(a) Admission Policies. - (i) The adult day care facility shall have written admission policies consistent with the program statement.
- (ii) The admission policies shall be discussed with each person entering the program, as well as with any family member, responsible party, guardian, or conservator who enrolls the participant. A copy of the admission policies shall be available upon request.
- (iii) Only those participants whose needs can be met by the facilitys program shall be admitted to the facility.
- (iv) All participants shall be eighteen (18) years of age or older.
(b) Assessment Policies. - (i) The facility staff shall be responsible for developing a written admission assessment of each participant based upon the information presented by the applicant, family members, friends or responsible party, guardian, or conservator and the report of any physical examination.
- (ii) The assessment shall be used to identify the participants strengths and needs to determine if and how the program can serve the participant.
- (iii) The assessment shall include at minimum a description of the participants:
- (A) Physical condition, including:
- (I) Ambulatory ability or limitations; and
- (II) Ability to perform activities of daily living, such as eating and toileting.
- (B) Social situation, including living arrangements and the availability of family, friends, and other people and organizations in the community to provide services to the participant; and
- (C) Mental status, including any intellectual impairment and known psychiatric or emotional problems; and
- (v) The initial written assessment shall be reviewed and updated on a scheduled basis, but at least every six months, or if there are changes in participants needs.
(c) Program Plan for Each Participant. - (i) Prior to admission, a beginning/preliminary program plan, based upon the assessment, shall be developed in writing for each participant. The plan shall be updated and completed within thirty (30) days of admission.
- (ii) The plan shall be designed to improve the functional capabilities of the participant when possible, or to prevent further deterioration. The plan shall include:
- (A) A description of the participants needs;
- (B) The participants activities and services;
- (C) Realistic program goals; and
- (D) The time by which the goals should be achieved.
- (iii) The written program plan and personal information shall be reviewed and updated on a scheduled basis as needed, but at least every six (6) months. The revised program plan shall be in writing.
- (iv) The revised plan shall conform to the requirements of the initial plan as specified in Section 11(c)(ii) of these rules and regulations.
(d) Agreement. - (i) There shall be a written agreement between the participant and the facility. The agreement shall be signed by the participant, his/her legal guardian and/or conservator, and the center facility representative.
- (ii) The agreement shall specify the services to be provided by the facility; conditions for dismissal or discharge; and financial arrangements.
- (iii) A copy of the agreement (or appropriate portion of the agreement) shall be given to the participant; and a copy shall be kept at the facility.
- (iv) The agreement shall be reviewed and updated whenever there is any change in the services or the financial arrangements.
- (v) There shall be given thirty (30) days prior written notice to any financial changes. A copy of notice shall be kept in each participants file.
(e) Personal Information for Each Participant. - (i) The following personal information shall be kept current for all participants, to be used for the initial and ongoing assessments and program plans, as well as in the event of an emergency:
- (A) Full names of participant, address, and telephone number; Medicaid number, if applicable; social security number; sex; date of birth;
- (B) Names, addresses, and telephone numbers of at least two family members, friends, or other designated people to be contacted in the event of illness or an emergency; and
- (C) Names, addresses, and telephone numbers of the participants personal physician, dentist, any clinics where the participant receives treatment, the name of the preferred hospital in the event of an emergency, and the LTC/HCBS case managers, if applicable.
- (ii) Individual records shall be kept for participants containing all information, reports, and documents required by these rules and regulations. These records will be written in ink, signed, and dated.
- (iii) Written records shall be kept of all accidents, injuries and illnesses occurring on the premises.
(f) Physical Examinations/Medical Information. - (i) Screening for tuberculosis and a physical examination by or under the direction of a licensed physician shall be obtained either within thirty (30) days prior to acceptance for admission or within thirty (30) days prior to admission.
- (ii) The report of the required physical examination shall include:
- (A) The date of the physical examination;
- (B) All diagnoses and/or significant medical problems;
- (C) Any special requirements and all recommendations for care including:
- (I) A list of medicines including dosages and time medicines are to be administered;
- (II) Any special diet or dietary restrictions;
- (III) Any allergies and/or any food intolerance;
- (IV) Any therapy the participant is undergoing or should receive; and
- (V) Any restrictions or limitations on physical activities or program participation.
- (D) A statement that the participant is or is not capable of administering his own medications without assistance;
- (E) A statement that the participant is or is not physically and mentally able to make an exit from the building in an emergency without the assistance of another person or without the use of a device such as, but not limited to, a wheelchair, walker or leg prosthesis.
- (F) A statement that the individual does not have tuberculosis in a communicable form, including the date of the test, type(s) of test(s) used and the results;
- (G) The signature of a licensed physician, the physicians designee or an official of a county health department; and
- (H) A statement that financial responsibility for conducting physical examinations and/or tests does not lie with the adult day care facility.
(g) Medical Reports After Admission. - (i) Any individual who comes in contact with a known case of tuberculosis or who develops chronic respiratory symptoms shall, within thirty (30) days after exposure/development, receive an evaluation in accordance with Section 9(c)(B) of these rules and regulations.
