[32 Pa.B. 4939]
[Continued from previous Web Page] § 2600.58. Staff training and orientation.
(a) Prior to working with residents, all staff including temporary staff, part-time staff and volunteers shall have an orientation that includes the following:
(1) General fire safety including:
(i) Evacuation procedures.
(ii) Responsibilities during fire drills.
(iii) The designated meeting place outside the building or within the fire-safe area in the event of an actual fire.
(iv) Smoking safety procedures and location of smoking areas, if applicable.
(v) The placement and use of fire extinguishers.
(vi) Smoke detectors and fire alarms.
(vii) Phone use and notification of the local fire or police departments, or both.
(2) Resident rights.
(3) Emergency medical plan.
(4) Personnel policies and procedures.
(5) General operation of the personal care home.
(b) Ancillary staff shall have a general orientation to their specific job functions as it relates to their position prior to working in that capacity.
(c) Training of direct care staff hired after ______ (Editor's Note: The blank refers to the effective date of adoption of this proposal.) shall include a demonstration of job duties, followed by guided practice, then proven competency before newly-hired direct care staff may provide unsupervised direct care in any particular area. Prior to direct contact with residents, all direct care staff shall successfully complete and pass the following competency-based training including the following specific job duties and responsibilities:
(1) Resident care.
(2) ADL's.
(3) Medication procedures, medical terminology and personal hygiene.
(4) Care of residents with mental illness and cognitive impairments.
(5) Personal care services.
(6) Implementation of the initial assessment, annual assessment and support plan.
(7) Nutrition, food handling and sanitation.
(8) Recreation.
(9) Gerontology.
(10) Staff supervision, if applicable.
(11) Needs of residents with special emphasis on the residents being served in the personal care home.
(12) Safety management and prevention.
(13) Use of medications, purposes and side effects of medications, and use of universal precautions.
(14) Policies and procedures of the home, including the following:
(i) Reportable incidents.
(ii) Implementation of support plans.
(d) Ancillary staff shall have a general orientation to their specific job functions as it relates to their position prior to working in that capacity. Ancillary staff shall receive training specific to their job function.
(e) Direct care home staff shall have at least 24 hours of annual training relating to their job duties. Staff orientation shall be included in the 24 hours of training for the first year of employment. On the job training for direct care staff may count for 12 out of the 24 training hours required annually.
(f) Training topics for the required annual training for direct care staff shall include the following:
(1) Current training in first aid, certification in obstructed airway techniques and certification in cardio-pulmonary resuscitation that is appropriate for the residents served, and shall be completed by an individual certified as a trainer by a hospital or other recognized health care organization. Registered nurses, licensed practical nurses, certified registered nurse practitioners, emergency medical technicians, paramedics, physician's assistants or licensed physicians are exempt from the requirement for annual first aid training.
(2) Medication self-administration training.
(3) Understanding, locating and implementing preadmission screening tools, initial assessments, annual assessments and support plans.
(4) Care for persons with dementia and cognitive impairments.
(5) Infection control and general principles of cleanliness and hygiene and areas associated with immobility, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.
(6) Personal care service needs of the resident.
(7) Safe management technique training, which shall include positive interventions such as:
(i) Improving communications.
(ii) Reinforcing appropriate behaviors.
(iii) Redirection.
(iv) Conflict resolution.
(v) Violence prevention.
(vi) Verbal praise.
(vii) Deescalation techniques.
(viii) Alternatives and techniques to identify depression.
(ix) Methods to identify and diffuse potential emergency safety situation.
(x) Managing medical emergencies.
(8) Care for persons with mental illness or mental retardation, or both, if the population is served in the home.
(g) Full-time, part-time and temporary staff persons and volunteers shall be trained annually on:
(1) Fire safety. Training in fire safety shall be completed by a fire safety expert or, in personal care homes serving 20 or fewer residents, by a staff person trained by a fire safety expert. Videotapes/DVD's prepared by a fire safety expert are acceptable for the training if accompanied by an onsite staff person trained by a fire safety expert.
