W. Va. Code R. § 64-2-6 - Administrative Requirements

6.1. General Administrative Requirements.

6.1.a. The licensee shall establish regular hours of operation of not less than four (4) hours per day and not more than fourteen (14) hours per day, a minimum of five (5) days per week. The center's hours of operation shall be during times that encompass a normal work week for participant's caregivers.

6.1.b. The licensee shall develop and adopt written policies and procedures that are consistent with this rule and specific to the medical adult day care center, governing the care and safety of participants, and all other policies and procedures required by this rule.

6.1.c. The licensee shall review all policies and procedures at least annually and shall sign and date the policies and procedures at the time of adoption, modification, and review.

6.1.d. The licensee shall have a copy of the policies and procedures available for review on request by employees, participants and the general public.

6.1.e. The licensee shall have a participant bill of rights, and rules of participation governing participant behavior and responsibilities, that are both in writing and consistent with this rule.

6.1.f. Unless otherwise approved in writing by the Secretary, a licensee shall not rent, lease or use any part of the center for any purpose other than the operation of a medical adult day care center.

6.1.g. Any individual, including an employee, or his or her spouse having a financial interest in the center shall not serve as a participant's legal representative.

6.2. The Licensee.

6.2.a. The licensee shall comply with this rule, the terms of the medical adult day care center's license, W. Va. Code § 16-5B-1 et seq., other applicable federal, state or local laws, and with the center's policies.

6.2.b. The licensee shall protect the physical and mental well-being of participants.

6.2.c. The licensee shall maintain the accurate records and reports required by this rule.

6.2.d. The licensee shall administer the center 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 center. The issuance of bad checks or accumulation of delinquent bills constitutes evidence that the licensee lacks satisfactory proof of financial ability to operate the center as required.

6.2.e. The licensee shall notify the Secretary in writing immediately and no later than within ten (10) days of any permanent change in the director and in the supervising registered professional nurse of the center. The center shall not operate more than thirty (30) days without a qualified director or supervising registered professional nurse.

6.2.f. The licensee shall report major incidents, as defined in Subsection 3.26 of this rule, to the office of health facility licensure and certification as soon as possible, and no later than the next business day.

6.3. Director.

6.3.a. The center shall employ a qualified director who is at least twenty-one (21) years of age and has completed at least two (2) years of post secondary education or has a high school diploma or the equivalent and a minimum of five (5) years experience and training in a social service or health care field with elderly or disability populations, at least two (2) years of which is in a supervisory and administrative capacity.

6.3.b. The director shall have a personal history that is free of evidence of abuse, fraud, or substantial and repeated violations of applicable laws and rules in the operation of any health or social care facility or service organization, or in the care of dependent persons; or conviction of crimes related to the care to a dependent persons as evidenced by a criminal investigative background check by the West Virginia state police through the central abuse registry.

6.3.c. The director shall participate in eight (8) hours of training related to the operation of a center annually and a record of this training shall be available for review.

6.3.d. The director 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 participants.

6.3.e. The director or a responsible employee, designated in writing and with the authority to make decisions in the director's absence, shall be present and in charge of the center at all times.

6.4. Staffing Requirements.

6.4.a. The center shall have a nurse on duty during all primary hours of operation, and on call during all other hours of operation. The nurse shall be responsible for provision of nursing services, medication administration and oversight of all participant care needs. Back-up coverage must be arranged in the event of absence due to illness or vacation.

6.4.b. The center shall employ or contract with a registered professional nurse to provide oversight of nursing services and participant care. The registered nurse shall possess a valid license to practice in West Virginia and at least two years experience or specialized training and one year experience in direct care of elderly or disability populations. The center shall maintain verification of required credentials on file.

6.4.c. The registered professional nurse shall be in the center a minimum of eight (8) hours per week. The supervising registered nurse shall:

6.4.c.1. Provide or supervise provision of nursing services to each participant;

6.4.c.2. Coordinate development and on-going review of participant care plans;

6.4.c.3. Note any significant changes in the participant's behavior and condition and report these to the participant's family;

6.4.c.4. Ensure the availability of needed medications;

6.4.c.5. Assist in obtaining emergency treatment and consultation;

6.4.c.6. Ensure documentation of a nursing note for each participant at least monthly, or more frequently if indicated by the participant's condition, that addresses change in condition, special needs including dietary compliance, medication administration, assistance with personal care and other health related issues as appropriate. If the monthly nursing note is completed by a licensed practical nurse, the registered nurse shall review and co-sign the monthly note;

6.4.c.7. Supervise the storage, handling and administration of all participant medications; and

6.4.c.8. Assist as necessary in the delivery of other center services.

6.4.d. If licensed practical nurses are employed, they shall work under the supervision of a registered professional nurse who is either on staff or under contract with the center. The licensed practical nurse shall possess a valid license to practice in West Virginia and at least one year experience or specialized training in direct care of elderly or disability populations. The center shall maintain verification of required credentials on file. The licensed practical nurse shall:

6.4.d.1. Provide nursing services to each participant under the supervision of the center's registered nurse;

6.4.d.2. If delegated by the registered nurse, write at least monthly, a nursing note for each participant in the participant record; and

6.4.d.3. Assist as necessary in the delivery of other center services.

