216-RICR-40-10-7
216-RICR-40-10-7. Licensing Adult Day Care Programs (version Amendment, 06/09/2020 to 10/07/2020)
7.1 Authority
These rules and regulations are promulgated pursuant to the
authority conferred under R.I. Gen. Laws §§ 23-1-52 (a)
and 42-35-2.10 and are established for the purpose of defining the
prevailing standards for licensed adult day care programs in Rhode
Island.
7.2 Incorporated Materials
A. These regulations hereby adopt and
incorporate "The American National Standard - Specifications for
Making Buildings and Facilities Accessible to and Usable by, the
Physically Handicapped" (1980) 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 "The Americans with Disabilities Act" 42 U.S.C
§ 12101-12213; 47 U.S.C §§ 152, 221, 225, 611; 29
U.S.C § 706 (1991) 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.
7.3 Definitions
A. Whenever used in these rules and regulations, the following terms
shall be construed as follows:
1. "Adult day care program" means a comprehensive,
nonresidential program designed to address the biological,
psychological, and social needs of adults through individual plans of
care that incorporate, as needed, a variety of health, social and
related support services in a protective
setting.
2. “Alzheimer dementia or other dementia special care services”
means a program that offers services to one or more participants with
a diagnosis of Alzheimer dementia or other dementia.
3. “Building Code” means the current Rhode Island State
Building Code, contained in R.I. Gen. Laws Chapter 23-27.3.
4. “Case management services” means a collaborative
process of assessment, planning, facilitation and advocacy for
options and services to meet an individual’s health needs
through communication and available resources to promote quality
cost-effective outcomes.
5. "Cloth face covering" means a protective article that
covers the wearer's mouth and nose.
6. "COVID-19" means the disease caused by novel coronavirus
"SARS-CoV-2."
7. "COVID-19 symptoms" means the occurrence of any of the
symptoms of COVID-19, as set forth in CDC guidance, when they develop
over a period of hours to days and cannot be explained by allergies
or other non-infectious disease. Such symptoms included, among
others, chills, repeated shaking with chills, muscle pain, body aches
or other symptoms consistent with fever, temperature measured above
100.4°F, cough, congestion, sore throat, shortness of breath,
headache, or new loss of taste or smell.
8. “Department” means the Rhode Island Department of
Health.
9. “Direct care staff” means the program director and all
other staff who work directly with program
participants.
10. “Director” means the Director of the Rhode Island
Department of Health.
11. “Disqualifying information” for criminal records
check purposes, and as used herein, means any conviction for murder,
voluntary manslaughter, involuntary manslaughter, first degree sexual
assault, second degree sexual assault, third degree sexual assault,
assault on persons sixty (60) years of age or older, assault with
intent to commit specified felonies (murder, robbery, rape, burglary,
or the abominable and detestable crime against nature) felony
assault, patient abuse, neglect or mistreatment of patients,
burglary, first degree arson, robbery, felony drug offenses, larceny,
or felony banking law violations.
12. “Elderly” means any person who is fifty-five (55)
years or older.
13. "Elopement", as used herein, means leaving the premises
without notice when the adult day care program has assumed
responsibility for the participant’s
whereabouts.
14. “Executive director” means the top administrative
staff member, however named, at the adult day care
program.
15. “Interdisciplinary team” means at least three (3)
professionals, with training in one of each of the following
disciplines: nursing, activities, and case management or social
work.
16. “Life Safety Code” means the current Rhode Island
State Fire Safety Code, as contained in R.I. Gen. Laws Chapter
23-28.1 .
17. “Medication aide” means a nursing assistant who has
had additional training in the administration of medications and is
registered with the Department in accordance with the “Rules
and Regulations Pertaining to Rhode Island Certificates of
Registration for Nursing Assistants, Medication Aides, and the
Approval of Nursing Assistants and Medication Aide Training
Programs”.
18. “Nurse” means a person who is licensed to practice
professional or practical nursing in accordance with R.I. Gen. Laws
Chapter 5-34 .
19. “Other authorized provider working within the scope of
his/her practice”, as used herein, means a physician
assistant, dentist, registered nurse practitioner, or other
person duly authorized by
law to
prescribe.
20. “Participant”, as used herein, means a person who is
18 years of age and enrolled in an adult day care
program.
21. “Person” means any individual, trust or estate,
partnership, corporation (including associations, joint stock
companies), limited liability companies, state, or political
subdivision or instrumentality of a
state.
22. "Stable groups" means the same individuals, including
participants and staff, being in the same group each day.
a. Participants shall not change from one group to another.
b. Stable groups must occupy the same space each day.
23. “Social worker” means a person licensed under R.I.
Gen. Laws Chapter 5-38.1 and the “Rules and Regulations for
Licensing Clinical Social Workers and Independent Clinical Social
Workers”.
7.4 Licensure
Requirements
7.4.1 General Requirements
A. These rules and regulations shall
apply to all adult day care programs that provide services to the
elderly who are in need of supportive care and supervision during the
daytime.
B. A license issued to a new adult day
care program, unless sooner suspended or revoked, shall expire by
limitation on March 31 st
of each odd-numbered year and may be renewed upon
application to the Department.
C. No person, acting alone or jointly
with any other person, shall establish, conduct or maintain an adult
day care program in this state without a license in accordance with
the requirements of R.I. Gen. Laws § 23-1-52 ,
and in conformity with this Part.
D. No facility or program shall
represent itself as an adult day care program or use the term “adult
day care program” or any other similar term in its title,
advertising, publication or other form of communication, unless
licensed as an adult day care program in accordance with the
provisions herein.
E. An application for a license shall be
made to the Department, upon forms provided by the Department and
shall contain such information as the Department reasonably
requires.
F. Upon receipt of a completed
application for a license, the Department may issue a license if the
applicant meets the requirements of R.I. Gen. Laws § 23-1-52 ,
and this Part.
G. A license issued hereunder shall be
the property of the state and loaned to such
licensee.
H. The license shall be posted in a
conspicuous place on the
premises.
I. Each license shall be issued only for
the premises and person(s) named in the application and shall not be
transferable or assignable except with the written approval of the
Department.
J. Each program shall be responsible for
complying with all local, state, and federal laws, codes, rules and
regulations that apply to the
program.
K. Each program shall be responsible for
maintaining a policy of nondiscrimination in the provision of
services to participants and in the employment of staff without
regard to race, color, creed, national origin, sex, sexual
orientation, age, handicapping condition or degree of handicap, in
accordance with all applicable state and federal statutes and
regulations.
7.4.2 Responsibilities of the
Governing Body/Program
A. Each adult day care program shall
have an organized governing body or other legal authority,
responsible for:
1. The management and control of the operation of the program;
2. The conformity of the program with:
a. All federal, state and local laws and regulations relating to
fire, safety, sanitation, communicable and reportable diseases;
b. Other relevant health and safety requirements; and
c. With all of the requirements contained in this Part.