(2) Disaster plans and recognition and response to crises and emergency situations.
(3) Resident rights.
(4) The Older Adult Protective Services Act (35 P. S. §§ 10225.101--10225.5102).
(5) Falls and accident prevention.
(6) New personnel policies and procedures of the home.
(7) New population groups that are being served at the home that were not previously served, if applicable.
(h) If a staff person has completed any of the required training identified in this section prior to the staff person's date of hire, the requirement for training in this section does not apply if the staff person provides written verification of completion of the training.
(i) If volunteers are used in the home as staff persons to provide direct personal care services, they shall meet the same requirements as staff provided for in this chapter.
(j) A record of training including the person trained, date, source, content, length of each course and copies of any certificates received, shall be kept on file at the home.
§ 2600.59. Staff training plan.
The administrator shall ensure that a comprehensive staff-training plan is developed and conducted annually for the development and improvement of the skills of the home's direct care staff. The staff training plan shall include the personal care home's policies and procedures for developing and conducting the staff training plan, indicating who is responsible and the time frames for completion of the following components:
(1) An annual assessment of staff training needs shall include questionnaires completed by all staff with data compiled, or a narrative summarizing group discussion of needs.
(2) An overall plan for addressing the needs identified in paragraph (1). This plan shall be based on the assessment of staff training needs, and shall indicate training content, trainers and proposed dates of training.
(3) A mechanism to collect written feedback on completed training.
(4) An annual evaluation of the staff-training plan, including the extent to which implementing the plan met the identified training needs.
§ 2600.60. Individual staff training plan.
A written individual staff training plan for each employee, appropriate to that employee's skill level, shall be developed annually with input from both the employee and the employee's supervisor. The individual training plan shall identify the subject areas and potential resources for training which meet the requirements for the employee's position and which relate to the employee's skill level and interest.
(1) The plan shall be based upon an employee's previous education, experience, current job functions and job performance.
(2) The employee shall complete the minimum training hours as listed in § 2600.58(d) (relating to staff training and orientation) with the subject selections being based upon the needs identified in the training plan.
(3) Annual documentation of the required training in the individual staff-training plan shall be maintained for all staff.
PHYSICAL SITE § 2600.81. Physical accommodations and equipment.
The home 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 and exiting the home.
§ 2600.82. 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 home are able to safely use or avoid poisonous materials.
§ 2600.83. Temperature.
(a) The indoor temperature shall be at least 70°F when residents are present in the home.
(b) If a home does not provide air conditioning, fans shall be made available to residents when the indoor temperature exceeds 80°F.
§ 2600.84. 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, shall be equipped with protective guards or insulation to prevent the resident from coming in contact with the heat source and being burned or otherwise harmed
§ 2600.85. Sanitation.
(a) Sanitary conditions shall be maintained in the home.
(b) There may be no evidence of infestation of insects, rodents or other animals in the home.
(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 home shall be kept in closed receptacles that prevent the penetration of insects and rodents.
(f) A home that is not connected to a public sewer system shall have a written sanitation approval for its sewage system by the sewage enforcement official of the municipality in which the home is located.
§ 2600.86. Ventilation.
All areas of the home that are used by the resident shall be ventilated. Ventilation shall include an operable window, air conditioner, fan or mechanical ventilation that ensures airflow.
§ 2600.87. Lighting.
The home's rooms, hallways, interior stairs, outside steps, outside doorways, porches, ramps, evacuation routes, outside walkways and fire escapes shall have operable and sufficient lighting to ensure safe evacuation of all persons in the home.
§ 2600.88. Surfaces.
(a) Floors, walls, ceilings, windows, doors and other surfaces shall be clean, in good repair and free of hazards.
(b) The home may not use asbestos products for renovations or new construction.
§ 2600.89. Water.
