[35 Pa.B. 2499]
[Continued from previous Web Page] SERVICES
§ 2600.222. Community social services
Fifteen commentators suggested defining the role of community social service agencies and describing the services that they offer so homes can encourage and assist residents to use community social services.
Response
The Department will provide training to assist homes in community social service options. The intent of this section is for a home to have readily available contacts and phone numbers to assist residents.
§ 2600.223. Description of services
Twenty-six commentators requested deletion of the entire section or individual subsections. In subsection (a), six commentators requested reference to the services provided in the resident contract.
Response
As noted by the commentators, specific services provided and not provided to each resident are required in § 2600.25. This section regarding description of services requires the home to have a broad, home-wide description of services and activities that the home provides. This description of services may cover the same items in the individual resident-home contracts, but in a broad sense to apply to the entire home.
§ 2600.224. Preadmission screening tool
Seven commentators recommended that the preadmission screening tool be provided by the Department and include a mobility assessment. One commentator requested deletion of subsection (a), stating that this will force homes to admit all residents who meet the screening criteria. Eight commentators asked whether subsection (b) means that if a home cannot meet an applicant's needs, the home must notify the area agency on aging. Several commentators suggested that current regulatory language about requirements for admission be kept.
Response
In collaboration with home providers and interested persons, the Department will develop and provide the preadmission screening tool as requested. The intent is not to force a home to admit all residents who meet screening criteria. The section requires that if a home cannot meet an applicant's needs, the home must notify the local appropriate assessment agency, such as the area agency on aging. Subsection (c) was added in response to comments to keep current language about requirements for admission in the final-form rulemaking.
§ 2600.225(a). Initial assessment and the annual assessment (redesignated as Initial and annual assessment)
Several advocacy organizations supported the requirement for an assessment within 72 hours. Several trade associations stated that it is unreasonable and unnecessary to require an assessment within 72 hours of admission and that the time period be increased to 30 days following admission. Several commentators opposed assessments altogether, stating that assessments push toward a medical model, which is not appropriate for personal care homes.
Twenty-one commentators opposed having the administrator or designee complete assessments. Some homes recommended that this assessment should be the responsibility of the referring agency. IRRC asked for clarification of the content of the assessment areas, the qualifications of the individuals who will complete the annual assessments, who will pay for these assessments and how this requirement will be implemented. Twenty-five commentators and IRRC suggested defining the term ''human service agency.''
Response
In response to concerns from the trade associations and upon review of the initial assessment requirements in other Departmental licensing regulations, the Department increased the time period for completion of the initial assessment to within 15 days following admission. This allows a reasonable time period for completion of the assessment and allows the home to observe the resident in his new setting to make an appropriate assessment of his service and protection needs.
The Department does not intend to mandate completion of the initial assessment by an outside professional or source, so as not to put an undue financial burden on the home. The initial assessment form will be able to be completed by an administrator who is qualified and trained under this chapter. The term ''human service agency'' is left undefined as it is meant to be broad and all inclusive to permit the home maximum flexibility.
§ 2600.225(b). Initial assessment and the annual assessment (redesignated as Initial and annual assessment)
Several commentators requested deletion or clarification of subsection (b), stating that this should be decided by the home. Several commentators asked for the addition of a mobility assessment.
Response
This subsection was deleted in response to comments. The Department's initial assessment form will include the content of the assessment and will be developed in collaboration with stakeholders. In developing the standard assessment form, the Department will consider the recommendation to add a mobility assessment.
§ 2600.225(c) and (d). Initial assessment and the annual assessment (redesignated as Initial and annual assessment)
One commentator requested allowing the home to use its own form if it contains the same information. Two commentators suggested changing ''materially'' to ''significantly'' in subsection (d)(1). Eight commentators suggested revising subsection (d)(2) to require a new updated assessment to be completed and put into the resident's record. Fourteen commentators requested deletion of subsection (d)(3) and (4). IRRC suggested defining the term ''state agency'' in subsection (d)(3).
Response
In response to comment, the Department revised this requirement to allow the home to use its own form if it contains the same information as the Department's form. The term ''materially'' was changed as suggested. Assessment are required to be kept in the resident record in § 2600.252 (relating to content of resident records). ''State agency'' was clarified as the Department. The Department deleted the requirement to complete a new assessment at the time of a hospital discharge.
§ 2600.225(e) and (g). Initial assessment and the annual assessment (redesignated as Initial and annual assessment)
One commentator requested deletion of subsection (e), stating that this should be decided by the home. Commentators suggested that subsection (g) should provide that if a resident is determined to be immobile, assessment requirements shall be met immediately. In subsection (g), ten commentators requested deletion of ''continually'' and insertion of ''mobility annually or upon a substantial change'' at the end of the sentence.
Response
The Department deleted proposed subsections (e) and (g) in response to comments and questions. The assessment of the resident's mobility will be addressed in the content of the assessment form and in the support plan. Mobility criteria is addressed in new § 2600.226 (relating to mobility criteria).
