[38 Pa.B. 4459]
[Saturday, August 9, 2008]
[Continued from previous Web Page] § 2800.28. Refunds.
(a) If, after the residence gives notice of transfer or discharge in accordance with § 2800.228(b) (relating to transfer and discharge), and the resident moves out of the residence before the 30 days are over, the residence shall give the resident a refund equal to the previously paid charges for rent, personal care services and supplemental health care services, if applicable, for the remainder of the 30-day time period. The refund shall be issued within 30-days of transfer or discharge. The resident's personal needs allowance shall be refunded within 2 business days of transfer or discharge.
(b) After a resident gives notice of the intent to leave in accordance with § 2800.25(b) (relating to resident-residence contract) and if the resident moves out of the residence before the expiration of the required 14 days, the resident owes the residence the charges for rent and personal care services and supplemental health care services, or both, for the entire length of the 14-day time period for which payment has not been made.
(c) If no notice is required, as set forth in subsection (d), the resident shall be required to pay only for the nights spent in the residence.
(d) If the residence does not require a written notice prior to a resident's departure, the administrator shall refund the remainder of previously paid charges to the resident within 30 days of the date the resident moved from the residence.
(e) In the event of the death of a resident under 60 years of age, the administrator shall refund the remainder of previously paid charges to the resident's estate within 30 days from the date the living unit is cleared of the resident's personal property. In the event of the death of a resident 60 years of age and older, the residence shall provide a refund in accordance with the Elder Care Payment Restitution Act (35 P. S. §§ 10226.101--10226.107). The residence shall keep documentation of the refund in the resident's record.
(f) Within 30 days of either the termination of service by the residence or the resident's leaving the residence, the resident shall receive an itemized written account of the resident's funds, including notification of funds still owed the residence by the resident or a refund owed the resident by the residence. Refunds shall be made within 30 days of discharge.
(g) Upon discharge of the resident or transfer of the resident, the administrator shall return the resident's funds being managed or stored by the residence to the resident within 2 business days from the date the living unit is cleared of the resident's personal property.
§ 2800.29. Hospice care and services.
Hospice care and services that are licensed by the Department of Health as a hospice may be provided in an assisted living residence.
§ 2800.30. Informed consent process.
(a) Initiation of process.
(1) When a licensee determines that a resident's decision, behavior or action creates a dangerous situation and places the resident, other residents or staff members at imminent risk of substantial harm by the resident's wish to exercise independence in directing the manner in which they receive care, the licensee may initiate an informed consent process to address the identified risk and to reach a mutually agreed-upon plan of action with the resident or the resident's designated person. The initiation of an informed consent process does not guarantee that an informed consent agreement, which is agreeable to all parties, will be reached and executed.
(2) When a resident wishes to exercise independence in directing the manner in which the resident receives care, the resident may initiate an informed consent process to modify the support plan and attempt to reach a mutually agreed upon plan of action with the licensee. A cognitively impaired resident shall be eligible for an informed consent agreement only if the resident's legal representative is included in the negotiation of the informed consent agreement and executes the agreement.
(b) Notification.
(1) When the licensee chooses to initiate an informed consent process, the provider shall do so by notifying the resident and, if applicable, the resident's designated person in writing and orally. The notification must include a statement that the long-term care ombudsman is available to assist in the process and include the contact information for the ombudsman. For cognitively impaired residents, the ombudsman shall be automatically notified by the licensee. Notification shall be documented in the resident's file by the licensee.
(2) When a resident or, if applicable, the resident's legal representative chooses to initiate an informed consent negotiation, the resident or the resident's legal representative shall do so by notifying the licensee in writing or orally. Notification shall be documented in the resident's file by the licensee.
(c) Resident's involvement. A resident who is not cognitively impaired shall be entitled, but is not required, to involve his legal representative and physician, and any other individual the resident wants involved, to participate or assist in the discussion of the resident's wish to exercise independence and, if necessary, in developing a satisfactory informed consent agreement that balances the resident's choices and capabilities with the possibility that the choices will place the resident or other residents at risk of harm.
(d) Informed consent meeting.
(1) In a manner the resident can understand, the licensee shall discuss the resident's wish to exercise independence in directing the manner in which he receives care. The discussion must relate to the decision, behavior or action that places the resident or persons other than the resident in imminent risk of substantial harm and hazards inherent in the resident's action. The discussion must include reasonable alternatives, if any, for mitigating the risk, the significant benefits and disadvantages of each alternative and the most likely outcome of each alternative. In the case of a resident with a cognitive impairment, the resident's legal representative shall participate in the discussion.
