Kentucky Administrative Regulations
Title 902 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH
Chapter 20 - Health Services and Facilities
Section 902 KAR 20:066 - Operation and services; adult day health care programs
Universal Citation: 902 KY Admin Regs Service 20:066
Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO: KRS 216B.010-216B.130, 216B.0441, 216B.0443(1), 216B.990
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Kentucky Cabinet for Health Services regulate health facilities and health services. KRS 216B.0441 and 216B.0443(1) mandate that the Cabinet for Health Services establish licensure requirements for adult day health care programs. This administrative regulation provides for the licensure requirements for the operation of adult day health care programs and the services to be provided by adult day health care programs.
Section 1. Definitions.
(1) "Administrator" means a person who:
(a) Has a minimum of two (2) years college,
or equivalent training with at least two (2) years of clinical experience, a
degree, or a license in a health related profession; or
(b) Is licensed as a nursing home
administrator pursuant to
KRS
216A.080.
(2) "Licensed practical nurse" means a person
who is licensed pursuant to
KRS
314.011(9).
(3) "Nursing services" means the delivery of
medication, or treatment by a registered nurse or a licensed practical nurse
supervised by a registered nurse, consistent with KRS Chapter 314 scope of
practice provisions and the Kentucky Board of Nursing scope of practice
determination guidelines.
(4)
"Occupational therapist" means a person who is currently licensed pursuant to
KRS Chapter 319A.
(5) "Personal
care services" means services to help patients achieve and maintain good
personal hygiene including assistance with:
(a) Bathing;
(b) Shaving;
(c) Cleaning and trimming of fingernails and
toenails;
(d) Cleaning of the mouth
and teeth; and
(e) Washing,
grooming, and cutting of hair.
(6) "Program" means an adult day health care
program as established in
KRS
216B.0441(1).
(7) "Physical therapist" means a person who
is currently licensed by the Kentucky Board of Physical Therapy.
(8) "Registered nurse" means a person who is
currently licensed pursuant to
KRS
314.011(5).
(9) "Speech-language pathologist" means a
person who is currently licensed by the Kentucky Board of Speech-Language
Pathology and Audiology.
Section 2. Administration and Operation.
(1) Licensee.
(a) The licensee shall be legally responsible
for the operation of the program and for compliance with federal, state, and
local laws pertaining to the operation of the program.
(b) The licensee shall ensure policies,
consistent with state or local laws, for the administration and operation of
the program are established in writing and enforced including:
1. A description of services provided by the
program;
2. A procedure for
providing first aid and making arrangements for medical care with a physician
or hospital in case of accidents or medical emergencies;
3. A procedure for transporting patients to a
physician or hospital in case of an accident or a medical emergency;
4. Procedures for admission, evaluation of
patient's needs, and discharge;
5.
A procedure which assures the reporting of abuse, neglect, or exploitation of
adults and children to the Cabinet for Families and Children pursuant to KRS
Chapters 209 and 620;
6. A policy
to ensure that a patient of the program is protected and accounted for while in
the care of the program;
7. An
infection control policy, which is consistent with the Centers for Disease
Control guidelines, to include policies which address the prevention of disease
transmission to and from patients, visitors, and employees including:
a. Blood and body fluid
precautions;
b. Precautions for
infections which can be transmitted by the airborne route; and
c. Work restrictions for employees with
infectious diseases;
8.
Guidelines for the storage and administration of medications that include:
a. A provision to ensure that medicines kept
by the program shall be labeled with the patient's name, name of the drug,
strength of the drug, name of the dispensing pharmacy, prescription number,
date, physician's name, caution statements, and directions for use;
b. A provision to ensure that medicines
requiring refrigeration are kept in a refrigerator;
c. A provision that medications kept by the
program are kept under lock;
d. A
provision to ensure that controlled substances are kept under double lock
(e.g., a locked box in a locked cabinet); and
e. A provision to ensure that there is a
controlled substances record, in which is recorded the name of the patient, the
date, time, kind, dosage, balance remaining, and method of administration of
controlled substances; the name of the physician who prescribed the controlled
substance; and the name of the nurse who administered the controlled substance,
or staff who supervised the self-administration of the controlled
substance;
9. A program
providing nursing services pursuant to Section 4 of this administrative
regulation shall have provisions for promptly and conveniently obtaining
prescribed drugs and biologicals from a community or institutional pharmacy
holding a valid pharmacy permit issued by the Kentucky Board of Pharmacy,
pursuant to
KRS
315.035; and
10. A written policy to ensure that a child
who attends the program:
a. Is free from
physical, verbal, and sexual abuse and neglect;
b. Has age appropriate programming and
activities; and
c. Is kept
segregated from adult patients except for meals and special
events.
