016.25.19 Ark. Code R. 005
RULES FOR ASSISTED LIVING FACILITIES LEVEL II
These rules constitute the basis for the licensure of Level I assisted living facilities by the Arkansas Department of Human Services, Division of Medical Services, Office of Long Term Care. The Office of Long Term Care reserves the right, and may at any time, waive any or all of the requirements herein in event of emergency or for good cause shown in the sole determination of the Office of Long Term Care.
The purpose of these rules is to establish standards for Level I assisted living facilities that provide services in a homelike environment for elderly and disabled persons. Level I assisted living facilities ensure that residents receive supportive health and social services as they are needed to enable them to maintain their individuality, privacy, dignity, and independence, in the highest degree possible in an apartment-style living unit. The assisted living environment actively encourages and supports these values through effective methods of service delivery and facility or program operation. The environment promotes resident self-direction and personal decision-making while protecting resident's health and safety.
As used in these rules, the following definitions shall apply unless the context clearly states otherwise. Where these rules refer to an enactment of the General Assembly, such reference 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. § 5-28101 and 42 CFR § 488.301. "Abuse" also includes sexual abuse as defined in Ark. Code Ann. § 5-28-101 (12).
Activities of Daily Living - The activities of daily living 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.
Administrator - The person who has successfully completed a course of training or instruction certified by the Office of Long Term Care as an assisted living facility administrator who is in charge of the daily operation of the facility. Until programs have been certified by the Office of Long Term Care, Residential Care Facility Administrators or Nursing Home Administrators may be used.
Advertise - To make publicly and generally known. For purposes of this definition, advertise includes, but is not limited to:
Alzheimer's Special Care Unit (ASCU) - A separate and distinct unit within an Assisted Living or other Long Term Care facility that segregates and provides a special program for residents with a diagnosis of probable Alzheimer's disease or related dementia, and that advertises, markets or otherwise promotes the facility as providing specialized Alzheimer's or related dementia care services.
Assisted Living Facility (ALF) - Any building or buildings, section or distinct part of a building, boarding home, home for the aged or other residential facility whether operated for profit or not that undertakes through its ownership or management to provide assisted living services for a period exceeding twenty-four (24) hours to more than three (3) adult residents of the facility who are not relatives of the owner or administrator. Assisted living facility means facilities in which assisted living services are provided either directly or through contractual arrangements or in which contracting in the name of residents is facilitated.
Assisted Living Program - A program of assisted living services.
Assisted Living Services - Housing, meals, laundry, social activities, assistance with transportation, direct care services, health care services, 24-hour supervision and care, and limited nursing services. For purposes of these rules, assistance with transportation means making arrangements for transportation.
Caregiver - Shall have the same meaning prescribed by Ark. Code Ann. § 5-28101.
Choice - Viable options available to a resident that enables the resident to exercise greater control over his or her life. Choice is supported by resident's self-directed care (including methods and scheduling) established through the care planning process, and the provision of sufficient private and common space within the facility to provide opportunities for residents to select when and how to spend time, and when and how to receive personal or assisted living services.
Common Areas (for Alzheimer's Special Care Units) - Portions of the Alzheimer's Special Care Unit, exclusive of residents' rooms and bathrooms. Common areas include any facility grounds accessible to residents of the Alzheimer's Special Care Unit.
Compliance Agreement - If needed, the written formal plan developed in consideration of shared responsibility, choice and assisted living values and negotiated between the resident or his or her responsible party and the assisted living facility to avoid or reduce the risk of adverse outcomes that may occur in an assisted living environment.
Continuous - Available at all times without cessation, break or interruption.
Deficiency - A facility's failure to meet program participation requirements as defined in these and other applicable rules and laws.
Dementia - A loss or decrease in intellectual ability that is of sufficient severity to interfere with social or occupational functioning; it describes a set of symptoms such as memory loss, personality change, poor reasoning or judgment, and language difficulties.
Department - The Department of Human Services and its divisions and offices.
Direct Care Services - Services that directly help a resident with certain activities of daily living such as assistance with mobility and transfers; assistance to resident 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 Service Plan - A written plan for direct care services that is developed to meet the needs and preferences of the resident or his or her responsible party through a negotiated process that becomes a part of the resident's occupancy admission agreement.
Direct Care Staff - Any licensed or certified staff acting on behalf of, employed by, or contracted by the facility, to provide services and who provides direct care services or assistance to residents, including activities of daily living and tasks related to medication administration or assistance.