B. The program shall:
1. Maintain names and affiliations of members of the agency’s
governing body;
2. Describe structure of the agency’s governing
body;
3. Provide functional and staff organizational
charts;
4. Maintain a copy of the organization's charter, constitution or
by-laws, that include but are not limited
to:
a. A definition of goals, purposes,
objectives;
b. A statement of compliance with civil rights act and other federal,
state, local laws safe guarding civil
rights;
c. Appropriate standing
committees;
d. A statement of asset disbursement in case of corporate
liquidation;
e. Evidence of consumer involvement or input into program
policies.
5. Provide documentation that the governing body does the
following:
a. Provides for annual
evaluation;
b. Oversees contracts, adopts and operates annual budget, maintains
financial records, provides annual audit by an independent certified
public accountant;
c. Adheres to accepted standards of
accounting;
d. Employs a director and gives said person the authority to manage
the daily affairs according to established personnel and corporate
policies;
e. Meets at least quarterly and maintains minutes of
proceedings.
C. The governing body shall review, approve, and revise a current,
written plan of operation, including a service description for
providing adult day care services to frail elderly persons. This
description shall be reviewed at least annually, updated as needed,
and made available to the Department, upon request.
D. The program shall demonstrate that it
has the capacity to carry out this plan of operation and perform
various operational functions needed to oversee and support the
program, including the ability
to:
1. Manage ongoing operations;
2. Coordinate across multiple sites, as
applicable;
3. Maintain partnerships with entities and programs;
and
4. Demonstrate an effective approach to program
management.
E. The program shall present a clear and
concise annual summary statement of activities and scope of service
(e.g., an annual report).
F. The program shall develop written
policies and procedures, consistent with Department regulations, for
providing services to
participants.
G. Written protocols shall be developed
to specify exactly when the program will be cancelled due to weather
conditions and other emergencies and the participants will be
evacuated due to power outage and other emergencies. These protocols
shall be easily accessible in the facility and in all program
vehicles that transport participants and shall include at least the
following:
1. Means by which participants and families are notified of
cancellations and early closings.
2. Description of location to which participants will be moved in
case of evacuation and letter of agreement if this location is not
affiliated with the program.
H. An organization chart shall be
developed to illustrate the lines of authority and communication
channels, and shall be provided to all program
staff.
I. The director shall have full
authority and responsibility to plan, staff, direct, implement, and
evaluate the program.
J. The director or designee shall be on
site to provide the program’s day-to-day management during
hours of operation.
K. The program shall have a policy
assuring that it follows all applicable federal and state
requirements including, but not limited
to:
1. Title V of the Civil Rights Act of
1964, 42
U.S.C. § 2000e ;
2. Drug-Free Workplace Act of 1988, 41
U.S.C. § 81 ;
3. The Rhode Island Lobbying Reform Act (R.I. Gen. Laws Chapter
42-139.1).
L. Each program shall inform its staff
and participants of the general content of the Department’s
regulations; and shall develop and implement written plans, policies
and procedures to ensure compliance with the Department’s
regulations. These documents shall be reviewed by the program’s
governing body at least annually and revised as
needed.
M. The program shall have at least the
following written documents:
1. Plan for community education and
involvement;
2. Statement of program philosophy and
objectives;
3. Mission statement;
4. Contracts and agreements with other agencies and
individuals.
N. The program shall have a policy and
procedure manual that is written in a format that can be updated, as
needed, and shall include date(s) of revision. Each policy shall be
signed by the executive director. This manual shall include at least
the following areas of program operation:
1. Mission and philosophy;
2. Organization structure;
3. Personnel, including staffing requirements and
responsibilities;
4. Program description, including program
evaluation;
5. Participant policies, including admission and discharge;
and
6. Environmental issues.
O. Upon request, copies of all policies,
procedures and statements adopted by the program pursuant to §
7.4.2(N) of this Part shall be provided to participants, their
representatives, and members of the general
public.
7.4.3 Program Evaluation
A. The program shall have a
self-evaluation and continuous improvement system. This
self-evaluation shall include a statement of the program’s
goals and objectives and shall be conducted at least annually.
B. The self-evaluation system shall
measure the program’s success in achieving the stated goals and
objectives and shall review the effectiveness of the program’s
policies and procedures.
C. Goals, objectives, policies and
procedures shall be revised as needed based on the results of the
self-evaluation.
D. All revised goals, objectives,
policies and procedures shall be made available to the program’s
employees, interns, trainees and
volunteers.
E. The self-evaluation and any changes
that result from it shall be
documented.
7.4.4 Personnel
Requirements
A. The program shall maintain written
personnel policies and procedures that shall include, but not be
limited to, the following
topics:
1. Hiring, training, and supervising all paid and unpaid
personnel;
2. Use of outside service
providers;
3. Use of volunteers;
4. Notification of employees, consultants, interns, trainees, and
volunteers of their responsibilities, rights, benefits, and
conditions of employment;
5. Written job descriptions:
a. Each staff member shall receive a copy of his/her job description
that shall include: educational and work qualifications; major job
duties; numbers and titles of persons supervised; and title of the
supervisor for the position;
b. Supervision and job
performance;
c. Required education and
training;
d. Records, including maintenance of
records;
e. Current salary/wage
schedules;
f. Fringe benefits and any conditions attached to the
benefits;
g. Disciplinary procedures and grounds for dismissal;
and
h. Equal opportunity plan that shall include a statement guaranteeing
that hiring and promotion shall be free from unlawful discrimination
on the basis of race, color, creed, national origin, sex, sexual
orientation, age, physical or mental handicap, or degree of handicap.
B. Each program shall have a written
plan for no less than ten (10) hours of staff training and
development. Training shall include at least the
following:
1. Orientation for all staff at the start of employment. This initial
training shall include orientation to the program’s policies,
procedures, rules, and
regulations;
2. Current first aid training, including cardiopulmonary
resuscitation (CPR) and Heimlich Maneuver, for direct program staff
(including drivers). Evidence of current first aid training shall be
maintained on file and shall be available to the Department upon
request.
3. Universal precautions and latex
safety;
4. Participants’ rights, with a focus on dignity, choice,
diversity, and cultural sensitivity;
5. Reporting abuse, mistreatment, and
neglect;
6. Fire safety;
7. Safe patient handling and body
mechanics;
8. Developing, implementing, and evaluating individual plans of care,
as applicable;
9. Specialized services offered by the
program;
10. Identifying participants who abuse alcohol and/or other
substances, suffer from depression, or are victims of elder abuse or
self-neglect;
11. Services available to participants from community programs or
agencies;
12. Medications prescribed for participants, the benefits of the
medications, common side effects and risks, and the laws governing
administration of prescribed medications;
and
13. Confidentiality of participant information and records. Each
employee, consultant, intern, trainee and volunteer shall sign a
statement agreeing to abide by the rules and regulations governing
participant confidentiality. This signed statement shall be included
in the individual’s personnel
record.
