Current through Register Vol. 49, No. 9, September, 2024
100
DEFINITIONS
As used in these rules and regulations, the following
definitions shall apply unless the context clearly states otherwise. Where
these rules and regulations refer to an enactment of the General Assembly, such
referenced shall include subsequent enactment or amendments by the General
Assembly on the same subject matter.
ABUSE Shall have the same meaning as
prescribed by Ark. Code Ann.§
12-12-1703. "Abuse"
also includes sexual abuse as defined in Ark. Code Ann. §
12-12-1703(18).
ACTIVITIES OF DAILY LIVING - The tasks
for self-care that are performed either independently, with supervision, with
assistance, or by others. Activities of daily living include but are not
limited to ambulating, transferring, grooming, bathing, dressing, eating and
toileting.
ADA - The Americans with Disabilities
Act.
ADULT DAY CARE PROGRAM - Adult Day
Care (ADC) is a program which provides care and supervision to meet the needs
of four (4) or more functionally impaired adults for periods of less than
twenty-four, but more than two hours per day in a place other than the adult's
own home.
ADULT DAY CARE PROVIDER - The person,
corporation, partnership, association or organization legally responsible for
the overall operation of the ADC Program and that is licensed to operate as an
ADC by the Office of Long Term Care (OLTC).
APPLICANT - The person, corporation,
partnership, association or organization which has submitted an application to
operate an ADC but has not yet been approved and issued a license by the Office
of Long Term Care.
CARE GIVER - Shall have the same
meaning prescribed by Ark. Code §
12-12-1703.
CONTACT DAYS - Contact days means the
number of days the client actually attended the Adult Day Care facility.
DEFICIENCY - A facility's failure to
meet program participation requirements as defined in these and other
applicable regulations and laws.
DEPARTMENT - The Department of Health
and Human Services.
DIRECT CARE SERVICES - Services that
directly help a client with certain routines and activities of daily living
such as assistance with mobility and transfers; assistance to clients to
consume a meal, grooming, shaving, trimming or shaping fingernails and
toenails, bathing, dressing, personal hygiene, bladder and bowel requirements,
including incontinence or assistance with medication only to the extent
permitted by the state Nurse Practice Act and interpretations thereto by the
Arkansas State Board of Nursing.
DIRECT CARE STAFF - Any staff,
compensated or volunteer, acting on behalf of, employed by, or contracted by
the facility either directly or through an employment agency, to provide
services and who provides direct care services or assistance to clients,
including activities of daily living and tasks related to medication
administration or assistance.
DIRECT CONTACT - The ability or
opportunity of employees of the facility, or individuals with whom the facility
contracts either directly or through an agency, to physically interact with or
be in the presence of clients.
DIRECTOR - The individual or entity
that conducts the business of the facility and is in charge of the daily
operations of the facility. The Director is the resource contact between the
facility and OLTC.
DISCHARGE - When a client leaves the
facility and it is not anticipated that the client will return.
EMERGENCY MEASURES - Those measures
necessary to respond to a serious situation that threatens the health and
safety of clients.
LONG-TERM CARE FACILITY RESIDENT -
Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703
and as amended.
EXPLOITATION - Shall have the same
meaning as prescribed by Ark. Code Ann. §
12-12-1703
and as amended.
FUNCTIONALLY IMPAIRED ADULT - An
individual, age eighteen (18) or older, who by reason of mental or physical
disability, requires care and supervision.
HEALTH CARD - A certificate issued by
the Arkansas Department of Health and Human Services' Divison of Health or any
entity certified by the Arkansas Department of Health and Human Services'
Divison of Health, that states the person named on the card has been tested for
tuberculosis.
HIPAA - Health Insurance Portability
Accountability Act required by federal law to "protect health information" of
clients. See www.dhhs.gov/ocr/hipaa for specific
details.
LICENSE - A time-limited
non-transferable permit required by Ark. Code Ann. §
20-10-224
and issued for a maximum period of 12 months to a licensee who complies with
the Office of Long Term Care rules and regulations. This document shall list
the maximum number of slots for the facility.
MALTREATMENT - Shall have the same
meaning as prescribed in Ark. Code Ann. §
12-12-1703.
MENTAL ABUSE - Verbal, written, or
gestured communications to a client a visitor, or staff, about a client within
the client's presence, or in a public forum, that a reasonable person finds to
be a material endangerment to the mental health of a client.
NEGLECT - Shall have the same meaning
as prescribed by Ark. Code Ann. §
12-12-1703.
NON-COMPLIANCE - Any violation of
these regulations, or of applicable law or regulations.
OFFICE OF LONG TERM CARE (OLTC) - The
Office in the Division of Medical Services of the Department of Health and
Human Services that has the responsibility for the licensure, certification and
regulation of long term care facilities, herein referred to as the Office or
OLTC.
PERSON - An individual, partnership,
association, corporation, or other entity.
PERSONNEL/STAFF/EMPLOYEE - Any person
who, under the direction, control, or supervision of facility administration,
provides services as defined in these regulations for compensation, or who
provides services voluntarily, and may include the owner, professional,
management and person, firms, or entities providing services pursuant to a
contract or agreement.
PLAN OF CARE - The Adult Day Care
Provider's written description of the scope of services to be provided to each
individual client.
PLAN OF CORRECTION (PoC) - A plan
developed by the facility and approved by OLTC that describes the actions the
facility will take to correct deficiencies, specifies the date by which those
deficiencies will be corrected, and sets forth the means and methods used to
evaluate the efficacy of the corrections.
PRN - A medication or treatment
prescribed by a medical professional to a person, allowing the mediation or
treatment to be given "as needed".
PROGRAM REQUIREMENTS - The
requirements for participation and licensure under these and other applicable
regulations and laws as an Adult Day Care Facility.
PROPRIETOR/LICENSEE - Any person,
firm, corporation, governmental agency or other legal entity, issued an Adult
Day Care license, and who is responsible for maintaining approved
standards.
SURVEY - The process of inspection,
interviews, or record reviews conducted by the Office of Long Term Care to
determine an Adult Day Care facility's compliance with program requirements and
with applicable regulations and laws.
200
LICENSURE
200.1 No Adult Day Care facility may be
established, conducted, or maintained in Arkansas without first obtaining a
long term care facility license as required by Ark. Code Ann. §
20-10-201,
et seq. and these licensing standards. All licenses issued
hereunder are nontransferable from one owner or proprietor to another or from
one site to another. Except when waived by the Office of Long Term Care in
times of emergency, no Adult Day Care facility may operate with more slots than
is stated in the license and no Adult Day Care facility may accept more clients
than the number of slots stated on the license.
200.2 The issuance of an Adult Day Care
facility license shall be a grant of authority to the facility to operate an
Adult Day Care facility. The initial license shall state the number of slots.
Subsequent licenses issued to the same owner will state the number of slots for
which the facility has been licensed at the time of the issuance of the
subsequent license. Licenses issued as a result of a change of ownership shall
state the number of slots for which the facility was licensed on the date of
sale of the facility or the date of sale of ownership of the
facility.
201
LICENSING
INFORMATION
201.1 Licenses to operate
an Adult Day Care facility are effective beginning July
1st and expiring on the following June 30.
201.2 Licenses shall be issued
only for the premises and persons specified in the application and shall not be
transferable.
201.3 Licenses shall
be posted in a conspicuous place on the licensed premises.
201.4 Separate licenses are required for
Adult Day Care facilities maintained on separate premises, even though they are
operated under the same management. Multiple buildings on contiguous land that
serve clients shall require and shall be licensed under a single
license.
201.5 Every Adult Day Care
facility owner shall designate a distinctive name for the facility which shall
be included on the application for a license. The name of the facility shall
not be changed without prior written notification to and approval from the
Office of Long Term Care.
202
INITIAL LICENSE
202.1 Initial licensure shall apply to:
(a) Newly constructed facilities designed to
operate as Adult Day Care facilities;
(b) Existing structures not already licensed
as Adult Day Care facilities on the effective date of these regulations;
and
(c) Facilities that change
ownership.
202.2 The
initial licensure application shall be accompanied by:
(a) Building plans showing a detailed floor
plan of the facility. Floor plans must contain exact measurements and identify
each room, hallway, window, exit, etc.
(b) A letter from the City or County Zoning
Commission, stating that the facility meets zoning requirements.
(c) A letter from a licensed electrician and
licensed plumber, with their name and license number included, stating that the
facility complies with State Codes.
(d) A letter from the County or State
Division of Health, stating approval for facilities with wells and septic
tanks, if applicable.
203
COMPLIANCE
An initial license will not be issued until the Department
verifies that the facility is in compliance with, and able to meet, the
licensing standards and program requirements set forth in these
regulations.
An initial license will be effective on the date specified by
the Office of Long Term Care once the Office of Long Term Care determines the
facility to be in compliance with these licensing standards and applicable laws
and regulations. The license will expire on June 30th
following the issuance of the license.
204 APPLICATION, EXPIRATION AND RENEWAL OF
LICENSE
204.1 Applicants for licensure or
renewal of Adult Day Care facility licensure shall obtain the necessary forms
for initial or renewal licensure or re-licensure of the facility after a change
of ownership (see Section 205) from the Office of Long Term Care. The issuance
of an application form is not a guarantee that the completed application will
be acceptable, or that the Department will issue a license.
204.2 The facility shall not admit any
clients until a license to operate an Adult Day Care facility has been
issued.
204.3 Applicants for
initial licensure, renewal, or re-licensure after a change in ownership shall
pay in advance a license fee of $5.00 per slot to the Department. Such fee
shall be refunded to the applicant in the event a license is not
issued.
204.4 Annual renewal is
required for all Adult Day Care facility licenses. Licenses are effective
beginning July 1 and shall expire on June 30th of
the following year. In the event that a facility's license is not renewed by
June 30th, the license will be void.
204.5 Applications for annual license renewal
shall be delivered or, if mailed, postmarked to the Office of Long Term Care no
later than June 1st before the June
301 expiration of the license. Any license fee
received by the Department after June 1 is subject to a ten percent (10%)
penalty.
204.6 The Director of the
facility shall sign applications and must successfully complete a criminal
background check pursuant to Ark. Code Ann. § 20-33-201, et seq.,
and in accordance with the Rules and Regulations for Conducting
Criminal Record Checks for Employees of Long Term Care Facilities.
204.7 When a change in ownership or
controlling interest in the facility is sold by person or persons named in the
license to any other person or persons, the new owner shall, at least 30 days
prior to completion of the sale, submit a new application and license fee,
request to be inspected and meet the applicable standards and regulations,
including but not limited to, life safety codes, at the time of inspection. The
seller, in writing, shall report such change in ownership to the Office of Long
Term Care at least thirty (30) days before the change is to be implemented.
With the exception of civil money penalties imposed for violations or
deficiencies that occurred prior to the sale of ownership or control, when a
license is granted pursuant to a change of ownership, the buyer shall be
responsible for implementation or performance of any remedy listed in Section
802 imposed against the facility for violations or deficiencies that occurred
prior to the sale of ownership or control. The seller shall remain liable for
all civil money penalties assessed against the facility that are imposed for
violations or deficiencies occurring prior to the sale of ownership or
operational control. The Department shall consider and may deny a license based
upon any criteria provided for at Ark. Code Ann. §
20-10-224(f)
(1), et seq. Failure to
comply with the provisions of this section will result in the denial of
licensure to the new owner.
