§ 2800.220. Service provision.
(a) Services. The residence shall provide assisted living services as specified in subsection (b). The residence shall offer and provide the core service packages
specified in subsection (c). The residence shall provide or arrange for the provi sion of supplemental health care services as specified in subsection (e). Other
individuals or agencies may furnish services directly or under arrangements with the residence in accordance with a mutually agreed upon charge or fee between
the residence, resident and other individual or agency. These other services shall be supplemental to the assisted living services provided by the residence and do
not supplant them.
(b) Assisted living services. The residence shall, at a minimum, provide the following services:
(1) Nutritious meals and snacks in accordance with §§ 2800.161 and 2800.162 (relating to nutritional adequacy; and meals).
(2) Laundry services in accordance with § 2800.105 (relating to laundry).
(3) A daily program of social and recreational activities in accordance with
§ 2800.221 (relating to activities program).
(4) Assistance with performing ADLs and IADLs in accordance with
§§ 2800.23 and 2800.24 (relating to activities; and personal hygiene).
(5) Assistance with self-administration of medication or medication administration as indicated in the resident’s assessment and support plan in accordance with
§§ 2800.181 and 2800.182 (relating to self-administration; and medication administration).
(6) Housekeeping services essential for the health, safety, and comfort of the resident based upon the resident’s needs and preferences.
(7) Transportation in accordance with § 2800.171 (relating to transportation).
(8) Financial management in accordance with § 2800.20 (relating to financial management).
(9) 24-hour supervision, monitoring, and emergency response.
(10) Activities and socialization.
(11) Basic cognitive support services as defined in § 2800.4 (relating to definitions).
(c) Core service packages. The residence shall, at a minimum, provide the
following core service packages:
(1) Independent Core Package. This core package shall be provided to residents who do not require assistance with ADLs. The services must include
the following:
(i) 24-hour supervision, monitoring and emergency response.
(ii) Nutritious meals and snacks in accordance with §§ 2800.161 and 2800.162.
(iii) Housekeeping services essential for the health, safety and comfort of the resident based upon the resident’s needs and preferences.
(iv) Laundry services in accordance with § 2800.105.
(v) Assistance with unanticipated ADLs for a defined recovery period.
(vi) A daily program of social and recreational activities in accordance with § 2800.221.
(vii) Basic cognitive support services as defined in § 2800.4.
(2) Enhanced Core Package. This core package shall be available to residents who require assistance with ADLs. The services must include the following:
(i) The services provided in the basic core package under paragraph
(c)(1)(i)—(vii).
(ii) Assistance with ADLs and unanticipated ADLs for an undefined period of time.
(iii) Transportation in accordance with § 2800.171.
(iv) Assistance with self-administration of medication or medication administration as indicated in the resident’s assessment and support plan in
accordance with §§ 2800.181 and 2800.182.
(d) Opt-out. If a resident wishes not to have the residence provide a service under subsection (c)(1)(ii)—(iv), the resident-residence contract must state the
following:
(1) The service not being provided.
(2) The corresponding fee schedule charge adjustment that takes into account the reduction in service.
(e) Supplemental health care services. The residence shall provide or arrange for the provision of supplemental health care services, including, but not limited to, the following:
(1) Hospice services.
(2) Occupational therapy.
(3) Skilled nursing services.
(4) Physical therapy.
(5) Behavioral health services.
(6) Home health services.
(7) Escort service if indicated in the resident’s support plan or requested by
the resident to and from medical appointments.
(8) Specialized cognitive support services as defined in § 2800.4.
§ 2800.221. Activities program.
(a) The residence shall develop a program of daily activities designed to promote each resident’s active involvement with other residents, the resident’s family
and the community and provide the necessary space and equipment for the activities in accordance with §§ 2800.98 and 2800.99 (relating to indoor activity
space; and recreation space). The residence shall offer the opportunity for the residents’ active participation in the development of the daily activities calendar.
(b) The program must be based upon individual and group interests and provide social, physical, intellectual and recreational activities in a planned, coordinated
and structured manner and shall encourage active participation in the community at large.
(c) The week’s daily activity calendar shall be posted in advance in a conspicuous and public place in the residence. The residence shall provide verbal
cueing and reminders of activities, their start times and locations within the residence.