(2) A resident may not have the right to place persons other than himself at risk, but, consistent with statutory and regulatory requirements, may elect to proceed with a decision, behavior or action affecting only his own safety or health status, foregoing alternatives for mitigating the risk, after consideration of the benefits and disadvantages of the alternatives including his wish to exercise independence in directing the manner in which he receives care. The licensee shall evaluate whether the resident understands and appreciates the nature and consequences of the risk, including the significant benefits and disadvantages of each alternative considered, and then shall further ascertain whether the resident is consenting to accept or mitigate the risk with full knowledge and forethought.
(e) Successful negotiation. If the parties agree, the informed consent agreement shall be reduced to writing and signed by all parties, including all individuals engaged in the negotiation at the request of the resident, and shall be retained in the resident's file as part of the service plan.
(f) Unsuccessful negotiation. If the parties do not agree, the licensee shall notify the resident, the resident's legal representative and the individuals engaged in the informed consent negotiation at the request of the resident. The residence shall include information on the local ombudsman or the appropriate advocacy organization for assistance relating to the disposition and whether the licensee will issue a notice of discharge.
(g) Freedom from duress. An informed consent agreement must be voluntary and free of force, fraud, deceit, duress, coercion or undue influence, provided that a licensee retains the right to issue a notice of involuntary discharge in the event a resident's decision, behavior or action creates a dangerous situation and places persons other than the resident at imminent risk of substantial harm and, after a discussion of the risk, the resident declines alternatives to mitigate the risk.
(h) Individualized nature. An informed consent agreement must be unique to the resident's situation and his wish to exercise independence in directing the manner in which he receives care. The informed consent agreement shall be utilized only when a resident's decision, behavior or action creates a situation and places the resident or persons other than the resident at imminent risk of substantial harm. A licensee may not require execution of an informed consent agreement as a standard condition of admission.
(i) Liability. Execution of an informed consent agreement does not constitute a waiver of liability beyond the scope of the agreement or with respect to acts of negligence or tort. An informed consent agreement does not relieve a licensee of liability for violation of statutory or regulatory requirements promulgated under this chapter nor affect enforceability of regulatory provisions including those provisions governing admission or discharge or the permissible level of care in an assisted living residence.
(j) Change in resident's condition. An informed consent agreement must be updated following a significant change in the resident's condition that affects the risk potential to the resident or persons other than the resident.
RESIDENT RIGHTS § 2800.41. Notification of rights and complaint procedures.
(a) Upon admission, each resident and, if applicable, the resident's designated person, shall be informed of resident rights and the right to lodge complaints without intimidation, retaliation or threats of retaliation by the residence or its staff persons against the reporter. Retaliation includes transfer or discharge from the residence.
(b) Notification of rights and complaint procedures shall be communicated in an easily understood manner and in a language understood by or mode of communication used by the resident and, if applicable, the resident's designated person.
(c) The Department's poster of the list of resident's rights shall be posted in a conspicuous and public place in the residence.
(d) A copy of the resident's rights and complaint procedures shall be given to the resident and, if applicable, the resident's designated person upon admission.
(e) A statement signed by the resident and, if applicable, the resident's designated person acknowledging receipt of a copy of the information specified in subsection (d), or documentation of efforts made to obtain signature, shall be kept in the resident's record.
§ 2800.42. Specific rights.
(a) A resident may not be discriminated against because of race, color, religious creed, disability, ancestry, sexual orientation, national origin, age or sex.
(b) A resident may not be neglected, intimidated, physically or verbally abused, mistreated, subjected to corporal punishment or disciplined in any way.
(c) A resident shall be treated with dignity and respect.
(d) A resident shall be informed of the rules of the residence and given 30 days' written notice prior to the effective date of a new residence rule.
(e) A resident shall have access to a telephone in the residence to make calls in privacy. Nontoll calls must be without charge to the resident.
(f) A resident has the right to receive and send mail.
(1) Outgoing mail may not be opened or read by staff persons unless the resident requests.
(2) Incoming mail may not be opened or read by staff persons unless upon the request of the resident or the resident's designated person.
(g) A resident has the right to communicate privately with and access the local ombudsman.
(h) A resident has the right to practice the religion or faith of the resident's choice, or not to practice any religion or faith.
(i) A resident shall receive assistance in accessing health care services.
(j) A resident shall receive assistance in obtaining and keeping clean, seasonal clothing. A resident's clothing may not be shared with other residents.
(k) A resident and the resident's designated person, and other individuals upon the resident's written approval shall have the right to access, review and request corrections to the resident's record.
(l) A resident has the right to furnish his living unit and purchase, receive, use and retain personal clothing and possessions.
(m) A resident has the right to leave and return to the residence at times consistent with the residence rules and the resident's support plan.
(n) A resident has the right to relocate and to request and receive assistance, from the residence, in relocating to another facility. The assistance must include helping the resident get information about living arrangements, making telephone calls and transferring records.
