216-RICR-40-10-2
216-RICR-40-10-2. Licensing Assisted Living Residences (version Amendment, 08/31/2021 to 02/27/2022)
2.1 Authority
A. These regulations are promulgated
pursuant to the authority conferred under R.I. Gen. Laws Chapter
23-17.4 ,
and are established for the purpose of defining the minimum standards
for licensed assisted living residences in Rhode Island; for the care
of residents in an assisted living residence; for the maintenance and
operation of assisted living residences which will:
1. Promote the dignity, individuality,
independence, privacy, and autonomy of residents;
2. Provide a safe and home-like
environment; and
3. Protect the safety, health and welfare
of residents; for the encouragement of quality of life for all
residents; and for the encouragement of quality in all aspects of the
operations of assisted living residences.
2.2 Incorporated Materials
A. These
regulations hereby adopt and incorporate Dietary Reference Intakes:
The Essential Guide to Nutrient Requirements, National Academies
Press, 2006, by reference, not including any further editions or
amendments thereof and only to the extent that the provisions therein
are not inconsistent with these regulations.
B. These
regulations hereby adopt and incorporate ANSI A117.1 - 2003
Accessible and Usable Buildings and Facilities, International Code
Council, 2003 by reference, not including any further editions or
amendments thereof and only to the extent that the provisions therein
are not inconsistent with these regulations.
C. These
regulations hereby adopt and incorporate Kroger, Andrew, et al.
“General Recommendations on Immunization: Recommendations of
the Advisory Committee on Immunization Practices (ACIP),”
Morbidity and Mortality Weekly Report Recommendations and Reports,
vol. 60, no. RR02, 2011,
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm, by reference,
not including any further editions or amendments thereof and only to
the extent that the provisions therein are not inconsistent with
these regulations.
2.3 Definitions
A. Whenever
used in these regulations, the following terms shall be construed as
follows:
1. "Abuse" means any assault as
defined in R.I. Gen. Laws Chapter 11-5
including, but not limited to hitting, kicking, pinching, slapping or
the pulling of hair, provided however, unless such is required as an
element of offense, it shall not be necessary to prove that the
patient or resident was injured thereby, or any assault as defined in
R.I. Gen. Laws Chapter 11-37
or any offense under R.I. Gen. Laws Chapter 11-10 ;
or
a. Any conduct which harms or is likely to
physically harm the resident except where the conduct is a part of
the care and treatment, and in furtherance of the health and safety
of the resident; or
b. Intentionally engaging in a pattern of
harassing conduct which causes or is likely to cause emotional or
psychological harm to the resident, including but not limited to
ridiculing or demeaning a patient or resident, making derogatory
remarks to a patient or resident or cursing directed towards a
patient or resident, or threatening to inflict physical or emotional
harm on a patient.
2. "Act" means R.I. Gen. Laws
Chapter 23-17.4 ,
entitled "Assisted Living Residence Licensing Act."
3. "Activities of daily living"
means bathing, dressing, eating, toileting, mobility and transfer.
4. "Administrator" means the
person who has responsibility for day to day administration or
operation of an assisted living residence.
5. “Alzheimer Dementia Special Care
Unit/Program” means a distinct living environment within an
assisted living residence that has been physically adapted to
accommodate the particular needs and behaviors of those with
dementia. The unit provides increased staffing, therapeutic
activities designed specifically for those with dementia and trains
its staff on an ongoing basis on the effective management of the
physical and behavioral problems of those with dementia. The
residents of the unit or program have had a standard medical
diagnostic evaluation and have been determined to have a diagnosis of
Alzheimer's dementia or another dementia.
6. "Assisted living residence"
means a publicly or privately operated residence that provides
directly or indirectly by means of contracts or arrangements personal
assistance and may include the delivery of limited health services,
as defined under R.I. Gen. Laws § 23-17.4-2(12) ,
to meet the resident's changing needs and preferences, lodging, and
meals to six (6) or more adults who are unrelated to the licensee or
administrator, excluding however, any privately operated
establishment or facility licensed pursuant to R.I. Gen. Laws Chapter
23-17
and those facilities licensed by or under the jurisdiction of the
Department of Behavioral Healthcare, Development Disabilities and
Hospitals, the Department of Children, Youth, and Families, or any
other state agency.
7. "Capable of self-preservation"
means the physical mobility and judgmental ability of the individual
to take appropriate action in emergency situations. Residents not
capable of self- preservation are limited to facilities that meet
more stringent Life Safety Code requirements as provided under R.I.
Gen. Laws § 23-17.4-6(b)(3) .
8. "Change in operator" means a
transfer by the licensee or operator of an assisted living residence
to any other person (excluding delegations of authority to the
administrative employees of the residence) of the licensee's
authority to:
a. Hire or fire the chief executive officer
of the assisted living residence;
b. Maintain and control the books and
records of assisted living residence;
c. Dispose of assets and incur liabilities
on behalf of the assisted living residence; or
d. Adopt and enforce policies regarding
operation of the assisted living residence.
e. This definition is not applicable to
circumstances wherein the licensee of an assisted living residence
for adults retains the immediate authority and jurisdiction over the
activities enumerated in §§ 2.3(A)(a) through (d) of this
Part above.
9. "Change in owner" means:
a. In the case of an assisted living
residence which is a partnership, the removal, addition or
substitution of a partner which results in a new partner acquiring a
controlling interest in such partnership;
b. In the case of an assisted living
residence which is an unincorporated solo proprietorship, the
transfer of the title and property to another person;
c. In the case of an assisted living
residence which is a corporation:
(1) A sale,
lease, exchange or other disposition of all, or substantially all of
the property and assets of the corporation; or
(2) A merger
of the corporation into another corporation; or
(3) The
consolidation of two or more corporations, resulting in the creation
of a new corporation; or
(4) In the
case of an assisted living residence which is a business corporation,
any transfer of corporate stock which results in a new person
acquiring a controlling interest in such corporation; or
(5) In the
case of an assisted living residence which is a non-business
corporation, any change in membership which results in a new person
acquiring a controlling vote in such corporation.
10. "COVID-19" means the disease
caused by the novel coronavirus SARS-CoV-2.
11. “Department” means the
Rhode Island Department of Health. The Department is also the
“licensing agency” designated pursuant to R.I. Gen. Laws
Chapter 23-17 .
12. "Director" means the Director
of the Rhode Island Department of Health.
13. “Center for Acute Infectious
Diseases Epidemiology” means Center for Acute Infectious
Diseases Epidemiology (CAIDE); Division of Preparedness, Response,
Infectious Disease & Emergency Medical Services; Rhode Island
Department of Health.
14. "Elopement," means leaving
the premises without notice when the residence has assumed
responsibility for the resident’s whereabouts.
15. “Employee” means any
individual, whether paid or unpaid, directly employed by or under
contract with the residence, who provides or delivers direct care
services to residents and/or who has routine contact with residents
without the presence of other employees.
16. "Established resident" means
a person living in an assisted living residence with a contract and
service plan in place based upon a complete assessment.
17. “Fiduciary agent” means one
who holds a fiduciary relation or acts in a fiduciary capacity.
18. "Vaccinated" means a person
has received all recommended dose(s) of a COVID-19 vaccine authorized
by the U.S. Food and Drug Administration ("FDA") or World
Health Organization ("WHO") or all recommended dose(s) of
another COVID-19 vaccine approved by the Department (e.g., Novavax).
19. "Health oversight agency"
means a public authority or other agency or organization authorized
by law to investigate or otherwise oversee the reporting of
allegations of failure to meet professional practice standards or
misconduct.
20. "High managerial agent" means
an officer of a residence, the administrator and assistant
administrator of the residence, the director and assistant director
of nursing services, or any other agent in a position of comparable
authority with respect to the formulation of policies of the
residence or the supervision in a managerial capacity of subordinate
employees.
21. "Level of licensure" means
the licensed authority to admit residents according to the following
classifications: [Note that residences must have both an "F"
(fire) and an "M" (medication) classification].
22. "Licensee" means any person
who holds an assisted living residence license from the Department.
23. "Life Safety Code" means the
current applicable Rhode Island Fire Safety Code, R.I. Gen. Laws
Chapter 23-28.1 .
24. "Limited health services"
means health services provided by a licensed assisted living
residence, as ordered by a resident's physician, and provided by
qualified licensed assisted living staff members. Limited health
services includes the following:
a. Stage I and stage II pressure ulcer
treatment and prevention;
b. Simple wound care including
postoperative suture care/removal and stasis ulcer care;
c. Ostomy care including appliance changes
for residents with established stomas;
d. Urinary catheter care.
25. “Medication aide” means a
nursing assistant who has had additional training in the
administration of medications and is registered with the Department
pursuant to R.I. Gen. Laws Chapter 23-17.9
and rules and regulations pertaining to Rhode Island Certificates of
Registration for Nursing Assistants, Medication Aides, and the
Approval of Nursing Assistant and Medication Aide Training Programs
(Part 05-22 of this Chapter).
26. "Mistreatment" means the
inappropriate use of medications, isolation, or use of physical or
chemical restraints as punishment, for employee convenience, as a
substitute for treatment or care, in conflict with a physician's
order, or in quantities which inhibit effective care of treatment,
which harms or is likely to harm the patient or resident.
27. "Neglect" means the
intentional failure to provide treatment, care, goods and services
necessary to maintain the health and safety of the patient or
resident, or the intentional failure to carry out a plan of treatment
or care prescribed by the physician of the patient or resident, or
the intentional failure to report patient or resident health problems
or changes in health conditions to an immediate supervisor or nurse,
or the intentional lack of attention to the physical needs of a
patient or resident including, but not limited to toileting, bathing,
meals and safety. “Neglect” also means failure to
promptly act upon any change in a resident’s condition that
would disqualify that resident from admission to the residence
pursuant to § 2.4.14(A)of this Part, including but not limited
to, the transfer of the resident to a health care facility. Provided,
however, no person shall be considered to be neglected for the sole
reason that he or she relies or is being furnished treatment in
accordance with the tenets and teachings or a well-recognized church
or denomination by a duly-accredited practitioner thereof.
28. “Center for Health Facilities
Regulation” means the Center for Health Facilities Regulation,
Division of Customer Services, Rhode Island Department of Health.
29. “Center for Food Protection”
means the Center for Food Protection, Division of Environmental
Health, Rhode Island Department of Health.
30. "Person" means any
individual, trust or estate, partnership, corporation (including
associations, joint stock companies, or limited liability companies)
state or political subdivision or instrumentality of a state.
31. "Personal assistance" means
the provision of one (1) or more of the following services, as
required by the resident or as reasonably requested by the resident,
on a scheduled or unscheduled basis, including:
a. Assisting the resident with personal
needs, including activities of daily living;
b. Assisting the resident with
self-administration of medication; or administration of medications
by appropriately licensed staff;
c. Providing or assisting the resident in
arranging for health and supportive services as may be reasonably
required;
d. Monitoring the activities of the
resident while on the premises of the residence to ensure his or her
health, safety, and well-being; and
e. Reasonable recreational, social and
personal services.
32. “Qualified designee” means
a licensed registered nurse, licensed practical nurse, or registered
medication aide.
33. "Qualified licensed assisted
living staff members" means a certified nursing assistant as
provided under R.I. Gen. Laws § 23-17.9-2(a)(3) ,
a licensed practical nurse as provided under R.I. Gen. Laws §
5-34-3(9)
and/or a registered nurse as provided under R.I. Gen. Laws §
5-34-3(10)
34. "Resident" means an
individual not requiring medical or nursing care as provided in a
health care facility but who as a result of choice and/or physical or
mental limitation requires personal assistance, lodging and meals and
may require the administration of medication and/or limited health
services. A resident must be capable of self-preservation in
emergency situations, unless the facility meets a more stringent Life
Safety Code as required under R.I. Gen. Laws § 23-17.4-6(b)(3) .
Persons needing medical or skilled nursing care, including daily
professional observation and evaluation, as provided in a health care
facility, and/or persons who are bedbound or in need of the
assistance of more than one (1) person for ambulation are not
appropriate to reside in assisted living residences. However, an
established resident may receive daily skilled nursing care or
therapy from a licensed health care provider for a condition that
results from a temporary illness or injury for up to forty-five (45)
days subject to an extension of additional days as approved by the
Department, or if the resident is under the care of a Rhode Island
licensed hospice agency provided the assisted living residence
assumes responsibility for ensuring that the required care is
received. Furthermore, a new resident may receive daily therapy
services and/or limited skilled nursing care services, as defined
through these regulations, from a Rhode Island licensed health care
provider for a condition that results from a temporary illness or
injury for up to forty-five (45) days subject to an extension of
additional days as approved by the Department, or if the resident is
under the care of a Rhode Island licensed hospice agency provided
that assisted living residence assumes responsibility for ensuring
that the care is received. Notwithstanding the aforementioned,
residents who are bed bound or in need of assistance of more than one
(1) staff person for ambulation may reside in a residence if they are
receiving hospice care in accordance with these regulations
"Resident" shall also mean the resident's agent as
designated in writing or legal guardian.
35. "Significant change" means an
improvement or decline in the resident's health status, behavior, or
cognitive and/or functional abilities that results in a change in the
resident's independence or quality of life, including but not limited
to:
a. Resident's ability to perform activities
of daily living;
b. A change in the resident’s
behavior or mood resulting in behavioral symptoms that present a
threat to the resident's self or others;
c. The elimination of problematic behavior
on a sustained basis;
d. Requirements for resident’s level
of service.
