[38 Pa.B. 4459]
[Saturday, August 9, 2008]
[Continued from previous Web Page] § 2800.105. Laundry.
(a) Laundry service for bed linens, towels and personal clothing shall be provided by the residence, 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 residence unless otherwise indicated in the resident-residence contract.
(c) The supply of bed linens and towels must 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.
§ 2800.106. Swimming areas.
If a residence 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.
§ 2800.107. Emergency preparedness.
(a) The administrator shall have a copy and be familiar with the emergency preparedness plan for the municipality in which the residence is located.
(b) The residence shall have written emergency procedures that include the following:
(1) Contact information for each resident's designated person.
(2) The residence'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 residence 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.
§ 2800.108. Firearms and weapons.
(a) A residence shall have a written policy regarding firearms.
(b) The policy must include, at a minimum, procedures regarding the safety, access and use of firearms, weapons and ammunition.
(c) Firearms, weapons and ammunition shall be permitted on the licensed premises of a residence 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' living unit 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' living unit 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 designee shall be the only individual permitted to open the locked cabinet containing the firearms and weapons and the locked area containing the ammunition.
(d) 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 the living area.
§ 2800.109. Pets.
(a) The residence rules must specify whether the residence permits pets on the premises.
(b) Cats and dogs present at the residence 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 residence has additional charges for pets, the charges shall be included in the resident-residence contract.
(e) A residence shall disclose to applicants whether pets are permitted and present in the residence.
FIRE SAFETY § 2800.121. Unobstructed egress.
(a) Stairways, hallways, doorways, passageways and egress routes from living units and from the building must be unlocked and unobstructed.
(b) Except as provided in § 2800.101 (relating to resident living units), doors used for egress routes from living units 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 residence has written approval or a variance from the Department of Labor and Industry, the Department of Health or the appropriate local building authority.
§ 2800.122. 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.
§ 2800.123. 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 § 2800.107 (relating to emergency preparedness) shall be posted in a conspicuous and public place in the residence and a copy shall be kept.
(c) For a residence 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 residence serves one or more residents with mobility needs above or below grade level of the residence, 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.
§ 2800.124. Notification of local fire officials.
The residence shall notify the local fire department in writing of the address of the residence, location of the living units and bedrooms and the assistance needed to evacuate in an emergency. Documentation of notification shall be kept.
§ 2800.125. 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.
§ 2800.126. 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.
§ 2800.127. Space heaters.
(a) Portable space heaters are prohibited.
(b) Nonportable space heaters must be well vented and installed with permanent connections and protectors.
§ 2800.128. 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.
§ 2800.129. 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.
§ 2800.130. Smoke detectors and fire alarms.
(a) There shall be an operable automatic smoke detector located in each living unit.
(b) 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.
(c) If the residence serves nine or more residents, there shall be at least one smoke detector on each floor interconnected and audible throughout the residence or an automatic fire alarm system that is interconnected and audible throughout the residence.
(d) 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.
(e) 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.
(f) 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.
(g) The residence's emergency procedures shall indicate the procedures that will be immediately implemented until the smoke detector or fire alarms are operable.
(h) In residences 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.
§ 2800.131. Fire extinguishers.
(a) There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor and living unit, 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 and in the living units. 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.
§ 2800.132. 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 residence 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 residence.
(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.
§ 2800.133. Exit signs.
The following requirements apply for a residence serving nine or more residents:
(1) Signs bearing the word ''EXIT'' in plain legible letters shall be placed at all exits.
(2) 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 § 2800.141. 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. 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.
(11) An indication that a tuberculin skin test has been administered with negative results within 2 years; or if the tuberculin skin test is positive, the result of a chest X-ray. In the event a tuberculin skin test has not been administered, the test shall be administered within 15 days after admission.
(12) Information about a resident's day-to-day personal care needs.
(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.
§ 2800.142. Assistance with health care and supplemental health care services.
