100
DEFINITIONS
As used in these rules and regulations, the following definitions shall apply unless the context clearly states otherwise. Where these rules and regulations refer to an enactment of the General Assembly, such referenced shall include subsequent enactment or amendments by the General Assembly on the same subject matter.
ABUSE - Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703. "Abuse" also includes sexual abuse as defined in Ark. Code Ann. §
12-12-1703(18).
ACTIVITIES OF DAILY LIVING - The tasks for self-care that are performed either independently, with supervision, with assistance, or by others. Activities of daily living include but are not limited to ambulating, transferring, grooming, bathing, dressing, eating and toileting.
ADA - The Americans with Disabilities Act.
ADULT DAY HEALTH CARE PROGRAM - Adult Day Health Care (ADHC) is a program which provides organized and continuing supportive health and social services and activities to meet the needs of four or more functionally impaired adults for periods of less than twenty-four, but more than two hours per day in a. place other than the adult's own home.
ADULT DAY HEALTH CARE PROVIDER - The person, corporation, partnership, association or organization legally responsible for the overall operation of the ADHC Program and is licensed to operate as an ADHC by the Office of Long Term Care (OLTC).
APPLICANT - The person, corporation, partnership, association or organization which has submitted an application to operate an ADHC but has not yet been approved and issued a license by the Office of Long Term Care.
CARE GIVER - Shall have the same meaning prescribed by Ark. Code §
12-12-1703.
CONTACT DAYS - The number of days the client actually attended the Adult Day Health Care facility.
DEFICIENCY - A facility's failure to meet program participation requirements as defined in these and other applicable regulations and laws.
DEPARTMENT - The Department of Health and Human Services.
DIRECT CARE SERVICES - Services that directly help a client with certain routines and activities of daily living such as assistance with mobility and transfers; assistance to consume a meal, grooming, shaving, trimming or shaping fingernails and toenails, bathing, dressing, personal hygiene, bladder and bowel requirements, including incontinence or assistance with medication only to the extent permitted by the state Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing.
DIRECT CARE STAFF - Any staff, compensated or volunteer, acting on behalf of, employed by, or contracted by the facility either directly or through an employment agency to provide services and who provides direct care services or assistance to clients, including activities of daily living and tasks related to medication administration or assistance.
DIRECT CONTACT - The ability or opportunity of employees of the facility, or individuals with whom the facility contracts either directly or through an employment agency, to physically interact with or be in the presence of clients.
DIRECTOR - The individual or entity that conducts the business of the facility and is in charge of the daily operations of the facility. The Director is the resource contact between the facility and OLTC.
DISCHARGE - When a client leaves the facility and it is not anticipated that the client will return.
EMERGENCY MEASURES - Those measures necessary to respond to a serious situation that threatens the health and safety of clients.
LONG-TERM CARE FACILITY RESIDENT - Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703 and as amended.
EXPLOITATION - Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703 and as amended.
FUNCTIONALLY FMPAIRED ADULT - An individual, age eighteen (18) or older, who by reason of mental or physical disability, requires care and supervision.
HEALTH CARD - A certificate issued by the Arkansas Department of Health and Human Services' Division of Health or any entity certified by the Arkansas Department of Health and Human Services' Division of Health, that states the person named on the card has been tested for tuberculosis.
HIPAA - Health Insurance Portability Accountability Act required by federal law to "protect health information" of clients. See www.dhhs.gov/ocr/hipaa for specific details.
LICENSE - A time-limited, non-transferable permit required by Ark. Code Ann. §
20-10-224 and issued for a maximum period of 12 months to a licensee who complies with the Office of Long Term Care rules and regulations. This document shall list the maximum number of slots for the facility.
MALTREATMENT - Shall have the same meaning as prescribed in Ark. Code Ann. §
12-12-1703.
MENTAL ABUSE - Verbal, written, or gestured communications to a client, or to a visitor or staff, about a client within the client's presence or in a public forum, that a reasonable person finds to be a material endangerment to the mental health of a client.
NEGLECT - Shall have the same meaning as prescribed by Ark. Code Ann. §
12-12-1703.
NON-COMPLIANCE - Any violation of these regulations, or of applicable law or regulations.
OFFICE OF LONG TERM CARE (OLTC) - The Office in the Division of Medical Services of the Department of Health and Human Services that has the responsibility for the licensure, certification and regulation of long term care facilities, herein referred to as the Office or OLTC.
PERSON - An individual, partnership, association, corporation, or other entity.
PERSONNEL/STAFF/EMPLOYEE - Any person who, under the direction, control, or supervision of facility administration, provides services as defined in these regulations for compensation, or who provides services voluntarily, and may include the owner, professional, management and person, firms, or entities providing services pursuant to a contract or agreement.
PLAN OF CARE - The Adult Day Health Care Provider's written description of the scope of services to be provided to each individual client.
PLAN OF CORRECTION (PoC) - A plan developed by the facility and approved by OLTC that describes the actions the facility will take to correct deficiencies, specifies the date by which those deficiencies will be corrected, and sets forth the means and methods used to evaluate the efficacy of the corrections.
PRN - A medication or treatment prescribed by a medical professional to a person, allowing the medication or treatment to be given "as needed".
PROGRAM REQUIREMENTS - The requirements for participation and licensure under these and other applicable regulations and laws as an Adult Day Health Care Facility.
PROPRIETOR/LICENSEE - Any person, firm, corporation, governmental agency or other legal entity issued an Adult Day Health Care license, and is responsible for maintaining approved standards.
SURVEY - The process of inspection, interviews, or record reviews conducted by the Office of Long Term Care to determine an Adult Day Health Care facility's compliance with program requirements and with applicable regulations and laws.
200
LICENSURE
200.1 No Adult Day Health Care facility may be established, conducted, or maintained in Arkansas without first obtaining a long term care facility license as required by Ark. Code Ann. §
20-10-201, et seq. and these licensing standards. All licenses issued hereunder are non-transferable from one owner or proprietor to another or from one site to another. Except when waived by the Office of Long Term Care in times of emergency, no Adult Day Health Care facility may operate with more slots than is stated in the license and no Adult Day Health Care facility may accept more clients than the number of slots stated on the license.
200.2 The issuance of an Adult Day Health Care facility license shall be a grant of authority to the facility to operate an Adult Day Health Care facility. The initial license shall state the number of slots. Subsequent licenses issued to the same owner will state the number of slots for which the facility has been licensed at the time of the issuance of the subsequent license. Licenses issued as a result of a change of ownership shall state the number of slots for which the facility was licensed on the date of sale of the facility or the date of sale of ownership of the facility.
201
LICENSING INFORMATION
201.1 Licenses to operate an Adult Day Health Care facility are effective beginning July 1st and expiring on the following June 30th.
201.2 Licenses shall be issued only for the premises and persons specified in the application and shall not be transferable.
201.3 Licenses shall be posted in a conspicuous place on the licensed premises.
201.4 Separate licenses are required for Adult Day Health Care facilities maintained on separate premises, even though they are operated under the same management.
Multiple buildings on contiguous land that serve clients shall require and shall be licensed under a single license.
201.5 Every Adult Day Health Care facility owner shall designate a distinctive name for the facility which shall be included on the application for a license. The name of the facility shall not be changed without prior written notification to and approval from the Office of Long Term Care.
202 INITIAL LICENSE
202.1 Initial licensure shall apply to:
(a) Newly constructed facilities designed to operate as Adult Day Health Care facilities;
(b) Existing structures not already licensed as Adult Day Health Care facilities on the effective date of these regulations; and
(c) Facilities that change ownership.
202.2 The initial licensure application shall be accompanied by:
(a) Building plans showing a detailed floor plan of the facility. Floor plans must contain exact measurements and identify each room, hallway, window, exit, etc.
