CHAPTER 2800. ASSISTED LIVING RESIDENCES

§ 2800.1. Purpose.

 (a)  The purpose of this chapter is to protect the health, safety and well-being of assisted living residents.

 (a)  This chapter applies to assisted living residences as defined in this chapter, and contains the minimum requirements that shall be met to obtain a license to operate an assisted living residence.

 (a)  The Department will annually conduct at least one onsite unannounced inspection of each assisted living residence.

 (b)  Additional announced or unannounced inspections may be conducted at the Department’s discretion.

 (c)  A license will be issued to the legal entity by the Department if, after an investigation by an authorized agent of the Department, the requirements for a license are met.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   ADL—Activities of daily living—The term includes eating, drinking, ambulating, transferring in and out of a bed or chair, toileting, bladder and bowel management, personal hygiene, securing health care, managing health care, self-administering medication and proper turning and positioning in a bed or chair.

   Abuse—The occurrence of one or more of the following acts:

     (i)   The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

     (ii)   The willful deprivation by the assisted living residence or its staff persons of goods or services which are necessary to maintain physical or mental health.

     (iii)   Sexual harassment, rape or abuse, as defined in 23 Pa.C.S. Chapter 61 (relating to protection from abuse).

     (iv)   Exploitation by an act or a course of conduct, including misrepresentation or failure to obtain informed consent which results in monetary, personal or other benefit, gain or profit for the perpetrator, or monetary or personal loss to the resident.

     (v)   Neglect of the resident, which results in physical harm, pain or mental anguish.

     (vi)   Abandonment or desertion by the assisted living residence or its staff persons.

   Adult—An individual who is 18 years of age or older.

   Age in place or aging in place—Receiving care and services at a licensed assisted living residence to accommodate changing needs and preferences in order to remain in the assisted living residence.

   Agent—An individual authorized by the Department to enter, visit, inspect or conduct an investigation of an assisted living residence.

   Ancillary staff person—An individual who provides services for the residents other than direct assistance with activities of daily living. Ancillary staff may include staff who do not provide direct care but who conduct assessment, care planning or care management activities, and who meet the direct care staff qualifications and training requirements. Ancillary staff may also include RNs, LPNs, dieticians, or skilled professionals who meet the requirements of their professional licensure and the direct care staff requirements, if they also provide direct assistance with activities of daily living. Other ancillary staff may include activities planners, housekeepers, cooking staff or facilities staff.

   Appropriate assessment agency—An organization serving adults who are older or adults with disabilities, such as a county mental health/mental retardation agency, a drug and alcohol agency, an area agency on aging or another human service agency or an individual in an occupation maintaining contact with adults who are older and adults with disabilities, such as medicine, nursing or rehabilitative therapies.

   Area agency on aging—The local agency designated by the Department of Aging as defined in section 2202-A of The Administrative Code of 1929 (71 P. S. §  581-2).

   Assessment—An instrument that includes screening of a resident or potential resident to determine whether the resident or potential resident requires the services of an assisted living residence.

   Assisted living residence administrator—An individual who is charged with the general administration of an assisted living residence, whether or not the individual has an ownership interest in the residence or his function and duties are shared with other individuals.

   Assisted living residence or residence—Any premises in which food, shelter, assisted living services, assistance or supervision and supplemental health care services are provided for a period exceeding 24-hours for four or more adults who are not relatives of the operator, who require assistance or supervision in matters such as dressing, bathing, diet, financial management, evacuation from the residence in the event of an emergency or medication prescribed for self-administration.

   Assisted living services—Services as defined in §  2800.220(b) (relating to service provision).

   Basic cognitive support services—These services include the following:

     (i)   Intermittent cueing.

     (ii)   Redirecting.

     (iii)   Environmental cues.

     (iv)   Measures to address wandering.

     (v)   Dementia-specific activity programming.

     (vi)   Specialized communication techniques.

   CAM—Complementary and alternative medications—Practices, substances and ideas used to prevent or treat illness or promote health and well-being outside the realm of modern conventional medicine. Alternative medicine is used alone or instead of conventional medicine. Complementary medicine is used along with or in addition to conventional medicine.

   CPB—Cognitive, physical, behavioral.

   CPR—Cardiopulmonary resuscitation.

   Cognitive support services—

     (i)   Services provided to an individual who has memory impairments and other cognitive problems which significantly interfere with his ability to carry out ADLs without assistance and who requires that supervision, monitoring and programming be available 24 hours per day, 7 days per week, in order to reside safely in the setting of his choice.

     (ii)   The term includes assessment, health support services and a full range of dementia-capable activity programming and crisis management.

   Commercial boarding home—A type of residential living facility providing only food and shelter, or other services normally provided by a hotel, for payment, for individuals who require no services beyond food, shelter and other services usually found in hotel or apartment rental.

   Common living area—Includes any of the following:

     (i)   Dining room.

     (ii)   Indoor activity space.

     (iii)   Recreational space.

     (iv)   Swimming area, if located in the residence.

   Complaint—A written or oral criticism, dispute or objection presented by or on behalf of a resident to the Department regarding the care, operations or management of an assisted living residence.

   Day—Calendar day.

   Dementia—A clinical syndrome characterized by a decline of long duration in mental function in an alert individual. Symptoms of dementia may include memory loss, personality change, chronic wandering and the loss or diminishing of other cognitive abilities, such as learning ability, judgment, comprehension, attention and orientation to time and place and to oneself.

   Department—The Department of Public Welfare of the Commonwealth.

   Designated person—An individual who may be chosen by the resident and documented in the resident’s record, to be notified in case of an emergency, termination of service, assisted living residence closure or other situations as indicated by the resident or as required by this chapter. A designated person may be the resident’s legal representative or an advocate.

   Designee—A staff person authorized in writing to act in the administrator’s absence.

   Direct care staff person—A staff person who directly assists residents with activities of daily living, and instrumental activities of daily living and provides services or is otherwise responsible for the health, safety and well-being of the residents.

   Discharge—Termination of an individual’s residency in an assisted living residence.

   Distinct part—A portion of a building that is visually separated such as a wing or floor, or sections or parts of floors.

   Emergency medical plan—A plan that ensures immediate and direct access to medical care and treatment for serious injury or illness, or both.

   Financial management—

     (i)   An assisted living service requested or required by the resident in accordance with his support plan, which includes taking responsibility for or assisting with paying bills, budgeting, maintaining accurate records of income and disbursements, safekeeping funds and making funds available to the resident upon request.

     (ii)   The term does not include solely storing funds in a safe place as a convenience for a resident.

   Fire safety expert—A member of a local fire department, fire protection engineer, Commonwealth-certified fire protection instructor, college instructor in fire science, county or Commonwealth fire school, volunteer trained and certified by a county or Commonwealth fire school, an insurance company loss control representative, Department of Labor and Industry building code inspector or construction code official.

   Health care or human services field—Includes the following:

     (i)   Child welfare services.

     (ii)   Adult services.

     (iii)   Older adult services.

     (iv)   Mental health/mental retardation services.

     (v)   Drug and alcohol services.

     (vi)   Services for individuals with disabilities.

     (vii)   Medicine.

     (viii)   Nursing.

     (ix)   Rehabilitative services.

     (x)   Any other human service or occupation that maintains contact with adults who are older or adults and children with disabilities.

   Housekeeping—The cleaning of the living unit and common living areas. Cleaning of the living unit includes at least weekly dusting, sweeping, vacuuming, mopping, emptying trash, and cleaning of bathroom, counters, refrigerator and microwave oven, if these appliances are in the resident’s living area. Housekeeping for common living areas means keeping them in clean sanitary condition.

   IADL—Instrumental activities of daily living—The term includes the following activities when done on behalf of a resident:

     (i)   Doing laundry.

     (ii)   Shopping.

     (iii)   Securing and using transportation.

     (iv)   Financial management.

     (v)   Using a telephone.

     (vi)   Making and keeping appointments.

     (vii)   Caring for personal possessions.

     (viii)   Writing correspondence.

     (ix)   Engaging in social and leisure activities.

     (x)   Using a prosthetic device.

     (xi)   Obtaining and keeping clean, seasonal clothing.

   INRBI—Intense neurobehavioral rehabilitation after brain injury.

   Informed consent agreement—A formal, mutually agreed upon, written understanding which:

     (i)   Results after thorough discussion among the assisted living residence staff, the resident and any individuals the resident wants to be involved.

     (ii)   Identifies how to balance the assisted living residence’s responsibilities to the individuals it serves with a resident’s choices and capabilities with the possibility that those choices will place the resident or other residents at risk of harm.

   LPN—Licensed practical nurse.

   Legal entity—A person, society, corporation, governing authority or partnership legally responsible for the administration and operation of an assisted living residence.

   Legal representative—An individual who holds a power of attorney, a court-appointed guardian or other person legally authorized to act for the resident.

   License—A certificate of compliance issued by the Department permitting the operation of an assisted living residence, at a given location, for a specific period of time, for a specified capacity, according to Chapter 20 (relating to licensure or approval of facilities and agencies).

   Licensee—A person legally responsible for the operations of an assisted living residence licensed in accordance with this chapter.

   Long-term care ombudsman—A representative of the Office of the State Long-Term Care Ombudsman in the Department of Aging who investigates and seeks to resolve complaints made by or on behalf of individuals who are 60 years of age or older who are consumers of long-term care services. These complaints may relate to action, inaction or decisions of providers of long-term care services, of public agencies, of social service agencies or their representatives, which may adversely affect the health, safety, well-being or rights of these consumers.

   Mobile resident—

     (i)   A resident who is physically and mentally capable of vacating the assisted living residence on the resident’s own power or with limited physical or oral assistance in the case of an emergency, including the capability to ascend or descend stairs if present on the exit path.

       (A)   Physical assistance means assistance in getting to one’s feet or into a wheelchair, walker or prosthetic device.

       (B)   Oral assistance means giving instructions to assist the resident in vacating the assisted living residence.

     (ii)   The term includes an individual who is able to effectively operate an ambulation device required for moving from one place to another, and able to understand and carry out instructions for vacating the assisted living residence.

   Neglect—The failure of an assisted living residence or its staff persons to provide goods or services essential to avoid a clear and serious threat to the physical or mental health of a resident. The failure or omission to provide the care, supervision and services that the assisted living residence has voluntarily, or by contract, agreed to provide and that are necessary to maintain the resident’s health, safety and well-being, including assisted living services, food, clothing, medicine, shelter, supervision and medical services. Neglect may be repeated conduct or a single incident.

   OTC—Over-the-counter or nonprescription.

   Premises—The grounds and buildings on the same grounds, used for providing services required by residents.

   Protective services unit—The local area agency on aging unit designated by the Department of Aging to investigate allegations of abuse of adults who are 60 years of age or older and assess the need for protective interventions.

   RN—Registered nurse.

   Referral agent—An agency or individual who arranges for or assists, or both, with placement of a resident into an assisted living residence.

   Relative—A spouse, parent, child, stepparent, stepchild, grandparent, grandchild, brother, sister, half-brother, half-sister, aunt, uncle, niece or nephew.

   Resident—An adult, unrelated to the legal entity, who resides in an assisted living residence, and who may require assisted living services or supplemental health care services, or both.

   Resident with mobility needs—An adult who is unable to move from one location to another, has difficulty in understanding and carrying out instructions without the continued full assistance of other individuals or is incapable of independently operating an ambulation device, such as a wheelchair, prosthesis, walker or cane to exit a building.

   Restraint—A manual, chemical or mechanical device used to limit or restrict the movement or normal function of an individual or a portion of the individual’s body.

   SSI—Supplemental Security Income.

   Secretary—The Secretary of the Department.

   Special care designation—A licensed assisted living residence or a distinct part of the residence which is specifically designated by the Department as capable of providing cognitive support services to residents with severe cognitive impairments, including dementia or Alzheimer’s disease, in the least restrictive manner to ensure the safety of the resident and others in the residence while maintaining the resident’s ability to age in place.

   Specialized cognitive support services—These services include the following:

     (i)   Nonpharmacological interventions.

     (ii)   Dining with dignity.

     (iii)   Routines and roles.

     (iv)   Close of day programming.

     (v)   Pain management and person-centered care planning.

     (vi)   Implementation and management.

   Staff person—An individual who works for the assisted living residence for compensation either on payroll or under contract.

   Supplemental health care services—The provision by an assisted living residence of any type of health care service, either directly or through contractors, subcontractors, agents or designated providers, except for any service that is required by law to be provided by a health care facility under the Health Care Facilities Act (35 P. S. § §  448.101—448.901).

   Support plan—A written document that describes for each resident the resident’s care, service or treatment needs based on the assessment of the resident, and when the care, service or treatment will be provided, and by whom.

   Third-party provider—Any contractor, subcontractor, agents or designated providers under contract with the resident or residence to provide services to any resident.

   Transfer—Movement of a resident within the assisted living residence or to a temporary placement outside the assisted living residence.

   Volunteer—

     (i)   An individual who, of his own free will, and without monetary compensation, provides direct care services for residents in the assisted living residence.

     (ii)   The term does not include visitors or individuals who provide nondirect services or entertainment on an occasional basis.

 (a)  The administrator, administrator designee or staff person designated under §  2800.56(c) (relating to administrator staffing) shall provide, upon request, immediate access to the residence, the residents and records to:

   (1)  Agents of the Department.

   (2)  Representatives of the area agency on aging.

   (3)  Representatives of the Long-Term Care Ombudsman Program.

   (4)  Representatives of the protection and advocacy system for individuals with disabilities designated under the Protection and Advocacy for Individual Rights Program of the Vocational Rehabilitation and Rehabilitation Services Act (29 U.S.C.A. §  794e), the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C.A. § §  10801—10851) and the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C.A. § §  15041—15043).

   (5)  The resident’s designated person, if so requested by the resident. The access to records under this paragraph is limited to the records of the resident.

 (b)  The administrator, administrator designee or staff person designated under §  2800.56(c) shall permit community service organizations and representatives of legal services programs to have access to the residence during visitation hours or by appointment for the purpose of assisting or informing the residents of the availability of services and assistance. A resident or a resident’s designated person if so authorized may decline the services of the community service organization or the legal service program.

GENERAL REQUIREMENTS

§ 2800.11. Procedural requirements for licensure or approval of assisted living residences; special care designation and dual licensure.

 (a)  Except for §  20.32 (relating to announced inspections), the requirements in Chapter 20 (relating to licensure or approval of facilities and agencies) apply to assisted living residences.

 (b)  Before a residence is initially licensed and permitted to open, operate or admit residents, it will be inspected by the Department and found to be in compliance with applicable laws and regulations including this chapter. The Department will reinspect newly licensed residences within 3 months of the date of initial licensure.

 (c)  After the Department determines that a residence meets the requirements for a license, the Department’s issuance or renewal of a license to a residence is contingent upon receipt by the Department of the following fees based on the number of beds in the residence, as follows:

   (1)  A $300 license application or renewal fee.

   (2)  A $75 per bed fee that may be adjusted by the Department annually at a rate not to exceed the Consumer Price Index. The Department will publish a notice in the Pennsylvania Bulletin when the per bed fee is increased.

 (d)  A person, organization or program may not use the term ‘‘assisted living’’ in any name or written material, except as a licensee in accordance with this chapter. Corporate entities which own subsidiaries that are licensed as assisted living residences may not use the term ‘‘assisted living’’ in any written material to market programs that are not licensed in accordance with this chapter.

 (e)  Multiple buildings located on the same premises may apply for a single assisted living residence license.

 (f)  A licensed assisted living residence may submit an application and a $150 application fee to the Department requesting special care designation. If the Department determines that the residence meets the requirements for special care designation, the residence will be issued a license indicating special care designation.

 (g)  A licensed personal care home may submit an application to the Department requesting dual licensure if the licensed personal care home and the assisted living residence are collocated in the same building and are each located in a distinct part of the building. If the Department determines that the licensed facility meets all of the requirements of this chapter, the facility will be issued a dual license.

   (1)  A facility that is dually licensed may not segregate residents or transfer residents from one licensed facility to another based on payment source.

 (a)  Appeals related to the licensure or approval of the assisted living residence shall be made in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure (GRAPP)).

 (b)  Appeals related to the licensure or approval of the assisted living residence shall be made by filing a petition within 30 days after service of notice of the action.

 (c)  Subsection (b) supersedes the appeal period of 1 Pa. Code §  35.20 (relating to appeals from actions of the staff).

 (a)  The maximum capacity is the total number of residents who are permitted to reside in the residence at any time. A request to increase the capacity shall be submitted to the Department and other applicable authorities and approved prior to the admission of additional residents. The maximum capacity is limited by physical plant space and other applicable laws and regulations.

 (a)  Prior to issuance of a license under this chapter, a written fire safety approval from the Department of Labor and Industry, the Department of Health or the appropriate local building authority under the Pennsylvania Construction Code Act (35 P. S. § §  7210.101—7210.1103) is required.

 (b)  If the fire safety approval is withdrawn or restricted, the residence shall notify the Department orally immediately, and in writing, within 48 hours of the withdrawal or restriction.

 (c)  If a building is structurally renovated or altered after the initial fire safety approval is issued, the residence shall submit the new fire safety approval, or written certification that a new fire safety approval is not required, from the appropriate fire safety authority. This documentation shall be submitted to the Department within 15 days of the completion of the renovation or alteration.

 (d)  The Department will request additional fire safety inspections by the appropriate agency if possible fire safety violations are observed during an inspection by the Department.

 (a)  The residence shall immediately report suspected abuse of a resident served in the residence in accordance with the Older Adult Protective Services Act (35 P. S. § §  10225.701—10225.707) and 6 Pa. Code § §  15.21—15.27 (relating to reporting suspected abuse, neglect, abandonment or exploitation) and comply with the requirements regarding restrictions on staff persons.

 (b)  If there is an allegation of abuse of a resident involving a residence’s staff person, the residence shall immediately develop and implement a plan of supervision or suspend the staff person involved in the alleged incident.

 (c)  The residence shall immediately submit to the Department’s assisted living residence office a plan of supervision or notice of suspension of the affected staff person.

 (d)  The residence shall immediately notify the resident and the resident’s designated person of a report of suspected abuse or neglect involving the resident.

 (a)  A reportable incident or condition includes the following:

   (1)  The death of a resident.

   (2)  A physical act by a resident to commit suicide.

   (3)  An injury, illness or trauma requiring treatment at a hospital or medical facility. This does not include minor injuries such as sprains or minor cuts.

   (4)  A violation of a resident’s rights in § §  2800.41—2800.44 (relating to resident rights).

   (5)  An unexplained absence of a resident for 24 hours or more, or when the support plan so provides, a period of less than 24 hours, or an absence of a resident from a special care unit.

   (6)  Misuse of a resident’s funds by the residence’s staff persons or legal entity.

   (7)  An outbreak of a serious communicable disease as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions).

   (8)  Food poisoning of residents.

   (9)  A physical or sexual assault by or against a resident.

   (10)  Fire or structural damage to the residence.

   (11)  An incident requiring the services of an emergency management agency, fire department or law enforcement agency, except for false alarms.

   (12)  A complaint of resident abuse, suspected resident abuse or referral of a complaint of resident abuse to a local authority.

   (13)  A prescription medication error as defined in §  2800.188 (relating to medication errors).

   (14)  An emergency in which the procedures under §  2800.107 (relating to emergency preparedness) are implemented.

   (15)  An unscheduled closure of the residence or the relocation of the residents.

   (16)  Bankruptcy filed by the legal entity.

   (17)  A criminal conviction against the legal entity, administrator or staff that is subsequent to the reporting on the criminal history checks under §  2800.51 (relating to criminal history checks).

   (18)  A termination notice from a utility.

   (19)  A violation of the health and safety laws under §  2800.18 (relating to applicable laws).

   (20)  An absence of staff so that residents receive inadequate care as defined by the respective resident’s support plan.

 (b)  The residence shall develop and implement written policies and procedures on the prevention, reporting, notification, investigation and management of reportable incidents and conditions.

