Code of Vermont Rules
Agency 13 - AGENCY OF HUMAN SERVICES
Sub-Agency 110 - DEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING
Chapter 009 - RESIDENTIAL CARE HOME LICENSING
Section 13 110 009 - RESIDENTIAL CARE HOME LICENSING
Universal Citation: VT Code of Rules 13 110 009
Current through August, 2024
Section I General Provisions
1.1 Introduction
The State regulates residential care homes for the dual purposes of protecting the welfare and rights of residents and assuring they receive an appropriate quality of care. Residential care homes provide care to persons unable to live wholly independently but not in need of the level of care and services provided in a nursing home. Toward that end, these regulations are designed to foster personal independence on the part of residents and a home-like environment in the homes.
Residential care homes are licensed as either Level IV or Level III. Both levels must provide room and board, assistance with personal care, general supervision and/or medication management. Level III homes also must provide the additional service of nursing overview.
The intention of the Department of Aging and Disabilities is to assist residential care home providers to attain and maintain compliance with these regulations.
1.2
Statutory Authority
Residential care homes are subject to the provisions of 33 V.S.A. Chapter 71. The Agency of Human Services has designated the Department of Aging and Disabilities, Division of Licensing and Protection, as the licensing and regulatory agency for residential care homes. That statute and the provisions of these regulations guide them in their work.
1.3 Statement of Intent
Upon the effective date of these regulations, all residential care homes in Vermont will be required to adhere to the regulations as adopted.
1.4 Exception and
Severability
If any provision of these regulations, or the application of any provision of these regulations, is determined to be invalid, the determination of invalidity will not affect any other provision of these regulations or the application of any other provision of these regulations.
1.5 Taxes
The applicant and licensee shall be in good standing with the Vermont Department of Taxes, pursuant to 32 V.S.A. § 3113. Failure to do so shall result in denial or revocation of license.
1.6 Material Misstatements
Any applicant or licensee who makes a material misstatement relating to the law or these regulations may be subject to denial of license, monetary fine, suspension and/or revocation of license.
1.7 Appeals
A person aggrieved by a decision of the licensing agency may file a request for a fair hearing with the Human Services Board as provided in 3 V.S.A. § 3091.
Section II Definitions
2.1 General Definitions
For the purposes of these regulations, words and phrases are given their normal meanings unless otherwise specifically defined.
2.2 Specific Definitions
The following words and phrases, as used in these regulations, have the following meanings unless otherwise provided:
a. "Activities of daily living (ADLs)" means
dressing and undressing, bathing, toileting, taking medication, grooming,
eating, transferring and ambulation.
b. "Administration of medication" means the
act of giving a resident the resident's prescribed medication when the resident
is incapable of managing his or her medication.
c. "Assistance with medication" means helping
a resident, who is capable of self-administration, to use or ingest, store and
monitor medications.
d. "Assistive
community care services" means the Medicaid State Plan service that pays for
the cost of a bundle of health care services delivered to Medicaid
beneficiaries who live in participating Level III residential care homes. The
service bundle includes case management, assistance with the performance of
activities of daily living, medication assistance, monitoring and
administration, 24 hour on-site assistive therapy, restorative nursing, nursing
assessment, health monitoring, and routine nursing tasks.
e. "Assistive therapy" means activities,
techniques and methods designed to maintain or improve ADLs, cognitive status
or behavior.
f. "Capable of
self-preservation" means able to evacuate the home in the event of an
emergency. Resident capability is further described in the National Fire
Protection Association Code.
g.
"Capable of self-administration" means a resident is able to direct the
administration of medication by being able to at least identify the resident's
medication and describe how, why and when a medication is to be administered;
choose whether to take the medication or not; and communicate to the staff if
the medication has had the desired effect or unintended side effects.
h. "Case management" means to assist
residents in gaining access to needed medical, social and other services. In
addition to the coordination of activities required in the resident's plan of
care, it includes consultation with providers and support person(s).
i. "Chemical restraint" means any drug that
is used for discipline or convenience and not required to treat medical
symptoms.
j. "Day of service" means
a day when an eligible resident is living in the home and is provided with the
resident's ACCS services. A day of service does not include any day in which a
resident is absent from the home for the entire 24 hours of the calendar day
and any day on which a resident is discharged or transferred from the home to
another care setting (hospital, nursing home, etc.).
k. "Delegation of nursing tasks" means the
formal process approved by the Vermont Board of Nursing which permits
professional nurses to assign nursing tasks to other individuals as long as the
registered nurse provides proper training, supervision and monitoring, and for
which the registered nurse retains responsibility.
l. "Discharge" means movement of a resident
out of the home without expectation that the resident will return.
m. "Home" means a licensed residential care
home.
n. "Inspection" means an
on-site visit to or survey of the home by staff of the Division of Licensing
and Protection or fire safety inspectors from the Department of Labor and
Industry to evaluate care and services and determine if the home is in
compliance with the regulations.
o.
"Investigation" means any gathering of facts, in the home or elsewhere, in
response to a complaint or to an allegation that the home is not in compliance
with regulations in order to determine if a home is in compliance with the
regulations.
p. "Legal
representative" means an individual empowered under state or federal law or
regulation to make decisions for or transact business for a resident of a home.
Legal representatives include, but are not limited to, court appointed
guardians, an attorney in fact appointed pursuant to a power of attorney and
representative payees. A resident's legal representative may make only those
decisions for a resident for which the legal representative has been given
authority.
q. "Level III" means a
residential care home licensed and required to provide room, board, personal
care, general supervision, medication management and nursing overview as
defined by these regulations.
r. "Level IV" means a residential care home licensed and required to provide room, board, personal care, general supervision and medication management as defined by these regulations.
s. "License certificate" means a document
issued by the licensing agency which signifies that a home is entitled to
operate.
t. "Licensed capacity" is
the maximum number of residents which the residential care home is licensed to
have at one time.
u. "Licensed
home" is a residential care home possessing a valid license to operate from the
licensing agency.
v. "Licensee"
means an individual, group of individuals, or corporation in whose name the
license is issued and upon whom rests the legal responsibility for maintaining
compliance with the regulations.
w.
"Licensing agency" means the Department of Aging and Disabilities, Division of
Licensing and Protection.
x.
"Manager" means the staff person who has been appointed by the home licensee or
owner as responsible for the daily management of a home, including supervision
of employees and residents.
y.
"Mechanical restraint" means any equipment, material or device that may be
applied to a resident or the resident's environment for the purpose of
restricting the resident's activity. Mechanical restraints include, but are not
limited to, full bed rails, gates, half doors, geri chairs, roll bars, dignity
aprons, wrist and ankle restraints, vests and pelvic restraints. The use of
mechanical restraint is a treatment procedure that requires nursing
overview.
z. "Medication
management" means a formal process of (1) assisting residents to self
administer their medications or (2) administering medications, under the
supervision and delegation by registered nurses, to designated residents by
designated staff of the home. It includes procuring and storing medications,
assessing the effects of medications, documentation, and collaborating with the
residents' personal physicians.
aa.
"Nurse" means a licensed practical nurse or registered nurse currently licensed
by the Vermont Board of Nursing to practice nursing.
bb. "Nursing care" means the performance of
services necessary to care for the sick or injured and which require
specialized knowledge, judgment and skill and meets the standards of the
nursing regimen or the medical regimen, or both, as defined in
26 V.S.A. §
1572(4)
and (5).
cc. "Nursing overview" means a process in
which a nurse assures that the health and psychosocial needs of the resident
are met. The process includes observation, assessment, goal setting, education
of staff, and the development, implementation, and evaluation of a written,
individualized treatment plan to maintain the resident's well-being.
dd. "Personal care" means assistance with
meals, dressing, movement, bathing, grooming, medication, or other personal
needs, and/or the general supervision of physical or mental
well-being.
ee. "Plan of care"
means a written description of the steps that will be taken to meet the
psychiatric, social, nursing and medical needs of a resident.
ff. "Plan of correction" means a specific,
time-limited plan of action, approved by the licensing agency, which states how
and when a violation will be corrected.
gg. "PRN medication" means medication ordered
by the physician that is not to be administered routinely but is prescribed to
be taken only as needed and as indicated by the resident's condition.
hh. "Psychoactive drug" means a drug that is
used to alter mood or behavior, including antipsychotic, anti-anxiety agents
and sedatives, as well as antidepressants or anticonvulsants when used for
behavior control.
ii. "Psychosocial
care" means care necessary to address an identified psychiatric, psychological,
behavioral or emotional problem, including problems related to adjustment to
the residential care home, bereavement and conflict with other
residents.
jj. "Registered nurse"
means an individual licensed as a registered nurse by the Vermont Board of
Nursing.
kk. "Resident" means any
individual, unrelated to the operator, who is admitted to a home in order to
receive room, board, personal care, general supervision, medication management,
or nursing overview as defined by these regulations. For the purposes of these
regulations, "resident" also means the individual legally authorized to act on
the resident's behalf when the resident is no longer able to exercise any or
all of his or her rights.
ll.
"Residential care home" means a place, however named, excluding a licensed
foster home, which provides for profit or otherwise, room, board and personal
care to three or more residents unrelated to the licensee.
mm. "Restorative nursing" means services to
promote and maintain function as defined in the resident's service plan of
care.
nn. "Staff" means any
individual other than a resident who is either the licensee or is an agent or
employee of the licensee, and who performs any service or carries out any
duties at the home which are subject to these regulations.
oo. "Supervision" means providing a
structured environment to ensure the resident's needs for food, shelter,
medical care, socialization and safety are met. If the home, or staff of the
home, provide or are responsible for providing such structure, then the home is
providing supervision. Examples of such structure include, but are not limited
to, arranging medical appointments, procuring medications, shopping, assigning
rooms, providing transportation.
pp. "Therapeutic diet" means a
physician-ordered diet to manage problematic health conditions. Examples
include: calorie specific, low-salt, low-fat, no added sugar,
supplements.
qq. "Transfer" means
the movement of a resident to another bed within the home or to another health
care setting with return to the home anticipated.
rr. "Unlicensed home" means a place, however
named, which meets the definition of a residential care home and which does not
possess a license to operate.
ss.