(a) The residence shall assist the resident to secure medical care and supplemental health care services. To the extent prominently displayed in the written admission agreement, a residence may require residents to use providers of supplemental health care services approved or designated by the residence. If the resident has health care coverage for the supplemental health care services, the approval may not be unreasonably withheld. The residence 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 residence 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.
§ 2800.143. Emergency medical plan.
(a) The residence 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.
§ 2800.144. Use of tobacco.
(a) A residence may permit smoking tobacco in a designated smoking room of the residence.
(b) The residence rules must specify whether the residence is designated as smoking or nonsmoking.
(c) A residence that permits smoking inside or outside of the residence shall develop and implement written fire safety policy and procedures that include the following:
(1) Proper safeguards inside and outside of the residence 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 residence, extinguishing procedures, fire resistant furniture both inside and outside the residence 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 residence.
(d) Smoking outside of the smoking room is prohibited.
NUTRITION § 2800.161. 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 resident at all times.
(g) Between-meal snacks and beverages shall be available at all times for each resident, unless medically contraindicated as documented in the resident's support plan.
(h) Residents have the right to purchase groceries and prepare their own food in addition to the three meal plan required in § 2800.220(b) (relating to assisted living residence services) in their living units unless it would be unsafe for them to do so consistent with their support plan.
§ 2800.162. 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 residence.
(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 residence and shall be accessible to a resident in advance of the meal. Meal substitutions shall be made in accordance with § 2800.161 (relating to nutritional adequacy).
(f) A resident shall receive adequate physical assistance with eating or be provided with appropriate adaptive devices, or both, as indicated in the resident's support plan.
(g) Appropriate cueing shall be used to encourage and remind residents to eat and drink.
§ 2800.163. 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.
§ 2800.164. Withholding or forcing of food prohibited.
(a) A residence 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 § 2800.171. Transportation.
(a) A residence shall be required to provide or coordinate transportation to and from medical and social appointments.
(b) The following requirements apply whenever staff persons or volunteers of the residence 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 residence 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 § 2800.65 (relating to direct care staff training and orientation).
(5) The vehicle must have a first aid kit with the contents as specified in § 2800.96 (relating to first aid kit).
(6) During vehicle operations, the driver may only use a hands-free cellular telephone.
(7) Transportation must include, when necessary, an assistant to the driver who assists the driver to escort residents in and out of the residence and provides assistance during the trip.
(c) The residence shall maintain current copies of the following documentation for each of the residence'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) If a residence supplies its own vehicle for transporting residents to and from medical and social appointments, a vehicle used for this purpose shall be accessible to resident wheelchair users and any other assistive equipment the resident may need.
MEDICATIONS § 2800.181. Self-administration.
(a) A residence 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 § 2800.227(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 living unit for self-administration. Medications stored in the resident's living unit shall be kept in a safe and secure location to protect against contamination, spillage and theft. The residence shall provide a lockable storage unit for this purpose.
(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.
§ 2800.182. Medication administration.
(a) A residence shall provide medication administration services for a resident who is assessed to need medication administration services in accordance with § 2800.181 (relating to self-administration) and for a resident who chooses not to self-administer medications.
(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 residence.
(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 residence.
(4) A staff person who has completed the medication administration training as specified in § 2800.190 (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 § 2800.187 (relating to medication records).
§ 2800.183. 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 unless kept in the resident's living unit.
(c) Prescription medications, OTC medications and CAM stored in a refrigerator shall be kept in an area or container that is locked unless the resident has the capacity to store the medications in the resident's own refrigerator in the resident's living unit.
(d) Only current prescription, OTC, sample and CAM for individuals living in the residence may be kept in the residence.
(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 residence 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 residence, 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 residence.
(g) Subsections (a) and (e) do not apply to a resident who self-administers medication and stores the medication in his living unit.
§ 2800.184. Labeling of medications.
(a) The original container for prescription medications must 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 must be identified with the resident's name.
