[32 Pa.B. 4939]
[Continued from previous Web Page] § 2600.18. Applicable health and safety laws.
A personal care home shall comply with applicable Federal, State and local statutes, ordinances and regulations, especially those statutes or regulations pertaining to fire and panic, public health, civil rights and protective services.
§ 2600.19. Waivers.
(a) A licensed personal care home may submit a written request for a waiver of a specific requirement contained in this chapter. The waiver request shall be on a form prescribed by the Department. The Department may grant a waiver of a specific section of this chapter if the following conditions are met:
(1) There is no jeopardy to the residents of the home.
(2) There is an alternative for providing an equivalent level of health, safety and well-being protection of the residents of the home.
(3) Residents will benefit from the waiver of the requirement.
(b) The scope, definitions, applicability or residents' rights under this chapter may not be waived.
(c) Thirty days prior to the submission of the completed written waiver request to the Department, the personal care home shall provide a copy of the completed written waiver request to the residents of the home to allow the residents the opportunity to submit comments to the Department. The personal care home shall also provide the residents with the name, address and phone number of the personal care home field licensing field office to submit their comments. The home shall interview affected residents as appropriate.
(d) A personal care home seeking a waiver shall submit a written request for a waiver to the appropriate personal care home licensing field office. A waiver granted by the Department will be in writing, also be part of the home's permanent record and shall be maintained on file in the home's records.
(e) The personal care home shall notify the residents of the approval or denial of the waiver request. A copy of the waiver request shall be posted in a conspicuous public place within the home.
(f) Waivers are subject to a periodic review by the Department to determine whether acceptable conditions exist for renewal of the waiver. The Department reserves the right to revoke the waiver if the conditions required by the waiver are not met.
(g) A structural waiver will not be granted to a new facility, new construction or renovations begun after ______ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.) Upon request, the Department will review building plans to assure compliance with the this chapter.
§ 2600.20. Resident funds.
(a) If the personal care home assumes the responsibility of maintaining a resident's financial resources, the following records shall be maintained for each resident:
(1) A separate record of financial resources, including the dates, amounts of deposits, amounts of withdrawals and the current balance.
(2) Deposits and expenditures shall be documented with written receipts. Disbursement of funds to the resident shall be documented and the resident shall acknowledge the receipt of funds in writing. Accounts shall clearly reflect deposits, receipt of funds, disbursal of funds and the current balance.
(3) A record of gifts or other funds received by or deposited with the home on behalf of the resident.
(b) If the personal care home assumes the responsibility of maintaining a resident's financial resources, the following requirements shall be met:
(1) There shall be documentation of counseling sessions, concerning the use of funds and property, if requested by the resident.
(2) The home may not prohibit the resident's right to manage his own finances.
(3) Resident funds and property shall only be used for the resident's benefit.
(4) The resident shall be given funds requested within 24 hours if available, and immediately if the request is for $10 or less. This service shall be offered on a daily basis.
(5) The home shall obtain a written receipt from the resident for cash disbursements.
(6) There may be no commingling of the resident's personal needs allowance with the home's or staff person's funds or the home's operating accounts.
(7) If a home is holding funds in excess of $200 for more than 2-consecutive months, the administrator shall notify the resident and offer assistance in establishing an interest-bearing account in the resident's name at a local Federally-insured financial institution. This does not include security deposits.
(8) The owners of the home, its administrators and employees are prohibited from being assigned power of attorney or guardianship of a resident.
(9) The home shall give the resident an annual written account of financial transactions made on the resident's behalf. The home shall provide the resident the opportunity to review his own financial record upon request during normal working hours. A copy shall be placed in the resident's record.
(10) Upon the death of a resident, the administrator shall surrender to the resident's estate funds and valuables of that resident which were entrusted to the administrator or left in the home. In addition, an itemized written account of the resident's funds and valuables, which were entrusted to the administrator, shall be surrendered, and a signed receipt shall be obtained and retained by the administrator.
(11) Within 30 days of either the termination of service by the home or the resident's decision to leave the home, the resident shall receive an itemized written account of funds, including notification of funds still owed the home by the resident or a refund owed the resident by the home.
