[35 Pa.B. 2499]
[Continued from previous Web Page]
SERVICES § 2600.221. Activities program.
(a) The administrator shall develop a program of activities designed to promote each resident's active involvement with other residents, the resident's family and the community.
(b) The program must provide social, physical, intellectual and recreational activities in a planned, coordinated and structured manner.
(c) A current weekly activity calendar shall be posted in a conspicuous and public place in the home.
§ 2600.222. Community social services.
Residents shall be encouraged and assisted in the access to and use of social services in the community which may benefit the resident, including a county mental health and mental retardation program, a drug and alcohol program, a senior citizens center, an area agency on aging or a home health care agency.
§ 2600.223. Description of services.
(a) The home shall have a current written description of services and activities that the home provides including the following:
(1) The scope and general description of the services and activities that the home provides.
(2) The criteria for admission and discharge.
(3) Specific services that the home does not provide, but will arrange or coordinate.
(b) The home shall develop written procedures for the delivery and management of services from admission to discharge.
§ 2600.224. Preadmission screening.
(a) A determination shall be made within 30 days prior to admission and documented on the Department's preadmission screening form that the needs of the resident can be met by the services provided by the home.
(b) An applicant whose personal care service needs cannot be met by the home shall be referred to a local appropriate assessment agency.
(c) The preadmission screening shall be completed by the administrator or designee. If the resident is referred by a State-operated facility, a county mental health and mental retardation program, a drug and alcohol program or an area agency on aging, a representative of the referral agent may complete the preadmission screening.
§ 2600.225. Initial and annual assessment.
(a) A resident shall have a written initial assessment that is documented on the Department's assessment form within 15 days of admission. The administrator or designee, or a human service agency may complete the initial assessment.
(b) A home may use its own assessment form if it includes the same information as the Department's assessment form.
(c) The resident shall have additional assessments as follows:
(1) Annually.
(2) If the condition of the resident significantly changes prior to the annual assessment.
(3) At the request of the Department upon cause to believe that an update is required.
(d) If the resident's physician or appropriate assessment agency determines that the resident requires a higher level of care, a plan for placement shall be made as soon as possible by the administrator in conjunction with the resident or designated person, or both.
§ 2600.226. Mobility criteria.
(a) The resident shall be assessed for mobility needs as part of the resident's assessment.
(b) If a resident is determined to have mobility needs as part of the initial or annual assessment, specific requirements relating to the care, health and safety of the resident shall be met immediately.
(c) The administrator shall notify the Department's personal care home regional office within 30 days after a resident with mobility needs is admitted to the home or the date when a resident develops mobility needs.
§ 2600.227. Development of the support plan.
(a) A resident requiring personal care services shall have a written support plan developed and implemented within 30 days of admission to the home. The support plan shall be documented on the Department's support plan form.
(b) A home may use its own support plan form if it includes the same information as the Department's support plan form.
(c) The support plan shall be revised within 30 days upon completion of the annual assessment or upon changes in the resident's needs as indicated on the current assessment.
(d) Each home shall document in the resident's support plan the medical, dental, vision, hearing, mental health or other behavioral care services that will be made available to the resident, or referrals for the resident to outside services if the resident's physician, physician's assistant or certified registered nurse practitioner, determine the necessity of these services. This requirement does not require a home to pay for the cost of these medical and behavioral care services.
(e) The resident's support plan must document the ability of the resident to self-administer medications or the need for medication reminders or medication administration.
(f) A resident may participate in the development and implementation of the support plan. A resident may include a designated person in making decisions about services.
(g) Individuals who participate in the development of the support plan shall sign and date the support plan.
(h) If a resident or designated person is unable or chooses not to sign the support plan, a notation of inability or refusal to sign shall be documented.
(i) The support plan shall be accessible by direct care staff persons at all times.
(j) The home shall give a copy of the support plan to the resident and the resident's designated person upon request.
§ 2600.228. Notification of termination.
(a) At the resident's request, the home shall provide assistance in relocating to the resident's own home or to another residence that meets the needs of the resident.
