6 Colo. Code Regs. § 1011-1 Chapter 07, pt. 11

Current through Register Vol. 47, No. 20, October 25, 2024

Part 11 - RESIDENT ADMISSION AND DISCHARGE

Move-In Criteria

11.1 The assisted living residence shall accept only those persons whose needs can be fully met by the existing staff, physical environment, and services already being provided. The assisted living residence's ability to meet resident needs shall be based upon a comprehensive pre-admission assessment of a resident's physical, mental, and social needs; cultural, religious and activity needs; preferences; and capacity for self-care.

Move-In Restrictions

11.2 An assisted living residence shall not allow to move in any person who:

(A) Needs regular 24-hour medical or nursing care;

(B) Is incapable of self-administration of medication and the assisted living residence does not have staff who are either licensed or qualified under 6 CCR 1011-1, Chapter 24 to administer medications;

(C) Has an acute physical illness which cannot be managed through medication or prescribed therapy;

(D) Has physical limitations that restrict mobility unless compensated for by available auxiliary aids or intermittent staff assistance;

(E) Has incontinence issues that cannot be managed by the resident or staff;

(F) Is profoundly disoriented to time, person, and place with safety concerns that require a secure environment and the assisted living residence does not provide a secure environment;

(G) Has a stage 3 or 4 pressure sore and does not meet the criteria in Part 12.4;

(H) Has a history of conduct that has been disclosed to the assisted living residence that would pose a danger to the resident or others, unless the ALR reasonably believes that the conduct can be managed through therapeutic approaches; or

(I) Needs restraints, as defined herein, of any kind except as statutorily allowed for assisted living residences which are certified to provide services specifically for the mentally ill.

(1) Assisted living residences certified to provide services for the mentally ill shall have policies, procedures, and appropriate staff training regarding the use of restraint and maintain current documentation to show that less restrictive measures were, and continue to be, unsuccessful.

Resident Agreement

11.3 At the time the resident moves in, the assisted living residence shall ensure that the resident and/or the resident's legal representative has received a copy of the written resident agreement and agreed to the terms set forth therein. The assisted living residence shall ensure that the agreement is signed and dated by both parties.

11.4 The terms of a resident agreement shall not alter, or be construed to relieve the assisted living residence of compliance with, any requirement or obligation under relevant federal, state, or local law and regulation.

11.5 The assisted living residence shall review its resident agreements annually and update or amend them as necessary. Amendments to the resident agreement shall also be signed and dated by both parties.

(A) When a change of ownership occurs, the new owner shall either acknowledge and agree to the terms of each existing resident agreement or establish a new agreement with each resident.

11.6 The written resident agreement shall specify the understanding between the parties concerning, at a minimum, the following items:

(A) Assisted living residence charges, refunds, and deposit policies;

(B) The general type of services and activities provided and not provided by the assisted living residence and those which the assisted living residence will assist the resident in obtaining;

(C) A list of specific assisted living residence services included for the agreed upon rates and charges, along with a list of all available optional services and the specified charge for each;

(D) The amount of any fee to hold a place for the resident in the assisted living residence while the resident is absent from the assisted living residence and the circumstances under which it will be charged;

(E) Responsibility for providing and maintaining bed linens, bath and hygiene supplies, room furnishings, communication devices, and auxiliary aids; and

(F) A guarantee that any security deposit will be fully reimbursed if the assisted living residence closes without giving resident(s) written notice at least thirty (30) calendar days before such closure,

(G) Reasons that the assisted living residence could pursue an involuntary discharge of the resident, as listed in Parts 11.11 and 11.12,

Written Disclosure of Information

11.7 The assisted living residence shall ensure that when a new resident moves in, he or she is provided with, and acknowledges receipt of, the following information:

(A) How to obtain access to the assisted living residence policies and procedures listed under Part 9.1;

(B) The resident's right to receive cardiopulmonary resuscitation (CPR) or have a written advance directive refusing CPR;

(C) Minimum staffing levels, whether the assisted living residence has awake staff 24 hours a day and the extent to which certified or licensed health care professionals are available on-site;

(D) Whether the assisted living residence has an automatic fire sprinkler system;

(E) Whether the assisted living residence uses egress alert devices, including details about when and where they are used;

(F) Whether the assisted living residence has resident location monitoring devices (such as video surveillance), when and where they are used, and how the assisted living residence determines that a resident requires monitoring;

(G) Whether the assisted living residence operates a secure environment and what that means;

(H) The resident's individualized care plan that addresses his or her functional capability and needs;

(I) Smoking prohibitions and/or designated areas for smoking;

(J) The readily available on-site location of the assisted living residence's most recent inspection report; and

(K) Upon request, a copy of the most recent version of these Chapter 7 rules.

Management of Resident Funds/Property

11.8 An assisted living residence shall not assume power of attorney or guardianship over a resident unless by court order, nor shall an assisted living residence require a resident to execute or assign a loan, advance, financial interest, mortgage, or other property in exchange for future services.

