Current through Register Vol. 49, No. 9, September, 2024
100
SCOPE
These rules and regulations constitute the basis for the
licensure of Level I assisted living facilities by the Arkansas Department of
Human Services, Division of Medical Services, Office of Long Term Care. The
Office of Long Term Care reserves the right, and may at any time, waive any or
all of the requirements herein in event of emergency or for good cause shown in
the sole determination of the Office of Long Term Care.
200
PURPOSE
The purpose of these rules and regulations is to establish
standards for Level I assisted living facilities that provide services in a
homelike environment for elderly and disabled persons. Level I assisted living
facilities ensure that residents receive supportive health and social services
as they are needed to enable them to maintain their individuality, privacy,
dignity, and independence, in the highest degree possible in an apartment-style
living unit. The assisted living environment actively encourages and supports
these values through effective methods of service delivery and facility or
program operation. The environment promotes resident self-direction and
personal decision-making while protecting resident?s health and safety.
300
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
reference 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. §
5-28-101 and
42
CFR §
488.301. Abuse? also includes
sexual abuse as defined in Ark. Code Ann. §
5-28-101 (12).
Activities of Daily Living ? The
activities of daily living 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.
Administrator ? The person who has
successfully completed a course of training or instruction certified by the
Office of Long Term Care as an assisted living facility administrator who is in
charge of the daily operation of the facility. Until programs have been
certified by the Office of Long Term Care, Residential
Care Facility Administrators or Nursing Home Administrators may be used.
Advertise ? To make publicly and
generally known. For purposes of this definition, advertise includes, but is
not limited to:
1. Signs, billboards,
or lettering;
2. Electronic
publishing or broadcasting, including the use of the Internet or e-mail;
and
3. Printed material.
Alzheimer?s Special Care Unit (ASCU) ?
A separate and distinct unit within an Assisted Living or other Long Term Care
facility that segregates and provides a special program for residents with a
diagnosis of probable Alzheimer?s disease or related dementia, and that
advertises, markets or otherwise promotes the facility as providing specialized
Alzheimer?s or related dementia care services.
Assisted Living Facility (ALF) ? Any
building or buildings, section or distinct part of a building, boarding home,
home for the aged or other residential facility whether operated for profit or
not that undertakes through its ownership or management to provide assisted
living services for a period exceeding twenty-four (24) hours to more than
three (3) adult residents of the facility who are not relatives of the owner or
administrator. Assisted living facility means facilities in which assisted
living services are provided either directly or through contractual
arrangements or in which contracting in the name of residents is
facilitated.
Assisted Living Program ? A program of
assisted living services.
Assisted Living Services ? Housing,
meals, laundry, social activities, assistance with transportation, direct care
services, health care services, 24-hour supervision and care, and limited
nursing services. For purposes of these regulations, assistance with
transportation means making arrangements for transportation.
Caregiver ? Shall have the same
meaning prescribed by Ark. Code Ann. §
5-28-101.
Choice ? Viable options available to a
resident that enables the resident to exercise greater control over his or her
life. Choice is supported by resident?s self-directed care (including methods
and scheduling) established through the care planning process, and the
provision of sufficient private and common space within the facility to provide
opportunities for residents to select when and how to spend time, and when and
how to receive personal or assisted living services.
Common Areas (for Alzheimer?s Special Care
Units) ? Portions of the Alzheimer?s Special Care Unit, exclusive
of residents? rooms and bathrooms. Common areas include any facility grounds
accessible to residents of the
Alzheimer?s Special Care Unit.
Compliance Agreement ? If needed, the
written formal plan developed in consideration of shared responsibility, choice
and assisted living values and negotiated between the resident or his or her
responsible party and the assisted living facility to avoid or reduce the risk
of adverse outcomes that may occur in an assisted living environment.
Continuous ? Available at all times
without cessation, break or interruption.
Deficiency ? A facility?s failure to
meet program participation requirements as defined in these and other
applicable regulations and laws.
Dementia ? A loss or decrease in
intellectual ability that is of sufficient severity to interfere with social or
occupational functioning; it describes a set of symptoms such as memory loss,
personality change, poor reasoning or judgment, and language
difficulties.
Department ? The Department of Human
Services and its divisions and offices.
Direct Care Services ? Services that
directly help a resident with certain activities of daily living such as
assistance with mobility and transfers; assistance to resident 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 Service Plan ? A written
plan for direct care services that is developed to meet the needs and
preferences of the resident or his or her responsible party through a
negotiated process that becomes a part of the resident?s occupancy admission
agreement.
Direct Care Staff ? Any licensed or
certified staff acting on behalf of, employed by, or contracted by the
facility, to provide services and who provides direct care services or
assistance to residents, including activities of daily living and tasks related
to medication administration or assistance.
Direct Care Staff (Alzheimer?s Special Care
Unit) ? An individual who is an employee of the facility, or an
individual who is an employee of a temporary or employment agency assigned to
work in the facility, who has received or will receive, in accordance with
these regulations, specialized training regarding Alzheimer?s or related
dementia, and who is responsible for providing direct, hands-on care or cuing
services to residents of the ASCU.
Direct Contact ? The ability or
opportunity of employees of the facility, or individuals with whom the facility
contracts, to physically interact with or be in the presence of
residents.
Direct Threat ? A significant risk to
the health or safety of self or others that cannot be eliminated by reasonable
accommodation. This term as used in these rules and regulations is designed to
ensure conformity with the Americans with Disabilities Act (ADA) in determining
whether a person with a disability poses a ?direct (health or safety)
threat?.
Directed Plan of Correction ? A plan
developed by the Office of Long Term Care that describes the actions the
facility will take to correct deficiencies and specifies the date by which
those deficiencies will be corrected.
Discharge ? When a resident leaves the
facility, and it is not anticipated that the resident will return. A discharge
occurs when a return to the facility by the resident requires that admission
procedures set forth in these regulations be followed.
Disclosure Statement (Alzheimer?s Special Care
Unit) ? A written statement prepared by the facility and provided
to individuals or their responsible parties, and to individual?s families,
prior to admission to the ASCU, disclosing the form of care, treatment, and
related services especially applicable to, or suitable for residents of, the
ASCU.
Elopement ? Circumstances where a
resident, who has been identified as being cognitively impaired, has left a
facility without staff knowledge. Facilities must comply with all reporting
requirements of any special programs in which they participate.
Emergency Measures ? Those measures
necessary to respond to a serious situation that threatens the health and
safety of residents.
Endangered Adult ? Shall have the same
meaning as prescribed by Ark. Code Ann. §
5-28-101 and as amended.
Exploitation ? Shall have the same
meaning as prescribed by Ark. Code Ann. §
5-28-101.
First Aid Measures ? Temporary
interventions necessary to treat trauma or injury.
Health Care Service Plan ? A written
plan for health care services that is developed to meet the needs and
preferences of the resident or his or her responsible party through a
negotiated process that becomes a part of the resident?s occupancy admission
agreement.
Health Care Services ? The provision
of services in an assisted living facility that assists the resident in
achieving and maintaining well-being (e.g., psychological, social, physical,
and spiritual) and functional status. This may include nursing assessments and
the monitoring and delegation of nursing tasks by registered nurses pursuant to
the Nurse Practice Act and interpretations thereto by the Arkansas State Board
of Nursing, care management, records management and coordinating basic health
care and social services in such settings. Health care services may not be
provided in a Level I Assisted Living Facility except as provided in Section
702 of these regulations.
Home Health Services ? Home health
aide services, medical supplies suitable for use in the resident?s assisted
living facility apartment, and nursing services as defined in the state Nurse
Practice Act and interpretations thereto by the Arkansas State Board of
Nursing.
IDR ? The informal dispute resolution
process as described in these regulations.
Imminent Danger to Health and Safety ?
Shall have the same meaning as prescribed by Ark. Code Ann. §
5-28-101.
Impaired Adult ? Shall have the same
meaning as prescribed by Ark. Code Ann. § 5-28-101.
Independence ? The maintenance and
promotion of resident capabilities to enhance the resident?s preferences and
choices within a barrier-free environment.
Individual Assessment Team (IAT) ? A
group of individuals possessing the knowledge and skills to identify the
medical, behavioral, and social needs of residents of the Alzheimer?s Special
Care Unit (ASCU), and to develop services designed to meet those needs.
Individual Support Plan ? A written
plan developed by an Individual Assessment Team (IAT) that identifies services
to a resident of the Alzheimer?s Special Care Unit (ASCU).
Limited Nursing Services ? Acts that
may be performed by licensed personnel while carrying out their professional
duties, but limited to those acts that the department specifies by rule. Acts
that may be specified by rule as allowable limited nursing services shall be
for persons who meet the admission criteria established by the Department for
facilities offering assisted living services, shall not be complex enough to
require twenty-four (24) hour nursing supervision and may include such services
as application and care of routine dressings, and care of casts, braces, and
splints.
Long Term Care Facility License ? A
time-limited, non-transferable, permit required by Ark. Code Ann. §
20-10-224 and issued for a maximum
period of twelve (12) months to a licensee who complies with Office of Long
Term Care rules and regulations. This document must list the maximum number of
beds for the facility.
Medication Assistance and Monitoring ?
Services provided by the facility, either directly or through contract, in
accordance with the Nurse Practices Act and interpretations thereto by the
Arkansas State Board of Nursing, designed to ensure that residents receive
necessary or prescribed medication, and to prevent wastage of
medication.
Mental Abuse ? Verbal, written, or
gestured communication, to a resident, or to a visitor or staff, about a
resident within the resident?s presence, or in a public forum, that a
reasonable person finds to be a material endangerment to the mental health of a
resident.
Neglect ? Shall have the same meaning
as prescribed by Ark. Code Ann. §
5-28-101 and
42
C.F.R. §
488.301.
New Admission ? An individual who is
being admitted to the facility for the first time, or who is returning after a
formal discharge.
Non-Compliance ? Any violation of
these regulations, or of applicable law or regulations.
Nurse Practice Act ? As used in these
regulations, the term Nurse Practice Act refers to Ark. Code Ann. §
17-87-101 et seq. and
interpretations thereto by the Arkansas State Board of Nursing.
Operator ? The individual or entity
that conducts the business of the facility. The individual or individuals
executing the licensure application form shall be deemed an operator.
OLTC ? The Office of Long Term
Care.
Office of Long Term Care ? The Office
in the Division of Medical Services of the Department of Human Services that
has 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, operator,
professional, management and persons, firms, or entities providing services
pursuant to a contract or agreement.
Plan of Correction (P-o-C) ? A plan
developed by the facility and approved by OLTC that describes the actions the
facility will take to correct deficiencies, and which specifies the date by
which those deficiencies will be corrected.
PRN ? A medication or treatment
prescribed by a medical professional to a person, allowing the medication or
ointment to be given ?as needed?.
Program Requirements ? The
requirements for participation and licensure under these and other applicable
regulations and laws as an assisted living facility.
Proprietor/Licensee ? Any person,
firm, corporation, governmental agency or other legal entity, issued an
assisted living facility license, and who is responsible for maintaining
approved standards.
Protective Services ? Shall have the
same meaning as prescribed by Ark. Code Ann. §
5-28-101.
Provisional Licensure is a temporary
grant of authority to the purchaser to operate an existing long-term care
facility upon application for licensure to the Office of Long Term Care.
Provisional Placement ? Placement in
an assisted living facility made for the purposes of assessment to determine
appropriateness of admission or emergency, such as placement by law enforcement
or Adult Protective Services. A provisional placement shall be permitted for no
longer than thirty (30) days, at which time the resident must either be
discharged or admitted to the facility in conformity with theses regulations. A
provisional placement shall not be an admission pursuant to these regulations,
and any individual in an assisted living facility pursuant to a provisional
placement shall not be deemed a resident of the facility.
Responsible Party ? An individual,
who, at the request of the applicant or resident, or by appointment by a court
of competent jurisdiction, agrees to act on behalf of a resident or applicant
for the purposes of making decisions regarding the needs and welfare of the
resident or applicant. These regulations, and this definition, does not grant
or permit, and should not be construed as granting or permitting, any
individual authority or permission to act for or on behalf of a resident or
applicant in excess of any authority or permission granted by law. A competent
resident may select a responsible party or may choose not to select a
responsible party. In no event may an individual act for, or on behalf of, a
resident or applicant when the resident or applicant has a legal guardian,
attorney-in-fact, or other legal representative. For purposes of these
regulations only, responsible party will also refer to the terms legal
representative, legal guardian, power of attorney or similar phrase.
Separate Premises ? Buildings housing
Assisted Living Facility operations that are located on non-contiguous
land.
Significant Change ? Any improvement
or decline in a resident?s medical, physiological, psychological, or social
condition, in which:
a. The decline
cannot be reasonably expected to resolve itself; or,
b. In which the decline may cause a worsening
of another or pre-existing medical, physiological, psychological, or social
condition.
Substandard Quality of Care ? One or
more deficiencies related to participation requirements, as set forth in these
or other applicable regulations or laws, that constitute either immediate
jeopardy to resident health or safety; a pattern of, or widespread actual harm,
that is not immediate jeopardy; or a widespread potential for more than minimal
harm, but less than immediate jeopardy, with no actual harm.
Survey ? The process of inspection,
interviews, or record reviews, conducted by the Office of Long Term
Care.
Standard Survey - A comprehensive
survey conducted by the Office of Long Term Care on an average of every 18
months for each facility.
Transfer ? The temporary or permanent
relocation of a resident from one living unit within the facility to another
living unit within the facility, or the temporary relocation of a resident to a
location outside the facility.
Twenty-Four (24) Hour Nursing ?
Services that are ordered by a physician or advance practice nurse for a
resident whose condition requires the supervision of a physician or advance
practice nurse and continued monitoring of vital signs and physical status and
whose condition is medically complex enough to require on-site nursing
supervision on a twenty-four (24) hour per day basis.
Visually and Functionally Distinct
Area ? A space that can be distinguished from other areas within
the apartment by sight. A visually and functionally distinct area need not be a
separate room. To create a visually distinct area, one or more of the following
methods must be employed: change in ceiling height, separation by ceiling
soffit(s) or wall returns, change in flooring color, partial height partitions
or counters, use of alcoves, use of permanent screening devices such as columns
or fixed screens. In the case of an ?L? shaped studio apartment or unit,
kitchenettes and living areas may be combined and bedroom areas may be in a leg
of an ?L? shaped plan and qualify without additional separation
methods.
400
LICENSURE
400.1 No Level I assisted living 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., Act 1230 of
2001, and these licensing standards. All licenses issued hereunder, and the
beds stated on the license, are non-transferable from one owner or proprietor
to another, or from one site or location to another. No Level I assisted living
facility may operate with more beds than is stated in the license, and no Level
I assisted living facility may accept more residents than the number of beds
stated on the license. No license shall be issued without proof of a valid,
current Permit of Approval issued by the Health Services Permit Commission or
Health Services Permit Agency.
400.2 The issuance of a Level I assisted
living facility license shall be a grant of authority to the facility to
operate an assisted living facility that does not provide services for or house
individuals who meet the medical eligibility for nursing home level of care
with the stated bed capacity set out in the license, subject to the provisions
regarding loss of beds below. The initial license shall state the number of
beds as set forth in the Permit of Approval. Subsequent licenses issued to the
same owner will state the number of beds for which the facility has been
authorized by the Health Services Permit Commission or the Health Services
Permit Agency 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 beds for
which the facility was licensed on the date of sale of the facility or the date
of the sale of ownership of the facility.
400.3 No individual meeting the criteria for
Level II level of care may reside or be housed in a Level I unit or Level I
bed.
401 LICENSING
INFORMATION
401.1 Licenses to operate a Level
I assisted living facility are issued to be effective beginning July 1st and
expiring on the following June 30th. Fees for new licensure applications will
be prorated by dividing the total licensure fee by three hundred sixty five
(365) and then multiplying the result by the total number of days from the date
the application is approved through June 30, inclusive.
401.2 Licenses shall be issued only for the
premises and persons specified in the application and shall not be
transferable.
401.3 Licenses shall
be posted in a conspicuous place on the licensed premises.
401.4 Separate licenses are required for
Level I assisted living facilities maintained on separate premises, even though
they are operated under the same management. When two or more buildings located
on contiguous land house Assisted Living operations, the owner or operator may
choose to license each operation in each building separately, or to have all
operations in all buildings operate under a single license. Multiple licenses
for multiple operations housed in separate buildings on contiguous land will be
considered and treated under these regulations as separate Assisted Living
Facilities, and each licensed operation must conform to the requirements of
these regulations independent of the other licensed operations housed in other
buildings on contiguous land.
401.5
Every Level I assisted living 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 receipt by the owner of the assisted living facility of approval from the
Office of Long Term Care.
402 INITIAL LICENSURE
402.1 Initial licensure requires that the
applicant for licensure possess a current, valid Permit of Approval (P-o-A)
issued by the Health Services Permit Commission (HSPC) or Health Services
Permit Agency (HSPA). Initial licensure shall apply to:
a. Newly constructed facilities designed to
operate as assisted living facilities;
b. Existing structures not already licensed
as a Level I assisted living facility on the effective date of these
regulations.
Permits of approval held by residential care facilities as of
the effective date of Act 1230 of 2001 or held by subsequent purchases of those
facilities shall also be considered permits of approval for assisted living
without further action. However, residential care facilities that choose to
offer Level I assisted living services are not exempt from assisted living
licensure requirements except as specifically provided by Act 1230 of
2001.
402.2 The
initial licensure application shall be accompanied by one set of building
plans.
403 COMPLIANCE
An initial license will not be issued until the Department
verifies that the facility is in compliance with the licensing standards 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.
404
APPLICATION, EXPIRATION AND RENEWAL OF LICENSE
404.1 Applicants for licensure or renewal of
Level I assisted living facility licensure shall obtain the necessary forms for
initial or renewal licensure or to request re-licensure of the facility after a
change of ownership (see Section 404.7 and Section 405) from the Office of Long
Term Care. The issuance of an application form shall not be construed to be a
guarantee that the completed application will be acceptable, or that the
Department will issue a license.
404.2 The facility shall not admit any
residents until a license to operate a Level I assisted living facility has
been issued, except as provided in Section 404.10(e) of these regulations for
purposes of inspection and initial licensure.
404.3 Applicants for initial licensure,
renewal, or re-licensure after a change in ownership shall pay in advance a
license fee of $10.00 per bed to the Department. Such fee shall be refunded to
the applicant in the event a license is not issued. An application fee of
$250.00 shall also accompany every application which shall be
non-refundable.
404.4 Annual
renewal is required for all Level I assisted living 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 30, the
license for the facility will be void.
404.5 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 30th expiration of the license. Any license
fee received by the Department after June 1 is subject to a ten percent (10%)
penalty.
404.6 The operator 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.
404.7 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
1004.2 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.
404.8 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 assisted living facility for which license
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;
e. A
statement from an authorized representative of the facility acknowledging that
the facility is responsible for any funds that are handled for the residents by
the facility or its staff, including personal allowance funds, together with an
acknowledgement that the failure to make restitution within ten (10) working
days for lost or stolen funds will result in the non-renewal of licensure, or
other sanctions;
f. A copy of any
required contract agreement for the provision of services meeting
specifications in Section 503 of these regulations;
g. A copy of the floor plan of the assisted
living facility. If the assisted living facility will be a part of another
facility under a different license, the distinct part of the facility that will
be assisted living shall be identified.
404.9 A Level I assisted living facility may
apply for and be granted a license to operate as a Level II facility. A
facility desiring to change its licensure status to a Level II from a Level I
shall meet all requirements for, and shall make application without additional
fee in accordance with, new licensure applications. The Level I facility must
meet the provisions of the International Building Code in effect at the time of
the licensure or construction of the facility, whichever is later.
404.10 Procedure for Licensure. The procedure
for obtaining an Assisted Living 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 and application 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, at the time of
application submission to the Office of Long Term Care the applicant shall, in
writing, request a life-safety code survey from the Office of Long Term
Care.
d. For a new facility, the
Office of Long Term Care will conduct an unannounced life-safety code survey to
determine compliance with applicable building code requirements.
e. For a new facility, upon being informed
that the facility meets all requirements for all applicable building codes the
facility may admit residents.
f.
For a new facility, upon admission of residents the facility shall, in writing,
request an initial survey.
g. For a
new facility, the Office of Long Term Care will conduct an unannounced initial
survey to determine compliance with applicable law and these
regulations.
h. For a new facility,
upon successful completion of the initial survey the facility shall be granted
a license to operate as an Assisted Living Facility.
i. The Office of Long Term Care may elect,
for any renewal application, to perform a survey prior to issuance of the
license, and issuance of the license is contingent upon the facility being
found in compliance with all program requirements.
405 CHANGE IN OWNERSHIP
405.1 Transactions constituting a change in
ownership include, but are not limited to, the following:
a. Sale or donation of the facility?s legal
title;
b. Lease of any portion of
facility?s real or personal property;
c. A sole proprietor becomes a member of a
partnership or corporation, succeeding him as the new operator;
d. A partnership dissolves;
e. One partnership is replaced by another
through the removal, addition or substitution of a partner;
f. The corporate owner merges with, or is
purchased by, another corporation or legal entity;
g. A not-for-profit corporation becomes a
general corporation, or a for-profit corporation becomes
not-for-profit.
405.2
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.
406 PROVISIONAL LICENSURE
Subject to the requirements below, a provisional license shall
be issued to the Applicant and new operator of the long-term care facility when
the Office of Long Term Care has received the Application for Licensure to
Conduct a Long Term Care Facility. A provisional license shall be effective
from the date the Office of Long-Term Care provides notice to the Applicant and
new operator, until the date the long-term care license is issued. With the
exception of Medicaid or Medicare provider status, a provisional license
confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
1. The purchaser and the seller of the
long-term care facility shall provide the Office of Long Term Care with written
notice of the change of ownership at least thirty (30) days prior to the
effective date of the sale.
2. The
Applicant and new operator of the long-term care facility shall provide the
Office of Long Term Care with the application for licensure, including all
applicable fees.
3. The Applicant
and new operator of the long-term care facility shall provide the Office of
Long Term Care with evidence of transfer of operational control signed by all
applicable parties.
A provisional license holder may operate the facility under a
new name, whether fictitious or otherwise. For purposes of this section, the
term new name means a name that is different than the name under which the
facility was operated by the prior owner, and the term ?operate? means that the
provisional license holder may hold the facility out to the public using the
new name. Examples include, but are not limited to, signage, letterhead,
brochures or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the
facility under a new name, the facility shall utilize the prior name in all
communications with the Office of Long Term Care until such time as the license
is issued. Such communications include, but are not limited to, incident
reports, notices, Plans of Correction, and MDS submissions. Upon the issuance
of the license, the facility shall utilize the new name in all communications
with the Office of Long Term Care.
501 GOVERNING BODY
Each Level I assisted living facility must 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 assisted living policies and
administrative policies governing the operation of the facility.
502 GENERAL PROGRAM REQUIREMENTS
Each person or legal entity issued a license to operate a Level
I assisted living facility shall provide continuous twenty-four (24)-hour
supervision and services that:
a.
Conform to Office of Long Term Care rules and regulations;
b. Meet the needs of the residents of the
facility;
c. Provide for the full
protection of residents? rights; and d. Promote the social, physical, and
mental well being of residents.
503 CONTRACTUAL AGREEMENTS
A Level I assisted living facility shall not admit, or continue
to provide care to, individuals whose needs are greater than the facility is
licensed to provide. For any service required under these regulations that is
not provided directly by the facility, the facility must have a written
contractual agreement or contract with an outside program, resource or service
to furnish the necessary service.
504 PERSONNEL AND GENERAL POLICIES AND
PROCEDURES
504.1 Required Policies and
Procedures Governing General Administration of the Facility
The facility must develop, maintain, and make available for
public inspection the following policies and procedures.
a. Resident policies and procedures as set
forth in Section 505;
b. Admission
policies as set forth in Section 601;
c. Discharge and transfer policies as set
forth in Section 602;
d. Incident
reporting policies and procedures as set forth in Section 507, including
procedures for reporting suspected abuse or neglect.
e. Policies and procedures for the management
of resident personal allowance accounts as set forth in Section 505.1 and
Section 603.1(3)(N);
f. Residents?
Rights policies and procedures as set forth in Section 603.1;
g. Fire safety standards as set forth in
Section 504.1.1(i) and Section 906;
h. Smoking policies for residents and
facility personnel as set forth in Section 504.1.1(j) and Section
906;
i. Policy and procedures
regarding visitors, mail and associates as set forth in Section 603.1(3)(K),
(L), and (M);
j. Policy and
procedures regarding emergency treatment plans as set forth in Section 505
(l);
k. Policy and procedures for
the relocation of residents in cases of emergencies (e.g., natural disasters,
or utility outages)
l. 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.
504.1.1 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. Personnel records for
each employee shall be maintained and shall include, as a minimum:
1. description of responsibilities and work
to be performed, and which shall be updated as they change;
2. minimal qualifications, to include
educational qualifications;
3.
evidence of credentials, including current professional licensure or
certification;
4. 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;
5. documentation of education, documentation
of continuing training, including orientation training and continuing education
units (CEUs) related to administration certification, personal care, food
management, etc. CEU documentation must include copies of the documentary
evidence of the award of hours by the certifying organization;
6. documentation of attendance at in-service
or on-the-job training, and orientation as required by the job
description;
7. employee?s signed
acknowledgement that he or she has received and read a copy of the Residents?
Bill of Rights;
8. results of the
criminal record check required by law or regulation.
c. Verification that employee is at least 18
years of age;
d. Documentation that
employees with communicable diseases, or with infected skin lesions, are
prohibited from direct contact with residents or with residents? food, if
direct contact will transmit the disease;
e. Verification that employee has not been
convicted or does not have a substantiated report of abusing or neglecting
residents or misappropriating resident property. The facility shall, at a
minimum, prior to employing any individual or for 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 Register maintained by the Department of Human Services, Division of
Aging and Adult Services, and shall conduct re-checks of all employees every
five (5) years. Inquires to the Adult Abuse Registry shall be made by
submitting a Request for Information form found in the Appendix, addressed to
Adult Protective Services Central Registry, P. O. Box 1437, Slot S540, Little
Rock, AR 72203;
f. 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;
g. A copy of a
current health card issued by the Arkansas Department of Health or other
entities as provided by law;
h.
Documentation that employee has been provided a copy of all personnel policies
and procedures. A copy of all personnel polices and procedures must be made
available to OLTC personnel or any other Department;
i. Documentation that policies and procedures
developed for personnel about fire safety standards and evacuation of building
have been provided to the employee;
j. Documentation that policies and procedures
developed for tobacco use have been provided to the employee;
Failure to comply with the provisions of this subsection or
violation of any policies or procedures developed pursuant to this subsection
shall be a violation pursuant to Ark. Code Ann. §
20-10-205, and Ark. Code Ann.
§
20-10-206, or may constitute a
deficiency finding against the facility.
504.1.2 The facility shall meet all
regulations issued by the Arkansas Department of Health regarding communicable
diseases. Further, the facility must prohibit employees with a communicable
disease, or with infected skin lesions, from direct contact with residents or
with residents? food, if direct contact will transmit the
disease.
504.2
Required Staffing
504.2.1
Administrator
504.2.1.1 Each facility must designate a
full-time (40 hours per week) administrator. The administrator must be on the
premises during normal business hours. The administrator has responsibility for
daily operation of the facility. Correspondence from the Office of Long Term
Care to the facility will be through the administrator. Sharing of
administrators between assisted living facilities and other types of long-term
care facilities is permitted pursuant to Section 504.2.1.4.
a. The administrator shall not leave the
premises housing the assisted living facility during the day tour of duty
without first designating an employee who will be responsible for the
management of the facility during the administrator?s absence.
b. The facility administrator shall notify
the OLTC in writing if the administrator will be absent from the facility for
seven (7) or more consecutive calendar days;
c. Each administrator will provide to the
OLTC, on an annual basis, a copy of his or her current administrator
certification. This submission must be every time when the facility seeks
licensure, renewal of licensure, or upon change of ownership.
504.2.1.2 All certifications must
be current as required by the certification agency. This submission shall be
made each time the facility seeks licensure, renewal of licensure, or upon a
change of administrators.
504.2.1.3
The administrator must have the following minimum qualifications:
a. Must be at least 21 years of
age;
b. Must have a high school
diploma or have a GED;
c. Must have
the ability and agree to comply with these regulations;
d. 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;
e. Must not have been convicted, or have a
substantiated report, of abusing, neglecting, or mistreating persons, or
misappropriation of resident property. The adult abuse register maintained by
the Department of Human Services, Division of Aging and Adult Services shall be
checked prior to employment;
f.
Must have no prior conviction pursuant to Ark. Code Ann. §
20-10-401, or relating to the
operation of a long-term care;
g.
Must be certified as an Assisted Living Facility Administrator through a
certification program approved by the OLTC or must be enrolled in a
certification program with an expected completion date of within twelve (12)
months. Until certification requirements for an Assisted Living Facility
Administrator are in place, certification as a Residential Care Facility
Administrator or licensure as a Nursing Home Administrator may be
used.
504.2.1.4 Full
time means forty (40) hours per week during normal business hours. Part time
means twenty (20) hours or more, but less than forty (40) hours, during normal
business hours. When a structure or building houses more than one type of
long-term care facility, a single administrator may be employed for all the
long-term care programs housed within that structure, building or premises,
provided:
a. The person employed as
administrator must meet the qualifications for, and be currently licensed or
certified as, an administrator for each type of long-term care facility for
which he or she will act as administrator;
b. A second administrator shall be employed
part-time when:
1. The total number of beds
for all long-term care programs within the facility is more than seventy (70),
and
2. The number of beds for each
long-term care program within the facility is more than twenty (20) per
program;
c. A second
administrator shall be employed full-time when:
1. The total number of beds for all long-term
care programs within the facility is more than seventy (70), and
2. The number of beds for each long-term care
program within the facility is more than forty (40) per program.
504.3 To effectuate the intent of these
regulations, the assisted living facility shall develop a staffing plan to
ensure sufficient personnel/staff/employees are available to meet the needs of
the residents. A facility shall meet minimum staffing ratios set forth below at
all times, and shall utilize sufficient staff to meet each resident?s
particular direct care needs as agreed to and specified in the resident?s
services plan portion of the occupancy admission agreement.
a. In facilities with sixteen (16) or fewer
residents, the facility administrator may be counted as direct care staff while
still acting as, or performing the duties of, administrator. In facilities with
more than sixteen (16) residents, the facility administrator may be counted as
direct care staff on shifts on which he or she is not performing or required to
perform the duties of an administrator. The administrator must meet all
licensing or certification requirements for the duties that the administrator
is performing.
b. The facility
shall have as many personnel/staff/employees awake and on duty at all times as
may be needed to properly safeguard the health, safety, or welfare of the
residents. For purposes of these regulations, on duty means that the individual
is on the premises of the facility, is awake, and is able to meet residents?
needs. At least one administrator, on-site manager, or a responsible staff
person shall be on the premises twenty-four (24) hours per day. Residents shall
not be left unsupervised, as that term is defined in subsection 601.3(a)(1).
The following are the required minimum staff/resident ratios and other staffing
requirements:
1. Required on-site
staff/resident ratios based on current resident census are for large and small
facilities:
|
# Residents
|
Direct Care Staff Required Per Shift
|
|
Day
|
Evening
|
Night
|
|
1-16
|
1
|
1
|
1
|
|
33-49
|
2
|
2
|
2
|
|
50-66
|
3
|
2
|
2
|
|
67-83
|
4
|
2
|
2
|
|
84-above
|
5
|
3
|
2
|
2.
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;
3. Staff requirements are as follows:
A. For facilities with sixteen (16) or less
residents, the facility shall have an electronic system, such as pagers or cell
phones, to contact relief staff if the on-duty staff person must leave the
facility for an emergency or other reason. A staff person who must leave the
facility shall utilize the system to obtain staff relief, and shall not leave
the facility until the relief person appears at the facility. For facilities
with more than sixteen (16) residents, a relief staff person must be available
to relieve staff and to cover if a staff person must leave the facility in an
emergency or any other reason;
B.
The staffing schedule must be posted in the facility;
C. The OLTC may, in its sole discretion,
grant waivers to staffing standards in situations where the facility
demonstrates an ability to adequately meet service requirements with fewer
staff.
504.4 All staff including contracted
personnel who provide services to residents, excluding licensed home health
agency staff, shall receive orientation and training on the following topics
within the time frames specified herein:
a.
Within seven (7) calendar days of hire:
1.
Building safety and emergency measures, including safe operation of fire
extinguishers and evacuation of residents from the building;
2. Appropriate response to emergencies;
3 Abuse, neglect, and financial
exploitation and reporting requirements;
4. Incident reporting;
5. Sanitation and food safety;
6. Resident health and related
problems;
7. General overview of
the job?s specific requirements;
8.
Philosophy and principles of independent living in an assisted living
residence.
9. Residents? Bill of
Rights;
b. Within thirty
(30) calendar days of hire:
1. Medication
assistance or monitoring;
2.
Communicable diseases, including AIDS or HIV and Hepatitis B; infection control
in the residence and the principles of universal precautions based on OSHA
guidelines;
3. Dementia and
cognitive impairment;
c.
Within one-hundred eighty (180) calendar days of hire:
1. Communication skills;
2. Review of the aging process and disability
sensitivity training.
504.4.1 All staff and contracted providers
having direct contact with residents and all food service personnel shall
receive a minimum of six (6) hours per year of ongoing education and training
to include in-service and on-the-job training designed to reinforce the
training set forth in Section 504.4(a)(b)(c).
504.5 Facility staff, administrators and
owners are prohibited from being appointed as, or acting as, guardian of the
person or the estate, or both, for residents of the
facility.
505 GENERAL
REQUIREMENTS CONCERNING RESIDENTS
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 residents, or threatens the health,
safety, or welfare of the resident or other residents.
b. Make keys to residences readily available
to facility personnel in the event of an emergency need to enter a
residence.
c. 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 assisted living 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 residents or guests. Current records of inoculations and
license, as required by 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 occupancy admission agreement.
d. Require that conduct in the common areas
shall be appropriate to the community standards as defined by the residents and
staff.
e. Ensure that there shall
be only one resident to an apartment or unit except in situations where
residents are husband and wife or are two consenting adults who have
voluntarily agreed in writing to share an apartment or unit that has been
executed by the resident or responsible party as appropriate and is maintained
by the facility in each resident?s record.
f. Except in cases of spouses, or consenting
adults who have agreed otherwise in writing, ensure that male and female
residents do not have adjoining rooms that do not have full floor to ceiling
partitions and closable solid core doors.
g. Ensure that residents not perform duties
in lieu of direct care staff, but may be employed by the facility in other
capacities.
h. Ensure that
residents are not left in charge of the facility.
i. Ensure that a minimum of one phone jack is
available in each resident?s apartment or unit for the resident to establish
private phone service in his or her name. In addition, there shall be, at a
minimum, one dedicated facility phone and phone line for every forty (40)
residents in common areas. The phone shall allow unlimited local calling
without charge. Long distance calling shall be possible at the expense of the
resident or responsible party via personal calling card, pre-paid phone card,
or similar methods. Residents shall be able to make phone calls in private.
Private? can be defined as placing the phone in an area that is secluded and
away from frequently used areas.
j.
Ensure that residents are afforded the opportunity to participate in social,
recreational, vocational, and religious activities within the community, and
any activities made available within the facility.
k. Document that each resident has a
physician or advance practice nurse of his or her choice who is responsible for
the overall management of the resident?s health;
l. In the event of a resident?s illness or
accident:
1. Notify the resident?s responsible
party or next of kin and personal physician or advance practice nurse, or in
the event such physician or advance practice nurse is not available, a
qualified alternate. A competent resident may decline to have someone
contacted, if such a request is in writing and is filed in the resident?s
file;
2. Take immediate and
appropriate steps to see that the resident receives necessary medical attention
including transfer to an appropriate medical facility;
3. Make a notation of the illness or accident
in the resident?s records.
505.1
Financial Management of
Resident Personal Allowance
Each facility must provide for the safekeeping and
accountability of resident funds in accordance with this Section and Section
603.1(3)(N). A facility may not require the resident to deposit funds with the
facility.
505.1.1 The facility must
have written policies and procedures for the management of personal funds
accounts with an employee designated to be responsible for these accounts. In
addition, the facility shall ensure that:
a.
Each person receiving SSI shall have the opportunity to place personal funds in
an account. No fee shall be charged by the facility for maintaining these
accounts;
b. Persons who receive
SSI are entitled to retain an amount from their income for personal needs
consistent with federal requirements;
c. The facility shall hold personal funds in
trust for the sole use of the residents, and such funds must not be commingled
with the funds of the facility or used for any purpose other than for the
benefit of the resident;
d. The
personal funds shall be used at the discretion of the resident or responsible
party;
e. The resident may
terminate his or her facility-maintained account and receive the current
balance within seven (7) calendar days of the termination of the
account;
f. The facility maintains
individual records for each resident who has an account that shows all debits
and credits to the account, and that maintains a running, current
balance;
g. The facility documents
all personal transactions and maintains all paid bills, vouchers, and other
appropriate payment and receipt documentation in the manner prescribed by the
Department or by law;
h. If the
facility deposits personal allowance funds, they shall be deposited in
individual or collective interest bearing, federally insured bank accounts. If
these accounts are established, the facility must develop a procedure to insure
the equitable distribution of interest to each resident?s account;
i. At least quarterly, the facility supplies
each resident or responsible party who has a personal account with a statement
showing all deposits, withdrawals and current balance of the resident?s
personal allowance account;
j. The
facility provides the Department access to required resident financial records
upon request;
k. At a minimum, the
resident has access to his or her personal allowance account during the hours
of 9:00 a.m. to 5:00 p.m. Monday through Friday;
l. The facility does not charge the resident
additional amounts for supplies or services that the facility is by law,
regulation, or agreement required to provide under the basic charge;
m. Services or supplies provided by the
facility beyond those that are required to be included in the basic charge are
charged to the person only with the specific written consent of the resident or
his or her responsible party;
n.
