[32 Pa.B. 4939]
[Continued from previous Web Page]
TRANSPORTATION § 2600.171. Transportation.
(a) The following requirements apply whenever staff persons or volunteers of the home provide transportation for the resident. These requirements do not apply if transportation is provided by a source other than the home.
(1) Staff to resident ratios specified in § 2600.56 (relating to staffing) apply.
(2) All vehicle occupants shall be in appropriate a safety restraint at all times the vehicle is in motion.
(3) The driver of a vehicle shall be 18 years of age or older and possess a valid driver's license.
(4) The driver of the vehicle cannot be a resident receiving services in the home.
(5) At least one staff member transporting residents has completed the initial new hire direct care staff training.
(6) The vehicle shall have nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, tape, scissors, and syrup of ipecac that are stored together.
(7) During vehicle operation the driver may only use a hands-free cellular telephone.
(b) The home shall maintain current copies of documentation for the following:
(1) Vehicle registration.
(2) Valid driver's license.
(3) Vehicle insurance.
(4) Current inspection.
(5) Commercial Driver's License where applicable.
(c) The home shall assist a resident with the coordination of transportation to and from medical appointments, if requested by resident, or if indicated in the resident's support plan.
MEDICATIONS § 2600.181. Self-administration.
(a) A home shall provide residents with assistance, as needed, with medication prescribed for the resident's self-administration. This assistance includes helping the resident to remember the schedule for taking the medication, storing the medication in a secure place and offering the resident the medication at the prescribed times.
(b) Medication not prescribed for the resident's self-administration shall be administered by a licensed physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic, as appropriate.
(c) The resident's support plan shall identify if the resident is able to self-administer medications.
(d) If the resident does not need assistance with medication, medication may be stored in a resident's room for self-administration. The administrator shall take precautions to assure that medications, which are stored in the resident's room, are maintained in a safe and secure manner to protect against contamination, spillage and pilferage.
(e) A resident is capable of self-administering medications if the resident can use the medication as prescribed in the manner prescribed. The resident shall be able to recognize and distinguish the medication and know the condition or illness for which the medication is prescribed, the correct dosage and when the medication is to be taken. Examples include being capable of placing medication in the resident's own mouth and swallowing completely, applying topical medications and not disturbing the application site, properly placing drops in eyes, correctly inhaling inhalants and properly snorting nasal therapies.
§ 2600.182. Storage and disposal of medications and medical supplies.
(a) Prescription, OTC and CAMs shall be kept in their original labeled containers and may not be removed more than 2 hours in advance of the scheduled administration. Assistance with injections and sterile liquids shall be provided immediately upon removal of the medication from its container.
(b) Prescription, OTC, CAM and syringes shall be kept in an area or container that is locked.
(c) Prescription, OTC and CAM stored in a refrigerator shall be kept in a separate locked container.
(d) Prescription, OTC and CAM shall be stored separately.
(e) Prescription, OTC and CAM shall be stored under proper conditions of sanitation, temperature, moisture and light comply with the manufacturer's instructions.
(f) Prescription, OTC and CAM, discontinued and expired medications, and prescription medications for residents who are no longer served at home shall be destroyed of in a safe manner according to the Department of Environmental Protection and all Federal and State regulations. When a resident permanently leaves the home, the resident's medications shall be given to the resident, the designated person, if any, or the person or entity taking responsibility for the new placement on the day of departure from the home.
(g) Antiseptics and medicines for external use shall be stored separately from oral and injectable medicines.
(h) Prescription, OTC, CAM and syringes shall be stored in accordance with Federal and State regulations.
§ 2600.183. Labeling of medications.
(a) The original container for prescription medications shall be labeled with a pharmacy label.
(b) OTC, CAM and sample medications shall be labeled with the original label.
(c) If the OTC and CAM belong to the resident, they shall be identified with the resident's name.
(d) Sample medications shall be identified to the particular resident's use and accompanied by a physician's order.
§ 2600.184. Accountability of medication and controlled substances.
(a) The home shall develop and implement policy and procedures addressing the methods to ensure the safekeeping of medications.
(b) At a minimum, the policy and procedures shall have:
(1) Documentation of the receipt and administration of controlled substances and prescription medications.
(2) A process that will be followed to investigate and account for missing medications and medications omissions.
