901. General.

A.Prior to admission, there shall be a written agreement between the resident, and/or his/her responsible
party, and the facility. The agreement shall be revised upon any changes and shall include at least the
following:
1. An explanation of the specific care, services, and/or equipment provided by the facility, e.g.,
administration of medication, provision of special diet as necessary, assistance with bathing, toileting,
feeding, dressing, and mobility;
2. Disclosure of fees for all care, services, and/or equipment provided;
3. Advance notice requirements of not less than thirty (30) days to change fee amount for care, services
and/or equipment;
4. Refund policy to include when monies are to be forwarded to the resident upon
discharge/transfer/relocation;
5. The date a resident is to receive his/her personal needs allowance;
24 | Regulation 61-84
6. The amount a resident receives for his/her personal needs allowance;
7. Transportation policy;
8. Discharge/transfer provisions to include the conditions under which the resident may be discharged
and the agreement terminated, and the disposition of personal belongings;
9. Documentation of the explanation of the Resident’s Bill of Rights and the grievance procedure. (II)

B.The facility shall coordinate with residents to provide care, including diet, services, i.e., routine and
emergency medical care, podiatry care, dental care, counseling and medications, as ordered by a physician
or other authorized healthcare provider. Such care shall be provided and coordinated among those
responsible during the process of providing such care/services and modified as warranted based upon any
changing needs of the resident. Such care and services shall be detailed in the ICP. (I)

C.The facility shall render care and services in accordance with orders from physicians or other
authorized healthcare providers and take precautions for residents with special conditions, e.g., pacemakers,
wheelchairs, dementia, etc. The facility shall assist in activities of daily living as needed and appropriate.
Each facility is required to provide only those activities of daily living and only to the levels specifically
designated in the written agreement between the resident, and/or his/her responsible party/guardian, and
the facility. (I)

D.The facility shall provide necessary items and assistance, if needed, for residents to maintain their
personal cleanliness, e.g., soap. (II)

E.The provision of care/services to residents shall be guided by the recognition of and respect for cultural
differences to assure reasonable accommodations shall be made for residents with regard to differences,
such as, but not limited to, religious practice and dietary preferences.

F. The facility shall make opportunities for participation in religious services available. Reasonable
assistance in obtaining pastoral counseling shall be provided by the facility upon request by the resident.

G.In the event of closure of a facility for any reason, the facility shall ensure continuity of care/services
by promptly notifying the resident’s attending physician or other authorized healthcare provider, and
responsible party, and arranging for referral to other facilities at the direction of the physician or other
authorized healthcare provider. (II)

902. Fiscal Management (II).

A.Provisions shall be made for safeguarding money and valuables for those residents who request this
assistance.

B.Residents shall manage their own funds whenever possible.

C.Only residents may endorse checks made payable to them, unless a legally constituted authority has
been authorized to endorse their checks.

D.In situations where a resident becomes unable to manage his/her funds, the administrator shall contact
a family member or the county probate court regarding the need for a court-appointed guardian or
conservator. The licensee, administrator, sponsor, or any of their relatives shall not be appointed guardian
or conservator.

E.Upon written request of the resident, the administrator may maintain the personal monies for the
resident.

F. The licensee may be designated payee for a resident.

G.There shall be an accurate accounting of residents’ personal monies and written evidence of purchases
by the facility on behalf of the residents to include a record of items/services purchased, written
authorization from residents of each item/service purchased, and an accounting of all monies paid to the
facility for care and services. Personal monies include all monies, including family donations. No personal
monies shall be given to anyone, including family members, without written consent of the resident. If a
resident’s money is given to anyone by the facility, a receipt shall be obtained.

H.A report of the balance of resident finances shall be physically provided to each resident by the facility
on a quarterly basis in accordance with the Resident’s Bill of Rights, regardless of the balance amount, e.g.,
zero balance. Documentation of quarterly reports to residents shall be readily available for review.

