2.4.1
General
Requirements for Licensing
A. No
person, acting alone or jointly with any other person, shall conduct or
maintain an assisted living residence in Rhode Island without a license in
accordance with the requirements of R.I. Gen. Laws §
23-17.4-4 and in
conformity with these Regulations.
1. All
assisted living residences are subject to and must meet the requirements of
§
2.4 of this Part to obtain and renew an assisted living residence
license.
2. Any assisted living
residence which offers to provide or provides services to residents with
Alzheimer disease or other dementia by means of an Alzheimer Dementia/Special
Care Unit/Program is also subject to the requirements of §
2.5 of this
Part to obtain and renew a license endorsement which authorized these
activities.
3. Any assisted living
residence which offers to provide or provides limited health services to
residents is also subject to the requirements of §
2.6 of this Part to
obtain and renew a license endorsement which authorized these
activities.
4. Any assisted living
residence that offers to provide or provides services for residents receiving
hospice services who are bed-bound or in need of assistance from more than one
staff person for ambulation is required to be licensed at the F1 level, as
defined in §
2.4.2(A)(1)(a) of this Part, and must have a license
endorsement, issued pursuant to these regulations, to provide limited health
services, and shall, at a minimum provide services for stage I and stage II
pressure ulcer treatment and prevention and meet the requirements of §
2.6 of this Part.
B. No
person, acting severally or jointly with any other person, shall admit or
retain a resident in an assisted living residence which residence:
1. Does not meet the definition and
requirements of the Act; or
2. Is
not able to provide the services needed by a resident as agreed to in the
service plan required under R.I. Gen. Laws §
23-17.4-15.6.
C. Each license shall specify the
licensed resident capacity of the residence. The occupancy of the residence
shall never exceed the licensed resident capacity.
1. The residence shall identify to the
Department the location of beds and shall maintain proper space and furnishings
for such locations.
2. The
residence may not house more assisted living residents than the licensed
capacity at any given time.
D. Proposed changes in bed capacity within a
residence shall be submitted to the Department in writing and shall be subject
to the approval of the Department.
E. No person and/or combination per area of
residence shall represent itself as an assisted living residence or use the
term residential care or any other similar term in its title, advertising,
publication or other form of communication, unless licensed as an assisted
living residence in accordance with the provisions herein.
2.4.2
Levels of Licensure
A. An assisted living residence shall only
admit and retain residents according to the level of licensure for which the
residence has been licensed. A residence may have areas which are licensed
separately.
1. Fire Code Classifications
a. Level F1 licensure: for residents who are
not capable of self-preservation. This level requires a more stringent Life
Safety Code, as defined in §
2.3(A)(25) of this Part; or
b. Level F2 licensure: for residents who are
capable of self-preservation.
2. Medication Classifications
a. Level M1 licensure: for one (1) or more
residents who require central storage and/or administration of medications;
or
b. Level M2 licensure: for
residents who require assistance (as elaborated in §
2.4.25(A)(3)(a) of
this Part) with self-administration of medications;
3. Dementia Care This category of licensure
shall be required when one (1) or more resident's dementia symptoms impact
their ability to function as demonstrated by any of the following:
a. Safety concerns due to elopement risk or
other behaviors;
b. Inappropriate
social behaviors that adversely impact the rights of others;
c. Inability to self-preserve due to
dementia;
d. A physician's
recommendation that the resident needs dementia support consistent with this
level; or if the residence advertises or represents special dementia services
or if the residence segregates residents with dementia. In addition to the
requirements for the basic license, licensing requirements for the "dementia
care" level shall include the following:
(1)
Staff training and/or requirements specific to dementia care as determined by
the Department;
(2) A registered
nurse on staff and available for consultation at all times;
(3) The residence shall provide for a secure
environment appropriate for the resident population.
e. A residence licensed at the "dementia
care" level shall:
(1) Be licensed as an "F1 -
M1" residence in accordance with the requirements of §§
2.4.2(A)(1)(a) and (2)(a) of this Part; and
(2) Meet the requirements of §§
2.4 and
2.5 of this Part.
4. Limited Health Care Services
a. This category of licensure shall be
required for any assisted living residence that provides or offers to provide
services in a manner as defined in §
2.3(A)(26) of this Part.
2.4.3
Quality Assurance
A. In
accordance with R.I. Gen. Laws §
23-17.4-10.1, each assisted living
residence shall develop, implement and maintain a documented, ongoing quality
assurance program.
1. The purpose of this
program shall be to attain and maintain a high quality assisted living
residence through an on-going process of quality improvement that monitors
quality, identifies areas to improve, methods to improve them, and evaluates
the progress achieved.
2. Each
licensed residence shall establish a quality improvement committee which shall
include at least the following: assisted living administrator, registered nurse
and a representative of dietary services.
3. The quality improvement committee shall
meet at least quarterly; shall maintain records of all quality improvement
activities; and shall keep records of committee meetings that shall be
available to the Department during any on-site visit.
4. The quality improvement committee shall
review and approve the quality improvement plan for the residence at intervals
not to exceed twelve (12) months. Said plan shall be available to the public
upon request.
5. Each assisted
living residence shall establish a written quality improvement plan that
includes:
a. Program objectives;
b. Oversight responsibility (e.g., reports to
the governing body, QI records);
c.
Includes methods to identify, evaluate, and correct identified
problems;
d. Provides criteria to
monitor personal assistance and resident services, including, but not limited
to:
(1) Resident/family
satisfaction;
(2) Medication
administration/errors;
(3)
Reportable incidents as specified in §
2.4.17 of this Part;
(4) Resident falls;
(5) Plans of correction developed in response
to the Department's inspection reports.
B. In addition to the requirements
of §§
2.4.3(A)(1) through (5) of this Part, all assisted living
residences with a "dementia care" license and/or a "limited health services
license" shall also address the following areas in their quality improvement
plan:
1. Prevention and treatment of decubitus
ulcers;
2. Dehydration, and
nutritional status and weight loss or gain; and
3. Changes in mental or psychological
status.
4. Quality improvement
documentation shall be kept on file for a minimum of five (5) years.
2.4.4
Informal
Dispute Resolution Process
A. In
accordance with R.I. Gen. Laws §
23-17.4-10.3, the licensee or its
designee has the right to an informal dispute resolution process to dispute any
violation found or enforcement remedy imposed by the licensing agency during an
inspection or complaint investigation. The purpose of the informal dispute
resolution process is to provide an opportunity for an exchange of information
that may lead to the modification, deletion, or removal of a violation, or
parts of a violation, or enforcement remedy imposed by the licensing
agency.
B. A request for an
informal dispute resolution shall be made to the licensing agency within ten
(10) business days from the receipt of a written finding of a violation or
enforcement remedy. The request shall identify the violation or violations and
enforcement remedy or remedies being disputed.
C. The licensing agency shall convene a
meeting with the licensee within ten (10) business days of receipt of the
request for informal dispute resolution, unless by mutual agreement a later
date is agreed upon.
D. The
licensee shall submit to the licensing agency, within fifteen (15) days, a plan
of correction to address any undisputed violations, and including any
violations that still remain following the informal dispute
resolution.
2.4.5
Financial Interest Disclosure
A.
Any licensed assisted living residence that refers residents to any health care
facility licensed pursuant to R.I. Gen. Laws Chapter 23-17, or to another
assisted living residence licensed pursuant to the Act, or to a licensed adult
day care program in which the referring entity has a financial interest shall,
at the time a referral is made, disclose the following information to the
resident:
1. That the referring entity has a
financial interest in the residence or provider to which the referral is being
made; and
2. That the resident has
the option of seeking care from a different residence or provider which is also
licensed and/or certified by the State of Rhode Island to provide similar
services to the resident.
B. The referring entity shall also offer the
resident a written list prepared by the Department of all such alternative
licensed and/or certified facilities or providers. Said written list may be
obtained by contacting the Department as specified in §
2.4.6 of this
Part.
C. Non-compliance with
§§
2.4.4(A) and (B) of this Part shall constitute grounds to revoke,
suspend or otherwise discipline the licensee or to deny an application for
licensure by the Director, or may result in imposition of an administrative
penalty in accordance with R.I. Gen. Laws Chapter 23-17.10.
2.4.6
Safe Resident
Handling
A. Each licensed assisted
living residence with an "Alzheimer's Dementia Special Care Unit or Program"
license and/or offers to provide or provides coordination of hospice services
for residents who are bed-bound or in need of assistance from more than one (1)
staff person for ambulation shall comply with the provisions of §§
2.4.5(B) through (E) of this Part as a condition of licensure.
1. A currently licensed assisted living
residence who applies for a new level of licensure must meet the requirements
of §§
2.4.6(B) through (E) of this Part prior to a new license level
being approved.
B. Each
licensed assisted living residence must maintain a safe resident handling
committee, which shall be chaired by a professional nurse or other appropriate
licensed health care professional. An assisted living residence may utilize any
appropriately configured committee to perform the responsibilities of this
section. At least half of the members of the committee shall be hourly,
non-managerial employees who provide direct resident care.
C. Each licensed assisted living residence
must have a written safe resident handling program, with input from the safe
handling committee, to prevent musculoskeletal disorders among health care
workers and injuries to residents. As part of this program, each licensed
assisted living residence shall:
1. Implement
a safe resident handling policy for all shifts and units of the residence that
will achieve the maximum reasonable reduction of manual lifting, transferring,
and repositioning of all or most of a resident's weight, except in emergency,
life-threatening, or otherwise exceptional circumstances;
2. Conduct a resident handling hazard
assessment. This assessment should consider such variables as handling-handling
tasks, types of units, resident populations, and the physical environment of
resident care areas;
3. Develop a
process to identify the appropriate use of the safe resident handling policy
based on the resident's physical and mental condition, the resident's choice,
and the availability of lifting equipment or lift teams. The policy shall
include a means to address circumstances under which it would be medically
contraindicated to use lifting or transfer aids or assistive devices for
particular residents;
4. Designate
and train a registered nurse or other appropriate licensed health care
professional to serve as an expert resource, and train all direct care staff on
safe resident handling policies, equipment, and devices before implementation,
and at intervals not to exceed twelve (12) months, or as changes are made to
the safe handling policies, equipment and/or devices being used; and
5. Conduct a performance evaluation of the
safe resident handling policy at intervals not to exceed twelve (12) months,
with the results of the evaluation reported to the safe resident handling
committee or other appropriately designated committee. The evaluation shall
determine the extent to which implementation of the program has resulted in a
reduction in musculoskeletal disorder claims and days of lost work attributable
to musculo-skeletal disorder caused by resident handling, and include
recommendations to increase the program's effectiveness.