C. Alzheimer Dementia or Other Dementia
Special Care Services: The executive director, or his/her designee,
shall ensure that all new employees who assist participants with
personal care at the Alzheimer Dementia or Other Dementia Special
Care Services level of care receive at least twelve (12) hours of
orientation and training in the areas listed below within thirty (30)
days of hire and prior to beginning work alone in the adult day care
program, in addition to the areas stipulated in § 7.4.4(B) of
this Part. Such areas shall include, but not be limited
to:
1. Understanding various
dementias;
2. Communicating effectively with persons with
dementia;
3. Managing behaviors.
D. Training shall be completed within
thirty (30) days of hire and prior to working without direct
supervision.
E. All staff shall receive no less than
(10) ten hours of training annually, and as needed, in the topics
stipulated in § 7.4.4(B) of this Part.
F. The program director or his/her
designee shall evaluate the performance of each employee at the end
of his/her probationary period and at least annually thereafter. The
governing body or designee shall evaluate the program director.
Performance evaluations shall be in writing, and a copy shall be
filed in the individual’s personnel record. The individual
shall be notified, in writing, of the evaluation
results.
G. The program shall maintain
confidential personnel records for each employee including time
sheets or other records showing all dates and hours worked by each
employee and holidays, sick leave, vacation, and unpaid leave taken.
Each individual shall have access to his/her personnel record. Each
record shall contain at least the
following:
1. A complete job application; and when appropriate, a
resume.
2. References, which may be documented verbal references or letters
of reference.
3. For every individual within the program who is licensed, certified
or registered by the state of Rhode Island, a mechanism shall be in
place to verify currency of licensure electronically via the
Department's licensure database.
4. Documentation of any participation in job related training, while
employed by the program, including the date(s) of training, the
provider, the topic, and proof of attendance and
completion.
5. Performance evaluations.
6. Statement signed by the individual agreeing to abide by the rules
and regulations regarding the confidentiality of participant
information and records.
7. The program shall have an adequate number of qualified staff to
meet the needs of its participants.
8. The program shall comply with local, state, and federal laws
governing hours and conditions of employment and
wages.
9. The program shall assign a staff member to oversee the
development, implementation, and periodic review of each
participant’s individual plan of care; and to monitor and
evaluate the participant’s progress in achieving his/her
treatment goals and objectives.
10. The program shall have a written agreement with any agency,
program, or other service provider that provides essential services
not provided directly by and otherwise the responsibility of the
program. This written agreement shall be updated annually. The nature
and extent of the services provided shall be documented.
11. Programs that use volunteers shall have a screening procedure to
select volunteers with appropriate skills to work with the
participants. The nature and extent of volunteer services shall be
documented.
H. Staffing Requirements
1. The program shall employ a nurse who shall be on site daily for a
minimum of six (6) hours.
2. The program shall designate one full-time staff member as the
program director. The program director shall designate a staff member
to act in his/her absence.
3. Each program shall employ at least one (1) nursing assistant
licensed by the Department.
4. Aides shall be nursing assistants licensed by the Department, or
shall be employees who have completed the employee orientation
program set forth in § 7.4.4(B) of this Part, prior to providing
direct care to participants.
5. Aides shall be responsible for assisting professional program
staff members as required in implementing services and meeting the
needs of individual
participants.
6. The program shall identify a staff person responsible for the
functions of an activities director who shall be on site daily for a
minimum of four (4) hours. The activities director shall have the
ability to develop and implement therapeutic activities for specific
participants and for groups.
7. Programs whose daily enrollment is twenty-four (24) or more
participants shall provide case management services on-site or shall
make them available for a minimum of twenty (20) hours each
week.
8. The program shall have at least one (1) staff member trained in
first aid, including cardiopulmonary resuscitation (CPR) and the
Heimlich maneuver on site during all operating hours.
I. Health Screening
1. 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 program participant. 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) promulgated by the
Department.
J. Criminal Background Checks
1. Criminal record review requirements are pursuant to R.I. Gen. Laws
§ 23-17-34.
2. If an applicant has undergone a criminal records check within
eighteen (18) months of an application for employment, an employer
may request from the BCI a letter indicating if any disqualifying
information was discovered. The BCI will respond without disclosing
the nature of the disqualifying information. This letter must be
maintained on file to satisfy the requirements of this
section.
7.4.5 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 Director 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.
C. Refusal to permit inspection or
investigation shall constitute a valid ground for suspension or
revocation of license or curtailment of
activities.
D. Each program shall be given notice by
the Department of its level of compliance with this Part, including a
list of all deficiencies reported as a result of an inspection or
investigation.
7.4.6 Denial, Suspension or
Revocation of License or Curtailment of Activities
A. The Department is authorized to deny,
suspend or revoke the license or curtail activities of any adult day
care program which:
1. Has failed to comply with the rules and regulations of this Part;
2. Has offered or provided services to participants outside of the
scope of its license;
3. Has failed to correct deficiencies or complete corrective action
plan; or
4. Has failed to comply with the provisions of R.I. Gen. Laws §
23-1-52 .
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 adult day
program.
C . Noncompliance with this Part may
constitute grounds to revoke, suspend, curtail the activities of,
deny an application for licensure, or otherwise discipline the
licensee by the Director.
7.4.7 Deficiencies and Plans of
Correction
A. The Department shall notify the
governing body or other legal authority of a program of violations of
these regulations through a notice of deficiencies which shall be
forwarded to the program within fifteen (15) days of inspection of
the program 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 § 23-1-52 .
B. A program which received a notice of
deficiencies shall submit a plan of correction to the Department
within fifteen (15) days of the date of the notice of
deficiencies.
C. The Department shall approve or
reject the plan of correction submitted by a program in accordance
with § 7.4.7(B) 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 program does not provide a plan of correction
within the fifteen (15) day period stipulated in § 7.4.7(B) of
this Part, or if a program 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 § 7.4.6 of
this Part.
7.4.8 Change of Ownership, Operation
and/or Location
A. When a change of ownership or
operation or location of an adult day program is planned or when
discontinuation of services is contemplated, the Department shall be
given written notice of pending changes within forty-five (45) days
of such pending changes.
B. A license shall immediately expire
and become void and shall be returned to the Department when
operation of an adult day program is discontinued or when any changes
in ownership occur.
C. Prior to operating under a new owner
or operator, the prospective licensee shall apply for a new license
in accordance with § 7.4.1 of this Part.
D. When there is a change in ownership
or in the operation or control of the program, the Department
reserves the right to extend the expiration date of such license,
allowing the program or program 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
participants, not to exceed six (6)
weeks.
7.5 Requirements for Adult Day
Care Programs
7.5.1 Admission Policies and
Procedures
A. Each adult day care program shall
define the target population(s) it
serves.
B. Each adult day care program shall
have a written policy on participants who are appropriate for
enrollment.
C. Each adult day care program shall
have a mission and philosophy statement that reflects the needs of
the participants and the care and services it
provides.
D. Each participant shall have a
physical/mental condition that indicates a need for nursing care,
supervision, therapeutic services, support services, and/or
socialization.
E. Each adult day care program shall
serve only participants whose needs are compatible with the program’s
resources.
F . No less than fifty-one percent (51%)
of the program’s average daily number of participants shall be
fifty-five (55) years of age or
older.
