residents, the assisted living community must
maintain on the vehicle: basic emergency contact information on the residents
being transported. |
| (1) |
An assisted living community must comply
with the requirements of Chapter 111-8-16, Rules and Regulations for Disaster
Preparedness Plans. |
| (2) |
Building
evacuation maps with routes of escape clearly marked must be posted
conspicuously on each floor of the assisted living community. Assisted living
communities must have a clearly accessible route for emergencies throughout the
common areas of the assisted living community. |
| (3) |
The disaster preparedness plan must be
readily accessible to staff, residents and their families at the assisted
living community and identify the staff position(s) responsible for
implementing the plan, obtaining necessary emergency medical attention or
intervention for residents. |
| (4) |
The
assisted living community must provide timely notification of the relocation
address to the residents, their family contacts and representatives, if any,
and the Department whenever the assisted living community must relocate the
residents as a result of an emergency situation which disrupts the provision of
room and board for the residents at the licensed location. |
| (1) |
Resident Profile for
Admission. The assisted living community must determine that the
potential residentmustmeet all of the following criteria at the time of
admission:
| (a) |
The resident must be an adult
who is at least 18 years of age. |
| (b) |
The resident must not have active
tuberculosis, or require continuous medical or nursing care and treatment or
require physical or chemical restraints, isolation or confinement for
behavioral control. |
| (c) |
The
resident's physical condition must be such that the resident is capable of
actively participating in transferring from place to place. |
| (d) |
The resident must be able to participate
in the social and leisure activities provided in the assisted living
community. |
|
| (2) |
Evaluation of Applicants for Admission. In determining whether the
assisted living community will be able to meet the needs of the applicant for
admission to the assisted living community, the administrator or on-site
manager of an assisted living community must consider and maintain
documentation of the following:
| (a) |
the
information provided in an interview with the applicant and/or representative
or legal surrogate, if any, regarding the applicant's care and social needs and
behavioral issues that may require more watchful oversight; |
| (b) |
a physical examination conducted by a
licensed physician, nurse practitioner or physician's assistant dated within 30
days prior to the date of admission which reflects that the resident does not
require continuous medical or nursing care and services and is free of active
tuberculosis. The report of the physical examination must be completed on forms
made available by the Department; |
| (c) |
either the results of an inquiry of the
National Sex Offender Registry website coordinated by the Federal Bureau of
Investigation or a fingerprint records check; |
| (d) |
where the applicant for admission is a
registered sex offender or has committed another violent crime, the assisted
living community must document the additional safety measures that the assisted
living community will employ to ensure the safety of all residents, such as
additional monitoring, room and roommate selection and in-servicing of staff;
and |
| (e) |
whether the applicant for
admission has retained the services of a designated proxy caregiver which
complies with the requirements of the Rules and Regulations for Proxy
Caregivers Used In Licensed Healthcare Facilities, Chapter 111-8-100. |
|
| (3) |
Emergency
Placement. Where the applicant for admission is being evaluated for
admission pursuant to an emergency placement made at the request of the Adult
Protective Services Section of the Division of Aging Services, Department of
Human Services or another licensed facility that is requesting the placement
pursuant to activation of its emergency preparedness plan for relocation of
residents, the complete physical examination required by Rule
111-8-63-.16(2)(b)
may be deferred for up to 14 days after the emergency admission if no record of
a qualifying physical examination or a copy of a current clinical record is
available at the time of admission. |
| (4) |
Community Admission
Decisions. The assisted living community must not admit residents who
either do not meet the admission profile or who meet the profile but whose care
needs cannot be met by staff available to provide assistance. The assisted
living community's decision to admit a resident must reflect that it has taken
into account the condition of the resident to be admitted, the needs of
currently admitted residents, the assistance with self-preservation current
residents require, and the construction of the building including whether such
building meets the state fire safety requirements applicable to an existing
health care occupancy. |
| (5) |
Community Retention Decisions. The assisted living community must
require a resident to move out when any one of the following occurs:
| (a) |
The resident requires continuous medical
or nursing care. |
| (b) |
The resident's
specific care needs cannot be met by available staff in the community, e.g.,
the resident is not ambulatory and not capable of assisted
self-preservation. |
| (c) |
The
community is not able to evacuate all of the current residents to a point of
safety within established fire safety standards. |
|
| (6) |
Change in Condition Requiring
Reevaluation. In the event a resident develops a significant change in
physical or mental condition, the assisted living community must obtain medical
information necessary to determine that the resident continues to meet the
retention requirements and the assisted living community is capable of meeting
the resident's needs. Where the Department has reason to believe either that
the assisted living community cannot meet needs of the resident or the resident
no longer meets the retention criteria for living in the licensed assisted
living community, the governing body must provide to the Department, upon
request, a current physical examination for the resident from a physician,
advanced practice registered nurse or physician's assistant as properly
authorized. |
| (1) |
Contents of the Written Admission
Agreement. The assisted living community must ensure that the admission
agreement is written in plain and understandable language and is consistent
with the information contained on the licensed residential care profile.
| (a) |
The admission agreement must include a
current statement of all fees and daily, weekly or monthly charges; the
services covered by those basic fees and any other services which the assisted
living community provides on an additional fee basis. |
| (b) |
The admission agreement must contain a
statement that residents and their representatives or legal surrogates shall be
informed, in writing, at least 30 days prior to any increase in established
charges related to the provision of personal services and at least 60 days
prior to any increase in charges for room and board. |
| (c) |
The admission agreement must contain
provisions for the administrator or on-site manager's continuous assessment of
the resident's needs, referral for appropriate services as may be required if
the resident's condition changes and referral for transfer or discharge if
required due to a change in the resident's condition. |
| (d) |
The admission agreement must contain a
description of how the community responds to formal complaints received from
residents and their representatives and how to file a complaint within the
community. |
| (e) |
The admission
agreement must contain provisions for transportation of residents for shopping,
recreation, rehabilitation, medical services. Such transportation service may
be provided by the assisted living community as either a basic service or on a
reimbursement basis; with transportation for emergency use available at all
times. |
| (f) |
The admission agreement
must include the assisted living community's refund policy when a resident
dies, is transferred or discharged. |
| (g) |
The admission agreement must include a
statement that a resident may not be required to perform services for the
assisted living community. |
| (h) |
The
admission agreement must include a copy of the house rules, which must be in
writing and also posted in the assisted living community and explain how
violations of the house rules will be addressed by the community. House rules
must be consistent with residents' rights. House rules must include, but not be
limited to policies regarding the use of tobacco and alcohol, the times and
frequency of use of the telephone, visitors elopement from the community, hours
and volume for viewing and listening to television, radio and other audiovisual
equipment, whether residents' personal pets or household pets are permitted and
the use of personal property. |
| (i) |
The admission agreement must disclose how and by what level of staff
medications are handled in the community. The agreement must also specify who
is responsible for initial acquisition and refilling of prescribed medications
utilizing unit or multidose packaging for the resident. Either this
responsibility will remain with the resident, representative or legal
surrogate, if any, or be assigned to the assisted living community operating
through the administrator or on-site manager. |
| (j) |
The admission agreement must disclose
whether the community permits the resident to employ independent proxy
caregivers, sitters, etc. or requires the purchase of such services from
approved providers. |
|
| (2) |
The assisted living community must provide each resident, representative, legal
surrogate with an opportunity to read the complete agreement prior to the
execution of the admissions agreement. In the event that a resident,
representative or legal surrogate is unable to read the agreement, the
administrator or on-site manager must take steps to assure communication of the
contents of the admission agreement to be signed. |
| (3) |
The assisted living community must
provide the resident and representative or legal surrogate, if any, with a
signed copy of the agreement. A copy signed by both parties (resident and
administrator or on-site manager) must be retained in the resident's file and
maintained by the administrator or on-site manager of the assisted living
community. |
| (1) |
The assisted living
community must not use a written admission agreement or any other written
agreement signed by the resident or the resident's legal representative which
waives or attempts to waive any of the resident's rights these rules
protect. |
| (1) |
The assisted living community must
provide assisted living, including protective care and watchful oversight,
which meets the needs of the residents it admits and retains. |
| (2) |
Resident Needs Assessment.