D. Nothing in §
2.4.5(A) of this Part
precludes lift team members from performing other duties as assigned during
their shift.
E. An employee may, in
accordance with established residence protocols, report to the committee, as
soon as possible, after being required to perform a resident handling activity
that he/she believes in good faith exposed the resident and/or employee to an
unacceptable risk of injury. Such employee reporting shall not be cause for
discipline or be subject to other adverse consequences by his/her employer.
These reportable incidents shall be included in the residence's annual
performance evaluation.
2.4.7
Communications
A. All communications and reports required to
be submitted to the Department pursuant to these Regulations shall be sent to:
Rhode Island Department of Health, Center for Health
Facilities Regulation
3 Capitol Hill, Room 306
Providence, RI 02908 401.222.2566 (phone)
401.222.3999 (FAX) or 401.222.5901 (FAX)
doh.ofr@health.ri.gov
B. The information in §
2.4.6(A) of this
Part shall be displayed in a conspicuous public area of the residence and shall
be identified as the Department point of contact for complaints concerning
potential violations of the Act or these Regulations.
C. Each assisted living residence shall
establish and maintain a facility specific electronic mail address (i.e.,
e-mail address) to be provided to the Department for the purposes of contacting
a high managerial agent for the residence with both routine communications and
emergency notices. The residence shall be responsible for providing notice to
the Department at any time that the residence's specific electronic mail
address is changed or updated.
D.
In the event or in the preparation of an onsite, local area, or statewide
emergency or natural disaster, the assisted living residence must respond to
requests for information and/or status reports as requested by the Department
and/or designated situation/incident commander.
2.4.8
Application for License
A. Application for a license to conduct,
maintain or operate an assisted living residence shall be made to the
Department upon forms provided by the Department and shall contain such
information as the Department reasonably requires which may include affirmative
evidence of ability to comply with the provisions of the Act, these Regulations
and compliance with Federal, State, and local laws and Rules and Regulations
pertaining to, but not limited to: the management and operation of assisted
living residences, fire, safety, zoning, building codes, sanitation, food
service, communicable and reportable diseases, and other relevant health and
safety requirements. The licensing application shall include evidence from the
applicant that criminal background checks on owners and operators of licensed
assisted living residences have been completed.
1. Each application shall be accompanied by a
non-refundable application fee per license plus an additional fee per licensed
bed, as set forth in Part 10-05-2 of this Title, Fee Structure for Licensing,
Laboratory and Administrative Services Provided by the Department of
Health.
2. Each application for a
license endorsement to provide an Alzheimer Dementia/Special Care Unit/Program
or limited health services shall be accompanied by a non-refundable application
fee, per license endorsement, as set forth in Part 10-05-2 of this Title, Fee
Structure for Licensing, Laboratory and Administrative Services Provided by the
Department of Health.
B.
A notarized listing of the names and addresses of direct and indirect owners
whether individual, partnership, or corporation, with percentages of ownership
designated, shall be provided with the application for licensure and shall be
updated at intervals not to exceed twelve (12) months. If a corporation, the
list shall include all officers, directors and other persons or any subsidiary
corporation owning stock.
2.4.9
Issuance and Renewal of
License
A. Upon receipt of an
application for a license, the Department shall issue a license if the
applicant meets the requirements of the Act and these Regulations. The license
issued, unless sooner suspended or revoked, shall expire by limitation on the
31st day of December following its issuance and may be renewed from year to
year subject to inspection and approval by the Department.
1. All renewal applications shall be
accompanied by a non-refundable application fee per license plus an additional
fee per licensed bed, as set forth in Part 10-05-2 of this Title, Fee Structure
for Licensing, Laboratory and Administrative Services Provided by the
Department of Health.
2. A renewal
application for a license endorsement to provide an Alzheimer Dementia/Special
Care Unit/Program or limited health services shall be accompanied by a
non-refundable application fee, per license endorsement, as set forth in Part
10-05-2 of this Title, Fee Structure for Licensing, Laboratory and
Administrative Services Provided by the Department of Health.
B. Each license shall be issued
only for the premises and persons named in the application, and shall not be
transferable or assignable except with the written approval of the
Department.
C. The license will
specify names of the owner and operator, the level of licensure or combination
of services that the residence may provide, and the area where service can be
provided (i.e., residents requiring assistance with selfpreservation, and/or
medication may only be admitted to facilities [or areas] with appropriate
licensing level).
D. A license
issued pursuant to these Regulations shall be the property of the State of
Rhode Island and loaned to such licensee and it shall be kept posted in a
conspicuous place on the premises.
E. In cases where a building has a mixed
population of independent and assisted living residents, the location of the
units on the assisted living license shall be documented in a roster available
at all times and certified by the administrator, or his/her designee, and kept
current on a daily basis.
2.4.10
Inspections
A. The Department shall make or cause to be
made such inspections and investigations as it deems necessary by duly
authorized agents of the Director at such time and frequencies as determined by
the Department.
B. A duly
authorized representative of the Department shall have the right to enter at
any time without prior notice, to inspect the premises and services for which
an application has been received, or for which a license has been issued.
1. Refusal to permit inspection or
investigation shall constitute a valid ground for suspension or revocation of
license or curtailment of activities.
C. Every residence shall be given notice by
the Department of all deficiencies reported as a result of an inspection or
investigation.
2.4.11
Change of Ownership, Operation and/or Location
A. When a change of ownership or operation or
location of an assisted living residence or when discontinuation of services is
contemplated, the Department shall be given written notice of pending
changes.
B. A license shall
immediately expire and become void and shall be returned to the Department when
operation of an assisted living residence is discontinued or when any changes
in ownership occur.
1. Prior to operating
under a new owner or operator, the prospective licensee shall apply for a new
license in accordance with §
2.4.7 of this Part, "Application for
License." Upon receipt of a complete application and if there are no changes in
existing operations of the residence, including:
a. Resident capacity,
b. Level of licensure,
c. Modifications or construction of the
physical plant,
2. The
Department may, following a review of the complete application, issue a license
to the prospective licensee without first inspecting the premises.
3. When there is a change in ownership or in
the operation or control of the residence, and provided a complete application
is submitted in accordance with §
2.4.10(B)(1) of this Part, the
Department reserves the right to extend the expiration date of the existing
license, allowing the residence to operate under the same license which applied
to the prior licensee for such time as shall be required for the processing of
a new application or reassignment of residents, not to exceed six (6)
weeks.
C. When a change
of certified administrator is contemplated, the Department shall be given
written notice prior to the change and at the time of the actual
change.
D. The Department shall be
notified immediately when a licensee/owner determines to cease operations and
close an assisted living residence. A meeting shall be conducted with the
Department and prior to notice or notification to residents and the public to
ensure there is a formal and comprehensive plan for an orderly closure, sixty
(60) days or more notice to residents, their guardian, or relative so appointed
or elected to be his/her decision maker, and the safe, orderly discharge and
transfer of residents.
1. The assisted living
residence closure plan shall include, but is not limited to the following:
a. Letter of intent and/or determining
factors/justification for the closure (i.e., voluntary, financial), to include:
(1) Proposed closure date;
(2) Contact information for staff member
responsible for implementing the closure plan;
(3) Projected fiscal management plan covering
operations during the closure period.
b. Staffing plan(s)
(1) By unit/program/location;
(2) Time line for individual closures of any
unit/program/service location;
(3)
Staff scale-down process as appropriate given planned transition/reduction of
patients/residents.
c.
Plans for providing notification and estimated implementation of notices
(1) Any required notice to third (3rd) party
payers (i.e., Medicaid, long-term care insurance);
(2) Notice to Accreditation entities - if
appropriate;
(3) Notice to
staff/union - meeting date(s);
(4)
Public notice;
(5) Community/public
meetings - if appropriate and/or planned.
d. Storage/access to medical records
(1) Location for self-storage, or
(2) Company/agency providing contract storage
services.
2.4.12
Denial, Suspension, Revocation
of License or Curtailment of Activities
A. The Department is authorized to deny,
suspend or revoke the license or curtail activities of any assisted living
residence which:
1. Has failed to comply with
these Regulations;
2. Has offered
or provided service to residents outside of the scope of its appropriate level
of license;
3. Has failed to
correct deficiencies or complete corrective action plan; or
4. Has failed to comply with the provisions
of the Act.
B. Reports
of deficiencies shall be maintained on file in the Department and shall be
considered by the Department in rendering determinations to deny, suspend or
revoke the license or to curtail activities of the assisted living
residence.
C. Whenever an action
shall be proposed to deny, suspend or revoke an assisted living residence
license, or curtail its activities, the Department shall notify the residence
by certified or registered mail or by personal service setting forth reasons
for the proposed action, and the applicant or licensee shall be given an
opportunity for a prompt and fair hearing in accordance with R.I. Gen. Laws
§§
23-17.4-8 and
42-35-9, and the provisions of §
2.4.36 of this
Part.
1. However, if the Department finds that
the safety and welfare of residents requires emergency action and incorporates
a finding to that effect in its order, the Department may order summary
suspension of license or curtailment of activities pending proceedings for
revocation or other action in accordance with R.I. Gen. Laws §
§
42-35-14(c) and 23-1-21.
D. The appropriate state and federal agencies
shall be notified of any action taken by the Department pertaining to either
denial, suspension, or revocation of license, or curtailment of
activities.
2.4.13
Administrative Management
A. All
licensees shall provide staffing which is sufficient to provide the necessary
care and services to attain or maintain the highest practicable physical,
mental and psychosocial well-being of the residents, according to the
appropriate level of licensing. At least one (1) staff person who has completed
employee training as outlined in §
2.4.12(G) of this Part shall be on the
premises at all times.
B. Each
licensee shall have responsible adult(s) who are employee(s) or who have a
contractual relationship with the residence to provide the services required by
these Regulations who is at least eighteen (18) years of age and
1. Awake and on the premises at all
times,
2. Designated in charge of
the operation of the residence; and
3. Physically and mentally capable of
communication with emergency personnel.
C. Pursuant to R.I. Gen. Laws §§
23-17.4-15.1.1 and
23-17.4-15.2, each assisted living residence shall have an
administrator who is licensed by the Department in accordance with Regulations
established pursuant to R.I. Gen. Laws §
23-17.4-21.1, in charge of the
maintenance and operation of the residence and the services to the residents.
The name and contact information for the current administrator shall be
displayed in a conspicuous public area of the residence. The administrator is
responsible for the safe and proper operation of the residence at all times by
competent and appropriate employee(s) and shall be responsible for no less than
the following:
1. The management and operation
of the residence and services to the residents;
2. Compliance with federal, state, and local
laws and Rules and Regulations pertaining to, but not limited to: the
management and operation of assisted living residences, fire, safety, zoning,
building codes, sanitation, food service, communicable and reportable diseases,
Americans with Disabilities Act, employee health and safety, other relevant
health and safety requirements, and these Regulations.
