Current through Register Vol. 46, No. 12, March 20, 2024
(a) The operator
shall designate an individual to be responsible for operating the residence in
compliance with applicable law and regulations and through direct performance or
coordination.
(b) Unless otherwise
stated in this section, the operator shall ensure sufficient staff in number and
qualifications to conduct the functions specified for an adult home or enriched
housing program as prescribed in 18 NYCRR Part 487 or 488,
respectively.
(c) The operator shall
provide staff sufficient in number and qualified by training and experience to
render, at a minimum, those services mandated by law or regulation, including:
(1) Case management.
(i) Staff shall carry out the functions
specified in section
1001.10(i)
of this Part.
(ii) In an assisted
living residence where the approved capacity is less than 25 beds, a qualified
case manager shall be on site for at least 20 hours per week and available to
provide case management services.
(iii) In a residence with 25 or more beds, a
qualified case manager shall be on site on a basis of one hour per week per each
additional bed up to a maximum of 40 hours per week and available to provide case
management services as follows:
Resident census | Case manager hours required |
1-24 | 20 hours/week |
25-44 | 20 hours/week +1 hour/week/each bed over 24
up to 40 hours |
(iv)
In a residence of 45 or more beds one or more case managers must be onsite at
least 40 hours and available to assure that case management services adequately
meet the needs of the residents.
(2) Personal care. The operator shall assign
sufficient staff, hereafter referred to as resident aides, to perform personal
care functions on a 24-hour basis as specified in 18 NYCRR sections 487.7 and
488.7.
(i) Resident aides shall receive 40
hours of initial training as specified in the department's training requirements
and curriculum or an approved equivalent program.
(ii) Resident aides shall receive 12 hours of
ongoing, inservice education annually in topics applicable to their
responsibilities.
(iii) Records
documenting training and education shall be maintained in the personnel record of
each resident aide as specified in section
1001.12 of this
Part.
(iv) An annual assessment of
the performance and effectiveness of all resident aides must be conducted
including at least one direct observation of performance.
(d) The operator shall ensure that
the health status of all new personnel is assessed and documented prior to
assuming resident care duties. The assessment shall be of sufficient scope that
no individual who is suffering from a degree of mental illness or habituation or
addiction to alcohol or other drugs such that the individual causes, or is likely
to cause, danger to himself or others or is unable to perform his or her assigned
duties, shall be employed or permitted to work as either an employee or a
volunteer.
(e) The operator shall
maintain, or if services are provided through contract, have access to, personnel
records which include the information specified in section
1001.12 of this
Part.
(f) All personnel must receive
orientation to the policies and procedures related to the provision of assisted
living residence, enhanced assisted living residence and/or special needs
assisted living residence services as applicable, to include, but not be limited
to general duties of staff, applicable facility and service delivery procedures,
responsibility for responding to resident emergencies, emergency evacuation and
disaster plan, and personal appearance of the employee.
(g) There must be a current written job
description for each position which delineates responsibilities and specific
education and experience requirements.
(h) A program must be implemented and enforced
for the prevention of circumstances which could result in an employee, including
but not limited to housekeeping and direct care staff, or resident becoming
exposed to significant body substance which could put them at significant risk of
HIV or other blood-borne pathogen infection during the provision of services, as
defined in sections
63.1 and
63.9
of this Title. Such a program shall include:
(1) use of scientifically accepted protective
barriers during job-related activities which involve, or may involve, exposure to
significant risk body substances. Such preventative action shall be taken by the
employee with each patient/client and shall constitute an essential element for
the prevention of bi-directional spread of HIV or other blood-borne
pathogen;
(2) use of scientifically
accepted preventative practices during job-related activities which involve the
use of contaminated instruments or equipment which may cause puncture
injuries;
(3) training at the time of
employment and yearly staff development programs on the use of protective
equipment, preventative practices, and circumstances which represent a
significant risk for all employees whose job-related tasks involve, or may
involve, exposure to significant risk body substances;
(4) provision of personal protective equipment
for employees which is appropriate to the tasks being performed; and
(5) a system for monitoring preventative
programs to assure compliance and safety shall be in place.
