[35 Pa.B. 2499]
[Continued from previous Web Page] § 2600.88. Surfaces.
(a) Floors, walls, ceilings, windows, doors and other surfaces must be clean, in good repair and free of hazards.
(b) The home may not use asbestos products for renovations or new construction.
§ 2600.89. Water.
(a) The home must have hot and cold water under pressure in each bathroom, kitchen and laundry area to accommodate the needs of the residents in the home.
(b) Hot water temperature in areas accessible to the resident may not exceed 120°F.
(c) A home that is not connected to a public water system shall have a coliform water test at least every 3 months, by a Department of Environmental Protection-certified laboratory, stating that the water is below maximum contaminant levels. A public water system is a system that provides water to the public for human consumption, which has at least 15 service connections or regularly serves an average of at least 25 individuals daily at least 60 days out of the year.
(d) If the water is found to be above maximum contaminant levels, the home shall conduct remediation activity to reduce the level of contaminants to below the maximum contaminant level. During remediation activity, an alternate source of drinking water shall be provided to the residents.
(e) The home shall keep documentation of the laboratory certification, in addition to the results and corrections made to ensure safe water for drinking.
§ 2600.90. Communication system.
(a) The home shall have a working, noncoin operated, landline telephone that is accessible in emergencies and accessible to individuals with disabilities.
(b) For a home serving 9 or more residents, there shall be a system or method of communication that enables staff persons to immediately contact other staff persons in the home for assistance in an emergency.
§ 2600.91. Emergency telephone numbers.
Telephone numbers for the nearest hospital, police department, fire department, ambulance, poison control, local emergency management and personal care home complaint hotline shall be posted on or by each telephone with an outside line.
§ 2600.92. Windows and screens.
Windows, including windows in doors, must be in good repair and securely screened when doors or windows are open.
§ 2600.93. Handrails and railings.
(a) Each ramp, interior stairway and outside steps must have a well-secured handrail.
(b) Each porch must have a well-secured railing.
§ 2600.94. Landings and stairs.
(a) Interior and exterior doors that open directly into a stairway and are used for exit doors, resident areas and fire exits must have a landing, which is a minimum of 3 feet by 3 feet.
(b) Interior stairs, exterior steps and ramps must have nonskid surfaces.
§ 2600.95. Furniture and equipment.
Furniture and equipment must be in good repair, clean and free of hazards.
§ 2600.96. First aid kit.
(a) The home shall have a first aid kit that includes nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, adhesive tape, scissors, breathing shield, eye coverings and tweezers.
(b) Staff persons shall know the location of the first aid kit.
(c) The first aid kit must be in a location that is easily accessible to staff persons.
§ 2600.97. Elevators and stair glides.
Each elevator and stair glide must have a certificate of operation from the Department of Labor and Industry or the appropriate local building authority in accordance with 34 Pa. Code Chapter 405 (relating to elevators and other lifting devices).
§ 2600.98. Indoor activity space.
(a) The home shall have indoor activity space for activities such as reading, recreation and group activities.
(b) The home shall have at least one furnished living room or lounge area for residents, their families and visitors. The combined living room or lounge areas shall accommodate all residents at one time. These rooms or areas shall contain tables, chairs and lighting to accommodate the residents, their families and visitors.
(c) The home shall have a working television and radio available to residents in a living room or lounge area.
§ 2600.99. Recreation space.
The home shall provide regular access to outdoor and indoor recreation space and recreational items, such as books, newspapers, magazines, puzzles, games, cards and crafts.
§ 2600.100. Exterior conditions.
(a) The exterior of the building and the building grounds or yard must be in good repair and free of hazards.
(b) The home shall ensure that ice, snow and obstructions are removed from outside walkways, ramps, steps, recreational areas and exterior fire escapes.
§ 2600.101. Resident bedrooms.
(a) Each single bedroom must have at least 80 square feet of floor space measured wall to wall, including space occupied by furniture.
(b) Each shared bedroom must have at least 60 square feet of floor space per resident measured wall to wall, including space occupied by furniture.
(c) Each bedroom for one or more residents with a mobility need must have at least 100 square feet per resident, to allow for easy passage between beds and other furniture, and for comfortable use of a resident's assistive devices, including wheelchairs, walkers, special furniture or oxygen equipment. This requirement does not apply if there is a medical order from the attending physician that states the resident can maneuver without the necessity of the additional space. A legal entity with a personal care home license for the home as of October 24, 2005, that has one or more bedrooms serving a resident with physical mobility needs as of October 24, 2005, shall be exempt from the requirements specified in this subsection for the bedroom. If a bedroom is exempt in accordance with this subsection, additional square footage may be required sufficient to accommodate the assistive devices of the resident with mobility needs.