36. “State Fire Marshal” means
the Division of the State Fire Marshal, Department of Public Safety,
State of Rhode Island.
37. "Supervision" means the
supervision requirements of qualified licensed assisted living staff
delivering limited health services.
2.4 Licensure Requirements
2.4.1 General
Requirements for Licensing
A. No person,
acting alone or jointly with any other person, shall conduct or
maintain an assisted living residence in Rhode Island without a
license in accordance with the requirements of R.I. Gen. Laws §
23-17.4-4
and in conformity with these regulations.
1. All assisted living residences are
subject to and must meet the requirements of § 2.4 of this Part
to obtain and renew an assisted living residence license.
2. Any assisted living residence which
offers to provide or provides services to residents with Alzheimer
disease or other dementia by means of an Alzheimer Dementia/Special
Care Unit/Program is also subject to the requirements of § 2.5
of this Part to obtain and renew a license endorsement which
authorized these activities.
3. Any assisted living residence which
offers to provide or provides limited health services to residents is
also subject to the requirements of § 2.6 of this Part to obtain
and renew a license endorsement which authorized these activities.
4. Any assisted living residence which
offers to provide or provides services for residents receiving
hospice services that are bed-bound or in need of assistance from
more than one staff person for ambulation is required to be licensed
at the F1 level, as defined in § 2.4.2(A)(1)(a) of this Part,
and must have a license endorsement, issued pursuant to these
regulations, to provide limited health services, and shall, at a
minimum provide services for stage I and stage II pressure ulcer
treatment and prevention and meet the requirements of § 2.6 of
this Part.
B. No person,
acting severally or jointly with any other person, shall admit or
retain a resident in an assisted living residence which residence:
1. does not meet the definition and
requirements of the Act; or
2. is not able to provide the services
needed by a resident as agreed to in the service plan required under
R.I. Gen. Laws § 23-17.4-15.6 .
C. Each
license shall specify the licensed resident capacity of the
residence. The occupancy of the residence shall never exceed the
licensed resident capacity.
1. The residence shall identify to the
Department the location of beds and shall maintain proper space and
furnishings for such locations.
2. The residence may not house more
assisted living residents than the licensed capacity at any given
time.
D. Proposed
changes in bed capacity within a residence shall be submitted to the
Department in writing and shall be subject to the approval of the
Department.
E. No person
and/or combination per area of residence shall represent itself as an
assisted living residence or use the term residential care or any
other similar term in its title, advertising, publication or other
form of communication, unless licensed as an assisted living
residence in accordance with the provisions herein.
2.4.2 Levels of Licensure
A. An assisted
living residence shall only admit and retain residents according to
the level of licensure for which the residence has been licensed. A
residence may have areas which are licensed separately.
1. Fire Code Classifications
a. Level F1 licensure: for residents who
are not capable of self-preservation. This level requires a more
stringent Life Safety Code, as defined in § 2.3(A)(21) of this
Part; or
b. Level F2 licensure: for residents who
are capable of self-preservation.
2. Medication Classifications
a. Level M1 licensure: for one (1) or more
residents who require central storage and/or administration of
medications; or
b. Level M2 licensure: for residents who
require assistance (as elaborated in § 2.4.24(A)(3)(a) of this
Part) with self-administration of medications;
3. Dementia Care
This category of licensure shall be
required when one (1) or more resident's dementia symptoms impact
their ability to function as demonstrated by any of the following:
a. Safety concerns due to elopement risk or
other behaviors;
b. Inappropriate social behaviors that
adversely impact the rights of others;
c. Inability to self-preserve due to
dementia;
d. A physician's recommendation that the
resident needs dementia support consistent with this level; or if the
residence advertises or represents special dementia services or if
the residence segregates residents with dementia. In addition to the
requirements for the basic license, licensing requirements for the
"dementia care" level shall include the following:
(1) Staff
training and/or requirements specific to dementia care as determined
by the Department;
(2) A
registered nurse on staff and available for consultation at all
times;
(3) The
residence shall provide for a secure environment appropriate for the
resident population.
e. A residence licensed at the "dementia
care" level shall:
(1) Be
licensed as an "F1--M1" residence in accordance with the
requirements of §§ 2.4.2(A)(1)(a) and (2)(a) of this Part;
and
(2) Meet the
requirements of §§ 2.4 and 2.5 of this Part.
4. Limited Health Care Services:
a. This category of licensure shall be
required for any assisted living residence that provides or offers to
provide services in a manner as defined in § 2.3(A)(22) of this
Part.
2.4.3 Quality
Assurance
A. In
accordance with R.I. Gen. Laws § 23-17.4-10.1 ,
each assisted living residence shall develop, implement and maintain
a documented, ongoing quality assurance program.
1. The purpose of this program shall be to
attain and maintain a high quality assisted living residence through
an on-going process of quality improvement that monitors quality,
identifies areas to improve, methods to improve them, and evaluates
the progress achieved.
2. Each licensed residence shall establish
a quality improvement committee which shall include at least the
following: assisted living administrator, registered nurse and a
representative of dietary services.
3. The quality improvement committee shall
meet at least quarterly; shall maintain records of all quality
improvement activities; and shall keep records of committee meetings
that shall be available to the Department during any on-site visit.
4. The quality improvement committee shall
review and approve the quality improvement plan for the residence at
intervals not to exceed twelve (12) months. Said plan shall be
available to the public upon request.
5. Each assisted living residence shall
establish a written quality improvement plan that includes:
a. Program objectives;
b. Oversight responsibility (e.g., reports
to the governing body, QI records);
c. Includes methods to identify, evaluate,
and correct identified problems;
d. Provides criteria to monitor personal
assistance and resident services, including, but not limited to:
(1) Resident/family
satisfaction;
(2) Medication
administration/errors;
(3) Reportable
incidents as specified in § 2.4.17 of this Part;
(4) Resident
falls;
(5) Plans of
correction developed in response to the Department’s inspection
reports.
B. In addition
to the requirements of §§ 2.4.3(A)(1) through (5) of this
Part, all assisted living residences with a “dementia care”
license and/or a “limited health services license” shall
also address the following areas in their quality improvement plan:
a. Prevention and treatment of decubitus
ulcers;
b. Dehydration, and nutritional status and
weight loss or gain; and
c. Changes in mental or psychological
status.
1. Quality improvement documentation shall
be kept on file for a minimum of five (5) years.
2.4.4 Financial
Interest Disclosure
A. Any
licensed assisted living residence which refers clients to any health
care facility licensed pursuant to R.I. Gen. Laws Chapter 23-17 ,
or to another assisted living residence licensed pursuant to the Act,
or to a certified adult day care program in which the referring
entity has a financial interest shall, at the time a referral is
made, disclose the following information to the client:
1. That the referring entity has a
financial interest in the residence or provider to which the referral
is being made; and
2. That the client has the option of
seeking care from a different residence or provider which is also
licensed and/or certified by the State of Rhode Island to provide
similar services to the client.
B. The
referring entity shall also offer the client a written list prepared
by the Department of all such alternative licensed and/or certified
facilities or providers. Said written list may be obtained by
contacting the Department as specified in § 2.4.6 of this Part.
C. Non-compliance
with §§ 2.4.4(A) and (B) of this Part shall constitute
grounds to revoke, suspend or otherwise discipline the licensee or to
deny an application for licensure by the Director, or may result in
imposition of an administrative penalty in accordance with R.I. Gen.
Laws Chapter 23-17.10 .
2.4.5 Safe
Resident Handling
A. Each
licensed assisted living residence with an “Alzheimer’s
Dementia Special Care Unit or Program” license and/or offers to
provide or provides coordination of hospice services for residents
who are bed-bound or in need of assistance from more than one staff
person for ambulation shall comply with the provisions of §§
2.4.5(B) through (E) of this Part as a condition of licensure.
1. Notwithstanding the requirements of §
2.4.5(A) of this Part, assisted living residences licensed for an
“Alzheimer’s Dementia Special Care Unit or Program”
prior to 1 June 2015 shall be in compliance with the requirements of
§§ 2.4.5(B) through (E) of this Part not later than 1 July
2015.
2. A currently licensed assisted living
residence who applies for a new level of licensure on or after 1 June
2015 will be required to meet the requirements of §§
2.4.5(B) through (E) of this Part prior to a new license level being
approved.
B. Shall
maintain a safe resident handling committee, which shall be chaired
by a professional nurse or other appropriate licensed health care
professional. An assisted living may utilize any appropriately
configured committee to perform the responsibilities of this section.
At least half of the members of the committee shall be hourly,
non-managerial employees who provide direct resident care.
C. Shall have
a written safe resident handling program, with input from the safe
handling committee, to prevent musculoskeletal disorders among health
care workers and injuries to residents. As part of this program, each
licensed assisted living shall:
1. Implement a safe resident handling
policy for all shifts and units of the residence that will achieve
the maximum reasonable reduction of manual lifting, transferring, and
repositioning of all or most of a resident's weight, except in
emergency, life-threatening, or otherwise exceptional circumstances;
2. Conduct a resident handling hazard
assessment. This assessment should consider such variables as
handling-handling tasks, types of units, resident populations, and
the physical environment of resident care areas;
3. Develop a process to identify the
appropriate use of the safe resident handling policy based on the
resident’s physical and mental condition, the resident's
choice, and the availability of lifting equipment or lift teams. The
policy shall include a means to address circumstances under which it
would be medically contraindicated to use lifting or transfer aids or
assistive devices for particular residents;
4. Designate and train a registered nurse
or other appropriate licensed health care professional to serve as an
expert resource, and train all direct care staff on safe resident
handling policies, equipment, and devices before implementation, and
at intervals not to exceed twelve (12) months, or as changes are made
to the safe handling policies, equipment and/or devices being used;
and
5. Conduct a performance evaluation of the
safe resident handling policy at intervals not to exceed twelve (12)
months, with the results of the evaluation reported to the safe
resident handling committee or other appropriately designated
committee. The evaluation shall determine the extent to which
implementation of the program has resulted in a reduction in
musculoskeletal disorder claims and days of lost work attributable to
musculo-skeletal disorder caused by resident handling, and include
recommendations to increase the program's effectiveness.
D. Nothing in
§ 2.4.5(A) of this Part precludes lift team members from
performing other duties as assigned during their shift.
E. An employee
may, in accordance with established residence protocols, report to
the committee, as soon as possible, after being required to perform a
resident handling activity that he/she believes in good faith exposed
the resident and/or employee to an unacceptable risk of injury. Such
employee reporting shall not be cause for discipline or be subject to
other adverse consequences by his/her employer. These reportable
incidents shall be included in the residence's annual performance
evaluation.
2.4.6 Communications
A. All
communications and reports required to be submitted to the Department
pursuant to these regulations shall be sent to:
Rhode Island Department of Health Center
for Health Facilities Regulation
3 Capitol Hill, Room 306
Providence, RI 02908 401.222.2566
(phone)
401.222.3999 (FAX) or 401.222.5901 (FAX)
[email protected]
B. The
information in § 2.4.6(A) of this Part shall be displayed in a
conspicuous public area of the residence and shall be identified as
the Department point of contact for complaints concerning potential
violations of the Act or these regulations.
C. Each
assisted living residence shall establish and maintain a facility
specific electronic mail address (i.e., e-mail address) to be
provided to the Department for the purposes of contacting a high
managerial agent for the residence with both routine communications
and emergency notices. The residence shall be responsible for
providing notice to the Department at any time that the residence’s
specific electronic mail address is changed or updated.
D. In the
event or in the preparation of an onsite, local area, or statewide
emergency or natural disaster, the assisted living residence will
respond to requests for information and/or status reports as
requested by the Department and/or designated situation/incident
commander.
2.4.7 Application
for License
A. Application for a license to conduct,
maintain or operate an assisted living residence shall be made to the
Department upon forms provided by the Department and shall contain
such information as the Department reasonably requires which may
include affirmative evidence of ability to comply with the provisions
of the Act, these regulations and compliance with federal, state, and
local laws and rules and regulations pertaining to, but not limited
to: the management and operation of assisted living residences, fire,
safety, zoning, building codes, sanitation, food service,
communicable and reportable diseases, and other relevant health and
safety requirements. The licensing application shall include evidence
from the applicant that criminal background checks on owners and
operators of licensed assisted living residences have been completed.
1. Each application shall be accompanied by
a non-refundable application fee per license plus an additional fee
per licensed bed, as set forth in the rules and regulations
pertaining to the Fee Structure for Licensing, Laboratory and
Administrative Services Provided by the Department of Health (Part
10-05-2 of this Title).
2. Each application for a license
endorsement to provide an Alzheimer Dementia/ Special Care
Unit/Program or limited health services shall be accompanied by a
non-refundable application fee, per license endorsement, as set forth
in the rules and regulations pertaining to the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the
Department of Health (Part 10-05-2 of this Title).
B. A notarized listing of the names and
addresses of direct and indirect owners whether individual,
partnership, or corporation, with percentages of ownership
designated, shall be provided with the application for licensure and
shall be updated at intervals not to exceed twelve (12) months. If a
corporation, the list shall include all officers, directors and other
persons or any subsidiary corporation owning stock.