204.8
The applicant/licensee must furnish the following information:
(a) The identity of each person having
(directly or indirectly) an ownership interest of five percent (5%) or more in
the facility;
(b) The complete name
and address of the Adult Day Care facility for which licensure is requested and
such additional information as the Department may require including, but not
limited to, affirmative evidence of ability to comply with standards, rules and
regulations as are lawfully prescribed hereunder;
(c) In case such facility is organized as a
corporation, the identity of each officer and director of the corporation,
together with a certificate of good standing from the Arkansas Secretary of
State; (d) In case such facility is organized as a partnership, the identity of
each partner and a copy of the partnership agreement.
204.9
Procedure for
Licensure
The procedure for obtaining an Adult Day Care License shall
be:
(a) The individual or entity
seeking licensure shall request or obtain all forms for licensure from the
Office of Long Term Care.
(b) The
individual or applicant shall fully complete all forms for licensure and submit
same to the Office of Long Term Care, along with all licensure fees. As
applicable and required by law or regulation, the individual or entity seeking
licensure shall submit drawings or plans for the facility to the Office of Long
Term Care at the time of application.
(c) For a new facility, the Office of Long
Term Care will conduct a Life-Safety code survey to determine compliance with
applicable building code requirements.
(d) For a new facility, upon being informed
that the facility meets all requirements for all applicable building codes, the
facility may admit clients.
(e) For
a new facility, upon successful completion of the initial survey, the facility
shall be granted a license to operate as an Adult Day Care.
(f) The Office of Long Term Care may elect,
for any renewal application, to perform a survey prior to the issuance of the
license, and issuance of the license is contingent upon the facility being
found in compliance with all program requirements.
(g) The Office of Long Term Care may elect,
for any renewal application, to deny re-licensure if the facility has unpaid
civil money penalties imposed by the Office of Long Term Care; and,
* The time for an appeal has passed with no appeal being filed
or all appeals have been exhausted and the imposition of the CMPs was upheld,
(h) The Office of Long
Term Care shall deny renewal of any license when a facility is unable to meet
program requirements at the time of renewal.
205 CHANGE IN OWNERSHIP
205.1 Transactions constituting a change in
ownership include, but are not limited to, the following:
(a) A sole proprietor becomes a member of a
partnership or corporation, succeeding him as the new Director;
(b) A partnership dissolves;
(c) One partnership is replaced by another
through the removal, addition or substitution of a partner;
(d) The corporate owner merges with, or is
purchased by, another corporation or legal entity;
(e) A not-for-profit corporation becomes a
general corporation, or a for-profit corporation becomes
not-for-profit.
205.2
Transactions that do not constitute a change of ownership include, but are not
limited to, the following:
(a) Changes in the
membership of a corporate board of directors or board of trustees,
or;
(b) Changes in the membership
of a not-for-profit corporation.
300 ADMINISTRATION
301 GOVERNING BODY
Each Adult Day Care facility shall have an owner or governing
body that has ultimate authority for:
(a) The overall operation of the
facility;
(b) The adequacy and
quality of care;
(c) The financial
solvency of the facility and the appropriate use of its funds;
(d) The implementation of the standards set
forth in these regulations; and
(e)
The adoption, implementation and maintenance, in accordance with the
requirement of state and federal laws and regulations and these licensing
standards, of the Adult Day Care policies and administrative policies governing
the operation of the facility.
302
GENERAL PROGRAM
REQUIREMENTS302.1 Each person or legal
entity issued a license to operate an Adult Day Care facility shall, through
their employees and agents, provide an organized program of supervision, care
and services that:
(a) Conform to Office of
Long Term Care rules and regulations;
(b) Meet the needs of the clients of the
facility;
(c) Provide for the full
protection of clients' rights; and
(d) Promote the social, physical and mental
well being of clients.
302.2 The facility shall provide any
authorized agents of DHHS or their designee, full access at anytime during
business hours to:
(a) Clients
(b) Grounds
(c) Buildings
(d) Books, files and/or papers relating to
clients or operation of the facility.
302.3 The facility shall provide for
maintenance and submission of such statistical, financial or other information
records or reports, in such form, at such time and in such a manner as DHHS may
require.
302.4 The facility shall
provide notification to DHHS when incidents/accidents occur involving the
facility or its clients as specified in Section 305.
303
PERSONNEL AND GENERAL POLICIES AND
PROCEDURES - Required Policies and Procedures governing general
administration of the facility.
303.1 The
facility must develop, maintain, follow and make available for public
inspection the following policies and procedures:
(a) Client policies and procedures as set
forth in Section 304.
(b) Admission
policies as set forth in Section 402.
(c) Discharge policies as set forth in
Section 403.
(d) Incident report
policies and procedures including procedures for reporting suspected abuse or
neglect as set forth in Section 305.
(e) Clients' Rights policies and procedures
as set forth in Section 403.
(f)
Fire Safety standards as set forth in Section 700.
(g) Smoking policies for clients and facility
personnel as set forth in Section 303.2, 504.1.19 and 705.
(h) Emergency Treatment plan policies and
procedures as set forth in Section 306
(i) Medication storage and administration
policies and procedures as set forth in Section 502.
(j) Policy and procedures for the relocation
of clients in cases of emergencies (such as fires, natural disasters, or
utility outages) Section 704. Failure of a facility to meet the requirements of
this subsection shall be a violation pursuant to Ark. Code Ann. §
20-10-205,
et seq.
303.2 Each facility must have written
employment and personnel policies and procedures. Personnel records shall
include, as a minimum, the following:
(a)
Employment applications for each employee.
(b) Written functional job descriptions for
each employee that is signed and dated by the employee.
(c) Minimum qualifications, to include
educational qualification and documentation of continuing training, including
orientation training and continuing education units (CEU) related to
professional license, personal care, food management, etc. CEU documentation
must include copies of the documentary evidence of the award of hours by the
certifying organization. Each facility is responsible for maintaining employee
educational records.
(d) Evidence
of credentials, including current professional licensure or
certification.
(e) Written
statements of reference or documentation of verbal reference check. Verbal
check documentation must include the name and title of the person giving the
reference, the substance of any statements made, the date and time of the call,
and the name of the facility employee who is making the call.
(f) Employee's signed acknowledgement that he
or she has received and read a copy of the Clients' Bill of Rights.
(g) Verification that employee is at least 18
years of age.
(h) Verification that
the employee has not been convicted or does not have a substantiated report of
abusing or neglecting clients or misappropriation of client property. The
facility shall, at a minimum, prior to employing any individual or any
individuals working in the facility through contract with a third party, make
inquiry to the Employment Clearance Registry of the Office of Long Term Care
and the Adult Abuse Registry maintained by the Department of Health and Human
Services, Division of Aging and Adult Services, and shall conduct re-checks of
all employees every five (5) years. Inquiries to the Adult Abuse Registry shall
be made by requesting a Request for Information form addressed to Adult
Protective Services Central Registry, P.O. Box 1437, Slot S540, Little Rock, AR
72203.
(i) Documentation that all
employees and other applicable individuals utilized by the facility as staff
have successfully completed a criminal background check pursuant to Ark. Code
Ann.§ 20-33-201, et seq. and in accordance with the Rules
and Regulations for Conducting Criminal Record Checks for Employees of Long
Term Care Facilities.
(j) A copy of
a current health card issued by Arkansas Department of Health and Human
Services or other entities as provided by law.
(k) Documentation that the employee has been
provided a copy of all personnel policies and procedures. A copy of all
personnel policies and procedures must be made available to OLTC personnel or
any other Department personnel..
(l) Documentation that policies and
procedures developed for fire safety standards and evacuation of building has
been provided to the employee,
(m)
Documentation that policies and procedures developed for tobacco use has been
provided to the employee. The facility shall meet all regulations issued by the
Arkansas Department of Health and Human Services regarding communicable
diseases.
303.3 Failure
to comply with the provisions of this subsection or violation of any policies
and procedures developed pursuant to this subsection shall be a violation
pursuant to Ark. Code Ann. §
20-10-205
or may constitute a deficiency finding against the facility.
303.4 Orientation records will be maintained
for each employee to include but not limited to:
(a) Job duties;
(b) Orientation to client rights;
(c) Abuse/neglect reporting requirements;
and,
(d) Fire and tornado
drills
303.5 In-service
training sessions for direct care staff are required at a minimum of four (4)
hours per annual quarter for a total of sixteen (16) hours per year. Training
shall be appropriate to job function and shall include but is not limited to:
(a) Client Rights;
(b) Safety standards;
(c) Abuse reporting;
(d) Normal signs of aging;
(e) Health problems of aging;
(f) Communications;
(g) Dementia Training.
303.6 In-service training sessions for
non-direct care staff are required at a minimum of two (2) hours per annual
quarter for a total of eight (8) hours per year.
303.7 In-service training sessions for
part-time workers (20 hours or less per week) are required at a minimum of two
(2) hours per annual quarter for a total of eight (8) hours per year.
303.8
Staffing
303.8.1 The staffing pattern shall be
dependent upon the enrollment criteria and the particular needs of the clients
who are to be served. The ratio of paid staff to client shall be adequate to
meet the goals and objectives of the program. The minimum ratios shall be at
least two (2) staff persons when two through 16 (2-16) clients are present and
one (1) additional staff person for any portion of eight (8) additional clients
are present. The Office of Long Term Care may require additional staff when it
is determined that the needs and services of the clients are not being met.
Secretaries, accountants, and other non-direct care staff members shall not be
considered in the staffing ratio. In case of an emergency when a direct care
staff must leave, one (1) non-direct care staff may count until the emergency
has been resolved.
303.8.2
Substitutes
Whenever paid staff are absent, substitutes must be used to
maintain the staff-client ratio and to assure proper supervision and delivery
of health services.
(a) In the absence
of a regular staff person, a substitute staff person may be used in order to
maintain the required staff-client ratio.
(b) Such substitute staff shall have the same
qualifications, training and personal credentials as the regular staff position
for whom they are substituting.
(c)
Trained volunteers, with the same qualifications, training and personal
credentials as the regular staff for whom they are volunteering, may be used
instead of paid substitutes.
303.8.3
Program
Director
The Program Director shall have the authority and
responsibility for the management of activities and direction of staff and
shall insure that activities and services are appropriate and in accordance
with established policies.
(a) ADC
facilities licensed for more than fifteen (15) clients must have a full-time
Director.
(b) The Director shall
meet all the minimum qualifications:
(1) Shall
be at least 21 years of age;
(2)
Shall have at least one year of work experience in the area of human services
(e.g., services to the elderly, disabled, or handicapped adults);
(3) Shall have demonstrated ability in
supervision and administration;
(4)
Shall have a current health card;
(5) Shall have knowledge of the aspects of
aging and appropriate activity programming.
303.8.4
Executive
Director
In adult day care programs where the executive director is
responsible for more than adult day care services, the Executive Director may
not be counted as direct care staff.
303.8.5
Personal Care
Staff
The ADC shall have sufficient other staff responsible for
personal care to comply with these regulations and the care requirements of the
clients. Minimum requirements are:
(a)
Be at least 18 years of age;
(b)
Have a current health card;
(c)
Have successfully completed a training course for nurse's aides, personal care
technicians or home health aides;
(d) Upon the effective date of these
regulations, those non-certified employees have one calendar year to complete a
certification class.
In-service training sessions are required for all direct care
staff. In-service sessions are four (4) hours per quarter for a total of 16
hours per year.