(3) Limited access to medication storage areas.
§ 2600.185. Use of medications.
(a) Prescription, OTC, CAM and sample medications shall be clearly marked for whom the medication was prescribed or approved.
(b) If the home helps with self-administration, then the only prescription, OTC and CAM medications that are allowed to be given are those prescribed, approved or ordered by a licensed physician, certified registered nurse practitioner, licensed dentist or physician's assistant within its scope of practice.
(c) Verbal changes in medication may only be made by the prescriber and shall be documented in writing in the resident's record and the medication record as soon as the home is notified of the change.
§ 2600.186. Medication records.
(a) If a resident stores medication for self-administration in the resident's room, a current list of prescribed medications taken by a resident as reported to the home shall be maintained in that resident's record.
(b) If the home helps the resident with self-administration, a medication record shall be kept to include the following for each resident's prescription, OTC and CAM:
(1) The prescribed dosage.
(2) Possible side effects.
(3) Contraindicated medications.
(4) Specific administration instructions.
(5) The name of the prescribing physician.
(6) Drug allergies.
(7) Dosage, date, time and the name of the person who helped with the self-administration of the medication.
(c) The information in subsection (b)(7) shall be recorded at the same time each dosage of medication is self-administered.
(d) If a resident refuses to take a medication, the refusal shall be documented in the resident's record and reported to the physician by the end of the shift. Subsequent refusals to take a prescribed medication shall be reported as required by the physician.
§ 2600.187. Medication errors.
(a) Documentation of medication errors shall be kept in the medication record. Medication errors include the failure to self-administer medication, self-administering the incorrect medication, self-administering the correct medication in an incorrect dosage, failure to document the self-administration of the medication, self-administering the correct medication at the incorrect time or medication taken by the wrong resident. A medication error shall be reported to the physician immediately.
(b) The home shall evaluate medication errors to include the following:
(1) There shall be a system in place to identify and document medication errors and the home's pattern of error.
(2) There shall be documentation of the follow-up action that was taken to prevent future medication errors.
§ 2600.188. Adverse reaction.
If a resident has a suspected adverse reaction to a medication, the home shall immediately consult a physician. The resident's family shall be notified, if applicable. The home shall document adverse reactions, the physician's response and any action taken in the resident's record.
SAFE MANAGEMENT TECHNIQUES § 2600.201. Safe management techniques.
(a) The home shall use positive interventions to modify or eliminate a behavior that endangers residents, staff or others. Positive interventions include improving communications, reinforcing appropriate behavior, redirection, conflict resolution, violence prevention, verbal praise, deescalation techniques and alternatives, techniques or methods to identify and defuse potential emergency situations.
(b) A home shall incorporate a quality improvement program designed to continuously review, assess, and analyze the home's ongoing steps to positively intervene when a resident demonstrates a behavior that endangers residents, staff or others.
§ 2600.202. Prohibition on the use of seclusion and restraints.
(a) The following procedures are prohibited in the homes:
(1) Seclusion, defined as involuntary confinement of a resident in a room from which the resident is physically prevented from leaving.
(2) The use of aversive conditioning, defined as the application of startling, painful or noxious stimuli.
(3) Pressure point techniques, defined as the application of pain for the purpose of achieving compliance.
(4) A chemical restraint, defined as use of any medication or biological for the purpose of immobilizing the resident, inducing a state of sleep or unconsciousness, or reducing the ability to move freely.
(i) When a physician orders a drug that is part of the resident's ongoing support plan, and has documented as such for treating the symptoms of mental, emotional, or behavioral condition, the drug is not considered as a chemical restraint.
(ii) A drug ordered by a licensed physician or dentist as part of ongoing medical treatment, or as pretreatment prior to a medical or dental examination or treatment, is not a chemical restraint.
(5) A mechanical restraint, defined as a device that restricts the movement or function of a resident or portion of a resident's body.
(i) Examples of mechanical restraints include handcuffs, anklets, wristlets, camisoles, helmet with fasteners, muffs and mitts with fasteners, poseys, waist straps, head straps, papoose boards, restraining sheets and similar devices.
(ii) A mechanical restraint does not include assistive devices, such as orthopedically prescribed appliances, surgical dressings and bandages, protective helmets, supportive body bands, and supports utilized for the achievement of functional body position or proper balance that have been prescribed by a medical professional.
