216-40-10 R.I. Code R. § 7.4

Current through June 12, 2024

Section 216-RICR-40-10-7.4 - Licensure Requirements

7.4.1General Requirements

A. These rules and regulations shall apply to all adult day care programs that provide services to the elderly who are in need of supportive care and supervision during the daytime.

B. A license issued to a new adult day care program, unless sooner suspended or revoked, shall expire by limitation on March 31^st of each odd-numbered year and may be renewed upon application to the Department.

C. No person, acting alone or jointly with any other person, shall establish, conduct or maintain an adult day care program in this state without a license in accordance with the requirements of R.I. Gen. Laws § 23-1-52, and in conformity with this Part.

D. No facility or program shall represent itself as an adult day care program or use the term "adult day care program" or any other similar term in its title, advertising, publication or other form of communication, unless licensed as an adult day care program in accordance with the provisions herein.

E. An application for a license shall be made to the Department, upon forms provided by the Department and shall contain such information as the Department reasonably requires.

F. Upon receipt of a completed application for a license, the Department may issue a license if the applicant meets the requirements of R.I. Gen. Laws § 23-1-52, and this Part.

G. A license issued hereunder shall be the property of the state and loaned to such licensee.

H. The license shall be posted in a conspicuous place on the premises.

I. Each license shall be issued only for the premises and person(s) named in the application and shall not be transferable or assignable except with the written approval of the Department.

J. Each program shall be responsible for complying with all local, state, and federal laws, codes, rules and regulations that apply to the program.

K. Each program shall be responsible for maintaining a policy of nondiscrimination in the provision of services to participants and in the employment of staff without regard to race, color, creed, national origin, sex, sexual orientation, age, handicapping condition or degree of handicap, in accordance with all applicable state and federal statutes and regulations.

7.4.2Responsibilities of the Governing Body/Program

A. Each adult day care program shall have an organized governing body or other legal authority, responsible for:

1. The management and control of the operation of the program;

2. The conformity of the program with:

a. All federal, state and local laws and regulations relating to fire, safety, sanitation, communicable and reportable diseases;

b. Other relevant health and safety requirements; and

c. With all of the requirements contained in this Part.

B. The program shall:

1. Maintain names and affiliations of members of the agency's governing body;

2. Describe structure of the agency's governing body;

3. Provide functional and staff organizational charts;

4. Maintain a copy of the organization's charter, constitution or by-laws, that include but are not limited to:

a. A definition of goals, purposes, objectives;

b. A statement of compliance with civil rights act and other federal, state, local laws safe guarding civil rights;

c. Appropriate standing committees;

d. A statement of asset disbursement in case of corporate liquidation;

e. Evidence of consumer involvement or input into program policies.

5. Provide documentation that the governing body does the following:

a. Provides for annual evaluation;

b. Oversees contracts, adopts and operates annual budget, maintains financial records, provides annual audit by an independent certified public accountant;

c. Adheres to accepted standards of accounting;

d. Employs a director and gives said person the authority to manage the daily affairs according to established personnel and corporate policies;

e. Meets at least quarterly and maintains minutes of proceedings.

C. The governing body shall review, approve, and revise a current, written plan of operation, including a service description for providing adult day care services to frail elderly persons. This description shall be reviewed at least annually, updated as needed, and made available to the Department, upon request.

D. The program shall demonstrate that it has the capacity to carry out this plan of operation and perform various operational functions needed to oversee and support the program, including the ability to:

1. Manage ongoing operations;

2. Coordinate across multiple sites, as applicable;

3. Maintain partnerships with entities and programs; and

4. Demonstrate an effective approach to program management.

E. The program shall present a clear and concise annual summary statement of activities and scope of service (e.g., an annual report).

F. The program shall develop written policies and procedures, consistent with Department regulations, for providing services to participants.

G. Written protocols shall be developed to specify exactly when the program will be cancelled due to weather conditions and other emergencies and the participants will be evacuated due to power outage and other emergencies. These protocols shall be easily accessible in the facility and in all program vehicles that transport participants and shall include at least the following:

1. Means by which participants and families are notified of cancellations and early closings.

2. Description of location to which participants will be moved in case of evacuation and letter of agreement if this location is not affiliated with the program.