Whenever a resident authorizes a facility to exercise control over his or her
personal allowance, such authorization is in writing and signed by the resident
or his or her responsible party, and the administrator of the facility or his
or her designee. Any such money shall not be commingled with the funds, or
become an asset, of the facility or the person receiving the same, but shall be
segregated and recorded on the facility?s financial records as independent
accounts.
505.1.2
Transfer of resident funds must meet the following requirements:
a. At the time of discharge from the assisted
living facility, the resident or his or her responsible party or agent shall be
provided a final accounting of the resident?s personal account and issued the
outstanding balance within seven (7) calendar days of the date of discharge. If
the resident is being transferred to another assisted living facility or health
care facility, the resident or responsible party shall be given an opportunity
to authorize transfer of the balance to a resident account at the receiving
facility;
b. Upon death of a
resident, a final statement of the account must be made and all remaining funds
shall be transferred to the resident?s estate, subject to applicable state
laws;
c. Upon change of ownership,
the existing owner must provide the new owner with a written statement of all
resident personal funds. This statement shall verify that the balance being
transferred in each resident fund account is true and accurate as of the date
of transfer;
d. At change of
ownership, the new owner must assume responsibility for account balances turned
over at the change of ownership together with responsibility for all
requirements of this Section, including holding of resident?s funds in
trust.
505.1.3 The
facility must maintain inventory records and security of all monies, property
or things of value that the facility agrees to store for the resident outside
of the resident?s apartment or unit and that the resident has voluntarily
authorized, in writing, the facility to hold in custody or exercise control
over at the time of admission or any time thereafter.
505.1.4 If a responsible party or payee fails
to pay an assisted living facility?s charges or to provide for the resident?s
personal needs, the facility shall notify the Department of Human Services,
Division of Aging and Adult Services, Adult Protective Services.
506 QUALITY ASSURANCE
The Assisted Living Facility shall develop and maintain a
quality assessment unit. The unit shall meet at least quarterly to identify
issues with respect to which quality assessment and assurance activities are
necessary, and to develop and implement appropriate plans of action to correct
identified quality deficiencies
The quality assessment unit shall consist of the individual or
individuals identified by the facility as having the ability to recognize and
identify issues of quality deficiencies and to implement changes to facility
and employee practices designed to eliminate identified issues of quality
deficiencies.
Good faith attempts by the unit to identify and correct quality
deficiencies will not be used as a basis for sanctions.
507 REPORTING SUSPECTED ABUSE, NEGLECT, OR
MISAPPROPRIATION OF RESIDENT PROPERTY
Pursuant to Ark. Code Ann. §
5-28-101, 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 residents;
? exploitation of residents or any misappropriation of resident
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.
507.1
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 501-682-8540 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
residents.
b. Any alleged,
suspected, or witnessed occurrence of misappropriation of resident property or
exploitation of a resident.
c. Any
alleged, suspected, or witnessed occurrences of sexual abuse to residents 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 507.5. Forms DMS-731 and DMS-742 are found in the
Appendix.
507.2
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 507.3, as applicable.
Facilities must maintain these incident report files in a manner that allows
verification of compliance with this provision.
a. Incidents where a resident attempts to
cause physical injury to another resident 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.
c. Loss of heating, air conditioning, or fire
alarm system for a period of greater than two (2) hours.
507.3
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 and DMS-742 as applicable.
All written reports will be reviewed, initialed, and dated by
the facility administrator or designee within five (5) days after
discovery.
1. All reports involving
accident or injury to residents will also be reviewed within five (5) days of
the incident by the facility administrator.
2. The services plan portion of the occupancy
admission agreement shall be reviewed by the administrator and:
a. Shall be amended upon any change of a
resident?s condition or need for services;
b. Copies of the amended versions of the
resident?s services plan shall be attached to the written report of the
incident or accident.
Reports of incidents specified in Section 507.2 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.
507.4
Other Reporting
Requirements
The facility?s administrator or designee is also required to
make any other reports as required by state and federal laws and
regulations.
507.5
Abuse Investigation Report
The facility must ensure that all alleged or suspected
incidents involving resident abuse, exploitation, neglect, or misappropriations
of resident 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 administrator 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 re-submitted at any time circumstances require.
507.6
Reporting Suspected Abuse
or Neglect
The facility?s written policies and procedures shall include,
at a minimum, requirements specified in this section.
507.6.1 The requirement that the facility?s
administrator or his or her designated agent immediately reports all cases of
suspected abuse or neglect of residents of an assisted living facility to the
local law enforcement agency in which the facility is located as required by
Ark. Code Ann. § 5-28-203(b) and as amended.
507.6.2 The requirement that the facility?s
administrator or his or her designated agent report suspected abuse or neglect
to the Office of Long Term Care as specified in this regulation.
507.6.3 The requirement that all facility
personnel/staff/employees who have reasonable cause to suspect that a resident
has been subjected to conditions or circumstances that have resulted in abuse
or neglect are required to immediately notify the facility administrator 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. § 5-28-203(b)).
507.6.4 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.
507.6.5
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.
507.7 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 resident property against a
resident, 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.
508 RESIDENT RECORDS
508.1 The assisted living facility must
maintain a separate and distinct record for each resident. The record must
contain:
a. Resident?s name;
b. Resident?s last address;
c. Date the resident began residing at the
facility;
d. Name, office telephone
number, and emergency telephone number of each physician or advance practice
nurse who treats the resident;
e.
Name, address, and telephone number of the responsible party, or if no
responsible party, the person who should be contacted in the event of an
emergency involving death of the resident;
f. All identification numbers such as
Medicaid, Medicare or Medipak, Social Security, Veterans Administration and
date of birth;
g. Any other
information that the resident requests the assisted living facility to keep on
record;
h. A copy of the resident?s
signed ?Residents? Bill of Rights? Statement;
i. A copy of the current occupancy admission
agreement that includes the resident?s services plan updated within the
specified time frames and transfer/discharge plan (when applicable);
j. On admission, and each time there is a
change in services provided the resident, a written acknowledgement that the
resident or his or her responsible party has been notified of the charges for
the services provided;
k.
Information about any specific health problem of the resident that might be
necessary in a medical emergency. Such records should specify any medication
allergies. If none, state ?no known allergies?;
l. A brief medical history;
m. A list of all current medications,
including strength and dosage, kept by the facility for the resident;
n. Name of the resident or his or her
responsible party?s preferred pharmacy;
o. An entry shall be made at any time the
resident?s status changes or in the event of an unusual occurrence. This
documentation shall include:
1.
Falls;
2. Illness;
3. Physician or advance practice nurse
visits;
4. Problem with staff
members or others;
5.
Hospitalization;
6. Physical injury
sustained, whatever the circumstances;
7. Changes in the resident?s mental or
physical condition;
p.
Copy of compliance agreement, if appropriate;
q. A copy of court orders, letters of
guardianship, or power of attorney if applicable;
r.Copy of any advance directive;
s. Discharge date.
508.2 The facility must maintain the
resident?s records in the following manner:
a.
Each resident shall have the right to inspect his or her records during normal
business hours in accordance with state and federal law;
b. The facility must not disclose any
resident records maintained by the facility to any person or agency other than
the facility personnel, the OLTC or the Attorney General?s Office except upon
expressed written consent of the resident or his or her responsible party
unless the disclosure is required by state or federal law or
regulation;
c. Each facility must
provide a locked file cabinet or locked room for keeping resident?s medical,
social, personal, and financial records;
d. The facility must maintain the original
records in an accessible manner for a period of five (5) years following the
death or discharge of a resident;
e. The original resident records shall be
kept on the facility premises at all times, unless removed pursuant to
subpoena.
f. In the event of a
change of ownership, the resident records shall remain with the
facility.
g. If the facility
closes, the resident records shall be stored by the owner of the facility
within the State of Arkansas for five (5) years.
h. The facility shall take reasonable actions
to protect the resident records from destruction, loss, or unauthorized use.
600
ADMISSION, DISCHARGE AND TRANSFER
Ark. Code Ann. §
20-10-1005 provides for
involuntary and voluntary discharges. These regulations are supplemental to the
statute and if in conflict, the statute governs.
601 ADMISSIONS
601.1
Admission
Criteria
The Level I assisted living facility shall not admit any
resident whose needs are greater than the facility is licensed to provide. The
Level I assisted living facility shall not provide services to residents
who:
a. need 24-hour nursing services
except as certified by a licensed home health agency for a period of sixty (60)
days with one (1) thirty (30) day extension. A copy of the licensed home health
agency?s plan shall be filed in the resident?s record;
b. are bedridden;
c. have transfer assistance needs, including
but not limited to assistance to evacuate the facility in case of emergency,
that the facility cannot meet with current staffing;
d. present a danger to self or others or
engage in criminal activities.
601.2
Pre-Admission
Evaluation
Each applicant shall receive an initial evaluation completed by
the facility prior to admission to determine whether the resident?s needs can
be met by the assisted living facility, and the resident?s needs are not
greater than the facility is licensed to provide.
601.3
Occupancy Admission
Agreement
Prior to or on the day of admission, the assisted living
facility and the resident or his or her responsible party shall enter into an
occupancy admission agreement. For admissions due to emergency circumstances,
an individual shall enter into the assisted living facility as a provisional
placement with an occupancy admission agreement between the assisted living
facility and the individual or his or her responsible party in place within
thirty (30) calendar days of admission if it is determined the individual is
appropriate for admission into the assisted living facility. The agreement
shall be in writing and shall be signed by both parties. Each resident or his
or her responsible party, prior to the execution of the occupancy admission
agreement, shall have an opportunity to read the agreement. In the event that a
resident or his or her responsible party is unable to read the agreement,
necessary steps shall be taken to ensure communication of its contents to the
resident or his or her responsible party. The resident or his or her
responsible party shall be given a signed copy of the agreement, and a copy
signed by the resident or his or her responsible party, and assisted living
facility shall be retained in the resident?s record. The occupancy admission
agreement shall include, at a minimum, the following:
a. Basic core services that the assisted
living facility shall provide including, but not limited to:
1. 24-hour staff supervision by awake staff.
Provided, however, that the phrase 24-hour staff supervision does not require
continuous, uninterrupted visual monitoring, and does not place any
responsibility with the facility for the conduct of a resident who is away from
the facility. This definition does not mean, and is not intended to imply, that
a facility is not responsible for any resident who has eloped, as that term is
defined in these regulations;
2.
Assistance in obtaining emergency care 24-hours a day. This provision may be
met with an agreement with an ambulance service or hospital or emergency
services through 911;
3. Assistance
with social, recreational and other activities;
4. Assistance with transportation (this does
not include the provision of transportation;
5. Linen service;
6. 3 meals a day;
b. Additional Services:
1. Services identified by the resident or his
or her responsible party that are not included in the assisted living
facility?s core services (see Section 601.3(a) for basic core services) but are
available in the facility on an additional fee basis (see Section 700.1.3,
Section 700.2.3, Section 700.3.3 and Section 903(i) for examples of services on
an additional fee basis) for which the resident or his or her responsible party
must sign a request that acknowledges the additional cost and the services
provided in the facility for that additional cost;
2. Arrangements for other services identified
as needed by the resident or his or her responsible party but are not available
in the assisted living facility;
c. Health Care Services:
Health care services identified as needed by the resident or
his or her responsible party that are being received through a licensed home
health agency. A copy of the home health agency?s plan shall be filed in the
resident?s record;
d.
Parameters for pets to include behavior and health;
e. A current statement of all:
1. Fees,
2. Daily, weekly or monthly
charges,
3. Any other services that
are available on an additional fee basis for which the resident or his or her
responsible party must sign a request acknowledging the additional cost and the
services provided for that charge;
All fees that a resident will be billed (basic core and other
fees) shall be disclosed in writing to the resident and made a part of the
occupancy admission agreement prior to the receipt of the services. If no prior
agreement is obtained, the services may not be billed to the resident or the
resident?s responsible party.
f. A statement that residents or their
responsible parties shall be informed, in writing, at least thirty (30) days
prior to general rate changes;
g.
The refund policy that addresses refund of advance payment(s) in the event of
transfer, death, or voluntary or involuntary discharge. The facility shall
ensure, and the policy shall include, as a minimum, the following:
1. For a fourteen-day (14) period beginning
on the date of entry into a facility, the resident or his or her responsible
party shall have the right to rescind any contractual obligation into which he
or she has entered and receive a full refund of any moneys transferred to the
facility. If the resident entered the facility and received some benefit
therefrom, the charges of the services provided shall be prorated and payment
made only for the benefits conferred prior to the refund;
2. In the event of discharge for medical
reasons, the refund policy must address the resident?s need to maintain
on-going medical care and services, and for that reason, refunds shall be on a
pro-rata basis regardless of income source;
3. If, after the expiration of the
fourteen-day (14) period referenced in Section 601.3(g)(1) above, the resident
or his or her responsible party provides a ten (10) day notice, any applicable
refund shall be available the day the resident is discharged from the facility.
If the resident or his or her responsible party does not provide a ten (10) day
notice, any applicable refund will be available within ten (10) days of the
resident?s departure;
h.
Procedure for nonpayment of fees;
i. Whether the resident or his or her
responsible party chooses to ask the facility to accept responsibility for the
resident?s personal funds;
j.
Whether the resident shall assume responsibility for his own
medication;
k. The resident or his
or her responsible party?s authorization and consent to release medical
information as needed;
l.
Provisions for the continuous assessment of the resident?s needs, referral for
appropriate services as may be required if the resident?s condition changes and
referral for transfer or discharge if required due to a change in the
resident?s condition;
m. A
statement that a resident may not be required to perform services for the
assisted living facility except as provided for in the occupancy admission
agreement or a subsequent written agreement. A resident and the assisted living
facility may agree in writing that a resident will perform certain activities
or services in the facility if the resident volunteers or is compensated at or
above prevailing rates in the community. If a resident is compensated for
performance of certain activities to which the resident and the facility agree,
the resident shall have to undergo a criminal record check;
n. Conditions under which emergency transfers
or discharges shall be made and procedures for handling such transfers or
discharges;
o. Conditions or events
resulting in termination of the occupancy admission agreement;
p. Resident's or his or her responsible
party?s responsibilities;
q.
Written documentation of the resident's or his or her responsible party?s
preference regarding the formulation of an Advance Directive in accordance with
Arkansas law. If applicable, a copy of the resident?s Advance Directive shall
be available;
r. Copy of Compliance
Agreement (if applicable);
s. Other
information as may be appropriate.
601.4
Retention
Conditions
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall
be permitted to remain in an assisted living facility if the resident?s
condition requires twenty-four (24) hour nursing care or other services that an
assisted living facility is not authorized by law to provide. Further, this
prohibition applies even if the resident is willing to execute an agreement
relieving the facility of responsibility attendant to the resident?s continued
placement. Subject to the foregoing restriction, an assisted living facility
may retain a resident who becomes incompetent or incapable of recognizing
danger, summoning assistance, expressing need or making care decisions provided
that the facility ensures all of the following:
a. That adequate oversight, protection and
services are provided for the person;
b. That the resident has a guardian or has an
agent with a current power of attorney, regardless of whether it is durable,
for health care or both. The power of attorney for health care must
substantially cover the person?s areas of incapacity to meet the requirement of
this subsection;
c. That both the
service agreement and compliance agreement, if required, is signed by the
guardian and the health care agent or the agent with power of attorney, if any;
and d. The retention is for a period of no more than ninety (90) days, with no
more than a total of two (2) ninety (90) day periods for a single resident in
any continuous twelve (12) month period.
602 INVOLUNTARY TRANSFER OR DISCHARGE OF
RESIDENT
Except in cases of provisional placements, in the event of the
involuntary transfer or discharge of a resident, the assisted living facility
shall:
a. Discuss with the resident
the decision to transfer or discharge the resident;
b. Inform the resident of the reason for the
transfer or discharge;
c. Inform
the resident of any available alternative to the transfer or
discharge;
d. Provide a thirty (30)
day written notice of transfer or discharge, unless an immediate discharge is
required to ensure the welfare of the resident or the welfare of other
residents may be immediately affected or the conditions found in Ark. Code Ann.
§
20-10-1005(a)(1)
exists. The written notice shall contain, at a minimum:
1. The reason or reasons for the transfer or
discharge;
2. A statement of the
resident?s right of appeal;
3. A
statement that an appeal must be made to the Office of Long Term
Care;
4. A statement that the
notice of appeal must be made within seven (7) calendar days of the written
notice of transfer or discharge to the resident.
e. In the event an immediate transfer or
discharge is required pursuant to the conditions set forth in Section 602(d),
the assisted living facility shall advise the resident or his or her
responsible party, and immediate arrangements shall be made based on the
written occupancy admission agreement to transfer or discharge such resident to
an appropriate facility.
f. Where
there is no responsible party or the responsible party is unwilling to act, the
assisted living facility shall notify the Department of Human Services? Adult
Protective Services for the county in which the assisted living facility is
located and other appropriate agencies when transfer assistance is
needed.
g. Provide a copy of
pertinent information that must include:
1.
Identifying information including social security number and Medicaid number if
there is one, date of birth;
2.
Responsible party contact information;
3. Summary of needs/problems;
4. Social history, if available.
h. Refund to the resident or his
or her responsible party any security deposit, less appropriate deductions for
damage or specific charges made to the assisted living facility by or on behalf
of the resident.
i. Document in the
resident?s file the reasons for the transfer or discharge.
Prior to making such transfer or discharge, the assisted living
facility shall:
1. Develop a transfer
or discharge plan consistent with the occupancy admission agreement;
2. Document in the resident?s file the
following:
A. The reason for the transfer or
discharge;
B. The strategies used,
if any, to prevent involuntary transfer or discharge;
C. The fact that the resident or his or her
responsible party was informed and the manner in which they were
informed;
D. The name, address, and
telephone number of the individual or location to which the resident is to be
transferred or discharged.
j. If it is determined that there is a
medical need for a transfer to another health care facility because the
assisted living facility cannot meet the resident?s needs, such transfers shall
be initiated promptly. The administrator shall be notified and shall ensure:
1. That the resident is receiving appropriate
care prior to transfer or discharge;
2. That discharge or transfer occurs in a
manner consistent with the medical needs of the resident including arrangements
for appropriate transportation.
602.1
Conditions of Termination
of the Occupancy Admission Agreement
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall
be permitted to remain in an assisted living facility if the resident?s
condition requires twenty-four (24) hour nursing care or other services that an
assisted living facility is not authorized by law to provide. See also Section
601.1. Further, this prohibition applies even if the resident is willing to
execute an agreement relieving the facility of responsibility attendant to the
resident?s continued placement. Subject to the foregoing, supplemental services
may be provided as an alternative to termination. In no event shall an assisted
living facility terminate an occupancy admission agreement if the resident or
his or her responsible party arranges for the needed services and any unmet
needs. Supplemental services may be provided by the resident?s family, facility
staff or private duty staff as agreed to between the resident and the facility.
The occupancy admission agreement shall not be terminated except under one of
the following conditions:
a. By
written notification by either party giving the other party thirty (30)
calendar days written notice, provided, however, that if an emergency condition
exists whereby the continued residency of the resident will constitute
immediate jeopardy, a direct threat or the substantial risk of serious harm,
serious injury, impairment or death to other residents, the facility may
immediately discharge the resident. In such cases, the facility shall document
the nature of the emergency and the reasons why it could not permit the
continued residency of a resident, and shall provide a written statement of
discharge containing the reason for the discharge, and stating the right and
method to appeal the discharge;
b.
The resident?s mental or physical condition deteriorates to a level requiring
services that cannot be provided in a Level I assisted living
facility;
c. The resident?s
condition requires twenty-four (24) hour nursing care as defined in Section
300;
d. The resident?s behavior or
condition poses an immediate threat to the health or safety of self or
others;
e. The resident or his or
her responsible party refuses to cooperate in an examination by a physician or
advance practice nurse or licensed psychologist of his or her own choosing to
determine the resident?s health or mental status for the purpose of
establishing appropriateness for retention or termination;
f. The resident?s fees have not been paid,
provided the resident or his or her responsible party was notified and given
thirty (30) days to pay any deficiency;
g. The resident or his or her responsible
party refuses to enter into a negotiated compliance agreement, refuses to
revise the compliance agreement when there is a documented medical reason for
the need of a negotiated compliance agreement or revision thereto, or refuses
to comply with the terms of the compliance agreement (See Section 704,
Compliance Agreements);
h. Other
written conditions as may be mutually established between the resident or his
or her responsible party and the assisted living facility at the time of
admission or any time thereafter.
603 BILL OF RIGHTS
603.1
Residents? Bill of
Rights1. Each assisted living
facility must post the Residents? Bill of Rights, as provided by the
Department, in a prominent place in the facility. The Residents? 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 Residents? Bill of Rights. Further, the facility shall
prominently display the contact information for the State ombudsman?s office. A
copy of the Residents? Bill of Rights must be given to each resident in a
manner and form comprehendible to the resident or his or her responsible
party.
2. A resident 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 resident 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 603.1(1)(2), each resident in the assisted living
facility has the right to, and the facility shall ensure that residents 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 resident 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
residents 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 resident?s
choice. The assisted living 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, sex, age, disability, marital
status, sexual orientation or source of payment. This means that the resident:
(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, and
(iii.) if protective measures are required,
has the right to designate a guardian or representative to ensure the right to
quality stewardship of his or her affairs to the extent permitted by
law;
G. Be provided a
safe and appropriate living environment;
H. Not be confined to his or her apartment or
bed;
I. Not be prohibited from
communicating in his or her native language with other residents or
personnel/staff/employees;
J. Be
permitted to complain about the resident?s care or treatment. The complaint may
be made anonymously or communicated by a person designated by the resident. 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 resident who makes a complaint or causes a complaint to be
made;
K. Be allowed to receive and
send unopened mail, and the provider must ensure that the resident?s mail is
sent and delivered promptly;
L. Be
allowed communication, including personal visitation with any person of the
resident?s choice, including family members, representatives of advocacy
groups, and community service organizations;
M. Be allowed to make contacts with the
community and to achieve the highest level of independence, autonomy, and
interaction with the community of which the resident is capable;
N. Be allowed to manage his or her financial
affairs. The resident may authorize in writing another person to manage his or
her money. The resident may choose the manner in which his or her money is
managed, including a money management program, a representative payee program,
a financial power of attorney, a trust, or a similar method, as desired by the
resident. The resident or his or her responsible party must be given, upon
request of the resident or his or her responsible party, but at least
quarterly, an accounting of financial transactions made on his or her behalf by
the facility should the facility accept his or her written delegation of this
responsibility to the facility in conformance with state law. Further, if a
facility agrees to manage residents? funds, the facility shall indemnify and
hold harmless the resident from any loss of or theft of funds;
O. Be allowed access to the resident?s
records. Resident records are confidential and may not be released without the
resident?s or his or her responsible party?s consent unless the release without
consent is required by law;
P. Have
the right and be allowed to choose and retain a personal physician or advance
practice nurse;
Q. Participate in
the development of the individual services plan portion of his or her occupancy
admission agreement that describes the resident?s services and how the needs
will be met;
R. Be given the
opportunity to refuse medication assistance or monitoring after the resident or
his or her responsible party:
(i.) is advised
by the person providing medication assistance or monitoring of the possible
consequences of refusing medication assistance or monitoring, and
(ii.) acknowledges that he or she understands
the consequences of refusing medication assistance or monitoring;
S. Be allowed unaccompanied access
to a telephone;
T. Have privacy
while attending to personal needs, and a private place for receiving visitors
or associating with other residents, unless providing privacy would infringe on
the rights of other residents. The right applies to medical treatment, written
communications, telephone conversations, meeting with family, and access to
resident councils;
U. If married,
have the right to share an apartment or unit with his or her spouse even if the
spouse is not receiving services through the assisted living facility. In the
case of two consenting adults, if one or both is receiving services through the
assisted living facility, the couple shall have the right to share an apartment
or unit;
V. Be allowed to retain
and use personal possessions, including, but not limited to, clothing and
furnishings, as space permits. The number of personal possessions may be
limited for the health and safety of other residents;
W. Be allowed to determine his or her dress,
hairstyle, or other personal effects according to individual preference, except
the resident has the responsibility to maintain personal hygiene;
X. Be allowed to retain and use personal
property in his or her immediate living quarters and shall have a lockable
apartment or unit door;
Y. Be
allowed to refuse to perform services for the facility;
Z. Be informed by the assisted living
facility no later than the 30th day after admission:
(i.) whether the resident is entitled to
benefits under Medicare or Medicaid, and
(ii.) which items and services are covered by
these benefits, including items or services for which the resident may not be
separately charged;
AA.
Residents are discharged or transferred in conformity with Ark. Code Ann §
20-10-1005 and the provisions
governing transfer and discharge in these regulations.
BB. Be allowed to immediately leave the
assisted living facility, either temporarily or permanently, subject to
contractual or financial obligations as specified in Section
601.3(g);
CC. Have access to the
services of a representative of the State Long Term Care Ombudsman Program,
Arkansas Department of Human Services, Division of Aging and Adult
Services;
DD. Be allowed to execute
an advance directive or designate a guardian in advance of need to make
decisions regarding the resident?s health care should the resident become
incapacitated.
EE. 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 residents? property that occurs
during laundering or cleaning of the facility, the resident?s room, or the
resident?s property, excluding normal wear and tear.
700
SERVICES
An assisted living facility shall provide, make available,
coordinate, or contract for services that meet the care needs identified in the
services plan portion of residents? occupancy admission agreements, to meet
unscheduled care needs of residents, and to make emergency assistance available
24 hours a day, all in a manner that does not pose an undue hardship on
residents. An assisted living facility shall respond to changes in residents?
needs for services by revising the services plan portion of residents?
occupancy admission agreements and, if necessary, by adjusting its staffing
plan or contracting for services from other providers. If non-residents utilize
services of the assisted living facility, it must occur in a manner that does
not unduly disturb residents or deprive residents of timely access to
services.
Services are provided according to the services plan portion of
residents? occupancy admission agreements, and may include, but are not limited
to, homemaker, attendant care, and medication oversight to the extent permitted
under State law. Services include 24-hour response staff to meet residents?
needs in a way that promotes maximum dignity and independence and provides
supervision, safety and security. Other individuals or agencies may furnish
care directly or under arrangements with the assisted living facility. Such
care shall be supplemental to the services provided by the assisted living
facility and does not supplant, nor may be substituted for, the requirements of
service provisions by the facility.
Services are furnished to a person who resides in his or her
own apartment or unit that may include dually occupied units when both
occupants consent to the arrangement. Each apartment or unit shall be of
adequate size and configuration to permit residents to perform, with or without
assistance, all the functions necessary for independent living, including
sleeping; sitting; dressing; personal hygiene; storing, preparing, serving and
eating food; storage of clothing and other personal possessions; doing personal
correspondence and paperwork and entertaining visitors. Care provision and
service delivery must be resident-driven to the maximum extent possible and
treat each person with dignity and respect. Care must be furnished in a way
that fosters the independence of each resident.
Occasional or intermittent guidance, direction or monitoring,
or assistance with activities of daily living and social activities and
transportation or travel, as defined in these regulations, for residents to
keep appointments for medical, dental, social, political or other services or
activities shall be made available to residents.
The resident may be assisted in making arrangements to secure
community based health or other professional services, examinations and reports
needed to maintain or document the maintenance of the resident?s health, safety
and welfare.
700.1
Housekeeping and Maintenance
700.1.1 Each assisted living facility shall
establish and conduct a housekeeping and maintenance program, to ensure the
continued maintenance of the facility in good repair, to promote good
housekeeping procedures, and to ensure sanitary practices throughout the
facility.
700.1.2 The facility
shall have full responsibility to clean and maintain all common areas and shall
make no additional charge to the resident or third parties, including Medicaid,
for such services. The facility shall ensure that each resident or staff person
maintains the residents? living quarters in a safe and sanitary condition. If
the resident declines housekeeping services, the resident?s apartment or unit
shall not impact negatively on other apartments or units or common areas (e.g.,
odors, pests).
700.1.3 For those
residents who do not wish to clean their own apartment or unit, the facility
shall include this service as part of the service package either for free, or
for an additional fee basis and indicate such in the occupancy admission
agreement.
700.1.4 Each assisted
living facility, in addition to meeting applicable fire and building codes,
shall meet the following housekeeping and maintenance requirements:
a. All areas of the facility shall be kept
clean and free of lingering odors, insects, rodents and trash;
b. Each resident?s apartment or unit shall be
cleaned before use by another resident;
c. Corridors shall not be used for
storage;
d. Attics, cellars,
basements, below stairways, and similar areas shall be kept clean of refuse,
old newspapers and discarded furniture;
e. Polish used on floors shall provide a
non-slip finish;
f. The building(s)
and grounds shall be maintained in a clean, orderly condition and in good
repair;
g. The interior walls,
ceilings and floors shall be clean. Cracked plaster, peeling wallpaper or
paint, missing or damaged tiles and torn or split floor coverings shall be
promptly and adequately repaired or replaced;
h. Electric systems, including appliance,
cords, and switches, shall be maintained in compliance with state and local
codes;
i. Plumbing and plumbing
fixtures shall be maintained in compliance with state plumbing and gas codes
governing them at the time of construction or as applicable due to
renovations;
j. Ventilation,
heating, air conditioning and air changing systems shall be properly
maintained. All HVAC and gas systems shall be inspected at least every 12
months to ensure safe operation. Inspection certificates, where applicable,
shall be maintained for review;
k.
The building(s), grounds and support structures shall be free of breeding areas
for flies, other insects and rodents;
l. Entrances, exits, steps, and outside
walkways shall be maintained in safe condition, including removing or treating
snow and ice within a reasonable amount of time of its accumulation;
m. Repairs or additions shall meet current
codes.
700.2
Linen and Laundry Services
700.2.1 Each assisted living facility shall
offer laundry facilities or services to its residents.
700.2.2 Each assisted living facility shall
meet the following laundry service requirements:
a. Each assisted living facility shall have
laundering facilities unless commercial laundries are used. The laundry shall
be located in a specifically designed area that is physically separate and
distinct from residents? rooms and from areas used for dining and food
preparation and service. There shall be adequate rooms and spaces for sorting,
processing and storage of soiled material. Laundry rooms shall not open
directly into resident care area or food service area. Domestic washers and
dryers that are for the use of residents may be provided in resident areas,
provided they are installed in such a manner that they do not cause a
sanitation problem or offensive odors.
b. Laundry dryers shall be properly vented to
the outside;
c. The laundry room
shall be cleaned after each day?s use to prevent lint accumulation and to
remove clutter;
d. Portable heaters
or stoves, or either of them, shall not be used in the laundry area;
e. The laundry room shall be well-lighted and
vented to the outside by either power vents, gravity vents or by outside
windows;
f. When facility staff is
performing laundry duties for the entire facility, resident?s clothing, kitchen
linens, and bed linens shall be washed separately. If linens, including
washable blankets, are not washed at a minimum temperature of 150 degrees
Fahrenheit, a disinfecting agent shall be used.
g. The facility shall be responsible, as part
of the services required under the basic charge, for providing laundry services
on all linens and supplies owned by the facility.
700.2.3 For those residents who do not wish
to launder their own personal items, the facility shall include this service as
part of the service package. The facility may provide this service for free, or
for an additional fee basis, and indicate as such in the occupancy admission
agreement.
700.3
Dietary Services
700.3.1
Required Facility Dietary
Services
700.3.2 As
part of the basic charge, each assisted living facility must make available
food for three (3) balanced meals, as specified in Section 601.3 (a)(6), 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. There shall be no more than five (5) hours between
breakfast and lunch and no more than seven (7) hours between lunch and the
evening meal. Variations from these stated parameters may be permitted at the
written request of the resident or his or her responsible party or as directed
by the resident?s personal physician or advance practice nurse in writing. The
facility shall retain documentation stating the reason for the
variance.
700.3.3 For those
residents who wish to have meals served in his or her apartment or unit, the
facility shall include this service as part of the service package, either for
free, or for an additional fee basis, and indicate as such in the occupancy
admission agreement.
700.3.4 In the
event that a resident 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 resident?s personal physician or advance practice nurse
and take appropriate action to ensure the physician or advance practice nurse?s
instructions are implemented. If a resident chooses not to consume regular
meals, it must be documented in the resident?s service plan portion of the
occupancy admission agreement. In the event that the resident refuses to
provide a written statement, the facility shall document the refusal, as well
as all contact with the resident?s personal physician or advance practice nurse
regarding the resident?s refusal to eat.
700.3.5 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 State Department of Health.
Assisted living facilities attached to other licensed long term care facilities
may utilize the kitchen facilities of the attached long term care facility,
however, the assisted living facility shall ensure that the kitchen facilities
so utilized are adequate to meet the needs of the residents of the assisted
living facility.
700.3.6 Dietary
personnel/staff/employees shall wear clean clothing and hair
coverings.
700.3.7 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.
700.3.8 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.
700.3.9 The kitchen and
dining area must be cleaned after each meal.
700.3.10 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.
700.3.11 Each assisted living 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.
700.3.12 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.
700.3.13 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.
700.3.14 Fresh whole eggs shall not be
cracked more than 2 hours before use.
700.3.15 Hot foods should leave the kitchen
(or steam table) above 140 degrees Fahrenheit and cold foods at or below 41
degrees Fahrenheit.
700.3.16
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.
700.3.17 In facilities that have a
residential 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.
700.3.18 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.
700.3.19 Leftover foods placed in the
refrigerator shall be sealed, dated, and used or disposed of within 48
hours.
700.3.20
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.
700.3.21 Menus shall be posted on a weekly
basis. The facility shall retain a copy of the last month?s menus.
700.3.22 Therapeutic diets shall be planned
by a licensed dietician. The dietician should review any dietetic
changes.
700.3.23 Each assisted
living facility shall make available a dietary manager, who is certified as
required by law or regulation, to prepare nutritionally balanced meal plans in
consultation with staff and residents or their responsible
parties.
701
DIRECT CARE SERVICES
Direct care services directly help a resident with certain
activities of daily living such as assistance with mobility and transfers;
hands-on or cuing assistance to a resident to eat meals or food, grooming,
shaving, trimming or shaping fingernails and toenails, bathing, dressing,
personal hygiene, bladder and bowel requirements, including incontinence; and
assistance with medication only to the extent permitted by the state Nurse
Practice Act and interpretations thereto by the
Arkansas State Board of Nursing. The assisted living facility
shall ensure the resident receives direct care services in accordance with the
services plan portion of the occupancy admission agreement. Direct care
services needs of all residents in the facility shall be reviewed at least
annually, and the services plan portion of the occupancy admission agreement
revised, if necessary. Revision of the services plan portion of the occupancy
admission agreement shall be revised within fourteen (14) days upon any
significant enduring change to the resident.
702 HEALTH CARE SERVICES
The assisted living facility shall ensure that the resident
receives health care services under the direction of a licensed home health
agency when services are needed on a short-term basis. A copy of the home
health agency?s plan shall be filed in the resident?s record.
702.1
Medications
702.1.1
Administration
702.1.1.1 Each assisted living facility must
have written policies and procedures to ensure, and facilities must ensure,
that residents receive medications as appropriate. In-service training on
facility medications policies and procedures (see Section 504.4(b)(1) and
Section 504.4.1) shall be provided at least annually for all facility
personnel/staff/employees supervising.
702.1.1.2 Facilities must comply with
applicable state laws and regulations governing the administering of
medications and restrictions applicable to non-licensed
personnel/staff/employees. The facility owner(s), personnel/staff/employees or
others acting on behalf of the facility are prohibited from administering,
repackaging or relabeling any resident medication; provided, however, that
administration of medication may be performed to the extent permitted by the
state Nurse Practice Act and interpretations thereto by the Arkansas State
Board of Nursing.
702.1.1.3 The
facility shall document in the resident?s record whether the resident or the
facility is responsible for storing the resident?s medication.
702.1.1.4 Residents must be familiar with
their medications and comprehend administration instructions. Facility staff
shall provide assistance to enable residents to self-administrator medications.
For clarification, examples for acceptable practices related to an unlicensed
facility staff person assisting with the self-administration of oral medication
are listed below:
a. The medication regimen on
the container label may be read to the resident;
b. A larger sterile or disposable container
may be provided to the resident if needed to prevent spillage. The containers
shall not be shared by residents;
c. The resident may be reminded of the time
to take the medication and be observed to ensure that the resident follows the
directions on the container;
d.
Facility staff may assist the resident in the self-administration of oral
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 resident. In
the presence of the resident, facility staff may remove the container cap or
loosen the packaging. If the resident 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 resident, may assist the
resident in removing oral medication from the container and in taking the
medication. If the resident 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 resident.
702.1.1.5 Changes in dosage or schedule of
the medication shall be made only upon the authorization of the resident?s
attending physician or advance practice nurse. Any such authorization shall be
documented by the facility in the resident?s record.
702.1.2
Medication
Storage702.1.2.1 Medication
stored for residents by the facility must be stored in a locked area in
individual compartments or bins labeled with the resident?s name.
702.1.2.2 Medications may be kept in the
residents? apartments or units. Prior to a resident being permitted to keep
medications in his or her apartment or unit, the facility shall:
a. Assess the resident to determine the
resident?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 or facility employees;
b. Document the assessment in the resident?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 resident?s ability to understand and follow
prescription or label directions and instructions;
c. Assess all residents to determine whether
any resident may be at risk of taking, or introducing into their system,
medications kept in the room of another resident. In the event that any
resident is found to be at risk due to medications being kept in an unsecured
room, the facility shall take actions to protect the resident, including but
not limited to, requiring that medications be kept in a locked container in
residents? rooms or that the rooms of residents keeping medication in their
rooms be locked.