"Unrelated to the operator" means anyone other than the licensee's spouse
(including an individual who has entered into a civil union, mother, father,
grandparent, child, grandchild, uncle, aunt, sibling, or mother-, father-,
sister-, brother-in-law or domestic partner).
tt. "Variance" means a written determination
from the licensing agency, based upon the written request of a licensee, which
temporarily and, in limited, defined circumstances, waives compliance with a
specific regulation.
uu.
"Violation" means a condition or practice in the home which is out of
compliance with the regulations.
Section III Variances
3.1. Variances from these regulations may be
granted upon a determination by the licensing agency that:
3.1.a Strict compliance would impose a
substantial hardship on the licensee or the resident; and
3.1.b The licensee will otherwise meet the
goal of the statutory provision or rule; and
3.1.c A variance will not result in less
protection of the health, safety and welfare of the residents.
3.2 A variance shall not be
granted from a statute or regulation pertaining to residents' rights.
3.3 A home requesting a variance must contact
the licensing agency in writing describing how the variance request meets the
criteria in 3.1 above.
3.4
Variances are subject to review and termination at any time.
3.5 A request for a variance from section
5.1.a to retain or admit a resident whose needs exceed that for which the home
is licensed to provide must include:
3.5.a A
current assessment, with a description of the resident's care needs and how the
home will meet those needs;
3.5.b A
written statement from the resident or the resident's legal representative
stating the resident's fully informed choice to remain in the home; and that
they have been informed the resident will have to leave if the variance is
terminated.
3.5.c A written
statement from the resident's physician giving the resident's prognosis and
recommending retention at or admission to the home.
Section IV Licensing Procedures
4.1 Application
4.1.a Any person desiring to operate or
establish a residential care home shall submit two copies of plans and
specifications for review, prior to beginning construction or operation, to:
Department of Aging and Disabilities
Division of Licensing and Protection
Ladd Hall, 103 South Main Street
Waterbury, Vermont 05671-2306
In addition, such person shall:
4.1.b Provide written evidence to the
licensing agency of compliance with local zoning codes, or a statement signed
by the city, town or village clerk that such a code has not been adopted in the
community.
4.1.c Submit a license
application to the licensing agency.
4.1.d At least ninety (90) days prior to the
projected opening date, request inspections by all entities referenced in
subsection
2,
a, b, and c below to which plans and specifications were submitted.
Modifications shall be made as required by these agencies to achieve full code
compliance.
4.1.e Provide the
licensing agency with at least three references from unrelated persons able to
attest to the applicant's abilities to run a residential care home and to the
applicant's character.
4.2 Review Process
The application will be reviewed by the following entities for compliance with applicable rules:
4.2.a Licensing and Protection requires the
applicant to submit blueprints for new construction or floor plans to the
licensing agency for review by an architect and engineer.
4.2.b Labor and Industry requires all
building plans to be submitted to Labor and Industry for compliance with the
fire safety code and accessibility.
4.2.c Environmental Conservation requires
applications to be reviewed with regard to water and sewage systems.
If the applicant requests, the Department of Aging and Disabilities shall attempt to convene a meeting of the relevant agencies with the applicant to discuss the review and facilitate a timely completion of the review process.
4.3 Assistive Community Care Services
4.3.a To participate as an Assistive
Community Care Services (ACCS) Medicaid provider, a home must be:
(1) Licensed as a Level
III home;
(2) Maintained in compliance with the
Residential Care Home Licensing Regulations; and
(3) Enrolled as a Medicaid
provider.
4.3.b A home
must submit a letter requesting ACCS status to the licensing agency that
includes:
(1) A brief statement of interest
in the program;
(2) A date when the
home proposes to begin participation in the program; and
(3) Whether any residents eligible for the
program currently reside in the home.
(4) A proposed amended resident agreement
reflecting program participation terms consistent with these
regulations;
(5) Proposed amended
policies and procedures reflecting participation in the ACCS program.
(6) A statement that all of the services
required in the ACCS definition found at 2.2.d of the regulations are available
and will be provided to meet the assessed needs of each resident.
4.3.c The licensing agency will
review the request and issue a response in writing within fourteen days. The
response will include the licensing agency's decision, the reasons for the
decision, and if the decision is to approve the effective date.
4.3.d Upon receiving approval to enroll in
the program, the home must give a 30 day notice of related rate and resident
agreement changes to all affected residents of the home and enter into the
standard agreement with the State as a Medicaid provider in the
program.
4.3.e A home shall give 90
days advance notice to the licensing agency and to its residents of a decision
to withdraw from the ACCS program in the time and manner required for closure
of a home pursuant to 5.3(h) of these regulations.
4.3.f The licensing agency shall investigate
and take action regarding any omissions, failures, and complaints associated
with a home's performance in the ACCS program pursuant to relevant regulatory
requirements.
4.4 Denial
of Application
4.4.a An applicant may be
denied a license for anyone of the following:
(1) Conviction of a crime, in Vermont or
elsewhere, for conduct which demonstrates unfitness to operate a
home;
(2) Substantiated complaint
of abuse, neglect or exploitation;
(3) Conviction, in Vermont or elsewhere, for
an offense related to bodily injury, theft or misuse of funds or
property;
(4) Conduct, in Vermont
or elsewhere, inimical to the public health, morals, welfare and
safety;
(5) Financial incapacity,
including capitalization, to provide adequate care and services; or
(6) An act or omission which would constitute
a violation of any of these regulations.
4.4.b When an applicant is denied for any of
the aforementioned reasons, the licensing agency may determine the applicant
has overcome the prohibition if presented with evidence of expungement or
suitability sufficient to ensure the safety of residents.
4.4.c Failure to provide complete, truthful
and accurate information within the required time during the application or
re-application process shall be grounds for automatic denial or revocation of a
license.
4.5
Re-application
4.5.a Application forms will
be mailed to the applicant approximately sixty (60) days before the end of the
licensing year. The completed application form must be returned to the
licensing agency not less than forty-five (45) days before the expiration date.
Upon receipt of a properly completed application, a license will be renewed
assuming all other conditions for licensure are met.
4.5.b Licenses shall be issued for a period
of one (1) year, unless the licensing agency determines that a home's lack of
compliance with these regulations indicates the home should be given a license
for a shorter period of time.
4.5.c
Requests for continued participation in the ACCS Medicaid program must be
submitted on an annual basis with the license re-application.
4.6 Expiration
A license expires on the date indicated on the licensure certification. However, if the licensee has made complete and accurate application to the licensing agency but the agency has failed to act on the license application, the current license remains in effect until the agency completes the renewal process.
4.7 Change in Licensed Capacity
4.7.a A home shall not provide care to more
residents than the capacity for which it is licensed. Requests for a change in
licensed capacity shall be made in writing to the licensing agency. A proper
staffing pattern to cover an increase in capacity shall be submitted when
requested.
4.7.b A home may provide
other related services, such as acting as a senior meals program meal site or
adult day care, provided the home:
(1) Has
adequate space, staff, and equipment to appropriately provide the
service;
(2) Has fully informed
residents on admission, or upon addition of a new service, about the additional
services;
(3) Ensures residents of
the home will not be inconvenienced by the service; and
(4) Has received approval from the licensing
agency in advance.
4.7.c
The offered service must meets accepted standards of practice and general
requirements for that service. For adult day care, the provider must meet the
standards for adult day care adopted by the Department of Aging and
Disabilities. For meal sites, the provider must meet the standards adopted for
the senior meals program through the Department of Aging and
Disabilities.
4.7.d If a
residential care home becomes a meal site, the home cannot charge a resident of
the home for a meal at the meal site unless that meal is in addition to the
meal the home is required to provide to the resident.
4.8 Temporary License
A temporary license may be issued permitting operation for such period or periods, and subject to such express conditions, as the licensing agency deems proper. Such license may be issued for a period not to exceed one year and renewals of such license shall not exceed thirty-six months.
4.9 Change in
Status
When a change of ownership or location is planned, the licensee or prospective licensee is required to file a new application for license at least ninety (90) days prior to the proposed date of the change. The new licensee shall provide each resident with a written agreement that describes all rates and charges as defined in 5.2.a.
4.10 Separate License
A separate license is required for each home that is owned and operated by the same management.
4.11 Transfer Prohibited
A license shall be issued only for the person(s) and premises named in the application and is not transferable or assignable.
4.12 License Certificate
The home's current license certificate shall be protected and appropriately displayed in such a place and manner as to be readily viewable by persons entering the home. Any conditions which affect the license in any way shall be posted adjacent to the license certificate.
4.13 Responsibility and Authority
4.13.a Each home shall be organized and
administered under one authority, which may be an individual, corporation,
partnership, association, state, subdivision or agency of the state, or any
other entity.
4.13.b Whenever the
authority is vested in the governing board of a firm, partnership, corporation,
company, association or joint stock association, there shall be appointed a
duly authorized qualified manager, however named, who will be in charge of the
daily management and business affairs of the home, who shall be fully
authorized and empowered to carry out the provisions of these regulations, and
who shall be charged with the responsibility of doing so. The manager of the
home shall be present in the home an average of 32 hours per week. The 32 hours
shall include time providing services, such as transporting, or attendance at
educational seminars. Vacations and sick time shall be taken into account for
the 32-hour requirement. In the event of extended absences, an interim manager
must be appointed.
4.13.c The
manager shall not leave the premises without delegating necessary authority to
a competent staff person who is at least eighteen (18) years of age. Staff left
in charge shall be qualified by experience to carry out the day to day
responsibilities of the manager, including being sufficiently familiar with the
needs of the residents to ensure that their care and personal needs are met in
a safe environment. Staff left in charge shall be fully authorized to take
necessary action to meet those needs or shall be able to contact the manager
immediately if necessary.
4.13.d
The qualifications for the manager of a home are, at a minimum:
(1) Completion of a State approved
certification course or
(2) One of
the following:
i. At least an Associates
Degree in the area of human services and two (2) years of administrative
experience in adult residential care; or
ii. Three (3) years of general experience in
residential care, including one year in management, supervisory or
administrative capacity; or
iii. A
current Vermont license as a nurse or nursing home administrator; or
iv. Other professional qualifications and
experience related to the provision of healthcare services or management of
healthcare facilities including, but not limited to, a licensed or certified
social worker.
4.14 Survey/Investigation
4.14.a The licensing agency shall inspect a
home prior to issuing a license and may inspect a home any other time it
considers an inspection necessary to determine if a home is in compliance with
these regulations.