6.4.e. The center shall employ a qualified professional to be responsible for planning and implementing an activity program to meet the needs of all participants. The activity director shall:

6.4.e.1. Be certified by the national certification council for activity professionals; (NCCAP) through any of the NCCAP's approved certification tracks as an activities director certified (ADC);

6.4.e.2. Be a qualified therapeutic recreation specialist who has two (2) years of experience in a social or recreational program within the last five (5) years, one of which was full-time in an activities program in a health care setting;

6.4.e.3. Be an occupational therapist or occupational therapy assistant currently licensed to practice in the state of West Virginia; or

6.4.e.4. Have a high school diploma or equivalent and a demonstrated ability to provide for an ongoing program of activities designed to meet the interests and the physical, mental and psychosocial needs of varied individuals and have completed an NCCAP approved ninety (90) hour modular education program for activity professionals (MEPAP) (part I) and the ninety (90) hour practicum. An activities director, who is qualified by virtue of having completed a NCCAP-approved training course and practicum shall complete ten (10) hours of activity related continuing education annually, with written evidence of continuing education maintained on file.

6.4.f. The activities director shall:

6.4.f.1. Complete activity assessments for participants;

6.4.f.2. Develop, consistent with participant plans of care, activity programs that meet individual participant needs;

6.4.f.3. Supervise the activity program and any assistants or volunteers;

6.4.f.4. Participate in the quarterly review of each participant's care plan;

6.4.f.5. Document monthly in the participant record regarding the participant's involvement in activities; and

6.4.f.6. Develop and maintain a weekly calendar of planned activities, posted in the center, that includes each activity, and the time and duration of each.

6.4.g. Direct care staff shall have a minimum of a tenth grade education, at least one year of full-time or part-time equivalent paid or volunteer experience working with adults in a health care or social service setting, and be able to read and write. The direct care staff shall:

6.4.g.1. Assist participants as needed with personal care, including dressing, grooming, personal hygiene, use of special aids, accident prevention and activities of daily living;

6.4.g.2. Assist participants at meal time including cutting foods and feeding participants as needed;

6.4.g.3. Continually monitor and supervise participants; and,

6.4.g.4. Assist and encourage activity involvement and provide individualized activities as needed.

6.4.h. If the center prepares meals on-site, the director shall designate a staff member to serve as food service supervisor. Prior to assuming these duties, this individual shall receive specialized training in food management and preparation, including preparation of therapeutic diets. The food service supervisor shall:

6.4.h.1. Oversee the daily operation of food preparation in accordance with menus prepared or approved by a registered dietician; and

6.4.h.2. Ensure that therapeutic diets are served as ordered by the physician.

6.4.i. Drivers used to transport participants shall possess a valid West Virginia driver's license or chauffeur's license, if required under the provisions of § 17B-2-1, et. seq., current first aid and cardiopulmonary resuscitation certification, and training in emergency procedures. The driver shall have experience in transporting passengers.

6.4.j. Volunteers used in the program shall serve as an adjunct to staff and shall possess qualifications and experience appropriate to the services they render. They shall receive orientation to the program and training on the specific tasks to be performed prior to working with participants and are subject to the same regulations on confidentiality as are paid staff members.

6.4.k. The center shall maintain a sufficient number of staff at all times to meet the care and service needs of all participants in the center. A minimum staffing level of one (1) full-time staff member involved in direct services to participants for each six (6) participants shall be maintained. Additional staff shall be added to meet participant needs. Volunteers shall not be used to meet the required staff ratio unless they are professionally trained and/or certified in a health occupation and oriented and trained as other staff. If a participant experiences a poor outcome related to a lack of supervision or unmet care needs, the Secretary may require the licensee to add staff.

6.4.l. The center shall have sufficient staff to meet the laundry, food service, housekeeping and maintenance requirements of this rule.

6.4.m. The licensee shall maintain staffing records that accurately reflect the actual employees on duty in the center at any given time, including the hours they have worked, and provide them to the Secretary upon request.

6.5. Personnel Records.

6.5.a. The licensee shall maintain a confidential personnel record for each employee, including the director, and a record for volunteers who provide personal assistance to more than one (1) participant. Each personnel record shall contain at least the following:

6.5.a.1. The employee's date of employment or volunteer's start date, current home address and telephone number, social security number and proof of compliance with age requirements of applicable federal and state laws;

6.5.a.2. Documentation of a screening by all required abuse registries completed prior to hiring. The licensee shall not hire or maintain as an employee any individual who is listed on these registries. If there is a break in employment of one (1) year or greater, the abuse registry screenings shall be repeated;

6.5.a.2.A. Prior to hiring an individual, the licensee shall submit the required information for a screening through the West Virginia state police central abuse registry regarding previous convictions involving abuse, mistreatment or neglect of dependent populations, or theft of the property of those populations. The center shall maintain written documentation of the information submitted and the results of the screening;

6.5.a.2.B. Documentation of the results of a screening by the state nurse aide abuse registry to determine if the individual is listed on the nurse aide abuse registry;

6.5.a.2.C. For licensed personnel, documentation of the results of a screening by the applicable licensing board; and,

6.5.a.2.D. Documentation of the results of a screening by the Bureau for Children and Families for substantiated abuse or neglect.