H. An organization chart shall be developed to illustrate the lines of authority and communication channels, and shall be provided to all program staff.

I. The director shall have full authority and responsibility to plan, staff, direct, implement, and evaluate the program.

J. The director or designee shall be on site to provide the program's day-to-day management during hours of operation.

K. The program shall have a policy assuring that it follows all applicable federal and state requirements including, but not limited to:

1. Title V of the Civil Rights Act of 1964, 42 U.S.C. § 2000e;

2. Drug-Free Workplace Act of 1988, 41 U.S.C. § 81;

3. The Rhode Island Lobbying Reform Act (R.I. Gen. Laws Chapter 42-139.1).

L. Each program shall inform its staff and participants of the general content of the Department's regulations; and shall develop and implement written plans, policies and procedures to ensure compliance with the Department's regulations. These documents shall be reviewed by the program's governing body at least annually and revised as needed.

M. The program shall have at least the following written documents:

1. Plan for community education and involvement;

2. Statement of program philosophy and objectives;

3. Mission statement;

4. Contracts and agreements with other agencies and individuals.

N. The program shall have a policy and procedure manual that is written in a format that can be updated, as needed, and shall include date(s) of revision. Each policy shall be signed by the executive director. This manual shall include at least the following areas of program operation:

1. Mission and philosophy;

2. Organization structure;

3. Personnel, including staffing requirements and responsibilities;

4. Program description, including program evaluation;

5. Participant policies, including admission and discharge; and

6. Environmental issues.

O. Upon request, copies of all policies, procedures and statements adopted by the program pursuant to §7.4.2(N) of this Part shall be provided to participants, their representatives, and members of the general public.

7.4.3Program Evaluation

A. The program shall have a self-evaluation and continuous improvement system. This self-evaluation shall include a statement of the program's goals and objectives and shall be conducted at least annually.

B. The self-evaluation system shall measure the program's success in achieving the stated goals and objectives and shall review the effectiveness of the program's policies and procedures.

C. Goals, objectives, policies and procedures shall be revised as needed based on the results of the self-evaluation.

D. All revised goals, objectives, policies and procedures shall be made available to the program's employees, interns, trainees and volunteers.

E. The self-evaluation and any changes that result from it shall be documented.

7.4.4Personnel Requirements

A. The program shall maintain written personnel policies and procedures that shall include, but not be limited to, the following topics:

1. Hiring, training, and supervising all paid and unpaid personnel;

2. Use of outside service providers;

3. Use of volunteers;

4. Notification of employees, consultants, interns, trainees, and volunteers of their responsibilities, rights, benefits, and conditions of employment;

5. Written job descriptions:

a. Each staff member shall receive a copy of his/her job description that shall include: educational and work qualifications; major job duties; numbers and titles of persons supervised; and title of the supervisor for the position;

b. Supervision and job performance;

c. Required education and training;

d. Records, including maintenance of records;

e. Current salary/wage schedules;

f. Fringe benefits and any conditions attached to the benefits;

g. Disciplinary procedures and grounds for dismissal; and

h. Equal opportunity plan that shall include a statement guaranteeing that hiring and promotion shall be free from unlawful discrimination on the basis of race, color, creed, national origin, sex, sexual orientation, age, physical or mental handicap, or degree of handicap.

B. Each program shall have a written plan for no less than ten (10) hours of staff training and development. Training shall include at least the following:

1. Orientation for all staff at the start of employment. This initial training shall include orientation to the program's policies, procedures, rules, and regulations;

2. Current first aid training, including cardiopulmonary resuscitation (CPR) and Heimlich Maneuver, for direct program staff (including drivers). Evidence of current first aid training shall be maintained on file and shall be available to the Department upon request.