The assisted living community must complete an assessment of the resident that
addresses the resident's care needs taking into account the resident's family
supports, the resident's functional capacity relative to the activities of
daily living, physical care needs, medical information provided, cognitive and
behavioral impairments, if any, and personal preferences relative to care
needs. |
| (3) |
Written Care
Plan. Utilizing the information acquired during the admission process
and the move-in adjustment period, the assisted living community mustdevelop
the resident's individual written care plan within 14 days of admission and
require staff to use the care plan as a guide for the delivery of care and
services to the resident. The care plan must include the following:
| (a) |
a description of the resident's care and
social needs and the services to be provided, including frequency to address
care and social needs; |
| (b) |
resident's particular preferences regarding care, activities and
interests; |
| (c) |
specific behaviors
to be addressed with interventions to be used; |
| (d) |
any physician order or order of a nurse
practitioner or physician assistant working under protocol or job description,
respectively for assistive devices; |
| (e) |
staff primarily responsible for
implementing the care plan; |
| (f) |
evidence of family involvement in the development of the plan when appropriate;
and |
| (g) |
evidence of the care plan
being updated at least annually and more frequently where the needs of the
resident change substantially or the resident is assigned to a specialized
memory care unit. |
|
| (4) |
Social Activities. Each assisted living community must provide
social activities on a daily basis that promote the physical, mental and social
well-being of each resident and take into account the personal preferences of
the residents. |
| (5) |
Activity
Resources. The assisted living community must provide, books, current
newspapers or magazines, and games for leisure time activities. The assisted
living community must offer assistance to residents who wish to participate in
hobbies, music, arts and crafts, religion, games, and sports, social,
recreational and cultural activities available in the assisted living community
and in the community. |
| (6) |
Available Telephone. The assisted living community must have at least
one operable, non-pay telephone which is accessible at all times for emergency
use by staff on the premises. Residents must also have access to an operable,
non-pay telephone in a private location, both to make and receive personal
calls. The same telephone may be used for staff and resident access. |
| (7) |
The assisted living community must not
restrict a resident's free access to the common areas of the assisted living
community or the specialized memory care unit or lock the resident into or out
of the resident's bedroom. |
| (8) |
Proxy Caregiver Services. Where the assisted living community
chooses to allow proxy caregivers to function in the community to perform
certain health maintenance activities that are not covered in the basic
assisted living care the community is required to provide, the assisted living
community must do either of the following:
| (a) |
Provide employees who are available for designation by a resident to serve as
proxy caregivers to perform certain health maintenance activities; or |
| (b) |
Permit the resident or a person legally
authorized to act on behalf of the resident to employ designated proxy
caregivers to provide health maintenance activities. |
|
| (9) |
Proxy Caregiver Records. The
community must maintain documentation on all proxy caregivers performing health
maintenance activities which complies with the Rules and Regulations for Proxy
Caregivers, Chapter 111-8-100. |
| (10) |
Prohibited Proxy Caregiver Services. Where the assisted living
community employs proxy caregivers, the community must not permit proxy
caregivers to provide assistance with or administer medications. |
| (11) |
Medical, nursing (other than developing
and updating care plans, training, medication administration and skills
competency determinations) health services required on a periodic basis, or for
short-term illness, must not be provided as services of the assisted living
community. When such services are required, they shall be purchased by the
resident or the resident's representative or legal surrogate, if any, from
appropriately licensed providers which are managed independently and not owned
or operated by the assisted living community. The assisted living community may
assist in arrangement for such services, but not in the provision of those
services. |
| (1) |
An assisted living community which serves
residents with cognitive deficits which place the residents at risk of eloping,
i.e. engaging in unsafe wandering activities outside the assisted living
community must do the following:
| (a) |
Develop,
train and enforce policies and procedures for staff to deal with residents who
may wander away from the assisted living community including what actions, are
to be taken if a resident wanders away (elopes) from the assisted living
community. |
| (b) |
Utilize appropriate
effective safety devices, which do not impede the residents' rights to mobility
and activity choice or violate fire safety standards, to protect the residents
who are at risk of eloping from the premises.
| 1. |
If the safety devices include magnetic
locks used on exit doors, as approved by the fire marshal having jurisdiction
over the assisted living community, then the locking device shall be electronic
and release whenever the following occurs: activation of the fire alarm or
sprinkler system, power failure to the assisted living community or by-pass for
routine use by the public and staff for service using a key button/key pad
located at the exit or continuous pressure for thirty (30) seconds or
less. |
| 2. |
If the safety devices
include the use of keypads to lock and unlock exits, then directions for their
operations shall be posted on the outside of the door to allow individuals'
access to the unit. However, if the unit is a whole assisted living community,
then directions for the operation of the locks need not be posted on the
outside of the door. The units must not have entrance and exit doors that are
closed with non-electronic keyed locks nor shall a door with a keyed lock be
placed between a resident and the exit. |
|
|
| (2) |
An assisted living community serving
residents who are at risk of eloping from the premises must retain on file at
the assisted living community current pictures of any such residents. |
| (1) |
In addition to
all other requirements contained in this Chapter, where an assisted living
community holds itself out as providing additional or specialized care to
persons with probable diagnoses of Alzheimer's Disease or other dementia or
charges rates in excess of that charged other residents because of cognitive
deficits which may place the residents at risk of eloping, the assisted living
community must meet the following requirements:
| (a) |
Written Description. The
assisted living community must include in its licensed residential care profile
an accurate written description of the special care unit that includes the
following:
| 1. |
a statement of philosophy and
mission; |
| 2. |
how the services and
activities of the special care unit are different from those provided in the
rest of the assisted living community; |
| 3. |
staffing including job titles of staff who
work in the unit, staff training and continuing education
requirements; |
| 4. |
admission
procedures, including screening criteria; |
| 5. |
assessment and service planning protocol,
including criteria to be used that would trigger a reassessment of the
resident's status before the customary quarterly review; |
| 6. |
staffing patterns, including the ratio of
direct care staff to resident for a 24-hour cycle, and a description of how the
staffing pattern differs from that of the rest of the program; |
| 7. |
a description of the physical environment
including safety and security features; |
| 8. |
a description of activities, including
frequency and type, and how the activities meet the needs of residents with
dementia, |
| 9. |
the program's fee or
fee structure for all services provided by the unit or assisted living
community; |
| 10. |
the discharge
criteria and procedures; |
| 11. |
the
procedures that will be utilized for handling emergency situations;
and |
| 12. |
the involvement of the unit
with families and family support programs. |
|
| (b) |
Physical Design, Environment, and
Safety. The memory care unit or special care unit must be designed to
accommodate residents with severe dementia or Alzheimer's Disease in an
assisted living community-like environment which includes the following:
| 1. |
multipurpose room(s) for dining, group and
individual activities which are appropriately furnished to accommodate the
activities taking place; |
| 2. |
secured
outdoor spaces and walkways which are wheel chair accessible and allow
residents to ambulate safely but prevent undetected egress; |
| 3. |
high visual contrast between floors and
walls and doorways and walls in resident use areas-except for fire exits, door
and access ways which may be designed to minimize contrast to conceal areas
where the residents should not enter; |
| 4. |
adequate and even lighting which minimizes
glare and shadows; |
| 5. |
the free
movement of the resident, as the resident chooses, between the common space and
the resident's own personal space in a bedroom that accommodates no more than
two (2) residents; |
| 6. |
individually
identified entrances to residents' rooms to assist residents in readily
identifying their own personal spaces; |
| 7. |
an effective automated device or system to
alert staff to individuals entering or leaving the unit in an unauthorized
manner. An assisted living community need not use an automated alert for an
exit door when the particular exit is always staffed by a receptionist or other
staff member who views and maintains a log of individuals entering and leaving
the assisted living community. If the exit door is not always staffed, then the
assisted living community must activate an automated alert when the door is not
attended; |
| 8. |
communication
system(s) which permit staff in the unit to communicate with other staff
outside the unit and with emergency services personnel as needed; and |
| 9. |
a unit providing specialized memory care
services which undergoes major renovation or is first constructed after
December 9, 2009, must be designed and constructed in compliance with
applicable state and local building and fire codes relevant to the specialized
unit and the assisted living community. |
|
| (c) |
Staffing and Initial Staff
Orientation. The assisted living community must ensure that the
contained unit is staffed with sufficient specially trained staff to meet the
unique needs of the residents in the unit.