(i) Policy and procedures shall be implemented
and enforced for the management of individuals who are exposed to significant
risk body substances under circumstances which constitute significant risk of
transmitting or contracting HIV or other blood-borne pathogen infection. The
policy and procedure shall include:
(1) a
system for reporting to a designated individual in the agency exposure thought to
represent a circumstance which constitutes significant risk of transmitting or
contracting HIV or other blood-borne pathogen infection;
(2) evaluation of the circumstances of a
reported exposure and services for providing follow-up of the exposed individual
which includes:
(i) medical and epidemiological
assessment of the individual who is the source of the exposure, where that
individual is known and available;
(ii) if indicated epidemiologically, HIV or
other blood-borne pathogen counseling and voluntary testing of the source
individual. Disclosure of the HIV status of the source individual can be made
with the express written consent of the protected individual, or a person
authorized pursuant to law to consent to health care for the protected individual
if such person lacks capacity to consent, or pursuant to court order, if the HIV
status is not known to the exposed individual;
(a) appropriate medical follow-up of the
exposed individual; and
(b)
assurances for protection of confidentiality for those involved in reported
exposures.
(j) An enhanced assisted living residence or a
special needs assisted living residence shall provide, either directly or through
contract, sufficient nursing staff to meet the health care needs of the
residents. Nursing coverage requirements, at a minimum, include:
(1) a registered professional nurse on duty and
on-site at the residence, for eight hours per day, five days a week, and a
licensed practical nurse shall be on duty and onsite at the residence for eight
hours per day for the remainder of such week;
(2) a registered professional nurse on call and
available for consultation 24 hours a day, seven days a week, if not available
onsite; and
(3) additional nursing
coverage, as determined necessary and documented by the resident's medical
evaluation or otherwise by the resident's attending physician and/or the
ISP.
(k) An applicant for,
or operator of, an enhanced assisted living residence or special needs assisted
living residence with 40 or fewer operational beds may submit to the department a
written request for a waiver of the minimum requirements for nursing coverage set
forth in paragraph (j)(1) of this section. This subdivision will apply to such
requests, in place of section
1001.6(e)
of this Part. Such waiver request must contain the following:
(1) documentation acceptable to the department
that either:
(i) the applicant or operator is
unable to meet such minimum requirements; or
(ii) the current needs of the residents can be
appropriately and safely met with coverage that is less than or otherwise
different from the minimum requirements; and
(2) a description acceptable to the department
of what will be done by the operator to protect the health, safety and well-being
of the residents, and specifically how the nursing needs of the residents will be
addressed, in accordance with the medical evaluations and ISPs of the residents;
and
(3) documentation acceptable to
the department that the operator will include in its disclosure statements
provided to prospective residents, residents and their representatives the
details of any such waiver of the minimum nursing coverage requirements, if
approved by the department; and
(4)
acknowledgment that the operator will be required to comply with paragraphs
(j)(3) and (4) of this section.
(l) The department will review each such waiver
request submitted pursuant to subdivision (k) of this section on a case-by-case
basis, and may approve a waiver request to the extent and for the duration it
deems appropriate, in accordance with the provisions of this section. No waiver
request may be implemented by the operator unless or until it receives written
approval from the department. Before granting a waiver request the department may
require additional information and may require that the operator adopt special
methods or procedures to protect resident health and safety. The department may
grant written approval to such waiver request only after making a determination
that the proposed waiver will not adversely affect the health, safety and
well-being of residents.
(m) A
licensed nurse assuming nursing coverage responsibilities in an enhanced assisted
living residence or special needs assisted living residence as specified in
subdivision (j) of this section may also provide:
(1) case management services as specified in
subdivision (c) of this section; or
(2) serve as administrator, so long as the
nursing care needs and case management needs of the residents, and the
administration needs of the residence, are adequately met.
(n) At any time in which a registered
professional nurse is not on duty and on-site at an enhanced assisted living
residence or a special needs assisted living residence, the operator shall
provide at a minimum directly or through contract, sufficient home health aide
staff to meet the care needs of the residents. In addition to the training
required in section
700.2 of this Title,
such home health aides shall receive training in first aid and medication
assistance as specified by the department, and shall be thoroughly oriented to
procedures to be followed in emergency situations, as approved by the
department.
(o) An enhanced assisted
living residence or a special needs assisted living residence may employ or
contract for appropriately trained personnel with professional licenses and
registrations, as applicable, to provide health care services directly.
(p) Home health aides in an enhanced assisted
living residence or a special needs assisted living residence must be trained as
specified in section
700.2 of this Title and
receive 12 hours of in-service education annually in topics relevant to their
responsibilities.
