411-066-0020 Standards for Adult Day Services Programs (1) SERVICE PLANS. ADS program participants must have a service plan that is based on individually assessed service needs and the ADS program's ability to provide services to meet the participants need. The service plan must include the following: (a) Intake Screening. The intake screening must be completed by the ADS prior to admission to determine the appropriateness of the ADS program for the participant and that the participant's needs are within the scope of the ADS program. (b) Application. An application or enrollment agreement must be completed and include all of the following: (A) Applicant's personal identifying information. (B) Information regarding health, safety, and emergency needs. (C) Identification of services to be provided. (c) Assessment. A written assessment of the participant must include all the following: (A) Functional abilities and disabilities. (B) Strengths and weaknesses. (C) Personal habits. (D) Preferences, interests, likes and dislikes. (E) Medical condition and medications. (F) Personal care. (G) Assistance required with activities of daily living. (H) A statement on the ability to live independently. (I) Any other information helpful to developing the service plan, such as life history. (d) Written Service Plans. The service plan, which is based on the assessed needs, strengths, and abilities of the participant, must include realistic long and short-term objectives. The service plan must: (A) Specify number of days per week of attendance. (B) Define the services to be provided. (C) Explain how the service meets the assessed need. (D) Identify staff responsible for providing or monitoring service delivery. (E) Include an activity plan that is based on the interests, needs, and abilities of the participant. (e) A disclosure statement that describes the ADS program's range of care and services, including: (A) Criteria for admission and discharge; and (B) Fees and arrangements for payment, including insurance coverage or other payment sources. (f) Coordination of Care. The need for coordination of care must be considered for each participant. If coordination of care is needed and the participant is receiving services from another agency or resides in a community-based care setting, the ADS service plan must be developed to acknowledge, and not duplicate, the services provided by that agency or facility. (g) Service Documentation and Reassessment. (A) Progress notes on each participant must be written at least quarterly, reflecting a review of the service plan. (B) Reassessing the participant's needs and reevaluating the appropriateness of the service plan must be completed not less than semiannually. (C) A reassessment of the participant's needs and service plan must also be completed as needed when significant changes occur in the participant's functional ability, service needs, health status, or living situation. (2) PARTICIPANT RECORDS. (a) All ADS programs must maintain a roster of all participants with dates of admission and discharge. (b) The ADS programs must maintain a daily attendance record, which documents the date and time the participant attends the ADS program. (c) ADS programs must maintain an individual file on each participant that contains all the following information: (A) Intake screening and application forms. (B) Photograph of participant and statement of use, such as identification, news articles, with a signed release by the individual or representative. (C) Medical information. The ADS program must obtain and document medical information to assist in developing a service plan. A participant's medical information must be reviewed semi-annually and the review must be notated in the participant's record. (i) Physician's name and contact information. (ii) Hospital's name and contact information. (iii) A list of the participant's medication. (iv) Advance health care directive form, if the participant has completed a directive. (v) A Physician's Order for Life Sustaining Treatment (POLST), a statement that none has been signed, or a completed form developed by the ADS program to document resuscitation status. (D) Nutritional status assessment including medically prescribed dietary needs, food allergies, preferred diet (i.e. vegetarian, vegan), and cultural or religious preference. (E) Person-Centered Service plan, including all information found in section (1) of this rule. (F) Correspondence. (G) Transportation Plans. Transportation planning must: (i) Specify the arrangements for transportation to and from the ADS program; and (ii) Arrange for transportation enabling participants to attend ADS program-sponsored outings. (H) The ADS program's progress notes. (I) Emergency contact information with at least two contacts (i.e. the participant's designated representative and others as indicated). (J) Emergency Medical Response for Participants. ADS programs must have a written procedure for handling participant medical emergencies. This documentation must include: (i) Procedures for notification; (ii) Transportation arrangements; and (iii) Provision for escorts, if necessary. (3) SERVICES. The ADS program must provide the following services and supports: (a) ADL Assistance. This includes assistance and supervision with activities