| 1. |
At a minimum, the assisted living community must employ certified medication
aides in the unit to administer certain medications. |
| 2. |
At least one staff member who is awake and
supervising the unit at all times and sufficient numbers of trained staff on
duty at all times to meet the needs of the residents. |
| 3. |
Staff who, prior to caring for residents
independently, have successfully completed an orientation program that includes
at least the following components in addition to the general training required
in Rule
111-8-63-.09:
| (i) |
the assisted living community's
philosophy related to the care of residents with dementia in the
unit; |
| (ii) |
the assisted living
community's policies and procedures related to care in the unit and the staff's
particular responsibilities including wandering and egress control;
and |
| (iii) |
an introduction to common
behavior problems characteristic of residents residing in the unit and
recommended behavior management techniques. |
|
|
| (d) |
Initial Staff Training.
Within the first six months of employment, staff assigned to the unit shall
receive training in the following topics:
| 1. |
the nature of Alzheimer's Disease and other dementias, including the definition
of dementia, and knowledge of dementia-specific care needs; |
| 2. |
common behavior problems and recommended
behavior management techniques; |
| 3. |
communication skills that facilitate better resident-staff relations; |
| 4. |
positive therapeutic interventions and
activities such as exercise, sensory stimulation, activities of daily living
skills; |
| 5. |
the role of the family
in caring for residents with dementia, as well as the support needed by the
family of these residents; |
| 6. |
environmental modifications that can avoid problematic behavior and create a
more therapeutic environment; |
| 7. |
development of comprehensive and individual service plans and how to update or
provide relevant information for updating and implementing them consistently
across all shifts, including establishing baseline care needs; |
| 8. |
new developments in dementia care that
impact the approach to caring for the residents in the special unit; |
| 9. |
skills for recognizing physical or
cognitive changes in the resident that warrant seeking medical attention;
and |
| 10. |
skills for maintaining the
safety of residents with dementia. |
|
| (e) |
Special Admission Requirements for
Unit Placement. Residents must have a physician's report of physical
examination completed within 30 days prior to admission to the community or
unit on forms made available by Department. The physical examination must
clearly reflect that the resident has a diagnosis of probable Alzheimer's
Disease or other dementia and has symptoms which demonstrate a need for
placement in the specialized unit. However, the unit may also care for a
resident who does not have a probable diagnosis of Alzheimer's Disease or other
dementia, but desires to live in this unit and waives his or her right to live
in a less restrictive environment. In addition, the physical examination report
must establish that the potential resident of the unit does not require 24-hour
skilled nursing care. |
| (f) |
Post-Admission Assessment. If the resident is admitted directly into the
specialized memory care unit, theunit must obtain an assessment of each
resident's care needs to include the following components: resident's family
supports, level of activities of daily living functioning, physical care needs
and level of behavior impairment. |
| (g) |
Individual Written Care Plan and
Reviews. The resident's written care plan will be developed or updated
by staff with at least one member of the specialized memory care staff
providing direct care participating. Input from each shift of direct care staff
that provides care to the resident will be requested. All team members
participating shall sign the written care plan and the plan will be shared with
the direct care staff providing care to the resident and serve as a guide for
the delivery of care to the resident. The written care plan must be reviewed at
least quarterly and modified as changes in the resident's needs
occur. |
| (h) |
Therapeutic
Activities. The unit shall provide activities appropriate to the needs
of the individual residents and adapt the activities, as necessary, to
encourage participation of the residents in the following at least weekly with
at least some therapeutic activities occurring daily:
| 1. |
gross motor activities; e.g. exercise,
dancing, gardening, cooking, etc; |
| 2. |
self-care activities; e.g. dressing,
personal hygiene/grooming; |
| 3. |
social activities; e.g. games, music; |
| 4. |
sensory enhancement activities, e.g.
distinguishing pictures and picture books, reminiscing and scent and tactile
stimulation; and |
| 5. |
outdoor
activities; e.g. walking outdoors and field trips. |
|
|
| (2) |
No licensed assisted living
community is permitted to hold itself out as providing specialized care for
residents with probable Alzheimer's disease or other dementia or charge a
differential rate for care of residents with cognitive deficits that place the
residents at risk of engaging in unsafe wandering activities (eloping) unless
it meets the additional requirements specified in Rule 111-8-63-.19(1) and its
subparagraphs (a) through (h) above. |
| (1) |
Self-Administration of Medications. Residents who have the
cognitive and functional capacities to engage in the self-administration of
medications safely and independently without staff assistance or supervision
must be allowed to store their own medications securely and self-administer
medications if they so desire. |
| (2) |
Assistance with Self-Administration. An assisted living community
must provide assistance with or supervision of self-administered medications to
those residents who have the cognitive capacity to engage in the
self-administration of medications, but require or request staff assistance
with or supervision of the self-administration of medications for safety or
convenience.
| (a) |
Such staff assistance with
or supervision of self-administered medications may only be provided for unit
or multi-dose packaged medications prescribed for the particular resident and
may include only the following tasks:
| 1. |
taking the medication, in its previously dispensed, properly labeled container,
from where it is stored, and bringing the medication to the resident; |
| 2. |
reading the label, opening the container,
removing a prescribed amount of medication from the container, and closing the
container, in the presence of the resident; |
| 3. |
placing an oral dosage in the resident's
hand or placing the dosage in another container where the resident requests
assistance; |
| 4. |
applying topical
medications; |
| 5. |
returning the
medication container to proper secured storage; and |
| 6. |
assisting the resident's use of an EPI pen
where the resident has known severe allergies for which an EPI pen has been
prescribed on condition that there is an established written protocol detailing
how it is to be used and when. The protocol must include immediately calling
Emergency Services, 911, after any use of the EPI pen. |
|
| (b) |
Staff assisting with or supervising
self-administration of medications must be proficient in English and able to
read, write and follow written instructions in English. |
|
| (3) |
Community Administration of
Medications. Where the residents either are not capable of
self-administration of medications or choose not to self-administer medications
with assistance or supervision, the assisted living community must provide
medication administration services to the residents in accordance with
physicians' orders, the needs of the residents and these rules. |
| (4) |
Specialized Staffing for Medication
Administration. The assisted living community offering medication
administration services must employ certified medication aides, at a minimum,
to administer medications. |
| (5) |
Certified Medication Aide Requirements. An assisted living
community using certified medication aides to administer specific medications
must do all of the following:
| (a) |
Check
the Registry. Ensure that the medication aides employed in the community
are listed in good standing on the Georgia Certified Medication Aide Registry
and have no record of being terminated for cause relating to the performance of
medication aide tasks before permitting the aides to administer
medications. |
| (b) |
Administer
Skills Competency Checks. Determine and document that the medication
aides who have been certified for more than one year upon hiring, continue to
have the knowledge and skills necessary to administer medications properly for
the particular community. The community must use a skills competency checklist
which meets the requirements contained in the standardized clinical skills
competency checklist used to certify medication aides. |
| (c) |
Quarterly Observations. Use
a licensed registered professional nurse or a pharmacist to conduct quarterly
random medication administration observations to determine that the aides are
administering medications correctly and in compliance with these rules and
report any issues to the assisted living community administration for
resolution. |
| (d) |
Quarterly
Drug Regimen Reviews. Secure the services of a licensed pharmacist to
perform all of the following duties:
| 1. |
Conduct quarterly reviews of the drug regimen for each resident of the assisted
living community and report any irregularities to the assisted living community
administration. |
| 2. |
Remove for
proper disposal any drugs that are expired, discontinued or in a deteriorated
condition or where the resident for whom such drugs were ordered is no longer a
resident. |
| 3. |
Establish or review
policies and procedures for safe and effective drug therapy, distribution, use
and control. |
| 4. |
Monitor compliance
with established policies and procedures for medication handling and
storage. |
|
| (e) |
Authorized Tasks for Certified Medication Aides. An assisted
living community may allow a certified medication aide to do only the following
tasks related the administration of medications utilizing only unit or
multidose packaging of medications:
| 1. |
Administer physician ordered oral, via a feeding tube, ophthalmic, topical,
otic, nasal, vaginal and rectal medications. |
| 2. |
Administer insulin, epinephrine, and B12
pursuant to physician direction and protocol. |
| 3. |
Administer medications via a metered dose
inhaler. |
| 4. |
Conduct finger stick
blood glucose testing following established protocol. |
| 5. |
Administer a commercially prepared
disposable enema ordered by a physician. |
| 6. |
Assist residents in the supervision of
self-administration of medications. |
| 7. |
Administer liquid morphine to a resident
of the community who is the patient of a licensed hospice, pursuant to a
hospice physician's written order that contains specific instructions for
indication, dosage, frequency and route of administration. |
|
| (f) |
Annual Competency Reviews.