(d) No more than four residents may share a bedroom.
(e) Ceiling height in each bedroom must be an average of at least 7 feet.
(f) Each bedroom must have a window with direct exposure to natural light.
(g) A resident's bedroom shall be used only by the occupying resident and not for activities common to other residents.
(h) A resident shall be able to access toilet, hand washing and bathing facilities without having to pass through another resident's bedroom.
(i) A resident shall have access to his bedroom at all times.
(j) Each resident shall have the following in the bedroom:
(1) A bed with a solid foundation and fire retardant mattress that is in good repair, clean and supports the resident. A legal entity with a personal care home license for the home as of October 24, 2005, shall be exempt from the requirement for a fire retardant mattress.
(2) A chair for each resident that meets the resident's needs.
(3) Pillows, bed linens and blankets that are clean and in good repair.
(4) A storage area for clothing that includes a chest of drawers and a closet or wardrobe space with clothing racks or shelves accessible to the resident.
(5) A bedside table or a shelf.
(6) A mirror.
(7) An operable lamp or other source of lighting that can be turned on at bedside.
(8) If a resident shares a bedroom with other residents, the items specified in paragraphs (4)--(7) may be shared with one other resident.
(k) Cots and portable beds are prohibited.
(l) Bunk beds or other raised beds that require residents to climb steps or ladders to get into or out of bed are prohibited.
(m) A bedroom may not be used as a exit from or used as a passageway to another part of the home unless in an emergency situation.
(n) A resident may not be required to share a bedroom with an individual of the opposite sex.
(o) The bedrooms must have walls, floors and ceilings, which are finished, clean and in good repair.
(p) There must be doors on the bedrooms.
(q) Space for storage of personal property shall be provided in a dry, protected area.
(r) There must be drapes, shades, curtains, blinds or shutters on the bedroom windows. Window coverings must be clean, in good repair, provide privacy and cover the entire window when drawn.
§ 2600.102. Bathrooms.
(a) There shall be at least one functioning flush toilet for every six or fewer users, including residents, staff persons and household members.
(b) There shall be at least one sink and wall mirror for every six or fewer users including residents, staff persons and household members.
(c) There shall be at least one bathtub or shower for every ten or fewer users, including residents, staff persons and household members.
(d) Toilet and bath areas must have grab bars, hand rails or assist bars. Bathtubs and showers must have slip-resistant surfaces.
(e) Privacy shall be provided for toilets, showers and bathtubs by partitions or doors.
(f) An individual towel, washcloth and soap shall be provided for each resident.
(g) Individual toiletry items including toothpaste, toothbrush, shampoo, deodorant, comb and hairbrush shall be made available to residents who are not recipients of SSI. If the home charges for these items, the charges shall be indicated in the resident-home contract. Availability of toiletry items for residents who are recipients of SSI is specified in § 2600.27(d)(1) (relating to SSI recipients).
(h) Toilet paper shall be provided for every toilet.
(i) A dispenser with soap shall be provided within reach of each bathroom sink. Bar soap is not permitted unless there is a separate bar clearly labeled for each resident who shares a bathroom.
(j) Towels and washcloths shall be in the possession of the resident in the resident's living space unless the resident has access to the home's linen supply.
(k) Use of a common towel is prohibited.
(l) Shelves or hooks for the resident's towel and clothing shall be provided.
(m) A legal entity with a personal care home license for the home as of October 24, 2005, shall be exempt from the requirements specified in subsection (c). If a home is exempt in accordance with this subsection, there shall be at least one bathtub or shower for every 15 or fewer users.
§ 2600.103. Food service.
(a) A home shall have access on the grounds to an operable kitchen with a refrigerator, sink, stove, oven, cooking equipment and cabinets or shelves for storage. If the kitchen is not in the home, the home shall have a kitchen area with a refrigerator, cooking equipment, a sink and food storage space.
(b) Kitchen surfaces must be of a nonporous material and cleaned and sanitized after each meal.
(c) Food shall be protected from contamination while being stored, prepared, transported and served.
(d) Food shall be stored off the floor.
(e) Food served and returned from an individual's plate may not be served again or used in the preparation of other dishes. Leftover food shall be labeled and dated.
(f) Food requiring refrigeration shall be stored at or below 40°F. Frozen food shall be kept at or below 0°F. Thermometers are required in refrigerators and freezers.
(g) Food shall be stored in closed or sealed containers.
(h) Food shall be thawed either in the refrigerator, microwave, under cool water or as part of the cooking process.
(i) Outdated or spoiled food or dented cans may not be used.
(j) Eating, drinking and cooking utensils shall be washed, rinsed and sanitized after each use by a method specified in 7 Pa. Code Chapter 46, Subchapter D (relating to equipment, utensils and linen).