of daily living. (b) Social Services. The following social services, if identified on the service plan, must be provided to participants: (A) Resources for mental health counseling within the community; (B) Resources for other community services; and (C) Advocating for the participant's human and civil rights. (c) Monitoring for changes in physical health and making recommendations and providing resources within the community. (d) Monitoring for changes in cognition and making recommendations and providing resources within the community. (e) Discharge planning and assisting in the transition. (f) Information and resources for persons who are not appropriate for adult day services. (g) Nutrition Services. ADS programs must screen and assess participants for nutrition needs and provide or refer for nutrition services within the community, as appropriate. (h) Food Services. ADS programs must: (A) Provide present participants at least one meal per day if they are present at a typical mealtime. (i) The meal must consider the nutritional status assessment. (ii) The meal must meet the adult daily nutritional requirement as established by state and federal regulations. (iii) Menus for the coming week must be prepared and posted weekly in a location accessible to participants. The ADS must maintain weekly menus for one month. (B) Make nourishing snacks available to participants between meals. (C) Prepare and make menus available at least one week in advance to all participants. (i) Therapeutic Activities. ADS programs must take into consideration participant differences in age, health status, sensory deficits, needs, interests, abilities, and skills by providing opportunities for a variety of activities that encompass differing levels of involvement. The activities may include social, intellectual, cultural, emotional, physical and spiritual activities. (j) Health-Related Services. The ADS program must provide any health-related services as indicated on the participant’s service plan. Services may include nursing consultation services, prevention education, and restorative therapy (e.g. physical therapy or occupational therapy). (4) PHYSICAL DESIGN, ENVIRONMENT, EMERGENCY STANDARDS, AND SAFETY. (a) The facility housing the ADS program must comply with applicable state and local building regulations, zoning, fire, and health codes or ordinances. (b) The facility must be designed in a way that it is accessible and functional in meeting the identified needs of the population it serves in accordance with the Americans with Disabilities Act as amended. (c) Emergency standards. The ADS must: (A) Emergency Plan. Each physical location must develop, maintain, update and enforce an emergency plan for the protection of all persons in the event of an emergency. The written emergency plan must: (i) Address fire, natural, and human caused events identified as a significant risk for the facility and locality. (ii) Specify how the ADS program shall notify participants or the participant's representative of closure. (iii) Be posted in an accessible location and provide the locations of fire extinguishers and exit routes. (B) Follow appropriate fire and safety standards. The ADS must: (i) Have an onsite fire inspection by the State Fire Marshall or local fire authority and meet inspection requirements. (ii) Install a fire warning system. (iii) Provide and maintain fire extinguisher in the number and class. (iv) Maintain records of fire and evacuation drills. Fire and evacuation drills must be held at least once every six months. (C) Have at least two well-identified exits available. (D) Have written protocol regarding sick or injured participants. This protocol must be provided to participants, family, and care providers upon admission. (E) Have emergency first aid kits which are visible and accessible to staff. Personnel trained in first aid and CPR must be on available whenever participants are present. (F) Must provide safe drinking water, as well as maintaining a supply of safe drinking water as part of the program's emergency disaster plan. Disposable paper cups, individual drinking cups, or drinking fountain must be provided. (d) Excluding hallways, offices, restrooms, and storage spaces the ADS program must have: (A) A minimum of 60 square feet of common floor space per participant. (B) At least 80 square feet of common floor space per participant if 25 percent or more of the program participants are cognitively impaired or require the use of adaptive equipment. (e) Cleaning and Maintenance. (A) The physical building, premises, and all equipment must be maintained in a clean and sanitary condition, free of hazards, and in good repair. (B) In facilities serving 16 or more persons, a utility sink must be provided. (f) Heating, cooling, ventilation, and lighting must be appropriate for the age and physical condition of the participants. (g) Flooring must be easily cleaned and made of a non-skid material. (h) Stairways must have handrails and the stairs must be covered with non-skid material. (i) Sufficient furniture for the entire participant population must be of sturdy construction that does not easily tip over or move when used for seating or support while walking. (j) Outside space used for outdoor activities must be safe, and accessible to indoor