Direct Care Staff (Alzheimer's Special Care Unit) - An individual who is an employee of the facility, or an individual who is an employee of a temporary or employment agency assigned to work in the facility, who has received or will receive, in accordance with these rules, specialized training regarding Alzheimer's or related dementia, and who is responsible for providing direct, hands-on care or cuing services to residents of the ASCU.
Direct Contact - The ability or opportunity of employees of the facility, or individuals with whom the facility contracts, to physically interact with or be in the presence of residents.
Direct Threat - A significant risk to the health or safety of self or others that cannot be eliminated by reasonable accommodation. This term as used in these rules is designed to ensure conformity with the Americans with Disabilities Act (ADA) in determining whether a person with a disability poses a "direct (health or safety) threat".
Directed Plan of Correction - A plan developed by the Office of Long Term Care that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected.
Discharge - When a resident leaves the facility, and it is not anticipated that the resident will return. A discharge occurs when a return to the facility by the resident requires that admission procedures set forth in these rules be followed.
Disclosure Statement (Alzheimer's Special Care Unit) - A written statement prepared by the facility and provided to individuals or their responsible parties, and to individual's families, prior to admission to the ASCU, disclosing the form of care, treatment, and related services especially applicable to, or suitable for residents of, the ASCU.
Elopement - Circumstances where a resident, who has been identified as being cognitively impaired, has left a facility without staff knowledge. Facilities must comply with all reporting requirements of any special programs in which they participate.
Emergency Measures - Those measures necessary to respond to a serious situation that threatens the health and safety of residents.
Endangered Adult - Shall have the same meaning as prescribed by Ark. Code Ann. § 5-28-101 and as amended.
Exploitation - Shall have the same meaning as prescribed by Ark. Code Ann. § 528-101.
First Aid Measures - Temporary interventions necessary to treat trauma or injury.
Health Care Service Plan - A written plan for health care services that is developed to meet the needs and preferences of the resident or his or her responsible party through a negotiated process that becomes a part of the resident's occupancy admission agreement.
Health Care Services - The provision of services in an assisted living facility that assists the resident in achieving and maintaining well-being (e.g., psychological, social, physical, and spiritual) and functional status. This may include nursing assessments and the monitoring and delegation of nursing tasks by registered nurses pursuant to the Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing, care management, records management and coordinating basic health care and social services in such settings. Health care services may not be provided in a Level I Assisted Living Facility except as provided in Section 702 of these rules.
Home Health Services - Home health aide services, medical supplies suitable for use in the resident's assisted living facility apartment, and nursing services as defined in the state Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing.
IDR - The informal dispute resolution process as described in these rules.
Imminent Danger to Health and Safety - Shall have the same meaning as prescribed by Ark. Code Ann. § 5-28-101.
Impaired Adult - Shall have the same meaning as prescribed by Ark. Code Ann. § 5-28-101.
Independence - The maintenance and promotion of resident capabilities to enhance the resident's preferences and choices within a barrier-free environment.
Individual Assessment Team (IAT) - A group of individuals possessing the knowledge and skills to identify the medical, behavioral, and social needs of residents of the Alzheimer's Special Care Unit (ASCU), and to develop services designed to meet those needs.
Individual Support Plan - A written plan developed by an Individual Assessment Team (IAT) that identifies services to a resident of the Alzheimer's Special Care Unit (ASCU).
Limited Nursing Services - Acts that may be performed by licensed personnel while carrying out their professional duties, but limited to those acts that the department specifies by rule. Acts that may be specified by rule as allowable limited nursing services shall be for persons who meet the admission criteria established by the Department for facilities offering assisted living services, shall not be complex enough to require twenty-four (24) hour nursing supervision and may include such services as application and care of routine dressings, and care of casts, braces, and splints.
Long Term Care Facility License - A time-limited, non-transferable, permit required by Ark. Code Ann. § 20-10-224 and issued for a maximum period of twelve (12) months to a licensee who complies with Office of Long Term Care rules. This document must list the maximum number of beds for the facility.
Medication Assistance and Monitoring - Services provided by the facility, either directly or through contract, in accordance with the Nurse Practices Act and interpretations thereto by the Arkansas State Board of Nursing, designed to ensure that residents receive necessary or prescribed medication, and to prevent wastage of medication.
Mental Abuse - Verbal, written, or gestured communication, to a resident, or to a visitor or staff, about a resident within the resident's presence, or in a public forum, that a reasonable person finds to be a material endangerment to the mental health of a resident.
Neglect - Shall have the same meaning as prescribed by Ark. Code Ann. § 5-28101 and 42 C.F.R. § 488.301.
New Admission - An individual who is being admitted to the facility for the first time, or who is returning after a formal discharge.