(6) A manual restraint, as defined in § 2600.4 (relating to definitions).
SERVICES § 2600.221. Activities program.
The administrator shall develop a program of activities designed to promote each resident's active involvement with other residents, the resident's family and the community. The program shall provide social, physical, intellectual and recreational activities in a planned, coordinated and structured manner. A current weekly activity calendar shall be posted in a conspicuous place in the home.
§ 2600.222. Community social services.
The administrator shall encourage and assist residents to use social services in the community which may benefit the resident, including a county mental health and mental retardation program, a drug and alcohol program, a senior citizens center, an area agency on aging or a home health care agency.
§ 2600.223. Description of services.
(a) The home shall have a written description of services and activities that the home provides to include the following:
(1) The scope and general description of the services provided by the home.
(2) The criteria for admission and discharge.
(3) Specific services provided by the home.
(b) The home shall develop written procedures for the delivery and management of services from admission to discharge.
§ 2600.224. Preadmission screening tool.
(a) A determination shall be made, prior to admission, and documented on the standardized preadmission screening tool in conjunction with the resident-home contract that the needs of the resident can be met by the services provided by the home.
(b) An applicant whose personal care service needs cannot be met by the home shall be referred to a local appropriate assessment agency or agent.
§ 2600.225. Initial assessment and the annual assessment.
(a) A resident shall have a written initial assessment that is documented on standardized forms provided by the Commonwealth, within 72 hours of admission or within 72 hours prior to admission. The personal care home administrator or a designee, or a human service agency may complete the initial assessment.
(b) The resident's initial assessment and annual assessment shall include the following areas:
(1) Background information.
(2) Medical assessment.
(3) Social assessment.
(4) Mobility assessment.
(5) ADL assessment.
(6) IADL assessment.
(7) Medication assessment.
(8) Psychological assessment.
(c) A home may use its own assessment forms, if its forms include the same information in subsection (b).
(d) In addition to the initial assessment at admission, the resident shall have additional assessments as follows:
(1) Annually within 30 days before or 30 days after the resident's anniversary date of admission.
(2) If the condition of the resident materially changes prior to the annual assessment, the review shall be completed and updated on the current version.
(3) At the request of the State agency upon cause to believe that an update is required.
(4) At the time of a hospital discharge.
(e) A resident who is referred by a State mental hospital, a State mental retardation center, a county mental health and mental retardation program, a drug and alcohol program or an area agency on aging may not be admitted to a home without first obtaining a written assessment of the resident's needs from the referral agent. The assessment shall include an identification of the personal care services required by the resident and shall be used to complete the preadmission screening tool and if admitted the initial intake assessment.
(f) If the resident's physician or local assessment agency determines that the resident requires a higher level of care, a plan for placement shall be made as soon as possible by the administrator in conjunction with the resident or designated person, or both.
(g) If a resident is determined to be immobile as part of the initial intake or annual assessment, specific requirements relating to the care, health and safety of an immobile resident shall be met immediately. The resident shall be continually assessed for mobility as part of the resident's support plan.
§ 2600.226. Development of the support plan.
(a) A support plan shall be developed and implemented for each resident within 15-calendar days of admission to the home. This plan shall also be revised within 30 days upon completion of the annual assessment or upon changes in the level of functioning of the resident as indicated on the assessment. It shall address all of the needs of the resident's current assessment including the resident's personal care needs.
(b) The resident or the resident's family or advocate, or both, shall be informed of the right to have the following people assist in the development of the resident's support plan:
(1) Case manager from the social service agency when the resident has a case manager.
(2) Other social service entities.
(3) The home staff.
(4) Family or advocates.
(5) Doctors.
(6) Other interested persons designated by the resident.
(c) Documentation of reasonable efforts made to involve the resident's family, with the consent of the resident, shall be kept. If the resident's family declines, this fact shall be documented in the record.
(d) Persons who participated in the development of the support plan shall sign and date the support plan.
(e) If a resident or family member chooses not to sign the support plan, proper documentation of the effort to obtain their signature must be shown.
§ 2600.227. Copies of the support plan.
The home shall make a copy of the support plan available to the resident.
§ 2600.228. Notification of termination.