§ 2600.226. Development of the support plan (redesignated as § 2600.227)
Two commentators asked to retain current regulation. One commentator opposed this section, stating that a medical model is not appropriate for personal care homes.
Response
This section was revised and relocated to § 2600.227.
§ 2600.228. Notification of termination
Commentators expressed concerns with subsection (b), explaining that a home would need to immediately remove a resident who threatens the health and safety of other residents or staff persons. IRRC recommended addressing situations when a resident needs to be moved quickly to protect both the resident and others at the home or for other reasons that impact the other residents. IRRC noted that the amendment should be consistent with proposed §§ 2600.26(a)(1)(viii) and (ix) and 2600.42(u).
Response
In response to public comments, clarifications to this section were made. The 30-day advance notice is not required if a delay in discharge or transfer would jeopardize the health, safety or well being of the resident or others in the home. These changes are consistent with § 2600.42(u) and § 2600.26(a)(1)(viii) and (ix) (redesignated § 2600.25(a)(1)(8) and (9)).
Clarification was added to subsection (h) to require consultation with an appropriate assessment agency or a physician if the resident disagrees with the home's decision to discharge or transfer based on a change in functional level. Subsection (h) was clarified to state that a fundamental alteration includes a change that would create an undue financial or programmatic burden on the home and to include documented, repeated violation of this chapter. The reference to ''efforts to obtain public funding'' was deleted.
SECURED UNIT REQUIREMENTS (redesignated as SECURED DEMENTIA CARE UNITS)
§§ 2600.231--2600.241 (redesignated as §§ 2600.231--2600.238)
Community Legal Services and the Office of the State Ombudsman suggested further development of the requirements for admission, resident care and program, staffing and notification to the Department for secured care dementia units.
Response
The consumer demand for secure care dementia units has increased the development of secure care dementia units in this Commonwealth. The Department has responded to the public service demand with increased protection standards for this special type of care. In response to public comment, the Department has strengthened and expanded the proposed rulemaking to strengthen the requirements for admission criteria, fire safety, resident care, program, staff training and notification to the Department for secured care dementia units.
§ 2600.231. Doors, locks and alarms. (redesignated as § 2600.233)
Fifteen commentators suggested enhancing the protection of the rights of residents residing in secured units. Some commentators requested continuance of their waivers for existing secure units and exempting current homes from compliance. Four commentators and IRRC noted the duplication of paragraph (10) with § 2600.87 (relating to lighting). Five commentators recommended deletion of paragraph (11). IRRC requested clarification of the applicability of this section in conjunction with § 2600.42(p) regarding the right to be free of restraints.
Response
As specified in § 2600.19(g), existing waivers for current secured dementia care units will no longer be in effect 1 year after the effective date of this final-form rulemaking. This means that a home has 18 months to comply with the new requirements in this section. The health and safety needs of the residents in secure dementia care are so intensive that the Department cannot permanently grandfather existing homes. The Department will however, consider new waiver requests under § 2600.19 for a specific section of this chapter.
Proposed paragraphs (10) and (11) were deleted in response to comment. This section is not in conflict with the resident's right to be free of restraints. The locking of doors to prevent resident injury or death in secure care is not a restraint.
The Department has added clarification of the type of locking devices permitted, the manufacturer's statement verifying the nature of the locking system and the posting of directions for operating locking devices.
§ 2600.232. Environmental standards (redesignated as Environmental protection)
Five commentators requested clarification of ''adequate'' in paragraph (1). Four commentators requested deletion of paragraph (2). Six commentators requested clarification of paragraph (4) to enhance environmental awareness.
Response
These suggested changes were made. The term ''adequate'' was deleted since it is subjective and not measurable.
§ 2600.233. Admission standards (redesignated as § 2600.231. Admission)
Commentators requested definitions of ''geriatric assessment team'' and ''legal representative.'' Nine commentators suggested adding how, by whom, when and with what frequency services will be provided.
Response
The Department has defined ''geriatric assessment team'' as suggested. The term ''legal representative'' was not defined in the final-form rulemaking, but means an individual who has been authorized by law to represent the resident with respect to a particular matter.
The Department has specified additional detail about the services, as suggested by the commentators.
In response to general comments to improve and expand the section on secure dementia care, the Department has clarified the definition of a ''secure dementia care unit,'' clarified the proposed requirements regarding the medical evaluation and cognitive assessment and further clarified the admission requirements for a secure dementia care unit.
§ 2600.234. Care standards (redesignated as Resident care)
Nine commentators suggested adding how, by whom, when and with what frequency services will be provided.
Response
In response to public comment, this section was revised.
§ 2600.235. Discharge standards (redesignated as Discharge)
Seventeen commentators suggested replacing 60-day written discharge notice with 30-day written discharge notice to assure that residents receive appropriate care.
Response
In response to comment, this change was made.
§ 2600.236. Administrator training (redesignated as Training)
Four commentators suggested requiring a specific number of hours of training and orientation. Seven commentators suggested requiring 8 additional hours of annual training regarding dementia for administrators and direct care staff. Two commentators suggested requiring 12 additional hours of annual training in dementia. Seven commentators suggested deleting the competency-tested training.