§ 2600.104. Dining room.
(a) A dining room area shall be equipped with tables and chairs and able to accommodate the maximum number of residents scheduled for meals at any one time.
(b) Dishes, glassware and utensils shall be provided for eating, drinking, preparing and serving food. These utensils must be clean, and free of chips and cracks. Plastic and paper plates, utensils and cups for meals may not be used on a regular basis.
(c) Condiments shall be available at the dining table.
(d) Adaptive eating equipment or utensils shall be available, if needed, to assist residents in eating at the table.
(e) Breakfast, midday and evening meals shall be served to residents in a dining room except in the following situations:
(1) Service in the resident's room shall be available at no additional charge when the resident is unable to come to the dining room due to illness.
(2) When room service is available in a home, a resident may choose to have a meal served in the resident's room. This service shall be provided at the resident's request and may not replace daily meals in a dining room.
§ 2600.105. Laundry.
(a) Laundry service for bed linens, towels and personal clothing shall be provided by the home, at no additional charge, to residents who are recipients of or eligible applicants for SSI benefits. Laundry service does not include dry cleaning.
(b) Laundry service for bed linens, towels and personal clothing for the residents who are not recipients of SSI shall be provided by the home unless otherwise indicated in the resident-home contract.
(c) The supply of bed linens and towels shall be sufficient to ensure a complete change of bed linen and towels at least once per week.
(d) Bed linens and towels shall be changed at least once every week and more often as needed to maintain sanitary conditions.
(e) Clean linens and towels shall be stored in an area separate from soiled linen and clothing.
(f) Measures shall be implemented to ensure that residents' clothing are not lost or misplaced during laundering or cleaning. The resident's clean clothing shall be returned to the resident within 24 hours after laundering.
(g) To reduce the risks of fire hazards, lint shall be removed from the lint trap and drum of clothes dryers after each use. Lint shall be cleaned from the vent duct and internal and external ductwork of clothes dryers according to the manufacturer's instructions.
§ 2600.106. Swimming areas.
If a home operates a swimming area, the following requirements apply:
(1) Swimming areas shall be operated in accordance with applicable laws and regulations.
(2) Written policy and procedures to protect the health, safety and well-being of the residents shall be developed and implemented.
§ 2600.107. Emergency preparedness.
(a) The administrator shall have a copy and be familiar with the emergency preparedness plan for the municipality in which the home is located.
(b) The home shall have written emergency procedures that include the following:
(1) Contact information for each resident's designated person.
(2) The home's plan to provide the emergency medical information for each resident that ensures confidentiality.
(3) Contact telephone numbers of local and State emergency management agencies and local resources for housing and emergency care of residents.
(4) Means of transportation in the event that relocation is required.
(5) Duties and responsibilities of staff persons during evacuation, transportation and at the emergency location. These duties and responsibilities shall be specific to each resident's emergency needs.
(6) Alternate means of meeting resident needs in the event of a utility outage.
(c) The home shall maintain at least a 3-day supply of nonperishable food and drinking water for residents.
(d) The written emergency procedures shall be reviewed, updated and submitted annually to the local emergency management agency.
§ 2600.108. Firearms and weapons.
Firearms, weapons and ammunition shall be permitted on the licensed premises of a home only when the following conditions are met:
(1) Firearms and weapons shall be contained in a locked cabinet located in a place other than the residents' room or in a common living area.
(2) Ammunition shall be contained in a locked area separate from firearms and weapons, and located in a place other than the residents' room or in a common living area.
(3) The key to the locked cabinet containing the firearms, weapons and ammunition shall be in the possession of the administrator or a designee.
(4) The administrator or a designee shall be the only individual permitted to open the locked cabinet containing the firearms and weapons and the locked area containing the ammunition.
(5) If a firearm, weapon or ammunition is the property of a resident, there shall be a written policy and procedures regarding the safety, access and use of firearms, weapons and ammunition. A resident may not take a firearm, weapon or ammunition out of the locked cabinet into living areas.
§ 2600.109. Pets.
(a) The home rules shall specify whether the home permits pets on the premises.
(b) Cats and dogs present at the home shall have a current rabies vaccination. A current certificate of rabies vaccination from a licensed veterinarian shall be kept.
(c) Pets that are accessible to the residents shall be in good health and nonaggressive to the residents.
(d) If a home has additional charges for pets, the charges shall be included in the resident-home contract.
FIRE SAFETY § 2600.121. Unobstructed egress.
(a) Stairways, hallways, doorways, passageways and egress routes from rooms and from the building must be unlocked and unobstructed.