(1) Authorized staff of
the licensing agency shall have access to the home at all times, with or
without notice.
(2) The living
quarters of the manager of a home may be subject to inspection only where the
inspector has reason to believe the licensed capacity of the home has been
exceeded and only for the purpose of determining if such a violation exists.
The inspector shall permit the manager to accompany him or her on such an
inspection.
(3) If an authorized
inspector is refused access to a home or the living quarters of the manager,
the licensing agency may, pursuant to
18 V.S.A. §
121, seek a search warrant authorizing the
inspection of such premises.
(4)
If, as a result of an investigation or survey, the licensing agency determines
that a home is unlicensed and meets the definition of a residential care home,
written notice of the violation shall be prepared pursuant to Title 33, §
2008(b)
and § 4.14 of these regulations.
4.14.b The licensing agency shall investigate
whenever it has reason to believe a violation of the law or regulations has
occurred. Investigations may be conducted by the licensing agency or its agents
and may be conducted at any place or include any person the licensing agency
believes possesses information relevant to its regulatory responsibility and
authority.
4.14.c After each
inspection, survey or investigation, an exit conference will be held with the
manager or designee. The exit conference shall include an oral summary of the
licensing agency's findings and if regulatory violations were found, notice
that the home must develop and submit an acceptable plan of correction.
Residents who wish to participate in the exit conference have the right to do
so. Representatives of the Office of the State Long Term Care Ombudsman may
also attend the exit conference.
4.14.d A written report shall be submitted to
the licensee at the conclusion of an investigation. The report will contain the
results of the investigation, any conclusions reached and any final
determinations made by the licensing agency.
4.14.e The licensing agency may, within the
limits of the resources available to it, provide technical assistance to the
home to enable it to comply with the law and the regulations. The licensing
agency shall respond in writing to reasonable written requests for
clarification of the regulations.
4.14.f The home shall make written reports
resulting from inspections readily available to residents and to the public in
a place readily accessible to residents where individuals wishing to examine
the results do not have to ask to see them. The home must post a notice of the
availability of such written reports. If a copy is requested and the home does
not have a copy machine, the home must inform the resident or member of the
public that they may request a copy from the licensing agency and provide the
address and telephone number of the licensing agency.
4.15 Violations: Notice Procedure
4.15.a If, as a result of survey or
investigation, the licensing agency finds a violation of a law or regulation,
it shall provide a written notice of violation to the home within 10 days. The
notice shall include the following:
(1) A
description of each condition that constitutes violation;
(2) Each rule or statutory provision alleged
to have been violated;
(3) The date
by which the home must return a plan of correction for the alleged
violations;
(4) The date by which
each violation must be corrected;
(5) Sanctions the licensing agency may impose
for failure to correct the violation or failure to provide proof of correction
by the date specified;
(6) The
right to apply for a variance as provided for in Section III of these
regulations;
(7) The right to an
informal review by the licensing agency; and
(8) The right to appeal the licensing agency
determination of violation, with said appeal being made to the Commissioner
within fifteen (15) days of the mailing of the notice of violation.
4.15.b The licensing agency shall
provide a copy of the survey results and any enforcement action as defined in
4.16 to the State Long Term Care Ombudsman.
4.15.c If the licensee fails either to return
a plan of corrective action or to correct any violation in accordance with the
notice of violation, the licensing agency shall provide written notice to the
licensee of its intention to impose specific sanctions, and the right of the
licensee to appeal.
4.15.d The
licensing agency shall mail its decision to the licensee within ten (10) days
of the conclusion of the review or, if no review was requested, within
twenty-five (25) days of the mailing of the notice of proposed sanctions. The
written notice shall include the licensee's right to appeal the decision to the
Commissioner within fifteen (15) days of the mailing of the decision by the
licensing agency.
4.15.e Nothing in
these regulations shall preclude the licensing agency from taking immediate
enforcement action to eliminate a condition which can reasonably be expected to
cause death or serious physical or mental harm to residents or staff. If the
licensing agency takes immediate enforcement action, it shall explain the
actions and the reasons for it in the notice of violation. At the time
immediate enforcement action is proposed, the licensee shall be given an
opportunity to request and appeal to the Commissioner. If immediate enforcement
action is taken, the licensee also shall be informed of the right to appeal the
Department's action to the Human Services Board.
4.16 Enforcement The purpose of enforcement
actions is to protect residents. Enforcement actions by the licensing agency
against a home may include the following:
4.16.a Administrative penalties against a
home for failure to correct a violation or failure to comply with a plan of
corrective action for such violation as follows:
(1) Up to $ 5.00 per resident or $ 50.00,
whichever is greater, for each day a violation remains uncorrected if the rule
or provision violated was adopted primarily for the administrative purposes of
the licensing agency;
(2) Up to $
8.00 per resident or $ 80.00, whichever is greater, for each day a violation
remains uncorrected if the rule or provision violated was adopted primarily to
protect the welfare or the rights of residents;
(3) Up to $ 10.00 per resident or $ 100.00,
whichever is greater, for each day a violation remains uncorrected if the rule
or provision violated was adopted primarily to protect the health or safety of
residents.
(4) For purposes of
imposing administrative penalties under this subsection, a violation shall be
deemed to have first occurred as of the date of the notice of
violation.
4.16.b
Suspension, revocation, modification or refusal to renew a license upon any of
the following grounds:
(1) Violation by the
licensee of any of the provisions of the law or regulations;
(2) Conviction of a crime for conduct which
demonstrates that the licensee or the principal owner is unfit to operate a
home;
(3) Conduct inimical to the
public health, morals, welfare and safety of the people of the State of Vermont
in the maintenance and operation of the premises for which a license is
issued;
(4) Financial incapacity of
the licensee to provide adequate care and services; or
(5) Failure to comply with a final decision
or action of the licensing agency.
4.16.c Suspension of admissions to a home, or
transfer of residents from a home to an alternative placement, for a violation
which may directly impair the health, safety or rights of residents, or for
operating without a license. Residents subject to transfer shall have the
procedural rights provided in Section 6.14.
4.16.d The licensing agency, the attorney
general, or a resident may bring an action for injunctive relief against a home
in accordance with the Rules of Civil Procedure to enjoin any act or omission
which constitutes a violation of the law or regulation. Notice of such action
shall be given to the State Long Term Care Ombudsman.
4.16.e The licensing agency, the attorney
general, or a resident may bring an action in accordance with the Rules of
Civil Procedure for appointment of a receiver for a home, if there are grounds
to support suspension, revocation, modification or refusal to renew the home's
license and alternative placements for the residents are not readily available.
Notice of such action shall be given to the State Long Term Care
Ombudsman.
4.16.f The licensing
agency may enforce a final order by filing a civil action in the superior court
in the county in which the home is located, or in Washington Superior
Court.
4.16.g The remedies provided
for violations of the law or regulations are cumulative.
4.17 Identification of Unlicensed Homes
With regard to residential care homes operating without a license, but required by law to be licensed, the following regulations shall apply:
4.17.a No physician, surgeon,
osteopath, chiropractor, physician's assistant (licensed, certified or
registered under the provisions of Title 26), resident physician, intern,
hospital administrator in any hospital in this state, registered nurse,
licensed practical nurse, medical examiner, psychologist, mental health
professional, social worker, probation officer, police officer, nursing home
administrator or employee, or owner, manager, or employee of a home shall
knowingly place, refer or recommend placement of a person to such a home if
that home is operating without a license.
4.17.b Any individual listed in 4.17.a who is
licensed or certified by the State of Vermont or who is employed by the state
or a municipality and who knows or has reason to believe that a home is
operating without the license required under this chapter shall report the home
and address of the home to the licensing agency.
4.17.c Violation of the above sections may
result in a criminal penalty of up to $ 500 and/or a prison sentence of up to
six months pursuant to 18 V.S.A. § 2013.
4.17.d The licensing agency shall investigate
any report filed by an individual listed above.
4.17.e The licensing agency shall investigate
any report filed by any person other than one listed in 4.17 a, unless it
reasonably believes that the complaint is without merit.
Section V Resident Care and Home Services
5.1 Eligibility
5.1.a The licensee shall not accept or retain
as a resident any individual who meets level of care eligibility for nursing
home admission, or who otherwise has care needs which exceed what the home is
able to safely and appropriately provide.
5.1.b A person with a serious, acute illness
requiring the medical, surgical or nursing care of a general or special
hospital shall not be admitted to or retained as a resident in a residential
care home.
5.1.c A person under
eighteen (18) years of age shall not be admitted to a residential care home
except by permission of the licensing agency.
5.2 Admission
5.2.a Prior to or at the time of admission,
each resident, and the resident's legal representative if any, shall be
provided with a written admission agreement which describes the daily, weekly,
or monthly rate to be charged, a description of the services that are covered
in the rate, and all other applicable financial issues, including an
explanation of the home's policy regarding discharge or transfer when a
resident's financial status changes from privately paying to paying with SSI or
ACCS benefits. This admission agreement shall specify at least how the
following services will be provided, and what additional charges there will be,
if any: all personal care services; nursing services; medication management;
laundry; transportation; toiletries; and any additional services provided under
ACCS or a Medicaid Waiver program. If applicable, the agreement must specify
the amount and purpose of any deposit. This agreement must also specify the
resident's transfer and discharge rights, including provisions for refunds, and
must include a description of the home's personal needs allowance policy.
(1) In addition to general resident agreement
requirements, agreements for all ACCS participants shall include: the ACCS
services, the specific room and board rate, the amount of personal needs
allowance and the provider's agreement to accept room and board and Medicaid as
sole payment.
(2) No home may
require that a resident purchase optional services as a condition of serving
the resident in the ACCS program. Medicaid regulations prohibit homes from
requiring deposits for ACCS covered services.
(3) The admission agreement shall inform the
resident whether the home will accept SSI or ACCS payments and allow a
privately-paying resident to continue residing in the home when the resident is
no longer able to continue privately paying the home's periodic rate.
Alternatively, the admission agreement shall inform the resident that the home
is not required to accept SSI or ACCS payments, that the home reserves the
right to make this decision on a case-by-case basis, and that the resident may
be transferred or discharged from the home in the event that the resident's
financial status changes and the resident is no longer able to continue
privately paying the home's periodic rate.