(c) Sample prescription medications must have written instructions from the prescriber that include the components specified in subsection (a).
§ 2800.185. Accountability of medication and controlled substances.
(a) The residence 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 living unit.
(5) To the extent indicated in the resident's support plan, the residence shall obtain prescribed medication for residents and keep an adequate supply of resident medication on hand at all times.
§ 2800.186. 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 residence receives written notice of the change.
§ 2800.187. 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 residence shall follow the directions of the prescriber.
§ 2800.188. 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 residence's pattern of error.
(e) There shall be documentation of the follow-up action that was taken to prevent future medication errors.
§ 2800.189. Adverse reaction.
(a) If a resident has a suspected adverse reaction to a medication, the residence shall immediately consult a physician or seek emergency medical treatment. The resident's designated person shall be notified, if applicable.
(b) The residence shall document adverse reactions, the prescriber's response and any action taken in the resident's record.
§ 2800.190. 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.
§ 2800.191. Resident education.
The residence 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 § 2800.201. Safe management techniques.
The residence 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.
§ 2800.202. Prohibitions.
The following procedures are prohibited:
(1) Seclusion, defined as involuntary confinement of a resident in a room or living unit 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 § 2800.231 (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 or the resident or his designee understands the need for the device and consents to its use.
(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.
§ 2800.203. Bedside rails.
(a) Bedside rails may not be used unless the resident can raise and lower the rails on his own. Bedside rails may not be used to keep a resident in bed. Use of any length rail longer than half the length of the bed is considered a restraint and is prohibited. Use of more than one rail on the same side of the bed is not permitted.
(b) Half-length rails are permitted only if the following conditions are met:
(1) The resident's assessment or support plan, or both, addresses the medical symptoms necessitating the use of half-length rails and the health and safety protection necessary in order to safely use half-length rails.
(2) The residence has attempted to use less restrictive alternatives.
(3) The resident or legal representative consented to the use of half-length rails after the risk, benefits and alternatives were explained.
SERVICES § 2800.220. Assisted living residence services.
(a) Services. The residence shall provide core services as specified in subsection (b). Other individuals or agencies may furnish services directly or under arrangements with the residence in accordance with a mutually agreed upon charge or fee between the residence, resident and other individual or agency. These other services shall be supplemental to the core services provided by the residence and shall not supplant them.
(b) Core services. The residence shall, at a minimum, provide the following services:
(1) Nutritious meals and snacks in accordance with §§ 2800.161 and 2800.162 (relating to nutritional adequacy; and meals).
(2) Laundry services in accordance with § 2800.105 (relating to laundry).
(3) A daily program of social and recreational activities in accordance with § 2800.221 (relating to activities program).
(4) Assistance with performing ADLs and IADLs as indicated in the resident's assessment and support plan in accordance with §§ 2800.23 and 2800.24 (relating to activities; and personal hygiene).
(5) Assistance with self-administration of medication or medication administration as indicated in the resident's assessment and support plan in accordance with §§ 2800.181 and 2800.182 (relating to self-administration; and medication administration).
(6) Household services essential for the health, safety and comfort of the resident based upon the resident's needs and preferences.
(7) Transportation in accordance with § 2800.171 (relating to transportation).
(c) Supplemental services. The residence shall provide or arrange for the provision of supplemental health care services, including, but not limited to, the following:
(1) Hospice services.
(2) Occupational therapy.
(3) Skilled nursing services.
(4) Physical therapy.
(5) Behavioral health services.
(6) Home health services.
(7) Escort service to and from medical appointments if transportation is coordinated by the residence.
(d) Cognitive support services. The residence shall provide cognitive support services to residents who require such services, whether in a special care unit or elsewhere in the residence.
§ 2800.221. Activities program.
(a) The residence shall develop a program of daily activities designed to promote each resident's active involvement with other residents, the resident's family and the community. The residence shall encourage the residents' active participation in the development of the daily activities calendar.