(o) A resident has the right to freely associate, organize and communicate with his friends, family, physician, attorney and other persons.
(p) A resident shall be free from restraints.
(q) A resident shall be compensated in accordance with State and Federal labor laws for labor performed on behalf of the residence. Residents may voluntarily and without coercion perform tasks related directly to the resident's personal space or common areas of the residence.
(r) A resident has the right to receive visitors at any time provided that the visits do not adversely affect other residents. A residence may adopt reasonable policies and procedures related to visits and access. If the residence adopts those policies and procedures, they will be binding on the residents.
(s) A resident has the right to privacy of self and possessions. Privacy shall be provided to the resident during bathing, dressing, changing and medical procedures.
(t) A resident has the right to file complaints on behalf of himself and others with any individual or agency and recommend changes in policies, residence rules and services of the residence without intimidation, retaliation or threat of discharge.
(u) A resident has the right to remain in the residence, as long as it is operating with a license, except as specified in § 2800.228 (relating to transfer and discharge).
(v) A resident has the right to receive services contracted for in the resident-residence contract.
(w) A resident has the right to use both the residence's procedures and external procedures, if any, to appeal involuntary discharge.
(x) A resident has the right to a system to safeguard a resident's money and property.
(y) To the extent prominently displayed in the written resident-residence contract, a residence may require residents to use providers of supplemental health care services as provided in § 2800.142 (relating to assistance with health care and supplemental health care services). When the residence does not designate, the resident may choose the supplemental health care service provider.
§ 2800.43. Prohibition against deprivation of rights.
(a) A resident may not be deprived of his rights.
(b) A resident's rights may not be used as a reward or sanction.
(c) Waiver of any resident right shall be void.
§ 2800.44. Complaint procedures.
(a) Prior to admission, the residence shall inform the resident and the resident's designated person of the right to file and the procedure for filing a complaint with the Department's Assisted Living Residence Office, local ombudsman or protective services unit in the area agency on aging, Pennsylvania Protection & Advocacy, Inc. or law enforcement agency.
(b) The residence shall permit and respond to oral and written complaints from any source regarding an alleged violation of resident rights, quality of care or other matter without retaliation or the threat of retaliation.
(c) If a resident indicates that he wishes to make a written complaint, but needs assistance in reducing the complaint to writing, the residence shall assist the resident in writing the complaint.
(d) The residence shall ensure investigation and resolution of complaints. The residence shall designate the staff person responsible for receiving complaints and determining the outcome of the complaint.
(e) Within 2 business days after the submission of a written complaint, a status report shall be provided by the residence to the complainant. If the resident is not the complainant, the resident and the resident's designated person shall receive the status report unless contraindicated by the support plan. The status report must indicate the steps that the residence is taking to investigate and address the complaint.
(f) Within 7 days after the submission of a written complaint, the residence shall give the complainant and, if applicable, the designated person, a written decision explaining the residence's investigation findings and the action the residence plans to take to resolve the complaint. If the resident is not the complainant, the affected resident shall receive a copy of the decision unless contraindicated by the support plan. If the residence's investigation validates the complaint allegations, a resident who could potentially be harmed or his designated person shall receive a copy of the decision, with the name of the affected resident removed, unless contraindicated by the support plan.
(g) The telephone number of the Department's Assisted Living Residence Office, the local ombudsman or protective services unit in the area agency on aging, Pennsylvania Protection & Advocacy, Inc., the local law enforcement agency, the Commonwealth Information Center and the assisted living residence complaint hotline shall be posted in large print in a conspicuous and public place in the residence.
STAFFING § 2800.51. Criminal history checks.
Criminal history checks and hiring policies shall be in accordance with the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102), and 6 Pa. Code Chapter 15 (relating to protective services for older adults).
§ 2800.52. Staff hiring, retention and utilization.
Hiring, retention and utilization of staff persons shall be in accordance with the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102), 6 Pa. Code Chapter 15 (relating to protective services for older adults) and other applicable regulations.
§ 2800.53. Qualifications and responsibilities of administrators.
(a) The administrator shall have one of the following qualifications:
(1) A license as a registered nurse from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.
(2) An associate's degree or 60 credit hours from an accredited college or university in a human services field and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.
(3) An associate's degree or 60 credit hours from an accredited college or university in a field that is not related to human services and 2 years, in the prior 10 years, of direct care or administrative experience in a health care or human services field.
(4) A license as a licensed practical nurse from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.
(5) A license as a nursing home administrator from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.
(b) The administrator shall be 21 years of age or older.
(c) The administrator shall be responsible for the administration and management of the residence, including the health, safety and well-being of the residents, implementation of policies and procedures and compliance with this chapter.
(d) The administrator shall have the ability to provide personal care services or to supervise or direct the work to provide personal care services.