(b) A letter from the City or County Zoning Commission stating that the facility meets zoning requirements.
(c) A letter from a licensed electrician and licensed plumber, with their name and license number included, stating that the facility complies with State Codes.
(d) A letter from the County or State Division of Health Department stating approval for facilities with wells and septic tanks, if applicable.
203 COMPLIANCE
An initial license will not be issued until the Department verifies that the facility is in compliance with, and able to meet, the licensing standards and program requirements set forth in these regulations.
An initial license will be effective on the date specified by the Office of Long Term Care once the Office of Long Term Care determines the facility to be in compliance with these licensing standards and applicable laws and regulations. The license will expire on June 30th following the issuance of the license.
204 APPLICATION, EXPIRATION AND RENEWAL OF LICENSE
204.1 Applicants for licensure or renewal of Adult Day Health Care facility licensure shall obtain the necessary forms for initial or renewal licensure or re-licensure of the facility after a change of ownership (see Section 205) from the Office of Long
Term Care. The issuance of an application form is not a guarantee that the completed application will be acceptable or that the Department will issue a license.
204.2 The facility shall not admit any clients until a license to operate an Adult Day Health Care facility has been issued.
204.3 Applicants for initial licensure, renewal, or re-licensure after a change in ownership shall pay in advance a license fee of $5.00 per slot to the Department. Such fee shall be refunded to the applicant in the event a license is not issued.
204.4 Annual renewal is required for all Adult Day Health Care facility licenses. Licenses are effective beginning July 1 and shall expire on June 30th of the following year. In the event that a facility's license is not renewed by June 30th, the license will be void.
204.5 Applications for annual license renewal shall be delivered or, if mailed, postmarked to the Office of Long Term Care no later than June 1st before the June 30th expiration of the license. Any license fee received by the Department after June 1 is subject to a ten percent (10%) penalty.
204.6 The Director of the facility shall sign applications and must successfully complete a criminal background check pursuant to Ark. Code Ann. § 20-33-201, et seq., and in accordance with the Rules and Regulations for Conducting Criminal Record Checks for Employees of Long Term Care Facilities.
204.7 When a change in ownership or controlling interest in the facility is sold by person or persons named in the license to any other person or persons, the new owner shall, at least 30 days prior to completion of the sale, submit a new application and license fee, request to be inspected and meet the applicable standards and regulations, including but not limited to, life safety codes, at the time of inspection. The seller, in writing, shall report such change in ownership to the Office of Long Term Care at least thirty (30) days before the change is to be implemented. With the exception of civil money penalties imposed for violations or deficiencies that occurred prior to the sale of ownership or control, when a license is granted pursuant to a change of ownership the buyer shall be responsible for implementation or performance of any remedy listed in Section 802 imposed against the facility for violations or deficiencies that occurred prior to the sale of ownership or control. The seller shall remain liable for all civil money penalties assessed against the facility that are imposed for violations or deficiencies occurring prior to the sale of ownership or operational control. The Department shall consider and may deny a license based upon any criteria provided for at Ark. Code Ann. §
20-10-224(f) (1), et seq. Failure to comply with the provisions of this section will result in the denial of licensure to the new owner.
204.8 The applicant/licensee must furnish the following information:
(a) The identity of each person having (directly or indirectly) an ownership interest of five percent (5%) or more in the facility;
(b) The complete name and address of the Adult Day Health Care facility for which licensure is requested and such additional information as the Department may require including, but not limited to, affirmative evidence of ability to comply with standards, rules and regulations as are lawfully prescribed hereunder;
(c) In case such facility is organized as a corporation, the identity of each officer and Director of the corporation, together with a certificate of good standing from the Arkansas Secretary of State;
(d) In case such facility is organized as a partnership, the identity of each partner and a copy of the partnership agreement.
204.9
Procedure for Licensure
The procedure for obtaining an Adult Day Health Care License shall be:
(a) The individual or entity seeking licensure shall request and obtain all forms for licensure from the Office of Long Term Care.
(b) The individual or applicant shall fully complete all forms for licensure and submit same to the Office of Long Term Care, along with all licensure fees. As applicable and required by law or regulation, the individual or entity seeking licensure shall submit drawings or plans for the facility to the Office of Long Term Care at the time of application.
(c) For a new facility, the Office of Long Term Care will conduct a Life-Safety code survey to determine compliance with applicable building code requirements.
(d) For a new facility, upon being informed that the facility meets all requirements for all applicable building codes the facility may admit clients.
(e) For a new facility, upon successful completion of the initial survey the facility shall be granted a license to operate as an Adult Day Health Care.
(f) The Office of Long Term Care may elect, for any renewal application, to perform a survey prior to the issuance of the license, and issuance of the license is contingent upon the facility being found in compliance with all program requirements.
(g) The Office of Long Term Care may elect, for any renewal application, to deny re-licensure if the facility has unpaid civil money penalties imposed by the Office of Long Term Care; and,
* The time for an appeal has passed with no appeal being filed or all appeals have been exhausted and the imposition of the CMPs was upheld.
(h) The Office of Long Term Care shall deny renewal of any license when a facility is unable to meet program requirements at the time of renewal.
205
CHANGE IN OWNERSHIP
205.1 Transactions constituting a change in ownership include, but are not limited to, the following:
(a) A sole proprietor becomes a member of a partnership or corporation, succeeding him as the new operator;
(b) A partnership dissolves;
(c) One partnership is replaced by another through the removal, addition or substitution of a partner;
(d) The corporate owner merges with, or is purchased by, another corporation or legal entity;
(e) A not-for-profit corporation becomes a general corporation, or a for-profit corporation becomes not-for-profit.
205.2 Transactions that do not constitute a change of ownership include, but are not limited to, the following:
(a) Changes in the membership of a corporate board of Directors or board of trustees, or;
(b) Changes in the membership of a not-for-profit corporation.
300
ADMINISTRATION
301
GOVERNING BODY
Each Adult Day Health Care facility shall have an owner or governing body that has ultimate authority for:
(a) The overall operation of the facility;
(b) The adequacy and quality of care;
(c) The financial solvency of the facility and the appropriate use of its funds;
(d) The implementation of the standards set forth in these regulations; and
(e) The adoption, implementation and maintenance, in accordance with the requirement of state and federal laws and regulations and these licensing standards, of the Adult Day Health Care policies and administrative policies governing the operation of the facility.
302
GENERAL PROGRAM REQUIREMENTS
302.1 Each person or legal entity issued a license to operate an Adult Day Health Care facility shall, through their employees and agents, provide an organized program of supervision, care and services that:
(a) Conform to Office of Long Term Care rules and regulations;
(b) Meet the needs of the clients of the facility;
(c) Provide for the full protection of clients' rights; and
(d) Promote the social, physical and mental well being of clients.
302.2 The facility shall provide any authorized agents of DHHS or their designee, full access at anytime during business hours to:
(a) Clients
(b) Grounds
(c) Buildings
(d) Books, files and/or papers relating to clients or operation of the facility.
302.3 The facility shall provide for maintenance and submission of such statistical, financial or other information, records or reports, in such form, at such time and in such a manner as DHHS may require.
302.3 The facility shall provide for notification to DHHS when incidents/accidents occur involving the facility or its clients as specified in Section 305.
303
PERSONNEL AND GENERAL POLICIES AND PROCEDURES
Required Policies and Procedures governing general administration of the facility.
303.1 The facility must develop, maintain, follow and make available for public inspection the following policies and procedure:
(a) Client policies and procedures as set forth in Section 304.
(b) Admission policies as set forth in Section 402.
(c) Discharge policies as set forth in Section 403.
(d) Incident report policies and procedures including procedures for reporting suspected abuse or neglect as set forth in Section 305.
(e) Client Rights policies and procedures as set forth in Section 403.
