Current through Register Vol. 47, No. 5, March 10, 2024
Move-In Criteria
11.1 The assisted living residence shall
accept only those persons whose needs can be fully met by the existing staff,
physical environment, and services already being provided. The assisted living
residence's ability to meet resident needs shall be based upon a comprehensive
pre-admission assessment of a resident's physical, mental, and social needs;
cultural, religious and activity needs; preferences; and capacity for
self-care.
Move-In Restrictions
11.2 An assisted living residence shall not
allow to move in any person who:
(A) Needs
regular 24-hour medical or nursing care;
(B) Is incapable of self-administration of
medication and the assisted living residence does not have staff who are either
licensed or qualified under
6 CCR
1011-1, Chapter 24 to administer
medications;
(C) Has an acute
physical illness which cannot be managed through medication or prescribed
therapy;
(D) Has physical
limitations that restrict mobility unless compensated for by available
auxiliary aids or intermittent staff assistance;
(E) Has incontinence issues that cannot be
managed by the resident or staff;
(F) Is profoundly disoriented to time,
person, and place with safety concerns that require a secure environment and
the assisted living residence does not provide a secure environment;
(G) Has a stage 3 or 4 pressure sore and does
not meet the criteria in Part 12.4;
(H) Has a history of conduct that has been
disclosed to the assisted living residence that would pose a danger to the
resident or others, unless the ALR reasonably believes that the conduct can be
managed through therapeutic approaches; or
(I) Needs restraints, as defined herein, of
any kind except as statutorily allowed for assisted living residences which are
certified to provide services specifically for the mentally ill.
(1) Assisted living residences certified to
provide services for the mentally ill shall have policies, procedures, and
appropriate staff training regarding the use of restraint and maintain current
documentation to show that less restrictive measures were, and continue to be,
unsuccessful.
Resident Agreement
11.3 At the time the resident moves in, the
assisted living residence shall ensure that the resident and/or the resident's
legal representative has received a copy of the written resident agreement and
agreed to the terms set forth therein. The assisted living residence shall
ensure that the agreement is signed and dated by both parties.
11.4 The terms of a resident agreement shall
not alter, or be construed to relieve the assisted living residence of
compliance with, any requirement or obligation under relevant federal, state,
or local law and regulation.
11.5
The assisted living residence shall review its resident agreements annually and
update or amend them as necessary. Amendments to the resident agreement shall
also be signed and dated by both parties.
(A)
When a change of ownership occurs, the new owner shall either acknowledge and
agree to the terms of each existing resident agreement or establish a new
agreement with each resident.
11.6 The written resident agreement shall
specify the understanding between the parties concerning, at a minimum, the
following items:
(A) Assisted living residence
charges, refunds, and deposit policies;
(B) The general type of services and
activities provided and not provided by the assisted living residence and those
which the assisted living residence will assist the resident in
obtaining;
(C) A list of specific
assisted living residence services included for the agreed upon rates and
charges, along with a list of all available optional services and the specified
charge for each;
(D) The amount of
any fee to hold a place for the resident in the assisted living residence while
the resident is absent from the assisted living residence and the circumstances
under which it will be charged;
(E)
Responsibility for providing and maintaining bed linens, bath and hygiene
supplies, room furnishings, communication devices, and auxiliary aids;
and
(F) A guarantee that any
security deposit will be fully reimbursed if the assisted living residence
closes without giving resident(s) written notice at least thirty (30) calendar
days before such closure,
(G)
Reasons that the assisted living residence could pursue an involuntary
discharge of the resident, as listed in Parts 11.11 and
11.12,
Written Disclosure of
Information
11.7 The
assisted living residence shall ensure that when a new resident moves in, he or
she is provided with, and acknowledges receipt of, the following information:
(A) How to obtain access to the assisted
living residence policies and procedures listed under Part 9.1;
(B) The resident's right to receive
cardiopulmonary resuscitation (CPR) or have a written advance directive
refusing CPR;
(C) Minimum staffing
levels, whether the assisted living residence has awake staff 24 hours a day
and the extent to which certified or licensed health care professionals are
available on-site;
(D) Whether the
assisted living residence has an automatic fire sprinkler system;
(E) Whether the assisted living residence
uses egress alert devices, including details about when and where they are
used;
(F) Whether the assisted
living residence has resident location monitoring devices (such as video
surveillance), when and where they are used, and how the assisted living
residence determines that a resident requires monitoring;
(G) Whether the assisted living residence
operates a secure environment and what that means;
(H) The resident's individualized care plan
that addresses his or her functional capability and needs;
(I) Smoking prohibitions and/or designated
areas for smoking;
(J) The readily
available on-site location of the assisted living residence's most recent
inspection report; and
(K) Upon
request, a copy of the most recent version of these Chapter 7
rules.
Management of Resident
Funds/Property
11.8 An
assisted living residence shall not assume power of attorney or guardianship
over a resident unless by court order, nor shall an assisted living residence
require a resident to execute or assign a loan, advance, financial interest,
mortgage, or other property in exchange for future services.
11.9 An assisted living residence shall not
be required to handle resident funds or property.