After the initial assessment, facilities shall perform
reassessments as needed, including upon changes of conditions of residents, and
shall perform the steps outlined in subsections (a) through (c), above. Failure
to assess or reassess, or to identify residents 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 reassess, or to
identify residents at risk of harm from medications in unsecured locations or
rooms, shall constitute a deficient facility practice.
702.1.2.3 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.
702.1.2.4
Prescriptive medications must be properly labeled in accordance with current
applicable laws and regulations pertaining to the practice of
pharmacy.
702.1.2.5 All medications
in the control or care of the facility shall have an expiration date that is
not expired.
702.1.2.6 Medications
must be individually labeled with the resident?s name and kept in the original
container unless the resident 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.
702.1.2.7 Any medication that is stored by
the facility that has been prescribed for but is no longer in use by a resident
must be destroyed or disposed of in accordance with state law or may be given
to the resident?s family in accordance with this section.
Scheduled II, III, IV and V drugs that are stored for residents
by the facility that are no longer needed by the resident must be delivered in
person or by registered mail to: Drug Control Division, Arkansas Department of
Health, along with the Arkansas Department of Health?s Form (PHA-DC-1) Report
of Drugs surrendered for Disposition According to Law. When unused portions of
controlled drugs go with a resident who leaves the facility, the person who
assumes responsibility for the resident and the person in charge of the
medications stored for residents by 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 resident is
discharged, transferred or visits home.
All other medications not taken out of the facility when the
resident leaves the facility shall be destroyed or returned in accordance with
law and applicable regulations.
702.1.2.8 Under no circumstance will one
resident?s medication that is under the facility?s control be shared with
another resident.
702.1.2.9 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.
702.1.2.10 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.
702.1.2.11 In cases in
which the facility destroys drugs, destruction shall be made by the
administrator, on-site manager or a responsible staff person and witnessed by
at least one other employee. A record shall be made of the date, quantity,
prescription number and name, resident?s name, and strength of the medication.
Destruction shall be by means of incineration, garbage disposal or flushing of
the medication down a commode, and must comply with state 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.
702.1.3
Medication Charting
702.1.3.1 If a facility stores a resident?s
medications, the facility shall maintain a list of those medications that must
be maintained in the resident?s record.
702.1.3.2 If the facility stores and
supervises a resident?s medication, a notation must be made on the individual
record for each resident who refuses, either through affirmative act, omission,
or silence, or is unable, to self-administer his or her medications. The
notation shall include the date, time and dosage of medication that was not
taken, including a notation that the resident?s attending physician or advance
practice nurse was notified, as required by physician or advance practice
nurse?s orders.
702.1.3.3 For
facilities providing assistance or monitoring medications, if medications are
prescribed to be taken as needed (PRN) by the resident, documentation in the
resident?s file should list the medication, the date and time received by the
resident and the reason given.
702.1.3.4 When a dose of a controlled drug
that is stored for a resident by the facility 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. One of the employees shall be the
administrator or on-site manager.
702.1.3.5 For all medications stored for
residents 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 storage of medications for residents in the facility, and shall
be witnessed by at least one other 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 702.1.3.4 above.
702.1.4
Cycle Fill and Change of
Condition
Medications that are stored by the facility for residents may
be cycle filled. Only oral solid medications may be cycle-filled. Provided,
however, that if an oral solid medication meets one of the categories below,
then that oral solid medication may not be cycle-filled.
a. PRN or ?as needed? medications
b. Controlled drugs (CII ? CV)
c. Refrigerated medications d. Antibiotics e.
Anti-infectives
An assisted living facility shall notify the pharmacy in
writing of any change of condition or circumstance that affects the medication
status of a resident. For purposes of this section, change of condition or
circumstance includes death, discharge or transfer of a resident, change of
pharmacy, as well as medical changes of condition or circumstance that
necessitate a change to the medication prescribed or the dosage given. The
notification shall be made within twenty-four (24) hours of the change of
condition or circumstance. If the notification would occur after 4:30 p.m.
Monday through Friday, or would occur on a weekend or holiday, the facility
shall notify the pharmacy by no later than 11:00 a.m. the next business day.
Documentation for drugs ordered, changed or discontinued shall be retained by
the facility for a period of no less than fifteen (15) months.
When a resident is transferred or enters a hospital, the
assisted living facility shall hold all medications that the facility stores
for the resident until the return of the resident unless otherwise directed by
the authorized prescriber. All continued or re-ordered medications will be
placed in active medication cycles upon the return of the resident. If the
resident does not return to the assisted living facility, any medications held
by the assisted living facility shall be placed with other medications or drugs
for destruction as described in Section 702.1.2.11 or returned as permitted by
State Board of Pharmacy regulations.
702.1.5
First-Aid
Procedures
Facility staff may perform emergency or first-aid procedures as
specified below:
a. Emergencies are
defined as those measures necessary to prevent death or trauma until such time
that the resident can be transported to the appropriate medical facility or
treated by appropriate medical personnel;
b. First-aid measures will be defined as
temporary procedures necessary to relieve trauma or injury;
c. First-aid supplies shall be available in
the facility.
702.1.6
Influenza Immunization of Residents
a. The
facility shall ensure that all Medicare-eligible residents receive annual
influenza immunizations except when:
1.
Objection is made on religious grounds; or,
2. Immunization is medically
contra-indicated.
b. The
facility shall record the following information:
1. The name of the resident;
2. The date that the immunization
occurred;
3. The exception
applicable to each resident who was not immunized.
c. The facility shall place the documentation
in each resident?s medical chart and retain the record in the same manner, and
for the same time period, as medical
records.
703 DEVELOPMENT AND IMPLEMENTATION OF SERVICE
PLAN
703.1
Services
703.1.1 An initial needs assessment or
evaluation is to be completed for each resident to identify all needed
services. Subsequent needs assessment or evaluation is to be completed on each
resident at least annually and more often as changes occur.
If the needs assessment or evaluation completed on the resident
indicates he/she has general service needs, a services plan shall be developed
and shall become a part of the resident?s occupancy admission agreement. If the
needs assessment or evaluation indicates the resident has health care service
needs, the resident is not appropriate for Level I assisted living unless the
health needs can be met by a licensed home health agency. A copy of the home
health agency?s plan shall be filed in the resident?s record.
703.1.2 The resident?s services plan portion
of the occupancy admission agreement shall include, but not be limited to, the
resident?s needs for assisted living facility services, including but not
limited to, assistance with activities of daily living (ADL).
703.1.3 If the resident does not have any
service needs, a resident services plan portion of the occupancy admission
agreement is not needed. However, the facility must document how and where the
evaluation was performed and that the resident does not have any service
needs.
703.1.4 If the needs
assessment or evaluation indicates that the resident will need assistance with
emergency evacuation, arrangements for staff to provide this assistance shall
be included in the services plan portion of the occupancy admission
agreement.
703.1.5 The resident or
his or her responsible party shall participate in and, if the resident or his
or her responsible party agrees, family members shall be invited to participate
in, the development of the resident?s services plan portion of the occupancy
admission agreement. Participation shall be documented in the resident?s
record.
703.2
Health Care Services
703.2.1 If the resident?s needs-assessment or
evaluation indicates that the resident requires health care services, the
resident is not appropriate for Level I assisted living unless the health needs
can be met by a licensed home health agency on a short-term basis. A copy of
the licensed home health agency?s plan shall be filed in the resident?s
record.
703.3
Ancillary Services
All ancillary services (both core services [Section 601.3(a)]
and any other ancillary services identified as wanted by the resident or his or
her responsible party to be provided by the facility at additional cost to the
resident or his or her responsible party [Section 700.1.3, Section 700.2.3 and
Section 700.3.3]) that are identified in the resident?s needs assessment or
evaluation shall be included in an ancillary services plan that shall become a
part of the resident?s occupancy admission agreement.
703.4
Review/Revision of
Services703.4.1 Services needs
of each resident in the facility shall be reviewed at least annually, and the
services plan portion of the occupancy admission agreement revised, if
necessary. Revision of the services plan portion of the occupancy admission
agreement shall be revised immediately upon any significant change to the
resident.
703.4.2 At least
annually, a physical exam shall be completed by a physician or advanced
practice nurse to assess the medical needs of each resident in the Level I
facility. A physical exam shall also be performed upon any change of the
resident?s condition that results in modification of the medical needs of the
resident.
704
COMPLIANCE AGREEMENTS
A Level I assisted living facility shall not admit any resident
whose needs are greater than the facility is licensed to provide. The Level I
assisted living facility shall not provide services to residents who:
a. need 24-hour nursing services except as
certified by a licensed home health agency for a period of sixty (60) days with
one (1) thirty (30) day extension. A copy of the licensed home health agency?s
plan shall be filed in the resident?s record;
b. are bedridden;
c. have transfer assistance needs, including
but not limited to assistance to evacuate the facility in case of emergency,
that the facility cannot meet with current staffing;
d. present a danger to self or others or
engages in criminal activities;
e.
require medication administration to be performed by the facility.
The choice and independence of action of a resident may need to
be limited when a resident?s individual choice, preference, or actions, are
identified as placing the resident or others at risk, lead to adverse outcomes,
or violate the norms of the facility or program or the majority of the
residents, or any combination of these events.
No resident shall be permitted to remain in a Level I assisted
living facility if his or her condition requires twenty-four (24) hour nursing
care or other services that an assisted living facility is not authorized by
law or these regulations to provide. This prohibition applies even if the
resident is willing to execute an agreement relieving the facility of
responsibility attendant to the resident?s continued placement.
When the resident evaluation indicates that there is a high
probability that a choice or action of the resident has resulted or will result
in any of the outcomes of placing the resident or others at risk, leading to
adverse outcomes, violating the norms of the facility or program or the
majority of the residents, or any combination of the events, the assisted
living facility shall:
1. Identify the
specific concern(s);
2. Provide the
resident or his or her responsible party (and if the resident agrees, the
resident?s family) with clear, understandable information about the possible
consequences of his or her choice or action;
3. Negotiate a compliance agreement with the
resident or his or her responsible party that will minimize the possible risk
and adverse consequences while still respecting the resident?s preferences.
Nothing in this provision requires a facility to successfully negotiate a
compliance agreement;
4. Document
the process of negotiation and, if no agreement can be reached, the lack of
agreement and the decisions of the parties involved.
Any compliance agreements negotiated, or attempted to be
negotiated, with the resident or his or her responsible party shall address the
following areas in writing:
1.
Consequence to resident ? any situation or condition that is or should be known
to the facility that involves a course of action taken or desired to be taken
by the resident contrary to the practice or advice of the facility and could
put the resident at risk of harm or injury;
2. The probable consequences if the resident
continues the choice or action identified as a cause for concern;
3. The resident or his or her responsible
party?s preference concerning how the situation is to be handled and the
possible consequences of action on that preference;
4. What the facility will and will not do to
meet the resident?s needs and comply with the resident?s preference to the
identified course of action;
5.
Alternatives offered by the assisted living facility or resident or his or her
responsible party to reduce the risk or mitigate the consequences relating to
the situation or condition;
6. The
agreed-upon course of action, including responsibilities of both the resident
or his or her responsible party and the facility;
7. The resident or his or her responsible
party?s understanding and acceptance of responsibility for the outcome from the
agreed-upon course of action and written proof that the resident or his or her
responsible party is making an informed decision, free from coercion, and that
the refusal of the resident or his or her responsible party to enter into a
compliance agreement with the facility or to revise the compliance agreement or
to comply with the terms of the compliance agreement may result in discharge
from the facility;
8. The date the
agreement is executed and, if needed, the timeframes in which the agreement
will be reviewed.
A copy of the compliance agreement shall be provided to the
resident or his or her responsible party, and the original shall be placed in
the resident?s record at the time it is implemented.
800
DEFINITIONS
For the purposes of these regulations the following terms are
defined as follows:
a. Activities of
Daily Living (ADL?s): Ambulating, toileting, grooming, eating, bathing, or
dressing.
b. Advertise: To make
publicly and generally known. For purposes of this definition, advertise
includes, but is not limited to:
1. Signs,
billboards, or lettering;
2.
Electronic publishing or broadcasting, including the use of the Internet or
email; and
3. Printed
material.
c. Alzheimer?s
Special Care Unit: A separate and distinct unit within a Long Term Care
facility that segregates and provides a special program for residents with a
diagnosis of probable Alzheimer?s disease or related dementia; and that
advertises, markets or otherwise promotes the facility as providing specialized
Alzheimer?s or related dementia care services.
d. Alzheimer?s Disease: An organic,
neurological disease of the brain that causes progressive degenerative
changes.
e. Common Areas: Portions
of the Special Care Unit, exclusive of residents? rooms and bathrooms. Common
areas include any facility grounds accessible to residents of the Alzheimer's
Special Care Unit (ASCU).
f.
Continuous: Available at all times without cessation, break or
interruption.
g. Dementia: A loss
or decrease in intellectual ability that is of sufficient severity to interfere
with social or occupational functioning; it describes a set of symptoms such as
memory loss, personality change, poor reasoning or judgment, and language
difficulties.
h. Department:
Department of Human Services (DHS), Division of Medical Services (DMS), or
Office of Long Term Care (OLTC)
i.
Direct Care Staff: An individual, such as a nurse or a certified Nurse's
Aide, who is an employee of the facility or who is an employee
of a temporary agency assigned to work in the facility, and who has received,
or will receive, in accordance with these regulations, specialized training
regarding Alzheimer's or related dementia, and is responsible for providing
direct, hands-on care or services to residents in the ASCU.
j. Disclosure Statement: A written statement
prepared by the facility and provided to individuals or their responsible
parties, and to individuals families, prior to admission to the unit,
disclosing form of care, treatment, and related services especially applicable
or suitable for the ASCU. The disclosure statement shall be approved by the
Department prior to use, and shall include, but not be limited to, the
following information about the facility?s ASCU:
1. The philosophy of how care and services
are provided to the residents;
2.
The pre-admission screening process;
3. The admission, discharge and transfer
criteria and procedures;
4.
Training topics, amount of training time spent on each topic, and the name and
qualification of the individuals used to train the direct care staff;
5. The minimum number of direct care staff
assigned to the unit each shift;
6.
A copy of the Residents' Rights;
7.
Assessment, Individual Support Plan & Implementation. The process used for
assessment and establishment of the plan of care and its implementation,
including the method by which the plan of care evolves and is responsive to
changes in condition;
8. Planning
and implementation of therapeutic activities and the methods used for
monitoring; and
9. Identification
of what stages of Alzheimer?s or related dementia for which the unit will
provide care.
l.
Facility: A Level I Assisted Living Facility that houses an ASCU.
m. Individual Assessment Team: A group of
individuals possessing the knowledge and skills to identify the medical,
behavioral, and social needs of a resident and to develop services designed to
meet those needs n. Individual Support Plan: A written plan developed by an
Individual Assessment Team (IAT) that identifies services to a resident. The
plan shall include and identify professions, disciplines and services that:
1. Identifies and states the resident?s
medical needs, social needs, disabilities and their causes;
2. Identifies the resident's specific
strengths;
3. Identifies the
resident's specific behavioral management needs;
4. Identifies the resident?s need for
services without regard to the actual availability of services;
5. Identifies and quantifies the resident's
speech, language, and auditory functioning;
6. Identifies and quantifies the resident's
cognitive and social development; and,
7. Identifies and specifies the independent
living skills, and other services, provided by the facility to meet the needs
of the resident.
o.
Nursing Personnel: Registered or Licensed Practical nurses who have specialized
training or will undergo specialized training, in accordance with these
regulations, by the Alzheimer's Special Care Unit.
p. Responsible Party: An individual, who, at
the request of the applicant or resident, or by appointment by a court of
competent jurisdiction, agrees to act on behalf of a resident or applicant for
the purposes of making decisions regarding the needs and welfare of the
resident or applicant. These regulations, and this definition, does not grant
or permit, nor should be construed as granting or permitting, any individual
authority or permission to act for, or on behalf of, a resident or applicant in
excess of the authority or permission granted by law. A competent resident may
select a responsible party or may choose to not select a responsible party. In
no event may an individual act for, or on behalf of, a resident or applicant
when the resident or applicant has a legal guardian, attorney-in-fact, or other
legal representative. For purposes of these regulations only, responsible party
will also refer to the terms legal representative, legal guardian, power of
attorney or similar phrase.
801 GENERAL ADMINISTRATION
a. Miscellaneous
1. Visitors shall be permitted at all times.
However, facilities may deny visitation when visitation results, or substantial
probability exists that visitation will result, in disruption of service to
other residents, or threatens the health, safety, or welfare of the resident or
other residents.
2. Birds, cats,
dogs, and other animals may be permitted in the Alzheimer?s Special Care Unit.
Animals shall have appropriate vaccinations and licenses. A veterinary record
shall be kept on all animals to verify vaccinations and be made readily
available for review. Pets may not be allowed in food preparation, food storage
or dining or serving areas.
3.
Unmarried male and female residents shall not be housed in the same room unless
either residents or their responsible parties have given authorized
consent.
b. General
Program Requirements
1. Each long-term care
facility that advertises or otherwise holds itself out as having one (1) or
more special units for residents with a diagnosis of probable Alzheimer's
disease or a related dementia shall provide an organized, continuous
24-hour-per-day program of supervision, care and services that shall:
A. Meet all state, federal and ASCU
regulations.
B. Requires the full
protection of residents' rights;
C.
Promotes the social, physical and mental well-being of residents;
D. Is a separate unit specifically designed
to meet the needs of residents with a physician?s diagnosis of Alzheimer?s
disease or other related dementia; and
E. Provides 24-hour-per-day care for those
residents with a dementia diagnosis, and meets all admission criteria
applicable for that particular long-term care facility.
2. Documentation shall be maintained by the
facility and shall include, but not be limited to, a signed copy of all
training received by the employee.
3. Provide for relief of direct care
personnel to ensure minimum staffing requirements are maintained at all
times.
4. Upon request, make
available to the Department payroll records of all staff employed during recent
pay periods.
5. Nursing,
direct-care, or personal care staff shall not perform the duties of cooks,
housekeepers, or laundry personnel during the same shift they perform nursing,
direct-care or personal care duties.
6. Regardless of other policies or procedures
developed by the facility, the ASCU will have specific policies and procedures
regarding:
A. Facility philosophy related to
the care of ASCU residents;
B. Use
of ancillary therapies and services;
C. Basic services provided;
D. Admission, discharge, transfer;
and
E. Activity
programming.
c. Residents' Rights
For the purposes of these regulations, Resident?s Rights are
those rights set forth in the Department?s numbered memorandum
LTC-M-89-03.
d. Resident
Record Maintenance
The ASCU shall develop and maintain a record-keeping system
that includes a separate record for each resident, and that documents each
resident?s health care, individual support plan, assessments, social
information, and protection of each resident?s rights.
e. Resident Records
The ASCU must follow the facility?s policies and procedures,
and applicable state and federal laws and regulations governing:
1. The release of any resident information,
including consent necessary from the client, parents or legal
guardian;
2. Record
retention;
3. Record maintenance;
and,
4. Record content.
802 ASSESSMENTS
a. Psychosocial and Physical Assessments
1. Each resident shall receive a psychosocial
and physical assessment which includes the resident?s degree or level of family
support, level of activities of daily living functioning, cognitive level,
behavioral impairment, and that identifies the resident?s strengths and
weaknesses.
2. Prior to admission
to the ASCU, the applicant must be evaluated by, and have received from a
physician, a diagnosis of Alzheimer?s or related dementia.
b. Individual Assessment Team (IAT)
1. Within 30 days after admission, the IAT
shall prepare for each resident an individual support plan. The ISP shall
address specific needs of, and services required by, the resident resulting
from the resident?s Alzheimer?s Disease or related dementia.
2. The IAT shall perform accurate assessments
or reassessments annually, and upon a significant change to a resident?s
physical, mental, emotional, functional, or behavioral condition or status in
which the resident:
a. Is regressing in, or
losing skills, already gained
b.
Is failing to progress toward or maintain identified objectives in the
ISP
c. Is being considered for
changes in the resident?s ISP
c. Individual Support Plan (ISP)
1. The ISP shall include a family and social
history. If the family and social history is unavailable, the ASCU personnel
shall document attempts to obtain the information, including but not limited
to, the names and telephone numbers of individuals contacted, or whom the
facility attempted to contact, and the date and time of the contact or
attempted contact.
2. Individual
support plans shall be developed and written by the IAT and signed by each
member of the team.
3. Individual
support plans shall have the input and participation of the resident or his or
her responsible party, and the resident?s family. If the resident's family or
responsible party cannot be contacted, or refuses to participate, the facility
shall document all attempts to notify the resident?s family or legal
representative. The documentation shall include, but not be limited to, the
names and telephone numbers of individuals contacted, or whom the facility
attempted to contact, and the date and time of the contact or attempted
contact.
4. The ISP shall be
reviewed, evaluated for its effectiveness, and updated at least quarterly, and
shall be updated when indicated by changing needs of the resident, or upon any
reassessments by the IAT. In the event that the reassessment by the IAT
documents a change of condition for which no change in services to meet
resident needs are required, the ISP shall document the change of condition,
and the reason or reasons why no change in services are required.
5. The ISP shall include:
A. Expected behavioral outcomes;
B. All barriers to expected
outcomes;
C. Services, including
frequency of delivery, designed to achieve expected behavioral
outcomes;
D. Methods of assessment
and monitoring. Monitoring shall occur no less than quarterly to determine
progress toward the outcome; and,
E. Documentation of results from services
provided, and achievement towards expected outcomes or regression, and reasons
for the regression.
F. The
resident?s likes, dislikes, and if appropriate, his or her choices.
6. A copy of the ISP shall be made
available to all staff that work with the resident, and the resident or his or
her responsible party.
7. The ISP
shall be implemented only with the documented, written consent of the resident
or his or her responsible party.
803 STANDARDS FOR ALZHEIMER?S SPECIAL CARE
UNITS
a. General Requirements
1. It is the intent of these regulations that
Alzheimer?s Special Care Units shall be designed to accommodate the complex and
varied needs of residents with dementia. The physical environment does not
exist in isolation, but interacts with the activity program, level of resident
capability, staffing and social milieu of the unit.
2. The environment shall be designed and
developed to meet the following objectives:
A.
Maximize awareness and orientation;
B. Ensure safety and security;
C. Provide privacy and a sense of
control;
D. Support functional
abilities; and,
E. Develop
environmental stimulation and challenge within a positive social
milieu.
b.
Physical Design
In addition to the physical design standards required for the
facility?s license, an Alzheimer?s Special Care Unit shall include the
following:
1. A floor plan design that
does not require visitors or staff to pass through the ASCU to reach other
areas of the facility;
2. A
multipurpose room or rooms for dining, group and individual activities, and
family visits, which complies with the LTC licensure requirements for common
space;
3. Secured outdoor space and
walkways that allow residents to ambulate, with or without assistive devices
such as wheelchairs or walkers, but prevents undetected egress. Such walkways
shall meet the accessibility requirements of the most current LTC and
Americans with Disabilities Act (ADA) structural building codes
or regulations. Unrestricted access to secured outdoor space and walkways shall
be provided, and such areas shall have fencing or barriers that prevent injury
and elopement. Fencing shall be no less than 72 inches high.
4. Prohibit the use of plants that are
poisonous or toxic for human contact or consumption;
5. Visual contrasts between floors and walls,
and doorways and walls, in resident use areas. Except for fire exits, exit
doors and access ways shall be designed to minimize contrast, and to obscure or
conceal areas the residents should not enter;
6. Non-reflective floors, walls, and
ceilings, to minimize glare;
7.
Evenly distributed lighting, to minimize glare and shadows; and,
8. A monitoring or nurses? station with:
A. A call system, to alert staff to any
emergency needs of the residents; and,
B.A space for charting, and for storage of
residents' records.
c. Physical Environment and Safety.
The Alzheimer?s Special Care Unit shall:
1. Provide freedom of movement for the
residents to common areas, and to their personal spaces. The facility shall not
lock residents out of, or inside, their rooms;
2. Provide plates and eating utensils which
provide visual contrast between the utensils and the table, and that maximizes
the independence of the residents;
3. In common areas, provide comfortable
seating sufficient to seat all residents at the same time. The seating shall
consist of a ratio of one (1) gliding or rocking chair for every five (5)
residents;
4. Encourage and assist
residents to decorate and furnish their rooms with personal items and
furnishings, based on the resident?s needs and preferences as documented by the
ASCU in the social history;
5.
Individually identify each resident's rooms based on the resident?s cognitive
level, to assist residents in locating their rooms, and to permit them to
differentiate their room from the rooms of other residents;
6. Keep corridors and passageways through
common-use areas free of objects which may cause falls, or which may obstruct
passage by physically impaired individuals; and,
7. Only use public address systems in the
unit for emergencies.
804 EGRESS CONTROL
a. Egress Policies
The Alzheimer?s Special Care Unit shall develop policies and
procedures to deal with residents who wander or may wander. The procedures
shall include actions to be taken by the facility to:
1. Identify missing residents;
2. Notify all individuals or institutions
that require notification under law or regulation when a resident is missing;
and,
3. Attempt to locate the
missing resident.
b.
Locking Devices
1. All locking devices used
on exit doors shall be approved by the OLTC, building code agencies, and the
fire marshal having jurisdiction over the facility, shall be electronic, and
shall release upon activation of the fire alarm or sprinkler system.
2. If the unit uses keypads to lock and
unlock exits, directions for the keypad's operations to allow entrance shall be
posted on the outside of the door.
3. The keypads and locks shall meet the
requirements under IBC applicable to Level I Assisted Living
Facilities.
4. Staff shall be
trained in all methods of releasing, or unlocking, the locking
device.
805
STAFFING
Alzheimer?s Special Care Units shall staff according to
staffing requirements as set forth in the Rules and Regulations for the
Licensure of Level I Assisted Living Facilities. However, staffing for the ASCU
shall be determined separately from the Assisted Living facility, based upon
the census for the ASCU only; likewise, the staffing for the Assisted Living
facility shall be based on the census of the Assisted Living facility,
excluding the ASCU census. It is the intent of this regulation that ASCU staff
be separate and distinct from the Assisted Living facility staff. In addition,
the following staffing requirements are established for Alzheimer's Special
Care Units.
a. Professional Program
Services
A social worker or other professional staff e.g., physician,
Registered Nurse, or Psychologist currently licensed by the State of Arkansas
shall be utilized to perform the following functions:
1. Complete an initial social history
evaluation on each resident on admission;
2. Development, coordination, and utilization
of state or national resources and networks to meet the needs of the residents
or their families;
3. Offering or
encouraging participation in monthly family support group meetings with
documentation of meetings offered; and,
4. Assist in development of the ISP,
including but not limited to:
A. Assuring that
verbal stimulation, socialization and reminiscing is identified in the ISP as a
need;
B. Defining the services to
be provided to address those needs identified above; and,
C. Identifying the resident's preferences,
likes, and dislikes.
b. Staff and Training
1. All ASCU staff members and consultants
shall have the training specified in these regulations in the care of residents
with Alzheimer?s Disease and other related dementia. The facility shall
maintain records documenting the training received, the date received, the
subject of the training, and the source of the training.
2. Within six (6) months of the date that the
long-term care facility first advertises or otherwise holds itself out as
having one (1) or more special units for residents with a diagnosis of probable
Alzheimer's disease or a related dementia, the facility shall
have trained all staff who are scheduled or employed to work in the
ASCU.
3. Subsequent to the
requirements set forth in Section 805(b)(2), fifty percent (50%) of the staff
working any shift shall have completed requirements as set forth in Section
805(b)(5)(a), (b), and (c).
4.
After meeting the requirements of Section 805(b)(2), all new employees of the
ASCU shall be trained within five (5) months of hiring, with no less than eight
(8) hours of training per month during the five (5) month period.
5. In addition to any training requirements
for any certification or licensure of the employee, training shall consist of,
at a minimum:
A. Thirty (30) hours on the
following subjects:
i. One (1) hour of the
ASCU's policies;
ii. Three (3)
hours of etiology, philosophy and treatment of dementia;
iii. Two (2) hours on the stages of
Alzheimer?s disease;
iv. Four (4)
hours on behavior management;
v.
Two (2) hours on use of physical restraints, wandering, and egress
control;
vi. Two (2) hours on
medication management;
vii. Four
(4) hours on communication skills;
viii. Two (2) hours of prevention of staff
burnout;
ix. Four (4) hours on
activity programming;
x. Three (3)
hours on ADLs and Individual-Centered Care xi. Three (3) hours on assessments
and creation of ISPs
B.
On-going in-service training consisting of at least 2 hours every quarter. The
topics to be addressed in the in-service training shall include the following,
and each topic shall be addressed at least once per year:
i. The nature of Alzheimer?s disease and
other dementia, including:
a. The definition
of dementia;
b. The harm to
individuals without a correct diagnosis; and,
c. The stages of Alzheimer?s
disease.
ii. Common
behavior problems resulting from Alzheimer's or related dementia, and
recommended behavior management for the problems;
iii. Communication skills to facilitate
improved staff relations with residents;
iv. Positive therapeutic interventions and
activities, such as:
a. Exercise;
b. Sensory stimulation; and,
c. Activities of daily living.
v. The benefits of family
interaction with the resident, and the need for family interaction;
vi. Developments and new trends in the fields
of Alzheimer's or related dementia, and treatments for same;
vii. Environmental modifications to minimize
the effects and problems associated with Alzheimer's or related dementia;
and,
viii. Development of ISPs,
including but not limited to instruction on the method of updating and
implementing ISPs across shifts.
C. If the facility identifies or documents
that a specific employee requires training in areas other than those set forth
in 805(b), the facility may provide training in the identified or documented
areas, and may be substituted for those subjects listed in Section
805(b)(5).
c.
Trainer Requirements
The individual providing the training shall have:
1. A minimum of one (1) year uninterrupted
employment in the care of Alzheimer?s residents, or
2. Shall have training in the care of
individuals with Alzheimer?s disease and other dementia, or
3. Is designated by the Alzheimer?s
Association or it?s local chapter as being qualified to meet training
requirements.
d.
Training Manual
The ASCU shall create and maintain a training manual consisting
of thee topics listed in Section 805(b). Further, the trainer shall provide
training consistent with the training manual.
806 ADMISSIONS, DISCHARGES, TRANSFERS
a. Criteria for Services
1. Each Alzheimer?s Special Care Unit shall
have written policy setting forth pre-admission screening, admission, and
discharge procedures.
2. Prior to
admission into the Alzheimer?s Special Care Unit, the facility shall provide a
copy of the disclosure statement and Residents' Rights policy to the applicant
or the applicant's responsible party. A copy of the disclosure statement signed
by the resident or the resident's responsible party shall be kept in the
resident?s file.
3. Admission
criteria shall require:
A. A physician?s
diagnosis of Alzheimer?s disease or related dementia;
B. The facility's assessment of the
resident?s level of needs; and,
C.
A list of the services that the ASCU can provide to address the needs
identified in 806(a)(3)(B).
4. Any individual admitted to the ASCU must
also meet admission criteria for the facility.
5. The ASCU shall not maintain a resident who
requires a level of care greater than for which the facility is licensed to
provide, and for whom the ASCU is unable to provide the level or types of
services to address the needs of the resident. Discharge from the ASCU shall
occur when:
A. The resident?s medical
condition exceeds the level of care for which the facility is licensed or is
able to provide;
B. The resident?s
medical condition requires specialized nursing procedures that constitute more
than limited nursing services, or nursing services the facility is unable to
provide;
C. The resident has a loss
of functional abilities (e.g. ambulation) that results in the resident?s level
of care requirements being greater than the level of care for which the
facility is licensed or able to provide;
D. Behavioral symptoms that results in the
resident?s level of care requirements being greater than the level of care for
which the facility is licensed or able to provide;
E. The resident requires a level of
involvement in therapeutic programming that is greater than the level of care
for which the facility is licensed or able to provide.
6. If the resident, or the resident's
responsible party, does not comply with, or refuses to accept, the requirements
of the ISP, the resident shall be discharged from the ASCU. The facility shall
document the refusal or non-compliance with the ISP. The documentation shall
include, but not be limited to:
A. The
identity of the person who is not willing or able to comply with the
requirements of the ISP; i.e., the resident or the resident's responsible
party;
B. The date and time of the
refusal;
C. The consequences of the
unwillingness or inability to comply with the requirements of the ISP, and the
name of the person providing this information to the resident or the resident's
responsible party.
b. Resident Movement, Transfer or Discharge
When a resident is moved, transferred or discharged, measures
shall be taken by the facility to minimize confusion and stress to the resident
until discharge. Further, the discharge shall comply with the regulations
applicable to the facility housing the ASCU, and Arkansas law.
807 THERAPEUTIC
ACTIVITIES
a. Intent and General
Requirements.
Therapeutic activities can improve a resident?s eating or
sleeping patterns; lessen wandering, restlessness, or anxiety; improve
socialization or cooperation; delay deterioration of skills; and improve
behavior management. Therapeutic activities shall be designed to meet the
resident's current needs.
1. All
facilities with Alzheimer?s Special Care Units shall provide activities
appropriate to the needs of individual residents. The activities shall be
provided and directed by direct care staff under the coordination of a program
director.
2. Each resident's daily
routine shall be structured or scheduled so that activities are provided seven
days a week.
3. A professional with
specialized training in the care of Alzheimer?s shall be utilized or contracted
to:
A. Develop required daily
activities;
B. Train direct care
staff in those programs; and,
C.
Provide ongoing consultation.
b. Required Daily Activities
The following activities shall be offered daily:
1. Gross motor activities (e.g., exercise,
dancing, gardening, cooking, etc.);
2. Self-care activities (e.g., dressing,
personal hygiene, or grooming);
3.
Social activities (e.g., games, music, socialization); and,
4. Sensory enhancement activities (e.g.,
reminiscing, scent and tactile stimulation).
901 NEW
CONSTRUCTION, REMODELING OR ADDITIONS
901.1
GENERAL
A new facility is one that had plans approved by the Office of
Long Term Care and began operation, or construction or renovation of a building
for the purpose of operating a Level I assisted living facility on or after the
adoption date of these regulations, or both. The regulations and codes
governing new facilities apply if and when the facility proposes to begin
operation in a building not previously and continuously used as a facility
licensed under these regulations. For purposes of these regulations,
construction refers to a new facility where none existed or to the addition of
new wings or other sections of the facility; renovation refers to any
structural changes to the existing facility; remodeling refers to cosmetic
changes to the existing structure, including but not limited to painting,
replacement or repair of carpet, tile or linoleum, and minor repairs.
Additions to existing facilities, construction, or renovation
shall meet the standards for new construction, and a copy of the facility floor
plan must be submitted to the Office of Long Term Care for approval. Provided,
however, that changes to the floor plan for areas of the facility unaffected by
the addition, construction or renovation are not required.
901.2
SITE LOCATION, INSPECTION
APPROVALS AND SUBSOIL INVESTIGATION
a. The building site shall afford good
drainage and shall not be subject to flooding or be located near insect
breeding areas, noise or other nuisance producing locations or hazardous
locations, industrial developments, airports, railways or near penal or other
objectionable institutions or near a cemetery. The site shall afford the safety
of residents and not be subject to air pollution.
b. A site shall be adequate to accommodate
roads and walks within the lot lines to at least the main entrance, ambulance
entrance, and service entrance. All facility sites shall contain enough square
footage to provide at least as much space for walks, drives and lawn space as
the square footage contained in the building.
c. The building site shall be inspected and
approved by the OLTC before construction is begun.
901.3
SUBMISSION OF PLANS,
SPECIFICATIONS AND ESTIMATESa.
When construction is contemplated either for new buildings, additions or major
alterations in excess of one hundred thousand dollars ($100,000), plans and
specifications shall be submitted in duplicate, one (1) to OLTC and one (1) to
the Plumbing Division of the Arkansas Department of Health, for review along
with a copy of the statement of approval from the Comprehensive Health Planning
Agency. Final plan approval shall be given by OLTC.
b. Such plans and specifications shall be
prepared by a registered professional engineer or an architect licensed in the
State of Arkansas pursuant to Act 270 of 1941, codified as Ark. Code Ann.
§
17-15-101, et seq. and shall be
drawn to scale with the title and date shown thereon. OLTC shall have a minimum
of three (3) weeks to review the drawing and specifications and submit their
comments to the applicant. Any proposed deviations from the approved plans and
specifications shall be submitted to the OLTC prior to making any changes.
Construction cannot start until approval of plans and specifications have been
received from the OLTC. The OLTC shall be notified as soon as construction of a
new building or alteration to an existing building is started.
c. An estimate shall accompany all working
plans and specifications when the total cost of construction is more than one
hundred thousand dollars ($100,000).
d. Representatives from the OLTC shall have
access to the construction premises and the construction project for purposes
of making whatever inspections the OLTC deems necessary throughout the course
of construction.
901.4
PLANS AND SPECIFICATIONS
All facilities licensed under these regulations shall be
designed and constructed to substantially comply with pertinent local and state
laws, codes, ordinances and standards. All new construction shall be in
accordance with the requirements for I-1 Groups as specified in the
International Building Code (IBC) 2000. All new construction shall be readily
accessible and useable by persons with physical disabilities including persons
who use wheelchairs. All construction shall comply with the requirements of the
ADA.
Plans shall be submitted to the OLTC in the following
stages:
1. Step (1) ?
Working drawings and specifications that shall be
prepared so that clear and distinct prints may be obtained; accurate dimensions
including all necessary explanatory notes, schedules and legends.
Working drawings shall be complete and adequate for contract
purposes. Separate drawings shall be prepared for each of the following
branches of work, architectural, structural, mechanical, and electrical, and
shall include the following:
A.
Approved plan showing all new topography, newly established levels and grades,
existing structures on the site (if any), new buildings and structures,
roadways, walks, and the extent of the areas to be seeded. All structures and
improvements that are to be removed under the construction contract shall be
shown. A print of the survey shall be included with the working
drawings;
B. Plan of each floor and
roof;
C. Elevations of each
facade;
D. Sections through
building;
E. Scale and full size
details as necessary to properly indicate portions of the work;
F. Schedule of finishes.
2. Step (2) ? Equipment
Drawings: Large-scale drawings of typical and special rooms
indicating all fixed equipment and major items of furniture and movable
equipment.