 (c)  The residence shall report the incident or condition to the Department’s assisted living residence office or the assisted living residence complaint hotline within 24 hours in a manner designated by the Department. The residence shall immediately report the incident or condition to the resident’s family and the resident’s designated person. Abuse reporting must also follow the guidelines in §  2800.15 (relating to abuse reporting covered by law).

 (d)  The residence shall submit a final report, on a form prescribed by the Department, to the Department’s assisted living residence office immediately following the conclusion of the investigation.

 (e)  If the residence’s final report validates the occurrence of the alleged incident or condition, the affected resident and other residents who could potentially be harmed or his designated person shall also be informed immediately following the conclusion of the investigation.

 A residence shall comply with applicable Federal, State and local laws, ordinances and regulations.

 (a)  A residence may submit a written request for a waiver of a specific requirement contained in this chapter. The waiver request must be on a form prescribed by the Department. The Secretary, or the Secretary’s appointee, may grant a waiver of a specific requirement of this chapter if the following conditions are met:

   (1)  There is no jeopardy to the residents.

   (2)  There is an alternative for providing an equivalent level of health, safety and well-being protection of the residents.

   (3)  Residents will benefit from the waiver of the requirement.

 (b)  Following receipt of a waiver request, the Department will post the waiver request on the Department’s website with a 30-day public comment period prior to final review and decision on the requested waiver.

 (c)  The scope, definitions, applicability or residents’ rights, assisted living service delivery requirements, special care designation requirements, staff training requirements, disclosure requirements, complaint rights or procedures, notice requirements to residents or the resident’s family, contract requirements, reporting requirements, fire safety requirements, assessment, support plan or service delivery requirements under this chapter may not be waived.

 (d)  At least 30 days prior to the submission of the completed written waiver request to the Department, the residence shall provide a copy of the completed written waiver request to the affected resident and designated person to provide the opportunity to submit comments to the Department. The residence shall provide the affected resident and designated person with the name, address and telephone number of the Department staff person to submit comments.

 (e)  The residence shall discuss the waiver request with the affected resident and designated person upon the request of the resident or designated person.

 (f)  The residence shall notify the affected resident and designated person of the approval or denial of the waiver. A copy of the waiver request and the Department’s written decision shall be posted in a conspicuous and public place within the residence.

 (a)  A resident may manage his personal finances unless the resident has a guardian of his estate.

 (b)  If the residence provides assistance with financial management or holds resident funds, the following requirements apply:

   (1)  The residence shall keep a record of financial transactions with the resident, including the dates, amounts of deposits, amounts of withdrawals and the current balance.

   (2)  Resident funds shall be disbursed during normal business hours within 24 hours of the resident’s request.

   (3)  The residence shall obtain a written receipt from the resident for cash disbursements at the time of disbursement.

   (4)  Resident funds and property shall only be used for the resident’s benefit.

   (5)  Commingling of resident funds and residence funds is prohibited.

   (6)  If a residence is holding more than $200 for a resident for more than 2 consecutive months, the administrator shall notify the resident and offer assistance in establishing an interest-bearing account in the resident’s name at a local Federally-insured financial institution. This does not include security deposits.

   (7)  The legal entity, administrator and staff persons of the residence are prohibited from being assigned power of attorney or guardianship of a resident or a resident’s estate.

   (8)  The residence shall give the resident and the resident’s designated person, an itemized account of financial transactions made on the resident’s behalf on a quarterly basis.

   (9)  A copy of the itemized account shall be kept in the resident’s record.

   (10)  The residence shall provide the resident the opportunity to review his own financial record upon request during normal business hours.

 (a)  Documentation. The following admission documents shall be completed for each resident:

   (1)  Medical evaluation completed within 60 days prior to admission on a form specified by the Department. The medical evaluation may be completed within 15 days after admission if one of the following conditions applies:

     (i)   The resident is being admitted directly to the residence from an acute care hospital.

     (ii)   The resident is being admitted to escape from an abusive situation.

     (iii)   The resident has no alternative living arrangement.

   (2)  Assisted living resident initial assessment completed within 30 days prior to admission on a form specified by the Department. The initial assessment may be completed within 15 days after admission subject to §  2800.224 (relating to initial assessment and preliminary support plan).

   (3)  Preliminary support plan developed within 30 days prior to admission. The preliminary support plan may be completed within 15 days after admission if one of the following conditions applies:

     (i)   The resident is being admitted directly to the residence from an acute care hospital.

     (ii)   The resident is being admitted to escape from an abusive situation.

     (iii)   The resident has no alternative living arrangement.

   (4)  Final support plan is developed and implemented within 30 days after admission.

   (5)  Resident-residence contract is completed prior to admission or within 24 hours after admission.

   (6)  Medical evaluations, resident assessments and support plans may be subsequently updated as needed, but no less frequently than required in § §  2800.225 and 2800.227 (relating to additional assessments; and development of the final support plan).

 (b)  Certification.

   (1)  A certification shall be made, prior to admission, that the needs of the potential resident can be met by the services provided by the residence.

   (2)  The certification shall be made by one of the following persons:

     (i)   The administrator acting in consultation with the supplemental health care providers.

     (ii)   The individual’s physician or certified registered nurse practitioner.

     (iii)   The medical director of the residence.

   (3)  A potential resident whose needs cannot be met by the residence shall be provided with a written decision denying his admission and provide a basis for the denial. The decision shall be confidential and may only be released with the consent of the potential resident or his designated person. The potential resident shall then be referred to a local appropriate assessment agency.

 (c)  Supplemental health care. A potential resident who requires assisted living services but does not currently require assistance in obtaining supplemental health care services may be admitted to the residence, provided the resident is only provided supplemental health care services required or requested by the resident. When supplemental health care services are required, the residence shall develop a preliminary support plan as required in §  2800.224. This subsection applies to residents under any of the following circumstances:

   (1)  A resident who currently does not require assistance in obtaining supplemental health care services, but who may require supplemental health care services in the future.

   (2)  A resident who wishes to obtain assistance in obtaining supplemental health care services.

   (3)  A resident who resides in a residence in which supplemental health care services are available.

 (d)  Adults requiring services of a long-term care nursing facility. Adults requiring the services of a licensed long-term care nursing facility, including those with mobility needs, may reside in a residence, provided that appropriate supplemental health care services are provided those residents and the design, construction, staffing and operation of the residence allows for their safe emergency evacuation.

 (e)  Written disclosure. Upon application for residency and prior to admission to the residence, the licensee shall provide each potential resident or potential resident’s designated person with written disclosures that include:

   (1)  A list of the nonwaivable resident rights.

   (2)  A copy of the contract the resident will be asked to sign.

   (3)  A copy of residence rules and resident handbook. The resident handbook shall be approved by the Department.

   (4)  Specific information about the following:

     (i)   The services and the core packages that are offered by the residence.

     (ii)   The cost of those services and of the core packages to the potential resident.

     (iii)   When a potential resident may require the services offered in a different core package.

     (iv)   The contact information for the Department.

     (v)   The licensing status of the most recent inspection reports and instructions for access to the Department’s public website for information on the residence’s most recent inspection reports.

     (vi)   The number of living units in the residence that comply with the Americans with Disabilities Act (42 U.S.C.A. § §  12101—12213).

     (vii)   Disclosure of any waivers that have been approved for the residence and are still in effect.

 (a)  A residence shall provide each resident with assistance with ADLs and appropriate cueing for ADLs as indicated in the resident’s assessment and support plan.

 (b)  A residence shall provide each resident with assistance with IADLs and appropriate cueing for IADLs as indicated in the resident’s assessment and support plan.

 A residence shall provide the resident with assistance with personal hygiene and appropriate cueing to encourage personal hygiene as indicated in the resident’s assessment and support plan. Personal hygiene includes one or more of the following:

   (1)  Bathing.

   (2)  Oral hygiene.

   (3)  Hair grooming and shampooing.

   (4)  Dressing, undressing and care of clothes.

   (5)  Shaving.

   (6)  Nail care.

   (7)  Foot care.

   (8)  Skin care.

 (a)  Prior to admission, or within 24 hours after admission, a written resident-residence contract between the resident and the residence must be in place. The administrator or a designee shall complete this contract and review and explain its contents to the resident and the resident’s designated person if any, prior to signature.

 (b)  The contract shall be signed by the administrator or a designee, the resident and the payer, if different from the resident, and cosigned by the resident’s designated person if any, if the resident agrees. The contract must run month-to-month with automatic renewal unless terminated by the resident with 14 days notice or by the residence with 30 days notice in accordance with §  2800.228 (relating to transfer and discharge).

 (c)  At a minimum, the contract must specify the following:

   (1)  Each resident shall retain, at a minimum, the current personal needs allowance as the resident’s own funds for personal expenditure. A contract to the contrary is not valid. A personal needs allowance is the amount that a resident shall be permitted to keep for his personal use.

   (2)  A fee schedule that lists the actual amount of charges for each of the assisted living services that are included in the resident’s core service package in accordance with §  2800.220 (relating to service provision).

   (3)  An explanation of the annual assessment, medical evaluation and support plan requirements and procedures, which shall be followed if either the assessment or the medical evaluation indicates the need for another and more appropriate level of care.

   (4)  The party responsible for payment.

   (5)  The method for payment of charges for long distance telephone calls.

   (6)  The conditions under which refunds will be made, including the refund of admission fees and refunds upon a resident’s death.

   (7)  The financial arrangements if assistance with financial management is to be provided.

   (8)  The residence’s rules related to residence services, including whether the residence permits smoking.

   (9)  The conditions under which the resident-residence contract may be terminated including residence closure as specified in §  2800.228.

   (10)  A statement that the resident is entitled to at least 30 days advance notice, in writing, of the residence’s request to change the contract.

   (11)  A list of assisted living services or supplemental health care services, or both, to be provided to the resident based on the outcome of the resident’s support plan, a list of the actual rates that the resident will be periodically charged for food, shelter and services and how, when and by whom payment is to be made.

   (12)  Charges to the resident for holding a bed during hospitalization or other extended absence from the residence.

   (13)  Written information on the resident’s rights and complaint procedures as specified in §  2800.41 (relating to notification of rights and complaint procedures).

 (d)  A residence may not seek or accept payments from an SSI resident in excess of one-half of any funds received by the resident under the Senior Citizens Rebate and Assistance Act (72 P. S. § §  4751-1—4751-12). If the residence will be assisting the resident to manage a portion of the rent rebate, the requirements of §  2800.20 (relating to financial management) may apply. There may be no charge for filling out this paperwork.

 (e)  The resident-residence contract must include whether the residence collects a portion of a resident’s rent rebate under subsection (d).

 (f)  If the residence collects a resident’s rent rebate under subsection (e), the resident-residence contract must include the following:

   (1)  The dollar amount or percentage of the rent rebate to be collected.

   (2)  The residence’s intended use of the revenue collected from the rent rebate.

 (g)  A statement signed by the resident, and the resident’s designated person if applicable, at the time of admission, informing the resident that the information required in subsections (e) and (f) is to be kept in the resident’s record.

 (h)  The resident, or a designated person, has the right to rescind the contract for up to 72 hours after the initial dated signature of the contract. The resident shall pay only for the services received. Rescission of the contract must be in writing addressed to the residence.

 (i)  The residence may not require or permit a resident to assign assets to the residence in return for a life care contract/guarantee. A life care contract/guarantee is an agreement between the legal entity and the resident that the legal entity will provide care to the resident for the duration of the resident’s life. Continuing care communities that have obtained a Certificate of Authority from the Insurance Department and have provided a copy of the certificate to the Department are exempt from this requirement.

 (j)  A copy of the signed resident-residence contract shall be given to the resident and a copy shall be filed in the resident’s record.

 (k)  The service needs addressed in the resident’s support plan shall be available to the resident every day of the year.

 (l)  The resident-residence contract shall identify the assisted living services included in the core service package the individual is purchasing and the total price for those services. Supplemental health care services shall be packaged, contracted and priced separately from the resident-residence contract. Services provided by or contracted for by the residence other than supplemental health care services must be priced separately from the service package in the resident-residence contract.

 (a)  The residence shall establish and implement a quality management plan.

 (b)  The quality management plan must address the periodic review and evaluation of the following, to assure compliance with law and with the relevant standard of care:

   (1)  The reportable incident and condition reporting procedures.

   (2)  Complaint procedures.

   (3)  Staff person training.

   (4)  Licensing violations and plans of correction, if applicable.

   (5)  Resident or family councils, or both, if applicable.

 (a)  If a residence agrees to admit a resident eligible for SSI benefits, the residence’s charges for actual rent and other services may not exceed the SSI resident’s actual current monthly income reduced by the current personal needs allowance.

 (b)  The administrator or staff persons may not include funds received as lump sum awards, gifts or inheritances, gains from the sale of property or retroactive government benefits when calculating payment of rent for an SSI recipient or for a resident eligible for SSI benefits.

 (c)  The administrator or staff persons may not seek or accept any payments from funds received as retroactive awards of SSI benefits, but may seek and accept the payments only to the extent that the retroactive awards cover periods of time during which the resident actually resided in the residence and for which full payment has not been received.

 (d)  The administrator shall provide each resident who is a recipient of SSI, at no charge beyond the amount determined in subsection (a), the following items or services as needed:

   (1)  Necessary personal hygiene items, such as a comb, toothbrush, toothpaste, soap and shampoo. Cosmetic items are not included.

   (2)  Laundry services for personal laundry, bed linens and towels, but not including dry cleaning or other specialized services.

   (3)  Assistance or supervision in ADL or IADL, or both.

 (e)  Third-party payments made on behalf of an SSI recipient and paid directly to the residence are permitted. These payments may not be used for food, clothing or shelter because to do so would reduce SSI payments. See 20 CFR 416.1100 and 416.1102 (relating to income and SSI eligibility; and what is income). These payments may be used to purchase items or services for the resident that are not food, clothing or shelter.

 (a)  If, after the residence gives notice of transfer or discharge in accordance with §  2800.228(b) (relating to transfer and discharge), and the resident moves out of the residence before the 30 days are over, the residence shall give the resident a refund equal to the previously paid charges for rent, assisted living services and supplemental health care services, if applicable, for the remainder of the 30-day time period. The refund shall be issued within 30-days of transfer or discharge. The resident’s personal needs allowance shall be refunded within 2 business days of transfer or discharge.

 (b)  After a resident gives notice of the intent to leave in accordance with §  2800.25(b) (relating to resident-residence contract) and if the resident moves out of the residence before the expiration of the required 14 days, the resident owes the residence the charges for rent and assisted living services and supplemental health care services, or both, for the entire length of the 14-day time period for which payment has not been made.

 (c)  If no notice is required, as set forth in subsection (d), the resident shall be required to pay only for the nights spent in the residence.

 (d)  If the residence does not require a written notice prior to a resident’s departure, the administrator shall refund the remainder of previously paid charges to the resident within 30 days of the date the resident moved from the residence.

 (e)  In the event of the death of a resident under 60 years of age, the administrator shall refund the remainder of previously paid charges to the resident’s estate within 30 days from the date the living unit is cleared of the resident’s personal property. In the event of the death of a resident 60 years of age and older, the residence shall provide a refund in accordance with the Elder Care Payment Restitution Act (35 P. S. § §  10226.101—10226.107). The residence shall keep documentation of the refund in the resident’s record.

 (f)  Within 30 days of either the termination of service by the residence or the resident’s leaving the residence, the resident shall receive an itemized written account of the resident’s funds, including notification of funds still owed the residence by the resident or a refund owed the resident by the residence. Refunds shall be made within 30 days of discharge.

 (a)  Initiation of process.

   (1)  When a licensee determines that a competent resident’s decision, behavior or action creates a dangerous situation and places the competent resident, other residents or staff members at risk of harm by the competent resident’s wish to exercise independence in directing the manner in which the competent resident receives care, the licensee may initiate an informed consent process to address the identified risk and to reach a mutually agreed-upon plan of action with the competent resident or the resident’s designated person. The initiation of an informed consent process does not guarantee that an informed consent agreement, which is agreeable to all parties, will be reached and executed.

   (2)  When a competent resident wishes to exercise independence in directing the manner in which the competent resident receives care, the competent resident may initiate an informed consent process to modify the support plan and attempt to reach a mutually agreed upon plan of action with the licensee.

   (3)  An incompetent resident shall be eligible for an informed consent agreement only if the resident’s legal representative is included in the negotiation of the informed consent agreement and executes the agreement.

 (b)  Notification.

   (1)  When the licensee chooses to initiate an informed consent process, the provider shall do so by notifying the competent resident and, if applicable, the resident’s designated person in writing and orally. The notification must include the contact information for the ombudsman. For incompetent residents, the ombudsman shall be automatically notified by the licensee. Notification shall be documented in the resident’s file by the licensee.

   (2)  When a competent resident chooses to initiate an informed consent negotiation, the competent resident shall do so by notifying the licensee in writing and orally. Notification shall be documented in the competent resident’s file by the licensee. When a legal representative for an incompetent resident chooses to initiate an informed consent negotiation, the legal representative shall do so by notifying the licensee in writing or orally. Notification shall be documented in the incompetent resident’s file by the licensee.

 (c)  Resident’s involvement. A resident who is not incompetent shall be entitled, but is not required, to involve his legal representative and physician, and any other individual the competent resident wants involved, to participate or assist in the discussion of the competent resident’s wish to exercise independence and, if necessary, in developing a satisfactory informed consent agreement that balances the competent resident’s choices and capabilities with the possibility that the choices will place the resident, other residents or staff members at risk of harm.

 (d)  Informed consent meeting.

   (1)  In a manner the competent resident can understand, the licensee shall discuss the competent resident’s wish to exercise independence in directing the manner in which he receives care. The discussion must relate to the decision, behavior or action that places the competent resident, other residents or staff members at risk of harm and hazards inherent in the resident’s action. The discussion must include reasonable alternatives, if any, for mitigating the risk, the significant benefits and disadvantages of each alternative and the most likely outcome of each alternative. In the case of an incompetent resident, the incompetent resident’s legal representative shall participate in the discussion.

   (2)  A resident may not have the right to place other residents or staff members at risk, but, consistent with statutory and regulatory requirements, may elect to proceed with a decision, behavior or action affecting only his own safety or health status, foregoing alternatives for mitigating the risk, after consideration of the benefits and disadvantages of the alternatives including his wish to exercise independence in directing the manner in which he receives care. The licensee shall evaluate whether the competent resident understands and appreciates the nature and consequences of the risk, including the significant benefits and disadvantages of each alternative considered, and then shall further ascertain whether the competent resident is consenting to accept or mitigate the risk with full knowledge and forethought.

 (e)  Successful negotiation. If the parties agree, the informed consent agreement shall be reduced to writing and signed by all parties, including all individuals engaged in the negotiation at the request of the competent resident, and shall be retained in the resident’s file as part of the service plan.

 (f)  Unsuccessful negotiation. If the parties do not agree, the licensee shall notify the resident, the resident’s legal representative and the individuals engaged in the informed consent negotiation at the request of the resident. The residence shall include contact information on the local ombudsman or the appropriate advocacy organization and whether the licensee will issue a notice of discharge.

 (g)  Freedom from duress. An informed consent agreement must be voluntary and free of force, fraud, deceit, duress, coercion or undue influence, provided that a licensee retains the right to issue a notice of involuntary discharge in the event a resident’s decision, behavior or action creates a dangerous situation and places other residents or staff members at risk of harm and, after a discussion of the risk, the resident declines alternatives to mitigate the risk.

 (h)  Individualized nature. An informed consent agreement must be unique to the resident’s situation and his wish to exercise independence in directing the manner in which he receives care. The informed consent agreement shall be utilized only when a resident’s decision, behavior or action creates a situation and places the resident, other residents or staff members at risk of harm. A licensee may not require execution of an informed consent agreement as a standard condition of admission.