3. Staffing the residence with adequate and
qualified personnel to attend to the food preparation, general housekeeping,
assistance with personal care, medication administration, if applicable, and
other such services;
4.
Establishment of written policies and procedures governing the operation of the
residence which are aimed, to the extent possible, at maintaining the
independence of residents. Such policies shall include provisions to implement
no less than the following:
a. The appropriate
provisions of §
2.4.18 of this Part and other applicable provisions
pertaining to admission, transfer, discharge, visitation privileges,
availability and utilization of community resources, leisure time and such
other;
b. Accountability of the
residence when acting as a fiduciary agent for the resident pursuant to §
2.4.18 of this Part;
c.
Notification of next of kin or other responsible person designated by the
resident in the event of illness, accident or death; and
d. Such other provisions as may be deemed
appropriate.
5.
Compliance with all requirements appropriate to the service level for which the
residence is licensed.
D. Cardiopulmonary Resuscitation
1. At all times, one (1) person on-site shall
have successfully completed instruction by the American Heart Association, the
American Red Cross, or the National Safety Council at the minimal
("Heartsaver") level to perform cardiopulmonary resuscitation.
E. A licensed administrator shall
be in charge of no more than three (3) residences with an aggregate resident
total of no more than one hundred twenty (120) residents.
F. The licensed administrator shall not leave
the premises without delegating necessary authority for operation of the
residence to a competent employee(s).
G. Employee Training
1. The administrator shall ensure that all
new employees shall receive at least two (2) hours of orientation and training
within ten (10) days of hire and prior to beginning work alone in the assisted
living residence, in addition to any training that may be required for a
specific job classification at the residence. Such areas include:
a. Fire prevention;
b. Recognition and reporting of abuse,
neglect, and mistreatment;
c.
Assisted living philosophy (goals/values: dignity, independence, autonomy,
choice);
d. Resident's
rights;
e.
Confidentiality;
f. Emergency
preparedness and procedures;
g.
Medical emergency procedures;
h.
Infection control policies and procedures; and
i. Resident elopement.
2. The administrator shall ensure that all
new employees who will have regular contact with residents and provide
residents with personal care shall receive at least ten (10) hours of
orientation and training within thirty (30) days of hire and prior to beginning
work alone in the assisted living residence, in addition to the areas
stipulated in §
2.4.12(G) of this Part. Such areas include:
a. Basic sanitation;
b. Food service;
c. Basic knowledge of cultural
differences;
d. Basic knowledge of
aging-related behaviors including dementia and Alzheimer's disease;
e. Personal assistance;
f. Assistance with medications;
g. Safety of residents;
h. Body Mechanics;
i. Resident Transfers (required for
residences licensed at the F1 level for fire safety);
j. Record-keeping;
k. Service plans; and
l. Internal reporting.
H. In-service Training
1. Employees shall have on-going, at
intervals not to exceed twelve (12) months, in-service training as appropriate
for their job classifications and including the topics cited in §
2.4.12(G) of this Part.
2. All new
employee orientation and on-going in-service training shall be documented in
the employee's personnel file, and maintained onsite at the licensed
residence.
I. Personnel
Records
1. The residence shall maintain
comprehensive personnel records for each employee. Personnel records shall be
maintained onsite of the licensed residence and/or electronically available at
all times.
2. Said personnel
records shall be reviewed and updated at intervals not to exceed twelve (12)
months and shall include, but not be limited to, all of the following
components:
a. Completed job application
and/or resume;
b. Written
statements of references or documentation of verbal reference check;
c. Written functional job descriptions;
(1) These descriptions shall be updated at
intervals not to exceed twelve (12) months and shall include, but not be
limited to, minimal qualifications for the position, major duties and
responsibilities, and shall be signed and dated by the individual
employee.
d. Evidence of
credentials, current professional licensure and/or certification;
e. Documentation of education and/or
continuing training, including continuing education units (CEUs) related to
administrator certification, food management, etc., medication administration,
and dementia care;
f. Documentation
of attendance at in-service training and/or orientation;
g. Documentation of at least one (1)
performance evaluation at intervals not to exceed twelve (12) months;
h. Signed copy of employee's awareness of
resident's rights;
i. Results of
the criminal record (BCI) check.
J. Personnel Criminal Records Check
1. Pursuant to R.I. Gen. Laws §
23-17.4-27, all employees of assisted living residences licensed under the Act,
hired after September 30, 2014, and having routine contact with a resident or
having access to a resident's belongings or funds shall undergo a national
criminal background records check which shall include fingerprints submitted to
the Federal Bureau of Investigation (FBI) by the Bureau of Criminal
Identification of the Department of Attorney General. The national criminal
records check shall be processed, prior to, or within one (1) week of
employment.
2. Said employee,
through the employer, shall apply to the Bureau of Criminal Identification of
the Department of Attorney General for a national criminal records
check.
3. In those situations in
which no disqualifying information has been found, the Bureau of Criminal
Identification of the Department of Attorney General shall inform the applicant
and the employer in writing of this fact.
4. Upon the discovery of any disqualifying
information, as defined in R.I. Gen. Laws §
23-17.4-30 and in these
Regulations, the Bureau of Criminal Identification of the Department of
Attorney General will inform the applicant in writing of the nature of the
disqualifying information; and, without disclosing the nature of the
disqualifying information, will notify the employer in writing that
disqualifying information has been discovered.
5. The employer shall maintain on file,
subject to inspection by the Department, evidence that the statewide criminal
records checks have been initiated on all employees seeking employment between
October 1, 1991 and September 30, 2014, and the results of those
checks.
6. The employer shall
maintain on file, subject to inspection by the Department, evidence that
national criminal records checks have been initiated on all employees seeking
employment on or after October 1, 2014, and the results of those
checks.
7. Failure to maintain this
evidence shall be grounds to revoke the license or registration of the
employer.
8. An employee against
whom disqualifying information has been found may provide a copy of the
national criminal records check to the employer. The administrator shall make a
judgment regarding the continued employment of the employee.
9. Due to the fact that juvenile proceedings
before the Rhode Island Family Court are exempt from disclosure, the
requirement for a statewide criminal records check shall be waived for
residence employees under the age of eighteen (18). Provided, however, the
residence must perform a reference check for employees under age eighteen (18).
Once the employee turns eighteen (18) years old, the required criminal records
check must be completed within seven (7) days of his or her eighteenth (18th)
birthday.
2.4.14
Management of Services
A. Each residence shall provide services with
adequate professional and ancillary employees and in accordance with applicable
state law. Further, the residence shall assure that all services are rendered
in a safe and effective manner and consistent with the requirements herein. The
residence shall provide all care and services to all residents in accordance
with the prevailing community standard of care.
B. The residence shall have a policy and
procedure manual that is reviewed and updated by the administrator at intervals
not to exceed twelve (12) months, and shall include, but not be limited to, the
following items:
1. A written description of
all services available to residents that shall be designed to promote the
resident's efforts to maintain independence;
2. A written statement of admission criteria
that shall include, at a minimum, the following information regarding the
resident population:
a. Nature and extent of
disabling condition(s) served; and
b. Restrictions (if any).
(1) The statement of admission criteria shall
include a statement that no otherwise qualified applicant shall be denied
admission to the residence solely on the basis of age, sex, gender identity or
expression, race, creed, color, religion, sexual orientation, marital status,
familial status, disability, source of income, source of payment or profession,
or national origin.
C. The residence shall develop and maintain
written admission procedures that shall include no less than the following
components:
1. Procedures for informing
residents of house rules (e.g., necessary information, tour of
residence);
2. A resident
assessment process;
3. Provision of
information to each resident related to:
a.
Results of initial assessment;
b.
Procedures for involuntary transfer within the residence;
c. Procedures for involuntary
discharge;
d. Procedures for
advanced directives;
e. Grievance
procedures;
f. Availability of
nursing services, if any.
4. Policies and procedures on
elopement;
5. Procedures to be
followed, including those for referral (in those cases where an applicant is
found to be ineligible for admission);
D. Prior to admission, the resident and/or
legal guardian shall be informed of any charges for services rendered,
including charges for special diets, if any.
E. The residence shall develop, maintain, and
enforce written policies and procedures for employee documentation of personal
care services/activities of daily living (ADLs) rendered to
residents.
F. The residence shall
maintain a written policy and procedures for assisting a resident in locating
and/or obtaining needed services, as appropriate.
G. The residence shall maintain a written
policy regarding reportable incidents and events in accordance with §
2.4.17 of this Part.
H. The
residence shall develop and maintain a statement of discharge criteria that
specifies the conditions under which a resident is considered to be ineligible
for continued residency and conditions under which a resident's advanced rental
fees are refunded.
I. Policies and
procedures pertaining to the provision of services, and supported by
appropriate manuals or reference materials where applicable, shall be
established by a designated professional employee or administrator and approved
by the licensee. Such policies shall pertain to no less than the following:
1. Residence staffing patterns;
2. Employee responsibility(ies) for the
provision of services;
3. A
statement that services rendered shall be performed in accordance with all
applicable laws and Regulations for each service provided;
4. A description of services that are
included in the monthly charge(s) and the additional cost(s), if any, for other
available services or amenities;
5.
Policies/procedures regarding medication management and/or assistance with
medication(s);
6. A policy that
medical waste, as defined in the Department of Environmental Management's
Medical Waste Regulations (
250-RICR-140-15-1 ) shall be managed in accordance
with the provisions of the aforementioned Regulations;
7. A policy regarding compliance with food
service and Part 50-10-1 of this Title, Rhode Island Food Code,
requirements;
8. Disclosure of
resident information in accordance with the requirements of R.I. Gen. Laws
§
23-3-26;
9. The procedure(s)
for resolution of resident grievances, including the inclusion of the name,
address, and telephone number of all pertinent resident advocacy groups, the
State Ombudsman, and the Department.
10. Quality assurance program.
J. Smoking Policy
1. If the residence permits smoking, it shall
have a policy that includes the following:
a.
Location of designated smoking area(s) separate from the common area;
b. Prohibition of smoking in any area other
than the designated area(s);
c.
Adequate ventilation in smoking areas;
d. Assessment (upon admission, quarterly, and
when a significant change in function occurs) of all residents that smoke to
ensure safe smoking capabilities.
K. Advance Directives
1. The residence shall have written policies
and procedures that address advanced directives that shall include, but not be
limited to, sufficient instructions for employees to follow in the event of
emergencies and the resuscitation of residents.
