ADMINISTRATION AND ADMINISTRATIVE SERVICES | VA

22VAC40-73-40. Licensee.

 

1. The licensee shall ensure compliance with all regulations for licensed assisted living facilities and terms of the license issued by the department; with relevant federal, state, and local laws; with other relevant regulations; and with the facility’s own policies and procedures.

 

1. The licensee shall:

 

1. Give evidence of financial responsibility and solvency.

22VAC40-73-40. Licensee.

 

2. Be of good character and reputation in accordance with § 63.2-1702 of the Code of Virginia. Character and reputation investigation includes background checks as required by § 63.2-1721 of the Code of Virginia.

 

3. Meet the requirements specified in the Regulation for Background Checks for Assisted Living Facilities and Adult Day Care Centers (22VAC40-90).

 

4. Act in accordance with General Procedures and Information for Licensure (22VAC40-80).

 

5. Protect the physical and mental well-being of residents.

 

6. Exercise general supervision over the affairs of the licensed facility and establish policies and procedures concerning its operation in conformance with applicable law, this chapter, and the welfare of the residents.

 

7. Ensure that he, his agents, the facility administrator, or facility staff or the relatives of any of these persons shall not act as, seek to become, or become the conservator or guardian of any resident unless specifically so appointed by a court of competent jurisdiction pursuant to Article 1 (§ 64.2-2000 et seq.) of Chapter 20 of Title 64.2 of the Code of Virginia.

 

8. Ensure that the current license is posted in the facility in a place conspicuous to the residents and the public.

 

9. Ensure that the facility keeps and maintains at the facility records, reports, plans, schedules, and other information as required by this chapter for licensed assisted living facilities.

 

10. Ensure that any document required by this chapter to be posted shall be in at least 12-point type or equivalent size, unless otherwise specified.

 

11. Make certain that when it is time to discard records, they are disposed of in a manner that ensures confidentiality.

 

12. Ensure that at all times the department’s representative is afforded reasonable opportunity to inspect all of the facility’s buildings, books, and records and to interview agents, employees, residents, and any person under its custody, control, direction, or supervision as specified in § 63.2-1706 of the Code of Virginia.

 

1. Upon initial application for an assisted living facility license, any person applying to operate such a facility who has not previously owned or managed or does not currently own or manage a licensed assisted living facility shall be required to undergo training by the commissioner. Training for such owners and currently employed administrators shall be

22VAC40-73-40. Licensee.

 

required at the time of initial application for licensure. In all cases, such training shall be completed prior to the granting of any initial license.

 

1. The commissioner may also approve training programs provided by other entities and allow owners or administrators to attend such approved training programs in lieu of training by the commissioner.

 

2. The commissioner may at his discretion also approve for licensure applicants who meet requisite experience criteria as established by the board.

 

3. The training programs shall focus on the health and safety regulations and resident rights as they pertain to assisted living facilities and shall be completed by the owner or administrator prior to the granting of an initial license.

 

4. The commissioner may, at his discretion, issue a license conditioned upon the completion by the owner or administrator of the required training.

 

1. The licensee shall notify in writing the regional licensing office of intent to sell or voluntarily close the facility. The following shall apply:

 

1. No less than 60 days prior to the planned sale date or closure, the licensee shall notify the regional licensing office, residents, and as relevant, legal representatives, case managers, assessors, eligibility workers, and designated contact persons of the intended sale or closure of the facility and the date for such.

 

EXCEPTION: If plans are made at such time that 60-day notice is not possible, the licensee shall notify the regional licensing office, the residents, legal representatives, case managers, assessors, eligibility workers, and designated contact persons as soon as the intent to sell or close the facility is known.

 

2. If the facility is to be sold, at the time of notification specified in subdivision 1 of this subsection, the licensee shall explain to each resident, his legal representative, case manager, assessor, and at least one designated contact person that the resident can choose whether to stay or relocate, unless the new licensee specifies relocation. If a resident chooses to stay, there must be a new resident agreement between the resident and the new licensee that meets the specifications of 22VAC40-73-390.

 

3. The licensee shall provide updates regarding the closure or sale of the facility to the regional licensing office, as requested.