(e) The administrator shall have knowledge of this chapter.
(f) The administrator shall have the ability to comply with applicable laws, rules and regulations, including this chapter.
(g) The administrator shall have the ability to maintain or supervise the maintenance of financial and other records.
(h) The administrator shall be free from a medical condition, including drug or alcohol addiction that would limit the administrator from performing duties with reasonable skill and safety.
§ 2800.54. Qualifications for direct care staff persons.
(a) Direct care staff persons shall have the following qualifications:
(1) Be 18 years of age or older, except as permitted in subsection (d).
(2) Have a high school diploma, GED or active registry status on the Pennsylvania nurse aide registry.
(3) Be free from a medical condition, including drug or alcohol addiction, that would limit direct care staff persons from providing necessary personal care services with reasonable skill and safety.
(b) A volunteer who performs or provides ADLs shall meet the direct staff person qualifications and training requirements specified in this chapter.
(c) A resident receiving personal care services who voluntarily performs tasks in the residence will not be considered a volunteer under this chapter.
(d) Food services or housekeeping staff may be 16 or 17 years of age.
§ 2800.55. Portability of staff qualifications and training.
A staff person who transfers to another licensed residence, or from a licensed personal care home shall be given credit for any completed hours of training that are required on an annual basis, provided however, that the staff person shall complete any additional training required by these regulations for assisted living residence direct care staff.
§ 2800.56. Administrator staffing.
(a) The administrator shall be present in the residence an average of 40 hours or more per week, in each calendar month. At least 30 hours per month shall be during normal business hours.
(b) The administrator shall designate a staff person to supervise the residence in the administrator's absence. The designee shall have the same training required for an administrator.
§ 2800.57. Direct care staffing.
(a) At all times one or more residents are present in the residence, a direct care staff person who is 21 years of age or older and who serves as the designee shall be present in the residence. The direct care staff person may be the administrator if the administrator provides direct care services.
(b) Direct care staff persons shall be available to provide at least 1 hour per day of personal care services to each mobile resident.
(c) Direct care staff persons shall be available to provide at least 2 hours per day of personal care services to each resident who has mobility needs.
(d) At least 75% of the personal care service hours specified in subsections (b) and (c) shall be available during waking hours.
§ 2800.58. Awake staff persons.
Direct care staff persons on duty in the residence shall be awake at all times.
§ 2800.59. Multiple buildings.
(a) For a residence with multiple buildings on the same premises that are within 300 feet of one another, the direct care staff person required in § 2800.57 (relating to direct care staffing) shall be on the premises and available by a two-way communication system at all times residents are present in the residence.
(b) For a residence with multiple buildings on the same premises regardless of the distance between buildings, the direct care staffing requirements in § 2800.57 apply at all times residents are present in the residence.
§ 2800.60. Additional staffing based on the needs of the residents.
(a) Staffing shall be provided to meet the needs of the residents as specified in the resident's assessment and support plan. Residence staff or service providers who provide services to the residents in the residence shall meet the applicable professional licensure requirements.
(b) The staffing level in this chapter is minimum only. The Department may require additional staffing as necessary to protect the health, safety and well-being of the residents. Requirements for additional staffing will be based on the resident's assessment and support plan, the design and construction of the residence and the operation and management of the residence.
(c) Additional staff hours, or contractual hours, shall be provided as necessary to meet the transportation, laundry, food service, housekeeping and maintenance needs of the residence.
(d) In addition to the staffing requirements in this chapter, the residence shall have a nurse on call at all times. The on-call nurse shall be either an employee of the residence or under contract with the residence.
(e) The residence shall have a dietician on staff or under contract to provide for any special dietary needs of a resident as indicated in his support plan.
§ 2800.61. Substitute personnel.
When regularly scheduled direct care staff persons are absent, the administrator shall arrange for coverage by substitute personnel who meet the direct care staff qualifications and training requirements as specified in §§ 2800.54 and 2800.65 (relating to qualifications for direct care staff persons; and direct care staff person training and orientation).
§ 2800.62. List of staff persons.
The administrator shall maintain a current list of the names, addresses and telephone numbers of staff persons including substitute personnel and volunteers.
§ 2800.63. First aid, CPR and obstructed airway training.
(a) There shall be sufficient staff trained in first aid and certified in obstructed airway techniques and CPR present in the residence at all times to meet the needs of the residents.
(b) Current training in first aid and certification in obstructed airway techniques and CPR shall be provided by an individual certified as a trainer by a hospital or other recognized health care organization.
(c) Licensed, certified and registered medical personnel meet the qualifications in subsection (a) and are exempt from the training requirements in subsections (a) and (b).
(d) A staff person who is trained in first aid or certified in obstructed airway techniques or CPR shall provide those services in accordance with his training, unless the resident has a do not resuscitate order.