- (ii) When there are indications that the adult day care facility can no longer provide appropriate or safe care because of changes in the participants physical or mental health, a report of examination by a physician shall be obtained.
- (A) The written report of the physical examination shall be dated and signed by the physician.
- (B) The report of the physical examination shall be used in evaluating the participants continued suitability for adult day care.
- (iii) All medical reports shall be kept at the facility.
(h) Medication Management. - (i) Participants may keep and take their own medicine provided that:
- (A) Their physicians have deemed them capable of administering medicine to themselves by written authorization; and
- (B) The facility ensures that other participants do not have access to another participants medicine.
- (ii) If a physician has deemed a participant incapable of administering medicine to himself, the following rules apply:
- (A) The medicine shall be kept in a locked compartment or area;
- (B) The medicine shall be kept in a darkened area, free from dampness and high temperatures, and refrigerated, if required;
- (C) The area in which the medicine is administered or prepared for distribution shall have sufficient light so that the labels can be accurately read and the correct dosage can be clearly determined;
- (D) Each staff person who administers the medicine shall be authorized by the Wyoming Nurse Practice Act; and
- (E) A written record shall be kept of all medicine administered or distributed to the participants while at the adult day care facility. This record shall be retained at the facility for six (6) years and shall include:
- (II) Name of participant;
- (III) Name of medication or prescription number;
- (IV) Time medication is administered;
- (V) Name of person administering; and
- (VI) Any adverse or unusual reaction to the medicine.
(i) Health Care Supervision. - (i) Changes in a participants physical or mental health, behavior, attitude or other significant changes, shall be discussed with the participant, family, physician or clinic, LTC/HCBS case manager, or other responsible party, guardian, or conservator, as appropriate. A written notation in the participants record shall document the change and the person to whom it was reported.
- (ii) If a participant suffers an illness or accident requiring medical attention:
- (A) The facility shall ensure that the participant receives immediate access to medical attention;
- (B) The family or other responsible party, guardian, and the participants personal physician shall be notified immediately; and
- (C) The notification shall be documented in the participants record along with the details of the incident and action taken.
(j) Health Care Needs. - (i) If facility staff identify a need for health care services, this need shall be discussed with the participant, family members, or other responsible party, guardian, or conservator, as appropriate. The discussion shall be documented in the participants record and included in the update of the program plan.
(k) Participants. - (i) A participant who is acutely ill shall not enter the adult day care facility without written approval from a physician.
- (ii) If a participant becomes ill during the day:
- (A) He shall be separated from all other participants in care;
- (B) The responsible person shall be notified immediately in order that the participant may be returned home, if necessary; and
- (C) The ill participant shall be checked on at least every fifteen (15) minutes, or more frequently as necessitated by the condition, until leaving the facility.
(l) Discharge Policies. - (i) When the participants needs can no longer be met by the program of care, plans shall be made for the participants discharge.
- (ii) The participant shall be informed of and participate in discharge planning, unless clearly impossible.
- (iii) In the event that the facility initiates the discharge, the written plan of discharge shall outline the services needed by the participant upon discharge. The plan shall be discussed with the participant and family members or other persons responsible for participants care. Although primary responsibility for the location and delivery of these services falls upon the participant and family members, or other responsible people, adult day care staff shall assist when possible.
(m) Planning the Activities and Services. - (i) Activities and services shall be planned to support the program plan for the participants, and shall be consistent with the program statement and the admission policies.
- (ii) Activities and services shall be planned under the supervision of the director who shall encourage involvement of participants and staff in the planning.
- (iii) Schedule of Activities.
- (A) There shall be planned activities and programs whenever the facility is in operation.
- (B) A written schedule of activities shall be developed at least monthly.
- (C) The schedule shall include:
- (I) Group activities for all participants or small groups of participants;
- (II) Personalized options for participants with varying interests; and
- (III) The name or type, date and hour of the activity.
- (D) If an activity is substituted for another, the change shall be noted on the schedule.
- (E) The current months schedule of activities shall be posted in a conspicuous place or otherwise made available to participants.
- (F) The schedule of activities for the past six (6) months shall be kept at the facility.
- (G) If a participant requires an individual schedule of activities, that schedule shall be a part of the program plan and shall be kept in the participants record.
- (iv) The activities shall be varied to appeal to the different interests, abilities, and needs of the participants.
- (v) All activities shall:
- (A) Support the physical, social, mental, and emotional abilities and skills of participants;
- (B) Promote or maintain the participants highest level of independence or functioning; and
- (C) Be within the economic capabilities of the participants.
- (vi) Physical activities shall be encouraged to the extent recommended by each participants physician.
(n) Rights of Participants. - (i) The participant shall be encouraged and supported in maintaining his highest level of independence.
- (ii) The participant shall be encouraged to participate in planning for his care, when appropriate.
- (iii) The participant shall be accorded dignity and treated with courtesy and respect at all times.
- (iv) The participant shall not be required to perform services for the adult day care facility.
- (v) The privacy of participants shall be fully respected, including unrestricted communication and private use of the telephone.
- (vi) The participant shall not be abused, neglected, exploited, punished, coerced, or threatened in any way.