Non-Compliance - Any violation of these rules, or of applicable law or rules.
Nurse Practice Act - As used in these rules, the term Nurse Practice Act refers to Ark. Code Ann. § 17-87-101et seq. and interpretations thereto by the Arkansas State Board of Nursing.
Operator - The individual or entity that conducts the business of the facility. The individual or individuals executing the licensure application form shall be deemed an operator.
OLTC - The Office of Long Term Care.
Office of Long Term Care - The Office in the Division of Medical Services of the Department of Human Services that has responsibility for the licensure, certification, and rules, 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 rules for compensation, or who provides services voluntarily, and may include the owner, operator, professional, management and persons, firms, or entities providing services pursuant to a contract or agreement.
Plan of Correction (P-o-C) - A plan developed by the facility and approved by OLTC that describes the actions the facility will take to correct deficiencies, and which specifies the date by which those deficiencies will be corrected.
PRN - A medication or treatment prescribed by a medical professional to a person, allowing the medication or ointment to be given "as needed".
Program Requirements - The requirements for participation and licensure under these and other applicable rules and laws as an assisted living facility.
Proprietor/Licensee - Any person, firm, corporation, governmental agency or other legal entity, issued an assisted living facility license, and who is responsible for maintaining approved standards.
Protective Services - Shall have the same meaning as prescribed by Ark. Code Ann. § 5-28-101.
Provisional Licensure is a temporary grant of authority to the purchaser to operate an existing long-term care facility upon application for licensure to the Office of Long Term Care.
Provisional Placement - Placement in an assisted living facility made for the purposes of assessment to determine appropriateness of admission or emergency, such as placement by law enforcement or Adult Protective Services. A provisional placement shall be permitted for no longer than thirty (30) days, at which time the resident must either be discharged or admitted to the facility in conformity with theses rules. A provisional placement shall not be an admission pursuant to these rules, and any individual in an assisted living facility pursuant to a provisional placement shall not be deemed a resident of the facility.
Responsible Party - An individual, who, at the request of the applicant or resident, or by appointment by a court of competent jurisdiction, agrees to act on behalf of a resident or applicant for the purposes of making decisions regarding the needs and welfare of the resident or applicant. These rules, and this definition, does not grant or permit, and should not be construed as granting or permitting, any individual authority or permission to act for or on behalf of a resident or applicant in excess of any authority or permission granted by law. A competent resident may select a responsible party or may choose not to select a responsible party. In no event may an individual act for, or on behalf of, a resident or applicant when the resident or applicant has a legal guardian, attorneyin-fact, or other legal representative. For purposes of these rules only, responsible party will also refer to the terms legal representative, legal guardian, power of attorney or similar phrase .
Separate Premises - Buildings housing Assisted Living Facility operations that are located on non-contiguous land.
Significant Change - Any improvement or decline in a resident's medical, physiological, psychological, or social condition, in which:
Substandard Quality of Care - One or more deficiencies related to participation requirements, as set forth in these or other applicable rules or laws, that constitute either immediate jeopardy to resident health or safety; a pattern of, or widespread actual harm, that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm.
Survey - The process of inspection, interviews, or record reviews, conducted by the Office of Long Term Care.
Standard Survey - A comprehensive survey conducted by the Office of Long Term Care on an average of every 18 months for each facility.
Transfer - The temporary or permanent relocation of a resident from one living unit within the facility to another living unit within the facility, or the temporary relocation of a resident to a location outside the facility.
Twenty-Four (24) Hour Nursing - Services that are ordered by a physician or advance practice nurse for a resident whose condition requires the supervision of a physician or advance practice nurse and continued monitoring of vital signs and physical status and whose condition is medically complex enough to require on site nursing supervision on a twenty-four (24) hour per day basis.
Visually and Functionally Distinct Area - A space that can be distinguished from other areas within the apartment by sight. A visually and functionally distinct area need not be a separate room. To create a visually distinct area, one or more of the following methods must be employed: change in ceiling height, separation by ceiling soffit(s) or wall returns, change in flooring color, partial height partitions or counters, use of alcoves, use of permanent screening devices such as columns or fixed screens. In the case of an "L" shaped studio apartment or unit, kitchenettes and living areas may be combined and bedroom areas may be in a leg of an "L" shaped plan and qualify without additional separation methods.
Permits of approval held by residential care facilities as of the effective date of Act 1230 of 2001 or held by subsequent purchases of those facilities shall also be considered permits of approval for assisted living without further action. However, residential care facilities that choose to offer Level I assisted living services are not exempt from assisted living licensure requirements except as specifically provided by Act 1230 of 2001.