3. Step (3) ?
Structural Drawings:
A. Plans of foundations, floors, roofs and
all intermediate levels shall show a complete design with sizes, sections, and
the relative location of the various members. Schedule of beams, girders, and
columns, shall be included;
B.
Floor levels, column centers, and offsets shall be dimensioned;
C. Special openings and pipe sleeves shall be
dimensioned or otherwise noted for easy reference;
D. Details of all special connections,
assemblies, and expansion joints shall be given.
4. Step (4) ?
Mechanical
Drawings: These drawings with specifications shall show the
complete heating and ventilation systems, plumbing, drainage and standpipe
system and laundry and shall include:
A.
Heating and air-conditioning systems, including:
1. Air-conditioning systems with required
equipment, water and refrigerant piping and ducts;
2. Exhaust and supply ventilating systems
with steam connections and piping;
3. Air quantities for all room supply and
exhaust ventilating duct openings;
B. Plumbing, drainage and standpipe systems,
including:
1. Size and elevation of street
sewer, house sewer, house drains, street water main, and water service into the
building;
2. Locations and size of
soil, waste, and vent stacks with connections to house drains, clean outs,
fixtures, and equipment;
3. Size
and location of hot, cold, and circulating mains, branches and risers from the
service entrance and tanks;
4.
Riser diagram to show all plumbing stacks with vents, water risers, and fixture
connections;
5. Gas, oxygen, and
special connections;
6. Plumbing
fixtures and equipment that require water and drain connections;
C. Elevators and dumbwaiters:
Details and dimensions of shaft, pit, and machine room; sizes of car platform
and doors;
D. Kitchens, laundry,
refrigeration, and laboratories: These shall be detailed at a satisfactory
scale to show the location, size, and connection of all fixed
equipment.
5. Step (5) ?
Electrical Drawings:
A. Drawings shall show electrical wiring,
outlets, smoke detectors, and equipment that require electrical
connections;
B. Electrical service
entrances with switches and feeder to the public service feeders shall be
shown;
C. Plan and diagram showing
main switchboard, power panels, light panels, and equipment;
D. Light outlets, receptacles, switches,
power outlets, and circuits;
E.
Nurses? call systems, either wireless systems or hardwired, with outlets for
beds, duty stations, door signal lights, enunciators, and wiring diagrams. If a
wireless system is employed, the electrical drawing will indicate the
implementation of the system including designations for residents call systems
in residents? apartments or units;
F. Fire alarm system with stations, signal
devices, control board, and wiring diagrams;
G. Emergency electrical system with outlets,
transfer switch, source of supply, feeders, and circuits.
6. Step (6) ?
Specifications: Specifications shall supplement the
drawings to fully describe types, sizes, capacities, workmanship, finishes, and
other characteristics of all materials and equipment, and shall include the
following:
A. Cover or title sheet;
B. Index;
C. General conditions;
D. General requirements;
E. Sections describing material and
workmanship in detail for each class of work.
901.5
CODES AND
STANDARDS
The following codes and standards are incorporated into and
made a part of these regulations:
a.
The 2000 edition of the International Building Code (IBC) applies to new
construction and alterations or additions to all facilities;
b. The American Disabilities Act
specifications for making buildings and facilities accessible to and usable by
the physically handicapped shall apply to all facilities;
c. Arkansas State Plumbing Code;
d. Fire Resistance Index 1971, Underwriters
Laboratories, Inc.;
e. Handbook of
Fundamentals, American Society of Heating, Refrigeration and Air-Conditioning
Engineers (ASHRAE), United Engineer Center, 345 East 47the Street, New York,
New York 10017;
f. Methods of Test
for Surface Burning
Characteristics of Building Materials, Standard No. E 84-61
American Society for Testing and Materials (ASTM) Standard No. 84-61, 1961 Race
Street, Philadelphia, Pennsylvania 19103;
g. Method of Fire Test of Building
Construction and Materials, Standard No. E119, American Society of Testing and
Materials (ASTMO), 1961 Race Street, Philadelphia, Pennsylvania
19103;
h. Minimum Power Supply
Requirements, Bulletin No. XR4-10 National Electrical Manufactures Association
(NEMA), 155 East 44th Street, New York, New York
10017.
902
CONVERTED FACILITIES
a. Existing facilities
that convert to Assisted Living Facilities must meet the following
requirements:
1. The facility shall provide a
small refrigerator in each resident's room, except as may otherwise be provided
by these regulation;
2. The
facility shall provide a microwave oven in each resident's room, except as may
be otherwise provided by regulation;
3. The facility must meet minimum space
requirements for resident rooms of one hundred fifty square feet (150 sq. ft.)
per person or two hundred thirty square feet (230 sq. ft.) for two (2) persons
sharing a room, exclusive of entryway, closet, and bathroom, or one hundred
square feet (100 sq. ft.) per person or one hundred eighty square feet (180 sq.
ft.) for two (2) persons if the room has a half or full bath or if there is a
shared bathroom between two (2) rooms; and,
4. The application conforms to all other
assisted living regulations.
b. For purposes of this section, the terms
existing facility and existing facilities shall mean:
1. A Residential Care Facility licensed or
holding a permit of approval as of April 2, 2001; and,
2. Facilities as described in Ark. Code Ann.
§
20-10-1709(b).
903 FURNISHINGS AND
EQUIPMENT
The following are general provisions concerning furnishing and
equipment that each Level I assisted living facility must meet:
a. All rooms must have working light switches
at the entrance to each room.
b.
Windows must be kept clean and in good repair and supplied with curtains,
shades or drapes. Each window that can be opened shall have a screen that is
clean and in good repair.
c. Light
fixtures in resident general use or common areas must be equipped with covers
to prevent glare and hazards to the residents.
d. All fans located within seven (7) feet of
the floor must be protected by screen guards.
e. Common dining room space and furnishings
in good repair must be provided for each resident in the facility. Dining room
space and furnishings must be sufficient to serve all residents. Facilities
shall be allowed to plan dining schedules to allow for two (2) seatings per
meal to increase resident?s choice of meal times.
f. All furnishings and equipment in common
areas must be durable, clean, and appropriate to its functions.
g. All areas of a facility must be well
lighted to ensure residents? safety.
h. The resident may furnish his or her
apartment with his or her own furnishings as long as the furnishings meet
requirements as outlined in these regulations. If the resident does not furnish
his or her apartment, the facility shall provide basic furnishings.
i. Throw- or scatter-rugs, or bath-rugs or
mats, shall have a non-skid backing.
j. Residents may provide their own linens,
but may not be required by the facility to do so. The facility must include in
the resident?s direct care service plan portion of the occupancy admission
agreement whether the resident or his or her responsible party prefers the
facility to provide linens or the resident or his or her responsible party will
provide his or her own linens, and whether the facility will launder the linens
or the resident or his or her responsible party will laundry his or her own
linens. Linens may be provided by the facility for no cost or may be provided
at an extra charge. If the resident or his or her responsible party chooses to
utilize facility linens, the following minimum amounts of linen must be
available in the facility at all times:
1.
Sheets ? three (3) sets for each resident;
2. Pillowcases ? three (3) sets for each
resident;
3. Bath towel ? three (3)
for each resident;
4. Hand towels ?
three (3) for each resident;
5.
Washcloths ?three (3) for each resident;
6. Blankets ? one (1) for each
resident;
7. Pillows ? one (1) per
resident.
If the resident or his or her responsible party wishes to use
his or her own personal linens, the facility will counsel the resident or his
or her responsible party on recommended quantities to maintain. In the case
where a resident or his or her responsible party uses personal linens, the
facility is not required to provide or keep available any linens for the
resident unless the resident does not have sufficient numbers of personal
linens available to maintain clean and sanitary conditions. If this is the
case, the facility shall provide additional linens up to the quantities
specified above. In both cases, clean linens may be stored in the resident?s
apartment.
k.
Bed linens must be changed at least weekly, or as often as needed to ensure
clean or non-soiled linens.
l.
Wastepaper baskets and trash containers used in the facility common areas must
be metal or Underwriter?s Laboratory approved plastic baskets. Outside trash
containers must be equipped with covers.
m. Practices that create an increased risk of
fire are prohibited. This includes, but is not limited to:
1. Space heaters. In cases of emergency, such
as extended power loss during periods of cold weather, space heaters are
permitted upon the approval of the Office of Long Term Care.
2. The accumulation or storage within the
facility of combustible materials such as rags, paper items, gasoline,
kerosene, paint or paint thinners.
3. The use of candles, oil lamps, incense or
open-flamed items.
4. The use of
extension cords or multi-plug adapters for electrical outlets. 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.
904 REQUIREMENTS FOR RESIDENT GENERAL
USE/COMMON AREAS
904.1
Distinct
Part Facilities
a. Physical and
programmatic separation ? an assisted living facility shall be both physically
and programmatically distinct from any residential care facility, nursing home
or hospital to which it is attached or of which it is a part, provided,
however, that programmatic separation shall not include social or recreational.
NOTE: This does not prohibit residents from walking through a
community based residential facility serving similar or compatible population,
e.g., the elderly or the physically disabled. This does not prohibit
independent living and assisted living to be in a combined building or prevent
assisted living from occupying apartments scattered throughout a project that
combines independent and assisted living. This does not require separation
between an assisted living facility and housing for the elderly or other purely
residential use. For example, assisted living facility apartments may be
interspersed with non-assisted living apartments that are non-licensed,
independent living apartments in the same building, and an assisted living
facility may share dining room and other common space with an attached
apartment building.
b.
Physical separation ? Residents shall not be required to first enter or pass
through a portion of the health care facility or community-based residential
facility in order to enter an assisted living facility, provided, however, that
residents may enter the assisted living facility through common areas
(reference the exception noted in Section 904.1(a) above). Similarly, persons
shall not be required to pass through the assisted living facility in order to
enter a health care facility or community-based residential facility. An
assisted living facility may share a common lobby and access area of a
multipurpose building and may be entered via elevator from the lobby or access
area. A dining room or activity area may be shared.
904.2 Each assisted living facility must meet
the following requirements for resident general use/common areas:
a. Each facility must have dining room and
living room space easily accessible to all residents (reference standards set
in Section 903.1(a)(b) above;
b.
Common dining rooms and living rooms must not be used as bedrooms;
c. Dining rooms must be furnished with enough
dining tables and chairs to permit all residents to be seated, or to permit
one-half of the resident census to be seated at one time and allowing
facilities to provide dining schedules that allow two settings per
meal.
d. Dining rooms and living
rooms must be available for use by residents at appropriate times to provide
periods of social diversion and individual or group activities;
e. Common area toilet facilities shall be
provided to meet the needs of residents, staff and visitors to the facility and
shall be located in areas other than the resident?s apartment or
unit.
f. All resident areas must be
painted and appropriately furnished;
g. Facilities in buildings constructed after
the effective date of these regulations shall be constructed with
hallways/corridors wide enough to allow two wheelchairs (six (6) feet) to pass
each other. Facilities in existing buildings that have not undergone
substantial renovation since the effective date of these regulations shall have
corridors large enough to meet current egress requirements mandated by
applicable codes.
h. A minimum of
one phone jack must be available in each resident?s apartment or unit for the
resident to establish private phone service in his or her name. In addition,
there shall be, at a minimum, one dedicated facility phone and phone line for
every forty (40) residents in common areas. The phone shall allow unlimited
local calling without charge. Long distance calling shall be possible at the
expense of the resident or responsible party via personal calling card,
pre-paid phone card, or similar methods. Residents shall be able to make phone
calls in private. Private? can be defined as placing the phone in an area that
is secluded and away from frequently used areas.
i. Facility?s laundry services area(s) shall
meet the requirements outlined in Section 700.2.2.
j. Facility?s pantry area(s) shall meet the
requirements outlined in Sections 700.3.11 and 700.3.13.
k. Facility?s medication storage area(s)
shall meet the requirements outlined in Sections 702.1.2.
904.3 Square footage requirements for common
area living room, dining room, and activities room is as follows:
a. All facilities:
1. The living and activity spaces must be
separate from the dining room with a combined total square footage of at least
20 square feet per licensed bed. Living and activity spaces do not include
corridors and lobby areas for the purposes of calculation. Living and activity
spaces may be combined;
2. The
facility must have at least 20 square feet of designated dining space per
licensed bed if dining will be conducted in one seating. If dining will be
conducted in two seatings, 10 square feet per resident will be required.
Facilities will document their dining seating plan, and maintain the
documentation for review by the OLTC;
3. In facilities that house residents in more
than one (1) building, there shall be a living room and/or activities room
located in each building with at least 10 square feet per licensed bed with an
additional 10 square feet available on the campus in a commons area. The
facility?s 10 square feet per licensed bed in the commons area shall be
distinct from any other square footage requirements for other campus
programs;
4. In facilities housing
residents in more than one (1) building, a single dining room may be used for
the complex. The dining room in a single building facility or a multi-building
facility must have at least 20 square feet of space per licensed bed in the
facility. If dining will be conducted in two (2) seatings, 10 square feet per
resident will be required. Facilities will document their dining seating plan,
and maintain the documentation for review by the OLTC. In facilities housing
residents in more than one (1) building, protection from the elements of the
weather shall be provided for residents who must access other
buildings;
b. Any
modification, alternation or addition must satisfy all physical environment
requirements in effect at the time that the modification, alteration, or
addition is placed into service and shall meet the requirements of the
ADA.
905
APARTMENTS
a. All living units in assisted
living facilities shall be independent apartments (Exceptions shall be granted
based on Act 1230 of 2001). Each apartment or unit shall be of adequate size
and configuration to permit residents to carry out, with or without assistance,
all the functions necessary for independent living, including sleeping;
sitting; dressing; personal hygiene; storing, preparing, serving and eating
food; storing clothing and other personal possessions; doing personal
correspondence and paperwork; and entertaining visitors. Each apartment or unit
shall be accessible to and useable by residents who use a wheelchair or other
mobility aid consistent with the accessibility standards.
b. Physical features. Each independent
apartment or unit shall have at least the following:
1. An individual lockable entrance and exit.
A single door may serve as both entrance and exit. Keys, code or other opening
devise for the door to the independent apartment or unit shall be supplied to
residents. Keys, code or other opening devise for the door(s) to the assisted
living facility shall be supplied to all residents without a credible diagnosis
of dementia. In situations where a provider feels a resident without a
diagnosis of dementia is at risk of injury to themselves if provided with a
key, code or other exit devise to the facility, a compliance agreement may be
negotiated. All apartments or units shall be accessible by means of a master
key or similar system that is available at all times in the facility and for
use by designated staff.
2. Each
apartment or unit of new construction resident units shall have a minimum of
150 square feet per person or 230 square feet for two (2) persons sharing a
room excluding entryway, bathroom and closets. No apartment or unit in an
assisted living facility shall be occupied by more than two persons;
3. Each apartment or unit shall have a
separate and complete bathroom with a toilet, bathtub or shower, and
sink;
4. The cooking capacity of
each apartment or unit may be removed or disconnected depending on the
individual needs of the resident;
5. Each apartment or unit shall have a call
system monitored 24-hours a day by facility staff in the facility. Wireless
call systems approved by the Office of Long Term Care may be
utilized;
6. Each apartment or unit
shall be equipped for telephone and television cable or central television
antenna system);
7. Each apartment
or unit shall have easy access to common areas such as living room(s), activity
room(s), dining room(s) and laundry;
8. Private accessible mailbox that complies
with U. S. Postal Service requirements for apartment style boxes in which the
resident may send and receive mail that meets postal standards. Mailboxes may
be grouped in a common area, located at the resident?s apartment or unit door
or located as required by the U. S. Postal Service;
9. Each apartment or unit shall have a
kitchen that is a visually and functionally distinct area within the apartment
or unit (see Section 300, definition of Visually and Functionally Distinct
Area). The kitchen, at a minimum, shall contain a small refrigerator with a
freezer compartment, a cabinet for food storage, a small bar-type sink with hot
and cold running water and space with electrical outlets suitable for small
cooking appliances, e.g., a microwave. Exceptions shall be granted based on Act
1230 of 2001. Upon entering the assisted living facility, the resident or his
or her responsible party shall be asked if they wish to have a cooking
appliance. If so, the appliance shall be provided by the facility, in
accordance with facility policies. If the resident or his or her responsible
party wishes to provide their own cooking appliance, it shall meet the
facility?s safety standards. The cooking appliances shall be designed so that
they can be disconnected and removed for resident safety or if the resident
chooses not to have cooking capability within his or her apartment.
10. Each apartment or unit shall have a
sleeping and living area that is a visually and functionally distinct area
within the apartment or unit (see Section 300, definition of Visually and
Functionally Distinct Area) but need not be separate rooms.
11. Male and female residents must not have
adjoining rooms that do not have full floor to ceiling partitions and closable
solid core doors.
906 SAFETY STANDARDS
Each assisted living facility built after these regulations
become effective must meet the requirements adopted by local municipalities as
based on National Fire Protection 101, Life Safety Code, 1985 or the 2000
edition of the International Building Code (IBC) and must be in compliance with
the ADA. If the local municipality in which the facility is located has not
adopted requirements based on the above standards, or if the Office of Long
Term Care determines that the regulations adopted by the local municipality are
not adequate to protect residents, the facility must meet the provisions of the
2000 Edition of the International Building Code (IBC), including the National
Fire Protection Association (NFPA) requirements referenced by the IBC.
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 within the facility.
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.
907 WATER SUPPLY
An adequate supply of water, under pressure, must be provided
at all times. When a public water system is available, a connection must be
made thereto. If water from a source other than a public water supply is used,
the supply must meet the requirements set forth under rules and regulations of
the State Board of Health.
907.1 A
contract to supply potable water shall be implemented with a third party not
associated with the operation of the assisted living facility in the event the
facility?s water supply should be interrupted.
908 SEWAGE
All sewage must be disposed of by means of either:
a. A public system where one is accessible
within 300 feet; or
b. An approved
sewage disposal system that is constructed and operated in conformance with the
standards established for such systems by the State Board of Health.
909 PLUMBING
Facilities must comply with all provisions of the state
plumbing and gas code and amendments thereto prescribing minimum requirements
for design, materials, appliances, workmanship, and methods of
installation.
910
ELECTRICAL
Electrical wiring, fixtures, appliances, motors, and other
electrical equipment must be installed in accordance with the national
electrical code National Fire Prevention Association?s Pamphlet #70 and comply
with local regulations and codes where they exist.
911 HEATING/COOLING
911.1 All liquefied petroleum gas systems
must be installed and maintained in accordance with the State Code for
Liquefied Petroleum Gas Containers and Equipment, State of Arkansas.
911.2 All gas heating units must bear the
stamp of approval of the American Gas
Association Testing Laboratories, Inc. or other nationally
recognized testing agency for enclosed, vented heaters for the type of fuel
used.
911.3 All gas heating
units and water heaters must be vented adequately to carry the products of
combustion to the outside atmosphere. Vents must be constructed and maintained
to provide a continuous draft to the outside atmosphere in accordance with the
American Gas Association Recommended Procedures.
911.4 All heating units must be provided with
a sufficient supply of outside air so as to support combustion without
depletion of the air in the occupied room.
911.5 All heating and cooling units must be
installed and maintained in a manner that will provide for the safety and
comfort of the occupants.
911.6 In
new facilities licensed after the effective date of these regulations, the
facility must provide each apartment or unit with an individual thermostat
controlling the temperature in that apartment or unit. In addition, the
facility must provide a heating, ventilating and air conditioning (HVAC)
system(s) for the apartments or units and common areas capable of maintaining
any temperature between 68 and 80 degrees at any time throughout the
year.
912 ZONING CODES
Each assisted living facility must be operated in areas
permitted by local codes. Each owner must provide the Office of Long Term Care
with documentation that the facility is in compliance with zoning
requirements.
913 LOT
REQUIREMENTS
Conditions of soil, ground water level, drainage and topography
must not create hazards to the property as to the health and safety of the
occupants. The site shall not be subject to unpredictable and/or sudden
flooding and shall be large enough to provide an exercise area for residents.
Exercise area shall mean, at a minimum, accessible exterior space configured
with walkways suitable for walking and benches for resting. The exterior space
may be on the facility?s property, on publicly accessible public or private
property (e.g., park, shopping mall), or on an area made available to the
residents by the facility through special arrangement with private property
owners. Special arrangements must be through long-term agreements deemed
sufficient by OLTC. Regardless of the arrangements, exercise areas must be
accessible from the property during daylight hours by means of a safe and
accessible walking route.
1000
IMPOSITION OF REMEDIES -
AUTHORITY
The following Rules and Regulations for the Imposition of
Remedies are duly adopted and promulgated by the Arkansas Department of 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.
1001 INSPECTIONS BY DEPARTMENT
a. All areas of the facility that are
accessible to residents or are used in the care or support of residents,
including but not limited to kitchen or food preparation areas, laundry areas,
and storage areas, and all resident records, including but not limited to
residents' financial records maintained by the facility and residents' 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 residents
and all employee records related to the care or protection of residents 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 residents of the survey
process and residents? rights with regard to privacy during the process.
Residents 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 residents or employees who consent to interviews, and shall
be permitted to photograph the facility. Residents and their apartments 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 resident 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 may require. Provided, however, that 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
working days of receipt of written notification of deficiencies (also referred
to as a Statement of Deficiencies) found during routine inspections or surveys,
special visits or complaint investigations. 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 residents or their responsible
parties and visitors. A copy shall be provided to each resident or resident?s
responsible party upon request of the resident or the resident?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.
1002 GENERAL
PROVISIONS
a. 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 with
respect to program requirements 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
residents, 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.
1003 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 Administrator.
7. Termination of license.
8. Transfer of residents.
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 Level I assisted living facility license.
1004 TEMPORARY ADMINISTRATION
a. Temporary administrator means the
temporary appointment by OLTC, or by the facility with the approval of OLTC, of
a substitute facility administrator 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 administrator may
be appointed by the Office of Long Term Care only upon the consent and
agreement of the facility. The temporary administrator 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
administrator 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 administrator's salary:
1. Is paid directly by the facility while the
temporary administrator 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 1005(c)(2) if OLTC is otherwise unable to attract a
qualified temporary administrator.
d. Failure to relinquish authority to
temporary administrator:
1. Termination of
assisted living facility licensure. If a facility fails to relinquish authority
to the temporary administrator, OLTC may impose additional remedies, including
but not limited to termination of the Level I assisted living facility
license.
2. Failure to pay salary
of temporary administrator. A facility's failure to pay the salary of the
temporary administrator is considered a failure to relinquish authority to
temporary administration.
3. When
imposed. The remedy of temporary administrator shall be used in only lieu of
termination of the facility license. Provided, however, that if the appointment
of the temporary administrator 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.
1005 STATE MONITORING
a. A State monitor:
1. Oversees the correction of deficiencies
specified by OLTC at the facility site and protects the facility's residents
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 resident 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.
1006 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 1009. The intent of a directed plan of correction is to
achieve correction of identified deficiencies and compliance with applicable
regulations.
1007 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.
1008 TRANSFER OF RESIDENTS OR CLOSURE OF THE
FACILITY AND TRANSFER OF RESIDENTS
a. Transfer
of residents, or closure of the facility and transfer of residents in an
emergency. OLTC has the authority to transfer residents to another facility
when:
1. An emergency exists wherein the
health, safety, or welfare of residents are imperiled, and no other remedy
exists that would ensure the continued health, safety or welfare of the
residents;
2. A facility intends to
close but has not arranged for the orderly transfer of its residents at least
thirty (30) days prior to closure.
3. The facility exceeds its bed capacity as
indicated or stated on the facility's license, or accepts more residents than
the facility has number of beds 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 assisted living facility 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
residents to another facility.
c.
When the Office of Long Term Care orders transfer of residents 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 residents' care and safety.
2. Assist in or arrange for transportation of
the residents, their medical records and belongings, assist in locating
alternative placement, assist in preparing the resident for transfer, and
permit the residents' legal guardians or responsible party to participate in
the selection of the residents' new placement.
3. Unless transfer is due to an emergency,
explain alternative placement options to the residents and provide orientation
to the placement chosen by the resident 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 residents are to be
transferred at least fifteen (15) days notice of the proposed
transfer.
1009
TERMINATION OF LEVEL I ASSISTED LIVING FACILITY 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 Section 1009(b), below.
b. Basis for termination. OLTC may terminate
a facility's Level I assisted living facility license if a facility:
1. Permits, aids or abets in the commission
of any unlawful act in connection with the operation of the Level I assisted
living facility;
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 1001(d) 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. Operator 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, et seq.;
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; or,
7. Has conditions wherein the health, safety,
or welfare of resident are imperiled, and no other remedy exists that would
ensure the continued health, safety, or welfare of the residents.
1010 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.
1011 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.
1012 CLOSURE
Any Level I assisted living 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.
1100 INFORMAL DISPUTE RESOLUTION (IDR)
When a long term care facility does not agree with deficiencies
cited on a Statement of Deficiencies, the facility may request an IDR meeting
of the deficiencies in lieu of, or in addition to, a formal appeal. The
Informal Dispute Resolution (IDR) process is governed by Act 1108 of 2003,
codified at Ark. Code Ann. §
20-10-1901 et seq.
The request for an informal dispute resolution of deficiencies
does not stay the requirement for submission of an acceptable plan of
correction and allegation of compliance within the required time frame or the
implementation of any remedy, and does not substitute for an appeal.
1101 REQUESTING AN INFORMAL
DISPUTE RESOLUTION (IDR)
A written request for an informal dispute resolution must be
made to the Arkansas Department of Health, Health Facility Services, 5800 West
10th, Suite 400, Little Rock, AR 72204 within ten calendar days of the receipt
of the Statement of Deficiencies from the Office of Long Term Care. The request
must:
1. List all deficiencies the
facility wishes to challenge; and,
2. Contain a statement whether the facility
wishes the IDR meeting to be conducted by telephone conference, by record
review, or by a meeting in which the parties appear before the impartial
decision maker.
1002 MATTERS WHICH MAY BE
HEARD AT IDR
The IDR is limited to deficiencies cited on a Statement of
Deficiencies. Issues that may not be heard at an IDR include, but are not
limited to:
1. The scope and severity
assigned the deficiency by the Office of Long Term Care, unless the scope and
severity allege substandard quality of care or immediate jeopardy;
2. Any remedies imposed;
3. Any alleged failure of the survey team to
comply with a requirement of the survey process;
4. Any alleged inconsistency of the survey
team in citing deficiencies among facilities; and,
5. Any alleged inadequacy or inaccuracy of
the IDR process.
1003
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, et seq.
APPENDIX FORMS
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL
SERVICES OFFICE OF LONG TERM CARE DMS-731
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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ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL
SERVICES OFFICE OF LONG TERM CARE DMS-742
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.
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INSTRUCTIONS
A. Enclosed are two (2) copies of
Application for Licensure. Complete one copy and return to the Office of Long
Term Care and retain one copy for your files.
B. Please read these instructions carefully
and complete this application in full. This application must be completed in
ink or typed.
C. This application
is not valid unless it is notarized.
D. This license application must be signed by
the following person(s) dependent upon the type of management and ownership.
1. If the institution is public (i.e.,
County, City, etc.) it must be signed by the person who is head of the
governmental department having jurisdiction over it (i.e., Chairman of County
Board or Chairman of Commission) or his duly authorized representative. This
authorization must be in writing, notarized and submitted along with this
application.
2. If the institution
is private, it must be signed by the following dependent upon the type of
business organization.
|
Type
|
Signer
|
|
Sole Proprietorship
|
Owner
|
|
Partnership
|
One of the partner
|
|
Corporation, Church, Non-Profit Association
|
If someone other than the above named is authorized to sign in
his or her behalf, such authorization must be in writing, notarized and
attached to this application.
E. All license expire on midnight June 30 of
the calendar year in which they are issued.
F. Application for annual renewal must be
postmarked no later than June 1 of the current year in order to avoid the
payment of a penalty. This penalty shall be 10% of the facility?s licensure
fee.
G. This application should be
returned by certified mail to the following address:
DEPARTMENT OF HUMAN SERVICES
OFFICE OF LONG TERM CARE
P.O. BOX 8059 SLOT S408
LITTLE ROCK, AR 72203
Please make certain that you use the above listed address only.
All other addresses used could cause delays and may result in penalties being
applied to your annual licensure renewal fees.
H. A check or money order for the required
licensure fee made payable to Arkansas Department of Human Services must
accompany this submission except for those facilities operated by the State.
Licensure Fee: $10.00 per bed
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RULES AND REGULATIONS
FOR
ASSISTED LIVING FACILITIES LEVEL
II
100
SCOPE
These rules and regulations constitute the basis for the
licensure of Level II assisted living facilities by the Arkansas Department of
Human Services, Division of Medical Services, Office of Long Term Care. The
Office of Long Term Care reserves the right, and may at any time, waive any or
all of the requirements herein in event of emergency or for good cause shown in
the sole determination of the Office of Long Term Care.
200
PURPOSE
The purpose of these rules and regulations is to establish
standards for Level II assisted living facilities that provide services in a
homelike environment for elderly and disabled persons. Level II assisted living
facilities ensure that residents receive supportive health and social services
as they are needed to enable them to maintain their individuality, privacy,
dignity, and independence, in the highest degree possible in an apartment-style
living unit. The assisted living environment actively encourages and supports
these values through effective methods of service delivery and facility or
program operation. The environment promotes resident self-direction and
personal decision-making while protecting resident?s health and safety.
300
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
reference 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. §
5-28-101 and
42
CFR §
488.301. Abuse? also includes
sexual abuse as defined in Ark. Code Ann. § 5-28-101(12).
Activities of Daily Living ? The
activities of daily living 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.
Administrator ? The person who has
successfully completed a course of training or instruction certified by the
Office of Long Term Care as an assisted living facility administrator who is in
charge of the daily operation of the facility.
Advertise ? To make publicly and
generally known. For purposes of this definition, advertise
includes, but is not limited to:
1. Signs, billboards, or lettering;
2. Electronic publishing or broadcasting,
including the use of the Internet or e-mail; and
3. Printed material.
Alzheimer?s Special Care Unit (ASCU) ?
A separate and distinct unit within an Assisted Living or other Long Term Care
facility that segregates and provides a special program for residents with a
diagnosis of probable Alzheimer?s disease or related dementia, and that
advertises, markets or otherwise promotes the facility as providing specialized
Alzheimer?s or related dementia care services.
Annual ? A twelve month period
preceding the last required action. Unless a date certain is specified in the
law or regulation requiring the action (e.g., the International Building Code ?
IBC) the action may be taken any time during the month in which it is due.
Actions which are required to be taken every five years may be taken any time
during the month in which they are due.
Ancillary Services ? A service that is
not included in the basic core services of the resident?s occupancy agreement
and which is provided by the facility or under arrangement with an outside
service provider. The ancillary service may or may not be provided for a charge
to the resident.
Assisted Living Facility (ALF) ? Any
building or buildings, section or distinct part of a building, boarding home,
home for the aged or other residential facility whether operated for profit or
not that undertakes through its ownership or management to provide assisted
living services for a period exceeding twenty-four (24) hours to more than
three (3) adult residents of the facility who are not relatives of the owner or
administrator. Assisted living facility means facilities in which assisted
living services are provided either directly or through contractual
arrangements or in which contracting in the name of residents is
facilitated.
Assisted Living Program ? A program of
assisted living services.
Assisted Living Services ? Housing,
meals, laundry, social activities, assistance with transportation, direct care
services, health care services, 24-hour supervision and care, and limited
nursing services. For purposes of these regulations, assistance with
transportation means making arrangements for transportation.
Caregiver ? Shall have the same
meaning prescribed by Ark. Code Ann. § 5-28-101.
Choice ? Viable options available to a
resident that enables the resident to exercise greater control over his or her
life. Choice is supported by resident?s self-directed care (including methods
and scheduling) established through the care planning process, and the
provision of sufficient private and common space within the facility to provide
opportunities for residents to select when and how to spend time, and when and
how to receive personal or assisted living services.
Common Areas (for Alzheimer?s Special Care
Units) ? Portions of the Alzheimer?s Special Care Unit, exclusive
of residents? rooms and bathrooms. Common areas include any facility grounds
accessible to residents of the Alzheimer?s Special Care Unit.
Compliance Agreement ? If needed, the
written formal plan developed in consideration of shared responsibility, choice
and assisted living values and negotiated between the resident or his or her
responsible party and the assisted living facility to avoid or reduce the risk
of adverse outcomes that may occur in an assisted living environment.
Continuous ? Available at all times
without cessation, break or interruption.
Deficiency ? A facility?s failure to
meet program participation requirements as defined in these and other
applicable regulations and laws.
Dementia ? A loss or decrease in
intellectual ability that is of sufficient severity to interfere with social or
occupational functioning; it describes a set of symptoms such as memory loss,
personality change, poor reasoning or judgment, and language
difficulties.
Department ? The Department of Human
Services and its divisions and offices.
Direct Care Services ? Services that
directly help a resident with certain activities of daily living such as
assistance with mobility and transfers; assistance to resident 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 Service Plan ? A written
plan for direct care services that is developed to meet the needs and
preferences of the resident or his or her responsible party through a
negotiated process that becomes a part of the resident?s occupancy admission
agreement.
Direct Care Staff ? Any licensed or
certified staff acting on behalf of, employed by, or contracted by the
facility, to provide services and who provides direct care services or
assistance to residents, including activities of daily living and tasks related
to medication administration or assistance.
Direct Care Staff (Alzheimer?s Special Care
Unit) ? An individual who is an employee of the facility, or an
individual who is an employee of a temporary or employment agency assigned to
work in the facility, who has received or will receive, in accordance with
these regulations, specialized training regarding Alzheimer?s or related
dementia, and who is responsible for providing direct, hands-on care or
services to residents of the ASCU.
Direct Contact ? The ability or
opportunity of employees of the facility, or individuals with whom the facility
contracts, to physically interact with or be in the presence of
residents.
Direct Threat ? A significant risk to
the health or safety of self or others that cannot be eliminated by reasonable
accommodation. This term as used in these rules and regulations is designed to
ensure conformity with the Americans with Disabilities Act (ADA) in determining
whether a person with a disability poses a ?direct (health or safety)
threat?.
Directed Plan of Correction ? A plan
developed by the Office of Long Term Care that describes the actions the
facility will take to correct deficiencies and specifies the date by which
those deficiencies will be corrected.
Discharge ? When a resident leaves the
facility, and it is not anticipated that the resident will return. A discharge
occurs when a return to the facility by the resident requires that admission
procedures set forth in these regulations be followed.
Disclosure Statement ? A written
statement prepared by the facility and provided to individuals or their
responsible parties, and to individual?s families, upon visiting a facility for
consideration of admission, and before admission, describing the form of care
offered, treatment, staffing, the emergency preparedness plan, special services
and related costs provided by the facility, and other information as required
by Ark. Code Ann. §
20-10-111. The facility disclosure
statement is reviewed annually. If it is not changed, then no further action is
required, except that the facility shall maintain documentation that the
statement was reviewed. If the statement is changed, then the resident or
responsible party shall sign the revised statement.
Elopement ? Circumstances where a
resident, who has been identified as being cognitively impaired, has left a
facility without staff knowledge. Facilities must comply with all reporting
requirements of any special programs in which they participate.
Emergency Measures ? Those measures
necessary to respond to a serious situation that threatens the health and
safety of residents.
Endangered Adult ? 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.
First Aid Measures ? Temporary
interventions necessary to treat trauma or injury.
Health Care Service Plan ? A written
plan for health care services that is developed to meet the needs and
preferences of the resident or his or her responsible party through a
negotiated process that becomes a part of the resident?s occupancy admission
agreement.
Health Care Services ? The provision
of services in an assisted living facility that assists the resident in
achieving and maintaining well-being (e.g., psychological, social, physical,
and spiritual) and functional status. This may include nursing assessments and
the monitoring and delegation of nursing tasks by registered nurses pursuant to
the Nurse Practice Act and interpretations thereto by the Arkansas State Board
of Nursing, care management, records management and coordinating basic health
care and social services in such settings.
Home Health Services ? Home health
aide services, medical supplies suitable for use in the resident?s assisted
living facility apartment, and nursing services as defined in the state Nurse
Practice Act and interpretations thereto by the Arkansas State Board of
Nursing.
IDR ? The informal dispute resolution
process as described in these regulations.
Imminent Danger to Health or Safety ?
Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703.
Impaired Adult ? Shall have the same
meaning as prescribed by Ark. Code Ann. §
12-12-1703.
Independence ? The maintenance and
promotions of resident capabilities to enhance the resident?s preferences and
choices within a barrier-free environment.
Individual Assessment Team (IAT) ? A
group of individuals possessing the knowledge and skills to identify the
medical, behavioral, and social needs of residents of the Alzheimer?s Special
Care Unit (ASCU), and to develop services designed to meet those needs.
Individual Support Plan ? A written
plan developed by an Individual Assessment Team (IAT) that identifies services
to a resident of the Alzheimer?s Special Care Unit (ASCU).
Limited Nursing Services ? Acts that
may be performed by licensed personnel while carrying out their professional
duties, but limited to those acts that the department specifies by rule. Acts
that may be specified by rule as allowable limited nursing services shall be
for persons who meet the admission criteria established by the Department for
facilities offering assisted living services, shall not be complex enough to
require twenty-four (24) hour nursing supervision and may include such services
as application and care of routine dressings, and care of casts, braces, and
splints.
Long Term Care Facility License ? A
time-limited, non-transferable, permit required by Ark. Code Ann. §
20-10-224 and issued for a maximum
period of twelve (12) months to a licensee who complies with Office of Long
Term Care rules and regulations. This document must list the maximum number of
beds for the facility.