 (i)  Liability. Execution of an informed consent agreement does not constitute a waiver of liability beyond the scope of the agreement or with respect to acts of negligence, tort, products defect, breach of fiduciary duty, contract violation, or any other claim or cause of action. An informed consent agreement does not relieve a licensee of liability for violation of statutory or regulatory requirements promulgated under this chapter nor does it affect the enforceability of regulatory provisions including those provisions governing admission or discharge or the permissible level of care in an assisted living residence.

 (j)  Change in resident’s condition. An informed consent agreement must be updated following a significant change in the resident’s condition that affects the risk potential to the resident, other residents or staff members.

 (k)  Either party has a right to rescind the informed consent agreement within 30 days of execution of the agreement.

   This section cited in 55 Pa. Code Appendix A (relating to assisted living resident rights: during residency and during discharge or termination of residency).

RESIDENT RIGHTS

§ 2800.41. Notification of rights and complaint procedures.

 (a)  Upon admission, each resident and, if applicable, the resident’s designated person, shall be informed of resident rights and the right to lodge complaints without intimidation, retaliation or threats of retaliation by the residence or its staff persons against the reporter. Retaliation includes transfer or discharge from the residence.

 (b)  Notification of rights and complaint procedures shall be communicated in an easily understood manner and in a language understood by or mode of communication used by the resident and, if applicable, the resident’s designated person.

 (c)  The Department’s poster of the list of resident’s rights shall be posted in a conspicuous and public place in the residence.

 (d)  A copy of the resident’s rights and complaint procedures shall be given to the resident and, if applicable, the resident’s designated person, upon admission.

 (e)  A statement signed by the resident and, if applicable, the resident’s designated person acknowledging receipt of a copy of the information specified in subsection (d), or documentation of efforts made to obtain signature, shall be kept in the resident’s record.

 (a)  A resident may not be discriminated against because of race, color, religious creed, disability, ancestry, sexual orientation, national origin, age or sex.

 (b)  A resident may not be neglected, intimidated, physically or verbally abused, mistreated, subjected to corporal punishment or disciplined in any way. A resident must be free from mental, physical, and sexual abuse and exploitation, neglect, financial exploitation and involuntary seclusion.

 (c)  A resident shall be treated with dignity and respect.

 (d)  A resident shall be informed of the rules of the residence and given 30 days’ written notice prior to the effective date of a new residence rule.

 (e)  A resident shall have access to a telephone in the residence to make calls in privacy. Nontoll calls must be without charge to the resident.

 (f)  A resident has the right to receive and send mail.

   (1)  Outgoing mail may not be opened or read by staff persons unless the resident requests.

   (2)  Incoming mail may not be opened or read by staff persons unless upon the request of the resident or the resident’s designated person.

 (g)  A resident has the right to communicate privately with and access the local ombudsman.

 (h)  A resident has the right to practice the religion or faith of the resident’s choice, or not to practice any religion or faith.

 (i)  A resident shall receive assistance in accessing health care services, including supplemental health care services.

 (j)  A resident shall receive assistance in obtaining and keeping clean, seasonal clothing. A resident’s clothing may not be shared with other residents.

 (k)  A resident and the resident’s designated person, and other individuals upon the resident’s written approval shall have the right to access, review and request corrections to the resident’s record.

 (l)  A resident has the right to furnish his living unit and purchase, receive, use and retain personal clothing and possessions.

 (m)  A resident has the right to leave and return to the residence at times consistent with the residence rules and the resident’s support plan.

 (n)  A resident has the right to relocate and to request and receive assistance, from the residence, in relocating to another facility. The assistance must include helping the resident get information about living arrangements, making telephone calls and transferring records.

 (o)  A resident has the right to freely associate, organize and communicate privately with his friends, family, physician, attorney and other persons.

 (p)  A resident shall be free from restraints.

 (q)  A resident shall be compensated in accordance with State and Federal labor laws for labor performed on behalf of the residence. Residents may voluntarily and without coercion perform tasks related directly to the resident’s personal space or common areas of the residence.

 (r)  A resident has the right to receive visitors at any time provided that the visits do not adversely affect other residents. A residence may adopt reasonable policies and procedures related to visits and access. If the residence adopts those policies and procedures, they will be binding on the residence.

 (s)  A resident has the right to privacy of self and possessions. Privacy shall be provided to the resident during bathing, dressing, changing and medical procedures.

 (t)  A resident has the right to file complaints, grievances or appeals with any individual or agency and recommend changes in policies, residence rules and services of the residence without intimidation, retaliation or threat of discharge.

 (u)  A resident has the right to remain in the residence, as long as it is operating with a license, except as specified in §  2800.228 (relating to transfer and discharge).

 (v)  A resident has the right to receive services contracted for in the resident-residence contract.

 (w)  A resident has the right to use both the residence’s procedures and external procedures to appeal involuntary discharge.

 (x)  A resident has the right to a system to safeguard a resident’s money and property.

 (y)  To the extent prominently displayed in the written resident-residence contract, a residence may require residents to use providers of supplemental health care services as provided in §  2800.142 (relating to assistance with medical care and supplemental health care services). When the residence does not designate, the resident may choose the supplemental health care service provider. The actions and procedures utilized by a supplemental health care service provider chosen by a resident must be consistent with the residence’s systems for caring for residents. This includes the handling and assisting with the administration of resident’s medications, and may not conflict with Federal laws governing residents.

 (z)  The resident has the right to choose his primary care physician.

 (a)  A resident may not be deprived of his rights.

 (b)  A resident’s rights may not be used as a reward or sanction.

 (c)  Waiver of any resident right shall be void.

 (a)  Prior to admission, the residence shall inform the resident and the resident’s designated person of the right to file and the procedure for filing a complaint with the Department’s Assisted Living Residence Licensing Office, local ombudsman or protective services unit in the area agency on aging, the Disability Rights Network or law enforcement agency.

 (b)  The residence shall permit and respond to oral and written complaints from any source regarding an alleged violation of resident rights, quality of care or other matter without retaliation or the threat of retaliation.

 (c)  If a resident indicates that he wishes to make a written complaint, but needs assistance in reducing the complaint to writing, the residence shall assist the resident in writing the complaint.

 (d)  The residence shall ensure investigation and resolution of complaints. The residence shall designate the staff person responsible for receiving complaints and determining the outcome of the complaint. The residence shall keep a log of all complaints and the outcomes of the complaints.

 (e)  Within 2 business days after the submission of a written complaint, a status report shall be provided by the residence to the complainant. If the resident is not the complainant, the resident and the resident’s designated person shall receive the status report unless contraindicated by the support plan. The status report must indicate the steps that the residence is taking to investigate and address the complaint.

 (f)  Within 7 days after the submission of a written complaint, the residence shall give the complainant and, if applicable, the designated person, a written decision explaining the residence’s investigation findings and the action the residence plans to take to resolve the complaint. If the resident is not the complainant, the affected resident shall receive a copy of the decision unless contraindicated by the support plan. If the residence’s investigation validates the complaint allegations, a resident who could potentially be harmed or his designated person shall receive a copy of the decision, with the name of the affected resident removed, unless contraindicated by the support plan.

 (g)  The telephone number of the Department’s Assisted Living Residence Licensing Office, the local ombudsman or protective services unit in the area agency on aging, the Disability Rights Network, the local law enforcement agency, the Commonwealth Information Center and the assisted living residence complaint hotline shall be posted in large print in a conspicuous and public place in the residence.

 (h)  Nothing in this section may affect in any way the right of the resident to file suit or claim for damages.

   This section cited in 55 Pa. Code §  2800.16 (relating to reportable incidents and conditions); and 55 Pa. Code Appendix A (relating to assisted living resident rights: during residency and during discharge or termination of residency).

STAFFING

§ 2800.51. Criminal history checks.

 (a)  Criminal history checks shall be in accordance with the Older Adult Protective Services Act (35 P. S. § §  10225.101—10225.5102), and 6 Pa. Code Chapter 15 (relating to protective services for older adults).

 (b)  The hiring policies shall be in accordance with the Department of Aging’s Older Adult Protective Services Act policy as posted on the Department of Aging’s web site.

 (a)  The administrator shall have one of the following qualifications:

   (1)  A license as an RN from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.

   (2)  An associate’s degree or 60 credit hours from an accredited college or university in a human services field and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.

   (3)  An associate’s degree or 60 credit hours from an accredited college or university in a field that is not related to human services and 2 years, in the prior 10 years, of direct care or administrative experience in a health care or human services field.

   (4)  A license as an LPN from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.

   (5)  A license as a nursing home administrator from the Department of State and 1 year, in the prior 10 years, of direct care or administrative experience in a health care or human services field.

   (6)  With the exception of administrators qualified under §  2600.53(a)(5) (relating to qualifications and responsibilities of administrators), experience as a personal care home administrator, if the following requirements are met:

     (i)   Employed as a personal care home administrator for 2 years prior to January 18, 2011.

     (ii)   Completed the administrator training requirements and pass the Department-approved competency-based training test in §  2800.64 (relating to administrator training and orientation) by January 18, 2012.

 (b)  The administrator shall be 21 years of age or older.

 (c)  The administrator shall be responsible for the administration and management of the residence, including the health, safety and well-being of the residents, implementation of policies and procedures and compliance with this chapter.

 (d)  The administrator shall have the ability to provide assisted living services or to supervise or direct the work to provide assisted living services.

 (e)  The administrator shall have knowledge of this chapter.

 (f)  The administrator shall have the ability to comply with applicable laws, rules and regulations, including this chapter.

 (g)  The administrator shall have the ability to maintain or supervise the maintenance of financial and other records.

 (h)  At all times the administrator shall be free from a medical condition, including drug or alcohol addiction that would limit the administrator from performing duties with reasonable skill and safety.

 (a)  Direct care staff persons shall have the following qualifications:

   (1)  Be 18 years of age or older, except as permitted in subsection (d).

   (2)  Have a high school diploma, GED or active registry status on the Pennsylvania nurse aide registry.

   (3)  Be free from a medical condition, including drug or alcohol addiction, that would limit direct care staff persons from providing necessary assisted living services with reasonable skill and safety.

   (4)  Be able to communicate in a mode or manner understood by the resident. Strategies that promote interactive communication on the part of direct care staff and individual residents shall be developed in accordance with the resident’s final support plan under §  2800.227(e) (relating to development of the final support plan).

 (b)  A volunteer who performs or provides ADLs shall meet the direct staff person qualifications and training requirements specified in this chapter.

 (c)  A resident receiving assisted living services who voluntarily performs tasks in the residence will not be considered a volunteer under this chapter.

 (d)  Food services or housekeeping staff may be 16 or 17 years of age.

 (a)  Except for temporary absences under subsection (b), the administrator shall be present in the residence an average of 36 hours or more per week, in each calendar month. At least 30 hours per week must be during normal business hours.

 (b)  If the administrator is unavailable to meet the hourly requirements in subsection (a) due to a temporary absence, the administrator shall assign an administrator designee in writing to supervise the residence during the administrator’s temporary absence. The administrator designee shall meet the following requirements:

   (1)  Have 3,000 hours of direct operational responsibility for a senior housing facility, health care facility, residential care facility, adult daily living facility or other group home licensed or approved by the Commonwealth.

   (2)  Pass the Department-approved competency-based administrator training test under §  2800.64(a)(3) (relating to administrator training and orientation.)

   (3)  Meet the qualification and training requirements of a direct care staff person under § §  2800.54 and 2800.65 (relating to qualifications for direct care staff persons; and staff orientation and direct care staff person training and orientation).

 (c)  The administrator shall assign a staff person in writing to supervise the residence during the administrator’s or administrator designee’s absence. The staff person shall meet the qualification and training requirements of a direct care staff person under § §  2800.54 and 2800.65.

 (d)  During the administrator’s and administrator designee’s absence, the administrator or administrator designee shall be on-call.

 (a)  At all times one or more residents are present in the residence, a direct care staff person who is 21 years of age or older shall be present in the residence. The direct care staff person may be the administrator if the administrator provides direct care services.

 (b)  Direct care staff persons shall be available to provide at least 1 hour per day of assisted living services to each mobile resident.

 (c)  Direct care staff persons shall be available to provide at least 2 hours per day of assisted living services to each resident who has mobility needs.

 (d)  At least 75% of the assisted living service hours specified in subsections (b) and (c) shall be available during waking hours.

 (a)  Staffing shall be provided to meet the needs of the residents as specified in the resident’s assessment and support plan. Residence staff or service providers who provide services to the residents in the residence shall meet the applicable professional licensure requirements.

 (b)  The staffing level in this chapter is minimum only. The Department may require additional staffing as necessary to protect the health, safety and well-being of the residents. Requirements for additional staffing will be based on the resident’s assessment and support plan, the design and construction of the residence and the operation and management of the residence.

 (c)  Additional staff hours, or contractual hours, shall be provided as necessary to meet the transportation, laundry, food service, housekeeping and maintenance needs of the residents.

 (d)  In addition to the staffing requirements in this chapter, the residence shall have a licensed nurse available in the building or on call at all times. The licensed nurse shall be either an employee of the residence or under contract with the residence.

 (a)  For every 35 residents, there shall be at least one staff person trained in first aid and certified in obstructed airway techniques and CPR present in the residence at all times to meet the needs of the residents.

 (b)  Current training in first aid and certification in obstructed airway techniques and CPR shall be provided by an individual certified as a trainer by a hospital or other recognized health care organization.

 (c)  Licensed, certified and registered medical personnel meet the qualifications in subsection (a) and are exempt from the training requirements in subsections (a) and (b).

 (d)  A staff person who is trained in first aid or certified in obstructed airway techniques or CPR shall provide those services in accordance with his training, unless the resident has a do not resuscitate order.

 (a)  Prior to initial employment as an administrator, a candidate shall successfully complete the following:

   (1)  An orientation program approved and administered by the Department.

   (2)  A 100-hour standardized Department-approved administrator training course. The training provided for in §  2800.69 (relating to additional dementia-specific training) shall be in addition to the 100-hour training course.

   (3)  A Department-approved competency-based training test with a passing score.

 (b)  The standardized Department-approved administrator training course specified in subsection (a)(2) must include the following:

   (1)  Fire prevention and emergency preparedness.

   (2)  Medication procedures, medication effects and side effects, universal precautions and personal hygiene.

   (3)  Certification in CPR and obstructed airway techniques and training in first aid.

   (4)  Assisted living services.

   (5)  Local, State and Federal laws and regulations pertaining to the operation of a residence.

   (6)  Nutrition, food handling and sanitation.

   (7)  Recreation.

   (8)  Care for residents with mental illness.

   (9)  Resident rights.

   (10)  Care for residents with cognitive and neurological impairments and other special needs.

   (11)  Care for residents with mental retardation.

   (12)  Community resources, social services and activities in the community.

   (13)  Staff supervision and staff person training including developing orientation and training guidelines for staff.

   (14)  Budgeting, financial recordkeeping and resident records including:

     (i)   Writing, completing and implementing initial assessments, annual assessments and support plans.

     (ii)   Resident-residence contracts.

   (15)  Gerontology.

   (16)  Abuse and neglect prevention and reporting.

   (17)  Cultural competency.

   (18)  Infection control.

   (19)  Training specific to the resident composition.

   (20)  Training on person-centered care, informed consent, aging in place and the availability of services to support aging in place.

   (21)  Incident management and incident reporting.

   (22)  The requirements of this chapter.

 (c)  An administrator shall have at least 24 hours of annual training relating to the job duties. The Department-approved administrator training course specified in subsection (a) fulfills the annual training requirement for the first year.

 (d)  Annual training shall be provided by Department-approved training sources listed in the Department’s assisted living residence training resource directory or by an accredited college or university, courses approved for credit by National Continuing Education Review Service/National Association of Boards of Examiners of Long-Term Care Administrators or the Bureau of Professional and Occupational Affairs in the Department of State.

 (e)  An administrator who has successfully completed the training in subsections (a)—(d) shall provide written verification of successful completion to the Department’s Assisted Living Residence Licensing Office.

 (f)  A record of training including the individual trained, date, source, content, length of each course and copies of certificates received shall be kept.

 (g)  A licensed nursing home administrator who is employed as an administrator prior to January 18, 2011, is exempt from the qualification and training requirements under this section and §  2800.53 (relating to qualifications and responsibilities of administrators) if the administrator continues to meet the applicable licensing requirements. A licensed nursing home administrator hired as an administrator after January 18, 2011, shall complete and pass the Department-approved assisted living administrator competency-based test.

 (a)  Prior to or during the first work day, direct care staff persons and other staff persons including ancillary staff persons, substitute personnel and volunteers shall have an orientation in general fire safety and emergency preparedness that includes the following:

   (1)  Evacuation procedures.

   (2)  Staff duties and responsibilities during fire drills, as well as during emergency evacuation, transportation and at an emergency location, if applicable.

   (3)  The designated meeting place outside the building or within the fire-safe area in the event of an actual fire.

   (4)  Smoking safety procedures, the residence’s smoking policy and location of smoking areas, if applicable.

   (5)  The location and use of fire extinguishers.

   (6)  Smoke detectors and fire alarms.

   (7)  Telephone use and notification of emergency services.

 (b)  Direct care staff persons shall complete an initial orientation approved by the Department before providing direct care to residents.

 (c)  Direct care staff persons shall be certified in first aid and CPR before providing direct care to residents.

 (d)  A sufficient number of direct care staff persons shall be certified in obstructed airway techniques to meet the staff to resident ratios under §  2800.63(a) (relating to first aid, CPR and obstructed airway training) before providing direct care to residents.

 (e)  Within 40 scheduled working hours, direct care staff persons, ancillary staff persons, substitute personnel and volunteers shall have an orientation training that includes the following:

   (1)  Resident rights.

   (2)  Emergency medical plan.

   (3)  Mandatory reporting of abuse and neglect under the Older Adult Protective Services Act (35 P. S. § §  10225.101—10225.5102).

   (4)  Reporting of reportable incidents and conditions.

   (5)  Safe management techniques.

   (6)  Core competency training that includes the following:

     (i)   Person-centered care.

     (ii)   Communication, problem solving and relationship skills.

     (iii)   Nutritional support according to resident preference.

 (f)  Ancillary staff persons shall have a general orientation to their specific job functions as it relates to their position prior to working in that capacity.

 (g)  Direct care staff persons may not provide unsupervised assisted living services until completion of 18 hours of training in the following areas:

   (1)  Training that includes a demonstration of job duties, followed by supervised practice.

   (2)  Successful completion and passing the Department-approved direct care training course and passing of the competency test.

   (3)  Initial direct care staff person training to include the following:

     (i)   Safe management techniques.

     (ii)   Assisting with ADLs and IADLs.

     (iii)   Personal hygiene.

     (iv)   Care of residents with mental illness, neurological impairments, mental retardation and other mental disabilities.

     (v)   The normal aging-cognitive, psychological and functional abilities of individuals who are older.

     (vi)   Implementation of the initial assessment, annual assessment and support plan.

     (vii)   Nutrition, food handling and sanitation.

     (viii)   Recreation, socialization, community resources, social services and activities in the community.

     (ix)   Gerontology.

     (x)   Staff person supervision, if applicable.

     (xi)   Care and needs of residents with special emphasis on the residents being served in the residence.

     (xii)   Safety management and hazard prevention.

     (xiii)   Universal precautions.

     (xiv)   The requirements of this chapter.

     (xv)   The signs and symptoms of infections and infection control.

     (xvi)   Care for individuals with mobility needs, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration, if applicable to the residents served in the residence.

     (xvii)   Behavioral management techniques.

     (xviii)   Understanding of the resident’s assessment and how to implement the resident’s support plan.

     (xix)   Person-centered care and aging in place.

 (h)  Direct care staff persons shall have at least 16 hours of annual training relating to their job duties. The training required in §  2800.69 (relating to additional dementia-specific training) shall be in addition to the 16 hour annual training.

 (i)  Training topics for the annual training for direct care staff persons must include the following:

   (1)  Medication self-administration training.

   (2)  Instruction on meeting the needs of the residents as described in the assessment tool, medical evaluation and support plan.

   (3)  Care for residents with dementia, cognitive and neurological impairments.