An initial license will not be issued until the Department verifies that the facility is in compliance with the licensing standards set forth in these rules.
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 rules. The license will expire on June 30th following the issuance of the license.
Subject to the requirements below, a provisional license shall be issued to the Applicant and new operator of the long-term care facility when the Office of Long Term Care has received the Application for Licensure to Conduct a Long Term Care Facility. A provisional license shall be effective from the date the Office of Long-Term Care provides notice to the Applicant and new operator, until the date the long-term care license is issued. With the exception of Medicaid or Medicare provider status, a provisional license confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
A provisional license holder may operate the facility under a new name, whether fictitious or otherwise. For purposes of this section, the term new name means a name that is different than the name under which the facility was operated by the prior owner, and the term "operate" means that the provisional license holder may hold the facility out to the public using the new name. Examples include, but are not limited to, signage, letterhead, brochures or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the facility under a new name, the facility shall utilize the prior name in all communications with the Office of Long Term Care until such time as the license is issued. Such communications include, but are not limited to, incident reports, notices, Plans of Correction, and MDS submissions. Upon the issuance of the license, the facility shall utilize the new name in all communications with the Office of Long Term Care.
Each Level I assisted living facility must have an owner or governing body that has ultimate authority for:
Each person or legal entity issued a license to operate a Level I assisted living facility shall provide continuous twenty-four (24)-hour supervision and services that:
A Level I assisted living facility shall not admit, or continue to provide care to, individuals whose needs are greater than the facility is licensed to provide. For any service required under these rules that is not provided directly by the facility, the facility must have a written contractual agreement or contract with an outside program, resource or service to furnish the necessary service.
The facility must develop, maintain, and make available for public inspection the following policies and procedures.
Failure to comply with the provisions of this subsection or violation of any policies or procedures developed pursuant to this subsection shall be a violation pursuant to Ark. Code Ann. § 20-10-205, and Ark. Code Ann. § 20-10-206, or may constitute a deficiency finding against the facility. 504.1.2 The facility shall meet all rules issued by the Arkansas Department of Health regarding communicable diseases. Further, the facility must prohibit employees with a communicable disease, or with infected skin lesions, from direct contact with residents or with residents' food, if direct contact will transmit the disease.
# Residents | Direct Care Staff Required Per Shift | ||
Day | Evening | Night | |
1-16 | 1 | 1 | 1 |
17-32 | 2 | 2 | 1 |
33-49 | 2 | 2 | 2 |
50-66 | 3 | 2 | 2 |
67-83 | 4 | 2 | 2 |
84-above | 5 | 3 | 2 |
The facility shall:
Each facility must provide for the safekeeping and accountability of resident funds in accordance with this Section and Section 603.1(3)(N). A facility may not require the resident to deposit funds with the facility.
The Assisted Living Facility shall develop and maintain a quality assessment unit. The unit shall meet at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary, and to develop and implement appropriate plans of action to correct identified quality deficiencies
The quality assessment unit shall consist of the individual or individuals identified by the facility as having the ability to recognize and identify issues of quality deficiencies and to implement changes to facility and employee practices designed to eliminate identified issues of quality deficiencies.
Good faith attempts by the unit to identify and correct quality deficiencies will not be used as a basis for sanctions.
Pursuant to Ark. Code Ann. § 5-28-101, 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 rules and by law, including:
* alleged or suspected abuse or neglect of residents;
* exploitation of residents or any misappropriation of resident property.
A facility is not required under this rule to report death by natural causes. However, nothing in this rule negates, waives, or alters the reporting requirements of a facility under other rules or statutes.
Facility policies and procedures regarding reporting, as addressed in these rules, must be included in orientation training for all new personnel/staff/employees and must be addressed at least annually during inservice training for all facility staff.
The following events shall be reported to the Office of Long Term Care by facsimile transmission to telephone number 501-682-8540 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 507.5. Forms DMS-731 and DMS-742 are found in the Appendix.
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 507.3, 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 administrator or designee within five (5) days after discovery.
Reports of incidents specified in Section 507.2 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 administrator 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 resident abuse, exploitation, neglect, or misappropriations of resident 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 administrator 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.
The facility's written policies and procedures shall include, at a minimum, requirements specified in this section.
Ark. Code Ann. § 20-10-1005 provides for involuntary and voluntary discharges. These rules are supplemental to the statute and if in conflict, the statute governs.