3. Universal precautions and latex safety;

4. Participants' rights, with a focus on dignity, choice, diversity, and cultural sensitivity;

5. Reporting abuse, mistreatment, and neglect;

6. Fire safety;

7. Safe patient handling and body mechanics;

8. Developing, implementing, and evaluating individual plans of care, as applicable;

9. Specialized services offered by the program;

10. Identifying participants who abuse alcohol and/or other substances, suffer from depression, or are victims of elder abuse or self-neglect;

11. Services available to participants from community programs or agencies;

12. Medications prescribed for participants, the benefits of the medications, common side effects and risks, and the laws governing administration of prescribed medications; and

13. Confidentiality of participant information and records. Each employee, consultant, intern, trainee and volunteer shall sign a statement agreeing to abide by the rules and regulations governing participant confidentiality. This signed statement shall be included in the individual's personnel record.

C. Alzheimer Dementia or Other Dementia Special Care Services: The executive director, or his/her designee, shall ensure that all new employees who assist participants with personal care at the Alzheimer Dementia or Other Dementia Special Care Services level of care receive at least twelve (12) hours of orientation and training in the areas listed below within thirty (30) days of hire and prior to beginning work alone in the adult day care program, in addition to the areas stipulated in §7.4.4(B) of this Part. Such areas shall include, but not be limited to:

1. Understanding various dementias;

2. Communicating effectively with persons with dementia;

3. Managing behaviors.

D. Training shall be completed within thirty (30) days of hire and prior to working without direct supervision.

E. All staff shall receive no less than (10) ten hours of training annually, and as needed, in the topics stipulated in §7.4.4(B) of this Part.

F. The program director or his/her designee shall evaluate the performance of each employee at the end of his/her probationary period and at least annually thereafter. The governing body or designee shall evaluate the program director. Performance evaluations shall be in writing, and a copy shall be filed in the individual's personnel record. The individual shall be notified, in writing, of the evaluation results.

G. The program shall maintain confidential personnel records for each employee including time sheets or other records showing all dates and hours worked by each employee and holidays, sick leave, vacation, and unpaid leave taken. Each individual shall have access to his/her personnel record. Each record shall contain at least the following:

1. A complete job application; and when appropriate, a resume.

2. References, which may be documented verbal references or letters of reference.

3. For every individual within the program who is licensed, certified or registered by the state of Rhode Island, a mechanism shall be in place to verify currency of licensure electronically via the Department's licensure database.

4. Documentation of any participation in job related training, while employed by the program, including the date(s) of training, the provider, the topic, and proof of attendance and completion.

5. Performance evaluations.

6. Statement signed by the individual agreeing to abide by the rules and regulations regarding the confidentiality of participant information and records.

7. The program shall have an adequate number of qualified staff to meet the needs of its participants.

8. The program shall comply with local, state, and federal laws governing hours and conditions of employment and wages.

9. The program shall assign a staff member to oversee the development, implementation, and periodic review of each participant's individual plan of care; and to monitor and evaluate the participant's progress in achieving his/her treatment goals and objectives.

10. The program shall have a written agreement with any agency, program, or other service provider that provides essential services not provided directly by and otherwise the responsibility of the program. This written agreement shall be updated annually. The nature and extent of the services provided shall be documented.

11. Programs that use volunteers shall have a screening procedure to select volunteers with appropriate skills to work with the participants. The nature and extent of volunteer services shall be documented.

H. Staffing Requirements

1. The program shall employ a nurse who shall be on site daily for a minimum of six (6) hours.

2. The program shall designate one full-time staff member as the program director. The program director shall designate a staff member to act in his/her absence.

3. Each program shall employ at least one (1) nursing assistant licensed by the Department.

4. Aides shall be nursing assistants licensed by the Department, or shall be employees who have completed the employee orientation program set forth in §7.4.4(B) of this Part, prior to providing direct care to participants.

5. Aides shall be responsible for assisting professional program staff members as required in implementing services and meeting the needs of individual participants.

6. The program shall identify a staff person responsible for the functions of an activities director who shall be on site daily for a minimum of four (4) hours. The activities director shall have the ability to develop and implement therapeutic activities for specific participants and for groups.

7. Programs whose daily enrollment is twenty-four (24) or more participants shall provide case management services on-site or shall make them available for a minimum of twenty (20) hours each week.