§ 2800.64. Administrator training and orientation.
(a) Prior to initial employment as an administrator, a candidate shall successfully complete the following:
(1) An orientation program approved and administered by the Department.
(2) A 100-hour standardized Department-approved administrator training course. The training provided for in § 2800.69 (relating to additional dementia-specific training) shall be in addition to the 100-hour training course.
(3) A Department-approved competency-based training test with a passing score.
(b) The standardized Department-approved administrator training course specified in subsection (a)(2) must include the following:
(1) Fire prevention and emergency preparedness.
(2) Medication procedures, medication effects and side effects, universal precautions and personal hygiene.
(3) Certification in CPR and obstructed airway techniques and training in first aid.
(4) Personal care services.
(5) Local, State and Federal laws and regulations pertaining to the operation of a residence.
(6) Nutrition, food handling and sanitation.
(7) Recreation.
(8) Care for residents with mental illness.
(9) Resident rights.
(10) Care for residents with special needs.
(11) Care for residents with mental retardation.
(12) Community resources, social services and activities in the community.
(13) Staff supervision and staff person training including developing orientation and training guidelines for staff.
(14) Budgeting, financial recordkeeping and resident records including:
(i) Writing, completing and implementing initial assessments, annual assessments and support plans.
(ii) Resident-residence contracts.
(15) Gerontology.
(16) Abuse and neglect prevention and reporting.
(17) Cultural competency.
(18) The requirements of this chapter.
(c) An administrator shall have at least 24 hours of annual training relating to the job duties. The Department-approved administrator training course specified in subsection (a) fulfills the annual training requirement for the first year.
(d) Annual training shall be provided by Department-approved training sources listed in the Department's assisted living residence training resource directory or by an accredited college or university.
(e) An administrator who has successfully completed the training in subsections (a)--(d) shall provide written verification of successful completion to the Department's Assisted Living Residence Office.
(f) A record of training including the individual trained, date, source, content, length of each course and copies of certificates received shall be kept.
§ 2800.65. Direct care staff person training and orientation.
(a) Prior to or during the first work day, direct care staff persons including ancillary staff persons, substitute personnel and volunteers shall have an orientation in general fire safety and emergency preparedness that includes the following:
(1) Evacuation procedures.
(2) Staff duties and responsibilities during fire drills, as well as during emergency evacuation, transportation and at an emergency location, if applicable.
(3) The designated meeting place outside the building or within the fire-safe area in the event of an actual fire.
(4) Smoking safety procedures, the residence's smoking policy and location of smoking areas, if applicable.
(5) The location and use of fire extinguishers.
(6) Smoke detectors and fire alarms.
(7) Telephone use and notification of emergency services.
(b) Within 40 scheduled working hours, direct care staff persons, ancillary staff persons, substitute personnel and volunteers shall have an orientation that includes the following:
(1) Resident rights.
(2) Emergency medical plan.
(3) Mandatory reporting of abuse and neglect under the Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102).
(4) Reporting of reportable incidents and conditions.
(5) Safe management techniques.
(6) Core competency training that includes the following:
(i) Person-centered care.
(ii) Communication, problem solving and relationship skills.
(iii) Nutritional support according to resident preference.
(c) Ancillary staff persons shall have a general orientation to their specific job functions as it relates to their position prior to working in that capacity.
(d) Direct care staff persons may not provide unsupervised ADL services until completion of the following:
(1) Training that includes a demonstration of job duties, followed by supervised practice.
(2) Successful completion and passing the Department-approved direct care training course and passing of the competency test.
(3) Initial direct care staff person training to include the following:
(i) Safe management techniques.
(ii) Assisting with ADLs and IADLs.
(iii) Personal hygiene.
(iv) Care of residents with mental illness, neurological impairments, mental retardation and other mental disabilities.
(v) The normal aging-cognitive, psychological and functional abilities of individuals who are older.
(vi) Implementation of the initial assessment, annual assessment and support plan.
(vii) Nutrition, food handling and sanitation.
(viii) Recreation, socialization, community resources, social services and activities in the community.
(ix) Gerontology.
(x) Staff person supervision, if applicable.
(xi) Care and needs of residents with special emphasis on the residents being served in the residence.
(xii) Safety management and hazard prevention.
(xiii) Universal precautions.
(xiv) The requirements of this chapter.
(xv) Infection control.
(xvi) Care for individuals with mobility needs, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration, if applicable to the residents served in the residence.
(e) Direct care staff persons shall have at least 12 hours of annual training relating to their job duties. The training required in § 2800.69 (relating to additional dementia-specific training) shall be in addition to the 12 hour annual training.
(f) Training topics for the annual training for direct care staff persons must include the following:
(1) Medication self-administration training.