6.5.a.3. A position title and proof of any required education or license; and

6.5.a.4. A health record containing the results of a tuberculosis skin test - (purified protein derivative PPD) or chest x-ray as indicated by exposure, prevalence or currently accepted medical practice in settings that serve vulnerable populations as indicated by the Secretary. The tuberculosis skin test or chest x-ray shall be completed prior to the employee working with participants. Thereafter, a tuberculosis screening shall be completed annually in accordance with current Center for Disease Control (CDC) guidelines.

6.5.b. The licensee shall maintain personnel records on file at the center for at least three (3) years following the termination of an employee and shall document the date of the termination.

6.6. Employee Orientation and Training.

6.6.a. 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 fourteen (14) days of employment and annually thereafter. Training shall include:

6.6.a.1. At a minimum, emergency procedures and disaster plans; the center's policies and procedures; participant rights; confidentiality; abuse prevention and reporting requirements; complaint procedures; specialty care based on individualized participant needs and service plans; the provision of group and individual participant activities; infection control; and needs of the elderly and disability populations;

6.6.a.2. Training on Alzheimer's disease and related dementias at least two (2) hours in duration that includes: basic understanding about 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; and,

6.6.a.3. For new employees, a minimum of five (5) days of supervised on the job training.

6.6.b. The licensee shall maintain a record of training provided to all staff that identifies at a minimum, the name of each participant, the name of the trainer, the date of the training and detailed content for the training.

6.6.c. All employees shall have current first aid training and current cardiopulmonary resuscitation (CPR) training. A record of this training shall be available for review.

6.7. Administrative Admission and Discharge.

6.7.a. The licensee shall not discriminate against participants or a prospective participant on the basis of race, national origin, religion, age, gender, sexual orientation or disability.

6.7.b. The licensee shall develop an admission packet to be given to the prospective participant that includes, at a minimum:

6.7.b.1. Admission criteria;

6.7.b.2. Information required for admission including but not limited to the participant's medical history, recent hospital and nursing facility admissions, current medications, dietary requirements, functional needs, limitations to participation in program activities, and special therapies, when applicable;

6.7.b.3. Discharge criteria, including notification policies;

6.7.b.4. How to file a complaint;

6.7.b.5. Medication storage, handling, distribution, and disposition, responsibility for payment and ensuring availability of medications;

6.7.b.6. The requirements for assuring availability of a portable source of oxygen for participants who require oxygen;

6.7.b.7. The days and hours the program is in operation, a schedule of holidays when the program is closed and procedures used for unplanned program closure due to disaster or inclement weather;

6.7.b.8. Rules governing participant behavior and responsibilities including but not limited to the minimum number of hours per week, if applicable;

6.7.b.9. The participant's bill of rights;

6.7.b.10. How the participant's personal belongings will be protected from loss and theft;

6.7.b.11. The requirements for medical examinations and treatment orders;

6.7.b.12. How participant confidentiality will be ensured, during treatment, participant records, etc.;

6.7.b.13. Whether or not the participant will be assisted in making appointments for medical, dental, nursing or mental health services, and if so, how transportation to and from these services will be arranged;

6.7.b.14. Applicable policies and procedures not otherwise addressed;

6.7.b.15. Notification of the use of visual and auditory devices to monitor common areas of the medical adult day care center, if applicable; and

6.7.b.16. A statement that employees or volunteers of the center shall not manage personal funds for participants.

6.7.c. The licensee shall enter into a written contract with the participant on admission to the center that specifies, at a minimum, the following information:

6.7.c.1. The type of client population that the center is licensed to serve and will serve;

6.7.c.2. The various services that the center will provide to meet the participant's needs, including cardiopulmonary resuscitation, and how they will be provided;

6.7.c.3. An hourly, daily, weekly 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 when the service period paid for is more than the service received and an assurance that the participant shall not be held liable for any cost that was not disclosed; and,

6.7.c.4. Whether or not the center provides transportation, and if so, the associated cost.

6.7.d. The licensee shall provide a copy of the contract to each party in the contract.

6.7.e. Thirty (30) days prior to any increase, addition or other modification of the rates of the participant's care or services, the licensee shall give the participant a written notice of the proposed change.

6.7.f. The licensee shall give the participant notice of and file a copy of the notice in the participant's record of the thirty (30) day written notice prior to discharge.

6.7.g. The licensee shall maintain documentation of all agreements or contracts entered into between the participant and the licensee.

6.7.h. The licensee shall maintain a register of all participants in order by the dates of the participants' admissions. The register shall include each participant's name, the date of admission, and the date of his or her last day at the center.

Notes

W. Va. Code R. § 64-2-6