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Standards for Licensed Assisted Living Facilities (22 VAC 40-73)

Standards for Licensed Assisted Living Facilities (22 VAC 40-73). New Regulation Training 2017 – 2018 Effective date: February 1, 2018 Department of Social Services Division of Licensing Programs – Adult Programs. Caveat.

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Standards for Licensed Assisted Living Facilities (22 VAC 40-73)

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  1. Standards for Licensed Assisted Living Facilities (22 VAC 40-73) New Regulation Training 2017 – 2018 Effective date: February 1, 2018 Department of Social Services Division of Licensing Programs – Adult Programs

  2. Caveat • The regulatory action we're discussing today repealed 22 VAC 40-72 and enacted 22 VAC 40-73. • It is impossible to discuss all the changes or all of the requirements in the new regulation. • Read the regulation, refer to it often, and contact your licensing representative if you have any questions.

  3. Part I General Provisions

  4. 22 VAC 40-73-30. Program of Care.Current 22 VAC 40-72-40 • Adds that the program of care will: • Meet the resident’s spiritual needs. • Promote the resident’s highest level of functioning, independence, and involvement with appropriate programs based on the resident’s needs and interests.

  5. Part II Administration and Administrative Services

  6. 22 VAC 40-73-40. Licensee.Current 22 VAC 40-72-50 • Adds: • That the licensee’s agent or relatives of the licensee, facility administrator, and facility staff are prohibited from acting as, seeking to become, or becoming the conservator or guardian of any resident unless appointed by a court. • Licensee must give evidence of financial responsibility and solvency. • Licensee must notify case managers, assessors, and eligibility workers of intended sale, closure, and the date.

  7. 22 VAC 40-73-40. Licensee.Continued Adds (continued): • If sold, licensee must explain to each resident, legal representative, case manager or assessor, and at least 1 designated contact person that resident can choose whether to stay or relocate, unless the new licensee specifies relocation.

  8. 22 VAC 40-73-45. Minimum amount for liability insurance disclosure. • Adds that the minimum amount of liability insurance coverage to be maintained by an ALF for disclosure purposes in the disclosure statement and the resident agreement is: • $500,000 per occurrence to compensate residents or others for injuries and losses from negligent acts of the ALF, and • $500,000 aggregate for the same purpose as noted immediately above. • An ALF shall not state that liability insurance is in place unless the insurance provides the minimum amount of coverage established in this section.

  9. 22 VAC 40-73-50. Disclosure.Current 22 VAC 40-72-60 • Adds: • That the ALF state whether or not it maintains liability insurance that provides at least the minimum amount of coverage established by the board for disclosure purposes to compensate residents or others for injuries and losses from negligent acts of the facility. The ALF must state in the disclosure statement that the minimum amount of coverage is $500,000 per occurrence, $500,000 aggregate.

  10. 22 VAC 40-73-60. Electronic records and signatures. • Adds: • Electronic records or signatures must comply with the Uniform Electronic Transactions Act. • An electronic signature is deemed a signature with the same effect as a written signature on a document when the licensee ensures the following: • Development, implementation, and maintenance of policies and procedures for use of electronic signatures. • Each electronic signature identifies the person signing the document by name and title.

  11. 22 VAC 40-73-60. Electronic records and signatures.Continued Ensures (continued): • The document cannot be altered after the signature has been affixed. • All users have signed statements that they alone have access to and use the key or computer password for their signature and will not share them with others. • There is strong and substantial evidence that would make it difficult for the signer or the receiving party to claim the electronic representation is not valid. • Adds that a back-up and security system must be used for all electronic documents.

  12. 22 VAC 40-73-70. Incident Reports.Current 22 VAC 40-72-100 • Changed reporting requirement from “by the next working day” to “within 24 hours.” • Added to the incident report: Actions to prevent recurrence of the incident, if applicable.

  13. 22 VAC 40-73-100. Infection Control.Current 22 VAC 40-72-90 • Adds: • The infection control program shall be consistent with the CDC guidelines and the OSHA blood borne pathogens regulations. • A licensed health care professional shall participate in the development of infection prevention policies and procedures and shall ensure compliance with applicable guidelines and regulations. • Must review infection prevention policies and procedures at least annually. A licensed health care professional must be included in this review.