Complete comprehensive clinical skills competency reviews for each certified
medication aide utilizing the skills competency checklist at least, annually
after hiring to determine that the aides continue to have the necessary skills
to perform the medication tasks assigned competently. Such skills competency
checklists must be administered by Georgia-licensed registered nurses,
pharmacists or physicians, who indicate in writing that the tasks observed are
being performed competently. |
| (g) |
Proper Notice of Separation for Cause. Ensure that where a
medication aide is terminated for cause relating to the performance of
medication aide tasks, the aide is provided with the following:
| 1. |
a separation notice that clearly describes
the facts that support the termination for cause; |
| 2. |
written notice that being terminated for
cause related to the administration of medications, if not successfully
appealed through a hearing on right to unemployment benefits will result in the
loss of good standing on the Georgia Certified Medication Aide Registry;
and |
| 3. |
the loss of good standing on
the Certified Medication Aide Registry will make the aide ineligible for hiring
as a certified medication aide by another assisted living community. |
|
| (h) |
Registry
Notification. Submit to the Georgia Certified Medication Aide Registry a
copy of the Separation Notice for the certified medication aide only if the
separation related specifically to the performance of medication aide tasks and
the termination for cause has either been finally upheld by the Department of
Labor or the time for appealing the Separation Notice has expired. |
|
| (6) |
Communities Conducting
Certified Medication Aide Training. A community choosing to provide a
certified medication aide training program must do all of the following:
| (a) |
Utilize the state-approved medication
aide training program ensuring that the training is administered by a
Georgia-licensed registered nurse, pharmacist, or physician. |
| (b) |
Require the aide to demonstrate the
requisite clinical skills to serve as a medication aide before a
Georgia-licensed registered nurse, pharmacist or physician utilizing the
standardized medication administration checklist developed by the
Department. |
| (c) |
Prepare the aide to
take the written competency examination to become a certified medication
aide. |
| (d) |
Verify that the aide is
in good standing on the Georgia certified nurse aide registry. |
| (e) |
Provide information to the aide on the
registration and locations for taking the written competency
examination. |
| (f) |
Provide the
documentation to the Georgia Certified Medication Aide Registry that is
necessary to complete the application for placement of the aide's name on the
Georgia Certified Medication Aide Registry. |
| (g) |
Not permit the aide to administer
medications independently unless the aide is listed on the Georgia certified
medication aide registry in good standing. |
|
| (7) |
Basic Medication Training for Staff
Assisting with Self-Administration. The assisted living community must
provide and document medication training for the unlicensed staff who are not
certified medication aides but who are providing assistance with or supervision
of self-administration of medications to capable residents. The medication
training must be conducted with an appropriate curriculum for providing
medication assistance and include at least the following topics:
| (a) |
the assisted living community's
medication policy and procedures, including actions to take if concerns
regarding resident's capacity to self-administer medications are
identified; |
| (b) |
how to read
prescription labels including common abbreviations; |
| (c) |
providing the right medication to the
right resident at the right time in the right amount and the right way
including how to measure various medications; |
| (d) |
actions to take when concerns regarding
medications are identified; |
| (e) |
infection control procedures relative to providing assistance with
medications; |
| (f) |
proper medication
storage and disposal; |
| (g) |
recognition of side effects and adverse reactions for the specific
medications; |
| (h) |
understanding the
common classifications of medications, typical side effects and adverse
reactions and medications for which unlicensed staff may never provide
assistance with or supervision of self-administration; and |
| (i) |
proper documentation and record keeping
using the Medication Assistance Record. |
|
| (8) |
Medication Skills Competency
Determinations. Unlicensed staff who are not certified as medication
aides providing assistance with or supervision of self-administered medications
must demonstrate when hired and at least, annually thereafter, the necessary
skills to perform the medication tasks assigned competently by completing
skills competency checklists before appropriately trained community
staff. |
| (9) |
Maintaining
Records on Medication Assistance and Administration. Where the assisted
living community either provides assistance with, or supervision of
self-administered medications or administers medications to residents, the
community must maintain a daily Medication Assistance Record (MAR) for each
resident who receives assistance or administration. The MAR must include the
name of the specific resident, any known allergies, the name and telephone
number of the resident's health care provider, the name, strength and specific
directions including key side effects and adverse reactions for use of each
medication and a chart for staff who provide assistance or administration to
record initials, time and date when medications are taken, refused or a
medication error is identified (e.g. missed dosage). The staff providing the
assistance or administration of medications must update the MAR each time the
medication is offered or taken.
| (a) |
The
assisted living community must make medication information concerning the
descriptions of medication, dosing, side effects, adverse reactions and
contraindications for each medication being administered to the residents
immediately available for reference by staff providing medication assistance or
administration. |
| (b) |
Staff of the
assisted living community providing assistance with or administration of
medications must document in the resident's record any unusual reactions to the
medications and provide such information to the resident, the resident's
representative and the health care provider as appropriate. |
| (c) |
For any administration of liquid morphine
by a certified medication aide, staff shall observe and document the following
in the resident's record:
| 1. |
the resident's
need for PRN liquid morphine, including but not limited to verbalizations of
pain, groaning, grimacing or restlessness; |
| 2. |
the date, time and location of the initial
dose administered by a licensed hospice health care professional; |
| 3. |
the dosage, time and route of
administration for the morphine administered in the community; |
| 4. |
the training provided by the licensed
hospice; and |
| 5. |
information
regarding the special circumstances under which the hospice was unavailable to
administer the medication. |
|
|
| (10) |
Orders Required for All
Medications. An assisted living community must not allow its staff to
assist with, provide supervision of self-administered medications or administer
any medications, including over-the-counter medications, unless there is a
physician's order specifying clear instructions for its use on file for the
resident. |
| (11) |
Timely
Management of Medication Procurement. Where the assisted living
community procures medications on behalf of the residents, the community must
obtain new prescriptions within 48 hours of receipt of notice of the
prescription or sooner if the prescribing physician indicates that a medication
change must be made immediately. If the pharmacy does not have the medication
needed for the immediate change, available and has not obtained further
directions from the physician, the community must notify the physician of the
unavailability of the prescription and request direction. Refills of prescribed
medications must be obtained timely so that there is no interruption in the
routine dosing. Where the assisted living community is provided with a new
medication for the resident, the MAR must be modified to reflect the addition
of the new medication within 48 hours or sooner if the prescribing physician
indicates that the medication change must be made immediately. |
| (12) |
Storage and Disposal of
Medications. Medications must be stored securely and inventoried
appropriately to prevent loss and unauthorized use. Medications must be stored
under lock and key at all times whether kept by a resident or kept by the
assisted living community for the resident, unless the medication is required
to be kept by the resident on his or her person or staff member in close
attendance due to the need for physician-prescribed frequent or emergency use.