(b) If the home initiates a discharge or transfer of a resident, or if the legal entity chooses to close the home, the home shall provide a 30-day advance written notice to the resident, the resident's designated person and the referral agent citing the reasons for the discharge or transfer. This shall be stipulated in the resident-home contract. A 30-day advance written 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, as certified by a physician or the Department. This may occur when the resident needs psychiatric or long-term care or is abused in the home, or the Department initiates closure of the home.
(c) A home shall give the Department written notice of its intent to close the home, at least 60 days prior to the anticipated date of closing.
(d) A home may not require a resident to leave the home prior to 30 days following the resident's receipt of a written notice from the home regarding the intended closure of the home, except when the Department determines that removal of the resident at an earlier time is necessary for the protection of the health, safety and well-being of the resident.
(e) The date and reason for the discharge or transfer, and the destination of the resident, if known, shall be recorded in the resident record.
(f) If the legal entity chooses to voluntarily close the home or if the Department has initiated legal action to close the home, the Department working in conjunction with appropriate local authorities, will offer relocation assistance to the residents. Except in the case of an emergency, each resident may participate in planning the transfer, and shall have the right to choose among the available alternatives after an opportunity to visit the alternative homes. These procedures shall apply even if the resident is placed in a temporary living situation.
(g) Within 30 days of the home's closure, the legal entity shall return the license to the Department's personal care home regional office.
(h) The only grounds for discharge or transfer of a resident from a home are for the following conditions:
(1) If a resident is a danger to himself or others.
(2) If the legal entity chooses to voluntarily close the home, or a portion of the home.
(3) If a home determines that a resident's functional level has advanced or declined so that the resident's needs cannot be met in the home. If a resident or the resident's designated person disagrees with the home's decision to discharge or transfer, consultation with an appropriate assessment agency or the resident's physician shall be made to determine if the resident needs a higher level of care. A plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident and the resident's designated person, if any. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/mental retardation program or drug and alcohol program, for assistance. The administrator shall also contact the Department's personal care home regional office.
(4) If meeting the resident's needs would require a fundamental alteration in the home's program or building site, or would create an undue financial or programmatic burden on the home.
(5) If the resident has failed to pay after reasonable documented efforts by the home to obtain payment.
(6) If closure of the home is initiated by the Department.
(7) Documented, repeated violation of the home rules.
SECURED DEMENTIA CARE UNITS § 2600.231. Admission.
(a) This section and §§ 2600.232--2600.239 apply to secured dementia care units. These provisions are in addition to the other provisions of this chapter. A secured dementia care unit is a home or portion of a home that provides specialized care and services for residents with Alzheimer's disease or other dementia.
(b) A resident shall have a medical evaluation by a physician, physician's assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior to admission. Documentation shall include the resident's diagnosis of Alzheimer's disease or other dementia and the need for the resident to be served in a secured dementia care unit.
(c) A written cognitive preadmission screening completed in collaboration with a physician or a geriatric assessment team and documented on the Department's preadmission screening form shall be completed for each resident within 72 hours prior to admission to a secured dementia care unit.
(d) A geriatric assessment team is a group of multidisciplinary specialists in the care of adults who are older that conducts a multidimensional evaluation of a resident and assists in developing a support plan by working with the resident's physician, designated person and family to coordinate the resident's care.
(e) Each resident record must have documentation that the resident and the resident's designated person have not objected to the resident's admission or transfer to the secured dementia care unit.
(f) In addition to the requirements in § 2600.225 (relating to initial and annual assessment), the resident shall also be assessed annually for the continuing need for the secured dementia care unit.
(g) An individual who does not have a primary diagnosis of Alzheimer's disease or other dementia may reside in the secured dementia care unit if desired by the resident.
(1) The individual shall have a medical evaluation by a physician, physician's assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior to residence or 30 days after residence.
(2) If the medical evaluation shows that personal care services are needed, the requirements of this chapter apply.
(3) The individual shall have access to and be able to follow directions for the operation of the key pads or other lock-releasing devices to exit the secured dementia care unit.
(h) The resident-home contract specified in § 2600.25 (relating to resident-home contract) must also include a disclosure of services, admission and discharge criteria, change in condition policies, special programming and costs and fees.