903. Recreation.

A.The facility shall offer a variety of recreational programs to suit the interests and physical/cognitive
capabilities of the residents that choose to participate. The facility shall provide recreational activities that
provide stimulation; promote or enhance physical, mental, and/or emotional health; are age-appropriate;
and are based on input from the residents and/or responsible party, as well as information obtained in the
initial assessment.

B.There shall be at least one different structured recreational activity provided daily each week that shall
accommodate residents’ needs/interests/capabilities as indicated in the ICP’s.

C.The facility shall designate a staff member responsible for the development of the recreational
program, including responsibility for obtaining and maintaining recreational supplies. At least one staff
person shall be responsible for providing/coordinating recreational activities for the residents.

D.The recreational supplies shall be adequate and shall be sufficient to accomplish the activities planned.
E.A current month’s schedule shall be posted in order for residents to be made aware of activities offered.
This schedule shall include activities, dates, times, and locations. Residents may choose activities and
schedules consistent with their interests and physical, mental, and psychosocial well-being. If a resident
has dementia and is unable to choose for him/herself, staff members/volunteers shall encourage
participation and assist when deemed necessary.

904. Transportation (I).
The facility shall secure or provide transportation for residents when a physician’s services are needed.
Local (as defined by the facility) transportation for medical reasons shall be provided by the facility at no
additional charge to the resident. If a physician’s services are not immediately available and the resident’s
condition requires immediate medical attention, the facility shall provide or secure transportation for the
resident to the appropriate health care providers such as, but not limited to, physicians, dentists, physical
therapists, or for treatment at renal dialysis facilities.

905. Safety Precautions/Restraints (I).

A.Periodic or continuous mechanical, physical or chemical restraints during routine care of a resident
shall not be used, nor shall residents be restrained for staff convenience or as a substitute for care/services.
However, in cases of extreme emergencies when a resident is a danger to him/herself or others, mechanical
and/or physical restraints may be used as ordered by a physician or other authorized healthcare provider,
and until appropriate medical care can be secured.
EXCEPTION: Antipsychotic medication administered to residents with Alzheimer’s disease or dementia
is not considered a chemical restraint if the resident has be prescribed the antipsychotic medication in a
physician order and/or PRN and the resident only receives the prescribed dosage of medication as indicated
on the physician order and/or PRN and every medication administration is recorded pursuant to the
requirements of this regulation.
B.Only those devices specifically designed as restraints may be used. Makeshift restraints shall not be
used under any circumstance.
C.Emergency restraint orders shall specify the reason for the use of the restraint, the type of restraint to
be used, the maximum time the restraint may be used, and instructions for observing the resident while
restrained, if different from the facility’s written procedures. Residents certified by a physician or other
authorized healthcare provider as requiring restraint for more than 24 hours shall be transferred to an
appropriate facility.
D.During emergency restraint, residents shall be monitored at least every 15 minutes, and provided with
an opportunity for motion and exercise at least every 30 minutes. Prescribed medications and treatments
shall be administered as ordered, and residents shall be offered nourishment and fluids and given bathroom
privileges.
906. Discharge/Transfer.
A.Residents shall be transferred or discharged only as appropriate per the provisions of the Resident’s
Bill of Rights. In cases of medical emergencies, immediate transfer is permissible; however, the family
member, and the sponsor, if any, shall be notified at the earliest practical hour, but not later than 24 hours
following the transfer. (II)
B.Prior to discharge, the resident, his/her appropriate family member, and the sponsor, if any, shall be
consulted.
C.Residents shall be transferred or discharged to a location appropriate to the residents needs and
abilities. Residents requiring care and/or supervision shall not be transferred/discharged to a location that
is not licensed to provide that care. (II)
D.Upon transfer/discharge of a resident, resident information shall be released in a manner that promotes
continuity in the care that serves the best interest of the resident.
E.Upon transfer/discharge, the facility shall ensure that medications, as appropriate, personal possessions
and funds are released to the resident and/or the receiving facility in a manner that ensures continuity of
care/services and maximum convenience of the resident. (II)

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