Additionally, for controlled substances, the secure storage must be a locked
cabinet or box of substantial construction and a log must be maintained and
updated daily by the community to account for all inventory.
| (a) |
Duplicate keys for all medication storage
containers must be available on site for appropriate use. |
| (b) |
Medications must be kept in original
containers with original labels intact. |
| (c) |
Medications must be properly labeled in
separate unit or multi-unit dose packaging and handled in accordance with
physician's instructions, and laws and regulations applicable to the
medications. |
| (d) |
The assisted
living community must ensure that it properly disposes of unused medications
using the current U.S. Food and Drug Administration or U.S. Environmental
Protection Agency guidelines for the specific medications. |
| (e) |
The supply of liquid morphine on site
shall be limited to 50 ml for each hospice patient in the community for which
there is a physician's order for such medication. |
|
| (1) |
Regularly Scheduled Meals.
The assisted living community must provide a minimum of three regularly
scheduled well-balanced meals per day seven days a week which meet the
nutritional needs of residents, and must provide therapeutic diets as ordered
by the residents' healthcare providers for residents that require special
diets. There must be no more than fourteen hours elapsing between the scheduled
evening and morning meals. |
| (2) |
Nutritious Meals. Meals must meet the general requirements for
nutrition adjusted for age, sex and activity, currently found in the
Recommended Daily Diet Allowances, Food and Nutrition Board, National Academy
of Sciences. |
| (3) |
Snacks. Food for at least one nutritious snack must be available
and offered each day in addition to the regularly scheduled meals. Snacks are
not considered to be meals for the purposes of calculating the time between
meals. |
| (4) |
Wholesome
Food. Food received or used in an assisted living community must be
clean, wholesome, free from spoilage, adulteration, and misbranding, and safe
for human consumption. |
| (5) |
Proper Handling of Food. All foods while being stored, prepared
and served must be protected from spoilage and contamination and be safe for
human consumption. At a minimum to protect from spoilage and contamination, the
assisted living community must do all of the following:
| (a) |
Store perishable foods, such as but not
limited to meat, fish, eggs, dairy products, juices at temperatures that will
minimize spoilage, i.e. at or below 41 degrees F. |
| (b) |
Thaw frozen foods properly, i.e. in the
refrigerator or under cold running water with an unplugged sink. |
| (c) |
Provide hot and cold running water and
sanitizing agents and ensure that they are used appropriately in the kitchen to
clean and sanitize food, hands and utensils as required for safe food
preparation. |
| (d) |
Prevent
cross-contamination of foods via hands, cutting boards or utensils during
preparation. |
| (e) |
Ensure that hot
foods leave the kitchen (pot, steam table, etc.) for serving at or above 140
degrees F. and that cold foods leave the kitchen for serving at or below 41
degrees F. |
|
| (6) |
Duties of Food Service Manager. The person designated by the
assisted living community as being responsible for managing the preparation of
meals for the residents must enforce safe food handling practices which address
basic food safety, hygiene, cross contamination, time and temperature
requirements and sanitation with staff and residents. |
| (7) |
Emergency Food Supply. A
3-day supply of non-perishable dry or canned foods and water, must be on hand
at all times in the assisted living community for emergency use. The quantity
of food required to be stored must be based on the usual resident census. The
food must be kept in sealed containers which are labeled and dated. The food
must be rotated in accordance with shelf life to ensure safety and
palatability. Water sufficient for drinking and food preparation must also be
stored. |
| (8) |
Properly
Furnished Food Areas. Kitchen and dining areas must be properly equipped
with appropriate cabinets, drawers, holders and shelves or racks for storage of
necessary equipment and utensils. These rooms must be kept clean and
disinfected at least daily unless more frequent sanitization is required to
prevent the spread of infection or food borne illnesses. |
| (9) |
Food Service Permit Required.
An assisted living community must either possess a valid food service
permit issued through the authority of the Department of Public Health pursuant
to Chapter 290-5-14 or a copy of the valid food service permit of the caterer'
who provides meals to the community. |
| (10) |
Menu Requirements. Menus to
be served in assisted living residences must be dated and planned at least one
week in advance for both regular and therapeutic diets. Residents must be
encouraged to participate in menu planning. Planned menus must be conspicuously
posted or easily available to residents. Regular and therapeutic menus as
served, with substitutions noted before the meal is served, must be kept on
file in the assisted living community for 30 days. |
| (11) |
Food Safety Reports. The
assisted living community must retain copies of food safety inspection reports
required by law which were issued during the year preceding the most recent
inspection. The most recent food service inspection report must be posted in
the assisted living community. |
| (12) |
Catered Food Service. When the assisted living community uses a
catered food service (food service establishment), the assisted living
community must ensure that the service is properly licensed, provides meals in
accordance with these rules, has a satisfactory record of compliance with food
safety requirements and properly transports and stores food at time of delivery
to maintain food safety. |
| (13) |
Catering Records. An assisted living community utilizing a catered
food service must maintain copies of the current contract between the assisted
living community and the food service establishment agreeing to provide food
service in the assisted living community, the certificate or license
authorizing the operation of the food service establishment issued by the
county health agency and the most recent food safety inspection
reports. |
| (1) |
The temperature throughout the assisted
living community must be maintained by an adequate central heating and cooling
system or its equivalent at ranges which are consistent with individual health
needs of residents and provides a comfortable environment for the
residents. |
| (2) |
Temperatures in the
assisted living community must not fall below 62 degrees F during sleeping
hours or above 85 degrees F during the day. Mechanical cooling devices shall be
made available for use in those areas of the building used by residents when
inside temperatures exceed 80 degrees F. |
| (3) |
Where a power outage or mechanical
failure impacting the ability of the assisted living community to maintain
these temperature ranges occurs, the assisted living community must take
immediate action to provide for the health and safety of the residents,
including but not limited to, arranging immediately for a service call,
providing additional blankets or fans or utilizing an emergency power generator
in accordance with the assisted living community's emergency preparedness
plan. |
| (1) |
The assisted living community must have
an effective infection control program which includes, at a minimum, the
following:
| (a) |
training provided to staff on
effective measures for minimizing the spread of infections and food borne
illnesses; |
| (b) |
responding to
disease outbreaks appropriately and participating in infection control
investigations; |
| (c) |
staff
demonstrating their understanding and use of proper infection control practices
in their delivery of care to the residents; and |
| (d) |
enforcing work and return to work
policies to minimize the spread of infection and illnesses. |
|
| (2) |
The assisted living community
must have an adequate supply of sanitizing and cleaning agents, e.g.. effective
hand hygiene products, hand soap, laundry soap, household disinfectants and
other cleaning materials, available and used in the assisted living community
to minimize the spread of infections. |
| (3) |
Toilet tissue, soap, hot and cold running
water and clean towels must be available for use wherever commodes are
located. |
| (4) |
The assisted living
community must have a supply of first-aid materials available for use. This
supply must include, at a minimum, gloves, band aids, thermometer, tape, gauze,
and an antiseptic. |
| (5) |
The storage
and disposal of bio-medical and hazardous wastes must comply with applicable
federal, state, and local rules and/or standards. |
| (6) |
Solid waste which is not disposed of by
mechanical means must be stored in vermin-proof, leak-proof, nonabsorbent
containers with close-fitting covers until removed. Waste must be removed from
the kitchen at least daily and from the premises at least weekly. |
| (7) |
An insect, rodent or pest control program
must be maintained and conducted in a manner which continually protects the
health of residents. |
| (8) |
Residents'
private living spaces or bedrooms must be thoroughly cleaned and sanitized
after residents move out of the rooms. |
| (9) |
The assisted living community must clean
the residents' private living spaces periodically and as needed to ensure that
the space does not pose a health hazard. |
| (1) |
An individual resident file must be
maintained by the administrator or on-site manager for each resident in the
assisted living community. Personal information must be treated as confidential
and must not be disclosed except to the resident and his or her representative
or legal surrogate, if any, an authorized agent of the Department, and others
to whom written authorization is given by the resident or his representative or
legal surrogate, if any. The resident file must be made available for
inspection and/or copying to the resident or the resident's representative or
legal surrogate, if any, and Department representatives, upon
request. |
| (2) |
Each resident's file
must include the following information:
| (a) |
identifying information including name, social security number, veteran status,
age, sex and previous address; |
| (b) |
name, address and telephone number of next of kin, legal guardian and/ or
