[38 Pa.B. 4459]
[Saturday, August 9, 2008]
[Continued from previous Web Page]
SPECIAL CARE UNITS § 2800.231. Admission.
(a) This section and §§ 2800.232--2800.239 apply to special care units. These provisions are in addition to the other provisions of this chapter. A special care unit is a residence or portion of a residence that provides specialized care and services for residents with Alzheimer's disease or other dementia in the least restrictive manner consistent with the resident's support plan to ensure the safety of the resident and others in the residence while maintaining the resident's ability to age in place. Admission of a resident to a special care unit shall be in consultation with the resident's family or designated person. Prior to admission into a special care unit, other service options that may be available to a resident shall be considered.
(b) A resident shall have a medical evaluation by a physician, physician's assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior to admission. Documentation must include the resident's diagnosis of Alzheimer's disease or other dementia and the need for the resident to be served in a special care unit.
(c) A written cognitive preadmission screening completed in collaboration with a physician or a geriatric assessment team and documented on the Department's preadmission screening form shall be completed for each resident within 72 hours prior to admission to a special care unit.
(d) A geriatric assessment team is a group of multidisciplinary specialists in the care of adults who are older that conducts a multidimensional evaluation of a resident and assists in developing a support plan by working with the resident's physician, designated person and family to coordinate the resident's care.
(e) Each resident record must have documentation that the resident and the resident's designated person have agreed to the resident's admission or transfer to the special care unit.
(f) In addition to the requirements in § 2800.225 (relating to initial and annual assessment), the resident shall also be assessed quarterly for the continuing need for the special care unit.
(g) An individual who does not have a primary diagnosis of Alzheimer's disease or other dementia may reside in the special care unit if desired by the resident or his designated person.
(1) The individual shall have a medical evaluation by a physician, physician's assistant or certified registered nurse practitioner, documented on a form provided by the Department within 60 days prior to residence or 15 days after residence.
(2) The individual shall have access to and be able to follow directions for the operation of the key pads or other lock-releasing devices to exit the special care unit.
(h) The resident-residence contract specified in § 2800.25 (relating to resident-residence contract) must also include a disclosure of services, admission and discharge criteria, change in condition policies, special programming and costs and fees.
(i) For individuals with Alzheimer's disease or dementia, or when the residence holds itself out to the public as providing services or housing for individuals with cognitive impairments, the residence shall disclose to individuals and provide materials that include the following:
(1) The residence's written statement of its philosophy and mission which reflects the needs of individuals with cognitive impairments.
(2) A description of the residence's physical environment and design features to support the functioning of individuals with cognitive impairments.
(3) A description of the frequency and types of individual and group activities designed specifically to meet the needs of individuals with cognitive impairments.
(4) A description of the security measures provided by the residence.
(5) A description of the training provided to staff regarding provision of care to individuals with cognitive impairments.
(6) A description of availability of family support programs and family involvement.
(7) The process used for assessment and establishment of a plan of services for the individual, including methods by which the plan of services will remain responsive to changes in the individual's condition.
(j) The residence shall identify measures to address individuals with cognitive impairments who have tendencies to wander.
§ 2800.232. Environmental protection.
(a) The residence shall provide exercise space, both indoor and outdoor.
(b) No more than two residents may occupy a living unit regardless of its size. A living unit shall meet the requirement in § 2800.101 (relating to resident living units), as applicable.
(c) The residence shall provide space for dining, group and individual activities and visits.
(d) The residence shall provide a full description of the measures taken to enhance environmental awareness and maximize independence of the residents. The measures to enhance environmental awareness and maximize independence of the residents shall be implemented.
§ 2800.233. Doors, locks and alarms.
(a) Doors equipped with key-locking devices, electronic card operated systems or other devices that prevent immediate egress are permitted only if there is written approval from the Department of Labor and Industry, Department of Health or appropriate local building authority permitting the use of the specific locking system.