11.9 An assisted living residence shall not be required to handle resident funds or property.

11.10 An assisted living residence that chooses to handle resident funds or property, shall have a policy regarding the management of such funds and shall comply with the following criteria:

(A) There shall be a written authorization that specifies the terms and duration of the financial management services to be performed by the assisted living residence. Such authorization shall be signed by the resident or resident's legal representative and notarized;

(B) Upon entering into an agreement with a resident for financial management services, the assisted living residence shall exercise fiduciary responsibility for these funds and property, including, but not limited to, maintaining any funds over the amount of five hundred dollars ($500) in an interest-bearing account, separate from the general operating fund of the ALR, which interest shall accrue to the resident;

(C) The assisted living residence shall post a surety bond in an amount sufficient to protect the residents' personal funds;

(D) The assisted living residence shall maintain a continuous, dated record of all financial transactions. The record shall begin with the date of the first handling of the personal funds of the resident and shall be kept on file for at least three years following termination of the resident's stay in the assisted living residence. Such record shall be available for inspection by the Department; and

(E) The assisted living residence shall provide the resident or legal representative a receipt each time funds are disbursed along with a quarterly report identifying the beginning and ending account balance along with a description of each and every transaction since the last report.

Discharge

11.11 The assisted living residence shall arrange to discharge any resident who:

(A) Has an acute physical illness which cannot be managed through medication or prescribed therapy;

(B) Has physical limitations that restrict mobility, and which cannot be compensated for by available auxiliary aids or intermittent staff assistance;

(C) Has incontinence issues that cannot be managed by the resident or staff;

(D) Has a stage 3 or stage 4 pressure sore and does not meet the criteria in Part 12.4;

(E) Is profoundly disoriented to time, person, and place with safety concerns that require a secure environment, and the assisted living residence does not provide a secure environment;

(F) Exhibits conduct that poses a danger to self or others and the assisted living residence is unable to sufficiently address those issues through therapeutic approach; and/or

(G) Needs more services than can be routinely provided by the assisted living residence or an external service provider.

11.12 The assisted living residence may also discharge a resident for:

(A) Nonpayment of basic services in accordance with the resident agreement; or

(B) The resident's failure to comply with a valid, signed resident agreement.

11.13 Where a resident has demonstrated that he or she has become a danger to self or others, the assisted living residence shall promptly implement the following process pending discharge:

(A) Take all appropriate measures necessary to protect other residents;

(B) Reassess the resident to be discharged and revise his or her care plan to identify the resident's current needs and what services the assisted living residence will provide to meet those needs; and

(C) Ensure all staff are aware of any new directives placed in the care plan and are properly trained to provide supervision and actions consistent with the care plan.

11.14 The assisted living residence shall coordinate a voluntary or involuntary discharge with the resident, the resident's legal representative and/or the appropriate agency. Prior to discharging a resident because of increased care needs, the assisted living residence shall make documented efforts to meet those needs through other means.

11.15 In the event a resident is transferred to another health care entity for additional care, the assisted living residence shall arrange to evaluate the resident prior to re-admission or discharge the resident in accordance with the discharge procedures specified below.

11.16 The assisted living residence shall provide written notice of any discharge 30 calendar days in advance of discharge except in cases in which the resident requires a level of care that cannot be met by the residence or the resident has demonstrated that they are a danger to themselves or others, whereupon the assisted living residence shall provide written notification with as much advance notice as is reasonable under the circumstances prior to the removal from the residence. Such written notice shall be provided to:

(A) The resident,

(B) The resident's legal representative, and

(C) Any relative or other person the resident has designated to receive notice of a discharge, as listed on the resident's face sheet in accordance with Part 18.9(G).

11.17 Written notice of involuntary discharge must include the following:

(A) A detailed explanation of the reason or reasons for the discharge, including, at a minimum:

(1) Facts and evidence supporting each reason given by the residence, and

(2) A recounting of events leading to the involuntary discharge, including interactions with the resident over a period of time prior to the notice and actions taken to avoid discharge, specifying the timing of the events and actions.

(B) Statements conveying the following information:

(1) That the individual receiving the notice has the right to file a grievance with the residence challenging the involuntary discharge within 14 days of the written notice, regardless of whether the resident has already been removed from the assisted living residence,

(2) That if a grievance is filed, the assisted living residence must provide a response to the grievance within five business days, and

(3) If the resident or person filing the grievance is dissatisfied with the response, that the resident or person filing the grievance may appeal to the executive director of the Colorado Department of Public Health and Environment or their designee.

(C) Names and contact information, including phone numbers, physical addresses, and email addresses, for the state long-term care ombudsman, the designated local ombudsman, and the Colorado Department of Public Health and Environment.

(D) If the involuntary discharge is initiated due to a medical or physical condition resulting in a required level of care that cannot be treated with medication or services routinely provided by the residence's staff or an external service provider, the notice must also include an assessment by the resident's applicable health-care or behavioral health provider of the resident's current needs in relation to the resident's medical and physical condition.

11.18 A copy of any involuntary discharge notice shall be sent to the state long-term care ombudsman and the designated local ombudsman, within five (5) calendar days of the date that it is provided to the resident and the resident's legal representative.

6 CCR 1011-1 Chapter 07, pt. 11

46 CR 24, December 25, 2023, effective 11/15/2023, exp. 3/14/2024 (Emergency)

46 CR 24, December 25, 2023, effective 1/14/2024