(a) The home shall have hot and cold water under pressure in each bathroom, kitchen and laundry area to accommodate the needs of the residents in the home.
(b) Hot water temperature in areas accessible to the resident may not exceed 120°F.
(c) A home 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 safe for drinking. 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 deemed unsafe for drinking, the home shall conduct remediation activity in accordance with the recommendations of the Department of Environmental Protection.
(e) The home shall keep documentation of the laboratory certification, in addition to the results and corrections made to ensure safe water for drinking.
§ 2600.90. Communication system.
(a) The home shall have a working, noncoin operated, telephone with an outside line that is accessible in emergencies and accessible to persons with disabilities.
(b) The home shall have a system or method of communication that enables staff persons to contact other staff persons in the home for assistance in an emergency.
§ 2600.91. Emergency telephone numbers.
Telephone numbers for the nearest hospital, police department, fire department, ambulance, poison control and personal care home hotline number shall be posted on or by each telephone with an outside line.
§ 2600.92. Screens.
Windows, including windows in doors, shall be in good repair and securely screened when doors or windows are open.
§ 2600.93. Handrails and railings.
(a) Each ramp, interior stairway and outside steps exceeding two steps shall have a well-secured handrail.
(b) Each porch that has over a 30-inch drop shall have a well-secured railing.
§ 2600.94. 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 shall have a landing, which is a minimum of 3 feet by 3 feet.
(b) Interior stairs, exterior steps, walkways and ramps shall have nonskid surfaces.
§ 2600.95. Furniture and equipment.
Furniture and equipment shall be in good repair, clean and free of hazards.
§ 2600.96. First aid supplies.
(a) The home shall have at a minimum, in each building, a first aid manual, nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, tape, scissors, breathing shield, eye coverings and syrup of ipecac. These items shall be stored together in a first aid kit.
(b) The staff shall be made aware of the location of the first aid kit.
(c) The first aid kit shall be in a location that is easily accessible to the staff.
§ 2600.97. Elevators and stair glides.
Each elevator and stair glide shall have a valid certificate of operation from the Department of Labor and Industry.
§ 2600.98. Indoor activity space.
(a) The home shall have indoor activity space for activities such as reading, recreation and group activities.
(b) The home shall have at least one furnished living room or lounge for the use of residents, their families and visitors. The combined living room or lounge areas shall be sufficient to accommodate all residents at one time. These rooms shall contain a sufficient number of tables, chairs and lighting to accommodate the residents, their families and visitors.
(c) The administrator of the home shall develop and ensure that the activities program is designed and implemented to promote each resident's active involvement with other residents, the resident's family and the community.
(d) The program shall provide social, physical, intellectual and recreational activities in a planned, coordinated and structured manner.
(e) A current weekly activity calendar shall be posted in a conspicuous place in the home that residents can access easily.
(f) The home shall have a working television and radio made available to residents in a living room or lounge area. If more than one living room or lounge area is available in the home, the largest of these shall have a working television. Large homes are encouraged to provide more than one television to allow residents an option to watch different programs. The Department will grant a waiver of this subsection if enforcement of this requirement would interfere with religious beliefs or doctrines of the residents, the home, or both. To obtain a waiver, the home's resident home contract shall contain a statement that a radio or television will not be provided by the home.
§ 2600.99. Recreation space.
The home shall provide regular access to outdoor and indoor recreation space and recreational items, including books, magazines, puzzles, games, cards, gliders, paper, markers and the like.
§ 2600.100. Exterior conditions.
(a) The exterior of the building and the building grounds or yard shall be in good repair and free of hazards.
(b) The home shall ensure that ice, snow and obstructions are removed from outside walkways, ramps, steps, recreational areas and exterior fire escapes.
§ 2600.101. Resident bedrooms.
(a) Each single bedroom shall have at least 80 square feet of floor space per resident measured wall to wall, including space occupied by furniture.