303.8.6
Volunteers
The ADC shall comply with the following in regard to
utilization of volunteers who provide direct care in lieu of paid staff:
(a) Volunteers shall:
1. Be at least 18 years of age;
2. Have a current health card;
(b) Volunteers shall be provided
written job descriptions. These shall describe in detail:
1. Task(s) to be performed;
2. Qualifications for performing assigned
task;
(c) The facility
shall designate a paid staff position who is responsible for supervising the
volunteer regarding:
* Hours
* Days
* And length of commitment of volunteer's services
(d) Volunteer shall receive a
formal orientation.
1. In-service training
sessions are required for all volunteers. In-service sessions shall total a
minimum of four (4) hours per annual quarter for full time volunteers and eight
(8) hours per year for part time volunteers (less than 20 hours per
week).
2. Paid staff shall be
informed of their responsibilities to the volunteer prior to the volunteer's
working in the program.
3. The
volunteer's job performance shall be evaluated as necessary.
4. Provision shall be made for recognition
and appreciation of the volunteer, at least on an annual basis.
5. Trained volunteers may be counted in the
direct care staff-client ratio. When counted in direct care staff-client ratio,
the volunteer shall have the same qualifications as the staff position being
substituted for.
303.8.7
Universal
Worker
Each staff person on duty may be counted as direct care staff
even if they are currently involved in housekeeping, laundry or dietary
activities as long as universal precautions are followed.
304
GENERAL
REQUIREMENTS CONCERNING CLIENTS
The facility shall:
(a) Permit unrestricted visiting hours.
However, facilities may deny visitation when visitation results, or substantial
probability exists, that visitation will result in disruption of service to
other clients or threatens the health, safety, or welfare of the client or
clients.
(b) With the exception of
fish in aquariums and service animals (e.g. guide dogs), live animals shall not
be permitted in common dining areas, storage areas, food preparation areas or
common serving areas. Pets may be permitted in Adult Day Care facilities if
sanitary conditions and appropriate behavior are maintained. If the facility
permits pets, the facility shall ensure that the facility is free of pet odors
and that pets' waste shall be disposed of regularly and properly. Pets must not
present a danger to clients or guests. Current records of inoculations and
license, as required by state law or local ordinance, shall be maintained on
file in the facility. For purposes of these regulations, pets
mean domesticated mammals (such as dogs and cats), birds or fish, but
not wild animals, reptiles, or livestock. Parameters for pets (including
behavior and health) must be set and be included in the admission
agreement.
(c) Require that conduct
in the common areas shall be appropriate to the community standards as defined
by the clients and staff.
(d)
Ensure that clients not perform duties in lieu of direct care staff, but may be
employed by the facility in other capacities.
(e) Ensure that clients are not left in
charge of the facility.
(f) In the
event of a client's acute change of condition or accident;
1. Notify the client's responsible party or
next of kin. A competent client may decline to have someone contacted, if such
a request is in writing and filed in the client's file;
2. Take immediate steps to see that the
client receives necessary medical attention including transfer to an
appropriate medical facility;
3.
Make a notation of the illness or accident in the client's records.
305
REPORTING
SUSPECTED ABUSE, NEGLECT, OR MISAPPROPRIATION OF CLIENT PROPERTY
Pursuant to Ark. Code Ann. §
12-12-1701
et seq. and Ark. Code Ann. § 12-12-501, et seq.,
the facility must develop and implement written policies and
procedures to ensure incidents are prohibited, reported, investigated and
documented as required by these regulations and by law, including:
* alleged or suspected abuse or neglect of clients;
* exploitation of clients or any misappropriation of client
property.
A facility is not required under this regulation to report
death by natural causes. However, nothing in this regulation negates, waives,
or alters the reporting requirements of a facility under other regulations or
statutes.
Facility policies and procedures regarding reporting, as
addressed in these regulations, must be included in orientation training for
all new personnel/staff/employees and must be addressed at least annually
during in-service training for all facility staff.
305.1
Next-Business-Day Reporting
of Incidents
The following events shall be reported to the Office of Long
Term Care by facsimile transmission to telephone number 501-683-5306 of the
completed Incident & Accident Intake Form (Form DMS-731) no later than
11:00 a.m. on the next business day following discovery by the facility.
a. Any alleged, suspected, or witnessed
occurrences of abuse, including verbal statements or gestures, or neglect to
clients.
b. Any alleged, suspected,
or witnessed occurrence of misappropriation of client property or exploitation
of a client.
c. Any alleged,
suspected, or witnessed occurrences of sexual abuse to clients by any
individual.
In addition to the requirement of a facsimile report by the
next business day on Form DMS-731, the facility shall complete a Form DMS-742
in accordance with Section 305.5. Forms DMS-731 and DMS-742 are found in the
Appendix or on the OLTC web site at:
http://www.medicaid.state.ar.us/InternetSolution/General/units/ol
tc/forms/forms.aspx.
305.2
Incidents or Occurrences
that Require Internal Reporting Only -Facsimile Report or Form DMS-742 Not
Required
The following incidents or occurrences shall require the
facility to prepare an internal report only and does not require a facsimile
report or Form DMS-742 to be made to the Office of Long Term Care. The internal
report shall include all content specified in Section 305.5, as applicable.
Facilities must maintain these incident report files in a manner that allows
verification of compliance with this provision.
a. Incidents where a client attempts to cause
physical injury to another client without resultant injury. The facility shall
maintain written reports on these types of incidents to document "patterns" of
behavior for subsequent actions.
b.
All cases of reportable disease as required by the Arkansas Department of
Health and Human Services, Division of Health.
c. Loss of heating, air conditioning, or fire
alarm system for a period of greater than two (2) hours.
305.3
Internal-Only Reporting
Procedure
Written reports of all incidents and accidents shall be
completed within five (5) days after discovery. The written incident and
accident reports shall be comprised of all information specified in forms
DMS-731 andDMS-742 as applicable.
All written reports will be reviewed, initialed, and dated by
the facility program director or designee within five (5) days after
discovery.
1. All reports involving
accident or injury to clients will also be reviewed, initialed, and dated by
the facility Director within five (5) days.
2. The care plan portion of the admission
agreement shall be reviewed by the Director and:
a. Shall be amended upon any change of a
client's condition or need for services;
b. Copies of the amended versions of the care
plan shall be attached to the written report of the incident or accident.
Reports of incidents specified in Section 305.3 will be
maintained in the facility only and are not required to be submitted to the
Office of Long Term Care.
All written incident and accident reports shall be maintained
on file in the facility for a period of three (3) years from the date of
occurrence or report, whichever is later.
305.4
Other Reporting
Requirements
The facility's program director or designee is also required to
make any other reports as required by state and federal laws and
regulations.
305.5
Abuse Investigation Report
The facility must ensure that all alleged or suspected
incidents involving client abuse, exploitation, neglect, or misappropriations
of client property are thoroughly investigated. The facility's investigation
must be in conformance with the process and documentation requirements
specified on the Form DMS-742, and must prevent the occurrence of further
incidents while the investigation is in progress.
The results of all investigations must be reported to the
facility's program director or designated representative and to other officials
in accordance with state law, including the Office of Long Term Care, within
five (5) working days of the facility's knowledge of the incident. If the
alleged violation is verified, appropriate corrective action must be
taken.
The DMS-742 shall be completed and mailed to the Office of Long
Term Care by the end of the 5th working day
following discovery of the incident by the facility. The DMS-742 may be amended
and resubmitted at any time circumstances require.
Reporting Suspected Abuse or
Neglect
The facility's written policies and procedures shall include,
at a minimum, requirements specified in this section.
305.5.1 The requirement that the facility's
program director or his or her designated agent immediately reports all cases
of suspected abuse or neglect of clients of an Adult Day Care to the local law
enforcement agency in which the facility is located as required by Ark. Code
Ann. §
12-12-1701
et seq. and as amended.
305.5.2 The requirement that the facility's
program director or his or her designated agent report suspected abuse or
neglect to the Office of Long Term Care as specified in these
regulations.
305.5.3 The
requirement that all facility personnel/staff/employees who have reasonable
cause to suspect that a client has been subjected to conditions or
circumstances that have resulted in abuse or neglect shall immediately notify
the facility program director or his or her designated agent (this does not
negate that all mandated reporters employed by or contracted with the facility
shall report immediately to the local law enforcement agency in which the
facility is located as required by Ark. Code Ann. §
12-12-1701
etseq.).
305.5.4
The requirement that, upon hiring, each facility employee be given a copy of
the abuse or neglect reporting and prevention policies and procedures and sign
a statement that the policies and procedures have been received and read. The
statement shall be filed in the employee's personnel file.
305.5.5 The requirement that all facility
personnel receive annual, in-service training in identifying, reporting and
preventing suspected abuse or neglect, and that the facility develops and
maintains policies and procedures for the prevention of abuse and neglect and
accidents.
305.5.6 When the Office
of Long Term Care makes a finding that a facility employee or personnel of the
facility committed an act of abuse, neglect or misappropriation of client
property against a client, the name of that employee or personnel shall be
placed in the Employment Clearance Registry of the Office of Long Term Care. If
the employee or personnel against whom a finding is made is a CNA, the name of
the CNA will be placed in the CNA Registry of the Office of Long Term Care.
Further, the Office of Long Term Care shall make report of its finding to the
appropriate licensing or enforcement agencies.
306
EMERGENCY MEDICAL PLAN
Each provider shall have a written emergency medical plan which
assures transportation to a hospital or other type of facility providing
emergency care.
306.1 The facility
shall have on file a written agreement, signed by the client or legal guardian,
granting permission to transport a client who needs emergency care to the
designated hospital or other type of facility.
306.2 Client records must note any accident,
injury or illness and emergency procedures that occur.
306.3 Emergency telephone numbers shall be
posted in a prominent place near the telephone where facility staff has full
access to its use.
306.4 Emergency
telephone numbers for each client shall be documented in the client's
file.
307
ADMINISTRATIVE RECORDS
Administrative records must include at least:
307.1 Written program description, copies of
which are available to the Department, clients, families or other interested
parties. The document shall describe at a minimum:
(a) Administrative organization;
(b) Maximum number of clients that can be
served;
(c) Admission criteria for
clients to be accepted;
(d) Days of
the week and hours of operation;
(e) Services available to clients including
cost for such services;
(f)
Criteria for discharge.
307.2 Current facility inspection reports
from local fire department, as applicable, and DHHS.
307.3 Current inspection report for any
catered services;
307.4 Record of
activities conducted for the previous three (3) months.
307.5 Weekly menu plan and record of actual
meals served for the previous month.
307.6 Emergency medical plan.
307.7 Fire safety plan.
307.8 Record of fire drills, disaster drills
and tornado drills for the past twelve (12) months.
307.9 Record of smoke detector checks and
fire extinguisher checks for the past twelve (12) months.
308
CLIENT RECORDS
The facility must maintain a separate and distinct record for
each client.