§ 2800.222. Community social services.
Residents shall be encouraged and assisted in the access to and use of social services in the community which may benefit the resident, including a county
mental health and intellectual disability program, a drug and alcohol program, a senior citizens center, an area agency on aging or a home health care agency.
§ 2800.223. Description of services.
(a) The residence shall have a current written description of services and activities that the residence provides including the following:
(1) The scope and general description of the services and activities that the residence provides.
(2) The criteria for admission and discharge.
(3) Specific services that the residence does not provide, but will arrange or coordinate.
(b) The residence shall develop written procedures for the delivery and management of services from admission to discharge. § 2800.224. Initial assessment
and preliminary support plan.
(a) Initial assessment.
(1) The administrator, administrator designee, or LPN, under the supervision of an RN, or an RN shall complete the initial assessment.
(2) An individual shall have a written initial assessment that is documented
on the Department’s assessment form within 30 days prior to admission unless
one of the conditions contained in paragraph (3) apply.
(3) A resident shall have a written initial assessment that is documented on the Department’s assessment form within 15 days after admission if one of the
following conditions applies:
(i) The resident is being admitted directly to the residence from an acute care hospital.
(ii) The resident is being admitted to escape from an abusive situation.
(iii) The resident has no alternative living arrangement.
(4) A residence may use its own assessment form if it includes the same information as the Department’s assessment form.
(5) The written initial assessment must, at a minimum include the following:
(i) The individual’s need for assistance with ADLs and IADLs.
(ii) The mobility needs of the individual.
(iii) The ability of the individual to self-administer medication.
(iv) The individual’s medical history, medical conditions, and current medical status and how they impact or interact with the individual’s service
needs.
(v) The individual’s need for supplemental health care services.
(vi) The individual’s need for special diet or meal requirements.
(vii) The individual’s ability to safely operate key-locking devices.
(viii) The individual’s ability to evacuate from the residence.
(b) An initial assessment will not be required to commence supplemental
health care services to a resident of a residence under any of the following circumstances:
(1) If the resident was not receiving the services at the time of the resident’s admission.
(2) To transfer a resident from a portion of a residence that does not provide supplemental health care services to a portion of the residence that provides such service.
(3) To transfer a resident from a personal care home to a residence licensed by the same operator.
(c) Preliminary support plan.
(1) An individual requiring services shall have a written preliminary support plan developed within 30 days prior to admission to the residence unless
one of the conditions contained in paragraph (2) applies.
(2) A resident requiring services shall have a written preliminary support plan developed within 15 days after admission if one of the following conditions applies:
(i) The resident is being admitted directly to the residence from an
acute care hospital.
(ii) The resident is being admitted to escape from an abusive situation.
(iii) Any other situation where the resident has no alternative living
arrangement.
(3) The written preliminary support plan must document the dietary, medical, dental, vision, hearing, mental health or other behavioral care services that
will be made available to the individual, or referrals for the individual to outside services if the individual’s physician, physician’s assistant or certified registered
nurse practitioner, determine the necessity of these services. This requirement does not require a residence to pay for the cost of these medical
and behavioral care services. The preliminary support plan must document the assisted living services and supplemental health care services, if applicable,
that will be provided to the individual.
(4) The preliminary support plan shall be documented on the Department’s support plan form.
(5) A residence may use its own support plan form it if includes the same
information as the Department’s support plan form. An LPN, under the supervision of an RN, or an RN shall review and approve the preliminary support plan.
(6) An individual’s preliminary support plan must document the ability of the individual to self-administer medications or the need for medication
reminders or medication administration and the ability of the resident to safely
operate key-locking devices.
(7) An individual shall be encouraged to participate in the development of the preliminary support plan. An individual may include a designated person or
family member in making decisions about services.
(8) Individuals who participate in the development of the preliminary support plan shall sign and date the preliminary support plan.
(9) If an individual or designated person is unable or chooses not to sign the preliminary support plan, a notation of inability or refusal to sign shall be
documented.
(10) The residence shall give a copy of the preliminary support plan to the resident and the resident’s designated person.