2.4.8 Issuance
and Renewal of License
A. Upon receipt of an application for a
license, the Department shall issue a license if the applicant meets
the requirements of the Act and these regulations. The license
issued, unless sooner suspended or revoked, shall expire by
limitation on the 31st day of December following its issuance and may
be renewed from year to year subject to inspection and approval by
the Department.
1. All renewal applications shall be
accompanied by a non-refundable application fee per license plus an
additional fee per licensed bed, as set forth in the rules and
regulations pertaining to the Fee Structure for Licensing, Laboratory
and Administrative Services Provided by the Department of Health
(Part 10-05-2 of this Title).
2. A renewal application for a license
endorsement to provide an Alzheimer Dementia / Special Care
Unit/Program or limited health services shall be accompanied by a
non- refundable application fee, per license endorsement, as set
forth in the rules and regulations pertaining to the Fee Structure
for Licensing, Laboratory and Administrative Services Provided by the
Department of Health (Part 10-05-2 of this Title).
B. Each license shall be issued only for
the premises and persons named in the application, and shall not be
transferable or assignable except with the written approval of the
Department.
C. The license will specify names of the
owner and operator, the level of licensure or combination of services
that the residence may provide, and the area where service can be
provided (i.e., residents requiring assistance with
self-preservation, and/or medication may only be admitted to
facilities [or areas] with appropriate licensing level).
D. A license issued pursuant to these
regulations shall be the property of the State of Rhode Island and
loaned to such licensee and it shall be kept posted in a conspicuous
place on the premises.
E. In cases where a building has a mixed
population of independent and assisted living residents, the location
of the units on the assisted living license shall be documented in a
roster available at all times and certified by the administrator, or
his/her designee, and kept current on a daily basis.
2.4.9 Inspections
A. The Department shall make or cause to be
made such inspections and investigations as it deems necessary by
duly authorized agents of the Director at such time and frequencies
as determined by the Department.
B. A duly authorized representative of the
Department shall have the right to enter at any time without prior
notice, to inspect the premises and services for which an application
has been received, or for which a license has been issued.
1. Refusal to permit inspection or
investigation shall constitute a valid ground for suspension or
revocation of license or curtailment of activities.
C. Every residence shall be given notice by
the Department of all deficiencies reported as a result of an
inspection or investigation.
2.4.10 Change
of Ownership, Operation and/or Location
A. When a change of ownership or operation
or location of an assisted living residence or when discontinuation
of services is contemplated, the Department shall be given written
notice of pending changes.
B. A license shall immediately expire and
become void and shall be returned to the Department when operation of
an assisted living residence is discontinued or when any changes in
ownership occur.
1. Prior to operating under a new owner or
operator, the prospective licensee shall apply for a new license in
accordance with § 2.4.7 of this Part, “Application for
License.” Upon receipt of a complete application and if there
are no changes in existing operations of the residence, including:
a. Resident capacity,
b. Level of licensure,
c. Modifications or construction of the
physical plant,
2. The Department may, following a review
of the complete application, issue a license to the prospective
licensee without first inspecting the premises.
3. When there is a change in ownership or
in the operation or control of the residence, and provided a complete
application is submitted in accordance with § 2.4.10(B)(1) of
this Part, the Department reserves the right to extend the expiration
date of the existing license, allowing the residence to operate under
the same license which applied to the prior licensee for such time as
shall be required for the processing of a new application or
reassignment of residents, not to exceed six (6) weeks.
C. When a
change of certified administrator is contemplated, the Department
shall be given written notice prior to the change and at the time of
the actual change.
D. The
Department shall be notified immediately when a licensee/owner
determines to cease operations and close an assisted living
residence. A meeting shall be conducted with the Department and prior
to notice or notification to residents and the public to ensure there
is a formal and comprehensive plan for an orderly closure, thirty
(30) days or more notice to residents, their guardian, or relative so
appointed or elected to be his or her decision maker, and the safe,
orderly discharge and transfer of residents.
1. The assisted living residence closure
plan shall include, but is not limited to the following:
a. Letter of intent and/or determining
factors/justification for the closure (i.e., voluntary, financial),
to include:
(1) Proposed closure date;
(2) Contact information for staff member
responsible for implementing the closure plan;
(3) Projected fiscal management plan
covering operations during the closure period.
b. Staffing plan(s):
(1) By
unit/program/location;
(2) Time line
for individual closures of any unit/program/service location;
(3) Staff
scale-down process as appropriate given planned transition/reduction
of patients/residents.
c. Plans for providing notification and
estimated implementation of notices:
(1) Any
required notice to 3rd party payers (i.e., Medicaid, long-term care
insurance);
(2) Notice to
Accreditation entities – if appropriate;
(3) Notice to
staff/union – meeting date(s);
(4) Public
notice;
(5) Community/public
meetings – if appropriate and/or planned.
d. Storage/access to medical records:
(1) Location
for self-storage, or
(2) Company/agency
providing contract storage services.
2.4.11 Denial,
Suspension, Revocation of License or Curtailment of Activities
A. The Department is authorized to deny,
suspend or revoke the license or curtail activities of any assisted
living residence which:
1. Has failed to comply with these
regulations;
2. Has offered or provided service to
residents outside of the scope of its appropriate level of license;
3. Has failed to correct deficiencies or
complete corrective action plan; or
4. Has failed to comply with the provisions
of the Act.
B. Reports of deficiencies shall be
maintained on file in the Department and shall be considered by the
Department in rendering determinations to deny, suspend or revoke the
license or to curtail activities of the assisted living residence.
C. Whenever an action shall be proposed to
deny, suspend or revoke an assisted living residence license, or
curtail its activities, the Department shall notify the residence by
certified or registered mail or by personal service setting forth
reasons for the proposed action, and the applicant or licensee shall
be given an opportunity for a prompt and fair hearing in accordance
with R.I. Gen. Laws §§ 23-17.4-8
and 42-35-9 ,
and the provisions of § 2.4.33 of this Part.
1. However, if the Department finds that
the safety and welfare of residents requires emergency action and
incorporates a finding to that effect in its order, the Department
may order summary suspension of license or curtailment of activities
pending proceedings for revocation or other action in accordance with
R.I. Gen. Laws §§
42-35-14(c) and 23-1-21 .
D. The
appropriate state and federal agencies shall be notified of any
action taken by the Department pertaining to either denial,
suspension, or revocation of license, or curtailment of activities.
2.4.12 Administrative
Management
A. All licensees shall provide staffing
which is sufficient to provide the necessary care and services to
attain or maintain the highest practicable physical, mental and
psychosocial well-being of the residents, according to the
appropriate level of licensing. At least one (1) staff person who has
completed employee training as outlined in § 2.4.12(G) of this
Part shall be on the premises at all times.
B. Each licensee shall have responsible
adult(s) who are employee(s) or who have a contractual relationship
with the residence to provide the services required by these
regulations who is at least eighteen (18) years of age and
1. Awake and on the premises at all times,
2. Designated in charge of the operation of
the residence; and
3. Physically and mentally capable of
communication with emergency personnel.
C. Pursuant to R.I. Gen. Laws §
23-17.4-15.1.1 ,
each assisted living residence shall have an administrator who is
certified by the Department in accordance with regulations
established pursuant to R.I. Gen. Laws § 23-17.4-21.1 ,
in charge of the maintenance and operation of the residence and the
services to the residents. The name and contact information for the
current administrator shall be displayed in a conspicuous public area
of the residence. The administrator is responsible for the safe and
proper operation of the residence at all times by competent and
appropriate employee(s) and shall be responsible for no less than the
following:
1. The management and operation of the
residence and services to the residents;
2. Compliance with federal, state, and
local laws and rules and regulations pertaining to, but not limited
to: the management and operation of assisted living residences, fire,
safety, zoning, building codes, sanitation, food service,
communicable and reportable diseases, Americans with Disabilities
Act, employee health and safety, other relevant health and safety
requirements, and these regulations.
3. Staffing the residence with adequate and
qualified personnel to attend to the food preparation, general
housekeeping, assistance with personal care, medication
administration, if applicable, and other such services;
4. Establishment of written policies and
procedures governing the operation of the residence which are aimed,
to the extent possible, at maintaining the independence of residents.
Such policies shall include provisions to implement no less than the
following:
a. The appropriate provisions of §
2.4.18 of this Part and other applicable provisions pertaining to
admission, transfer, discharge, visitation privileges, availability
and utilization of community resources, leisure time and such other;
b. Accountability of the residence when
acting as a fiduciary agent for the resident pursuant to §
2.4.18 of this Part;
c. Notification of next of kin or other
responsible person designated by the resident in the event of
illness, accident or death; and
d. Such other provisions as may be deemed
appropriate.
5. Compliance with all requirements
appropriate to the service level for which the residence is licensed.
D. Cardiopulmonary Resuscitation
1. At all times, one person on-site shall
have successfully completed instruction by the American Heart
Association, the American Red Cross, or the National Safety Council
at the minimal ("Heartsaver") level to perform
cardiopulmonary resuscitation.
E. A certified administrator shall be in
charge of no more than three (3) residences with an aggregate
resident total of no more than one hundred twenty (120) residents.
F. The certified administrator shall not
leave the premises without delegating necessary authority for
operation of the residence to a competent employee(s).
G. Employee Training
1. The administrator shall ensure that all
new employees shall receive at least two (2) hours of orientation and
training within ten (10) days of hire and prior to beginning work
alone in the assisted living residence, in addition to any training
that may be required for a specific job classification at the
residence. Such areas include:
a. Fire prevention;
b. Recognition and reporting of abuse,
neglect, and mistreatment;
c. Assisted living philosophy
(goals/values: dignity, independence, autonomy, choice);
d. Resident's rights;
e. Confidentiality.
f. Emergency preparedness and procedures;
g. Medical emergency procedures;
h. Infection control policies and
procedures; and
i. Resident elopement.
2. The administrator shall ensure that all
new employees who will have regular contact with residents and
provide residents with personal care shall receive at least ten (10)
hours of orientation and training within thirty (30) days of hire and
prior to beginning work alone in the assisted living residence, in
addition to the areas stipulated in § 2.4.12(G) of this Part.
Such areas include:
a. Basic sanitation;
b. Food service;
c. Basic knowledge of cultural differences;
d. Basic knowledge of aging-related
behaviors including dementia and Alzheimer’s disease;
e. Personal assistance;
f. Assistance with medications;
g. Safety of residents;
h. Body Mechanics;
i. Resident Transfers (required for
residences licensed at the F1 level for fire safety);
j. Record-keeping;
k. Service plans; and
l. Internal reporting.
H. In-service
Training
1. Employees shall have on-going, at
intervals not to exceed twelve (12) months, in-service training as
appropriate for their job classifications and including the topics
cited in § 2.4.12(G) of this Part.
2. All new employee orientation and
on-going in-service training shall be documented in the employee's
personnel file, and maintained onsite at the licensed residence.
I. Personnel
Records
1. The residence shall maintain
comprehensive personnel records for each employee. Personnel records
shall be maintained onsite of the licensed residence and/or
electronically available at all times.
2. Said personnel records shall be reviewed
and updated at intervals not to exceed twelve (12) months and shall
include, but not be limited to, all of the following components:
a. Completed job application and/or resume;
b. Written statements of references or
documentation of verbal reference check;
c. Written functional job descriptions;
(1) These
descriptions shall be updated at intervals not to exceed twelve (12)
months and shall include, but not be limited to, minimal
qualifications for the position, major duties and responsibilities,
and shall be signed and dated by the individual employee.
d. Evidence of credentials, current
professional licensure and/or certification;
e. Documentation of education and/or
continuing training, including continuing education units (CEUs)
related to administrator certification, food management, etc.,
medication administration, and dementia care;
f. Documentation of attendance at
in-service training and/or orientation;
g. Documentation of at least one (1)
performance evaluation at intervals not to exceed twelve (12) months;
h. Signed copy of employee’s
awareness of resident’s rights;
i. Results of the criminal record (BCI)
check.
J. Personnel
Criminal Records Check
1. Pursuant to R.I. Gen. Laws §
23-17.4-27 ,
all employees of assisted living residences licensed under the Act,
hired after September 30, 2014, and having routine contact with a
resident or having access to a resident's belongings or funds shall
undergo a national criminal background records check which shall
include fingerprints submitted to the Federal Bureau of Investigation
(FBI) by the Bureau of Criminal Identification of the Department of
Attorney General. The national criminal records check shall be
processed, prior to, or within one (1) week of employment.
2. Said employee, through the employer,
shall apply to the Bureau of Criminal Identification of the
Department of Attorney General for a national criminal records check.
3. In those situations in which no
disqualifying information has been found, the Bureau of Criminal
Identification of the Department of Attorney General shall inform the
applicant and the employer in writing of this fact.
4. Upon the discovery of any disqualifying
information, as defined in R.I. Gen. Laws § 23-17.4-30
and in these regulations, the Bureau of Criminal Identification of
the Department of Attorney General will inform the applicant in
writing of the nature of the disqualifying information; and, without
disclosing the nature of the disqualifying information, will notify
the employer in writing that disqualifying information has been
discovered.
5. The employer shall maintain on file,
subject to inspection by the Department, evidence that statewide
criminal records checks have been initiated on all employees seeking
employment between October 1, 1991 and September 30, 2014, and the
results of those checks.