(12) Upon discharge or transfer of the resident, the administrator shall immediately return the resident's funds being managed or being stored by the home to the resident.
§ 2600.21. Offsite services.
If services or activities are provided by the home at a location other than the premises, the home shall ensure that the residents' support plans are followed and that the health and safety needs are met for all of the residents.
§ 2600.22. Legal entity.
The legal entity shall operate the home in accordance with this chapter.
§ 2600.23. Personnel management.
The personal care home shall:
(1) Establish a work schedule and maintain copies for a year or until all litigation or audits are resolved, whichever is later.
(2) Establish and maintain written job descriptions for all positions that include:
(i) Job title.
(ii) Tasks, responsibilities and essential functions of the job.
(iii) Qualifications.
(3) Provide each staff member with a copy of the job description at the time of hire and whenever the job description is changed. This shall be documented.
§ 2600.24. Tasks of daily living.
A home shall provide residents with assistance with tasks of daily living as indicated in their support plan and assessment, including one or more of the following:
(1) Securing transportation.
(2) Shopping.
(3) Making and keeping appointments.
(4) Care of personal possessions.
(5) Use of the telephone.
(6) Correspondence.
(7) Personal laundry.
(8) Social and leisure activities.
(9) Securing health care.
(10) Ambulation.
(11) Use of prosthetic devices.
(12) Eating.
§ 2600.25. Personal hygiene.
A personal care home shall provide residents with assistance with personal hygiene as indicated in the support plan and assessment, including one or more of the following:
(1) Bathing.
(2) Oral hygiene.
(3) Hair grooming and shampooing.
(4) Dressing and care of clothes.
(5) Shaving.
§ 2600.26. Resident-home contract: information on resident rights.
(a) Prior to, or within 24 hours after admission, a written admission contract between the resident and the personal care home shall be in place. The administrator or a designee is responsible for completing this contract and shall review and explain its contents to the resident and the resident's designee, if any, prior to signature.
(1) The contract shall be signed by the administrator or a designee, and the resident and the payer, if different from the resident, and cosigned by the resident's designee, if any, if the resident agrees. At a minimum, the contract shall specify the following:
(i) Each resident shall retain, at a minimum, the current personal needs allowance as the resident's own funds for personal expenditure. A contract to the contrary is not valid.
(ii) The actual amount of allowable resident charges for each service or item. The actual amount of the periodic--for example, monthly--charge for food, shelter, services and additional charges, and how, when and by whom payment is to be made.
(iii) An explanation of the annual screening, medical evaluation, and support plan requirements and procedures, which shall be followed if either the screening or the medical evaluation indicates the need of another and more appropriate level of care.
(iv) The party responsible for payment.
(v) The method for payment of charges for long distance telephone calls.
(vi) The conditions under which refunds will be made, including the refund of admission fees and refunds upon a resident's death.
(vii) The financial arrangements if assistance with financial management is to be provided.
(viii) The home's rules and requirements related to home services, including whether the home is designated as a smoking or nonsmoking home.
(ix) The conditions under which the agreement may be terminated including home closure as specified in § 2600.228 (relating to notification of termination).
(x) A statement that the resident is entitled to at least 30 days' advance notice, in writing, of the home's intent to change the contract.
(xi) A list of personal care services and their costs to be provided to the resident based on the outcome of the resident's support plan.
(xii) Additional services and their costs that shall be billed to the resident for the cost of services or items not included in the cost of care.
(xiii) Written information on the resident's rights and grievance procedures as specified in § 2600.41 (relating to notification of rights and complaint procedures).
(xiv) Charges to the resident for holding a bed during hospitalization or other extended absence from the home shall be specified.
(2) A personal care home may not seek or accept payments from a resident in excess of one-half of any funds received by the resident under the Senior Citizens Rebate and Assistance Act (72 P. S. §§ 4751-1--4751-12). If the personal care home will be assisting the resident to manage a portion of the rent rebate, the requirements of § 2600.20 (relating to resident funds) may apply. There may be no charge for filling out this paperwork.
(3) The resident, or a designee, has the right to rescind the contract for up to 72 hours after the initial dated signature of the contract. Rescission of the contract shall be in writing addressed to the home.