(2) Instruction on meeting the needs of the residents as described in the preadmission screening form, assessment tool, medical evaluation and support plan.
(3) Care for residents with dementia and cognitive impairments.
(4) Infection control and general principles of cleanliness and hygiene and areas associated with immobility, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.
(5) Personal care service needs of the resident.
(6) Safe management techniques.
(7) Care for residents with mental illness or mental retardation, or both, if the population is served in the residence.
(g) Direct care staff persons, ancillary staff persons, substitute personnel and regularly scheduled volunteers shall be trained annually in the following areas:
(1) Fire safety completed by a fire safety expert or by a staff person trained by a fire safety expert. Videos prepared by a fire safety expert are acceptable for the training if accompanied by an onsite staff person trained by a fire safety expert.
(2) Emergency preparedness procedures and recognition and response to crises and emergency situations.
(3) Resident rights.
(4) The Older Adult Protective Services Act.
(5) Falls and accident prevention.
(6) New population groups that are being served at the residence that were not previously served, if applicable.
(h) If a staff person has completed the required initial direct care staff person training within the past year as a direct care staff person at another residence, the requirement for initial direct care staff person training in this section does not apply if the staff person provides written verification of completion of the training.
(i) A record of training including the staff person trained, date, source, content, length of each course and copies of any certificates received, shall be kept.
§ 2800.66. Staff training plan.
(a) A staff training plan shall be developed annually.
(b) The plan must include training aimed at improving the knowledge and skills of the residence's direct care staff persons in carrying out their job responsibilities. The staff training plan must include the following:
(1) The name, position and duties of each direct care staff person.
(2) The required training courses for each staff person.
(3) The dates, times and locations of the scheduled training for each staff person for the upcoming year.
(c) Documentation of compliance with the staff training plan shall be kept.
§ 2800.67. Training institution registration.
(a) An institution and the course of study offered by an educational institution, association, professional society or organization for the purpose of educating and qualifying applicants for certification as assisted living residence administrators shall be registered and approved by the Department prior to offering the course of study.
(b) An application for registration of an institution and approval of a course of study shall be submitted to the Department on a form provided by the Department and include the following information:
(1) The full name, address, telephone number, facsimile number and electronic mail address of the prospective training provider, each instructor and the program coordinator.
(2) The training objectives, instructional materials, content and teaching methods to be used and the number of clock hours.
(3) The recommended class size.
(4) The attendance certification method.
(5) Proof that each course instructor is certified by the Department to conduct administrator training.
(6) The subject that each instructor will teach and documentation of the instructor's academic credentials, instructional experience and work experience to teach the subject.
(7) The location of the training site, which shall accommodate the number of anticipated participants.
(c) A request to amend a Department-approved course of study shall be submitted for the Department's review and approval prior to implementation of a change in the course of study.
(d) The training institution shall issue a training certificate to each participant who successfully completes the Department-approved course and passes the competency test. Each training certificate must indicate the participant's name, the name of the training institution, the date and location of the training and the number of clock hours completed for each training topic.
§ 2800.68. Instructor approval.
(a) Training for assisted living residence administrators provided by an individual who is not certified as an instructor by the Department will not be considered valid training.
(b) To receive the Department's certification as an approved instructor for assisted living residence administrators, an instructor shall successfully complete the Department's train-the-trainer course. The train-the-trainer course is designed to provide and reinforce basic training skills, including the roles and responsibilities of the trainer, training methodology, the use of instructional aids and recordkeeping.
(c) An instructor shall demonstrate competent instructional skills and knowledge of the applicable topic and meet the Department's qualifications for the topic being taught.
(d) An instructor is subject to unannounced monitoring by the Department while conducting training.
(e) The Department will establish approval standards that include the following:
(1) The mechanism to measure the quality of the training being offered.
(2) The criteria for selecting and evaluating instructors, subject matter and instructional materials.
(3) The criteria for evaluating requests to amend a course.
(4) The criteria for evaluating the effectiveness of each course.
(5) The instructor qualifications for each subject being taught.
(f) The Department may withdraw approval under the following conditions:
(1) Failure to follow the approved curriculum.
(2) Lack of trainer competency.
(3) A pattern of violations of this chapter by a residence conducting the training.
§ 2800.69. Additional dementia-specific training.
Administrative staff, direct care staff persons, ancillary staff persons, substitute personnel and volunteers shall receive at least 4 hours of dementia-specific training within 30 days of hire and at least 2 hours of dementia-specific training annually thereafter in addition to the training requirements of this chapter.
PHYSICAL SITE § 2800.81. Physical accommodations and equipment.
(a) The residence shall provide or arrange for physical site accommodations and equipment necessary to meet the health and safety needs of a resident with a disability and to allow safe movement within the residence and exiting from the residence.
