902 KAR 20:041 - Operation and services; family care homes
RELATES TO: KRS 209.030(1)- (3), 216.510-216.525, 216.532, 216B.010, 216B.015, 216B.030, 216B.105, 216B.990, 311.560(4), 314.011(8), 314.042(8), 320.210(2)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Cabinet for Health Services regulate health facilities and health services. This administrative regulation provides for the licensure requirements for the operation of family care homes.
Section 1. Definitions.
(1) "Ambulatory" means able to walk without
assistance.
(2) "Home" means a
family care home.
(3) "Impaired
capacity for self care" means mental or physical limitation which decreases the
ability to function in a normal adult manner and requires supervision,
assistance, or the use of prescription medicines to normalize daily
living.
(4) "Licensee" means the
operator of the family care home.
(5) "Mobile nonambulatory" means unable to
walk without assistance, but able to move from place to place, and self exit
the building, with the use of a device such as a walker, crutches, or
wheelchair and capable of independent bed-to-chair transfer.
(6) "Protective environment" means an
environment in which basic health care needs, personal care needs, nutritional
needs and safety are insured for the resident who is not capable of providing
these services in an effective manner.
(7) "Resident" means a person who is admitted
to a family care home for the purpose of receiving personal care and
assistance.
Section 2.
Scope of Operations and Services. A family care home shall provide twenty-four
(24) hour supervision and personal care services in residential accommodations
for a resident who because of impaired capacity for self care, elects to have
or requires a protective environment but does not have an illness, injury, or
disability for which constant medical care or skilled nursing services are
required. A resident shall be ambulatory or mobile nonambulatory and able to
manage most of the activities of daily living.
Section 3. Operation and Management.
(1) The licensee shall be legally responsible
for the operation of the home and for compliance with federal, state and local
laws and regulations pertaining to the operation of the home.
(2) The licensee shall be a mature literate
adult, at least eighteen (18) years of age, who has knowledge and understanding
of adults who require supervision and personal care services.
(3) The licensee shall be directly
responsible for the twenty-four (24) hour daily operation of the home and for
delegating that responsibility to another similarly qualified individual if a
temporary absence is necessary. The name of the individual to whom the
responsibility may be delegated shall be in writing and provided to the
representative of the Division of Licensing and Regulation inspecting the
home.
(4) An employee of the home
who contracts an infectious disease shall not appear for work until the
infectious disease can no longer be transmitted.
(5) The licensee shall attend at least one
(1) training program for family care home operators per year if offered or
approved by the Cabinet for Health Services.
(6) The home shall have no more than three
(3) residents who are not related to the operator within the third degree of
consanguinity.
(7) The licensee
shall provide opportunities for a resident to become involved in community
activities and activities within the home. A resident in cooperation with the
licensee and family shall be allowed to use areas of the home, other than his
bedroom, such as living rooms, kitchen, dining areas, and recreation areas for
entertainment, recreation, and visitation.
(8) The licensee shall maintain a record,
located on the premises and available for inspection which contains the
following information typed or in ink about each resident:
(a) Resident name and sex.
(b) Marital status.
(c) Birthdate and age.
(d) Religion and personal clergyman, if any,
with consent of resident.
(e)
Attending physician and dentist, if any; address and phone number for
each.
(f) Next of kin or
responsible person or agency, address and telephone number.
(g) Date of admission and
discharge.
(h) Other relevant
information including physician visits or assessment reports.
(i) Amount charged per week or month as
compensation for care.
(9) The licensee shall make arrangements with
other health agencies and facilities for residents who, at some time, may
require a transfer to a different level of care.
(10) The licensee shall have phone numbers of
a hospital, an ambulance service, fire department, and a physician for
emergencies posted by the telephone in large legible print if phone service is
available in the area.
(11) The
licensee shall have a written procedure for providing or obtaining emergency
services.
(12) The licensee shall:
(a) Make a written report of an accident
involving a resident, an incident involving a resident's health, welfare or
safety, and the death of a resident;
(b) Send the original, within seven (7) days
of the incident, to the Cabinet for Health Services, Office of the Inspector
General, Division for Licensing and Regulation, 275 East Main Street,
Frankfort, Kentucky 40621; and
(c)
Retain one (1) file copy.
(13) The licensee shall provide for patient
rights pursuant to
KRS
216.510 to
216.525.
(14) A resident shall be at least eighteen
(18) years of age.
(15)
(a) A representative of the Division for
Licensing and Regulation shall visit the home of the applicant for initial
licensure.
(b) A representative of
the Department for Social Services shall:
1.