22VAC40-73-45. Minimum amount for liability insurance disclosure.

 

1. The minimum amount of liability insurance coverage to be maintained by an assisted living facility for purposes of disclosure in the statement required by 22VAC40-73-50 and the resident agreement required by 22VAC40-73-390 is as follows:

 

1. $500,000 per occurrence to compensate residents or other individuals for injuries and losses from the negligent acts of the facility; and

 

2. $500,000 aggregate to compensate residents or other individuals for injuries and losses from the negligent acts of the facility.

 

1. No facility shall state that liability insurance is in place unless the insurance provides the minimum amount of coverage established in subsection A of this section.

 

22VAC40-73-50. Disclosure.

 

1. The assisted living facility shall prepare and provide a statement to the prospective resident and his legal representative, if any, that discloses information about the facility. The statement shall be on a form developed by the department and shall:

 

1. Disclose information fully and accurately in plain language;

 

2. Be provided in advance of admission and prior to signing an admission agreement or contract;

 

3. Be provided upon request; and

 

4. Disclose the following information, which shall be kept current:

 

1. Name of the facility;

 

1. Name of the licensee;

 

1. Ownership structure of the facility (e.g., individual, partnership, corporation, limited liability company, unincorporated association, or public agency);

 

1. Description of all accommodations, services, and care that the facility offers;

 

1. Fees charged for accommodations, services, and care, including clear information about what is included in the base fee and all fees for additional accommodations, services, and care;

 

1. Criteria for admission to the facility and restrictions on admission;

 

1. Criteria for transfer to a different living area within the same facility, including transfer to another level or type of care within the same facility or complex;

22VAC40-73-50. Disclosure.

 

1. Criteria for discharge;

 

1. Categories, frequency, and number of activities provided for residents;

 

1. General number, position types, and qualifications of staff on each shift;

 

1. Whether or not the facility maintains liability insurance that provides at least the minimum amount of coverage established by the board for disclosure purposes set forth in 22VAC40-73-45 to compensate residents or other individuals for injuries and losses from negligent acts of the facility. The facility shall state in the disclosure statement the minimum amount of coverage established by the board in 22VAC40-73-45;

 

1. Whether or not the facility has an on-site emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply. If the facility does have an on-site emergency electrical power source, the statement must include: (i) the items for which the source will supply power and

 

• whether or not staff of the facility have been trained to maintain and operate the power source. For the purposes of this subdivision, an on-site emergency electrical power supply shall include both permanent emergency electrical power sources and portable emergency electrical power sources, provided that such temporary electrical power supply source remains on the premises of the facility at all times. Written acknowledgement of the disclosure shall be evidenced by the signature or initials of the resident or his legal representative immediately following the on-site emergency electrical power source disclosure statement.

 

1. Notation that additional information about the facility that is included in the resident agreement is available upon request; and

 

1. The department’s website address, with a note that additional information about the facility may be obtained from the website.

 

1. Written acknowledgment of the receipt of the disclosure by the resident or his legal representative shall be retained in the resident’s record.

 

1. The disclosure statement shall also be available to the general public, upon request.

 

22VAC40-73-60. Electronic records and signatures.

 

A. Use of electronic records or signatures shall comply with the provisions of the Uniform Electronic Transactions Act (§ 59.1-479 et seq. of the Code of Virginia).

 

22VAC40-73-60. Electronic records and signatures.

 

1. In addition to the requirements of the Uniform Electronic Transactions Act, the use of electronic signatures shall be deemed to constitute a signature and have the same effect as a written signature on a document as long as the licensee:

 

1. Develops, implements, and maintains specific policies and procedures for the use of electronic signatures;

 

2. Ensures that each electronic signature identifies the individual signing the document by name and title;

 

3. Ensures that the document cannot be altered after the signature has been affixed;

 

4. Ensures that access to the code or key sequence is limited;

 

5. Ensures that all users have signed statements that they alone have access to and use the key or computer password for their signature and will not share their key or password with others; and

 

6. Ensures that strong and substantial evidence exists that would make it difficult for the signer or the receiving party to claim the electronic representation is not valid.