308.1 The record must
contain:
(a) Client's name;
(b) Client's address;
(c) Admission date;
(d) Name, office telephone number and
emergency telephone number of each primary care physician or advanced practice
nurse who treats the client;
(e)
Name, address and telephone number of family members and the person identified
by the client who should be contacted in the event of an emergency;
(f) Date of birth;
(g) All identification numbers, such as
Medicaid, Medicare/Medipak, Veterans Administration;
(h) Transportation arrangements, (if
applicable);
(i) A copy of the
client's signed Rights Statement;
(j) A copy of the client's signed Admission,
Discharge Agreements;
(k) A written
acknowledgement that the client or responsible party has been notified of the
charges for the services provided;
(l) Medical and social history;
(m) Progress notes, including any significant
change in client's health status, either positive or negative;
(n) Significant changes must be reported to
the appropriate person (physician, Advance Practice Nurse, or, caregiver, etc.)
as soon as possible;
(o)
Documentation of who was notified and when they were notified shall be placed
in the client's file;
(p) A list
of all current medications kept by the facility for the client;
(q) Documentation of any treatment or
therapies;
(r) Documentation of any
special diets, if applicable;
(s)
Documentation regarding any accident or incidents;
(t) A copy of court orders, letters of
guardianship, or power of attorney, if applicable;
(u) Copy of any advance directive;
(v) Copy of the client's care plan;
(w) Discharge date;
(x) A signed copy of the HIPPA release
form.
308.2
Confidentiality of Records
(a) Client's records are confidential and
shall not be released without legal authorization or subpoena.
(b) Active records shall be available to
authorized agents of DHHS or their designee during normal business
hours.
(c) Record shall contain a
copy of a signed copy of the HIPPA release form indicating that the facility is
in compliance with HIPPA regulations.
308.3
Record
Retention
(a) All client records
will be retained for a period of five (5) years. In the event that an audit,
litigation or other action involving these pertinent records is started before
the end of the five year period, those records shall be retained until all
issues arising out of the actions are resolved or until the end of the five (5)
year period, whichever is later.
(b) Documentation concerning persons whose
requests for services were denied as a result of the assessment process will
also be retained for five (5) years.
(c) All records shall be maintained on site.
They shall be made available within 24 hours of an official request. When a
facility changes ownership, the original records shall remain at the
facility.
(d) Documentation shall
be on file that the client or responsible party has been informed of their
right to privacy under HIPPA.
308.4
Care Plan
There shall be a written care plan for each client. Care
plans:
(a) Shall be developed within
five (5) contact days following the client's entry into the program;
(b) Shall be designed to maintain the client
at the optimal level of functioning;
(c) Shall cover all:
1. Medications
2. Treatments
3. Rehabilitative services (where
appropriate)
4. Diets
5. Precautions related to
activities
6. Plans for continuing
care
7. Discharge
(d) Shall be individualized for
each client to address:
1. Functional
activities, interests, and specific goals;
2. Means of accomplishing these
goals;
(e) Shall
identify the client's regularly scheduled days for attendance including arrival
and departure times;
(f) Shall be
revised as frequently as warranted by the client's condition;
(g) Shall be reviewed and documented at least
every six (6) months and updated as necessary.
400
ADMISSION/DISCHARGE
401
Admission Agreement
Each Director shall execute with and provide to each client at
or prior to admission (and periodically thereafter, for changes as specified in
this section) a written Admission Agreement dated and signed by the client or
their legal guardian.
401.1.1 The ADC
shall have a written agreement that shall be printed and contain the entire
agreement between the parties, that includes but is not limited to:
(a) A complete statement enumerating in
detail all charges, expenses and other assessments, if any, for services,
materials, equipment and food required by law or regulations, and other
services, materials equipment and food which the facility agrees to furnish and
supply to clients during their period of stay;
(b) The maximum total monthly, weekly, daily
or hourly rate to be charged to the client or responsible person;
(c) A provision that no additional charges
shall be levied by the Director unless specified in the listing of supplemental
services and supplies and agreed to in writing by the client or the responsible
person;
(d) The conditions under
which the Director may adjust the basic monthly, daily or hourly charges for
supplemental services and supplies, including the provision of written
notification, in writing, of such adjustments to the client or responsible
person at least 30 days prior to their effective date;
(e) A provision that refund of advance
payment(s) in the event of death, voluntary or involuntary discharge shall be
calculated on a pro-rata basis. The formula for such calculations shall be
detailed.
401.1.2 Once
executed, neither party may waive any provision of the Admission Agreement;
changes to the Admission Agreement must be agreed to in writing by all parties
subject to the Admission Agreement.
401.2
Admission
Criteria
401.2.1 To be eligible
for an ADC, clients must;
(a) Be a
functionally impaired adult;
(b)
Have a current medical history provided;
(d) Have a written plan of care, if the
client is on an approved Waiver program.
401.2.2 Clients will be ineligible for an ADC
if they;
(a) Are bed-fast;
(b) Cannot self administer their
medications;
(c) Have behavior
problems that create a hazard or danger to themselves or others.
402
Discharge Criteria
The facility must develop and implement written discharge
policies and procedures that are in accordance with Ark. Code Ann. §
20-10-1005
and that include, at a minimum, the following:
402.1 A client may be discharged only when:
(a) The transfer or discharge is necessary to
meet the resident's welfare, and the resident's welfare cannot be met in the
facility;
(b) The transfer or
discharge is appropriate because the resident's health has improved
sufficiently so that the resident no longer needs the services provided by the
facility;
(c) The transfer or
discharge is appropriate because the resident is no longer benefiting from
therapeutic programming;
(d) The
safety of individuals in the facility is endangered;
(e) The health of individuals in the facility
would otherwise be endangered;
(f)
The resident has failed, after reasonable and appropriate notice, to pay or to
have paid under state-administered programs on the resident's behalf an
allowable charge imposed by the facility for an item or service requested by
the resident and for which a charge may be imposed consistent with federal and
state laws and regulations; or
(g)
The facility ceases to operate.
402.2 The reasons for discharge of a client
must be documented in the client's permanent record and the discharge must be
discussed with the client and his guardian or personal representative, who must
be given a copy of the documentation setting forth the alternatives available.
This notice must be given thirty (30) days prior to the date of discharge. An
immediate discharge for emergency on the grounds set forth in Section 402.1
does not require that the facility provide notice of the discharge thirty (30)
days in advance of the discharge. However, the facility shall provide the
notice as soon as practicable.
The facility shall document, prior to the discharge, the facts
and circumstances leading to the emergency discharge.
402.3 Written appeals process for clients
objecting to discharge must be developed by the facility in conformity with
Ark. Code Ann. §
20-10-1002, as
amended, as well as all applicable regulations. That process shall include:
(a) The written notice of discharge must
state the reason for the proposed discharge as documented in 402.2. The notice
must inform the client that he/she has the right to appeal the decision to the
Director within seven (7) calendar days. The client must be assisted by the
facility in filing the written objection to the discharge.
(b) Within fourteen (14) days of filing of
the written objections, a hearing will be scheduled.
(c) A final determination in the matter will
be rendered within seven (7) days of the hearing.
(d) The facility must provide assistance to
clients to ensure safe and orderly discharge.
402.4 The facility, in conjunction with the
responsible party, must make arrangements to discharge clients who require a
higher level of medical, nursing or psychiatric care than can be safely and
effectively provided in an Adult Day Care facility.
402.5 If the Office of Long Term Care
determines that a client is inappropriate for continued placement in the
facility, the provider must arrange for discharge of the client within ten
calendar (10) days of such notification or as otherwise specified by the Office
of Long Term Care. Less time may be given by the Office of Long Term Care when
a client's life or health requires immediate medical attention. The
responsibility for the client's care or lack of care shall rest with the
provider. If OLTC determines that the discharge of a client is necessary for
reasons other than appropriateness of placement, the facility will have up to
thirty (30) days to effectuate the discharge or as otherwise specified by the
Office of Long Term Care.
403
Client Rights
The facility shall develop, maintain and follow written
policies and procedures defining the rights and responsibilities of clients.
The policies shall present a clear statement defining how clients are to be
treated by the facility, its personnel, volunteers and others involved in
providing care.
403.1 A copy of the
synopsis of the clients' bill of rights must be prominently displayed within
the facility in a general use area.
403.2 Each client admitted to the facility is
to be fully informed of these rights and of all rules and regulations governing
client conduct and responsibilities.
403.3 Appropriate means shall be utilized to
inform non-English speaking, deaf or blind clients of their rights.
403.4 The facility shall communicate these
expectations/rights during the period of not more than two (2) weeks before or
five (5) working days after admission.
403.5 The facility shall obtain a signed and
dated acknowledgement from the client or his legal guardian that they have read
and understand these rights.
403.6
The signed and dated acknowledgement shall be maintained in the client's
file.
403.7 Clients' Rights shall
be deemed appropriately signed if signed by:
(a) A client capable of understanding. Client
and one witness sign;
(b) A client
incapable because of illness. The attending physician documents the specific
impairment that prevents the client from understanding or signing their rights
and legal guardian and two witnesses sign;
(c) A client is mentally retarded. Rights
read and if understood by the client, he/she and two witnesses sign. At least
one witness shall be an outside disinterested party. If client cannot
understand rights, legal guardian and one witness sign;
(d) A client capable of understanding but
signs with a mark other than name: Client signs with a mark (i.e. "X") and two
witnesses sign.
404 Facility employees shall be provided a
copy of client Rights and complete a signed and dated acknowledgement stating
they have received and read the Rights. A copy of the acknowledgement shall be
placed in the employee's personnel file.
405
Bill of Rights
1. Each Adult Day Care must post the Clients'
Bill of Rights, as provided by the Department, in a prominent place in the
facility. The Clients' Bill of Rights must prominently display the toll-free
number for contacting the Office of Long Term Care and filing a complaint, or
the facility must post the number and its purpose beside the Clients' Bill of
Rights. Further, the facility shall prominently display the contact information
for the State Ombudsman's office. A copy of the Clients' Bill of Rights must be
given to each client in a manner and form comprehendible to the client or his
or her responsible party.
2. A
client has all the rights, benefits, responsibilities, and privileges granted
by the constitution and laws and regulations of this state and the United
States except where lawfully restricted. The client has the right to be free of
interference, coercion, discrimination, or reprisal in exercising these civil
rights.
3. In addition to the
provisions of Section 404.1(1) and (2), each client in the Adult Day Care has
the right to, and the facility shall ensure that clients shall:
a. Be free from physical or mental abuse,
including corporal punishment;
b.
Be permitted to participate in activities of social, religious, or community
groups unless the participation interferes with the rights of others;
c. Be provided a schedule of individual and
group activities appropriate to individual client's needs, interests and
wishes;
d. Be, at a minimum,
provided:
(i) In-house activities and
programs, the character and scope of which shall be disclosed to potential
clients or their responsible parties in writing as part of the application
process;
(ii) Group recreation and
socialization;
e. Not be
prevented in any way from the practice of the religion of the client's choice.