Response
The proposed section was deleted and replaced with a requirement that each direct care staff person must have an additional 6 hours of annual training related to dementia care and services.
§ 2600.237. Staff training on dementia (redesignated as Program)
In response to general comments to improve and expand the section on secure dementia care, the proposed section on training was deleted and replaced with requirements for activities.
§ 2600.238. Additional staffing (redesignated as Staffing)
Five commentators suggested that the Department establish minimum staffing standards for secure dementia care units, subject to public review and comment.
Response
Based on discussions with and recommendations of the Committee, this change was not made. The Department will consider increased staffing requirements for secure dementia care units for a future rulemaking. The Department clarified that for purposes of applying the staffing requirements in § 2600.57(c), the residents in secure dementia care are considered to be residents with mobility needs.
§ 2600.239. Programming standards (deleted on final-form)
Five commentators requested deletion of paragraph (1) because it is subjective and not measurable. One commentator recommended deleting ''general activity programming, which shall'' in paragraph (2), deleting paragraph (3) and renumbering subparagraphs (i)-(iv) as paragraphs. Three commentators suggested deleting ''and social status'' and inserting ''and cognitive limitations'' in subparagraph (iii) and deleting ''taking advantage of the'' and inserting ''should promote the'' in subparagraph (iv).
Response
This proposed section was deleted in response to public comment.
§ 2600.240. Notification to Department (redesignated as § 2600.239)
Many commentators suggested clarifying that the home must submit a request for approval of secured unit and that the Department must inspect and approve the unit prior to operation. Commentators also suggested many technical and clarification changes throughout this section.
Response
In response to comment the Department revised this section on final-form rulemaking. As suggested, the Department clarified that the home must submit a request for approval of a secure care dementia unit, and be inspected and approved by the Department, prior to operation or a change in the secured care dementia unit.
§ 2600.241. Mobility standards (deleted on final-form)
Eight commentators suggested that this standard should be expanded to include the three levels of independently mobile, mobile with assistance and immobile. Four commentators requested clarification of ''specific requirements'' in subsection (b). Five commentators requested deletion of subsection (c) as unnecessary.
Response
This section was deleted since any special requirements related to mobility are addressed in the appropriate section of this chapter.
RESIDENT RECORDS
§ 2600.251. Resident records
Eight commentators requested deletion of this section, suggesting that there is no documented need to increase recordkeeping requirements.
Response
These are basic recordkeeping requirements that must be met to provide a separate record for each resident, accurate recording of resident information and availability to appropriate individuals. The Department clarified that the record is also available to the resident's designated person.
§ 2600.252(a) and (b). Content of records (redesignated as Content of resident records)
Nine commentators requested deletion of this section, suggesting that there is no documented need to increase recordkeeping requirements. A suggestion was received to make the recent photograph optional. Eight commentators suggested deleting race. Eleven commentators suggested requiring a photograph only if the resident agrees, and allowing photographs up to 5 years old. Three commentators suggested adding a requirement for information on a resident's dentist and other medical specialists, if applicable. Eight commentators suggested clarifying that only incident reports that are reportable to the Department must be kept in resident files. Two commentators suggested deleting the record of incident reports with the medical record since it is contrary to legal advice and makes the home vulnerable to potential legal action.
Seven commentators suggested eliminating emergency medical plan. Four commentators requested deletion of proposed subsection (d)(5), due to difficulty in obtaining the information. Five commentators suggested deleting proposed subsection (d)(12), because homes are not medical facilities. Four commentators requested deletion of subsection (d)(14) because services are listed in the contract.
Response
The majority of these record content items are found at other locations within this chapter. In most cases, these are not new requirements, with the exception of the resident descriptive data in paragraphs (1)--(3), which is important for identification purposes. Although incident reports must be kept in the resident's record, information that includes confidential identifying information relating to the resident or another resident should be redacted before release or review of this information. Information about the resident's source of health care is found on the resident's physical evaluation.
A photograph and the resident's race is important to identify the resident in the case a resident is missing or needs to be identified for emergency medical services. Identification of the resident's race is also important for protection of the resident's civil rights. Religious affiliation was added so that appropriate end-of-life services may be provided, if appropriate.
In response to comment, the requirements for notice of grievance procedures, consent to treatment protection and individual services were deleted.
§ 2600.253. Record retention and disposal
Twenty commentators requested deletion of proposed paragraphs (2) and (3).
Response
The Department needs information regarding residents who have been discharged from the home to verify compliance with this chapter and to investigate a complaint. The Department also added that the general records of the home required in this chapter, such as fire drill records and menus, must be kept for 3 years. Again, this is necessary for regulatory administration and enforcement purposes.
§ 2600.254. Record access and security
Six commentators recommended deletion of this section, indicating that these records do not contain highly confidential information and do not need to have restricted access. Seven commentators suggested deleting ''solely'' and ''at all times'' and inserting ''during normal business hours.'' Ten commentators requested clarification of subsection (c).