(b) The program must be based upon individual and group interests and provide social, physical, intellectual and recreational activities in a planned, coordinated and structured manner and shall encourage active participation in the community at large.
(c) The week's daily activity calendar shall be posted in advance in a conspicuous and public place in the residence.
§ 2800.222. 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.
§ 2800.223. Description of services.
(a) The residence shall have a current written description of services and activities that the residence provides including the following:
(1) The scope and general description of the services and activities that the residence provides.
(2) The criteria for admission and discharge.
(3) Specific services that the residence does not provide, but will arrange or coordinate.
(b) The residence shall develop written procedures for the delivery and management of services from admission to discharge.
§ 2800.224. Preadmission screening.
(a) A determination shall be made by the administrator or designee within 30 days prior to admission and documented on the Department's preadmission screening form that the needs of the potential resident can be met by the services provided by the residence.
(b) A potential resident whose needs cannot be met by the residence shall be provided with a written decision denying their admission and provide a basis for their denial. The potential resident shall then be referred to a local appropriate assessment agency.
(c) The preadmission screening shall be completed by the administrator or designee. If the potential 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.
(d) A potential resident who requires assisted living services but does not currently require assistance in obtaining supplemental health care services may be admitted to the residence, provided the resident is only provided assisted living services required or requested by the resident. When services are required, the residence shall develop a support plan as required in § 2800.227 (relating to development of the support plan). This subsection applies to residents under any of the following circumstances:
(1) A resident who may require supplemental health care services in the future.
(2) A resident who wishes to obtain assistance in obtaining the services.
(3) A resident who resides in a facility in which the services are available.
(e) An initial screening will not be required to commence supplemental health care services to a resident of a residence under any of the following circumstances:
(1) If the resident was not receiving the services at the time of the resident's admission.
(2) To transfer a resident from a portion of a residence that does not provide supplemental health care services to a portion of the residence that provides such service.
(3) To transfer a resident from a personal care home to a residence licensed by the same operator.
(f) Each residence shall demonstrate the ability to provide or arrange for the provision of supplemental health care services in a manner protective of the health, safety and well-being of its residents utilizing employees, independent contractors or contractual arrangements with other health care facilities or practitioners licensed, registered or certified to the extent required by law to provide the service.
(g) Persons requiring the services of a licensed long-term care nursing facility, may reside in a residence, provided that appropriate supplemental health care services are provided and the design, construction, staffing and operation of the residence allows for safe emergency evacuation.
§ 2800.225. 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 licensed practical nurse, under the supervision of a registered nurse, may complete the initial assessment.
(b) A residence 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.
§ 2800.226. 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 resident's 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 within 30 days after a resident with mobility needs is admitted to the residence or the date when a resident develops mobility needs.
§ 2800.227. Development of the support plan.
(a) Each resident requiring services shall have a written support plan developed and implemented within 30 days of admission to the residence. The support plan shall be documented on the Department's support plan form.
(b) A residence may use its own support plan form if it includes the same information as the Department's support plan form. A licensed practical nurse, under the supervision of a registered nurse, shall review and approve the support plan.
(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. The residence shall review each resident's support plan on a quarterly basis and modify as necessary to meet the resident's needs.
(d) Each residence shall document in the resident's support plan the dietary, 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 residence 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 shall be encouraged to participate in the development and implementation of the support plan. A resident may include a designated person or family member 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) A resident or a designated person has a right to request the review and modification of his support plan.
(k) The residence shall give a copy of the support plan to the resident and the resident's designated person.
§ 2800.228. Transfer and discharge.
(a) The facility shall ensure that a transfer or discharge is safe and orderly and that the transfer or discharge is appropriate to meet the resident's needs. This includes ensuring that a resident is transferred or discharged with all his medications, durable medical equipment and personal property. The residence shall permit the resident to participate in the decision relating to the relocation.
(b) If the residence initiates a transfer or discharge of a resident, or if the legal entity chooses to close the residence, the residence shall provide a 30-day advance written notice to the resident, the resident's family or designated person and the referral agent citing the reasons for the transfer or discharge. This shall be stipulated in the resident-residence contract.