Medication Administration ? Service
provided only by licensed medical staff, either directly or through contract,
and in accordance with the Nurse Practices Act and interpretations of the
Arkansas State Board of Nursing.
Medication Assistance and Monitoring ?
Services provided by the facility, either directly or through contract, in
accordance with the Nurse Practices Act and interpretations by the Arkansas
State Board of Nursing, designed to ensure that residents receive necessary or
prescribed medication, and to prevent wastage of medication.
Medication ? Self Administer ?
Resident, without cueing, is capable of storing, managing, and
self-administering his or her medications. Using a medication assessment
instrument, facility staff has determined that the resident has the ability to
store, manage, and self-administer his or her medications.
Mental Abuse ? Verbal, written, or
gestured communication, to a resident, or to a visitor or staff, about a
resident within the resident?s presence, or in a public forum, that a
reasonable person finds to be a material endangerment to the mental health of a
resident.
Neglect ? Shall have the same meaning
as prescribed by Ark. Code Ann. §
12-12-1703 and
42
C.F.R. §
488.301.
New Admission ? An individual who is
being admitted to the facility for the first time, or who is returning after a
formal discharge.
Non-Compliance ? Any violation of
these regulations, or of applicable law or regulations.
Nurse Practice Act ? As used in these
regulations, the term Nurse Practice Act refers to Ark. Code
Ann. §
17-87-101
et seq.
and interpretations thereto by the Arkansas State Board of
Nursing.
Operator ? The individual or entity
that conducts the business of the facility. The individual or individuals
executing the licensure application form shall be deemed an operator.
OLTC ? The Office of Long Term
Care.
Office of Long Term Care ? The Office
in the Division of Medical Services of the Department of Human Services that
has 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, operator,
professional, management and persons, firms, or entities providing services
pursuant to a contract or agreement.
Plan of Correction (P-o-C) ? A plan
developed by the facility and approved by OLTC that describes the actions the
facility will take to correct deficiencies, and which specifies the date by
which those deficiencies will be corrected.
PRN ? A medication or treatment
prescribed by a medical professional to a person, allowing the medication or
ointment to be given ?as needed?.
Program Requirements ? The
requirements for participation and licensure under these and other applicable
regulations and laws as an assisted living facility.
Proprietor/Licensee ? Any person,
firm, corporation, governmental agency or other legal entity, issued an
assisted living facility license, and who is responsible for maintaining
approved standards.
Provisional Licensure is a temporary
grant of authority to the purchaser to operate an existing long-term care
facility upon application for licensure to the Office of Long Term Care.
Provisional Placement ? Placement in
an assisted living facility made for the purposes of assessment to determine
appropriateness of admission or emergency, such as placement by law enforcement
or Adult Protective Services. A provisional placement shall be permitted for no
longer than thirty (30) days, at which time the resident must either be
discharged or admitted to the facility in conformity with theses regulations. A
provisional placement shall not be an admission pursuant to these regulations,
and any individual in an assisted living facility pursuant to a provisional
placement shall not be deemed a resident of the facility.
Quarterly ? A measure of time in which
a calendar year is divided into four (4) segments of three (3) months per
segment. When, under these or other applicable laws or regulation, an action
must be taken quarterly, the required action shall be completed once in each
quarter on any day within a calendar quarter. Provided, however, that no more
than ninety (90) days may elapse between the required events.
Responsible Party ? An individual,
who, at the request of the applicant or resident, or by appointment by a court
of competent jurisdiction, agrees to act on behalf of a resident or applicant
for the purposes of making decisions regarding the needs and welfare of the
resident or applicant. These regulations, and this definition, does not grant
or permit, and should not be construed as granting or permitting, any
individual authority or permission to act for or on behalf of a resident or
applicant in excess of any authority or permission granted by law. A competent
resident may select a responsible party or may choose not to select a
responsible party. In no event may an individual act for, or on behalf of, a
resident or applicant when the resident or applicant has a legal guardian,
attorney-in-fact, or other legal representative. For purposes of these
regulations only, responsible party will also refer to the terms legal
representative, legal guardian, power of attorney or similar
phrase.
Separate Premises ? Buildings housing
Assisted Living Facility operations that are located on non-contiguous
land.
Significant Change ? Any improvement
or decline in a resident?s medical, physiological, psychological, or social
condition, in which:
a. The decline
cannot be reasonably expected to resolve itself; or,
b. The decline may cause a worsening of
another or pre-existing medical, physiological, psychological, or social
condition.
Substandard Quality of Care ? One or
more deficiencies related to participation requirements, as set forth in these
or other applicable regulations or laws, that constitute either immediate
jeopardy to resident health or safety; a pattern of, or widespread actual harm,
that is not immediate jeopardy; or a widespread potential for more than minimal
harm, but less than immediate jeopardy, with no actual harm.
Survey ? The process of inspection,
interviews, or record reviews, conducted by the Office of Long Term
Care.
Standard Survey - A comprehensive
survey conducted by the Office of Long Term Care on an average of every 18
months for each facility.
Therapeutic Diet ? A diet ordered by a
physician or an advance practice nurse to manage problematic health
conditions.
Transfer ? The temporary or permanent
relocation of a resident from one living unit within the facility to another
living unit within the facility, or the temporary relocation of a resident to a
location outside the facility.
Twenty-four Hour Staff ? Staff present
in the facility at all times who are awake and available to respond to resident
needs.
Universal Precautions ? Set of
guidelines, or precautions, designed to prevent transmission of infectious
agents, including blood-borne pathogens, when providing health care, and which
assume that all human blood and body fluids are treated as if known to be
infectious.
Universal Worker ? An employee trained
to perform a variety of functional duties to meet the needs of residents,
including direct care, and who is counted in the staff to resident staffing
ratios.
Visually and Functionally Distinct
Area ? A space that can be distinguished from other areas within
the apartment by sight. A visually and functionally distinct area need not be a
separate room. To create a visually distinct area, one or more of the following
methods must be employed: change in ceiling height, separation by ceiling
soffit(s) or wall returns, change in flooring color, partial height partitions
or counters, use of alcoves, use of permanent screening devices such as columns
or fixed screens. In the case of an ?L? shaped studio apartment or unit,
kitchenettes and living areas may be combined and bedroom areas may be in a leg
of an ?L? shaped plan and qualify without additional separation
methods.
400
LICENSURE
400.1 No Level II assisted living 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., Act 1230 of 2001, and these licensing standards. All licenses
issued hereunder, and the beds stated on the license, are non-transferable from
one owner or proprietor to another, or from one site or location to another. No
Level II assisted living facility may operate with more beds than is stated in
the license, and no Level II assisted living facility may accept more residents
than the number of beds stated on the license. No license shall be issued
without proof of a valid, current Permit of Approval issued by the Health
Services Permit Commission or Health Services Permit Agency.
400.2 The grant of a license for a facility
as a Level II assisted living facility shall also be a grant of licensure as a
Level I assisted living facility. However, separate licenses shall be issued
for each, and shall reflect the number of beds for each as indicated on the
application. Specifically, the issuance of a Level II assisted living facility
license shall be a grant of authority to the facility to operate with the
stated bed capacity set out in the Assisted Living Facility II license for the
housing or delivery of services to individuals who are medically eligible for
nursing home level of care or who receive services through the Medicaid 1915
(c) H&CBS wavier for assisted living. The issuance of a Level I assisted
living facility license shall be a grant of authority to the facility to
operate with the stated bed capacity set out in the Assisted Living Facility I
license for the housing or delivery of services to those individuals who are
not medically eligible for nursing home level of care or who do not receive
services through the Medicaid 1915 (c) H&CBS Wavier for assisted living.
The initial licenses together shall reflect the total number of beds as set
forth in the Permit of Approval. Subsequent licenses issued to the same owner
will state the number of beds for which the facility has been authorized by the
Health Services Permit Commission or the Health Services Permit Agency at the
time of the issuance of the subsequent license, and which are designated for
the respective Level I and Level II licenses. Licenses issued as a result of a
change of ownership shall state the number of beds for which the facility was
licensed on the date of sale of the facility or the date of the sale of
ownership of the facility.
400.3
When a facility is licensed as a Level II assisted living facility, the
facility shall maintain physically distinct parts or wings to house individuals
that receive or are medically eligible for the nursing home level of care
separate and apart from those individuals who do not receive, or are not
medically eligible for the nursing home level of care. Common areas must meet
all requirements for a Level II facility.
However, Level II units may house Level I-level of care
residents under the following conditions:
a. Any and all individuals residing in a
Level II unit shall be counted as a Level II resident for purposes of
determining staff for the Level II unit; and,
b. No individual meeting the criteria for
Level II level of care may reside or be housed in a Level I unit or Level I
bed.
c. Common areas must meet all
requirements for a Level II facility.
Staffing within the Level II parts or wings of the facility
must meet the requirements for Level II assisted living facilities at all
times, independent of the staffing requirements for the Level I parts or wings
of the facility, and regardless whether the Level II parts or wings house
individuals who do not receive, or are not eligible for, nursing home level of
care.
401
LICENSING
INFORMATION
401.1
Licenses to operate a Level II assisted living facility are issued to be
effective beginning July 1st and expiring on the following June 30th. Fees for
new licensure applications will be prorated by dividing the total licensure fee
by three hundred sixty five (365) and then multiplying the result by the total
number of days from the date the application is approved through June 30,
inclusive.
401.2 Licenses shall be
issued only for the premises and persons specified in the application and shall
not be transferable.
401.3 Licenses
shall be posted in a conspicuous place on the licensed premises.
401.4 Separate licenses are required for
Level II assisted living facilities maintained on separate premises, even
though they are operated under the same management. When two or more buildings
located on contiguous land house Assisted Living operations, the owner or
operator may choose to license each operation in each building separately, or
to have all operations in all buildings operate under a single license.
Multiple licenses for multiple operations housed in separate buildings on
contiguous land will be considered and treated under these regulations as
separate Assisted Living Facilities, and each licensed operation must conform
to the requirements of these regulations independent of the other licensed
operations housed in other buildings on contiguous land.
401.5 Every Level II assisted living 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 receipt by the owner of
the assisted living facility of approval from the Office of Long Term
Care.
402
INITIAL LICENSURE
402.1 Initial licensure requires that the
applicant for licensure possess a current, valid Permit of Approval (P-o-A)
issued by the Health Services Permit Commission (HSPC) or Health Services
Permit Agency (HSPA). Initial licensure shall apply to:
a. Newly constructed facilities designed to
operate as assisted living facilities;
b. Existing structures not already licensed
as a Level II assisted living facility on the effective date of these
regulations.
Permits of approval held by residential care facilities as of
the effective date of Act 1230 of 2001 or held by subsequent purchases of those
facilities shall also be considered permits of approval for assisted living
without further action. However, residential care facilities that choose to
offer Level II assisted living services are not exempt from assisted living
licensure requirements except as specifically provided by Act 1230 of
2001.
402.2 The
initial licensure application shall be accompanied by one set of building
plans.
403
COMPLIANCE
An initial license will not be issued until the Department
verifies that the facility is in compliance with the licensing standards 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.
404
APPLICATION, EXPIRATION AND RENEWAL OF LICENSE
404.1 Applicants for licensure or renewal of
Level II assisted living facility licensure shall obtain the necessary forms
for initial or renewal licensure or to request re-licensure of the facility
after a change of ownership (see Section 404.7 and Section 405) from the Office
of Long Term Care. The issuance of an application form shall not be construed
to be a guarantee that the completed application will be acceptable, or that
the Department will issue a license.
404.2 The facility shall not admit any
residents until a license to operate a Level II assisted living facility has
been issued, except as provided in Section 404.10(e) of these regulations for
purposes of inspection and initial licensure.
404.3 Applicants for initial licensure,
renewal, or re-licensure after a change in ownership shall pay in advance a
license fee of $10.00 per bed to the Department. Such fee shall be refunded to
the applicant in the event a license is not issued. An application fee of
$250.00 shall also accompany every application which shall be
non-refundable.
404.4 Annual
renewal is required for all Level II assisted living 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
30, the license for the facility will be void.
404.5 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 30th expiration of the license. Any license
fee received by the Department after June 1 is subject to a ten percent (10%)
penalty.
404.6 The operator 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.
404.7 When a change in ownership of
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
1004.2 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.
404.8 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 assisted living facility for which license
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;
e. A
statement from an authorized representative of the facility acknowledging that
the facility is responsible for any funds that are handled for the residents by
the facility or its staff, including personal allowance funds, together with an
acknowledgement that the failure to make restitution within ten (10) working
days for lost or stolen funds will result in the non-renewal of licensure, or
other sanctions;
f. A copy of any
required contract agreement for the provision of services meeting
specifications in Section 503 of these regulations;
g. A copy of the floor plan of the assisted
living facility. If the assisted living facility will be a part of another
facility under a different license, the distinct part of the facility that will
be assisted living shall be identified.
404.9 A Level II assisted living facility may
apply for and be granted a license to operate as a Level I-only facility. The
facility shall, prior to the issuance of the license, provide a written plan to
the Office of Long Term Care setting forth:
a.
The means by which alternative placement for individuals who receive, or meet
the medical eligibility for, nursing home level of care, will be made;
and
b. The date of transfer to
alternative placement for each resident that receives, or meets the medical
eligibility for, nursing home level of care.
The Office of Long Term Care shall evaluate all written plans,
and will grant the license as a Level I-only facility only upon determination,
in the sole discretion of the Office, that the proposed plan meets the best
interest of residents. The facility shall comply with all requirements of
Section 602 regarding transfer of residents. A facility desiring to change its
licensure status to a Level I from a Level II shall meet all requirements for,
and shall make application without additional fee in accordance with, new
licensure applications.
404.10 Procedure for Licensure. The procedure
for obtaining an Assisted Living 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 and application 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, at the time of
application submission to the Office of Long Term Care the applicant shall, in
writing, request a life-safety code survey from the Office of Long Term
Care.
d. For a new facility, the
Office of Long Term Care will conduct an unannounced life-safety code survey to
determine compliance with applicable building code requirements.
e. For a new facility, upon being informed
that the facility meets all requirements for all applicable building codes the
facility may admit residents.
f.
For a new facility, upon admission of residents the facility shall, in writing,
request an initial survey.
g. For a
new facility, the Office of Long Term Care will conduct an unannounced initial
survey to determine compliance with applicable law and these
regulations.
h. For a new facility,
upon successful completion of the initial survey the facility shall be granted
a license to operate as an Assisted Living Facility.
i. The Office of Long Term Care may elect,
for any renewal application, to perform a survey prior to issuance of the
license, and issuance of the license is contingent upon the facility being
found in compliance with all program requirements.
405
CHANGE IN OWNERSHIP
405.1 Transactions constituting a change in
ownership include, but are not limited to, the following:
a. Sale or donation of the facility?s legal
title;
b. Lease of any portion of
facility?s real or personal property;
c. A sole proprietor becomes a member of a
partnership or corporation, succeeding him as the new operator;
d. A partnership dissolves;
e. One partnership is replaced by another
through the removal, addition or substitution of a partner;
f. The corporate owner merges with, or is
purchased by, another corporation or legal entity;
g. A not-for-profit corporation becomes a
general corporation, or a for-profit corporation becomes
not-for-profit.
405.2
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.
406
PROVISIONAL LICENSURE
Subject to the requirements below, a provisional license shall
be issued to the Applicant and new operator of the long-term care facility when
the Office of Long Term Care has received the Application for Licensure to
Conduct a Long Term Care Facility. A provisional license shall be effective
from the date the Office of Long-Term Care provides notice to the Applicant and
new operator, until the date the long-term care license is issued. With the
exception of Medicaid or Medicare provider status, a provisional license
confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
1. The purchaser and the seller of the
long-term care facility shall provide the Office of Long Term Care with written
notice of the change of ownership at least thirty (30) days prior to the
effective date of the sale.
2. The
Applicant and new operator of the long-term care facility shall provide the
Office of Long Term Care with the application for licensure, including all
applicable fees.
3. The Applicant
and new operator of the long-term care facility shall provide the Office of
Long Term Care with evidence of transfer of operational control signed by all
applicable parties.
A provisional license holder may operate the facility under a
new name, whether fictitious or otherwise. For purposes of this section, the
term new name means a name that is different than the name
under which the facility was operated by the prior owner, and the term
?operate? means that the provisional license holder may hold the facility out
to the public using the new name. Examples include, but are not limited to,
signage, letterhead, brochures or advertising (regardless of media) that bears
the new name.
In the event that the provisional license holder operates the
facility under a new name, the facility shall utilize the prior name in all
communications with the Office of Long Term Care until such time as the license
is issued. Such communications include, but are not limited to, incident
reports, notices, Plans of Correction, and MDS submissions. Upon the issuance
of the license, the facility shall utilize the new name in all communications
with the Office of Long Term Care.
501
GOVERNING
BODY
Each Level II assisted living facility must 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 assisted living policies and
administrative policies governing the operation of the facility.
502
GENERAL
PROGRAM REQUIREMENTS
Each person or legal entity issued a license to operate a Level
II assisted living facility shall provide continuous twenty-four (24)-hour
supervision and services that:
a.
Conform to Office of Long Term Care rules and regulations;
b. Meet the needs of the residents of the
facility;
c. Provide for the full
protection of residents? rights; and d. Promote the social, physical, and
mental well being of residents.
503
CONTRACTUAL
AGREEMENTS
A Level II assisted living facility shall not admit, or
continue to provide care to, individuals whose needs are greater than the
facility is licensed to provide. For any service required under these
regulations that is not provided directly by the facility, the facility must
have a written contractual agreement or contract with an outside program,
resource or service to furnish the necessary service.
504
PERSONNEL AND GENERAL
POLICIES AND PROCEDURES
504.1 Required Policies and Procedures
Governing General Administration of the Facility
The facility must develop, maintain, and make available for
public inspection the following policies and procedures.
a. Resident policies and procedures as set
forth in Section 505;
b. Admission
policies as set forth in Section 601;
c. Discharge and transfer policies as set
forth in Section 602;
d. Incident
reporting policies and procedures as set forth in Section 507, including
procedures for reporting suspected abuse or neglect.
e. Policies and procedures for the management
of resident personal allowance accounts as set forth in Section 505.1 and
Section 603.1(3)(N);
f. Residents?
Rights policies and procedures as set forth in Section 603.1;
g. Fire safety standards as set forth in
Section 504.1.1(i) and Section 906;
h. Smoking policies for residents and
facility personnel as set forth in Section 504.1. 1(j) and Section 906;
i. Policy and procedures regarding
visitors, mail and associates as set forth in Section 603.1(3)(K), (L), and
(M);
j. Policy and procedures
regarding emergency treatment plans as set forth in Section 505 (l);
k. Policy and procedures for the relocation
of residents in cases of emergencies (e.g., natural disasters, or utility
outages)
l. 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.
504.1.1 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.
Personnel records for each employee shall be maintained and shall include, as a
minimum:
1. description of responsibilities
and work to be performed, and which shall be updated as they change;
2. minimal qualifications, to include
educational qualifications;
3.
evidence of credentials, including current professional licensure or
certification;
4. 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 making the call;
5. documentation of education, documentation
of continuing training, including orientation training and continuing education
units (CEUs) related to administration certification, personal care, food
management, etc. CEU documentation must include copies of the documentary
evidence of the award of hours by the certifying organization;
6. documentation of attendance at in-service
or on-the-job training, and orientation as required by the job
description;
7. employee?s signed
acknowledgement that he or she has received and read a copy of the Residents?
Bill of Rights;
8. results of the
criminal record check required by law or regulation.
c. Verification that employee is at least 18
years of age;
d. Documentation that
employees with communicable diseases, or with infected skin lesions, are
prohibited from direct contact with residents or with residents? food, if
direct contact will transmit the disease;
e. Verification that employee has not been
convicted or does not have a substantiated report of abusing or neglecting
residents or misappropriating resident property. The facility shall, at a
minimum, prior to employing any individual or for 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 Register maintained by the Department of Human Services, Division of
Aging and Adult Services, and shall conduct re-checks of all employees every
five(5) years. Inquires to the Adult Abuse Registry shall be made by submitting
a Request for Information form found in the Appendix, addressed to Adult
Protective Services Central Registry, P. O. Box 1437, Slot S540, Little Rock,
AR 72203;
f. Documentation that
all employees and other applicable individuals utilized by the facility as
staff have 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;
g. A
copy of a current health card issued by the Arkansas Department of Health or
other entities as provided by law;
h. 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;
i. Documentation that policies and procedures
developed for personnel about fire safety standards and evacuation of building
have been provided to the employee;
j. Documentation that policies and procedures
developed for smoking have been provided to the employee;
Failure to comply with the provisions of this subsection or
violation of any policies or procedures developed pursuant to this subsection
shall be a violation pursuant to Ark. Code Ann. §
20-10-205, and Ark. Code Ann.
§206, or may constitute a deficiency finding against the facility.
504.1.2 The facility
shall meet all regulations issued by the Arkansas Department of Health
regarding communicable diseases. Further, the facility must prohibit employees
with a communicable disease, or with infected skin lesions, from direct contact
with residents or with residents? food, if direct contact will transmit the
disease.
504.2
Required Staffing
504.2.1
Administrator
504.2.1.1 Each facility must designate a
full-time (40 hours per week) administrator.
The administrator must be on the premises during normal
business hours. The administrator has responsibility for daily operation of the
facility. Correspondence from the Office of Long Term Care to the facility will
be through the administrator. Sharing of administrators between assisted living
facilities and other types of long-term care facilities is permitted pursuant
to Section 504.2.1.4.
a. The
administrator shall not leave the premises housing the assisted living facility
during the day tour of duty without first designating an employee who will be
responsible for the management of the facility during the administrator?s
absence.
b. The facility
administrator shall notify the OLTC in writing if the administrator will be
absent from the facility for seven (7) or more consecutive calendar
days;
c. Each administrator will
provide to the OLTC, on an annual basis, a copy of his or her current
administrator certification. This submission must be every time when the
facility seeks licensure, renewal of licensure, or upon change of
ownership.
d. The facility may
employ an individual to act both as administrator and as the facility?s
registered nurse under Section 504.2.2. At no time may the duties of
administrator take precedence over, interfere with, or diminish the
responsibilities and duties associated with the registered nurse position. In
addition, when an individual is utilized or employed in a dual capacity to meet
the requirements of this section and Section 504.2.2:
1. The person employed in the dual capacity
must meet all licensing and certification requirements for both
positions;
2. The use of a
registered nurse as administrator does not remove or negate any requirements
for a criminal record check for either position;
3. A registered nurse also employed as an
administrator must meet the requirements of this section regarding remaining on
the premises of the facility; the provisions for same in Section 504.2.2 do not
apply.
504.2.1.2 All certifications must be current
as required by the certification agency. This submission shall be made each
time the facility seeks licensure, renewal of licensure, or upon a change of
administrators.
504.2.1.3 The
administrator must have the following minimum qualifications:
a. Must be at least 21 years of
age;
b. Must have a high school
diploma or have a GED;
c. Must have
the ability and agree to comply with these regulations;
d. 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;
e. Must not have been convicted, or have a
substantiated report, of abusing, neglecting, or mistreating persons, or
misappropriation of resident property. An inquiry with the Adult Maltreatment
Central Registry (form APS 0001), maintained by the Department of Human
Services, Division of Aging and Adult Services shall be checked prior to
employment;
f. Must have no prior
conviction pursuant to Ark. Code Ann. §
20-10-401, or relating to the
operation of a long term care;
g.
Must be certified as an Assisted Living Facility Administrator through a
certification program approved by the OLTC or must be enrolled in a
certification program with an expected completion date within four (4) months
of hire. Administrators who are not certified within this time period may no
longer work as an Assisted Living Facility Administrator.
504.2.1.4
Full time means
forty (40) hours per week during normal business hours.
Part time means twenty (20) hours or more, but
less than forty (40) hours, during normal business hours. When a structure or
building houses more than one type of long-term care facility, a single
administrator may be employed for all the long-term care programs housed within
that structure, building or premises, provided:
a. The person employed as administrator must
meet the qualifications for, and be currently licensed or certified as, an
administrator for each type of long-term care facility for which he or she will
act as administrator;
b. A second
administrator shall be employed part-time when:
1. The total number of beds for all long-term
care programs within the facility is more than seventy (70), and
2. The number of beds for each long-term care
program within the facility is more than twenty (20) per program;
c. A second administrator shall be
employed full-time when:
1. The total number
of beds for all long-term care programs within the facility is more than
seventy (70), and
2. The number of
beds for each long-term care program within the facility is more than forty
(40) per program.
504.2.2
Registered Nurse
(RN)
The facility shall employ or contract with at least one (1) RN.
The assisted living facility RN need not be physically present at the facility,
but must be available to the facility by phone or pager. Except for
participants of the Assisted Living 1915 (c) home and community based services
Medicaid Waiver, the assisted living facility RN shall be responsible for the
preparation, coordination, and implementation of the direct care services plan
portion of the resident?s occupancy admission agreement. An RN employed by the
Division of Aging and Adult Services and who works with the Assisted Living
1915 (c) Home and Community Based Services Medicaid Waiver Program shall be
responsible for Medicaid waiver participants? direct care services plan
portions of the occupancy admission agreement. The assisted living facility RN,
in conjunction with the physician, shall be responsible for the preparation,
coordination and implementation of the health care services plan portion of the
resident?s occupancy admission agreement and shall review and oversee all LPN,
CNA and PCA personnel. The assisted living facility RN may perform all job
functions and duties of LPNs, CNAs or PCAs. The RN must be licensed by, and in
good standing with, the Arkansas State Board of Nursing, and must comply with
all requirements, including continuing education requirements, as established
by law or regulation.
504.2.3
Licensed Practical Nurses
(LPN)
The facility shall employ or contract with LPNs to provide
nursing or direct care services to residents. LPNs may administer medication
and deliver nursing services as provided by Arkansas law or applicable
regulation. The LPN can perform all job functions and duties of a CNA or PCA.
All LPNs must be licensed by, and in good standing with, the Arkansas State
Board of Nursing, and must comply with all requirements, including continuing
education, as established by law or regulation.
504.2.4
Certified Nursing
Assistants (CNA)
The facility shall employ CNAs to provide direct care services
to residents. CNAs shall be permitted to perform the nurse aide duties set
forth in Part II, Unit VII of the Rules and Regulations governing Long Term
Care Facility Nursing Assistant Training Curriculum. These nurse aide duties
include taking vital signs (temperature, pulse, respiration, blood pressure,
height/weight); recognizing and reporting abnormal changes; death and dying and
admission/transfer/discharge. The CNA can perform all job functions and duties
of PCAs. All CNAs must be certified by, and in good standing with, the State of
Arkansas, and must comply with all requirements, including continuing
education, as established by law or regulation. No individual who is
uncertified may be employed as a CNA, with the exception of CNA Trainees. CNA
Trainees may be employed to perform those CNA duties for which they have
completed their CNA training, and have been determined competent by the CNA
program instructor. When utilizing CNA trainees, the facility shall have
verification on file that demonstrates each trainee?s competency to perform
assigned duties and shall utilize CNA trainees in the manner and for the time
permitted by Long Term Care Facility Nursing Assistant Training Program
regulations. For purposes of this section, competency means skills performance
approval by the trainee?s instructor.
504.2.5
Personal Care Aide
(PCA)
The facility may employ PCAs. Any PCA employed by the facility
to provide direct care services to residents must have:
a. Attended and successfully completed an
established curriculum for personal care aides; or,
b. Completed an established curriculum for
nurse aides but is not State certified.
504.3 To effectuate the intent of these
regulations, the assisted living facility shall develop a staffing plan to
ensure sufficient personnel/staff/employees are available to meet the needs of
the residents. A facility shall meet minimum staffing ratios set forth below at
all times, and shall utilize sufficient staff to meet each resident?s
particular direct care needs as agreed to and specified in the resident?s
direct care services plan portion of the occupancy admission agreement.
a. The facility administrator may be counted
as direct care staff on shifts on which he or she is not performing or required
to perform the duties of an administrator. The administrator must meet all
licensing or certification requirements for the duties that the administrator
is performing.
b. The facility
shall have as many personnel/staff/employees awake and on duty at all times as
may be needed to properly safeguard the health, safety, or welfare of the
residents. For purposes of these regulations,
on duty means
that the individual is on the premises of the facility, is awake, and is able
to meet residents? needs. Residents shall not be left unsupervised, as that
term is defined in subsection 601.3(a)(1). A minimum on-site staff-to-resident
ratio shall be one (1) staff person per fifteen (15) residents from 7:00 a.m.
to 8:00 p.m., and one (1) staff person per twenty-five (25) residents from 8:00
p.m. to 7:00 a.m., but in no event shall there be fewer than two (2) staff
persons on-duty at all times, one of which shall be a CNA. The facility shall
designate one staff member as the on-site manager outside normal business
hours. In addition to the staff requirements set forth above in this
subsection, facilities shall have an administrator on-site during normal
business hours, as required in Section 504.2.1.1. Staff persons who live on
site but are sleeping shall not be counted for minimum staffing. All needed
direct care staff may be PCAs, unless otherwise specified elsewhere in these
regulations.
Facilities may employ flex staffing. Flex
staffing permits facilities to vary the beginning and ending hours for shifts,
so that facilities may maximize staff time to the benefit of residents.
Facilities can designate that their shifts will begin earlier or later than
specified above.
When facilities utilize flex staffing, the shifts must meet the
staffing requirements set forth herein for the entire period of the
shift. As way of example only, if a facility begins a shift at 6:00
a.m., rather than 7:00 a.m. in the example above, the minimum staffing
requirement of one (1) staff person per fifteen (15) residents will be required
until 7:00 p.m., and those minimums must be maintained throughout the entire
period.
The Office of Long Term Care shall be notified in writing when
a facility implements a flex-staffing schedule. The written notice shall state
the beginning and ending hours of each shift under the flex staffing.
c. 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.
504.4 All
staff and contracted providers having direct contact with residents as well as
all food service personnel shall receive orientation and training on the
following topics within the time frames specified herein, provided, however,
that individuals employed and paid by the resident, resident?s family, or a
representative of the resident are exempt from this requirement:
a. Within seven (7) calendar days of hire:
1. Building safety and emergency measures,
including safe operation of fire extinguishers and evacuation of residents from
the building;
2. Appropriate
response to emergencies;
3 Abuse,
neglect, and financial exploitation and reporting requirements;
4. Incident reporting;
5. Sanitation and food safety;
6. Resident health and related
problems;
7. Medication assistance
or administration;
8. Resident
safety and fall prevention;
9.
Resident elopement policies and procedures;
10. General overview of the job?s specific
requirements;
11. Philosophy and
principles of independent living in an assisted living residence.
12. Residents? Bill of Rights;
b. Within thirty (30) calendar
days of hire:
1. Communicable diseases,
including AIDS or HIV and Hepatitis B; infection control in the residence and
the principles of universal precautions based on OSHA guidelines;
2. Dementia and cognitive
impairment;
c. Within
one hundred eighty (180) calendar days of hire:
1. Communication skills;
2. Review of the aging process and disability
sensitivity training.
504.4.1 All staff and contracted providers
having direct contact with residents and all food service personnel shall
receive a minimum of six (6) hours per year of ongoing education and training
to include in-service and on-the-job training designed to reinforce the
training set forth in Section 504.4(a)(b)(c).
504.5 Facility staff, administrators and
owners are prohibited from being appointed as, or acting as, guardian of the
person or the estate, or both, for residents of the
facility.
505
GENERAL REQUIREMENTS CONCERNING RESIDENTS
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 residents, or threatens the health,
safety, or welfare of the resident or other residents.
b. Make keys to residences readily available
to facility personnel in the event of an emergency need to enter a
residence.
c. 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 assisted living 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 residents or guests. Current records of inoculations and
license, as required by 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 occupancy admission
agreement.
d. Require that conduct
in the common areas shall be appropriate to the community standards as defined
by the residents and staff.
e.
Ensure that there shall be only one resident to an apartment or unit except in
situations where residents are husband and wife or are two consenting adults
who have voluntarily agreed in writing to share an apartment or unit that has
been executed by the resident or responsible party as appropriate. A copy of
the agreement shall be maintained by the facility in each resident?s
record.
f. Except in cases of
spouses, or consenting adults who have agreed otherwise in writing, ensure that
male and female residents do not have adjoining rooms that do not have full
floor to ceiling partitions and closable solid core doors.
g. Ensure that residents not perform duties
in lieu of direct care staff, but may be employed by the facility in other
capacities.
h. Ensure that
residents are not left in charge of the facility.
i. Ensure that a minimum of one phone jack is
available in each resident?s apartment or unit for the resident to establish
private phone service in his or her name. In addition, there shall be, at a
minimum, one dedicated facility phone and phone line for every forty (40)
residents in common areas. The phone shall allow unlimited local calling
without charge. Long distance calling shall be possible at the expense of the
resident or responsible party via personal calling card, pre-paid phone card,
or similar methods. Residents shall be able to make phone calls in private.
Private? can be defined as placing the phone in an area that is secluded and
away from frequently used areas.
j.
Ensure that residents are afforded the opportunity to participate in social,
recreational, vocational, and religious activities within the community, and
any activities made available within the facility.
k. Document that each resident has a
physician or advance practice nurse of his or her choice who is responsible for
the overall management of the resident?s health.
l. In the event of a resident?s illness or
accident:
1. Notify the resident?s responsible
party or next of kin and personal physician or advance practice nurse, or in
the event such physician or advance practice nurse is not available, a
qualified alternate. A competent resident may decline to have someone
contacted, if such a request is in writing and is filed in the resident?s
file;
2. Take immediate and
appropriate steps to see that the resident receives necessary medical attention
including transfer to an appropriate medical facility;
3. Make a notation of the illness or accident
in the resident?s records.
505.1
Financial Management of
Resident Personal Allowance
Each facility must provide for the safekeeping and
accountability of resident funds in accordance with this Section and Section
603.1(3)(N). A facility may not require the resident to deposit funds with the
facility.
505.1.1 The facility must
have written policies and procedures for the management of personal funds
accounts with an employee designated to be responsible for these accounts. In
addition, the facility shall ensure that:
a.
Each person receiving SSI shall have the opportunity to place personal funds in
an account. No fee shall be charged by the facility for maintaining these
accounts;
b. Persons who receive
SSI are entitled to retain an amount from their income for personal needs
consistent with federal requirements;
c. The facility shall hold personal funds in
trust for the sole use of the residents, and such funds must not be commingled
with the funds of the facility or used for any purpose other than for the
benefit of the resident;
d. The
personal funds shall be used at the discretion of the resident or responsible
party;
e. The resident may
terminate his or her facility-maintained account and receive the current
balance within seven (7) calendar days of the termination of the
account;
f. The facility maintains
individual records for each resident who has an account that shows all debits
and credits to the account, and that maintains a running, current
balance;
g. The facility documents
all personal transactions and maintains all paid bills, vouchers, and other
appropriate payment and receipt documentation in the manner prescribed by the
Department or by law;
h. If the
facility deposits personal allowance funds, they shall be deposited in
individual or collective interest bearing, federally insured bank accounts. If
these accounts are established, the facility must develop a procedure to insure
the equitable distribution of interest to each resident?s account;
i. At least quarterly, the facility supplies
each resident or responsible party who has a personal account with a statement
showing all deposits, withdrawals and current balance of the resident?s
personal allowance account;
j. The
facility provides the Department access to required resident financial records
upon request;
k. At a minimum, the
resident has access to his or her personal allowance account during the hours
of 9:00 a.m. to 5:00 p.m. Monday through Friday;
l. The facility does not charge the resident
additional amounts for supplies or services that the facility is by law,
regulation, or agreement required to provide under the basic charge;
m. Services or supplies provided by the
facility beyond those that are required to be included in the basic charge are
charged to the person only with the specific written consent of the resident or
his or her responsible party;
n.
Whenever a resident authorizes a facility to exercise control over his or her
personal allowance, such authorization is in writing and signed by the resident
or his or her responsible party, and the administrator of the facility or his
or her designee. Any such money shall not be commingled with the funds, or
become an asset, of the facility or the person receiving the same, but shall be
segregated and recorded on the facility?s financial records as independent
accounts.
505.1.2
Transfer of resident funds must meet the following requirements:
a. At the time of discharge from the assisted
living facility, the resident or his or her responsible party or agent shall be
provided a final accounting of the resident?s personal account and issued the
outstanding balance within seven (7) calendar days of the date of discharge
except as otherwise required by the Social Security Administration for
representative payees. If the resident is being transferred to another assisted
living facility or health care facility, the resident or responsible party
shall be given an opportunity to authorize transfer of the balance to a
resident account at the receiving facility except as otherwise required by the
Social Security Administration for representative payees;
b. Upon death of a resident, a final
statement of the account must be made and all remaining funds shall be
transferred to the resident?s estate, subject to applicable state
laws;
c. Upon change of ownership,
the existing owner must provide the new owner with a written statement of all
resident personal funds. This statement shall verify that the balance being
transferred in each resident fund account is true and accurate as of the date
of transfer;
d. At change of
ownership, the new owner must assume responsibility for account balances turned
over at the change of ownership together with responsibility for all
requirements of this Section, including holding of resident?s funds in
trust.
505.1.3 The
facility must maintain inventory records and security of all monies, property
or things of value that the facility agrees to store for the resident outside
of the resident?s apartment or unit and that the resident has voluntarily
authorized, in writing, the facility to hold in custody or exercise control
over at the time of admission or any time thereafter.
505.1.4 If a responsible party or payee fails
to pay an assisted living facility?s charges or to provide for the resident?s
personal needs, the facility shall notify the Department of Human Services,
Division of Aging and Adult Services, Adult Protective Services.