(f) Fire Safety standards as set forth in Section 700.
(g) Smoking policies for clients and facility personnel as set forth in Sections 303.2, 705 and 504.1.19.
(h) Emergency Treatment plan policies and procedures as set forth in Section 306.
(i) Medication Storage and administration policies and procedures as set forth in Section 503.
(j) Policy and procedures for the relocation of clients in cases of emergencies (such as fires, natural disasters, or utility outages) in Section 704.
(k) Failure of a facility to meet the requirements of this subsection shall be a violation pursuant to Ark. Code Ann. §
20-10-205, et seq.
303.2 Each facility must have written employment and personnel policies and procedures. Personnel records shall include, as a minimum, the following:
(a) Employment applications for each employee.
(b) Written functional job descriptions for each employee that are signed and dated by the employee.
(c) Minimum qualifications, to include educational qualification and documentation of continuing training, including orientation training and continuing education units (CEU) related to professional licensure, personal care, food management, etc. CEU documentation must include copies of the documentary evidence of the award of hours by the certifying organization. Each facility is responsible for maintaining employee educational records.
(d) Evidence of credentials, including current professional licensure or certification.
(e) Written statements of reference or documentation of verbal reference check. Verbal check documentation must include the name and title of the person giving the reference, the substance of any statements made, the date and time of the call, and the name of the facility employee who is making the call.
(f) Employee's signed acknowledgement that he or she has received and read a copy of the Clients' Bill of Rights.
(g) Verification that the employee is at least 18 years of age.
(h) Verification that the employee has not been convicted or does not have a substantiated report of abusing or neglecting clients or misappropriation of client property. The facility shall, at a minimum, prior to employing any individual or any individuals working in the facility through contract with a third party, make inquiry to the Employment Clearance Registry of the Office of Long Term Care and the Adult Abuse Registry maintained by the Department of Health and Human Services, Division of Aging and Adult Services, and shall conduct re-checks of all employees every five (5) years. Inquiries to the Adult Abuse Registry shall be made by requesting a Request for Information form addressed to Adult Protective Services Central Registry, P.O. Box 1437, Slot S540, Little Rock, AR 72203.
(i) Documentation that all employees and other applicable individuals utilized by the facility as staff have successfully completed a criminal background check pursuant to Ark. Code Ann.§20-33- 201,
et seq. and in accordance with the Rules and Regulations for
Conducting Criminal Record Checks for Employees of Long Term Care Facilities,
(j) A copy of a current health card issued by Arkansas Department of Health and Human Services or other entities as provided by law.
(k) Documentation that the employee has been provided a copy of all personnel policies and procedures. A copy of all personnel policies and procedures must be made available to OLTC personnel or any other Department personnel.
(l) Documentation that policies and procedures developed for fire safety standards and evacuation of building has been provided to the employee,
(m) Documentation that policies and procedures developed for tobacco use has been provided to the employee,
(n) The facility shall meet all regulations issued by the Arkansas Department of Health and Human Services regarding communicable diseases.
303.3 Failure to comply with the provisions of this subsection or violation of any policies and procedures developed pursuant to this subsection shall be a violation pursuant to Ark. Code Ann. §
20-10-205 or may constitute a deficiency finding against the facility.
303.4 Orientation records will be maintained for each employee to include but not limited to:
(a) Job duties;
(b) Orientation to client rights;
(c) Abuse/neglect reporting requirements; and,
(d) Fire and tornado drills
303.5 In-service training sessions for direct care staff are required at a minimum of four (4) hours per annual quarter for a total of sixteen (16) hours per year. Training shall be appropriate to job function and shall include but is not limited to:
(a) Client Rights;
(b) Safety standards;
(c) Abuse reporting;
(d) Normal signs of aging;
(e) Health problems of aging;
(f) Communications
(g) Alzheimer's or Dementia Training
303.6 In-service training sessions for non-direct care staff are required at a minimum of two (2) hours per annual quarter for a total of eight (8) hours per year.
303.7 In-services training sessions for part-time workers (20 hours or less per week) are required at a minimum of two (2) hours per annual quarter for a total of eight (8) hours per year.
303.8
Staffing
303.8.1 The staffing pattern shall be dependent upon the enrollment criteria and the particular needs of the clients who are to be served. The ratio of paid staff to client shall be adequate to meet the goals and objectives of the program. The minimum ratios shall be one paid full-time staff position with the responsibility for direct care for each five (5) clients. The Office of Long Term Care may require additional staff when it is determined that the needs and services of the clients are not being met. Secretaries, accountants, and other non-direct care staff shall not be considered in the staffing ratio. In case of an emergency when a direct care staff must leave, one (1) non-direct care staff may count until the emergency has been resolved.
303.8.2
Substitutes
Whenever paid staff are absent, substitutes must be used to maintain the staff-client ratio and to assure proper supervision and delivery of health services.
(a) In the absence of a regular staff person a substitute staff person may be used in order to maintain the required staff-client ratio.
(b) Such substitute staff shall have the same qualifications, training and personal credentials as the regular staff position they are substituting.
(c) Trained volunteers, with the same qualifications, training and personal credentials as the regular staff they are volunteering, may be used instead of paid substitutes.
303.8.3
Program Director
The Program Director shall have the authority and responsibility for the management of activities and direction of staff and shall insure that activities and services are appropriate and in accordance with established policies.
(a) ADHC facilities licensed for more than fifteen (15) clients must have a full-time Director.
(b) Facilities licensed for fifteen (15) or fewer clients may have a full-time Director who also serves as the Health Care Coordinator, provided that this individual meets all the qualifications of both positions, and the requirements for the staffing pattern are met.
(c) The Director shall meet all the minimum qualifications:
(1) Shall be at least 21 years of age;
(2) Shall have at least one year of work experience in the area of human services (e.g., services to the elderly, disabled, or handicapped adults);
(3) Shall have demonstrated ability in supervision and administration;
(4) Shall have a current health card;
(5) Shall have knowledge of the aspects of aging and appropriate activity programming.
303.8.4
Executive Director
In Adult Day Health Care programs where the executive Director is responsible for more than Adult Day Health Care services, the Executive Director may not be counted as direct care staff.
303.8.5
Health Care Coordinator
The program must have a full-time Health Care Coordinator to supervise the delivery of health care services.
(a) Responsibilities include but are not limited to:
1. Periodic screening of vital signs, weight, dental health, general nutrition and hygiene of clients;
2. Monitoring medical regimen;
3. Monitoring provision of personal care; coordinating with other health care professionals and family members concerning health matters;
4. Educating other staff members about emergency procedures and educating staff and family members about health concerns and conditions of clients;
5. Providing minor first aid treatment as needed;
6. Administration of medication.
(b) The Health Care Coordinator shall meet all the minimum qualifications:
1. Shall be at least 21 years of age;
2. Shall be licensed by, and in good standing with, the State of Arkansas, and shall comply with all requirements including continuing education requirements, as established by law or regulation. No individual who is unlicensed may be employed as a Registered nurse (RN).
3. May be a Licensed Practical Nurse working under supervision of a Registered Nurse. A statement from the supervising RN must be on file as well as a copy of the RN's current license.
4. Shall have a current health card.
(c) Prior experience shall include at least:
1. Managerial and administrative skills, including the ability to supervise staff and to plan and coordinate meaningful staff training; and
2. Knowledge and understanding of the physical and emotional aspects of aging, its associated diseases and infirmities, and related medication and rehabilitative measures.
(d) To be qualified as a Health Care Coordinator in an ADHC program, the health care professional must have knowledge of the aspects of aging and appropriate activity programming.