(a) A resident shall have the right to request and receive assistance in relocating from the home to a facility that meets the needs of the resident.
(b) If the home initiates a discharge or transfer of a resident, or if the legal entity chooses to close the home, the home shall provide a 30-day advance written notice to the resident, the resident's legal representative, and the referral agent citing the reasons for the discharge or transfer. This shall be stipulated in the resident-home contract signed prior to admission to the home. A 30-day advance written notice may not be given if a delay in discharge or transfer would jeopardize the health or safety of the resident or others in the home, as certified by a physician. This shall occur when the resident needs psychiatric or long-term care or is abused in the home, or the Department initiates a closure of the home.
(c) A home shall give the Department written notice of its intent to close the home, not later than 60 days prior to the anticipated date of closing.
(d) A home may not require a resident to leave the home prior to 30 days following the resident's receipt of a written notice from the home regarding the intended closure of the home, except when the Department determines that removal of the resident at an earlier time is necessary for the protection of the health and safety of the resident.
(e) The date and reason for the discharge or transfer, and the destination of the resident, if known, shall be recorded in the resident record.
(f) If the legal entity chooses to voluntarily close the home, the Department working in conjunction with appropriate local authorities, shall offer relocation assistance to the residents. Each resident shall participate in planning the transfer, except in the case of an emergency and shall have the right to choose among the available alternatives after an opportunity to visit the alternative homes except in the case of an emergency. These procedures shall apply even if the resident is placed in a temporary living situation.
(g) Within 30 days of the home's closure, the legal entity shall return the license to the personal care home regional field licensing office.
(h) The only grounds for discharge or transfer of a resident from a home are for the following conditions:
(1) If a resident is a danger to himself or others.
(2) If the legal entity chooses to voluntarily close the home.
(3) If a resident's functional level has advanced or declined so that the resident's needs cannot be met in the facility even with supplemental services provided by outside providers. In this situation, a plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident or designated person, if any, or both. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/mental retardation program or drug and alcohol program, for assistance. The administrator shall also contact the appropriate personal care home regional field licensing office.
(4) If the resident's needs would require a fundamental alteration in facility program or building site.
(5) If the resident has failed to pay or cooperate with efforts to obtain public funding.
(6) If closure of the home is initiated by the Department.
SECURED UNIT REQUIREMENTS § 2600.231. Doors, locks and alarms.
Doors locked by using an electronic or magnetic system to prevent egress are considered mechanical device restraints and are permitted in licensed homes for specialized secured units so long as the following safety standards are met:
(1) If the building meets current Labor and Industry occupancy certification for a small or large personal care home, the secured unit shall be located at grade level of home with an outside enclosed area such as a porch or patio located on same grade level adjacent to the secured unit.
(2) If the building exceeds current Labor and Industry occupancy certification for a small or large home, and meets C-1 or better Life Safety or BOCA/IBC Code for Institutional or higher rating, an above-grade unit may be approved if the other stipulations in this section are met.
(3) A mechanical device, such as a key, deadbolt or sliding bolt lock may not lock exit doors.
(4) Doors that open into the enclosed areas may not be operated by an electronic or magnetic locking system, or similar device.
(5) Residents shall have free and easy access to the enclosed areas year round, except after dusk and during inclement weather.
(6) Doors that open onto areas such as parking lots, or other open, potentially unsafe areas, shall be permitted to be locked by an electronic or magnetic system.
(7) Facilities shall provide a statement from the manufacturer, specific to that home, verifying that the electronic or magnetic system will shut down when the fire alarm system is activated, and that all doors will open easily and immediately.
(8) Written approval or a variance shall be obtained from the Department of Labor and Industry, or from the Department of Health for C-1 or Better Life Safety or BOCA/IBC or the appropriate fire safety authority in the cities of Scranton, Pittsburgh and Philadelphia.
(9) Fire alarm systems shall be interconnected to the local fire department, where available, or a 24-hour monitoring/security service approved by the local fire department.
(10) The home shall provide for even illumination and appropriate levels of light to maximize vision.
(11) The home shall minimize hazards and risk of falls through the provision of sturdy furniture, ramps and removal of clutter.
§ 2600.232. Environmental standards.
Environmental standards include the following:
(1) The home shall provide adequate exercise space, both indoor and outdoor.