(b) Doors used for egress routes from rooms and from the building may not be equipped with key-locking devices, electronic card operated systems or other devices which prevent immediate egress of residents from the building, unless the home has written approval or a variance from the Department of Labor and Industry, the Department of Health or the appropriate local building authority.
§ 2600.122. Exits.
Unless otherwise regulated by the Department of Labor and Industry, the Department of Health or the appropriate local building authority, all buildings must have at least two independent and accessible exits from every floor, arranged to reduce the possibility that both will be blocked in an emergency situation.
§ 2600.123. Emergency evacuation.
(a) Exit doors must be equipped so that they can be easily opened by residents from the inside without the use of a key or other manual device that can be removed, misplaced or lost.
(b) Copies of the emergency procedures as specified in § 2600.107 (relating to emergency preparedness) shall be posted in a conspicuous and public place in the home and a copy shall be kept.
(c) For a home serving nine or more residents, an emergency evacuation diagram of each floor showing corridors, line of travel to exit doors and location of the fire extinguishers and pull signals shall be posted in a conspicuous and public place on each floor.
(d) If the home serves one or more residents with mobility needs above or below grade level of the home, there shall be a fire-safe area, as specified in writing within the past year by a fire safety expert, on the same floor as each resident with mobility needs.
§ 2600.124. Notification of local fire officials.
The home shall notify the local fire department in writing of the address of the home, location of the bedrooms and the assistance needed to evacuate in an emergency. Documentation of notification shall be kept.
§ 2600.125. Flammable and combustible materials.
(a) Combustible and flammable materials may not be located near heat sources or hot water heaters.
(b) Combustible materials shall be inaccessible to residents.
§ 2600.126. Furnaces.
(a) A professional furnace cleaning company or trained maintenance staff person shall inspect furnaces at least annually. Documentation of the inspection shall be kept.
(b) Furnaces shall be cleaned according to the manufacturer's instructions. Documentation of the cleaning shall be kept.
§ 2600.127. Space heaters.
(a) Portable space heaters are prohibited.
(b) Nonportable space heaters must be well vented and installed with permanent connections and protectors.
§ 2600.128. Supplemental heating sources.
(a) The use of kerosene burning heaters is prohibited.
(b) Wood and coal burning stoves shall be used only if a local fire department or other municipal fire safety authority, professional cleaning company or trained maintenance staff person inspects and approves them annually. Wood and coal burning stoves that are used as a regular heating source shall be cleaned every year according to the manufacturer's instructions. Documentation of wood and coal burning stove inspections and cleanings shall be kept.
(c) Wood and coal burning stoves must be securely screened or equipped with protective guards while in use.
§ 2600.129. Fireplaces.
(a) A fireplace must be securely screened or equipped with protective guards while in use.
(b) A fireplace chimney and flue shall be cleaned when there is an accumulation of creosote. Written documentation of the cleaning shall be kept.
§ 2600.130. Smoke detectors and fire alarms.
(a) There shall be an operable automatic smoke detector located within 15 feet of each bedroom door.
(b) The smoke detectors specified in subsection (a) shall be located in hallways.
(c) Smoke detectors and fire alarms must be of a type approved by the Department of Labor and Industry, the appropriate local building authority or local fire safety expert, or listed by Underwriters Laboratories.
(d) If the home serves nine or more residents, there shall be at least one smoke detector on each floor interconnected and audible throughout the home or an automatic fire alarm system that is interconnected and audible throughout the home.
(e) If one or more residents or staff persons are not able to hear the smoke detector or fire alarm system, a signaling device approved by a fire safety expert shall be used and tested so that each resident and staff person with a hearing impairment will be alerted in the event of a fire.
(f) Smoke detectors and fire alarms shall be tested for operability at least once per month. A written record of the monthly testing shall be kept.
(g) If a smoke detector or fire alarm becomes inoperative, repair shall be completed within 48 hours of the time the detector or alarm was found to be inoperative.
(h) The home's emergency procedures shall indicate the procedures that will be immediately implemented until the smoke detector or fire alarms are operable.
(i) In homes housing five or more residents with mobility needs, the fire alarm system shall be directly connected to the local fire department or 24-hour monitoring service approved by the local fire department, if this service is available in the community.
§ 2600.131. Fire extinguishers.
(a) There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic.
(b) If the indoor floor area on a floor including the basement or attic is more than 3,000 square feet, there shall be an additional fire extinguisher with a minimum 2-A rating for each additional 3,000 square feet of indoor floor space.
(c) A fire extinguisher with a minimum 2A-10BC rating shall be located in each kitchen. The kitchen extinguisher must meet the requirements for one floor as required in subsection (a).
(d) Fire extinguishers must be listed by Underwriters Laboratories or approved by Factory Mutual Systems.
