309-040-0390 Standards and Practices for Care and Services (1) The provider, resident manager and substitute caregivers must understand administration of each resident’s medications, including the reason the medication was ordered, route, frequency, parameters (such as when to hold or call the prescriber), required monitoring, how the medication is intended to work, common side effects, and adverse reactions. (2) Medication resource material must be readily available in the AFH. Acceptable resource materials include prescription drug information sheets, drug fact labels for over-the-counter medications, supplement fact labels, nutritional fact labels, current drug manuals and drug references websites. Caregivers must be able to readily access the internet when drug reference websites are the chosen material. (3) Medications and Prescriber's Orders: (a) There must be a signed copy of all medications, dietary supplements, over-the-counter medications, treatments, or therapies ordered by a prescribing practitioner or requested by the resident in the resident’s file, except as otherwise permitted under OAR 309-040-0390(4)-(5) Visit summary documents that list current medications are not consider medical orders even if the prescribing practitioner signs the document. Written orders must include: (A) Dated order; (B) Name of the medication; (C) Strength of the medication; (D) Dose; (E) Frequency; (F) Administration route; (G) Reason medication is being taken; and (H) Prescriber’s signature or typed name. (b) A provider, resident manager, or substitute caregiver must dispense medications, dietary supplements, over-the-counter medications, treatments, and therapies as prescribed unless the resident or the resident’s legal representative refuses to consent. (c) The prescribing practitioner must be notified of refusal to consent to an order. (d) Changes to orders may not be made without a prescribing practitioner order. Changes made over the phone must be followed-up with a, written or electronic copy of the order within 72 hours of the change notice. (A) The provider, resident manager, or substitute caregiver must promptly notify the resident’s case manager of any request for a change in the resident’s orders for medications, treatments, or therapies; (B) Changes in the dosage or frequency of an existing medication require a new properly labeled and dispensed medication container. If a new properly labeled and dispensed medication container is not obtained, the change must be written on an auxiliary label attached to the medication container, not to deface the existing original pharmacy label, and the information must match the new medication order. (C) Changes for a medication packaged in a blister pack, must be made by the Pharmacist that filled the order. (e) All medications, including over-the-counter medications must be in the original container and be clearly labeled with the pharmacist's label or the manufacturer's original label. Over-the-counter medications must be marked with the resident’s name. (f) All medications, including over-the-counter medications, must be stored as directed by the manufacturer, and kept in a locked location except as otherwise permitted under OAR 309-040-0390(4)-(5), that is cool, clean, dry and not subject to direct sunlight or fluctuations in temperature. (A) The provider or provider's family medication must be stored in a separate locked location. (B) All medication for pets or other animals must be stored in a separate locked location. (C) Medication requiring refrigeration must also be locked and stored separately from medications of others. (4) The program must ensure at least one unexpired opioid overdose kit for emergency response to suspected overdose is available in the facility at all times. Opioid overdose kits do not require a prescription and are not specific to an individual (see ORS 689.800). (a) All opioid overdose kits must include an ultraviolet light-protected hard case and must contain, but not be limited to: (A) Two doses of an FDA-approved short-acting, non-injectable, opioid antagonist medication; (B) One pair non-latex gloves; (C) One face mask; (D) One face shield for rescue breathing that is maintained according to manufacturer’s recommendations; and (E) One short-acting, non-injectable, opioid antagonist medication administration instruction card. (b) Opioid overdose kits must be: (A) Installed in an easily accessible, highly visible, and unlocked location; (B) At a height of no more than 48 inches from the floor; (C) In a location without direct sunlight; (D) In an area where temperatures are maintained between 59 degrees Fahrenheit and 77 degrees Fahrenheit; and (E) Have a sign clearly indicating the location and content of the kit. (c) Short-acting, non-injectable, opioid antagonist medication not within installed opioid overdose kits must be stored in a locked cabinet with other resident medications. (d) Opioid overdose kits must be: (A) Checked daily to ensure the required components have not been removed or damaged, with documentation of daily checks maintained for three years; (B) Checked monthly to ensure the short-acting, non-injectable, opioid antagonist medication has not expired, with documentation of monthly checks maintained for three years; and (C) Restocked immediately after use. (e) Upon recognizing a person appears to be experiencing an overdose, program staff must immediate respond based on the medical emergency procedures of the facility. (f) A person who has reasonable cause to believe and in good faith administers short-acting, non-injectable, opioid antagonist medication to a person experiencing an overdose, is protected against civil liability or criminal prosecution unless the person, while rendering care, acts with gross negligence, willful misconduct, or intentional wrongdoing as described in Oregon Revised Statute (ORS) 689.800. (g) Administration