(2) The home shall ensure that no more than two residents are housed in a bedroom regardless of its size to help the resident live as confortably as possible in a secured unit.
(3) Space shall be provided for privacy and for common activities.
(4) The home shall provide a full description of the environmental cues and way-finding assistance to be utilized for the resident population.
§ 2600.233. Admission standards.
Admission standards include the following:
(1) A complete medical and cognitive assessment, which documents the need for the resident to be placed into a secured unit, shall be completed for each resident prior to admission to a home which provides a secured unit.
(2) A licensed physician, or a geriatric assessment team shall complete these assessments for the resident requiring the secured unit.
(3) A complete medical and cognitive assessment is not required for the spouse or relative of the resident requiring the secured unit, if the spouse or relative does not have a diagnosis requiring the secured unit but expresses a desire to live with the resident.
(4) Each resident record shall have documentation that the resident or the resident's legal representative has consented to the resident's admission or transfer to the secured unit.
(5) The home shall maintain a written agreement containing a full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming and cost and fees pertaining to the resident.
§ 2600.234. Care standards.
Care standards include the following:
(1) The home shall maintain the current assessment of the resident to confirm the diagnosis of the dementia and the assessment of other co-occurring health conditions.
(2) Within 72 hours of the admission or within 72 hours prior to the resident's admission to the secured unit, a support plan shall be developed, implemented and documented in the resident record and shall identify the resident's physical, medical, social, cognitive and safety needs, who will address these needs and the responsible person.
(3) These plans shall be reviewed at least annually or as the resident's condition changes.
(4) The resident or the resident's legal representative, or both, shall be involved in the development and review of the support plan.
§ 2600.235. Discharge standards.
Discharge standards which shall provide that if the home initiates a discharge or transfer of a resident, or the legal entity chooses to close the home, the administrator shall give a 60-day advance written notice to the resident, the resident's legal representative and the referral agent citing the reasons for the discharge or transfer. This requirement shall be stipulated in the resident-home contract signed prior to admission to the secured unit.
§ 2600.236. Administrator training.
Administrator training includes the following:
(1) In addition to the training requirements found in § 2600.57 (relating to administrator training and orientation), the administrator of the home with a secured unit shall complete orientation related to dementia, secured unit management and staff training.
(2) Ongoing education shall be competency-tested training including the following content areas specific to the stage of dementia and addressing issues particular to the resident:
(i) Psychosocial issues.
(ii) Specific cultural issues.
(iii) Psychological changes.
(iv) Functional consequences of other age-related diseases.
(v) Interpersonal skills in communications and team building.
(vi) Care-giving strategies.
(vii) Sexuality issues.
(viii) Nutrition issues.
(ix) Communication issues with residents and family and therapeutic activities, techniques and strategies.
(x) Medication use, effects and side effects.
(xi) Abuse prevention and resident rights consistent with the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102).
§ 2600.237. Staff training on dementia.
In addition to the training requirements in § 2600.58 (relating to staff training and orientation), all staff of a secured unit shall receive and successfully pass competency-based training related to dementia, to include the following:
(1) The normal aging-cognitive, psychological and functional abilities of older persons.
(2) The definition and diagnosis of dementia, description of reversible and irreversible causes, and an explanation of differences between dementia, delirium and depression.
(3) The definition of dementia and related disorders, progression, stages and individual variability.
(4) Communication techniques.
(5) The description of behavioral symptoms of dementia and how to manage resident behaviors.
(6) The role of personality, culture and environmental factors in behavioral symptoms and dementia care.
(7) The home's philosophy of dementia care, including mission statement, goals, policies and procedures.
(8) Working with family members.
(9) Resources for residents with dementia and their families.
(10) Team building and stress reduction for the staff.
(11) The Older Adult Protective Services Act (35 P. S. §§ 10225.701--10225.707).
§ 2600.238. Additional staffing.
Residents of secured units are considered to be mentally immobile. In addition to the requirements of § 2600.56 (relating to staffing), the Department will exercise its option to require additional staffing when necessary.
§ 2600.239. Programming standards.
Programming standards include the following:
(1) Activity programming in the secured unit, which shall maximize independence while focusing on strengths and abilities.
(2) General activity programming, which shall be offered with a frequency that meets the individual needs of the resident.
