12.1 The assisted living residence shall make available, either directly or indirectly through a resident
agreement, the following services, sufficient to meet the needs of the residents:
(A) A physically safe and sanitary environment including, but not limited to, measures to
reduce the risk of potential hazards in the physical environment related to the unique
characteristics of the population;
(B) Room and board;
(C) Personal services including, but not limited to, a system for identifying and reporting
resident concerns that require either an immediate individualized approach or on-going
monitoring and possible re-assessment;
(D) Protective oversight including, but not limited to, taking appropriate measures when
confronted with an unanticipated situation or event involving one or more residents and
the identification of urgent issues or concerns that require an immediate individualized
(E) Social care and resident engagement.
12.2 Nurses may provide nursing services to support the personal services provided to residents of the
assisted living residence, except that such services shall not rise to the level that requires
resident discharge as described in section 11.11 or becomes regular 24-hour medical or nursing
(A) Other staff may assist with nursing services if they are trained and evaluated for
competency prior to assignment.
(B) Staff assisting with nursing services shall be supervised by a nurse.
(C) Only staff employed or contracted by the assisted living residence shall provide or assist
with nursing services on behalf of the assisted living residence.
12.3 The following occasionally required services may only be provided by an external service provider
or the nurse of the assisted living residence:
(A) Syringe or tube feeding,
(B) Intravenous medication,
(C) Catheter care that involves changing the catheter, irrigation of the catheter and/or total
assistance with catheter,
(D) Ostomy care where the ostomy site is new or unstable, and
(E) Care for a stage 1 or stage 2 pressure sore if the condition is stable and resolving.
12.4 An assisted living residence shall not admit or keep a resident with a stage 3 or stage 4 pressure
sore unless the resident has a terminal condition and is receiving continuing care from an
external service provider.
12.5 The assisted living residence shall have a policy and procedure regarding when a practitioner’s
assessment of a resident is appropriate. At a minimum, the assisted living residence shall contact
the resident’s primary practitioner when any of the following circumstances occur and follow the
practitioner’s recommendation regarding further action.
(A) The resident experiences a significant change in their baseline status,
(B) The resident has physical signs of possible infection (open sores, etc.),
(C) The resident sustains an injury or accident,
(D) The resident has known exposure to a communicable disease, and/or
(E) The resident develops any condition which would have initially precluded admission to
the assisted living residence.
Comprehensive Resident Assessment
12.6 At the time a new resident moves in, the assisted living residence shall complete a
comprehensive assessment that reflects information requested and received from the resident,
the resident’s representative if requested by the resident, and a practitioner. Information from the
comprehensive assessment shall be used to establish an individualized care plan.
12.7 The comprehensive assessment shall include all the following items:
(A) Information from the comprehensive pre-admission assessment described in section 11.1,
(B) Information regarding the resident’s overall health and physical functioning ability,
(C) Information regarding the resident’s advance directives,
(D) Communication ability and any specific needs to facilitate effective communication,
(E) Current diagnoses and any known or anticipated need or impact related to the diagnoses,
(F) Food and dining preferences, unique needs and restrictions,
(G) Individual bathroom routines, sleep and awake patterns,
(H) Reactions to the environment and others, including changes that may occur at certain
times or in certain circumstances,
(I) Routines and interests,
(J) History and circumstances of recent falls and any known approaches to prevent future falls,
(K) Safety awareness,
(L) Types of physical, mental and social support required; and
(M) Personal background, including information regarding any other individuals who are
supportive of the resident, cultural preferences and spiritual needs.
12.8 The comprehensive assessment shall be documented in writing and kept in the resident’s health
12.9 The comprehensive assessment shall be updated for each resident at least annually and
whenever the resident’s condition changes from baseline status.
Resident Care Plan
12.10 Each resident care plan shall:
(A) Be developed with input from the resident and the resident representative,
(B) Reflect the most current assessment information,
(C) Promote resident choice, mobility, independence and safety,
(D) Detail specific personal service needs and preferences along with the staff tasks
necessary to meet those needs,
(E) Identify all external service providers along with care coordination arrangements, and
(F) Identify formal, planned, and informal spontaneous engagement opportunities that match
the resident’s personal choices and needs.
12.11 The assisted living residence shall be responsible for the coordination of resident care services
with known external service providers.
12.12 The assisted living residence shall notify the resident’s representative whenever the resident
experiences a significant change from baseline status.
12.13 An assisted living residence shall not use restraints of any kind or deprive a resident of his or her
liberty for purposes of care or safety except as allowed by section 11.2(I), section 25, or as set
12.14 A device that facilitates a resident’s well-being and/or independence may be used only if all of the
following criteria are met:
(A) The resident has the functional ability to alter his or her position;
(B) The resident is able to remove the device to allow for normal movement;
(C) The device improves the resident’s physical or emotional state and allows the resident to
participate in activities that would otherwise be difficult or impossible; and
(D) There is an order from a practitioner for its use.
(1) There shall also be interdisciplinary documentation from both the practitioner and
a therapist describing the benefits and hazards associated with the device and
information on its appropriate use.
(2) A resident’s continued use of such device shall be re-evaluated by both therapist
and practitioner at least annually or whenever the resident experiences a
significant change in status.
(3) Documentation of compliance with this subsection (D) shall be retained in the
resident’s care plan.
Fall Management Program
12.15 The assisted living residence shall develop policies and procedures to establish a fall
management program. The program shall include the following:
(A) Providing fall management education and materials to residents and family members;
(B) Detailing in each resident’s care plan the individualized approach necessary to address
fall risk related to deficits in strength, balance and eyesight, or effects of medication as
identified during the comprehensive resident assessment;
(C) Providing resident engagement activities to improve strength and balance as specified in
(D) Routinely inspecting and maintaining a safe exterior and interior environment as specified
in sections 21 and 22; and
(E) Providing staff training related to fall prevention as specified in section 7.9(H).