Visit the home of the applicant upon notification by the Division of Licensing
and Regulation; and
2. Provide the
division information relating to its prelicensure assessment of the
applicant.
(16)
An initial license shall be denied and an existing license shall be revoked if
the applicant for licensure or the licensee has been convicted of a crime that
has a bearing upon the applicant's suitability to operate a family care home,
unless the applicant shows that:
(a) The
crime occurred more than five (5) years ago; and
(b) The applicant has been sufficiently
rehabilitated.
(17) An
initial license shall be denied and an existing license shall be revoked if the
applicant for licensure or the licensee:
(a)
Has failed to assure that nutrition, medication, or treatment of an individual
under his care is in accordance with acceptable professional
practice;
(b) Has aided, abetted,
sanctioned, condoned or participated in the commission of an illegal act
involving an individual under his care; or
(c) Has had a license to operate a facility
or service suspended or revoked during the three (3) years immediately
proceeding an application for licensure.
(18) The licensee shall comply with
KRS
216.532.
(19) The licensee shall report all cases of
abuse, neglect, or exploitation of an adult pursuant to
KRS
209.030(2) and
(3).
Section 4. Services.
(1) Basic health and health related services.
(a) A family care home shall, through
continuous supervision and monitoring, assure that a resident's health care
needs are met by:
1. Supervising
self-administration of medication;
2. Monitoring storage and control of
medication; and
3. Arranging for
necessary therapeutic or physician services.
(b) A licensee shall not knowingly admit a
person who has a communicable disease which is re-portable to the health
department, except a noninfectious tuberculosis patient under continuing
medical supervision for his tuberculosis disease.
(c) If a resident is suspected of having a
communicable disease that would endanger the health and welfare of another
resident, the licensee shall assure that a physician is contacted and that
medically appropriate measures are taken on behalf of that resident and the
other residents in the home.
(d)
The licensee shall show evidence that a resident has obtained a physical
examination by a physician within three (3) months prior to admission to the
home. If admitted from another health care facility, a discharge summary or
transfer form shall be in the resident's record which includes a medical
history, record of physical examination and diagnosis.
(e) The licensee shall obtain the services of
a physician in case of accident or acute illness of a resident.
(f) A prescription medication administered to
a resident shall be noted in writing, with the date, time and dosage, and
signed by the person administering the medication.
(g) Medication shall not be administered to a
resident except on the written order of a physician or other practitioner
acting within the limits of his statutory scope of practice. If medication
requires administration by a licensed person, an arrangement shall be made to
procure the services of a person licensed to administer medication.
(h) A medication kept in the home shall be
kept in a locked cabinet.
(i)
Self-administration of a prescription medication shall be allowed only upon the
written instruction of the attending physician or other practitioner acting
within the limits of his statutory scope of practice.
(j) A resident admitted or retained for care
shall not require because of illness, injury or disease, a degree of care
exceeding the skill of the operator to provide.
(2) Personal care services.
(a) A resident in a family care home shall be
assisted to achieve and maintain good personal hygiene by providing assistance
as required by individual needs with:
1.
Washing and bathing of the body to maintain clean skin and freedom from
offensive odors with the following items provided for each resident and not
used by others: soap, clean towels and wash cloths, brushes and combs and other
appropriate toilet articles.
2.
Shaving.
3. Cleaning of the mouth
and teeth to maintain good oral hygiene as well as care of the lips to prevent
dryness and cracking. A resident shall be provided with a toothbrush,
dentifrice, and denture container, if applicable.
4. Washing, grooming and cutting of
hair.
(b) The home shall
provide each resident with a bureau or cupboard for storage of personal
belongings.
(c) The home shall
provide each resident with a bed equipped with substantial springs, a clean
comfortable mattress, two (2) sheets, a pillow, and bed covering as required
for resident's health and comfort.
(d) A resident shall be allowed rest periods
in his own bed if he desires.
(3) Dietary services.
(a) Food shall be prepared with consideration
for individual dietary requirements and appetites.
(b) The menu shall be planned in writing and
rotated to avoid repetition. A written record shall be kept of foods served,
including food offered as snacks.
(c) Nutritional needs shall be met in
accordance with the current recommended dietary allowances of the Food and
Nutrition Board of the National Research Council and adjusted for age, sex, and
activity in accordance with physician's orders.
(d) Food returned from residents' dishes
shall be discarded at the conclusion of the meal and not served again in any
form.
(e) Therapeutic diets. A
special diet or dietary restriction shall be medically prescribed.
(f) At least three (3) meals per day shall be
served with not more than a fifteen (15) hour span between the evening meal and
breakfast. A snack shall be provided if desired or requested by a patient,
except if it conflicts with a special diet prescribed by a licensed
physician.