Response
Resident records must be kept confidential and private because they contain resident-identifying information, which must be protected. The term ''solely'' was not deleted to ensure that records are kept in a separate and confidential location. The enclosed area does not need to be a separate room and could be a locked file cabinet. The records contain important health and service information and must be available and able to be accessed at all times, including after business hours. Subsection (c) was clarified.
ENFORCEMENT
§§ 2600.261--2600.264. Enforcement (redesignated as §§ 2600.261--2600.270)
The Department received many comments requesting stronger enforcement provisions. IRRC, personal care homes, advocates, the City of Philadelphia and the Committee recommended the implementation of the current classification system of violations, bans on admissions for homes without a full license, increased requirements for plans of correction, quicker appeal decisions by the Department, better disclosure of public information and establishment of a complaint investigation team. Commentators suggested adding a fourth classification for violations that have no adverse effect on the health, safety or well-being of residents. Commentators suggested that multidisciplinary teams should conduct all inspections of homes. Commentators suggested adding a section regarding voluntary and involuntary home closures.
Response
The Department is very pleased that many providers and other stakeholders have supported strengthened enforcement protections. Many of the enforcement recommendations of the public commentators have been adopted in this final-form rulemaking. The Department's implementation of the current classification system of violations has been underway for almost 2 years. In response to the request for enhanced enforcement, the Department strengthened the proposed provisions and added several new sections in §§ 2600.268--2660.270 (relating to notice of violations; ban on admissions; and correction of violations).
Section 2600.268 is added to conform to section 1057.3(a)(4) of the Public Welfare Code.
New § 2600.269 is necessary because a home that cannot care for its current residents in compliance with this chapter should not be allowed to take new residents and expose them to the risks resulting from the regulatory violations.
New § 2600.270 addresses the issue of the large difference of timeframes between the statutory requirements for the correction of a violation to avoid a fine and the duration of a provisional license. In 1988, under section 1086 of the Public Welfare Code and section 1087 of the Public Welfare Code (62 P. S. § 1087), licensing enforcement of personal care homes was strengthened through the implementation of a system of fines for regulatory violations based on the seriousness of the violation. However, in section 1087 of the Public Welfare Code, the Department is permitted to continue to use traditional licensing enforcement methods, such as the use of a provisional license under section 1008 of the Public Welfare Code (62 P. S. § 1008). The timeframe for correction of a violation under traditional enforcement methods in section 1008 of the Public Welfare Code allows up to 6 months; however, the timeframe under the system of fines in section 1086 of the Public Welfare Code allows a correction period of up to 15 days. Correction of a violation under section 1086 of the Public Welfare Code does not necessarily qualify a home for a regular license. To quality for a regular license, the home must demonstrate compliance over a sufficient period of time so that the correction is shown to be permanent and not temporary.
A classification for violations that have no adverse effect on the health, safety or well-being of residents was not added because it would be inconsistent with section 1085 of the Public Welfare Code. Also, a violation of any section of this chapter endangers residents to some degree.
The Department's licensing inspectors work in conjunction with other special investigators, such as the Department of Aging ombudsman, advocacy organizations and police, as appropriate, to investigate complaints.
The Department supports the need for more timely appeal decisions by the Department; however, the appeal workload includes more than just personal care home licensing appeals and must be balanced to meet the needs of all appellants and parties.
§ 2600.261. Classification of violations
Fifteen commentators recommended including classification guidelines, adding definitions and language to control subjective application of classifications and penalties, and listing routine Class I, Class II and Class III violations. Five commentators found the criteria for Class I violations outdated, punitive and unreasonable.
Response
The Department reviews the determinations of Class I, Class II and Class III violations made by the personal care home regional offices to ensure the uniformity and consistency of the classification process. The Department continues to refine the standard guidelines for the classification of violations and evaluates the use of these guidelines to ensure the uniformity and consistency of the classification process. Penalties for Class I violations are designed to be punitive because they have a substantial probability of resulting in death or serious mental or physical harm to a resident.
§ 2600.262(a) and (b). Penalties
Fourteen commentators suggested changing the legal base. Commentators indicated that there should be no penalty for violations that do not affect health, safety and well-being of residents or for violations that are corrected in a reasonable time. Commentators recommended that there be no penalties for administrative errors corrected within 24 hours of discovery that do not have an adverse effect upon the health, safety or well-being of residents.
Response
The Department semiannually reviews its classification guidelines for the classification of violations and evaluates the use of these guidelines. This review is to ensure the uniformity and consistency of the classification process. Many minor violations are classified as Class III violations. There is no monetary penalty for Class III violations unless the home fails to correct the violation within 15 calendar days.
The Department added Class III violations in subsection (b) to conform to section 1086(b) of the Public Welfare Code.
§ 2600.262(c). Penalties
Four commentators suggested that fines should not be levied if the Department has accepted the plan of correction or if a vendor delays action. Commentators suggested adding that the Department shall establish a formal process to enable each home to file for an extension. Several commentators requested deletion of ''this time period may be extended for good cause.''