(b) Wheelchairs, walkers, prosthetic devices and other apparatus used by residents must be clean, in good repair and free of hazards.
§ 2800.82. Poisons.
(a) Poisonous materials shall be stored in their original, labeled containers.
(b) Poisonous materials shall be stored separately from food, food preparation surfaces and dining surfaces.
(c) Poisonous materials shall be kept locked and inaccessible to residents unless all of the residents living in the residence are able to safely use or avoid poisonous materials.
§ 2800.83. Temperature.
(a) The indoor temperature, in areas used by the residents, must be at least 70° F when residents are present in the residence.
(b) A residence in existence prior to _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.) shall provide central air conditioning. If central air conditioning is not feasible or is cost prohibitive, window air conditioning units shall be provided. The residence shall submit justification to the Department for the use of window air conditioning units.
(c) For new construction after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), the residence shall provide central air conditioning.
§ 2800.84. Heat sources.
Heat sources, such as steam and hot heating pipes, water pipes, fixed space heaters, hot water heaters and radiators exceeding 120° F that are accessible to the resident must be equipped with protective guards or insulation to prevent the resident from coming in contact with the heat source.
§ 2800.85. Sanitation.
(a) Sanitary conditions shall be maintained.
(b) There may be no evidence of infestation of insects or rodents in the residence.
(c) Trash shall be removed from the premises at least once a week.
(d) Trash in kitchens and bathrooms shall be kept in covered trash receptacles that prevent the penetration of insects and rodents.
(e) Trash outside the residence shall be kept in covered receptacles that prevent the penetration of insects and rodents.
(f) For a residence serving 9 or more residents that is not connected to a public sewer system, there shall be a written sanitation approval for its sewage system by the sewage enforcement official of the municipality in which the residence is located.
§ 2800.86. Ventilation.
(a) All areas of the residence that are used by the resident shall be ventilated. Ventilation includes an operable window, air conditioner, fan or mechanical ventilation that ensures airflow.
(b) A bathroom that does not have an operable, outside window must be equipped with an exhaust fan for ventilation.
§ 2800.87. Lighting.
The residence's rooms, hallways, interior stairs, outside steps, outside doorways, porches, ramps, evacuation routes, outside walkways and fire escapes must be lighted and marked to ensure that residents, including those with vision impairments, can safely move through the residence and safely evacuate.
§ 2800.88. Surfaces.
(a) Floors, walls, ceilings, windows, doors and other surfaces must be clean, in good repair and free of hazards.
(b) The residence may not use asbestos products for renovations or new construction.
§ 2800.89. Water.
(a) The residence must have hot and cold water under pressure in each bathroom, kitchen and laundry area to accommodate the needs of the residents in the residence.
(b) Hot water temperature in areas accessible to the resident may not exceed 120° F.
(c) A residence 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 residence 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 residence shall keep documentation of the laboratory certification, in addition to the results and corrections made to ensure safe water for drinking.
§ 2800.90. Communication system.
(a) The residence shall have a working, noncoin operated, landline telephone that is accessible in emergencies and accessible to individuals with disabilities.
(b) For a residence 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 residence for assistance in an emergency.
§ 2800.91. Emergency telephone numbers.
Telephone numbers for the nearest hospital, police department, fire department, ambulance, poison control, local emergency management and assisted living residence complaint hotline shall be posted on or by each telephone with an outside line.
§ 2800.92. Windows and screens.
Windows, including windows in doors, must be in good repair and securely screened when doors or windows are open.
§ 2800.93. Handrails and railings.
(a) Each ramp, interior stairway, hallway and outside steps must have a well-secured handrail.
(b) Each porch must have a well-secured railing.
§ 2800.94. 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.
(c) Stairs must have strips for those with vision impairments.
§ 2800.95. Furniture and equipment.
Furniture and equipment must be in good repair, clean and free of hazards.
§ 2800.96. First aid kit.
(a) The residence shall have a first aid kit that includes an automatic electronic defibrillation device, 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.
§ 2800.97. 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).
§ 2800.98. Indoor activity space.
(a) The residence shall have at least two indoor wheelchair accessible common rooms for all residents for activities such as reading, recreation and group activities. One of the common rooms shall be available for resident use at any time, provided the use does not affect or disturb others.
(b) The residence shall have at least one furnished living room or lounge area for residents, their families and visitors. The combined living room or lounge areas must accommodate all residents at one time. There must be at least 15 square feet per living unit for up to 50 living units. There must be a total of 750 square feet if there are more than 50 living units. These rooms or areas must contain tables, chairs and lighting to accommodate the residents, their families and visitors.
(c) The residence shall have a working television and radio available to residents in a living room or lounge area.
§ 2800.99. Recreation space.