(a) The administrator or administrator designee, or an LPN, under the supervision of an RN, or an RN shall complete additional written assessments for each
resident. A residence may use its own assessment form if it includes the same
information as the Department’s assessment form. Additional written assessments
shall be completed as follows:
(1) Annually.
(2) If the condition of the resident significantly changes prior to the annual assessment.
(3) At the request of the Department upon cause to believe that an update is required.
(b) The assessment must, at a minimum include the following:
(1) The resident’s need for assistance with ADLs and IADLs.
(2) The mobility needs of the resident.
(3) The ability of the resident to self-administer medication.
(4) The resident’s medical history, medical conditions, and current medical
status and how these impact or interact with the individual’s service needs.
(5) The resident’s need for supplemental health care services.
(6) The resident’s need for special diet or meal requirements.
(7) The resident’s ability to safely operate key-locking devices.
§ 2800.226. Mobility criteria.
(a) The resident shall be assessed for mobility needs as part of the resident’s assessment.
(b) If a resident is determined to have mobility needs as part of the resident’s initial or annual assessment, specific requirements relating to the care, health and
safety of the resident shall be met immediately.
(c) The administrator or the administrator designee shall notify the Department within 30 days after a resident with mobility needs is admitted to the residence
and compile a monthly list of when a resident develops mobility needs.
§ 2800.227. Development of the final support plan.
(a) Each resident requiring services shall have a written final support plan developed and implemented within 30 days after admission to the residence. The
final support plan shall be documented on the Department’s support plan form.
(b) A residence may use its own support plan form if it includes the same information as the Department’s support plan form. An LPN, under the supervision of
an RN, shall review and approve the final support plan.
(c) The final support plan shall be revised within 30 days upon completion of the annual assessment or upon changes in the resident’s needs as indicated on
the current assessment. The residence shall review each resident’s final support plan on a quarterly basis and modify as necessary to meet the resident’s needs.
(d) Each residence shall document in the resident’s final support plan the dietary, medical, dental, vision, hearing, mental health or other behavioral care
services that will be made available to the resident, or referrals for the resident to outside services if the resident’s physician, physician’s assistant or certified
registered nurse practitioner, determine the necessity of these services. This requirement does not require a residence to pay for the cost of these medical and
behavioral care services. The final support plan must document the assisted living services and supplemental health care services, if applicable, that will be provided
to the resident.
(e) The resident’s final support plan must document the ability of the resident to self-administer medications or the need for medication reminders or
medication administration and the ability of the resident to safely operate key-locking devices. Strategies that promote interactive communication on
the part of and between direct care staff and individual residents shall also be included in the final support plan.
(f) A resident shall be encouraged to participate in the development and implementation of the final support plan. A resident may include a designated
person or family member in making decisions about services.
(g) Individuals who participate in the development of the final support plan shall sign and date the support plan.
(h) If a resident or designated person is unable or chooses not to sign the final support plan, a notation of inability or refusal to sign shall be documented.
(i) The final support plan shall be accessible by direct care staff persons at all times.
(j) A resident or a designated person has a right to request the review and modification of his support plan.
(k) The residence shall give a copy of the final support plan to the resident
and the resident’s designated person. The final support plan shall be attached to
or incorporated into and serve as part of the resident-residence contract.
§ 2800.228. Transfer and discharge.
(a) The facility shall ensure that a transfer or discharge is safe and orderly and that the transfer or discharge is appropriate to meet the resident’s needs. This
includes ensuring that a resident is transferred or discharged with all his medications, durable medical equipment and personal property.
The residence shall permit the resident to participate in the decision relating to the relocation.
(b) If the residence initiates a transfer or discharge of a resident, or if the legal entity chooses to close the residence, the residence shall provide a 30-day
advance written notice to the resident, the resident’s family or designated person and the referral agent citing the reasons for the transfer or discharge. This shall
be stipulated in the resident-residence contract.
(1) The 30-day advance written notice must be written in language in which the resident understands, or performed in American Sign Language or
presented orally in a language the resident understands if the resident does not speak standard English. The notice must include the following:
(i) The specific reason for the transfer or discharge.
(ii) The effective date of the transfer or discharge.
(iii) The location to which the resident will be transferred or discharged.
(iv) An explanation of the measures the resident or the resident’s designated person can take if they disagree with the residence decision to transfer
or discharge which includes the name, mailing address, and telephone number of the State and local long-term care ombudsman.