  14. 22 VAC 40-73-100. Infection Control.Continued • Adds (continued): • A staff person who has been trained in basic infection prevention shall participate in the annual review and serve as point of contact for the program; responsible for on-going monitoring of the program. • Infection control program is applicable to volunteers. • Procedures for the use of personal protective equipment.

  15. 22 VAC 40-73-100. Infection Control.Continued • Adds that the infection control program shall include procedures for other infection prevention measures: • Determination of whether residents have acute infectious disease and use of appropriate measures to prevent disease transmission. • Use of safe injection practices and other procedures where the potential for exposure to blood or body fluids exists. • Blood glucose monitoring practices that are consistent with CDC recommendations; finger stick devices shall not be used for more than one person.

  16. 22 VAC 40-73-100. Infection Control.Continued • Adds that the infection control program include: • Sanitation of rooms, including cleaning and disinfecting procedures, agents, and schedules. • Sanitation of equipment, including medical equipment that may be used on more than one resident. • Adds requirements for: • Readily accessible handwashing equipment and necessary personal protective equipment for staff and volunteers. • Product specific instructions for use of cleaning and disinfecting agents (ex. MSDS sheets).

  17. 22 VAC 40-73-100. Infection Control.Continued • Adds that the facility shall have a staff health program that includes: • Information on recommended vaccinations to facility staff and volunteers who have any potential exposure to residents or to infectious materials. • Assurance that employees with communicable diseases are identified and prevented from work activities that could result in transmission to other personnel or residents. • An exposure control plan for blood borne pathogens.

  18. 22 VAC 40-73-100. Infection Control.Continued • Staff health program includes (continued): • Documentation of screening and immunizations offered to, received by, or declined by employees. • Compliance with requirements of OSHA for reporting workplace injuries or exposure to infection. • Adds that the report of an outbreak of disease shall be made to the licensing representative of DSS in the regional licensing office.

  19. Part III Personnel

  20. 22 VAC 40-73-120. Staff orientation and initial training.Current 22 VAC 40-72-180 • Changes the time frame for orientation and training to the first 7working days of employment. • Adds: • All staff shall be oriented to the facility's organizational structure. • Staff orientation and initial training can be counted toward the first year’s annual training hours.

  21. 22 VAC 40-73-130. Reports of abuse, neglect, or exploitation. • Adds: • Requires mandated reporters to report suspected abuse, neglect, or exploitation of residents as required by Code. • Requires the facility to notify the resident’s contact person or legal representative when a report of suspected abuse, neglect, or exploitation is made, without identifying any confidential information.

  22. 22 VAC 40-73-160. Administrator training.Current 22 VAC 40-72-210 • Administrators that supervise RMAs, but are not licensed or registered to administer medications themselves, must complete the 68 hour training prior to supervising the RMAs. • Administrators must complete 4 hours of annual medication administration training or complete an annual refresher course provided by a BON approved program.

  23. 22 VAC 40-73-200. Direct care staff qualifications. Current 22 VAC 40-72-250 • Qualification requirements now apply to direct care staff working in ALL licensed ALFs. • Adds that: • Successful completion of a nursing education program preparing for RN or LPN licensure is acceptable to meet the standard. • Current enrollment in a nursing education program preparing for RN or LPN licensure and completion of at least 1 clinical course in the nursing program that includes at least 40 hours of direct client care clinical experience is acceptable to meet the standard.

  24. 22 VAC 40-73-210. Direct care staff training.Current 22 VAC 40-72-260 • In a facility licensed for residential care only, the annual training hours increase from 8 to 14 hours. • In a facility licensed for both residential and assisted living care, the annual training hours increase from 16 to 18 hours. • In facilities licensed for residential care only, the required hours for topics related to residents’ mental impairments increase from 2 to 4 hours annually.

  25. 22 VAC 40-73-220. Private duty personnel. • When private duty personnel from licensed home care organizations provide direct care or companion services to ALF residents, the following applies: • Before services begin, obtain written information on the type, care and frequency of the services to be delivered to the resident. • Services must be identified on the ISP. • Ensure TB requirements are met. • Ensure proper orientation and training of policies and procedures related to their duties.