 

1. A back-up and security system shall be utilized for all electronic documents.

 

22VAC40-73-70. Incident reports.

 

1. Each facility shall report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident.

 

1. The report required in subsection A of this section shall include (i) the name of the facility, (ii) the name or names of the resident or residents involved in the incident, (iii) the name of the person making the report, (iv) the date of the incident, (v) a description of the incident, and (vi) the actions taken in response to the incident.

 

1. The facility shall submit a written report of each incident specified in subsection A of this section to the regional licensing office within seven days from the date of the incident. The report shall be signed and dated by the administrator and include the following information:

 

1. Name and address of the facility;

 

2. Name of the resident or residents involved in the incident;

 

3. Date and time of the incident;

22VAC40-73-70. Incident reports.

 

4. Description of the incident, the circumstances under which it happened, and, when applicable, extent of injury or damage;

 

5. Location of the incident;

 

6. Actions taken in response to the incident;

 

7. Actions to prevent recurrence of the incident, if applicable;

 

8. Name of staff person in charge at the time of the incident;

 

9. Names, telephone numbers, and addresses of witnesses to the incident, if any; and

 

10. Name, title, and signature of the person making the report, if other than the administrator, and date of the completion of the report.

 

1. The facility shall submit to the regional licensing office amendments to the written report when circumstances require, such as when substantial additional actions are taken, when significant new information becomes available, or there is resolution of the incident after submission of the report.

 

1. A copy of the written report of each incident shall be maintained by the facility for at least two years from the date of the incident.

 

1. If applicable, the facility shall ensure that there is documentation in the resident’s record as required by 22VAC40-73-470 F.

 

22VAC40-73-80. Management and control of resident funds.

 

Pursuant to § 63.2-1808 A 3 of the Code of Virginia, the resident shall be free to manage his personal finances and funds regardless of source, unless a committee, conservator, or guardian has been appointed for a resident. However, the resident may request that the facility assist with the management of personal funds, and the facility may assist the resident in such management under the following conditions:

 

1. There shall be documentation of this request and delegation, signed and dated by the resident and the administrator. The documentation shall be maintained in the resident’s record.

 

2. All resident funds shall be held separately from any other moneys of the facility. No resident funds shall be borrowed, used as assets of the facility, or used for purposes of personal interest by the licensee, operator, administrator, or facility staff.

22VAC40-73-80. Management and control of resident funds.

 

3. The resident shall be given a choice of whether he wishes his funds to be maintained in an individual resident account or in a single account for the accumulated funds of multiple residents. Either type of account may be interest-bearing. If the account is interest-bearing, the resident must be provided his appropriate portion of the interest.

 

4. The facility may charge a reasonable amount for administration of the account, except for residents who are recipients of an auxiliary grant as account administration is covered by the grant.

 

5. The facility shall maintain a written accounting of money received and disbursed by the facility that shows a current balance. The written accounting of the funds shall be made available to the resident at least quarterly and upon request, and a copy shall also be placed in the resident’s record.

 

6. The resident’s funds shall be made available to the resident upon request.

 

22VAC40-73-90. Safeguarding residents’ funds.

 

No licensee, facility administrator, or staff person shall act as either attorney-in-fact or trustee unless the resident has no other preferred designee and the resident himself expressly requests such service by or through facility personnel. When the licensee, facility administrator, or staff person acts as attorney-in-fact or trustee, the following applies:

 

1. There shall be documentation that the resident has requested such service and

 

from whom, signed and dated by the resident, the licensee, the facility administrator, and if a staff person is to provide the service, the staff person. The documentation shall be maintained in the resident’s record.

 

2. The licensee, facility administrator, or staff person so named attorney-in-fact or trustee shall be accountable at all times in the proper discharge of such fiduciary responsibility as provided under Virginia law.

 

3. The facility shall maintain a written accounting of money received and disbursed by the licensee, facility administrator, or staff person that shows a current balance. The written accounting of the funds shall be made available to the resident at least quarterly and upon request, and a copy shall also be placed in the resident’s record.

 

4. The resident’s funds shall be made available to the resident upon request.

 

Upon termination of the power of attorney or trust for any reason, the licensee, facility administrator, or staff person so named attorney-in-fact or trustee shall return all funds and assets, with full accounting, to the resident or to another responsible party expressly designated by the resident.