303.8.6
Personal Care Staff
The ADHC shall have sufficient other staff responsible for personal care to comply with these regulations and the care requirements of the clients. Minimum requirements are:
(a) Be at least 18 years of age;
(b) Have a current health card;
(c) Have successfully completed an approved training course for nurse's aides, patient care technicians or home health aides;
(d) In-service training sessions are required for all direct care staff. In-service sessions are four (4) hours per annual quarter for a total of 16 hours per year.
303.8.7
Volunteers
The ADHC shall comply with the following in regard to utilization of volunteers who provide direct care in lieu of paid staff:
(a) Volunteers shall:
1. Be at least 18 years of age;
2. Have a current health card;
(b) Volunteers shall be provided written job descriptions. These shall describe in detail:
1. Task(s) to be performed;
2. Qualifications for performing assigned task;
(c) Paid staff position who is responsible for supervising the volunteer and specifics regarding:
* Hours
* Days
* And length of commitment of volunteer's services
(d) Volunteers shall receive a formal orientation.
1. In-service training sessions are required for all volunteers. In-service sessions shall total a minimum of four (4) hours per annual quarter for full time volunteers and eight (8) hours per year for part time volunteers (less than 20 hours per week).
2. Paid staff shall be informed of their responsibilities to the volunteer prior to the volunteer's working in the program.
3. The volunteer's job performance shall be evaluated as necessary.
4. Provision shall be made for recognition and appreciation of the volunteer, at least on an annual basis.
5. Trained volunteers may be counted in the direct care staff-client ratio. When counted in direct care staff-client ratio, the volunteer shall have the same qualifications as the staff position being substituted for.
303.8.8
Universal Worker
Each staff person on duty may be counted as direct care staff even if they are currently involved in housekeeping, laundry or dietary activities as long as universal precautions are followed.
304
GENERAL REQUIREMENTS CONCERNING CLIENTS
The facility shall:
(a) Permit unrestricted visiting hours. However, facilities may deny visitation when visitation results or substantial probability exists that visitation will result in disruption of service to other clients or threatens the health, safety, or welfare of the client or clients.
(b) With the exception of fish in aquariums and service animals (e.g. guide dogs), live animals shall not be permitted in common dining areas, storage areas, food preparation areas or common serving areas. Pets may be permitted in Adult Day Health Care facilities if sanitary conditions and appropriate behavior are maintained. If the facility permits pets, the facility shall ensure that the facility is free of pet odors and that pets' waste shall be disposed of regularly and properly. Pets must not present a danger to clients or guests. Current records of inoculations and license, as required by state law or local ordinance, shall be maintained on file in the facility. For purposes of these regulations, pets mean domesticated mammals (such as dogs and cats), birds or fish, but not wild animals, reptiles, or livestock. Parameters for pets (including behavior and health) must be set and be included in the admission agreement.
(c) Require that conduct in the common areas shall be appropriate to the community standards as defined by the clients and staff.
(d) Ensure that clients not perform duties in lieu of direct care staff, but may be employed by the facility in other capacities.
(e) Ensure that clients are not left in charge of the facility.
(f) In the event of an acute change in client's condition or accident;
1. Notify the client's responsible party or next of kin and personal physician or advance practice nurse, or in the event such physician or advance practice nurse is not available, a qualified alternate. A competent client may decline to have someone contacted, if such a request is in writing and filed in the client's file;
2. Take immediate steps to see that the client receives necessary medical attention including transfer to an appropriate medical facility;
3. Make a notation of the illness or accident in the client's records.
305
REPORTING SUSPECTED ABUSE, NEGLECT, OR MISAPPROPRIATION OF CLIENT PROPERTY
Pursuant to Ark. Code Ann. §
12-12-1701, et seq. and Ark. Code Ann. § 12-12-501, et seq., the facility must develop and implement written policies and procedures to ensure incidents are prohibited, reported, investigated and documented as required by these regulations and by law, including:
* alleged or suspected abuse or neglect of clients;
* exploitation of clients or any misappropriation of client property.
A facility is not required under this regulation to report death by natural causes. However, nothing in this regulation negates, waives, or alters the reporting requirements of a facility under other regulations or statutes.
Facility policies and procedures regarding reporting, as addressed in these regulations, must be included in orientation training for all new personnel/staff/employees and must be addressed at least annually during in-service training for all facility staff.
305.1
Next-Business-Day Reporting of Incidents
The following events shall be reported to the Office of Long Term Care by facsimile transmission to telephone number 501-683-5306 of the completed Incident & Accident Intake Form (Form DMS-731) no later than 11:00 a.m. on the next business day following discovery by the facility.
a. Any alleged, suspected, or witnessed occurrences of abuse, including verbal statements or gestures, or neglect to clients.
b. Any alleged, suspected, or witnessed occurrence of misappropriation of client property or exploitation of a client.
c. Any alleged, suspected, or witnessed occurrences of sexual abuse to clients by any individual.
In addition to the requirement of a facsimile report by the next business day on Form DMS-731, the facility shall complete a Form DMS-742 in accordance with Section 305.5. Forms DMS-731 and DMS-742 are found in the Appendix or on the OLTC website at:
http://www.medicaid.state.ar.us/InternetSolution/General/units/oltc/forms/forms.aspx
305.2
Incidents or Occurrences that Require Internal Reporting Only - Facsimile Report or Form DMS-742 Not Required
The following incidents or occurrences shall require the facility to prepare an internal report only and does not require a facsimile report or Form DMS-742 to be made to the Office of Long Term Care. The internal report shall include all content specified in Section 305.5, as applicable. Facilities must maintain these incident report files in a manner that allows verification of compliance with this provision.
a. Incidents where a client attempts to cause physical injury to another client without resultant injury. The facility shall maintain written reports on these types of incidents to document "patterns" of behavior for subsequent actions.
b. All cases of reportable disease as required by the Arkansas Department of Health and Human Services, Division of Health.
c. Loss of heating, air conditioning, or fire alarm system for a period of greater than two (2) hours.
305.3
Internal-Only Reporting Procedure
Written reports of all incidents and accidents shall be completed within five (5) days after discovery. The written incident and accident reports shall be comprised of all information specified in forms DMS-731 and DMS-742 as applicable.
All written reports will be reviewed, initialed, and dated by the facility program Director or designee within five (5) days after discovery.
1. All reports involving accident or injury to clients will also be reviewed, initialed, and dated by the facility registered nurse within five (5) days of the review by the facility program Director.
2. The care plan portion of the admission agreement shall be reviewed by the registered nurse and:
a. Shall be amended upon any change of a client's condition or need for services;
b. Copies of the amended versions of the care plan shall be attached to the written report of the incident or accident.
Reports of incidents specified in Section 305.3 will be maintained in the facility only and are not required to be submitted to the Office of Long Term Care.
All written incident and accident reports shall be maintained on file in the facility for a period of three (3) years from the date of occurrence or report, whichever is later.
305.4
Other Reporting Requirements
The facility's program Director or designee is also required to make any other reports as required by state and federal laws and regulations.
305.5
Abuse Investigation Report
The facility must ensure that all alleged or suspected incidents involving client abuse, exploitation, neglect, or misappropriations of client property are thoroughly investigated. The facility's investigation must be in conformance with the process and documentation requirements specified on the Form DMS-742, and must prevent the occurrence of further incidents while the investigation is in progress.
The results of all investigations must be reported to the facility's program Director or designated representative and to other officials in accordance with state law, including the Office of Long Term Care, within five (5) working days of the facility's knowledge of the incident. If the alleged violation is verified, appropriate corrective action must be taken.
The DMS-742 shall be completed and mailed to the Office of Long Term Care by the end of the 5th working day following discovery of the incident by the facility. The DMS-742 may be amended and re-submitted at any time circumstances require.
Reporting Suspected Abuse or Neglect
The facility's written policies and procedures shall include, at a minimum, requirements specified in this section.