G . Prior to an individual’s
acceptance as a participant, the program shall require a notice from
the applicant’s primary care physician (or other authorized
provider acting within the scope of his/her practice) including a
medical history and documentation that a physical examination has
taken place within the past year. Physician’s (or other
authorized provider acting within the scope of his/her practice)
documentation shall include, but not be limited to, the following:
1. A list of current medications and
treatments;
2. A list of immunizations (e.g., tetanus, pneumococcal, influenza)
with dates; and indication of TB test results, if test has been
given;
3. Any special dietary
requirements;
4. A statement indicating any limitations to the individual’s
participation in program activities;
5. Recommendations for therapy, when
applicable.
H . In a documented crisis situation, the
program may allow up to thirty (30) days after enrollment in the
program for receipt of the complete physician’s documentation
as required in § 7.5.1(G) of this Part.
I . The program shall have procedures for
orientation of the participant and/or family to policies, services,
and facilities.
J . The program shall assure that all
participants or their authorized representatives review all consents
and permission
documents and
either sign
where indicated
or state
in writing
that they have read and understand the documents and are
unwilling to sign them. Copies of these signed documents shall be
filed in the participant’s individual
record.
K . The participant (or their authorized
representative) and family shall be informed of the program’s
procedures for advance directives.
L . Program policies shall define the
target population, admission criteria, discharge criteria, medication
policy, participant rights, confidentiality, and grievance
procedures.
7.5.2 Participant Policies
A. All programs shall promote a
restraint-free environment. The use of chemical and/or physical
restraints shall be restricted to those participants whose physicians
(or other authorized provider acting within the scope of his/her
practice) have ordered such
restraints.
B. The rights listed in § 7.5.3(A)
of this Part shall be posted. These rights shall be explained to all
participants or their representatives, families, staff, and
volunteers in the language understood by the
individual.
C. A grievance procedure shall be
established to enable participants and their families/caregivers to
have their concerns addressed without fear of
recrimination.
D. The program shall comply with the
state mandatory procedures for reporting suspected elder abuse to the
Department as outlined in R.I. Gen. Laws Chapter 23-17.8 .
Any employee of a licensed adult day care program who has reasonable
cause to believe that a participant has been abused, exploited,
neglected, or mistreated shall, within twenty-four (24) hours of the
receipt of said information, transfer such to the Director. Staff
shall be trained in signs and symptoms of potential
abuse.
7.5.3 Participant Rights and
Responsibilities
A. Adult day care programs shall assure
that all participants are afforded the following rights, as well as
any others deemed appropriate by the specific
program:
1. The right to be treated with consideration, respect, and dignity,
including privacy in treatment;
2. The right to participate in program of services and activities
designed to encourage independence, learning, growth and awareness of
constructive ways to develop one’s interests and
abilities;
3. The right to self-determination within the adult day care setting,
including the opportunity to:
a. Participate in developing or changing one’s plan for
services;
b. Decide whether or not to participate in any given
activity;
c. Be involved to the extent possible in program planning and
operation;
d. Refuse treatment and be informed of the consequences of such
refusal;
e. End participation in the adult day care program at any
time.
4. The right to a thorough initial assessment, development of an
individualized plan of care, and a determination of the required
level of care;
5. The right to be cared for in an atmosphere of sincere interest and
concern in which needed support and services are
provided;
6. The right to a safe, secure, and clean
environment;
7. The right to receive nourishment and assistance with meals as
necessary to maximize functional abilities and quality of
life;
8. The right to confidentiality and the guarantee that no personal or
medical information will be released to persons not authorized under
law to receive it without the participant’s written consent, in
accordance with R.I. Gen. Laws Chapter 5-37.3 ;
9. The right to voice grievances about care or treatment without
discrimination or reprisal;
10. The right to be fully informed, as documented by the
participant’s written acknowledgment, of all participants’
rights and of all rules and regulations regarding participant conduct
and responsibilities;
11. The right to be free from harm, including unnecessary physical or
chemical restraint, isolation, excessive medication, abuse, or
neglect;
12. The right to be fully informed, at the time of acceptance into
the program, of services and activities available and related
charges;
13. The right to communicate with others to the extent of the
participant’s capability.
7.5.4 Program Services
A. Programs shall offer, or make
available through arrangements with community agencies, the services
specified below in order to meet the needs of the participant
population:
1. Nursing services shall be provided in accordance with the
particular needs of each participant and shall include, but not be
limited to, the following:
a. Supervision of and/or administration of medications and treatments
as prescribed by the participant’s physician (or other
authorized provider working within the scope of his/her
practice);
b. Participation in the development and implementation of the
individual participant’s plan of
care;
c. Ongoing monitoring of each participant’s health
status;
d. Maintenance-therapy treatment as recommended by a therapist;
and
e. Coordination of orders from the participant’s physician (or
other authorized provider working within the scope of his/her
practice).
2. Programs shall provide or arrange for health education, which may
include promotion, prevention, screening and
detection.
B. Therapeutic services shall be
provided to, or coordinated for, each participant, as needed, when
recommended by a therapist or prescribed by a physician (or other
authorized provider working within the scope of his/her
practice).
1. Therapeutic services shall include occupational, physical, and/or
speech therapy.
C. The program shall establish written
agreements with occupational, physical, and speech therapists to
define the nature and extent of the working
relationship.
D. Program staff members shall provide
therapeutic services to participants following a plan of care devised
by a therapist.
E. Program staff members shall provide
maintenance therapy to meet the particular needs of a participant
when indicated by the program therapy consultants or the
participant’s physician (or other authorized provider acting
within the scope of his/her practice). The program’s nurse, or
other licensed professional, shall supervise the administration of
maintenance therapy to
participants.
F. Program staff members shall provide
individual and group activity programs that offer social,
recreational, and educational
events.
G. The dignity, interests, and
therapeutic needs of individual participants shall be considered in
the development of activity
programs.
H. Nursing assistants and aides, under
the supervision of a nurse, shall provide personal care services and
shall offer training and assistance in dressing, grooming, personal
hygiene, use of special aids, accident prevention, and activities of
daily living.
I. Personal care services and assistance
with activities of daily living shall be provided in a safe and
hygienic manner, with recognition of each individual participant’s
dignity and right to privacy, and in a manner that encourages the
maximum level of independence.
J. Programs shall provide a noon meal
and make available two (2) snacks per day for each participant every
full day he/she attends the
program.
K. Menus shall be developed under the
direction of a nutritionist or registered dietician licensed by the
Department.
L. The noon meal shall be equivalent to
at least one-third the recommended daily dietary allowance
established by the U.S. Department of Agriculture
(USDA).
M. The program shall provide or arrange
for any special diets, if required by a participant and prescribed by
his/her physician (or other authorized provider working within the
scope of his/her practice).
N. The program shall offer or arrange
for nutritional counseling, as
necessary.
O. Food shall be prepared in accordance
with the Rhode Island Food Code (Part 50-10-1 of this Title).
P. The program shall assist participants
and their families with personal and social
issues.
Q. The program shall provide or arrange
for mental health and substance abuse services for participants when
indicated by a physician (or other authorized provider working within
the scope of his/her practice).