(4) If the home agrees to accept SSI or ACCS
payments and allows the resident to remain in the home when the resident's
financial status changes, the home must provide the resident with a new
admission agreement as provided to all ACCS participants.
(5) If a resident loses SSI or ACCS benefits
and the loss of such benefits will result in discharge from the home, the home
shall provide a thirty (30) day notice prior to discharge or transfer as
required in 5.3.a.
(6) If an ACCS
resident resides in a home under a variance, the home may accept one of the
following amounts in addition to the resident's required payment and the ACCS
daily rate:
i. A payment from a Medicaid
Waiver program, if applicable; or
ii. A payment from another source. In such
cases, the amount accepted shall be clearly stated in the resident agreement,
and the home shall state whether the resident shall be eligible to remain in
the home at the ACCS rate alone if the resident no longer meets the applicable
guideline for a higher level of care.
5.2.b On admission, the home must also
determine if the resident has any form of advance directive and explain the
resident's right under state law to formulate, or not to formulate, an advance
directive. Any change of rate or services shall be preceded by a thirty (30)
day written notice to the resident and the resident's legal representative, if
any.
5.2.c The home must provide
each resident with information regarding how to contact the Long Term Care
Ombudsman, Vermont Protection and Advocacy, Inc. or the Vermont Senior
Citizen's Law Project.
5.2.d On
admission each resident shall be accompanied by a physician's statement, which
shall include: medical diagnosis, including psychiatric diagnosis if
applicable.
5.3
Discharge and Transfer Requirements
5.3.a
Involuntary Discharge or Transfer of Residents
(1) An involuntary discharge of a resident is
the removal of the resident from a residential care home when the resident or
the resident's legal representative has not requested or consented in advance
to the removal. A transfer is the removal of the resident from the room the
resident currently occupies to another room in the home or to another facility
with an anticipated return to the home. An involuntary discharge or transfer
may occur only when:
i. The resident's care
needs exceed those which the home is licensed or approved through a variance to
provide; or
ii. The home is unable
to meet the resident's assessed needs; or
iii. The resident presents a threat to the
resident's self or the welfare of other residents or staff; or
iv. The discharge or transfer is ordered by a
court; or
v. The resident has
failed to pay monthly charges for room, board and care in accordance with the
admission agreement.
(2)
In the case of an involuntary discharge or transfer, the manager shall:
i. Notify the resident, and if known, a
family member and/or legal representative of the resident, of the discharge or
transfer and the specific reasons for the move in writing and in a language and
manner the resident understands at least 72 hours before a transfer within the
home and thirty (30) days before discharge from the home. If the resident does
not have a family member or legal representative and requests assistance, the
notice shall be sent to the Long Term Care Ombudsman, Vermont Protection and
Advocacy or Vermont Senior Citizens Law Project.
ii. Use the form prescribed by the licensing
agency for giving written notice of discharge or transfer and include a
statement in large print that the resident has the right to appeal the home's
decision to transfer or discharge with the appropriate information regarding
how to do so.
iii. Include a
statement in the written notice that the resident may remain in the room or
home during the appeal.
iv. Place a
copy of the notice in the resident's clinical record.
(3) A resident has the right to appeal the
decision by the home to discharge or transfer. The process for appeal is as
follows:
i. To appeal the decision to
transfer or discharge, the resident must notify the administrator of the home
or the director of the licensing agency. Upon receipt of an appeal, the
administrator must immediately notify the director of the licensing
agency.
ii. The request to appeal
the decision may be oral or written and must be made within 10 business days of
the receipt of the notice by the resident.
iii. Both the home and the resident shall
provide all the materials deemed relevant to the decision to transfer or
discharge to the director of the licensing agency as soon as the notice of
appeal is filed. The resident may submit orally if unable to submit in writing.
Copies of all materials submitted to the licensing agency will be available to
the resident upon request.
iv. The
director of the licensing agency will render a decision within eight business
days of receipt of the notice of appeal.
v. The notice of decision from the director
will be sent to the resident and to the home, will state that the decision may
be appealed to the Human Services Board, and will include information on how to
do so.
vi. The resident or the home
will have 10 business days to file a request for an appeal with the Human
Services Board by writing to the Board. The Human Services Board will conduct a
de novo evidentiary hearing in accordance with
3 V.S.A. §
3091.
5.3.b Emergency Discharge or Transfer of
Residents
(1) An emergency discharge or
transfer may be made with less than thirty (30) days notice under the following
circumstances:
i. The resident's attending
physician documents in the resident's record that the discharge or transfer is
an emergency measure necessary for the health and safety of the resident or
other residents; or
ii. A natural
disaster or emergency necessitates the evacuation of residents from the home;
or
iii. The resident presents an
immediate threat to the health or safety of self or others. In that case, the
licensee shall request permission from the licensing agency to discharge or
transfer the resident immediately. Permission from the licensing agency is not
necessary when the immediate threat requires intervention of the police, mental
health crisis personnel, or emergency medical services personnel who render the
professional judgement that discharge or transfer must occur immediately. In
such cases, the licensing agency shall be notified on the next business day;
or
iv. When ordered or permitted by
a court.
5.3.c If the resident agrees to a discharge
or transfer, the discharge or transfer may occur prior to the effective date of
notice.
5.3.d A home must provide
sufficient preparation and orientation to residents to ensure a safe and
orderly transfer or discharge from the home.
5.3.e A home may not initiate an involuntary
discharge of a resident whose care is provided and paid for under the ACCS
program because of voluntary temporary, leaves from the home.
5.3.f A home is responsible for any charges
associated with disconnecting, relocating or reconnecting telephones, cable
television, air-conditioning or other similar costs resulting from a home's
decision to transfer the resident.
5.3.g A licensee who intends to discontinue
all or part of the operation, or to change the admission or retention policy,
ownership, or location of the home in such a way as to necessitate the
discharge or transfer of residents shall notify the licensing agency and
residents at least ninety (90) days prior to the proposed date of change. The
licensee is responsible for ensuring that all residents are discharged or
transferred in a safe and orderly manner. When such change in status does not
necessitate the discharge or transfer of residents, the licensee shall give the
licensing agency and residents at least thirty (30) days prior written
notice.
5.3.h The home may include
language in its admission agreement requiring residents to provide thirty (30)
days notice when the resident intends to voluntarily leave the
home.
5.4 Refunds
5.4.a When a resident is discharged, the
resident shall receive a refund, within 15 days of discharge, for any funds
paid in advance for each day care was not provided. In the case of a discharge
to a hospital or other temporary placement, the effective date for this
provision shall be the day the home is notified the resident will not be
returning. For the purposes of providing refunds, "day of discharge" shall be
considered the day the resident's room is empty of the resident's belongings,
if those belongings are too large or difficult for the home to store
temporarily. The facility shall temporarily store small items such as clothing
and other personal items if necessary.
5.4.b The home shall document in the
resident's record the date of notification that the resident would not return,
and from whom notice was received.
5.4.c A home may not seek to recover for lost
income from ACCS residents for care on days that are not days of service. A
home may not require, induce or accept payment for care for residents in the
ACCS program for days of residence that are not days of service.
In the case of ACCS residents and homes, the refund shall be based on any funds paid in advance by the resident for care and services. A home shall not offset all or any part of the refund by charging the resident for covered or optional services for any day that does not meet the definition of a day of service.
5.5 General Care
5.5.a Upon a resident's admission to a
residential care home, necessary services shall be provided or arranged to meet
the resident's personal, psychosocial, nursing and medical care
needs.
5.5.b Staff shall provide
care that respects each resident's dignity and each resident's accomplishments
and abilities. Residents shall be encouraged to participate in their own
activities of daily living. Families shall be encouraged to participate in care
and care planning according to their ability and interest and with the
permission of the resident.
5.5.c
Each resident's medication, treatment, and dietary services shall be consistent
with the physician's orders.
5.5.d
A home certified to provide assistive community care services (ACCS) shall
designate a staff person responsible for case management, who shall provide at
least the following case management services: maintenance and implementation of
a current assessment and plan of care, and coordination of available community
services.
5.6 Special
Care Units
5.6.a The home must obtain
approval from the licensing agency prior to establishing and operating a
special care unit. Approval will be based on a demonstration that the unit will
provide specialized services to a specific population.
5.6.b A request for approval must include all
of the following:
(1) A statement outlining
the philosophy, purpose and scope of services to be provided;
(2) A definition of the categories of
residents to be served;
(3) A
description of the organizational structure of the unit consistent with the
unit's philosophy, purpose and scope of services;
(4) A description and identification of the
physical environment;
(5) The
criteria for admission, continued stay and discharge; and
(6) A description of unit staffing, to
include:
i. Staff qualifications;
ii. Orientation;
iii. In-service education and specialized
training; and
iv. Medical
management and credentialing as necessary.
5.6.c A home that has received approval to
operate a special care unit must comply with the specifications contained in
the request for approval. The home will be surveyed to determine if the special
care unit is providing the services, staffing, training and physical
environment that was outlined in the request for approval.
5.6.d The requirements of sections 5.2 and
5.3 above shall apply to all residential care home residents including those in
special care units.
5.7
Assessment
5.7.a An assessment shall be
completed for each resident within 14 days of admission, consistent with the
physician's diagnosis and orders, using an assessment instrument provided by
the licensing agency. The resident's abilities regarding medication management
shall be assessed within 24 hours and nursing delegation implemented, if
necessary.
5.7.b If a resident
requires nursing overview or nursing care, the resident shall be assessed by a
licensed nurse within fourteen days of admission to the home or the
commencement of nursing services, using an assessment instrument provided by
the licensing agency.
5.7.c Each
resident shall also be reassessed annually and at any point in which there is a
change in the resident's physical or mental condition.
5.8 Physician Services
5.8.a All residents shall be under the
continuing general supervision of a physician of their choosing, and shall
receive assistance, if needed, in scheduling medical appointments.
5.8.b A resident has the right to refuse all
medical care for religious reasons or other reasons of conviction, but in such
cases, the home must assess its ability to properly care for the resident and
document the refusal and the reasons for it in the resident's record.
5.8.c Any refusal of medical care and the
reasons for the refusal must be documented in the resident's record. If the
resident has an attending physician, the physician shall be notified.