The Adult Day Care facility shall not be expected to participate or facilitate
the practice of religion beyond arranging or coordinating transportation to the
extent possible;
f. Be treated with
respect, kindness, consideration, and recognition of his or her dignity and
individuality, without regard to race, religion, national origin, gender, age,
disability, marital status, sexual orientation or source of payment. This means
that the client:
(i) Has the right to make his
or her own choices regarding personal affairs, care, benefits, and
services;
(ii) Has the right to be
free from abuse, neglect, and exploitation;
g. Be provided a safe and appropriate
environment;
h. Not be confined to
his or her chair;
i. Not be
prohibited from communicating in his or her native language with other clients
or personnel/staff/employees;
j. Be
permitted to complain about the client's care or treatment. The complaint may
be made anonymously or communicated by a person designated by the client. The
provider must promptly respond to resolve the complaint. The provider must not
discriminate or take any punitive, retaliatory, or adverse action whatsoever
against a client who makes a complaint or causes a complaint to be
made;
k. Be allowed communication,
including personal visitation with any person of the client's choice, including
family members, representatives of advocacy groups, and community service
organizations;
l. Be allowed access
to the client's records. Client records are confidential and may not be
released without the client's or his or her responsible party's consent unless
the release without consent is required by law;
m. Have the right and be allowed to choose
and retain a personal physician or advance practice nurse;
n. Participate in the development of the
individual care that describes the client's direct care services and how the
needs will be met;
o. Be given the
opportunity to refuse medical treatment or services after the client or his or
her responsible party:
(i) Is advised by the
person providing services of the possible consequences of refusing treatment or
services, and
(ii) Acknowledges
that he or she understands the consequences of refusing treatment or
services;
p. Be allowed
unaccompanied access to a telephone;
q. Have privacy while attending to personal
needs, and a private place for receiving visitors or associating with other
clients, unless providing privacy would infringe on the rights of other
clients. The right applies to medical treatment, toileting and bathing, written
communications, telephone conversations, and meeting with family;
r. Be allowed to determine his or her dress,
hairstyle, or other personal appearance according to individual preference,
except the client has the responsibility to maintain personal
hygiene;
s. Be allowed to refuse to
perform services for the facility;
t. Clients are discharged or transferred in
conformity with Ark. Code Ann. §
20-10-1005
and the provisions governing transfer and discharge in these
regulations.
u. Be allowed to
immediately leave the Adult Day Care facility, either temporarily or
permanently, subject to contractual or financial obligations as specified in
Section 401.1;
v. Have access to
the services of a representative of the State Long Term Care Ombudsman Program
of the Arkansas Department of Health and Human Services, Division of Aging and
Adult Services;
w. Be allowed to
maintain an advance directive or designate a guardian in advance of need to
make decisions regarding the client's health care should the client become
incapacitated;
x. Receive
reimbursement from the facility for any lost, misappropriated, or destroyed
property or funds, when the loss, misappropriation, or destruction occurs at a
time in which the facility was exercising care or control over the funds or
properties, including loss or destruction of client's property that occurs
during laundering or cleaning of the facility, or the client's property,
excluding normal wear and tear.
500
MANDATORY SERVICES
The Adult Day Care program shall provide at least the following
services:
501
Activities
of daily living.
501.1 The adult
day care program shall provide assistance with walking, toileting, feeding,
grooming, dressing and other activities of daily living;
501.2 Assistance to clients and caregivers
with diets;
501.3 Counseling with
individual clients, as needed, regarding health care;
501.4 Minor first aid treatment if
needed;
501.5 Facilitating
specialized services (i.e., speech therapy, physical therapy, counseling, etc.)
which may be arranged for or provided through the program as needed by
individual clients or as available through community sources.
502
Activities
502.1 A
monthly schedule of group activities shall be planned and posted in the
facility.
502.2 Activities may be
conducted individually and in groups.
502.3 Activities shall be planned to suit the
needs and interests of clients and designed to stimulate interest, rekindle
motivation and encourage physical exercise.
502.4 Planned activities shall include but
not be limited to:
(a) Exercise;
(b) Recreation;
(c) Social activities.
502.5 Physical exercise shall be:
(a) Designed in relation to each individual's
needs, impairments and abilities;
(b) Shall be alternated with rest periods or
quite activities
503
Medications
503.1
Administration
503.1.1 Each Adult Day Care must have written
policies and procedures to ensure, and facilities shall ensure, that clients
receive medications as ordered. In-service training on facility medications
policies and procedures (Section 303.1) shall be provided at least annually for
all facility personnel/staff/employees/volunteers supervising or administering
medications.
503.1.2 Clients must
be able to self administer their own medication.
503.1.3 Facilities must comply with
applicable state laws and regulations governing the administering of
medications and restrictions applicable to non-licensed
personnel/staff/employees/volunteers.
503.1.4 The facility shall document in the
client's record whether the client or the facility is responsible for storing
the client's medication.
503.1.5
The facility shall document in the client's record whether the client will
self-administer medication.
503.1.6
Clients who self-administer their medications must be familiar with their
medications and comprehend administration instructions. Facility staff shall
provide assistance to enable clients to self-administer medications. For
clarification, examples for acceptable practices are listed below:
a. The medication regimen on the container
label may be read to the client;
b.
A larger sterile or disposable container may be provided to the client if
needed to prevent spillage;
The containers shall not be shared by clients.
c. The client may be reminded of
the time to take the medication and be observed to ensure that the client
follows the directions on the container;
d. Facility staff may assist the client in
the self-administration of medication by taking the medication in its container
from the area where it is stored and handing the container with the medication
in it to the client. In the presence of the client, facility staff may remove
the container cap or loosen the packaging. If the client is physically impaired
but cognitively able (has awareness with perception, reasoning, intuition and
memory), facility staff, upon request by or with the consent of the client, may
assist the client in removing oral medication from the container and in taking
the medication e.g., if the client is physically unable to place a dose of oral
medication in his or her mouth without spilling or dropping it, facility staff
may place the dose of medication in another container and place that container
to the mouth of the client.
503.1.7 Changes in dosage or schedule of the
medication shall be made only upon the authorization of the client's attending
physician or advance practice nurse or the client or the client's responsible
party. Any such authorization shall be documented by the facility in the
client's care plan.
503.2
Medication Storage
503.2.1 Medication stored for clients by the
facility must be stored in a locked area in individual compartments or bins
labeled with the client's name. Drugs or medications kept by the facility for
external use shall be kept in a location accessible to clients and staff and
that is separate and apart from other medications and drugs. Provided, however,
that if the client administers his or her own medication, the client shall have
access to his or her medication.
503.2.2 Medications may be kept on the
client's person. Prior to a client being permitted to keep his/her medications,
the facility shall:
a. Assess the client to
determine the client's understanding of, and ability to follow, the
instructions on the prescription or label, and the understanding of and ability
to follow storage requirements or recommendations on the prescription or label,
or as made by the pharmacist;
b.
Document the assessment in the client's records. The assessment shall include
at a minimum:
1. Date of
assessment;
2. Name of person
performing assessment; and,
3. The
information obtained by the assessment that indicated the client's ability to
understand and follow prescription or label directions and instructions.
After the initial assessment, facilities shall perform
reassessments as needed, including changes of conditions of clients, and shall
perform the steps outlined in subsections (a) through (b) above. Failure to
assess or re-assess, or to identify clients at risk of harm from medications in
unsecured locations or rooms, shall constitute a deficient facility practice.
Resulting harm from a failure to assess or re-assess, or to identify clients at
risk of harm from medications in unsecured locations or rooms, shall constitute
a deficient facility practice.
503.2.3 Medications must be stored in an
environment that is clean, dry and not exposed to extreme temperature ranges.
Medications requiring cold storage shall be refrigerated. A locked container
placed below food level in a facility's refrigerator is acceptable storage. All
drugs on the premises of the facility shall be labeled in accordance with
accepted professional principles and practices, and shall include the
appropriate accessory and cautionary instructions, and the expiration
date.
503.2.4 Prescriptive
medications must be properly labeled in accordance with current applicable laws
and regulations pertaining to the practice of pharmacy.
503.2.5 All medications in the control or
care of the facility shall have an expiration date that is not
expired.
503.2.6 Medications must
be individually labeled with the client's name and kept in the original
container unless the client or responsible party transfers the medication into
individual dosage containers. Under no circumstances may an owner or
personnel/staff/employee of the facility repackage medication.
503.2.7 Any medication that is stored by the
facility that has been prescribed for but is no longer in use by a client must
be destroyed or disposed of in accordance with state law or may be given to the
client's family in accordance with this section.
Scheduled II, III, IV and V drugs dispensed by prescription for
a client and no longer needed by the client must be delivered in person or by
registered mail to: Drug Control Division, Arkansas Department of Health and
Human Services, along with the Arkansas Department of Health and Human
Services' Form (PHA-DC-1) Report of Drugs surrendered for Disposition According
to Law. When unused portions of controlled drugs go with a client who leaves
the facility, the person who assumes responsibility for the client and the
person in charge of the medications for the facility shall sign the Controlled
Drug Record in the facility. This shall be done only on the written order of
the physician or advance practice nurse and at the time that the client is
discharged, transferred or visits home.
All other medications not taken out of the facility when the
client leaves the facility shall be destroyed or returned in accordance with
law and applicable regulations.
503.2.8 Under no circumstance will one
client's medication that is under the facility's control be shared with another
client.
503.2.9 For all medication
that is stored by the facility, the facility must remove from use:
1. Outdated or expired medication or
drugs;
2. Drug containers with
illegible or missing labels;
3.
Drugs and biologicals discontinued by the physician or advance practice nurse.
All such medications shall be destroyed or returned in
accordance with law and applicable regulations.
503.2.10 All controlled drugs or substances
stored by the facility shall be stored in a locked, permanently affixed,
substantially constructed cabinet within a locked room designed for the storage
of drugs. When mobile medication carts for unit-dose or multiple day card
systems are used:
1. The cart must be in a
locked room when the cart is not in use and the unit contains controlled
drugs;
2. The facility shall ensure
that the cart remains in the observation of staff utilizing the cart when the
cart is in use, and that clients are not able to access the cart or obtain
medications from the cart. Controlled substances of less than minimal quantity
shall be stored in a separately locked compartment within the cart. Minimal
quantity means a twenty-four (24) hour or less supply.
503.2.11 Medication destruction shall comply
with state and federal laws and regulations governing the destruction of drugs.
The record of the destruction shall be recorded in a bound ledger, in ink, with
consecutively numbered pages, and retained by the facility as a permanent,
retrievable record.
503.3
Medication Charting
503.3.1 If a facility stores a client's
medications, the facility shall maintain a list of those medications.
503.3.2 If the facility stores and supervises
a client's medication, a notation must be made on the individual record for
each client who refuses, either through affirmative act, omission, or silence,
or is unable to self-administer his or her medications or refuses to take his
or her medication. The notation shall include the date, time and dosage of
medication that was not taken or administered to or by the client, including a
notation that the client's family or responsible party was notified.
503.3.3 If medications are prescribed to be
taken as needed (PRN) by the client, documentation in the client's file should
list the medication, the date and time received by the client and the reason
taken.
503.3.4 A record shall be
maintained in a bound ledger book, in ink, with consecutively numbered pages,
of all controlled drugs stored and which are supervised by the facility. The
record shall contain:
1. Name, strength and
quantity of drug;
2. Date received
and date, time and dosage administered;
3. Name of the client for whom the drug was
prescribed, or who received the drug;
4. Name of the prescribing physician or
advance practice nurse;
5. Name of
the dispensing pharmacy;
6.
Quantity of drug remaining after each administrated dosage;
7. Signature of the individual observing the
client's self administration of the drug.
503.3.5 When a dose of a controlled drug is
dropped, broken or lost, two (2) employees shall record in the record the facts
of the event and sign or otherwise identify themselves for the record.
503.3.6 For all medications stored
by the facility, there shall be a weekly count of all Scheduled II, III, IV and
V controlled medications. The count shall be made by the person responsible for
medications in the facility, and shall be witnessed by a non-licensed employee.
The count shall be documented by both employees, and shall include the date and
time of the event, a statement as to whether the count was correct, and if
incorrect, an explanation of the discrepancy. When the count is incorrect, the
facility shall document as required under Section 503.2.7 above.
503.3.7 Medications stored and supervised by
the facility shall be recorded in each client's medical record. The notation
shall be in ink, and shall state, at a minimum:
a. The name of the medication;
b. The dosage prescribed and the dosage taken
or administered;
c. The method of
administration; and,
d. The date
and time of the administration.