Response
A Class II violation is defined as having a substantial adverse effect upon the health, safety or well-being of a resident. The law permits the Department to consider whether a home has a substantial reason, such as extenuating circumstances beyond the home's control, for failing to correct a violation on a timely basis. The Department may permit a longer time for correction if for good cause. The retroactive fine is included in subsection (c).
The Department clarified that if the home fails to provide proof of correction of the violation to the Department within the 5-day period, the fine will be retroactive to the date of the citation. It is necessary for the home to demonstrate correction of the violation to the Department.
§ 2600.262(g). Penalties (redesignated as § 2600.262(f))
Seven commentators suggested longer time frames for correction.
Response
The time frames specified are set in law, but the Department may permit a longer time for correction if for good cause in the case of Class II violations.
§ 2600.262(j). Penalties (redesignated as § 2600.263(a))
Three commentators suggested adding language regarding expungement from the Department's records and from the Department's website when available. Five commentators suggested that fines collected by the Department should be used to educate facilities that were cited and fined.
Response
Expungement is not permitted because patterns of violations over time are legally significant. See section 1057.1(b) of the Public Welfare Code (62 P. S. § 1057.1(b)).
As specified in § 2600.264 (relating to use of fines), fines collected by the Department are placed in a special restricted account. Money collected is used first to defray the expenses incurred by residents being relocated, and then used to assist with paying for enforcement of this chapter.
§ 2600.263. Revocation or nonrenewal of licenses (redesignated as § 2600.263. Appeals of penalty; § 2600.264. Use of fines; § 2600.265. Review of classifications)
Twenty-one commentators recommended revoking licenses only for uncorrected violations that affect health, safety and well-being of residents. Commentators recommended the time period for operation following a revocation to 2 to 3 years, but reserving 5 year revocation or nonrenewal for multiple noncompliance issues. One commentator requested a ban on admissions for homes with a provisional license and posting information about homes with a provisional license due to regulatory violations on the Department's website.
Response
Correction of violations prior to the expiration of the license will result in the issuance of a license. Section 2600.269 was added regarding bans on admissions. The time period for operation following a revocation will remain at 5 years to conform to section 1087(a)(4) of the Public Welfare Code. The Department website lists licensing information about homes on its website and will consider including information about a home's provisional license status in the future.
§ 2600.264. Policies, plans and procedures of the personal care home (deleted on final-form)
Fourteen commentators expressed concern about the amount of time that developing policies, plans and procedures will take from resident care. Commentators expressed concern about cost. Commentators suggested listing the required policies, plans and procedures.
Response
The proposed § 2600.264 was deleted. The Department will develop sample policies and procedures to assist homes to comply with requirements for policies and procedures.
ADDITIONAL CHANGES
In addition to the major changes previously discussed, the Department made additional changes in preparation of the final-form rulemaking to correct typographical errors, reformat to enhance readability, revise language to improve clarity and conform to the changes previously discussed.
Contact Person
For additional information on this final-form rulemaking, contact Karen E. Kroh, Department of Public Welfare, Health and Welfare Building, Harrisburg, PA 17120, (717) 783-2800.
Regulatory Review Act
Under section 5.1(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on September 23, 2002, the Department submitted a copy of the notice of proposed rulemaking, published at 32 Pa.B. 4939, to IRRC and the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC and the Committees were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the House and Senate Committees and the public.
Under section 5.1(j.1) and (j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.1) and (j.2)), on February 23, 2005, the final-form rulemaking was deemed approved by the House and Senate Committees. Under section 5.1(e) of the Regulatory Review Act, IRRC met on February 24, 2005, and approved the final-form rulemaking.
Findings
The Department finds that:
(1) The public notice of intention to adopt the administrative regulations by this order has been given under sections 201 and 202 of the Commonwealth Documents Law (45 P. S. §§ 1201 and 1202) and the regulations promulgated hereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) The adoption of these regulations in the manner provided in this order is necessary and appropriate for the administration and enforcement of section 211 and Articles IX and X of the Public Welfare Code (62 P. S. § 211, §§ 901--922 and §§ 1001--1087).
Order
The Department, acting under the Public Welfare Code, orders that:
(a) The regulation of the Department, 55 Pa. Code Chapter 2600 and 2620, are amended by adding §§ 2600.1--2600.5, 2600.11--2600.29, 2600.41--2600.44, 2600.51--2600.68, 2600.81--2600.109, 2600.121--2600.133, 2600.141--2600.144, 2600.161--2600.164, 2600.171, 2600.181--2600.191, 2600.201, 2600.202, 2600.221--2600.228, 2600.231--2600.239, 2600.251--2600.254 and 2600.261--2600.270; and by deleting §§ 2620.1--2620.3, 2620.5, 2620.11--2620.14, 2620.21--2620.24, 2620.24a, 2620.25--2620.28, 2620.31--2620.40, 2620.51--2620.55, 2620.61--2620.74 and 2620.81--2620.83, to read as set forth in Annex A.
