23.1 The assisted living residence shall have written policies and procedures that provide for effective
control and eradication of insects, rodents and other pests.
23.2 The assisted living residence shall have a contract with a licensed pest control company or an
effective means for pest control using the least toxic and least flammable effective pesticides. The
pesticides shall not be stored in resident or food areas and shall be kept under lock and only
properly trained responsible personnel shall be allowed to apply them.
23.3 Screens or other pest control measures shall be provided on all exterior openings except where
prohibited by fire regulations. Assisted living residence doors, door screens and window screens
shall fit with sufficient tightness at their perimeters to exclude pests.
Sewage and Sewer Systems
24.1 All sewage shall be discharged into a public sewer system, or if such is not available, disposed of
in a manner approved by the State and local health authorities and the Colorado Water Quality
A) When private sewage disposal systems are in use, records of maintenance and the
system design plans shall be kept on the premises.
B) No unprotected exposed sewer line shall be located directly above working, storage or
eating surfaces in kitchens, dining rooms, pantries, food storage rooms, or where medical
or nursing supplies are prepared, processed or stored.
24.2 Assisted living residents shall not transport, manage or dispose of medical waste unless in
accordance with the 6 CCR 1007-2, Part 1, Regulations Pertaining to Solid Waste Disposal Sites
and Facilities, Section 13, Medical Waste.
24.3 Assisted living residences that generate waste including medical waste shall make a hazardous
waste determination in accordance with Part 261 of the state hazardous waste regulations at 6
CCR 1007-3. If the facility generates hazardous waste, it shall manage, transport and dispose of
such waste in accordance with 6 CCR 1007-3.
24.4 All garbage and rubbish that is not disposed of as sewage shall be collected in impervious
containers in such manner as not to become a nuisance or a health hazard and shall be removed
to an outside storage area at least once a day.
A) The refuse storage area shall be kept clean, and free from nuisance.
B) A sufficient number of impervious containers with tight fitting lids shall be provided and
kept clean and in good repair.
C) Carts used to transport refuse shall be constructed of impervious materials, enclosed,
used solely for refuse and maintained in a sanitary manner.
25.1 An assisted living residence may choose to provide a secure environment as that term is defined
in section 2. A secure environment, which may be provided throughout an entire assisted living
residence or in a distinct part of an assisted living residence, shall comply with sections 1 through
24 of this chapter in addition to the requirements in this section 25.
25.2 An assisted living residence that uses any methods or devices to limit, restrict or prohibit free
egress of one or more residents to move unsupervised outside of the ALR or any separate and
distinct part of the ALR shall comply with this section regarding secure environment.
25.3 An assisted living residence with a secure environment shall include all the services provided in
an unsecured environment plus any additional services specified in this section 25.
25.4 In addition to the information listed in section 11.7(A) through (K), an assisted living residence
shall also disclose the following information to each potential resident and his or her legal
representative before such individual moves into a secure environment:
(A) The criteria for admission including the types of required assessments used to determine
unique resident needs,
(B) The location of the secure environment and the methods of restrictions that are used,
(C) How the safety of residents is monitored within the building and the outdoor area, and
(D) Information on any specialty services such as memory care and/or special care services,
including, but not limited to, a description of daily engagement opportunities.
25.5 Before an individual moves in, the assisted living residence shall complete a pre-admission
assessment to determine the appropriateness and need for secure environment residency. The
pre-admission assessment shall include all the items required for the comprehensive assessment
in section 12.7(A) through (M), plus the following:
(A) A face to face evaluation by a licensed practitioner which has occurred within the
previous 90 calendar days and which describes the resident’s medical condition and any
cognitive deficits that contribute to wandering, compromised safety awareness and other
types of conduct; and
(B) Detailed information from the resident’s family and/or representative concerning the
resident’s recent relevant history and patterns of reduced safety awareness and
wandering along with any strategies used to prevent unsafe wandering or successful
exiting and any other known types of conduct.
25.6 No individual shall be required to move in to a secure environment against their will unless legal
authority for the admission of the individual has been established by guardianship, court order,
medical durable power of attorney, health care proxy or other means allowed by Colorado law.