503.4
PHARMACEUTICAL
SERVICES
Responsibility for Pharmacy
Compliance
The Director shall be responsible for full compliance with
federal and state laws and regulations governing procurement, control and
administration of all drugs. Full compliance is required with the Comprehensive
Drug Abuse Prevention and Control Act of 1970, Public Law 91-513 and all
amendments of this set and all regulations and rulings passed down by the
federal Drug Enforcement Agency (DEA), Arkansas Act No. 590 (Title 5, Subtitle
6, Chapter 64 of the Arkansas Code Annotated) and all amendments to it and
these rules and regulations.
504
Dietary504.1
Required Facility Dietary Services
504.1.2 Each Adult Day Care facility must
make available food for balanced meals and make between-meal snacks available.
Potable water and other drinking fluids shall be available at all times. Meals
shall be served at approximately the same time each day. Variations from these
stated parameters may be permitted at the written request of the client or his
or her responsible party or as directed by the client's personal physician or
advance practice nurse in writing. The facility shall retain documentation of
the request to, and stating the reason for, the variance.
504.1.3 In the event that a client is unable
or unwilling to consume regular meals served to him or her for more than two
(2) consecutive days, the facility shall immediately notify the client's family
or responsible party. If a client chooses not to consume regular meals, this
must be documented in the care plan.
504.1.4 For those facilities that prepare
food on site, a supply of food shall be maintained on the premises at all
times. This shall include at least a 24-hour supply of perishable food and a
three (3)-day supply of non-perishable food. The food supply shall come from a
source approved by the Arkansas Department of Health and Human Services'
Division of Health. Adult Day Care facilities attached to other licensed long
term care facilities may utilize the kitchen facilities of the attached long
term care facility; however, the Adult Day Care shall ensure that the kitchen
facilities so utilized are adequate to meet the needs of the clients of the
Adult Day Care.
504.1.5 Dietary
personnel/staff/employees shall wear clean clothing and hair
coverings.
504.1.6 Each facility
shall comply with all applicable regulations relating to food service for
sanitation, safety, and health as set forth by state, county, and local health
departments.
504.1.7 Food service
personnel/staff/employees shall ensure that all food is prepared, cooked,
served, and stored in such a manner that protects against contamination and
spoilage.
504.1.8 The kitchen and
dining area must be cleaned after each meal.
504.1.9 An adequate supply of eating utensils
(e.g., cups, saucers, plates, glasses, bowls, and flatware) will be maintained
in the facility's kitchen to meet the needs of the communal dining program. An
adequate number of pots and pans shall be provided for preparing meals. Eating
utensils shall be free of chips or cracks.
504.1.10 Each Adult Day Care facility shall
have adequate refrigeration and storage space. An adequately sized storage room
shall be provided with adequate shelving. The storage room shall be constructed
to prevent the invasion of rodents, insects, sewage, water leakage or any other
contamination. The bottom shelf shall be of sufficient height from the floor to
allow cleaning of the area underneath the bottom shelf.
504.1.11 Refrigerator temperature shall be
maintained at 41 degrees Fahrenheit or below, and freezer temperatures shall be
maintained at 0 degrees Fahrenheit or below. Thermometers will be placed in
each refrigerator and freezer.
504.1.12 Raw meat and eggs shall be separated
from cooked foods and other foods when refrigerated. Raw meat is to be stored
in such a way that juices do not drip on other foods.
504.1.13 Fresh whole eggs shall not be
cracked more than 2 hours before use.
504.1.14 Hot foods should leave the kitchen
(or steam table) above 140 degrees Fahrenheit and cold foods at or below 41
degrees Fahrenheit.
504.1.15
Containers of food shall not be stored on the floor of a walk-in refrigerator,
freezer, or storage rooms. Containers shall be seamless with tight-fitting lids
and shall be clearly labeled as to content.
504.1.16 In facilities that have a home-style
type kitchen, a five (5)-lb. ABC fire extinguisher is required in the kitchen.
In facilities that have commercial kitchens with automatic extinguishers in the
range hood, the portable five (5)-lb. fire extinguisher must be compatible with
the chemicals used in the range hood extinguisher. The manufacturer
recommendations shall be followed.
504.1.17 Food scraps shall be placed in
garbage cans with airtight fitting lids and bag liners. Garbage cans shall be
emptied as necessary, but no less than daily.
504.1.18 Leftover foods placed in the
refrigerator and freezer shall be sealed, dated, and used or disposed of within
48 hours.
504.1.19
Personnel/staff/employees shall not use tobacco, in any form, while engaged in
food preparation or service, nor while in areas used for equipment or utensil
washing, or for food preparation.
504.1.20 Menus shall be posted on a weekly
basis. The facility shall retain a copy of the last month's menus.
504.1.21 The Adult Day Care facility shall
arrange for clients' special diets and other diet
modifications.
505 OTHER SERVICES
The Provider may offer the following services:
505.1 Transportation between the client's
home and the facility. If transportation services are offered, whether provided
directly or under contract, the facility shall ensure that:
(a) The driver has a valid Arkansas Driver's
License;
(b) Liability insurance is
in force;
(c) All vehicles have
seat belts;
(d) All clients wear
seat belts while being transported;
(e) Any charge for transportation shall be
described in advance to the client or responsible party;
(f) All applicable federal, state and local
laws and ordinances are followed concerning the condition of the vehicle used
for transportation and the manner in which it is operated;
(g) add locking mechanisms for vans with
wheelchairs.
600
FACILITY PHYSICAL
REQUIREMENTS
601
Space
Requirements601.1 Space
requirements shall be forty (40) square feet per participant.
601.2 Minimum space requirements do not
include office space, bathrooms, storage, or dining rooms, unless the latter
are also used for activities;
601.3
Adult Day Care facilities located in buildings that house other facilities
(e.g., child care) shall not share required space or bathrooms. Kitchen
facilities are not included in this requirement.
601.4 There shall be at least one room where
all of the clients can gather.
601.5 There shall be a quiet room for rest.
This room shall have walls that extend to the ceiling and a swinging door that
latches.
601.6 The quiet room shall
be equipped with a comfortable bed in good repair with clean linens and
pillows.
601.7 The quiet room shall
not be used for any other purpose.
602
Furnishings
602.1 All equipment and furnishings shall be
safe and in good condition. Furniture, including dining tables and chairs,
shall be of a size and design that is easily used by persons with physical
limitations. Furniture shall be sturdy and secure so that it cannot easily tip
when used for support by someone walking, standing, sitting, or arising from
the furniture.
602.2 Minimum
requirements for furnishings:
(a) At least one
comfortable chair per participant;
(b) Table space and chairs adequate for all
clients to be served a meal at the same time;
(c) Reclining lounge chairs or other sturdy
comfortable furniture, the number to be determined by the needs of the clients.
603
Equipment and Supplies
Equipment and supplies shall be adequate to meet the needs of
clients. They shall include items necessary to provide direct care and to
encourage active participation and group interaction.
604
Building
Construction/Maintenance
The building in which the program is located shall be of sound
construction and maintained in good repair. No facility shall be licensed in a
factory-built structure constructed in accordance with the Federal Manufactured
Home Construction and Safety Standards and transported to the site as one or
more sections on a permanent chassis.
605
Ventilation
605.1 Ventilation shall be by either natural
or mechanical means.
605.2 All
screen doors shall be equipped with self-closing devices and shall fit tightly
within the door frame.
605.3 Doors,
windows and other openings to the outside shall be screened to prevent entrance
of insects and vermin.
606
Heating and
Cooling
The heating system shall be in compliance with the all state
and local codes.
606.1 Exposed heating
pipes, hot water pipes, or radiators in rooms and areas used by clients shall
be covered or protected and insulated when appropriate.
606.2 Portable space heaters shall not be
used.
606.3 Room temperatures shall
be maintained between seventy (70) degrees Fahrenheit and eighty-five (85)
degrees Fahrenheit in all seasons, and the reasonable comfort needs of the
individual clients shall be met.
607
Lighting/Electrical
607.1 There shall be illumination in all
participant use areas that is appropriate to the uses of the area and the needs
of clients.
607.2 Glare shall be
kept at a minimum by providing shades at all windows exposed to direct
sunlight.
607.3 Light fixtures
shall have shades or globes.
607.4
Extension cords shall not be used.
607.5 Facilities may utilize Transient
Voltage Surge Protectors or Surge Suppressors with microprocessor electronic
equipment such as computers or CD/DVD recorders or players. Any Transient
Voltage Surge Protectors or Surge Suppressors must have a maximum UL rating of
330v and must have a functioning protection indicator light. Facilities may not
use Transient Voltage Surge Protectors or Surge Suppressors that do not have a
functioning protection indicator light or Transient Voltage Surge Protectors or
Surge Suppressors in which the functioning protection indicator light does not
light to indicate that the device is functioning.
608
Plumbing
608.1 All plumbing and plumbing fixtures
shall conform to applicable local codes.
608.2 There shall be no cross-connection
between any potable water supply and any source of pollution through which the
potable water supply might become contaminated.
609
Water System
609.1 An adequate supply of water, the source
of which is approved by the state water control authority, under sufficient
pressure to properly serve the facility, shall be provided.
609.2 The potable water system shall be
installed to preclude the possibility of backflow.
610
Drinking Water
610.1 Drinking water shall be easily
accessible to the clients and provided by either an angle jet drinking fountain
with mouth guard or by a running water supply with individual drinking cups, or
bottled water supply with individual drinking cups.
610.2 Drinking facilities shall not be
located in the toilet room.
611
Toilet
Facilities611.1 At least one (1)
toilet and washbowl shall be provided for each ten (10) clients and shall have
an additional toilet and washbowl for each 5 clients over the 10 e.g., the
facility has 35 licensed slots the facility shall have four toilets and
washbowls.
611.2 At least one
toilet room shall be accessible to handicapped persons.
611.3 Toilet rooms shall provide privacy for
clients.
611.4 Each toilet room
shall be equipped with ventilation approved by the Office of Long Term
Care.
611.5 All toilets shall have
grab rails that are securely affixed to walls in such a manner as to support
the weight of clients using the rails to raise or lower themselves.
611.6 The washbowl shall be in proximity to
each toilet and shall have hot and cold running water.
611.7 Hot water temperature will be between
one hundred (100) and one hundred fifteen (115) degrees Fahrenheit.
611.8 Individual paper towels, a trash
receptacle, soap and toilet paper shall be provided at all times and shall be
within reach of the clients.
612
Accommodations for
Handicapped
Facilities shall have ramps or other means of accessibility for
handicapped persons to all areas of the facility utilized by clients. All
facilities will make provisions for the clients they accept.
613
Stairways/Hallways
613.1 Stairways and hallways shall be kept
free of obstructions and shall be well lighted.
613.2 All stairways and ramps shall have
non-slip surface or treads.
613.3
All inside and outside stairways and ramps shall have handrails securely
affixed to the wall and able to support the weight of a client utilizing the
handrail in locomotion or in raising or lowering themselves.
614
Floor
Covering
614.1 All rugs and
floor coverings shall be secured to the floor.
614.2 Throw rugs shall not be used.
614.3 Polish used on floors shall provide a
non-slip finish.
615
Housekeeping and Maintenance
Sufficient housekeeping and maintenance service shall be
provided to maintain the facility in good repair and in a safe, clean, orderly
and sanitary manner.
615.1 All areas
of the facility must be kept clean and free of insects, trash, and lingering
odors.
615.2 Corridors shall not be
used for storage.