(e) Fire extinguishers shall be accessible to staff persons. Fire extinguishers shall be kept locked if access to the extinguisher by a resident could cause a safety risk to the resident. If fire extinguishers are kept locked, each staff person shall be able to immediately unlock the fire extinguisher in the event of a fire emergency.
(f) Fire extinguishers shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher.
§ 2600.132. Fire drills.
(a) An unannounced fire drill shall be held at least once a month.
(b) A fire safety inspection and fire drill conducted by a fire safety expert shall be completed annually. Documentation of this fire drill and fire safety inspection shall be kept.
(c) A written fire drill record must include the date, time, the amount of time it took for evacuation, the exit route used, the number of residents in the home at the time of the drill, the number of residents evacuated, the number of staff persons participating, problems encountered and whether the fire alarm or smoke detector was operative.
(d) Residents shall be able to evacuate the entire building to a public thoroughfare, or to a fire-safe area designated in writing within the past year by a fire safety expert within the period of time specified in writing within the past year by a fire safety expert. For purposes of this subsection, the fire safety expert may not be a staff person of the home.
(e) A fire drill shall be held during sleeping hours once every 6 months.
(f) Alternate exit routes shall be used during fire drills.
(g) Fire drills shall be held on different days of the week, at different times of the day and night, not routinely held when additional staff persons are present and not routinely held at times when resident attendance is low.
(h) Residents shall evacuate to a designated meeting place away from the building or within the fire-safe area during each fire drill.
(i) A fire alarm or smoke detector shall be set off during each fire drill.
(j) Elevators may not be used during a fire drill or a fire.
§ 2600.133. Exit signs.
The following requirements apply for a home serving nine or more residents:
(1) Signs bearing the word ''EXIT'' in plain legible letters shall be placed at all exits.
(2) If the exit or way to reach the exit is not immediately visible, access to exits shall be marked with readily visible signs indicating the direction to travel.
(3) Exit sign letters must be at least 6 inches in height with the principal strokes of letters at least 3/4 inch wide.
RESIDENT HEALTH § 2600.141. Resident medical evaluation and health care.
(a) A resident shall have a medical evaluation by a physician, physician's assistant or certified registered nurse practitioner documented on a form specified by the Department, within 60 days prior to admission or within 30 days after admission. The evaluation must include the following:
(1) A general physical examination by a physician, physician's assistant or nurse practitioner.
(2) Medical diagnosis including physical or mental disabilities of the resident, if any.
(3) Medical information pertinent to diagnosis and treatment in case of an emergency.
(4) Special health or dietary needs of the resident.
(5) Allergies.
(6) Immunization history.
(7) Medication regimen, contraindicated medications, medication side effects and the ability to self-administer medications.
(8) Body positioning and movement stimulation for residents, if appropriate.
(9) Health status.
(10) Mobility assessment, updated annually or at the Department's request.
(b) A resident shall have a medical evaluation:
(1) At least annually.
(2) If the medical condition of the resident changes prior to the annual medical evaluation.
§ 2600.142. Assistance with health care.
(a) The home shall assist the resident to secure medical care if a resident's health status declines. The home shall document the resident's need for the medical care, including updating the resident's assessment and support plan.
(b) If a resident refuses routine medical or dental examination or treatment, the refusal and the continued attempts to educate and inform the resident about the need for health care shall be documented in the resident's record.
(c) If a resident has a serious medical or dental condition, reasonable efforts shall be made to obtain consent for treatment from the resident or the resident's designated person.
(d) The home shall assist the resident to secure preventative medical, dental, vision and behavioral health care as requested by a physician, physician's assistant or certified registered nurse practitioner.
§ 2600.143. Emergency medical plan.
(a) The home shall have a written emergency medical plan that includes the following:
(1) The hospital or source of health care that will be used in an emergency. This shall be the resident's choice, if possible.
(2) Emergency transportation to be used.
(3) An emergency-staffing plan.
(b) The following current emergency medical and health information shall be available at all times for each resident and shall accompany the resident when the resident needs emergency medical attention:
(1) The resident's name and birth date.
(2) The resident's Social Security number.
(3) The resident's medical diagnosis.
(4) The resident's physician's name and telephone number.
(5) Current medication, including the dosage and frequency.
(6) A list of allergies.
(7) Other relevant medical conditions.
(8) Insurance or third party payer and identification number.
(9) The power of attorney for health care or health care proxy, if applicable.
(10) The resident's designated person with current address and telephone number.
(11) Personal information and related instructions regarding advance directives, do not resuscitate orders or organ donation, if applicable.
§ 2600.144. Use of tobacco.
(a) A home may permit smoking tobacco in a designated smoking room of the home.