of short-acting, non-injectable, opioid antagonist medication must be documented by the caregiver who administered the medication. Documentation must be submitted to the Authority within 48 hours of the incident and must include: (A) Name of the individual; (B) Description of the incident including date, time, and location; (C) Time 9-1-1 contacted; (D) Time of administration(s) of short-acting, non-injectable, opioid antagonist medication; (E) Individual’s response; (F) Transfer of care to EMS; and (G) Signature of caregiver. (h) Program staff must fully cooperate with emergency medical service (EMS) personnel. Program staff must not interfere with or impede the administration of emergency medical services. (5) Opioid overdose medication and kits which are the personal property of a resident, do not need to be kept in a locked location or maintained as described under OAR 309-040-0390(4). (6) Discontinued, outdated, or recalled medications may not be kept in the AFH and must be disposed in a manner advised by Department of Environmental Quality, (a) The provider must document disposal of all discontinued, outdated, and recalled medication on resident’s drug disposal forms. (b) Disposal must occur within 10 calendar days of expiration, discontinuation, or provider’s knowledge of recall. (c) Prescription medications for resident’s who have died, must be disposed of within 24 hours. Prescription medications are not transferable to anyone other than the resident identified on the prescription label. (7) Medications may only not be mixed together in another container prior to administration as directed by a physician order, or as packaged by the pharmacy. (8) A written medication administration record (MAR) or electronic MAR must be maintained for each resident. (a) The MAR must include: (A) The name of all medications, treatments and therapies administered by the program staff to that resident, including over-the-counter medications and prescribed or dietary supplements. (B) The name of all medications, treatments and therapies self-administered by the resident and indicate that they are self-administered. Resident do not have to document self-administrations on the MAR. (C) The name of medication, dosage and frequency of administration, route or method, dates and times given, and any parameters for each prescribed medication, over-the-counter medication, and supplements. (D) Scheduled medications must have a specific time assigned on the MAR when the medication will be administered. Medications administered “as needed” (also known as PRN medications) must be listed as “PRN” and not have a specific time. (E) PRN medications must include what dosages not to exceed in a 24-hour period and may not include any dosage ranges. (F) Documentation of any known allergy or adverse reactions to a food or medication. (b) The MAR must be immediately initialed by the caregiver dispensing using only blue or black indelible ink. (c) Treatments, therapies, and special diets must be immediately documented on the medication administration record including the specific time given, type of treatment or therapy, and initials of the caregiver giving it using only blue or black indelible ink. (d) The medication administration record must have a legible signature for each set of initials using only blue or black indelible ink; (e) The MAR must indicate when medications are provided to non-staff, alternate caregivers (e.g. family members) to administer when residents will be away from the home. (f) The MAR must include , documentation and an explanation of why a PRN medication was administered and the results of such administration; (g) Medication may not be used for the convenience of the caregiver and must never be used to discipline a resident. (h) Changed or discontinued orders must be immediately documented on the MAR showing the date of the change or discontinued order. A changed order must be written on a new line. (i) Missed or refused medication, treatment or therapy must be documented by circling the caregivers initials and completing a brief explanation in the results section of the MAR. (j) The prescribing practitioner must be notified when there are observed side effects or concerns regarding the resident’s response to medication. (9) Subcutaneous, intramuscular, and intravenous injections may be self-administered by the resident if the resident is fully independent in the task, administered by a relative of the resident, or administered by a current Oregon licensed registered nurse. A current Oregon licensed practical nurse may administer subcutaneous and intramuscular injections. Providers and caregivers who have been delegated and trained by a registered nurse in accordance with administrative rules of the Board of Nursing chapter 851, division 047 may administer subcutaneous injections. Intramuscular and intravenous injections may not be delegated except as allowed by (3)(S) of this rule. Documentation regarding the training or delegation must be maintained in the resident’s record; (a) Intramuscular injections used to administer medications for lifesaving emergencies as outlined in ORS 433.800 to 433.830 and Chapter 333 Division 55 must be taught by a registered nurse, a pharmacist, or the prescriber, and the AFH provider must be given written detailed step-by-step instructions; and (b) Precautions must be taken to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures. All sharps, including, but not limited to, needles and lancets, must be disposed of in approved sharps containers that: (A) Are puncture-resistant; (B) Are leak-proof; (C) Are labeled or color-coded red to warn the contents are hazardous; (D) Have a lid, flap, door, or other means of closing the container and inhibits the ability to remove sharps from the container; (E) Are not overfilled; (F) Are stored in an upright position in a secure location as close as