   (4)  Infection control and general principles of cleanliness and hygiene and areas associated with immobility, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.

   (5)  Assisted living service needs of the resident.

   (6)  Safe management techniques.

   (7)  Care for residents with mental illness or mental retardation, or both, if the population is served in the residence.

 (j)  Direct care staff persons, ancillary staff persons, substitute personnel and regularly scheduled volunteers shall be trained annually in the following areas:

   (1)  Fire safety completed by a fire safety expert or by a staff person trained by a fire safety expert. Videos prepared by a fire safety expert are acceptable for the training if accompanied by an onsite staff person trained by a fire safety expert.

   (2)  Emergency preparedness procedures and recognition and response to crises and emergency situations.

   (3)  Resident rights.

   (4)  The Older Adult Protective Services Act (35 P. S. § §  10225.101—10225.708).

   (5)  Falls and accident prevention.

   (6)  New population groups that are being served at the residence that were not previously served, if applicable.

 (k)  If a staff person has completed the required initial direct care staff person training within the past year as a direct care staff person at another residence, the requirement for initial direct care staff person training in this section does not apply if the staff person provides written verification of completion of the training.

 (l)  A record of training including the staff person trained, date, source, content, length of each course and copies of any certificates received, shall be kept.

 (a)  A staff training plan shall be developed annually.

 (b)  The plan must include training aimed at improving the knowledge and skills of the residence’s direct care staff persons in carrying out their job responsibilities. The staff training plan must include the following:

   (1)  The name, position and duties of each direct care staff person.

   (2)  The required training courses for each staff person.

   (3)  The dates, times and locations of the scheduled training for each staff person for the upcoming year.

 (a)  An institution and the course of study offered by an educational institution, association, professional society or organization for the purpose of educating and qualifying applicants for certification as assisted living residence administrators shall be registered and approved by the Department prior to offering the course of study.

 (b)  An application for registration of an institution and approval of a course of study shall be submitted to the Department on a form provided by the Department and include the following information:

   (1)  The full name, address, telephone number, facsimile number and electronic mail address of the prospective training provider, each instructor and the program coordinator.

   (2)  The training objectives, instructional materials, content and teaching methods to be used and the number of clock hours.

   (3)  The recommended class size.

   (4)  The attendance certification method.

   (5)  Proof that each course instructor is certified by the Department to conduct administrator training.

   (6)  The subject that each instructor will teach and documentation of the instructor’s academic credentials, instructional experience and work experience to teach the subject.

   (7)  The location of the training site, which shall accommodate the number of anticipated participants.

 (c)  A request to amend a Department-approved course of study shall be submitted for the Department’s review and approval prior to implementation of a change in the course of study.

 (a)  Training for assisted living residence administrators provided by an individual who is not certified as an instructor by the Department will not be considered valid training.

 (b)  To receive the Department’s certification as an approved instructor for assisted living residence administrators, an instructor shall successfully complete the Department’s train-the-trainer course. The train-the-trainer course is designed to provide and reinforce basic training skills, including the roles and responsibilities of the trainer, training methodology, the use of instructional aids and recordkeeping.

 (c)  An instructor shall demonstrate competent instructional skills and knowledge of the applicable topic and meet the Department’s qualifications for the topic being taught.

 (d)  An instructor is subject to unannounced monitoring by the Department while conducting training.

 (e)  The Department will establish approval standards that include the following:

   (1)  The mechanism to measure the quality of the training being offered.

   (2)  The criteria for selecting and evaluating instructors, subject matter and instructional materials.

   (3)  The criteria for evaluating requests to amend a course.

   (4)  The criteria for evaluating the effectiveness of each course.

   (5)  The instructor qualifications for each subject being taught.

 (f)  The Department may withdraw approval under the following conditions:

   (1)  Failure to follow the approved curriculum.

   (2)  Lack of trainer competency.

 Administrative staff, direct care staff persons, ancillary staff persons, substitute personnel and volunteers shall receive at least 4 hours of dementia-specific training within 30 days of hire and at least 2 hours of dementia-specific training annually thereafter in addition to the training requirements of this chapter.

   This section cited in 55 Pa. Code §  2800.64 (relating to administrator training and orientation); and 55 Pa. Code §  2800.65 (relating to staff orientation and direct care staff person training and orientation).

PHYSICAL SITE

§ 2800.81. Physical accommodations and equipment.

 (a)  The residence shall provide or arrange for physical site accommodations and equipment necessary to meet the health and safety needs of a resident with a disability and to allow safe movement within the residence and exiting from the residence.

 (a)  Poisonous materials shall be stored in their original, labeled containers.

 (b)  Poisonous materials shall be stored separately from food, food preparation surfaces and dining surfaces.

 (a)  The indoor temperature, in areas used by the residents, must be at least 70° F when residents are present in the residence.

 (b)  A residence in existence prior to January 18, 2011, shall provide central air conditioning. If central air conditioning is not feasible or is cost prohibitive, window air conditioning units shall be provided. The residence shall submit justification to the Department for the use of window air conditioning units.

 (a)  Sanitary conditions shall be maintained.

 (b)  There may be no evidence of infestation of insects or rodents in the residence.

 (c)  Trash shall be removed from the premises at least once a week.

 (d)  Trash in kitchens and bathrooms shall be kept in covered trash receptacles that prevent the penetration of insects and rodents.

 (e)  Trash outside the residence shall be kept in covered receptacles that prevent the penetration of insects and rodents.

 (a)  All areas of the residence that are used by the resident shall be ventilated. Ventilation includes an operable window, air conditioner, fan or mechanical ventilation that ensures airflow.

 (a)  Floors, walls, ceilings, windows, doors and other surfaces must be clean, in good repair and free of hazards.

 (b)  The residence may not use asbestos products for renovations or new construction.

 (a)  The residence must have hot and cold water under pressure in each bathroom, kitchen and laundry area to accommodate the needs of the residents in the residence.

 (b)  Hot water temperature in areas accessible to the resident may not exceed 120° F.

 (c)  A residence that is not connected to a public water system shall have a coliform water test at least every 3 months, by a Department of Environmental Protection-certified laboratory, stating that the water is below maximum contaminant levels. A public water system is a system that provides water to the public for human consumption, which has at least 15 service connections or regularly serves an average of at least 25 individuals daily at least 60 days out of the year.

 (d)  If the water is found to be above maximum contaminant levels, the residence shall conduct remediation activity to reduce the level of contaminants to below the maximum contaminant level. During remediation activity, an alternate source of drinking water shall be provided to the residents.

 (a)  The residence shall have a working, noncoin operated, landline telephone that is accessible in emergencies and accessible to individuals with disabilities.

 (a)  Each ramp, interior stairway, hallway and outside steps must have a well-secured handrail.

 (a)  Interior and exterior doors that open directly into a stairway and are used for exit doors, resident areas and fire exits must have a landing, which is a minimum of 3 feet by 3 feet.

 (b)  Interior stairs, exterior steps and ramps must have nonskid surfaces.

 (a)  The residence shall have a first aid kit in each building on the premises that includes nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, adhesive tape, scissors, breathing shield, eye coverings and tweezers. The residence shall have an automatic external defibrillation device located in each building on the premises.

 (b)  Staff persons shall know the location of the first aid kit.

 (c)  The first aid kit must be in a location that is easily accessible to staff persons.

 (a)  The residence shall have at least two indoor wheelchair accessible common rooms for all residents for activities such as reading, recreation and group activities. One of the common rooms shall be available for resident use at any time, provided the use does not affect or disturb others.

 (b)  The residence shall have at least one furnished living room or lounge area for residents, their families and visitors. The combined living room or lounge areas must accommodate all residents at one time. There must be at least 15 square feet per living unit for up to 50 living units. There must be a total of 750 square feet if there are more than 50 living units. These rooms or areas must contain tables, chairs and lighting to accommodate the residents, their families and visitors.

 (c)  The residence shall have a working television and radio available to residents in a living room or lounge area.

 The residence shall provide regular access to outdoor and indoor recreation space and recreational items, such as books, newspapers, magazines, puzzles, games, cards and crafts.

 (a)  The exterior of the building and the building grounds or yard must be in good repair and free of hazards.

 (a)  A residence shall provide a resident with the resident’s own living unit unless the conditions of subsection (c) are met.

 (b)  The following conditions apply to a residence:

   (1)  For new construction of residences after January 18, 2011, each living unit for a single resident must have at least 225 square feet of floor space measured wall-to-wall, excluding bathrooms and closet space. If two residents share a living unit, there must be a total of 300 square feet in the living unit. Exceptions to the size of the living unit may be made at the Department’s discretion.

   (2)  For facilities in existence prior to January 18, 2011, each living unit must have at least 160 square feet measured wall to wall, excluding bathrooms and closet space. If two residents share a living unit, there must be a total of 210 square feet in the living unit. Exceptions to the size of the living unit may be made at the Department’s discretion.

   (3)  Each living unit must have a telephone jack and individually controlled thermostats for heating and cooling.

   (4)  The doors in living units, including entrance doors, must be accessible or adaptable for wheelchair use.

 (c)  Two residents may voluntarily agree to share one living unit provided that the agreement is in writing and contained in each of the resident-residence contract of those residents. A licensee may not require residents to share a living unit. The maximum number of residents in any living unit shall be two residents.

 (d)  Kitchen capacity requirements are as follows:

   (1)  New construction. For new construction of residences after January 18, 2011, the kitchen capacity, at a minimum, must contain a cabinet for food storage, a small bar-type sink with hot and cold running water and space with electrical outlets suitable for small appliances such as a microwave oven and a small refrigerator.

     (i)   Upon entering the assisted living residence, the resident or his designated person shall be asked if the resident wishes to have a cooking appliance or small refrigerator, or both. The cooking appliance or small refrigerator, or both, shall be provided by the residence if desired by the resident or his designated person. If the resident or the designated person wishes to provide his own cooking appliance or small refrigerator, or both, it shall meet the residence’s safety standards.

     (ii)   An appliance shall be designed so it can be disconnected and removed for resident safety or if the resident chooses not to have the appliance within his living unit.

   (2)  Existing facilities. Facilities that convert to residences after January 18, 2011, must meet the following requirements related to kitchen capacity:

     (i)   The residence shall provide space with electrical outlets suitable for small appliances, such as a microwave oven and small refrigerator.

       (A)   Upon entering the assisted living residence, the resident or his designated person shall be asked if the resident wishes to have a cooking appliance or small refrigerator, or both. The cooking appliance or small refrigerator, or both, shall be provided by the residence if desired by the resident or his designated person. If the resident or his designated person wishes to provide his own cooking appliance or small refrigerator, or both, it must meet the residence’s safety standards.

       (B)   An appliance shall be designed so it can be disconnected and removed for resident safety or if the resident chooses not to have the appliance within his living unit.

     (ii)   The residence shall provide access to a sink for dishes, a stovetop for hot food preparation and a food preparation area in a common area. A common resident kitchen may not include the kitchen used by the residence staff for the preparation of resident or employee meals, or the storage of goods.

 (e)  Ceiling height in each living unit must be an average of at least 7 feet.

 (f)  Each living unit must have at least one window with direct exposure to natural light.

 (g)  A resident’s bedroom in the living unit shall be used only by the occupying resident unless two consenting adult residents agree to share a bedroom and the requirements of subsection (c) are met.

 (h)  Each living unit must have a door with a lock, except where a lock in a unit under a special care designation would pose a risk or be unsafe. The administrator shall maintain a master key that can open all locks in the event of an emergency.

 (i)  A resident shall have access to his living unit at all times.

 (j)  Each resident shall have the following in the living unit:

   (1)  A bed with a solid foundation and fire retardant mattress that is in good repair, clean and supports the resident. An exception will be permitted for residents who wish to provide their own mattresses.

   (2)  A chair for each resident that meets the resident’s needs.

   (3)  Pillows, bed linens and blankets that are clean and in good repair.

   (4)  A storage area for clothing that includes a chest of drawers and a closet or wardrobe space with clothing racks or shelves accessible to the resident.

   (5)  A bedside table or a shelf.

   (6)  A mirror.

   (7)  An operable lamp or other source of lighting that can be turned on at bedside.

   (8)  If a resident shares a bedroom with another resident, the items specified in paragraphs (4)—(7) may be shared with one other resident.

 (k)  Cots and portable beds are prohibited.

 (l)  Bunk beds or other raised beds that require residents to climb steps or ladders to get into or out of bed are prohibited.

 (m)  A living unit may not be used as an exit from or used as a passageway to another part of the residence unless in an emergency situation.

 (n)  The living unit must have walls, floors and ceilings, which are finished, clean and in good repair.

 (o)  In living units with a separate bedroom, there must be a door on the bedroom.

 (p)  Space for storage of personal property shall be provided in a dry, protected area.

 (q)  There must be drapes, shades, curtains, blinds or shutters on the living unit windows. Window coverings must be clean, in good repair, provide privacy and cover the entire window when drawn.

 (r)  Each living unit must be equipped with an emergency notification system to notify staff in the event of an emergency.

 (a)  There must be one functioning flush toilet in the bathroom in the living unit.

 (b)  There must be at least one sink and wall mirror in the bathroom of the living unit.

 (c)  There must be at least one bathtub or shower in the bathroom of the living unit.

 (d)  Toilet and bath areas in the living unit must have grab bars, hand rails or assist bars. Bathtubs and showers must have slip-resistant surfaces.

 (e)  Privacy in the living unit must be provided for toilets, showers and bathtubs by partitions or doors. Bathroom doors in a double occupancy living unit must be lockable by the resident, unless contraindicated by the support plan.

 (f)  An individual towel, washcloth and soap shall be provided for each resident unless the resident provides his own supplies of these items.

 (g)  Individual toiletry items including toothpaste, toothbrush, shampoo, deodorant, comb and hairbrush shall be made available to residents who are not recipients of SSI. If the residence charges for these items, the charges shall be indicated in the resident-residence contract. Availability of toiletry items for residents who are recipients of SSI is specified in §  2800.27(d)(1) (relating to SSI recipients).

 (h)  Toilet paper shall be provided for every toilet.

 (i)  Bar soap or a dispenser with soap shall be provided within reach of each bathroom sink. Bar soap, however, is not permitted when a living unit is shared unless there is a separate bar clearly labeled for each resident sharing the living unit.

 (j)  Towels and washcloths shall be in the possession of the resident in the resident’s living unit unless the resident has access to the residence’s linen supply.

 (k)  Use of a common towel is prohibited.

 (l)  Shelves or hooks for the resident’s towel and clothing shall be provided.

 (m)  A residence shall have at least one public restroom that is convenient to common areas and wheelchair accessible.

 (a)  A residence shall have access on the grounds to an operable kitchen with a refrigerator, sink, stove, oven, cooking equipment and cabinets or shelves for storage. If the kitchen is not in the residence, the residence shall have a kitchen area with a refrigerator, cooking equipment, a sink and food storage space.

 (b)  Kitchen surfaces must be of a nonporous material and cleaned and sanitized after each meal.

 (c)  Food shall be protected from contamination while being stored, prepared, transported and served.

 (d)  Food shall be stored off the floor.

 (e)  Food served and returned from an individual’s plate may not be served again or used in the preparation of other dishes. Leftover food shall be labeled and dated.

 (f)  Food requiring refrigeration shall be stored at or below 40° F. Frozen food shall be kept at or below 0° F. Thermometers are required in refrigerators and freezers.

 (g)  Food shall be stored in closed or sealed containers.

 (h)  Food shall be thawed either in the refrigerator, microwave oven, under cool water or as part of the cooking process.

 (i)  Outdated or spoiled food or dented cans may not be used.

 (a)  An assisted living residence shall have an accessible common dining space outside the resident living units. A dining room area must be equipped with tables and chairs and able to accommodate the maximum number of residents scheduled for meals at any one time. There must be at least 15 square feet per person for residents scheduled for meals at any one time.

 (b)  Dishes, glassware and utensils shall be provided for eating, drinking, preparing and serving food. These utensils must be clean, and free of chips and cracks. Plastic and paper plates, utensils and cups for meals may not be used on a regular basis.

 (c)  Condiments shall be available at the dining table.

 (d)  Adaptive eating equipment or utensils shall be available, if needed, to assist residents in eating at the table.

 (e)  Breakfast, midday and evening meals shall be served to residents in a dining room except in the following situations:

   (1)  Service in the resident’s living unit shall be available at no additional charge when the resident is unable to come to the dining room due to illness.

 (a)  Laundry service for bed linens, towels and personal clothing shall be provided by the residence, at no additional charge, to residents who are recipients of or eligible applicants for SSI benefits. Laundry service does not include dry cleaning.

 (b)  Laundry service for bed linens, towels and personal clothing for the residents who are not recipients of SSI shall be provided by the residence unless otherwise indicated in the resident-residence contract. If a residence provides laundry facilities, there may not be a prohibition against residents doing their own laundry.

 (c)  The supply of bed linens and towels must be sufficient to ensure a complete change of bed linen and towels at least once per week.

 (d)  Bed linens and towels shall be changed at least once every week and more often as needed to maintain sanitary conditions.

 (e)  Clean linens and towels shall be stored in an area separate from soiled linen and clothing.

 (f)  Measures shall be implemented to ensure that residents’ clothing are not lost or misplaced during laundering or cleaning. The resident’s clean clothing shall be returned to the resident within 24 hours after laundering.

 (g)  To reduce the risks of fire hazards, lint shall be removed from the lint trap and drum of clothes dryers after each use. Lint shall be cleaned from the vent duct and internal and external ductwork of clothes dryers according to the manufacturer’s instructions.

 If a residence operates a swimming area, the following requirements apply:

   (1)  Swimming areas shall be operated in accordance with applicable laws and regulations.

 (a)  The administrator shall have a copy and be familiar with the emergency preparedness plan for the municipality in which the residence is located.

 (b)  The residence shall have written emergency procedures that include the following:

   (1)  Contact information for each resident’s designated person.

   (2)  The residence’s plan to provide the emergency medical information for each resident that ensures confidentiality.

   (3)  Contact telephone numbers of local and State emergency management agencies and local resources for housing and emergency care of residents.

   (4)  Means of transportation in the event that relocation is required.

   (5)  Duties and responsibilities of staff persons during evacuation, transportation and at the emergency location. These duties and responsibilities shall be specific to each resident’s emergency needs.

   (6)  Alternate means of meeting resident needs in the event of a utility outage.

 (c)  The residence shall maintain at least a 3-day supply of nonperishable food and drinking water for residents.

 (d)  The written emergency procedures shall be reviewed, updated and submitted annually to the local emergency management agency.

 (a)  A residence shall have a written policy regarding firearms, weapons and ammunition where these items are on the premises or in possession of any resident or staff member. A residence is not required to permit firearms, weapons and ammunition.

 (b)  The policy must include, at a minimum, procedures regarding the safety, access and use of firearms, weapons and ammunition.

 (c)  Firearms, weapons and ammunition shall be permitted on the licensed premises of a residence only when the following conditions are met:

   (1)  Firearms and weapons shall be contained in a locked cabinet located in a place other than the residents’ living unit or in a common living area.

   (2)  Ammunition shall be contained in a locked area separate from firearms and weapons, and located in a place other than the residents’ living unit or in a common living area.

   (3)  The key to the locked cabinet containing the firearms, weapons and ammunition shall be in the possession of the administrator or a designee.

   (4)  The administrator or designee shall be the only individual permitted to open the locked cabinet containing the firearms and weapons and the locked area containing the ammunition.

 (a)  The residence rules must specify whether the residence permits pets on the premises.

 (b)  Cats and dogs present at the residence shall have a current rabies vaccination. A current certificate of rabies vaccination from a licensed veterinarian shall be kept.

 (c)  Pets that are accessible to the residents shall be in good health and nonaggressive to the residents.

 (d)  If a residence has additional charges for pets, the charges shall be included in the resident-residence contract.

 (e)  A residence shall disclose to applicants whether pets are permitted and present in the residence.