506
QUALITY ASSURANCE
The Assisted Living Facility shall develop and maintain a
quality assessment unit. The unit shall meet at least quarterly to identify
issues with respect to which quality assessment and assurance activities are
necessary, and to develop and implement appropriate plans of action to correct
identified quality deficiencies
The quality assessment unit shall consist of the individual or
individuals identified by the facility as having the ability to recognize and
identify issues of quality deficiencies and to implement changes to facility
and employee practices designed to eliminate identified issues of quality
deficiencies.
Good faith attempts by the unit to identify and correct quality
deficiencies will not be used as a basis for sanctions.
507
REPORTINGSUSPECTEDABUSE,NEGLECT,OR
MISAPPROPRIATION OF RESIDENT PROPERTY
Pursuant to Ark. Code Ann. §
12-12-1701
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 residents;
? Exploitation of residents or any misappropriation of resident
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.
507.1
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 gesturers, or
neglect to residents.
b. Any
alleged, suspected, or witnessed occurrence of misappropriation of resident
property or exploitation of a resident.
c. Any alleged, suspected, or witnessed
occurrences of sexual abuse to residents 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 507.5. Forms DMS-731 and DMS-742 are found in the
Appendix.
507.2
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 507.3, as applicable.
Facilities must maintain these incident report files in a manner that allows
verification of compliance with this provision.
a. Incidents where a resident attempts to
cause physical injury to another resident 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.
c. Loss of heating, air conditioning, or fire
alarm system for a period of greater than two (2) hours.
507.3
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 and DMS-742 as applicable.
All written reports will be reviewed, initialed, and dated by
the facility administrator or designee within five (5) days after
discovery.
1. All reports involving
accident or injury to residents will also be reviewed, initialed, and dated by
the facility registered nurse within five (5) days of the review by the
facility administrator.
2. The
direct care services and health care services plan portions of the occupancy
admission agreement shall be reviewed by the registered nurse and:
a. Shall be amended upon any change of a
resident?s condition or need for services;
b. Copies of the amended versions of the
direct care services and health care plan, or both of them, shall be attached
to the written report of the incident or accident.
Reports of incidents specified in Section 507.2 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.
507.4
Other Reporting
Requirements
The facility?s administrator or designee is also required to
make any other reports as required by state and federal laws and
regulations.
507.5
Abuse Investigation Report
The facility must ensure that all alleged or suspected
incidents involving resident abuse, exploitation, neglect, or misappropriations
of resident 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 administrator 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 re-submitted at any time circumstances require.
507.6
Reporting Suspected Abuse
or Neglect
The facility?s written policies and procedures shall include,
at a minimum, requirements specified in this section.
507.6.1 The requirement that the facility?s
administrator or his or her designated agent immediately reports all cases of
suspected abuse or neglect of residents of an assisted living facility 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.
507.6.2 The requirement that the facility?s
administrator or his or her designated agent report suspected abuse or neglect
to the Office of Long Term Care as specified in this regulation.
507.6.3 The requirement that all facility
personnel/staff/employees who have reasonable cause to suspect that a resident
has been subjected to conditions or circumstances that have resulted in abuse
or neglect are required to immediately notify the facility administrator 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
et
seq.
507.6.4 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.
507.6.5 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.
507.7 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 resident property against a resident, 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.
508
RESIDENT RECORDS
508.1 The assisted living facility must
maintain a separate and distinct record for each resident. The record must
contain:
a. Resident?s name;
b. Resident?s last address;
c. Date the resident began residing at the
facility;
d. Name, office telephone
number, and emergency telephone number of each physician or advance practice
nurse who treats the resident;
e.
Name, address, and telephone number of the responsible party, or if no
responsible party, the person who should be contacted in the event of an
emergency involving death of the resident;
f. All identification numbers such as
Medicaid, Medicare or Medipak, Social Security, Veterans Administration and
date of birth;
g. Any other
information that the resident requests the assisted living facility to keep on
record;
h. A copy of the resident?s
signed ?Residents? Bill of Rights? Statement;
i. A copy of the current occupancy admission
agreement that includes the resident?s direct care services plan, health care
services plan updated within the specified time frames and transfer/discharge
plan (when applicable);
j. On
admission, and each time there is a change in services provided the resident, a
written acknowledgement that the resident or his or her responsible party has
been notified of the charges for the services provided;
k. Information about any specific health
problem of the resident that might be necessary in a medical emergency. Such
records should specify any medication allergies. If none, state ?no known
allergies?;
l. A brief medical
history;
m. A list of all current
medications, including strength and dosage, kept by the facility for the
resident;
n. Name of the
resident?s or his or her responsible party?s preferred
pharmacy;
o. An entry shall be made
at any time the resident?s status changes or in the event of an unusual
occurrence. This documentation shall include:
1. Falls;
2. Illness;
3. Physician or advance practice nurse
visits;
4. Problem with staff
members or others;
5.
Hospitalization;
6. Physical injury
sustained;
7. Changes in the
resident?s mental or physical condition;
p. Copy of any compliance
agreement;
q. A copy of court
orders, letters of guardianship, or power of attorney if applicable;
r. Copy of advance directive, if
applicable;
s. Discharge
date.
508.2 The facility
must maintain the resident?s records in the following manner:
a. Each resident shall have the right to
inspect his or her records during normal business hours in accordance with
state and federal law;
b. The
facility must not disclose any resident records maintained by the facility to
any person or agency other than the facility personnel, the OLTC or the
Attorney General?s Office except upon expressed written consent of the resident
or his or her responsible party unless the disclosure is required by state or
federal law or regulation;
c. Each
facility must provide a locked file cabinet or locked room for keeping
resident?s medical, social, personal, and financial records;
d. The facility must maintain the original
records in an accessible manner for a period of five (5) years following the
death or discharge of a resident;
e. The original resident records shall be
kept on the facility premises at all times, unless removed pursuant to
subpoena.
f. In the event of a
change of ownership, the resident records shall remain with the
facility.
g. If the facility
closes, the resident records shall be stored by the owner of the facility
within the State of Arkansas for five (5) years.
h. The facility shall take reasonable actions
to protect the resident records from destruction, loss, or unauthorized
use.
600
ADMISSION, DISCHARGE AND TRANSFER
Ark. Code Ann. §
20-10-1005 provides for
involuntary and voluntary discharges. These regulations are supplemental to the
statute and if in conflict, the statute governs.
601
ADMISSIONS
601.1
Admission
Criteria
The Level II licensed assisted living facility shall not admit
any resident whose needs are greater than the facility is licensed to provide.
The assisted living facility shall not provide services to residents
who:
a. need 24-hour nursing
services;
b. are
bedridden;
c. have a temporary
(more than fourteen (14) consecutive days) or terminal condition unless a
physician or advance practice nurse certifies the resident?s needs may be
safely met by a service agreement developed by the assisted living facility,
the attending physician or advance practice nurse, a registered nurse, the
resident or his or her responsible party if the resident is incapable of making
decisions, and other appropriate health care professionals as determined by the
resident?s needs;
d. have transfer
assistance needs, including but not limited to assistance to evacuate the
facility in case of emergency, that the facility cannot meet with current
staffing;
e. present a danger to
self or others or engage in criminal activities.
601.2
Pre-Admission
Evaluation
Each applicant shall receive an initial evaluation completed by
the facility prior to admission to determine whether the resident?s needs can
be met by the assisted living facility, and the resident?s needs are not
greater than the facility is licensed to provide.
601.3
Occupancy Admission
Agreement
Prior to or on the day of admission, the assisted living
facility and the resident or his or her responsible party shall enter into an
occupancy admission agreement. For admissions due to emergency circumstances,
an individual shall enter into the assisted living facility as a provisional
placement with an occupancy admission agreement between the assisted living
facility and the individual or his or her responsible party in place within
thirty (30) calendar days of admission if it is determined the individual is
appropriate for admission into the assisted living facility. The agreement
shall be in writing and shall be signed by both parties. Each resident or his
or her responsible party, prior to the execution of the occupancy admission
agreement, shall have an opportunity to read the agreement. In the event that a
resident or his or her responsible party is unable to read the agreement,
necessary steps shall be taken to ensure communication of its contents to the
resident or his or her responsible party. The resident or his or her
responsible party shall be given a signed copy of the agreement, and a copy
signed by the resident or his or her responsible party, and assisted living
facility shall be retained in the resident?s record. The occupancy admission
agreement shall include, at a minimum, the following:
a. Basic core services that the assisted
living facility shall provide including, but not limited to:
1. 24-Hour Staff. The phrase 24-hour
staff does not require continuous, uninterrupted visual monitoring,
and does not place any responsibility with the facility for the conduct of a
resident who is away from the facility. This definition does not mean, and is
not intended to imply, that a facility is not responsible for any resident who
has eloped, as that term is defined in these regulations;
2. Assistance in obtaining emergency care
24-hours a day. This provision may be met with an agreement with an ambulance
service or hospital or emergency services through 911;
3. Assistance with social, recreational and
other activities;
4. Assistance
with transportation (this does not include the provision of
transportation;
5. Linen
service;
6. 3 meals a
day;
b. Direct Care
Services and Ancillary Services:
1. Services
identified by the resident or his or her responsible party that are not
included in the assisted living facility?s core services (see Section 601.3(a)
for basic core services) but are available in the facility on an additional fee
basis (see Section 700.1.3, Section 700.2.3, Section 700.3.3 and Section 903(i)
for examples of ancillary services on an additional fee basis) for which the
resident or his or her responsible party must sign a request that acknowledges
the additional cost and the services provided in the facility for that
additional cost;
2. Arrangements
for other services identified as needed by the resident or his or her
responsible party but are not available in the assisted living
facility;
c. Health Care
Services:
1. Health care services identified
as needed by the resident or his or her responsible party that are not included
in the assisted living facility?s basic core services but are available in the
facility on an additional fee basis, for which the resident or his or her
responsible party must sign a request that acknowledges the additional cost and
the services provided in the facility for that additional cost;
2. Arrangements for other health care
services identified as needed by the resident or his or her responsible party
but are not available in the assisted living facility;
d. Parameters for pets to include behavior
and health;
e. A current statement
of all:
1. Fees,
2. Daily, weekly or monthly
charges,
3. Any other services that
are available on an additional fee basis for which the resident or his or her
responsible party must sign a request acknowledging the additional cost and the
services provided for that charge;
All fees that a resident will be billed (basic core and other
fees) shall be disclosed in writing to the resident and made a part of the
occupancy admission agreement prior to the receipt of the services. If no prior
agreement is obtained, the services may not be billed to the resident or the
resident?s responsible party.
f. A statement that residents or their
responsible parties shall be informed, in writing, at least thirty (30) days
prior to general rate changes;
g.
The refund policy that addresses refund of advance payment(s) in the event of
transfer, death or voluntary or involuntary discharge. The facility shall
ensure, and the policy shall include, as a minimum, the following:
1. For a fourteen-day (14) period beginning
on the date of entry into a facility, the resident or his or her responsible
party shall have the right to rescind any contractual obligation into which he
or she has entered and receive a full refund of any moneys transferred to the
facility. If the resident entered the facility and received some benefit, the
charges of the services provided shall be prorated and payment made only for
the benefits conferred prior to the refund;
2. In the event of discharge for medical
reasons, the refund policy must address the resident?s need to maintain
on-going medical care and services, and for that reason, refunds shall be on a
pro-rata basis regardless of income source;
3. If, after the expiration of the
fourteen-day (14) period referenced in Section 601.3(g)(1) above, the resident
or his or her responsible party provides a ten (10) day notice, any applicable
refund shall be available the day the resident is discharged from the facility.
If the resident or his or her responsible party does not provide a ten (10) day
notice, any applicable refund will be available within ten (10) days of the
resident?s departure;
h.
Procedure for nonpayment of fees;
i. Whether the resident or his or her
responsible party chooses to ask the facility to accept responsibility for the
resident?s personal funds;
j.
Whether the resident shall assume responsibility for his own
medication;
k. The resident or his
or her responsible party?s authorization and consent to release medical
information as needed;
l.
Provisions for the continuous assessment of the resident?s needs, referral for
appropriate services as may be required if the resident?s condition changes and
referral for transfer or discharge if required due to a change in the
resident?s condition;
m. A
statement that a resident may not be required to perform services for the
assisted living facility except as provided for in the occupancy admission
agreement or a subsequent written agreement. A resident and the assisted living
facility may agree in writing that a resident will perform certain activities
or services in the facility if the resident volunteers or is compensated at or
above prevailing rates in the community. If a resident is compensated for
performance of certain activities to which the resident and the facility agree,
the resident shall have to undergo a criminal record check;
n. Conditions under which emergency transfers
or discharges shall be made and procedures for handling such transfers or
discharges;
o. Conditions or events
resulting in termination of the occupancy admission agreement;
p. Resident's or his or her responsible
party?s responsibilities;
q.
Written documentation of the resident's or his or her responsible party?s
preference regarding the formulation of an Advance Directive in accordance with
Arkansas law. If applicable, a copy of the resident?s Advance Directive shall
be available;
r. Copy of Compliance
Agreement (if applicable);
s.
Evidence that the resident or responsible party was provided a copy of the
facility Disclosure Statement, and annual updates upon revision of
Statement;
t. HIPAA authorization
forms, if any;
u. Documentation of
Options Counseling form;
v. Other
information as may be appropriate.
601.4
Retention
Conditions
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall
be permitted to remain in an assisted living facility if the resident?s
condition requires twenty-four (24) hour nursing care or other services that an
assisted living facility is not authorized by law to provide, and the care is
more than episodic as set forth in subsection (d) below. Further, this
prohibition applies even if the resident is willing to execute an agreement
relieving the facility of responsibility attendant to the resident?s continued
placement.
A diagnosis of Alzheimer?s or related dementia, standing alone,
shall not disqualify an individual from placement or residency in a Level II
Assisted Living Facility. However, if the individual with a diagnosis of
Alzheimer?s or related dementia requires twenty-four hour nursing care, and the
period of twenty-four (24) hour nursing care is more than episodic as set forth
in subsection (d), below, the individual cannot be admitted to, or remain a
resident of, a Level II Assisted Living Facility.
An assisted living facility may retain a resident whose
condition requires episodic, twenty-four (24) hour nursing care, or who becomes
incompetent or incapable of recognizing danger, summoning assistance, or
expressing need provided that the facility ensures all of the following:
a. That adequate oversight, protection and
services are provided for the person;
b. That the resident has a guardian or has an
agent with a current power of attorney, regardless of whether it is durable,
for health care or both. The power of attorney for health care must
substantially cover the person?s areas of incapacity to meet the requirement of
this subsection;
c. That both the
service agreement and compliance agreement, if required, is signed by the
guardian and the health care agent or the agent with power of attorney, if any;
and d. The retention is for a period of no more than ninety (90) days, with no
more than a total of two (2) ninety (90) day periods for a single resident in
any continuous twelve (12) month period.
602
INVOLUNTARY TRANSFER
OR DISCHARGE OF RESIDENT
Except in cases of provisional placements, in the event of
involuntary transfer or discharge of a resident, the assisted living facility
shall:
a. Discuss with the resident
the decision to transfer or discharge the resident;
b. Inform the resident of the reason for the
transfer or discharge;
c. Inform
the resident of any available alternative to the transfer or
discharge;
d. Provide a thirty (30)
day written notice of transfer or discharge, unless an immediate discharge is
required to ensure the welfare of the resident or the welfare of other
residents may be immediately affected or the conditions found in Ark. Code Ann.
§
20-10-1005(a)(1)
exist. The written notice shall contain, at a minimum:
1. The reason or reasons for the transfer or
discharge;
2. Except for a transfer
pursuant to Section 404.9, a statement of the resident?s right of
appeal;
3. Except for a transfer
pursuant to Section 404.9, a statement that an appeal must be made to the
Office of Long Term Care;
4. Except
for a transfer pursuant to Section 404.9, a statement that the notice of appeal
must be made within seven (7) calendar days of the written notice of transfer
or discharge to the resident.
e. In the event an immediate transfer or
discharge is required pursuant to the conditions set forth in Section 602(d),
the assisted living facility shall advise the resident or his or her
responsible party, and immediate arrangements shall be made based on the
written occupancy admission agreement to transfer or discharge such resident to
an appropriate facility.
f. Where
there is no responsible party or the responsible party is unwilling to act, the
assisted living facility shall notify the Department of Human Services? Adult
Protective Services for the county in which the assisted living facility is
located and other appropriate agencies when transfer assistance is
needed.
g. Provide a copy of
pertinent information that must include:
1.
Identifying information including social security number and Medicaid number if
there is one, and birth date;
2.
Responsible party contact information;
3. Summary of needs/problems including
medications, treatments and diagnosis;
4. Social history, if available;
h. Refund to the resident or his
or her responsible party any security deposit,
less appropriate deductions for damage or specific charges made
to the assisted living facility by or on behalf of the resident.
i. Document in the resident?s file
the reasons for the transfer or discharge.
Prior to making such transfer or discharge, the assisted living
facility shall:
1. Develop a transfer
or discharge plan consistent with the occupancy admission agreement;
2. Document in the resident?s file the
following:
A. The reason for the transfer or
discharge;
B. The strategies used,
if any, to prevent involuntary transfer or discharge;
C. The fact that the resident or his or her
responsible party was informed and the manner in which they were
informed;
D. The name, address, and
telephone number of the individual or location to which the resident is to be
transferred or discharged.
j. If it is determined that there is a
medical need for a transfer to another health care facility because the
assisted living facility cannot meet the resident?s needs, such transfers shall
be initiated promptly. The registered nurse shall be notified and shall ensure:
1. That the resident is receiving appropriate
care prior to transfer or discharge;
2. That discharge or transfer occurs in a
manner consistent with the medical needs of the resident including arrangements
for appropriate transportation.
602.1
Conditions of Termination
of the Occupancy Admission Agreement
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall
be permitted to remain in an assisted living facility if the resident?s
condition requires twenty-four (24) hour nursing care or other services that an
assisted living facility is not authorized by law to provide. See also Section
601.1. Further, this prohibition applies even if the resident is willing to
execute an agreement relieving the facility of responsibility attendant to the
resident?s continued placement. Subject to the foregoing, supplemental services
may be provided as an alternative to termination. In no event shall an assisted
living facility terminate an occupancy admission agreement if the resident or
his or her responsible party arranges for the needed services and any unmet
needs. Supplemental services may be provided by the resident?s family, facility
staff or private duty staff as agreed between the resident and the facility.
The occupancy admission agreement shall not be terminated except under one of
the following conditions:
a. By
written notification by either party giving the other party thirty (30)
calendar days written notice, provided, however, that if an emergency condition
exists whereby the continued residency of the resident will constitute
immediate jeopardy, a direct threat or the substantial risk of serious harm,
serious injury, impairment or death to other residents, the facility may
immediately discharge the resident. In such cases, the facility shall document
the nature of the emergency and the reasons why it could not permit the
continued residency of a resident, and shall provide a written statement of
discharge containing the reason for the discharge, and stating the right and
method to appeal the discharge;
b.
The resident?s mental or physical condition deteriorates to a level requiring
services that cannot be provided in a Level II assisted living
facility;
c. The resident?s
condition requires twenty-four (24) hour nursing care as defined in Section
300;
d. The resident?s behavior or
condition poses an immediate threat to the health or safety of self or
others;
e. The resident or his or
her responsible party refuses to cooperate in an examination by a physician or
advance practice nurse or licensed psychologist of his or her own choosing to
determine the resident?s health or mental status for the purpose of
establishing appropriateness for retention or termination;
f. The resident?s fees have not been paid,
provided the resident or his or her responsible party was notified and given
thirty (30) days to pay any deficiency;
g. The resident or his or her responsible
party refuses to enter into a negotiated compliance agreement, refuses to
revise the compliance agreement when there is a documented medical reason for
the need of a negotiated compliance agreement or revision thereto, or refuses
to comply with the terms of the compliance agreement (See Section 704,
Compliance Agreements);
h. Other
written conditions as may be mutually established between the resident or his
or her responsible party and the assisted living facility at the time of
admission or any time thereafter.
603
BILL OF
RIGHTS
603.1
Residents? Bill of Rights
1. Each assisted living facility must post
the Residents? Bill of Rights, as provided by the Department, in a prominent
place in the facility. The Residents? 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
Residents? Bill of Rights. Further, the facility shall prominently display the
contact information for the State Ombudsman?s office. A copy of the Residents?
Bill of Rights must be given to each resident in a manner and form
comprehendible to the resident or his or her responsible party.
2. A resident 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 resident 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
603.1(1)(2), each resident in the assisted living facility has the right to,
and the facility shall ensure that residents 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 resident 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
residents 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 resident?s
choice. The assisted living 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, sex, age, disability, marital
status, sexual orientation or source of payment. This means that the resident:
(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, and
(iii.) if protective measures are required,
has the right to designate a guardian or representative to ensure the right to
quality stewardship of his or her affairs to the extent permitted by
law;
G. Be provided a
safe and appropriate living environment;
H. Not be confined to his or her apartment or
bed;
I. Not be prohibited from
communicating in his or her native language with other residents or
personnel/staff/employees;
J. Be
permitted to complain about the resident?s care or treatment.
The complaint may be made anonymously or communicated by a
person designated by the resident. 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 resident who makes a
complaint or causes a complaint to be made;
K. Be allowed to receive and send unopened
mail, and the provider must ensure that the resident?s mail is sent and
delivered promptly;
L. Be allowed
communication, including personal visitation with any person of the resident?s
choice, including family members, representatives of advocacy groups, and
community service organizations;
M.
Be allowed to make contacts with the community and to achieve the highest level
of independence, autonomy, and interaction with the community of which the
resident is capable;
N. Be allowed
to manage his or her financial affairs. The resident may authorize in writing
another person to manage his or her money. The resident may choose the manner
in which his or her money is managed, including a money management program, a
representative payee program, a financial power of attorney, a trust, or a
similar method, as desired by the resident. The resident or his or her
responsible party must be given, upon request of the resident or his or her
responsible party, but at least quarterly, an accounting of financial
transactions made on his or her behalf by the facility should the facility
accept his or her written delegation of this responsibility to the facility in
conformance with state law. Further, if a facility agrees to manage residents?
funds, the facility shall indemnify and hold harmless the resident from any
loss of or theft of funds;
O. Be
allowed access to the resident?s records. Resident records are confidential and
may not be released without the resident?s or his or her responsible party?s
consent unless the release without consent is required by law;
P. Have the right and be allowed to choose
and retain a personal physician or advance practice nurse;
Q. Participate in the development of the
individual direct care services and health care services plan portions of his
or her occupancy admission agreement that describes the resident?s direct care
services and how the needs will be met;
R. Be given the opportunity to refuse medical
treatment or services after the resident 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;
S. Be allowed unaccompanied access
to a telephone;
T. Have privacy
while attending to personal needs, and a private place for receiving visitors
or associating with other residents, unless providing privacy would infringe on
the rights of other residents. The right applies to medical treatment, written
communications, telephone conversations, meeting with family, and access to
resident councils;
U. If married,
have the right to share an apartment or unit with his or her spouse even if the
spouse is not receiving services through the assisted living facility. In the
case of two consenting adults, if one or both is receiving services through the
assisted living facility, the couple shall have the right to share an apartment
or unit;
V. Be allowed to retain
and use personal possessions, including, but not limited to, clothing and
furnishings, as space permits. The number of personal possessions may be
limited for the health and safety of other residents;
W. Be allowed to determine his or her dress,
hairstyle, or other personal effects according to individual preference, except
the resident has the responsibility to maintain personal hygiene;
X. Be allowed to retain and use personal
property in his or her immediate living quarters and shall have a lockable
apartment or unit door;
Y. Be
allowed to refuse to perform services for the facility;
Z. Be informed by the assisted living
facility no later than the 30th day after admission:
(i.) whether the resident is entitled to
benefits under Medicare or Medicaid, and
(ii.) which items and services are covered by
these benefits, including items or services for which the resident may not be
separately charged;
AA.
Residents are discharged or transferred in conformity with Ark. Code Ann.
§
20-10-1005 and the provisions
governing transfer and discharge in these regulations.
BB. Be allowed to immediately leave the
assisted living facility, either temporarily or permanently, subject to
contractual or financial obligations as specified in Section
601.3(g);
CC. Have access to the
services of a representative of the State Long Term Care Ombudsman Program,
Arkansas Department of Human Services, Division of Aging and Adult
Services;
DD. Be allowed to execute
an advance directive or designate a guardian in advance of need to make
decisions regarding the resident?s health care should the resident become
incapacitated.
EE. 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 residents? property that occurs
during laundering or cleaning of the facility, the resident?s room, or the
resident?s property, excluding normal wear and tear.
700
SERVICES
An assisted living facility shall provide, make available,
coordinate, or contract for services that meet the care needs identified in the
direct care services and health care services plan portions of residents?
occupancy admission agreements, to meet unscheduled care needs of residents,
and to make emergency assistance available 24 hours a day, all in a manner that
does not pose an undue hardship on residents. An assisted living facility shall
respond to changes in residents? needs for services by revising the direct care
services or health care services plan portions of residents? occupancy
admission agreements, or both, and, if necessary, by adjusting its staffing
plan or contracting for services from other providers. If non-residents utilize
services of the assisted living facility, it must occur in a manner that does
not unduly disturb residents or deprive residents of timely access to
services.
Services are provided according to the direct care services or
health care services plan portions of residents? occupancy admission
agreements, or both, and may include, but are not limited to, homemaker,
attendant care, and medication oversight to the extent permitted under State
law. Services include 24-hour available staff to respond to residents? needs in
a way that promotes maximum dignity and independence and provides supervision,
safety and security. Other individuals or agencies may furnish care directly or
under arrangements with the assisted living facility. Such care shall be
supplemental to the services provided by the assisted living facility and does
not supplant, nor may be substituted for, the requirements of service
provisions by the facility.
Services are furnished to a person who resides in his or her
own apartment or unit that may include dually occupied units when both
occupants consent to the arrangement. Each apartment or unit shall be of
adequate size and configuration to permit residents to perform, with or without
assistance, all the functions necessary for independent living, including
sleeping; sitting; dressing; personal hygiene; storing, preparing, serving and
eating food; storage of clothing and other personal possessions; doing personal
correspondence and paperwork and entertaining visitors. Care provision and
service delivery must be resident-driven to the maximum extent possible and
treat each person with dignity and respect. Care must be furnished in a way
that fosters the independence of each resident.
Occasional or intermittent guidance, direction or monitoring,
or assistance with activities of daily living and social activities and
transportation or travel, as defined in these regulations, for residents to
keep appointments for medical, dental, social, political or other services or
activities shall be made available to residents.
The resident may be assisted in making arrangements to secure
community based health or other professional services, examinations and reports
needed to maintain or document the maintenance of the resident?s health, safety
and welfare.
700.1
Housekeeping and Maintenance
700.1.1 Each assisted living facility shall
establish and conduct a housekeeping and maintenance program, to ensure the
continued maintenance of the facility in good repair, to promote good
housekeeping procedures, and to ensure sanitary practices throughout the
facility.
700.1.2 The facility
shall have full responsibility to clean and maintain all common areas and shall
make no additional charge to the resident or third parties, including Medicaid,
for such services. The facility shall ensure that each resident or staff person
maintains the residents? living quarters in a safe and sanitary condition. If
the resident declines housekeeping services, the resident?s apartment or unit
shall not impact negatively on other apartments or units or common areas (e.g.,
odors, pests).
700.1.3 For those
residents who do not wish to clean their own apartment or unit, the facility
shall include this service as part of the service package either for free, or
for an additional fee basis and indicate such in the occupancy admission
agreement.
700.1.4 Each assisted
living facility, in addition to meeting applicable fire and building codes,
shall meet the following housekeeping and maintenance requirements:
a. All areas of the facility shall be kept
clean and free of lingering odors, insects, rodents and trash;
b. Each resident?s apartment or unit shall be
cleaned before use by another resident;
c. Corridors shall not be used for
storage;
d. Attics, cellars,
basements, below stairways, and similar areas shall be kept clean of refuse,
old newspapers and discarded furniture;
e. Polish used on floors shall provide a
non-slip finish;
f. The building(s)
and grounds shall be maintained in a clean, orderly condition and in good
repair;
g. The interior walls,
ceilings and floors shall be clean. Cracked plaster, peeling wallpaper or
paint, missing or damaged tiles and torn or split floor coverings shall be
promptly and adequately repaired or replaced;
h. Electric systems, including appliance,
cords, and switches, shall be maintained in compliance with state and local
codes;
i. Plumbing and plumbing
fixtures shall be maintained in compliance with state plumbing and gas codes
governing them at the time of construction or as applicable due to
renovations;
j. Ventilation,
heating, air conditioning and air changing systems shall be properly
maintained. All HVAC and gas systems shall be inspected at least every 12
months to ensure safe operation. Inspection certificates, where applicable,
shall be maintained for review;
k.
The building(s), grounds and support structures shall be free of breeding areas
for flies, other insects and rodents;
l. Entrances, exits, steps, and outside
walkways shall be maintained in safe condition, including removing or treating
snow and ice within a reasonable amount of time of its accumulation;
m. Repairs or additions shall meet current
codes.
700.2
Linen and Laundry Services
700.2.1 Each assisted living facility shall
offer laundry facilities or services to its residents.
700.2.2 Each assisted living facility shall
meet the following laundry service requirements:
a. Each assisted living facility shall have
laundering facilities unless commercial laundries are used. The laundry shall
be located in a specifically designed area that is physically separate and
distinct from residents? rooms and from areas used for dining and food
preparation and service. There shall be adequate rooms and spaces for sorting,
processing and storage of soiled material. Laundry rooms shall not open
directly into resident care area or food service area. Domestic washers and
dryers that are for the use of residents may be provided in resident areas,
provided they are installed in such a manner that they do not cause a
sanitation problem or offensive odors.
b. Laundry dryers shall be properly vented to
the outside;
c. The laundry room
shall be cleaned after each day?s use to prevent lint accumulation and to
remove clutter;
d. Portable heaters
or stoves, or either of them, shall not be used in the laundry area;
e. The laundry room shall be well lighted and
vented to the outside by either power vents, gravity vents or by outside
windows;
f. When facility staff is
performing laundry duties for the entire facility, resident?s clothing, kitchen
linens, and bed linens shall be washed separately. If linens, including
washable blankets, are not washed at a minimum temperature of 150 degrees
Fahrenheit, a disinfecting agent shall be used.
g. The facility shall be responsible, as part
of the services required under the basic charge, for providing laundry services
on all linens and supplies owned by the facility.
700.2.3 For those residents who do not wish
to launder their own personal items, the facility shall include this service as
part of the service package. The facility may provide this service for free, or
for an additional fee basis, and indicate as such in the occupancy admission
agreement.
700.3
Dietary Services
700.3.1 Required Facility Dietary
Services
700.3.2 As part of the
basic charge, each assisted living facility must make available food for three
(3) balanced meals, as specified in Section 601.3 (a)(6), 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. There
shall be no more than five (5) hours between breakfast and lunch and no more
than seven (7) hours between lunch and the evening meal. Variations from these
stated parameters may be permitted at the written request of the resident or
his or her responsible party or as directed by the resident?s personal
physician or advance practice nurse in writing. The facility shall retain
documentation stating the reason for the variance.
700.3.3 For those residents who wish to have
meals served in his or her apartment or unit, the facility shall include this
service as part of the service package, either for free, or for an additional
fee basis, and indicate as such in the occupancy admission agreement.
700.3.4 In the event that a resident 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 resident?s
personal physician or advance practice nurse and take appropriate action to
ensure the physician or advance practice nurse?s instructions are implemented.
If a resident chooses not to consume regular meals, this must be documented in
the resident?s service plan portion of the occupancy admission agreement. In
the event that the resident refuses to provide a written statement, the
facility shall document the refusal, as well as all contact with the resident?s
personal physician or advance practice nurse regarding the resident?s refusal
to eat.
700.3.5 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 State Department
of Health. Assisted living facilities attached to other licensed long term care
facilities may utilize the kitchen facilities of the attached long term care
facility, however, the assisted living facility shall ensure that the kitchen
facilities so utilized are adequate to meet the needs of the residents of the
assisted living facility.
700.3.6
Dietary personnel and universal workers shall wear clean clothing and hair
coverings while in the kitchen preparing or handling food.
700.3.7 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.
700.3.8 Food service personnel and universal
workers shall ensure that all food is prepared, cooked, served, and stored in
such a manner that protects against contamination and spoilage.
700.3.9 The kitchen and dining area must be
cleaned after each meal.
700.3.10
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.
700.3.11 Each assisted
living 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.
700.3.12 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.
700.3.13 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.
700.3.14 Fresh whole eggs shall not be
cracked more than 2 hours before use.
700.3.15 Hot foods should leave the kitchen
(or steam table) above 140 degrees Fahrenheit and cold foods at or below 41
degrees Fahrenheit.
700.3.16
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.
700.3.17 In facilities that have a
residential 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.
700.3.18 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.
700.3.19 Leftover foods placed in the
refrigerator shall be sealed, dated, and used or disposed of within 48
hours.
700.3.20
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.
700.3.21 Menus shall be posted on a weekly
basis. The facility shall retain a copy of the last month?s menus.
700.3.22 A therapeutic diet shall be planned
by a licensed dietician. The dietician should review any therapeutic dietetic
changes.
700.3.23 Each assisted
living facility shall make available a dietary manager, who is certified as
required by law or regulation, to prepare nutritionally balanced meal plans in
consultation with staff and residents or their responsible parties. A chef that
has documentation of graduation from a culinary school may also function as a
certified dietary manager.
700.4
Ancillary
Services
All ancillary services (both core services [Section 601.3(a)]
and any other ancillary services identified as wanted by the resident or his or
her responsible party to be provided by the facility at additional cost to the
resident or his or her responsible party [Section 700.1.3, Section 700.2.3 and
Section 700.3.3]) that are identified in the resident?s needs assessment or
evaluation and shall be included in the resident?s occupancy admission
agreement.
701
DIRECT CARE SERVICES
701.1 (a) Direct care services directly help
a resident with certain activities of daily living such as assistance with
mobility and transfers; hands-on or cuing assistance to a resident to eat meals
or food, grooming, shaving, trimming or shaping fingernails and toenails,
bathing, dressing, personal hygiene, bladder and bowel requirements, including
incontinence; and assistance with medication only to the extent permitted by
the state Nurse Practice Act and interpretations thereto by the Arkansas State
Board of Nursing.
701.1 (b) The
assisted living facility shall ensure the resident receives direct care
services in accordance with the services plan portion of the occupancy
admission agreement. Direct care services needs of all residents in the
facility shall be reviewed at least annually, and the services plan portion of
the occupancy admission agreement revised, if necessary.
701.1 (c) Revision of the services plan
portion of the occupancy admission agreement shall be revised within fourteen
(14) days upon any significant enduring change to the resident.
701.1.2 An initial needs assessment or
evaluation is to be completed for each resident to identify all needed direct
care
701.1.3 If the needs
assessment or evaluation indicates that the resident has general service needs,
a resident direct care services plan portion of the occupancy admission
agreement shall be developed. The resident?s direct care services plan portion
of the occupancy admission agreement shall include, but not be limited to, the
resident?s needs for assisted living facility services, including but not
limited to, assistance with activities of daily living (ADL).
701.1.4 If the resident does not have any
direct care service needs, a resident direct care services plan portion of the
occupancy admission agreement is not needed. However, the facility must
document how and where the evaluation was performed and that the resident does
not have any direct care service needs.
701.1.5 If the needs assessment or evaluation
indicates that the resident will need assistance with emergency evacuation,
arrangements for staff to provide this assistance shall be included in the
direct care services plan portion of the occupancy admission
agreement.
701.1.6 The resident or
his or her responsible party shall participate in and, if the resident or his
or her responsible party agrees, family members shall be invited to participate
in, the development of the resident direct care services plan portion of the
occupancy admission agreement. Participation shall be documented in the
resident?s record.
701.1.7 Direct
care staff may perform emergency or first-aid procedures as specified below:
1. Emergencies are defined as those measures
necessary to prevent death or trauma until such time that the resident can be
transported to the appropriate medical facility or treated by appropriate
medical personnel;
2. First-aid
measures will be defined as temporary procedures necessary to relieve trauma or
injury;
3. First-aid supplies shall
be available in the facility.
702
HEALTH CARE SERVICES
and HEALTH CARE SERVICES PLAN
702.1 The assisted living facility shall
ensure that the resident receives health care services under the direction of a
registered nurse in accordance with the health care services plan portion of
the occupancy admission agreement.
a. Each
resident shall be examined by a physician or by an advance practice nurse or by
a nurse practitioner or by a physician assistant within 60 days of admission
that shall be documented in the resident?s record.
b. The facility shall have at least one
registered nurse available at all times. Available, in this instance, shall
mean on call, capable of being reached by telephone or pager and capable of
appearing at the facility as required to meet residents? needs.
c. A registered nurse shall be responsible
for developing nursing policies and procedures and the coordination of all
health care services required in the resident?s health care services plan
portion of the occupancy admission agreement.
d. The facility shall ensure, at a minimum,
the following:
1. Assessment of the health
care services needs of all residents in the facility shall be performed
annually, except that those residents who have a health care services plan
portion of the occupancy admission agreement shall be reassessed quarterly and
revisions made as needed. The health care services plan portion of the
occupancy admission agreement shall be revised within fourteen (14) days upon
any significant enduring change to the resident;
2. Monitoring of the conditions of the
residents on a periodic basis;
3.
Notification of the registered nurse if there are significant changes in a
resident?s condition;
4. Assessment
of the resident?s need for referral to a physician or advance practice nurse or
community agencies as appropriate; and
5. Maintenance of records as
required.
e. In the
planning of health care services:
1. The
assisted living facility shall arrange for health care services to be provided
to residents as needed or ordered by the resident?s physician or advance
practice nurse and documented in the health care services plan portion of the
occupancy admission agreement.
2.
At the time of admission, arrangements shall be made between the assisted
living facility and the resident or his or her responsible party regarding the
physician or advance practice nurse and dentist to be called in case of illness
or the person to be called for a resident who, because of religious affiliation
or personal choice, is opposed to medical treatment, if any.