 

22VAC40-73-100. Infection control program.

 

1. The assisted living facility shall develop, in writing, and implement an infection control program addressing the surveillance, prevention, and control of disease and infection that is consistent with the federal Centers for Disease Control and Prevention (CDC) guidelines and the federal Occupational Safety and Health Administration (OSHA) bloodborne pathogens regulations.

 

1. A licensed health care professional, practicing within the scope of his profession and with training in infection prevention, shall participate in the development of infection prevention policies and procedures and shall ensure compliance with applicable guidelines and regulations.

 

2. The administrator shall ensure at least an annual review of infection prevention policies and procedures for any necessary updates. A licensed health care

 

professional, practicing within the scope of his profession and with training in infection prevention, shall be included in the review to ensure compliance with applicable guidelines and regulations. Documentation of the review shall be maintained at the facility.

 

3. A staff person who has been trained in basic infection prevention shall participate in the annual review and serve as point of contact for the program. This person shall be responsible for on-going monitoring of the implementation of the infection control program.

 

1. The infection control program shall be applicable to all staff and volunteers and encompass all services as well as the entire premises.

 

1. The infection control program shall include:

 

1. Procedures for the implementation of infection prevention measures by staff and volunteers to include:

 

1. Use of standard precautions;

 

1. Use of personal protective equipment; and

 

1. Means to ensure hand hygiene;

 

2. Procedures for other infection prevention measures related to job duties include:

 

1. Determination of whether prospective or returning residents have acute infectious disease and use of appropriate measures to prevent disease transmission;

22VAC40-73-100. Infection control program.

 

1. Use of safe injection practices and other procedures where the potential for exposure to blood or body fluids exists;

 

1. Blood glucose monitoring practices that are consistent with CDC recommendations. When assisted blood glucose monitoring is required, fingerstick devices shall not be used for more than one person;

 

1. The handling, storing, processing, and transporting of linens, supplies, and equipment in a manner that prevents the spread of infection;

 

1. The sanitation of rooms, including cleaning and disinfecting procedures, agents, and schedules;

 

1. The sanitation of equipment, including medical equipment that may be used on more than one resident (e.g., blood glucose meters and blood pressure cuffs, including cleaning and disinfecting procedures, agents, and schedules);

 

1. The handling, storing, processing, and transporting of medical waste in accordance with applicable regulations; and

 

1. Maintenance of an effective pest control program;

 

3. Readily accessible handwashing equipment and necessary personal protective equipment for staff and volunteers (e.g., soap, alcohol-based hand rubs, disposable towels or hot air dryers, and gloves);

 

4. Product specific instructions for use of cleaning and disinfecting agents (e.g., dilution, contact time, and management of accidental exposures); and

 

5. Initial training as specified in 22VAC40-73-120 C 4 and annual retraining of staff and volunteers in infection prevention methods, as applicable to job responsibilities and as required by 22VAC40-73-210 F.

 

1. The facility shall have a staff health program that includes:

 

1. Provision of information on recommended vaccinations, per guidelines from the CDC Advisory Committee on Immunization Practices (ACIP), to facility staff and volunteers who have any potential exposure to residents or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air;

 

2. Assurance that employees with communicable diseases are identified and prevented from work activities that could result in transmission to other personnel or residents;

22VAC40-73-100. Infection control program.

 

3. An exposure control plan for bloodborne pathogens;

 

4. Documentation of screening and immunizations offered to, received by, or declined by employees in accordance with law, regulation, or recommendations of public health authorities, including access to hepatitis B vaccine; and

 

5. Compliance with requirements of the OSHA for reporting of workplace associated injuries or exposure to infection.

 

1. The facility administrator shall immediately make or cause to be made a report of an outbreak of disease as defined by the State Board of Health. Such report shall be made by rapid means to the local health director or to the Commissioner of the Virginia Department of Health and to the licensing representative of the Department of Social Services in the regional licensing office.

 

When recommendations are made by the Virginia Department of Health to prevent or control transmission of an infectious agent in the facility, the recommendations must be followed.