305.5.1 The requirement that the facility's program Director or his or her designated agent immediately reports all cases of suspected abuse or neglect of clients of an Adult Day Health Care to the local law enforcement agency in which the facility is located as required by Ark. Code Ann. §
12-12-1708(b)(l)(A) and as amended.
305.5.2 The requirement that the facility's program Director or his or her designated agent report suspected abuse or neglect to the Office of Long Term Care as specified in this regulation.
305.5.3 The requirement that all facility personnel/staff/employees who have reasonable cause to suspect that a client has been subjected to conditions or circumstances that have resulted in abuse or neglect are required to immediately notify the facility program Director or his or her designated agent (this does not negate that all mandated reporters employed by or contracted with the facility shall report immediately to the local law enforcement agency in which the facility is located as required by Ark. Code Ann. §
12-12-1708(b)(l)(A)).
305.5.4 The requirement that, upon hiring, each facility employee be given a copy of the abuse or neglect reporting and prevention policies and procedures and sign a statement that the policies and procedures have been received and read. The statement shall be filed in the employee's personnel file.
305.5.5 The requirement that all facility personnel receive annual, in-service training in identifying, reporting and preventing suspected abuse or neglect, and that the facility develops and maintains policies and procedures for the prevention of abuse and neglect and accidents.
305.6 When the Office of Long Term Care makes a finding that a facility employee or personnel of the facility committed an act of abuse, neglect or misappropriation of client property against a client, the name of that employee or personnel shall be placed in the Employment Clearance Registry of the Office of Long Term Care. If the employee or personnel against whom a finding is made is a CNA, the name of the CNA will be placed in the CNA Registry of the Office of Long Term Care. Further, the Office of Long Term Care shall make report of its finding to the appropriate licensing or enforcement agencies.
306
EMERGENCY MEDICAL PLAN
Each provider shall have a written emergency medical plan which assures transportation to a hospital or other type of facility providing emergency care.
306.1 The facility shall have on file a written agreement, signed by the client or legal guardian, granting permission to transport a client who needs emergency care to the designated hospital or other type of facility.
306.2 Client records must note any accident, injury or illness and emergency procedures that occur.
306.3 Emergency telephone numbers shall be posted in a prominent place near the telephone where facility staff has full access to its use.
306.4 Emergency telephone numbers for each client shall be documented in the client's file.
307
ADMINISTRATIVE RECORDS
Administrative records must include at least:
307.1 Written program description, copies of which are available to the Department, clients, families or other interested parties. The document shall describe at a minimum:
(a) Administrative organization;
(b) Maximum number of clients that can be served;
(c) Admission criteria for clients to be accepted;
(d) Days of the week and hours of operation'
(e) Services available to clients including cost for such services;
(f) Criteria for discharge.
307.2 Current facility inspection reports from local fire departments as applicable, and/or DHHS.
307.3 Current inspection report for any catered services;
307.4 Record of activities conducted for the previous three (3) months.
307.5 Weekly menu plan and record of actual meals served for the previous one (1) month.
307.6 Emergency medical plan.
307.7 Fire safety plan.
307.8 Record of fire drills, disaster drills and tornado drills for the past twelve (12) months.
307.9 Record of smoke detector checks and fire extinguisher checks for the past twelve (12) months.
308
CLIENT RECORDS
The facility must maintain a separate and distinct record for each client.
308.1 The record must contain:
(a) Client's name;
(b) Client's address;
(c) Admission date;
(d) Name, office telephone number and emergency telephone number of each physician or advanced practice nurse who treats the client;
(e) Name, address and telephone number of family members and the person identified by the client who should be contacted in the event of an emergency;
(f) Date of birth;
(g) All identification numbers, such as Medicaid, Medicare/Medipak, Veterans Administration;
(h) Transportation arrangements, (if applicable);
(i) A copy of the client's signed Rights Statement;
(j) A copy of the client's signed Admission, Discharge Agreements;
(k) A written acknowledgement that the client or responsible party has been notified of the charges for the services provided;
(l) Medical and social history;
(m) Progress notes, including any significant change in client's health status, either positive or negative;
(n) Significant changes must be reported to the appropriate person (physician, Advance Practice Nurse, or, caregiver, etc.) as soon as possible,
(o) Documentation of who was notified and when they were notified shall be placed in the client's file
(p) A list of all current medications kept by the facility for the client;
(q) Documentation of any treatment or therapies;
(r) Documentation of any special diets, if applicable;
(s) Documentation regarding any accident or incidents;
(t) A copy of court orders or letters of guardianship, or power of attorney, if applicable;
(u) Copy of any advance directive;
(v) Copy of the client's care plan;
(w) Discharge date;
(x) A signed copy of the HIPP A release form.
308.2
Confidentiality of Records
(a) Client records are confidential and shall not be released without legal authorization or subpoena.
(b) Active records shall be available to authorized agents of DHHS or their designee during business hours.
(c) Record shall contain a copy of a signed copy of the HIPPA release form indicating that the facility is in compliance with HIPPA regulations.
308.3
Record Retention
(a) In accordance with regulations, all pertinent records will be retained for a period of five (5) years. In the event that an audit, litigation or other action involving these pertinent records is started before the end of the five year period, those records shall be retained until all issues arising out of the actions are resolved or until the end of the five (5) year period, whichever is later.
(b) Documentation concerning persons whose requests for services were denied as a result of the assessment process will also be retained for five (5) years.
(c) All records shall be maintained on site. They shall be made available within 24 hours of an official request. When a facility changes ownership, the original records shall remain at the facility.
(d) Documentation shall be on file that the client or responsible party has been informed of their right to privacy under HIPPA.
308.4
Care Plan
There shall be a written care plan for each client based on the referring physician's orders. Care plans:
(a) Shall be developed within five (5) contact days following the client's entry into the program;
(b) Shall be designed to maintain the client at the optimal level of functioning;
(c) Shall cover all:
1. Medications
2. Treatments
3. Rehabilitative services (where appropriate)
4. Diets
5. Precautions related to activities
6. Plans for continuing care
7. Discharge
(d) Shall be individualized for each client to address:
1. Functional activities and interests, and specific goals;
2. Means of accomplishing these goals;
(e) Shall identify the client's regularly scheduled days for attendance including arrival and departure times
(f) Shall be revised as frequently as warranted by the client's condition
(g) Shall be reviewed and documented at least every six (6) months and updated as necessary.
600
FACILITY PHYSICAL REQUIREMENTS
601
Space Requirements
601.1 Space requirements shall be forty (40) square feet per participant.
601.2 Minimum space requirements do not include office space, bathrooms, storage, or dining rooms, unless the latter are also used for activities;
601.3 Adult Day Health Care facilities located in buildings that house other facilities (e.g., child care) shall not share required space or bathrooms. Kitchen facilities are not included in this requirement.
601.4 There shall be at least one room where all of the clients can gather.
601.5 There shall be a quiet room for rest. This room shall have walls that extend to the ceiling and a swinging door that latches.
601.6 The quiet room shall be equipped with a comfortable bed in good repair with clean linens and pillows.
601.7 The quiet room shall not be used for any other purpose.
602
Furnishings
602.1 All equipment and furnishings shall be safe and in good condition. Furniture including dining tables and chairs shall be of size and design that is easily used by persons with physical limitations. Furniture shall be sturdy and secure so that it cannot easily tip when used for support by someone walking, standing, sitting, or arising from the furniture.
602.2 Minimum requirements for furnishings:
(a) At least one comfortable chair per participant;
(b) Table space and chairs adequate for all clients to be served a meal at the same time;
(c) Reclining lounge chairs or other sturdy comfortable furniture, the number to be determined by the needs of the clients.
603
Equipment and Supplies
Equipment and supplies shall be adequate to meet the needs of clients. They shall include items necessary to provide direct care and to encourage active participation and group interaction.