§ 2600.232. Environmental protection.
(a) The home shall provide exercise space, both indoor and outdoor.
(b) No more than two residents may occupy a bedroom regardless of its size. A bedroom shall meet the requirement in § 2600.101(a), (b) or (c) (relating to resident bedrooms), as applicable. Section 2600.101(d) does not apply to a secured dementia care unit.
(c) The home shall provide space for dining, group and individual activities and visits.
(d) The home shall provide a full description of the measures taken to enhance environmental awareness and maximize independence of the residents. The measures to enhance environmental awareness and maximize independence of the residents shall be implemented.
§ 2600.233. Doors, locks and alarms.
(a) Doors equipped with key-locking devices, electronic card operated systems or other devices that prevent immediate egress are permitted only if there is written approval from the Department of Labor and Industry, Department of Health or appropriate local building authority permitting the use of the specific locking system.
(b) A home shall have a statement from the manufacturer, specific to that home, verifying that the electronic or magnetic locking system will shut down, and that all doors will open easily and immediately when one of more of the following occurs:
(1) Upon a signal from an activated fire alarm system, heat or smoke detector.
(2) Power failure to the home.
(3) Overriding the electronic or magnetic locking system by use of a key pad or other lock-releasing device.
(c) If key-locking devices, electronic cards systems or other devices that prevent immediate egress are used to lock and unlock exits, directions for their operation shall be conspicuously posted near the device.
(d) Doors that open onto areas such as parking lots, or other potentially unsafe areas, shall be locked by an electronic or magnetic system.
(e) Fire alarm systems shall be interconnected to the local fire department, when available, or a 24-hour monitoring service approved by the local fire department.
§ 2600.234. Resident care.
(a) Within 72 hours of the admission, or within 72 hours prior to the resident's admission to the secured dementia care unit, a support plan shall be developed, implemented and documented in the resident record.
(b) The support plan must identify the resident's physical, medical, social, cognitive and safety needs.
(c) The support plan must identify the individual responsible to address the resident's needs.
(d) The support plan shall be revised at least annually and as the resident's condition changes.
(e) The resident or the resident's designated person shall be involved in the development and the revisions of the support plan.
§ 2600.235. Discharge.
If the home initiates a discharge or transfer of a resident, or the legal entity chooses to close the home, the administrator shall give a 30-day advance written notice to the resident, the resident's designated person and the referral agent citing the reasons for the discharge or transfer. This requirement shall be stipulated in the resident-home contract signed prior to admission to the secured dementia care unit.
§ 2600.236. Training.
Each direct care staff person working in a secured dementia care unit shall have 6 hours of annual training related to dementia care and services, in addition to the 12 hours of annual training specified in § 2600.65 (relating to direct care staff person training and orientation).
§ 2600.237. Program.
(a) The following types of activities shall be offered at least weekly:
(1) Gross motor activities, such as dancing, stretching and other exercise.
(2) Self-care activities, such as personal hygiene.
(3) Social activities, such as games, music and holiday and seasonal celebrations.
(4) Crafts, such as sewing, decorations and pictures.
(5) Sensory and memory enhancement activities, such as review of current events, movies, story telling, picture albums, cooking, pet therapy and reminiscing.
(6) Outdoor activities, as weather permits, such as walking, gardening and field trips.
(b) Resident participation in general activity programming shall:
(1) Be voluntary.
(2) Respect the resident's age and cognitive abilities.
(3) Support the retention of the resident's abilities.
§ 2600.238. Staffing.
Each resident in a secured dementia care unit shall be considered to be a resident with mobility needs under § 2600.57(c) (relating to direct care staffing).
§ 2600.239. Notification to Department.
(a) The legal entity shall submit a written request to the Department's personal care home regional office at least 60 days prior to the following:
(1) Opening a secured care dementia unit.
(2) Adding a secured dementia care unit to an existing home.
(3) Increasing the maximum capacity in an existing unit.
(4) Changing the locking system, exit doors or floor plan of an existing unit.
(b) The Department will inspect and approve the secured care dementia unit prior to operation or change. The requirements of this chapter shall be met prior to operation.