(b) The personal care home may not require or permit a resident to assign assets to the home in return for a life care contract/guarantee. Continuing care communities that have obtained a Certificate of Authority from the Insurance Department are required to provide a copy of the certificate to the Department and will then be exempt from this requirement.
(c) A copy of the signed admission contract shall be given to the resident and a copy shall be filed in the resident's record.
(d) The service needs addressed in the resident's support plan shall be available to the resident 365 days a year.
§ 2600.27. Quality management.
(a) The personal care home shall establish and implement quality assessment and management plans.
(b) At minimum, the following shall be addressed in the plan review:
(1) Incident reports.
(2) Complaint procedures.
(3) Staff training.
(4) Monitoring licensing data and plans of correction, if applicable.
(5) Resident or family councils, or both.
(c) If the personal care home fails to establish and implement quality assessment and management plans, the Department reserves the right to create the criteria that the home will utilize in establishing those plans.
§ 2600.28. Supplemental Security Income (SSI) recipients.
(a) For a resident eligible for SSI benefits, the personal care home charges for actual rent and other services may not exceed the SSI resident's actual current monthly income reduced by the current personal needs allowance.
(b) The administrator may not include funds received as lump sum awards, gifts or inheritances, gains from the sale of property, or retroactive government benefits when calculating payment of rent for an SSI recipient or for a resident eligible for SSI benefits.
(c) An administrator may seek and accept payments from funds received as retroactive awards of SSI benefits, but only to the extent that the retroactive awards cover periods of time during which the resident actually resided in the personal care home and for which full payment has not been received.
(d) An administrator shall provide each resident who is a recipient of SSI, at no charge beyond the amount determined in subsection (a), the following items or services as needed:
(1) Necessary personal hygiene items, such as a comb, toothbrush, toothpaste, soap and shampoo. Cosmetic items are not included.
(2) Laundry services, including personal laundry, but not including dry cleaning or other specialized services.
(3) Personal care services.
(e) Third-party payments made on behalf of an SSI recipient and paid directly to the home are permitted. These payments may not be used for food, clothing or shelter because to do so would reduce SSI payments. See 20 CFR 416.1100 and 416.1102 (relating to income and SSI eligibility; and what is income). These payments may be used to purchase items or services which are not food, clothing or shelter.
§ 2600.29. Refunds.
(a) If, after the personal care home gives notice of discharge or transfer in accordance with § 2600.26 (relating to requirements for resident/home contract; information on resident rights), and the resident moves out of the home before the 30 days are over, the home shall give the resident a refund equal to the previously paid charges for rent and personal care services for the remainder of the 30-day time period. The refund shall be issued within 30 days of discharge. The resident's personal needs allowance shall be refunded within 1 week of discharge or transfer.
(b) After a resident gives notice of the intent to leave in accordance with § 2600.26, and if the resident moves out of the home before expiration of the required 30 days, the resident owes the home the charges for rent and personal care services for the entire length of the 30-day time period for which payment has not been made.
(c) If no notice is required, as set forth in subsection (d), the resident is required to pay only for the nights spent in the home.
(d) If the personal care home does not require a written notice prior to a resident's departure, the administrator shall refund the remainder of previously paid charges to the resident within 7 days of the date the resident moved from the home. In the event of a death of a resident, the administrator shall refund the remainder of previously paid charges to the estate of the resident when the room is vacated and within 30 days of death. The home shall keep documentation of the refund in the resident's file.
(e) If a resident is identified as needing a higher level of care and is discharged to another facility, the personal care home shall provide a refund within 7 days from the date of discharge when the room is vacated or within 7 days from notification by the facility.
§ 2600.30. Fees.
After the Department determines that a personal care home meets the requirements for a license, the Department's issuance or renewal of a license to a home is contingent upon receipt by the Department of an application fee based on the number of beds in the home, as follows:
(1) 0-20 beds--$15.
(2) 21-50 beds--$20.
(3) 51-100 beds--$30.
(4) 101 beds and over--$50.
RESIDENT RIGHTS § 2600.41. Notification of rights and complaint procedures.