(g) Food shall be stored
above the floor so as to be protected from dust, flies, vermin, or other forms
of contamination.
(h) Each
refrigerator shall have a complete seal, be clean, free of odors, and kept at a
temperature below forty-five (45) degrees Fahrenheit. A thermometer shall be
placed in each refrigerator and freezer.
(i) Food showing evidence of spoilage or
infestation shall be disposed of immediately upon detection.
(4) Housekeeping and sanitation.
Each family care home shall:
(a) Maintain a
clean, uncluttered and safe facility with screens on doors and
windows;
(b) Eliminate odors at
their source by prompt and thorough cleaning of commodes, and other obvious
sources;
(c) Maintain the premises
so as to prevent infestation by rodents and insects;
(d) Change bed linens as often as necessary
to provide a clean bed at all times. A mattress pad or other protective
covering (excluding paper) shall be used on mattresses;
(e) Give soiled clothing and linens immediate
attention and not allow them to accumulate. Clothing or bedding used by one (1)
patient shall not be used by another until it has been laundered or dry
cleaned;
(f) Have appropriate
toilet facilities which dispose of wastes in a sanitary manner into a public
system where available, or if none is available, disposal shall be made into a
private system designed, constructed and operated in accordance with the
requirements of the cabinet; except if a public sewerage system subsequently
becomes available, connections shall be made to that system and any other
sewerage system shall be discontinued. An outside toilet shall be allowed if
local county health department approves; and
(g) Collect and dispose of all garbage,
refuse, trash, and litter in compliance with applicable state and local laws
and administrative regulations. A garbage container shall be made of metal or
other impervious material and shall be water tight and rodent proof and shall
have tight-fitting covers.
Section 5. Accommodations. Each family care
home shall:
(1) Be safe and of substantial
construction and comply with applicable state and local laws relating to
location, zoning, plumbing, and sanitation.
(2) Be adequately lighted by natural or
artificial light including each hall, stairway, entryway, patient area,
kitchen, and bathroom.
(3) Have a
water supply of a safe, sanitary quality approved by the local health
department or other qualified laboratory or agency.
(4) Have an ample supply of hot and cold
running water available at all times for general use. The water temperature at
a tap used by a resident shall not exceed 110 degrees Fahrenheit.
(5) Have appropriate sanitary toilet and
bathing facilities conveniently available for resident use with no less than
one (1) toilet and lavatory per six (6) persons residing in the home.
(6) Have adequate ventilation in areas used
by residents. A toilet room shall be vented to the outside, if there is no
window. There shall be an exterior window in each resident room, which can be
opened.
(7) A bed occupied by a
resident shall be placed so that the resident shall not experience discomfort
due to proximity to a radiator, heat outlet, or exposure to drafts.
(8) Not use "bunk" beds.
(9) Have beds that are no less than
thirty-three (33) inches wide and six (6) feet long.
(10) Not house a resident in a room or
detached building or other enclosure that has not been previously inspected and
approved for resident use, or in a basement not constructed for sleeping
quarters. An approved basement shall have an outside door.
(11) Not be located in a house trailer or
motor home.
(12) Provide a heating
system which can maintain an even temperature of at least seventy-two (72)
degrees Fahrenheit in resident occupied areas under winter conditions and a
maximum temperature of eighty-five (85) degrees under summer
conditions.
(13) Have telephone
service, if available in the area, accessible to the residents.
(14) If the home accepts a resident who uses
a wheelchair, insure that the resident is able to exit the building without
assistance (i.e., ramps, rails, etc.).
(15) Have a three (3) day supply of food on
hand at all times.
Section
6. Safety. Each home shall take appropriate precautions to insure
the safety of the residents and visitors by having:
(1) Exterior grounds including sidewalks,
steps, porches, ramps, and fences in good repair;
(2) The home's interior including walls,
ceilings, floors, floor coverings, steps, windows, window coverings, doors,
plumbing, and electrical fixtures in good repair;
(3) A fire control and evacuation
plan;
(4) An adequate number of
ABC-rated fire extinguishers located throughout the home with a minimum of one
(1) per floor or level of the residence;
(5) A person in charge thoroughly oriented in
the evacuation of the residents in the event of a fire;
(6) Firearms and ammunition locked in a
cabinet, drawer, or closet with the key not accessible to residents. Firearms
shall not be loaded; and
(7) At
least two (2) functioning smoke detectors in the home, one of which shall be in
each resident bedroom or in a hall adjacent to the resident bedroom.
Notes
STATUTORY AUTHORITY: KRS 209.030(1), 216B.010, 216B.042
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