(b) A residence shall have a statement from the manufacturer, specific to that residence, verifying that the electronic or magnetic locking system will shut down, and that all doors will open easily and immediately when one or more of the following occurs:
(1) Upon a signal from an activated fire alarm system, heat or smoke detector.
(2) Power failure to the residence.
(3) Overriding the electronic or magnetic locking system by use of a key pad or other lock-releasing device.
(c) If key-locking devices, electronic card systems or other devices that prevent immediate egress are used to lock and unlock exits, directions for their operation shall be conspicuously posted near the device.
(d) Doors that open onto areas such as parking lots, or other potentially unsafe areas, shall be locked by an electronic or magnetic system.
(e) Fire alarm systems must be interconnected to the local fire department, when available, or a 24-hour monitoring service approved by the local fire department.
§ 2800.234. Resident care.
(a) Within 72 hours of the admission, or within 72 hours prior to the resident's admission to the special care unit, a support plan shall be developed, implemented and documented in the resident record.
(b) The support plan must identify the resident's physical, medical, social, cognitive and safety needs.
(c) The support plan must identify the individual responsible to address the resident's needs.
(d) The support plan shall be reviewed, and if necessary, revised at least quarterly and as the resident's condition changes.
(e) The resident or the resident's designated person shall be involved in the development and the revisions of the support plan.
§ 2800.235. Discharge.
If the residence initiates a discharge or transfer of a resident, or the legal entity chooses to close the residence, the administrator shall give a 30-day advance written notice to the resident, the resident's designated person and the referral agent citing the reasons for the discharge or transfer. This requirement shall be stipulated in the resident-residence contract signed prior to admission to the special care unit.
§ 2800.236. Training.
(a) Each direct care staff person working in a special care unit shall have 8 hours of initial training within the first 30 days of the date of hire and a minimum of 8 hours of annual training related to dementia care and services, in addition to the 12 hours of annual training specified in § 2800.65 (relating to direct care staff person training and orientation).
(b) The training at a minimum must include the following topics:
(1) An overview of Alzheimer's disease and related dementias.
(2) Managing challenging behaviors.
(3) Effective communications.
(4) Assistance with ADLs.
(5) Creating a safe environment.
§ 2800.237. Program.
(a) The following types of activities shall be offered at least weekly:
(1) Gross motor activities, such as dancing, stretching and other exercise.
(2) Self-care activities, such as personal hygiene.
(3) Social activities, such as games, music and holiday and seasonal celebrations.
(4) Crafts, such as sewing, decorations and pictures.
(5) Sensory and memory enhancement activities, such as review of current events, movies, story telling, picture albums, cooking, pet therapy and reminiscing.
(6) Outdoor activities, as weather permits, such as walking, gardening and field trips.
(b) Resident participation in general activity programming shall:
(1) Be voluntary.
(2) Respect the resident's age and cognitive abilities.
(3) Support the retention of the resident's abilities.
§ 2800.238. Staffing.
Each resident in a special care unit shall be considered to be a resident with mobility needs under § 2800.57(c) (relating to direct care staffing).
§ 2800.239. Application to Department.
(a) The legal entity shall submit a written request to the Department at least 60 days prior to the following:
(1) Opening a special care unit.
(2) Adding a special care unit to an existing residence.
(3) Increasing the maximum capacity in an existing unit.
(4) Changing the locking system, exit doors or floor plan of an existing unit.
(b) The Department will inspect and approve the special care unit prior to operation or change. The requirements of this chapter shall be met prior to operation.
(c) The following documents shall be included in the written request specified in subsection (a):
(1) The name, address and legal entity of the residence.
(2) The name of the administrator of the residence.
(3) The maximum capacity of the residence.
(4) The requested resident population of the special care unit.
(5) A building description.
(6) A unit description.
(7) The type of locking system.
(8) Policy and procedures to be implemented for emergency egress and resident elopement.