(v) The resident’s transfer or discharge rights, as applicable.
(2) Prior to initiating a transfer or discharge of a resident, the residence shall make reasonable accommodation for aging in place that may include services
from outside providers. The residence shall demonstrate through support plan modification and documentation the attempts to resolve the reason for the
transfer or discharge. Supplemental services may be provided by the resident’s family, residence staff or private duty staff as agreed to by the resident and the
residence. This shall be stipulated in the resident-residence contract.
(3) Practicable notice, rather than a 30-day advance written notice is required if a delay in transfer or discharge would jeopardize the health, safety
or well-being of the resident or others in the residence, as certified by a physician or the Department. This may occur when the resident needs psychiatric
services or is abused in the residence, or the Department initiates closure of the residence.
(c) A residence shall give the Department written notice of its intent to close the residence, at least 60 days prior to the anticipated date of closing.
(d) A residence may not require a resident to leave the residence prior to 30 days following the resident’s receipt of a written notice from the residence
regarding the intended closure of the residence, except when the Department
determines that removal of the resident at an earlier time is necessary for the protection of the health, safety and well-being of the resident.
(e) The date and reason for the transfer or discharge, and the destination of the resident, if known, shall be recorded in the resident record and tracked in a
transfer and discharge tracking chart that the residence shall maintain and make available to the Department.
(f) If the legal entity chooses to voluntarily close the residence or if the Department has initiated legal action to close the residence, the Department
working in conjunction with appropriate local authorities, will offer relocation assistance to the residents. Except in the case of an emergency, each resident may
participate in planning the transfer, and shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences.
These procedures apply even if the resident is placed in a temporary living situation.
(g) Within 30 days of the residence’s closure, the legal entity shall return the license to the Department.
(h) The only grounds for transfer or discharge of a resident from a residence are for the following conditions:
(1) If a resident is a danger to himself or others and the behavior cannot be
managed through interventions, services planning or informed consent agreements.
(2) If the legal entity chooses to voluntarily close the residence, or a portion of the residence.
(3) If a residence determines that a resident’s functional level has advanced or declined so that the resident’s needs cannot be met in the residence under
§ 2800.229 (relating to excludable conditions; exceptions) or within the scope of licensure for a residence. In that case, the residence shall notify the resident
and the resident’s designated person. The residence shall provide justification for the residence’s determination that the needs of the resident cannot be met.
In the event that there is no disagreement related to the transfer or discharge, a plan for other placement shall be made as soon as possible by the administrator
in conjunction with the resident and the resident’s designated person, if any. If assistance with relocation is needed, the administrator shall contact
appropriate local agencies, such as the area agency on aging, county mental health/intellectual disability program or drug and alcohol program, for assistance.
The administrator shall also contact the Department.
(4) If meeting the resident’s needs would require a fundamental alteration in the residence’s program or building site, or would create an undue financial
or programmatic burden on the residence.
(5) If the resident has failed to pay after reasonable documented efforts by the residence to obtain payment.
(6) If closure of the residence is initiated by the Department.
(7) Documented, repeated violation of the residence rules.
(8) A court has ordered the transfer or discharge.
(i) If grounds for transfer or discharge is based upon subsection (h)(1) or (3), a certification from one of the following individuals shall be required to certify
in writing that the resident can no longer be retained in the residence:
(1) The administrator acting in consultation with supplemental health care providers.
(2) The resident’s physician or certified registered nurse practitioner.
(3) The medical director of the residence.
§ 2800.229. Excludable conditions; exceptions.
(a) Excludable conditions. Except as provided in subsection (b), a residence may not admit, retain or serve an individual with any of the following conditions
or health care needs:
(1) Ventilator dependency.
(2) Stage III and IV decubiti and vascular ulcers that are not in a healing stage.
(3) Continuous intravenous fluids.
(4) Reportable infectious diseases, such as tuberculosis, in a communicable state that requires isolation of the individual or requires special precautions by
a caretaker to prevent transmission of the disease unless the Department of Health directs that isolation be established within the residence.
(5) Nasogastric tubes.
(6) Physical restraints.
(7) Continuous skilled nursing care 24 hours a day.