(3) Resident participation in general activity programming, which shall:
(i) Have a purpose that the resident can appreciate and endorses.
(ii) Be done voluntarily.
(iii) Respect the resident's age and social status.
(iv) Take advantage of the resident's retained abilities.
§ 2600.240. Notification to Department.
Notification to the Department is required as follows:
(1) Sixty days prior to the secured unit becoming operational for the first time, the legal entity of the home shall notify the appropriate Department regional office in writing of the home's need or desire to implement a secured unit within the home.
(2) If the home makes changes to the current secured unit with respect to increase or decrease of resident capacity, change in locking system, additional doors to be locked or floor plan changes, the legal entity of the home shall notify the appropriate regional field licensing office in writing, 60 days prior to completion of these changes.
(3) The following documents shall be included in the written notification:
(i) The name, address and legal entity of the home.
(ii) The name of the administrator of the home.
(iii) The total resident population of the home.
(iv) The total resident population of the secured unit.
(v) A building description and general information.
(vi) A unit description.
(vii) The type of locking system.
(viii) Emergency egress.
(ix) A sample of a 2-week staffing schedule.
(x) Verification of completion of additional training requirements.
(xi) The operational description of the secured unit locking system of all doors.
(xii) The manufacturer's statement regarding the secured unit locking system.
(xiii) A written approval or a variance from the Department of Labor and Industry, or the appropriate fire safety authority in the cities of Scranton, Pittsburgh and Philadelphia.
(xiv) The name of the municipality or 24-hour monitoring service maintaining the interconnection with the home's fire alarm system.
(xv) A statement from the local fire and building code authorities of meeting all applicable fire safety and building code requirements.
(xvi) A sample plan of care and service for the resident addressing the physical, medical, social, cognitive and safety needs, who will address these needs and the responsible person
(xvii) The activity standards to be followed.
(xviii) A sample of the complete medical and cognitive preadmission assessment, which is completed upon admission and reviewed and updated annually.
(xix) A sample consent form from the resident, or the resident's legal representative agreeing to the resident's placement in the secured unit.
(xx) A sample of the written agreement containing full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming and cost and fees.
(xxi) A description of environmental cues being utilized.
(xxii) A general floor plan of the entire home.
(xxiii) A specific floor plan of the secured unit, outside enclosed area and exercise space.
§ 2600.241. Mobility standards.
(a) An immobile person who does not require the services in or of a long-term care facility, but who does require personal care services, may be admitted to a home as a resident.
(b) If a resident is determined to be immobile as part of the initial or annual standardized screening instrument including mobility assessment, specific requirements relating to the care, health and safety of an immobile resident shall be met immediately.
(c) The administrator shall notify the appropriate regional field licensing office within 30 days when an immobile person is admitted to the home or the date when a resident becomes immobile in order for field office staff to evaluate compliance of the home with staffing requirements for homes housing immobile residents.
RESIDENT RECORDS § 2600.251. Resident records.
(a) A separate record shall be kept for each resident.
(b) The entries in a resident's record shall be permanent legible, dated and signed by the person making the entry.
(c) The home shall maintain resident records on standardized forms utilized by the home.
(d) The administrator shall maintain individual resident records on the premises where the resident lives. Resident records shall be made available to residents during normal working hours.
(e) The home shall comply with § 2600.17 (relating to confidentiality of records).
§ 2600.252. Content of records.
(a) Each resident's record shall include personal information such as:
(1) The name, gender, admission date, birth date and Social Security number.
(2) The race, height, weight, color of hair, color of eyes and identifying marks.
(3) A current photograph of the resident that is no more than 2 years old.
(4) Language or means of communication spoken or used by the resident.
(b) Each resident's record shall include emergency information such as:
(1) The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency.
(2) The name, address and telephone number of the resident's physician or source of health care and health insurance information, if any.
(3) The current and previous 2 years' physician's examination reports, including copies of the medical evaluation forms.
(4) A list of prescribed medications.
(5) Dietary restrictions.
(6) A record of incident reports for the individual resident.
(7) A list of allergies, if known.
(8) The documentation of physician visits and orders, including orders for the services of visiting nurse or home health agencies.
(c) The emergency information contents and procedures shall accompany residents as specified in § 2600.143 (relating to emergency medical plan).