(b) Each shared bedroom shall have at least 60 square feet of floor space per resident measured wall to wall, including space occupied by furniture.
(c) Each bedroom for a resident with a physical immobility shall have 100 square feet per resident, or allow for easy passage between beds and other furniture, and for comfortable use of a resident's assistive devices, including wheelchairs, walkers, special furniture or oxygen equipment. This requirement does not apply if there is a medical order from the attending physician that states the resident can maneuver without the necessity of the additional space.
(d) No more than four residents may share a bedroom.
(e) Ceiling height in each bedroom shall be at least 7 feet for new homes licensed after ______ (Editor's Note: The blank refers to the effective date of adoption of this proposal.).
(f) Each bedroom shall have an operable window with a source of natural light. This window shall be able to be opened by the resident without the use of tools and shall be screened.
(g) A resident's bedroom shall be only for the occupying resident's individual use and not for activities common to other residents.
(h) A resident shall be able to access toilet, hand washing and bathing facilities without having to pass through another resident's bedroom.
(i) Bedrooms shall be equipped to ensure the resident's privacy.
(j) A resident shall have access to the resident's bedroom at all times.
(k) Each resident shall have the following in the bedroom:
(1) A bed with a solid foundation and fire retardant mattress that is in good repair, clean and supports the resident.
(2) A mattress that is plastic-covered if supplied by the home.
(3) Pillows and bedding that is clean and in good repair.
(4) A storage area for clothing that shall include a chest of drawers and a closet or wardrobe space with clothing racks or shelves accessible to the resident.
(l) Cots and portable beds are prohibited.
(m) Bunk beds are prohibited.
(n) A bedroom may not be used as a means of egress from or used as a passageway to another part of the home unless in an emergency situation.
(o) A resident may not be required to share a bedroom with a person of the opposite sex.
(p) The bedrooms shall have walls, floors and ceilings, which are finished, clean and in good repair.
(q) There shall be doors on the bedrooms.
(r) There shall be a minimum of one comfortable chair per resident per bedroom. The resident shall determine what type of chair is comfortable.
(s) There shall be a minimum of one operable ceiling light per bedroom or a minimum of one operable lamp per resident.
(t) There shall be drapes, shades, curtains, blinds or shutters on the bedroom windows, which are clean, in good repair, provide privacy, and are sufficient to cover the entire window when drawn.
§ 2600.102. Bathrooms.
(a) There shall be at least one functioning flush toilet for every six or less users, including residents, family and personnel.
(b) There shall be at least one sink and wall mirror for every six or less users, including residents, family and personnel.
(c) There shall be at least one bathtub or shower for every 15 or less users, including residents, family and personnel.
(d) There shall be slip-resistant surfaces in all bathtubs and showers.
(e) Privacy shall be provided for toilets, showers and bathtubs by partitions or doors.
(f) An individual towel, washcloth and soap shall be provided for each resident.
(g) Individual toiletry items including toothpaste, toothbrush, shampoo, deodorant, comb and hairbrush shall be made available.
(h) Toilet paper shall be provided for every toilet.
(i) A dispenser with soap shall be provided in all of the bathrooms. Bar soap is not permitted unless there is a separate bar clearly labeled for each resident.
(j) Toiletries and linens shall be in the possession of the resident in the resident's living space.
§ 2600.103. Kitchen areas.
(a) A home shall have an operable kitchen area with a refrigerator, sink, stove, oven, cooking equipment and cabinets for storage.
(b) Kitchen surfaces shall 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 or the lowest shelf shall be sealed to the floor.
(e) Food shall be labeled, dated, rotated and inventoried weekly.
(f) Food requiring refrigeration shall be stored at or below 40°F. Frozen food shall be kept at or below 0°F. Thermometers shall be 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, under cool water or as part of the cooking process.
(i) Food shall be served with the holding temperature of 140°F for hot items; cold items shall have a holding temperature of 40°F or less.