R. Mental health and substance abuse
services shall be documented in the individual participant’s
plan of care.
S. The program shall establish written
emergency policies and procedures. Emergency procedures shall
include, but not be limited to, the
following:
1. A written plan and/or agreement for emergency
care;
2. A written plan and/or agreement for emergency
transportation;
3. A file readily located for each participant containing at least
the following:
a. Name and telephone number of his/her
physician;
b. Hospital preference;
c. Insurance information;
d. Medications and allergies;
e. Current diagnoses and
history;
f. Name and telephone number of emergency
contact;
g. Copy of any advance directive, power of health care attorney,
etc.; and
h. Photograph (for participant
identification);
4. A conspicuously displayed notice indicating emergency fire
procedures in accordance with local and state fire department
regulations;
5. Training for participants in emergency procedures, written records
of which shall be kept; and
6. Annual training for direct program staff members, including
drivers, in emergency procedures, written records of which shall be
kept.
T. The program shall provide a balance
of purposeful activities to meet the participants’ needs and
interests (i.e., social, intellectual, cultural, economic, emotional,
physical, and spiritual).
U. Program activities and services shall
be designed to promote personal growth and enhance the self-image,
and/or improve and maintain the functioning level of participants to
the extent possible.
V. Activity opportunities shall be
available whenever the program is in
operation.
W. If a participant receives services
from several community agencies, the program shall coordinate with
the participant’s case manager to ensure that services are not
duplicated.
X. Programs shall arrange for ancillary
services to meet needs identified through the assessment and
individual care planning
process.
Y. Ancillary services shall include
education for the participant and/or family caregiver and may be
delivered on a one-to-one basis or in a group
setting.
Z. Ancillary services shall be provided
within the framework of the individualized plan of care and as part
of the overall array of services the participant
receives.
AA. Services shall be rendered in
accordance with the prevailing community standard of
practice.
7.5.5 Alzheimer Dementia or Other
Dementia Special Care Services
Disclosure
A. Any adult day care program that
offers to provide or provides services to participants with Alzheimer
dementia or other dementia shall be required to disclose on a
standard disclosure form provided by the Department the type of
services provided, in addition to those services required by this
Part.
B. Said disclosure shall be made to the
Department and to any person seeking placement in an Alzheimer
Dementia or other dementia special care services component of an
adult day care program.
C. The information disclosed shall
explain the additional care that is provided in each of the following
areas:
1. Philosophy: the Alzheimer Dementia or other Dementia special care
services written statement of its overall philosophy and mission
which reflects the needs of participants affected by
dementia;
2. Termination from the Program: the process and criteria for
transfer or termination from the
program/unit;
3. Assessment, Service Planning and 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 and 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
adults;
6. Participant Activities: the frequency and types of activities for
participants;
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.
D. The Department shall review the
information provided on the disclosure form by the adult day care
program to verify the accuracy of the information reported on it. Any
significant changes in the information provided by the adult day care
program on its disclosure form shall be reported to the Department at
the time the changes are made.
E. Any adult day care program that
provides care for participants with Alzheimer disease or other
dementia shall maintain written policies and procedures that detail
specific services, including admission and discharge criteria for
participants and/or their responsible parties in the
program.
F. Training for employees who work in an
Alzheimer Dementia or other dementia special care services program
shall meet all of the requirements of §§ 7.4.4(B) and
(C) of this Part.
G. The adult day care program that has
an Alzheimer Dementia or other dementia special care services program
shall have no less than one (1) registered nurse on staff and
available for consultation at all times with appropriate training
and/or experience with dementia to manage and supervise all
participant dementia-related health and behavioral
issues.
H. The adult day care program with an
Alzheimer Dementia or other dementia special care services program
shall provide a secure environment appropriate for the participant
population. This requirement may include, but not be limited to, a
locked unit, secured perimeter, or other protocol to ensure
participant safety and quality of life. The adult day care program
shall have elopement policies in
place.
7.5.6 Individual Assessments, Plans
of Care, and Participant Records
A. Each adult day services program shall
conduct an assessment of each potential participant in order to
determine whether or not that participant is suitable for enrollment
in the program.
B. This assessment shall be conducted by
a licensed staff member working within the scope of his/her practice,
shall be reviewed by a registered nurse, and shall include interviews
of family members, as
appropriate.
C. Initial assessment information and
information provided by the applicant’s physician (or other
authorized provider acting within the scope of his/her practice)
shall be reviewed by at least one registered nurse member of the
program.
D. The assessment shall include no less
than the following components:
1. Participant’s ability to self-preserve including cognitive
and physical considerations;
2. Assistance with medications that may be
required;
3. Health status including medical and nursing
needs;
4. Dementia care needs;
5. Assistance with personal needs, including activities of daily
living;
6. Providing or arranging for health and supportive
services;
7. Monitoring activities to ensure health, safety, and
well–being;
8. Cognitive needs;
9. Functional needs; and
10. Social needs.
E. Written documentation of this initial
assessment shall be maintained by the program in the participant’s
record.
F. Upon admission to the program,
program staff shall negotiate a written agreement with the
participant (or their authorized representative), and if appropriate,
with the participant’s legal guardian. This agreement shall
specify at least the following:
1. A disclosure statement that describes the program’s range of
care and services;
2. Basic services offered to the participant by the
program;
3. Staffing profile;
4. Participant confidentiality policies and
procedures;
5. Admission, discharge, and/or transfer
criteria;
6. Fees and arrangements for reimbursement and
payment;
7. Identification of and authorization for third party
payers;
8. Any non-financial obligations of the participant and his/her
family, such as a commitment by the participant to attend the program
a specified number of days per week;
9. Days and hours of program
operation;
10. Schedule of holidays when the program is
closed;
11. Announcement procedures for unexpected closing of the program due
to disaster or severe weather
conditions.
G. Each participant shall designate a
health care provider to contact in the event of an emergency and for
ongoing care.
H. Each program shall maintain a
participant record system, including a separate record for each
participant.
I. Programs shall conduct the assessment
as required herein and utilize the results of this assessment to
develop an individual written plan of care for each participant
within thirty (30) days after the individual enters the
program.
J. Each plan of care shall be drafted by
an interdisciplinary team, with input from nursing assistants. The
participant, caregiver, and other service providers shall have the
opportunity to contribute to the development, implementation, and
evaluation of his/her care plan.
K. If coordination of care is needed and
if the participant is a client of another agency, the care plan shall
be developed in conjunction with the services provided by that
agency. The participant’s case manager or other appropriate
staff member from that agency shall be invited to participate in the
care-planning meeting.
L. The individual plan of care shall
consist of these elements:
1. Specific problems, needs or challenges faced by the
participant;
2. Realistic goals
and/or objectives
for the
participant for
each item
identified in
§ 7.5.7(L)(1) of this Part;
3. Measurable action steps to be taken during the coming quarter to
achieve the goals and/or objectives identified in § 7.5.7(L)(2)
of this Part;
4. Specific observations to be made and/or data to be collected to
measure progress toward achieving the goals and/or objectives
identified in § 7.5.7(L)(2) of this Part;
and
5. Specific timelines
for making
observations and
collecting data
as identified
in §
7.5.7(L)(4) of this Part.