  26. 22 VAC 40-73-220. Private duty personnel. Continued • Licensed home care organizations (continued): • Ensure that documentation of resident care required by the standards is maintained. • Monitor the delivery of direct care and companion services to the resident by private duty personnel.

  27. 22 VAC 40-73-220. Private duty personnel. Continued • For private duty personnel, who are not employees of a licensed home care organization: • Ensure that private duty personnel are qualified for the types of direct care or companion services they are responsible for providing and maintain documentation of qualifications. • Review original criminal history record report issued by the VDSP for each private duty personnel prior to initiation of services. • The date of the report must be no more than 90 days prior to initiation of services.

  28. 22 VAC 40-73-240. Volunteers. Current 22 VAC 40-72-280 • Adds: • ALF must maintain documentation on qualifications, orientation, training, and education required by these standards. • Volunteers must sign and date a statement that they have received and understand the orientation information. • Deletes the word “direct” from the supervision that must be provided to volunteers by a designated staff person when residents are present.

  29. 22 VAC 40-73-260. First Aid and CPR Certification.Current 22 VAC 40-72-300 • Adds that: • There shall be at least 1 staff member at all times who has current certification in first aid in each building, rather than on the premises. • There shall be at least 1 staff member at all times who has current certification in CPR in each building, rather than on the premises.

  30. Part IV Staffing and Supervision

  31. 22 VAC 40-73-290. Work schedule and posting. • Adds: • A requirement to indicate the person in charge at any given time. • Absences and substitutions shall be noted on the schedule. • Develop and implement a procedure for posting the name of the current on-site person in charge in a place conspicuous to the residents and the public.

  32. 22 VAC 40-73-300. Communication among staff.Current 22 VAC 40-72-330 • Adds: • Procedures established for communication among administrators, designated assistant administrators, managers, and designated staff persons in charge, are reviewed with staff. • Written communication that keeps direct care staff informed of significant happenings or problems experienced by residents, shall be included in the records of the involved residents.

  33. Part V Admission, Retention, and Discharge of Residents

  34. 22 VAC40-73-310. Admission and retention of residents.Current 22 VAC 40-72-340 • Adds: • Residents shall not be required to relinquish their residents rights as a condition of admission or retention. • If hospice care is provided, there shall be a written agreement between the ALF and any hospice program that provides care in the facility. The agreement shall include: • Policies and procedures to ensure appropriate communication and coordination between the facility and the hospice program.

  35. 22 VAC40-73-310. Admission and retention of residents.Continued • Agreement (continued): • Specification of the roles, responsibilities, and services between the facility and the hospice program. • Services provided to each resident shall be reflected on the ISP.

  36. 22 VAC 40-73-325. Fall risk rating. • Adds, for residents who meet the criteria for assisted living care: • By the time the comprehensive ISP is completed, a written fall risk rating shall be completed. • The fall risk rating shall be reviewed and updated: • At least annually; • When the condition of the resident changes; and • After a fall. • Should a resident fall, the facility must show documentation of an analysis of the circumstances of the fall and interventions that were initiated to prevent or reduce risk of subsequent falls.

  37. 22 VAC 40-73-330. Mental health screening.Current 22 VAC 40-72-360 • Adds an additional exception that states the mental health screening is not required for prospective residents when: • They are under the care of a qualified mental health professional at the time of admission; and • Provided there is documentation of the person's psychosocial and behavioral functioning, as specified in 22 VAC 40-73-340 A.

  38. 22 VAC 40-73-340. Psychosocial and behavioral history.Current 22 VAC 40-72-365 • Clarifies that when: • Information is relevant to a prospective resident’s psychosocial and behavioral history, the information must be provided prior to admission. • A prospective resident is coming from a private residence, the required information related to his psychosocial and behavioral history can come from family members, friends, or a physician.