(q) In addition to
the assessed and documented health status of all new personnel required pursuant
to subdivision (d) of this section, the operator shall maintain a record of the
following tests for direct care staff of an enhanced assisted living residence or
a special needs assisted living residence:
(1)
a certificate of immunization against rubella;
(2) a certificate of immunization against
measles for all personnel born on or after January 1, 1957;
(3) a written statement, if applicable from any
licensed physician, physician assistant, special assistant, licensed midwife or
nurse practitioner, which certifies that immunization with measles and/or rubella
vaccine may be detrimental to the person's health. The requirements of paragraphs
(1) and (2) of this subdivision relating to measles and/or rubella immunizations
shall be inapplicable until such immunization is found no longer to be
detrimental to such person's health. The nature and duration of the medical
exemption must be stated in the individual's personnel record and must be in
accordance with generally accepted medical standards (for example, the
recommendations of the Immunization Practices Advisory Committee of the U.S.
Department of Health and Human Services); and
(4) for all personnel prior to employment or
affiliation, except for personnel with no clinical or patient contact
responsibilities who are located in a building or site with no patient care
services, an initial individual tuberculosis (TB) risk assessment, symptom
evaluation, and TB test (either tuberculin skin test or Food and Drug
Administration (FDA) approved blood assay for the detection of latent
tuberculosis infection), and annual assessments thereafter. Positive findings
shall require appropriate clinical follow-up. The residence shall develop and
implement policies regarding follow-up of positive test results, including
procedures for facilitating and documenting treatment for latent TB infection
where indicated. Annual TB assessment shall include education, individual risk
assessment, and follow-up tests as indicated.
(5) documentation of COVID-19 vaccination or a
valid medical exemption to such vaccination, pursuant to section 2.61 of this
Title, in accordance with applicable privacy laws, and making such documentation
available immediately upon request by the Department, as well as any reasonable
accommodation addressing such exemption.
(r) If an enhanced assisted living residence
employs or uses advanced home health aides, the operator must ensure that every
advanced home health aide:
(1) is listed on the
home care worker registry maintained by the department; and
(2) is trained as specified in section
700.2 of this title and
receives 18 hours of in-service education annually to include medication
management, infection control, injection safety and other topics relevant to
their responsibilities which must be directly supervised by a registered
professional nurse; and
(3) is
directly supervised by a registered professional nurse who:
(i) provides training, guidance, direction and
oversight, and evaluation related to the performance of advanced tasks by the
advanced home health aide;
(ii)
assigns advanced tasks to be performed by the advanced home health aide after
completing a nursing assessment to determine the resident's current health status
and care needs;
(iii) provides case
specific training to the advanced home health aide to verify and ensure the
advanced home health aide can safely and competently perform the advanced tasks
for the resident;
(iv) provides
written, patient specific instructions for performing advanced tasks, including
the criteria for identifying, reporting, and responding to problems, errors or
complications;
(v) conducts a
comprehensive medication review including evaluation of the resident's current
medication use, and prescribed drug regimen and identifies and resolves any
discrepancies prior to assigning the advanced home health aide to administer
medications;
(vi) determines direct
supervision of the advanced home health aide based on the complexity of advanced
tasks, the skill and experience of the advanced home health aide assigned to
perform the advanced tasks, and the health status of the resident for whom the
advanced tasks are being performed;
(vii) while on duty is continuously available
to communicate with the advanced home health aide by phone or other
means;
(viii) conducts home visits or
arranges for another qualified registered professional nurse whenever necessary
to protect the health and safety of the resident;
(ix) performs an initial and ongoing
assessments of the resident's needs; and
(x) visits the resident in the residence at
least every two weeks and more frequently as determined by the registered
professional nurse, to observe, evaluate, and oversee services provided by the
advanced home health aide;
(4) a process is in place to document the
limitation or revocation of the assignment of advanced tasks by an advanced home
health aide when deemed appropriate by a supervising registered professional
nurse and to ensure that such information is available to other registered
professional nurses that may supervise such aide; and
(5) any failure by a supervising registered
professional nurse to comply with the requirements of paragraph three of this
subdivision shall be reported to the department.
The
amended version of this section by
New
York State Register October 4, 2023/Volume XLV, Issue 40, eff.
10/4/2023 is not yet
available.