(a) Upon admission each resident and, if applicable, the resident's family and advocate, if any, shall be informed of the resident rights and the right to lodge complaints without retaliation, or the fear or threats of retaliation of the home or its staff against the reporter. Retaliation includes discharge or transfer from the home.
(b) The information in subsection (a) shall be communicated in an easily understood manner, and in a language understood by or mode of communication of the resident and, if applicable, the resident's family and advocate, if any.
(c) A copy of the resident's rights and the complaint procedures, shall be posted in a conspicuous place in the home and given to the resident and, if applicable, the resident's family and advocate, if any, upon admission.
(d) A statement signed by the resident and, if applicable, the resident's family and advocate, if any, acknowledging receipt of a copy of the information specified in subsection (a), or documentation of efforts made to obtain signature, shall be kept in the resident's record.
(e) A resident and, if applicable, the resident's family and advocate, if any, have the right to lodge a complaint with the home for an alleged violation of specific or civil rights without retaliation, or the fear or threats of retaliation.
(f) The personal care home shall ensure investigation and resolution of complaints regarding an alleged violation of a resident's rights. The procedures shall include the timeframes, steps, and the person or persons responsible for determining the outcome of the complaint and appeal procedures.
(g) The personal care home shall render a decision within 14-calendar days upon receipt of the complaint and inform the resident and, if applicable, the resident's family and advocate, if any, of the outcome in writing.
(h) The personal care home shall inform the resident and, if applicable, the resident's family and advocate, if any, about the right to file complaints and appeals beyond the home's internal system. A resident and, if applicable, the resident's family and advocate, if any, may file a complaint with the local ombudsman in the area agency on aging, or in the case of abuse incidents with the local protective services unit of the area agency on aging, law enforcement or the appropriate Departmental licensing office. These phone numbers shall be posted in large print in a conspicuous place in the home.
(i) In addition, the resident and, if applicable, the resident's family and advocate, if any, shall be made aware of the telephone number of the Governor's Action Center Toll Free Line, (800) 932-0784, the personal care home complaint hotline, (800) 254-5164, the local long-term care ombudsman, and other advocacy agencies to which the resident and, if applicable, the resident's family or advocate, if any, may address complaints when the resident and, if applicable, the resident's family or advocate, if any, feels that complaints have not been properly resolved through the home's complaint procedure. The telephone numbers for the Governor's Action Center Toll Free Line, the personal care home complaint hotline and the local long-term care ombudsman shall be posted in large print in a conspicuous place in the home.
(j) The resident has the right to access the public inspection records of the home.
§ 2600.42. Specific rights.
(a) A resident may not be discriminated against because of race, color, religious creed, disability, handicap, ancestry, sexual orientation, national origin, age or sex.
(b) A resident may not be neglected, abused, mistreated or subjected to corporal punishment.
(c) A resident shall be treated with dignity and respect.
(d) A resident shall be informed of the rules of the personal care home and given 30 days' written notice prior to the effective date of a new rule of the home.
(e) A resident shall have private access to a telephone in the personal care home. Local calls shall be without charge.
(f) A resident shall have the right to receive and send mail.
(1) Outgoing mail may not be opened or read by staff persons.
(2) Incoming mail may not be opened or read by staff persons unless upon resident request.
(g) A resident shall have the assurance that personal care homes shall be open 365 days and provide the service needs identified in the resident's support plan.
(h) A resident shall have the right to practice the religion or faith of the resident's choice, or not to practice any religion or faith.
(i) A resident shall receive assistance in accessing medical, behavioral health, rehabilitation services and dental treatment.
(j) A resident shall receive assistance in attaining clean, seasonal clothing that is age and gender appropriate.
(k) A resident and, upon their request, the resident's family and advocate, if any, shall have the right to access, review and request modifications to the resident's record.
(l) A resident shall have the right to purchase, receive and use personal property.
(m) A resident shall have the right to leave and return to the home at reasonable times consistent with the personal care home's rules.
(n) A resident shall have the right to request and receive assistance, from the personal care home, in relocating to another facility.
(o) A resident shall be free to associate and communicate with others privately.
(p) A resident shall be free from restraints.
