• 64-14-7. Health Care Standards.


7.1.  Admission and Discharge.


7.1.a.  The licensee shall not admit to the assisted living residence individuals requiring ongoing or extensive nursing care and shall not admit or retain individuals requiring a level of service that the residence is not licensed to provide or does not provide.  (Class I)


7.1.b.  A resident whose condition declines after admission, and is receiving services coordinated by a licensed hospice or certified home health agency, may receive these services in the residence if the residence has a  backup power generator for services using equipment that requires auxiliary electrical power in the event of a power failure.  The licensee shall ensure that a resident who requires ongoing or extensive nursing care is provided the care and services necessary to meet his or her needs.  The provision of services to the resident receiving nursing care or hospice care shall not interfere with the provision of services to other residents.  (Class I)


7.1.c.  If a resident exhibits symptoms of a mental or developmental disorder that seems to pose a  risk to self or others, and the resident is not receiving behavioral health services, the licensee shall advise the resident or his or her legal representative of the behavioral health service options within the community.  The resident shall have thirty (30) days to obtain necessary services.  If the resident or his or her legal representative fails to seek treatment in a timely manner, then the licensee after consultation with the resident’s physician, shall refer the resident to a licensed behavioral health provider.  (Class II)


7.1.d.  The licensee shall seek immediate treatment for a resident or may refuse to admit or retain a resident if there is reason to believe that the resident may suffer serious harm, or is likely to cause serious harm to himself, herself or to others, if appropriate interventions are not provided in a timely manner.  (Class I)


7.1.e.  If a resident has care needs that exceed the level of care for which the residence is licensed or can provide, the licensee shall inform the resident, or his or her legal representative, of the need to move to a health care facility that can provide the needed level of care.  (Class III)


7.1.f.  The licensee shall assist the resident, or his or her legal representative, to secure placement in another health care facility and shall document in the resident’s record the efforts made to obtain placement.  (Class III)


7.1.g.  Prior to transfer or discharge of a resident, the licensee shall prepare a summary to accompany the resident that includes the resident’s medical history, functional needs assessment and service plans, the current physician’s orders, the resident’s advanced directives, any allergies and pertinent progress notes.  (Class II)


7.2.  Records.


7.2.a.  The licensee shall retain residents’ records in a secure area in the residence and shall make the records available for inspection by the commissioner.  (Class III)


7.2.b.  Upon a resident’s admission, the licensee shall start a record for him or her that includes:


7.2.b.1.  The resident’s name, social security number, date of birth, sex, marital status,; and religious preference, if any;


7.2.b.2.  The names, addresses and telephone numbers of the following, if applicable: the resident’s physician, dentist, legal representative, person or agency responsible for the resident’s support payments, next of kin or person to be notified in case of an emergency, and any case management agency involved in the resident’s care.


7.2.b.3.  All agreements or contracts entered into between the resident and the licensee;


7.2.b.4.  Advanced directives, allergies, the dates of appointments with physicians, dentists, or other health care providers, all contacts by the residence’s staff with the resident’s physician, and observations by licensed nurses, physicians, and others authorized to care for the resident; and


7.2.b.5.  Any other information as required in Subsections 7.3, 7.4, 7.5, 7.6, 7.7, and 9.1.  of this section.  (Class III)


7.2.c.  The licensee shall keep in each resident’s record current documentation regarding the resident’s health status, any changes in health status, and staff responses to the changes. (Class II)


7.3.  Assessments and Service Plans.


7.3.a.  Each resident shall have a written, signed and dated health assessment by a physician or other licensed health care professional, authorized under state law to perform this assessment, not more than sixty (60) days prior to the resident’s admission, or no more than five (5) working days following admission, and at least annually after that.  The admission and annual health assessment shall include screening for tuberculosis and other communicable diseases if indicated by exposure, prevalence or risk according to current medical practice in congregate living situations as indicated by the secretary.  The licensee shall maintain documentation of the assessment in the resident’s medical record.  (Class II)


7.3.b.  Within seven (7) days of admission, each resident shall have an individualized functional needs assessment completed in writing by a licensed health care professional which is maintained in the resident’s medical record.  At a minimum, the resident’s assessment shall include a review of health status and functional, psycho social, activity and dietary needs.  (Class II)


