[40 Pa.B. 4073]
[Saturday, July 17, 2010]
[Continued from previous Web Page] § 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 January 18, 2011, 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 January 18, 2011, 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.
(c) If asbestos is found in a residence or contained in any part of the residence, the residence shall have a certification from an asbestos remediation company that the residence is safe for residents and that the asbestos does not pose a risk.
§ 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 nine or more residents, there shall be a system or method of communication such as an intercom, public address, pager or cell phone system 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 in each building on the premises that includes nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, adhesive tape, scissors, breathing shield, eye coverings and tweezers. The residence shall have an automatic external defibrillation device located in each building on the premises.
(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) The following conditions apply to a residence:
(1) For new construction of residences after January 18, 2011, each living unit for a single resident must have at least 225 square feet of floor space measured wall-to-wall, excluding bathrooms and closet space. If two residents share a living unit, there must be a total of 300 square feet in the living unit. Exceptions to the size of the living unit may be made at the Department's discretion.
(2) For facilities in existence prior to January 18, 2011, each living unit must have at least 160 square feet measured wall to wall, excluding bathrooms and closet space. If two residents share a living unit, there must be a total of 210 square feet in the living unit. Exceptions to the size of the living unit may be made at the Department's discretion.
(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 January 18, 2011, the kitchen capacity, at a minimum, must contain a cabinet for food storage, a small bar-type sink with hot and cold running water and space with electrical outlets suitable for small appliances such as a microwave oven and a small refrigerator.
(i) Upon entering the assisted living residence, the resident or his designated person shall be asked if the resident wishes to have a cooking appliance or small refrigerator, or both. The cooking appliance or small refrigerator, or both, shall be provided by the residence if desired by the resident or his designated person. If the resident or the designated person wishes to provide his own cooking appliance or small refrigerator, or both, it shall meet the residence's safety standards.
(ii) An appliance shall be designed so it can be disconnected and removed for resident safety or if the resident chooses not to have the appliance within his living unit.
(2) Existing facilities. Facilities that convert to residences after January 18, 2011, must meet the following requirements related to kitchen capacity:
(i) The residence shall provide space with electrical outlets suitable for small appliances, such as a microwave oven and small refrigerator.
(A) Upon entering the assisted living residence, the resident or his designated person shall be asked if the resident wishes to have a cooking appliance or small refrigerator, or both. The cooking appliance or small refrigerator, or both, shall be provided by the residence if desired by the resident or his designated person. If the resident or his designated person wishes to provide his own cooking appliance or small refrigerator, or both, it must meet the residence's safety standards.
(B) An appliance shall be designed so it can be disconnected and removed for resident safety or if the resident chooses not to have the appliance within his living unit.
(ii) 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. The administrator shall maintain a master key that can open all locks in the event of an emergency.
(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. An exception will be permitted for residents who wish to provide their own mattresses.
(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 must be one functioning flush toilet in the bathroom in the living unit.
(b) There must be at least one sink and wall mirror in the bathroom of the living unit.
(c) There must 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 must be provided for toilets, showers and bathtubs by partitions or doors. Bathroom doors in a double occupancy living unit must be lockable by the resident, unless contraindicated by the support plan.
(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) Bar soap or a dispenser with soap shall be provided within reach of each bathroom sink. Bar soap, however, is not permitted when a living unit is shared unless there is a separate bar clearly labeled for each resident sharing the living unit.
(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 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 linens).
§ 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.
§ 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. If a residence provides laundry facilities, there may not be a prohibition against residents doing their own laundry.
(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, weapons and ammunition where these items are on the premises or in possession of any resident or staff member. A residence is not required to permit firearms, weapons and ammunition.
(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 common 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.
(c) A fireplace chimney and flue that is used must be serviced annually and written documentation of the servicing 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 must 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, including public walkways and common living areas every 3,000 square feet, 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 of the residence. 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, subject to the provisions of § 2800.22 (relating to application and 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 assisted living service 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 medical care and supplemental health care services.
(a) 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.
(b) The residence shall assist the resident to secure medical care and supplemental health care services.
(1) The residence shall permit a resident to select or retain his primary care physician.
(2) 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.
(3) The residence shall document the resident's need for the medical care, including updating the resident's assessment and support plan.
(c) 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 medical care shall be documented in the resident's record.
(d) 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.
(e) 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) A 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.
(12) A speech, hearing or vision need which requires accommodation or awareness, such as written communication or American sign language.
(13) A language need which requires accommodation or awareness, such as an interpreter of translation.
§ 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 service provision) 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, as indicated in the resident's support plan.
§ 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 arrange for transportation on a regular weekly basis that permits residents to schedule medical and social appointments within a reasonable local area.
(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 staff orientation and direct care staff person 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). The inclusion of an automatic external defibrillation device in a vehicle is optional.
(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 vehicles for transporting residents to and from medical and social appointments, a minimum of one vehicle used for this purpose shall be accessible to resident wheelchair users and any other assistive equipment the resident may need.
(1) The residence shall schedule a pick-up time to transport the resident to the medical or social appointment. The residence shall make every reasonable effort to pick-up the resident within 15 minutes before or after the scheduled pick-up time.
(2) The resident may not be dropped off at the medical or social appointment more that 1 hour prior to the time of the appointment.
(3) The residence shall make every reasonable effort to pick-up a resident from a medical appointment no later than 1 hour after the medical appointment.
(4) The residence shall make every reasonable effort to pick-up a resident from a social appointment no later than 1 hour after the end of the social appointment.
(e) If a residence arranges for transportation for residents to and from medical and social appointments the following apply:
(1) The residence shall schedule a pick-up time for the resident to be transported to the medical or social appointment. The residence shall make every reasonable effort for a resident to be picked-up within 15 minutes before or after the scheduled pick-up time.
(2) The residence shall make every reasonable effort for a resident to not be dropped off at the medical or social appointment more that 1 hour prior to the time of the appointment.
(3) The residence shall make every reasonable effort for a resident to be picked-up from the medical appointment no later than 1 hour after the medical appointment.
(4) The residence shall make every reasonable effort for a resident to be picked-up from the social appointment no later than 1 hour after the end of the social appointment.
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. Appropriate cueing shall be used to remind residents to take their medication.
(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 final 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, RN, certified registered nurse practitioner, LPN 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 medications, 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.
[Continued on next Web Page]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