The residence shall provide regular access to outdoor and indoor recreation space and recreational items, such as books, newspapers, magazines, puzzles, games, cards and crafts.
§ 2800.100. 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 residence shall ensure that ice, snow and obstructions are removed from outside walkways, ramps, steps, recreational areas and exterior fire escapes.
§ 2800.101. Resident living units.
(a) A residence shall provide a resident with the resident's own living unit unless the conditions of subsection (c) are met.
(b)(1) For new construction of residences after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), each living unit for a single resident must have at least 250 square feet of floor space measured wall-to-wall, excluding bathrooms and closet space. If two residents share a living unit, there must be an additional 80 square feet in the living unit.
(2) For residences in existence prior to _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), each living unit must have at least 175 square feet measured wall to wall, excluding bathrooms and closet space. If two residents share a living unit, there must be an additional 80 square feet in the living unit.
(3) Each living unit must have a telephone jack and individually controlled thermostats for heating and cooling.
(4) The doors in living units, including entrance doors, must be accessible or adaptable for wheelchair use.
(c) Two residents may voluntarily agree to share one living unit provided that the agreement is in writing and contained in each of the resident-residence contract of those residents. A licensee may not require residents to share a living unit. The maximum number of residents in any living unit shall be two residents.
(d) Kitchen capacity requirements are as follows:
(1) New construction. For new construction of residences after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), the kitchen capacity, at a minimum, must contain a small refrigerator with a freezer compartment, a cabinet for food storage, a small bar-type sink with hot and cold running water and space with electrical outlets suitable for small cooking appliances such as a microwave oven. The cooking appliances shall be designed so that they can be disconnected and removed for resident safety or if the resident chooses not to have cooking capability in his living unit.
(2) Existing facilities. Facilities that convert to residences after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.), must meet the following requirements related to kitchen capacity:
(i) The residence shall provide a small refrigerator in each living unit.
(ii) The residence shall provide a microwave oven in each living unit.
(iii) The residence shall provide access to a sink for dishes, a stovetop for hot food preparation and a food preparation area in a common area. A common resident kitchen may not include the kitchen used by the residence staff for the preparation of resident or employee meals, or the storage of goods.
(e) Ceiling height in each living unit must be an average of at least 7 feet.
(f) Each living unit must have at least one window with direct exposure to natural light.
(g) A resident's bedroom in the living unit shall be used only by the occupying resident unless two consenting adult residents agree to share a bedroom and the requirements of subsection (c) are met.
(h) Each living unit must have a door with a lock, except where a lock in a unit under a special care designation would pose a risk or be unsafe.
(i) A resident shall have access to his living unit at all times.
(j) Each resident shall have the following in the living unit:
(1) A bed with a solid foundation and fire retardant mattress that is in good repair, clean and supports the resident.
(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 another resident, 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 living unit may not be used as an exit from or used as a passageway to another part of the residence unless in an emergency situation.
(n) The living unit must have walls, floors and ceilings, which are finished, clean and in good repair.
(o) In living units with a separate bedroom, there must be a door on the bedroom.
(p) Space for storage of personal property shall be provided in a dry, protected area.
(q) There must be drapes, shades, curtains, blinds or shutters on the living unit windows. Window coverings must be clean, in good repair, provide privacy and cover the entire window when drawn.
(r) Each living unit must be equipped with an emergency notification system to notify staff in the event of an emergency.
§ 2800.102. Bathrooms.
(a) There shall be one functioning flush toilet in the bathroom in the living unit.
(b) There shall be at least one sink and wall mirror in the bathroom of the living unit.
(c) There shall be at least one bathtub or shower in the bathroom of the living unit.
(d) Toilet and bath areas in the living unit must have grab bars, hand rails or assist bars. Bathtubs and showers must have slip-resistant surfaces.
(e) Privacy in the living unit 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 unless the resident provides his own supplies of these items.
(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 residence charges for these items, the charges shall be indicated in the resident-residence contract. Availability of toiletry items for residents who are recipients of SSI is specified in § 2800.27(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 unit unless the resident has access to the residence'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 residence shall have at least one public restroom that meets applicable local, State and Federal laws and guidelines and that is convenient to common areas and wheelchair accessible.
(n) Each bathroom must be equipped with an emergency notification system to notify staff in the event of an emergency.
§ 2800.103. Food service.
(a) A residence 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 residence, the residence 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 oven, 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).
§ 2800.104. Dining room.
(a) An assisted living residence shall have an accessible common dining space outside the resident living units. A dining room area must be equipped with tables and chairs and able to accommodate the maximum number of residents scheduled for meals at any one time. There must be at least 15 square feet per person for 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 living unit 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 residence, a resident may choose to have a meal served in the resident's living unit. This service shall be provided at the resident's request and may not replace daily meals in a dining room.
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