L. Medical Orders for Life Sustaining
Treatment (MOLST)
1. The residence shall have
written policies/procedures to accept, update if appropriate, and offer each
qualified patient the opportunity to complete a MOLST in accordance with Part
20-15-4 of this Title, Medical Orders for Life Sustaining Treatment.
2.4.15
Residency
Requirements
A. Each licensee, or
his/her designee, through the assessment and evaluation procedures delineated
in these Regulations (see §
2.4.16(C) of this Part) shall be responsible
to ensure that admission to and residency in an assisted living residence be
limited to those individuals who meet the definition of "resident" in
accordance with §
2.3(A)(34) of this Part.
B. Disclosure
1. Each assisted living residence shall
disclose certain information about the residence to each potential resident,
the resident's interested family, and the resident's agent as early as
practical in the decision-making process and at least prior to the admission
decision being made. The disclosed information shall be in print format and
shall include at a minimum:
a. Identification
of the residence and its owner and operator;
b. Level of license and an explanation of
each level of licensure;
c.
Admission and discharge criteria;
d. Services available;
e. Financial terms to include all fees and
deposits, including any first (1st) month rental arrangements, and the
residence's policy regarding notification to tenants of increases in fees,
rates, services and deposits;
f.
Terms of the residency agreement, including the process used in the event that
a resident can no longer afford the cost of care being provided.
g. The names, addresses, and telephone
numbers of: the Department; the Medicaid Fraud and Patient Abuse Unit of the
Department of Attorney General; the State ombudsperson, and local police
offices.
C.
Residency Agreement or Contract
1. Pursuant to
R.I. Gen. Laws §
23-17.4-16, prior to exchange of any funds and prior to
admission, the residence shall execute a residency agreement or contract,
signed by both the residence and the resident, that defines the services the
residence will provide and the financial agreements between the residence and
the resident or the resident's representative.
a. Any advanced deposit, application fee, or
other pre-admission payment shall be subject to a signed document explaining
fully the terms of the payment.
b.
In cases of emergency placement, the residency agreement or contract shall be
executed within five (5) working days of admissions.
2. The residency agreement or contract shall
include (or reference other documents that include) no less than the following
items:
a. Resident's rights;
b. Admission criteria;
c. Discharge criteria;
d. Discharge policies;
e. Description of the unit to be rented by
the resident;
f. Description of
shared space and facilities;
g.
Services to be provided;
h.
Services that can be arranged;
i.
Financial terms between resident and residence;
(1) Basic rates;
(2) Extra charges at signing;
(3) Extra charges that may apply in the
future;
(4) Deposits and advanced
fees;
(5) Rate increase
policy.
j. Special care
provisions (as applicable);
k.
Resident's responsibilities and house rules;
l. Initial and on-going assessment and
service plan;
m. Grievance
procedure.
D.
The minimum prior notification time for changes in rates, fees, service
charges, or any other payments required by the residence shall be thirty (30)
days written notice to the resident.
2.4.16
Resident Records
A. Each residence shall, at a minimum,
maintain the following information for each resident:
1. The resident's name;
2. The resident's last address;
3. The name of the person or agency referring
the resident to the home;
4. The
name, specialty (if any), telephone number, and emergency telephone number of
each physician who is currently treating the resident;
5. The date the resident began residing in
the home;
6. A list of medications
taken by the resident, including dosage, and specific records of medication
administration as required by the Department;
a. In residences licensed at the M2 level, if
a resident refuses to provide the information cited in §
2.4.15(A)(6) of
this Part, this fact shall be documented in the resident's service
agreement.
7. Written
acknowledgments that the resident has signed and received copies of the rights
as provided in R.I. Gen. Laws §
23-17.4-16;
8. Information about any specific health
problems of the resident, which may be useful in a medical emergency, including
diagnostic and/or therapeutic orders;
9. A record of personal property and funds
which the resident has entrusted to the residence;
10. The name, address, and telephone number
of a person identified by the resident who should be contacted in the event of
an emergency or death of the resident and the name, address, and telephone
number of the legal guardian;
11.
Any other health-related emergency, or pertinent information which the resident
requests the residence to keep on record;
12. A copy of the initial and periodic
assessments described in §
2.4.16 of this Part;
13. A copy of the service plan and nurse
review as described in §
2.4.16 of this Part;
14. A copy of the residency agreement as
described in §
2.4.14(C) of this Part.
B. Entries in the resident's record relating
to treatment, medication and diagnostic tests shall be made by the responsible
persons at the time of administration and/or service. Only physicians shall
enter or authenticate medical opinions or judgment.
1. Detailed descriptions of all pressure
ulcers, or other skin lesions, shall be recorded in the resident's
record.
C. At time of
discharge, a discharge summary, summarizing the resident's stay, shall be
completed promptly and signed by the residence's administrator or registered
nurse.
D. Resident records of
discharged residents shall be completed within a reasonable period of time (not
to exceed sixty (60) days) with all clinical information pertaining to the
resident's stay made part of the resident's record.
E. Confidentiality of resident records shall
be governed by the provisions of R.I. Gen. Laws Chapter 5-37.3 and the
following;
1. Only authorized personnel shall
have access to the records.
2. The
residence shall release resident's medical information only with the written
consent of the resident, parent, guardian or legal representative in accordance
with R.I. Gen. Laws Chapter 5-37.3.
F. Such information shall be contained in
record formats appropriate to the efficient and effective delivery of resident
services and accessible for review upon request by the licensure agency or
other appropriate health oversight agency.
G. The licensee shall retain resident records
for seven (7) years from the date of discharge in accordance with the
provisions of R.I. Gen. Laws §
23-3-26.
H. Statement of Resident's Rights
1. In accordance with R.I. Gen. Laws §
23-17.4-16.1, each resident and/or legal guardian shall be given a written
statement of the resident's rights and responsibilities in the residence that
shall be signed by the resident and/or guardian attesting to his/her
comprehension of these rights and responsibilities as explained by the employee
who shall witness the resident's signature. A copy of the signed document shall
also be placed in the resident's record.
2.4.17
Resident Assessments and Service
Plans
A. Prior to the admission of a
resident, or the signing of a residency agreement with a resident, the
administrator shall have a comprehensive assessment of the resident's health,
physical, social, functional, activity, and cognitive needs and preferences
conducted and signed by a registered nurse.
B. This assessment shall be used to determine
if the resident's needs and preferences can be met by the assisted living
residence within the range of services offered by the residence at its
licensure level. The conclusions shall be shared with the resident or the
resident's representative. If a reasonable accommodation can enable a resident
to live in an assisted living residence, the nature of that accommodation and a
plan for implementation or reason for denial should be included in the
assessment. Provided, however, any reasonable accommodation provided to a
resident shall be provided within the range of services offered by the
residence at its licensure level.
1. As part
of the initial resident admission and assessment process, the residence shall
review and consider any notice provided to the facility as required in R.I.
Gen. Laws §
42-56-10(23) concerning the resident's or prospective
resident's status on parole and recommendations, if any, from the Department of
Corrections regarding safety and security measures.
C. The Department-approved assessment form,
or such other assessment form as approved by the Department, shall be utilized
in completing the assessment on each resident who is admitted to the residence.
(Approved Department form is available for downloading online at
http://health.ri.gov/forms/assessment/AssistedLivingResident.pdf).
1. Assisted living residences not intending
to use the Department's assessment form shall submit their proposed assessment
forms with a cover letter of intent to the Center for Health Facilities
Regulation as specified in §
2.4.6(A) of this Part.
2. All assessment forms shall report
information appropriate to determine compatibility and compliance with the
residency criteria, and shall indicate that the resident's needs can be met by
the assisted living residence within its licensure level, and shall gather
information appropriate for the development of an individualized service plan.
a. The assessment form shall be designed to
demonstrate compliance with the assisted living residence's criteria for
residency.
b. The assessment form
shall also be designed to demonstrate that the assisted living residence can
meet the resident's needs and preferences.
3. The assessment form shall also be designed
to provide information appropriate for the development of an individualized
service plan in accordance with §
2.4.16(G)(1) of this Part.
D. The assessment shall be
reviewed and at intervals not to exceed twelve (12) months and each time a
resident's condition changes significantly.
E. In the event a resident has an admission
to a health care facility and is scheduled to return to the residence without a
significant change in status, then the assessment shall be updated within five
(5) working days of readmission.
1. In case of
an emergency admission, the required assessment shall take place within five
(5) working days and shall include the following:
a. An immediate admission necessitated by
natural disaster, crisis, or threat to public safety at another licensed
assisted living residence, independent living situation, community residential
facility, or private residence;
b.
An immediate admission necessitated by the unanticipated incapacitation of the
primary caregiver of the person to be admitted;
c. Conditions or circumstances warranting
emergency admission and as approved by Center for Health Facilities Regulation
staff within forty-eight (48) hours.
F. Nurse Review
1. Nurse review is necessary for all levels
of licensure.
a. A registered nurse shall
visit the residence at least once every thirty (30) days except as provided in
§
2.4.16(F)(1)(b) of this Part and shall complete a review to include the
following:
(1) Monitor the medication regimen
for all residents;
(2) Review any
new physician orders and evaluate the health status of all residents by
identifying symptoms of illness and/or changes in mental/physical health
status;
(3) Evaluate the
appropriateness of placement for each resident;
(4) Make any necessary recommendations to the
administrator;
(5) Follow up on
previous recommendations;
(6)
Provide a signed, written report in the residence documenting:
(AA) Date and time of assessment;
(BB) Recommendations for follow-up;
(CC) Progress on previous
recommendations;
(DD) Verification
that the medication listed by the pharmacist on the mediset, blister pack or
medication container is current with physician orders (M-1 level
only);
(EE) Physical assessment
identifying symptoms of illness and/or changes in mental or physical health
status and appropriateness of placement;
(FF) Such reports shall be on file at the
residence.
(7) Complete
the quarterly evaluation of the residence's registered medication aide(s)
administration of medication. (Approved Department form is available for
downloading online).
b.
In those residences that have one (1) or more licensed registered nurses (i.e.,
at least one (1) full-time equivalent equal to thirty-five (35) hours) on-site,
the nurse review shall be completed at least once every ninety (90)
days.
G.
Service Plans
1. Within a reasonable time
after move-in, not to exceed seven (7) days, the Administrator shall be
responsible for the development of a written service plan based on the initial
assessment. The service plan shall include at least:
a. The services and interventions needed,
including all services provided by outside healthcare agencies (e.g., home
nursing care, hospice);
b.
Description, frequency, duration relating to the service or intervention,
including personal assistance, medication, special diets, recreational
activities, and other similar services rendered;
c. Party responsible for arranging and/or
providing the service; and
d. The
resident's requested and/or therapeutically needed recreational and social
activities.