(b) The Secretary of the Department shall submit this order and Annex A to the Offices of General Counsel and Attorney General for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify and deposit this order and Annex A with the Legislative Reference Bureau as required by law.
(d) This Order shall take effect on October 24, 2005, with the exception of § 2600.65(d) that shall take effect on April 24, 2005, § 2600.19(g) that shall take effect on October 24, 2006, and §§ 2600.122, 2600.130(e) and 2600.182 that shall take effect on April 24, 2007.
ESTELLE B. RICHMAN,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 35 Pa.B. 1734 (March 12, 2005).)
Fiscal Note: Fiscal Note 14-475 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 55. PUBLIC WELFARE
PART IV. ADULT SERVICES MANUAL
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 2600. PERSONAL CARE HOMES
GENERAL PROVISIONS Sec.
2600.1. Purpose. 2600.2. Scope. 2600.3. Inspections and licenses. 2600.4. Definitions. 2600.5. Access.
GENERAL REQUIREMENTS
2600.11. Procedural requirements for licensure or approval of personal care homes. 2600.12. Appeals. 2600.13. Maximum capacity. 2600.14. Fire safety approval. 2600.15. Abuse reporting covered by law. 2600.16. Reportable incidents and conditions. 2600.17. Confidentiality of records. 2600.18. Applicable health and safety laws. 2600.19. Waivers. 2600.20. Financial management. 2600.21. Offsite services. 2600.22. Admission. 2600.23. Activities. 2600.24. Personal hygiene. 2600.25. Resident-home contract. 2600.26. Quality management. 2600.27. SSI recipients. 2600.28. Refunds. 2600.29. Hospice care and services.
RESIDENT RIGHTS
2600.41. Notification of rights and complaint procedures. 2600.42. Specific rights. 2600.43. Prohibition against deprivation of rights. 2600.44. Complaint procedures.
STAFFING
2600.51. Criminal history checks. 2600.52. Staff hiring, retention and utilization. 2600.53. Qualifications and responsibilities of administrators. 2600.54. Qualifications for direct care staff persons. 2600.55. Exceptions for staff qualifications. 2600.56. Administrator staffing. 2600.57. Direct care staffing. 2600.58. Awake staff persons. 2600.59. Multiple buildings. 2600.60. Additional staffing based on the needs of the residents. 2600.61. Substitute personnel. 2600.62. List of staff persons. 2600.63. First aid, CPR and obstructed airway training. 2600.64. Administrator training and orientation. 2600.65. Direct care staff person training and orientation. 2600.66. Staff training plan. 2600.67. Training institution registration. 2600.68. Instructor approval.
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. Windows and screens. 2600.93. Handrails and railings. 2600.94. Landings and stairs. 2600.95. Furniture and equipment. 2600.96. First aid kit. 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. Food service. 2600.104. Dining room. 2600.105. Laundry. 2600.106. Swimming areas. 2600.107. Emergency preparedness. 2600.108. Firearms and weapons. 2600.109. Pets.
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 medical evaluation and health care. 2600.142. Assistance with health care. 2600.143. Emergency medical plan. 2600.144. Use of tobacco.
NUTRITION
2600.161. Nutritional adequacy. 2600.162. Meals. 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. Medication administration. 2600.183. Storage and disposal of medications and medical supplies. 2600.184. Labeling of medications. 2600.185. Accountability of medication and controlled substances. 2600.186. Prescription medications. 2600.187. Medication records. 2600.188. Medication errors. 2600.189. Adverse reaction. 2600.190. Medication administration training. 2600.191. Resident education.
SAFE MANAGEMENT TECHNIQUES
2600.201. Safe management techniques. 2600.202. Prohibitions.
SERVICES
2600.221. Activities program. 2600.222. Community social services. 2600.223. Description of services. 2600.224. Preadmission screening tool. 2600.225. Initial and annual assessment. 2600.226. Mobility criteria. 2600.227. Development of the support plan. 2600.228. Notification of termination.
SECURED DEMENTIA CARE UNITS
2600.231. Admission. 2600.232. Environmental protection. 2600.233. Doors, locks and alarms. 2600.234. Resident care. 2600.235. Discharge. 2600.236. Training. 2600.237. Program. 2600.238. Staffing. 2600.239. Notification to Department.
RESIDENT RECORDS
2600.251. Resident records. 2600.252. Content of resident records. 2600.253. Record retention and disposal. 2600.254. Record access and security.
ENFORCEMENT
2600.261. Classification of violations. 2600.262. Penalties. 2600.263. Appeals of penalty. 2600.264. Use of fines. 2600.265. Review of classifications. 2600.266. Revocation or nonrenewal of licenses. 2600.267. Relocation of residents. 2600.268. Notice of violations. 2600.269. Ban on admissions. 2600.270. Correction of violations.
GENERAL PROVISIONS § 2600.1. Purpose.
(a) The purpose of this chapter is to protect the health, safety and well-being of personal care home residents.