M. There shall be a care plan review
quarterly conducted by one of the three members of the
interdisciplinary team, including the participant and/or family/
caregiver, that reassesses the individual participant’s needs
and reevaluates the appropriateness of service plans. At least the
following items shall be
reviewed:
1. Scheduled days of attendance;
2. Services, objectives, and goals of the plan of
care;
3. Progress, or lack thereof, in achieving objectives and goals of
the plan of care; and
4. Conditions of participation.
N. Progress notes shall be written no
less than monthly by a licensed member of the interdisciplinary team
and shall be maintained as part of each participant’s
record.
O. The program shall maintain individual
participant records arranged for ready access by
staff.
P. Each individual participant record
shall contain at least the following
sections:
1. Progress notes no less than monthly and
quarterly;
2. Assessment information;
3. Summary of quarterly plan of care meetings, including names and
titles of all in attendance and documentation of any person(s)
invited who did not attend;
4. Medical and other health-related information, including
physician’s (or other authorized health care provider’s)
orders;
5. Medication records; and
6. Financial records, including eligibility and payment
documents.
Q. Emergency information about each
participant and a recent photograph of each participant shall be
maintained for ready access.
R. Individual participant records and
all other documents associated with identifiable individual
participants shall be maintained as confidential materials in
accordance with current state and federal laws, rules and
regulations. Storage of all participant records and documents shall
assure their safety from inappropriate use and from fire and other
unplanned destruction.
S. The program shall develop and follow
written policies establishing guidelines for storage and retention of
participant records, including but not limited to the
following:
1. The required participant information shall be contained in record
formats appropriate to the efficient and effective delivery of
services and accessible for review upon request by the Department or
other appropriate health oversight
agency.
2. Guidelines for the removal of participant records from
file.
3. Retention of participant records for five (5) years from the date
of discharge in accordance with R.I. Gen. Laws Chapter 23-3 .
7.5.7 Discharge
Planning
A. The program shall develop a
re-evaluation protocol that
specifies:
1. Those changes in medical and/or behavioral status that trigger an
unscheduled reassessment of the
participant;
2. Observational and data-gathering procedures—including
inquiries made of the family concerning the participant’s
status outside program hours—to yield measurable status
changes;
3. Procedures to be followed by the treatment team to attempt to
modify status changes so that the participant may continue in the
program;
4. Description of criteria to be followed to determine that discharge
procedures should be initiated.
B. Steps taken under the re-evaluation
protocol shall be documented in the individual participant record.
C. The program shall develop a discharge
protocol that includes criteria and notification procedures.
D. Discharge/transition plans shall be
developed for participants that describe changes in service needs and
changes in functional status that prompted another level of
care.
E. Each participant and/or
family/caregiver shall be given written notice if the participant is
to be discharged from the
program.
F. Discharge procedures shall include at
least the following:
1. A discharge summary;
2. Recommendations for continuing
care;
3. In consultation with the participant, family member or guardian,
referral to community service agencies for any appropriate services,
if the participant is returning to more independent
living.
G. The program shall complete and
maintain on file a discharge form indicating a discharge plan for
each participant leaving the
program.
H. The program shall discuss and agree
upon the discharge plan with the participant and his/her family as
far in advance of discharge as
possible.
I. Any adult day care program that
refers participants to any health care facility licensed pursuant to
R.I. Gen. Laws Chapter 23-17 ,
to an assisted living residence licensed pursuant to R.I. Gen. Laws
Chapter 23-17.4 ,
or to an adult day care program in which the referring entity has a
financial interest shall, at the time a referral is made, disclose
and document that the following information was provided to the
participant:
1. That the referring entity has a financial interest in the program
or provider to which the referral is being
made;
2. That the participant has the option of seeking care from a
different program or provider that is also licensed by the state to
provide similar services to the
participant.
J. The adult day care program shall
offer the participant a written list prepared by the Department of
all alternative licensed health care facilities, assisted living
residences, and adult day services programs. Said written list may be
obtained by contacting:
Rhode
Island Department of Health Office of Facilities Regulation
3
Capitol Hill, Room 305
Providence,
RI 02908
(401)
222-2566
www.health.ri.gov
7.5.8 Medication Services
A. The program shall store and
administer medications to participants as required and in accordance
with all applicable state and federal laws and
regulations.
B. Participants shall have the right to
refuse any and all medications.
C. The program shall inform the
participant’s family or a participant’s authorized
representative when a participant has refused medication(s). The
nurse shall inform the participant’s physician (or other
authorized provider acting within the scope of his/her practice), as
she/he deems appropriate.
D. The program shall have the right not
to accept, and/or to discharge a participant who refuses assistance
with medications if the program reasonably feels that the participant
cannot safely possess and control his/her
medications.
E. The program shall record each
instance of medication refusal by a participant in the participant’s
individual record.
F. All medications shall be stored
securely and in a manner to prevent spoilage, dosage errors,
administrative errors, inappropriate access, or diversion. Provided,
further, medications stored in a refrigerator shall be stored
separately from the food in a secured
container.
G. Licensed nurses and medication aides
may administer medications and monitor health indicators.
H. All medications shall be checked
against a physician’s (or other authorized provider working
within the scope of his/her practice) orders by a nurse or
pharmacist.
I. All medications shall be in the
original pharmacy-dispensed container with a proper label and
directions attached and shall be administered in accordance with such
label.
J. Injectable medications, including but
not limited to insulin, shall be administered by a
nurse.
K. Individual medication records shall
be retained for each participant to whom medications are being
administered and each dose administered to the participant shall be
properly recorded.
L. Such records shall be retained by the
program for no less than five (5) years after discharge from the
program.
M. A nurse shall monitor the medication
regimen for all participants.
N. Unused or discontinued prescription
medications shall be the property of the participant and shall be
given to the participant’s family or authorized representative,
whenever possible.
O. Any unused or discontinued
prescription medications that are left with a program shall be
disposed of in accordance with the Rules and Regulations Governing
the Disposal of Legend Drugs.
7.6 Environmental
Requirements
7.6.1 Environment
A. The facility housing the program
shall be constructed, equipped, and maintained to protect the safety
and well-being of participants.
B. The facility shall comply with
applicable state and local building regulations and zoning, fire, and
health codes and ordinances, including Rhode Island State Fire Safety
Code ( R.I. Gen. Laws Chapter 23-28.1 )
and the Rhode Island State Building Code (R.I. Gen. Laws Chapter
23-27.3 ).
C. The program shall comply with the
requirements of the federal Americans with Disabilities Act
incorporated above at § 7.2(B) of this Part.
D. A program with participants who are
blind, deaf and /or physically disabled shall be subject to all
applicable requirements of “The American National Standard -
Specifications for Making Buildings and Facilities Accessible to and
Usable by, the Physically Handicapped” incorporated above at §
7.2(A) of this Part.
E. The program shall obtain annual
certification from its local fire department approving the facility
for program operation. Such certification shall indicate the maximum
daily occupancy.