(q) A resident shall be compensated in accordance with State and Federal labor statutes for labor performed on behalf of the personal care home. Residents shall perform personal housekeeping tasks related directly to the resident's personal space but may not perform tasks in lieu of a staff person who is otherwise required to perform these tasks.
(r) A resident, the resident's family, advocates, if any, community service organizations and legal representatives shall have access to the personal care home during visitation hours or by appointment. A resident shall have the right to receive visitors for a minimum of 8 hours daily, 7 days per week.
(s) A resident shall have the right to privacy of self and possessions.
(t) A resident shall have the right to voice complaints and recommend changes in policies and services of the personal care home without fear of reprisal, intimidation or retaliation.
(u) A resident shall have the right to remain in the personal care home, as long as it is operating with a license, except in the circumstances of:
(1) Nonpayment following a documented effort to obtain payment.
(2) Higher level of care needs.
(3) The resident is a danger to himself or others.
(v) A resident shall have the right to receive services contracted for in the resident's agreement.
(w) A resident shall have the right to appeal discharge, reductions, changes or denials of services originally contracted. The personal care home shall have written resident appeal policies and procedures. The resident shall receive an answer to the appeal within 14-calendar days after submission.
(x) A resident shall have the right to immediate payment by the personal care home to resident's money stolen or mismanaged by the home's staff.
(y) A resident shall have the right to manage personal financial affairs.
(z) A resident shall have the right to be free from excessive medication.
§ 2600.43. Prohibition against deprivation of rights.
(a) A resident may not be deprived of his civil rights.
(b) A resident's rights may not be used as a reward or sanction.
Subchapter B. HEALTH AND SAFETY REQUIREMENTS STAFFING
Sec.
2600.51. Resident abuse and criminal history checks. 2600.52. Staff hiring, retention and utilization. 2600.53. Staff titles and qualifications for administrators. 2600.54. Staff titles and qualifications for direct care staff. 2600.55. Exceptions for staff qualifications. 2600.56. Staffing. 2600.57. Administrator training and orientation. 2600.58. Staff training and orientation. 2600.59. Staff training plan. 2600.60. Individual staff training plan. PHYSICAL SITE
2600.81. Physical accommodations and equipment. 2600.82. Poisons. 2600.83. Temperature. 2600.84. Heat sources. 2600.85. Sanitation. 2600.86. Ventilation. 2600.87. Lighting. 2600.88. Surfaces. 2600.89. Water. 2600.90. Communication system. 2600.91. Emergency telephone numbers. 2600.92. Screens. 2600.93. Handrails and railings. 2600.94. Landings and stairs. 2600.95. Furniture and equipment. 2600.96. First aid supplies. 2600.97. Elevators and stair glides. 2600.98. Indoor activity space. 2600.99. Recreation space. 2600.100. Exterior conditions. 2600.101. Resident bedrooms. 2600.102. Bathrooms. 2600.103. Kitchen areas. 2600.104. Dining room. 2600.105. Laundry. 2600.106. Swimming areas. 2600.107. Internal and external disasters. 2600.108. General health and safety. 2600.109. Firearms and weapons. FIRE SAFETY
2600.121. Unobstructed egress. 2600.122. Exits. 2600.123. Emergency evacuation. 2600.124. Notification of local fire officials. 2600.125. Flammable and combustible materials. 2600.126. Furnaces. 2600.127. Space heaters. 2600.128. Supplemental heating sources. 2600.129. Fireplaces. 2600.130. Smoke detectors and fire alarms. 2600.131. Fire extinguishers. 2600.132. Fire drills. 2600.133. Exit signs. RESIDENT HEALTH
2600.141. Resident health exam and medical care. 2600.142. Physical and behavioral health. 2600.143. Emergency medical plan. 2600.144. Use of tobacco and tobacco-related products. 2600.145. Supervised care. NUTRITION
2600.161. Nutritional adequacy. 2600.162. Meal preparation. 2600.163. Personal hygiene for food service workers. 2600.164. Withholding or forcing of food prohibited. TRANSPORTATION
2600.171. Transportation. MEDICATIONS
2600.181. Self-administration. 2600.182. Storage and disposal of medications and medical supplies. 2600.183. Labeling of medications. 2600.184. Accountability of medication and controlled substances. 2600.185. Use of medications. 2600.186. Medication records. 2600.187. Medication errors. 2600.188. Adverse reaction. SAFE MANAGEMENT TECHNIQUES