604
Building Construction/Maintenance
The building in which the program is located shall be of sound construction and maintained in good repair. No facility shall be licensed in a factory built structure constructed in accordance with the Federal Manufactured Home Construction and Safety Standards and transported to the site as one or more sections on a permanent chassis.
605
Ventilation
605.1 The facility shall be ventilated by either natural or mechanical means.
605.2 All screen doors shall be equipped with self-closing devices and shall fit tightly within the door frame.
605.3 Doors, windows and other openings to the outside shall be screened to prevent entrance of insects and vermin.
606
Heating and Cooling
The heating system shall be in compliance with all state and local codes.
606.1 Exposed heating pipes, hot water pipes, or radiators in rooms and areas used by clients shall be covered or protected, and insulated when appropriate.
606.2 Portable space heaters shall not be used.
606.3 Room temperatures shall be maintained between seventy (70) degrees Fahrenheit and eighty-five (85) degrees Fahrenheit in all seasons, and the reasonable comfort needs of the individual clients shall be met.
607
Li ghting/El ectri cal
607.1 There shall be illumination in all participant use areas that is appropriate to the uses of the area and the need of the clients.
607.2 Glare shall be kept at a minimum by providing shades at all windows exposed to direct sunlight.
607.3 Light fixtures shall have shades or globes.
607.4 Extension cords shall not be used.
607.5 Facilities may utilize Transient Voltage Surge Protectors or Surge Suppressors with microprocessor electronic equipment such as computers or CD/DVD recorders or players. Any Transient Voltage Surge Protectors or Surge Suppressors must have a maximum UL rating of 330v and must have a functioning protection indicator light. Facilities may not use Transient Voltage Surge Protectors or Surge Suppressors that do not have a functioning protection indicator light or Transient Voltage Surge Protectors or Surge Suppressors in which the functioning protection indicator light does not light to indicate that the device is functioning.
608
Plumbing
608.1 All plumbing and plumbing fixtures shall conform to applicable local codes.
608.2 There shall be no cross-connection between any potable water supply and any source of pollution through which the potable water supply might become contaminated.
609
Water System
609.1 An adequate supply of water, the source of which is approved by the state water control authority, under sufficient pressure to properly serve the facility, shall be provided.
609.2 The potable water system shall be installed to preclude the possibility of backflow.
610
Drinking Water
610.1 Drinking water shall be easily accessible to the clients and provided by either an angle jet drinking fountain with mouth guard or by a running water supply with individual drinking cups, or bottled water supply with individual drinking cups.
610.2 Drinking facilities shall not be located in the toilet room.
611
Toilet Facilities
611.1 At least one (1) toilet and washbowl shall be provided for each ten (10) clients and shall have an additional toilet and washbowl for each 5 clients over the 10 e.g., the facility has 35 licensed slots the facility shall have four toilets and washbowls.
611.2 At least one toilet room shall be accessible to handicapped persons.
611.3 Toilet rooms shall provide privacy for clients.
611.4 Each toilet room shall be ventilated by either natural or mechanical means.
611.5 All toilets shall have grab rails that are securely affixed to walls in such a manner as to support the weight of clients using the rails to raise or lower themselves.
611.6 The washbowl shall be in proximity to each toilet and shall have hot and cold running water.
611.7 Hot water temperature will be between one hundred (100) and one hundred fifteen (115) degrees Fahrenheit.
611.8 Individual paper towels, a trash receptacle, soap and toilet paper shall be provided at all times and shall be within reach of the clients.
612
Accommodations for Handicapped
Facilities shall have ramps or other means of accessibility for handicapped persons to all areas of the facility utilized by clients. All facilities will make provisions for the clients they accept.
613
Stairways/Hallways
613.1 Stairways and hallways shall be kept free of obstructions and shall be well lighted.
613.2 All stairways and ramps shall have non-slip surface or treads.
613.3 All inside and outside stairways and ramps shall have handrails securely affixed to the wall and able to support the weight of a client utilizing the handrail in locomotion or in raising or lowering themselves.
614
Floor Covering
614.1 All rugs and floor coverings shall be secured to the floor.
614.2 Throw rugs shall not be used.
614.3 Polish used on floors shall provide a non-slip finish.
615
Housekeeping and Maintenance
Sufficient housekeeping and maintenance service shall be provided to maintain the facility in good repair and in a safe, clean, orderly and sanitary manner.
615.1 All areas of the facility must be kept clean and free of insects, trash, and lingering odors.
615.2 Corridors shall not be used for storage.
615.3 Attics, cellars, basements, under or below stairways and similar areas must be kept clean of accumulation of refuse, old newspapers and discarded furniture.
615.4 Garbage shall be stored in a closed container and disposed of in a manner approved by OLTC, or applicable laws, regulations, or ordinances.
615.5 Ventilation, heating, air conditioning, and air changing systems shall be properly maintained. Gas systems shall be inspected at least every 12 months to assure safe operation. Inspection certificates, where applicable, shall be maintained for review.
615.6 Entrances, exits, steps and outside walkways shall be free from ice, snow and other hazards.
615.7 Repairs or additions must meet applicable building codes at the time construction begins.
615.8 The facility shall be maintained free of insects and rodents. Documented control measures shall be taken to prevent rodent and insect infestation.
616
Storage of Cleaning Supplies
Cleaning agents, pesticides and poisonous products shall be stored at all times apart from food and in a locked room, closet or cabinet and shall be issued and utilized in a manner which assures the safety of clients and staff.
800 IMPOSITION OF REMEDIES - AUTHORITY
The following Rules and Regulations for the Imposition of Remedies are duly adopted and promulgated by the Arkansas Department of Human Services, Office of Long Term Care, pursuant to the authority conferred by Ark. Code Ann. §
20-10-203 and Ark. Code Ann. §
25-10-129.
801
Inspections by the Department
a. All areas of the facility that are accessible to clients or are used in the care or support of clients, including but not limited to kitchen or food preparation areas, laundry areas, and storage areas, and all client records, including but not limited to clients' financial records maintained by the facility and clients' medical records maintained by the facility, shall be open for inspection by the Department, the Office of Long Term Care, or the Office of the Attorney General. All facility records related to the care or protection of clients and all employee records related to the care or protection of clients shall be open for inspection by the Department or OLTC or the Attorney General's Office for the purpose of enforcing these regulations and applicable laws. The facility shall provide access to any copying equipment the facility has on premises to permit the above-named entities the ability to make copies of facility records. This shall not be construed as a requirement that a facility be required to have copy equipment on its premises.
b. The facility shall submit to regular and unannounced inspection surveys and complaint investigations in order to receive or maintain a license. The facility shall inform clients of the survey process and clients' rights with regard to privacy during the process. Clients or employees may refuse to be interviewed or photographed. The Department or its agents, the Office of Long Term Care or its agents or the Attorney General's Office or its agents have the right to conduct interviews in a private area with clients or employees who consent to interviews, and shall be permitted to photograph the facility. Clients shall be photographed in accordance with Ark. Code Ann. §
20-10-104. This regulation shall not be construed as a waiver of any constitutional rights, including but not limited to the right against self-incrimination.
c. An inspection may occur at any time, in the discretion of the Department or its agents, the Office of Long Term Care or its agents or the Attorney General's Office or its agents.
d. The facility shall provide for the maintenance and submission of such statistical, financial or other information, records, or reports related to client care or property in such form and at such time and in such manner as the Department or its agents, the Office of Long Term Care or its agents, Attorney General or its agents may require. Provided, however, those records created by, or for the exclusive use of, the quality assessment unit shall not be subject to release to the Department or its agents, or the Office of Long Term Care or its agents.
e. Facilities must provide a written acceptable plan of correction within 15 business days of receipt of written notification of deficiencies (also referred to as a Statement of Deficiencies) found during any inspections or surveys. The OLTC shall determine whether the proposed plan of correction, including any proposed dates by which correction will be made, is acceptable.
f The facility must post the Statement of Deficiencies and the facility's response and the outcome of the response from the latest survey in a public area utilized by clients or their responsible parties and visitors. A copy shall be provided to each client or client's responsible party upon request of the client or the client's responsible party. The last twelve (12) months of deficiency notices and facility responses and outcomes of responses, for all surveys shall be provided to persons or their responsible parties upon request when they apply for residence in the facility.