6. The employer shall maintain on file,
subject to inspection by the Department, evidence that national
criminal records checks have been initiated on all employees seeking
employment on or after October 1, 2014, and the results of those
checks.
7. Failure to maintain this evidence shall
be grounds to revoke the license or registration of the employer.
8. An employee against whom disqualifying
information has been found may provide a copy of the national
criminal records check to the employer. The administrator shall make
a judgment regarding the continued employment of the employee.
2.4.13 Management
of Services
A. Each
residence shall provide services with adequate professional and
ancillary employees and in accordance with applicable state law.
Further, the residence shall assure that all services are rendered in
a safe and effective manner and consistent with the requirements
herein. The residence shall provide all care and services to all
residents in accordance with the prevailing community standard of
care.
B. The
residence shall have a policy and procedure manual that is reviewed
and updated by the administrator at intervals not to exceed twelve
(12) months, and shall include, but not be limited to, the following
items:
1. A written description of all services
available to residents that shall be designed to promote the
resident’s efforts to maintain independence;
2. A written statement of admission
criteria that shall include, at a minimum, the following information
regarding the resident population:
a. Nature and extent of disabling
condition(s) served; and
b. Restrictions (if any).
(1) The
statement of admission criteria shall include a statement that no
otherwise qualified applicant shall be denied admission to the
residence solely on the basis of race, creed, color, religion, sexual
orientation, or national origin.
C. The
residence shall develop and maintain written admission procedures
that shall include no less than the following components:
1. Procedures for informing residents of
house rules (e.g., necessary information, tour of residence);
2. A resident assessment process;
3. Provision of information to each
resident related to:
a. Results of initial assessment;
b. Procedures for involuntary transfer
within the residence;
c. Procedures for involuntary discharge;
d. Procedures for advanced directives;
e. Grievance procedures;
f. Availability of nursing services, if
any.
4. Policies and procedures on elopement;
5. Procedures to be followed, including
those for referral (in those cases where an applicant is found to be
ineligible for admission);
D. Prior to admission, the resident and/or
legal guardian shall be informed of any charges for services
rendered, including charges for special diets, if any.
E. The residence shall develop, maintain,
and enforce written policies and procedures for employee
documentation of personal care services/activities of daily living
(ADLs) rendered to residents.
F. The residence shall maintain a written
policy and procedures for assisting a resident in locating and/or
obtaining needed services, as appropriate.
G. The residence shall maintain a written
policy regarding reportable incidents and events in accordance with §
2.4.17 of this Part.
H. The residence shall develop and maintain
a statement of discharge criteria that specifies the conditions under
which a resident is considered to be ineligible for continued
residency and conditions under which a resident’s advanced
rental fees are refunded.
I. Policies and procedures pertaining to
the provision of services, and supported by appropriate manuals or
reference materials where applicable, shall be established by a
designated professional employee or administrator and approved by the
licensee. Such policies shall pertain to no less than the following:
1. Residence staffing patterns;
2. Employee responsibility(ies) for the
provision of services;
3. A statement that services rendered shall
be performed in accordance with all applicable laws and regulations
for each service provided;
4. A description of services that are
included in the monthly charge(s) and the additional cost(s), if any,
for other available services or amenities;
5. Policies/procedures regarding medication
management and/or assistance with medication(s);
6. A policy that medical waste, as defined
in the Department of Environmental Management’s Medical Waste
Regulations (250-RICR-140-15-1) shall be managed in accordance with
the provisions of the aforementioned regulations;
7. A policy regarding compliance with food
service and Food Code (Part 50-10-1 of this Title) requirements;
8. Disclosure of resident information in
accordance with the requirements of R.I. Gen. Laws § 23-3-26 ;
9. The procedure(s) for resolution of
resident grievances, including the inclusion of the name, address,
and telephone number of all pertinent resident advocacy groups, the
State Ombudsman, and the Department.
10. Quality assurance program.
J. Smoking Policy
1. If the residence permits smoking, it
shall have a policy that includes the following:
a. Location of designated smoking area(s)
separate from the common area;
b. Prohibition of smoking in any area other
than the designated area(s);
c. Adequate ventilation in smoking areas;
d. Assessment (upon admission, quarterly,
and when a significant change in function occurs) of all residents
that smoke to ensure safe smoking capabilities.
K. Advance Directives
1. The residence shall have written
policies and procedures that address advanced directives that shall
include, but not be limited to, sufficient instructions for employees
to follow in the event of emergencies and the resuscitation of
residents.
L. Medical Orders for Life Sustaining
Treatment (MOLST)
1. The residence shall have written
policies/procedures to accept, update if appropriate, and offer each
qualified patient the opportunity to complete a MOLST in accordance
with the rules and regulations pertaining to Medical Orders for Life
Sustaining Treatment (Part 20-15-4 of this Title).
2.4.14 Residency
Requirements
A. Each licensee, or his/her designee,
through the assessment and evaluation procedures delineated in these
regulations (see § 2.4.16(C) of this Part) shall be responsible
to ensure that admission to and residency in an assisted living
residence be limited to those individuals who meet the definition of
"resident" in accordance with § 2.3(A)(32) of this
Part.
B. Disclosure
1. Each assisted living residence shall
disclose certain information about the residence to each potential
resident, the resident's interested family, and the resident's agent
as early as practical in the decision-making process and at least
prior to the admission decision being made. The disclosed information
shall be in print format and shall include at a minimum:
a. Identification of the residence and its
owner and operator;
b. Level of license and an explanation of
each level of licensure;
c. Admission and discharge criteria;
d. Services available;
e. Financial terms to include all fees and
deposits, including any first month rental arrangements, and the
residence's policy regarding notification to tenants of increases in
fees, rates, services and deposits;
f. Terms of the residency agreement,
including the process used in the event that a resident can no longer
afford the cost of care being provided.
g. The names, addresses, and telephone
numbers of: the Department; the Medicaid Fraud and Patient Abuse Unit
of the Department of Attorney General; the state ombudsperson, and
local police offices.
C. Residency
Agreement or Contract
1. Pursuant
to R.I. Gen. Laws § 23-17.4-16 ,
prior to exchange of any funds and prior to admission, the residence
shall execute a residency agreement or contract, signed by both the
residence and the resident, that defines the services the residence
will provide and the financial agreements between the residence and
the resident or the resident's representative.
a. Any advanced deposit, application fee,
or other pre-admission payment shall be subject to a signed document
explaining fully the terms of the payment.
b. In cases of emergency placement, the
residency agreement or contract shall be executed within five (5)
working days of admissions.
2. The residency agreement or contract
shall include (or reference other documents that include) no less
than the following items:
a. Resident's rights;
b. Admission criteria;
c. Discharge criteria;
d. Discharge policies;
e. Description of the unit to be rented by
the resident;
f. Description of shared space and
facilities;
g. Services to be provided;
h. Services that can be arranged;
i. Financial terms between resident and
residence;
(1) Basic rates;
(2) Extra charges at signing;
(3) Extra charges that may apply in the
future;
(4) Deposits and advanced fees;
(5) Rate increase policy.
j. Special care provisions (as applicable);
k. Resident's responsibilities and house
rules;
l. Initial and on-going assessment and
service plan;
m. Grievance procedure.
D. The minimum prior notification time for
changes in rates, fees, service charges, or any other payments
required by the residence shall be thirty (30) days written notice to
the resident.
2.4.15 Resident
Records
A. Each
residence shall, at a minimum, maintain the following information for
each resident:
1. The resident's name;
2. The resident's last address;
3. The name of the person or agency
referring the resident to the home;
4. The name, specialty (if any), telephone
number, and emergency telephone number of each physician who is
currently treating the resident;
5. The date the resident began residing in
the home;
6. A list of medications taken by the
resident, including dosage, and specific records of medication
administration as required by the Department;
a. In residences licensed at the M2 level,
if a resident refuses to provide the information cited in §
2.4.15(A)(6) of this Part, this fact shall be documented in the
resident’s service agreement.
7. Written acknowledgments that the
resident has signed and received copies of the rights as provided in
R.I. Gen. Laws § 23-17.4-16 ;
8. Information about any specific health
problems of the resident, which may be useful in a medical emergency,
including diagnostic and/or therapeutic orders;
9. A record of personal property and funds
which the resident has entrusted to the residence;
10. The name, address, and telephone number
of a person identified by the resident who should be contacted in the
event of an emergency or death of the resident and the name, address,
and telephone number of the legal guardian;
11. Any other health-related emergency, or
pertinent information which the resident requests the residence to
keep on record;
12. A copy of the initial and periodic
assessments described in § 2.4.16 of this Part;
13. A copy of the service plan and nurse
review as described in § 2.4.16 of this Part;
14. A copy of the residency agreement as
described in § 2.4.14(C) of this Part.
B. Entries in
the resident’s record relating to treatment, medication and
diagnostic tests shall be made by the responsible persons at the time
of administration and/or service. Only physicians shall enter or
authenticate medical opinions or judgment.
1. Detailed descriptions of all pressure
ulcers, or other skin lesions, shall be recorded in the resident's
record.
C. At time of
discharge, a discharge summary, summarizing the resident's stay,
shall be completed promptly and signed by the residence’s
administrator or registered nurse.
D. Resident
records of discharged residents shall be completed within a
reasonable period of time (not to exceed sixty (60) days) with all
clinical information pertaining to the resident's stay made part of
the resident's record.
E. Confidentiality
of resident records shall be governed by the provisions of R.I. Gen.
Laws Chapter 5-37.3
and the following;
1. Only authorized personnel shall have
access to the records.
2. The residence shall release resident's
medical information only with the written consent of the resident,
parent, guardian or legal representative in accordance with R.I. Gen.
Laws Chapter 5-37.3 .
F. Such
information shall be contained in record formats appropriate to the
efficient and effective delivery of resident services and accessible
for review upon request by the licensure agency or other appropriate
health oversight agency.
G. The
licensee shall retain resident records for five (5) years from the
date of discharge in accordance with the provisions of R.I. Gen. Laws
§ 23-3-26 .
H. Statement
of Resident's Rights
1. In accordance with R.I. Gen. Laws §
23-17.4-16.1 ,
each resident and/or legal guardian shall be given a written
statement of the resident’s rights and responsibilities in the
residence that shall be signed by the resident and/or guardian
attesting to his/her comprehension of these rights and
responsibilities as explained by the employee who shall witness the
resident’s signature. A copy of the signed document shall also
be placed in the resident’s record.
2.4.16 Resident
Assessments and Service Plans
A. Prior to
the admission of a resident, or the signing of a residency agreement
with a resident, the administrator shall have a comprehensive
assessment of the resident's health, physical, social, functional,
activity, and cognitive needs and preferences conducted and signed by
a registered nurse.
B. This
assessment shall be used to determine if the resident's needs and
preferences can be met by the assisted living residence within the
range of services offered by the residence at its licensure level.
The conclusions shall be shared with the resident or the resident's
representative. If a reasonable accommodation can enable a resident
to live in an assisted living residence, the nature of that
accommodation and a plan for implementation or reason for denial
should be included in the assessment. Provided, however, any
reasonable accommodation provided to a resident shall be provided
within the range of services offered by the residence at its
licensure level.
1. As part of the initial resident
admission and assessment process, the residence shall review and
consider any notice provided to the facility as required in R.I. Gen.
Laws § 42-56-10(23)
concerning the resident's or prospective resident's status on parole
and recommendations, if any, from the Department of Corrections
regarding safety and security measures.
C. The
Department-approved assessment form, or such other assessment form as
approved by the Department, shall be utilized in completing the
assessment on each resident who is admitted to the residence.
(Approved Department form is available for downloading online at
http://health.ri.gov/forms/assessment/AssistedLivingResident.pdf ).
1. Assisted living residences not intending
to use the Department’s assessment form shall submit their
proposed assessment forms with a cover letter of intent to the Center
for Health Facilities Regulation as specified in § 2.4.6(A) of
this Part.
2. All assessment forms shall report
information appropriate to determine compatibility and compliance
with the residency criteria, and shall indicate that the resident’s
needs can be met by the assisted living residence within its
licensure level, and shall gather information appropriate for the
development of an individualized service plan.
a. The assessment form shall be designed to
demonstrate compliance with the assisted living residence’s
criteria for residency.
b. The assessment form shall also be
designed to demonstrate that the assisted living residence can meet
the resident’s needs and preferences.
3. The assessment form shall also be
designed to provide information appropriate for the development of an
individualized service plan in accordance with § 2.4.16(G)(1) of
this Part.
D. The
assessment shall be reviewed and at intervals not to exceed twelve
(12) months and each time a resident's condition changes
significantly.
E. In the
event a resident has an admission to a health care facility and is
scheduled to return to the residence without a significant change in
status, then the assessment shall be updated within five (5) working
days of readmission.
1. In case of an emergency admission, the
required assessment shall take place within five (5) working days and
shall include the following:
a. An immediate admission necessitated by
natural disaster, crisis, or threat to public safety at another
licensed assisted living residence, independent living situation,
community residential facility, or private residence;
b. An immediate admission necessitated by
the unanticipated incapacitation of the primary caregiver of the
person to be admitted;
c. Conditions or circumstances warranting
emergency admission and as approved by Center for Health Facilities
Regulation staff within forty-eight (48) hours.