(2) Administrator. A program shall have an
administrator who shall be responsible for the operation of the facility and
shall delegate such responsibility in his absence.
(3) A patient shall be evaluated upon
admission to determine his program needs. A care plan shall be developed for
the patient.
(4) Personnel.
(a) The program shall employ or have access
to a sufficient number of qualified personnel as may be required to provide the
services required by this administrative regulation and indicated by the need
of the program's patients.
(b)
Written job descriptions and standards of qualifications shall be developed for
each category of personnel. Job descriptions shall include necessary
qualifications, lines of authority, and specific duty assignments. Job
descriptions shall be reviewed annually and revised as necessary.
(c) Current employee records shall be
maintained and shall include a resume of an employee's training and experience,
evidence of current licensure or registration if required by law, health
records and evaluation of performance, along with an employee's name, address,
and Social Security number.
(d)
Supportive personnel, assistants and volunteers shall be supervised and shall
function within the policies and procedures of the program.
(e) An employee shall have a test for
tuberculosis prior to or within the first week of employment and annually
thereafter. An employee contracting an infectious disease shall not appear at
work until the infectious disease can no longer be transmitted.
(f) The program shall conduct an orientation
for new employees.
(g) A planned
in-service training program shall be provided to employees covering policies
and procedures pertinent to their roles within the program.
(h) The administrator shall attend
educational programs appropriate to the responsibilities of the position and
arrange for other professional personnel to attend appropriate educational
programs on supervision and subjects related to personal care, activities,
nutrition, and other pertinent subjects.
(i) Staffing. The administrator shall
designate the person who shall be primarily responsible for the coordination
and provision of a dietary and activity service.
(j) An employee of the program who has direct
patient care responsibilities shall have current cardiopulmonary resuscitation
(CPR) certification from either the American Heart Association or the American
Red Cross.
(5) Patient's
records.
(a) The facility shall maintain an
individual record for a patient and shall develop a system of identification
and filing to ensure prompt location of the patient's record. Records shall be
treated with confidentiality, shall be in ink or typed, and shall be legible.
The record shall include the:
1. Patient's
name, address, and Social Security number (if available);
2. Name, address, and telephone number of a
referral agency;
3. Name and
telephone number of personal physician;
4. Patient's history and physical examination
report;
5. Patient's medication and
food allergies;
6. Name, telephone
number, and address of next of kin or other responsible person; and
7. Date of admission and discharge.
(b) A progress record shall be
maintained stating goals for a patient and shall indicate changes in the
patient's condition, behavior, responses, attitude, appetite, and other changes
as noted by staff, and shall include a discharge summary. An entry in the
record shall be signed and dated.
(c) If the patient has been referred on
orders of a physician, the record shall contain a dated and signed medical
summary and care plan including orders for special diet, contraindications for
specific types of activities, and other special procedures required for the
safety and well-being of the patient.
(d) A consultant involved in the program
shall make a written report of his findings and recommendations at the time of
his visit to be included in the patient's record.
(e) If a medication shall be administered to
a patient during the period of time he is in the program, a medication sheet
shall be maintained which contains the date, time given, name of medication,
dosage, name of prescribing physician, and by whom administered.
(f) A full written report of an incident or
accident involving a patient or employee shall be made and signed by the
administrator or his designee and shall include the names of any
witnesses.