3. The initial health care assessment shall
be documented by the facility and shall be updated as required, in accordance
with professional standards of practice or upon a significant change of
condition. In no event shall the health care assessment be updated less
frequently than annually.
The resident?s physician or advance practice nurse shall be
notified of any significant change in the resident?s physical or psychological
condition and any intervention by the physician or advance practice nurse shall
be recorded. Intervention includes, but is not limited to, orders given by the
physician or advance practice nurse or documentation that the physician or
advance practice nurse did not issue an order after notice of the significant
change of condition. For purposes of documentation, the facility shall
document:
A. The name and address of
the physician or advance practice nurse whom the facility contacted;
B. The date and time of the notice to the
physician or advance practice nurse whom the facility contacted;
C. The information provided to the physician
or advance practice nurse whom the facility contacted, regarding the
significant change of condition; and,
D. The response of the physician or advance
practice nurse whom the facility contacted.
f. Residents or their responsible parties
shall be permitted free choice of physician or advance practice nurse and of
pharmacy. A facility may make a selection of a treating physician or advance
practice nurse or pharmacy only when the resident or his or her responsible
party is fully informed of his or her right of choice and waives that right in
writing. The facility shall maintain any written waives in the resident's
file.
702.2
Health Care Services
702.2.1 If the resident needs assessment or
evaluation indicates that the resident requires health care services, a written
health care service plan shall be completed and become a part of the resident?s
occupancy admission agreement within 30 days of the date of admission by a
registered nurse using an assessment instrument that meets the requirement of
Section 702.3 Based on the health care assessment, a written health care
service plan shall be developed as part of the resident?s occupancy admission
agreement. The health care service plan shall include, but not be limited to,
the following:
1. Orders for treatment or
services, medications and diet, if needed;
2. The resident?s needs and
preferences;
3. The specific goals
of treatment or services, if appropriate;
4. The time intervals at which the resident?s
response to treatment will be reviewed;
5. The measures to be used to assess the
effects of treatment.
702.2.2 Each resident health care assessment
shall include, at a minimum,
evaluation of the following:
1. Physical health, status and abilities,
including but not limited to:
a. Functional
limitations and capacities;
b.
Ability to self-administer medication;
c. Strengths, abilities and capacity for
self-care;
d. Disease
diagnosis;
e. Oral and dental
status;
f. Nutritional status and
needs;
g. Skin conditions; h.
Continence;
2. Mental
and emotional health, including but not limited to:
a. Mood and behavior patterns;
b. Ability to self-administer
medications;
c. Cognitive
patterns;
d. Strengths, abilities
and capacity for self-care;
3. Medications;
4. Social and leisure needs and
preferences;
5. Communication and
hearing patterns;
6. Visual
patterns;
7. Situations or
conditions that could put the resident at risk of harm or injury;
8. Frequency of monitoring that the
resident?s condition requires;
9.
Special treatment and procedures.
702.2.3 If the resident does not need a
health care service, a health care service plan does not have to be included in
the resident?s occupancy admission agreement. However, the facility must
document that the health care assessment was performed and that the resident
does not have any health care service needs.
702.2.4 Assessment of the health care
services needs of all residents in the facility shall be performed at least
annually, except that those residents who have a health care services plan
portion of the occupancy admission agreement shall be reassessed quarterly and
revisions made as needed. The health care services plan portion of the
occupancy admission agreement shall be revised within fourteen (14) days upon
any significant change to the resident.
703
Medications
703.1
Administration
703.1.1 Each assisted living facility must
have written policies and procedures to ensure that residents receive
medications as ordered. In-service training on facility medications policies
and procedures (see Sections 504.4(b)(1) and 504.4.1) shall be provided at
least annually for all facility personnel supervising or administering
medications.
703.1.2 Facilities
must comply with applicable state laws and regulations governing the
administration of medications and restrictions applicable to non-licensed
personnel/staff/employees. However, licensed nursing personnel (RN, LPN) may
administer medication in accordance with Sections 504.2.2 and 504.2.3 of these
regulations in cases in which the resident is assessed as being unable to
self-administer his or her medication. In such cases, the facility shall
document, and shall be responsible to ensure, that medications are administered
by licensed nursing personnel/staff/employees, and are administered without an
error rate greater than 5% (see 703.1.2.1).
703.1.2.1
Medication
Errorsa. The facility must
ensure that:
1. It is free of medication error
rates of five percent (5%) or greater; and
2. Residents are free of any significant
medication errors.
b.
Medication error means the observed preparation or administration of drugs or
biologicals which is not in accordance with:
1. Physician?s orders;
2. Manufacturer?s specifications (not
recommendations) regarding the preparation and administration of the drug or
biological; or,
3. Accepted
professional standards and principles which apply to professionals providing
services. Accepted professional standards and principles include the various
practice regulations in Arkansas, and current commonly accepted health
standards established by national organizations, boards, and councils.
Medication error rate means the percentage of both significant
and nonsignificant medication errors. Significant medication error means one
which causes the resident discomfort or jeopardizes his or her health and
safety. Whether a medication error is significant is determined by
consideration of the resident?s condition, the drug category, and the frequency
of the error. Non-significant medication error means a medication error that
does not meet the definition of a significant medication error.
c. Determining
medication error rate
The medication error rate is determined by dividing the number
of errors by the opportunities for errors and multiplying the result by 100,
and is expressed as Medication Error Rate = (Number of Errors Observed
/ the Opportunities for Errors) X 100. The Number of Errors
Observed is the total number of errors that the survey team observes,
both significant and non-significant. The Opportunities for Errors
includes all the doses the observed being administered plus the doses
ordered but not administered.
703.1.3 The facility shall document in the
resident?s record whether the resident or the facility is responsible for
storing the resident?s medication.
703.1.4 The facility shall document in the
resident?s record whether the resident will self-administer medication or the
facility will administer medication to the resident.
703.1.5 Residents who have been assessed to
manage their medications must be familiar with their medications and comprehend
administration instructions.
703.1.6 Facility staff shall provide
assistance to enable residents to manage their medications. For clarification,
examples for acceptable practices are listed below:
1. The medication regimen on the container
label may be read to the resident;
2. A larger sterile or disposable container
may be provided to the resident if needed to prevent spillage. The containers
shall not be shared by residents.
3. The resident may be reminded of the time
to take the medication and be observed to ensure that the resident follows the
directions on the container;
4.
Facility staff may assist residents in the management of their medications by:
a. taking the medication in its container
from the area where it is stored and handing the container with the medication
in it to the resident.
b. In the
presence of the resident, facility staff may remove the container cap or loosen
the packaging. If the resident 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 resident, may assist the resident in
removing oral medication from the container and in taking the
medication.
c. If the resident 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
resident;
703.1.7 Changes in dosage or schedule of the
medication shall be made only upon the authorization of the resident?s
physician or advance practice nurse. This regulation is not applicable to
residents who manage their own medications.
703.2
Medication
Storage703.2.1 All medications
stored for residents by the facility must be stored in a locked area or a
locked medication cart labeled with the resident?s name. Provided, however,
that if the resident administers his or her own medication, the resident shall
have access to his or her medication.
703.2.2 Medications may be kept in the
residents? apartments or units. Prior to a resident being permitted to keep
medications in his or her apartment or unit, the facility shall:
a. Assess the resident to determine the
resident?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 or
facility employees;
b.
Document the assessment in the resident?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 resident?s ability to
understand and follow prescription or label directions and
instructions;
c. Assess
all residents to determine whether any resident may be at risk of taking, or
introducing into their system, medications kept in the room of another
resident. In the event that any resident is found to be at risk due to
medications being kept in an unsecured room, the facility shall take actions to
protect the resident, including but not limited to, requiring that medications
be kept in a locked container in residents? rooms or that the rooms of
residents keeping medication in their rooms be locked.
d. Residents who have been assessed and are
able to manage their own medications may determine which medications they will
keep in their rooms to self-administer and which if any, they will request the
facility to store. The assessment shall be documented in the residents
occupancy admission agreement.
After the initial assessment, facilities shall perform
reassessments as needed, including upon changes of conditions of residents, and
shall perform the steps outlined in subsections (a) through (c), above. Failure
to assess or reassess, or to identify residents 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 reassess, or to
identify residents at risk of harm from medications in unsecured locations or
rooms, shall constitute a deficient facility practice.
703.2.3 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.
703.2.4 All drugs on the
premises of the facility shall be labeled in accordance with accepted
professional principles and practices.
703.2.5 Prescriptive medications must be
properly labeled in accordance with current applicable laws and regulations
pertaining to the practice of pharmacy.
703.2.6 All medications in the control or
care of the facility shall have an expiration date that is not
expired.
703.2.7 Medications must
be individually labeled with the resident?s name and kept in the original
container unless the resident or responsible party transfers the medication
into individual dosage containers. Under no circumstances may an owner or
personnel of the facility repackage medication.
703.2.8 Any medication that is stored by the
facility that has been prescribed for but is no longer in use by a resident
must be destroyed or disposed of in accordance with state law or may be given
to the resident?s family in accordance with this section. Any medication stored
by the facility that has been placed on hold status by the resident?s physician
or advance practice nurse may be transferred to a locked medication cabinet in
a locked office for future use by the resident. Upon physician notice to resume
the mediation, all current medication labeling must be in accordance with
703.2.5
Scheduled II, III, IV and V drugs dispensed by prescription for
a resident and no longer needed by the resident must be delivered in person or
by registered mail to: Drug Control Division, Arkansas Department of Health,
along with the Arkansas Department of Health?s Form (PHA-DC-1) Report of Drugs
surrendered for Disposition According to Law. When unused portions of
controlled drugs go with a resident who leaves the facility, the person who
assumes responsibility for the resident 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 resident is discharged,
transferred or visits home.
All other medications not taken out of the facility when the
resident leaves the facility shall be destroyed or returned in accordance with
law and applicable regulations.
703.2.9 Under no circumstance will one
resident?s medication that is under the facility?s control be shared with
another resident.
703.2.10 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.
703.2.11 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, the cart must be:
1. In a
locked room when the cart is not in use and the unit contains controlled
drugs;
2. When the cart is in use,
the facility shall ensure that the cart remains in the observation of staff
utilizing the cart, and that residents 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.
703.2.12 In all cases in which the
facility destroys drugs, destruction shall be made by a nurse, and witnessed by
a non-licensed employee. A record shall be made of the date, quantity,
prescription number and name, resident?s name, and strength of the medication.
Destruction shall comply with state 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.
703.2.13 Reporting Misappropriation of
controlled Substances. Reporting misappropriation of controlled substances
shall be in accordance with the Arkansas Department of Health Pharmacy Services
Branch rules and regulations.
703.3
Medication
Charting
703.3.1 If a facility
stores a resident?s medications, the facility shall maintain a list of those
medications.
703.3.2 If the
facility stores and supervises a resident?s medication, a notation must be made
on the individual record for each resident who refuses, either through
affirmative act, omission, or silence, or is unable, to self-administer his or
her medications. The notation shall include the date, time and dosage of
medication that was not taken or administered to or by the resident, including
a notation that the resident?s attending physician or advance practice nurse
was notified, as required by physician or advance practice nurse?s
orders.
703.3.3 If medications are
prescribed to be taken as needed (PRN) by the resident, documentation in the
resident?s file should list the medication, the date and time received by the
resident and the reason given.
703.3.4 A record shall be maintained in a
bound ledger book, in ink, with consecutively numbered pages, of all controlled
drugs procured or administered. The record shall contain:
1. Name, strength and quantity of
drug;
2. Date received and date,
time and dosage administered;
3.
Name of the resident for whom the drug was prescribed, or 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 administering the drug.
703.3.5 When a dose of a controlled drug,
managed by the facility, 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.
703.3.6
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 703.3.4 above.
703.3.7 Medication administered by the
facility shall be recorded in each resident's medical record no less than once
each shift in which the medication is administered. 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.
703.3.8
Cycle Fill and Change of Condition
Only oral solid medications may be cycle-filled. Provided,
however, that if an oral solid medication meets one of the categories below,
then that oral solid medication may not be cycle-filled.
a. PRN or ?as needed? medications
b. Controlled drugs (CII ? CV)
c. Refrigerated medications d.
Antibiotics
e. Anti-infectives
An assisted living facility shall notify the pharmacy in
writing of any change of condition or circumstance that affects the medication
status of a resident. For purposes of this section, change of condition
or circumstance includes death, discharge or transfer of a resident,
change of pharmacy, as well as medical changes of condition or circumstance
that necessitate a change to the medication prescribed or the dosage given. The
notification shall be made within twenty-four (24) hours of the change of
condition or circumstance. If the notification would occur after 4:30 p.m.
Monday through Friday, or would occur on a weekend or holiday, the facility
shall notify the pharmacy by no later than 11:00 a.m. the next business day.
Documentation for drugs ordered, changed or discontinued shall be retained by
the facility for a period of no less than fifteen (15) months.
When a resident is transferred or enters a hospital, the
assisted living facility shall hold all medication until the return of the
resident, unless otherwise directed by the authorized prescriber. All continued
or reordered medications will be placed in active medication cycles upon the
return of the resident. If the resident does not return to the assisted living
facility, any medications held by the assisted living facility shall be placed
with other medications or drugs for destruction as described in Section
703.2.10 or return as permitted by State Board of Pharmacy regulations.
703.4
PHARMACEUTICAL SERVICES
703.4.1
Responsibility for
Pharmacy Compliance
The administrator shall be responsible for full compliance with
Federal and State laws governing procurement, control and administration of all
drugs. Full compliance is expected 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 and all amendments to it and these rules and
regulations.
Each facility shall contract with, or otherwise employ, a
consultant pharmacist. For purposes of these regulations, consultant
pharmacist means an individual licensed or certified by the Arkansas
State Board of Pharmacy as a Consultant Pharmacist in Charge.
The consultant pharmacist shall, at least quarterly per
year:
1. Review the methods employed
by the facility to store, label, distribute, administer and safeguard all
medication. The consultant pharmacy shall prepare a written report to the
facility detailing:
a. Any areas in which the
consultant pharmacist determines that the methods employed by the facility are
deficient, or have the potential to adversely affect the health, safety or
welfare of residents; and
b. The
recommended alterations to the methods, or additions to the methods, to correct
any methods determined by the consultant pharmacist to have the potential to
adversely affect the health, safety or welfare of residents.
2. Review all orders for
medication prescribed since the last review and prepare a report to the
facility detailing:
a. All instances in which
medication has been improperly prescribed or administered; and
b. Instances in which, in the opinion of the
consultant pharmacist, the facility should seek physician review of the number
or types of prescribed medications for residents.
The facility shall retain the consultant pharmacist?s reports
for a period of eighteen (18) months or until the facility review, whichever is
the longer period.
703.4.2
Prescriptions On
Individual Basis
All drugs prescribed for each resident shall be on an
individual prescription basis. Medications prescribed for one resident shall
not be administered to another resident.
703.5
Influenza Immunization of
Residentsa. The facility shall
ensure that all Medicare-eligible residents receive annual influenza
immunizations except when:
1. Objection is
made on religious grounds; or,
2.
Immunization is medically contra-indicated.
b. The facility shall record the following
information:
1. The name of the
resident;
2. The date that the
immunization occurred;
3. The
exception applicable to each resident who was not immunized.
c. The facility shall place the
documentation in each resident?s medical chart and retain the record in the
same manner, and for the same time period, as medical records.
704
COMPLIANCE AGREEMENTS
The Level II licensed assisted living facility shall not admit
any resident whose needs are greater than the facility is licensed to provide.
The assisted living facility shall not provide services to residents
who:
a. need 24-hour nursing
services;
b. are
bedridden;
c. has a temporary (more
than fourteen (14) consecutive days) or terminal condition unless a physician
or advance practice nurse certifies the resident?s needs may be safely met by a
service agreement developed by the assisted living facility, the attending
physician or advance practice nurse, a registered nurse, the resident or his or
her responsible party if the resident is incapable of making decisions, and
other appropriate health care professionals as determined by the resident?s
needs;
d. have transfer assistance
needs that the facility cannot meet with current staffing;
e. present a danger to self or others or
engages in criminal activities.
The choice and independence of action of a resident may need to
be limited when a resident?s individual choice, preference, or actions, are
identified as placing the resident or others at risk, lead to adverse outcomes,
or violate the norms of the facility or program or the majority of the
residents, or any combination of these events.
No resident shall be permitted to remain in an assisted living
facility if his or her condition requires twenty-four (24) hour nursing care or
other services that a Level II assisted living facility is not authorized by
law or these regulations to provide. This prohibition applies even if the
resident is willing to execute an agreement relieving the facility of
responsibility attendant to the resident?s continued placement.
When the resident evaluation indicates that there is a high
probability that a choice or action of the resident has resulted or will result
in any of the outcomes of placing the resident or others at risk, leading to
adverse outcomes, violating the norms of the facility or program or the
majority of the residents, or any combination of the events, the assisted
living facility shall:
1. Identify the
specific concern(s);
2. Provide the
resident or his or her responsible party (and if the resident agrees, the
resident?s family) with clear, understandable information about the possible
consequences of his or her choice or action;
3. Negotiate a compliance agreement with the
resident or his or her responsible party that will minimize the possible risk
and adverse consequences while still respecting the resident?s preferences.
Nothing in this provision requires a facility to successfully negotiate a
compliance agreement;
4. Document
the process of negotiation and, if no agreement can be reached, the lack of
agreement and the decisions of the parties involved.
Any compliance agreements negotiated, or attempted to be
negotiated, with the resident or his or her responsible party shall address the
following areas in writing:
1.
Consequence to resident ? any situation or condition that is or should be known
to the facility that involves a course of action taken or desired to be taken
by the resident contrary to the practice or advice of the facility and could
put the resident at risk of harm or injury;
2. The probable consequences if the resident
continues the choice or action identified as a cause for concern;
3. The resident or his or her responsible
party?s preference concerning how the situation is to be handled and the
possible consequences of action on that preference;
4. What the facility will and will not do to
meet the resident?s needs and comply with the resident?s preference to the
identified course of action;
5.
Alternatives offered by the assisted living facility or resident or his or her
responsible party to reduce the risk or mitigate the consequences relating to
the situation or condition;
6. The
agreed-upon course of action, including responsibilities of both the resident
or his or her responsible party and the facility;
7. The resident or his or her responsible
party?s understanding and acceptance of responsibility for the outcome from the
agreed-upon course of action and written proof that the resident or his or her
responsible party is making an informed decision, free from coercion, and that
the refusal of the resident or his or her responsible party to enter into a
compliance agreement with the facility, or to revise the compliance agreement
or to comply with the terms of the compliance agreement may result in discharge
from the facility;
8. The date the
agreement is executed and, if needed, the timeframes in which the agreement
will be reviewed.
A copy of the compliance agreement shall be provided to the
resident or his or her responsible party, and the original shall be placed in
the resident?s record at the time it is implemented.
800
ALZHEIMER?S SPECIAL CARE UNITS - DEFINITIONS
For the purposes of these regulations the following terms are
defined as follows:
a.
Activities of Daily Living (ADL?s): Ambulating, toileting,
grooming, eating, bathing, or dressing.
b.
Advertise: To make publicly
and generally known. For purposes of this definition,
advertise
includes, but is not limited to:
1.
Signs, billboards, or lettering;
2.
Electronic publishing or broadcasting, including the use of the Internet or
email; and
3. Printed
material.
c.
Alzheimer?s Special Care Unit: A separate and distinct unit within
a Long Term Care facility that segregates and provides a special program for
residents with a diagnosis of probable Alzheimer?s disease or related dementia;
and that advertises, markets or otherwise promotes the facility as providing
specialized Alzheimer?s or related dementia care services.
d.
Alzheimer?s Disease: An
organic, neurological disease of the brain that causes progressive degenerative
changes.
e.
Common Areas:
Portions of the Alzheimer's Special Care Unit, exclusive of residents?
rooms and bathrooms. Common areas include any facility grounds accessible to
residents of the Alzheimer's Special Care Unit (ASCU).
f.
Continuous: Available at all
times without cessation, break or interruption.
g.
Dementia: A loss or decrease
in intellectual ability that is of sufficient severity to interfere with social
or occupational functioning; it describes a set of symptoms such as memory
loss, personality change, poor reasoning or judgment, and language
difficulties.
h.
Department:
Department of Human Services (DHS), Division of
Medical Services (DMS), or Office of Long Term Care
(OLTC)
i.
Direct Care
Staff: An individual, such as a nurse or a certified Nurse's
Aide, who is an employee of the facility or who is an employee
of a temporary agency assigned to work in the facility, and who has received,
or will receive, in accordance with these regulations, specialized training
regarding Alzheimer's or related dementia, and is responsible for providing
direct, hands-on care or services to residents in the ASCU.
j.
Disclosure Statement: A
written statement prepared by the facility and provided to individuals or their
responsible parties, and to individuals families, prior to admission to the
unit, disclosing form of care, treatment, and related services especially
applicable or suitable for the ASCU. The disclosure statement shall be approved
by the Department prior to use, and shall include, but not be limited to, the
following information about the facility?s ASCU:
1. The philosophy of how care and services
are provided to the residents;
2.
The pre-admission screening process;
3. The admission, discharge and transfer
criteria and procedures;
4.
Training topics, amount of training time spent on each topic, and the name and
qualification of the individuals used to train the direct care staff;
5. The minimum number of direct care staff
assigned to the unit each shift;
6.
A copy of the Residents' Rights;
7.
Assessment, Individual Support Plan & Implementation. The process used for
assessment and establishment of the plan of care and its implementation,
including the method by which the plan of care evolves and is responsive to
changes in condition;
8. Planning
and implementation of therapeutic activities and the methods used for
monitoring; and
9. Identification
of what stages of Alzheimer?s or related dementia for which the unit will
provide care.
k.
Facility: A Level II Assisted Living Facility that houses an
ASCU.
l.
Individual
Assessment Team:A group of individuals possessing the knowledge and
skills to identify the medical, behavioral, and social needs of a resident and
to develop services designed to meet those needs m.
Individual Support
Plan: A written plan developed by an Individual Assessment Team (IAT)
that identifies services to a resident. The plan shall include and identify
professions, disciplines and services that:
1.
Identifies and states the resident?s medical needs, social needs, disabilities
and their causes;
2. Identifies the
resident's specific strengths;
3.
Identifies the resident's specific behavioral management needs;
4. Identifies the resident?s need for
services without regard to the actual availability of services;
5. Identifies and quantifies the resident's
speech, language, and auditory functioning;
6. Identifies and quantifies the resident's
cognitive and social development; and,
7. Identifies and specifies the independent
living skills, and other services, provided by the facility to meet the needs
of the resident.
n.
Nursing Personnel: Registered or Licensed Practical nurses who
have specialized training or will undergo specialized training, in accordance
with these regulations, by the Alzheimer's Special Care Unit.
o.
Responsible Party: An
individual, who, at the request of the applicant or resident, or by appointment
by a court of competent jurisdiction, agrees to act on behalf of a resident or
applicant for the purposes of making decisions regarding the needs and welfare
of the resident or applicant. These regulations, and this definition, does not
grant or permit, nor should be construed as granting or permitting, any
individual authority or permission to act for, or on behalf of, a resident or
applicant in excess of the authority or permission granted by law. A competent
resident may select a responsible party or may choose to not select a
responsible party. In no event may an individual act for, or on behalf of, a
resident or applicant when the resident or applicant has a legal guardian,
attorney-in-fact, or other legal representative. For purposes of these
regulations only, responsible party will also refer to the terms legal
representative, legal guardian, power of attorney or similar
phrase.
801
GENERAL
ADMINISTRATION
a.
Miscellaneous
1. Visitors shall be permitted
at all times. However, facilities may deny visitation when visitation results,
or substantial probability exists that visitation will result, in disruption of
service to other residents, or threatens the health, safety, or welfare of the
resident or other residents.
2.
Birds, cats, dogs, and other animals may be permitted in the Alzheimer?s
Special Care Unit. Animals shall have appropriate vaccinations and licenses. A
veterinary record shall be kept on all animals to verify vaccinations and be
made readily available for review. Pets may not be allowed in food preparation,
food storage or dining or serving areas.
3. Unmarried male and female residents shall
not be housed in the same room unless either residents or their responsible
parties have given authorized consent.
b. General Program Requirements
1. Each long-term care facility that
advertises or otherwise holds itself out as having one (1) or more special
units for residents with a diagnosis of probable Alzheimer's disease or a
related dementia shall provide an organized, continuous 24-hour-per-day program
of supervision, care and services that shall:
A. Meet all state, federal and ASCU
regulations.
B. Requires the full
protection of residents' rights;
C.
Promotes the social, physical and mental well-being of residents;
D. Is a separate unit specifically designed
to meet the needs of residents with a physician?s diagnosis of Alzheimer?s
disease or other related dementia; and
E. Provides 24-hour-per-day care for those
residents with a dementia diagnosis, and meets all admission criteria
applicable for that particular long-term care facility.
2. Documentation shall be maintained by the
facility and shall include, but not be limited to, a signed copy of all
training received by the employee.
3. Provide for relief of direct care
personnel to ensure minimum staffing requirements are maintained at all
times.
4. Upon request, make
available to the Department payroll records of all staff employed during recent
pay periods.
5. Nursing,
direct-care, or personal care staff shall not perform the duties of cooks,
housekeepers, or laundry personnel during the same shift they perform nursing,
direct-care or personal care duties.
6. Regardless of other policies or procedures
developed by the facility, the ASCU will have specific policies and procedures
regarding:
A. Facility philosophy related to
the care of ASCU residents;
B. Use
of ancillary therapies and services;
C. Basic services provided;
D. Admission, discharge, transfer;
and
E. Activity
programming.
c. Residents' Rights
For the purposes of these regulations, Resident?s Rights are
those rights set forth in the Department?s numbered memorandum
LTC-M-89-03.
d. Resident
Record Maintenance
The ASCU shall develop and maintain a record-keeping system
that includes a separate record for each resident, and that documents each
resident?s health care, individual support plan, assessments, social
information, and protection of each resident?s rights.
e. Resident Records
The ASCU must follow the facility?s policies and procedures,
and applicable state and federal laws and regulations governing:
1. The release of any resident information,
including consent necessary from the client, parents or legal
guardian;
2. Record
retention;
3. Record maintenance;
and,
4. Record content.
802
ASSESSMENTS
a.
Psychosocial and Physical Assessments
1. Each
resident shall receive a psychosocial and physical assessment which includes
the resident?s degree or level of family support, level of activities of daily
living functioning, cognitive level, behavioral impairment, and that identifies
the resident?s strengths and weaknesses.
2. Prior to admission to the ASCU, the
applicant must be evaluated by, and have received from a physician, a diagnosis
of Alzheimer?s or related dementia.
b. Individual Assessment Team (IAT)
1. Within 30 days after admission, the IAT
shall prepare for each resident an individual support plan. The ISP shall
address specific needs of, and services required by, the resident resulting
from the resident?s Alzheimer?s disease or related dementia.
2. The IAT shall perform accurate assessments
or reassessments annually, and upon a significant change to a resident?s
physical, mental, emotional, functional, or behavioral condition or status in
which the resident:
a. Is regressing in, or
losing skills, already gained
b. Is
failing to progress toward or maintain identified objectives in the
ISP
c. Is being considered for
changes in the resident?s ISP
c. Individual Support Plan (ISP)
1. The ISP shall include a family and social
history. If the family and social history is unavailable, the ASCU personnel
shall document attempts to obtain the information, including but not limited
to, the names and telephone numbers of individuals contacted, or whom the
facility attempted to contact, and the date and time of the contact or
attempted contact.
2. Individual
support plans shall be developed and written by the IAT and signed by each
member of the team.
3. Individual
support plans shall have the input and participation of the resident or his or
her responsible party, and the resident?s family. If the resident's family or
responsible party cannot be contacted, or refuses to participate, the facility
shall document all attempts to notify the resident?s family or legal
representative. The documentation shall include, but not be limited to, the
names and telephone numbers of individuals contacted, or whom the facility
attempted to contact, and the date and time of the contact or attempted
contact.
4. The ISP shall be
reviewed, evaluated for its effectiveness, and updated at least quarterly, and
shall be updated when indicated by changing needs of the resident, or upon any
reassessments by the IAT. In the event that the reassessment by the IAT
documents a change of condition for which no change in services to meet
resident needs are required, the ISP shall document the change of condition,
and the reason or reasons why no change in services are required.
5. The ISP shall include:
A. Expected behavioral outcomes;
B. All barriers to expected
outcomes;
C. Services, including
frequency of delivery, designed to achieve expected behavioral
outcomes;
D. Methods of assessment
and monitoring. Monitoring shall occur no less than quarterly to determine
progress toward the outcome; and,
E. Documentation of results from services
provided, and achievement towards expected outcomes or regression, and reasons
for the regression.
F. The
resident?s likes, dislikes, and if appropriate, his or her choices.
6. A copy of the ISP shall be made
available to all staff that work with the resident, and the resident or his or
her responsible party.
7. The ISP
shall be implemented only with the documented, written consent of the resident
or his or her responsible party.
803
STANDARDS FOR
ALZHEIMER?S SPECIAL CARE UNITS
a. General Requirements
1. It is the intent of these regulations that
Alzheimer?s Special Care Units shall be designed to accommodate the complex and
varied needs of residents with dementia. The physical environment does not
exist in isolation, but interacts with the activity program, level of resident
capability, staffing and social milieu of the unit.
2. The environment shall be designed and
developed to meet the following objectives:
A.
Maximize awareness and orientation;
B. Ensure safety and security;
C. Provide privacy and a sense of
control;
D. Support functional
abilities; and,
E. Develop
environmental stimulation and challenge within a positive social
milieu.
b.
Physical Design
In addition to the physical design standards required for the
facility?s license, an Alzheimer?s Special Care Unit shall include the
following:
1. A floor plan design that
does not require visitors or staff to pass through the ASCU to reach other
areas of the facility;
2. A
multipurpose room or rooms for dining, group and individual activities, and
family visits, which complies with the LTC licensure requirements for common
space;
3. Secured outdoor space and
walkways that allow residents to ambulate, with or without assistive devices
such as wheelchairs or walkers, but prevents undetected egress. Such walkways
shall meet the accessibility requirements of the most current LTC and Americans
with Disabilities Act (ADA) structural building codes or regulations.
Unrestricted access to secured outdoor space and walkways shall be provided,
and such areas shall have fencing or barriers that prevent injury and
elopement. Fencing shall be no less than 72 inches high.
4. Prohibit the use of plants that are
poisonous or toxic for human contact or consumption;
5. Visual contrasts between floors and walls,
and doorways and walls, in resident use areas. Except for fire exits, exit
doors and access ways shall be designed to minimize contrast, and to obscure or
conceal areas the residents should not enter;
6. Non-reflective floors, walls, and
ceilings, to minimize glare;
7.
Evenly distributed lighting, to minimize glare and shadows; and,
8. A monitoring or nurses? station with:
A. A call system, to alert staff to any
emergency needs of the residents; and,
B. A space for charting, and for storage of
residents' records.
c. Physical Environment and Safety.
The Alzheimer?s Special Care Unit shall:
1. Provide freedom of movement for the
residents to common areas, and to their personal spaces. The facility shall not
lock residents out of, or inside, their rooms;
2. Provide plates and eating utensils which
provide visual contrast between the utensils and the table, and that maximizes
the independence of the residents;
3. In common areas, provide comfortable
seating sufficient to seat all residents at the same time. The seating shall
consist of a ratio of one (1) gliding or rocking chair for every five (5)
residents;
4. Encourage and assist
residents to decorate and furnish their rooms with personal items and
furnishings, based on the resident?s needs and preferences as documented by the
ASCU in the social history;
5.
Individually identify each resident's rooms based on the resident?s cognitive
level, to assist residents in locating their rooms, and to permit them to
differentiate their room from the rooms of other residents;
6. Keep corridors and passageways through
common-use areas free of objects which may cause falls, or which may obstruct
passage by physically impaired individuals; and,
7. Only use public address systems in the
unit for emergencies.
804
EGRESS
CONTROL
a. Egress Policies
The Alzheimer?s Special Care Unit shall develop policies and
procedures to deal with residents who wander or may wander. The procedures
shall include actions to be taken by the facility to:
1. Identify missing residents;
2. Notify all individuals or institutions
that require notification under law or regulation when a resident is missing;
and,
3. Attempt to locate the
missing resident.
b.
Locking Devices
1. All locking devices used on
exit doors shall be approved by the OLTC, building code agencies, and the fire
marshal having jurisdiction over the facility, shall be electronic, and shall
release upon activation of the fire alarm or sprinkler system.
2. If the unit uses keypads to lock and
unlock exits, directions for the keypad's operations to allow entrance shall be
posted on the outside of the door.
3. The keypads and locks shall meet the under
IBC applicable to Level II Assisted Living Facilities.
4. Staff shall be trained in all methods of
releasing, or unlocking, the locking device.
805
STAFFING
Alzheimer?s Special Care Units shall staff according to the
Rules and Regulations for Assisted Living Facilities II. However, staffing for
the ASCU shall be determined separately from the Assisted Living facility,
based upon the census for the ASCU only; likewise, the staffing for the
Assisted Living facility shall be based on the census of the Assisted Living
facility, excluding the ASCU census. It is the intent of this regulation that
ASCU staff be separate and distinct from the
Assisted Living facility staff. In addition, the following
staffing requirements are established for Alzheimer's Special Care
Units.
a. Professional Program
Services
A social worker or other professional staff e.g., physician,
Registered Nurse, or Psychologist currently licensed by the State of Arkansas
shall be utilized to perform the following functions:
1. Complete an initial social history
evaluation on each resident on admission;
2. Development, coordination, and utilization
of state or national resources and networks to meet the needs of the residents
or their families;
3. Offering or
encouraging participation in monthly family support group meetings with
documentation of meetings offered; and,
4. Assist in development of the ISP,
including but not limited to:
A. Assuring that
verbal stimulation, socialization and reminiscing is identified in the ISP as a
need;
B. Defining the services to
be provided to address those needs identified above; and,
C. Identifying the resident's preferences,
likes, and dislikes.
b. Staff and Training
1. All ASCU staff members and consultants
shall have the training specified in these regulations in the care of residents
with Alzheimer?s Disease and other related dementia. The facility shall
maintain records documenting what training has been received, the date it was
received, the subject of the training, and the source of the
training.
2. Within six (6) months
of the date that the long-term care facility first advertises or otherwise
holds itself out as having one (1) or more special units for residents with a
diagnosis of probable Alzheimer's disease or a related dementia, the facility
shall have trained all staff who are scheduled or employed to work in the
ASCU.
3. Subsequent to the
requirements set forth in Section 805(b)(2), fifty percent (50%) of the staff
working any shift shall have completed requirements as set forth in Section
805(b)(5)(a), (b), and (c).
4.
After meeting the requirements of Section 805(b)(2), all new employees shall be
trained within five (5) months of hiring, with no less than eight (8) hours of
training per month during the five (5) month period.
5. In addition to any training requirements
for any certification or licensure of the employee, training shall consist of,
at a minimum:
A. Thirty (30) hours on the
following subjects:
i. One (1) hour of the
ASCU's policies;
ii. Three (3)
hours of etiology, philosophy and treatment of dementia;
iii. Two (2) hours on the stages of
Alzheimer?s disease;
iv. Four (4)
hours on behavior management;
v.
Two (2) hours on use of physical restraints,
wandering, and egress control;
vi. Two (2) hours on medication
management;
vii. Four (4) hours on
communication skills;
viii. Two (2)
hours of prevention of staff burnout;
ix. Four (4) hours on activity
programming;
x. Three (3) hours on
ADLs and Individual-Centered Care
xi. Three (3) hours on assessments and
creation of ISPs
B.
On-going in-service training consisting of at least 2 hours every quarter. The
topics to be addressed in the in-service training shall include the following,
and each topic shall be addressed at least once per year:
i. The nature of Alzheimer?s disease and
other dementia, including:
1. The definition
of dementia;
2. The harm to
individuals without a correct diagnosis; and,
3. The stages of Alzheimer?s
disease.
ii. Common
behavior problems resulting from Alzheimer's or related dementia, and
recommended behavior management for the problems;
iii. Communication skills to facilitate
improved staff relations with residents;
iv. Positive therapeutic interventions and
activities, such as:
a. Exercise;
b. Sensory stimulation; and,
c. Activities of daily living.
v. The benefits of family
interaction with the resident, and the need for family interaction;
vi. Developments and new trends in the fields
of Alzheimer's or related dementia, and treatments for same;
vii. Environmental modifications to minimize
the effects and problems associated with Alzheimer's or related dementia;
and,
viii. Development of ISPs,
including but not limited to instruction on the method of updating and
implementing ISPs across shifts.
C. If the facility identifies or documents
that a specific employee requires training in areas other than those set forth
in 805(b), the facility may provide training in the identified or documented
areas, and may be substituted for those subjects listed in Section
805(b)(5).
c.
Trainer Requirements
The individual providing the training shall have:
1. A minimum of one (1) year uninterrupted
employment in the care of Alzheimer?s residents, or
2. Shall have training in the care of
individuals with Alzheimer?s disease and other dementia, or
3. Is designated by the Alzheimer?s
Association or its local chapter as being qualified to meet training
requirements.
d.
Training Manual
The ASCU shall create and maintain a training manual consisting
of thee topics listed in Section 805(b). Further, the trainer shall provide
training consistent with the training manual.
806
ADMISSIONS,
DISCHARGES, TRANSFERS
a.
Criteria for Services
1. Each Alzheimer?s
Special Care Unit shall have written policy setting forth pre-admission
screening, admission, and discharge procedures.
2. Prior to admission into the Alzheimer?s
Special Care Unit, the facility shall provide a copy of the disclosure
statement and Residents' Rights policy to the applicant or the applicant's
responsible party. A copy of the disclosure statement signed by the resident or
the resident's responsible party shall be kept in the resident?s
file.