areas and to those with a disability. (k) Smoking, if permitted, must be supervised in a designated outdoor area that is adequately ventilated, and away from the main ADS program. (l) The facility must have an accessible bathroom with a minimum of one toilet per 10 participants. Each bathroom must: (A) Be equipped with a sink, grab bars, and call system appropriate to the population served. (B) Function properly and be maintained in a sanitary and odor free condition. (C) Contain an adequate supply of liquid hand soap, toilet tissue, and paper hand towels with a dispenser or an electrical hand dryer. (m) There must be sufficient private space for: (A) Consultation between staff and participant. (B) The participant to rest. (C) Personal telephone use by participants. (D) Storage of files, records, recreational and cleaning supplies. (n) Food Services, Standards, and Precautions. To ensure the provision of safe and sanitary food: (A) All ADS programs serving 16 or more persons must meet the minimum requirements as outlined in the OHA, Public Health Division's Food Sanitation Rules, OAR chapter 333, division 150. (B) ADS programs serving 15 or fewer persons, or a facility that purchases meals from an outside meal source or serves prepared meals, must meet the minimum requirements in OAR chapter 333, division 150 relating to the preparation, storage, and serving of food. Facilities serving 15 or fewer persons are not required to use commercial equipment. (C) If the ADS employee's duties include preparing and serving food, the employee must have a food handler's certificate. (D) Garbage, Refuse, and Recycling. (i) Garbage and refuse containers must be insect-proof, rodent-proof, leak-proof and nonabsorbent. (ii) Garbage and refuse must be removed at least once a week from the premises or more often if needed to prevent odors and attraction of insects, rodents and other animals. (iii) Items being recycled must be clean and pending removal, stored in a manner that does not present rodent harborage or insect breeding. (iv) Recycled items must be stored separately from food supplies and food preparation equipment. (o) Sewage Disposal. If a community disposal system is available it must be utilized by the facility. If a septic system is utilized, it must be properly operating and meet code requirements. (p) Standards for Handling Soiled Items. Written procedures for the safe handling of soiled items minimizing the potential for the spread of communicable diseases must be established. Such procedures must include: (A) Soiled item disposal and storage; (B) Hand washing; (C) Sanitizing of contaminated surfaces; and (D) Preventing contamination. (5) Medication and nursing services. If provided by the ADS program, the ADS must: (a) Designate a secured area for storing labeled medication away from the participant activity area. (b) Have a written medication management policy, approved by a Registered Nurse or Pharmacist. This policy must designate which staff are trained and authorized to administer medications. (c) Only dispense physician approved medications. (d) Meet local health department standards regarding infection control and communicable diseases. (6) STAFFING. (a) Program Director. To meet certification standards, the program director must meet the following minimum qualification standards: (A) Be at least 21 years of age; and (B) Have a: (i) Bachelor's degree in health care or management; or (ii) High school diploma and have at least two years of professional or management experience within the five years prior to becoming program director. (b) Employees and Volunteer Requirements. All employees and volunteers must: (A) Comply with the criminal history and abuse check rules in OAR 407-007-0200 through 407-007-0380. There must be written procedures to evaluate and determine employment status based on criminal findings. (B) Background checks are to be completed every two years on all staff and volunteers. (C) All subject individuals must self-report to the licensee any: (i) Potentially disqualifying condition listed in OAR 125-007-0270. (ii) Disqualifying condition as described in OAR 407-007-0275. (iii) Potentially disqualifying condition as described in OAR 407-007-0279 and OAR 407-007-0290. (D) Be competent and have education or experience dealing with the adult day services population. (E) Comply with standards for tuberculosis testing and hepatitis immunization specified by the local public health department. (c) Staffing Numbers. (A) The staff to participant ratio must be a minimum of one staff person to six participants. (B) ADS programs serving over 50 percent of participants who require full assistance with three or more activities of daily living must have a staff to participant ratio of one to four. (C) Volunteers may be included in the staff ratio only when they conform to the same standards and requirements: (i) As paid staff; (ii) Meet the job qualifications; (iii) Have designated responsibilities; (iv) Have a signed written job description; and (v) Documentation of volunteers' schedule in the facility. (D) Each ADS program located in a facility, such as a hospital, nursing facility, senior center, church, or community-based care facility, must be separate and distinct with designated staff and staff hours committed to