Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 158.000 - Licensure of Adult Day Health Programs
Section 158.038 - Quality of Care and Services

Universal Citation: 105 MA Code of Regs 105.158

Current through Register 1531, September 27, 2024

(A) All services provided by a Program shall meet professional standards of care and shall be provided by qualified persons.

(B) A Program shall provide services in accordance with each participant's comprehensive assessment and plan of care that support each participant's highest level of functioning, and that support the participant's and caregiver's goals to maintain the participant in the community.

(C) A Program shall provide all services, including those identified in 105 CMR 158.038(D), in accordance with the Program's written policies and procedures and in accordance with 105 CMR 158.000.

(D) A Program shall provide the following services:

(1) Nursing care;

(2) Service coordination;

(3) Therapeutic activities;

(4) Dietary services; and,

(5) Medication management services.

(E) Nursing Care. Nursing care shall be an integral part of the health care provided at a Program and shall emphasize the promotion and maintenance of health and the education, counseling, and emotional support of participants and caregivers. Nursing care includes coordination and collaboration with other professions and organizations within the community.

(F) Service Coordination.

(1) A Program shall provide sufficient service coordination to coordinate care and ensure participants attain or maintain their highest practicable physical, behavioral, and psychosocial well-being in accordance with the participants' plans of care, the written policies and procedures, and 105 CMR 158.000.

(2) Service coordination shall be coordinated with the nursing care, therapeutic activities, and other Program services.

(3) Service coordination shall include educational programs for Program personnel in order to promote the development of a therapeutic community, a congenial atmosphere, and healthy interpersonal relationships in the Program.

(G) Therapeutic Activities.

(1) A Program shall provide an on-going, regularly scheduled, organized program of meaningful and purposeful therapeutic activities for at least four hours per eight hour time period, exclusive of meal time and snack time.

(2) Therapeutic activities shall be individualized and designed to improve or maintain participants' self-awareness and level of functioning and shall be reasonably suited to the needs and interests of participants. Therapeutic activities shall be provided in a congenial environment on an individual and group basis.

(3) Program personnel shall seek ways to engage participants in therapeutic activities.

(4) The therapeutic activities program may utilize community resources to enhance participant-community interactions.

(5) A Program shall provide, maintain, and store basic supplies and equipment for therapeutic activities.

(6) A Program shall provide sufficient space for therapeutic activities.

(7) A Program that serves both participants with and without Alzheimer's disease and related disorders shall provide a separate space, as necessary, for therapeutic activities for participants with advanced dementia.

(8) Therapeutic activities shall be:
(a) Based on an assessment of each participant's gross motor, self-care, sensory, cognitive, and memory skills;

(b) Structured and planned to maximize the functional independence of each participant;

(c) Purposeful and meaningfully designed to assist participants in self-help and functional skills necessary to reside successfully in home and community based settings;

(d) Cognitively stimulating;

(e) Designed to enhance memory, to the extent practicable;

(f) Designed to promote physical fitness;

(g) Opportunities for self-expression;

(h) Coordinated with community service providers for necessary therapies; and

(i) Implemented in accordance with standards of practice for specific populations, including participants with Alzheimer's and related disorders, and appropriate to the stage of disease of the participants.

(H) Dietary Service.

(1) A Program shall provide adequate dietary services for participants in accordance with participants' nutritional needs.

(2) A Program may provide dietary services directly or may contract for the procurement of prepared meals provided the contracted service complies with 105 CMR 158.038(H).

(3) A Program shall maintain a written record of dates, times, services rendered, and recommendations made by the registered dietitian.

(4) Nutrition.
(a) A Program shall provide at least one third of the daily nutritional and dietary needs of each participant, as specified in guidelines of the Department.

(b) A Program shall provide each participant with a minimum of one nourishing and palatable hot mid-day meal. Occasional seasonal variations to the hot meal may be made as appropriate.

(c) Menus shall be planned and food supplies maintained so that a nutritionally adequate equivalent alternate meal can be provided at all times. Alternate meals shall be planned.

(d) An alternate meal reference book approved by the registered dietitian shall be maintained at the Program for reference.

(e) A Program shall provide morning and afternoon snacks that are appropriate to participants' dietary needs.

(f) A Program shall maintain records of menus as served for at least 30 days.

(5) Therapeutic Diets.
(a) A Program that has participants in need of therapeutic diets shall plan, prepare, and serve therapeutic diets as prescribed by primary care providers.

(b) A current diet manual shall be readily available to personnel.

(6) Food and Equipment.
(a) A Program shall provide convenient and suitable utensils such as forks, knives, tongs, spoons, or scoops, in order to minimize direct handling of food at all points where food is prepared or served.

(b) Single service items shall be discarded after one use.

(c) A Program shall establish procedures and provide equipment to maintain food at a proper temperature during service and transportation.

(d) Hot food shall be hot, and cold food shall be cold, when it reaches the participant.

(e) A Program shall serve food in a home-like, pleasant, clean, relaxing, and quiet atmosphere.

(f) Meals may not be served and activities may not occur simultaneously at the same table. Meals shall be served only after activities have been discontinued at the table, the area cleared of such supplies, and the area cleaned and prepared for meal service.

(g) A Program shall establish a written Disaster Dietary Plan and staff shall be familiar with it. The dietary disaster plan shall include, but not be limited to, alternate methods for preparing and serving food, including proper sanitation of dishes and utensils, in the event of an emergency or loss of electrical power, and a supply of food and water sufficient to provide for the dietary needs of the participants in the event that it becomes advisable to shelter in place.

(7) Sanitation.
(a) Sanitary conditions shall be maintained in all aspects of the storage, preparation, and distribution of food.

(b) Written reports of inspections by state and local health authorities shall be kept on file and posted in the Program with the notations made of action taken by the Program to comply with any recommendations.

(c) All food shall be maintained at safe temperatures and in accordance with 105 CMR 590.000: State Sanitary Code Chapter X - Minimum Sanitation Standards for Food Establishments.

(d) All food service personnel shall wear clean, washable garments, closed toe shoes, and hairnets or clean caps, and shall keep their hands and fingernails clean at all times.

(e) All food service personnel shall be in good health, shall practice hygienic food handling techniques, and shall conform to 105 CMR 590.000: State Sanitary Code Chapter X -Minimum Sanitation Standards for Food Establishments.

(f) A Program shall maintain an inventory of food and related supplies.

(g) A Program shall establish and follow written policies and procedures for cleaning, disinfecting, and sanitizing all equipment and work areas.

(h) Poisonous and toxic materials shall be stored in locked cabinets that are not used for any other purpose, and in a place that is separate from all food storage areas, food preparation areas, and clean equipment and utensils.

(I) Rehabilitation Services.

(1) A Program shall arrange for or coordinate rehabilitation services by licensed physical, occupational, and speech, hearing and language therapists for participants in need of these rehabilitation services.

(2) Rehabilitation services shall be coordinated with the nursing, dietary, service coordination, therapeutic activity, and other services provided to participants in order to promote restoration or maintenance of the participant to his or her maximum potential.

(J) Interpreter Services. A Program shall provide interpreter services, as necessary, that are appropriate to the population served. Interpreter services may be provided by a telephone interpreter service where appropriate.

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