25.7 An individual may voluntarily agree to reside in a secure environment even though his or her
physical or psychosocial status does not require such placement. In such circumstances, the
assisted living residence shall assure that the resident has freedom of movement inside and
outside of the secure environment at all times and that there is a signed resident agreement to
25.8 Once a resident moves into a secure environment, the assisted living residence shall comply with
(A) The assisted living residence shall evaluate a resident when the resident expresses the
desire to move out of a secure environment and contact the resident’s legal
representative, practitioner and the state and/or local long-term care ombudsman, when
(B) The assisted living residence shall ensure that admission to and continuing residence in
a secure environment is the least restrictive alternative available and is necessary for the
physical and psychosocial well-being of the resident; and
(C) If at any time a resident is determined to be a danger to self or others, the assisted living
residence shall be responsible for developing and implementing a temporary plan to
monitor the resident’s safety along with the protection of others until the issue is
appropriately resolved and/or the resident is discharged from the assisted living
25.9 Each resident shall be re-assessed to determine his or her continued need for a secure
environment every six months and whenever the resident’s condition changes from baseline
(A) As part of the secure environment re-assessment, the assisted living residence shall
consult with the resident’s attending practitioner, family and/or resident representative
and review service documentation dating back to the most recent comprehensive
Enhanced Resident Care Plan
25.10 In addition to the information required for a resident care plan at section 12.10, the care plan for
each resident in a secure environment shall include the following:
(A) A description of the resident’s wandering patterns and known behavioral expressions
along with individualized approaches to be implemented by staff to protect the resident
and other residents with whom they have contact,
(B) A description of how the resident will have continuous independent access to his or her
individual room along with the ALR’s plan to protect the resident from unwanted visitation
by other residents,
(C) Identification of the type and level of staff oversight, monitoring and/or accompaniment
that the ALR deems necessary to meet the needs of the resident within the secure
environment and secure outdoor area, and
(D) Documentation describing the personal grooming and hygiene items that are determined
safe for the resident to have in their own possession for self-care and how those items
are stored to prevent unauthorized access by other residents.
25.11 The enhanced resident care plan shall be updated to reflect changes in the staff approach to
meeting resident needs and when any medical assessment, appraisal or observations indicate
the resident’s care needs have changed.
25.12 The assisted living residence shall have a policy and procedure regarding the training of staff who
provide services in a secure environment. The policy shall include, at a minimum, information on
the appropriate staff response when there is a missing resident or resident incident/altercation
along with distribution of staff when responding to such an event to ensure that there is sufficient
staff presence for the continued supervision of other residents.
25.13 In addition to the training requirements in section 7.9, staff assigned to a secure environment
shall receive training and education on assisted living residence policies and procedures specific
to the secure environment resident care, services and protections. Such training shall include, at
a minimum, the following:
(A) Information on the secure environment that identifies and describes the areas where
residents have free passage, where passage may be restricted and where passage is
(B) Information regarding the current mobility status of all residents so that staff are prepared
to successfully evacuate all residents in the event of an emergency,
(C) Information on the location of the storage area which is not accessible to residents
including a description of what items or contents are required to be kept in the storage
(D) Information on the equipment and devices used to secure the environment including how
to override or disarm such devices, along with expectations for response if staff are
alerted to an alarm.
25.14 Before a staff member is allowed to work independently in the secure environment, the assisted
living residence shall provide each staff member with a minimum of eight hours of training and
education on the provision of care and services for residents with dementia/cognitive impairment.
(A) The training shall be provided through structured, formalized classes, correspondence
courses, competency-based computer courses, training videos or distance learning
(B) The training content shall be provided or recognized by an academic institution, a
recognized state or national organization or association, or an independent contractor or
group that emphasizes dementia/cognitive impairment care.
(C) The training shall cover, at a minimum, the following topics:
(1) Information on disease processes associated with dementia and cognitive
impairment including progression of the diseases, types and stages of memory
loss, family dynamics, behavioral symptoms and limitations to normal activities of
(2) Information on non-pharmacological techniques and approaches used to guide
and support residents with dementia/cognitive impairment, wandering and
socially challenging behavioral expressions of need or distress;
(3) Information on communication techniques that facilitate supportive and
interactive staff-resident relations;
(4) Positive therapeutic approaches and activities such as exercise, sensory
stimulation, activities of daily living and social, recreation and rehabilitative
(5) Information on recognizing physical symptoms that may cause a change in
dementia/cognitive impairment such as dehydration, infection, and swallowing
difficulty; along with individualized approaches to assist or address associated
symptoms such as pain, decreased appetite and fluid intake and/or isolation; and
(6) Benefits and importance of person-centered care planning and collaborative
approaches to delivery of care.