- (vii) The participant shall be protected from solicitation, harassment and unwanted visitors.
- (viii) The participant shall be allowed to participate in activities of social, religious, and community groups.
- (ix) Confidentiality of health and personal records will be maintained.
- (x) The participant shall be provided an opportunity to read the aforementioned rights. The rights shall be read to those participants who are unable to read. All attempts shall be made to answer questions a participant has regarding his rights.
- (xi) A signed and dated copy of the participants rights shall be kept in the participants record.
(o) Nutrition and Food Service. - (i) Meals and snacks shall be provided by the facility. Payment for such food services will be made to the adult day care facility in addition to the daily fee and at the standard rate outlined for home delivered meals.
- (ii) Serving of Meals and Snacks.
- (A) Facilities which open before 7:00 a.m. shall serve breakfast.
- (B) Facilities shall serve appropriate meals and snacks, depending on the hours of operation; i.e.,
- (I) A facility open during the hours of 7:00 a.m. to 1:00 p.m. must serve a morning snack and a midday meal;
- (II) A facility open during the hours of 8:00 a.m. to 5:00 p.m. must serve a morning snack, a midday meal, and an afternoon snack;
- (III) A facility open during the hours of 2:00 p.m. to 6:00 p.m. must serve an afternoon snack;
- (IV) A facility open after 6:00 p.m. to 9:00 p.m. must serve an evening meal; and
- (V) A facility open after 9:00 p.m. shall serve an evening snack.
- (iii) There shall be at least two (2) hours between snacks and meals.
- (iv) Each meal, including the morning meal, the midday meal, and the evening meal, shall provide at least one-fourth (¼) of an adults daily recommended dietary allowance (RDA); or any one meal and any one snack combined shall provide at least one-third ( ) of the RDA.
- (v) Meals and snacks served to the participants shall be attractive in appearance, consist of a variety of foods, and conform to the following meal patterns:
- (A) Minimum Amount
- (II) SNACKS (Select at least two of these four components)
Milk ½ cup
Juice* or fruit
or vegetable ½ cup
Bread or bread alternate**
(including cereal)
Meat, poultry, fish or seafood, or meat alternate*** 1 slice, ½ cup cooked, ¾ cup dry, or 1 oz.
- (III) MIDDAY AND EVENING MEALS
Meat, poultry, fish or seafood, or meat alternate*** 2 oz.
Vegetables and/or fruits (two or more) ½ cup each
Bread or bread alternate** 1 slice
NOTE: Other foods and additional servings may be served to enhance the meals or meet energy needs.
*Juice: Full strength juices made from fruits or vegetables or frozen concentrate according to directions for full strength Juice.
**Bread alternates: ½ cup rice, grits, or pasta; cereal; 4 crackers, etc.
***Meat alternates: 1 egg, 1 oz. cheese, ½ cup cooked dry beans or dry peas, or 2 tablespoons peanut butter.
- (B) At least one (1) source of Vitamin C must be served per day.
- (C) At least one (1) source of Vitamin A shall be served three times a week.
- (vi) Meals shall be planned in accordance with the needs of the age group in care (i.e., energy needs are less and nutritional needs are higher, special diets may be necessary, participants might have poorly fitting dentures, etc.).
- (vii) If a participant needs to follow a special or modified diet recommended by a physician, the adult day care facility shall ensure that the diet is provided in accordance with the physicians orders.
- (viii) Assistance in eating shall be provided for participants opening containers, cutting foods, etc.
- (ix) The facility shall either prepare the food or have it catered. If catering or contract food service is selected, the alternative food service source used shall be approved by the County Health Department or appropriate entity. The adult day care facility is responsible for negotiating a contract with and providing payment for services received from the alternative food service source.
- (x) Menus.
- (A) A menu listing all meals and snacks to be served by the facility during the current one-week period shall be dated and posted in a location conspicuous to participants.
- (B) Posted menus shall indicate substitutions.
- (C) Menus shall be kept at the facility for one year.
(p) Assistance with Personal Care. - (i) Staff shall provide special attention, additional supervision, and assistance in activities of daily living, such as feeding and toileting, to participants who require it.
(q) Transportation Services. NOTE: If transportation is not provided by the adult day care facility, the following standards do not apply. - (i) The driver must have an appropriate Wyoming drivers license for that vehicle. The vehicle must be equipped with a manual for first aid, a first aid kit, and a fire extinguisher.
- (ii) The vehicle shall be accessible and appropriate for the people using it, considering any physical impairments they might have.
- (iii) Every person must have a seat in the vehicle, except those people who remain in their wheelchairs.
- (iv) Wheelchairs shall be secured when the vehicle is in motion.
- (v) Every person shall be seated while the vehicle is in motion.
- (vi) Every seat shall be equipped with a seat belt or shoulder harness. Every person shall be directed to use them.
- (vii) Participants shall not be left unattended and/or unsupervised while in a vehicle.
- (viii) Adequate liability insurance coverage with a minimum limit of at least $500,000 each occurrence/$500,000 aggregate shall be maintained according to the size of the vehicle and the number of participants being transported.
048-7 Wyo. Code R. § 7-12