5.8.d All physicians' orders obtained via
telephone shall be countersigned by the physician/licensed practitioner within
15 days of the date the order was given.
5.9 Level of Care and Nursing Services
5.9.a Residents who require more than nursing
overview or medication management shall not be retained in a residential care
home unless the provisions of the following subsections (l)-(5) are all met:
(1) The nursing services required are either:
i. Provided fewer than three times per week;
or
ii. Provided for up to seven
days a week for no more than 60 days and the resident's condition is improving
during that time and the nursing service provided is limited in nature;
or
iii. Provided by a
Medicare-certified Hospice program; and
(2) The home has a registered nurse on staff,
or a written agreement with a registered nurse or home health agency, to
provide the necessary nursing services and to delegate related appropriate
nursing care to qualified staff; and
(3) The home is able to meet the resident's
needs without detracting from services to other residents; and
(4) The home has a written policy, explained
to prospective residents before or at the time of admission, which explains
what nursing care the home provides or arranges for, how it is paid for and
under what circumstances the resident will be required to move to another level
of care; and
(5) Residents
receiving such care are fully informed of their options and agree to such care
in the residential care home.
5.9.b The following services are not
permitted in a residential care home except under a variance granted by the
licensing agency: intravenous therapy; ventilators or respirators; daily
catheter irrigation; feeding tubes; care of stage III or IV decubitus;
suctioning; sterile dressings.
5.9.c For each resident requiring nursing
overview, administration of medication, or nursing care, the nurse shall:
(1) Complete an assessment of the resident in
accordance with section 5.7;
(2)
Oversee development of a written plan of care for each resident that is based
on abilities and needs as identified in the resident assessment. A plan of care
must describe the care and services necessary to assist the resident to
maintain independence and well-being;
(3) Provide instruction and supervision to
all direct care personnel regarding each resident's health care needs and
nutritional needs and delegate nursing tasks as appropriate;
(4) Maintain a current list for review by
staff and physician of all residents' medications. The list shall include:
resident's name; medications; date medication ordered; dosage and frequency of
administration; and likely side effects to monitor;
(5) Assure that residents' medications are
reviewed periodically and that all resident medications have either a
supporting medical diagnosis or problem;
(6) Maintain a current list of all treatments
for each resident that shall include: the name, date treatment ordered,
treatment and frequency prescribed and documentation to reflect that treatment
was carried out;
(7) Assure that
symptoms or signs of illness or accident are recorded at the time of
occurrence, along with action taken;
(8) Ensure that the resident's record
documents any changes in a resident's condition;
(9) Review all therapeutic diets and food
allergies with dietary staff as needed to assure nutritional standards are met
and are consistent with physician orders;
(10) Monitor stability of each resident's
weight;
(11) Implement assistive
therapy as necessary to maintain or improve the resident's functional status,
with consultation from a licensed professional as needed; and
(12) Assume responsibility for staff
performance in the administration of or assistance with resident medication in
accordance with the home's policies.
5.9.d Residents of Level III or Level IV may
receive home health services on a resident-specific basis to provide care the
home cannot readily provide, including skilled nursing, speech therapy,
physical therapy and occupational therapy on an intermittent basis (less than
three times per week) or more intensively for short term (up to seven days a
week for no more than 60 days) to the extent agreed upon by the service
provider and the resident if all other provisions of these regulations are met.
(1) Level III homes may utilize home health
agency services to provide nursing overview or medication management provided
such services are provided on a contractual basis to the home and the cost for
such a service is not charged to Medicare or the resident. Level IV homes may
utilize home health agency services to provide nursing overview or medication
management on a resident specific basis without a special contractual
arrangement.
(2) If a resident
requires skilled nursing services from a home health agency because the home
cannot provide the services and the services will continue for more than sixty
(60) days, the home must request a variance in writing from the licensing
agency to retain the resident.
(3)
Home health agencies shall not provide personal care services, such as bathing,
for residents in residential care homes except with the permission of the
licensing agency. Personal care by home health agencies associated with hospice
care is permitted as long as the home meets all other requirements.
5.10 Medication
Management
5.10.a Each residential care home
must have written policies and procedures describing the home's medication
management practices. The policies must cover at least the following:
(1) Level III homes must provide medication
management under the supervision of a licensed nurse. Level IV homes must
determine whether the home is capable of and willing to provide assistance with
medications and/or administration of medications as provided under these
regulations. Residents must be fully informed of the home's policy prior to
admission.
(2) Who provides the
professional nursing delegation if the home administers medications to
residents unable to self-administer and how the process of delegation is to be
carried out in the home.
(3)
Qualifications of the staff who will be managing medications or administering
medications and the home's process for nursing supervision of the
staff.
(4) How medications shall be
obtained for residents including choices of pharmacies.
(5) Procedures for documentation of
medication administration.
(6)
Procedures for disposing of outdated or unused medication, including
designation of a person or persons with responsibility for disposal.
(7) Procedures for monitoring side effects of
psychoactive medications.
5.10.b The manager of the home is responsible
for ensuring that all medications are handled according to the home's policies
and that designated staff are fully trained in the policies and
procedures.
5.10.c Staff will not
assist with or administer any medication, prescription or over-the-counter
medications for which there is not a physician's written, signed order and
supporting diagnosis or problem statement in the resident's record.
5.10.d If a resident requires medication
administration, unlicensed staff may administer medications under the following
conditions:
(1) A registered nurse must
conduct an assessment consistent with the physician's diagnosis and orders of
the resident's care needs as required in section 5.7.c.
(2) A registered nurse must delegate the
responsibility for the administration of specific medications to designated
staff for designated residents.
(3)
The registered nurse must accept responsibility for the proper administration
of medications, and is responsible for:
i.
Teaching designated staff proper techniques for medication administration and
providing appropriate information about the resident's condition, relevant
medications, and potential side effects;
ii. Establishing a process for routine
communication with designated staff about the resident's condition and the
effect of medications, as well as changes in medications;
iii. Assessing the resident's condition and
the need for any changes in medications; and
iv. Monitoring and evaluating the designated
staff performance in carrying out the nurse's instructions.
(4) All medications must be
administered by the person who prepared the doses unless the nurse responsible
for delegation approves of an alternative method of preparation and
administration of the medications.
(5) Staff other than a nurse may administer
PRN psychoactive medications only when the home has a written plan for the use
of the PRN medication which: describes the specific behaviors the medication is
intended to correct or address; specifies the circumstances that indicate the
use of the medication; educates the staff about what desired effects or
undesired side effects the staff must monitor for; and documents the time of,
reason for and specific results of the medication use.
(6) Insulin. Staff other than a nurse may
administer insulin injections only when:
i.
The diabetic resident's condition and medication regimen is considered stable
by the registered nurse who is responsible for delegating the administration;
and
ii. The designated staff to
administer insulin to the resident have received additional training in the
administration of insulin, including return demonstration, and the registered
nurse has deemed them competent and documented that assessment; and
iii. The registered nurse monitors the
resident's condition regularly and is available when changes in condition or
medication might occur.
5.10.e Staff responsible for assisting
residents with medications must receive training in the following areas before
assisting with any medications from the licensed nurse:
(1) The basis for determining "assistance"
versus "administration".
(2) The
resident's right to direct the resident's own care, including the right to
refuse medications.
(3) Proper
techniques for assisting with medications, including hand washing and checking
the medication for the right resident, medication, dose, time, route.
(4) Signs, symptoms and likely side effects
to be aware of for any medication a resident receives.
(5) The home's policies and procedures for
assistance with medications.
5.10.f Residents who are capable of
self-administration have the right to purchase and self administer
over-the-counter medications. However, the home must make every reasonable
effort to be aware of such medications in order to monitor for and educate the
residents about possible adverse reactions or interactions with other
medications without violating the resident's rights to direct the resident's
own care. If a resident's over-the-counter medications use poses a significant
threat to the resident's health, staff must notify the physician.
5.10.g Homes must establish procedures for
documentation sufficient to indicate to the physician, registered nurse,
certified manager or representatives of the licensing agency that the
medication regimen as ordered is appropriate and effective. At a minimum, this
shall include:
(1) Documentation that
medications were administered as ordered;
(2) All instances of refusal of medications,
including the reason why and the actions taken by the home;
(3) All PRN medications administered,
including the date, time, reason for giving the medication, and the
effect;
(4) A current list of who
is administering medications to residents, including staff to whom a nurse has
delegated administration; and
(5)
For residents receiving psychoactive medications, a record of monitoring for
side effects.
(6) All incidents of
medication errors.
5.10.h All medicines and chemicals used in
the home must be labeled in accordance with currently accepted professional
standards of practice. Medication shall be used only for the resident
identified on the pharmacy label.
(1)
Resident medications that the home manages must be stored in locked
compartments under proper temperature controls. Only authorized personnel shall
have access to the keys.
(2)
Medications requiring refrigeration shall be stored in a separate, locked
container impervious to water and air if kept in the same refrigerator used for
storage of food.
(3) Residents who
are capable of self-administration may choose to store their own medications
provided that the home is able to provide the resident with a secure storage
space to prevent unauthorized access to the resident's medications. Whether or
not the home is able to provide such a secured space must be explained to the
resident on or before admission.
(4) Medications left after the death or
discharge of a resident, or outdated medications, shall be promptly disposed of
in accordance with the home's policy and applicable standards of
practice.
(5) Narcotics and other
controlled drugs must be kept in a locked cabinet. Narcotics must be accounted
for on a daily basis. Other controlled drugs shall be accounted for on at least
a weekly basis.
5.11 Staff Services
5.11.a There shall be sufficient number of
qualified personnel available at all times to provide necessary care, to
maintain a safe and healthy environment, and to assure prompt, appropriate
action in cases of injury, illness, fire or other emergencies.
5.11.b The home must ensure that staff
demonstrate competency in the skills and techniques they are expected to
perform before providing any direct care to residents. There shall be at least
twelve (12) hours of training each year for each staff person providing direct
care to residents. The training must include, but is not limited to, the
following:
(1) Resident rights;
(2) Fire safety and emergency
evacuation;
(3) Resident emergency
response procedures, such as the Heimlich maneuver, accidents, police or
ambulance contact and first aid;
(4) Policies and procedures regarding
mandatory reports of abuse, neglect and exploitation;
(5) Respectful and effective interaction with
residents;
(6) Infection control
measures, including but not limited to, handwashing, handling of linens,
maintaining clean environments, blood borne pathogens and universal
precautions; and
(7) General
supervision and care of residents.