615.3 Attics,
cellars, basements, under or below stairways and similar areas shall be kept
clean of accumulation of refuse, old newspapers and discarded
furniture.
615.4 Garbage shall be
stored in a closed container and disposed of in a manner approved by the Office
of Long Term Care, applicable law or regulation, or ordinance.
615.5 Ventilation, heating, air conditioning,
and air changing systems shall be properly maintained. Gas systems shall be
inspected at least every 12 months to assure safe operation. Inspection
certificates, where applicable, shall be maintained for review.
615.6 Entrances, exits, steps and outside
walkways must be free from ice, snow and other hazards.
615.7 Repairs or additions must meet
applicable building codes at the time construction begins.
615.8 The facility shall be maintained free
of insects and rodents. Documented control measures shall be taken to prevent
rodent and insect infestation.
616
Storage of Cleaning
Supplies
Cleaning agents, pesticides and poisonous products shall be
stored at all times apart from food and in a locked room, closet or cabinet and
shall be issued and utilized in a manner which assures the safety of clients
and staff.
700
FIRE SAFETY
701
Written Approval
Adult Day Care facilities located in organized areas or
municipalities shall obtain from local fire safety officials annual written
certification that the facility complies with local fire codes. If there are no
applicable codes, or if the Division determines that such codes are not
adequate to assure the safety of older or handicapped persons, the provisions
of the National Fire Protection Association Life Safety Code 101, Section 16,
2000 Edition, shall apply.
702
Exits
702.1 The facility shall have a minimum of
two (2) exits remote from each other.
702.2 Exits shall be clearly marked with exit
signs.
702.3 Exits shall provide
egress at ground level. Facilities shall be housed only on the ground floor of
the building.
702.4 Each exit door
shall be equipped with a device to sound an alarm when the door is
opened.
702.5 Each exit door shall
swing out in those facilities with over twenty (20) licensed slots.
702.6 Emergency lighting shall be provided in
accordance with NFPA Life Safety Code 101, Section 16.2.9, 2000 Edition, and be
in working order.
703
Smoke Detection/Fire Extinguishers
703.1 Each provider shall locate, install and
maintain in operable condition, smoke detectors in each room of the Adult Day
Care.
(a) Smoke detectors shall be inspected
monthly.
(b) Documentation of the
monthly inspection shall be kept at the facility.
703.2 Fire extinguishers, of the appropriate
type as determined in consultation with local fire authorities shall be
installed and maintained in operable condition.
(a) Fire extinguishers shall comply with NFPA
10 requirements.
(b) Fire
extinguishers shall be inspected monthly and the inspection results
documented.
(c) Fire extinguishers
shall be inspected annually by a company/person licensed by the State of
Arkansas to provide this service.
704
Fire/Disaster
Drills
Employees shall be trained in the rapid evacuation of the
building, including assistance to clients in evacuation.
704.1 Clients and staff shall take part in
quarterly fire drills. Documentation of the fire drills shall be kept at the
facility.
704.2 Disaster drills
shall be held annually.
(a) Documentation of
the annual disaster drill shall be kept at the facility.
(b) The facility shall have a written
training plan and schedule for staff and volunteers on safety responsibilities
and actions to be taken if an emergency occurs. Such training shall be
conducted and documented semi-annually.
(c) Tornado drills shall be conducted at
least annually. Documentation of training by clients and staff shall be kept at
the facility.
705
Smoking
Facilities may elect to prohibit smoking in the facility or on
the grounds or both. If a facility elects to permit smoking in the facility or
on the grounds, the facility shall include the following minimal provisions,
and the facility shall ensure that:
a.
In facilities equipped with sprinkler systems, the facility may designate a
smoking area or areas within the facility. The designated area or areas shall
have a ventilation system that is separate from the ventilation system for
non-smoking areas of the facility. Facilities lacking a sprinkler system are
prohibited from designating smoking areas in any area in which there is not
constant, uninterrupted supervision and observation by facility
staff.
b. Smoking shall be
prohibited in any room, ward or compartment where flammable liquids,
combustible gases or oxygen is used or stored and in other hazardous location
and any general use/common areas of the assisted living facility. Such areas
shall be posted with "NO SMOKING" signs.
c. Smoking by residents classified as not
responsible shall be prohibited unless the resident is under direct
supervision.
d. Ashtrays of
noncombustible material and safe design shall be placed in all areas where
smoking is permitted.
e. Metal
containers with self-closing cover devices into which ashtrays may be emptied
shall be placed in all areas where smoking is permitted.
800
IMPOSITION OF
REMEDIES - AUTHORITY
The following Rules and Regulations for the Imposition of
Remedies are duly adopted and promulgated by the Arkansas Department of Health
and Human Services, Office of Long Term Care, pursuant to the authority
conferred by Ark. Code Ann. §
20-10-203 and
Ark. Code Ann. §
25-10-129.
801
Inspections by the
Department
a. All areas of the
facility that are accessible to clients or are used in the care or support of
clients, including but not limited to kitchen or food preparation areas,
laundry areas, and storage areas, and all client records, including but not
limited to clients' financial records maintained by the facility and clients'
medical records maintained by the facility, shall be open for inspection by the
Department, the Office of Long Term Care, or the Office of the Attorney
General. All facility records related to the care or protection of clients and
all employee records related to the care or protection of clients shall be open
for inspection by the Department or OLTC or the Attorney General's Office for
the purpose of enforcing these regulations and applicable laws. The facility
shall provide access to any copying equipment the facility has on premises to
permit the above-named entities the ability to make copies of facility records.
This shall not be construed as a requirement that a facility be required to
have copy equipment on its premises.
b. The facility shall submit to regular and
unannounced inspection surveys and complaint investigations in order to receive
or maintain a license. The facility shall inform clients of the survey process
and clients' rights with regard to privacy during the process. Clients or
employees may refuse to be interviewed or photographed. The Department or its
agents, the Office of Long Term Care or its agents or the Attorney General's
Office or its agents have the right to conduct interviews in a private area
with clients or employees who consent to interviews, and shall be permitted to
photograph the facility. Clients shall be photographed in accordance with Ark.
Code Ann. §
20-10-104.
This regulation shall not be construed as a waiver of any constitutional
rights, including but not limited to the right against
self-incrimination.
c. An
inspection may occur at any time, in the discretion of the Department or its
agents, the Office of Long Term Care or its agents or the Attorney General's
Office or its agents.
d. The
facility shall provide for the maintenance and submission of such statistical,
financial or other information, records, or reports related to client care or
property in such form and at such time and in such manner as the Department or
its agents, the Office of Long Term Care or its agents, Attorney General or its
agents may require. Provided, however, those records created by, or for the
exclusive use of, the quality assessment unit shall not be subject to release
to the Department or its agents, or the Office of Long Term Care or its
agents.
e. Facilities must provide
a written acceptable plan of correction within 15 business days of receipt of
written notification of deficiencies (also referred to as a Statement of
Deficiencies) found during any inspections or surveys. The OLTC shall determine
whether the proposed plan of correction, including any proposed dates by which
correction will be made, is acceptable.
f. The facility must post the Statement of
Deficiencies and the facility's response and the outcome of the response from
the latest survey in a public area utilized by clients or their responsible
parties and visitors. A copy shall be provided to each client or client's
responsible party upon request of the client or the client's responsible party.
The last twelve (12) months of deficiency notices and facility responses and
outcomes of responses, for all surveys, shall be provided to persons or their
responsible parties upon request when they apply for residence in the
facility.
802
General Provisionsa.
The provisions of this section are supplemental to, and independent of, the
provisions of Title 20 of the Arkansas Code Annotated.
b.
Purpose of remedies. The
purpose of remedies is to ensure prompt compliance with program
requirements.
c.
Basis for
imposition and duration of remedies. When OLTC chooses to apply one or
more remedies specified herein, the remedies are applied on the basis of
noncompliance found during surveys or inspections of any nature conducted by
OLTC, or for failure to comply with applicable laws or regulations.
d.
Number of remedies. OLTC
may apply one or more remedies for each deficiency constituting noncompliance
or for all deficiencies constituting noncompliance.
e.
Plan of correction
requirement.1. Regardless which
remedy is applied, or the nature or severity of the violation, each facility
that has deficiencies must submit a plan of correction for approval by OLTC.
The plan of correction shall be set forth on the Statement of Deficiencies.
While a facility may provide a disclaimer in the plan of correction, the
facility is still required to provide corrective actions to address the cited
deficiencies, the time frames in which the corrective actions will be
completed, and the manner to be utilized by the facility to monitor the
effectiveness of the corrective action.
2. Failure by the facility to provide an
acceptable plan of correction may result in the imposition of additional
remedies pursuant to these regulations at the discretion of the OLTC or in a
finding of a violation and imposition of additional remedies set forth in Title
20 of the Arkansas Code Annotated, or set forth in these regulations, or
both.
f. Notification
Requirements
1. Except in cases of emergency
termination of a license or in cases or emergency removal or transfer or
clients, OLTC shall give the provider notice of the remedy, including:
A. Nature of the noncompliance;
B. Remedy or remedies imposed;
C. Date the remedy begins; and,
D. Right to appeal the determination leading
to the remedy.
2. Notice
shall not be required for state monitoring. 803
Remedies
a.
Available Remedies. In conformity with, and in addition to
remedies as set forth in Title 20 of the Arkansas Code Annotated, the following
remedies are available:
1. Civil Money
Penalties (CMP) pursuant to Ark. Code Ann. §
20-10-205
and §
20-10-206.
2. Denial of New Admissions.
3. Directed in-service training.
4. Directed plan of correction.
5. State monitoring.
6. Temporary Director.
7. Termination of license.
8. Transfer of clients.
b. Duration of Remedies. Unless otherwise
provided by law or other applicable regulations, remedies continue until:
1. The facility has corrected the cited
deficiencies that resulted in the imposition of the remedy or remedies, as
determined by the Office of Long Term Care based upon a revisit, or after an
examination of credible written evidence that it can verify without an on-site
visit, or both; or,
2. OLTC
terminates the Adult Day Care license.
804
Temporary Directora.
Temporary Director means the temporary appointment by OLTC, or
by the facility with the approval of OLTC, of a substitute facility Director
with authority to hire, terminate or reassign staff, obligate facility funds,
alter facility procedures and manage the facility to correct deficiencies
identified in the facility's operation, or to assist in the orderly closure of
a facility. A temporary Director may be appointed by the Office of Long Term
Care only upon the consent and agreement of the facility. The temporary
Director shall provide reports to the OLTC regarding the operation of the
facility and the efforts toward correction by the facility as requested by the
OLTC.
b.
Qualifications.
The temporary Director must:
1. Be
qualified to oversee correction of deficiencies on the basis of experience and
education, as determined by OLTC;
2. Not have been found guilty of misconduct
by any licensing board or professional society in any State;
3. Have, or a member of his or her immediate
family have, no financial ownership interest in the facility;
4. Not currently serve or, within the past 2
years, have served, unless approval has been obtained from the OLTC, as a
member of the staff of the facility;
5. Successfully undergo a criminal record
check pursuant to the Rules and Regulations of the Office of Long Term
Care.
c.
Payment
of salary. The temporary Director's salary:
1. Is paid directly by the facility while the
temporary Director is assigned to that facility; and
2. Must be at least equivalent to the sum of
the following:
A. The prevailing salary paid
by providers for positions of this type in what OLTC considers the facility's
geographic area;
B. Additional
costs that would have reasonably been incurred by the provider if such person
had been in an employment relationship; and
C. Any other costs incurred by such a person
in furnishing services under such an arrangement or as otherwise set by
OLTC.