representative or legal surrogate, if any, or representative payee and any
court order or written document designating the resident's representative or
legal surrogate, if any; |
| (c) |
name,
address and telephone number of any person or agency providing additional
services to the resident. This information must include the name of the agency
personnel primarily responsible where provided to the community by the person
or agency, (i.e., the caseworker, case manager, or therapist); |
| (d) |
an admission and discharge log to include
the date of admission, prior residence of resident, referral source, agency
contact and telephone number of referral source date of discharge, facility or
residence discharged to and telephone number; |
| (e) |
all individual written care plans
required by the serules and the rules for proxy caregivers, Chapter 111-8-100
if applicable; |
| (f) |
the name,
address and telephone number of a physician, hospital and pharmacy of the
resident's choice; |
| (g) |
a record of
all monetary transactions conducted on behalf of the resident with itemized
receipts of all disbursements and deposits; |
| (h) |
a record of all monies and other valuable
sentrusted to the assisted living community for safe keeping; a receipt for
same shall be provided to the resident or representative or legal surrogate, if
any, at the time of admission and at any time there after when the resident
acquires additional property and wishes to entrust such property to the
assisted living community for safe keeping; |
| (i) |
health information including all health
appraisals, diagnoses, prescribed diets, medications, and physician's
instructions; |
| (j) |
an inventory of
valuable personal items brought to the assisted living community for use by the
resident to be updated at anytime after admission if a resident or
representative or legal surrogate, if any, submits to the assisted living
community a new inventory of the resident's personal items; |
| (k) |
a signed copy of the Resident's Rights
form; |
| (l) |
a signed copy of the
admission agreement; |
| (m) |
any power
of attorney or document issued by a court or by the Social Security
Administration or any other governmental authority which designates another
person as responsible for management of the resident's finances; |
| (n) |
a copy of a living will and/or durable
power of attorney for healthcare if executed prior to 2007 or a copy of an
executed Georgia advance directive for healthcare, if any, the forms for which
must be made available at the time of admission and remain available to the
resident upon request; |
| (o) |
any
signed medical or ders impacting end of life care, e.g. do not resuscitate,
physician's orders for life sustaining treatment, etc. |
| (p) |
a copy of the resident's written waiver,
if any, of the personal needs allowance charge pursuant to the provisions of
Rule
111-8-63-.25(p)1; |
| (q) |
a copy of any findings from a search of
the National Sex Offender Registry maintained through the Department of
Justice, etc.; and |
| (r) |
any informed
written consents signed by the resident or resident's representative,
designating and delegating to any trained proxy caregiver, whether employed by
the assisted living community or not, the performance of identified health
maintenance activities. |
| (s) |
evidence the resident has received educational information on influenza disease
no later than September 1 of each year. Such information shall include, but is
not limited to, the risks associated with influenza disease; the availability,
effectiveness, and known contraindications of the influenza immunization;
causes and symptoms of influenza; and the means in which it is spread.
Provision of the appropriate and current Vaccine Information Statement as
provided by the Centers for Disease Control and Prevention shall be deemed to
comply with this regulation. |
|
| (3) |
The following information may be given
voluntarily by the resident, guardian, or representative or legal surrogate, if
any, but may not be required of the resident:
| (a) |
religious preference, church membership,
name and telephone number of minister, priest or rabbi, if applicable;
and |
| (b) |
information about insurance
policies and prearranged funeral and burial provisions, if any. |
|
| (4) |
Resident files must be
maintained by the assisted living community for a period of three years after a
resident's discharge. |
| (1) |
The assisted
living community must operate in a manner that respects the personal dignity of
the residents and the human rights of the residents which rights cannot be
waived, except as provided in these rules by the resident or the resident's
representative or legal surrogate.
| (a) |
The
assisted living community must provide to each resident care and services which
are adequate, appropriate, and in compliance with state law and
regulations. |
| (b) |
The assisted
living community, its agents or employees must not punish or harass a resident
because of the resident's efforts to enforce his or her rights. |
| (c) |
The assisted living community must
operate in a manner that protects each resident's rights to do all of the
following:
| 1. |
exercise the constitutional
rights guaranteed to citizens of this state and this country including, but not
limited to, the right to vote; |
| 2. |
choose activities and schedules consistent with the resident's interests, and
assessments; |
| 3. |
interact with
members of the community both inside and outside the assisted living community
and to participate fully in the life of the community; and |
| 4. |
make choices about aspects of his or her
life in the assisted living community that are significant to the
resident. |
|
| (d) |
Each
resident must have the right to enjoy privacy in his or her room. Assisted
living community staff and others must respect this right by knocking on the
door before entering the resident's room. |
| (e) |
Each resident must have the right to
associate and communicate freely and privately with persons and groups of the
resident's choice without being censored by staff. |
| (f) |
If a resident is married and the spouse
is also a resident in the assisted living community, the residents must be
permitted to share a room unless they request otherwise, subject to the
limitation that no more than two residents may share a bedroom or private
living space. |
| (g) |
Each resident
must be treated with dignity, kindness, consideration and respect and be given
privacy in the provision of assisted living care. Each resident must be
accorded privacy and freedom to use the bathroom(s) at all hours. |
| (h) |
No religious belief or practice must be
imposed upon any resident. Residents must be free to practice their religious
beliefs as they choose. Each resident must have the right to participate in
social, religious, and community activities that do not interfere with the
rights of other residents. |
| (i) |
Each
resident must have the right to be free from mental, verbal, sexual and
physical abuse, neglect and exploitation. |
| (j) |
Each resident has the right to be free
from actual or threatened physical or chemical restraints and the right to be
free from isolation, corporal, or unusual punishment including interference
with the daily functions of living, such as eating or sleeping. |
| (k) |
Each resident must have the right to use,
keep and control his or her own personal property and possessions in the
immediate living quarters, except to the extent a resident's use of his or her
property would interfere with the safety or health of other residents. Each
resident must have the right to reasonable safeguards for the protection and
security of his personal property and possessions brought into the assisted
living community. |
| (l) |
Each
resident's mail must be delivered unopened to the resident on the day it is
delivered to the assisted living community. The assisted living community must
not permit any resident's outgoing correspondence to be opened or tampered with
prior to being mailed or otherwise delivered. |
| (m) |
Each resident must have access to a
telephone made available by the assisted living community and the right to have
a private telephone, at the resident's own expense. Telephones must be placed
in areas to insure privacy without denying accessibility. |
| (n) |
Each assisted living community must
permit immediate access to residents by others who are visiting with the
consent of the resident. Residents have the right to have visitors at mutually
agreed upon hours. Once the hours are agreed upon, no prior notice is
necessary. Each resident also has the right to refuse to see visitors or
terminate any visit. |
| (o) |
Each
resident must have the right to manage his own financial affairs, including the
right to keep and spend his own money unless that resident has been adjudicated
incompetent by a court of competent jurisdiction. Each resident must have the
right to be free from coercion to assign or transfer to the assisted living
community money, valuables, benefits, property or anything of value other than
payment for services rendered by the assisted living community. |
| (p) |
Each resident must have the right to a
personal needs allowance for the free use of the resident in the amount of
twenty dollars per week to be distributed by the administrator, on-site
manager, or a responsible staff person in the assisted living community. The
following conditions must be met regarding the personal needs allowance:
| 1. |
The personal needs allowance must be
included as a charge for services to each resident's account which a resident
or a resident's representative or legal surrogate, if any, may waive by signing
a written waiver upon admission or anytime thereafter. No allowance charge may
be assessed where a resident or a resident's representative or legal surrogate,
if any, has signed a written waiver of the personal needs allowance. Such a
waiver must be kept in a resident's file. |
| 2. |
Where no waiver has been signed, the
personal needs allowance must be tendered to each resident, in cash, on the
same day each week. |
| 3. |
The personal
needs allowance must not be intended or needed for purchasing necessary goods
such as toilet paper and light bulbs which the assisted living community
ordinarily supplies, and shall in no way relieve the assisted living community
of the obligation to insure that such necessary goods are available to the
resident. |
|
| (q) |
Each
resident must have the right to receive or reject medical care, dental care, or