  39. 22 VAC 40-73-350. Sex offender information.Current 22 VAC 40-72-367 • Adds that facility must: • Document that each resident or his legal representative has been informed how he can research registered sex offenders, and maintain the documentation in the resident’s record. • Requires that upon request, the facility must • Assist the resident or his legal representative in accessing the information on registered sex offenders, and • Provide printed copies of the information

  40. 22 VAC 40-73-360. Emergency placement.Current 22 VAC 40-72-370 • Changes from “seven working days” to “seven days” for a person to remain in the ALF unless all the requirements for admission have been met and the person has been admitted. • Adds that the facility obtain sufficient information to protect the person’s health, safety, and welfare while he remains at the facility.

  41. 22 VAC 40-73-370. Respite care. • Adds: • ISP is to be completed prior to participating in respite care and need not include expected outcome. • Upon return for respite care, the ALF must reevaluate the person’s condition and care needs, and ensure that the UAI, ISP, and medication orders are updated. • If the period of time between respite care stays is 6 months or longer, a new TB screening is only required 1 time per year. The physical examination must be within 30 days prior to the person’s return for respite care.

  42. 22 VAC 40-73-390. Resident agreement with facility. Current 22 VAC 40-72-390 • Adds: • For an AG recipient, the agreement contains a list of services included under the AG rate. • AG recipients may not be charged an advance or deposit payment. • All facilities (not only AG) shall inform the resident that he may refuse release of information regarding personal affairs and records to anyone outside the facility. Exceptions: release required by law or transfer to another caregiving facility.

  43. 22 VAC 40-73-390. Resident agreement with facility.Continued • Adds (continued): • Written notification whether the facility maintains liability insurance that provides at least the minimum amount of coverage established by the board for disclosure purposes to compensate residents or other individuals for injuries and losses from negligent acts of the facility. • The notification must state that the minimum amount of coverage is $500,000 per occurrence, $500,000 aggregate. The notification must be on the form developed by DSS.

  44. 22 VAC 40-73-420. Acceptance back in facility.Current 22 VAC 40-72-410 • Adds: • Obtain written recommendations from a qualified mental health professional regarding supportive services necessary to address the mental health needs of the resident returning to the facility. • Document whether the recommendations can be implemented based on facility or community resources and whether the resident can be retained or would need to be discharged.

  45. 22 VAC 40-73-420. Acceptance back in facility.Continued • Adds (Continued): • Update the resident's ISP. • Ensure that direct care staff receive clear and timely communication regarding their responsibilities for the mental health needs of the resident and behavioral or emotional indicators of possible crisis situations. • For recipients of an AG, the bed hold policy must be consistent with AG program policy and guidance.

  46. 22 VAC 40-73-430. Discharge of residents.Current 22 VAC 40-72-420 • Adds: • Resident will be moved within 30 days unless there are extenuating circumstances. • Written notification shall be given to the eligibility worker and assessor for public pay residents during all instances of discharge. • Written notice is required to be given to all parties at least 14 days prior to the date of discharge. • Written notification regarding the death of a public pay resident must be provided to the eligibility worker and assessor within 5 days.

  47. Part VI Resident Care and Related Services

  48. 22 VAC 40-73-450. Individualized service plans. Current 22 VAC 40-73-440 • Adds: • A preliminary plan of care is to be developed on or within 7 days prior to the day of admission to address the basic needs of the resident to protect the resident’s health, safety and welfare. • A preliminary plan of care is not necessary if a comprehensive ISP is developed on the day of admission. • The department approved ISP training must be provided by a licensed health care professional. • Private pay UAI training must be completed as a prerequisite to ISP training.

  49. 22 VAC 40-73-450. Individualized service plans.Continued • Adds (continued) • The date a need is identified and the date an outcome is achieved to the ISP. • A requirement for all those that contribute to the development of the ISP to be documented with the date and title or relationship. • A current copy of the ISP must be provided to the resident.

  50. 22 VAC 40-73-470. Health care services.Current 22 VAC 40-72-460 • Adds: • Written policy for resident allergies, allergic reactions, life-threatening conditions, and actions that staff may need to take. • Gastric tubes - the following criteria shall be met: • Prior to GT care being provided, the facility shall obtain a signed informed consent that includes an acknowledgment of how GT care will be provided.

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