(b) The home rules shall specify whether the home is designated as smoking or nonsmoking.
(c) A home that permits smoking inside or outside of the home shall develop and implement written fire safety policy and procedures that include the following:
(1) Proper safeguards inside and outside of the home to prevent fire hazards involved in smoking, including providing fireproof receptacles and ashtrays, direct outside ventilation, no interior ventilation from the smoking room through other parts of the home, extinguishing procedures, fire resistant furniture both inside and outside the home and fire extinguishers in the smoking rooms.
(2) Location of a smoking room or outside smoking area a safe distance from heat sources, hot water heaters, combustible or flammable materials and away from common walkways and exits.
(3) Prohibition of the use of tobacco during transportation by the home.
(d) Smoking outside of the smoking room is prohibited.
NUTRITION § 2600.161. Nutritional adequacy.
(a) Meals shall be offered that meet the recommended dietary allowances established by the United States Department of Agriculture.
(b) At least three nutritionally well-balanced meals shall be offered daily to the resident. Each meal shall include an alternative food and drink item from which the resident may choose.
(c) Additional portions of meals and beverages at mealtimes shall be available for the resident.
(d) A resident's special dietary needs as prescribed by a physician, physician's assistant, certified registered nurse practitioner or dietitian shall be met. Documentation of the resident's special dietary needs shall be kept in the resident's record.
(e) Dietary alternatives shall be available for a resident who has special health needs or religious beliefs regarding dietary restrictions.
(f) Drinking water shall be available to the residents at all times.
§ 2600.162. Meals.
(a) There may not be more than 15 hours between the evening meal and the first meal of the next day. There may not be more than 6 hours between breakfast and lunch, and between lunch and supper. This requirement does not apply if a resident's physician has prescribed otherwise.
(b) When a resident misses a meal, food adequate to meet daily nutritional requirements shall be available and offered to the resident.
(c) Menus, stating the specific food being served at each meal, shall be prepared for 1 week in advance and shall be followed. Weekly menus shall be posted 1 week in advance in a conspicuous and public place in the home.
(d) Past menus of meals that were served, including changes, shall be kept for at least 1 month.
(e) A change to a menu shall be posted in a conspicuous and public place in the home and shall be accessible to a resident in advance of the meal. Meal substitutions shall be made in accordance with § 2600.161 (relating to nutritional adequacy).
§ 2600.163. Personal hygiene for food service workers.
(a) Staff persons, volunteers and residents involved in the storage, preparation, serving and distributing of food shall wash their hands with hot water and soap prior to working in the kitchen areas and after using the bathroom.
(b) Staff persons, volunteers and residents shall follow sanitary practices while working in the kitchen areas.
(c) Staff persons, volunteers and residents involved with the storage, preparation, serving and distributing of food shall be in good health.
(d) Staff persons, volunteers and residents who have a discharging or infected wound, sore, lesion on hands, arms or any exposed portion of their body may not work in the kitchen areas in any capacity.
§ 2600.164. Withholding or forcing of food prohibited.
(a) A home may not withhold meals, beverages, snacks or desserts as punishment. Food and beverages may be withheld in accordance with prescribed medical or dental procedures.
(b) A resident may not be forced to eat food.
(c) If a resident refuses to eat or drink continuously during a 24-hour period, the resident's primary care physician and the resident's designated person shall be immediately notified.
(d) If a resident has a cognitive impairment that affects the resident's ability to consume adequate amounts of food and water, a staff person shall encourage and remind the resident to eat and drink.
TRANSPORTATION § 2600.171. Transportation.
(a) A home may not be required to provide transportation.
(b) The following requirements apply whenever staff persons or volunteers of the home provide transportation for the resident:
(1) The occupants of the vehicle shall be in an appropriate safety restraint at all times the vehicle is in motion.
(2) The driver of a vehicle shall be 18 years of age or older and possess a valid driver's license.
(3) The driver of the home vehicle cannot be a resident.
(4) At least one staff member transporting or accompanying the residents shall have completed the initial new hire direct care staff person training as specified in § 2600.65 (relating to direct care staff training and orientation).
(5) The vehicle must have a first aid kit with the contents as specified in § 2600.96 (relating to first aid kit).
(6) During vehicle operations, the driver may only use a hands-free cellular telephone.
(7) Transportation shall include, when necessary, an assistant to the driver who assists the driver to escort residents in and out of the home and provides assistance during the trip.
(c) The home shall maintain current copies of the following documentation for each of the home's vehicles used to transport residents:
(1) Vehicle registration.
(2) Valid driver's license for vehicle operator.
(3) Vehicle insurance.
(4) Current inspection.
(5) Commercial driver's license for vehicle operator if applicable.