7.3.c.  Within seven (7) days of admission, each resident shall have a service plan based upon his or her functional needs assessment and individual needs that includes, but is not limited to, the type of assistance needed to perform activities of daily living, to receive prescribed medications and treatments, to follow any planned diet, rest or activity regimen, to engage in activities and programs appropriate to the individual’s level of functioning, and to use equipment such as hearing aides, glasses, and canes.  Staff shall have access to the service plan, use it as a guide for providing resident care, and maintain it as a part of the resident’s medical record.  (Class II)


7.3.d.  The licensee shall ensure that the assessment and service plans reflect the resident’s current needs and are updated annually or as indicated by a significant change in the resident’s condition.  (Class II)


7.4.  Medications and Treatments.


7.4.a.  The licensee shall ensure that resident care is provided by appropriately licensed health care professionals, and that medications and treatments given to residents are administered as required by applicable federal and state law, including W. Va. Code §§16-5O-1 et seq. and Division of Health rule, “Medication Administration by Unlicensed Personnel,” 64CSR60.  (Class I)


7.4.b.  A prescription, written or verbal order from a professional authorized by state law to prescribe medications is required for obtaining, altering, discontinuing and administering or self-administering prescription and over-the counter medications, treatments, and therapies.  The licensee shall keep copies of the prescriptions or written orders in the resident’s record.  (Class I)


7.4.c.  A licensed health care professional shall determine whether or not a resident is capable of self-administration of medications in accordance with Subsection 3.33. of this rule and shall document it in the resident’s medical record prior to the resident self administering medications, and also on a significant change of the resident’s condition.  (Class II)


7.4.d.  The prescribing health care professional who gives a verbal order shall review and sign the order within thirty (30) working days of the original order date.  (Class II)


7.4.e.  The attending physician, prescribing health care professional, or a consulting pharmacist shall review the medication regimen of each resident as needed, and at least annually.  The resident’s record shall contain documentation of this review.  (Class II)


7.4.f.  The licensee shall keep a record of all medications given to each resident indicating each dose given.  The record shall include the resident’s name; the name of the medication; the dosage to be administered and route of administration; the time or intervals at which the medication is to be administered; the date the medication is to begin and end; the printed name, initials and signature of the individual who administered the medication; and any special instructions for handling or administering the medication, including instructions for maintaining aseptic conditions and appropriate storage.  (Class I)


7.4.g.  The licensee shall keep medications in a locked room, cabinet or other storage receptacle, accessible only to the staff responsible for medications.  If a resident is capable of self administration of medication, the licensee shall provide him or her resources to store medications in a manner to be inaccessible to other residents.  (Class I)


7.4.h.  The licensee shall store all medications in their original containers, legally dispensed and labeled in accordance with the rules of the West Virginia board of pharmacy, for the resident for whom it has been prescribed, including the name and strength of medication, manufacturer name, lot number, and expiration date.  Only a licensed pharmacist shall re-label medications.  If the prescribing health care provider changes medication directions, the licensee shall have a written signed and dated order for the change in the resident’s record.  (Class I)


7.4.i.  If refrigeration of medication is required, the licensee shall provide: a refrigerator in a locked room; a locked refrigerator; or a locked box within the refrigerator for storage.  A thermometer is required in a refrigerator storing medications.  The licensee shall store refrigerated medications within the recommended temperature range on the medication package.  (Class II)


7.4.j.  If Schedule II drugs of the Uniform Controlled Substances Act W. Va. Code §§60 A -1-101 et seq. are administered, a copy of the written prescription signed by the physician shall be in the resident’s record and a proof of use record shall be maintained.  Schedule II drugs shall be stored in a manner so that they are securely protected by two (2) locks.  The key to the separately locked Schedule II drugs shall not be the same key that is used to gain access to non-scheduled drugs.  (Class I)


7.4.k.  The licensee shall not return unused, discontinued, or outdated drugs listed in Schedules II, III, IV or V of the Federal Comprehensive Drug Abuse Prevention and Control Act of 1970 21 U.S.C. §801 et seq. to the pharmacy, but shall destroy them in the presence of a pharmacist and a registered nurse; and keep a record for at least two (2) years that contains the resident’s name that was on the prescription, the name and strength of the drug, the prescription number, the amount destroyed, the date of destruction and the signatures of the witnesses.  (Class III)


7.4.l.  When a resident requires oxygen, the licensee shall assure there is a portable source available for out-of-room activities and in the event of power failure.  The licensee shall post no smoking signs conspicuously and prohibit smoking in any location when oxygen is in use.  (Class I)


