R9-10-815. Directed Care Services

A. A manager shall ensure that a resident’s representative is designated for a resident who is unable to direct self-care. B. A manager of an assisted living facility authorized to provide directed care services shall not accept or retain a resident who, except as provided in R9-10-814(B)(2): 1. Is confined to a bed or chair because of an inability to ambulate even with assistance; or 2. Has a stage 3 or stage 4 pressure sore, as determined by a registered nurse or medical practitioner. C. In addition to the requirements in R9-10-808(A)(3), a manager shall ensure that the service plan for a resident receiving directed care services includes: 1. The requirements in R9-10-814(F)(1) through (3); 2. If applicable, the determination in R9-10- 814(B)(2)(b)(iii); 3. Cognitive stimulation and activities to maximize functioning; 4. Strategies to ensure a resident’s personal safety; 5. Encouragement to eat meals and snacks; 6. Documentation: a. Of the resident’s weight, or b. From a medical practitioner stating that weighing the resident is contraindicated; 7. Coordination of communications with the resident’s representative, family members, and, if applicable, other individuals identified in the resident’s service plan; and 8. If the resident is receiving memory care services: a. Identification of specialized environmental features to support memory care services, such as secure areas to prevent wandering and spaces designed for cognitive stimulation and engagement; b. Strategies for providing person-centered care that aligns with the principles of dementia-friendly environments, including familiar surroundings, optimized sensory stimulation, and meaningful activities; and c. Strategies for administering medications as ordered. D. A manager shall ensure that an employee does not provide non-prescription medication to a resident receiving directed care services unless the resident has an order from a medical practitioner for the non-prescription medication. E. A manager shall ensure that: 1. A bell, intercom, or other mechanical means to alert employees to a resident’s needs or emergencies is available in a bedroom being used by a resident receiving directed care services; or 2. An assisted living facility has implemented another means to alert a caregiver or assistant caregiver to a resident’s needs or emergencies. F. A manager of an assisted living facility authorized to provide directed care services shall ensure that: 1. Policies and procedures are established, documented, and implemented that ensure the safety of a resident who may wander; 2. There is a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort that meets one of the following: a. Provides access to an outside area that: i. Allows the resident to be at least 30 feet away from the facility that is secure, and ii. Monitors or alerts employees of the egress of a resident from the facility; b. Provides access to an outside area: i. From which a resident may exit to a location at least 30 feet away from the facility that is secure, and ii. Monitors or alerts employees of the egress of a resident from the facility; or c. Uses a mechanism that meets the Special Egress- Control Devices provisions in the International Building Code incorporated by reference in R9-10- 104.01; and 3. A caregiver or an assistant caregiver complies with the requirements for incidents in R9-10-804 when a resident who is unable to direct self-care wanders into an area not designated by the governing authority for use by the resident.