12.16 Each assisted living residence shall direct staff to assist residents who have fallen or are
otherwise unable to independently get up off the floor. The assisted living residence’s policy on
staff providing lift assistance shall be made available to its local emergency medical responder.
12.17 The assisted living residence shall ensure that it has trained staff available to evaluate residents
who have fallen or are otherwise unable to independently get up off the floor and provide lift
assistance when determined appropriate instead of relying on emergency medical responders.
(A) Each situation shall be evaluated to determine if the resident can be assisted in a safe
manner such as when the resident has no pain and/or there is no change from baseline,
the resident’s mental status is unchanged from baseline, and there is no or minor
(B) Once the situation has been evaluated, assisted living residence policy shall require staff
to take the following actions:
(1) Physically perform the lift assistance using techniques provided in staff training
and monitor the resident, or
(2) Not lift and call 9-1-1 when the resident is unconscious, the resident’s physical or
mental status has declined from baseline, the resident experiences an increase
in pain when lifting is attempted, the resident wants 9-1-1 called, and/or the
resident either can’t assist in any way or refuses to assist because of pain, injury,
or other physical complications.
(C) The assisted living residence shall promptly notify the resident’s practitioner, family
and/or legal representative of the occurrence of either circumstance identified in section
12.17(B)(1) or (2), along with information regarding the ALR’s response.
12.18 The assisted living residence’s policy shall also require documentation of the action taken by staff
and ongoing efforts to prevent a reoccurrence of the situation in the future.
12.19 The assisted living residence shall encourage residents to maintain and develop their fullest
potential for independent living through individual and group engagement opportunities.
12.20 The assisted living residence shall provide all residents with regular opportunities to participate in
structured engagement and shall support the pursuit of each resident’s interests.
12.21 If requested, the assisted living residence shall assist a resident with identifying and accessing
outside services and community events.
12.22 Examples of resident engagement include, but are not limited to, the following:
(A) Individual or group conversation, recreation, art, crafts, music and pet care;
(B) Use of daily living skills that foster and maintain a sense of purpose and significance;
(C) Physical pursuits such as games, sports and exercise that develop and maintain
strength, coordination and range of motion;
(D) Educational opportunities such as special classes or community events;
(E) Cultivation of personal interests and pursuits; and
(F) Encouraging engagement with others.
12.23 The assisted living residence shall encourage residents to contribute to the planning, preparation,
conduct, clean-up and critique of any structured engagement offering.
12.24 The assisted living residence shall evaluate its resident engagement program at least every three
months to ascertain whether the opportunities offered to residents are relevant and well-received
and/or if changes are appropriate in response to resident feed-back.
12.25 The assisted living residence shall, whenever feasible, coordinate with local agencies and
volunteer organizations to promote resident participation in community centered activities
including, but not limited to:
(A) Public service endeavors;
(B) Community events such as concerts, exhibits and plays;
(C) Community organized group engagement such as senior citizen groups, sports leagues
and service clubs; and
(D) Attendance at the place of worship of the resident’s choice.
12.26 Each assisted living residence shall place notices of planned resident engagement offerings in a
central location readily accessible to residents, relatives and the public. Copies shall be retained
for at least six months.
Resident Engagement Management
19 or fewer residents
12.27 In assisted living residences that are licensed for 19 or fewer residents, the administrator shall be
primarily responsible for organizing, conducting and evaluating resident engagement. If an
assisted living residence can demonstrate that its residents are self-directed to the extent that
they are able to plan, organize and conduct the ALR’s resident engagement activities themselves,
the ALR may request a waiver of this requirement.
20 to 49 residents
12.28 In assisted living residences that are licensed for 20 to 49 residents, the administrator shall
designate one staff member to be responsible for organizing, conducting and evaluating resident
engagement. The designated staff member shall have had at least six months experience in
providing structured resident engagement offerings or have completed or be enrolled in an
equivalent education and/or training program.
50 or more residents
12.29 In assisted living residences that are licensed for 50 or more residents, there shall be at least one
staff member whose sole responsibility is to organize, conduct and evaluate resident
engagement. The ALR shall provide such staff member with as much accommodation and staff
support as necessary to ensure that all residents have on-going opportunities to participate in
planned in advance, documented in writing, kept up to date and made available to all residents.
The responsible staff member shall have had at least one year of experience or equivalent
education and/or training in providing structured resident engagement offerings and be
knowledgeable in evaluating resident needs, supervising other staff and in training volunteers.
Use of Volunteers
12.30 Each assisted living residence shall encourage participation of volunteers in resident engagement
opportunities. All such volunteers shall be supervised and directed by the administrator or staff
member primarily responsible for resident engagement.
Physical Space and Equipment:
12.31 Each assisted living residence shall have sufficient physical space to accommodate both indoor
and outdoor resident engagement. Such accommodations shall include, at a minimum:
(A) A comfortable, appropriately furnished area such as a living room, family room or great
room available to all residents for their relaxation and for socializing with friends and
(B) An outdoor activity area which is easily accessible to residents and protected from traffic.
Outdoor spaces shall be sufficient in size to comfortably accommodate all residents
participating in an activity.
12.32 Each assisted living residence shall provide sufficient recreational equipment and supplies to
meet the needs of the resident engagement program. Special equipment and supplies necessary
to accommodate persons with special needs shall be made available as appropriate. When not in
use, recreational equipment and supplies shall be stored in such a way that they do not create a
12.33 Each assisted living residence shall ensure that staff who accompany residents away from the
assisted living residence have ready access to the pertinent personal information of those
residents in the event of an emergency.