802
General Provisions
a. The provisions of this section are supplemental to, and independent of, the provisions of Title 20 of the Arkansas Code Annotated.
b.
Purpose of remedies. The purpose of remedies is to ensure prompt compliance with program requirements.
c.
Basis for imposition and duration of remedies. When OLTC chooses to apply one or more remedies specified herein, the remedies are applied on the basis of noncompliance found during surveys or inspections of any nature conducted by OLTC, or for failure to comply with applicable laws or regulations.
d.
Number of remedies. OLTC may apply one or more remedies for each deficiency constituting noncompliance or for all deficiencies constituting noncompliance.
e.
Plan of correction requirement.
1. Regardless which remedy is applied, or the nature or severity of the violation, each facility that has deficiencies must submit a plan of correction for approval by OLTC. The plan of correction shall be set forth on the Statement of Deficiencies. While a facility may provide a disclaimer in the plan of correction, the facility is still required to provide corrective actions to address the cited deficiencies, the time frames in which the corrective actions will be completed, and the manner to be utilized by the facility to monitor the effectiveness of the corrective action.
2. Failure by the facility to provide an acceptable plan of correction may result in the imposition of additional remedies pursuant to these regulations at the discretion of the OLTC or in a finding of a violation and imposition of additional remedies set forth in Title 20 of the Arkansas Code Annotated, or set forth in these regulations, or both.
f Notification requirements
1. Except in cases of emergency termination of a license or in cases or emergency removal or transfer or clients, OLTC shall give the provider notice of the remedy, including:
a. Nature of the noncompliance;
b. Remedy or remedies imposed;
c. Date the remedy begins; and,
d. Right to appeal the determination leading to the remedy.
2. Notice shall not be required for state monitoring.
803
Remedies
a.
Available Remedies. In conformity with, and in addition to remedies as set forth in Title 20 of the Arkansas Code Annotated, the following remedies are available:
1. Civil Money Penalties (CMP) pursuant to Ark. Code Ann. §
20-10-205 and §
20-10-206.
2. Denial of New Admissions.
3. Directed in-service training.
4. Directed plan of correction.
5. State monitoring.
6. Temporary Director.
7. Termination of license.
8. Transfer of clients.
b. Duration of Remedies. Unless otherwise provided by law or other applicable regulations, remedies continue until:
1. The facility has corrected the cited deficiencies that resulted in the imposition of the remedy or remedies, as determined by the Office of Long Term Care based upon a revisit, or after an examination of credible written evidence that it can verify without an on-site visit, or both; or,
2. OLTC terminates the Adult Day Health Care license.
804
Temporary Director
a.
Temporary Director means the temporary appointment by OLTC, or by the facility with the approval of OLTC, of a substitute facility Director with authority to hire, terminate or reassign staff, obligate facility funds, alter facility procedures and manage the facility to correct deficiencies identified in the facility's operation, or to assist in the orderly closure of a facility. A temporary Director may be appointed by the Office of Long Term Care only upon the consent and agreement of the facility. The temporary Director shall provide reports to the OLTC regarding the operation of the facility and the efforts toward correction by the facility as requested by the OLTC.
b.
Qualifications. The temporary Director must:
1. Be qualified to oversee correction of deficiencies on the basis of experience and education, as determined by OLTC;
2. Not have been found guilty of misconduct by any licensing board or professional society in any State;
3. Have, or a member of his or her immediate family have, no financial ownership interest in the facility;
4. Not currently serve or, within the past 2 years, have served, unless approval has been obtained from the OLTC, as a member of the staff of the facility;
5. Successfully undergo a criminal record check pursuant to the Rules and Regulations of the Office of Long Term Care.
c.
Payment of salary. The temporary Director's salary:
1. Is paid directly by the facility while the temporary Director is assigned to that facility; and
2. Must be at least equivalent to the sum of the following:
A. The prevailing salary paid by providers for positions of this type in what OLTC considers the facility's geographic area;
B. Additional costs that would have reasonably been incurred by the provider if such person had been in an employment relationship; and
C. Any other costs incurred by such a person in furnishing services under such an arrangement or as otherwise set by OLTC.
3. May exceed the amount specified in Section 804(c)(2) if OLTC is otherwise unable to attract a qualified temporary Director.
d.
Failure to relinquish authority to temporary Director:
1.
Termination of Adult Day Health Care licensure. If a facility fails to relinquish authority to the temporary Director, OLTC may impose additional remedies, including but not limited to termination of the Adult Day Health Care license.
2.
Failure to pay salary of temporary Director. A facility's failure to pay the salary of the temporary Director is considered a failure to relinquish authority to temporary administration.
3.
When imposed. The remedy of temporary Director shall be used only in lieu of termination of the facility license. Provided, however, that if the appointment of the temporary Director does not result in compliance by the facility within the time frames estimated by the temporary manager and agreed to by the Office of Long Term Care, the remedy of termination or revocation of license may be imposed.
805
State Monitoring
a. A State monitor:
1. Oversees the correction of deficiencies specified by OLTC at the facility site and protects the facility's clients from harm;
2. Is an employee or a contractor of OLTC;
3. Is identified by OLTC as an appropriate professional to monitor cited deficiencies;
4. Is not an employee of the facility;
5. Does not function as a consultant to the facility;
6. Does not have an immediate family member who is a client of the facility to be monitored; and,
7. Does not have an immediate family member who owns the facility or who works in the facility or the corporation that operates or owns the facility.
b. A State monitor may be utilized by the Office of Long Term Care for any level or severity of deficiency.
806
Directed Plan of Correction
The Office of Long Term Care, or the temporary manager with OLTC approval, may develop a plan of correction. A directed plan of correction sets forth the tasks to be undertaken and the manner in which the tasks are to be performed by the facility to correct deficiencies, and the time frame in which the tasks will be performed. A facility's failure to comply with a directed plan of correction may result in additional remedies, including revocation of license when the failure to correct meets the conditions specified in Section 809. The intent of a directed plan of correction is to achieve correction of identified deficiencies and compliance with applicable regulations.
807
Directed In-Service Training
a.
Required training. OLTC may require the staff of a facility to attend an in-service training program if education is likely to correct, or is likely to assist in correcting, cited deficiencies. The Office of Long Term Care may specify the time frames in which the training will be performed, the type or nature of the training, and the individual or entities to provide the training.
b.
Action following training. After the staff has received in-service training, if the facility has corrected the violations or deficiencies that led to the imposition of remedies, OLTC may impose one or more other remedies.
c.
Payment. The facility pays for directed in-service training.
808 Transfer of Clients or Closure of the Facility and Transfer of Clients
a.
Transfer of clients, or closure of the facility and transfer of clients in an emergency. OLTC has the authority to transfer clients to another facility when:
1. An emergency exists wherein the health, safety, or welfare of clients is imperiled, and no other remedy exists that would ensure the continued health, safety or welfare of the clients;
2. A facility intends to close but has not arranged for the orderly transfer of its clients at least thirty (30) days prior to closure.
3. The facility exceeds its slot capacity as indicated or stated on the facility's license, or accepts more clients than the facility has number of slots as indicated or stated on the facility's license, unless granted a waiver by the Office of Long Term Care.
b.