2. The
service plan shall be developed by a registered nurse and/or the certified
assisted living residence administrator, and shall be signed, approved, and
dated by both parties.
3. The
service plan shall be reviewed by both parties at intervals not to exceed
twelve (12) months and each time a resident's condition changes significantly
and all changes shall be acknowledged in writing by both parties.
4. A copy of the service plan shall be placed
in the resident's record.
2.4.18
Reporting Requirements
A. The person responsible for the operation
of the residence shall promptly notify the next of kin as instructed or other
responsible person designated by the resident or guardian of any illness,
injury or death of a resident.
B.
Accidents, incidents, and medication errors resulting in out-of-residence
emergency medical services resulting in a hospital admission of any resident
shall be reported to the Center for Health Facilities Regulation in writing,
via facsimile or electronic transmission to doh.ofr@health.ri.gov by the end of
the next working day. A copy of each report shall be retained by the residence
for review during subsequent inspections by the Department.
C. The death of any resident of an assisted
living residence occurring on the premises within twenty-four (24) hours of
assuming residency shall be reported to the Office of the State Medical
Examiners and the Center for Health Facilities Regulation. Also, all deaths
occurring in the residence which are sudden or unexpected, suspicious or
unnatural, the result of trauma, remote or otherwise, or when unattended by a
physician or are otherwise reportable in accordance with the provisions of R.I.
Gen. Laws Chapter 23-4 shall be reported to the State Medical Examiner's Office
and the Center for Health Facilities Regulation.
D. Any employee of an assisted living
residence who has reasonable cause to believe that a resident has been abused,
exploited, neglected, or mistreated shall immediately, but not later than four
(4) hours after the allegation is made, if the events that cause the allegation
involve abuse or result in serious bodily injury, or not later than twenty-four
(24) hours if the events that cause the allegation do not involve abuse and do
not result in serious bodily injury, report such to the Director and to the
Office of the Long-Term Care Ombudsman. Any person required to make a report
pursuant to this section shall be deemed to have complied with these
requirements if a report is made to a high managerial agent. Once notified,
said agent shall be required to meet the above reporting requirements. The
residence shall establish a written policy or procedure for reporting abused,
exploited or neglected residents that complies with the provisions of this
section. The report may be submitted by telephone but shall be followed up in
writing.
1. Upon receipt of such information
or allegation, the Director shall forthwith conduct such investigation as may
be necessary and submit a report of findings of the investigation(s) to the
Attorney General of the State of Rhode Island.
E. Unscheduled implementation of the
residence's fire, evacuation, and/or disaster plan shall be reported
immediately via telephone (401) 222-5200, and shall be followed up in writing,
on forms supplied by the Department, and faxed to the Department within three
(3) business days.
F. Any elopement
of a resident that results in police being called must be reported in writing
to the Department within twenty-four (24) hours or by the end of the next
business day.
G. All reports, as
required by these Regulations, shall be provided to the Department in writing
via facsimile or electronic transmission to doh.ofr@health.ri.gov on forms
supplied by the Department. A copy of each report shall be retained by the
residence for review during subsequent inspections by the Department.
H. The residence shall maintain evidence that
all reportable incidents have been thoroughly investigated and that actions
have been taken to prevent further incidents while the investigation is in
progress. Appropriate corrective action shall be taken, as necessary. The
results of said investigation shall be reported to the Department, within five
(5) business days, on forms supplied by the Department.
I. Reporting requirements, pursuant to R.I.
Gen. Laws Chapter 23-17.8 must be posted in the residence in plain view of all
residents and employees.
J. The
administrator shall notify the Department in writing of any emergency
admissions in accordance with §
2.4.16(E)(1)(c) of this Part within
forty-eight (48) hours.
K. The
administrator shall be responsible for the investigation and documentation of
incidents that involve residence operations, resident services, or related
event(s) that directly or indirectly jeopardize the health and safety of
residents, or that results in a resident injury that requires assessment by a
licensed practitioner or where the injury was not witnessed or explained by the
resident.
1. Documentation of incidents shall
include:
a. Date and time of
incident;
b. Reporter's
name;
c. Name of resident(s)
involved or affected;
d. Any
injury(ies) to resident(s); and
e.
Action taken by the residence in response to the incident.
2. Such documentation shall be made available
for review during a survey inspection by the licensing agency Department or as
required by any health oversight agency.
3. Such documentation shall be retained by
the licensee for no less than seven (7) years after the event or
incident.
2.4.19
Rights of Residents
A. Every assisted living residence for adults
licensed pursuant to these Regulations shall observe the standards stated in
R.I. Gen. Laws §
23-17.4-16, "Rights of Residents" and such other
appropriate standards as may be prescribed in Rules and Regulations promulgated
by the Department with respect to each resident of the residence.
B. For purposes of the following standards
stated in §§
2.4.18(B)(1) through (7) of this Part the term
"resident" shall also mean the resident's agent as designated in writing or
legal guardian.
1. Upon request have access to
all records pertaining to the resident, including clinical records, within the
next business day or immediately in emergency situations;
2. Upon admission and during the resident's
stay be fully informed in a language the resident understands, of all resident
rights and rules governing resident conduct and responsibilities;
a. Each resident shall receive a copy of
their rights.
b. Each resident
shall acknowledge receipt in writing; and
c. Each resident shall be informed promptly
of any changes.
3. Be
informed in writing, prior to, or at the time of admission or at the signing of
a residential contract or agreement of:
a. The
scope of the services available through the residence's service program,
including health services, and of all related fees and charges, including
charges not covered either under Federal and/or State programs by other third
(3rd) party payers or by the residence's basic rate;
b. The residence's policies regarding overdue
payment including notice provisions and a schedule for late fee
charges;
c. The residence's policy
regarding acceptance of State and Federal government reimbursement for care in
the residence both at time of admission and during the course of residency if
the resident depletes his/her own private resources;
d. The residence's criteria for occupancy and
termination of residency agreements;
e. The residence's capacity to serve
residents with physical and cognitive impairments;
f. Support any health services that the
residence includes in its service package or will make appropriate arrangements
to provide these services;
4. Upon provision of at least thirty (30)
days' notice, if a resident chooses to leave a residence, the resident shall be
refunded any advanced payment made provided that the resident is current in all
payments;
5. The residence can
discharge a resident only for the following reasons and within the following
guidelines:
a. Except in life-threatening
emergencies and for nonpayment of fees and costs, the residence gives thirty
(30) days' advance written notice of termination of residency agreement with a
statement containing the reason, the effective date of termination, the
resident's right to an appeal under State law, and the name/address of the
State Ombudsperson's office;
b. If
resident does not meet the requirements for residency criteria stated in the
residency agreement or requirements of state or local laws or
Regulations;
c. If resident is a
danger to self or the welfare of others; and the residence has attempted to
make a reasonable accommodation without success to address resident behavior in
ways that would make termination of residency agreement or change unnecessary;
which would be documented in the resident's records;
d. For failure to pay all fees and costs
stated in the contract, resulting in bills more than thirty (30) days
outstanding. A resident who has been given notice to vacate for nonpayment of
rent has the right to retain possession of the premises, up to any time prior
to eviction from the premises, by tendering to the provider the entire amount
of fees for services, rent, interest, and costs then due. The provider may
impose reasonable late fees for overdue payment; provided that the resident has
received due notice of such charges in accordance with the residence's
policies. Chronic and repeated failure to pay rent is a violation of the lease
covenant. However the residence must make reasonable efforts to accommodate
temporary financial hardship and provide information on government or private
subsidies available that may be available to help with costs; and
e. The residence makes a good faith effort to
counsel the resident if the resident shows indications of no longer meeting
residence criteria or if service with a termination notice is
anticipated;
6. To be
able to share a room or unit with a spouse or other consenting resident of the
residence in accordance with terms of the resident contract;
7. To live in a safe and clean
environment.
C. In
addition to the standards stated in R.I. Gen. Laws §
23-17.4-16, residents
are entitled to the following:
1. Receive
dental services from a dentist of his/her choice;
2. Each resident shall be given, in writing,
the names, addresses, and telephone numbers of: the Department; the Medicaid
Fraud and Patient Abuse Unit of the Department of Attorney General; the State
Ombudsperson; and local police offices.
D. The residence must:
1. Implement written policies and procedures
to ensure that all residence employees are aware of and protect the resident's
rights contained in these Regulations;
2. Have prominently displayed a posting of
the most recent State licensing survey of the assisted living residence;
and
3. Provide each resident or
his/her representative upon admission, a copy of the provisions of §
2.4.18 of this Part and shall display in a conspicuous place on the premises a
copy of the "Rights of Residents."
2.4.20
Essential Caregivers During a
Declared Emergency
A. The provisions of
this section shall apply for the period commencing fifteen (15) days after a
declaration of disaster emergency and last until sixty (60) days after the
termination or expiration of the declaration of disaster emergency by executive
order, proclamation, or operation of law.
B. Each residence shall allow a resident of
an assisted living residence, or an individual with decision-making authority
for the resident, to designate an individual as the resident's essential
caregiver during a declaration of a disaster emergency.
C. Qualifications and Caregiver Designation
1. In order to be designated as an essential
caregiver to provide in-person physical or emotional support to a resident
during a declaration of disaster emergency, the individual must be at least
eighteen (18) years old.
2. One (1)
essential caregiver may be designated at any given time for each
resident.
D. Safety
Measures
1. Each residence shall develop and
implement safety protocols for essential caregivers within fifteen (15) days of
a declaration of disaster emergency. Such protocols must be consistent with the
Department, state and federal guidance. Residences must update safety protocols
in the event of any new guidance from state or federal partners within
seventy-two (72) hours.
2. The
safety protocols for an essential caregiver, shall include, but not be limited
to, procedures on:
a. Restrictions on travel;
(1) Restrictions on travel must not be more
restrictive than travel restrictions for all Rhode Island residents for the
declaration of disaster emergency.
b. Enhanced testing for communicable
diseases, as applicable; and
(1) Enhanced
testing, also known as surveillance testing, for essential caregivers must not
be more stringent than surveillance testing required for residence
staff.
c. Use of
personal protective equipment (PPE)
(1) The
required PPE for essential caregivers will vary depending on tasks, actions,
and nature of emergency.
(2) A
residence is not required to provide personal protective equipment (PPE) to
essential caregivers.
2. An essential caregiver must comply with
routine surveillance testing during the course of a declared disaster
emergency.
3. The residence shall
be responsible for verifying/tracking the testing status, as applicable, of
essential caregivers.