other services by those authorized and/or licensed to provide such medical care
except as required by law or regulations. |
| (r) |
Each resident must have the right to
choose and retain the services of a personal physician and any other health
care professional or service. No assisted living community is permitted to
interfere with the resident's right to receive from the resident's attending
physician complete and current information concerning the resident's diagnosis,
treatment and prognosis. Each resident and his or her representative or legal
surrogate, if any, must have the right to be fully informed about care provided
in the community and of any changes in that care and the right of access to all
information in medical records retained by the community. |
| (s) |
Each resident must have the right to
fully participate in the planning of his or her care and to question the need
for changes in the plan of care. Case discussion, consultation and examination
must be confidential and conducted discreetly. A person who is not directly
involved in the resident's care may be present when care is being rendered only
if he or she has the resident's permission. The resident's duly appointed legal
surrogate(s) shall have the authority to act on the resident's behalf as
established by written applicable federal and state of Georgia law, and shall
be entitled to receive information relevant to the exercise of his or her
authority. |
| (t) |
Each resident,
representative or legal surrogate must have the right to inspect his or her
records on request. Each resident must have the right to make a copy of all
records pertaining to the resident on the premises or obtain a copy from the
community. The community may charge a fee for providing photocopies of the
records, but such charge may not exceed what is charged by the local library
for photocopies. Each resident has the right to confidential treatment of
personal information in the resident file. |
| (u) |
Each resident who has not been committed
to the assisted living community by court order or who does not have a
representative or legal surrogate with specific written authority to admit,
transfer or discharge, may discharge or transfer himself or herself upon 30
days written notification to the assisted living community in conformance with
the assisted living community's policies and procedures. |
| (v) |
Each resident must have the right to
access to the State Long-Term Care Ombudsman Program O.C.G.A. § 31-8-50et
seq. and the name, address, and telephone number of the ombudsman
assigned to the assisted living community must be posted in a common area of
the assisted living community. |
| (w) |
Residents must have the right to form a Resident Council and have meetings in
the assisted living community outside the presence of owners, management or
staff members of the assisted living community and the assisted living
community must provide assistance in coordinating the meetings of the Resident
Council. |
|
| (2) |
Each
resident must be provided, at the time of admission to the assisted living
community, with a copy of the Resident's Bill of Rights, as provided in Rule
111-8-63.25. The Bill of Rights must include provisions for protecting the
personal and civil rights of each resident. In the event that a resident is
unable to read the Resident's Bill of Rights the manager must take steps to
assure communication of its contents to the resident. |
| (3) |
An assisted living community must comply
with the provisions of the "Remedies for Residents of Personal Care Homes Act"
as outlined in O.C.G.A. § 31-8-131et
seq. |
| (4) |
The assisted
living community must ensure that residents and their representatives, where
applicable, are given opportunities to provide feedback in writing and
otherwise on their satisfaction with the services being provided by the
assisted living community with respect to at least the following areas: quality
of care, food, activities, cleanliness of the assisted living community and
helpfulness of the staff. |
| (5) |
The
assisted living community must retain a copy of the resident's record for two
years following the date of discharge. |
| (6) |
The assisted living community must
maintain documentation of the feedback it receives and its response to the
feedback. |
| (1) |
In case of an accident or sudden adverse
change in a resident's condition or adjustment, an assisted living community
must immediately take the actions appropriate to the specific circumstances to
address the needs of the resident, including notifying the representative or
legal surrogate, if any. The assisted living community must retain a record of
all such adverse changes and the assisted living community's response in the
resident's files. |
| (2) |
Where the
sudden change in the resident's condition causes the resident to become
unresponsive, the assisted living community must immediately take one of the
following actions:
| (a) |
If the resident is
enrolled in a licensed hospice and has a specific hospice plan of care, the
assisted living community must contact the hospice for directions regarding the
care to be provided. If the hospice staff is not available to provide
direction, then the assisted living community must immediately contact the
duly-appointed health care agent for direction. If no health care agent has
been appointed or is not available, then the assisted living community must
immediately contact emergency medical services to arrange for emergency
transport and must initiate cardiopulmonary resuscitation if no DNR order has
been written. |
| (b) |
If the resident
has a valid Do Not Resuscitate (DNR) order readily available, the caregiver may
effectuate the DNR order if done in good faith. |
| (c) |
If the resident has appointed a health
care agent in a living will, durable power of attorney for health care or an
advance directive for health care which complies with the requirements of
O.C.G.A. § 31-32-1et
seq.,then the assisted living community must immediately contact the
health care agent for directions regarding the care to be provided. Where the
health care agent is not immediately available and there is no valid DNR order
for the resident, the assisted living community must immediately contact
emergency medical services to arrange for emergency transport and must initiate
cardiopulmonary resuscitation. |
| (d) |
If the resident is not enrolled in hospice, and does not have either a DNR or
an advance directive, then the staff of the assisted living community must
immediately contact emergency medical services to arrange for emergency
transport and must initiate cardiopulmonary resuscitation where it is not
obvious from physical observation of the resident's body (e.g. body is stiff,
cool to the touch, blue or grayish in color, etc.) that such efforts would be
futile and there is not a physician, or authorized registered nurse or
physician's assistant on site to assess and provide other direction. |
|
| (2) |
The staff must have ready
access to phone numbers for emergency medical personnel and the resident's file
or appropriate emergency medical and contact information for each resident,
both at the assisted living community and when residents are being transported
by the assisted living community for any reason. |
| (3) |
Immediate investigation of the cause of
an accident, injury or death involving a resident must be initiated by the
administrator or on-site manager of the assisted living community and a report
made to the representative or legal surrogate, if any, with a copy of the
report maintained in the resident's file and in a central file for quality
assurance review. |
| (1) |
Should a resident die while in the
assisted living community, the administrator, on-site manager or designated
staff must immediately notify the resident's physician, the next of kin, and
the representative or legal surrogate, if any, and appropriate law enforcement
authorities where the law so requires, such as in the case of a sudden or
unexpected death. |
| (2) |
Upon death of
the resident, the assisted living community must refund to the representative
or legal surrogate, if any, any security deposit made to the assisted living
community by or on behalf of the resident in compliance with O.C.G.A. § 44-7-30et
seq. |
| (1) |
The administrator or on-site manager of
the assisted living community must initiate an immediate transfer to an
appropriate setting if the resident develops a physical or mental condition
requiring continuous medical care or nursing care. |
| (2) |
Where immediate transfer is required to
be made, the administrator or on-site manager shall make arrangements for
transfer in accordance with the admission agreement and must transfer the
resident to an appropriate setting where the resident's needs can be met. Prior
to making such transfer, the administrator or on-site manager shall:
| (a) |
inform the resident and representative or
legal surrogate, if any, of the reason for the immediate transfer; |
| (b) |
inquire as to any preference of the
resident and representative or legal surrogate, if any, regarding the
appropriate setting to which the resident is to be transferred; |
| (c) |
inform the representative or legal
surrogate, if any, of the resident's choice regarding such transfer; |
| (d) |
inform the resident and the
representative or legal surrogate, if any, of the place to which the resident
is to be discharged; |
| (e) |
provide a
copy of the resident file to the receiving setting within 24 hours of transfer;
and |
| (f) |
document in the resident's
file the following:
| 1. |
the reason for the
immediate transfer; |
| 2. |
the fact
that the resident and the representative or legal surrogate, if anywhere
informed pursuant to this paragraph; and |
| 3. |
appropriate location and contact
information regarding the place to which the resident is to be transferred or
discharged. |
|
|
| (3) |
Upon immediate transfer of the resident,
the assisted living community must refund to the resident or representative or
legal surrogate, if any, any security deposit made to the assisted living
community by or on behalf of the resident in compliance with O.C.G.A. § 44-7-30et
seq. |
| (1) |
Each admission agreement shall include a
written procedure for handling the discharge and transfer of the resident. The
administrator or on-site manager must contact the representative or legal
surrogate, if any, when there is need to discharge or transfer of a resident.