(g) A record shall be
retained for a minimum of five (5) years or, in the case of a minor, three (3)
years after the patient reaches the age of majority under state law, whichever
is the longest.
(h) A telephone
order from a physician or another individual acting within his scope of
practice shall be countersigned within thirty (30) days.
(i) If nursing services are provided pursuant
to Section 4 of this administrative regulation, the record shall indicate a
description of the nursing service provided, the date the service was provided,
and pertinent information relating to the delivery of the service.
(6) Registry. The program shall
maintain a permanent, chronological patient registry book showing date of
admission, name of patient, and date of discharge.
(7) Equipment and supplies. The program shall
have equipment and supplies of sufficient quality and quantity to meet
patients' needs.
Section 3. Health services.
(1) Health
care services shall include:
(a) Supervision
and monitoring of the patients to assure that health care needs are being met
including supervision of self-administration of medications;
(b) Providing first aid and making
arrangements for medical care with a physician or hospital in case of accidents
or medical emergencies; and
(c)
Arranging for the transportation of a patient to a physician's office or
hospital in case of accidents or medical emergencies.
(2) Medical therapeutic services such as
physical therapy or speech therapy shall be administered upon written order of
the physician and shall be provided by a physical therapist or a
speech-language pathologist or under the supervision of a physical therapist or
a speech-language pathologist.
(3)
Occupational therapy shall be provided by an occupational therapist or under
the supervision of an occupational therapist.
(4) A patient receiving medical therapeutic
services or occupational therapy shall be ensured privacy and
dignity.
Section 4. Nursing Services.
(1) A program that provides
nursing services shall obtain a license to provide nursing services pursuant to
subsection (5) of this section.
(2)
Nursing services administered to patients by a registered nurse or licensed
practical nurse supervised by a registered nurse shall be ordered in writing by
the patient's physician or another licensed professional acting within his
scope of practice.
(3) If an order
for treatment or medication is received by telephone it shall be given to a
registered nurse or licensed practical nurse and immediately reduced to
writing.
(4) Nursing services,
other than the delivery of oral medications, shall be provided in a treatment
room.
(5) Special licensing
provisions for a program providing nursing services:
(a) A program currently licensed by the
cabinet may complete a revised form OIG 144 indicating that nursing services
shall be provided.
(b) The Office
of the Inspector General may conduct a survey as defined in
902 KAR
20:008 to ensure the requirements for providing
nursing services are met.
(c) The
program shall be issued an amended license reflecting the authority to provide
nursing services.
(d) A program
that is applying for an initial license shall indicate on the form OIG 144 that
nursing services shall be provided and the initial license issued by the Office
of the Inspector General shall reflect the authority to provide nursing
services.
(6) A program
licensed as of September 1, 2000 that applies for an amended license to provide
nursing services shall not be required to comply with Section 6(10) or (11) of
this administrative regulation, prior to September 1, 2001.
Section 5. Other Services.
(1) Self-care training. The program shall
provide a training program for self-care to assist a patient to gain
independent living status.
(2)
Personal care. Personal care services shall be provided.
(3) Activity program.
(a) The program shall include a balanced
activity program for all ages served. A patient shall choose and plan, if
feasible, a variety of activities that the patient desires, and the involvement
of the staff shall be advisory. There shall be a written activity program with
activities planned to fill patient needs with a sufficient variety for choice
including:
1. Recreation and physical
exercise;
2. Diversion, games,
music, and crafts;
3. Intellectual
and educational stimulation, current events, and educational films;
and
4. Participation in planning
menus and preparation of food.
(b) Activities shall be group or individually
oriented aimed at participation at all levels of capability.
(c) A specific period of the day shall be set
aside for rest. There shall be appropriate accommodations for rest.
(4) Transportation. If
transportation of the patient to or from the program is provided by the
program:
(a) A special provision shall be made
for a patient who uses a wheelchair; and
(b) An escort or assistant to the driver
shall be provided if necessary.
(5) Dietary services.
(a) Food service and preparation.
1. The program shall offer one (1) or more
hot meals providing no less than one-third (1/3) of the daily nutritional
requirements per meal.