(d) Additionally, each resident's record shall include:
(1) The initial intake assessment and the most current version of the annual assessment.
(2) A support plan.
(3) A court order, if applicable.
(4) The resident's medical insurance information.
(5) The date of entrance into the home, relocations and discharges, including the transfer of the resident to other homes owned by the same licensee.
(6) An inventory of the resident's personal property as voluntarily declared by the resident upon admission and voluntarily updated.
(7) An inventory of the resident's property entrusted to the administrator for safekeeping.
(8) The financial records of residents receiving assistance with financial management.
(9) The reason for termination of services or transfer of the resident, the date of transfer and the destination.
(10) Copies of transfer and discharge summaries from hospitals, if available.
(11) If the resident dies in the home, a record of the death of the resident. A copy of the official death certificate shall be retained in the resident's file.
(12) Signed notification of rights, grievance procedures and applicable consent to treatment protections specified in § 2600.41 (relating to notification of rights and complaint procedures).
(13) A copy of the resident-home contract
(14) The individual personal care services to be provided and changes in the services.
(15) A termination notice, if any.
§ 2600.253. Record retention and disposal.
Each home shall have and utilize a policy and procedures for closure and storage of the original or reprographic reproduction of resident records. The policy and procedure shall include the following:
(1) The resident's entire record shall be maintained for a minimum of 3 years following the resident's discharge from the home or until any audit or litigation is resolved.
(2) The resident's record shall be destroyed 4 years after the resident's discharge from the home. The records shall be destroyed in a manner that protects confidentiality.
(3) The home shall maintain a log of resident records destroyed on or after ______ (Editor's Note: The blank refers to the effective date of adoption of the proposal.). This log shall include the resident's name, record number, birth date, admission date and discharge date.
§ 2600.254. Record access and security.
(a) Records of active and discharged residents shall be maintained in a confidential manner, which prevents unauthorized access.
(b) Each home shall have and utilize a policy and procedures addressing record accessibility, security, storage, authorized use and release, and who is responsible for the records.
(c) Resident identifying information shall be stored in locked containers or a secured, enclosed area used solely for record storage and be accessible at all times to the administrator or a designee.
ENFORCEMENT § 2600.261. Classification of violations.
(a) The Department will classify each violation of this chapter pertaining to homes into one of three categories as described in paragraphs (1)--(3). A violation identified may be classified as Class I, Class II or Class III, depending upon the severity, duration and the adverse effect on the health and safety of residents.
(1) Class I. Class I violations have a substantial probability of resulting in death or serious mental or physical harm to a resident.
(2) Class II. Class II violations have a substantial adverse effect upon the health, safety or well being of a resident.
(3) Class III. Class III violations are minor violations, which have an adverse effect upon the health, safety or well being of a resident.
(b) The Department's criteria for determining the classification of violations are available from the appropriate personal care home regional field licensing office.
§ 2600.262. Penalties.
(a) The Department will assess a penalty for each violation of this chapter.
(b) Penalties will be assessed on a daily basis from the date on which the citation was issued until the date the violation is corrected, except in the case of Class II violations.
(c) In the case of a Class II violation, assessment of the penalty will be suspended for 5 days from the date of citation to permit sufficient time for the licensee to correct the violation. This time period may be extended for good cause. If the violation has not been corrected within the 5-day period, the fine will be retroactive to the date of citation.
(d) The Department will assess a penalty of $20 per resident per day for each Class I violation. Each Class I violation shall be corrected within 24 hours.
(e) The Department will assess a minimum penalty of $5 per resident per day, up to a maximum penalty of $15 per resident per day, for each Class II violation.
(f) There is no monetary penalty for Class III violations unless the home fails to correct the violation within 15 days.
(g) Failure to correct a Class III violation within 15 days may result in a penalty assessment of up to $3 per resident per day for each Class III violation retroactive to the date of the citation.
(h) If a home is found to be operating without a license, a penalty of $500 will be assessed. After 14 days, if the home operator cited for operating without a license fails to file an application for a license, the Department will assess an additional $20 for each resident for each day during which the home operator fails to apply.
(i) A home charged with a violation of this chapter or Chapter 20 (relating to licensure or approval of facilities and agencies) has 30 days to pay the assessed penalty in full.
