W. Va. Code R. § 64-14-4 - Administrative Requirements

4.1. General Administrative Requirements.

4.1.1. The licensee shall develop and adopt written policies and procedures that are consistent with this rule and specific to the assisted living residence, governing the care and safety of residents, and all other policies and procedures required by this rule. The licensee shall sign and date the policies and procedures at the time of adoption and of any changes. (Class III)

4.1.2. The licensee shall have a copy of the policies and procedures available for review on request by employees, residents, and the general public. (Class III)

4.1.3. The licensee shall have a resident bill of rights, and house rules governing resident behavior and responsibilities, that are both in writing and consistent with this rule. (Class III)

4.1.4. Unless otherwise approved in writing by the Secretary, a licensee shall not rent, lease, or use any part of the residence for any purpose other than the operation of housing residents. (Class III)

4.1.5. A licensee that intends to provide adult day care shall obtain prior approval from the Secretary by notifying the Secretary of the number of individuals the residence proposes to serve in addition to the residence's licensed bed capacity. Individuals to be served shall have the same health screening as required for the residents and shall not have extensive or ongoing nursing care needs. The Secretary's determination shall be based on space requirements, services proposed to be provided, staffing, and the residence's history of compliance with this rule. (Class III)

4.1.6. Any individual, including an employee, or his or her spouse, having a financial interest in the residence shall not serve as a resident's legal representative, with the exception of a representative payee under the United States Social Security Act, unless he or she is related to the resident within the consanguinity of second cousin. (Class III)

4.1.7. All employees of an assisted living residence shall be subject to the provisions of the West Virginia Clearance for Access: Registry and Employment Screening Act, W. Va. Code §§16-49-1, et seq. and W. Va. Code R. §§69-10-1, et seq. (Class II)

4.2. The Licensee.

4.2.1. The licensee shall comply with this rule; the terms of the assisted living residence's license; W. Va. Code §§16-5D-1, et seq.; other applicable federal, state, or local laws; and with the residence's policies. (Class II)

4.2.2. The licensee shall protect the physical and mental well-being of residents. (Class I)

4.2.3. The licensee shall maintain accurate records and reports required by this rule. (Class II)

4.2.4. The licensee shall administer the residence on a sound financial basis consistent with good business practices and shall maintain fiscal records that accurately identify, summarize, and classify funds received and disbursed for the operation of the residence. The issuance of bad checks or accumulation of delinquent bills constitute evidence that the licensee lacks satisfactory proof of financial ability to operate the residence in accordance with the requirements of W. Va. Code §16-5D-6. (Class II)

4.2.5. The licensee shall notify the Secretary in writing within 10 days of any permanent change in the administrator and in the consulting or supervising registered professional nurse of the residence. A licensee shall not operate a residence more than 30 days without a qualified administrator or supervising registered professional nurse, unless the Secretary grants an extension, based on a determination that a reasonable attempt has been made to find a suitable replacement. (Class III)

4.2.6. The licensee shall report major incidents, as defined in subsection 2.23. of this rule, to the Office of Health Facility Licensure and Certification as soon as possible, and no later than the next business day. (Class III)

4.3. Administrator.

4.3.1. A large residence shall have an administrator who is at least 21 years of age and has an associate degree or its equivalent in a related field, except an individual who was approved as an administrator prior to August 15, 1996, who shall have at least a high school education or its equivalent approved by the State Department of Education. A small residence shall have an administrator who is at least 21 years of age and has completed high school or a general education development (GED) certificate. (Class III)

4.3.2. The assisted living residence shall have an administrator who has received an eligibility fitness determination or variance from the West Virginia Clearance for Access: Registry and Employment Screening unit of the Department of Health and Human Resources. (Class II)

4.3.3. The administrator shall participate in eight hours of training related to the operation of a residence annually and a record of this training shall be available for review. (Class III)

4.3.4. The administrator shall know the requirements of this rule, develop and execute all policies and procedures required by this rule, ensure compliance with all applicable laws, and ensure the adequacy and appropriateness of services delivered to the residents. (Class II)

4.3.5. The administrator or a responsible employee, designated in writing, shall be present and in charge of the residence at all times. (Class II)

4.4. Staffing Requirements.

4.4.1. Each assisted living residence shall have a minimum of one direct care staff person 24 hours per day, who can read and write, and shall have a sufficient number of qualified employees on duty to provide the residents with all of the care and services they require. (Class I)

4.4.1.a. Day shift - In addition to the one direct care staff person on the day shift, the residence shall have one direct care staff on the day shift for each 10 residents identified on their needs assessments to have two or more of the following care needs: dependence on staff for eating, toileting, ambulating residents from one location to another, bathing, dressing, repositioning, oral hygiene, personal grooming, or one or more inappropriate behaviors that reasonably require additional staff to control, such as sexually acting out, stripping in public settings, refusing basic care, destroying property, or injurious behavior to self or others (hereinafter referred to as "special care needs");

4.4.1.b. Evening shift - In addition to the one direct care person on the evening shift, the residence shall have at least one additional direct care staff on the evening shift for each 15 residents identified on their functional needs assessments to have two or more special care needs;

4.4.1.c. Night shift - In addition to the one direct care person on the night shift, the residence shall have at least one additional direct care staff on the night shift for each 18 residents identified on their functional needs assessments to have two or more special care needs.