practical to the use area. The container must be accessible to residents and not close to any food preparation or food storage area; and (G) Must be closed immediately once full and properly disposed of within 10 days, according to the home’s waste management company’s or pharmacy’s instructions. (10) Nursing tasks may be delegated by a registered nurse to providers and other caregivers only in accordance with administrative rules of the Board of Nursing chapter 851, division 47. This includes but is not limited to the following conditions: (a) The registered nurse has assessed the resident’s condition to determine there is not a significant risk to the resident if the provider or other caregiver performs the task; (b) The registered nurse has determined the provider or other caregiver is capable of performing the task; (c) The registered nurse has taught the provider or caregiver how to do the task; (d) The provider or caregiver has satisfactorily demonstrated to the registered nurse the ability to perform the task safely and accurately; (e) The registered nurse provides written instructions for the provider or caregiver to use as a reference; (f) The provider or caregiver has been instructed that the task is delegated for this specific person only and is not transferable to other residents or taught to other care providers; (g) The registered nurse has determined the frequency for monitoring the provider or caregiver's delivery of the delegated task; and (h) The registered nurse has documented a residential care plan for the resident including delegated procedures, frequency of registered nurse follow-up visits, and signature and license number of the registered nurse doing the delegating. (11) The initial residential care plan must be developed within 24 hours of admission to the AFH. (a) During the initial 30 calendar days following the resident’s admission to the AFH, the provider must continue to assess and document the resident’s preferences and care needs. The provider must complete and document the assessment in an RCP within 30 days after admission, unless the resident is admitted to the AFH for crisis-respite services; (b) An RCP is an individualized plan intended to implement and document the provider’s delivery of services and identifies the goals to be accomplished through those services. The RCP must describe the resident’s needs, preferences, and capabilities relating to their activities of daily living and instrumental activities of daily living needs identified in their person centered service plan, and what assistance the individual requires for various tasks; (c) The provider must develop the RCP based upon the findings of the resident assessment and the person-centered service plan with participation of the resident and through collaboration with the resident’s primary mental health treatment provider. With consent of the resident, family members, representatives from involved agencies, and others with an interest in the resident’s circumstances may be invited to participate in the development of the RCP. The provider must have proper, prior authorization from the resident or the resident’s representative prior to such contact; (d) The RCP must adequately consider and facilitate the implementation of the resident’s person-centered service plan by addressing the following: (A) The resident’s care needs including night care. (B) The resident’s continued ability to evacuate the AFH in less than 3 minutes, and describe any supports that are needed to do so if applicable (C) Any current self-administration for medications, treatments or therapies and describe the providers responsibilities to support the self-administration. (D) Any approved individually based limitation and describe how the provider monitors resident progress in the area of the limitation. (E) Address the implementation and provision of services by the provider consistent with the obligations imposed by the person-centered service plan; (F) Identify the resident’s service needs, desired outcomes, and service strategies to advance all areas identified in the person-centered service plan to include, the resident’s physical and medical needs, medication regimen, self-care, social-emotional adjustment, behavioral concerns, independent living capability and community navigation, as well as any other area of concern or the other goals set by the resident; (G) Document all behavior intervention program approvals; (H) How the provider supports each identified services and support need identified in the Individual Services Plan including a description of what service/support is provide, and the duration and frequency of the support. Support services must include how the provider supports the resident in accessing community resources and engaging in community activities; and (I) If the person-centered service plan is unavailable for use in developing the RCP, providers must still develop an RCP based on the information available. Upon receipt of the person-centered service plan , the providers must amend the RCP as necessary to comply with this rule (e) The provider must attach the person-centered service plan to the RCP. (f) The RCP must be signed by the resident, the provider, or the provider’s designee, and others, as appropriate, to indicate mutual agreement with the course of services outlined in the plan; (g) The provider must review and update each resident’s RCP every six months and when a resident’s condition changes. The review must be documented in the resident’s record at the time of the review and include the date of the review and the provider’s signature. If a RCP changes the provider must write a new care plan. (12) A person-centered service plan must be completed in the following circumstances: (a) A person-centered service plan coordinator under contract with the Division must complete a person-centered service plan with each resident