(j) If the home wishes to contest the amount of the penalty or the fact of the violation, the home shall forward the assessed penalty, not to exceed $500, to the Secretary of Public Welfare (Secretary) for placement in an escrow account with the State Treasurer. A letter stating the wish to appeal the citation or penalty shall be submitted with the assessed penalty. This process constitutes an appeal.
(1) If, through an administrative hearing or judicial review of the proposed penalty, it is determined that no violation occurred or that the amount of the penalty shall be reduced, the Secretary will, within 30 days, remit the appropriate amount to the licensee together with interest accumulated on these funds in the escrow deposit.
(2) Failure to forward payment of the assessed penalty to the Secretary of Public Welfare within 30 days will result in a waiver of the right to contest the fact of the violation or the amount of the penalty.
(3) After an administrative hearing or a waiver of the administrative hearing, the assessed penalty amount will be made payable to the ''Commonwealth of Pennsylvania.'' It will be collectible in a manner provided by law for the collection of debts.
(4) If a home liable to pay the penalty neglects or refuses to pay the penalty upon demand, the failure to pay will constitute a judgment in favor of the Commonwealth in the amount of the penalty, together with the interest and costs that may accrue on these funds.
(5) Money collected by the Department under this section will be placed in a special restricted receipt account and will be used first to defray the expenses incurred by residents relocated under this chapter or Chapter 20. The Department each year will use money remaining in this account to assist with paying for enforcement of this chapter relating to licensing. Fines collected will not be subject to 42 Pa.C.S. § 3733 (relating to deposits into account).
(6) The Department will review the determinations of Class II and Class III violations made by the personal care home regional field licensing offices. This will be done on a monthly basis to ensure the uniformity and consistency of the classification process.
(7) Semiannually, the Department will review the standard criteria for the classification of violations and evaluate the use of these guidelines. This review is to ensure the uniformity and consistency of the classification process.
§ 2600.263. Revocation or nonrenewal of licenses.
(a) The Department will temporarily revoke the license of a personal care home if, without good cause, one or more Class I violations remain uncorrected 24 hours after the personal care home has been cited for the violation.
(b) The Department will temporarily revoke the license of a personal care home if, without good cause, one or more Class II violations remain uncorrected 15 days after the citation.
(c) Upon the revocation of a license in the instances described in subsections (a) and (b), or if the personal care home continues to operate without applying for a license as described in § 2600.262(h) (relating to penalties), residents shall be relocated.
(1) If the relocation of residents is due to the failure of the personal care home to apply for a license, the Department will offer relocation assistance to the residents. This assistance will include each resident's involvement in planning the relocation, except in the case of an emergency. Each resident shall have the right to choose among the available alternatives after an opportunity to visit the alternative personal care homes. These procedures will occur even if the residents are placed in a temporary living situation.
(2) A resident will not be relocated if the Secretary of Public Welfare determines in writing that the relocation is not in the best interest of the resident.
(d) The revocation of a license may terminate upon the Department's determination that its violation is corrected.
(e) If, after 3 months, the Department has cause to refuse or to deny a new license for a personal care home, the prior license is revoked under this section
(1) Revocation or nonrenewal under this section will be for a minimum of 5 years.
(2) A personal care home, which has had a license revoked or not renewed under this section, will not be allowed to operate, staff or hold an interest in a personal care home which applies for a license for 5 years after the revocation or nonrenewal.
(f) If a personal care home has been found to have Class I violations on two or more separate occasions during a 2-year period without justification, the Department will revoke or refuse to renew the license of the personal care home.
(g) The power of the Department to revoke or refuse to renew or issue a license under this section is in addition to the powers and duties of the Department under section 1026 of the Public Welfare Code (62 P. S. § 1026).
§ 2600.264. Policies, plans and procedures of the personal care home.
Policies, plans and procedures, which the personal care home is required by this chapter to develop, shall be implemented and followed by the personal care home.
CHAPTER 2620. (Reserved) (Editor's Note: The Department is proposing to delete Chapter 2620 as it currently appears in the Pennsylvania Code, pages 2620-1 to 2620-40 (serial pages (242443) to (242450), (257369) to (257372), (242455) to (242458), (257373) to (257378) and (242465) to (242482).)
[Pa.B. Doc. No. 02-1769. Filed for public inspection October 4, 2002, 9:00 a.m.]
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