(j) Eating, drinking and cooking utensils shall be washed, rinsed and sanitized after each use by a mechanical dishwasher or by a method approved by the Department of Agriculture.
(k) Garbage shall be stored in covered containers.
(l) Animals are not permitted in the kitchen or other food service areas when meals are being prepared, served or consumed.
§ 2600.104. Dining room.
(a) A dining room area shall be equipped with tables and chairs and able to accommodate the maximum number of 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 shall be clean, and free of chips or cracks. There may not be regular use of plastic/paper plates, utensils and cups for meals.
(c) Condiments shall be available at the dining table.
(d) Special provisions shall be made and adaptive equipment shall be provided, when necessary, to assist residents in eating at the table.
(e) Animals are not permitted in the dining room when meals are being prepared, served or consumed. Guide or support animals assisting a person due to blindness, deafness or physical disability or who are under the supervision of a handler or trainer of these animals are exempt from this prohibition.
(f) Midday and evening meals shall be served to residents in a dining room or dining area, except that service in the resident's room shall be available when the resident is unable to come to the dining room due to temporary illness.
(g) Breakfast shall be served to residents in a dining room or dining area except in the following situations:
(1) Service in the resident's room shall be available at no additional charge when the resident is unable to come to the dining room due to temporary illness.
(2) When room service is available in a home, a resident shall make an individual choice to have breakfast served in the resident's room. This service shall be provided at the resident's request, and may not replace daily meals in a dining area.
§ 2600.105. Laundry.
(a) Laundry service for bed linens, towels and personal clothing shall be provided by the home, at no additional charge, to residents who are recipients of or eligible applicants for Supplemental Security Income (SSI) benefits. This service shall also be made available to all residents who are unable to perform these tasks independently. 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 home unless otherwise indicated in the written agreement.
(c) The supply of linen and towels shall 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
(e) Clean linens and towels shall be stored in an area separate from soiled linen and clothing.
(f) The administrator and staff shall implement reasonable measures to ensure that residents' clothing are not lost or misplaced in the process of laundering or cleaning.
(g) To reduce the risks of fire hazards, the home shall ensure all lint is removed from all clothes.
§ 2600.106. Swimming areas.
If a home operates a swimming area, it shall abide by the following requirements:
(1) The home shall operate swimming areas in conformity with applicable laws and regulations.
(2) The home shall develop, utilize and implement policy and procedures that protect the health and safety of all of the residents in the home.
§ 2600.107. Internal and external disasters.
(a) The home shall have written emergency procedures that shall be developed and approved by qualified fire, safety and local emergency management offices.
(b) The written emergency procedures shall be reviewed and updated annually by the administrator, qualified fire, safety and local emergency management offices.
(c) Disaster plans shall include at a minimum:
(1) Contact names.
(2) Contact phone numbers of emergency management agencies and local resources for the housing and emergency care of residents affected.
(3) Alternate means of supply of utilities shall be identified and secured.
(4) The home shall maintain at least a 3-day supply of nonperishable food and drinking water for all residents and personnel.
(5) The home shall maintain at least a 3-day supply of all resident medications.
§ 2600.108. General health and safety.
Conditions at the home may not pose a threat to the health or safety of the residents.
§ 2600.109. Firearms and weapons.
Firearms, weapons and ammunition shall be permitted on the licensed premises of a home 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' room 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' room 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 a designee shall be the only person permitted to open the locked cabinet containing the firearms and weapons and the locked area containing the ammunition.
(5) If a firearm, weapon or ammunition is the property of at least one resident, the personal care home shall have written policies regarding safety and access of firearms, weapons and ammunition. A resident may not take a firearm, weapon or ammunition out of the locked cabinet or area into living areas of the personal care home.
FIRE SAFETY § 2600.121. Unobstructed egress.
(a) Stairways, hallways, doorways, passageways and egress routes from rooms and from the building shall be unlocked and unobstructed, unless the fire safety approval specified in § 2600.14 (relating to fire safety approval) permits locking of certain means of egress as specified in writing.