(9) A sample of a 2-week staffing schedule.
(10) Verification of completion of additional training requirements.
(11) The operational description of the special care unit locking system of the doors.
(12) The manufacturer's statement regarding the special care unit locking system.
(13) A written approval or a variance permitting locked exit doors from the Department of Labor and Industry, the Department of Health or the appropriate local building authority.
(14) The name of the municipality or 24-hour monitoring service maintaining the interconnection with the residence's fire alarm system.
(15) A sample plan of care and service for the resident addressing the resident's physical, medical, social, cognitive and safety needs for the residents.
(16) The activity standards.
(17) The complete medical and cognitive preadmission assessment, that is completed upon admission and reviewed and updated annually.
(18) A consent form agreeing to the resident's placement in the special care unit, to be signed by the resident or the resident's designated person.
(19) A written agreement containing full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming, costs and fees.
(20) A description of environmental cues being utilized.
(21) A general floor plan of the entire residence.
(22) A specific floor plan of the special care unit, outside enclosed area and exercise space.
RESIDENT RECORDS § 2800.251. Resident records.
(a) A separate record shall be kept for each resident.
(b) The entries in a resident's record must be permanent, legible, dated and signed by the staff person making the entry.
(c) The residence shall use standardized forms to record information in the resident's record.
(d) Separate resident records shall be kept on the premises where the resident lives.
(e) Resident records shall be made available to the resident and the resident's designated person during normal working hours. Resident records shall be made available upon request to the resident and the family members.
§ 2800.252. Content of resident records.
Each resident's record must include the following information:
(1) Name, gender, admission date, birth date and Social Security number.
(2) Race, height, weight, color of hair, color of eyes, religious affiliation, if any, and identifying marks.
(3) A photograph of the resident that is no more than 2 years old.
(4) Language or means of communication spoken or used by the resident.
(5) The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency.
(6) The name, address and telephone number of the resident's physician or source of health care.
(7) The current and previous 2 years' physician's examination reports, including copies of the medical evaluation forms.
(8) A list of prescribed medications, OTC medications and CAM.
(9) Dietary restrictions.
(10) A record of incident reports for the individual resident.
(11) A list of allergies.
(12) The documentation of health care services and orders, including orders for the services of visiting nurse or home health agencies.
(13) The preadmission screening, initial intake assessment and the most current version of the annual assessment.
(14) A support plan.
(15) Applicable court order, if any.
(16) The resident's medical insurance information.
(17) The date of entrance into the residence, relocations and discharges, including the transfer of the resident to other residences owned by the same legal entity.
(18) An inventory of the resident's personal property as voluntarily declared by the resident upon admission and voluntarily updated.
(19) An inventory of the resident's property entrusted to the administrator for safekeeping.
(20) The financial records of residents receiving assistance with financial management.
(21) The reason for termination of services or transfer of the resident, the date of transfer and the destination.
(22) Copies of transfer and discharge summaries from hospitals, if available.
(23) If the resident dies in the residence, a copy of the official death certificate.
(24) Signed notification of rights, grievance procedures and applicable consent to treatment protections specified in § 2800.41 (relating to notification of rights and complaint procedures).
(25) A copy of the resident-residence contract.
(26) A termination notice, if any.
(27) A record relating to any exception request under § 2800.229 (relating to excludable conditions; exceptions).
(28) Ongoing resident progress notes.
§ 2800.253. Record retention and disposal.
(a) The resident's entire record shall be maintained for a minimum of 3 years following the resident's discharge from the residence or until any audit or litigation is resolved.
(b) Records shall be destroyed in a manner that protects confidentiality.
(c) The residence shall keep a log of resident records destroyed on or after _____ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.). This log must include the resident's name, record number, birth date, admission date and discharge date.
(d) Records required under this chapter that are not part of the resident records shall be kept for a minimum of 3 years or until any audit or litigation is resolved.
§ 2800.254. Record access and security.