5.11.c All training to meet the requirements
of 5.11.b shall be documented. Training in direct care skills by a home's nurse
may meet this requirement, provided the nurse documents the content and amount
of training.
5.11.d The licensee
shall not have on staff a person who has had a charge of abuse, neglect or
exploitation substantiated against him or her, as defined in 33 V.S.A. Chapters
49 and 69, or one who has been convicted of an offense for actions related to
bodily injury, theft or misuse of funds or property, or other crimes inimical
to the public welfare, in any jurisdiction whether within or outside of the
State of Vermont. This provision shall apply to the manager of the home as
well, regardless of whether the manager is the licensee or not. The licensee
shall take all reasonable steps to comply with this requirement, including, but
not limited to, obtaining and checking personal and work references and
contacting the Division of Licensing and Protection in accordance with
33 V.S.A.
§
6911 to see if prospective employees
are on the abuse registry or have a record of convictions.
5.11.e Staff persons shall not perform any
duties when their judgment or physical ability is impaired to the extent that
they cannot perform duties adequately or be held accountable for their
duties.
5.11.f There shall be at
least one (1) staff member on duty and in charge at all times. In homes with
more than fifteen (15) residents, there shall be at least one (1) responsible
staff member on duty and awake at all times. There shall be a record of the
staff on duty, including names, titles, dates and hours on duty.
5.11.g The licensing agency may require a
home to have specified staffing levels in order to meet the needs of residents.
5.12 Records/Reports
5.12.a The licensee shall be responsible for
maintaining, filing and submitting all records required by the licensing
agency. Such records shall be kept current and available for review at any time
by authorized representatives of the licensing agency.
5.12.b The following records shall be
maintained and kept on file:
(1) A resident
register including all discharges, transfers out of the home and
admissions.
(2) A record for each
resident which includes: resident's name; emergency notification numbers; name,
address and telephone number of any legal representative or, if there is none,
the next of kin; physician's name, address and telephone number; instructions
in case of resident's death; the resident's assessment(s); progress notes
regarding any accident or incident and subsequent follow-up; list of allergies;
a signed admission agreement; a recent photograph of the resident, unless the
resident objects; a copy of the resident's advance directives, if any
completed; and a copy of the document giving legal authority to another, if
any.
(3) For residents requiring
nursing care, including nursing overview or medication management, the record
shall also contain: initial assessment; annual reassessment; significant change
assessment; physician's admission statement and current orders; staff progress
notes including changes in the resident's condition and action taken; and
reports of physician visits, signed telephone orders and treatment
documentation; and resident plan of care.
(4) The results of the criminal record and
adult abuse registry checks for all staff.
5.12.c A home must file the following reports
with the licensing agency:
(1) When a fire
occurs in the home, regardless of size or damage, the licensing agency and the
Department of Labor and Industry must be notified within twenty-four (24)
hours. A written report must be submitted to both departments within
seventy-two (72) hours. A copy of the report shall be kept on file.
(2) A written report of any accident or
illness shall be placed in the resident's record. Any untimely deaths shall be
reported and a record kept on file.
(3) A report of any unexplained absence of a
resident from a home for more than 12 hours shall be reported to the police,
legal representative and family, if any. The incident shall be reported to the
licensing agency within twenty-four (24) hours of disappearance followed by a
written report within seventy-two (72) hours, a copy of which shall be
maintained.
(4) A written report of
any breakdown or cessation to the home's physical plant's major services
(plumbing, heat, water supply, etc.) or supplied service, which disrupts the
normal course of operation. The licensee shall notify the licensing agency
immediately whenever such an incident occurs. A copy of the report shall be
sent to the licensing agency within seventy-two (72) hours.
(5) A written report of any reports or
incidents of abuse, neglect or exploitation reported to the licensing
agency.
(6) A written report of
resident injury or death following the use of mechanical or chemical
restraint.
5.12.d
Reports and records shall be filed and stored in an orderly manner so that they
are readily available for reference. Resident records shall be kept on file at
least seven (7) years after the date of either the discharge or death of the
resident.
5.13 First Aid
Equipment and Supplies Equipment and such supplies as are necessary for
universal precautions, to meet resident needs and for care of minor cuts,
wounds, abrasions, contusions, and similar sudden accidental injuries shall be
readily available and in good repair.
5.14 Restraints
5.14.a Mechanical restraints may be used only
in an emergency to prevent injury to a resident or others and shall not be used
as an on-going form of treatment. The use of a mechanical restraint shall
constitute nursing care.
5.14.b
When a temporary mechanical restraint is applied by the staff, a physician must
be consulted immediately and written approval for continuation of the restraint
obtained. The written order, signed by the physician, should contain the
resident's name, date, time of order, and reason for restraint, means of
restriction, and period of time the resident is to be restrained. A record
shall be kept of every time the restraint is applied and removed during the day
and night. Restraints must be removed at least every two (2) hours when in use
so as to permit personal care to be given. A resident in a restraint shall be
under continuous supervision by the staff of the home.
5.14.c A resident shall not be secluded in
any room by locking or fastening a solid door from the outside. Half doors or
gates may be employed only with the prior approval of both the physician and
the licensing agency.
5.14.d The
home shall notify the licensing agency and the resident representative within
24 hours when a restraint is used, and within 72 hours must complete a
reassessment of the resident to determine if the resident's needs can be met
within the residential care setting. The reassessment shall include
consultation with the physician and the resident or the resident's
representative.
5.14.e Residents
shall have a right to be free from chemical restraints and unnecessary
mechanical restraints. Residents shall be notified at the time a restraint is
applied of their right to challenge the use of the restraint. A resident has
the right to meet with and discuss the challenge with the following
individuals:
(1) The home manager;
(2) The licensing agency;
(3) The Commissioner of the licensing agency.
In the event that a resident does challenge the use of a restraint, the home operator shall inform the licensing agency at the time the challenge is raised.
5.14.f A home may not install a door security
system which prevents residents from readily exiting the building without prior
approval of the licensing agency.
5.15 Policies and Procedures
Each home must have written policies and procedures that govern all services provided by the home. A copy shall be available at the home for review upon request.
5.16 Transportation
5.16.a Each home must have a written policy
about what transportation is available to residents of the home. The policy
must be explained at the time of admission.
5.16.b Transportation for medical services
and local community functions shall be provided up to twenty (20) miles,
round-trip without charge, not to exceed four (4) round-trips per month.
Residents may be charged, at a reasonable rate, for those miles in excess of
twenty (20) miles round-trip and for any or all mileage for transportation not
prescribed herein. $
5.17 Death of a Resident
5.17.a In those deaths in which the law
applies (such as an unexpected, untimely death), pursuant to
18
V.S.A. §
5205(a), the
manager shall be responsible for immediately notifying the regional medical
examiner.
5.17.b In those deaths in
which the medical examiner need not be notified, the manager shall:
(1) Follow the instructions of the deceased,
legal representative, if any, next of kin, or other relative regarding funeral
and other related arrangements.
(2)
In instances where the services of an undertaker are not immediately available,
and the resident occupied a multi-bed room, the manager shall arrange for the
immediate removal of the body of the deceased resident to a separate unoccupied
room.
(3) Remove a deceased
resident's body from the home within four (4) hours.
5.17.c When a resident dies unexpectedly or
within 48 hours of a fall or injury, in addition to notifying the medical
examiner, the licensee shall send a report to the licensing agency with the
following information:
(1) Name of
resident;
(2) Circumstances of the
death;
(3) Circumstances of any
recent injuries or falls; and
(4) A
list of all medications and treatments received by the resident during the two
(2) weeks prior to the death.
5.18 Reporting of Abuse, Neglect or
Exploitation
5.18.a The licensee and staff
shall report any case of suspected abuse, neglect or exploitation to the Adult
Protective Services (APS) as required by
33
V.S.A. §
6903. APS may be contacted by
calling toll-free 1-800-564-1612. Reports must be made to APS within 48 hours
of learning of the suspected, reported or alleged incident.
5.18.b The licensee and staff are required to
report suspected or reported incidents of abuse, neglect or exploitation. It is
not the licensee's or staff's responsibility to determine if the alleged
incident did occur or not; that is the responsibility of the licensing agency.
A home may, and should, conduct its own investigation. However, that must not
delay reporting of the alleged or suspected incident to Adult Protective
Services.
5.18.c Incidents
involving resident-toresident abuse must be reported to the licensing agency if
a resident alleges abuse, sexual abuse, or if an injury requiring physician
intervention results, or if there is a pattern of abusive behavior. All
resident-to-resident incidents, even minor ones, must be recorded in the
resident's record. Families or legal representatives must be notified and a
plan must be developed to deal with the behaviors.
5.19 Access by Ombudsman, Protection and
Advocacy System
5.19.a The home shall permit
representatives of Adult Protective Services, the Office of the Long Term Care
Ombudsman and Vermont Protection and Advocacy, Inc. to have access to the home
and its residents in order to: visit; talk with; and make personal, social and
legal services available to all residents; inform residents of their rights and
entitlements; assist residents in resolving problems and grievances.
5.19.b Any designated representative of the
Office of the Long Term Care Ombudsman or Protection and Advocacy, Inc. shall
have access to the home at any time in accordance with those programs' state
and federal mandates and requirements. Those representatives shall also have
access to the resident's records with the permission of the resident or as
otherwise provided by state or federal law.
5.19.c Individual residents have the complete
right to deny or terminate any visits by persons having access pursuant to this
section.
5.19.d If a resident's
room does not permit private consultation to occur, the resident may request,
and the home must provide, an appropriate place for such a
meeting.
Section VI Residents' Rights
6.1 Every
resident shall be treated with consideration, respect and full recognition of
the resident's dignity, individuality, and privacy. A home may not ask a
resident to waive the resident's rights.
6.2 Each home shall establish and adhere to a
written policy, consistent with these regulations, regarding the rights and
responsibilities of residents, which shall be explained to residents at the
time of admission.
6.3 Residents
may retain personal clothing and possessions as space permits, unless to do so
would infringe on the rights of others or would create a fire or safety
hazard.