4. The
essential caregiver must adhere to face-masking, hand hygiene, social
distancing, and other safety measures at the direction of residence
staff.
5. In accordance with R.I.
Gen. Laws §
23-17.5-37(b)(4), a residence that enters a lock down phase to
establish safety measures for residents and essential caregivers shall not
exceed a period of thirty (30) days. During the lock-down phase, essential
caregivers are not permitted to enter.
6. A residence may establish additional
safety requirements to protect the residents of the residence if the
requirements meet all of the following criteria:
a. The requirements are directly linked to a
declaration of disaster emergency.
b. The requirements are not so burdensome and
onerous as to substantially prevent an essential caregiver from being able to
physically or emotionally support a resident of the assisted living residence
in person.
E.
Administration
1. The residence must establish
and implement policies and procedures for designating and utilizing essential
caregivers during the period of a declared disaster emergency.
2. The residence must allow an essential
caregiver to have regular and sustained in-person visitation and physical
access to an assisted living residence resident.
a. The residence must ensure visits with
essential caregivers are conducted with a reasonable degree of
privacy.
3. The
essential caregiver may sign an agreement with the residence that outlines what
support and activities will be provided by the essential caregiver.
4. An essential caregiver visit may be
suspended in the event of the essential caregiver's failure to comply with the
residence's requirements or these Regulations during a visit.
5. A residence must have a policy or
procedure in place for a resident or an individual with decision making
authority for the resident, to immediately designate a replacement essential
caregiver in the event an essential caregiver is suspended.
7. The residence must have a policy or
procedures in place to replace an essential caregiver due to necessary
circumstances, including but not limited to, illness or death of the essential
caregiver.
8. Assisted living
residences shall provide training to essential caregivers that includes, but is
not limited, to the following:
a. Infection
prevention and control, including proper donning and doffing of PPE, hand
hygiene, and mask use;
b. Signs and
symptoms of any communicable disease(s) that are associated with the declared
disaster emergency;
c. Safety and
efficacy of any available vaccination(s) for communicable disease(s) associated
with the declared disaster emergency.
2.4.21
Accessibility to the
Residence and Residents
A. Access to
assisted living residences for adults and its residents by individuals other
than relatives and friends of the residents shall be pursuant to R.I. Gen. Laws
§
23-17.4-11.
2.4.22
Illness and Emergencies
A. Each residence shall have written
procedures for residents in the event of temporary illness and emergencies
which shall include procedures for the evacuation of the premises.
B. Residents shall not be restricted from
obtaining community health services at any time or when confined to the
residence for a temporary illness.
C. Reporting of Communicable Diseases
1. Each residence shall report promptly to
the Center for Acute Infectious Diseases Epidemiology (IDE), cases of
communicable diseases designated as "reportable diseases" when such cases are
diagnosed in the residence in accordance with Part 30-05-1 of this Title,
Reporting and Testing of Infectious, Environmental and Occupational
Diseases.
2. When infectious
diseases present a potential hazard to residents or personnel, these shall be
reported to the Center for Acute Infectious Diseases Epidemiology (IDE) even if
not designated as "reportable diseases."
3. When outbreaks of food-borne illness are
suspected, such occurrences shall be reported immediately to the Center for
Acute Infectious Diseases Epidemiology (IDE) or to the Center for Food
Protection.
4. Residences must
comply with the provisions of R.I. Gen. Laws §
23-28.36-3, which requires
notification of fire fighters, police officers and emergency medical
technicians after exposure to infectious diseases.
5. Infection Control
Infection control provisions shall be established for the
mutual protection of residents, employees, and the public. The residence shall
be responsible for no less than the following:
a. Establishing and maintaining a
residence-specific infection prevention program;
b. Establishing policies governing the
admission and isolation of residents with known or suspected infectious
diseases;
c. Developing, evaluating
and revising on a continuing basis infection control policies, procedures and
techniques for all appropriate areas of the residence;
d. Developing and implementing protocols for:
(1) Discharge planning to home that include
full instructions to the family or caregivers regarding necessary infection
control measures; and
(2) Hospital
and/or nursing facility transfer of residents with infectious diseases which
may present the risk of continuing transmission. Examples of such diseases
include, but are not limited to, tuberculosis (TB), Methicillin resistant
staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), and
clostridium difficile;
6. Resident Immunization Policies/Practices
Except as provided in §
2.4.21(C)(6)(e) of this Part,
every residence in Rhode Island shall request that residents be immunized for
influenza virus and pneumococcal disease. Influenza, pneumococcal, and other
adult vaccination policies and protocols shall be developed and implemented by
the residence and shall contain no less than the following provisions:
a. Notice to Resident. Upon admission, the
residence shall notify the resident and legal guardian of the immunization
requirements and request that the resident agree to be immunized against
influenza virus and pneumococcal disease.
b. Records and Immunizations. Every residence
shall document the annual immunization against influenza virus and immunization
against pneumococcal disease for each resident which includes written evidence
from a health care provider indicating the date and location the vaccine was
administered.
c. Other
Immunizations. An individual who becomes a resident shall have his status for
influenza and pneumococcal immunization determined by the residence, and, if
found to be deficient, the residence shall assist the resident in obtaining the
necessary immunizations.
d.
Vaccinations must be provided in accordance with "General Recommendations on
Immunization: Recommendations of the Advisory Committee on Immunization
Practices (ACIP)," incorporated above at §
2.2(C) of this Part.
e. Exceptions. No resident shall be required
to receive either the influenza or pneumococcal vaccine if any of the following
apply:
(1) The vaccine is
contraindicated;
(2) It is against
his/her religious beliefs; or
(3)
The resident or the resident's legal guardian refuses the vaccine after being
fully informed of the health risks of such action.
2.4.23
Dietetic Services
A. Residents
shall be provided three (3) balanced, varied meals each day (refer to Dietary
Reference Intakes: The Essential Guide to Nutrient Requirements incorporated
above at §
2.2(A) of this Part).
B. Food shall be served on dinnerware of good
quality, such as ceramic, plastic or other materials that are
durable.
C. The food service in
each residence shall comply with the appropriate requirements of R.I. Gen. Laws
Chapters 21-27 and 21-31, Part 50-10-1 of this Title, Rhode
Island Food Code, and such other applicable statutory or regulatory
provisions.
D. In the event of any
construction, addition or alteration, the residence shall comply with the
requirements of R.I. Gen. Laws §
23-1-31.
E. Weekly menus shall be posted in each
residence and followed accordingly.
F. Residences must provide residents with a
diet appropriate to their medical regime.
G. All food services shall be conducted in
accordance with Part 50-10-2 of this Title, Certification of Managers in Food
Safety that include but are not limited to the following provisions:
1. Each residence where potentially hazardous
foods are prepared shall employ at least one (1) full-time, on-site manager
certified in food safety who is at least eighteen (18) years of age.
2. Residences that primarily serve the
elderly and individuals with diminished immune systems shall have a manager
certified in food safety present during preparation of all hot potentially
hazardous foods.
3. Residences that
have a licensed capacity of twenty-six (26) or more residents and that employ
ten (10) or more full-time equivalent employees directly involved in food
preparation shall employ at least two (2) full time, on-site managers certified
in food safety.
4. Residences that
have a licensed capacity of twenty-five (25) or fewer residents and that employ
five (5) or fewer full-time equivalent employees involved in preparation and
serving of food, shall only be required to employ one (1) full time manager
certified in food safety.
5. Once a
manager certified in food safety terminates employment, establishments shall
have sixty (60) days to employ a new manager certified in food safety, or have
an individual enrolled in a Center for Food Protection approved food manager
certification program in food safety. However, said time period may be extended
by the Center for Food Protection.
a.
Residences that have a licensed capacity of twenty-five (25) or fewer residents
and that employ five (5) or fewer full-time equivalent employees involved in
preparation and serving of food shall only have fifteen (15) days to employ a
new manager certified in food safety. However, said time period may be extended
by the Center for Food Protection.
6. Department certificates for managers
certified in food safety shall be prominently posted in the residence next to
the license to operate. The certificate shall be removed when the individual is
no longer employed by the residence.
7. No person shall use the title "Manager
Certified in Food Safety," or in any way represent himself as a manager
certified in food safety unless they hold a current certificate pursuant Part
50-10-2 of this Title, Certification of Managers in Food Safety.
H. All menus including alternate
choices shall be planned at least one (1) week in advance, to meet the
standards for nutritional care in accordance with Dietary Reference Intakes:
The Essential Guide to Nutrient Requirements, incorporated above at §
2.2(A) of this Part, and to provide for a variety of foods, adjusted for
seasonal changes, and reflecting the dietary preferences of residents.
1. Menus shall indicate nourishments
available to residents between evening meal and bedtime.
2. Menus shall be posted in a conspicuous
place in the dietary department and in resident areas.
3. Records of menus actually served shall be
retained for thirty (30) days.
2.4.24
Housekeeping
A. The residence shall maintain a
comfortable, safe, clean, sanitary and orderly environment, free of litter,
rubbish and offensive odors.
2.4.25
Laundry Services
A. Each residence shall make provisions for
the cleaning of personal laundry of residents and all linens and other washable
goods either directly or through other suitable arrangement.
2.4.26
Medication
Services
A. Medication Services
1. For M1 and M2 licensure levels, each
resident shall have the right to:
a. Retain
the services of his/her own personal physician and dentist;
b. Select the pharmacy or pharmacist of
his/her choice provided that the pharmacy or pharmacist supplies medications
suitably packaged for the residence's program;
c. Refuse any or all medications;
d. Retain possession and control of his/her
medications, provided that such possession and control is deemed safe by the
resident, the resident's guardian, if appropriate, and the administrator or
his/her designee in consultation with the resident's physician(s).
2. For M1 and M2 licensure levels,
the residence shall have the right:
a. To
inform family, guardian, physician, or other party designated by the resident
or guardian if a resident has refused medication(s).
b. Not to accept, and/or to evict a resident
who refuses assistance with medications if the residence reasonably feels that
the resident cannot safely possess and control medications without danger to
self or others, in accordance with the requirements of the Resident's Rights
statement.