Required transfer when a facility's Adult Day Health Care license is terminated. When a facility's license is terminated, or when the facility closes either voluntarily or involuntarily, OLTC may assist in the safe and orderly transfer of all clients to another facility.
c. When the Office of Long Term Care orders transfer of clients from a facility, the Office of Long Term Care may:
1. Assist in providing for the orderly transfer to other suitable facilities or make other provisions for the clients' care and safety.
2. Assist in or arrange for transportation of the clients, their medical records and belongings, assist in locating alternative placement, assist in preparing the client for transfer, and permit the clients' legal guardians or responsible party to participate in the selection of the clients' new placement.
3. Unless transfer is due to an emergency, explain alternative placement options to the clients and provide orientation to the placement chosen by the client or their guardian or responsible party.
d.
Notice of Transfer Remedy. Unless transfer is due to an emergency, the Office of Long Term Care shall provide the facility from which the clients are to be transferred at least fifteen (15) days notice of the proposed transfer.
809
Termination of Adult Day Health Care License
a. The remedy of termination or revocation of licensure is a remedy of last resort, and may be imposed only in accordance with law or as set forth in Section 809(b), below.
b.
Basis for termination. OLTC may terminate a facility's Adult Day Health Care license if a facility:
1. Permits, aids or abets in the commission of any unlawful act in connection with the operation of the Adult Day Health Care;
2. Refuses to allow entry or inspection by the Office of Long Term Care;
3. Fails to make any or all records set forth in Section 801 available to representatives or agents of the Department or the_OLTC, unless such refusal is made pursuant to court order or during the pendency of an appeal specifically on the issue of the release of the records, or the records are records created by the quality assessment unit;
4. Closes, either voluntarily or through action of the State;
5. Director or owner refuses to obtain a criminal record check of any individual required to undergo a criminal record check pursuant to the Rules and Regulations for Conducting Criminal Record Checks for Employees of Long Term Care Facilities or pursuant to Ark. Code Ann. § 20-33-201, etseq.;
6. Is cited for a third Class A violation within six months of the citation of the first Class A violation, or is cited for a third Class B violation within six months of the citation of the first Class B violation, in accordance with Ark. Code Ann. §
20-10-205 and §
20-10-206;
7. Has conditions wherein the health, safety, or welfare of clients is imperiled, and no other remedy exists that would ensure the continued health, safety, or welfare of the clients.
8. Is unable to meet program requirements.
810
Denial or Suspension of New Admissions
The Office of Long Term Care may deny to, or suspend the ability of, a facility to admit new admissions upon the imposition of a Class A violation as defined and set forth in Ark. Code Ann. §
20-10-205 and §
20-10-206.
811
Civil Money Penalties
The Office of Long Term Care may impose civil money penalties in accordance with Ark. Code Ann. §
20-10-205 and §
20-10-206.
812
Closure
Any Adult Day Health Care facility that closes or ceases operation or surrenders or fails to timely renew its license must meet the regulations then in effect for new construction and licensure to be eligible for future licensure. Closure of a facility shall result in the immediate revocation of the license.
A facility that closes or is unable to operate due to natural disaster or similar circumstances beyond the control of the owner of the facility, or a facility that closes, regardless of the reason, to effectuate repairs or renovations, may make written request to the Office of Long Term Care for renewal of the facility license to effect repairs or renovation to the facility. The Office of Long Term Care may, at its sole discretion, grant the written request.
If the request for licensure renewal is granted, the Office of Long Term Care will provide written notification to the facility, which will include deadlines for various stages of the repairs or renovations, including the completion date. In no event shall the completion date set by the Office of Long Term Care extend beyond twenty-four months of the date of the request; provided, however, that the deadlines may be extended by the Office of Long Term Care upon good cause shown by the facility. For purposes of this regulation, good cause means natural disasters or similar circumstances, such as extended inclement weather that prevents repairs or construction within the established deadlines, beyond the control of the owner of the facility. Good cause shall not include the unwillingness or inability of the owner of the facility to secure financing for the renovations or repairs. The facility shall comply with all deadlines established by the Office of Long Term Care in its notice. Failure to comply with the deadlines established by the Office of Long Term Care shall constitute grounds for revocation of the license and for denial of re-licensure.
900
Appeals to the Court
Any applicant or licensee who considers himself/herself injured in his or her person, business or property by final Department administrative adjudication shall be entitled to judicial review thereof as provided for by law. All petitions for judicial review shall be in accordance with the Arkansas Administrative Procedure Act as codified at Ark. Code Ann. §
25-15-201, etseq.
APPENDIX
FORMS
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF MEDICAL SERVICES OFFICE OF LONG TERM CARE
Incident & Accident Next Day Reporting Form
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of resident abuse, neglect, misappropriation of property or injuries of an unknown source by individuals providing services to residents in Arkansas long term care facilities for next day reporting pursuant to Section 507.1.
The purpose of this process is for the facility to compile the information required in the form DMS-731, so that next day reporting of the incident or accident can be made to the Office of Long Term Care.
Completion/Routing This form, with the exception of hand written witness statements, MUST BE TYPED !
The following sections are not to be completed by the facility; the Office of Long Term Care completes them:
1. The top section entitled COPIES FOR:
2. The
FOR OLTC USE ONLY section found at the bottom of the form.
All remaining spaces must be completed. If the information can not be obtained, please provide an explanation, such as "moved/address unknown", "unlisted phone", etc.
If a requested attachment can not be provided please provide an explanation why it can not be furnished or when it will be forwarded to OLTC.
The original of this form must be faxed to the Office of Long Term Care the next business day following discover by the facility. Any material submitted as copies or attachments must be legible and of such quality to allow recopying.
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SUMMARY OF INCIDENT
STEPS TAKEN TO PREVENT CONTINUED ABUSE OR NEGLECT DURING THE INVESTIGATION
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
Facility Investigation Report for Resident Abuse, Neglect, Misappropriation of Property, & Exploitation of Residents in Long Term Care Facilities
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of resident abuse, neglect, or misappropriation of property or exploitation of residents by individuals providing services to residents in Arkansas long term care facilities. This investigative format complies with the current regulations requiring an internal investigation of such incidents and submittal of the written findings to the Office of Long Term Care (OLTC) within five (5) working days.
The purpose of this process is for the facility to compile a substantial body of credible information to enable the Office of Long Term Care to determine if additional information is required by the facility, or if an allegation against an individual(s) can be validated based on the contents of the report.
Completion/Routing This form, with the exception of hand written witness statements, MUST BE TYPED !
Complete all spaces! If the information can not be obtained, please provide an explanation, such as "moved/address unknown", "unlisted phone", etc. Required information includes the actions taken to prevent continued abuse or neglect during the investigation.
If a requested attachment can not be provided please provide an explanation why it can not be furnished or when it will be forwarded to OLTC.
This form, and all witness and accused party statements, must be originals. Other material submitted as copies must be legible and of such quality to allow re-copying.
The facility's investigation and this form must be completed and submitted to OLTC within five (5) working days from when the incident became known to the facility.
Upon completion, send the form by certified mail to:
Office of Long Term Care, P.O. Box 8059, Slot 404, Little Rock, AR 72203-8059.
Any other routing or disclosure of the contents of this report, except as provided for in LTC 507.4 and 507.5, may violate state and federal law.
Facility Investigation Report for Resident Abuse, Neglect, Misappropriation of Property, & Exploitation of Residents in Long Term Care Facilities
Section I-Reporting Information
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Section Il
-Complete Description of Incident "See Attached Is Not Acceptable! "
Section III
- Findings and Actions Taken Please include Resident's current medical condition
_________________ _____________________
Facility Administrator's Signature Date
Section IV - Notification/Status
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Section VI -Accused Party Information
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Section VII
- Attachments
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