(d) The home shall assist a resident with the coordination of transportation to and from medical appointments, if requested by the 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) If assistance includes helping the resident to remember the schedule for taking the medication, the resident shall be reminded of the prescribed schedule.
(c) The resident's assessment shall identify if the resident is able to self-administer medications as specified in § 2600.227(e) (relating to development of the support plan). A resident who desires to self-administer medications shall be assessed by a physician, physician's assistant or certified registered nurse practitioner regarding the ability to self-administer and the need for medication reminders.
(d) If the resident does not need assistance with medication, medication may be stored in a resident's room for self-administration. Medications stored in the resident's room shall be kept locked in a safe and secure location to protect against contamination, spillage and theft.
(e) To be considered capable to self-administer medications, a resident shall:
(1) Be able to recognize and distinguish his medication.
(2) Know how much medication is to be taken.
(3) Know when medication is to be taken.
(f) The resident's record shall include a current list of prescription, CAM and OTC medications for each resident who is self-administering his medication.
§ 2600.182. Medication administration.
(a) A home may provide medication administration services for a resident who is assessed to need medication administration services in accordance with § 2600.181 (relating to self-administration) and for a resident who chooses not to self-administer medications. If a home does not provide medication administration services, the resident shall be referred to an appropriate assessment agency.
(b) Prescription medication that is not self-administered by a resident shall be administered by one of the following:
(1) A physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic.
(2) A graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the home.
(3) A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the home.
(4) A staff person who has completed the medication administration training as specified in § 2600.190 (relating to medication administration training) for the administration of oral; topical; eye, nose and ear drop prescription medications; insulin injections and epinephrine injections for insect bites or other allergies.
(c) Medication administration includes the following activities, based on the needs of the resident:
(1) Identify the correct resident.
(2) If indicated by the prescriber's orders, measure vital signs and administer medications accordingly.
(3) Remove the medication from the original container.
(4) Crush or split the medication as ordered by the prescriber.
(5) Place the medication in a medication cup or other appropriate container, or in the resident's hand.
(6) Place the medication in the resident's hand, mouth or other route as ordered by the prescriber, in accordance with the limitations specified in subsection (b)(4).
(7) Complete documentation in accordance with § 2600.187 (relating to medication records).
§ 2600.183. Storage and disposal of medications and medical supplies.
(a) Prescription medications, OTC medications and CAM 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 insulin and epinephrine injections and sterile liquids shall be provided immediately upon removal of the medication from its container.
(b) Prescription medications, OTC medications, CAM and syringes shall be kept in an area or container that is locked. This includes medications and syringes kept in the resident's room.
(c) Prescription medications, OTC medications and CAM stored in a refrigerator shall be kept in an area or container that is locked.
(d) Only current prescription, OTC, sample and CAM for individuals living in the home may be kept in the home.
(e) Prescription medications, OTC medications and CAM shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions.
(f) Prescription medications, OTC medications and CAM that are discontinued, expired or for residents who are no longer served at the home shall be destroyed in a safe manner according to the Department of Environmental Protection and 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) Subsections (a) and (e) do not apply to a resident who self-administers medication and stores the medication in his room.
§ 2600.184. Labeling of medications.
(a) The original container for prescription medications shall be labeled with a pharmacy label that includes the following:
(1) The resident's name.
(2) The name of the medication.
(3) The date the prescription was issued.
(4) The prescribed dosage and instructions for administration.
(5) The name and title of the prescriber.
(b) If the OTC medications and CAM belong to the resident, they shall be identified with the resident's name.
(c) Sample prescription medications shall have written instructions from the prescriber that include the components specified in subsection (a).
§ 2600.185. Accountability of medication and controlled substances.
(a) The home shall develop and implement procedures for the safe storage, access, security, distribution and use of medications and medical equipment by trained staff persons.
(b) At a minimum, the procedures must include:
(1) Documentation of the receipt of controlled substances and prescription medications.
(2) A process to investigate and account for missing medications and medication errors.
(3) Limited access to medication storage areas.
(4) Documentation of the administration of prescription medications, OTC medications and CAM for residents who receive medication administration services or assistance with self-administration. This requirement does not apply to a resident who self-administers medication without the assistance of a staff person and stores the medication in his room.
§ 2600.186. Prescription medications.
(a) Each prescription medication must be prescribed in writing by an authorized prescriber. Prescription orders shall be kept current.
(b) Prescription medications shall be used only by the resident for whom the prescription was prescribed.
(c) Changes in medication may only be made in writing by the prescriber, or in the case of an emergency, an alternate prescriber, except for circumstances in which oral orders may be accepted by nurses in accordance with regulations of the Department of State. The resident's medication record shall be updated as soon as the home receives written notice of the change.