The community must provide 30 days' written notice of its intent to discharge
or transfer the resident unless an immediate transfer is required. The written
notice must be issued to both the resident and the representative or legal
surrogate, if any. |
| (2) |
In all cases
except those requiring immediate transfer pursuant to Rule
111-8-63-.28, residents whose needs
cannot be met by the assisted living community or who no longer choose to live
in the assisted living community must be discharged or transferred to an
appropriate facility or other appropriate setting in accordance with the
resident's, representative or legal surrogate's wishes based on discharge and
transfer procedures entered into at the time of admission. Where there is no
representative or legal surrogate or the representative or legal surrogate is
unwilling to act to consent to the discharge or transfer, the administrator or
on-site manager must petition the probate court in the county where the
assisted living community is located for an order authorizing the discharge or
transfer. The transferring assisted living community must provide a copy of the
resident file to the receiving facility prior to or at the time of
transfer. |
| (3) |
Where the Department
has reason to believe that a resident is receiving or requires continuous
medical or nursing care, other than as permitted by a certified medication
aide, the Department may require the assisted living community to discharge the
resident. However, the provision of medical, nursing or health services
required by the resident on a periodic basis or for a short-term illness, where
such services are not provided by the assisted living community is
permissible. |
| (4) |
Upon discharge or
transfer of the resident, the assisted living community must refund to the
resident or representative or legal surrogate, if any, any security deposit
made to the assisted living community by or on behalf of the resident in
compliance with O.C.G.A. § 44-7-30et
seq. |
| (1) |
The staff of the assisted living
community must call the local police department to report the elopement of any
resident from the assisted living community within 30 minutes of the staff
receiving actual knowledge that such person is missing from the assisted living
community in accordance with the Mattie's Call Act and the requirements set
forth in O.C.G.A. § 35-3-170et
seq. The assisted living community shall also report the initiation
and discontinuation of a Mattie's call to the Department within thirty (30)
minutes of communications with local law enforcement authorities having
occurred. |
| (2) |
Whenever a serious
incident involving a resident occurs, the assisted living community must report
in a format acceptable to the Department either within 24 hours after the
incident has occurred, or the assisted living community has reasonable cause to
believe that a reportable incident involving a resident has occurred. The
serious incidents that must be reported to the Department include the
following:
| (a) |
any accidental or
unanticipated death not directly related to the natural course of the
resident's underlying medical condition; |
| (b) |
any serious injury to a resident that
requires medical attention; |
| (c) |
any
rape, assault, any battery on a resident, or any abuse, neglect, or
exploitation of a Resident in accordance with the Long Term Care Resident Abuse
Reporting Act O.C.G.A. § 31-8-80et
seq.; |
| (d) |
an external
disaster or other emergency situation that affects the continued safe operation
of the residence; and |
| (e) |
when an
owner, director or employee acquires a criminal record as defined in these
rules. |
|
| (3) |
The incident
report required by these rules must be filed with the Department, in confidence
and must include at least:
| (a) |
the name of the
assisted living community and the name of the administrator or site
manager; |
| (b) |
the date of the
incident and the date the assisted living community became aware of the
incident; |
| (c) |
the type of incident
suspected, with a brief description of the incident; and |
| (d) |
any immediate corrective or preventative
action taken by the assisted living community to ensure against the replication
of the incident. |
|
| (4) |
Where the Department determines that a rule violation related to the incident
has occurred, the Department will initiate a separate complaint investigation
of the incident. The complaint investigation report and the report of any rule
violation compiled by the Department arising either from the initial report
received from the assisted living community or an independent source is subject
to disclosure in accordance with applicable laws. |
The Department may accept the certification or accreditation
of an assisted living community by an accreditation body or certifying
authority recognized and approved by the Department provided that certification
or accreditation constitutes compliance with standards that are substantially
equivalent to these rules. Nothing herein shall prohibit any departmental
inspection to determine compliance with licensure rules.
| (1) |
The Department may, in its discretion,
grant variances and waivers of specific rules upon application or petition
filed on forms made available by the Department. The Department may establish
conditions which must be met by the assisted living community in order to
operate under the variance or waiver granted.
| (a) |
Variance. A variance may be
granted by the Department upon a showing by the applicant or petitioner that
the particular rule or regulation that is the subject of the variance request
should not be applied as written because strict application of the rule would
cause undue hardship. The applicant or petitioner must also show that adequate
standards affording protection for the health, safety, and care of the
residents exist and will be met in lieu of the exact requirements of the rule
or regulations in question. The Department may require additional documentation
by the assisted living community to support its application for a variance or
waiver. |
| (b) |
Waiver.
The Department may dispense entirely with the enforcement of a rule or
regulation by granting a waiver upon a showing by the applicant or petitioner
that the purpose of the rule or regulation is met through equivalent standards
affording equivalent protection for the health, safety, care, and rights of the
residents. |
| (c) |
Experimental
Variance or Waiver. The Department may grant variances and waivers to
allow experimentation and demonstration of new and innovative approaches to
delivery of services upon a showing by the applicant or petitioner that the
intended protections afforded by the rule or regulation which is the subject of
the request are met and that the innovative approach has the potential to
improve service delivery without compromising health, safety, residents'
rights, or other relevant standards. |
|
| (2) |
The decision of the Department regarding
either granting or denying the application of the governing body of the
assisted living community for a waiver or variance is not subject to further
administrative review. The governing body may file a petition for judicial
review in the appropriate superior court. |
| (3) |
Where the Department has denied the
application for a waiver or variance in writing, the Department will not
consider a subsequent application for the same waiver or variance as a new
application unless the applicant includes new evidence of a substantial change
in the circumstances which formed the basis for the initial request. |
An assisted living community that fails to comply with
licensing requirements contained in these rules, the Rules and Regulations for
the Use of Proxy Caregivers, Chapter 111-8-100 and the Rules and Regulations
for General Licensing and Enforcement Requirements, Chapter 111-8-25, is
subject to civil and administrative actions brought by the Department to
enforce licensing requirements as provided by law and rules. Such actions will
be initiated in compliance with the Georgia Administrative Procedures Act,
O.C.G.A. § 50-13-1et
seq., O.C.G.A. § 31-2-11
and the Rules and Regulations for General Licensing and Enforcement
Requirements, Chapter 111-8-25.
In the event that any rule, sentence, clause or phrase of any
of the rules and regulations may be construed by any court of competent
jurisdiction to be invalid, illegal, unconstitutional, or otherwise
unenforceable, such determination or adjudication shall in no manner affect the
remaining rules or portions thereof. The remaining rules or portions thereof
shall remain in full force and effect as if such rule or portions thereof so
determined, declared or adjudicated invalid or unconstitutional were not
originally part of these rules.