The Level I assisted living facility shall not admit any resident whose needs are greater than the facility is licensed to provide. The Level I assisted living facility shall not provide services to residents who:
Each applicant shall receive an initial evaluation completed by the facility prior to admission to determine whether the resident's needs can be met by the assisted living facility, and the resident's needs are not greater than the facility is licensed to provide.
Prior to or on the day of admission, the assisted living facility and the resident or his or her responsible party shall enter into an occupancy admission agreement. For admissions due to emergency circumstances, an individual shall enter into the assisted living facility as a provisional placement with an occupancy admission agreement between the assisted living facility and the individual or his or her responsible party in place within thirty (30) calendar days of admission if it is determined the individual is appropriate for admission into the assisted living facility. The agreement shall be in writing and shall be signed by both parties. Each resident or his or her responsible party, prior to the execution of the occupancy admission agreement, shall have an opportunity to read the agreement. In the event that a resident or his or her responsible party is unable to read the agreement, necessary steps shall be taken to ensure communication of its contents to the resident or his or her responsible party. The resident or his or her responsible party shall be given a signed copy of the agreement, and a copy signed by the resident or his or her responsible party, and assisted living facility shall be retained in the resident's record. The occupancy admission agreement shall include, at a minimum, the following:
Health care services identified as needed by the resident or his or her responsible party that are being received through a licensed home health agency. A copy of the home health agency's plan shall be filed in the resident's record;
All fees that a resident will be billed (basic core and other fees) shall be disclosed in writing to the resident and made a part of the occupancy admission agreement prior to the receipt of the services. If no prior agreement is obtained, the services may not be billed to the resident or the resident's responsible party.
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall be permitted to remain in an assisted living facility if the resident's condition requires twenty-four (24) hour nursing care or other services that an assisted living facility is not authorized by law to provide. Further, this prohibition applies even if the resident is willing to execute an agreement relieving the facility of responsibility attendant to the resident's continued placement. Subject to the foregoing restriction, an assisted living facility may retain a resident who becomes incompetent or incapable of recognizing danger, summoning assistance, expressing need or making care decisions provided that the facility ensures all of the following:
Except in cases of provisional placements, in the event of the involuntary transfer or discharge of a resident, the assisted living facility shall:
Pursuant to Act 1230 of 2001, Section 4 (c), no resident shall be permitted to remain in an assisted living facility if the resident's condition requires twenty-four (24) hour nursing care or other services that an assisted living facility is not authorized by law to provide. See also Section 601.1. Further, this prohibition applies even if the resident is willing to execute an agreement relieving the facility of responsibility attendant to the resident's continued placement. Subject to the foregoing, supplemental services may be provided as an alternative to termination. In no event shall an assisted living facility terminate an occupancy admission agreement if the resident or his or her responsible party arranges for the needed services and any unmet needs. Supplemental services may be provided by the resident's family, facility staff or private duty staff as agreed to between the resident and the facility. The occupancy admission agreement shall not be terminated except under one of the following conditions:
An assisted living facility shall provide, make available, coordinate, or contract for services that meet the care needs identified in the services plan portion of residents' occupancy admission agreements, to meet unscheduled care needs of residents, and to make emergency assistance available 24 hours a day, all in a manner that does not pose an undue hardship on residents. An assisted living facility shall respond to changes in residents' needs for services by revising the services plan portion of residents' occupancy admission agreements and, if necessary, by adjusting its staffing plan or contracting for services from other providers. If non-residents utilize services of the assisted living facility, it must occur in a manner that does not unduly disturb residents or deprive residents of timely access to services.
Services are provided according to the services plan portion of residents' occupancy admission agreements, and may include, but are not limited to, homemaker, attendant care, and medication oversight to the extent permitted under State law. Services include 24-hour response staff to meet residents' needs in a way that promotes maximum dignity and independence and provides supervision, safety and security. Other individuals or agencies may furnish care directly or under arrangements with the assisted living facility. Such care shall be supplemental to the services provided by the assisted living facility and does not supplant, nor may be substituted for, the requirements of service provisions by the facility.
Services are furnished to a person who resides in his or her own apartment or unit that may include dually occupied units when both occupants consent to the arrangement. Each apartment or unit shall be of adequate size and configuration to permit residents to perform, with or without assistance, all the functions necessary for independent living, including sleeping; sitting; dressing; personal hygiene; storing, preparing, serving and eating food; storage of clothing and other personal possessions; doing personal correspondence and paperwork and entertaining visitors. Care provision and service delivery must be resident-driven to the maximum extent possible and treat each person with dignity and respect. Care must be furnished in a way that fosters the independence of each resident.