§ 2600.187. Medication records.
(a) A medication record shall be kept to include the following for each resident for whom medications are administered:
(1) Resident's name.
(2) Drug allergies.
(3) Name of medication.
(4) Strength.
(5) Dosage form.
(6) Dose.
(7) Route of administration.
(8) Frequency of administration.
(9) Administration times.
(10) Duration of therapy, if applicable.
(11) Special precautions, if applicable.
(12) Diagnosis or purpose for the medication, including pro re nata (PRN).
(13) Date and time of medication administration.
(14) Name and initials of the staff person administering the medication.
(b) The information in subsection (a)(13) and (14) shall be recorded at the time the medication is administered.
(c) If a resident refuses to take a prescribed medication, the refusal shall be documented in the resident's record and on the medication record. The refusal shall be reported to the prescriber within 24 hours, unless otherwise instructed by the prescriber. Subsequent refusals to take a prescribed medication shall be reported as required by the prescriber.
(d) The home shall follow the directions of the prescriber.
§ 2600.188. Medication errors.
(a) Medication errors include the following:
(1) Failure to administer a medication.
(2) Administration of the wrong medication.
(3) Administration of the wrong amount of medication.
(4) Failure to administer a medication at the prescribed time.
(5) Administration to the wrong resident.
(6) Administration through the wrong route.
(b) A medication error shall be immediately reported to the resident, the resident's designated person and the prescriber.
(c) Documentation of medication errors and the prescriber's response shall be kept in the resident's record.
(d) There shall be a system in place to identify and document medication errors and the home's pattern of error.
(e) There shall be documentation of the follow-up action that was taken to prevent future medication errors.
§ 2600.189. Adverse reaction.
(a) If a resident has a suspected adverse reaction to a medication, the home shall immediately consult a physician or seek emergency medical treatment. The resident's designated person shall be notified, if applicable.
(b) The home shall document adverse reactions, the prescriber's response and any action taken in the resident's record.
§ 2600.190. Medication administration training.
(a) A staff person who has successfully completed a Department-approved medications administration course that includes the passing of the Department's performance-based competency test within the past 2 years may administer oral; topical; eye, nose and ear drop prescription medications and epinephrine injections for insect bites or other allergies.
(b) A staff person is permitted to administer insulin injections following successful completion of a Department-approved medications administration course that includes the passing of a written performance-based competency test within the past 2 years, as well as successful completion of a Department-approved diabetes patient education program within the past 12 months.
(c) A record of the training shall be kept including the staff person trained, the date, source, name of trainer and documentation that the course was successfully completed.
§ 2600.191. Resident education.
The home shall educate the resident of the right to question or refuse a medication if the resident believes there may be a medication error. Documentation of this resident education shall be kept.
SAFE MANAGEMENT TECHNIQUES § 2600.201. Safe management techniques.
The home shall use positive interventions to modify or eliminate a behavior that endangers the resident himself or others. Positive interventions include improving communications, reinforcing appropriate behavior, redirection, conflict resolution, violence prevention, praise, deescalation techniques and alternative techniques or methods to identify and defuse potential emergency situations.
§ 2600.202. Prohibitions.
The following procedures are prohibited:
(1) Seclusion, defined as involuntary confinement of a resident in a room from which the resident is physically prevented from leaving, is prohibited. This does not include the admission of a resident in a secured dementia care unit in accordance with § 2600.231 (relating to admission).
(2) Aversive conditioning, defined as the application of startling, painful or noxious stimuli, is prohibited.
(3) Pressure point techniques, defined as the application of pain for the purpose of achieving compliance, is prohibited.
(4) A chemical restraint, defined as use of drugs or chemicals for the specific and exclusive purpose of controlling acute or episodic aggressive behavior, is prohibited. A chemical restraint does not include a drug ordered by a physician or dentist to treat the symptoms of a specific mental, emotional or behavioral condition, or as pretreatment prior to a medical or dental examination or treatment.
(5) A mechanical restraint, defined as a device that restricts the movement or function of a resident or portion of a resident's body, is prohibited. Mechanical restraints include geriatric chairs, handcuffs, anklets, wristlets, camisoles, helmet with fasteners, muffs and mitts with fasteners, poseys, waist straps, head straps, papoose boards, restraining sheets, chest restraints and other types of locked restraints. A mechanical restraint does not include a device used to provide support for the achievement of functional body position or proper balance that has been prescribed by a medical professional as long as the resident can easily remove the device.
(6) A manual restraint, defined as a hands-on physical means that restricts, immobilizes or reduces a resident's ability to move his arms, legs, head or other body parts freely, is prohibited. A manual restraint does not include prompting, escorting or guiding a resident to assist in the ADLs or IADLs.
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