6.4 A resident shall not be
required to perform work for the licensee. If a resident chooses to perform
specific tasks for the licensee the resident shall receive reasonable
compensation which shall be specified in a written agreement with the
resident.
6.5 Each resident shall
be allowed to associate, communicate and meet privately with persons of the
resident's own choice. Homes shall allow visiting hours from at least 8 a.m. to
8 p.m., or longer. Visiting hours shall be posted in a public place.
6.6 Each resident may send and receive
personal mail unopened.
6.7
Residents have the right to reasonable access to a telephone for private
conversations. Residents shall have reasonable access to the home's telephone
except when restricted because of excessive unpaid toll charges or misuse.
Restrictions as to telephone use shall be in writing. Any resident may, at the
resident's own expense, maintain a personal telephone in his or her own
room.
6.8 A resident may complain
or voice a grievance without interference, coercion or reprisal. Each home
shall establish a written grievance procedure for resolving residents' concerns
or complaints that is explained to residents at the time of admission. The
grievance procedure shall include at a minimum, time frames, a process for
responding to residents in writing, and a method by which each resident filing
a complaint will be made aware of the Office of the Long Term Care Ombudsman
and Vermont Protection and Advocacy as an alternative or in addition to the
home's grievance mechanism.
6.9
Residents may manage their own personal finances. The home or licensee shall
not manage a resident's finances unless requested in writing by the resident
and then in accordance with the resident's wishes. The home or licensee shall
keep a record of all transactions and make the record available, upon request,
to the resident or legal representative, and shall provide the resident with an
accounting of all transactions at least quarterly. Resident funds must be kept
separate from other accounts or funds of the home.
6.10 The resident's right to privacy extends
to all records and personal information. Personal information about a resident
shall not be discussed with anyone not directly involved in the resident's
care. Release of any record, excerpts from or information contained in such
records shall be subject to the resident's written approval, except as
requested by representatives of the licensing agency to carry out its
responsibilities or as otherwise provided by law.
6.11 The resident has the right to review the
resident's medical or financial records upon request.
6.12 Residents shall be free from mental,
verbal or physical abuse, neglect, and exploitation. Residents shall also be
free from restraints as described in Section 5.14.
6.13 When a resident is adjudicated mentally
disabled, such powers as have been delegated by the Probate or Family Court to
the resident's guardian shall devolve to the guardian pursuant to applicable
law.
6.14 Residents subject to
transfer or discharge from the home, under Section 5.3 of these regulations,
shall:
6.14.a Be allowed to participate in
the decision-making process of the home concerning the selection of an
alternative placement;
6.14.b
Receive adequate notice of a pending transfer; and
6.14.c Be allowed to contest their transfer
or discharge by filing a request for a fair hearing before the Human Services
Board in accordance with the procedures in
3 V.S.A. §
3091.
6.15 Residents have the right to refuse care
to the extent allowed by law. This includes the right to discharge himself or
herself from the home. The home must fully inform the resident of the
consequences of refusing care. If the resident makes a fully informed decision
to refuse care, the home must respect that decision and is absolved of further
responsibility. If the refusal of care will result in a resident's needs
increasing beyond what the home is licensed to provide, or will result in the
home being in violation of these regulations, the home may issue the resident a
thirty (30) day notice of discharge in accordance with section 5.3.a of these
regulations.
6.16 Residents have
the right to formulate advance directives as provided by state law and to have
the home follow the residents' wishes.
6.17 ACCS residents have the right to be away
from the home for voluntary leaves of more than 24 hours, unless a legally
appointed guardian directs the home otherwise. ACCS residents have the right to
make decisions about such voluntary leaves without influence from the
home.
6.18 The enumeration of
residents' rights shall not be construed to limit, modify, abridge or reduce in
any way any rights that a resident otherwise enjoys as a human being or
citizen. A summary of the obligations of the residential care home to its
residents shall be written in clear language, large print, given to residents
on admission, and posted conspicuously in a public place in the home. Such
notice shall also summarize the home's grievance procedure and directions for
contacting the Ombudsman Program and Vermont Protection and Advocacy,
Inc.
Section VII Nutrition and Food Services
7.1 Food Services
7.1.a Menus and Nutritional Standards
(1) Menus for regular and therapeutic diets
shall be planned and written at least one (1) week in advance.
(2) The meals served each day must provide
100% of the Recommended Dietary Allowances (RDA) as established by the Food and
Nutrition Board of the National Research Council of the National Academy of
Sciences and comply with the Dietary Guidelines for Americans.
(3) The current week's regular and
therapeutic menu shall be posted in a public place for residents and other
interested parties.
(4) The home
must follow the written, posted menus. If a substitution must be made, the
substitution shall be recorded on the written menu.
(5) The home shall keep menus, including any
substitutions, for the previous month on file and available for examination by
the licensing agency.
(6) There
shall be a written physician's order in the resident's record for all
therapeutic diets.
(7) The home
shall maintain sufficient food supplies at hand on the premises to meet the
requirements of the planned weekly menus.
(8) No more than 14 hours shall elapse
between the end of an evening meal and the morning meal.
7.1.b Meal Patterns
The following guide provides the basis for meal planning and will provide nearly 100% of the RDA for most residents. In cases of a resident's advanced age and very light activity, homes may consider each resident's needs with respect to portion size and frequency of eating but shall not compromise overall nutrient intake. In addition to the suggested food servings, particular emphasis must be given to fluid intake for residents.
|
Food Group |
Suggested Daily |
What Counts as a Servings |
|
%HServing Bread, Cereal,Rice, Pasta |
6-11 |
1 slice bread, tortilla 1/2 bagel, English Muffin hamburger/hot dog roll,pita 1/2 cup cooked cereal, rice,pasta 1 oz ready-to-eat cereal 3-4 small or 2 large crackers 1/2 hamburger/hot dog roll,pita |
|
Fruit |
2-4 |
3/4 cup 100% fruit juice 1 medium apple, banana or other fruit 1/2 cup fresh, cooked or canned fruit 1/4 cup dried fruit |
|
Vegetables |
3-5 |
1/2 cup cooked or chopped raw vegetables 1 cup leafy, raw vegetables 3/4 cup vegetable juice |
|
Milk, Yogurt,Cheese |
3 or more |
1 cup milk, yogurt 1 1/2 oz natural cheese |
|
Food Group |
Suggested Daily |
What Counts as a Servings |
|
%HServing Meat, Poultry,Legumes, Eggs Nuts |
2 (total of 4-5 oz/day) |
2-3 oz cooked lean meat, poultry or fish 1/2 cup cooked legumes 1 egg 2 tablespoons peanut butter 1/3 cup nuts |
|
Fluids |
8 cups (8 fluid oz each) |
Water, juice, herbal tea, non-caffeineated coffee, tea |
. At least one serving of citrus fruit or other fruit or vegetable rich in vitamin C shall be served each day.
. At least one serving of fruit or vegetable rich in vitamin A shall be served at least every other day.
7.1.c Meal Service
(1) Each home shall provide residents with
three nutritionally balanced, attractive and satisfying meals in accordance
with these regulations. Meals shall be served at appropriate temperature and at
normal meal hours. Texture modifications will be accommodated as
needed.
(2) Supplemental
nourishment (snacks) shall be offered to residents before their hour of
retiring and between meals.
(3)
Residents shall be allowed an adequate amount of time to eat each meal at an
unhurried pace.
(4) Residents shall
be provided with alternatives to the planned meal upon request.
7.2 Food Safety and
Sanitation
7.2.a Each home must procure food
from sources that comply with all laws relating to food and food labeling. Food
must be safe for human consumption, free of spoilage, filth or other
contamination. All milk products served and used in food preparation must be
pasteurized. Cans with dents, swelling or leaks shall be rejected and kept
separate until returned to the supplier.
7.2.b All perishable food and drink shall be
labeled, dated and held at proper temperatures:
(1) At or below 40 degrees
Fahrenheit.
(2) At or above 140
degrees Fahrenheit when served or heated prior to service.
7.2.c All work surfaces are cleaned and
sanitized after each use. Equipment and utensils are cleaned and sanitized
after each use and stored properly.
7.2.d The home shall assure that food
handling and storage techniques are consistent with safe food handling
practices.
7.2.e The use of
outdated, unlabeled or damaged canned goods is prohibited and such goods shall
not be maintained on the premises.
7.3 Food Storage and Equipment
7.3.a All food and drink shall be stored so
as to protect from dust, insects, rodents, overhead leakage, unnecessary
handling and all other sources of contamination.
7.3.b Areas of the home used for storage of
food, drink, equipment or utensils shall be constructed to be easily cleaned
and shall be kept clean.
7.3.c All
food service equipment shall be kept clean and maintained according to
manufacturer's guidelines.
7.3.d
All equipment, utensils and dinnerware shall be in good repair. Cracked or
badly chipped dishes and glassware shall not be used.
7.3.e Single service items, such as paper
cups, plates and straws, shall be used only once. They shall be purchased and
stored in sanitary packages or containers in a clean dry place and handled in a
sanitary manner.
7.3.f Food service
areas shall not be used to empty bed pans or urinals or as access to toilet and
utility rooms. If soiled linen is transported through food service areas, the
linen must be in an impervious container.
7.3.g Doors, windows and other openings to
the outdoors shall be screened against insects, as required by seasonal
conditions.
7.3.h All garbage shall
be collected and stored to prevent the transmission of contagious diseases,
creation of a nuisance, or the breeding of insects and rodents, and shall be
disposed of at least weekly. Garbage or trash in the kitchen area must be
placed in lined containers with covers.
7.3.i Poisonous compounds (such as cleaning
products and insecticides) shall be labeled for easy identification and shall
not be stored in the food storage area unless they are stored in a separate,
locked compartment within the food storage area.
Section VIII Laundry Services
8.1 The home shall launder bed and bath
linens used by the residents. The home shall launder and return the residents'
personal clothing in order for residents to be clean, well-groomed and
comfortable.
8.1.a The home shall make
provisions for residents who choose to launder their own personal
clothing.
8.1.b Clean and soiled
laundry shall be separated at all times.
8.1.c All soiled laundry will be stored and
transported in a closed impervious container.
8.1.d Each resident's personal laundry shall
be identified by a distinctive marking or other method and shall be returned to
the resident after laundering.
8.1.e Laundering shall be done so that
laundered items are clean and in good condition. Personal items damaged or lost
by the home shall be replaced by the home.