FIRE SAFETY

§ 2800.121. Unobstructed egress.

 (a)  Stairways, hallways, doorways, passageways and egress routes from living units and from the building must be unlocked and unobstructed.

 (a)  Exit doors must be equipped so that they can be easily opened by residents from the inside without the use of a key or other manual device that can be removed, misplaced or lost.

 (b)  Copies of the emergency procedures as specified in §  2800.107 (relating to emergency preparedness) shall be posted in a conspicuous and public place in the residence and a copy shall be kept.

 (c)  For a residence serving nine or more residents, an emergency evacuation diagram of each floor showing corridors, line of travel to exit doors and location of the fire extinguishers and pull signals shall be posted in a conspicuous and public place on each floor.

 (a)  Combustible and flammable materials may not be located near heat sources or hot water heaters.

 (a)  A professional furnace cleaning company or trained maintenance staff person shall inspect furnaces at least annually. Documentation of the inspection shall be kept.

 (a)  Portable space heaters are prohibited.

 (a)  The use of kerosene burning heaters is prohibited.

 (b)  Wood and coal burning stoves shall be used only if a local fire department or other municipal fire safety authority, professional cleaning company or trained maintenance staff person inspects and approves them annually. Wood and coal burning stoves that are used as a regular heating source shall be cleaned every year according to the manufacturer’s instructions. Documentation of wood and coal burning stove inspections and cleanings shall be kept.

 (a)  A fireplace must be securely screened or equipped with protective guards while in use.

 (b)  A fireplace chimney and flue shall be cleaned when there is an accumulation of creosote. Written documentation of the cleaning shall be kept.

 (a)  There shall be an operable automatic smoke detector located in each living unit.

 (b)  Smoke detectors and fire alarms must be of a type approved by the Department of Labor and Industry, the appropriate local building authority or local fire safety expert, or listed by Underwriters Laboratories.

 (c)  If the residence serves nine or more residents, there shall be at least one smoke detector on each floor interconnected and audible throughout the residence or an automatic fire alarm system that is interconnected and audible throughout the residence.

 (d)  If one or more residents or staff persons are not able to hear the smoke detector or fire alarm system, a signaling device approved by a fire safety expert shall be used and tested so that each resident and staff person with a hearing impairment will be alerted in the event of a fire.

 (e)  Smoke detectors and fire alarms shall be tested for operability at least once per month. A written record of the monthly testing shall be kept.

 (f)  If a smoke detector or fire alarm becomes inoperative, repair shall be completed within 48 hours of the time the detector or alarm was found to be inoperative.

 (g)  The residence’s emergency procedures must indicate the procedures that will be immediately implemented until the smoke detector or fire alarms are operable.

 (a)  There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including public walkways and common living areas every 3,000 square feet, the basement and attic.

 (b)  If the indoor floor area on a floor including the basement or attic is more than 3,000 square feet, there shall be an additional fire extinguisher with a minimum 2-A rating for each additional 3,000 square feet of indoor floor space.

 (c)  A fire extinguisher with a minimum 2A-10BC rating shall be located in each kitchen of the residence. The kitchen extinguisher must meet the requirements for one floor as required in subsection (a).

 (d)  Fire extinguishers must be listed by Underwriters Laboratories or approved by Factory Mutual Systems.

 (e)  Fire extinguishers shall be accessible to staff persons. Fire extinguishers shall be kept locked if access to the extinguisher by a resident could cause a safety risk to the resident. If fire extinguishers are kept locked, each staff person shall be able to immediately unlock the fire extinguisher in the event of a fire emergency.

 (a)  An unannounced fire drill shall be held at least once a month.

 (b)  A fire safety inspection and fire drill conducted by a fire safety expert shall be completed annually. Documentation of this fire drill and fire safety inspection shall be kept.

 (c)  A written fire drill record must include the date, time, the amount of time it took for evacuation, the exit route used, the number of residents in the residence at the time of the drill, the number of residents evacuated, the number of staff persons participating, problems encountered and whether the fire alarm or smoke detector was operative.

 (d)  Residents shall be able to evacuate the entire building to a public thoroughfare, or to a fire-safe area designated in writing within the past year by a fire safety expert within the period of time specified in writing within the past year by a fire safety expert. For purposes of this subsection, the fire safety expert may not be a staff person of the residence.

 (e)  A fire drill shall be held during sleeping hours once every 6 months.

 (f)  Alternate exit routes shall be used during fire drills.

 (g)  Fire drills shall be held on different days of the week, at different times of the day and night, not routinely held when additional staff persons are present and not routinely held at times when resident attendance is low.

 (h)  Residents shall evacuate to a designated meeting place away from the building or within the fire-safe area during each fire drill.

 (i)  A fire alarm or smoke detector shall be set off during each fire drill.

 The following requirements apply for a residence serving nine or more residents:

   (1)  Signs bearing the word ‘‘EXIT’’ in plain legible letters shall be placed at all exits.

   (2)  Access to exits shall be marked with readily visible signs indicating the direction to travel.

   (3)  Exit sign letters must be at least 6 inches in height with the principal strokes of letters at least 3/4 inch wide.

RESIDENT HEALTH

§ 2800.141. Resident medical evaluation and health care.

 (a)  A resident shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner documented on a form specified by the Department, subject to the provisions of §  2800.22 (relating to application and admission). The evaluation must include the following:

   (1)  A general physical examination by a physician, physician’s assistant or nurse practitioner.

   (2)  Medical diagnosis including physical or mental disabilities of the resident, if any.

   (3)  Medical information pertinent to diagnosis and treatment in case of an emergency.

   (4)  Special health or dietary needs of the resident.

   (5)  Allergies.

   (6)  Immunization history.

   (7)  Medication regimen, contraindicated medications, medication side effects and the ability to self-administer medications.

   (8)  Body positioning and movement stimulation for residents, if appropriate.

   (9)  Health status.

   (10)  Mobility assessment, updated annually or at the Department’s request.

   (11)  An indication that a tuberculin skin test has been administered with negative results within 2 years; or if the tuberculin skin test is positive, the result of a chest X-ray. In the event a tuberculin skin test has not been administered, the test shall be administered within 15 days after admission.

   (12)  Information about a resident’s day-to-day assisted living service needs.

 (b)  A resident shall have a medical evaluation:

   (1)  At least annually.

 (a)  Each residence shall demonstrate the ability to provide or arrange for the provision of supplemental health care services in a manner protective of the health, safety and well-being of its residents utilizing employees, independent contractors or contractual arrangements with other health care facilities or practitioners licensed, registered or certified to the extent required by law to provide the service.

 (b)  The residence shall assist the resident to secure medical care and supplemental health care services.

   (1)  The residence shall permit a resident to select or retain his primary care physician.

   (2)  To the extent prominently displayed in the written admission agreement, a residence may require residents to use providers of supplemental health care services approved or designated by the residence.

   (3)  The residence shall document the resident’s need for the medical care, including updating the resident’s assessment and support plan.

 (c)  If a resident refuses routine medical or dental examination or treatment, the refusal and the continued attempts to educate and inform the resident about the need for medical care shall be documented in the resident’s record.

 (d)  If a resident has a serious medical or dental condition, reasonable efforts shall be made to obtain consent for treatment from the resident or the resident’s designated person.

 (e)  The residence shall assist the resident to secure preventative medical, dental, vision and behavioral health care as requested by a physician, physician’s assistant or certified registered nurse practitioner.

 (a)  The residence shall have a written emergency medical plan that includes the following:

   (1)  The hospital or source of health care that will be used in an emergency. This shall be the resident’s choice, if possible.

   (2)  Emergency transportation to be used.

   (3)  An emergency staffing plan.

 (b)  The following current emergency medical and health information shall be available at all times for each resident and shall accompany the resident when the resident needs emergency medical attention:

   (1)  The resident’s name and birth date.

   (2)  The resident’s Social Security number.

   (3)  The resident’s medical diagnosis.

   (4)  The resident’s physician’s name and telephone number.

   (5)  Current medication, including the dosage and frequency.

   (6)  A list of allergies.

   (7)  Other relevant medical conditions.

   (8)  Insurance or third party payer and identification number.

   (9)  A power of attorney for health care or health care proxy, if applicable.

   (10)  The resident’s designated person with current address and telephone number.

   (11)  Personal information and related instructions regarding advance directives, do not resuscitate orders or organ donation, if applicable.

   (12)  A speech, hearing or vision need which requires accommodation or awareness, such as written communication or American sign language.

 (a)  A residence may permit smoking tobacco in a designated smoking room of the residence.

 (b)  The residence rules must specify whether the residence is designated as smoking or nonsmoking.

 (c)  A residence that permits smoking inside or outside of the residence shall develop and implement written fire safety policy and procedures that include the following:

   (1)  Proper safeguards inside and outside of the residence to prevent fire hazards involved in smoking, including providing fireproof receptacles and ashtrays, direct outside ventilation, no interior ventilation from the smoking room through other parts of the residence, extinguishing procedures, fire resistant furniture both inside and outside the residence and fire extinguishers in the smoking rooms.

   (2)  Location of a smoking room or outside smoking area a safe distance from heat sources, hot water heaters, combustible or flammable materials and away from common walkways and exits.

   (3)  Prohibition of the use of tobacco during transportation by the residence.

 (d)  Smoking outside of the smoking room is prohibited.

NUTRITION

§ 2800.161. Nutritional adequacy.

 (a)  Meals shall be offered that meet the recommended dietary allowances established by the United States Department of Agriculture.

 (b)  At least three nutritionally well-balanced meals shall be offered daily to the resident. Each meal shall include an alternative food and drink item from which the resident may choose.

 (c)  Additional portions of meals and beverages at mealtimes shall be available for the resident.

 (d)  A resident’s special dietary needs as prescribed by a physician, physician’s assistant, certified registered nurse practitioner or dietitian shall be met. Documentation of the resident’s special dietary needs shall be kept in the resident’s record.

 (e)  Dietary alternatives shall be available for a resident who has special health needs or religious beliefs regarding dietary restrictions.

 (f)  Drinking water shall be available to the resident at all times.

 (g)  Between-meal snacks and beverages shall be available at all times for each resident, unless medically contraindicated as documented in the resident’s support plan.

 (h)  Residents have the right to purchase groceries and prepare their own food in addition to the three meal plan required in §  2800.220(b) (relating to service provision) in their living units unless it would be unsafe for them to do so consistent with their support plan.

 (a)  There may not be more than 15 hours between the evening meal and the first meal of the next day. There may not be more than 6 hours between breakfast and lunch, and between lunch and supper. This requirement does not apply if a resident’s physician has prescribed otherwise.

 (b)  When a resident misses a meal, food adequate to meet daily nutritional requirements shall be available and offered to the resident.

 (c)  Menus, stating the specific food being served at each meal, shall be prepared for 1 week in advance and shall be followed. Weekly menus shall be posted 1 week in advance in a conspicuous and public place in the residence.

 (d)  Past menus of meals that were served, including changes, shall be kept for at least 1 month.

 (e)  A change to a menu shall be posted in a conspicuous and public place in the residence and shall be accessible to a resident in advance of the meal. Meal substitutions shall be made in accordance with §  2800.161 (relating to nutritional adequacy).

 (f)  A resident shall receive adequate physical assistance with eating or be provided with appropriate adaptive devices, or both, as indicated in the resident’s support plan.

 (g)  Appropriate cueing shall be used to encourage and remind residents to eat and drink, as indicated in the resident’s support plan.

 (a)  Staff persons, volunteers and residents involved in the storage, preparation, serving and distributing of food shall wash their hands with hot water and soap prior to working in the kitchen areas and after using the bathroom.

 (b)  Staff persons, volunteers and residents shall follow sanitary practices while working in the kitchen areas.

 (c)  Staff persons, volunteers and residents involved with the storage, preparation, serving and distributing of food shall be in good health.

 (a)  A residence may not withhold meals, beverages, snacks or desserts as punishment. Food and beverages may be withheld in accordance with prescribed medical or dental procedures.

 (b)  A resident may not be forced to eat food.

 (c)  If a resident refuses to eat or drink continuously during a 24-hour period, the resident’s primary care physician and the resident’s designated person shall be immediately notified.

 (d)  If a resident has a cognitive impairment that affects the resident’s ability to consume adequate amounts of food and water, a staff person shall encourage and remind the resident to eat and drink.

TRANSPORTATION

§ 2800.171. Transportation.

 (a)  A residence shall be required to provide or arrange for transportation on a regular weekly basis that permits residents to schedule medical and social appointments within a reasonable local area.

 (b)  The following requirements apply whenever staff persons or volunteers of the residence provide transportation for the resident:

   (1)  The occupants of the vehicle shall be in an appropriate safety restraint at all times the vehicle is in motion.

   (2)  The driver of a vehicle shall be 18 years of age or older and possess a valid driver’s license.

   (3)  The driver of the residence vehicle cannot be a resident.

   (4)  At least one staff member transporting or accompanying the residents shall have completed the initial new hire direct care staff person training as specified in §  2800.65 (relating to staff orientation and direct care staff person training and orientation).

   (5)  The vehicle must have a first aid kit with the contents as specified in §  2800.96 (relating to first aid kit). The inclusion of an automatic external defibrillation device in a vehicle is optional.

   (6)  During vehicle operations, the driver may only use a hands-free cellular telephone.

   (7)  Transportation must include, when necessary, an assistant to the driver who assists the driver to escort residents in and out of the residence and provides assistance during the trip.

 (c)  The residence shall maintain current copies of the following documentation for each of the residence’s vehicles used to transport residents:

   (1)  Vehicle registration.

   (2)  Valid driver’s license for vehicle operator.

   (3)  Vehicle insurance.

   (4)  Current inspection.

   (5)  Commercial driver’s license for vehicle operator if applicable.

 (d)  If a residence supplies its own vehicles for transporting residents to and from medical and social appointments, a minimum of one vehicle used for this purpose shall be accessible to resident wheelchair users and any other assistive equipment the resident may need.

   (1)  The residence shall schedule a pick-up time to transport the resident to the medical or social appointment. The residence shall make every reasonable effort to pick-up the resident within 15 minutes before or after the scheduled pick-up time.

   (2)  The resident may not be dropped off at the medical or social appointment more that 1 hour prior to the time of the appointment.

   (3)  The residence shall make every reasonable effort to pick-up a resident from a medical appointment no later than 1 hour after the medical appointment.

   (4)  The residence shall make every reasonable effort to pick-up a resident from a social appointment no later than 1 hour after the end of the social appointment.

 (e)  If a residence arranges for transportation for residents to and from medical and social appointments the following apply:

   (1)  The residence shall schedule a pick-up time for the resident to be transported to the medical or social appointment. The residence shall make every reasonable effort for a resident to be picked-up within 15 minutes before or after the scheduled pick-up time.

   (2)  The residence shall make every reasonable effort for a resident to not be dropped off at the medical or social appointment more that 1 hour prior to the time of the appointment.

   (3)  The residence shall make every reasonable effort for a resident to be picked-up from the medical appointment no later than 1 hour after the medical appointment.

   (4)  The residence shall make every reasonable effort for a resident to be picked-up from the social appointment no later than 1 hour after the end of the social appointment.

   This section cited in 55 Pa. Code §  2800.220 (relating to service provision).

MEDICATIONS

§ 2800.181. Self-administration.

 (a)  A residence shall provide residents with assistance, as needed, with medication prescribed for the resident’s self-administration. This assistance includes helping the resident to remember the schedule for taking the medication, storing the medication in a secure place and offering the resident the medication at the prescribed times.

 (b)  If assistance includes helping the resident to remember the schedule for taking the medication, the resident shall be reminded of the prescribed schedule. Appropriate cueing shall be used to remind residents to take their medication.

 (c)  The resident’s assessment shall identify if the resident is able to self-administer medications as specified in §  2800.227(e) (relating to development of the final support plan). A resident who desires to self-administer medications shall be assessed by a physician, physician’s assistant or certified registered nurse practitioner regarding the ability to self-administer and the need for medication reminders.

 (d)  If the resident does not need assistance with medication, medication may be stored in a resident’s living unit for self-administration. Medications stored in the resident’s living unit shall be kept in a safe and secure location to protect against contamination, spillage and theft. The residence shall provide a lockable storage unit for this purpose.

 (e)  To be considered capable to self-administer medications, a resident shall:

   (1)  Be able to recognize and distinguish his medication.

   (2)  Know how much medication is to be taken.

   (3)  Know when medication is to be taken.

 (f)  The resident’s record shall include a current list of prescription, CAM and OTC medications for each resident who is self-administering his medication.

 (a)  A residence shall provide medication administration services for a resident who is assessed to need medication administration services in accordance with §  2800.181 (relating to self-administration) and for a resident who chooses not to self-administer medications.

 (b)  Prescription medication that is not self-administered by a resident shall be administered by one of the following:

   (1)  A physician, licensed dentist, licensed physician’s assistant, RN, certified registered nurse practitioner, LPN or licensed paramedic.

   (2)  A graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the residence.

   (3)  A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the residence.

   (4)  A staff person who has completed the medication administration training as specified in §  2800.190 (relating to medication administration training) for the administration of oral; topical; eye, nose and ear drop prescription medications; insulin injections and epinephrine injections for insect bites or other allergies.

 (c)  Medication administration includes the following activities, based on the needs of the resident:

   (1)  Identify the correct resident.

   (2)  If indicated by the prescriber’s orders, measure vital signs and administer medications accordingly.

   (3)  Remove the medication from the original container.

   (4)  Crush or split the medication as ordered by the prescriber.

   (5)  Place the medication in a medication cup or other appropriate container, or in the resident’s hand.

   (6)  Place the medication in the resident’s hand, mouth or other route as ordered by the prescriber, in accordance with the limitations specified in subsection (b)(4).

   (7)  Complete documentation in accordance with §  2800.187 (relating to medication records).

 (a)  Prescription medications, OTC medications and CAM shall be kept in their original labeled containers and may not be removed more than 2 hours in advance of the scheduled administration. Assistance with insulin and epinephrine injections and sterile liquids shall be provided immediately upon removal of the medication from its container.

 (b)  Prescription medications, OTC medications, CAM and syringes shall be kept in an area or container that is locked. This includes medications and syringes unless kept in the resident’s living unit.

 (c)  Prescription medications, OTC medications and CAM stored in a refrigerator shall be kept in an area or container that is locked unless the resident has the capacity to store the medications in the resident’s own refrigerator in the resident’s living unit.

 (d)  Only current prescription, OTC medications, sample and CAM for individuals living in the residence may be kept in the residence.

 (e)  Prescription medications, OTC medications and CAM shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer’s instructions.

 (f)  Prescription medications, OTC medications and CAM that are discontinued, expired or for residents who are no longer served at the residence shall be destroyed in a safe manner according to the Department of Environmental Protection and Federal and State regulations. When a resident permanently leaves the residence, the resident’s medications shall be given to the resident, the designated person, if any, or the person or entity taking responsibility for the new placement on the day of departure from the residence.

 (a)  The original container for prescription medications must be labeled with a pharmacy label that includes the following:

   (1)  The resident’s name.

   (2)  The name of the medication.

   (3)  The date the prescription was issued.

   (4)  The prescribed dosage and instructions for administration.

   (5)  The name and title of the prescriber.

 (b)  If the OTC medications and CAM belong to the resident, they must be identified with the resident’s name.

 (a)  The residence shall develop and implement procedures for the safe storage, access, security, distribution and use of medications and medical equipment by trained staff persons.

 (b)  At a minimum, the procedures must include:

   (1)  Documentation of the receipt of controlled substances and prescription medications.

   (2)  A process to investigate and account for missing medications and medication errors.

   (3)  Limited access to medication storage areas.

   (4)  Documentation of the administration of prescription medications, OTC medications and CAM for residents who receive medication administration services or assistance with self-administration. This requirement does not apply to a resident who self-administers medication without the assistance of a staff person and stores the medication in his living unit.

 (a)  Each prescription medication must be prescribed in writing by an authorized prescriber. Prescription orders shall be kept current.