(b) Personal care homes are designed to provide safe, humane, comfortable and supportive residential settings for adults who do not require the services in or of a licensed long-term care facility, but who do require assistance or supervision with activities of daily living, instrumental activities of daily living, or both. Residents who live in personal care homes that meet the requirements in this chapter will receive the encouragement and assistance they need to develop and maintain maximum independence and self-determination.
§ 2600.2. Scope.
(a) This chapter applies to personal care homes as defined in this chapter, and contains the minimum requirements that shall be met to obtain a license to operate a personal care home.
(b) This chapter does not apply to commercial boarding homes or to facilities operated by a religious organization exclusively for the care of clergy or other individuals in a religious profession.
§ 2600.3. Inspections and licenses.
(a) The Department will annually conduct at least one onsite unannounced inspection of each personal care home.
(b) A license will be issued to the legal entity by the Department if, after an investigation by an authorized agent of the Department, the requirements for a license are met.
(c) The personal care home shall post the current license, a copy of the current license inspection summary issued by the Department and a copy of this chapter in a conspicuous and public place in the personal care home.
§ 2600.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
ADL--Activities of daily living--The term includes eating, drinking, ambulating, transferring in and out of a bed or chair, toileting, bladder and bowel management, personal hygiene, securing health care, managing health care, self-administering medication and proper turning and positioning in a bed or chair.
Abuse--The occurrence of one or more of the following acts:
(i) The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.
(ii) The willful deprivation by the personal care home or its staff persons of goods or services which are necessary to maintain physical or mental health.
(iii) Sexual harassment, rape or abuse, as defined in 23 Pa.C.S. Chapter 61 (relating to protection from abuse).
(iv) Exploitation by an act or a course of conduct, including misrepresentation or failure to obtain informed consent which results in monetary, personal or other benefit, gain or profit for the perpetrator, or monetary or personal loss to the resident.
(v) Neglect of the resident, which results in physical harm, pain or mental anguish.
(vi) Abandonment or desertion by the personal care home or its staff persons.
Adult--An individual who is 18 years of age or older.
Ancillary staff person--An individual who provides services for the residents other than activities of daily living.
Agent--An individual authorized by the Department to enter, visit, inspect or conduct an investigation of a personal care home.
Appropriate assessment agency--An organization serving adults who are older or adults with disabilities, such as a county mental health/mental retardation agency, a drug and alcohol agency, an area agency on aging or another human service agency or an individual in an occupation maintaining contact with adults who are older and adults with disabilities, such as medicine, nursing or rehabilitative therapies.
CAM--Complementary and alternative medications--Practices, substances and ideas used to prevent or treat illness or promote health and well-being outside the realm of modern conventional medicine. Alternative medicine is used alone or instead of conventional medicine. Complementary medicine is used along with or in addition to conventional medicine.
CPR--Cardiopulmonary resuscitation.
Commercial boarding home--A type of residential living facility providing only food and shelter, or other services normally provided by a hotel, for payment, for individuals who require no services beyond food, shelter and other services usually found in hotel or apartment rental.
Complaint--A written or oral criticism, dispute or objection presented by or on behalf of a resident to the Department regarding the care, operations or management of a personal care home.
Day--Calendar day.
Dementia--A clinical syndrome characterized by a decline of long duration in mental function in an alert individual. Symptoms of dementia may include memory loss, personality change, chronic wandering and the loss or diminishing of other cognitive abilities, such as learning ability, judgment, comprehension, attention and orientation to time and place and to oneself.
Department--The Department of Public Welfare of the Commonwealth.
Designated person--An individual who may be chosen by the resident and documented in the resident's record, to be notified in case of an emergency, termination of service, personal care home closure or other situations as indicated by the resident or as required by this chapter. A designated person may be the resident's legal representative or an advocate.
Designee--A staff person authorized in writing to act in the administrator's absence.
Direct care staff person--A staff person who directly assists residents with activities of daily living, and instrumental activities of daily living and provides services or is otherwise responsible for the health, safety and well-being of the residents.
Emergency medical plan--A plan that ensures immediate and direct access to medical care and treatment for serious injury or illness, or both.
Financial management--
(i) A personal care service provided whenever the administrator serves as representative payee or as a guardian or power of attorney assigned prior to December 21, 1988, for a resident, or when a resident requests and receives assistance in budgeting and spending of the personal needs allowance.
(ii) The term does not include solely storing funds in a safe place as a convenience for a resident.
Fire safety expert--A member of a local fire department, fire protection engineer, Commonwealth-certified fire protection instructor, college instructor in fire science, county or Commonwealth fire school, volunteer trained and certified by a county or Commonwealth fire school, an insurance company loss control representative, Department of Labor and Industry building code inspector or construction code official.
IADL--Instrumental activities of daily living--The term includes the following activities when done on behalf of a resident:
(i) Doing laundry.
(ii) Shopping.
(iii) Securing and using transportation.
(iv) Managing finances.
(v) Using a telephone.
(vi) Making and keeping appointments.