7.4.m.  The licensee shall provide all resident care and services in accordance with current standards of practice using appropriate infection control techniques.  (Class I)


7.5.  Accident, Illness and Major Incident Procedures.


7.5.a.  The licensee shall have readily available at all times a standard first-aid kit, or its equivalent, to provide emergency aid for commonly occurring household injuries.  (Class III)


7.5.b.  When a resident has an illness or accident that results in an injury or a resident complaint, the staff shall contact an appropriately licensed health care professional to assess the severity and cause of the illness or accident, advise of the treatment needed related to the accident or illness, and record actions taken in the resident’s record.  If the resident needs emergency assistance, the staff on duty shall first obtain the necessary assistance.  (Class I)


7.5.c.  Staff shall monitor and document the resident’s condition at least once every eight (8) hours for a period of twenty-four (24) hours following the accident or the onset of the illness, more frequently if specified by the licensed health care professional or at least every four (4) hours if the resident suffers from Alzheimer’s disease or a related dementia and cannot communicate his or her condition or needs.  (Class II)


7.5.d.  When a major incident or any significant change in the resident’s condition occurs, the staff shall promptly notify the resident’s physician or other appropriately licensed health care professional, such as emergency medical personnel, and the responsible party or next of kin, and document this notification in the resident’s record.  (Class I)

7.5.e.  If an epidemic occurs or a reportable disease is diagnosed, the licensee shall comply with the recommendations of the local public health authority in handling and reporting it.  (Class I)


7.6.  Limited and Intermittent Nursing Care.


7.6.a.  The licensee shall arrange for a registered professional nurse to assume responsibility for the oversight of nursing care and services.  Arrangements for nursing services may be made by contract with a registered nurse or a nursing service with a management entity; or the licensee may employ a registered nurse.  Arrangements with a home care agency will satisfy the requirement for nursing oversight, if they meet all the requirements of this section. (Class I)


7.6.b.  The licensee shall ensure that the registered nurse is notified immediately when a resident with nursing care needs is admitted or readmitted, and immediately when a nursing care need for a current resident is identified.  (Class I)


7.6.c.  Within reasonable expectations, the licensee shall implement the recommendations of the registered nurse regarding care, services and staff training.  (Class I)


7.6.d.  Unless the licensee employs a full time registered nurse, he or she shall ensure that the registered nurse maintains a record with an entry for each visit which shall include at least the date, time in and time out; a list of duties performed during each visit; a brief statement regarding  identified concerns and recommended actions taken to resolve them; and a complete signature.   (Class III)


7.6.e.  The licensee shall develop a plan that provides for twenty-four (24) hour accessibility between the residence, the registered nurse, and other emergency personnel.  (Class I)


7.6.f.  A registered nurse shall perform and document a nursing assessment for each resident with nursing needs within twenty-four (24) hours following admission, and update the assessment at the time of any significant temporary or permanent change in the resident’s condition.  (Class I)


7.6.g.  A registered nurse shall develop and document a service plan to meet any identified nursing and medical needs of the resident within seven (7) days after admission and shall update the plan at the time of a significant temporary or permanent change in condition.  (Class I)


7.6.h.  A registered nurse shall see the resident weekly and more often if indicated by the needs of the resident, and document a progress note in the resident’s record reflecting the status of the resident and any changes in his or her condition.  (Class II)


7.6.i.  A registered nurse shall provide needed training or recommend to the licensee appropriate training for staff, including when to contact the registered nurse regarding changes in a resident’s condition.  (Class II)


7.6.j.  A registered nurse shall participate in the decision to admit or discharge a resident with nursing care needs.  (Class II)


7.7.  Resident Death.


7.7.a.  Staff shall immediately report the suspected death of a resident to the resident’s physician, to the resident’s next of kin or legal representative, and hospice staff if applicable.  Any death suspected to be the result of abuse or neglect shall be immediately reported to the coroner.  (Class III)


7.7.b.  Upon the death of a resident, the following information shall be entered in the resident’s record:


7.7.b.1.  A record of the date and time of the notification of the resident’s physician or hospice staff, the resident’s representative or next of kin; and


7.7.b.2.  The date, time and circumstance of death, including the name of person to whom the body was released and any other details specific to the death.  (Class III)

7.7.c.  Upon a resident’s death, the licensee shall release all of the resident’s belongings and funds to the estate administrator or executor.  (Class III)