 (b)  Prescription medications shall be used only by the resident for whom the prescription was prescribed.

 (a)  A medication record shall be kept to include the following for each resident for whom medications are administered:

   (1)  Resident’s name.

   (2)  Drug allergies.

   (3)  Name of medication.

   (4)  Strength.

   (5)  Dosage form.

   (6)  Dose.

   (7)  Route of administration.

   (8)  Frequency of administration.

   (9)  Administration times.

   (10)  Duration of therapy, if applicable.

   (11)  Special precautions, if applicable.

   (12)  Diagnosis or purpose for the medication, including pro re nata (PRN).

   (13)  Date and time of medication administration.

   (14)  Name and initials of the staff person administering the medication.

 (b)  The information in subsection (a)(13) and (14) shall be recorded at the time the medication is administered.

 (c)  If a resident refuses to take a prescribed medication, the refusal shall be documented in the resident’s record and on the medication record. The refusal shall be reported to the prescriber within 24 hours, unless otherwise instructed by the prescriber. Subsequent refusals to take a prescribed medication shall be reported as required by the prescriber.

 (d)  The residence shall follow the directions of the prescriber.

 (a)  Medication errors include the following:

   (1)  Failure to administer a medication.

   (2)  Administration of the wrong medication.

   (3)  Administration of the wrong amount of medication.

   (4)  Failure to administer a medication at the prescribed time.

   (5)  Administration to the wrong resident.

   (6)  Administration through the wrong route.

 (b)  A medication error shall be immediately reported to the resident, the resident’s designated person and the prescriber.

 (c)  Documentation of medication errors and the prescriber’s response shall be kept in the resident’s record.

 (d)  There shall be a system in place to identify and document medication errors and the residence’s pattern of error.

 (e)  There shall be documentation of the follow-up action that was taken to prevent future medication errors.

 (a)  If a resident has a suspected adverse reaction to a medication, the residence shall immediately consult a physician or seek emergency medical treatment. The resident’s designated person shall be notified, if applicable.

 (a)  A staff person who has successfully completed a Department-approved medications administration course that includes the passing of the Department’s performance-based competency test within the past 2 years may administer oral; topical; eye, nose and ear drop prescription medications and epinephrine injections for insect bites or other allergies.

 (b)  A staff person is permitted to administer insulin injections following successful completion of a Department-approved medications administration course that includes the passing of a written performance-based competency test within the past 2 years, as well as successful completion of a Department-approved diabetes patient education program within the past 12 months.

 (c)  A record of the training shall be kept including the staff person trained, the date, source, name of trainer and documentation that the course was successfully completed.

 The residence shall educate the resident of the right to question or refuse a medication if the resident believes there may be a medication error. Documentation of this resident education shall be kept.

   This section cited in 55 Pa. Code Appendix A (relating to assisted living resident rights: during residency and during discharge or termination of residency).

SAFE MANAGEMENT TECHNIQUES

§ 2800.201. Safe management techniques.

 The following procedures are prohibited:

   (1)  Seclusion, defined as involuntary confinement of a resident in a room or living unit from which the resident is physically prevented from leaving, is prohibited. This does not include the admission of a resident in a secured dementia care unit in accordance with §  2800.231 (relating to admission).

   (2)  Aversive conditioning, defined as the application of startling, painful or noxious stimuli, is prohibited.

   (3)  Pressure point techniques, defined as the application of pain for the purpose of achieving compliance, is prohibited.

   (4)  A chemical restraint, defined as use of drugs or chemicals for the specific and exclusive purpose of controlling acute or episodic aggressive behavior, is prohibited. A chemical restraint does not include a drug ordered by a physician or dentist to treat the symptoms of a specific mental, emotional or behavioral condition, or as pretreatment prior to a medical or dental examination or treatment.

   (5)  A mechanical restraint, defined as a device that restricts the movement or function of a resident or portion of a resident’s body, is prohibited. Mechanical restraints include geriatric chairs, handcuffs, anklets, wristlets, camisoles, helmet with fasteners, muffs and mitts with fasteners, poseys, waist straps, head straps, papoose boards, restraining sheets, chest restraints and other types of locked restraints. A mechanical restraint does not include a device used to provide support for the achievement of functional body position or proper balance that has been prescribed by a medical professional as long as the resident can easily remove the device or the resident or his designee understands the need for the device and consents to its use.

 (a)  Bedside rails may not be used unless the resident can raise and lower the rails on his own. Bedside rails may not be used to keep a resident in bed. Use of any length rail longer than half the length of the bed is considered a restraint and is prohibited. Use of more than one rail on the same side of the bed is not permitted.

 (b)  Half-length rails are permitted only if the following conditions are met:

   (1)  The resident’s assessment or support plan, or both, addresses the medical symptoms necessitating the use of half-length rails and the health and safety protection necessary in order to safely use half-length rails.

   (2)  The residence has attempted to use less restrictive alternatives.

   (3)  The resident or legal representative consented to the use of half-length rails after the risk, benefits and alternatives were explained.

SERVICES

§ 2800.220. Service provision.

 (a)  Services. The residence shall provide assisted living services as specified in subsection (b). The residence shall offer and provide the core service packages specified in subsection (c). The residence shall provide or arrange for the provision of supplemental health care services as specified in subsection (e). Other individuals or agencies may furnish services directly or under arrangements with the residence in accordance with a mutually agreed upon charge or fee between the residence, resident and other individual or agency. These other services shall be supplemental to the assisted living services provided by the residence and do not supplant them.

 (b)  Assisted living services. The residence shall, at a minimum, provide the following services:

   (1)  Nutritious meals and snacks in accordance with § §  2800.161 and 2800.162 (relating to nutritional adequacy; and meals).

   (2)  Laundry services in accordance with §  2800.105 (relating to laundry).

   (3)  A daily program of social and recreational activities in accordance with §  2800.221 (relating to activities program).

   (4)  Assistance with performing ADLs and IADLs in accordance with § §  2800.23 and 2800.24 (relating to activities; and personal hygiene).

   (5)  Assistance with self-administration of medication or medication administration as indicated in the resident’s assessment and support plan in accordance with § §  2800.181 and 2800.182 (relating to self-administration; and medication administration).

   (6)  Housekeeping services essential for the health, safety and comfort of the resident based upon the resident’s needs and preferences.

   (7)  Transportation in accordance with §  2800.171 (relating to transportation).

   (8)  Financial management in accordance with §  2800.20 (relating to financial management).

   (9)  24-hour supervision, monitoring and emergency response.

   (10)  Activities and socialization.

   (11)  Basic cognitive support services as defined in §  2800.4 (relating to definitions).

 (c)  Core service packages. The residence shall, at a minimum, provide the following core service packages:

   (1)  Independent Core Package. This core package shall be provided to residents who do not require assistance with ADLs. The services must include the following:

     (i)   24-hour supervision, monitoring and emergency response.

     (ii)   Nutritious meals and snacks in accordance with § §  2800.161 and 2800.162.

     (iii)   Housekeeping services essential for the health, safety and comfort of the resident based upon the resident’s needs and preferences.

     (iv)   Laundry services in accordance with §  2800.105.

     (v)   Assistance with unanticipated ADLs for a defined recovery period.

     (vi)   A daily program of social and recreational activities in accordance with §  2800.221.

     (vii)   Basic cognitive support services as defined in §  2800.4.

   (2)  Enhanced Core Package. This core package shall be available to residents who require assistance with ADLs. The services must include the following:

     (i)   The services provided in the basic core package under paragraph (c)(1)(i)—(vii).

     (ii)   Assistance with ADLs and unanticipated ADLs for an undefined period of time.

     (iii)   Transportation in accordance with §  2800.171.

     (iv)   Assistance with self-administration of medication or medication administration as indicated in the resident’s assessment and support plan in accordance with § §  2800.181 and 2800.182.

 (d)  Opt-out. If a resident wishes not to have the residence provide a service under subsection (c)(1)(ii)—(iv), the resident-residence contract must state the following:

   (1)  The service not being provided.

   (2)  The corresponding fee schedule charge adjustment that takes into account the reduction in service.

 (e)  Supplemental health care services. The residence shall provide or arrange for the provision of supplemental health care services, including, but not limited to, the following:

   (1)  Hospice services.

   (2)  Occupational therapy.

   (3)  Skilled nursing services.

   (4)  Physical therapy.

   (5)  Behavioral health services.

   (6)  Home health services.

   (7)  Escort service if indicated in the resident’s support plan or requested by the resident to and from medical appointments.

   (8)  Specialized cognitive support services as defined in §  2800.4.

 (a)  The residence shall develop a program of daily activities designed to promote each resident’s active involvement with other residents, the resident’s family and the community and provide the necessary space and equipment for the activities in accordance with § §  2800.98 and 2800.99 (relating to indoor activity space; and recreation space). The residence shall offer the opportunity for the residents’ active participation in the development of the daily activities calendar.

 (b)  The program must be based upon individual and group interests and provide social, physical, intellectual and recreational activities in a planned, coordinated and structured manner and shall encourage active participation in the community at large.

 (c)  The week’s daily activity calendar shall be posted in advance in a conspicuous and public place in the residence. The residence shall provide verbal cueing and reminders of activities, their start times and locations within the residence.

 (a)  The residence shall have a current written description of services and activities that the residence provides including the following:

   (1)  The scope and general description of the services and activities that the residence provides.

   (2)  The criteria for admission and discharge.

   (3)  Specific services that the residence does not provide, but will arrange or coordinate.

 (a)  Initial assessment.

   (1)  The administrator, administrator designee, or LPN, under the supervision of an RN, or an RN shall complete the initial assessment.

   (2)  An individual shall have a written initial assessment that is documented on the Department’s assessment form within 30 days prior to admission unless one of the conditions contained in paragraph (3) apply.

   (3)  A resident shall have a written initial assessment that is documented on the Department’s assessment form within 15 days after admission if one of the following conditions applies:

     (i)   The resident is being admitted directly to the residence from an acute care hospital.

     (ii)   The resident is being admitted to escape from an abusive situation.

     (iii)   The resident has no alternative living arrangement.

   (4)  A residence may use its own assessment form if it includes the same information as the Department’s assessment form.

   (5)  The written initial assessment must, at a minimum include the following:

     (i)   The individual’s need for assistance with ADLs and IADLs.

     (ii)   The mobility needs of the individual.

     (iii)   The ability of the individual to self-administer medication.

     (iv)   The individual’s medical history, medical conditions, and current medical status and how they impact or interact with the individual’s service needs.

     (v)   The individual’s need for supplemental health care services.

     (vi)   The individual’s need for special diet or meal requirements.

     (vii)   The individual’s ability to safely operate key-locking devices.

     (viii)   The individual’s ability to evacuate from the residence.

 (b)  An initial assessment will not be required to commence supplemental health care services to a resident of a residence under any of the following circumstances:

   (1)  If the resident was not receiving the services at the time of the resident’s admission.

   (2)  To transfer a resident from a portion of a residence that does not provide supplemental health care services to a portion of the residence that provides such service.

   (3)  To transfer a resident from a personal care home to a residence licensed by the same operator.

 (c)  Preliminary support plan.

   (1)  An individual requiring services shall have a written preliminary support plan developed within 30 days prior to admission to the residence unless one of the conditions contained in paragraph (2) applies.

   (2)  A resident requiring services shall have a written preliminary support plan developed within 15 days after admission if one of the following conditions applies:

     (i)   The resident is being admitted directly to the residence from an acute care hospital.

     (ii)   The resident is being admitted to escape from an abusive situation.

     (iii)   Any other situation where the resident has no alternative living arrangement.

   (3)  The written preliminary support plan must document the dietary, medical, dental, vision, hearing, mental health or other behavioral care services that will be made available to the individual, or referrals for the individual to outside services if the individual’s physician, physician’s assistant or certified registered nurse practitioner, determine the necessity of these services. This requirement does not require a residence to pay for the cost of these medical and behavioral care services. The preliminary support plan must document the assisted living services and supplemental health care services, if applicable, that will be provided to the individual.

   (4)  The preliminary support plan shall be documented on the Department’s support plan form.

   (5)  A residence may use its own support plan form it if includes the same information as the Department’s support plan form. An LPN, under the supervision of an RN, or an RN shall review and approve the preliminary support plan.

   (6)  An individual’s preliminary support plan must document the ability of the individual to self-administer medications or the need for medication reminders or medication administration and the ability of the resident to safely operate key-locking devices.

   (7)  An individual shall be encouraged to participate in the development of the preliminary support plan. An individual may include a designated person or family member in making decisions about services.

   (8)  Individuals who participate in the development of the preliminary support plan shall sign and date the preliminary support plan.

   (9)  If an individual or designated person is unable or chooses not to sign the preliminary support plan, a notation of inability or refusal to sign shall be documented.

   (10)  The residence shall give a copy of the preliminary support plan to the resident and the resident’s designated person.

 (a)  The administrator or administrator designee, or an LPN, under the supervision of an RN, or an RN shall complete additional written assessments for each resident. A residence may use its own assessment form if it includes the same information as the Department’s assessment form. Additional written assessments shall be completed as follows:

   (1)  Annually.

   (2)  If the condition of the resident significantly changes prior to the annual assessment.

   (3)  At the request of the Department upon cause to believe that an update is required.

 (b)  The assessment must, at a minimum include the following:

   (1)  The resident’s need for assistance with ADLs and IADLs.

   (2)  The mobility needs of the resident.

   (3)  The ability of the resident to self-administer medication.

   (4)  The resident’s medical history, medical conditions, and current medical status and how these impact or interact with the individual’s service needs.

   (5)  The resident’s need for supplemental health care services.

   (6)  The resident’s need for special diet or meal requirements.

   (7)  The resident’s ability to safely operate key-locking devices.

 (a)  The resident shall be assessed for mobility needs as part of the resident’s assessment.

 (b)  If a resident is determined to have mobility needs as part of the resident’s initial or annual assessment, specific requirements relating to the care, health and safety of the resident shall be met immediately.

 (a)  Each resident requiring services shall have a written final support plan developed and implemented within 30 days after admission to the residence. The final support plan shall be documented on the Department’s support plan form.

 (b)  A residence may use its own support plan form if it includes the same information as the Department’s support plan form. An LPN, under the supervision of an RN, shall review and approve the final support plan.

 (c)  The final support plan shall be revised within 30 days upon completion of the annual assessment or upon changes in the resident’s needs as indicated on the current assessment. The residence shall review each resident’s final support plan on a quarterly basis and modify as necessary to meet the resident’s needs.

 (d)  Each residence shall document in the resident’s final support plan the dietary, medical, dental, vision, hearing, mental health or other behavioral care services that will be made available to the resident, or referrals for the resident to outside services if the resident’s physician, physician’s assistant or certified registered nurse practitioner, determine the necessity of these services. This requirement does not require a residence to pay for the cost of these medical and behavioral care services. The final support plan must document the assisted living services and supplemental health care services, if applicable, that will be provided to the resident.

 (e)  The resident’s final support plan must document the ability of the resident to self-administer medications or the need for medication reminders or medication administration and the ability of the resident to safely operate key-locking devices. Strategies that promote interactive communication on the part of and between direct care staff and individual residents shall also be included in the final support plan.

 (f)  A resident shall be encouraged to participate in the development and implementation of the final support plan. A resident may include a designated person or family member in making decisions about services.

 (g)  Individuals who participate in the development of the final support plan shall sign and date the support plan.

 (h)  If a resident or designated person is unable or chooses not to sign the final support plan, a notation of inability or refusal to sign shall be documented.

 (i)  The final support plan shall be accessible by direct care staff persons at all times.

 (j)  A resident or a designated person has a right to request the review and modification of his support plan.

 (k)  The residence shall give a copy of the final support plan to the resident and the resident’s designated person. The final support plan shall be attached to or incorporated into and serve as part of the resident-residence contract.

 (a)  The facility shall ensure that a transfer or discharge is safe and orderly and that the transfer or discharge is appropriate to meet the resident’s needs. This includes ensuring that a resident is transferred or discharged with all his medications, durable medical equipment and personal property. The residence shall permit the resident to participate in the decision relating to the relocation.

 (b)  If the residence initiates a transfer or discharge of a resident, or if the legal entity chooses to close the residence, the residence shall provide a 30-day advance written notice to the resident, the resident’s family or designated person and the referral agent citing the reasons for the transfer or discharge. This shall be stipulated in the resident-residence contract.

   (1)  The 30-day advance written notice must be written in language in which the resident understands, or performed in American Sign Language or presented orally in a language the resident understands if the resident does not speak standard English. The notice must include the following:

     (i)   The specific reason for the transfer or discharge.

     (ii)   The effective date of the transfer or discharge.

     (iii)   The location to which the resident will be transferred or discharged.

     (iv)   An explanation of the measures the resident or the resident’s designated person can take if they disagree with the residence decision to transfer or discharge which includes the name, mailing address, and telephone number of the State and local long-term care ombudsman.

     (v)   The resident’s transfer or discharge rights, as applicable.

   (2)  Prior to initiating a transfer or discharge of a resident, the residence shall make reasonable accommodation for aging in place that may include services from outside providers. The residence shall demonstrate through support plan modification and documentation the attempts to resolve the reason for the transfer or discharge. Supplemental services may be provided by the resident’s family, residence staff or private duty staff as agreed to by the resident and the residence. This shall be stipulated in the resident-residence contract.

   (3)  Practicable notice, rather than a 30-day advance written notice is required if a delay in transfer or discharge would jeopardize the health, safety or well-being of the resident or others in the residence, as certified by a physician or the Department. This may occur when the resident needs psychiatric services or is abused in the residence, or the Department initiates closure of the residence.

 (c)  A residence shall give the Department written notice of its intent to close the residence, at least 60 days prior to the anticipated date of closing.

 (d)  A residence may not require a resident to leave the residence prior to 30 days following the resident’s receipt of a written notice from the residence regarding the intended closure of the residence, except when the Department determines that removal of the resident at an earlier time is necessary for the protection of the health, safety and well-being of the resident.

 (e)  The date and reason for the transfer or discharge, and the destination of the resident, if known, shall be recorded in the resident record and tracked in a transfer and discharge tracking chart that the residence shall maintain and make available to the Department.

 (f)  If the legal entity chooses to voluntarily close the residence or if the Department has initiated legal action to close the residence, the Department working in conjunction with appropriate local authorities, will offer relocation assistance to the residents. Except in the case of an emergency, each resident may participate in planning the transfer, and shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences. These procedures apply even if the resident is placed in a temporary living situation.

 (g)  Within 30 days of the residence’s closure, the legal entity shall return the license to the Department.

 (h)  The only grounds for transfer or discharge of a resident from a residence are for the following conditions:

   (1)  If a resident is a danger to himself or others and the behavior cannot be managed through interventions, services planning or informed consent agreements.

   (2)  If the legal entity chooses to voluntarily close the residence, or a portion of the residence.

   (3)  If a residence determines that a resident’s functional level has advanced or declined so that the resident’s needs cannot be met in the residence under §  2800.229 (relating to excludable conditions; exceptions) or within the scope of licensure for a residence. In that case, the residence shall notify the resident and the resident’s designated person. The residence shall provide justification for the residence’s determination that the needs of the resident cannot be met. In the event that there is no disagreement related to the transfer or discharge, a plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident and the resident’s designated person, if any. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/mental retardation program or drug and alcohol program, for assistance. The administrator shall also contact the Department.

   (4)  If meeting the resident’s needs would require a fundamental alteration in the residence’s program or building site, or would create an undue financial or programmatic burden on the residence.

   (5)  If the resident has failed to pay after reasonable documented efforts by the residence to obtain payment.

   (6)  If closure of the residence is initiated by the Department.

   (7)  Documented, repeated violation of the residence rules.

   (8)  A court has ordered the transfer or discharge.

 (i)  If grounds for transfer or discharge is based upon subsection (h)(1) or (3), a certification from one of the following individuals shall be required to certify in writing that the resident can no longer be retained in the residence:

   (1)  The administrator acting in consultation with supplemental health care providers.