F. Nurse
Review
1. Nurse review is necessary for all levels
of licensure.
a. A registered nurse shall visit the
residence at least once every thirty (30) days except as provided in
§ 2.4.16(F)(1)(b) of this Part and shall complete a review to
include the following:
(1) Monitor
the medication regimen for all residents;
(2) Review any
new physician orders and evaluate the health status of all residents
by identifying symptoms of illness and/or changes in mental/physical
health status;
(3) Evaluate
the appropriateness of placement for each resident;
(4) Make any
necessary recommendations to the administrator;
(5) Follow up
on previous recommendations;
(6) Provide a
signed, written report in the residence documenting:
(AA) Date and time of assessment;
(BB) Recommendations for follow-up;
(CC) Progress on previous recommendations;
(DD) Verification that the medication
listed by the pharmacist on the mediset, blister pack or medication
container is current with physician orders (M-1 level only);
(EE) Physical assessment identifying
symptoms of illness and/or changes in mental or physical health
status and appropriateness of placement;
(FF) Such reports shall be on file at the
residence.
(7) Complete
the quarterly evaluation of the residence’s registered
medication aide(s) administration of medication. (Approved Department
form is available for downloading online).
b. In those residences that have one or
more licensed registered nurses (i.e., at least one full-time
equivalent equal to thirty-five (35) hours) on-site, the nurse review
shall be completed at least once every ninety (90) days.
G. Service
Plans
1. Within a reasonable time after move-in,
not to exceed seven (7) days, the Administrator shall be responsible
for the development of a written service plan based on the initial
assessment. The service plan shall include at least:
a. The services and interventions needed,
including all services provided by outside healthcare agencies (e.g.,
home nursing care, hospice);
b. Description, frequency, duration
relating to the service or intervention, including personal
assistance, medication, special diets, recreational activities, and
other similar services rendered;
c. Party responsible for arranging and/or
providing the service; and
d. The resident’s requested and/or
therapeutically needed recreational and social activities.
2. The service plan shall be developed by a
registered nurse and/or the certified assisted living residence
administrator, and shall be signed, approved, and dated by both
parties.
3. The service plan shall be reviewed by
both parties at intervals not to exceed twelve (12) months and each
time a resident's condition changes significantly and all changes
shall be acknowledged in writing by both parties.
4. A copy of the service plan shall be
placed in the resident's record.
2.4.17 Reporting
Requirements
A. The person responsible for the operation
of the residence shall promptly notify the next of kin as instructed
or other responsible person designated by the resident or guardian of
any illness, injury or death of a resident.
B. Accidents, incidents, and medication
errors resulting in out-of-residence emergency medical services
resulting in a hospital admission of any resident shall be reported
to the Center for Health Facilities Regulation in writing, via
facsimile or electronic transmission to [email protected]
by the end of the next working day. A copy of each report shall be
retained by the residence for review during subsequent inspections by
the Department.
C. The death of any resident of an assisted
living residence occurring on the premises within twenty-four (24)
hours of assuming residency shall be reported to the Office of the
State Medical Examiners and the Center for Health Facilities
Regulation. Also, all deaths occurring in the residence which are
sudden or unexpected, suspicious or unnatural, the result of trauma,
remote or otherwise, or when unattended by a physician or are
otherwise reportable in accordance with the provisions of R.I. Gen.
Laws Chapter 23-4
shall be reported to the State Medical Examiner’s Office and
the Center for Health Facilities Regulation.
D. Any employee of an assisted living
residence who has reasonable cause to believe that a resident has
been abused, exploited, neglected, or mistreated shall within
twenty-four (24) hours of the receipt of said information, transfer
such to the Director and to the Office of the Long- Term Care
Ombudsman. Any person required to make a report pursuant to this
section shall be deemed to have complied with these requirements if a
report is made to a high managerial agent. Once notified, said agent
shall be required to meet the above reporting requirements. The
residence shall establish a written policy or procedure for reporting
abused, exploited or neglected residents that complies with the
provisions of this section. The report may be submitted by telephone
but shall be followed up in writing.
1. Upon receipt of such information or
allegation, the Director shall forthwith conduct such investigation
as may be necessary and submit a report of findings of the
investigation(s) to the Attorney General of the State of Rhode
Island.
E. Unscheduled
implementation of the residence’s fire, evacuation, and/or
disaster plan shall be reported immediately via telephone, but shall
be followed up in writing, on forms supplied by the Department, by
the end of the next working day.
F. All
reports, as required by these regulations, shall be provided to the
Department in writing via facsimile or electronic transmission to
[email protected] on
forms supplied by the Department. A copy of each report shall be
retained by the residence for review during subsequent inspections by
the Department.
G. The
residence shall maintain evidence that all reportable incidents have
been thoroughly investigated and that actions have been taken to
prevent further incidents while the investigation is in progress.
Appropriate corrective action shall be taken, as necessary. The
results of said investigation shall be reported to the Department,
within five (5) business days, on forms supplied by the Department.
H. Reporting
requirements, pursuant to R.I. Gen. Laws Chapter
23-17.8
must be posted in the residence in plain view of all residents and
employees.
I. The
administrator shall notify the Department in writing of any emergency
admissions in accordance with § 2.4.16(E)(1)(c) of this Part
within forty-eight (48) hours.
J. The
administrator shall be responsible for the investigation and
documentation of incidents that involve residence operations,
resident services, or related event(s) that directly or indirectly
jeopardize the health and safety of residents, or that results in a
resident injury that requires assessment by a licensed practitioner
or where the injury was not witnessed or explained by the resident.
1. Documentation of incidents shall
include:
a. Date and time of incident;
b. Reporter’s name;
c. Name of resident(s) involved or
affected;
d. Any injury(ies) to resident(s); and
e. Action taken by the residence in
response to the incident.
2. Such documentation shall be made
available for review during a survey inspection by the licensing
agency Department or as required by any health oversight agency.
3. Such documentation shall be retained by
the licensee for no less than five (5) years after the event or
incident.
2.4.18 Rights
of Residents
A. Every
assisted living residence for adults licensed pursuant to these
regulations shall observe the standards stated in R.I. Gen. Laws §
23-17.4-16 ,
“Rights of Residents” and such other appropriate
standards as may be prescribed in rules and regulations promulgated
by the Department with respect to each resident of the residence.
B. For purposes of the following standards
stated in §§ 2.4.18(B)(1) through (7) of this Part the term
"resident" shall also mean the resident's agent as
designated in writing or legal guardian.
1. Upon request have access to all records
pertaining to the resident, including clinical records, within the
next business day or immediately in emergency situations;
2. Upon admission and during the resident's
stay be fully informed in a language the resident understands, of all
resident rights and rules governing resident conduct and
responsibilities;
a. Each resident shall receive a copy of
their rights.
b. Each resident shall acknowledge receipt
in writing; and
c. Each resident shall be informed promptly
of any changes.
3. Be informed in writing, prior to, or at
the time of admission or at the signing of a residential contract or
agreement of:
a. The scope of the services available
through the residence's service program, including health services,
and of all related fees and charges, including charges not covered
either under federal and/or state programs by other third party
payers or by the residence's basic rate;
b. The residence's policies regarding
overdue payment including notice provisions and a schedule for late
fee charges;
c. The residence's policy regarding
acceptance of state and federal government reimbursement for care in
the residence both at time of admission and during the course of
residency if the resident depletes his or her own private resources;
d. The residence's criteria for occupancy
and termination of residency agreements;
e. The residence's capacity to serve
residents with physical and cognitive impairments;
f. Support any health services that the
residence includes in its service package or will make appropriate
arrangements to provide these services;
4. Upon provision of at least thirty (30)
days notice, if a resident chooses to leave a residence, the resident
shall be refunded any advanced payment made provided that the
resident is current in all payments;
5. The residence can discharge a resident
only for the following reasons and within the following guidelines:
a. Except in life-threatening emergencies
and for nonpayment of fees and costs, the residence gives thirty (30)
days' advance written notice of termination of residency agreement
with a statement containing the reason, the effective date of
termination, the resident's right to an appeal under state law, and
the name/address of the State Ombudsperson’s office;
b. If resident does not meet the
requirements for residency criteria stated in the residency agreement
or requirements of state or local laws or regulations;
c. If resident is a danger to self or the
welfare of others; and the residence has attempted to make a
reasonable accommodation without success to address resident behavior
in ways that would make termination of residency agreement or change
unnecessary; which would be documented in the resident's records;
d. For failure to pay all fees and costs
stated in the contract, resulting in bills more than thirty (30) days
outstanding. A resident who has been given notice to vacate for
nonpayment of rent has the right to retain possession of the
premises, up to any time prior to eviction from the premises, by
tendering to the provider the entire amount of fees for services,
rent, interest, and costs then due. The provider may impose
reasonable late fees for overdue payment; provided that the resident
has received due notice of such charges in accordance with the
residence's policies. Chronic and repeated failure to pay rent is a
violation of the lease covenant. However the residence must make
reasonable efforts to accommodate temporary financial hardship and
provide information on government or private subsidies available that
may be available to help with costs; and
e. The residence makes a good faith effort
to counsel the resident if the resident shows indications of no
longer meeting residence criteria or if service with a termination
notice is anticipated;
6. To be able to share a room or unit with
a spouse or other consenting resident of the residence in accordance
with terms of the resident contract;
7. To live in a safe and clean environment.
C. In addition to the standards stated in
R.I. Gen. Laws § 23-17.4-16 ,
residents are entitled to the following:
1. Receive dental services from a dentist
of his/her choice;
2. Each resident shall be given, in
writing, the names, addresses, and telephone numbers of: the
Department; the Medicaid Fraud and Patient Abuse Unit of the
Department of Attorney General; the State Ombudsperson; and local
police offices.
D. The residence must:
1. Implement written policies and
procedures to ensure that all residence employees are aware of and
protect the resident's rights contained in these regulations;
2. Have prominently displayed a posting of
the most recent state licensing survey of the assisted living
residence; and
3. Provide each resident or his or her
representative upon admission, a copy of the provisions of §
2.4.18 of this Part and shall display in a conspicuous place on the
premises a copy of the "Rights of Residents."
2.4.19 Accessibility
to the Residence and Residents
Access to assisted living residences for
adults and its residents by individuals other than relatives and
friends of the residents shall be pursuant to R.I. Gen. Laws §
23-17.4-11 .
2.4.20 Illness
and Emergencies
A. Each
residence shall have written procedures for residents in the event of
temporary illness and emergencies which shall include procedures for
the evacuation of the premises.
B. Residents
shall not be restricted from obtaining community health services at
any time or when confined to the residence for a temporary illness.
C. Reporting
of Communicable Diseases
1. Each residence shall report promptly to
the Center for Acute Infectious Diseases Epidemiology (IDE), cases of
communicable diseases designated as "reportable diseases"
when such cases are diagnosed in the residence in accordance with
rules and regulations pertaining to the " Rules
and Regulations Pertaining to Counseling, Testing, Reporting and
Confidentiality ".
2. When infectious diseases present a
potential hazard to residents or personnel, these shall be reported
to the Center for Acute Infectious Diseases Epidemiology (IDE) even
if not designated as "reportable diseases."
3. When outbreaks of food-borne illness are
suspected, such occurrences shall be reported immediately to the
Center for Acute Infectious Diseases Epidemiology (IDE) or to the
Center for Food Protection.
4. Residences must comply with the
provisions of R.I. Gen. Laws § 23-28.36-3 ,
which requires notification of fire fighters, police officers and
emergency medical technicians after exposure to infectious diseases.
5. Infection Control
Infection control provisions shall be
established for the mutual protection of residents, employees, and
the public. The residence shall be responsible for no less than the
following:
a. Establishing and maintaining a
residence-specific infection prevention program;
b. Establishing policies governing the
admission and isolation of residents with known or suspected
infectious diseases;
c. Developing, evaluating and revising on a
continuing basis infection control policies, procedures and
techniques for all appropriate areas of the residence;
d. Developing and implementing protocols
for:
(1) Discharge planning to home that include
full instructions to the family or caregivers regarding necessary
infection control measures; and
(2) Hospital and/or nursing facility
transfer of residents with infectious diseases which may present the
risk of continuing transmission. Examples of such diseases include,
but are not limited to, tuberculosis (TB), Methicillin resistant
staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE),
and clostridium difficile;
6. Resident Immunization Policies/Practices
Except as provided in §
2.4.20(C)(6)(e) of this Part, every residence in Rhode Island shall
request that residents be immunized for influenza virus and
pneumococcal disease. Influenza, pneumococcal, and other adult
vaccination policies and protocols shall be developed and implemented
by the residence and shall contain no less than the following
provisions:
a. Notice to Resident. Upon admission, the
residence shall notify the resident and legal guardian of the
immunization requirements and request that the resident agree to be
immunized against influenza virus and pneumococcal disease.
b. Records and Immunizations. Every
residence shall document the annual immunization against influenza
virus and immunization against pneumococcal disease for each resident
which includes written evidence from a health care provider
indicating the date and location the vaccine was administered.
c. Other Immunizations. An individual who
becomes a resident shall have his status for influenza and
pneumococcal immunization determined by the residence, and, if found
to be deficient, the residence shall assist the resident in obtaining
the necessary immunizations.
d. Vaccinations must be provided in
accordance with “General Recommendations on Immunization:
Recommendations of the Advisory Committee on Immunization Practices
(ACIP),” incorporated above at § 2.2(C) of this Part.
e. Exceptions. No resident shall be
required to receive either the influenza or pneumococcal vaccine if
any of the following apply:
(1) The vaccine is contraindicated;
(2) It is against his/her religious
beliefs; or
(3) The resident or the resident's legal
guardian refuses the vaccine after being fully informed of the health
risks of such action.