Section IX Physical Plant
9.1 Environment
9.1.a The home must provide and maintain a
safe, functional, sanitary, homelike and comfortable environment.
9.1.b All homes shall comply with all current
applicable state and local rules, regulations, codes and ordinances. Where
there is a difference between codes, the code with the higher standard shall
apply.
9.2 Residents'
Rooms
9.2.a Each bedroom shall have at least
100 square feet of useable floor space in single rooms and at least 80 square
feet per bed in double-bed rooms, exclusive of toilets, closets, lockers,
wardrobes, alcoves or vestibules. These specifications may be waived for beds
licensed prior to the adoption of the 1987 regulations.
9.2.b Rooms shall be of dimensions that allow
for the potential of not less than three (3) feet between beds and three feet
between the bed and the side wall to facilitate cleaning and easy
access.
9.2.c Each bedroom shall
have an outside window.
(1) Windows shall be
openable and screened except in construction containing approved mechanical air
circulation and ventilation equipment.
(2) Window shades, venetian blinds or
curtains shall be provided to control natural light and offer
privacy.
9.2.d The door
opening of each bedroom shall be fitted with a full-size door of solid core
construction.
9.2.e Resident
bedrooms shall be used only as the personal sleeping and living quarters of the
residents assigned to them.
9.2.f A
resident shall not have to pass through another bedroom or bathroom to reach
the resident's own bedroom.
9.2.g
Each resident shall be provided the resident's own bed that shall be a
standard-size full or twin bed. Roll away beds, cots and folding beds shall not
be used.
9.2.h Each bed shall be in
good repair, with a clean, comfortable mattress that is at least 6 inches
thick, and standard in size for the particular bed, a pillow, bedspread, and a
minimum of one (1) blanket, two (2) sheets, and one (1) pillowcase.
9.2.i Each resident shall be provided
adequate closet and drawer space to accommodate clothing and personal needs.
9.3 Toilet, Bathing and
Lavatory Facilities
9.3.a Toilet, lavatories
and bathing areas shall be equipped with grab bars for the safety of the
residents. There shall be at least one (1) full bathroom that meets the
requirements of the Americans with Disabilities Act of 1990 and state building
accessibility requirements as enforced by the Department of Labor and
Industry.
9.3.b There shall be a
minimum of one (1) bath unit, toilet and lavatory sink, exclusively available
to residents, per eight (8) licensed beds per floor. Licensed beds having
private lavatory facilities are not included in this ratio.
9.3.c Each lavatory sink shall be at least of
standard size and shall be equipped with hot and cold running water, soap, and,
if used by multiple residents, paper towels.
9.3.d Each bathtub and shower shall be
constructed and enclosed so as to ensure adequate space and privacy while in
use.
9.3.e Resident lavatories and
toilets shall not be used as utility rooms.
9.4 Recreation and Dining Rooms
9.4.a All homes shall provide at least one
(1) well-lighted and ventilated living or recreational room and dining room for
the use of residents.
9.4.b
Combination dining and recreational rooms are acceptable but must be large
enough to serve a dual function.
9.4.c Dining rooms shall be of sufficient
size to seat and serve all residents of the home at the same time.
9.4.d Smoking shall be permitted only in
designated areas and the home must ensure that residents who object to smoke
have "smoke free" dining or recreation space.
9.5 Home Requirements for Persons with
Physical Disabilities
9.5.a Each home shall
be accessible to and functional for residents, personnel and members of the
public with physical disabilities in compliance with the Americans with
Disabilities Act.
9.5.b Blind or
physically disabled residents shall not be housed above the first floor unless
the home is in compliance with all applicable codes, regulations and laws as
required by the Department of Labor and Industry.
9.6 Plumbing
9.6.a All plumbing shall operate in such a
manner as to prevent back-siphonage and cross-connections between potable and
nonpotable water. All plumbing fixtures and any part of the water distribution
or sewage disposal system shall operate properly and be maintained in good
repair.
9.6.b Plumbing and drainage
for the disposal of sewage, infectious discharge, household and institutional
wastes shall comply with all State and Federal regulations.
9.6.c All plumbing fixtures shall be clean
and free from cracks, breaks and leaks.
9.6.d Hot water temperatures shall not exceed
120 degrees Fahrenheit in resident areas.
9.7 Water Supply
9.7.a Each home shall be connected to an
approved public water supply when available and where said supply is in
compliance with the Department of Health's public water system
regulations.
9.7.b If a home uses a
private water supply, said supply shall conform to the construction, operation
and sanitation standards published by the Department of Health. Private water
supplies shall be tested annually for contamination, and copies of results
shall be kept on premises.
9.7.c
Water shall be distributed to conveniently located taps and fixtures throughout
the building and shall be adequate in temperature, volume and pressure for all
purposes, including fire fighting if there is a residential sprinkler
system.
9.8 Heating
9.8.a Each home shall be equipped with a
heating system which is of sufficient size and capability to maintain all areas
of the home used by residents and which complies with applicable fire and
safety regulations.
9.8.b The
minimum temperature shall be maintained at an ambient temperature of 70 degrees
Fahrenheit in all areas of the home utilized by residents and staff during all
weather conditions.
9.9
Ventilation
9.9.a Homes shall be adequately
ventilated to provide fresh air and shall be kept free from smoke and
objectionable odors.
9.9.b
Kitchens, laundries, toilet rooms, bathrooms, and utility rooms shall be
ventilated to the outside by window or by ventilating duct and fan of
sufficient size.
9.10
Life Safety/Building Construction
All homes shall meet all of the applicable fire safety and building requirements of the Department of Labor and Industry, Division of Fire Prevention.
9.11 Disaster
and Emergency Preparedness
9.11.a The
licensee or manager of each home shall maintain a written disaster preparedness
plan. The plan shall outline procedures to be followed in the event of any
emergency potentially necessitating the evacuation of residents, including but
not limited to: fire, flood, loss of heat or power, or threat to the
home.
9.11.b If the home is located
within ten (10) miles of a nuclear power plant, the plan shall include specific
measures for the protection, treatment and removal of residents in the event of
a nuclear disaster.
9.11.c Each
home shall have in effect, and available to staff and residents, written copies
of a plan for the protection of all persons in the event of fire and for the
evacuation of the building when necessary. All staff shall be instructed
periodically and kept informed of their duties under the plan. Fire drills
shall be conducted on at least a quarterly basis and shall rotate times of day
among morning, afternoon, evening, and night. The date and time of each drill
and the names of participating staff members shall be documented.
9.11.d There shall be an operable telephone
on each floor of the home, at all times. A list of emergency telephone numbers
shall be posted by each telephone.
Section X Pets
10.1 Pets may visit the home providing the
following conditions are met:
10.1.a The pet
owner must provide evidence of current vaccinations.
10.1.b The pet must be clean, properly
groomed and healthy.
10.1.c The pet
owner is responsible for the pet's behavior and shall maintain control of the
pet at all times.
10.2
Pets, owned by a resident or the home, may reside in the home providing the
following conditions are met:
10.2a The home
shall ensure that the presence of a pet causes no discomfort to any
resident.
10.2.b The home shall
ensure that pet behavior poses no risk to residents, staff or
visitors.
10.2.c The home must have
procedures to ensure that pets are kept under control, fed, watered, exercised
and kept clean and well-groomed and that they are cleaned up after.
10.2.d Pets must be free from disease
including leukemia, heartworm, hepititis, leptos psorisos, parvo, worms, fleas,
ticks, ear mites, and skin disorders, and must be current at all times with
rabies and distemper vaccinations.
10.2.e Pet health records shall be maintained
by the home and made available to the public.
10.2.f The home shall maintain a separate
area for feeding cats and dogs other than the kitchen or resident dining
areas.
Section XI Resident Funds and Property
11.1 A resident's money and other valuables
shall be in the control of the resident, except where there is a guardian,
attorney in fact (power of attorney), or representative payee who requests
otherwise. The home may manage the resident's finances only upon the written
request of the resident. There shall be a written agreement stating the
assistance requested, the terms of same, the funds or property and persons
involved.
11.2 If the home manages
the resident's finances, the home must keep a record of all transactions,
provide the resident with a quarterly statement, and keep all resident funds
separate from the home or licensee's funds.
11.3 The personal property of the resident
shall be available for the resident's use and securely maintained when not in
use.
11.4 The resident shall not be
solicited for gifts or other consideration by persons connected with the home,
in any way.
11.5 When it becomes
apparent that a resident is no longer capable of managing funds and/or
property, the licensee shall contact the resident's legal representative if
any, or the next of kin. If there is no legal representative or next of kin,
the licensee shall contact the licensing agency.
11.6 When a resident is absent without
explanation for a period of thirty-one (31) days and there is no responsible
person, the licensee shall hold the property for six (6) months. At the
conclusion of this period, the property shall be transferred to the selectmen
of the town.
11.7 Each home shall
develop and implement a written policy regarding resident's personal needs. The
policy shall be explained to the resident upon admission, with a copy provided
to the resident at that time. Code of Vermont Rules Section
XI February 2007 13 110 009-21
11.7.a The policy shall include a provision
that recipients of Supplemental Security Income (SSI) shall retain from their
monthly income an amount adequate to meet their personal needs exclusive of all
other rates, fees or charges by the home. The amount shall be sufficient to
meet such personal needs as clothing and incidental items, reading matter,
small gifts, toiletries, occasional foods not provided by the home and other
such items.
11.7.b For SSI or
Medicaid recipients in homes participating in ACCS, the amount shall be at
least as much as the personal needs allowance provided Medicaid recipients in
nursing homes as set by federal and state law.
11.8 The licensee, the licensee's relative or
any staff member shall not be the legal guardian, trustee or legal
representative for any resident other than a relative. The licensee or any
staff of the home are permitted to act as the resident's representative payee
according to Social Security regulations provided the resident or the
resident's legal representative agrees in writing to this arrangement and all
other provisions of these regulations related to money management are
met.
11.9 No licensee, staff or
other employee of the home may solicit, offer or receive a gift, including
money or gratuities, from a resident. Nominal gifts, such as candy or flowers
that can be enjoyed by all staff, are permissible.33 V.S.A. Chapter
71
Disclaimer: These regulations may not be the most recent version. Vermont 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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