   (2)  The resident’s physician or certified registered nurse practitioner.

   (3)  The medical director of the residence.

 (a)  Excludable conditions. Except as provided in subsection (b), a residence may not admit, retain or serve an individual with any of the following conditions or health care needs:

   (1)  Ventilator dependency.

   (2)  Stage III and IV decubiti and vascular ulcers that are not in a healing stage.

   (3)  Continuous intravenous fluids.

   (4)  Reportable infectious diseases, such as tuberculosis, in a communicable state that requires isolation of the individual or requires special precautions by a caretaker to prevent transmission of the disease unless the Department of Health directs that isolation be established within the residence.

   (5)  Nasogastric tubes.

   (6)  Physical restraints.

   (7)  Continuous skilled nursing care 24 hours a day.

 (b)  Exception. The residence may submit a written request to the Department on a form provided by the Department for an exception related to any of the conditions or health care needs listed in subsection (a) or (e) to allow the residence to admit, retain or serve an individual with one of those conditions or health care needs, unless a determination is unnecessary as set forth in subsection (e).

 (c)  Submission, review and determination of an exception request.

   (1)  The administrator of the residence shall submit the exception request. The exception request must be signed and affirmed by an individual listed in subsection (d) and accompanied by a support plan which includes the residence accommodations for treating the excludable condition requiring the exception request. Proposed accommodations must conform with the provisions contained within the resident-residence contract.

   (2)  The Department will review the exception request in consultation with a certified registered nurse practitioner or a physician, with experience caring for the elderly and disabled in long-term living settings.

   (3)  The Department will respond to the exception request in writing within 5 business days of receipt.

   (4)  The Department may approve the exception request if the following conditions are met:

     (i)   The exception request is desired by the resident or applicant.

     (ii)   The resident or applicant will benefit from the approval of the exception request.

     (iii)   The residence demonstrates to the Department’s satisfaction that the residence has the staff, skills and expertise necessary to care for the resident’s needs related to the excludable condition.

     (iv)   The residence demonstrates to the Department’s satisfaction that any necessary supplemental health care provider has the staff, skills and expertise necessary to care for the resident’s needs related to the excludable condition.

     (v)   The residence provides a written alternate care plan that ensures the availability of staff with the skills and expertise necessary to care for the resident’s needs related to the excludable condition in the event the supplemental health care provider is unavailable.

   (5)  The Department will render decisions on exception requests on a case-by-case basis and not provide for facility-wide exceptions.

 (d)  Certification providers. The following persons may certify that an individual with an excludable condition may not be admitted or retained in a residence:

   (1)  The administrator acting in consultation with supplemental health care providers.

   (2)  The individual’s physician or certified registered nurse practitioner.

   (3)  The medical director of the residence.

 (e)  Departmental exceptions. A residence may admit, retain or serve an individual for whom a determination is made by the Department, upon the written request of the residence, that the individual’s specific health care needs can be met by a provider of assisted living services or within a residence, including an individual requiring:

   (1)  Gastric tubes, except that a determination will not be required if the individual is capable of self-care of the gastric tube or a licensed health care professional or other qualified individual cares for the gastric tube.

   (2)  Tracheostomy, except that a determination will not be required if the individual is independently capable of self-care of the tracheostomy.

   (3)  Skilled nursing care 24 hours a day, except that a determination will not be required if the skilled nursing care is provided on a temporary or intermittent basis.

   (4)  A sliding scale insulin administration, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the insulin.

   (5)  Intermittent intravenous therapy, except that a determination will not be required if a licensed health care professional manages the therapy.

   (6)  Insertions, sterile irrigation and replacement of a catheter, except that a determination will not be required for routine maintenance of a urinary catheter, if the individual is capable of self-administration or a licensed health care professional administers the catheter.

   (7)  Oxygen, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the oxygen.

   (8)  Inhalation therapy, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the therapy.

   (9)  Other types of supplemental health care services that the administrator, acting in consultation with supplemental health care providers, determines can be provided in a safe and effective manner by the residence.

   (10)  For purposes of paragraphs (1), (4), (7) and (8), a ‘‘qualified individual’’ means an individual who has been determined by a certification provider listed under subsection (d) to be capable of care or administration under paragraphs (1), (4), (7) and (8).

 (f)  Request for exception by resident. Nothing herein prevents an individual seeking admission to a residence or a resident from requesting that the residence apply for an exception from the Department for a condition listed in this section for which an exception must be granted by the Department. The residence’s determination on whether or not to seek such an exception shall be documented on a form supplied by the Department.

 (g)  Record. A written record of the exception request, the supporting documentation to justify the exception request and the determination related to the exception request shall be kept in the records of the residence. The information required by this subsection shall also be kept in the resident’s record.

 (h)  Decisions. The residence shall record the following decisions made on the basis of this section.

   (1)  Admission denials.

   (2)  Transfer or discharge decisions that are made on the basis of this section.

   This section cited in 55 Pa. Code §  2800.228 (relating to transfer and discharge); and 55 Pa. Code §  2800.252 (relating to content of resident records).

SPECIAL CARE UNITS

§ 2800.231. Admission.

 (a)  Special care units. This section and § §  2800.232—2800.239 apply to special care units. These provisions are in addition to the other provisions of this chapter. A special care unit is a residence or portion of a residence that provides one or both of the following:

   (1)  Specialized care and services for residents with Alzheimer’s disease or dementia in the least restrictive manner consistent with the resident’s support plan to ensure the safety of the resident and others in the residence while maintaining the resident’s ability to age in place.

     (i)   Admission of a resident shall be in consultation with the resident’s family or designated person.

     (ii)   Prior to admission other service options that may be available to a resident shall be considered.

   (2)  Intense neurobehavioral rehabilitation for residents with severely disruptive and potentially dangerous behaviors as a result of brain injury in the least restrictive manner consistent with the resident’s rehabilitation and support plan to ensure the safety of the resident and others in the residence.

     (i)   Each resident of a special care unit for INRBI shall have a rehabilitation and support plan that supports independence and promotes recovery and thereby discharge to a less restrictive setting.

     (ii)   Special care units for INRBI shall provide for each resident to age in place.

     (iii)   Admission of a resident shall be in consultation with the resident or potential resident and, when appropriate, the resident’s designated person or the resident’s family, or both.

     (iv)   Prior to admission other less restrictive service options that may be available to a resident or potential resident shall be considered.

 (b)  Medical evaluation. A resident or potential resident shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner, documented on a form provided by the Department, within 60 days prior to admission.

   (1)  Documentation for a special care unit for residents with Alzheimer’s disease or dementia must include the resident’s diagnosis of Alzheimer’s disease or dementia and the need for the resident to be served in a special care unit.

   (2)  Documentation for a special care unit for INRBI must include the resident’s or potential resident’s diagnosis of brain injury and need for residential services to be provided in a special care unit for INRBI. The evaluation must include visual function, hearing, swallowing, mobility and hand function.

 (c)  Preadmission screening.

   (1)  Special care unit for residents with Alzheimer’s disease or dementia.

     (i)   A written cognitive preadmission screening completed in collaboration with a physician or a geriatric assessment team and documented on the Department’s cognitive preadmission screening form shall be completed for each resident within 72 hours prior to admission to a special care unit.

     (ii)   A geriatric assessment team is a group of multidisciplinary specialists in the care of adults who are older that conducts a multidimensional evaluation of a resident and assists in developing a support plan by working with the resident’s physician, designated person and the resident’s family to coordinate the resident’s care.

   (2)  Special care unit for INRBI.

     (i)   A written CPB preadmission screening completed in collaboration with a physician, neuropsychologist or cognitive, physical, behavioral assessment team and documented on the Department’s CPB preadmission screening form shall be completed for each resident or potential resident within 72 hours prior to admission to a special care unit for INRBI.

     (ii)   A cognitive, physical, behavioral specialist with brain injury experience shall assist in developing a rehabilitation and support plan by working with the resident’s physician, neuropsychologist and, when appropriate, the resident’s designated person or the resident’s family, or both to develop the resident’s rehabilitation and support plan. This plan must include a high level of nursing and behavioral supervision, medication management, occupational therapy, cognitive therapy, behavioral therapy, vocational services, support for social reentry, and a personalized treatment plan.

 (d)  Resident admission to special care unit. Each resident record must have documentation that the resident or potential resident and, when appropriate, the resident’s designated person or the resident’s family have agreed to the resident’s admission or transfer to the special care unit.

 (e)  Additional assessments.

   (1)  In addition to the requirements in §  2800.225 (relating to additional assessments), residents of a special care unit for Alzheimer’s disease or dementia shall also be assessed quarterly for the continuing need for the special care unit for Alzheimer’s disease or dementia.

   (2)  In addition to the requirements in §  2800.225, residents of a special care unit for INRBI shall also be assessed at least semiannually or more frequently as necessary to assure the continuing need for residence in the special care unit for INRBI.

 (f)  Additional resident in special care unit. A spouse, friend or family member who does not have a primary diagnosis of Alzheimer’s disease or dementia or brain injury may reside in the special care unit if desired by the resident or his designated person.

   (1)  The spouse, friend or family member shall have a medical evaluation by a physician, physician’s assistant or certified registered nurse practitioner, documented on a form provided by the Department within 60 days prior to admission to the residence or 15 days after admission to the residence.

   (2)  The spouse, friend or family member shall have access to and be able to follow directions for the operation of the key pads or other lock-releasing devices to exit the special care unit.

 (g)  Disclosure of services. The resident-residence contract specified in §  2800.25 (relating to resident-residence contract) must also include a disclosure of services, admission and discharge criteria, change in condition policies, special programming and costs and fees.

 (h)  Alzheimer’s disease or dementia. When the residence holds itself out to the public as providing services or housing for individuals with Alzheimer’s disease or dementia, the residence shall disclose to individuals and provide materials that include the following:

   (1)  The residence’s written statement of its philosophy and mission which reflects the needs of individuals with Alzheimer’s disease or dementia.

   (2)  A description of the residence’s physical environment and design features to support the functioning of individuals with Alzheimer’s disease or dementia.

   (3)  A description of the frequency and types of individual and group activities designed specifically to meet the needs of individuals with Alzheimer’s disease or dementia.

   (4)  A description of the security measures provided by the residence.

   (5)  A description of the training provided to staff regarding provision of care to individuals with Alzheimer’s disease or dementia.

   (6)  A description of availability of family support programs and family involvement.

   (7)  The process used for assessment and establishment of a plan of services for the individual, including methods by which the plan of services will remain responsive to changes in the individual’s condition.

 (i)  Special care unit for INRBI. When an assisted living residence holds itself out to the public as a special care unit for INRBI, the residence shall disclose and provide materials to individuals and, when appropriate, the individual’s designated person or the individual’s family, or both, that include the following information:

   (1)  The residence’s written statement of its philosophy and mission which reflects the needs of individuals with brain injury for intense neurobehavioral rehabilitation and support.

   (2)  A description of the residence’s physical environment and design features that support and promote the functioning and rehabilitation of individuals who need INRBI.

   (3)  A description of the types of individual and group activities that have been designed specifically to meet the requirements of the rehabilitation and support plans of specific residents with brain injury.

   (4)  A description of the security measures provided by the residence.

   (5)  A description of the credentials and experience required and the training provided to staff regarding the provision of rehabilitation and support for individuals who require INRBI.

   (6)  A description of availability of family support programs, family education programs, and family involvement.

   (7)  The process used for assessment and establishment of a plan of services for the resident, including methods by which the plan of services will remain responsive to progress in the resident’s recovery.

 (j)  Residents who wander. The residence shall identify measures to address individuals with Alzheimer’s disease or dementia or with INRBI who have tendencies to wander.

 (k)  Individuals with INRBI. The residence with a special care unit for INRBI shall identify measures to address individuals who require INRBI who have problems that may actually impede rehabilitation such as:

   (1)  Anger.

   (2)  Self-control.

   (3)  Aggression toward others.

   (4)  Self-injury.

   (5)  Deficient judgment and problem solving due to cognitive deficits.

   (6)  Frequent agitation.

   (7)  Prolonged confusional state.

   (8)  Seizure disorders and related behavioral problems.

   (9)  Significant memory and learning problems.

   (10)  Disruption of sleep and wake cycles.

   (11)  Problems with attention.

   (12)  Filtering and focusing.

   (13)  Emergence of mental health problems or exacerbation of preexisting mental health issues.

   (14)  Emergence of substance abuse problems or exacerbation of preexisting substance abuse issues.

   (15)  Other cognitive and behavioral problems which have or would prevent successful completion of traditional rehabilitation programs.

 (l)  Professionals caring for individuals requiring INRBI. The residence with a special care unit for INRBI shall identify at a minimum the following professionals with expertise in providing care for individuals requiring INRBI.

   (1)  Onsite behavioral specialist.

   (2)  Onsite cognitive rehabilitation therapist.

   (3)  A consulting physiatrist; a consulting neuro-psychologist.

   (4)  A consulting neuropsychiatrist or psychiatrist for prescribing and monitoring the psychiatric medications that may be needed for residents with behavioral health issues.

 (a)  The residence shall provide exercise space, both indoor and outdoor.

 (b)  No more than two residents may occupy a living unit regardless of its size. A living unit must meet the requirement in §  2800.101 (relating to resident living units), as applicable. Kitchen facilities may not be included in a living unit located in a special care unit for INRBI.

 (c)  The residence shall provide space for dining, group and individual activities and visits.

 (d)  The residence shall provide a full description of the measures implemented to enhance environmental awareness, minimize environmental stimulation and maximize independence of the residents in public and private spaces based on the needs of the individuals being served.

 (e)  The residence with a special care unit for INRBI shall identify the process used to assure conformity of the individual resident’s living unit to the ongoing rehabilitation recommendations of the neuropsychologist and the cognitive physical, emotional behavioral assessment team as expressed in the current rehabilitation and support plan.

 (a)  Doors equipped with key-locking devices, electronic card operated systems or other devices that prevent immediate egress are permitted only if there is written approval from the Department of Labor and Industry, Department of Health or appropriate local building authority permitting the use of the specific locking system.

 (b)  A residence shall have a statement from the manufacturer, specific to that residence, verifying that the electronic or magnetic locking system will shut down, and that all doors will open easily and immediately when one or more of the following occurs:

   (1)  Upon a signal from an activated fire alarm system, heat or smoke detector.

   (2)  Power failure to the residence.

   (3)  Overriding the electronic or magnetic locking system by use of a key pad or other lock-releasing device.

 (c)  If key-locking devices, electronic card systems or other devices that prevent immediate egress are used to lock and unlock exits, directions for their operation shall be conspicuously posted near the device.

 (d)  Doors that open onto areas such as parking lots, or other potentially unsafe areas, shall be locked by an electronic or magnetic system.

 (e)  Fire alarm systems must be interconnected to the local fire department, when available, or a 24-hour monitoring service approved by the local fire department.

 (a)  Support or rehabilitation plan.

   (1)  Within 72 hours of the admission, or within 72 hours prior to the resident’s admission to the special care unit, a support plan shall be developed, implemented and documented in each resident’s record.

   (2)  For individuals being admitted into a special care unit for INRBI, a rehabilitation plan shall be developed, implemented and documented in the resident record. This rehabilitation plan and the individual’s support plan shall be based on the CPB preadmission assessment and other available records and information.

 (b)  Plan requirements.

   (1)  The support plan and if applicable, the rehabilitation plan must identify the resident’s physical, medical, social, cognitive and safety needs.

   (2)  The rehabilitation and support plan for residents of a special care unit for INRBI must identify the residents’ emotional and behavioral needs.

 (c)  Responsible individual. The support plan and if applicable, the rehabilitation plan must identify the individual responsible to address the resident’s needs.

 (d)  Review of plans.

   (1)  The support plan for a resident of a special care unit for residents with Alzheimer’s disease or dementia shall be reviewed, and if necessary, revised at least quarterly and as the resident’s condition changes.

   (2)  The support plan and rehabilitation plan for a resident of a special care unit for INRBI shall be reviewed, and if necessary, revised at least monthly and as the resident’s condition changes.

 (e)  Resident involvement in development of plan. The resident, the resident’s designated person or the resident’s family shall be involved in the development and the revisions of the support plan and if applicable, the rehabilitation plan.

 (a)  If the residence initiates a discharge or transfer of a resident, or the legal entity chooses to close the residence, the administrator shall give a 30-day advance written notice to the resident, the resident’s designated person and the referral agent citing the reasons for the discharge or transfer. This requirement shall be stipulated in the resident-residence contract signed prior to admission to the special care unit.

 (b)  If a resident of a special care unit for INRBI, or when appropriate, the resident’s designated person or the resident’s family, request discharge to another facility, another assisted living residence or an independent living arrangement, transition services shall be provided by the special care unit.

 (a)  Each direct care staff person working in a special care unit for residents with Alzheimer’s disease or dementia shall have 8 hours of initial training within the first 30 days of the date of hire and a minimum of 8 hours of annual training related to dementia care and services, in addition to the 16 hours of annual training specified in §  2800.65 (relating to staff orientation and direct care staff person training and orientation).

 (b)  The training for each direct care staff person working in a special care unit for residents with Alzheimer’s disease or dementia at a minimum must include the following topics:

   (1)  An overview of Alzheimer’s disease and related dementias.

   (2)  Managing challenging behaviors.

   (3)  Effective communications.

   (4)  Assistance with ADLs.

   (5)  Creating a safe environment.

 (c)  Each direct care staff person working in a special care unit for INRBI shall have 8 hours of initial training within the first 30 days of the date of hire and a minimum of 8 hours of annual training related to brain injury, in addition to the 16 hours of annual training specified in §  2800.65 and any continuing education required for professional licensing.

 (d)  The training for each direct care staff person working in a special care unit for INRBI in addition to subsection (b)(3), (4) and (5), must at a minimum include the following topics:

   (1)  An overview of brain injury including the common cognitive, physical and behavioral effects.

   (2)  Understanding and managing challenging behaviors which follow from the cognitive, physical and behavioral effects of brain injury.

   (3)  Tailoring activities and interactions to provide individualized rehabilitation and support in accordance with the resident’s rehabilitation and support plan.

   (4)  Coaching and cueing, interactive problem solving, promoting the initiation of self-soothing activities, and timing the fading of supports.

 (a)  The following types of activities shall be offered at least weekly to residents of a special care unit for residents with Alzheimer’s disease or dementia:

   (1)  Gross motor activities, such as dancing, stretching and other exercise.

   (2)  Self-care activities, such as personal hygiene.

   (3)  Social activities, such as games, music and holiday and seasonal celebrations.

   (4)  Crafts, such as sewing, decorations and pictures.

   (5)  Sensory and memory enhancement activities, such as review of current events, movies, story telling, picture albums, cooking, pet therapy and reminiscing.

   (6)  Outdoor activities, as weather permits, such as walking, gardening and field trips.

 (b)  Resident participation for residents of a special care unit for residents with Alzheimer’s disease or dementia in general activity programming shall:

   (1)  Be voluntary.

   (2)  Respect the resident’s age and cognitive abilities.

   (3)  Support the retention of the resident’s abilities.

 (c)  The rehabilitation and support plans of the residents in a special care unit for INRBI will determine the types and frequency of the individual and group activities to be offered.

 Each resident in a special care unit shall be considered to be a resident with mobility needs under §  2800.57(c) (relating to direct care staffing).

 (a)  The legal entity shall submit an application to the Department at least 60 days prior to the following:

   (1)  Opening a special care unit.

   (2)  Adding a special care unit to an existing residence.

   (3)  Increasing the maximum capacity in an existing unit.

   (4)  Changing the locking system, exit doors or floor plan of an existing unit.

 (b)  The Department will inspect and approve the special care unit prior to operation or change. The requirements of this chapter shall be met prior to operation.

 (c)  The following documents shall be included in the application specified in subsection (a):

   (1)  The name, address and legal entity of the residence.

   (2)  The name of the administrator of the residence.

   (3)  The maximum capacity of the residence.