(vii) Caring for personal possessions.
(viii) Writing correspondence.
(ix) Engaging in social and leisure activities.
(x) Using a prosthetic device.
(xi) Obtaining and keeping clean, seasonal clothing.
Legal entity--A person, society, corporation, governing authority or partnership legally responsible for the administration and operation of a personal care home.
License--A certificate of compliance issued by the Department permitting the operation of a personal care home, at a given location, for a specific period of time, for a specified capacity, according to Chapter 20 (relating to licensure or approval of facilities and agencies).
Long-term care ombudsman--A representative of the Office of the State Long-Term Care Ombudsman in the Department of Aging who investigates and seeks to resolve complaints made by or on behalf of individuals who are 60 years of age or older who are consumers of long-term care services. These complaints may relate to action, inaction or decisions of providers of long-term care services, of public agencies, of social service agencies or their representatives, which may adversely affect the health, safety, well-being or rights of these consumers.
Mobile resident--
(i) A resident who is physically and mentally capable of vacating the personal care home on the resident's own power or with limited physical or oral assistance in the case of an emergency, including the capability to ascend or descend stairs if present on the exit path.
(A) Physical assistance means assistance in getting to one's feet or into a wheelchair, walker or prosthetic device.
(B) Oral assistance means giving instructions to assist the resident in vacating the personal care home.
(ii) The term includes an individual who is able to effectively operate an ambulation device required for moving from one place to another, and able to understand and carry out instructions for vacating the personal care home.
Neglect--The failure of a personal care home or its staff persons to provide goods or services essential to avoid a clear and serious threat to the physical or mental health of a resident. The failure or omission to provide the care, supervision and services that the personal care home has voluntarily, or by contract, agreed to provide and that are necessary to maintain the resident's health, safety and well-being, including personal care services, food, clothing, medicine, shelter, supervision and medical services. Neglect may be repeated conduct or a single incident.
OTC--Over the counter or nonprescription.
Personal care home or home--
(i) A premise in which food, shelter and personal assistance or supervision are provided for a period exceeding 24 hours, for four or more adults who are not relatives of the operator, who do not require the services in or of a licensed long-term care facility, but who do require assistance or supervision in activities of daily living or instrumental activities of daily living.
(ii) The term includes a premise that has held or presently holds itself out as a personal care home and provides food and shelter to four or more adults who need personal care services, but who are not receiving the services.
Personal care home administrator or administrator--An individual who is charged with the general administration of a personal care home, whether the individual has an ownership interest in the personal care home, and whether functions and duties are shared with other individuals.
Personal care services--Assistance or supervision in ADL or IADL, or both.
Premises--The grounds and buildings on the same grounds, used for providing personal care services.
Protective services unit--The local area agency on aging unit designated by the Department of Aging to investigate allegations of abuse of adults who are 60 years of age or older and assess the need for protective interventions.
Referral agent--An agency or individual who arranges for or assists, or both, with placement of a resident into a personal care home.
Relative--A spouse, parent, child, stepparent, stepchild, grandparent, grandchild, brother, sister, half-brother, half-sister, aunt, uncle, niece or nephew.
Resident--An individual, unrelated to the legal entity, who resides in a personal care home, and who requires personal care services, but who does not require the level of care provided by a hospital or long-term care facility.
Resident with mobility needs--An individual who is unable to move from one location to another, has difficulty in understanding and carrying out instructions without the continued full assistance of other individuals or is incapable of independently operating an ambulation device, such as a wheelchair, prosthesis, walker or cane to exit a building.
Restraint--A manual, chemical or mechanical device used to limit or restrict the movement or normal function of an individual or a portion of the individual's body.
SSI--Supplemental Security Income.
Secretary--The Secretary of the Department.
Staff person--An individual who works for the personal care home for compensation either on payroll or under contract.
Support plan--A written document that describes for each resident the resident's care, service or treatment needs based on the assessment of the resident, and when the care, service or treatment will be provided, and by whom.
Volunteer--
(i) An individual who, of his own free will, and without monetary compensation, provides direct care services for residents in the personal care home.
(ii) The term does not include visitors or individuals who provide nondirect services or entertainment on an occasional basis.
§ 2600.5. Access.
(a) The administrator or a designee shall provide, upon request, immediate access to the home, the residents and records to:
(1) Agents of the Department.
(2) Representatives of the area agency on aging.
(3) Representatives of the Long-Term Care Ombudsman Program.
(4) Representatives of the protection and advocacy system for individuals with disabilities designated under the Protection and Advocacy for Individual Rights Program of the Vocational Rehabilitation and Rehabilitation Services Act (29 U.S.C.A. § 794e), the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C.A. §§ 10801--10851) and the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C.A. §§ 15041--15043).
(b) The administrator or a designee shall permit community service organizations and representatives of community legal services programs to have access to the home during visitation hours or by appointment for the purpose of assisting or informing the residents of the availability of services and assistance. A resident or a resident's designated person may decline the services of the community service organization or the community legal service program.
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