16 Del. Admin. Code § 3360-9.0

Current through Register Vol. 28, No. 3, September 1, 2024

Section 3360-9.0 - Support Services

9.1 Aide/Assistant/Technician as defined at Section 2.0 or licensed nurses shall provide supervision and assistance in activities of daily living, such as feeding and toileting, to participants who require those services. Facilities that have been in operation before the adoption of these regulations shall comply with this requirement within 12 months of the adoption date of the regulations.

9.2 Rehabilitation services, including occupational therapy, physical therapy, and speech therapy, if provided, shall be ordered by the participant's physician and be performed by qualified therapists or therapy aides under supervision of a qualified therapist.

9.3 Medication Management

9.3.1 Medication shall not be administered to a participant unless prescribed by a licensed practitioner with independent prescriptive authority as provided by Delaware Code.

9.3.2 All adult day care programs shall have an up-to-date drug reference manual/compendium which lists drug actions, interactions, and side effects.

9.3.3 All medication administered to participants shall be ordered in writing, dated and signed by the attending physician. All prescription medications shall be properly labeled in accordance with DE Code, Title 24, Chapter 25, Subchapter III, § 2536. The label shall contain the following information:

9.3.3.1 The prescription number;

9.3.3.2 The date such drugs were originally dispensed to the participant;

9.3.3.3 The participant's full name;

9.3.3.4 The brand or established name and strength of the drug to the extent that it can be measured;

9.3.3.5 The physician's directions as found on the prescription;

9.3.3.6 The physician's name;

9.3.3.7 The name and address of the dispensing pharmacy or physician.

9.3.4 Medications may be self-administered or administered in accordance with all State and Federal laws, including the State of Delaware Nurse Practice Act. Those participants who, upon admission, are incapable of self-administration or who become incapable of self-administration shall have their medications administered according to the Nurse Practice Act.

9.3.5 The adult day care facility shall maintain a record of all medication provided to a participant indicating time of day, type of medication, dose, route of self-administrationdministration, by whom given and any reactions noted.

9.3.6 Medication Storage

9.3.6.1 If medications are administered on site, provisions for the locked storage of medications shall be provided. The key to the medication storage must be in the possession of or accessible only to authorized licensed personnel responsible for the distribution for self-administrationdministration of medications.

9.3.6.2 Prescription medication not requiring refrigeration shall be kept in the original container stored in a locked cabinet or drawer, and clearly labeled for the specific participant. These medications shall be stored within the U.S.P. recommended temperature range of 59° - 86°F unless the manufacturer's labeling states otherwise.

9.3.6.2 Prescription medication requiring refrigeration shall be stored in a separate and secured locked container within the refrigerator. The temperature must be maintained within the U.S.P. recommended range of 36º - 46ºF.

9.3.6.3 For the safety and welfare of all participants, medication to be self-administered shall be stored as noted and distributed to the participant as requested.]

9.3.6.4 Schedule II substances/prescriptions shall be kept in separately locked, securely fixed boxes (approved under Delaware law and standards) or drawers in the secure locked medication cabinet. Medication cabinets utilized will have a 2-lock system.

9.3.6.4.1 Schedule II substances shall be handled in the manner outlined by the State and Federal laws and regulations.

9.3.6.4.2 Schedule II substances brought to the facility by the participant/family on a daily basis shall be counted with the participant/family when received in the facility and shall be counted with the participant/family before removed from the facility.

9.3.6.4.3 Schedule II substances brought to the facility and remaining in the facility shall be counted with the participant/family when received in the facility and the empty container shall be returned to the participant/family for disposition.]

9.3.6.4.4 All unused Schedule II substances shall be returned to the participant or representative for disposition.

9.3.6.4.5 The adult day care facility must develop policies to prevent possible diversion of controlled substances.

9.3.6.5 Internal medications shall be stored separately from external medications.

9.3.7 The adult day care facility shall ensure that prescription medication is not used by other than the participant for whom the medication was prescribed.

9.3.8 The adult day care facility shall develop policies to permit those participants who are able to self-administer medication to keep and use such over-the-counter products as cough drops, lip balm and skin moisturizer.

9.3.9 The center may maintain a supply of over-the-counter medications, such as antacids and aspirin. However, over-the-counter medications shall only be administered upon the order of the participant's physician.