(a) Records of active and discharged residents shall be maintained in a confidential manner, which prevents unauthorized access.
(b) Each residence shall develop and implement policy and procedures addressing record accessibility, security, storage, authorized use and release and who is responsible for the records.
(c) Resident records shall be stored in locked containers or a secured, enclosed area used solely for record storage and be accessible at all times to the administrator, the administrator's designee, or the nurse involved in assessment and support plan development and upon request, to the Department or representatives of the area agency on aging.
ENFORCEMENT § 2800.261. Classification of violations.
(a) The Department will classify each violation of this chapter into one of three categories as described in paragraphs (1)--(3). A violation identified may be classified as Class I, Class II or Class III, depending upon the severity, duration and the adverse effect on the health and safety of residents.
(1) Class I. Class I violations have a substantial probability of resulting in death or serious mental or physical harm to a resident.
(2) Class II. Class II violations have a substantial adverse effect upon the health, safety or well-being of a resident.
(3) Class III. Class III violations are minor violations, which have an adverse effect upon the health, safety or well-being of a resident.
(b) The Department's guidelines for determining the classification of violations are available from the Department.
§ 2800.262. Penalties and corrective action.
(a) The Department will assess a penalty for each violation of this chapter.
(b) Penalties will be assessed on a daily basis from the date on which the citation was issued until the date the violation is corrected, except in the case of Class II and Class III violations.
(c) In the case of a Class II violation, assessment of the penalty will be suspended for 5 days from the date of citation to permit sufficient time for the residence to correct the violation. If the residence fails to provide proof of correction of the violation to the Department within the 5-day period, the fine will be retroactive to the date of citation. The Department may extend the time period for good cause.
(d) The Department will assess a penalty of $20 per resident per day for each Class I violation. Each Class I violation shall be corrected within 24 hours.
(e) The Department will assess a minimum penalty of $5 per resident per day, up to a maximum penalty of $15 per resident per day, for each Class II violation.
(f) There is no monetary penalty for Class III violations unless the residence fails to correct the violation within 15 days. Failure to correct a Class III violation within the 15-day period may result in a penalty assessment of up to $3 per resident per day for each Class III violation retroactive to the date of the citation.
(g) If a residence is found to be operating without a license, a penalty of $500 will be assessed. After 14 days, if the residence operator cited for operating without a license fails to file an application for a license, the Department will assess an additional $20 for each resident for each day during which the residence operator fails to apply.
(h) A residence charged with a violation of this chapter or Chapter 20 (relating to licensure or approval of facilities and agencies) has 30 days to pay the assessed penalty in full.
§ 2800.263. Appeals of penalty.
(a) If the residence that is fined intends to appeal the amount of the penalty or the fact of the violation, the residence shall forward the assessed penalty, not to exceed $500, to the Secretary for placement in an escrow account with the State Treasurer. A letter appealing the penalty shall be submitted with the assessed penalty. This process constitutes an appeal.
(b) If, through an administrative hearing or judicial review of the proposed penalty, it is determined that no violation occurred or that the amount of the penalty shall be reduced, the Secretary will, within 30 days, remit the appropriate amount to the legal entity together with interest accumulated on these funds in the escrow deposit.
(c) Failure to forward payment of the assessed penalty to the Secretary within 30 days will result in a waiver of the right to contest the fact of the violation or the amount of the penalty.
(d) After an administrative hearing decision that is adverse to the legal entity, or a waiver of the administrative hearing, the assessed penalty amount will be made payable to the ''Commonwealth of Pennsylvania.'' It will be collectible in a manner provided by law for the collection of debts.
(e) If a residence liable to pay the penalty neglects or refuses to pay the penalty upon demand, the failure to pay will constitute a judgment in favor of the Commonwealth in the amount of the penalty, together with the interest and costs that may accrue on these funds.
§ 2800.264. Use of fines.
(a) Money collected by the Department under this section will be placed in a special restricted receipt account.