(1) The 30-day advance written notice must be written in language in which the resident understands, or performed in American Sign Language or presented orally in a language the resident understands if the resident does not speak standard English. The notice must include the following:
(i) The specific reason for the transfer or discharge.
(ii) The effective date of the transfer or discharge.
(iii) The location to which the resident will be transferred or discharged.
(iv) An explanation of the measures the resident or the resident's designated person can take if they disagree with the residence decision to transfer or discharge which includes the name, mailing address, and telephone number of the State and local long-term care ombudsman.
(2) Prior to initiating a transfer or discharge of a resident, the residence shall make reasonable accommodation for aging in place that may include services from outside providers. The residence shall demonstrate through support plan modification and documentation the attempts to resolve the reason for the transfer or discharge. The residence may not transfer or discharge a resident if the resident or his designated person arranges for the needed services. Supplemental services may be provided by the resident's family, residence staff or private duty staff as agreed to by the resident and the residence. This shall be stipulated in the resident-residence contract.
(3) Practicable notice, rather than a 30-day advance written notice is required if a delay in transfer or discharge would jeopardize the health, safety or well-being of the resident or others in the residence, as certified by a physician or the Department. This may occur when the resident needs psychiatric services or is abused in the residence, or the Department initiates closure of the residence.
(c) A residence shall give the Department written notice of its intent to close the residence, at least 60 days prior to the anticipated date of closing.
(d) A residence may not require a resident to leave the residence prior to 30 days following the resident's receipt of a written notice from the residence regarding the intended closure of the residence, 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 transfer or discharge, and the destination of the resident, if known, shall be recorded in the resident record and tracked in a transfer and discharge tracking chart that the residence shall maintain and make available to the Department.
(f) If the legal entity chooses to voluntarily close the residence or if the Department has initiated legal action to close the residence, 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 residences. These procedures apply even if the resident is placed in a temporary living situation.
(g) Within 30 days of the residence's closure, the legal entity shall return the license to the Department.
(h) The only grounds for transfer or discharge of a resident from a residence are for the following conditions:
(1) If a resident is a danger to himself or others and the behavior cannot be managed through interventions, services planning or informed consent agreements.
(2) If the legal entity chooses to voluntarily close the residence, or a portion of the residence.
(3) If a residence determines that a resident's functional level has advanced or declined so that the resident's needs cannot be met in the residence under § 2800.229 (relating to excludable conditions; exceptions) or within the scope of licensure for a residence. In that case, the residence shall notify the resident, the resident's designated person and the local ombudsman. The residence shall provide justification for the residence's determination that the needs of the resident cannot be met. If a resident or the resident's designated person disagrees with the residence's decision to transfer or discharge, the residence shall contact the local ombudsman. If the residence decides to proceed with the transfer or discharge, the ombudsman shall notify the Department. The Department may take any appropriate licensure action it deems necessary based upon the report of the ombudsman. In the event that there is no disagreement related to the transfer or discharge, 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.
(4) If meeting the resident's needs would require a fundamental alteration in the residence's program or building site, or would create an undue financial or programmatic burden on the residence.
(5) If the resident has failed to pay after reasonable documented efforts by the residence to obtain payment.
(6) If closure of the residence is initiated by the Department.
(7) Documented, repeated violation of the residence rules.
(8) A court has ordered the transfer or discharge.
§ 2800.229. Excludable conditions; exceptions.
(a) Excludable conditions. Except as provided in subsection (b), a residence may not admit, retain or serve an individual with any of the following conditions or health care needs:
(1) Ventilator dependency.
(2) Stage III and IV decubiti and vascular ulcers that are not in a healing stage.
(3) Continuous intravenous fluids.
(4) Reportable infectious diseases, such as tuberculosis, in a communicable state that requires isolation of the individual or requires special precautions by a caretaker to prevent transmission of the disease unless the Department of Health directs that isolation be established within the residence.