2600.201. Safe management techniques. 2600.202. Prohibition on the use of seclusion and restraints. SERVICES
2600.221. Activities program. 2600.222. Community social services. 2600.223. Description of services. 2600.224. Preadmission screening tool. 2600.225. Initial assessment and the annual assessment. 2600.226. Development of the support plan. 2600.227. Copies of the support plan. 2600.228. Notification of termination. SECURED UNIT REQUIREMENTS
2600.231. Doors, locks and alarms. 2600.232. Environmental standards. 2600.233. Admission standards. 2600.234. Care standards. 2600.235. Discharge standards. 2600.236. Administrator training. 2600.237. Staff training on dementia. 2600.238. Additional staffing. 2600.239. Programming standards. 2600.240. Notification to Department. 2600.241. Mobility standards. RESIDENT RECORDS
2600.251. Resident records. 2600.252. Content of records. 2600.253. Record retention and disposal. 2600.254. Record access and security. ENFORCEMENT
2600.261. Classification of violations. 2600.262. Penalties. 2600.263. Revocation or nonrenewal of licenses. 2600.264. Policies, plans, and procedures of the personal care home.
STAFFING § 2600.51. Resident abuse and criminal history checks.
Criminal history checks and hiring policies shall be in accordance with the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102) and 6 Pa. Code Chapter 15 (relating to protective services for older adults).
§ 2600.52. Staff hiring, retention and utilization.
Staff hiring retention and utilization shall be in accordance with the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102) and 6 Pa. Code Chapter 15 (relating to protective services for older adults) and other applicable regulations.
§ 2600.53. Staff titles and qualifications for administrators.
(a) The administrator shall have one of the following qualifications:
(1) A valid license as a registered nurse from the Commonwealth.
(2) An associate's degree or 60 credit hours from an accredited college or university.
(3) A valid license as a licensed practical nurse from the Commonwealth and 1 year of work experience in a related field.
(4) A valid license as a nursing home administrator, from the Commonwealth.
(b) The administrator shall be 21 years of age or older.
(c) The administrator shall complete at least the minimum training required by the Department.
(d) The administrator shall be responsible for the administration and management of the personal care home, including the safety and protection of the residents, implementation of policies and procedures and compliance with this chapter.
(e) The administrator shall have the ability to provide personal care services, or to supervise or direct the work of others to provide personal care services.
(f) The administrator shall have knowledge of this chapter.
(g) The administrator shall have the ability to conform to applicable statutes, rules and regulations, including this chapter.
(h) The administrator shall have the ability to maintain or supervise the maintenance of financial and other records.
(i) The administrator shall be of good moral character.
(j) The administrator shall be free from a medical condition, including drug or alcohol addiction that would limit the administrator from performing duties with reasonable skill and safety.
§ 2600.54. Staff titles and qualifications for direct care staff.
Direct care staff shall have the following qualifications:
(1) Be 18 years of age or older.
(2) Have a high school diploma or GED.
(3) Be of good moral character.
(4) Be free from a medical condition, including drug or alcohol addiction that would limit the direct care staff from providing necessary personal care services with reasonable skill and safety.
§ 2600.55. Exceptions for staff qualifications.
(a) The staff qualification requirements for administrator and direct care staff do not apply to persons hired or promoted to the specified positions prior to ______ (Editor's Note: The blank refers to the effective date of adoption of this proposal.) as long as the home maintains a current license.
(b) A staff person who transfers to another licensed home, with no more than a 1-year break in service, may work in the same capacity as long as the staff person meets the qualifications outlined in subsection (a).
(c) Notwithstanding § 2600.54 (relating to staff titles and qualifications for direct care staff), a 16 or 17 year old may be employed as a staff person at a personal care home, but may not perform tasks related to medication administration, and the incontinence care or bathing of persons of the opposite sex.
§ 2600.56. Staffing.