Occasional or intermittent guidance, direction or monitoring, or assistance with activities of daily living and social activities and transportation or travel, as defined in these rules, for residents to keep appointments for medical, dental, social, political or other services or activities shall be made available to residents.
The resident may be assisted in making arrangements to secure community based health or other professional services, examinations and reports needed to maintain or document the maintenance of the resident's health, safety and welfare.
Direct care services directly help a resident with certain activities of daily living such as assistance with mobility and transfers; hands-on or cuing assistance to a resident to eat meals or food, grooming, shaving, trimming or shaping fingernails and toenails, bathing, dressing, personal hygiene, bladder and bowel requirements, including incontinence; and assistance with medication only to the extent permitted by the state Nurse Practice Act and interpretations thereto by the Arkansas State Board of Nursing. The assisted living facility shall ensure the resident receives direct care services in accordance with the services plan portion of the occupancy admission agreement. Direct care services needs of all residents in the facility shall be reviewed at least annually, and the services plan portion of the occupancy admission agreement revised, if necessary. Revision of the services plan portion of the occupancy admission agreement shall be revised within fourteen (14) days upon any significant enduring change to the resident.
The assisted living facility shall ensure that the resident receives health care services under the direction of a licensed home health agency when services are needed on a short-term basis. A copy of the home health agency's plan shall be filed in the resident's record.
After the initial assessment, facilities shall perform reassessments as needed, including upon changes of conditions of residents, and shall perform the steps outlined in subsections (a) through (c), above. Failure to assess or reassess, or to identify residents 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 residents at risk of harm from medications in unsecured locations or rooms, shall constitute a deficient facility practice.
Scheduled II, III, IV and V drugs that are stored for residents by the facility that are no longer needed by the resident must be delivered in person or by registered mail to: Drug Control Division, Arkansas Department of Health, along with the Arkansas Department of Health's Form (PHA-DC-1) Report of Drugs surrendered for Disposition According to Law. When unused portions of controlled drugs go with a resident who leaves the facility, the person who assumes responsibility for the resident and the person in charge of the medications stored for residents by 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 resident is discharged, transferred or visits home.
All other medications not taken out of the facility when the resident leaves the facility shall be destroyed or returned in accordance with law and applicable rules.
All such medications shall be destroyed or returned in accordance with law and applicable rules.
Medications that are stored by the facility for residents may be cycle filled. Only oral solid medications may be cycle-filled. Provided, however, that if an oral solid medication meets one of the categories below, then that oral solid medication may not be cycle-filled.
An assisted living facility shall notify the pharmacy in writing of any change of condition or circumstance that affects the medication status of a resident. For purposes of this section, change of condition or circumstance includes death, discharge or transfer of a resident, change of pharmacy, as well as medical changes of condition or circumstance that necessitate a change to the medication prescribed or the dosage given. The notification shall be made within twenty-four (24) hours of the change of condition or circumstance. If the notification would occur after 4:30 p.m. Monday through Friday, or would occur on a weekend or holiday, the facility shall notify the pharmacy by no later than 11:00 a.m. the next business day. Documentation for drugs ordered, changed or discontinued shall be retained by the facility for a period of no less than fifteen (15) months.
When a resident is transferred or enters a hospital, the assisted living facility shall hold all medications that the facility stores for the resident until the return of the resident unless otherwise directed by the authorized prescriber. All continued or re-ordered medications will be placed in active medication cycles upon the return of the resident. If the resident does not return to the assisted living facility, any medications held by the assisted living facility shall be placed with other medications or drugs for destruction as described in Section 702.1.2.11 or returned as permitted by State Board of Pharmacy rules.
Facility staff may perform emergency or first-aid procedures as specified below:
If the needs assessment or evaluation completed on the resident indicates he/she has general service needs, a services plan shall be developed and shall become a part of the resident's occupancy admission agreement. If the needs assessment or evaluation indicates the resident has health care service needs, the resident is not appropriate for Level I assisted living unless the health needs can be met by a licensed home health agency. A copy of the home health agency's plan shall be filed in the resident's record.
All ancillary services (both core services [Section 601.3(a)] and any other ancillary services identified as wanted by the resident or his or her responsible party to be provided by the facility at additional cost to the resident or his or her responsible party [Section 700.1.3, Section 700.2.3 and Section 700.3.3]) that are identified in the resident's needs assessment or evaluation shall be included in an ancillary services plan that shall become a part of the resident's occupancy admission agreement.