(b) Doors used for egress routes from rooms 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.
§ 2600.122. Exits.
Unless otherwise regulated by the Department of Labor and Industry, all buildings shall have at least two independent and accessible exits from every floor, each arranged to reduce the possibility that both will be blocked in an emergency situation.
§ 2600.123. Emergency evacuation.
(a) In homes housing five or more immobile residents, the fire alarm system shall be directly connected to the local fire department or 24-hour monitoring service that has been approved by the local fire department.
(b) Evacuation routes shall be well lighted and clear of obstructions at all times.
(c) Exit doors shall be equipped so that they can be easily opened by residents from the inside without the use of a key.
(d) Copies of an emergency evacuation plan as specified in § 2600.107 (relating to internal and external disasters) shall be prepared by the administrator, in conjunction with fire, safety or local emergency management offices. The plan shall be posted throughout the home and a copy shall be kept in the administrator's records.
(e) A diagram of each floor showing corridors, line of travel, exit doors and location of the fire extinguishers and pull signals shall be posted on each floor in view of residents and personnel.
§ 2600.124. Notification of local fire officials.
The home shall notify local fire officials in writing of the address of the home, location of the bedrooms, and the assistance needed to evacuate in an emergency. Documentation of notification shall be kept.
§ 2600.125. Flammable and combustible materials.
(a) Combustible materials may not be located near heat sources and hot water heaters.
(b) Flammable materials shall be used safely and stored away from heat sources and hot water heaters.
(c) The materials described in subsections (a) and (b) shall be inaccessible to residents.
§ 2600.126. Furnaces.
(a) A professional furnace cleaning company or trained maintenance staff persons 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.
§ 2600.127. Space heaters.
Portable space heaters are prohibited. Nonportable space heaters shall be adequately vented and installed with permanent connections and protectors.
§ 2600.128. 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 inspects them annually. Wood and coal burning stoves shall be cleaned every year. Documentation of these inspections and cleanings shall be maintained.
§ 2600.129. Fireplaces.
(a) A fireplace shall be securely screened or equipped with protective guards while in use.
(b) A fireplace chimney and flue shall be inspected at least once a year. Written documentation of the inspection shall be kept on file.
(c) A resident shall only be permitted to tend to the fire under staff supervision.
§ 2600.130. Smoke detectors and fire alarms.
(a) There shall be an operable automatic smoke detector located within 15 feet of each bedroom door.
(b) The smoke detectors specified in subsection (a) shall be located in common areas or hallways.
(c) Smoke detectors and fire alarms shall be of a type approved by the Department of Labor and Industry or local fire authority, or listed by Underwriters Laboratories.
(d) If the home serves four or more residents or if the home has three or more stories including the basement and attic, there shall be at least one smoke detector on each floor interconnected and audible throughout the home or an automatic fire alarm system that is audible throughout the home.
(e) If one or more residents or staff persons are not able to hear the smoke detector or fire alarm system, all smoke detectors and fire alarms shall be equipped so that each person with a hearing impairment will be alerted in the event of a fire.
(f) All smoke detectors and fire alarms shall be tested for operability at least once monthly. A written record of the monthly testing shall be kept.
(g) 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.
(h) The home's fire safety procedures shall indicate the emergency procedures that will be immediately implemented until the smoke detector or fire alarms are operable.
(i) In homes housing five or more immobile residents, the fire alarm system shall be directly connected to the local fire department or 24-hour monitoring service approved by the local fire department.
§ 2600.131. Fire extinguishers.
(a) There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, 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. The kitchen extinguisher meets the requirements for one floor as required in subsection (a).
(d) Fire extinguishers shall 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.
§ 2600.132. Fire drills.
(a) An unannounced fire drill shall be held at least once a month.
(b) There shall be a documented annual fire safety inspection and fire drill conducted by a fire safety expert. The administrator shall keep documentation of this drill and inspection.