(c) The following documents shall be included in the written request specified in subsection (a):
(1) The name, address and legal entity of the home.
(2) The name of the administrator of the home.
(3) The maximum capacity of the home.
(4) The requested resident population of the secured dementia care unit.
(5) A building description.
(6) A unit description.
(7) The type of locking system.
(8) Policy and procedures to be implemented for emergency egress and resident elopement.
(9) A sample of a 2-week staffing schedule.
(10) Verification of completion of additional training requirements.
(11) The operational description of the secured dementia care unit locking system of the doors.
(12) The manufacturer's statement regarding the secured dementia care unit locking system.
(13) A written approval or a variance permitting locked exit doors from the Department of Labor and Industry, the Department of Health or the appropriate local building authority.
(14) The name of the municipality or 24-hour monitoring service maintaining the interconnection with the home's fire alarm system.
(15) A sample plan of care and service for the resident addressing the resident's physical, medical, social, cognitive and safety needs for the residents.
(16) The activity standards.
(17) The complete medical and cognitive preadmission assessment, that is completed upon admission and reviewed and updated annually.
(18) A consent form agreeing to the resident's placement in the secured unit, to be signed by the resident or the resident's designated person.
(19) A written agreement containing full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming, costs and fees.
(20) A description of environmental cues being utilized.
(21) A general floor plan of the entire home.
(22) A specific floor plan of the secured dementia care unit, outside enclosed area and exercise space.
RESIDENT RECORDS § 2600.251. Resident records.
(a) A separate record shall be kept for each resident.
(b) The entries in a resident's record must be permanent, legible, dated and signed by the staff person making the entry.
(c) The home shall use standardized forms to record information in the resident's record.
(d) Separate resident records shall be kept on the premises where the resident lives.
(e) Resident records shall be made available to the resident and the resident's designated person during normal working hours.
§ 2600.252. Content of resident records.
Each resident's record must include the following information:
(1) Name, gender, admission date, birth date and Social Security number.
(2) Race, height, weight, color of hair, color of eyes, religious affiliation, if any, and identifying marks.
(3) A photograph of the resident that is no more than 2 years old.
(4) Language or means of communication spoken or used by the resident.
(5) The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency.
(6) The name, address and telephone number of the resident's physician or source of health care.
(7) The current and previous 2 years' physician's examination reports, including copies of the medical evaluation forms.
(8) A list of prescribed medications, OTC medications and CAM.
(9) Dietary restrictions.
(10) A record of incident reports for the individual resident.
(11) A list of allergies.
(12) The documentation of health care services and orders, including orders for the services of visiting nurse or home health agencies.
(13) The preadmission screening, initial intake assessment and the most current version of the annual assessment.
(14) A support plan.
(15) Applicable court order, if any.
(16) The resident's medical insurance information.
(17) The date of entrance into the home, relocations and discharges, including the transfer of the resident to other homes owned by the same legal entity.
(18) An inventory of the resident's personal property as voluntarily declared by the resident upon admission and voluntarily updated.
(19) An inventory of the resident's property entrusted to the administrator for safekeeping.
(20) The financial records of residents receiving assistance with financial management.
(21) The reason for termination of services or transfer of the resident, the date of transfer and the destination.
(22) Copies of transfer and discharge summaries from hospitals, if available.
(23) If the resident dies in the home, a copy of the official death certificate.
(24) Signed notification of rights, grievance procedures and applicable consent to treatment protections specified in § 2600.41 (relating to notification of rights and complaint procedures).
(25) A copy of the resident-home contract.
(26) A termination notice, if any.
§ 2600.253. Record retention and disposal.
(a) The resident's entire record shall be maintained for a minimum of 3 years following the resident's discharge from the home or until any audit or litigation is resolved.
(b) Records shall be destroyed in a manner that protects confidentiality.
(c) The home shall keep a log of resident records destroyed on or after October 24, 2005. This log must include the resident's name, record number, birth date, admission date and discharge date.
(d) Records required under this chapter that are not part of the resident records shall be kept for a minimum of 3 years or until any audit or litigation is resolved.