the ADS program. (E) To ensure adequate care and safety of participants, there must be qualified substitute staff available. (d) Staff and Volunteer Orientation and Training. The adult day service must provide a general orientation and continued in-service training for paid staff and volunteers including, but not limited to: (A) Program mission and philosophy. (B) Fire, safety, and disaster planning, building evacuation, and emergency procedures. (C) Mandatory reporting laws and signs of abuse and neglect. (D) Standard infection control. (E) CPR and first aid. (F) Body mechanics and transfer techniques. (G) Personal care. (H) Behavioral intervention and behavior acceptance and accommodations. (I) Understanding each participant’s service plan. (7) ADMINISTRATION. (a) Plan of Operation. Each ADS program must develop and implement a plan of operation that must be reviewed and, if necessary, revised annually. The plan must include: (A) A definition of the target population. (B) Geographical definition of the service area. (C) Description of basic and optional services. (D) Hours and days of operation. (E) Admission and discharge policies and procedures. (F) Staffing. (G) Statement of participants' rights and grievance procedure. (H) Rates. (I) Procedures for reporting suspected abuse. (J) A written policy for helping participants who wander including providing some type of identification. (K) Emergency policies and procedures, including a policy on facility-wide medical emergencies. (b) Discharge and Grievance Policy. (A) The ADS program must develop a participant discharge policy that includes at a minimum: (i) Timeframe for discharge; (ii) Criteria for discharge; (iii) Notification of discharge procedures; (iv) How to appeal a discharge; and (v) End of service. (vi) When possible, the ADS program must provide referrals or resources to the participant for services from other organizations whether the discharge was voluntary or involuntary. (B) The discharge notification provided to the participant and representative must include: (i) Reasons for discharge and a discharge summary. (ii) A minimum of two weeks' notice while an alternative plan is being developed. (iii) Notice may be issued with less than two weeks when the service needs have increased to the level at which the ADS program is no longer meet the participant's needs safely or adequately. (iv) Advance notice when the participant presents imminent danger to other participants or themselves. (C) A grievance policy for resolving participants' concerns or complaints about the ADS program must be developed and include, but not be limited to: (i) Filing process and time frames. (ii) A written response to the participant. (iii) A written record of the grievance must be on file at the facility. (c) Program Evaluation. (A) As part of the quality assurance plan, the ADS program must develop policies and procedures for evaluating operation and services. (B) The plan must include a survey of employees, participants, families or services providers and referral services discussing all aspects of the ADS program. (C) The ADS program must use the evaluation to determine further action to ensure continuous improvement in service delivery. (D) A written report summarizing the annual evaluation findings must be posted for review with implementation or correction time tables. The report shall be maintained as part of the facilities permanent record and provided to the: (i) ADS program's advisory committee or Board of Directors; and (ii) State's ADS program coordinator. (d) Personnel Policies and Practices. The ADS program must have written personnel policies for both staff and volunteers. (e) General Records Policies. The ADS program must have a records policy for administrative records and participants' records. (A) The ADS programs must maintain administrative records including, but not limited to: (i) Personnel records. (ii) Fiscal records. (iii) Statistical reports. (iv) Government-related records. (v) Contracts. (vi) Organizational records. (vii) Quality improvement or quality assurance plans. (viii) Advisory committee minutes. (ix) Certificates of biennial fire and health inspections as required by local ordinances, and incident reports. (B) The ADS program must retain records for: (i) Clinical records, seven years. (ii) Financial and other records, at leave five years from the date of service. (f) Staff must hold personal information about participants and their families in confidence, treating all participants with respect and dignity. The ADS program must develop a written policy on confidentiality and the protection of participants' records. The policy must define procedures for the use and removal of: (A) Participants' records. (B) Conditions for release of information. (C) Conditions that may require authorization, in writing, by the participant or their representative for the release of information, not otherwise authorized by law. Statutory/Other Authority: ORS 409.050, 410.070, 410.490, 410.495, 413.085 Statutes/Other Implemented: ORS 410.485 - 410.495 History: APD 10-2019, amend filed 02/13/2019, effective 02/15/2019 SPD 19-2007, f. & cert. ef. 11-7-07 SPD 6-2007(Temp), f. & cert. ef. 5-15-07 thru 11-11-07 SDSD 4-1999, f. & cert. ef. 3-15-99 SSD 12-1992, f. & cert. ef. 12-1-92