4.4.2. One employee who has current first aid training and current cardiopulmonary resuscitation (CPR) training, as applicable, shall be on duty at all times. A record of this training shall be available for review. (Class I)

4.4.3. A multi-story residence shall have at least one awake staff per story while residents are sleeping, unless the residents are certified by a physician or psychologist as not in need of sleep time supervision, and the residence has an emergency call system from the residents to the awake staff person. (Class I)

4.4.4. The residence shall have sufficient staff to meet the laundry, food service, housekeeping, and maintenance requirements of this rule. (Class II)

4.4.5. The licensee shall maintain staffing records that accurately reflect the actual employees on duty in the residence at any given time, including the hours they have worked and the positions they worked, and provide them to the Secretary upon request. (Class III)

4.4.6. If a resident experiences a poor outcome related to a lack of supervision or unmet care needs, the Secretary may require the licensee to add staff. (Class I)

4.5. Employee Orientation and Training.

4.5.1. The licensee shall provide and maintain a record of training to new employees prior to scheduling them to work unsupervised, and no later than within the first 15 days of employment, in accordance with a written plan that includes, at a minimum, emergency procedures and disaster plans; the residence's policies and procedures; resident rights; confidentiality; abuse prevention and reporting requirements; the ombudsmen's role; complaint procedures; specialty care based on individualized resident needs and service plans; the provision of group and individual resident activities; and infection control. (Class II)

4.5.2. The licensee shall provide and maintain a record of in-service training annually to all staff on the topics of resident rights, confidentiality, abuse prevention and reporting requirements, the provision of resident activities, infection control, fire safety and evacuation plans, and specialty care based on individual resident needs and service plans. (Class II)

4.5.3. The licensee shall provide training to all new employees within 15 days of employment and annually thereafter on Alzheimer's disease and related dementias. The licensee shall maintain an employee training record. The training shall be a minimum of two hours in duration and shall include all the following: basic understanding of Alzheimer's disease and other dementias; communication approaches and techniques for use when interacting with persons with Alzheimer's disease or a related dementia; prevention and management of problem behaviors; and activities and programming appropriate for these individuals. (Class II)

4.6. Personnel Records.

4.6.1. The licensee shall maintain a confidential personnel record for each employee, including the administrator, and for volunteers who provide personal assistance to more than one resident. Each record shall contain at least the following:

4.6.1.a. The employee's date of employment, current home address and telephone number, social security number, and proof of compliance with age requirements of applicable federal and state laws;

4.6.1.b. Evidence that each assisted living residence employee, independent contractor, or volunteer has received an eligibility fitness determination or variance from the West Virginia Clearance for Access: Registry and Employment Screening unit of the Department of Health and Human Resources, if applicable;

4.6.1.c. A position title and proof of any required education or license; and

4.6.1.d. A health record containing the results of a pre-employment and annual screening for tuberculosis and other communicable diseases as indicated by exposure, prevalence, or currently accepted medical practice in congregate living situations as indicated by the Secretary. (Class III)

4.6.2. The licensee shall maintain personnel records on file at the residence for at least three years following the termination of an employee and shall document the date and reason for the termination. (Class III)

4.7. Administrative Admission and Discharge.

4.7.1. The licensee shall not discriminate against residents or a prospective resident on the basis of race, national origin, religion, age, gender, sexual orientation, or disability. (Class III)

4.7.2. The licensee shall enter into a written contract with the resident on admission to the residence that specifies, at a minimum, the following information:

4.7.2.a. The type of resident population that the residence is licensed to serve and will serve;

4.7.2.b. The health and nursing care services that the residence will provide to meet the resident's needs, including cardiopulmonary resuscitation and how they will be provided;

4.7.2.c. An annual or monthly contract price, full disclosure of all costs including what changes in care needs will result in increases, additions or modifications to the costs, the refund policy, and an assurance that the resident shall not be held liable for any cost that was not disclosed;

4.7.2.d. Discharge criteria, including notification policies;

4.7.2.e. How to file a complaint;

4.7.2.f. Medication storage, handling, distribution, and disposition, and responsibility for payment;