8. The program shall have at least one (1) staff member trained in first aid, including cardiopulmonary resuscitation (CPR) and the Heimlich maneuver on site during all operating hours.

I. Health Screening

1. Upon hire and prior to delivering services, employment health screenings shall be required for each individual who has or may have direct contact with a program participant. Such health screening shall be conducted in accordance with the rules and regulations pertaining to Immunization, Testing, and Health Screening for Health Care Workers (Part 20-15-7 of this Title) promulgated by the Department.

J. Criminal Background Checks

1. Criminal record review requirements are pursuant to R.I. Gen. Laws § 23-17-34.

2. If an applicant has undergone a criminal records check within eighteen (18) months of an application for employment, an employer may request from the BCI a letter indicating if any disqualifying information was discovered. The BCI will respond without disclosing the nature of the disqualifying information. This letter must be maintained on file to satisfy the requirements of this section.

7.4.5Inspections

A. The Department shall make or cause to be made such inspections and investigations, as it deems necessary by duly authorized agents of the Director at such time and frequencies as determined by the Department.

B. A duly authorized representative of the Director shall have the right to enter at any time without prior notice, to inspect the premises and services for which an application has been received, or for which a license has been issued.

C. Refusal to permit inspection or investigation shall constitute a valid ground for suspension or revocation of license or curtailment of activities.

D. Each program shall be given notice by the Department of its level of compliance with this Part, including a list of all deficiencies reported as a result of an inspection or investigation.

7.4.6Denial, Suspension or Revocation of License or Curtailment of Activities

A. The Department is authorized to deny, suspend or revoke the license or curtail activities of any adult day care program which:

1. Has failed to comply with the rules and regulations of this Part;

2. Has offered or provided services to participants outside of the scope of its license;

3. Has failed to correct deficiencies or complete corrective action plan; or

4. Has failed to comply with the provisions of R.I. Gen. Laws § 23-1-52.

B. Reports of deficiencies shall be maintained on file in the Department and shall be considered by the Department in rendering determinations to deny, suspend or revoke the license or to curtail activities of the adult day program.

C. Noncompliance with this Part may constitute grounds to revoke, suspend, curtail the activities of, deny an application for licensure, or otherwise discipline the licensee by the Director.

7.4.7Deficiencies and Plans of Correction

A. The Department shall notify the governing body or other legal authority of a program of violations of these regulations through a notice of deficiencies which shall be forwarded to the program within fifteen (15) days of inspection of the program unless the Director determines that immediate action is necessary to protect the health, welfare, or safety of the public or any member thereof through the issuance of an immediate compliance order in accordance with R.I. Gen. Laws § 23-1-52.

B. A program which received a notice of deficiencies shall submit a plan of correction to the Department within fifteen (15) days of the date of the notice of deficiencies.

C. The Department shall approve or reject the plan of correction submitted by a program in accordance with §7.4.7(B) of this Part within fifteen (15) days of receipt of the plan of correction.

D. If the Department rejects the plan of correction, or if the program does not provide a plan of correction within the fifteen (15) day period stipulated in §7.4.7(B) of this Part, or if a program whose plan of correction has been approved by the Department fails to execute its plan within a reasonable time, the Department may invoke the sanctions enumerated in §7.4.6 of this Part.

7.4.8Change of Ownership, Operation and/or Location

A. When a change of ownership or operation or location of an adult day program is planned or when discontinuation of services is contemplated, the Department shall be given written notice of pending changes within forty-five (45) days of such pending changes.

B. A license shall immediately expire and become void and shall be returned to the Department when operation of an adult day program is discontinued or when any changes in ownership occur.

C. Prior to operating under a new owner or operator, the prospective licensee shall apply for a new license in accordance with §7.4.1 of this Part.

D. When there is a change in ownership or in the operation or control of the program, the Department reserves the right to extend the expiration date of such license, allowing the program or program to operate under the same license which applied to the prior licensee for such time as shall be required for the processing of a new application or reassignment of participants, not to exceed six (6) weeks.

216 R.I. Code R. § 216-RICR-40-10-7.4