3. May exceed the
amount specified in Section 804(c)(2) if OLTC is otherwise unable to attract a
qualified temporary Director.
d.
Failure to relinquish authority to
temporary Director.1.
Termination of Adult Day Care licensure. If a facility fails
to relinquish authority to the temporary Director, OLTC may impose additional
remedies, including but not limited to termination of the Adult Day Care
license.
2.
Failure to pay
salary of temporary Director. A facility's failure to pay the salary
of the temporary Director is considered a failure to relinquish authority to
temporary administration.
3.
When imposed. The remedy of temporary Director shall be used
only in lieu of termination of the facility license. Provided, however, that if
the appointment of the temporary Director does not result in compliance by the
facility within the time frames estimated by the temporary manager and agreed
to by the Office of Long Term Care, the remedy of termination or revocation of
license may be imposed.
805
State Monitoring
a. A State monitor:
1. Oversees the correction of deficiencies
specified by OLTC at the facility site and protects the facility's clients from
harm;
2. Is an employee or a
contractor of OLTC;
3. Is
identified by OLTC as an appropriate professional to monitor cited
deficiencies;
4. Is not an employee
of the facility;
5. Does not
function as a consultant to the facility;
6. Does not have an immediate family member
who is a client of the facility to be monitored; and,
7. Does not have an immediate family member
who owns the facility or who works in the facility or the corporation that
operates or owns the facility.
b. A State monitor may be utilized by the
Office of Long Term Care for any level or severity of
deficiency.
806
Directed Plan Of Correction
The Office of Long Term Care, or the temporary manager with
OLTC approval, may develop a plan of correction. A directed plan of correction
sets forth the tasks to be undertaken, and the manner in which the tasks are to
be performed by the facility to correct deficiencies and the time frame in
which the tasks will be performed. A facility's failure to comply with a
directed plan of correction may result in additional remedies, including
revocation of license when the failure to correct meets the conditions
specified in Section 809. The intent of a directed plan of correction is to
achieve correction of identified deficiencies and compliance with applicable
regulations.
807
Directed In-Service Training
a.
Required training. OLTC
may require the staff of a facility to attend an in-service training program if
education is likely to correct, or is likely to assist in correcting, cited
deficiencies. The Office of Long Term Care may specify the time frames in which
the training will be performed, the type or nature of the training, and the
individual or entities to provide the training.
b.
Action following training.
After the staff has received in-service training, if the facility has
corrected the violations or deficiencies that led to the imposition of
remedies, OLTC may impose one or more other remedies.
c.
Payment. The facility
pays for directed in-service training.
808
Transfer of Clients or
Closure of the Facility and Transfer of Clients
a.
Transfer of clients, or closure of
the facility and transfer of clients in an emergency. OLTC has the
authority to transfer clients to another facility when:
1. An emergency exists wherein the health,
safety, or welfare of clients is imperiled, and no other remedy exists that
would ensure the continued health, safety or welfare of the clients;
2. A facility intends to close but has not
arranged for the orderly transfer of its clients at least thirty (30) days
prior to closure;
3. The facility
exceeds its slot capacity as indicated or stated on the facility's license, or
accepts more clients than the facility has number of slots as indicated or
stated on the facility's license, unless granted a waiver by the Office of Long
Term Care.
b.
Required transfer when a facility's Adult Day Care license is
terminated. When a facility's license is terminated, or when the
facility closes either voluntarily or involuntarily, OLTC may assist in the
safe and orderly transfer of all clients to another facility.
c. When the Office of Long Term Care orders
transfer of clients from a facility, the Office of Long Term Care may:
1. Assist in providing for the orderly
transfer to other suitable facilities or make other provisions for the clients'
care and safety.
2. Assist in or
arrange for transportation of the clients, their medical records and
belongings, assist in locating alternative placement, assist in preparing the
client for transfer, and permit the clients' legal guardians or responsible
party to participate in the selection of the clients' new placement.
3. Unless transfer is due to an emergency,
explain alternative placement options to the clients and provide orientation to
the placement chosen by the client or their guardian or responsible
party.
d.
Notice
of Transfer Remedy. Unless transfer is due to an emergency, the Office
of Long Term Care shall provide the facility from which the clients are to be
transferred at least fifteen (15) days notice of the proposed
transfer.
809
Termination of Adult Day Care License
a. The remedy of termination or revocation of
licensure is a remedy of last resort, and may be imposed only in accordance
with law or as set forth in these regulations.
b.
Basis for termination.
OLTC may terminate a facility's Adult Day Care license if a facility:
1. Permits, aids or abets in the commission
of any unlawful act in connection with the operation of the Adult Day
Care;
2. Refuses to allow entry or
inspection by the Office of Long Term Care;
3. Fails to make any or all records set forth
in Section 801 available to representatives or agents of the Department or the
OLTC, unless such refusal is made pursuant to court order or during the
pendency of an appeal specifically on the issue of the release of the records,
or the records are records created by the quality assessment unit;
4. Closes, either voluntarily or through
action of the State;
5. Director or
owner refuses to obtain a criminal record check of any individual required to
undergo a criminal record check pursuant to the Rules and Regulations for
Conducting Criminal Record Checks for Employees of Long Term Care Facilities or
pursuant to Ark. Code Ann. § 20-33-201, etseq.;
6. Is cited for a third Class A violation
within six months of the citation of the first Class A violation, or is cited
for a third Class B violation within six months of the citation of the first
Class B violation, in accordance with Ark. Code Ann. §
20-10-205
and §
20-10-206;
7. Has conditions wherein the health, safety,
or welfare of client is imperiled, and no other remedy exists that would ensure
the continued health, safety, or welfare of the clients; or,
8. Is unable to meet program
requirements.
810
Denial or Suspension Of New
Admissions
The Office of Long Term Care may deny to, or suspend the
ability of, a facility to admit new admissions upon the imposition of a Class A
violation as defined and set forth in Ark. Code Ann. §
20-10-205
and §
20-10-206.
811
Civil Money
Penalties
The Office of Long Term Care may impose civil money penalties
in accordance with Ark. Code Ann. §
20-10-205
and §
20-10-206.
812
Closure
Any Adult Day Care facility that closes or ceases operation or
surrenders or fails to timely renew its license must meet the regulations then
in effect for new construction and licensure to be eligible for future
licensure. Closure of a facility shall result in the immediate revocation of
the license.
A facility that closes or is unable to operate due to natural
disaster or similar circumstances beyond the control of the owner of the
facility, or a facility that closes, regardless of the reason, to effectuate
repairs or renovations, may make written request to the Office of Long Term
Care for renewal of the facility license to effect repairs or renovation to the
facility. The Office of Long Term Care may, at its sole discretion, grant the
written request.
If the request for licensure renewal is granted, the Office of
Long Term Care will provide written notification to the facility, which will
include deadlines for various stages of the repairs or renovations, including
the completion date. In no event shall the completion date set by the Office of
Long Term Care extend beyond twenty-four months of the date of the request;
provided, however, that the deadlines may be extended by the Office of Long
Term Care upon good cause shown by the facility. For purposes of this
regulation, good cause means natural disasters or similar
circumstances, such as extended inclement weather that prevents repairs or
construction within the established deadlines, beyond the control of the owner
of the facility. Good cause shall not include the
unwillingness or inability of the owner of the facility to secure financing for
the renovations or repairs. The facility shall comply with all deadlines
established by the Office of Long Term Care in its notice. Failure to comply
with the deadlines established by the Office of Long Term Care shall constitute
grounds for revocation of the license and for denial of re-licensure.
900
APPEALS TO
COURT
Any applicant or licensee who considers himself/herself injured
in his or her person, business or property by final Department administrative
adjudication shall be entitled to judicial review thereof as provided for by
law. All petitions for judicial review shall be in accordance with the Arkansas
Administrative Procedure Act as codified at Ark. Code Ann. §
25-15-201,
etseq.
APPENDIX
FORMS
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN
SERVICES
DIVISION OF MEDICAL SERVICES OFFICE OF LONG TERM
CARE
Incident & Accident Next Day Reporting
Form
Purpose/Process
This form is designed to standardize and facilitate the process
for the reporting allegations of resident abuse, neglect, misappropriation of
property or injuries of an unknown source by individuals providing services to
residents in Arkansas long term care facilities for next day reporting pursuant
to Section
507.1.
The purpose of this process is for the facility to compile the
information required in the form DMS-731, so that next day reporting of the
incident or accident can be made to the Office of Long Term Care.
Completion/Routing
This form, with the exception of hand written witness
statements, MUST BE TYPED !
The following sections are not to be completed by
the facility; the Office of Long Term Care completes them:
1. The top section entitled COPIES
FOR:
2. The FOR OLTC
USE ONLY section found at the bottom of the form.
All remaining spaces must be
completed. If the information can not be obtained, please provide an
explanation, such as "moved/address unknown", "unlisted phone", etc.
If a requested attachment can not be provided please provide an
explanation why it can not be furnished or when it will be forwarded to
OLTC.
The original of this form must be faxed to the Office of
Long Term Care the next business day following discover by the facility.
Any material submitted as copies or attachments must be legible and of
such quality to allow recopying.
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SUMMARY OF INCIDENT
STEPS TAKEN TO PREVENT CONTINUED ABUSE OR NEGLECT DURING THE
INVESTIGATION
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN
SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
Facility Investigation Report for Resident
Abuse, Neglect, Misappropriation of Property, & Exploitation of Residents
in Long Term Care Facilities
Purpose/Process
This form is designed to standardize and facilitate the process
for the reporting allegations of resident abuse, neglect, or misappropriation
of property or exploitation of residents by individuals providing services to
residents in Arkansas long term care facilities. This investigative format
complies with the current regulations requiring an internal investigation of
such incidents and submittal of the written findings to the Office of Long Term
Care (OLTC) within five (5) working days.
The purpose of this process is for the facility to compile a
substantial body of credible information to enable the Office of Long Term Care
to determine if additional information is required by the facility, or if an
allegation against an individual(s) can be validated based on the contents of
the report.
Completion/Routing This form, with the exception of hand
written witness statements, MUST BE TYPED
!
Complete all spaces! If the information can not be
obtained, please provide an explanation, such as "moved/address unknown",
"unlisted phone", etc. Required information includes the actions taken to
prevent continued abuse or neglect during the investigation.
If a requested attachment can not be provided please provide an
explanation why it can not be furnished or when it will be forwarded to
OLTC.
This form, and all witness and accused party statements,
must be originals. Other material submitted as copies must be
legible and of such quality to allow re-copying.
The facility's investigation and this form must be completed
and submitted to OLTC within five (5) working days from when the incident
became known to the facility.
Upon completion, send the form by certified mail to:
Office of Long Term Care, P.O. Box 8059, Slot 404, Little Rock,
AR 72203-8059.
Any other routing or disclosure of the contents of this report,
except as provided for in LTC 507.4 and 507.5, may violate state and federal
law.
Facility Investigation Report for Resident Abuse,
Neglect, Misappropriation of Property, & Exploitation of Residents in Long
Term Care Facilities
Section
I-Reporting Information
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Section
Il
-Complete Description of Incident "See
Attached Is Not Acceptable! "
(Attach Additional Pages as Necessary)
Section III - Findings and Actions Taken
Please include Resident's current medical condition
__________________________ _________
Facility Administrator's Signature Date
Section IV - Notification/Status
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Section
VI -Accused Party Information
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