3. Each
residence shall provide medication services only in accordance with the
appropriate level of licensure for which the residence is licensed, which shall
be as follows:
a. For assisted living
residences licensed at the M2 Level, assistance with self- administration by
unlicensed employees means that the residence shall only be responsible for
reminding residents to take medications, and:
(1) The resident or guardian must provide
written authorization for the residence to provide assistance with the
selfadministration of medications;
(2) The residence must provide, in writing, a
description of services provided by the residence to each physician prescribing
for a resident, including limitations on services;
(3) Employees may only remind the resident
and observe the self-administration of medication;
(4) The resident shall not require nursing
assessment of health status before receiving the medication, nor nursing
assessment of the therapeutic or side effects after the medication is
taken;
(5) Except as provided in
§
2.4.25(A)(3)(a)(7) of this Part, the medication shall be in the original
pharmacy-dispensed container with proper label and directions
attached;
(6) Unlicensed employees
shall not monitor health indicators, make medication decisions, adjust
medications or provide other medical or nursing decisions;
(7) For residents capable of
self-administration of medication but who wish to ask assisted living residence
employees to use a medi-set (pre-poured packaging distribution system), only
registered medication aide, licensed nurse, or pharmacist shall organize the
medications for up to one (1) week;
(8) All medication in the residence,
regardless of whether controlled by employees or by the resident, shall be
stored securely. All medications shall be stored in a manner to prevent
spoilage, dosage errors, administration errors or inappropriate access by other
residents, visitors, or unauthorized employees. Provisions for safe storage may
include lockable containers, secure spaces, or lockable units, as appropriate
to the residence and the resident population.
(9) There shall be documented policies or
procedures regarding medication disposal and inventory procedures in the
policies and procedures manual.
(10) Each person assisting residents with
self-administration of medications shall:
(AA)
Be an employee of the residence;
(BB) Be literate in English; and
(CC) Receive orientation, instruction and
on-the-job training regarding relevant policies and procedures; or
(DD) Be a licensed nurse.
(EE) M2 level facilities may limit record
keeping for residents who retain possession and control of medications to the
requirements of §
2.4.15(A)(6) of this Part.
b. For assisted living residences
licensed at the M1 level, licensed employees (registered medication aides,
registered nurses, licensed practical nurses) may administer oral or topical
drugs and monitor health indicators. However, schedule II medications shall
only be administered by licensed personnel. The physician or nurse supervisor
shall conduct and document quarterly evaluations of the registered medication
aides who are administering drugs and place a copy in the employee's personnel
record.
c. For the first three (3)
months of employment, a licensed nurse designated by the health care facility,
adult day care program, or assisted living residence, as appropriate, shall
conduct and document monthly evaluations (in accordance with the evaluation
checklist on the Department website) of a medication aide who administers
medication. After the first three (3) months, the evaluation shall be conducted
no less than quarterly. Copies of said evaluations shall be placed in the
medication aides' personnel records.
B. Administration of Medications
1. Residences licensed at the M1 level may
administer medications to residents including, but not limited to, removing
medication containers from storage, assisting with the removal of a medication
from a container for residents with disability which prevents independence in
this act, and/or administering the medication directly to the resident.
a. The resident or guardian must provide
written authorization for the residence to provide administration of
medications.
b. Medications shall
be administered in accordance with written orders of a physician. The residence
must provide in writing, a description of services provided by the residence to
each physician, including limitations on service.
c. All medications must be checked against a
physician's orders by a licensed nurse, or pharmacist.
d. The resident must be identified prior to
administration of any medication.
e. The medication must be in the original
pharmacy-dispensed container with proper label and directions attached and be
administered in accordance with such label.
f. Injectable medications, including but not
limited to insulin, which cannot be self-administered by the resident, must be
administered by a licensed nurse.
g. There shall be written a policy/procedure
for the disposal of hypodermic needles, syringes and other such instruments
that is in compliance with Part 20-15-6 of this Title, Hypodermic Needles,
Syringes, and Other Such Instruments.
(1) The
legal destruction of hypodermic needles, syringes or other such instruments is
the responsibility of the last entitled or authorized possessor.
(AA) All personnel or residents legally
authorized to use disposal syringes and needles, shall destroy them after one
(1) use.
(BB) Excess and undesired
needles, syringes and other such instruments shall be stored in impervious,
rigid, puncture-resistant container for disposal. Intact needles shall be
placed directly into the collection containers.
(CC) Personnel handling disposal waste
materials such as needles, syringes, and other such instruments may treat and
destroy such waste by a DEM-approved alternative treatment/destruction
technology or prepare the regulated medical waste for off-site transport by a
DEM-permitted medical waste transporter.
h. Individual medication records must be
retained for each resident to whom medications are being administered and each
dose administered to the resident must be properly recorded.
i. Any medication administered by the
residence and refused by a resident shall be documented and reported, as
appropriate.
j. Medications shall
be stored securely and in such a manner to prevent spoilage, dosage errors,
administration errors, and/or inappropriate access. Provisions for safe storage
may include lockable containers, secure spaces, or lockable units, as
appropriate to the residence and the resident population.
k. All medication in the residence,
regardless of whether controlled by employees or by the resident, shall be
stored securely as stated in §
2.4.25(A)(3)(a)(8) of this Part.
l. All centrally stored medications shall be
maintained in accordance with manufacturer's labeling and administered by
authorized personnel.
2.
For M1 and M2 licensure levels, unused or discontinued prescription medications
that are left with a residence shall be inventoried and disposed of in
accordance with the following requirements:
a.
Disposal of Controlled Substances
(1) M1
residences that are lawfully in possession of excess and undesired controlled
substances that are centrally stored shall inventory and dispose of all such
controlled substances in accordance with all applicable Federal, State, and
local laws and Regulations.
(2)
Only centrally stored medications in M1 residences may be disposed of in the
following manner:
(AA) The residence's
registered nurse and either another registered nurse, a licensed practical
nurse, or the residence's administrator may carry out flushing destruction
activity, and appropriate records shall be maintained at the residence for two
(2) years, as permitted by State and local laws and Regulations. The Director
is authorized to enter any premises and inspect any and all aspects of the
disposal process and related records.
b. Disposal of All Other Legend Drugs (i.e.,
Non-Controlled Substances)
(1) All other
legend drugs (i.e., those not classified as controlled substances) shall be the
responsibility of the resident or authorized personnel to dispose of as
provided in Part 20-20-1 of this Title, Disposal of Drugs:
(AA) Legend drugs may be disposed of as solid
waste provided that all of the following conditions are met:
(i) The legend drugs are rendered
unrecognizable;
(ii) The legend
drug would not pose a threat to the public or to the environment; and
(iii) The legend drugs cannot be recycled;
or
(BB) The legend drugs
may be disposed of as regulated medical waste through the use of an entity
holding a regulated medical waste transporter permit issued pursuant to the
requirements and in compliance with
250-RICR-140-15-1, Medical Waste
Regulations.
3. Ordering medications
a. In M1 and M2 facilities, when assistance
is needed, the certified administrator, or his/her qualified designee, shall
assist with ordering medications. Assistance shall include coordinating
prescriptions and delivery of medications, reorders of prescriptions, and
receiving deliveries.
2.4.27
Recreational and Other
Services
A. Reasonable recreational and
social activities and/or services shall be offered to each resident to:
1. Promote opportunities for engaging in
normal pursuits including religious activities of the resident's
choice;
2. Promote the physical,
social and mental well-being of each resident;
3. Promote independent as well as group
activities;
4. Harmonize with each
resident's needs.
B. The
residence shall post a calendar or schedule of social and recreational events
offered to the residents and shall keep a record of the events that were
actually presented to the residents. Said calendars and records shall be
retained for at least one (1) year by the residence.
C. Personal assistance shall be provided as
necessary, pursuant to the provisions of §
2.3(A)(31) of this Part and
shall consist of activities such as bathing, oral hygiene, fingernail care,
shampooing, shaving, dressing or assistance with ambulation or nutrition and
hydration.
2.4.28
New Construction, Modification, Additions, or Room Conversions
A. All new construction, modification,
additions, or room conversions of an existing residence shall be subject to the
provisions of Fire Safety Code - General Provisions (R.I. Gen. Laws Chapter
23-28.1), State Building Code (R.I. Gen. Laws Chapter 23-27.3), ANSI A117.1 -
2009 Accessible and Usable Buildings and Facilities (incorporated above at
§
2.2(B) of this Part), Americans with Disabilities Act (42 U.S.C. §§
12101 through
12213), and such other applicable State and local
laws, codes and Regulations as may be applicable. Where there is a difference
between codes, the code having the more stringent or higher standard shall
apply.
2.4.29
General Provisions
A. Fire Code
and Structural Requirements
1. Existing
facilities shall be constructed, equipped and maintained to protect the safety
and well-being of residents, and shall provide a comfortable, sanitary
environment, and shall furthermore comply with the applicable requirements of
the Fire Safety Code - General Provisions (R.I. Gen. Laws Chapter 23-28.1), as
determined by the State Fire Marshal and the Regulations.
a. Pursuant to R.I. Gen. Laws §
23-17.4-6, a residence with Fire Code deficiencies may be granted a license
which may be renewed subject to the submission of a plan of correction
acceptable to the State Fire Marshal and provided the nature of the
deficiencies are such that they do not jeopardize the health, safety, and
welfare of the residents.
b. A
residence with residents who are blind, deaf, and physically disabled shall be
subject to the applicable requirements of ANSI A117.1 - 2009 Accessible and
Usable Buildings and Facilities (incorporated above at §
2.2(B) of this
Part), and any other provisions that may be required by these
Regulations.
c. Resident occupancy
shall be permitted only in those areas where building design or structural
limitations do not prevent, delay or reduce a resident from exercising
self-preservation in an emergency.
d. A residence that elects to comply with a
higher Life Safety Code (F1) and is so approved by the State Fire Marshal and
meets the Department's requirements for the appropriate level of licensure may
admit residents not capable of self-preservation.
e. Facilities must have an annual inspection
to assess compliance with the Fire Safety Code. The inspection shall be
conducted under the authority of the State Fire Marshal.
(1) Documentation of the State Fire Marshal
inspection required under §
2.4.28(A)(1)(e) of this Part must be submitted
with the application for renewal of licensure. The documentation must reflect
compliance with the Fire Safety Code or be in accordance with §
2.4.28 (A)(1)(a) of this Part.
B. Assisted living residences shall not be
utilized for any other purposes, unless such purposes are compatible with the
objectives and the nature of an assisted living residence and are approved by
the Department.
C. All rooms
utilized by resident(s) shall have proper ventilation and shall have an outside
opening with satisfactory screening.
D. All steps, stairs and corridors shall be
suitably lighted, both day and night. Stairs used by residents shall have
banisters, hand rails or other types of support. All stair treads shall be well
maintained to prevent hazards.
E.
Requirements for heat relief are pursuant to R.I. Gen. Laws §
23-17.4-16.4.
2.4.30
Residents Rooms, Toilets and Bathing Fixtures
A. The bedroom of residents shall be designed
and equipped with suitable furnishings for the safety, comfort and privacy of
each resident and with no more than two (2) beds per room.