4.7.2.g. Management of residents' funds; and

4.7.2.h. Whether or not the residence has liability insurance coverage. (Class III)

4.7.3. The licensee shall provide a copy of the contract to each party in the contract and maintain a copy of the contract on file in the residence. If the existing contract does not meet the requirements of this rule, the licensee shall provide current residents with a new or updated contract that includes the required provisions within 90 days of the effective date of this rule. (Class III)

4.7.4. At the same time as providing the contract, the licensee shall also provide the resident with the following information:

4.7.4.a. House rules governing resident behavior and responsibilities, including the residence's smoking policy;

4.7.4.b. The resident's bill of rights;

4.7.4.c. How the resident's personal property will be protected from loss and theft;

4.7.4.d. The requirements for medical examinations and treatment orders;

4.7.4.e. How the resident will be assisted in making appointments for medical, dental, nursing, or mental health services, and how transportation to and from these services will be arranged; and

4.7.4.f. How to access the residence's policies and procedures. (Class III)

4.7.5. The licensee is prohibited from entering into a life care contract without the prior written permission of the Secretary. In making a determination to grant permission, the Secretary shall consider the licensee's financial situation by reviewing the licensee's financial statements for a minimum of three years and any related information he or she requests; the licensee's experience in the management of a life care community; and the licensee's ability to potentially manage residents with a catastrophic illness or disease. (Class III)

4.7.6. Thirty days prior to any increase, addition, or other modification of the rates of the resident's care or services, the licensee shall give the resident a written notice of the proposed change. However, when the increase, addition, or modification in cost is required by the resident's increased care needs as determined by a licensed health care professional, and the licensee has informed the residents, in writing, of the possibility of such increase, addition, or modification at the time of admission and periodically during his or her stay, the 30-day notice shall be waived. The licensee shall instead give the residents a choice between paying the increase, addition, or modification or moving to another residence. If the resident chooses to move, the resident is required to give notice of the move as set out in the admission contract. (Class III)

4.7.7. The licensee shall give the resident notice of and file a copy of the notice in the resident's record of the 30-day written notice prior to discharge, unless an emergency situation arises that requires the resident's transfer to a hospital or other higher level of care, or if the resident is a danger to him or herself or others. (Class III) The licensee shall assist the resident to find an alternative placement that is appropriate to the resident's individual needs as identified by the service plan.

4.7.8. The licensee shall maintain a register of all residents in order by the dates of the residents' admissions. The register shall include each resident's name, the date of admission, the date of his or her last day in the residence, and if transferred, the name of the place to which the resident was transferred. (Class III)

4.7.9. The licensee shall keep resident records in safe storage for at least five years from the date of the death, discharge, or transfer of the resident. If the residence ceases to operate, the licensee shall procure a holding area for the resident records that will ensure the confidentiality and safety of the records from loss, destruction, or unauthorized use. (Class III)

4.8. Management and Control of Resident Funds.

4.8.1. The licensee shall manage a resident's funds at the written request of the resident only, in the manner directed by the resident, in the resident's best interests, using generally accepted accounting principles to manage the funds, and in accordance with this rule. (Class III)

4.8.2. The licensee shall assure that the accounting system does not commingle resident funds with the assisted living residence's funds or with the funds of any other person. (Class III)

4.8.3. The licensee shall deposit a resident's personal funds exceeding $200 in an interest-bearing account at a local bank. (Class III)

4.8.4. If the licensee handles resident funds in excess of $25 per resident and in excess of $500 for all residents in any month, he or she shall file a bond in an amount and with such surety as the Secretary approves that is sufficient to cover all resident funds at all times. The sum of the bond to be fixed by the Secretary based upon the amount of resident funds may not be less than $2,500, as shown in Table 64-14 A at the end of this rule. When the amount of any bond that is filed is insufficient to adequately protect the resident funds, or when the amount of the bond is impaired, the licensee shall file an additional bond in an amount necessary to adequately protect the resident funds. (Class III)

4.8.5. The licensee shall maintain an account record with supporting documentation for each resident that shows in detail all funds received on behalf of the resident and the disposition of all funds received. Persons shopping for residents shall provide a list with a description and price of items purchased if the purchase exceeds $10, along with payment receipts, for these items. (Class III)

4.8.6. The licensee shall provide upon request a complete, accurate accounting of the receipt, management, and disposition of resident funds to the resident and his or her representative, any authorized entity, and to the Secretary, and at least quarterly to the resident if not requested. (Class III)

4.8.7. If the resident or legal representative requests to terminate the resident's account, the licensee shall provide an accounting for all funds received and expended, and refund any money remaining in the account to the resident or legal representative. (Class III)

Notes

W. Va. Code R. § 64-14-4