(a) A personal care home shall employ a sufficient number of trained staff to ensure the daily provision of the aggregate total of personal care service hours required by the support plans for all residents in the facility. At minimum, each mobile resident shall receive an average of 1 hour of personal care services per day, and each immobile resident or resident with special needs shall receive an average of 2 hours of personal care services per day.
(b) If a resident's support plan indicates that the resident's personal care service needs exceed the minimum staffing levels in subsection (a), the personal care home shall provide a sufficient number of trained direct care staff to provide the necessary level of care required by the resident's support plan. If a home cannot meet a resident's needs, the resident shall be referred to a local assessment agency or agent under § 2600.225(e) (relating to initial assessment and the annual assessment).
(c) An administrator, or a designee who is 21 years of age or older and meets the qualifications outlined in § 2600.54 (relating to staff titles and qualifications for direct care staff), shall be on the premises on a 24-hour basis. The administrator shall be present in the personal care home an average of at least 20 hours per week, or in the alternative, a designee shall meet all of the qualifications and training for an administrator under § 2600.53 (relating to staff titles and qualifications for administrators).
(d) When one or more residents requiring personal care services is physically present, the personal care home shall maintain a sufficient number of trained direct care staff to provide the necessary level of care required by the residents, and to be physically present to accommodate each resident's needs, as identified in each resident's support plan, and to ensure a safe and efficient evacuation of the home in case of an emergency. At least 75% of the personal care service hours shall be available during waking hours.
(e) A personal care home with multiple buildings that are within 300 feet of one another and have three or fewer residents present per building shall have one direct care staff person who circulates between the buildings every hour, conducting inspections of the building and checking in on the residents. Each building shall maintain an operable two-way communication system to serve residents in buildings where a direct care staff person is not present. Multiple buildings, regardless of footage from other buildings, with four or more residents present, shall provide at least one direct care staff person per building who is on the premises and awake.
(f) A personal care home with 4--15 mobile residents, all of whom are mobile, shall maintain coverage by the administrator, or a designee, or a direct care staff person who is physically present and available on the premises at all times when one or more residents requiring personal care services is physically present.
(g) In a personal care home with 16 or more mobile residents, the administrator, or a designee, shall maintain coverage by direct care staff persons who are awake, physically present and available on the premises during 24 hours of the day.
(h) During sleeping hours, there shall be at least one direct care staff person, who remains awake, available and in each building housing one or more immobile residents.
(i) Additional staffing may be required by the Department, and will be based on safety, the Department's assessment of the amount of care needed by the residents as reflected in their support plans, and the design, construction, staffing or operation of the home.
(j) Additional staff hours, or contractual services, shall be provided as necessary to meet the laundry, food service, housekeeping and maintenance needs of the personal care home.
(k) When regularly scheduled direct care staff persons are absent, the administrator shall arrange for coverage by substitute personnel who meet the direct care staff qualifications and training requirements.
(l) The administrator shall maintain a current list of the names, addresses and telephone numbers of all employees, including substitute personnel.
(m) An administrator may be counted in the staffing ratios if the administrator is scheduled to provide direct care services.
§ 2600.57. Administrator training and orientation.
(a) Prior to initial employment at a personal care home, an administrator shall successfully complete an orientation program approved by the Department and administered by the Department or its approved designee.
(b) Prior to licensure of a personal care home, the legal entity shall appoint an administrator who has successfully completed and passed a Department-approved competency-based training that includes 60 hours of Department-approved competency-based training, and has successfully completed and passed 80 hours of competency-based internship in a licensed home under the supervision of a Department-trained administrator.
(c) The 60 hours of Department-approved competency-based training shall include the following:
(1) Fire prevention and emergency planning.
(2) First aid training, medications, medical terminology and personal hygiene, which shall include:
(i) Medication procedures.
(ii) Cardio-pulmonary resuscitation (CPR) certification.
(iii) Obstructed airway techniques certification.
(3) Local, State and Federal laws and regulations pertaining to the operation of a home.
(4) Nutrition, food handling and sanitation.
(5) Recreation.
(6) Mental illness and gerontology, which shall include:
(i) Resident rights.
(ii) Care for persons with dementia and cognitive impairments.
(iii) Care for persons with mental retardation.
(7) Community resources and social services.