(b) Exception. The residence may submit a written request to the Department on a form provided by the Department for an exception related to any of the
conditions or health care needs listed in subsection (a) or (e) to allow the residence to admit, retain or serve an individual with one of those conditions or health care
needs, unless a determination is unnecessary as set forth in subsection (e).
(c) Submission, review and determination of an exception request.
(1) The administrator of the residence shall submit the exception request. The exception request must be signed and affirmed by an individual listed in
subsection (d) and accompanied by a support plan which includes the residence accommodations for treating the excludable condition requiring the exception
request. Proposed accommodations must conform with the provisions contained within the resident-residence contract.
(2) The Department will review the exception request in consultation with a certified registered nurse practitioner or a physician, with experience caring
for the elderly and disabled in long-term living settings.
(3) The Department will respond to the exception request in writing within 5 business days of receipt.
(4) The Department may approve the exception request if the following conditions are met:
(i) The exception request is desired by the resident or applicant.
(ii) The resident or applicant will benefit from the approval of the exception request.
(iii) The residence demonstrates to the Department’s satisfaction that the
residence has the staff, skills and expertise necessary to care for the resident’s needs related to the excludable condition.
(iv) The residence demonstrates to the Department’s satisfaction that any necessary supplemental health care provider has the staff, skills and
expertise necessary to care for the resident’s needs related to the excludable condition.
(v) The residence provides a written alternate care plan that ensures the
availability of staff with the skills and expertise necessary to care for the
resident’s needs related to the excludable condition in the event the supplemental health care provider is unavailable.
(5) The Department will render decisions on exception requests on a caseby-case basis and not provide for facility-wide exceptions.
(d) Certification providers. The following persons may certify that an individual with an excludable condition may not be admitted or retained in a residence:
(1) The administrator acting in consultation with supplemental health care
providers.
(2) The individual’s physician or certified registered nurse practitioner.
(3) The medical director of the residence.
(e) Departmental exceptions. A residence may admit, retain or serve an individual for whom a determination is made by the Department, upon the written
request of the residence, that the individual’s specific health care needs can be met by a provider of assisted living services or within a residence, including an
individual requiring:
(1) Gastric tubes, except that a determination will not be required if the individual is capable of self-care of the gastric tube or a licensed health care
professional or other qualified individual cares for the gastric tube.
(2) Tracheostomy, except that a determination will not be required if the individual is independently capable of self-care of the tracheostomy.
(3) Skilled nursing care 24 hours a day, except that a determination will not be required if the skilled nursing care is provided on a temporary or intermittent basis.
(4) A sliding scale insulin administration, except that a determination will not be required if the individual is capable of self-administration or a licensed
health care professional or other qualified individual administers the insulin.
(5) Intermittent intravenous therapy, except that a determination will not be required if a licensed health care professional manages the therapy.
(6) Insertions, sterile irrigation and replacement of a catheter, except that a
determination will not be required for routine maintenance of a urinary catheter, if the individual is capable of self-administration or a licensed health care
professional administers the catheter.
(7) Oxygen, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or
other qualified individual administers the oxygen.
(8) Inhalation therapy, except that a determination will not be required if
the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the therapy.
(9) Other types of supplemental health care services that the administrator,
acting in consultation with supplemental health care providers, determines can
be provided in a safe and effective manner by the residence.
(10) For purposes of paragraphs (1), (4), (7) and (8), a ‘‘qualified individual’’ means an individual who has been determined by a certification provider listed
under subsection (d) to be capable of care or administration under
paragraphs (1), (4), (7) and (8).
(f) Request for exception by resident. Nothing herein prevents an individual seeking admission to a residence or a resident from requesting that the residence
apply for an exception from the Department for a condition listed in this section for which an exception must be granted by the Department. The residence’s
determination on whether or not to seek such an exception shall be documented on a form supplied by the Department.
(g) Record. A written record of the exception request, the supporting documentation to justify the exception request and the determination related to the
exception request shall be kept in the records of the residence. The information
required by this subsection shall also be kept in the resident’s record.
(h) Decisions. The residence shall record the following decisions made on the basis of this section.
(1) Admission denials.
(2) Transfer or discharge decisions that are made on the basis of this section.