11.10 An assisted living residence that
chooses to handle resident funds or property, shall have a policy regarding the
management of such funds and shall comply with the following criteria:
(A) There shall be a written authorization
that specifies the terms and duration of the financial management services to
be performed by the assisted living residence. Such authorization shall be
signed by the resident or resident's legal representative and
notarized;
(B) Upon entering into
an agreement with a resident for financial management services, the assisted
living residence shall exercise fiduciary responsibility for these funds and
property, including, but not limited to, maintaining any funds over the amount
of five hundred dollars ($500) in an interest-bearing account, separate from
the general operating fund of the ALR, which interest shall accrue to the
resident;
(C) The assisted living
residence shall post a surety bond in an amount sufficient to protect the
residents' personal funds;
(D) The
assisted living residence shall maintain a continuous, dated record of all
financial transactions. The record shall begin with the date of the first
handling of the personal funds of the resident and shall be kept on file for at
least three years following termination of the resident's stay in the assisted
living residence. Such record shall be available for inspection by the
Department; and
(E) The assisted
living residence shall provide the resident or legal representative a receipt
each time funds are disbursed along with a quarterly report identifying the
beginning and ending account balance along with a description of each and every
transaction since the last report.
11.11 The assisted living residence shall
arrange to discharge any resident who:
(A) Has
an acute physical illness which cannot be managed through medication or
prescribed therapy;
(B) Has
physical limitations that restrict mobility, and which cannot be compensated
for by available auxiliary aids or intermittent staff assistance;
(C) Has incontinence issues that cannot be
managed by the resident or staff;
(D) Has a stage 3 or stage 4 pressure sore
and does not meet the criteria in Part 12.4;
(E) Is profoundly disoriented to time,
person, and place with safety concerns that require a secure environment, and
the assisted living residence does not provide a secure environment;
(F) Exhibits conduct that poses a danger to
self or others and the assisted living residence is unable to sufficiently
address those issues through therapeutic approach; and/or
(G) Needs more services than can be routinely
provided by the assisted living residence or an external service
provider.
11.12 The
assisted living residence may also discharge a resident for:
(A) Nonpayment of basic services in
accordance with the resident agreement; or
(B) The resident's failure to comply with a
valid, signed resident agreement.
11.13 Where a resident has demonstrated that
he or she has become a danger to self or others, the assisted living residence
shall promptly implement the following process pending discharge:
(A) Take all appropriate measures necessary
to protect other residents;
(B)
Reassess the resident to be discharged and revise his or her care plan to
identify the resident's current needs and what services the assisted living
residence will provide to meet those needs; and
(C) Ensure all staff are aware of any new
directives placed in the care plan and are properly trained to provide
supervision and actions consistent with the care plan.
11.14 The assisted living residence shall
coordinate a voluntary or involuntary discharge with the resident, the
resident's legal representative and/or the appropriate agency. Prior to
discharging a resident because of increased care needs, the assisted living
residence shall make documented efforts to meet those needs through other
means.
11.15 In the event a
resident is transferred to another health care entity for additional care, the
assisted living residence shall arrange to evaluate the resident prior to
re-admission or discharge the resident in accordance with the discharge
procedures specified below.
11.16
The assisted living residence shall provide written notice of any discharge 30
calendar days in advance of discharge except in cases in which the resident
requires a level of care that cannot be met by the residence or the resident
has demonstrated that they are a danger to themselves or others, whereupon the
assisted living residence shall provide written notification with as much
advance notice as is reasonable under the circumstances prior to the removal
from the residence. Such written notice shall be provided to:
(A) The resident,
(B) The resident's legal representative,
and
(C) Any relative or other
person the resident has designated to receive notice of a discharge, as listed
on the resident's face sheet in accordance with Part 18.9(G).
11.17 Written notice of
involuntary discharge must include the following:
(A) A detailed explanation of the reason or
reasons for the discharge, including, at a minimum:
(1) Facts and evidence supporting each reason
given by the residence, and
(2) A
recounting of events leading to the involuntary discharge, including
interactions with the resident over a period of time prior to the notice and
actions taken to avoid discharge, specifying the timing of the events and
actions.
(B) Statements
conveying the following information:
(1) That
the individual receiving the notice has the right to file a grievance with the
residence challenging the involuntary discharge within 14 days of the written
notice, regardless of whether the resident has already been removed from the
assisted living residence,
(2) That
if a grievance is filed, the assisted living residence must provide a response
to the grievance within five business days, and
(3) If the resident or person filing the
grievance is dissatisfied with the response, that the resident or person filing
the grievance may appeal to the executive director of the Colorado Department
of Public Health and Environment or their designee.
(C) Names and contact information, including
phone numbers, physical addresses, and email addresses, for the state long-term
care ombudsman, the designated local ombudsman, and the Colorado Department of
Public Health and Environment.
(D)
If the involuntary discharge is initiated due to a medical or physical
condition resulting in a required level of care that cannot be treated with
medication or services routinely provided by the residence's staff or an
external service provider, the notice must also include an assessment by the
resident's applicable health-care or behavioral health provider of the
resident's current needs in relation to the resident's medical and physical
condition.
11.18 A copy
of any involuntary discharge notice shall be sent to the state long-term care
ombudsman and the designated local ombudsman, within five (5) calendar days of
the date that it is provided to the resident and the resident's legal
representative.