(8) Staff supervision, budgeting, financial recordkeeping and training, which includes the following:
(i) Writing, completing and implementing pre-admission screening tools, initial assessments, annual assessments and support plans.
(ii) Resident-home contracts.
(iii) Development of orientation and training guidelines for staff.
(d) The 80 hours of competency-based internship in a licensed personal care home under the supervision of a Department-trained administrator shall include the following:
(1) Staff supervision, budgeting, financial record keeping and training, which shall includes the following:
(i) Writing, completing and implementing preadmission screening tools, initial assessments, annual assessments and support plans.
(ii) Resident-home contracts.
(iii) Staff management.
(iv) Marketing.
(2) Community resources and social services.
(3) Nutrition, food handling and sanitation, which includes the following:
(i) Housekeeping.
(ii) Dietary needs.
(iii) Laundry.
(iv) Maintenance.
(v) Safety.
(4) Medications, medical terminology and personal hygiene.
(5) Mental illness and gerontology, which includes the following:
(i) Resident rights.
(ii) Care for persons with dementia and cognitive impairments.
(iii) Care for persons with mental retardation.
(6) Local, State and Federal laws and regulations pertaining to the operation of a home.
(e) An administrator shall have at least 24 hours of annual training relating to the job duties, which includes the following:
(1) Current training in first aid, certification in obstructed airway techniques and certification in cardio-pulmonary resuscitation that is appropriate for the population served. Training in first aid, obstructed airway techniques and cardiopulmonary resuscitation shall be provided by an individual certified as a trainer by a hospital or other recognized health care organization. Registered nurses, licensed practical nurses, certified registered nurse practitioners, emergency medical technicians, paramedics, physician's assistants or licensed physicians are exempt from the requirement for annual first aid training.
(2) Personal care service needs of the resident.
(3) Fire prevention and emergency planning.
(4) Medications, medical terminology and personal hygiene, which includes the following:
(i) Medication procedures.
(ii) Medication self-administration.
(iii) Infection control and general principles of cleanliness and hygiene, and areas associated with immobility such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.
(5) Staff supervision, budgeting, financial recordkeeping and training, which includes the following:
(i) Writing, completing and implementing preadmission screening tools, initial assessments, annual assessments and support plans.
(ii) Resident-home contracts.
(iii) Development of orientation and training guidelines for staff.
(6) Local, State and Federal laws and regulations pertaining to the operation of a home.
(7) Nutrition, food handling and sanitation.
(8) Recreation.
(9) Mental illness and gerontology, which includes the following:
(i) Resident rights.
(ii) Care for persons with dementia and cognitive impairments.
(iii) Care for persons with mental retardation.
(iv) Safe management technique training, which includes positive interventions such as:
(A) Improving communications.
(B) Reinforcing appropriate behaviors.
(C) Redirection.
(D) Conflict resolution.
(E) Violence prevention.
(F) Verbal praise.
(G) Deescalation techniques.
(H) Alternatives and techniques to identify depression.
(I) Methods to identify and diffuse potential emergency safety situations.
(J) Managing medical emergencies.
(10) Community resources and social services.
(11) Staff supervision, budgeting, financial recordkeeping and training, which includes the following:
(i) Writing and completing preadmission screening tools, initial intake assessments, annual assessments and support plans.
(ii) Resident-home contracts.
(iii) Development of orientation and training guidelines for staff.
(f) An administrator who has successfully completed the training in subsections (a)--(e) shall provide written verification of successful completion to the appropriate personal care home regional field licensing office designated by the Department.
(g) A licensed nursing home administrator who is employed as a personal care home administrator prior to ______ (Editor's Note: The blank refers to the effective date of adoption of this proposal.) is exempt from the training and educational requirements of this chapter if the administrator continues to meet the requirements of the State Board of Nursing Home Administrators. A licensed nursing home administrator hired as a personal care home administrator after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposal.) shall pass the 40-hour personal care home administrators competency-based training test. A licensed nursing home administrator who fails to pass the test shall attend the required 40-hour personal care home administrators training, and retake the competency test, until a passing grade is achieved.
(h) A record of training including the person trained, date, source, content, length of each course and copies of any certificates received, shall be kept by the personal care home.
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