F. The program shall submit copies of
such certifications to the Department with application for license.
G. The sign for the program shall be
visible, and the entrance to the program shall be clearly identified.
H. The program, when it is co-located in
a facility housing other services, shall have its own separate
identifiable space for activity areas during operating
hours.
I. The facility shall have sufficient
space to accommodate the full range of program activities, services,
and equipment.
J. Each program shall have the following
areas:
1. A dining area;
2. A food preparation area in compliance with the Rhode Island Food
Code (Part 50-10-1 of this Title);
3. A project area equipped with adequate table and seating space (a
dining area may be used);
4. A group activity area;
5. A private, enclosed space, free from disruption, for individual
nursing services and counseling;
6. A properly equipped rest area;
and
7. Properly equipped, handicapped-accessible
bathrooms.
K. There shall be private space to
permit staff to work effectively and without
interruption.
L. Identified space shall be available
for participants and/or family/ caregivers to have private
discussions with staff.
M. There shall be storage space for
program and operating supplies.
N. Outside space that is used for
outdoor activities shall be safe, accessible to indoor areas, and
accessible to persons with a
disability.
O. The program shall provide a
comfortable, sanitary environment for the population it
serves.
P. All rooms utilized by participants
shall have proper ventilation.
Q. All steps, stairs, and corridors
shall be suitably lighted. Stairs used by participants shall have
banisters, hand rails or other types of support. All stair treads
shall be well maintained to prevent
hazards.
R. Halls and exit ways shall be free
from all encumbrances and/or
impediments.
S. Space shall be available for the safe
arrival and departure of
participants.
T. Illumination in all areas shall be
adequate and glare shall be
avoided.
U. Sound transmission shall be
controlled.
V. Conditions shall be maintained within
a comfortable temperature range to accommodate the population served.
W. Sufficient, appropriate furnishings
shall be available for the entire participant population present.
X. Program restrooms shall be located as
near the activity area as
possible.
1. Restrooms shall meet current Americans With Disabilities Act (ADA)
requirements.
2. Every restroom door shall be designed to permit the opening of the
locked door from the outside.
Y. Each program shall have at least one
(1) shower or other accommodation for
bathing.
Z. The overall design of the program
shall facilitate participants’ movement throughout the facility
and encourage involvement in activities and
services.
7.6.2 Construction and Renovations
A. Any licensee or applicant desiring to
make alterations or additions to its facility or to construct a new
facility shall, before commencing such alteration, addition, or new
construction, inform the Department. The Department may conduct
preliminary inspection and approval or make recommendations with
respect to compliance with the regulations
herein.
B. All new construction, modification,
additions, or room conversions shall be subject to the provisions of
R.I. Gen. Laws Chapters 23-28.1
and 23-27.3 ,
”The American National Standard - Specifications for Making
Buildings and Facilities Accessible to and Usable by, the Physically
Handicapped" incorporated above at § 7.2(A) of this Part
and "The Americans with Disabilities Act" incorporated
above at § 7.2(B) of this Part and such other applicable
federal, state and local laws, codes and regulations as may be
applicable. Where there is a difference between codes, the code
having the more stringent standard shall
apply.
7.6.3 Transportation Services
A. The program shall provide
transportation and/or assist in arranging transportation services for
participants and maximize the use of transportation arranged by the
participant’s family.
B. When transportation is provided to
participants through program operated vehicles, the operation of each
vehicle shall be in conformity with all applicable state and federal
regulations related to the driver, vehicle, and transportation
services.
C. Programs that operate their own
vehicle(s) shall employ drivers who possess the appropriate current
motor vehicle license(s) for the size and seating capacity of the
vehicle(s).
D. Drivers shall have experience in
transporting passengers and shall be sensitive to the needs of aged
individuals and individuals with handicapping
conditions.
7.6.4 Safety and Sanitation
A. The facility and grounds shall be
safe, clean and accessible to all
participants.
B. Smoking shall not be permitted in the
facility.
C. At least two (2) well-identified
exits shall be available to
participants.
D. Universal precautions shall be
practiced by all staff.
E. The program shall comply with rules
and regulations pertaining to the use of latex gloves by health care
workers promulgated by the Department and as contained in the rules
and regulations for the Use of Latex Gloves by Health Care Workers,
In Licensed Health Care Facilities, and by Other Persons, Firms, or
Corporations Licensed or Registered by the Department (Part 20-15-3
of this Title).
F. The program shall be free of hazards,
such as exposed electrical cords, loose area rugs and steep
grades.
G. Steps and curbs shall be painted and
the edges of stairs marked appropriately to highlight them.
H. Procedures for fire safety as
approved by the state and local fire authorities shall be adopted and
posted.
I. Appropriate fire extinguishers shall
be installed on each occupied level of the facility and maintained in
a usable condition, inspected at specified intervals as stipulated by
manufacturers and local and state fire
authorities.
J. The program shall develop and
maintain a written plan and procedure for the evacuation of the
premises in case of fire or other
emergency.
K. An evacuation plan shall be posted in
each room.
L. Emergency procedures shall be clearly
outlined and posted in conspicuous locations throughout the
facility.
M. Drills simulating emergency
conditions to test the effectiveness of the plan shall be conducted
in accordance with the requirements of the Office of the State Fire
Marshal with documentation of observed ability of participants and
staff to carry out evacuation
procedures.
N. Emergency first aid kits shall be
accessible to staff.
O. There shall be sufficient maintenance
and housekeeping personnel to assure that the facility is clean,
sanitary, and safe at all times.
P. Toxic substances, whether for
activities or cleaning, shall be stored in a locked area not
accessible to participants.
Q. A safety guide for dealing with
spills of toxic substances, chemicals, and other liquids including
blood shall be posted and followed by all
staff.
R. Insect infestation control shall be
scheduled at a time when participants are not in the
facility.
S. Equipment shall be adequately and
safely maintained.
T. The program shall have a sufficient
budget for equipment maintenance, repair, or replacement of all
equipment.
U. Programs shall have on-site at least
the following health care and safety
equipment:
1. An emergency first aid kit;
2. A scale for weighing
participants;
3. A blood pressure cuff and
stethoscope;
4. A thermometer;
5. A proper, secure storage space (including refrigeration, as
needed) for medications;
6. Sufficient number of blankets;
and
7. A portable oxygen tank for
emergencies.
7.7 Variance, Practices, and
Procedures
7.7.1 Variance
Process
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 or safety of
the participants.
B. A request for a variance shall be
submitted in writing by the applicant or licensee to the Department
for review.
C. Within a reasonable time thereafter,
the Department will review the application and return a written
decision to the applicant.
D. If the applicant is dissatisfied with
the decision of the Department, an appeal may be made through the
process outlined in § 7.7.2
of this Part.
7.7.2 Rules Governing Practices and
Procedures
All hearings and reviews required under
the provisions of R.I. Gen. Laws § 23-1-52 ,
shall be held in accordance with the provisions of the “Rules
and Regulations Pertaining to Practices and Procedures Before the
Rhode Island Department of Health” and “Rules and
Regulations Pertaining to Access to Public Records of the Rhode
Island Department of Health”.