(b) Money collected will be used first to defray the expenses incurred by residents relocated under this chapter.
(c) The Department will use money remaining in this account to assist with paying for enforcement of this chapter. Fines collected will not be subject to 42 Pa.C.S. § 3733 (relating to deposits into account).
§ 2800.265. Review of classifications.
Semiannually, the Department will review the standard guidelines for the classification of violations and evaluate the use of these guidelines. This review is to ensure the uniformity and consistency of the classification process.
§ 2800.266. Revocation or nonrenewal of licenses.
(a) The Department will temporarily revoke the license of a residence if, without good cause, one or more Class I violations remain uncorrected 24 hours after the residence has been cited for the violation.
(b) The Department will temporarily revoke the license of a residence if, without good cause, one or more Class II violations remain uncorrected 15 days after the citation.
(c) Upon the revocation of a license in the instances described in subsections (a) and (b), or if the residence continues to operate without applying for a license as described in § 2800.262(h) (relating to penalties), residents shall be relocated.
(d) The revocation of a license may terminate upon the Department's determination that its violation is corrected.
(e) If, after 3 months, the Department does not issue a new license for a residence, the prior license is revoked under section 1087 of the Public Welfare Code (62 P. S. § 1087).
(1) Revocation or nonrenewal under this section will be for a minimum of 5 years.
(2) A residence, which has had a license revoked or not renewed under this section, will not be allowed to operate, staff or hold an interest in a residence which applies for a license for 5 years after the revocation or nonrenewal.
(f) If a residence has been found to have Class I violations on two or more separate occasions during a 2-year period without justification, the Department will revoke or refuse to renew the license of the residence.
(g) The power of the Department to revoke or refuse to renew or issue a license under this section is in addition to the powers and duties of the Department under section 1026 of the Public Welfare Code (62 P. S. § 1026).
§ 2800.267. Relocation of residents.
(a) If the relocation of residents is due to the failure of the residence to apply for a license, the Department will offer relocation assistance to the residents. This assistance will include each resident's involvement in planning the relocation, except in the case of an emergency. Each resident shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences. These procedures will occur even if the residents are placed in a temporary living situation.
(b) A resident will not be relocated if the Secretary determines in writing that the relocation is not in the best interest of the resident.
§ 2800.268. Notice of violations.
(a) The administrator shall give each resident and the resident's designated person written notification of a Class I violation within 24 hours of the citation.
(b) The administrator shall give each resident and the resident's designated person oral or written notification of a Class I or Class II violation, as defined in § 2800.261 (relating to classification of violations), which remains uncorrected for 5 days after the date of citation.
(c) If a Class II violation remains uncorrected within 5 days following the citation, the administrator shall give written notice of the violation to each resident and the resident's designated person on the 6th day from the date of the citation.
(d) The Department will provide immediate written notification to the appropriate long-term care ombudsman of Class I violations, and notification of Class II violations which remain uncorrected 5 days after the date of citation.
§ 2800.269. Ban on admissions.
(a) The Department will ban new admissions to a residence:
(1) That has been found to have a Class I violation.
(2) That has been found to have a Class II violation that remains uncorrected without good cause 5 days after being cited for the violation.
(3) Whose license has been revoked or nonrenewed.
(b) The Department may ban new admissions to a residence that has been found to have a repeated Class II violation within the past 2 years.
(c) A ban on admissions will remain in effect until the Department determines that the residence has corrected the violation, and after the correction has been made, has maintained regulatory compliance for a period of time sufficient to permit a conclusion that the compliance will be maintained for a prolonged period.
§ 2800.270. Correction of violations.
The correction of a violation cited under section 1086 of the Public Welfare Code (62 P. S. § 1086) does not preclude the Department from issuing a provisional license based upon the same violation.
[Pa.B. Doc. No. 08-1481. Filed for public inspection August 8, 2008, 9:00 a.m.]
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