2. Foods
shall be prepared by appropriate methods to conserve their nutritive value and
enhance their flavor and appearance.
3. Nutritional needs shall be met in
accordance with the current Recommended Dietary Allowance of the Food and
Nutrition Board of the National Research Council, adjusted for age, sex, and
activity and in accordance with physician's orders.
4. Food shall be cut, chopped, or ground to
meet individual needs.
5. Effective
equipment shall be provided and procedures established to maintain food at
proper temperature during service.
6. A patient requiring help in eating shall
be assisted.
7. Adaptive self-help
devices shall be provided if required in such a manner as to contribute to the
patient's independence in eating.
(b) Maintenance of sanitary condition.
1. The dietary department shall comply with
all applicable provisions of
KRS
219.011 to
KRS 219.081 and
902 KAR
45:005. If the program contracts for food service, the
catering service shall comply with the applicable requirements of
902 KAR 45:005
and the applicable requirements of this administrative regulation.
2. Perishable foods shall be refrigerated at
the appropriate temperature and in an orderly and sanitary manner. Leftover
food items shall be covered and dated if refrigerated.
Section 6. Facility Requirements.
(1) The facility shall be
maintained in a safe and clean manner, free from offensive odors, safety
hazards, and accumulations of dirt, rubbish and dust.
(2) A deodorizer shall not be used to conceal
an odor caused by unsanitary conditions or poor housekeeping
practices.
(3) The grounds shall be
kept free from refuse and litter. Areas around buildings, sidewalks, gardens,
and patios shall be kept clear of dense undergrowth.
(4) The facility shall be maintained free
from insects and rodents.
(5) Open
windows and doors shall be screened.
(6) Nests and entrances for insects and
rodents shall be eliminated.
(7)
Waste disposal.
(a) Sharp waste.
1. Sharp waste, including needles, scalpels,
razors, or other sharp instruments used for patient care procedures, shall be
segregated from other waste and placed in puncture resistant containers
immediately after use.
2. A needle
or other contaminated sharp instrument shall not be purposely bent, broken, or
otherwise manipulated by hand as a means of disposal, except as permitted by
Occupational Safety and Health Administration guidelines established in
29 CFR
1910.1030(d)(2)(vii).
3. The containers of sharp waste shall be
incinerated on or off site, or be rendered nonhazardous.
(b) Disposable waste.
1. Disposable waste shall be placed in
suitable bags or closed containers to prevent leakage or spillage, and shall be
handled, stored, and disposed of minimizing direct exposure of personnel to
waste materials.
2. The program
shall establish specific written policies regarding handling and disposal of
waste.
3. The following waste shall
be disposed of by incineration, or be autoclaved before disposal, or be
carefully poured down a drain connected to a sanitary sewer:
a. Blood;
b. Blood specimens;
c. Blood products; or
d. Used blood tubes.
(8) There shall be
adequate space in the facility to provide for patient needs and
comfort.
(9) The facility shall
have space to allow a patient who has become ill to rest in comfort and
privacy.
(10) A program that
provides nursing services shall have a treatment room.
(a) The treatment room shall have a minimum
floor area of 120 square feet.
(b)
The treatment room shall contain:
1. A
lavatory or sink equipped for hand washing;
2. A work counter;
3. Storage facilities for storage and
distribution of clean and sterile supplies; and
4. Adequate furnishings to safely and
comfortably provide nursing services.
(11) A program that provides nursing services
shall have a workroom or closet that contains:
(a) A sink equipped for hand
washing;
(b) A waste receptacle;
and
(c) A linen receptacle for the
collection of soiled linen.
Section 7. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) Kentucky Board of Nursing Scope
of Practice Determination Guidelines, April 1995 edition; and
(b) Form OIG 144, Application for a License
to Operate a Health Facility or Service, February 2001 edition.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Office of the Inspector General, 275 East Main Street, Fifth Floor East,
Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.
STATUTORY AUTHORITY: KRS 216B.042, 216B.0441, 216B.0443(1), 216B.105
Disclaimer: These regulations may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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