A Level I assisted living facility shall not admit any resident whose needs are greater than the facility is licensed to provide. The Level I assisted living facility shall not provide services to residents who:
The choice and independence of action of a resident may need to be limited when a resident's individual choice, preference, or actions, are identified as placing the resident or others at risk, lead to adverse outcomes, or violate the norms of the facility or program or the majority of the residents, or any combination of these events.
No resident shall be permitted to remain in a Level I assisted living facility if his or her condition requires twenty-four (24) hour nursing care or other services that an assisted living facility is not authorized by law or these rules to provide. This prohibition applies even if the resident is willing to execute an agreement relieving the facility of responsibility attendant to the resident's continued placement.
When the resident evaluation indicates that there is a high probability that a choice or action of the resident has resulted or will result in any of the outcomes of placing the resident or others at risk, leading to adverse outcomes, violating the norms of the facility or program or the majority of the residents, or any combination of the events, the assisted living facility shall:
Any compliance agreements negotiated, or attempted to be negotiated, with the resident or his or her responsible party shall address the following areas in writing:
A copy of the compliance agreement shall be provided to the resident or his or her responsible party, and the original shall be placed in the resident's record at the time it is implemented.
For the purposes of these rules the following terms are defined as follows:
For the purposes of these rules, Resident's Rights are those rights set forth in the Department's numbered memorandum LTC-M-89-03.
The ASCU shall develop and maintain a record-keeping system that includes a separate record for each resident, and that documents each resident's health care, individual support plan, assessments, social information, and protection of each resident's rights.
The ASCU must follow the facility's policies and procedures, and applicable state and federal laws and regulations governing:
In addition to the physical design standards required for the facility's license, an Alzheimer's Special Care Unit shall include the following:
The Alzheimer's Special Care Unit shall:
The Alzheimer's Special Care Unit shall develop policies and procedures to deal with residents who wander or may wander. The procedures shall include actions to be taken by the facility to:
Alzheimer's Special Care Units shall staff according to staffing requirements as set forth in the Rules for the Licensure of Level I Assisted Living Facilities. However, staffing for the ASCU shall be determined separately from the Assisted Living facility, based upon the census for the ASCU only; likewise, the staffing for the Assisted Living facility shall be based on the census of the Assisted Living facility, excluding the ASCU census. It is the intent of this rule that ASCU staff be separate and distinct from the Assisted Living facility staff. In addition, the following staffing requirements are established for Alzheimer's Special Care Units.
A social worker or other professional staff e.g., physician, Registered Nurse, or Psychologist currently licensed by the State of Arkansas shall be utilized to perform the following functions:
The individual providing the training shall have:
The ASCU shall create and maintain a training manual consisting of thee topics listed in Section 805(b). Further, the trainer shall provide training consistent with the training manual.
When a resident is moved, transferred or discharged, measures shall be taken by the facility to minimize confusion and stress to the resident until discharge. Further, the discharge shall comply with the rules applicable to the facility housing the ASCU, and Arkansas law.
Therapeutic activities can improve a resident's eating or sleeping patterns; lessen wandering, restlessness, or anxiety; improve socialization or cooperation; delay deterioration of skills; and improve behavior management. Therapeutic activities shall be designed to meet the resident's current needs.
The following activities shall be offered daily:
A new facility is one that had plans approved by the Office of Long Term Care and began operation, or construction or renovation of a building for the purpose of operating a Level I assisted living facility on or after the adoption date of these rules, or both. The rules and codes governing new facilities apply if and when the facility proposes to begin operation in a building not previously and continuously used as a facility licensed under these rules. For purposes of these rules, construction refers to a new facility where none existed or to the addition of new wings or other sections of the facility; renovation refers to any structural changes to the existing facility; remodeling refers to cosmetic changes to the existing structure, including but not limited to painting, replacement or repair of carpet, tile or linoleum, and minor repairs.
Additions to existing facilities, construction, or renovation shall meet the standards for new construction, and a copy of the facility floor plan must be submitted to the Office of Long Term Care for approval. Provided, however, that changes to the floor plan for areas of the facility unaffected by the addition, construction or renovation are not required.
All facilities licensed under these rules shall be designed and constructed to substantially comply with pertinent local and state laws, codes, ordinances and standards. All new construction shall be in accordance with the requirements for I-1 Groups as specified in the International Building Code (IBC) 2000. All new construction shall be readily accessible and useable by persons with physical disabilities including persons who use wheelchairs. All construction shall comply with the requirements of the ADA.