1. Single rooms shall be no less than one
hundred (100) square feet in area and no less than eight feet (8') wide,
exclusive of toilet rooms, closets, lockers, wardrobes, alcoves or
vestibules.
2. Double bedrooms
shall be no less than one hundred sixty (160) square feet in area and no less
than ten feet (10') wide, exclusive of toilet rooms, closets, lockers,
wardrobes, alcoves or vestibules.
B. Provisions shall be made for an area
within the resident's bedroom and/or residence to be under lock for the safe
keeping of personal possessions.
C.
Each bedroom shall have a window which can be easily opened. The window sill
shall not be higher than three feet (3') above the floor and shall be above
ground level.
D. Comfortable
temperature levels shall be maintained in all parts of the residence occupied
by residents with a centralized heating system to maintain a minimum of seventy
degrees Fahrenheit (70° F) during the coldest periods.
E. There shall be no less than one (1) bath
per ten (10) beds and one (1) toilet per eight (8) beds or fraction thereof on
each floor where residents rooms are located and which are not otherwise
serviced by bathing facilities within the resident's room.
1. Policies and procedures shall be in place
to ensure resident comfort and safety regarding water temperature at each site
in the residence where residents shower or bathe. Provided, however, such
policies/procedures shall state that in resident areas hot water temperatures
shall not be less than one hundred degrees Fahrenheit (100° F) nor exceed
one hundred eighteen degrees Fahrenheit (118° F). Thermometers shall be
provided in resident areas to check water temperature periodically at each site
where residents bathe or shower.
2.4.31
Dining and Living Areas
A. Each residence shall provide one (1) or
more clear, orderly and appropriately furnished and easily accessible room of
adequate size to include all residents for resident dining and activity, which
shall be appropriately lighted.
1. If a
multi-purpose room is used, there must be sufficient space to accommodate all
residents for dining and activities and to prevent interference between
activities.
2.4.32
Safety Requirements
A. Halls and exit ways shall be free from all
encumbrances and/or impediments.
B.
All locks on bedrooms shall be operable by a master key, under the control of
the person in charge in accordance with §§
2.4.12(B) and (C) of this
Part.
C. Every closet door latch
shall be a type that cannot be locked from the inside.
D. Every bathroom door shall be designed to
permit the opening of the locked door from outside in an emergency.
E. There shall be no portable cooking
equipment (employing flame, gasoline, kerosene or exposed electrical heating
elements) used in residents' rooms.
F. Portable space heaters shall not be
permitted.
G. Proper safeguards
shall be taken at all times against the fire hazards involved in
smoking.
H. A telephone shall be
easily accessible to residents in the event of emergencies. (Pay phones shall
not be acceptable substitutes). The telephone number of the local fire
department and law enforcement agencies serving the residence shall be posted
by each telephone.
I. Each
residence shall develop and maintain a written plan and procedure for the
evacuation of the premises in case of fire or other emergency, based on F1/F2
licensure requirements, Fire Safety Code - General Provisions (R.I. Gen. Laws
Chapter 23-28.1) requirements.
1. Emergency
steps of action shall be clearly outlined and posted in conspicuous locations
throughout the residence.
2. Drills
simulating fire emergencies, testing the effectiveness of the fire evacuation
plan shall be conducted at least six (6) times per year on a bimonthly basis
with a minimum of two (2) drills conducted during the night when residents are
sleeping with documentation of observed ability of residents to carry out
evacuation procedures. At least fifty percent (50%) of these drills shall be
obstructed drills, as defined in Fire Safety Code - General Provisions (R.I.
Gen. Laws Chapter 23-28.1).
3. The
drills shall be permitted to be announced in advance to the residents. The
drills shall involve the actual evacuation of all residents to an assembly
point as specified in the emergency plan and shall provide residents with
experience in egressing through all exits and means of escape required by the
Fire Safety Code - General Provisions (R.I. Gen. Laws Chapter 23-28.1). Exits
and means of escape not used in any fire drill shall not be credited in meeting
the requirements of the Fire Safety Code - General Provisions (R.I. Gen. Laws
Chapter 23-28.1).
a. Documentation of fire
drills shall be maintained and shall include no less than the following
information:
(1) Name of the person conducting
the drill;
(2) Date and time of the
drill;
(3) Amount of time taken to
evacuate the building or unit;
(4)
Type of drill (i.e., obstructed or unobstructed);
(5) Record of problems encountered and steps
taken to rectify them;
(6) Employee
observation of each resident's ability to carry out evacuation
procedures.
4. Residents shall be instructed in all
alternative methods of escape since the primary exit may be unusable due to
fire and/or smoke. Such instruction shall be documented in the record described
in §
2.4.31(I)(3)(a) of this Part.
5. Each new resident shall be oriented to the
fire drill procedure on admission, with documentation of the orientation placed
in the resident's record.
J. Appropriate fire extinguishers shall be
installed on each occupied level and maintained in a usable condition,
inspected at specified intervals as stipulated by manufacturers and the State
Fire Marshal.
K. Each residence
shall develop written emergency plans related to internal and external
disasters.
L. Disaster Preparedness
1. Each residence shall develop back-up or
contingency plans to address possible internal systems and/or equipment
failures.
2.4.33
COVID-19 Practices and
Procedures
A. Assisted Living Residents
1. Upon the identification of residents who
test positive for COVID-19, the residence shall take proper actions to prevent
the transmission of COVID-19 in accordance with Department guidance.
2. Assisted living residences shall have
policies and procedures in place for addressing residents who refuse testing or
unable to be tested.
3. The
assisted living residence shall document all COVID-19 testing, which
documentation shall include at minimum the individual's name, date of test, and
test result.
B. Assisted
Living Personnel
1. For the purposes of §
2.4.32 of this Part, "personnel" means employees, as well as volunteers,
students, trainees, and any individuals, whether paid or unpaid, directly
employed by or under contract with the assisted living residence on a part time
or full-time basis.
2. Upon the
identification of personnel who test positive for COVID-19, the residence shall
take proper actions to prevent the transmission of COVID-19.
3. The assisted living residence shall
develop and implement policies and procedures for ongoing tracking of personnel
who are employed outside of the assisted living residence. Tracking shall
include the name and location of the establishment and any other pertinent
information.
2.4.34
Variance Procedure
A. The Department may grant a variance either
upon its own motion or upon request of the applicant from the provisions of any
Rule or Regulation in a specific case if it finds that a literal enforcement of
such provision will result in unnecessary hardship to the applicant and that
such a variance will not be contrary to the public interest, public health
and/or health and safety of residents.
B. A request for a variance shall be filed by
a high managerial agent of the assisted living residence in writing, and must
set forth in detail the basis upon which the request is made including:
1. Identification of the specific regulatory
section(s) herein;
2. Alternative
actions, processes, or procedures that through the facility's implementation
will facilitate compliance with the specific regulatory intent, and how the
Residence will ensure staff awareness and training regarding the variance, when
appropriate.
3. A variance period
shall not exceed the assisted living residence's license period. An assisted
living residence must request renewal of the variance when it submits its
annual license renewal application.
4. Upon the filing of each request for
variance with the Department, and within a reasonable time thereafter, the
Department shall notify the applicant of its approval or in the case of a
denial, a hearing date, time and place may be scheduled if the residence
appeals the denial and held in accordance with the provisions of §
2.4.35 of this Part.
C.
Variances may be granted as follows (to be submitted on a RIDOH form):
1. Residents with in-dwelling Foley catheters
will be granted a six (6) month variance and the resident may remain in the
residence as long as there are no signs or symptoms of infection; and the
residence assumes responsibility for ensuring that the required care is
received.
2. Residents with
chronic, non-pressure related ulcers, such as venous stasis ulcers, may remain
in the residence as long as there are no signs or symptoms of infection; and
the residence assumes responsibility for ensuring that the required care is
received.
3. Hospice variances are
granted on a six (6) month basis.
2.4.35
Deficiencies and Plans of
Correction
A. The Department shall
notify the licensee and the residence's administrator or other legal authority
of the residence of violations of individual standards through a notice of
deficiencies which shall be forwarded to the residence within fifteen (15) days
of inspection of the residence unless the Director determines that immediate
action is necessary to protect the health, welfare, or safety of the public or
any member thereof through the issuance of an immediate compliance order in
accordance with R.I. Gen. Laws §
23-1-21.
B. A licensee, or their designee, who
receives a notice of deficient practices must submit a plan of correction to
the Department within fifteen (15) days of the date of the notice of deficient
practices. The plan of correction shall detail any requests for variances as
well as document the reasons therefor.
1. An
acceptable plan of correction shall include, for each individual standard
cited:
a. How the licensee or their designee
intends to correct each deficiency and comply with the stated
regulation;
b. What measures will
be put in place, or what systemic changes will be made to ensure that the
deficient practice does not reoccur; and
c. The date the deficiency shall be
corrected.
2. The
criteria for acceptability shall be whether the submitted plan shall achieve
compliance with the Act and these Regulations.
3. The plan of correction shall detail any
requests for variances in accordance with §
2.4.33 of this Part.
C. The Department will be required
to accept or reject the plan of correction submitted by a residence in
accordance with §§
2.4.33(B)(1) and (2) of this Part within fifteen
(15) days of receipt of the plan of correction.
D. If the Department rejects the plan of
correction, or if the residence does not provide a plan of correction within
the fifteen (15) day period stipulated in §
2.4.33(B) of this Part, or if
a residence whose plan of correction has been approved by the Department fails
to execute its plan within a reasonable time, the Department may invoke the
sanctions enumerated in §
2.4.11 of this Part. If the residence is
aggrieved by the sanctions of the Department, the residence may appeal the
decision and request a hearing in accordance with R.I. Gen. Laws Chapter
42-35.
E. The notice of the hearing
to be given by the Department shall comply in all respects with the provisions
of R.I. Gen. Laws Chapter 42-35. The hearing shall in all respects comply
therein.
2.4.36
Rules Governing Practices and Procedures
A. All hearings and reviews required by these
Regulations shall be held in accordance with the provisions of R.I. Gen. Laws
Chapter 42-35 and Part 10-05-4 of this Title, Practices and Procedures Before
the Rhode Island Department of Health.
2.4.37
Violations and Sanctions
A. Any person establishing, conducting,
managing or operating an assisted living residence without a license pursuant
to the provisions of the Act and these Regulations shall be liable for the
penalty contained in R.I. Gen. Laws §
23-17.4-14.
B. Any person who obtains access to an
assisted living residence or to its residents under false representation shall
be subject to the provisions of R.I. Gen. Laws §
23-17.4-12.
C. The penalty for violation of R.I. Gen.
Laws §
23-17.4-10 shall be in accordance with R.I. Gen. Laws §
23-17.4-10.2.