7.8 COVID-19 Practices and
Procedures
A. The provisions of § 7.8 of this Part shall be in effect
during the pendency of the state of emergency declared by the
governor for the State of Rhode Island on March 9, 2020 due to the
dangers to health and life posed by COVID-19.
B. Adult day care programs are covered entities, as that term is
defined in § 50-15-7.2(A)(6) of this Title, and the provisions
of § 7.8 of this Part are in addition to Part 50-15-7 of this
Title.
C. With respect to adult day care programs, to the extent the
provisions of Part 50-15-7 of this Title conflict with the provisions
of § 7.8 of this Part, the provisions of § 7.8 of this Part
control.
D. COVID-19 Practices
During the pendency of the state of emergency declared by the
governor for the State of Rhode Island on March 9, 2020, each adult
day care program shall ensure, in addition to compliance with all
other applicable law
1. That it establishes and continues communication with local and
State authorities to stay informed of its community's mitigation
practices and to implement any such necessary additional practices;
2. That it develops and implement a plan relative to COVID-19
mitigation, including but not limited to policies restricting
participants, participant families, visitors, and program staff who
have any COVID-19 symptoms. This plan should include, at a minimum,
measures to prevent the spread of existing COVID-like illness and
COVID-19, proper screening of all staff and participants, and
identify clear steps to take regarding dining and cleaning.
3. That anyone entering the program facility, including all
participants, staff, and visitors, including participant families, be
screened at entry, using a screening tool such as that found at
health.ri.gov/forms/screening/COVID-19, which screening shall
include, at a minimum: questioning relative to COVID-19 symptoms and
contact in the last fourteen (14) days with other individuals who are
COVID-19 positive or who have COVID-19 symptoms.
4. That all returning and/or new participants and program staff,
prior to participating in the program, provide proof of having tested
negative for COVID-19 within seventy-two (72) hours of commencing
participation/employment.
5. That in the event a participant, visitor, or program staff is
identified as COVID-19 positive or having any COVID-19 symptoms or
having had contact in the last fourteen (14) days with an individual
who at the time or since has had COVID-19, such person shall be
required to leave the program facility. Such person shall be
isolated, and arrangements made for the person to leave the program
facility as soon as possible.
a. In the event that a participant, program staff, or visitor has
answered screening questions to indicate COVID-19 symptoms, such
person will not be allowed to enter the program facility.
Participants and/or staff who develop COVID-19 symptoms during the
day will be isolated and arrangements made for the person to leave
the program facility as soon as possible. Appropriate action will be
taken at this time, such as deep cleaning of all frequently touched
surfaces.
b. In the event that a participant or program staff are unable to
attend the program due to COVID-19 symptoms, the program must be
notified, and the program facility will take appropriate action, such
as a deep cleaning of all frequently touched surfaces and work in
collaboration with the Rhode Island Department of Health to conduct
contact tracing and follow up procedures.
6. That any participant, visitor, or program staff sent home may not
return until he or she provides competent evidence to the program
demonstrating that:
a. after being sent home he or she tested negative for COVID-19; or
b. after being sent home he or she tested positive for COVID-19 but
he or she has since been proven to be COVID-19 negative; or
c. he or she has been symptom free, without use of medication, for at
least seventy-two (72) hours and at least ten (10) days have passed
since his or her symptoms first appeared; or
d. he or she is not contagious (e.g., physician's note).
7. That participants maintain a distance of at least six (6) feet
from each other at all times, including during meal service. This
includes maintaining distance between participants within the same
stable group.
8. That program staff are properly educated and trained on the use of
surgical masks and that they be required to wear face coverings no
less protective than a surgical mask at all times unless one or more
of the exceptions set forth in § 50-15-7.3(D) of this Title
applies.
9. That participants are properly educated on the requirement and
proper use of cloth face coverings, or more protective face
coverings, in accordance with § 50-15-7.3(D) of this Title.
10. That stable groups of participants within the facility be limited
to no more than five (5).
11. That participants be placed in the same stable group each day,
limiting the number of participants with whom each participant will
be in contact to no more than four (4). Intergroup activities are
prohibited.
12. That, unless impracticable, program staff be assigned to the same
participant group each day
13. That the program has adequate supplies to support healthy hygiene
behaviors, which supplies include but are not limited to soap, hand
sanitizer with at least sixty (60) percent alcohol, tissues, and
lined wastebaskets to dispose of used tissues.
14. That hand sanitizer be made available to participants and program
staff at all times throughout the program facility.
15. That participants and program staff wash their hands with soap
and water or, in the event soap and water are not available, use hand
sanitizer prior to and after meal service.
16. That single use, disposable service utensils, plates, cups, and
silverware be used during meal service.
17. That program staff wear single-use gloves when providing direct
care to participants, the use of which gloves shall be limited to the
provision of care to a single participant, after which the gloves
shall be removed and discarded. In the event gloves are unavailable,
program staff shall wash their hands with soap and water or use hand
sanitizer prior to and after providing direct care to each
participant.
18. That visitors, including participant family members and
volunteers, are prohibited from entering the program facility except
in emergency situations.
19. That it sets and adheres to a program cleaning schedule and that
a log be kept documenting the date and time of cleanings and the
items and surfaces cleaned.
a. Clean and disinfect high touch surfaces regularly, at least once
every four (4) hours. Frequently touched surfaces and objects can
vary by location. Examples include doorknobs, light switches,
handrails, kitchen appliances, counters, drawer pulls, tables, sinks,
faucet and toilet handles, drinking fountains, elevator buttons, push
plates, phones, keys and remote controls.
b. Dining tables should be cleaned and disinfected after each group.
Meals should occur with the same groups to limit contact.
Participants should be six (6) feet apart when dining.
c. Cleaning and disinfecting products approved by the Environmental
Protection Agency (EPA) for COVID-19 should be used when feasible. A
list of EPA products can be found here:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
d. Objects used for games and activities should be cleaned and
disinfected between uses.
20. That disinfectant and cleaning supplies be used in the manner
intended and on the appropriate surfaces and are securely stored when
not in use.
21. That any ventilation systems are checked daily to ensure proper
operation and that measures are taken to allow for more fresh air to
enter program space, such as adjusting the ventilation system to
maximize intake of fresh air into the program space and frequent
opening of windows, weather permitting.
22. That, prior to reopening any program facility following prolonged
closure due to COVID-19, any program facility water systems and
features, including but not limited to drinking fountains and
decorative fountains, be checked to ensure that they are safe to use,
to minimize the risk of Legionnaires' Disease and other diseases
associated with water, consistent with CDC guidance available here:
https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html
23. That practices are implemented, such as staggered arrival and
drop-off times, marking of adequate spacing on floors throughout the
program facility, and encouraging family members to transport
participants to the program, to limit direct contact among
participants, participant families, and program staff as much as
possible.
a. If a participant requires assistance entering and exiting the
facility the transporting person shall be considered an essential
visitor, subject to the same screening and monitoring protocols, for
the purposes of assisting the participant access in and out of the
program facility.