016.06.06 Ark. Code R. 059
ADMINISTRATIVE RULES FOR PROVIDERS OF ADULT DAY HEALTH CARE
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.
Multiple buildings on contiguous land that serve clients shall require and shall be licensed under a single license.
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.
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.
The procedure for obtaining an Adult Day Health Care License shall be:
* 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.
Each Adult Day Health Care facility shall have an owner or governing body that has ultimate authority for:
Required Policies and Procedures governing general administration of the facility.
Conducting Criminal Record Checks for Employees of Long Term Care Facilities,
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.
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.
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.
The program must have a full-time Health Care Coordinator to supervise the delivery of health care services.
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:
The ADHC shall comply with the following in regard to utilization of volunteers who provide direct care in lieu of paid staff:
* Hours
* Days
* And length of commitment of volunteer's services
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.
The facility shall:
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.
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.
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
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.
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.
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.
The facility's program Director or designee is also required to make any other reports as required by state and federal laws and regulations.
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.
Each provider shall have a written emergency medical plan which assures transportation to a hospital or other type of facility providing emergency care.
Administrative records must include at least:
The facility must maintain a separate and distinct record for each client.
There shall be a written care plan for each client based on the referring physician's orders. Care plans:
Each Director shall execute with and provide to each client at or prior to admission (and periodically thereafter, for changes as specified in this section) a written Admission Agreement dated and signed by the client or their legal guardian.
The facility must develop and implement written discharge policies and procedures that are in accordance with Ark. Code Ann. § 20-10-1005 and include, at a minimum, the following:
Term Care when a client's life or health requires immediate medical attention. The responsibility for the client's care or lack of care shall rest with the provider. If OLTC determines that the discharge of a client is necessary for reasons other than appropriateness of placement, the facility will have up to thirty (30) days to effectuate the discharge or as otherwise specified by the Office of Long Term Care.
The facility shall develop, maintain and follow written policies and procedures defining the rights and responsibilities of clients. The policies shall present a clear statement defining how clients are to be treated by the facility, its personnel, volunteers and others involved in providing care.
The Adult Day Health Care program shall provide at least the following health care services:
After the initial assessment, facilities shall perform reassessments as needed, including upon changes of conditions of clients, and shall perform the steps outlined in subsections (a) through (b) above. Failure to assess or reassess, or to identify clients at risk of harm from medications in unsecured locations or rooms, shall constitute a deficient facility practice. Resulting harm from a failure to assess or reassess, or to identify clients at risk of harm from medications in unsecured locations or rooms, shall constitute a deficient facility practice.
Scheduled II, III, IV and V drugs dispensed by prescription for a client and no longer needed by the client must be delivered in person or by registered mail to: Drug Control Division, Arkansas Department of
Health and Human Services, along with the Arkansas Department of Health and Human Services' Form (PHA-DC-1) Report of Drugs surrendered for Disposition According to Law. When unused portions of controlled drugs go with a client who leaves the facility, the person who assumes responsibility for the client and the person in charge of the medications for the facility shall sign the Controlled Drug Record in the facility. This shall be done only on the written order of the physician or advance practice nurse and at the time that the client is discharged, transferred or visits home.
All other medications not taken out of the facility when the client leaves the facility shall be destroyed or returned in accordance with law and applicable regulations.
All such medications shall be destroyed or returned in accordance with law and applicable regulations.
Responsibility for Pharmacy Compliance
The Director shall be responsible for full compliance with federal and state laws and regulations governing control and administration of all drugs. Full compliance is required with the Comprehensive Drug Abuse Prevention and Control Act of 1970, Public Law 91-513 and all amendments of this set and all regulations and rulings passed down by the federal Drug Enforcement Agency (DEA), Arkansas Act No. 590 (Title 5, Subtitle 6, Chapter 64 of the Arkansas Code Annotated) and all amendments to it and these rules and regulations.
The Provider may offer the following services:
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.
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.
The heating system shall be in compliance with all state and local codes.
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.
Sufficient housekeeping and maintenance service shall be provided to maintain the facility in good repair and in a safe, clean, orderly and sanitary manner.
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.
Adult Day Health Care facilities located in organized areas or municipalities shall obtain from local fire safety officials annual written certification that the facility complies with local fire codes. If there are no applicable codes, or if the Division determines that such codes are not adequate to assure the safety of older or handicapped persons, the provisions of the National Fire Protection Association Life Safety Code 101, Section 16, 2000 Edition shall apply.
Employees shall be trained in the rapid evacuation of the building, including assistance to clients in evacuation.
Facilities may elect to prohibit smoking in the facility or on the grounds or both. If a facility elects to permit smoking in the facility or on the grounds, the facility shall include the following minimal provisions, and the facility shall ensure that:
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.
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.
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.
The Office of Long Term Care may impose civil money penalties in accordance with Ark. Code Ann. § 20-10-205 and § 20-10-206.
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.
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:
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.
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
_________________ _____________________
Facility Administrator's Signature Date
016.06.06 Ark. Code R. 059