   (4)  The requested resident population of the special care unit.

   (5)  A building description.

   (6)  A unit description.

   (7)  The type of locking system.

   (8)  Policy and procedures to be implemented for emergency egress and resident elopement.

   (9)  A sample of a 2-week staffing schedule.

   (10)  Verification of completion of additional training requirements.

   (11)  The operational description of the special care unit locking system of the doors.

   (12)  The manufacturer’s statement regarding the special care unit locking system.

   (13)  A written approval or a variance permitting locked exit doors from the Department of Labor and Industry, the Department of Health or the appropriate local building authority.

   (14)  The name of the municipality or 24-hour monitoring service maintaining the interconnection with the residence’s fire alarm system.

   (15)  A sample plan of care and service for the resident addressing the resident’s physical, medical, social, cognitive and safety needs for the residents.

   (16)  The activity standards.

   (17)  The complete medical and cognitive preadmission assessment that is completed upon admission and reviewed and updated annually.

   (18)  A consent form agreeing to the resident’s placement in the special care unit, to be signed by the resident or the resident’s designated person.

   (19)  A written agreement containing full disclosure of services, admission and discharge criteria, change in condition policies, services, special programming, costs and fees.

   (20)  A description of environmental cues being utilized.

   (21)  A general floor plan of the entire residence.

   (22)  A specific floor plan of the special care unit, outside enclosed area and exercise space.

   This section cited in 55 Pa. Code §  2800.231 (relating to admission).

RESIDENT RECORDS

§ 2800.251. Resident records.

 (a)  A separate record shall be kept for each resident.

 (b)  The entries in a resident’s record must be permanent, legible, dated and signed by the staff person making the entry.

 (c)  The residence shall use standardized forms to record information in the resident’s record.

 (d)  Separate resident records shall be kept on the premises where the resident lives.

 Each resident’s record must include the following information:

   (1)  Name, gender, admission date, birth date and Social Security number.

   (2)  Race, height, weight at time of admission, color of hair, color of eyes, religious affiliation, if any, and identifying marks.

   (3)  A photograph of the resident that is no more than 2 years old.

   (4)  A language, speech, hearing or vision need which requires accommodation or awareness of during oral or written communication.

   (5)  The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency.

   (6)  The name, address and telephone number of the resident’s physician or source of health care.

   (7)  The current and previous 2 years’ physician’s examination reports, including copies of the medical evaluation forms.

   (8)  A list of prescribed medications, OTC medications and CAM.

   (9)  Dietary restrictions.

   (10)  A record of incident reports for the individual resident.

   (11)  A list of allergies.

   (12)  Documentation of health care services and orders, including orders for the services of visiting nurse or home health agencies.

   (13)  The initial assessment, the preliminary support plan and the most current version of the annual assessment.

   (14)  A final support plan.

   (15)  Applicable court order, if any.

   (16)  The resident’s medical insurance information.

   (17)  The date of entrance into the residence, relocations and discharges, including the transfer of the resident to other residences owned by the same legal entity.

   (18)  An inventory of the resident’s personal property as voluntarily declared by the resident upon admission and voluntarily updated.

   (19)  An inventory of the resident’s property entrusted to the administrator for safekeeping.

   (20)  The financial records of residents receiving assistance with financial management.

   (21)  The reason for termination of services or transfer of the resident, the date of transfer and the destination.

   (22)  Copies of transfer and discharge summaries from hospitals, if available.

   (23)  If the resident dies in the residence, a copy of the official death certificate.

   (24)  Signed notification of rights, grievance procedures and applicable consent to treatment protections specified in §  2800.41 (relating to notification of rights and complaint procedures).

   (25)  A copy of the resident-residence contract.

   (26)  A termination notice, if any.

   (27)  A record relating to any exception request under §  2800.229 (relating to excludable conditions; exceptions).

 (a)  The resident’s entire record shall be maintained for a minimum of 3 years following the resident’s death, discharge from the residence or until any audit or litigation is resolved.

 (b)  Records shall be destroyed in a manner that protects confidentiality.

 (c)  The residence shall keep a log of resident records destroyed on or after January 18, 2011. This log must include the resident’s name, record number, birth date, admission date and discharge date.

 (a)  Records of active and discharged residents shall be maintained in a confidential manner, which prevents unauthorized access.

 (b)  Each residence shall develop and implement policy and procedures addressing record accessibility, security, storage, authorized use and release and who is responsible for the records.

 (c)  Resident records shall be stored in locked containers or a secured, enclosed area used solely for record storage and be accessible at all times to the administrator, the administrator’s designee, or the nurse involved in assessment and support plan development and upon request, to the Department or representatives of the area agency on aging.

ENFORCEMENT

§ 2800.261. Classification of violations.

 (a)  The Department will classify each violation of this chapter into one of three categories as described in paragraphs (1)—(3). A violation identified may be classified as Class I, Class II or Class III, depending upon the severity, duration and the adverse effect on the health and safety of residents.

   (1)  Class I. Class I violations have resulted in or have a substantial probability of resulting in death or serious mental or physical harm to a resident.

   (2)  Class II. Class II violations have a substantial adverse effect upon the health, safety or well-being of a resident.

   (3)  Class III. Class III violations are minor violations, which have an adverse effect upon the health, safety or well-being of a resident.

 (b)  The Department’s guidelines for determining the classification of violations are available from the Department.

 (a)  The Department will assess a penalty for each violation of this chapter.

 (b)  Penalties will be assessed on a daily basis from the date on which the citation was issued until the date the violation is corrected, except in the case of Class II and Class III violations.

 (c)  In the case of a Class II violation, assessment of the penalty will be suspended for 5 days from the date of citation to permit sufficient time for the residence to correct the violation. If the residence fails to provide proof of correction of the violation to the Department within the 5-day period, the fine will be retroactive to the date of citation. The Department may extend the time period for good cause.

 (d)  The Department will assess a penalty of $20 per resident per day for each Class I violation. Each Class I violation shall be corrected within 24 hours.

 (e)  The Department will assess a minimum penalty of $5 per resident per day, up to a maximum penalty of $15 per resident per day, for each Class II violation.

 (f)  There is no monetary penalty for Class III violations unless the residence fails to correct the violation within 15 days. Failure to correct a Class III violation within the 15-day period may result in a penalty assessment of up to $3 per resident per day for each Class III violation retroactive to the date of the citation.

 (g)  If a residence is found to be operating without a license, a penalty of $500 will be assessed. After 14 days, if the residence operator cited for operating without a license fails to file an application for a license, the Department will assess an additional $20 for each resident for each day during which the residence operator fails to apply.

 (h)  A residence charged with a violation of this chapter or Chapter 20 (relating to licensure or approval of facilities and agencies) has 30 days to pay the assessed penalty in full.

 (a)  If the residence that is fined intends to appeal the amount of the penalty or the fact of the violation, the residence shall forward the assessed penalty, not to exceed $500, to the Secretary for placement in an escrow account with the State Treasurer. A letter appealing the penalty shall be submitted with the assessed penalty. This process constitutes an appeal.

 (b)  If, through an administrative hearing or judicial review of the proposed penalty, it is determined that no violation occurred or that the amount of the penalty shall be reduced, the Secretary will, within 30 days, remit the appropriate amount to the legal entity together with interest accumulated on these funds in the escrow deposit.

 (c)  Failure to forward payment of the assessed penalty to the Secretary within 30 days will result in a waiver of the right to contest the fact of the violation or the amount of the penalty.

 (d)  After an administrative hearing decision that is adverse to the legal entity, or a waiver of the administrative hearing, the assessed penalty amount will be made payable to the ‘‘Commonwealth of Pennsylvania.’’ It will be collectible in a manner provided by law for the collection of debts.

 (a)  Money collected by the Department under this section will be placed in a special restricted receipt account.

 (b)  Money collected will be used first to defray the expenses incurred by residents relocated under this chapter.

 (a)  The Department will temporarily revoke the license of a residence if, without good cause, one or more Class I violations remain uncorrected 24 hours after the residence has been cited for the violation.

 (b)  The Department will temporarily revoke the license of a residence if, without good cause, one or more Class II violations remain uncorrected 15 days after the citation.

 (c)  Upon the revocation of a license in the instances described in subsections (a) and (b), or if the residence continues to operate without applying for a license as described in §  2800.262(h) (relating to penalties and corrective action), residents shall be relocated.

 (d)  The revocation of a license may terminate upon the Department’s determination that its violation is corrected.

 (e)  If, after 3 months, the Department does not issue a new license for a residence, the prior license is revoked under section 1087 of the Public Welfare Code (62 P. S. §  1087).

   (1)  Revocation or nonrenewal under this section will be for a minimum of 5 years.

   (2)  A residence, which has had a license revoked or not renewed under this section, will not be allowed to operate, staff or hold an interest in a residence which applies for a license for 5 years after the revocation or nonrenewal.

 (f)  If a residence has been found to have Class I violations on two or more separate occasions during a 2-year period without justification, the Department will revoke or refuse to renew the license of the residence.

 (a)  If the relocation of residents is due to the failure of the residence to apply for a license, the Department will offer relocation assistance to the residents. This assistance will include each resident’s involvement in planning the relocation, except in the case of an emergency. Each resident shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences. These procedures will occur even if the residents are placed in a temporary living situation.

 (b)  A resident will not be relocated if the Secretary determines in writing that the relocation is not in the best interest of the resident.

 (a)  The administrator shall give each resident and the resident’s designated person written notification of a Class I violation within 24 hours of the citation.

 (b)  The administrator shall give each resident and the resident’s designated person oral or written notification of a Class I or Class II violation, as defined in §  2800.261 (relating to classification of violations), which remains uncorrected for 5 days after the date of citation.

 (c)  If a Class II violation remains uncorrected within 5 days following the citation, the administrator shall give written notice of the violation to each resident and the resident’s designated person on the 6th day from the date of the citation.

 (a)  The Department will ban new admissions to a residence:

   (1)  That has been found to have a Class I violation.

   (2)  That has been found to have a Class II violation that remains uncorrected without good cause 5 days after being cited for the violation.

   (3)  Whose license has been revoked or nonrenewed.

 (b)  The Department may ban new admissions to a residence that has been found to have a repeated Class II violation within the past 2 years.

 The correction of a violation cited under section 1086 of the Public Welfare Code (62 P. S. §  1086) does not preclude the Department from issuing a provisional license based upon the same violation.

Appendix A

Assisted Living Resident Rights:
During Residency and During Discharge or Termination of Residency

 The following are assisted living resident rights, including the notification of a resident’s designated person:

General Requirements

1	The resident, or a designated person, has the right to rescind the contract for up to 72 hours after the initial dated signature of the contract.	§  2800.25(h) Resident-residence contract
2	Either party has a right to rescind the informed consent agreement within 30 days of execution of the agreement.	§  2800.30(k) Informed consent process

Resident Rights

3	Upon admission, each resident and, if applicable, the resident’s designated person, shall be informed of resident rights and the right to lodge complaints without intimidation, retaliation or threats of retaliation by the residence or its staff persons against the reporter. Retaliation includes transfer or discharge from the residence.	§  2800.41(a) Notification of rights and complaint procedures
4	Notification of rights and complaint procedures shall be communicated in an easily understood manner and in a language understood by or mode of communication used by the resident, and if applicable, the resident’s designated person.	§  2800.41(b) Notification of rights and complaint procedures
5	The Department’s poster of the list of resident’s rights shall be posted in a conspicuous and public place in the residence.	§  2800.41(c) Notification of rights and complaint procedures
6	A copy of the resident’s rights and complaint procedures shall be given to the resident and, if applicable, the resident’s designated person upon admission.	§  2800.41(d) Notification of rights and complaint procedures
7	A statement signed by the resident and, if applicable, the resident’s designated person acknowledging receipt of a copy of the information specified in subsection (d), or documentation of efforts made to obtain signature, shall be kept in the resident’s record.	§  2800.41(e) Notification of rights and complaint procedures
8	A resident may not be discriminated against because of race, color, religious creed, disability, ancestry, sexual orientation, national origin, age or sex.	§  2800.42(a) Specific rights
9	A resident may not be neglected, intimidated, physically or verbally abused, mistreated, subjected to corporal punishment or disciplined in any way. A resident must be free from mental, physical, and sexual abuse and exploitation, neglect, financial exploitation and involuntary seclusion.	§  2800.42(b) Specific rights
10	A resident shall be treated with dignity and respect.	§  2800.42(c) Specific rights
11	A resident shall be informed of the rules of the residence and given 30 days written notice prior to the effective date of a new residence rule.	§  2800.42(d) Specific rights
12	A resident shall have access to a telephone in the residence to make calls in privacy. Nontoll calls must be without charge to the resident.	§  2800.42(e) Specific rights
13	A resident has the right to receive and send mail. 1. Outgoing mail may not be opened or read by staff persons unless the resident requests. 2. Incoming mail may not be opened or read by staff persons unless the resident requests.	§  2800.42(f)(1) & (2) Specific rights
14	A resident has the right to communicate privately with and access the local ombudsman.	§  2800.42(g) Specific rights
15	A resident has the right to practice the religion or faith of the resident’s choice, or not to practice any religion or faith.	§  2800.42(h) Specific rights
16	A resident shall receive assistance in accessing health care services, including supplemental health care services.	§  2800.42(i) Specific rights
17	A resident shall receive assistance in obtaining and keeping clean, seasonal clothing. A resident’s clothing may not be shared with other residents.	§  2800.42(j) Specific rights
18	A resident and the resident’s designated person, and other individuals upon the resident’s written approval shall have the right to access, review and request corrections to the resident’s record.	§  2800.42(k) Specific rights
19	A resident has the right to furnish his living unit and purchase, receive, use and retain personal clothing and possessions.	§  2800.42(l) Specific rights
20	A resident has the right to leave and return to the residence at times consistent with the residence rules and the resident’s support plan.	§  2800.42(m) Specific rights
21	A resident has the right to relocate and to request and receive assistance, from the residence, in relocating to another facility. The assistance must include helping the resident get information about living arrangements, making telephone calls and transferring records.	§  2800.42(n) Specific rights
22	A resident has the right to freely associate, organize and communicate privately with his friends, family, physician, attorney and other persons.	§  2800.42(o) Specific rights
23	A resident shall be free from restraints.	§  2800.42(p) Specific rights
24	A resident shall be compensated in accordance with State and Federal labor laws for labor performed on behalf of the residence. Residents may voluntarily and without coercion perform tasks related directly to the resident’s personal space or common areas of the residence.	§  2800.42(q) Specific rights
25	A resident has the right to receive visitors at any time provided that the visits do not adversely affect other residents. A residence may adopt reasonable policies and procedures related to visits and access. If the residence adopts those policies and procedures, they will be binding on the residence.	§  2800.42(r) Specific rights
26	A resident has the right to privacy of self and possessions. Privacy shall be provided to the resident during bathing, dressing, changing and medical procedures.	§  2800.42(s) Specific rights
27	A resident has the right to file complaints, grievances or appeals with any individual or agency and recommend changes in policies, residence rules and services of the residence without intimidation, retaliation or threat of discharge.	§  2800.42(t) Specific rights
28	A resident has the right to remain in the residence, as long as it is operating with a license, except as specified in §  2800.228 (relating to transfer and discharge).	§  2800.42(u) Specific rights
29	A resident has the right to receive services contracted for in the resident-residence contract.	§  2800.42(v) Specific rights
30	A resident has the right to use both the residence’s procedures and external procedures to appeal involuntary discharge.	§  2800.42(w) Specific rights
31	A resident has the right to a system to safeguard a resident’s money and property.	§  2800.42(x) Specific rights
32	To the extent prominently displayed in the written resident-residence contract, a residence may require residents to use providers of supplemental health care services as provided in §  2800.142 (relating to assistance with medical care and supplemental health care services). When the residence does not designate, the resident may choose the supplemental health care services provider. The actions and procedures utilized by a supplemental health care service provider chosen by a resident must be consistent with the residence’s systems for caring for residents. This includes the handling and assisting with the administration of resident’s medications, and shall not conflict with Federal laws governing residents.	§  2800.42(y) Specific rights
33	The resident has the right to choose his primary care physician.	§  2800.42(z) Specific rights
34	A resident may not be deprived of his rights.	§  2800.43(a) Prohibition against deprivation of rights
35	A resident’s rights may not be used as a reward or sanction.	§  2800.43(b) Prohibition against deprivation of rights
36	Waiver of any resident right shall be void.	§  2800.43(c) Prohibition against deprivation of rights
37	Prior to admission, the residence shall inform the resident and the resident’s designated person of the right to file and the procedure for filing a complaint with the Department’s Assisted Living Residence Licensing Office, local ombudsman or protective services unit in the area agency on aging, the Disability Rights Network or law enforcement agency.	§  2800.44(a) Complaint procedures
38	The residence shall permit and respond to oral and written complaints from any source regarding an alleged violation of resident rights, quality of care or other matter without retaliation or the threat of retaliation.	§  2800.44(b) Complaint procedures
39	If a resident indicates that he wishes to make a written complaint, but needs assistance in reducing the complaint to writing, the residence shall assist the resident in writing the complaint.	§  2800.44(c) Complaint procedures
40	The residence shall ensure investigation and resolution of complaints. The residence shall designate the staff person responsible for receiving complaints and determining the outcome of the complaint. The residence shall keep a log of all complaints and the outcomes of the complaints.	§  2800.44(d) Complaint procedures
41	Within 2 business days after the submission of a written complaint, a status report shall be provided by the residence to the complainant. If the resident is not the complainant, the resident and the resident’s designated person shall receive the status report unless contraindicated by the support plan. The status report must indicate the steps that the residence is taking to investigate and address the complaint.	§  2800.44(e) Complaint procedures
42	Within 7 days after the submission of a written complaint, the residence shall give the complainant and, if applicable, the designated person, a written decision explaining the residence’s investigation findings and the action the residence plans to take to resolve the complaint. If the resident is not the complainant, the affected resident shall receive a copy of the decision unless contraindicated by the support plan. If the residence’s investigation validates the complaint allegations, a resident who could potentially be harmed or his designated person shall receive a copy of the decision, with the name of the affected resident removed, unless contraindicated by the support plan.	§  2800.44(f) Complaint procedures
43	The telephone number of the Department’s Assisted Living Residence Licensing Office, the local ombudsman or protective services unit in the area agency on aging, the Disability Rights Network, the local law enforcement agency, the Commonwealth Information Center and the assisted living residence complaint hotline shall be posted in large print in a conspicuous and public place in the residence.	§  2800.44(g) Complaint procedures
44	Nothing in this §  2800.44 (relating to complaint procedures) shall affect in any way the right of the resident to file suit or claim for damages.	§  2800.44(h) Complaint procedures

Nutrition

45

Residents have the right to purchase groceries and prepare their own food in addition to the three meal plan required in §  2800.220 (b) (relating to service provision) in their living units unless it would be unsafe for them to do so consistent with their support plan.

§  2800.161(h) Nutritional adequacy

Medications

46

The residence shall educate the resident of the right to question or refuse a medication if the resident believes there may be a medication error. Documentation of this resident education shall be kept.

§  2800.191 Resident Education

Services

47	A resident or a designated person has a right to request the review and modification of his support plan.	§  2800.227(j) Development of the final support plan
48	If the legal entity chooses to voluntarily close the residence or if the Department has initiated legal action to close the residence, the Department working in conjunction with appropriate local authorities, will offer relocation assistance to the residents. Except in the case of an emergency, each resident may participate in planning the transfer, and shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences. These procedures apply even if the resident is placed in a temporary living situation.	§  2800.228(f) Transfer and discharge

Enforcement

49

If the relocation of residents is due to the failure of the residence to apply for a license, the Department will offer relocation assistance to the residents. This assistance will include each resident’s involvement in planning the relocation, except in the case of an emergency. Each resident shall have the right to choose among the available alternatives after an opportunity to visit the alternative residences. These procedures will occur even if the residents are placed in a temporary living situation.

§  2800.267(a) Relocation of residents