§ 2600.254. Record access and security.
(a) Records of active and discharged residents shall be maintained in a confidential manner, which prevents unauthorized access.
(b) Each home shall develop and implement policy and procedures addressing record accessibility, security, storage, authorized use and release and who is responsible for the records.
(c) Resident records shall be stored in locked containers or a secured, enclosed area used solely for record storage and be accessible at all times to the administrator or the administrator's designee, and upon request, to the Department or representatives of the area agency on aging.
ENFORCEMENT § 2600.261. Classification of violations.
(a) The Department will classify each violation of this chapter into one of three categories as described in paragraphs (1)--(3). A violation identified may be classified as Class I, Class II or Class III, depending upon the severity, duration and the adverse effect on the health and safety of residents.
(1) Class I. Class I violations have a substantial probability of resulting in death or serious mental or physical harm to a resident.
(2) Class II. Class II violations have a substantial adverse effect upon the health, safety or well-being of a resident.
(3) Class III. Class III violations are minor violations, which have an adverse effect upon the health, safety or well-being of a resident.
(b) The Department's guidelines for determining the classification of violations are available from the Department's personal care home regional office.
§ 2600.262. Penalties.
(a) The Department will assess a penalty for each violation of this chapter.
(b) Penalties will be assessed on a daily basis from the date on which the citation was issued until the date the violation is corrected, except in the case of Class II and Class III violations.
(c) In the case of a Class II violation, assessment of the penalty will be suspended for 5 days from the date of citation to permit sufficient time for the home to correct the violation. 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 citation. The Department may extend the time period for good cause.
(d) The Department will assess a penalty of $20 per resident per day for each Class I violation. Each Class I violation shall be corrected within 24 hours.
(e) The Department will assess a minimum penalty of $5 per resident per day, up to a maximum penalty of $15 per resident per day, for each Class II violation.
(f) There is no monetary penalty for Class III violations unless the home fails to correct the violation within 15 days. Failure to correct a Class III violation within the 15-day period may result in a penalty assessment of up to $3 per resident per day for each Class III violation retroactive to the date of the citation.
(g) If a home is found to be operating without a license, a penalty of $500 will be assessed. After 14 days, if the home operator cited for operating without a license fails to file an application for a license, the Department will assess an additional $20 for each resident for each day during which the home operator fails to apply.
(h) A home charged with a violation of this chapter or Chapter 20 (relating to licensure or approval of facilities and agencies) has 30 days to pay the assessed penalty in full.
§ 2600.263. Appeals of penalty.
(a) If the home that is fined intends to appeal the amount of the penalty or the fact of the violation, the home shall forward the assessed penalty, not to exceed $500, to the Secretary for placement in an escrow account with the State Treasurer. A letter appealing the penalty shall be submitted with the assessed penalty. This process constitutes an appeal.
(b) If, through an administrative hearing or judicial review of the proposed penalty, it is determined that no violation occurred or that the amount of the penalty shall be reduced, the Secretary will, within 30 days, remit the appropriate amount to the legal entity together with interest accumulated on these funds in the escrow deposit.
(c) Failure to forward payment of the assessed penalty to the Secretary within 30 days will result in a waiver of the right to contest the fact of the violation or the amount of the penalty.
(d) After an administrative hearing decision that is adverse to the legal entity, or a waiver of the administrative hearing, the assessed penalty amount will be made payable to the ''Commonwealth of Pennsylvania.'' It will be collectible in a manner provided by law for the collection of debts.
(e) If a home liable to pay the penalty neglects or refuses to pay the penalty upon demand, the failure to pay will constitute a judgment in favor of the Commonwealth in the amount of the penalty, together with the interest and costs that may accrue on these funds.
§ 2600.264. Use of fines.
(a) Money collected by the Department under this section will be placed in a special restricted receipt account.
(b) Money collected will be used first to defray the expenses incurred by residents relocated under this chapter.
(c) The Department will use money remaining in this account to assist with paying for enforcement of this chapter. Fines collected will not be subject to 42 Pa.C.S. § 3733 (relating to deposits into account).
§ 2600.265. Review of classifications.