2.4.21 Dietetic
Services
A. Residents
shall be provided three (3) balanced, varied meals each day (refer to
Dietary Reference Intakes: The Essential Guide to Nutrient
Requirements incorporated above at § 2.2(A) of this Part).
B. Food shall
be served on dinnerware of good quality, such as ceramic, plastic or
other materials that are durable.
C. The food
service in each residence shall comply with the appropriate
requirements of R.I. Gen. Laws Chapters 21-27
and 21-31 ,
Rhode
Island Food Code (Part 50-10-1 of this Title), and such other
applicable statutory or regulatory provisions.
D. In the
event of any construction, addition or alteration, the residence
shall comply with the requirements of R.I. Gen. Laws §
23-1-31 .
E. Weekly
menus shall be posted in each residence and followed accordingly.
F. Residences
must provide residents with a diet appropriate to their medical
regime.
G. All food
services shall be conducted in accordance with the rules and
regulations pertaining to Certification of Managers in Food Safety
(Part 50-10-2 of this Title) that include but are not limited to the
following provisions:
1. Each residence where potentially
hazardous foods are prepared shall employ at least one (1) full-time,
on-site manager certified in food safety who is at least eighteen
(18) years of age.
2. Residences that primarily serve the
elderly and individuals with diminished immune systems shall have a
manager certified in food safety present during preparation of all
hot potentially hazardous foods.
3. Residences that have a licensed capacity
of twenty-six (26) or more residents and that employ ten (10) or more
full-time equivalent employees directly involved in food preparation
shall employ at least two (2) full time, on-site managers certified
in food safety.
4. Residences that have a licensed capacity
of twenty-five (25) or fewer residents and that employ five (5) or
fewer full-time equivalent employees involved in preparation and
serving of food, shall only be required to employ one (1) full time
manager certified in food safety.
5. Once a manager certified in food safety
terminates employment, establishments shall have sixty (60) days to
employ a new manager certified in food safety, or have an individual
enrolled in a Center for Food Protection approved food manager
certification program in food safety. However, said time period may
be extended by the Center for Food Protection.
a. Residences that have a licensed capacity
of twenty-five (25) or fewer residents and that employ five (5) or
fewer full-time equivalent employees involved in preparation and
serving of food shall only have fifteen (15) days to employ a new
manager certified in food safety. However, said time period may be
extended by the Center for Food Protection.
6. Department certificates for managers
certified in food safety shall be prominently posted in the residence
next to the license to operate. The certificate shall be removed when
the individual is no longer employed by the residence.
7. No person shall use the title "Manager
Certified in Food Safety," or in any way represent himself as a
manager certified in food safety unless they hold a current
certificate pursuant to the rules and regulations pertaining to
Certification of Managers in Food Safety (Part 50-10-2 of this
Title).
H. All menus
including alternate choices shall be planned at least one (1) week in
advance, to meet the standards for nutritional care in accordance
with Dietary Reference Intakes: The Essential Guide to Nutrient
Requirements, incorporated above at § 2.2(A) of this Part, and
to provide for a variety of foods, adjusted for seasonal changes, and
reflecting the dietary preferences of residents.
1. Menus shall indicate nourishments
available to residents between evening meal and bedtime.
2. Menus shall be posted in a conspicuous
place in the dietary department and in resident areas.
3. Records of menus actually served shall
be retained for thirty (30) days.
2.4.22 Housekeeping
The residence shall maintain a
comfortable, safe, clean, sanitary and orderly environment, free of
litter, rubbish and offensive odors.
2.4.23 Laundry
Services
Each residence shall make provisions for
the cleaning of personal laundry of residents and all linens and
other washable goods either directly or through other suitable
arrangement.
2.4.24 Medication
Services
A. Medication Services
1. For M1 and M2 licensure levels, each
resident shall have the right to:
a. Retain the services of his/her own
personal physician and dentist;
b. Select the pharmacy or pharmacist of
his/her choice provided that the pharmacy or pharmacist supplies
medications suitably packaged for the residence's program;
c. Refuse any or all medications;
d. Retain possession and control of his/her
medications, provided that such possession and control is deemed safe
by the resident, the resident's guardian, if appropriate, and the
administrator or his/her designee in consultation with the resident's
physician(s).
2. For M1 and M2 licensure levels, the
residence shall have the right:
a. To inform family, guardian, physician,
or other party designated by the resident or guardian if a resident
has refused medication(s).
b. Not to accept, and/or to evict a
resident who refuses assistance with medications if the residence
reasonably feels that the resident cannot safely possess and control
medications without danger to self or others, in accordance with the
requirements of the Resident’s Rights statement.
3. Each residence shall provide medication
services only in accordance with the appropriate level of licensure
for which the residence is licensed, which shall be as follows:
a. For assisted living residences licensed
at the M2 Level, assistance with self- administration by unlicensed
employees means that the residence shall only be responsible for
reminding residents to take medications, and:
(1) The resident or guardian must provide
written authorization for the residence to provide assistance with
the self-administration of medications;
(2) The residence must provide, in writing,
a description of services provided by the residence to each physician
prescribing for a resident, including limitations on services;
(3) Employees may only remind the resident
and observe the self-administration of medication;
(4) The resident shall not require nursing
assessment of health status before receiving the medication, nor
nursing assessment of the therapeutic or side effects after the
medication is taken;
(5) Except as provided in §
2.4.24(A)(3)(a)(7) of this Part, the medication shall be in the
original pharmacy-dispensed container with proper label and
directions attached;
(6) Unlicensed employees shall not monitor
health indicators, make medication decisions, adjust medications or
provide other medical or nursing decisions;
(7) For residents capable of
self-administration of medication but who wish to ask assisted living
residence employees to use a medi-set (pre-poured packaging
distribution system), only registered medication aide, licensed
nurse, or pharmacist shall organize the medications for up to one (1)
week;
(8) All medication in the residence,
regardless of whether controlled by employees or by the resident,
shall be stored securely. All medications shall be stored in a manner
to prevent spoilage, dosage errors, administration errors or
inappropriate access by other residents, visitors, or unauthorized
employees. Provisions for safe storage may include lockable
containers, secure spaces, or lockable units, as appropriate to the
residence and the resident population.
(9) There shall be documented policies or
procedures regarding medication disposal and inventory procedures in
the policies and procedures manual.
(10) Each person assisting residents with
self-administration of medications shall:
(AA) Be an employee of the residence;
(BB) Be literate in English; and
(CC) Receive orientation, instruction and
on-the-job training regarding relevant policies and procedures; or
(DD) Be a licensed nurse.
(EE) M2 level facilities may limit record
keeping for residents who retain possession and control of
medications to the requirements of § 2.4.15(A)(6) of this Part.
b. For assisted living residences licensed
at the M1 level, licensed employees (registered medication aides,
registered nurses, licensed practical nurses) may administer oral or
topical drugs and monitor health indicators. However, schedule II
medications shall only be administered by licensed personnel. The
physician or nurse supervisor shall conduct and document quarterly
evaluations of the registered medication aides who are administering
drugs and place a copy in the employee's personnel record.
B. Administration
of Medications
1. Residences licensed at the M1 level may
administer medications to residents including, but not limited to,
removing medication containers from storage, assisting with the
removal of a medication from a container for residents with
disability which prevents independence in this act, and/or
administering the medication directly to the resident.
a. The resident or guardian must provide
written authorization for the residence to provide administration of
medications.
b. Medications shall be administered in
accordance with written orders of a physician. The residence must
provide in writing, a description of services provided by the
residence to each physician, including limitations on service.
c. All medications must be checked against
a physician's orders by a licensed nurse, or pharmacist.
d. The resident must be identified prior to
administration of any medication.
e. The medication must be in the original
pharmacy-dispensed container with proper label and directions
attached and be administered in accordance with such label.
f. Injectable medications, including but
not limited to insulin, which cannot be self- administered by the
resident, must be administered by a licensed nurse.
g. There shall be written a
policy/procedure for the disposal of hypodermic needles, syringes and
other such instruments that is in compliance with rules and
regulations governing Hypodermic Needles, Syringes & Other Such
Instruments (Part 20-15-6 of this Title).
(1) The legal
destruction of hypodermic needles, syringes or other such instruments
is the responsibility of the last entitled or authorized possessor.
(AA) All personnel or residents legally
authorized to use disposal syringes and needles, shall destroy them
after one (1) use.
(BB) Excess and undesired needles, syringes
and other such instruments shall be stored in impervious, rigid,
puncture-resistant container for disposal. Intact needles shall be
placed directly into the collection containers.
(CC) Personnel handling disposal waste
materials such as needles, syringes, and other such instruments may
treat and destroy such waste by a DEM-approved alternative
treatment/destruction technology or prepare the regulated medical
waste for off-site transport by a DEM-permitted medical waste
transporter.
h. Individual medication records must be
retained for each resident to whom medications are being administered
and each dose administered to the resident must be properly recorded.
i. Any medication administered by the
residence and refused by a resident shall be documented and reported,
as appropriate.
j. Medications shall be stored securely and
in such a manner to prevent spoilage, dosage errors, administration
errors, and/or inappropriate access. Provisions for safe storage may
include lockable containers, secure spaces, or lockable units, as
appropriate to the residence and the resident population.
k. All medication in the residence,
regardless of whether controlled by employees or by the resident,
shall be stored securely as stated in § 2.4.24(A)(3)(a)(8) of
this Part.
l. All centrally stored medications shall
be maintained in accordance with manufacturer’s labeling and
administered by authorized personnel.
2. For M1 and M2 licensure levels, unused
or discontinued prescription medications that are left with a
residence shall be inventoried and disposed of in accordance with the
following requirements:
a. Disposal of Controlled Substances
(1) M1
residences that are lawfully in possession of excess and undesired
controlled substances that are centrally stored shall inventory and
dispose of all such controlled substances in accordance with all
applicable federal, state, and local laws and regulations.
(2) Only
centrally stored medications in M1 residences may be disposed of in
the following manner:
(AA) The residence’s registered nurse
and either another registered nurse, a licensed practical nurse, or
the residence’s administrator may carry out flushing
destruction activity, and appropriate records shall be maintained at
the residence for two (2) years, as permitted by state and local laws
and regulations. The Director is authorized to enter any premises and
inspect any and all aspects of the disposal process and related
records.
b. Disposal of All Other Legend Drugs
(i.e., Non-Controlled Substances)
(1) All other legend drugs (i.e., those not
classified as controlled substances) shall be the responsibility of
the resident or authorized personnel to dispose of as provided in
rules and regulations governing the "Disposal of Legend Drugs":
(AA) Legend drugs may be disposed of as
solid waste provided that all of the following conditions are met:
(i) the
legend drugs are rendered unrecognizable;
(ii) the
legend drug would not pose a threat to the public or to the
environment; and
(iii) the
legend drugs cannot be recycled; or
(BB) The legend drugs may be disposed of as
regulated medical waste through the use of an entity holding a
regulated medical waste transporter permit issued pursuant to the
requirements and in compliance with the rules and regulations
Governing the Generation, Transportation, Storage, Treatment,
Management and Disposal of Regulated Medical Waste in Rhode Island.
3. Ordering medications
a. In M1 and M2 facilities, when assistance
is needed, the certified administrator, or his/her qualified
designee, shall assist with ordering medications. Assistance shall
include coordinating prescriptions and delivery of medications,
reorders of prescriptions, and receiving deliveries.
2.4.25 Recreational
and Other Services
A. Reasonable
recreational and social activities and/or services shall be offered
to each resident to:
1. Promote opportunities for engaging in
normal pursuits including religious activities of the resident's
choice;
2. Promote the physical, social and mental
well-being of each resident;
3. Promote independent as well as group
activities;
4. Harmonize with each resident's needs.
B. The residence shall post a calendar or
schedule of social and recreational events offered to the residents
and shall keep a record of the events that were actually presented to
the residents. Said calendars and records shall be retained for at
least one (1) year by the residence.
C. Personal assistance shall be provided as
necessary, pursuant to the provisions of § 2.3(A)(29) of this
Part and shall consist of activities such as bathing, oral hygiene,
fingernail care, shampooing, shaving, dressing or assistance with
ambulation or nutrition and hydration.
2.4.26 New
Construction, Modification, Additions, or Room Conversions
All new construction, modification,
additions, or room conversions of an existing residence shall be
subject to the provisions of Fire Safety Code-General Provisions
(R.I. Gen. Laws Chapter 23-28.1 ),
State Building Code (R.I. Gen. Laws Chapter 23-27.3 ),
ANSI A117.1 - 2003 Accessible and Usable Buildings and Facilities
(incorporated above at § 2.2(B) of this Part), Americans with
Disabilities Act (42 U.S.C. §§ 12101 through 12213), and
such other applicable state and local laws, codes and regulations as
may be applicable. Where there is a difference between codes, the
code having the more stringent or higher standard shall apply.