(5) Nasogastric tubes.
(6) Physical restraints.
(7) Continuous skilled nursing care 24 hours a day.
(b) Exception. The residence may submit a written request to the Department on a form provided by the Department for an exception related to any of the conditions or health care needs listed in subsection (a) or (e) to allow the residence to admit, retain or serve an individual with one of those conditions or health care needs, unless a determination is unnecessary as set forth in subsection (e).
(c) Submission, review and determination of an exception request.
(1) The administrator of the residence shall submit the exception request. The exception request must be signed and affirmed by an individual listed in subsection (d) and accompanied by a support plan which includes the residence accommodations for treating the excludable condition requiring the exception request. Proposed accommodations must conform with the provisions contained within the resident-residence contract.
(2) The Department will review the exception request in consultation with a certified registered nurse practitioner or a physician, with experience caring for the elderly and disabled in long-term living settings.
(3) The Department will respond to the exception request in writing within 5 business days of receipt.
(4) The Department may approve the exception request if the following conditions are met:
(i) The exception request is desired by the resident or applicant.
(ii) The resident or applicant will benefit from the approval of the exception request.
(iii) The residence demonstrates to the Department's satisfaction that the residence has the staff, skills and expertise necessary to care for the resident's needs related to the excludable condition.
(iv) The residence demonstrates to the Department's satisfaction that any necessary supplemental health care provider has the staff, skills and expertise necessary to care for the resident's needs related to the excludable condition.
(v) The residence provides a written alternate care plan that ensures the availability of staff with the skills and expertise necessary to care for the resident's needs related to the excludable condition in the event the supplemental health care provider is unavailable.
(5) The Department will render decisions on exception requests on a case-by-case basis and not provide for facility-wide exceptions.
(d) Certification providers. The following persons may certify that an individual may not be admitted or retained in a residence:
(1) The administrator acting in consultation with supplemental health care providers.
(2) The individual's physician or certified registered nurse practitioner.
(3) The medical director of the residence.
(e) Departmental exceptions. A residence may admit, retain or serve an individual for whom a determination is made by the Department, upon the written request of the residence, that the individual's specific health care needs can be met by a provider of assisted living services or within a residence, including an individual requiring:
(1) Gastric tubes, except that a determination will not be required if the individual is capable of self-care of the gastric tube or a licensed health care professional or other qualified individual cares for the gastric tube.
(2) Tracheostomy, except that a determination will not be required if the individual is independently capable of self-care of the tracheostomy.
(3) Skilled nursing care 24 hours a day, except that a determination will not be required if the skilled nursing care is provided on a temporary or intermittent basis.
(4) A sliding scale insulin administration, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the insulin.
(5) Intermittent intravenous therapy, except that a determination will not be required if a licensed health care professional manages the therapy.
(6) Insertions, sterile irrigation and replacement of a catheter, except that a determination will not be required for routine maintenance of a urinary catheter, if the individual is capable of self-administration or a licensed health care professional administers the catheter.
(7) Oxygen, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the oxygen.
(8) Inhalation therapy, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the therapy.
(9) Other types of supplemental health care services that the administrator, acting in consultation with supplemental health care providers, determines can be provided in a safe and effective manner by the residence.
(f) Request for exception by resident. Nothing herein prevents an individual seeking admission to a residence or a resident from requesting that the residence apply for an exception from the Department for a condition listed in this section for which an exception must be granted by the Department. The residence's determination on whether or not to seek such an exception shall be documented on a form supplied by the Department.
(g) Record. A written record of the exception request, the supporting documentation to justify the exception request and the determination related to the exception request shall be kept in the records of the residence. The information required by this subsection shall also be kept in the resident's record.
(h) Decisions. The residence shall record the following decisions made on the basis of this section.
(1) Admission denials.
(2) Transfer or discharge decisions that are made on the basis of this section.
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