9.3.10 Used needles and syringes shall not be recapped, but placed immediately after use into an approved and secured Sharps container and disposed of properly.

9.4 Transportation Services

9.4.1 When transportation services are provided directly or under contract by the adult day care facility:

9.4.1.1 The vehicle shall be accessible and appropriate to the participants using it, considering any physical disabilities and impairments.

9.4.1.2 Every participant shall have a seat in the vehicle, except those participants who remain in their wheelchairs.

9.4.1.3 Wheelchairs shall be secured when the vehicle is in motion.

9.4.1.4 Each participant shall be seated while the vehicle is in motion.

9.4.1.5 Vehicles shall have adequate seat belt and securement devices for ambulatory and wheelchair bound passengers.

9.4.1.6 Participants shall not be left unsupervised (must always be within eyesight of the driverttendant) while in a vehicle.

9.4.1.7 Assistance by a driver or attendant shall be provided from the ground floor of the passenger's residence to the ground floor of the day care facility.

9.4.1.8 The driver shall have a valid and appropriate Delaware driver's license. The driver shall meet any state requirements for licensure or certification for the vehicle operated.

9.4.1.9 Each vehicle shall have a first aid kit, along with fire extinguisher and safety triangles.

9.4.1.10 The driver or attendant shall be trained in first aid procedures which include but are not necessarily limited to the following:

9.4.1.10.1 Cardiopulmonary Resuscitation (CPR);

9.4.1.10.2 Care during a seizure;

9.4.1.10.3 Care of minor scrapes and abrasions; and,

9.4.1.10.4 Summoning help in the event of an emergency.

9.4.1.11 The driver or attendant shall have medical and emergency information in the vehicle for participants being transported.

9.4.1.12 All transportation vehicles shall be equipped with a device for two-way communication.

9.5 Nutrition and Food Services

9.5.1 Kitchen and Food Storage Areas

9.5.1.1 If meals are prepared by the adult day care facility the State of Delaware Food Code shall apply.

9.5.2 The adult day care facility shall assure the availability of meals and supplemental snacks in accordance with each participant's individual plan of care.

9.5.3 The adult day care facility shall provide or make arrangements for a minimum of one meal daily which is of suitable quality and quantity for participants who are in the center for four (4) or more hours. The meal shall meet at least one-third (1/3) of an adult's current recommended dietary allowance (RDA) of the Food and Nutrition Board, National Academy of Sciences-National Research Council.

9.5.4 A morning snack shall be offered daily to participants. Those participants remaining in the facility for more than three (3) hours after completion of lunch shall be offered a mid-afternoon snack. Facilities open in the evening shall serve an evening meal. Evening meals shall be served approximately four (4) hours after completion of lunch, but no later than seven (7) p.m. Beverages shall be available to participants at all times and shall be offered periodically to promote good hydration. Snacks shall have nutritional value.

9.5.5 Food shall be stored, prepared, served, or any combination of these on site in accordance with the State of Delaware Food Code.

9.5.6 Food that is prepared for the adult day facility at an alternate site shall be prepared in a facility which is in compliance with the State of Delaware Food Code and has been issued a permit.

9.5.7 Menus shall be planned and written for a minimum of a two-week cycle, if meals are prepared on-site, and approved by a dietitian.

9.5.8 The menu shall be dated for the week of service and posted in a prominent area for the availability to the participant and representative, if any.

9.5.9 A therapeutic diet shall be provided for a participant when prescribed in writing by a physician. Therapeutic diet menus shall be prepared by a dietitian.

9.5.10 A dietitian shall be available for consultation with staff on basic and special nutritional needs and proper food handling techniques and shall provide in-service training to staff on these topics at least annually.

9.5.11 Appropriate food containers and utensils shall be available as needed for use by disabled participants.

9.5.12 Equipment for adequate refrigeration to maintain foods at 40°F and for the heating of foods shall be provided if needed to assist in the provision of meals and snacks.

9.5.13 Drinking water shall be easily accessible to the participants and provided by either an angle jet drinking fountain with mouth guard or by a running water supply with individual service drinking cups.

9.6 Nursing Services

9.6.1 Nursing services may be provided by the adult day care facility in accordance with the Delaware Nurse Practice Act and shall meet the needs of the participants.

16 Del. Admin. Code § 3360-9.0

25 DE Reg. 776( 2/1/2022) (Final)