(c) A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, the number of residents in the home at the time of the drill, the number of residents evacuated, the number of staff evacuated, problems encountered and whether the fire alarm or smoke detector was operative.
(d) Residents shall be able to evacuate the entire building into a public thoroughfare, or to a fire-safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employee of the home.
(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, on different and normal staffing shifts, 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 outside 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.
§ 2600.133. Exit signs.
(a) Signs bearing the word ''EXIT'' in plain legible letters shall be placed at all exits.
(b) If the exit or way to reach the exit is not immediately visible, access to exits shall be marked with readily visible signs indicating the direction to travel.
(c) Exit sign letters shall be at least 6 inches in height with the principal strokes of letters at least 3/4 inch wide.
RESIDENT HEALTH § 2600.141. Resident health exam and medical care.
(a) A resident shall have a health examination that is documented on standardized forms provided by the Department within 60 days prior to admission or within 30 days after admission. The resident health examination shall be completed annually thereafter. The exam shall include the following:
(1) A general physical examination by a licensed 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 and medication side effects.
(8) Body positioning and movement stimulation for residents, if appropriate.
(9) Health status with required written consent in accordance with applicable laws.
(10) Specific precautions to be taken if the resident has a communicable disease, to prevent spread of the disease to other residents.
(11) Annually updated mobility assessment or at the Department's request.
(b) Residents shall have access to medical care. If a resident needs assistance obtaining this care, the home shall make the arrangements for the resident.
§ 2600.142. Physical and behavioral health.
(a) Each home shall address in the resident's support plan the 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 deemed necessary by the health exam. This requirement does not mandate a home to pay for the cost of these medical and behavioral care services.
(b) If a resident refuses routine medical or dental examination or treatment, the refusal and the continued attempts to train 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 a designee, in accordance with applicable laws.
§ 2600.143. Emergency medical plan.
(a) The home shall have a written emergency medical plan that ensures immediate and direct access to emergency medical care and treatment. If a resident becomes ill or injured and is unable to secure necessary care, the administrator or a designee shall secure necessary assistance or care. Arrangements shall be made in advance between the administrator or a designee and the resident regarding the physician or dentist and designated person or community agency to be contacted, in case of illness or injury, and those persons shall be contacted.
(b) If admission to a hospital is necessary, the resident shall be transported to the hospital of the resident's choice, if possible.
(c) The emergency medical plan shall include the following:
(1) The hospital or source of health care that will be used in an emergency.
(2) The method of transportation to be used.
(3) An emergency-staffing plan.
(d) Current emergency medical and health information shall be made available at all times for each resident in case the resident requires emergency medical attention. The following information shall accompany the resident when the resident needs emergency medical attention:
(1) The resident's name, age 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 to make available in case of a medical emergency.
(8) Insurance or third party payer and identification number.
(9) A power of attorney.
(10) A designated contact person with a current address and telephone numbers.
(11) Personal information and related instructions from the resident regarding advanced directives, do not resuscitate orders or organ donation if the resident has executed the documents.
(12) The home shall develop an individualized plan to contact the resident's family or designated emergency contact person, if applicable. The support plan shall be part of the resident record and staff shall be able to access the support plan in an emergency.
(e) If the resident's medical condition, as determined by a physician, indicates the need for a transfer to a hospital or long term care facility, the administrator shall notify the resident's designated emergency contact person or family member, or both, as appropriate, and shall provide whatever assistance is necessary in making arrangements for the resident's transfer to an appropriate facility.
§ 2600.144. Use of tobacco and tobacco-related products.
(a) A home may permit smoking tobacco and using tobacco-related products in designated areas of the personal care home.
(b) If a home permits smoking in designated areas, the home shall ensure that proper safeguards are taken at all times to:
(1) Prevent fire hazards involved in smoking, including providing ashtrays, outside ventilation, smoke detectors, fire retardant furniture and fire extinguishers in designated smoking areas.