Plans shall be submitted to the OLTC in the following stages:
The following codes and standards are incorporated into and made a part of these rules:
The following are general provisions concerning furnishing and equipment that each Level I assisted living facility must meet:
If the resident or his or her responsible party wishes to use his or her own personal linens, the facility will counsel the resident or his or her responsible party on recommended quantities to maintain. In the case where a resident or his or her responsible party uses personal linens, the facility is not required to provide or keep available any linens for the resident unless the resident does not have sufficient numbers of personal linens available to maintain clean and sanitary conditions. If this is the case, the facility shall provide additional linens up to the quantities specified above. In both cases, clean linens may be stored in the resident's apartment.
NOTE: This does not prohibit residents from walking through a community based residential facility serving similar or compatible population, e.g., the elderly or the physically disabled. This does not prohibit independent living and assisted living to be in a combined building or prevent assisted living from occupying apartments scattered throughout a project that combines independent and assisted living. This does not require separation between an assisted living facility and housing for the elderly or other purely residential use. For example, assisted living facility apartments may be interspersed with non-assisted living apartments that are non-licensed, independent living apartments in the same building, and an assisted living facility may share dining room and other common space with an attached apartment building.
Each assisted living facility built after these rules become effective must meet the requirements adopted by local municipalities as based on National Fire Protection 101, Life Safety Code, 1985 or the 2000 edition of the International Building Code (IBC) and must be in compliance with the ADA. If the local municipality in which the facility is located has not adopted requirements based on the above standards, or if the Office of Long Term Care determines that the rules adopted by the local municipality are not adequate to protect residents, the facility must meet the provisions of the 2000 Edition of the International Building Code (IBC), including the National Fire Protection Association (NFPA) requirements referenced by the IBC.
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:
An adequate supply of water, under pressure, must be provided at all times. When a public water system is available, a connection must be made thereto. If water from a source other than a public water supply is used, the supply must meet the requirements set forth under rules of the State Board of Health.
All sewage must be disposed of by means of either:
Facilities must comply with all provisions of the state plumbing and gas code and amendments thereto prescribing minimum requirements for design, materials, appliances, workmanship, and methods of installation.
Electrical wiring, fixtures, appliances, motors, and other electrical equipment must be installed in accordance with the national electrical code National Fire Prevention Association's Pamphlet #70 and comply with local regulations and codes where they exist.
Each assisted living facility must be operated in areas permitted by local codes. Each owner must provide the Office of Long Term Care with documentation that the facility is in compliance with zoning requirements.
Conditions of soil, ground water level, drainage and topography must not create hazards to the property as to the health and safety of the occupants. The site shall not be subject to unpredictable and/or sudden flooding and shall be large enough to provide an exercise area for residents. Exercise area shall mean, at a minimum, accessible exterior space configured with walkways suitable for walking and benches for resting. The exterior space may be on the facility's property, on publicly accessible public or private property (e.g., park, shopping mall), or on an area made available to the residents by the facility through special arrangement with private property owners. Special arrangements must be through long-term agreements deemed sufficient by OLTC. Regardless of the arrangements, exercise areas must be accessible from the property during daylight hours by means of a safe and accessible walking route.
The following Rules 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. §2010-203 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 1009. The intent of a directed plan of correction is to achieve correction of identified deficiencies and compliance with applicable rules.
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 Level I assisted living facility that closes or ceases operation or surrenders or fails to timely renew its license must meet the rules 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 rule, 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.
When a long term care facility does not agree with deficiencies cited on a Statement of Deficiencies, the facility may request an IDR meeting of the deficiencies in lieu of, or in addition to, a formal appeal. The Informal Dispute Resolution (IDR) process is governed by Act 1108 of 2003, codified at Ark. Code Ann. § 20-10-1901et seq.
The request for an informal dispute resolution of deficiencies does not stay the requirement for submission of an acceptable plan of correction and allegation of compliance within the required time frame or the implementation of any remedy, and does not substitute for an appeal.
A written requestfor an informal dispute resolution must be made to the Arkansas Department of Health, Health Facility Services, 5800 West 10th, Suite 400, Little Rock, AR 72204 within ten calendar days of the receipt of the Statement of Deficiencies from the Office of Long Term Care. The request must:
The IDR is limited to deficiencies cited on a Statement of Deficiencies. Issues that may not be heard at an IDR include, but are not limited to:
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, et seq.
APPENDIX
FORMS
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES OFFICE OF LONG TERM CARE DMS-731
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.
ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES OFFICE OF LONG TERM CARE DMS-742
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 rules 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
"See Attached Is Not Acceptable!"
Please include Resident's current medical condition
Attach the following information to the back of this form. If you do not have one of the specified attachments, please provide an explanation why it can not be obtained or if it will be forwarded in the future.
016.25.19 Ark. Code R. 005