2.4.27 General
Provisions
A. Fire Code
and Structural Requirements
1. Existing facilities shall be
constructed, equipped and maintained to protect the safety and well-
being of residents, and shall provide a comfortable, sanitary
environment, and shall furthermore comply with the applicable
requirements of the Fire Safety Code-General Provisions (R.I. Gen.
Laws Chapter 23-28.1 ),
as determined by the State Fire Marshal and the regulations.
a. Pursuant to R.I. Gen. Laws §
23-17.4-6 ,
a residence with fire code deficiencies may be granted a license
which may be renewed subject to the submission of a plan of
correction acceptable to the State Fire Marshal and provided the
nature of the deficiencies are such that they do not jeopardize the
health, safety, and welfare of the residents.
b. A residence with residents who are
blind, deaf, and physically disabled shall be subject to the
applicable requirements of ANSI A117.1 - 2003 Accessible and Usable
Buildings and Facilities (incorporated above at § 2.2(B) of this
Part), and any other provisions that may be required by these
regulations.
c. Resident occupancy shall be permitted
only in those areas where building design or structural limitations
do not prevent, delay or reduce a resident from exercising self-
preservation in an emergency.
d. A residence that elects to comply with a
higher Life Safety Code (F1) and is so approved by the State Fire
Marshal and meets the Department's requirements for the appropriate
level of licensure may admit residents not capable of
self-preservation.
e. Facilities must have an annual
inspection to assess compliance with the Fire Safety Code. The
inspection shall be conducted under the authority of the State Fire
Marshal.
(1) Documentation of the State Fire Marshal
inspection required under § 2.4.27(A)(1)(e) of this Part must be
submitted with the application for renewal of licensure. The
documentation must reflect compliance with the Fire Safety Code or be
in accordance with § 2.4.27 (A)(1)(a) of this Part.
B. Assisted living residences shall not be
utilized for any other purposes, unless such purposes are compatible
with the objectives and the nature of an assisted living residence
and are approved by the Department.
C. All rooms utilized by resident(s) shall
have proper ventilation and shall have an outside opening with
satisfactory screening.
D. All steps, stairs and corridors shall be
suitably lighted, both day and night. Stairs used by residents shall
have banisters, hand rails or other types of support. All stair
treads shall be well maintained to prevent hazards.
E. Requirements for heat relief are
pursuant to R.I. Gen. Laws § 23-17.4-16.4.
2.4.28 Residents
Rooms, Toilets and Bathing Fixtures
A. The bedroom
of residents shall be designed and equipped with suitable furnishings
for the safety, comfort and privacy of each resident and with no more
than two (2) beds per room.
1. Single rooms shall be no less than one
hundred (100) square feet in area and no less than eight (8) feet
wide, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves
or vestibules.
2. Double bedrooms shall be no less than
one hundred sixty (160) square feet in area and no less than ten (10)
feet wide, exclusive of toilet rooms, closets, lockers, wardrobes,
alcoves or vestibules.
B. Provisions
shall be made for an area within the resident's bedroom and/or
residence to be under lock for the safe keeping of personal
possessions.
C. Each
bedroom shall have a window which can be easily opened. The window
sill shall not be higher than three (3) feet above the floor and
shall be above ground level.
D. Comfortable
temperature levels shall be maintained in all parts of the residence
occupied by residents with a centralized heating system to maintain a
minimum of seventy degrees Fahrenheit (70° F) during the coldest
periods.
E. There shall
be no less than one (1) bath per ten (10) beds and one (1) toilet per
eight (8) beds or fraction thereof on each floor where residents
rooms are located and which are not otherwise serviced by bathing
facilities within the resident's room.
1. Policies and procedures shall be in
place to ensure resident comfort and safety regarding water
temperature at each site in the residence where residents shower or
bathe. Provided, however, such policies/procedures shall state that
in resident areas hot water temperatures shall not be less than one
hundred degrees Fahrenheit (100°F) nor exceed one hundred
eighteen degrees Fahrenheit (118° F). Thermometers shall be
provided in resident areas to check water temperature periodically at
each site where residents bathe or shower.
2.4.29 Dining
and Living Areas
A. Each residence shall provide one (1) or
more clear, orderly and appropriately furnished and easily accessible
room of adequate size to include all residents for resident dining
and activity, which shall be appropriately lighted.
1. If a multi-purpose room is used, there
must be sufficient space to accommodate all residents for dining and
activities and to prevent interference between activities.
2.4.30 Safety
Requirements
A. Halls and
exit ways shall be free from all encumbrances and/or impediments.
B. All locks
on bedrooms shall be operable by a master key, under the control of
the person in charge in accordance with §§ 2.4.12(B) and
(C) of this Part.
C. Every
closet door latch shall be a type that cannot be locked from the
inside.
D. Every
bathroom door shall be designed to permit the opening of the locked
door from outside in an emergency.
E. There shall
be no portable cooking equipment (employing flame, gasoline, kerosene
or exposed electrical heating elements) used in residents' rooms.
F. Portable
space heaters shall not be permitted.
G. Proper
safeguards shall be taken at all times against the fire hazards
involved in smoking.
H. A telephone
shall be easily accessible to residents in the event of emergencies.
(Pay phones shall not be acceptable substitutes). The telephone
number of the local fire department and law enforcement agencies
serving the residence shall be posted by each telephone.
I. Each
residence shall develop and maintain a written plan and procedure for
the evacuation of the premises in case of fire or other emergency,
based on F1 / F2 licensure requirements, Fire Safety Code-General
Provisions (R.I. Gen. Laws Chapter 23-28.1 )
requirements.
1. Emergency steps of action shall be
clearly outlined and posted in conspicuous locations throughout the
residence.
2. Drills simulating fire emergencies,
testing the effectiveness of the fire evacuation plan shall be
conducted at least six (6) times per year on a bimonthly basis with a
minimum of two (2) drills conducted during the night when residents
are sleeping with documentation of observed ability of residents to
carry out evacuation procedures. At least fifty percent (50%) of
these drills shall be obstructed drills, as defined in Fire Safety
Code-General Provisions (R.I. Gen. Laws Chapter 23-28.1 ).
3. The drills shall be permitted to be
announced in advance to the residents. The drills shall involve the
actual evacuation of all residents to an assembly point as specified
in the emergency plan and shall provide residents with experience in
egressing through all exits and means of escape required by the Fire
Safety Code-General Provisions (R.I. Gen. Laws Chapter 23-28.1 ).
Exits and means of escape not used in any fire drill shall not be
credited in meeting the requirements of the Fire Safety Code-General
Provisions (R.I. Gen. Laws Chapter 23-28.1 ).
a. Documentation of fire drills shall be
maintained and shall include no less than the following information:
(1) Name of the person conducting the
drill;
(2) Date and time of the drill;
(3) Amount of time taken to evacuate the
building or unit;
(4) Type of drill (i.e., obstructed or
unobstructed);
(5) Record of problems encountered and
steps taken to rectify them;
(6) Employee observation of each resident’s
ability to carry out evacuation procedures.
4. Residents shall be instructed in all
alternative methods of escape since the primary exit may be unusable
due to fire and/or smoke. Such instruction shall be documented in the
record described in § 2.4.30(I)(3)(a) of this Part.
5. Each new resident shall be oriented to
the fire drill procedure on admission, with documentation of the
orientation placed in the resident’s record.
J. Appropriate
fire extinguishers shall be installed on each occupied level and
maintained in a usable condition, inspected at specified intervals as
stipulated by manufacturers and the State Fire Marshal.
K. Each
residence shall develop written emergency plans related to internal
and external disasters.
L. Disaster
Preparedness
1. Each residence shall develop back-up or
contingency plans to address possible internal systems and/or
equipment failures.
2.4.31 COVID-19
Practices and Procedures
A. Assisted Living Residents.
1. All assisted living residences shall
ensure residents who are not vaccinated are tested at least once
every fourteen (14) days during a period in which COVID-19 prevalence
rate is greater than or equal to ten (10) cases per one hundred
thousand (100,000) people per week, as reported by RIDOH.
2. Upon the identification of residents who
test positive for COVID-19, the residence shall take proper actions
to prevent the transmission of COVID-19 in accordance with Department
guidance.
3. Assisted living residences shall have
policies and procedures in place for addressing residents who refuse
testing or unable to be tested.
4. The assisted living residence shall
document all COVID-19 testing, which documentation shall include at
minimum the individual's name, date of test, and test result.
B. Assisted Living Personnel
1. For the purposes of § 2.4.31 of
this Part, "personnel" means employees, as well as
volunteers, students, trainees, and any individuals, whether paid or
unpaid, directly employed by or under contract with the assisted
living residence on a part time or full-time basis.
2. All assisted living residences shall
ensure personnel who are not vaccinated are tested in accordance with
Part 20-15-8 of this Title.
3. Assisted living residences shall ensure
that all personnel who are vaccinated are tested in at least once
every seven (7) days during a period in which the COVID-19 prevalence
rate is greater than or equal to one hundred (100) cases per one
hundred thousand (100,000) people per week, as reported by RIDOH.
4. Upon the identification of personnel who
test positive for COVID-19, the residence shall take proper actions
to prevent the transmission of COVID-19 in accordance with Department
guidance.
a. Each assisted living residence shall
deny access to any personnel who have not been tested for COVID-19 in
accordance with the requirements set forth in § 2.4.31(B)(2) and
(3) of this Part.
5. The assisted living residence shall
document all COVID-19 testing, which documentation shall include at
minimum the individual's name, date of test, and test result.
a. In the event personnel are tested for
COVID-19 outside the assisted living residence, the personnel must
provide proof of testing to the assisted living residence. The
assisted living residence shall have procedures in place to require
personnel to submit test results, or proof thereof, immediately upon
receipt of the results.
6. The assisted living residence shall
develop and implement policies and procedures for ongoing tracking of
personnel who are employed outside of the assisted living residence.
Tracking shall include the name and location of the establishment and
any other pertinent information.
7. In accordance with state and federal
guidance, personnel shall not incur any out of pocket expenses (e.g.,
copays, deductibles) for testing required pursuant to § 2.4.31
of this Part.
a. Assisted living residences must collect
and transmit personnel health insurance information to the testing
laboratory prior to using any other method of payment for COVID-19
testing.
C. COVID-19 Vaccination Monitoring and
Reporting.
1. Each assisted living residence shall
ensure the documentation in its internal records of the COVID-19
immunization status of its personnel. With such documentation, each
assisted living residence shall additionally maintain documentary
proof of COVID-19 vaccination. Documentation of status and proof of
vaccination, including month, day, and year of vaccine
administration, shall be made available to the Department upon
request.
2. Acceptable documentary proof of COVID-19
vaccination shall consist of an official immunization card, health
records, and/or paper/electronic documentation of vaccination given.
D. Posting.
1. Each assisted living residence shall
post monthly, at a public location within the residence readily
accessible to residents and personnel, and on its website as
applicable, a report containing detailed, aggregated data pertaining
to the COVID-19 vaccination status of its personnel.
2. Such reports shall be created in a
manner and format set forth by the Director, and shall include, but
not be limited to, the following:
a. The present total number of personnel;
b. The present number of personnel who have
received one (1) dose of a multi-dose COVID-19 vaccine;
c. The present number of personnel who are
vaccinated;
d. The present percentage of personnel who
have received one (1) dose of a multi-dose COVID-19 vaccine; and
e. The present percentage of personnel who
are vaccinated.
2.4.32 Variance Procedure
A. The
Department may grant a variance either upon its own motion or upon
request of the applicant from the provisions of any rule or
regulation in a specific case if it finds that a literal enforcement
of such provision will result in unnecessary hardship to the
applicant and that such a variance will not be contrary to the public
interest, public health and/or health and safety of residents.
B. A request
for a variance shall be filed by a high managerial agent of the
assisted living residence in writing, and must set forth in detail
the basis upon which the request is made including:
1. Identification of the specific
regulatory section(s) herein;
2. Alternative actions, processes, or
procedures that through the facility’s implementation will
facilitate compliance with the specific regulatory intent, and how
the Residence will ensure staff awareness and training regarding the
variance, when appropriate.
3. A variance period shall not exceed the
assisted living residence’s license period. An assisted living
residence must request renewal of the variance when it submits its
annual license renewal application.
4. Upon the filing of each request for
variance with the Department, and within a reasonable time
thereafter, the Department shall notify the applicant by certified
mail of its approval or in the case of a denial, a hearing date, time
and place may be scheduled if the residence appeals the denial and
held in accordance with the provisions of § 2.4.33 of this Part.
2.4.3 3 Deficiencies
and Plans of Correction
A. The
Department shall notify the licensee and the residence's
administrator or other legal authority of the residence of violations
of individual standards through a notice of deficiencies which shall
be forwarded to the residence within fifteen (15) days of inspection
of the residence unless the Director determines that immediate action
is necessary to protect the health, welfare, or safety of the public
or any member thereof through the issuance of an immediate compliance
order in accordance with R.I. Gen. Laws § 23-1-21 .
B. A licensee,
or their designee, who receives a notice of deficient practices must
submit a plan of correction to the Department within fifteen (15)
days of the date of the notice of deficient practices. The plan of
correction shall detail any requests for variances as well as
document the reasons therefore.