3. Admission criteria shall
require:
A. A physician?s diagnosis of
Alzheimer?s disease or related dementia;
B. The facility's assessment of the
resident?s level of needs; and,
C.
A list of the services that the ASCU can provide to address the needs
identified in 806(a)(3)(B).
4. Any individual admitted to the ASCU must
also meet admission criteria for the facility.
5. The ASCU shall not maintain a resident who
requires a level of care greater than for which the facility is licensed to
provide, or for whom the ASCU is unable to provide the level or types of
services to address the needs of the resident. Discharge from the ASCU shall
occur when:
A. The resident?s medical
condition exceeds the level of care for which the facility is licensed or is
able to provide;
B. The resident?s
medical condition requires specialized nursing procedures that constitute more
than limited nursing services, or nursing services the facility is unable to
provide;
C. The resident has a loss
of functional abilities (e.g. ambulation) that results in the resident?s level
of care requirements being greater than the level of care for which the
facility is licensed or able to provide;
D. Behavioral symptoms that results in the
resident?s level of care requirements being greater than the level of care for
which the facility is licensed or able to provide;
E. The resident requires a level of
involvement in therapeutic programming that is greater than the level of care
for which the facility is licensed or able to provide.
6. If the resident, or the resident's
responsible party, does not comply with, or refuses to accept, the requirements
of the ISP, the resident shall be discharged from the ASCU. The facility shall
document the refusal or non-compliance with the ISP. The documentation shall
include, but not be limited to:
A. The
identity of the person who is not willing or able to comply with the
requirements of the ISP; i.e., the resident or the resident's responsible
party;
B. The date and time of the
refusal;
C. The consequences of the
unwillingness or inability to comply with the requirements of the ISP, and the
name of the person providing this information to the resident or the resident's
responsible party.
b. Resident Movement, Transfer or Discharge
When a resident is moved, transferred or discharged, measures
shall be taken by the facility to minimize confusion and stress to the resident
until discharge. Further, the discharge shall comply with the regulations
applicable to the facility housing the ASCU, and Arkansas law.
807
THERAPEUTIC ACTIVITIES
a. Intent and General Requirements.
Therapeutic activities can improve a resident?s eating or
sleeping patterns; lessen wandering, restlessness, or anxiety; improve
socialization or cooperation; delay deterioration of skills; and improve
behavior management. Therapeutic activities shall be designed to meet the
resident's current needs.
1. All
facilities with Alzheimer?s Special Care Units shall provide activities
appropriate to the needs of individual residents. The activities shall be
provided and directed by direct care staff under the coordination of a program
director.
2. Each resident's daily
routine shall be structured or scheduled so that activities are provided seven
days a week.
3. A professional with
specialized training in the care of Alzheimer?s shall be utilized or contracted
to:
A. Develop required daily
activities;
B. Train direct care
staff in those programs; and,
C.
Provide ongoing consultation.
b. Required Daily Activities
The following activities shall be offered daily:
1. Gross motor activities (e.g., exercise,
dancing, gardening, cooking, etc.);
2. Self-care activities (e.g., dressing,
personal hygiene, or grooming);
3.
Social activities (e.g., games, music, socialization); and,
4. Sensory enhancement activities (e.g.,
reminiscing, scent and tactile stimulation).
901
NEW CONSTRUCTION, REMODELING OR
ADDITIONS
901.1
GENERAL
A new facility is one that had plans approved by the Office of
Long Term Care and began operation, or construction or renovation of a building
for the purpose of operating a Level II assisted living facility on or after
the adoption date of these regulations, or both. The regulations and codes
governing new facilities apply if and when the facility proposes to begin
operation in a building not previously and continuously used as a facility
licensed under these regulations. For purposes of these regulations,
construction refers to a new facility where none existed or to
the addition of new wings or other sections of the facility; renovation
refers to any structural changes to the existing facility, including
but not limited to painting, replacement or repair of carpet, tile or linoleum,
and minor repairs.
Additions to existing facilities, construction, or renovation
shall meet the standards for new construction, and a copy of the facility floor
plan must be submitted to the Office of Long Term Care for approval. Provided,
however, that changes to the floor plan for areas of the facility unaffected by
the addition, construction or renovation are not required.
901.2
SITE LOCATION,
INSPECTION APPROVALS AND SUBSOIL INVESTIGATION
a. The building site shall afford good
drainage and shall not be subject to flooding or be located near insect
breeding areas, noise or other nuisance producing locations or hazardous
locations, industrial developments, airports, railways or near penal or other
objectionable institutions or near a cemetery. The site shall afford the safety
of residents and not be subject to air pollution.
b. A site shall be adequate to accommodate
roads and walks within the lot lines to at least the main entrance, ambulance
entrance, and service entrance. All facility sites shall contain enough square
footage to provide at least as much space for walks, drives and lawn space as
the square footage contained in the building.
c. The building site shall be inspected and
approved by the OLTC before construction is begun.
901.3
SUBMISSION OF PLANS,
SPECIFICATIONS AND ESTIMATES
a. When construction is contemplated either
for new buildings, additions or major alterations in excess of one hundred
thousand dollars ($100,000),
plans and specifications shall be submitted in duplicate, one
(1) to OLTC and one (1) to the Plumbing Division of the Arkansas Department of
Health, for review along with a copy of the statement of approval from the
Comprehensive Health Planning Agency. Final plan approval shall be given by
OLTC.
b. Such plans and
specifications shall be prepared by a registered professional engineer or an
architect licensed in the State of Arkansas pursuant to Act 270 of 1941,
codified as Ark. Code Ann. §
17-15-101, et
seq. and shall be drawn to scale with the title and date shown
thereon. OLTC shall have a minimum of three (3) weeks to review the drawing and
specifications and submit their comments to the applicant. Any proposed
deviations from the approved plans and specifications shall be submitted to the
OLTC prior to making any changes. Construction cannot start until approval of
plans and specifications have been received from the OLTC. The OLTC shall be
notified as soon as construction of a new building or alteration to an existing
building is started.
c. An estimate
shall accompany all working plans and specifications when the total cost of
construction is more than one hundred thousand dollars ($100,000).
d. Representatives from the OLTC shall have
access to the construction premises and the construction project for purposes
of making whatever inspections the OLTC deems necessary throughout the course
of construction.
901.4
PLANS AND SPECIFICATIONS
All facilities licensed under these regulations shall be
designed and constructed to substantially comply with pertinent local and state
laws, codes, ordinances and standards. All new construction shall be in
accordance with the requirements for I-2 Groups as specified in the
International Building Code (IBC) 2000, except that:
1. All exit corridors shall be no less than
six (6) feet wide, and shall be clear of obstructions. In fully sprinkled
buildings, furnishings and seating areas are permitted in corridors as long as
at least a corridor width of six (6) feet remains clear of
obstructions;
2. Exit doors from
patient or resident rooms shall be no less than thirty-six inches (36?) wide;
and,
3. Doors shall, at a minimum,
meet or exceed the fire ratings specified for I-2 Group construction under the
IBC 2000. Compliance with this requirement shall be determined by the approved
fire rating of the door conducted in accordance with IBC requirements, and not
as to the door?s construction type, such as hollow- or solid-core.
The facility shall develop and shall comply with a written
evacuation plan approved by the local fire marshal. All new construction shall
be readily accessible and useable by persons with physical disabilities
including persons who use wheelchairs. All construction shall comply with the
requirements of the ADA.
Plans shall be submitted to the OLTC in the following
stages:
1. Step (1) ?
Working drawings and specifications that shall be
prepared so that clear and distinct prints may be obtained; accurate dimensions
including all necessary explanatory notes, schedules and legends. Working
drawings shall be complete and adequate for contract purposes. Separate
drawings shall be prepared for each of the following branches of work,
architectural, structural, mechanical, and electrical, and shall include the
following:
A. Approved plan showing all new
topography, newly established levels and grades, existing structures on the
site (if any), new buildings and structures, roadways, walks, and the extent of
the areas to be seeded. All structures and improvements that are to be removed
under the construction contract shall be shown. A print of the survey shall be
included with the working drawings;
B. Plan of each floor and roof;
C. Elevations of each facade;
D. Sections through building;
E. Scale and full size details as necessary
to properly indicate portions of the work;
F. Schedule of finishes.
2. Step (2) ? Equipment
Drawings: Large-scale drawings of typical and special rooms
indicating all fixed equipment and major items of furniture and movable
equipment.
3. Step (3) ?
Structural Drawings:
A. Plans of foundations, floors, roofs and
all intermediate levels shall show a complete design with sizes, sections, and
the relative location of the various members. Schedule of beams, girders, and
columns, shall be included;
B.
Floor levels, column centers, and offsets shall be dimensioned;
C. Special openings and pipe sleeves shall be
dimensioned or otherwise noted for easy reference;
D. Details of all special connections,
assemblies, and expansion joints shall be given.
4. Step (4) ?
Mechanical
Drawings: These drawings with specifications shall show the
complete heating and ventilation systems, plumbing, drainage and standpipe
system and laundry and shall include:
A.
Heating and air-conditioning systems, including:
1. Air-conditioning systems with required
equipment, water and refrigerant piping and ducts;
2. Exhaust and supply ventilating systems
with steam connections and piping;
3. Air quantities for all room supply and
exhaust ventilating duct openings;
B. Plumbing, drainage and standpipe systems,
including:
1. Size and elevation of street
sewer, house sewer, house drains, street water main, and water service into the
building;
2. Locations and size of
soil, waste, and vent stacks with connections to house drains, clean outs,
fixtures, and equipment;
3. Size
and location of hot, cold, and circulating mains, branches and risers from the
service entrance and tanks;
4.
Riser diagram to show all plumbing stacks with vents, water risers, and fixture
connections;
5. Gas, oxygen, and
special connections;
6. Plumbing
fixtures and equipment that require water and drain connections;
C. Elevators and dumbwaiters:
Details and dimensions of shaft, pit, and machine room; sizes of car platform
and doors;
D. Kitchens, laundry,
refrigeration, and laboratories: These shall be detailed at a satisfactory
scale to show the location, size, and connection of all fixed
equipment.
5. Step (5) ?
Electrical Drawings:
A. Drawings shall show electrical wiring,
outlets, smoke detectors, and equipment that require electrical
connections;
B. Electrical service
entrances with switches and feeder to the public service feeders shall be
shown;
C. Plan and diagram showing
main switchboard, power panels, light panels, and equipment;
D. Light outlets, receptacles, switches,
power outlets, and circuits;
E.
Nurses? call systems, either wireless systems or hardwired, with outlets for
beds, duty stations, door signal lights, enunciators, and wiring diagrams. If a
wireless system is employed, the electrical drawing will indicate the
implementation of the system including designations for residents call systems
in residents? apartments or units;
F. Fire alarm system with stations, signal
devices, control board, and wiring diagrams;
G. Emergency electrical system with outlets,
transfer switch, source of supply, feeders, and circuits.
6. Step (6) ?
Specifications: Specifications shall supplement the
drawings to fully describe types, sizes, capacities, workmanship, finishes, and
other characteristics of all materials and equipment, and shall include the
following:
A. Cover or title sheet;
B. Index;
C. General conditions;
D. General requirements;
E. Sections describing material and
workmanship in detail for each class of work.
901.5
CODES AND
STANDARDS
The following codes and standards are incorporated into and
made a part of these regulations:
a.
The 2000 edition of the International Building Code (IBC) applies to new
construction and alterations or additions to all facilities;
b. The American Disabilities Act
specifications for making buildings and facilities accessible to and usable by
the physically handicapped shall apply to all facilities;
c. Arkansas State Plumbing Code;
d. Fire Resistance Index 1971, Underwriters
Laboratories, Inc.;
e. Handbook of
Fundamentals, American Society of Heating, Refrigeration and Air-Conditioning
Engineers (ASHRAE), United Engineer Center, 345 East 47the Street, New York,
New York 10017;
f. Methods of Test
for Surface Burning
Characteristics of Building Materials, Standard No. E 84-61
American Society for Testing and Materials (ASTM) Standard No. 84-61, 1961 Race
Street, Philadelphia, Pennsylvania 19103;
g. Method of Fire Test of Building
Construction and Materials, Standard No. E119, American Society of Testing and
Materials (ASTMO), 1961 Race Street, Philadelphia, Pennsylvania
19103;
h. Minimum Power Supply
Requirements, Bulletin No. XR4-10 National
Electrical Manufactures Association (NEMA), 155 East
44th Street, New York, New York 10017.
902
CONVERTED FACILITIES
a. Existing facilities that convert to
Assisted Living Facilities must meet the following requirements:
1. The facility shall provide a small
refrigerator in each resident's room, except as may otherwise be provided by
these regulation;
2. The facility
shall provide a microwave oven in each resident's room, except as may be
otherwise provided by regulation;
3. The facility must meet minimum space
requirements for resident rooms of one hundred fifty square feet (150 sq. ft.)
per person or two hundred thirty square feet (230 sq. ft.) for two (2) persons
sharing a room, exclusive of entryway, closet, and bathroom, or one hundred
square feet (100 sq. ft.) per person or one hundred eighty square feet (180 sq.
ft.) for two (2) persons if the room has a half or full bath or if there is a
shared bathroom between two (2) rooms; and,
4. The application conforms to all other
assisted living regulations.
b. For purposes of this section, the terms
existing facility and
existing facilities
shall mean:
1. A Residential Care Facility
licensed or holding a permit of approval as of April 2, 2001; and,
2. Facilities as described in Ark. Code Ann.
§
20-10-1709(b).
903
FURNISHINGS AND EQUIPMENT
The following are general provisions concerning furnishing and
equipment that each Level II assisted living facility must meet:
a. All rooms must have working light switches
at the entrance to each room.
b.
Windows must be kept clean and in good repair and supplied with curtains,
shades or drapes. Each window that can be opened shall have a screen that is
clean and in good repair.
c. Light
fixtures in resident general use or common areas must be equipped with covers
to prevent glare and hazards to the residents. A fixture without a cover is
permitted with the use of a Teflon coated bulb.
d. All fans located within seven (7) feet of
the floor must be protected by screen guards.
e. Common dining room space and furnishings
in good repair must be provided for each resident in the facility. Dining room
space and furnishings must be sufficient to serve all residents. Facilities
shall be allowed to plan dining schedules to allow for two (2) seatings per
meal to increase resident?s choice of meal times.
f. All furnishings and equipment in common
areas must be durable, clean, and appropriate to its functions.
g. All areas of a facility must be well
lighted to ensure residents? safety.
i. Throw- or scatter-rugs, or bath-rugs or
mats, shall have a non-skid backing.
j. Residents may provide their own linens,
but may not be required by the facility to do so. The facility must include in
the resident?s direct care service plan portion of the occupancy admission
agreement whether the resident or his or her responsible party prefers the
facility to provide linens or the resident or his or her responsible party will
provide his or her own linens, and whether the facility will launder the linens
or the resident or his or her responsible party will laundry his or her own
linens. Linens may be provided by the facility for no cost or may be provided
at an extra charge. If the resident or his or her responsible party chooses to
utilize facility linens, the following minimum amounts of linen must be
available in the facility at all times:
1.
Sheets ? three (3) sets for each resident;
2. Pillowcases ? three (3) sets for each
resident;
3. Bath towel ? three (3)
for each resident;
4. Hand towels ?
three (3) for each resident;
5.
Washcloths ?three (3) for each resident;
6. Blankets ? one (1) for each
resident;
7. Pillows ? one (1) per
resident.
If the resident or his or her responsible party wishes to use
his or her own personal linens, the facility will counsel the resident or his
or her responsible party on recommended quantities to maintain. In the case
where a resident or his or her responsible party uses personal linens, the
facility is not required to provide or keep available any linens for the
resident unless the resident does not have sufficient numbers of personal
linens available to maintain clean and sanitary conditions. If this is the
case, the facility shall provide additional linens up to the quantities
specified above. In both cases, clean linens may be stored in the resident?s
apartment.
k.
Bed linens must be changed at least weekly, or as often as needed to ensure
clean or non-soiled linens.
l.
Wastepaper baskets and trash containers used in the facility common areas must
be metal or Underwriter?s Laboratory approved plastic baskets. Outside trash
containers must be equipped with covers.
m. Practices that create an increased risk of
fire are prohibited. This includes, but is not limited to:
1. Space heaters. In cases of emergency, such
as extended power loss during periods of cold weather, space heaters are
permitted upon the approval of the Office of Long Term Care.
2. The accumulation or storage within the
facility of combustible materials such as rags, paper items, gasoline,
kerosene, paint or paint thinners.
3. The use of candles, oil lamps, incense or
open-flamed items.
4. The use of
extension cords or multi-plug adapters for electrical outlets. 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. Automatic electrical timers with a UL rating are
permitted, for programmed time periods, for energy efficiency and safety, if
the facility or residents elect to use it for lamps, holiday decorations, or
other small electrical devices.
904
REQUIREMENTS FOR
RESIDENT GENERAL USE/COMMON AREAS
904.1
Distinct Part
Facilitiesa. Physical and
programmatic separation ? an assisted living facility shall be both physically
and programmatically distinct from any residential care facility, nursing home
or hospital to which it is attached or of which it is a part, provided,
however, that programmatic separation shall not include social or recreational.
NOTE: This does not prohibit residents from walking through a
community based residential facility serving similar or compatible population,
e.g., the elderly or the physically disabled. This does not prohibit
independent living and assisted living to be in a combined building or prevent
assisted living from occupying apartments scattered throughout a project that
combines independent and assisted living. This does not require separation
between an assisted living facility and housing for the elderly or other purely
residential use. For example, assisted living facility apartments may be
interspersed with non-assisted living apartments that are non-licensed,
independent living apartments in the same building, and an assisted living
facility may share dining room and other common space with an attached
apartment building.
b.
Physical separation ? Residents shall not be required to first enter or pass
through a portion of the health care facility or community-based residential
facility in order to enter an assisted living facility, provided, however, that
residents may enter the assisted living facility through common areas
(reference the exception noted in Section 904.1(a) above). Similarly, persons
shall not be required to pass through the assisted living facility in order to
enter a health care facility or community-based residential facility. An
assisted living facility may share a common lobby and access area of a
multipurpose building and may be entered via elevator from the lobby or access
area. A dining room or activity area may be shared.
904.2 Each assisted living facility must meet
the following requirements for resident general use/common areas:
a. Each facility must have dining room and
living room space easily accessible to all residents (reference standards set
in Section 903.1(a)(b) above;
b.
Common dining rooms and living rooms must not be used as bedrooms;
c. Dining rooms must be furnished with enough
dining tables and chairs to permit all residents to be seated, or to permit
one-half of the resident census to be seated at one time and allowing
facilities to provide dining schedules that allow two settings per
meal.
d. Dining rooms and living
rooms must be available for use by residents at appropriate times to provide
periods of social diversion and individual or group activities;
e. Common area toilet facilities shall be
provided to meet the needs of residents, staff and visitors to the facility and
shall be located in areas other than the resident?s apartment or
unit.
f. All resident areas must be
painted and appropriately furnished;
g. Facilities in buildings constructed after
the effective date of these regulations shall be constructed with
hallways/corridors wide enough to allow two wheelchairs (six (6) feet) to pass
each other. Facilities in existing buildings that have not undergone
substantial renovation since the effective date of these regulations shall have
corridors large enough to meet current egress requirements mandated by
applicable codes.
h. A minimum of
one phone jack must be available in each resident?s apartment or unit for the
resident to establish private phone service in his or her name. In addition,
there shall be, at a minimum, one dedicated facility phone and phone line for
every forty (40) residents in common areas. The phone shall allow unlimited
local calling without charge. Long distance calling shall be possible at the
expense of the resident or responsible party via personal calling card,
pre-paid phone card, or similar methods. Residents shall be able to make phone
calls in private. Private? can be defined as placing the phone in an area that
is secluded and away from frequently used areas.
i. Facility?s laundry services area(s) shall
meet the requirements outlined in Section 700.2.2.
j. Facility?s pantry area(s) shall meet the
requirements outlined in Sections 700.3.11 and 700.3.13.
k. Facility?s medication storage area(s)
shall meet the requirements outlined in Sections 702.1.2.200 Square footage
requirements for common area living room, dining room, and activities room are
as follows:
a. All facilities:
1. The living and activity spaces must be
separate from the dining room with a combined total square footage of at least
20 square feet per licensed bed. Living and activity spaces do not include
corridors and lobby areas for the purposes of calculation. Living and activity
spaces may be combined;
2. The
facility must have at least 20 square feet of designated dining space per
licensed bed if dining will be conducted in one seating. If dining will be
conducted in two seatings, 10 square feet per resident will be required.
Facilities will document their dining seating plan, and maintain the
documentation for review by the OLTC;
3. In facilities that house residents in more
than one (1) building, there shall be a living room and/or activities room
located in each building with at least 10 square feet per licensed bed with an
additional 10 square feet available on the campus in a commons area. The
facility?s 10 square feet per licensed bed in the commons area shall be
distinct from any other square footage requirements for other campus
programs;
4. In facilities housing
residents in more than one (1) building, a single dining room may be used for
the complex. The dining room in a single building facility or a multi-building
facility must have at least 20 square feet of space per licensed bed in the
facility. If dining will be conducted in two (2) seatings, 10 square feet per
resident will be required. Facilities will document their dining seating plan,
and maintain the documentation for review by the OLTC. In facilities housing
residents in more than one (1) building, protection from the elements of the
weather shall be provided for residents who must access other
buildings;
b. Any
modification, alternation or addition must satisfy all physical environment
requirements in effect at the time that the modification, alteration, or
addition is placed into service and shall meet the requirements of the
ADA.
905
APARTMENTS
a.
All living units in assisted living facilities shall be independent apartments
(exceptions shall be granted based on Act 1230 of 2001). Each apartment or unit
shall be of adequate size and configuration to permit residents to carry out,
with or without assistance, all the functions necessary for independent living,
including sleeping; sitting; dressing; personal hygiene; storing, preparing,
serving and eating food; storing clothing and other personal possessions; doing
personal correspondence and paperwork; and entertaining visitors. Each
apartment or unit shall be accessible to and useable by residents who use a
wheelchair or other mobility aid consistent with the accessibility standards.
b. Physical features. Each
independent apartment or unit shall have at least the following:
1. An individual lockable entrance and exit.
A single door may serve as both entrance and exit. Keys, code or other opening
devise for the door to the independent apartment or unit shall be supplied to
residents. Keys, code or other opening devise for the door(s) to the assisted
living facility shall be supplied to all residents without a credible diagnosis
of dementia. In situations where a provider feels a resident without a
diagnosis of dementia is at risk of injury to themselves if provided with a
key, code or other exit devise to the facility, a compliance agreement may be
negotiated. All apartments or units shall be accessible by means of a master
key or similar system that is available at all times in the facility and for
use by designated staff.
2. Each
apartment or unit of new construction resident units shall have a minimum of
150 square feet per person or 230 square feet for two (2) persons sharing a
room excluding entryway, bathroom and closets. No apartment or unit in an
assisted living facility shall be occupied by more than two persons;
3. Each apartment or unit shall have a
separate and complete bathroom with a toilet, bathtub or shower, and
sink;
4. The cooking capacity of
each apartment or unit may be removed or disconnected depending on the
individual needs of the resident;
5. Each apartment or unit shall have a call
system monitored 24-hours a day by facility staff in the facility. Wireless
call systems approved by the Office of Long Term Care may be
utilized;
6. Each apartment or unit
shall be equipped for telephone and television cable or central television
antenna system;
7. Each apartment
or unit shall have easy access to common areas such as living room(s), activity
room(s), dining room(s) and laundry;
8. Private accessible mailbox that complies
with U. S. Postal Service requirements for apartment style boxes in which the
resident may send and receive mail that meets postal standards. Mailboxes may
be grouped in a common area, located at the resident?s apartment or unit door
or located as required by the U. S. Postal Service;
9. Each apartment or unit shall have a
kitchen that is a visually and functionally distinct area within the apartment
or unit (see Section 300, definition of Visually and Functionally Distinct
Area). The kitchen, at a minimum, shall contain a small refrigerator with a
freezer compartment, a cabinet for food storage, a small bar-type sink with hot
and cold running water and space with electrical outlets suitable for small
cooking appliances, e.g., a microwave. Exceptions shall be granted based on Act
1230 of 2001. Upon entering the assisted living facility, the resident or his
or her responsible party shall be asked if they wish to have a cooking
appliance. If so, the appliance shall be provided by the facility, in
accordance with facility policies. If the resident or his or her responsible
party wishes to provide their own cooking appliance, it shall meet the
facility?s safety standards. The cooking appliances shall be designed so that
they can be disconnected and removed for resident safety or if the resident
chooses not to have cooking capability within his or her apartment.
10. Each apartment or unit shall have a
sleeping and living area that is a visually and functionally distinct area
within the apartment or unit (see Section 300, definition of Visually and
Functionally Distinct Area) but need not be separate rooms.
11. Male and female residents must not have
adjoining rooms that do not have full floor to ceiling partitions and closable
solid core doors.
906
SAFETY
STANDARDS
a. Each assisted
living facility built after these regulations become effective must meet the
Group 1-2 requirements of the 2000 edition of the International Building Code
(IBC).
b. If the local municipality
in which the facility is located has not adopted requirements based on the
above standards, or if the Office of Long Term Care determines that the
regulations adopted by the local municipality are not adequate to protect
residents, the facility must meet the provisions of the 2000 Edition of the
International Building Code (IBC), including the National Fire Protection
Association (NFPA) requirements referenced by the IBC.
c. A fire drill must be conducted quarterly
with all staff participation on each shift. Resident participation is the
facility?s option. A tornado/evacuation drill must be conducted annually with
all staff. Resident participation is at the facility?s option.
d. 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:
i. 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 within the facility.
ii.
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.
iii. Smoking by residents classified as not
responsible shall be prohibited unless the resident is under direct
supervision.
iv. Ashtrays of
noncombustible material and safe design shall be placed in all areas where
smoking is permitted.
v. Metal
containers with self-closing cover devices into which ashtrays may be emptied
shall be placed in all areas where smoking is permitted.
e. Elevated outdoor spaces accessible to
residents. All outdoor areas accessible to residents that are located above
ground level shall:
i. Be constructed with a
barrier no less than forty-eight inches (48?) I height to prevent resident from
falling or eloping;
ii. Provide
overhead protection from the elements, such as rain, snow, and sleet; and,
iii. Be surrounded or enclosed by
screening that extends from the top of the barrier to the underside of the
overhead protection.
907
WATER
SUPPLY
An adequate supply of water, under pressure, must be provided
at all times. When a public water system is available, a connection must be
made thereto. If water from a source other than a public water supply is used,
the supply must meet the requirements set forth under rules and regulations of
the State Board of
Health.
907.1 A
contract to supply potable water shall be implemented with a third party not
associated with the operation of the assisted living facility in the event the
facility?s water supply should be interrupted.
908
SEWAGE
All sewage must be disposed of by means of either:
a. A public system where one is accessible
within 300 feet; or
b. An approved
sewage disposal system that is constructed and operated in conformance with the
standards established for such systems by the State Board of Health.
909
PLUMBING
Facilities must comply with all provisions of the state
plumbing and gas code and amendments thereto prescribing minimum requirements
for design, materials, appliances, workmanship, and methods of
installation.
910
ELECTRICAL
Electrical wiring, fixtures, appliances, motors, and other
electrical equipment must be installed in accordance with the national
electrical code National Fire Prevention Association?s Pamphlet #70 and comply
with local regulations and codes where they exist.
911
HEATING/COOLING
911.1 All liquefied petroleum gas systems
must be installed and maintained in accordance with the State Code for
Liquefied Petroleum Gas Containers and Equipment, State of Arkansas.
911.2 All gas heating units must bear the
stamp of approval of the American Gas Association Testing Laboratories, Inc. or
other nationally recognized testing agency for enclosed, vented heaters for the
type of fuel used.
911.3 All gas
heating units and water heaters must be vented adequately to carry the products
of combustion to the outside atmosphere. Vents must be constructed and
maintained to provide a continuous draft to the outside atmosphere in
accordance with the American Gas Association Recommended Procedures.
911.4 All heating units must be provided with
a sufficient supply of outside air so as to support combustion without
depletion of the air in the occupied room.
911.5 All heating and cooling units must be
installed and maintained in a manner that will provide for the safety and
comfort of the occupants.
911.6 In
new facilities licensed after the effective date of these regulations, the
facility must provide each apartment or unit with an individual thermostat
controlling the temperature in that apartment or unit. In addition, the
facility must provide a heating, ventilating and air conditioning (HVAC)
system(s) for the apartments or units and common areas capable of maintaining
any temperature between 68 and 80 degrees at any time throughout the
year.
912
ZONING CODES
Each assisted living facility must be operated in areas
permitted by local codes. Each owner must provide the Office of Long Term Care
with documentation that the facility is in compliance with zoning
requirements.
913
LOT REQUIREMENTS
Conditions of soil, ground water level, drainage and topography
must not create hazards to the property as to the health and safety of the
occupants. The site shall not be subject to unpredictable and/or sudden
flooding and shall be large enough to provide an exercise area for residents.
Exercise area shall mean, at a minimum, accessible exterior space configured
with walkways suitable for walking and benches for resting. The exterior space
may be on the facility?s property, on publicly accessible public or private
property (e.g., park, shopping mall), or on an area made available to the
residents by the facility through special arrangement with private property
owners. Special arrangements must be through long-term agreements deemed
sufficient by OLTC. Regardless of the arrangements, exercise areas must be
accessible from the property during daylight hours by means of a safe and
accessible walking route.
1000
IMPOSITION OF
REMEDIES - AUTHORITY
The following Rules and Regulations for the Imposition of
Remedies are duly adopted and promulgated by the Arkansas Department of 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.
1001
INSPECTIONS BY
DEPARTMENT
a. All areas
of the facility that are accessible to residents or are used in the care or
support of residents, including but not limited to kitchen or food preparation
areas, laundry areas, and storage areas, and all resident records, including
but not limited to residents' financial records maintained by the facility and
residents' 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
residents and all employee records related to the care or protection of
residents 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 residents of the survey
process and residents? rights with regard to privacy during the process.
Residents 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 residents or employees who consent to interviews, and shall
be permitted to photograph the facility. Residents and their apartments 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 resident 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 may require. Provided, however, 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. Records created pursuant to Section 702.2.1(1) of these
regulations regarding consultant pharmacists shall not be subject to release to
the Department. Records created pursuant to Section 702.2.1(2) of these
regulations regarding consultant pharmacists shall be subject to release to the
Department.
e. Facilities must
provide a written acceptable plan of correction within 15 working days of
receipt of written notification of deficiencies (also referred to as a
Statement of Deficiencies) found during routine inspections or surveys, special
visits or complaint investigations. 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 residents or their responsible parties and visitors. A copy shall
be provided to each resident or resident?s responsible party upon request of
the resident or the resident?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.
1002
GENERAL
PROVISIONS
a. 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 with respect to program requirements 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 requirements1.
Except in cases of emergency termination of a license or in cases or emergency
removal or transfer or residents, 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.
1003
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 Administrator.
7. Termination of license.
8. Transfer of residents.
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 Level II assisted living facility license.
1004
TEMPORARY
ADMINISTRATION
a.
Temporary administrator means the temporary appointment by
OLTC, or by the facility with the approval of OLTC, of a substitute facility
administrator 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 administrator may be appointed by
the Office of Long Term Care only upon the consent and agreement of the
facility. The temporary administrator 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 administrator 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 administrator's salary:
1. Is paid directly by the facility while the
temporary administrator 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 1005(c)(2) if OLTC is otherwise unable to attract a
qualified temporary administrator.
d.
Failure to relinquish authority to
temporary administrator:
1.
Termination of assisted living facility licensure. If a
facility fails to relinquish authority to the temporary administrator, OLTC may
impose additional remedies, including but not limited to termination of the
Level II assisted living facility license.
2.
Failure to pay salary of temporary
administrator. A facility's failure to pay the salary of the temporary
administrator is considered a failure to relinquish authority to temporary
administration.
3.
When
imposed. The remedy of temporary administrator shall be used in only
lieu of termination of the facility license. Provided, however, that if the
appointment of the temporary administrator 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.
1005
STATE
MONITORING
a. A State
monitor:
1. Oversees the correction of
deficiencies specified by OLTC at the facility site and protects the facility's
residents 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 resident 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.
1006
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 1009. The intent of a directed plan of correction is to
achieve correction of identified deficiencies and compliance with applicable
regulations.
1007
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.
1008
TRANSFER OF RESIDENTS
OR CLOSURE OF THE FACILITY AND TRANSFER OF RESIDENTS
a.
Transfer of residents, or closure
of the facility and transfer of residents in an emergency. OLTC has
the authority to transfer residents to another facility when:
1. An emergency exists wherein the health,
safety, or welfare of residents are imperiled, and no other remedy exists that
would ensure the continued health, safety or welfare of the
residents;
2. A facility intends to
close but has not arranged for the orderly transfer of its residents at least
thirty (30) days prior to closure.
3. The facility exceeds its bed capacity as
indicated or stated on the facility's license, or accepts more residents than
the facility has number of beds 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 assisted living facility 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 residents to another facility.
c. When the Office of Long Term Care orders
transfer of residents 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
residents' care and safety.
2.
Assist in or arrange for transportation of the residents, their medical records
and belongings, assist in locating alternative placement, assist in preparing
the resident for transfer, and permit the residents' legal guardians or
responsible party to participate in the selection of the residents' new
placement.
3. Unless transfer is
due to an emergency, explain alternative placement options to the residents and
provide orientation to the placement chosen by the resident 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 residents are to be transferred at least fifteen (15) days notice of the
proposed transfer.
1009
TERMINATION OF LEVEL
II ASSISTED LIVING FACILITY 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 Section 1009(b), below.
b.
Basis for termination.
OLTC may terminate a facility's Level II assisted living facility license if a
facility:
1. Permits, aids or abets in the
commission of any unlawful act in connection with the operation of the Level II
assisted living facility;
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 1001(d) 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. Operator 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, et
seq.;
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; or,
7. Has conditions wherein the health, safety,
or welfare of resident are imperiled, and no other remedy exists that would
ensure the continued health, safety, or welfare of the residents.
1010
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.
1011
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.
1012
CLOSURE
Any Level II assisted living 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.
1100
INFORMAL
DISPUTE RESOLUTION (IDR)
When a long term care facility does not agree with deficiencies
cited on a Statement of Deficiencies, the facility may request an IDR meeting
of the deficiencies in lieu of, or in addition to, a formal appeal. The
Informal Dispute Resolution (IDR) process is governed by Act 1108 of 2003,
codified at Ark. Code Ann. §
20-10-1901
et
seq.
The request for an informal dispute resolution of deficiencies
does not stay the requirement for submission of an acceptable plan of
correction and allegation of compliance within the required time frame or the
implementation of any remedy, and does not substitute for an appeal.
1101
REQUESTING
AN INFORMAL DISPUTE RESOLUTION (IDR)
A written request for an informal dispute
resolution must be made to the Arkansas Department of Health, Health Facility
Services, 5800 West 10th, Suite 400, Little Rock, AR 72204 within ten calendar
days of the receipt of the Statement of Deficiencies from the Office of Long
Term Care. The request must:
1. List
all deficiencies the facility wishes to challenge; and,
2. Contain a statement whether the facility
wishes the IDR meeting to be conducted by telephone conference, by record
review, or by a meeting in which the parties appear before the impartial
decision maker.
1102
MATTERS WHICH MAY BE HEARD AT IDR
The IDR is limited to deficiencies cited on a Statement of
Deficiencies. Issues that may not be heard at an IDR include, but are not
limited to:
1. The scope and severity
assigned the deficiency by the Office of Long Term Care, unless the scope and
severity allege substandard quality of care or immediate jeopardy;
2. Any remedies imposed;
3. Any alleged failure of the survey team to
comply with a requirement of the survey process;
4. Any alleged inconsistency of the survey
team in citing deficiencies among facilities; and,
5. Any alleged inadequacy or inaccuracy of
the IDR process.
1103
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, et
seq.
APPENDIX FORMS
ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-731
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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ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-742
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.
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INSTRUCTIONS
A. Enclosed are two (2) copies of Application
for Licensure. Complete one copy and return to the Office of Long Term Care and
retain one copy for your files.
B.
Please read these instructions carefully and complete this application in full.
This application must be completed in ink or typed.
C. This application is not valid unless it is
notarized.
D. This license
application must be signed by the following person(s) dependent upon the type
of management and ownership.
1. If the
institution is public (i.e., County, City, etc.) it must be signed by the
person who is head of the governmental department having jurisdiction over it
(i.e., Chairman of County Board or Chairman of Commission) or his duly
authorized representative. This authorization must be in writing, notarized and
submitted along with this application.
2. If the institution is private, it must be
signed by the following dependent upon the type of business organization.
|
Type
|
Signer
|
|
Sole Proprietorship
|
Owner
|
|
Partnership
|
One of the partner
|
|
Corporation, Church, Non-Profit Association
|
If someone other than the above named is authorized to
sign in his or her behalf, such authorization must be in writing, notarized and
attached to this application.
E. All license expire on midnight June
30 of the calendar year in which they are issued.
F. Application for annual renewal must
be postmarked no later than June 1 of the current year in order to avoid
the payment of a penalty. This penalty shall be 10% of the facility?s licensure
fee.
G. This application should be
returned by certified mail
to the
following address:
DEPARTMENT OF HUMAN
SERVICES
OFFICE OF LONG TERM CARE
P.O. BOX 8059 SLOT S408
LITTLE ROCK, AR 72203
Please make certain that you use the above listed address
only. All other addresses used could cause delays and may result in penalties
being applied to your annual licensure renewal fees.
H.
A check or money order for the
required licensure fee made payable to Arkansas Department of Human Services
must accompany this submission except for those facilities operated by the
State.
Licensure Fee: $10.00 per bed
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