(2) Ensure the protection of the rights of nonsmoking residents.
(c) The designated smoking area shall be in an area that is a safe distance from heat sources, hot water heaters and areas containing combustible or flammable materials.
(d) Smoking tobacco and using tobacco-related products during the transportation of a resident, which is provided by the home, is prohibited.
(e) Smoking in resident bedrooms is prohibited.
(f) If a home has a designated smoking area, the home's written fire safety procedures shall include the designated smoking area.
(g) Written fire safety procedures shall be followed.
§ 2600.145. Supervised care.
Personal care services shall be provided by trained, qualified staff persons and with ongoing oversight and general supervision of the resident's care by the administrator. A resident in need of services that are beyond services available in the home in which the resident resides shall be referred to the appropriate assessment agency.
NUTRITION § 2600.161. Nutritional adequacy.
(a) Meals shall be offered which meet the nutritional needs of the resident in accordance with the Recommended Daily Allowance (RDA) of the Food and Nutrition Board of the National Research Council of the National Academy of Science.
(b) At least three nutritionally well-balanced meals shall be provided 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) Each meal shall contain at least one item from the dairy, protein, fruits and vegetables, and grain food groups, unless otherwise prescribed in writing by a licensed physician or certified nurse practitioner for a specific resident.
(e) Dietary alternatives shall be available for a resident who has special health needs, religious beliefs regarding dietary restrictions or vegetarian preferences.
(f) Therapeutic diets as prescribed by a physician or certified nurse practitioner, shall be followed. Documentation shall be retained in the resident's record.
(g) Drinking water shall be available to the residents at all times. Other beverages shall be available and offered to the resident at least every 2 hours.
§ 2600.162. Meal preparation.
(a) Foods shall be prepared in a consistency designed to meet the needs of the resident.
(b) Uneaten food from a person's dish may not be served again or used in the preparation of other dishes.
(c) There may not be more than 14-16 hours between the evening meal and the first meal of the next day, unless a resident's physician has prescribed otherwise, and there may not be more than 4-6 hours between breakfast and lunch, and between lunch and supper.
(d) Food shall be procured from sources approved or considered satisfactory by Federal, State or local authorities. Outdated or spoiled food or severely dented cans may not be used.
(e) When a resident misses a meal, food adequate to meet daily nutritional requirements shall be available and offered to the resident.
(f) Meals shall include a variety of hot and cold food.
(g) Milk shall be pasteurized.
(h) Adaptive eating equipment or utensils shall be made available and meet the needs of the residents.
(i) If a home contracts for food services, the contractor shall provide meals and snacks that meet the nutritional and dietary recommendations of the Recommended Daily Allowance (RDA) of the Food and Nutrition Board of the National Research Council of the National Academy of Science.
(j) Menus, stating the specific food being served at each meal, shall be prepared for 1 week in advance. Menus shall be posted for the current week and 1 week in advance, and shall be posted in a conspicuous place where the resident can review them.
(k) Past menus of meals that were served, including changes, shall be retained for at least 1 month.
(l) A change to a menu shall be posted and accessible to a resident in advance of the meal.
(m) Food stored, prepared or served shall be clean and safe for human consumption.
§ 2600.163. Personal hygiene for food service workers.
(a) Staff, volunteers or 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 or after using the toilet room.
(b) Staff, volunteers or residents shall follow sanitary practices while working in the kitchen areas.
(c) Staff, volunteers or residents involved with the storage, preparation, serving and distributing of food shall be in good health.
(d) Staff, volunteers or 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.
§ 2600.164. Withholding or forcing of food prohibited.
(a) A home may not withhold meals, beverages, snacks or desserts as punishment.
(b) A resident may not be forced to eat food.
(c) If a resident refuses to eat consecutively during a 24-hour period, the resident's primary care physician and the resident's designee or a family member shall be immediately notified.
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