1. An acceptable plan of correction shall
include, for each individual standard cited:
a. How the licensee or their designee
intends to correct each deficiency and comply with the stated
regulation;
b. What measures will be put in place, or
what systemic changes will be made to ensure that the deficient
practice does not reoccur; and
c. The date the deficiency shall be
corrected.
2. The criteria for acceptability shall be
whether the submitted plan shall achieve compliance with the Act and
these regulations.
3. The plan of correction shall detail any
requests for variances in accordance with § 2.4.31 of this Part.
C. The Department will be required to
accept or reject the plan of correction submitted by a residence in
accordance with §§ 2.4.32(B)(1) and (2) of this Part within
fifteen (15) days of receipt of the plan of correction.
D. If the Department rejects the plan of
correction, or if the residence does not provide a plan of correction
within the fifteen (15) day period stipulated in § 2.4.32(B) of
this Part, or if a residence whose plan of correction has been
approved by the Department fails to execute its plan within a
reasonable time, the Department may invoke the sanctions enumerated
in § 2.4.11 of this Part. If the residence is aggrieved by the
sanctions of the Department, the residence may appeal the decision
and request a hearing in accordance with R.I. Gen. Laws Chapter
42-35 .
E. The notice of the hearing to be given by
the Department shall comply in all respects with the provisions of
R.I. Gen. Laws Chapter 42-35 .
The hearing shall in all respects comply therein.
2.4.3 4 Rules
Governing Practices and Procedures
All hearings and reviews required by these
regulations shall be held in accordance with the provisions of R.I.
Gen. Laws Chapter 42-35
and the rules and regulations pertaining to "Rules and
Regulations Pertaining to Practices and Procedures Before the Rhode
Island Department of Health [R42-35-PP]".
2.4.3 5 Violations
and Sanctions
A. Any person establishing, conducting,
managing or operating an assisted living residence without a license
pursuant to the provisions of the Act and these regulations shall be
liable to the penalty of R.I. Gen. Laws § 23-17.4-14 .
B. Any person who obtains access to an
assisted living residence or to its residents under false
representation shall be subject to the provisions of R.I. Gen. Laws §
23-17.4-12 .
C. The penalty for violation of R.I. Gen.
Laws § 23-17.4-10
shall be in accordance with R.I. Gen. Laws §
23-17.4-10.2 .
2.5 Alzheimer Dementia Special Care Unit/Program License Requirements
2.5.1 Applicability
Any assisted living residence which offers
to provide or provides services to residents with Alzheimer disease
or other dementia by means of an Alzheimer Dementia/Special Care
Unit/Program shall be required to meet all requirements of §§
2.4 and 2.5 of this Part.
2.5.2
Specific Requirements
A. A residence licensed at the "dementia
care" level shall be licensed as an "F1--M1" residence
in accordance with the requirements of § 2.4.10(B) of this Part;
and
B. Any assisted living residence which
offers to provide or provides services to residents with Alzheimer
disease or other dementia by means of an Alzheimer Dementia Special
Care Unit/Program shall be required to disclose in writing the type
of services provided.
C. The disclosure shall be made to the
Department and to any person seeking placement in an Alzheimer
Dementia Special Care Unit/Program of an assisted living residence.
D. The information disclosed shall explain
the additional care that is provided in each of the following areas:
1. Philosophy: The Alzheimer Dementia
Special Care Unit's/Program’s written statement of its overall
philosophy and mission which reflects the needs of residents
afflicted with dementia;
2. Pre-Occupancy, Occupancy, and
Termination of Residence: The process and criteria for occupancy,
transfer or termination of residency from the unit;
3. Assessment, Service Planning &
Implementation: The process used for assessment and establishing the
plan of service and its implementation, including the method by which
the plan of service evolves and is responsive to changes in
condition;
4. Staffing Patterns & Training Ratios:
Staff training and continuing education practices;
5. Physical Environment: The physical
environment and design features appropriate to support the
functioning of cognitively impaired adult residents;
6. Resident Activities: The frequency and
types of resident activities;
7. Family Role in Providing Support and
Services: The involvement in families and family support programs;
8. Program Costs: The cost of care and any
additional fees, and the process used in the event that a resident
can no longer afford the cost of care being provided.
E. The Department shall develop a standard
disclosure form and shall review the information provided on the
disclosure form by the assisted living residence to verify the
accuracy of the information reported on it. Any significant changes
in the information provided by the assisted living residence shall be
reported to the Department at the time the changes are made.
F. Any residence that provides care for
residents with Alzheimer disease or other dementia by means of an
Alzheimer Dementia Special Care Unit/Program shall maintain written
policies and procedures that detail specific services, including
admission and discharge criteria, for residents and/or their
responsible parties on the Unit/Program.
G. The Alzheimer Dementia Special Care
Unit/Program shall operate and provide services to all residents of
the unit/program in accordance with the prevailing community standard
of care for residents with the particular needs and behaviors with
dementia.
H. Staff assigned to provide direct care
services to residents of the Alzheimer Dementia Special Care
Unit/Program shall be a qualified licensed assisted living staff
member as defined in § 2.3(A)(31) of this Part. Notwithstanding
this requirement, staff hired before January 1, 2015, that are not
qualified licensed assisted living staff members, may continue to
provide direct care services to residents residing in existing
Alzheimer Dementia Special Care Unit/Programs.
I. The Alzheimer Dementia Special Care
Unit/Program shall have on staff, at a minimum, a registered nurse(s)
with appropriate training and/or experience with dementia to manage
and supervise all resident dementia-related health and behavioral
issues. The nurse shall be on-site full-time (minimum of thirty-five
(35) hours per week), and shall be available for consultation at all
times.
J. Menus for the Alzheimer Dementia Special
Care Unit/Program shall be developed under the direction of a
nutritionist or registered dietician licensed by the Department.
K. All menus including alternate choices
shall be planned at least one (1) week in advance, to meet the
standards for nutritional care in accordance with Dietary Reference
Intakes: The Essential Guide to Nutrient Requirements, incorporated
above at § 2.2(A) of this Part, and to provide for a variety of
foods, adjusted for seasonal changes, and reflecting the dietary
preferences of residents.
1. Menus shall indicate nourishments
available to residents between evening meal and bedtime.
2. Menus shall be posted in a conspicuous
place in the dietary department and in resident areas.
3. Records of menus actually served shall
be retained for thirty (30) days.
L. The Alzheimer Dementia Special Care
Unit/Program shall provide a secure distinct living environment
appropriate for the resident population. This requirement may
include, but not be limited to, a locked unit, secured perimeter, or
other mechanism to ensure resident safety and quality of life. The
residence shall have elopement policies in place, specific to the
Unit/Program.
M. Staff Training - Dementia Care Level
The administrator shall ensure that all
new employees who will assist residents with personal care at the
dementia level of care receive at least four (4) hours of orientation
and training in the areas listed below prior to beginning work alone
in the assisted living residence, in addition to the areas stipulated
in §§ 2.4.12(G) of this Part. Staff will be provided no
less than twelve (12) hours of continued education in the following
areas at intervals not to exceed twelve (12) months.
1. Understanding various dementias;
2. Communicating effectively with dementia
residents;
3. Managing behaviors;
4. Elopement procedures for the
Unit/Program;
5. Creating a safe environment for
residents;
6. Medications commonly prescribed for
resident residing in the unit/program and potential side effects.
2.5.3
Emergency Power
A. The residence shall provide an emergency
source of electrical power necessary to protect the health and safety
of residents in the event the normal electrical supply is
interrupted.
1. Such emergency power system shall supply
power adequate at least for:
a. Lighting all means of egress; and
b. Equipment to maintain detection, alarm
and extinguishing systems.
2.6 Limited Health Services License Requirements
2.6.1 Applicability
Any assisted living residence which offers
to provide or provides limited health services to residents shall be
required to meet all requirements of §§ 2.4 and 2.6 of this
Part.
2.6.2 Specific
Requirements
A. All limited
health services provided by a licensed assisted living residence
shall be ordered by the resident’s physician, and provided by
qualified licensed assisted living staff members.
B. Assisted
living residences licensed to provide limited health services may
provide any or all of the following services:
1. Stage I and stage II pressure ulcer
treatment and prevention;
2. Simple wound care including
postoperative suture care/removal and stasis ulcer care;
3. Ostomy care including appliance changes
for residents with established stomas;
4. Urinary catheter care.
C. An assisted living residence licensed to
provide limited health services and offers to provide services to
residents receiving hospice services that are bed-bound or in need of
assistance from more than one staff person for ambulation is required
to be licensed at the F1 licensure level as defined in §
2.4.2(A)(1)(a) of this Part.
D. When it is identified that a resident
requires a limited health services as defined in § 2.6.2(B) of
this Part, the residence must inform the resident in writing of
his/her right to access a licensed home nursing care agency or
hospice provider for the services needed.
E. Assisted living residences licensed to
provide limited health services are required to disclose in writing
all services offered.
F. The disclosure shall be made to the
licensing agency and to any person seeking placement in an assisted
living residence licensed to provide limited health services.
G. The information disclosed shall explain
the care that is provided in each of the following areas:
1. Philosophy: Written statement of its
overall philosophy and mission which reflects how the assisted living
provides limited health services;
2. Pre-Occupancy, Occupancy, and
Termination of Residence: The process and criteria for occupancy,
transfer or termination of residency;
3. Assessment, Service Planning and
Implementation: The process used for assessment and establishing the
plan of services and its implementation, including the method by
which the plan of services evolves and is responsive to changes in
condition;
4. Family Role in Providing Support and
Services: The involvement in families and family support programs;
5. Program Costs: The cost of care and any
additional fees and the process used in the event that a resident can
no longer afford the cost of care being provided.
H. Any significant changes in the
disclosure information provided by the assisted living residence
shall be reported to the Department at the time the changes are made.
I. An assisted living residence that
determines to cease offering a limited health service(s) shall
notify, in writing, the Department, all residents, their guardian, or
relative so appointed or elected to be his or her decision maker,
every resident’s physician and to the Office of the Long-Term
Care Ombudsman of its intent thirty (30) days or more before ceasing
to offer a limited health service.
1. The written notification shall include,
but is not limited to the following:
a. Letter of intent and/or determining
factors/justification for stopping the service(s);
b. Proposed date that services would be
discontinued;
c. Plan for ensuring that residents
continue to receive services until other acceptable arrangements are
made; and
d. Contact information of staff member
responsible for implementing plan.
J. Based upon approval by the Department,
an assisted living residence that that does not provide all limited
health services, as defined in § 2.6.2(B) of this Part, may add
additional service(s) under its license one time per annual licensing
period.
K. Assisted living residences licensed to
provide limited health services are required to develop and maintain
written policies and procedures that detail the services offered,
including:
1. Admission and discharge criteria for
residents requiring limited health services;
2. Stage I and stage II pressure ulcer
treatment and prevention;
3. Simple wound care including
postoperative suture care/removal and stasis ulcer care;
4. Ostomy care including appliance changes
for residents with established stomas;
5. Urinary catheter care;
6. If applicable, coordination of hospice
services for residents who are bed-bound or in need of assistance
from more than one staff person for ambulation.
L. All written
policies and procedures for limited health services shall be
developed under the direction of a licensed physician which shall be
reviewed and approved at intervals not to exceed twelve (12) months.
M. Assisted
living residences licensed to provide limited health services are
required to have a licensed physician, a certified nurse practitioner
or a licensed physician assistant as a member of the Quality
Improvement Committee as defined in § 2.4.3 of this Part.
N. All limited
health services shall operate and provide services in accordance with
the prevailing community standard of care.
O. Evidence of
Pre-employment and Ongoing Health Screening
Upon hire and prior to delivering services,
employment health screenings shall be required for each individual
who has or may have direct contact with a resident receiving limited
health services. Such health screening shall be conducted in
accordance with the rules and regulations pertaining to Immunization,
Testing, and Health Screening for Health Care Workers (Part
20-15-7 of this Title).
P. All staff
providing direct care services to residents receiving limited health
services and/or hospice services for residents that are bed-bound or
in need of assistance from more than one staff person for ambulation
shall be qualified licensed assisted living staff members and may
only perform duties and services as permitted by their respective
license and/or certificate of registration.
Q. Assisted
living residences licensed to provide limited health services are
required to have on staff, at a minimum, a registered nurse(s). The
nurse shall be on-site full-time (minimum of thirty-five (35) hours
per week), and shall be available for consultation at all times.
R. Staff Training - Limited Health Services
All employees, including those who will
assist residents with personal care receive at least four (4) hours
of orientation and training in the areas listed below prior to
beginning work alone with a resident receiving limited health
services. Staff will be provided no less than two (2) hours of
continued education in the following areas at intervals not to exceed
twelve (12) months.
1. Pressure ulcer treatment and prevention;
2. Simple wound care including
postoperative suture care/removal and stasis ulcer care;
3. Ostomy care including appliance changes
for residents with established stomas;
4. Urinary catheter care;
5. Reporting changes in condition;
6. Signs and symptoms of infection(s); and
7. Signs and symptoms of dehydration.
2.6.3
Emergency Power
A. The residence shall provide an emergency
source of electrical power necessary to protect the health and safety
of residents in the event the normal electrical supply is
interrupted.
1. Such emergency power system shall supply
power adequate at least for:
a. Lighting all means of egress; and
b. Equipment to maintain detection, alarm
and extinguishing systems.