(a) The Department will review the determinations of Class I, Class II and Class III violations made by the Department's personal care home regional offices.
(b) Semiannually, the Department will review the standard guidelines for the classification of violations and evaluate the use of these guidelines. This review is to ensure the uniformity and consistency of the classification process.
§ 2600.266. Revocation or nonrenewal of licenses.
(a) The Department will temporarily revoke the license of a home if, without good cause, one or more Class I violations remain uncorrected 24 hours after the home has been cited for the violation.
(b) The Department will temporarily revoke the license of a home if, without good cause, one or more Class II violations remain uncorrected 15 days after the citation.
(c) Upon the revocation of a license in the instances described in subsections (a) and (b), or if the home continues to operate without applying for a license as described in § 2600.262(h) (relating to penalties), residents shall be relocated.
(d) The revocation of a license may terminate upon the Department's determination that its violation is corrected.
(e) If, after 3 months, the Department does not issue a new license for a home, the prior license is revoked under section 1087 of the Public Welfare Code (62 P. S. § 1087).
(1) Revocation or nonrenewal under this section will be for a minimum of 5 years.
(2) A home, which has had a license revoked or not renewed under this section, will not be allowed to operate, staff or hold an interest in a home which applies for a license for 5 years after the revocation or nonrenewal.
(f) If a home has been found to have Class I violations on two or more separate occasions during a 2-year period without justification, the Department will revoke or refuse to renew the license of the home.
(g) The power of the Department to revoke or refuse to renew or issue a license under this section is in addition to the powers and duties of the Department under section 1026 of the Public Welfare Code (62 P. S. § 1026).
§ 2600.267. Relocation of residents.
(a) If the relocation of residents is due to the failure of the home to apply for a license, the Department will offer relocation assistance to the residents. This assistance will include each resident's involvement in planning the relocation, except in the case of an emergency. Each resident shall have the right to choose among the available alternatives after an opportunity to visit the alternative homes. These procedures will occur even if the residents are placed in a temporary living situation.
(b) A resident will not be relocated if the Secretary determines in writing that the relocation is not in the best interest of the resident.
§ 2600.268. Notice of violations.
(a) The administrator shall give each resident and the resident's designated person written notification of a Class I violation within 24 hours of the citation.
(b) The administrator shall give each resident and the resident's designated person oral or written notification of a Class I or Class II violation, as defined in § 2600.261 (relating to classification of violations), which remains uncorrected for 5 days after the date of citation.
(c) If a Class II violation remains uncorrected within 5 days following the citation, the administrator shall give written notice of the violation to each resident and the resident's designated person on the 6th day from the date of the citation.
(d) The Department will provide immediate written notification to the appropriate long-term care ombudsman of Class I violations, and notification of Class II violations which remain uncorrected 5 days after the date of citation.
§ 2600.269. Ban on admissions.
(a) The Department will ban new admissions to a home:
(1) That has been found to have a Class I violation.
(2) That has been found to have a Class II violation that remains uncorrected without good cause 5 days after being cited for the violation.
(3) Whose license has been revoked or nonrenewed.
(b) The Department may ban new admissions to a home that has been found to have a repeated Class II violation within the past 2 years.
(c) A ban on admissions will remain in effect until the Department determines that the home has corrected the violation, and after the correction has been made, has maintained regulatory compliance for a period of time sufficient to permit a conclusion that the compliance will be maintained for a prolonged period.
§ 2600.270. Correction of violations.
The correction of a violation cited under section 1086 of the Public Welfare Code (62 P. S. § 1086) does not preclude the Department from issuing a provisional license based upon the same violation.
CHAPTER 2620. (Reserved). §§ 2620.1--2620.5. (Reserved).
§§ 2620.11--2620.15. (Reserved).
§§ 2620.21--2620.28. (Reserved).
§§ 2620.31--2620.42. (Reserved).
§§ 2620.51--2620.55. (Reserved).
§§ 2620.61--2620.74. (Reserved).
§§ 2620.81--2620.83. (Reserved).
[Pa.B. Doc. No. 05-823. Filed for public inspection April 22, 2005, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