25.15 The assisted living residence shall ensure that each staff member assigned to the secure
environment completes eight clock hours of continuing education within each 12-month period
beginning with the date of initial assignment. The education shall include topics covered in the
initial training and may include other topics relevant to the population served at the assisted living
25.16 The assisted living residence shall have a sufficient number of trained staff members on duty in
the secure environment to ensure each resident’s physical, social and emotional health care and
safety needs are met in accordance with their individualized care plan.
25.17 The assisted living residence shall consider the day to day resident needs and activity, including
the intensity of staff assistance, on an individual resident basis to determine the appropriate level
of staffing. At a minimum, there shall be one trained, awake staff member on duty at all times.
25.18 Staff members shall be familiar with each resident’s specific care-planned needs and the unique
approaches for assisting with care and safety.
Care and Services
25.19 In addition to the requirements for resident care services in section 12, each assisted living
residence with a secure environment shall establish policies and procedures for the delivery of
resident care and services that include, at a minimum, the following:
(A) A system or method of accounting for the whereabouts of each resident;
(B) The system or method staff members are to use for observation, identification,
evaluation, individualized approach to and documentation of resident behavioral
expression; and(C) Assistance with the transition of residents to and from the secure environment and when
changing rooms within a secure environment.
25.20 Residents who indicate a desire to go outside the secured area shall be permitted to do so with
staff supervision except in those situations where it would be detrimental to the resident’s health,
safety or welfare.
(A) If the assisted living residence is aware of an ongoing issue or pattern of behavioral
expression that would be exacerbated by allowing a resident to go outside the secure
area, it shall be documented in the resident’s enhanced, individualized care plan.
25.21 The assisted living residence shall meet the requirements of section 13.10 regarding the internal
grievance and complaint resolution process. In addition, the assisted living residence shall hold
regular meetings to allow residents, their family members, friends, and representatives to provide
mutual support and share concerns and/or recommendations about the care and services within
each separate secure environment.
(A) Such meetings shall be held at least quarterly at a place and time that reasonably
accommodates participation; and
(B) The assisted living residence shall provide adequate advance notice of the meeting and
ensure that details regarding any meeting are readily available in a common area within
the secure environment.
25.22 The assisted living residence shall ensure that residents in a secure environment have all the
same resident rights as set forth in section 13 of this chapter including, but not limited to, the right
to privacy and confidentiality.
25.23 The assisted living residence shall follow the requirements of sections 11.11 through 11.17
regarding resident discharge when moving a resident out of a secure environment unless the
move is voluntarily initiated by the resident’s legal representative.
Physical Design, Environment and Safety
25.24 The assisted living residence shall ensure that residents have freedom of movement to common
areas and resident personal spaces.
25.25 A secure environment shall meet the following criteria:
(A) There shall be a multipurpose room for dining, group and individual activities and family
(B) Resident access to appliances shall only be allowed with staff supervision,
(C) There shall be a storage area which is inaccessible to residents for storage of items that
could pose a risk or danger such as chemicals, toxic materials and sharp objects;
(D) The corridors and passageways shall be free of objects or obstacles that could pose a
(E) There shall be documentation of routine monthly testing of all equipment and devices
used to secure the environment, and
(F) There shall be a secure outdoor area that is available for resident use year-round that:
(1) Is directly supervised by staff,
(2) Is independently accessible to residents without staff assistance for entrance or
(3) Has comfortable seating areas,
(4) Has one or more areas that provide protection from weather elements, and
(5) Has a fence or enclosure around the perimeter of the outdoor area that is no less
than 6 feet in height and constructed to reduce the risk of resident wandering or
elopement from the area.
(a) If the fence or enclosure has gated access which is locked, all staff
assigned to the secure environment shall have a readily available means
of unlocking the gate in case of emergency.