pursuant to OAR 411-004-0030. The provider must make a good faith effort to implement and complete all elements the provider is responsible for implementing as identified in the person-centered service plan; (b) The person-centered service plan coordinator documents the person-centered service plan on behalf of the resident and provides the necessary information and supports to ensure the resident directs the person-centered service planning process to the maximum extent possible; (c) The person-centered service plan must be developed by the resident, and as applicable, the legal or designated representative of the resident, and the person-centered service plan coordinator. Others may be included only at the invitation of the resident and, as applicable, the resident’s representative; (d) To avoid conflict of interest, the person-centered service plan may not be developed by the provider for residents receiving Medicaid. The Division may grant exceptions when it determines that the provider is the only willing and qualified entity to provide case management and develop the person-centered service plan in a specific geographic area; (e) For private pay residents, a person-centered service plan may be developed by the resident, or as applicable, the legal or designated representative of the resident, and others chosen by the resident. Providers must assist private pay residents in developing person-centered service plans when no alternative resources are available. Private pay residents are not required to have a written person-centered service plan. (13) A person-centered service plan must be developed through a person-centered service planning process. The person-centered service planning process includes the following: (a) Is driven by the resident; (b) Includes people chosen by the resident; (c) Provides necessary information and supports to ensure the resident directs the process to the maximum extent possible and is enabled to make informed choices and decisions; (d) Is timely, responsive to changing needs, occurs at times and locations convenient to the resident, and is reviewed at least annually; (e) Reflects the cultural considerations of the resident; (f) Uses language, format, and presentation methods appropriate for effective communication according to the needs and abilities of the resident and, as applicable, the resident’s representative; (g) Includes strategies for resolving disagreement within the process, including clear conflict of interest guidelines for all planning participants, such as: (A) Discussing the concerns of the resident and determining acceptable solutions; (B) Supporting the resident in arranging and conducting a person-centered service planning meeting; (C) Utilizing any available greater community conflict resolution resources; (D) Referring concerns to the Office of the Long-Term Care Ombudsman; or (E) For Medicaid recipients, following existing, program-specific grievance processes. (h) Offers choices to the resident regarding the services and supports the resident receives and from whom, and records the alternative HCB settings that were considered by the resident; (i) Provides a method for the resident to request updates to the person-centered service plan for the resident; (j) Is conducted to reflect what is important to the resident to ensure delivery of services in a manner reflecting personal preferences and ensuring health and welfare; (k) Identifies the strengths and preferences, service and support needs, goals, and desired outcomes of the resident; (l) Includes any services that are self-directed, if applicable; (m) Includes but is not limited to individually identified goals and preferences related to relationships, greater community participation, employment, income and savings, healthcare and wellness, and education; (n) Includes risk factors and plans to minimize any identified risk factors; and (o) Results in a person-centered service plan documented by the person-centered services plan coordinator, signed by the resident, participants in the person-centered service planning process, and all individuals responsible for the implementation of the person-centered service plan, including the provider, as described in these rules. The person-centered service plan is distributed to the resident and other people involved in the person-centered service plan as described in these rules. (14) Required contents of the person-centered service plan: (a) When the provider is required to develop the person-centered service plan, the provider must ensure that the plan includes the following: (A) HCBS and setting options based on the needs and preferences of the resident and for residential settings, the available resources of the resident for room and board; (B) The HCBS and settings are chosen by the resident, or resident’s legal representative, and are integrated in and support full access to the greater community; (C) Opportunities to seek employment and work in competitive integrated employment settings for those residents who desire to work. If the resident wishes to pursue employment, a non-disability specific setting option must be presented and documented in the person-centered service plan; (D) Opportunities to engage in greater community life, control personal resources, and receive services in the greater community to the same degree of access as people not receiving HCBS; (E) The strengths and preferences of the resident; (F) The service and support needs of the resident; (G) The goals and desired outcomes of the individual; (H) The providers of services and supports, including unpaid supports provided voluntarily; (I) Risk factors and measures in place to minimize risk; (J) Individualized backup plans and strategies, when needed; (K) People who are important in supporting the resident; (L) The person responsible for monitoring the person-centered service plan; (M) Language, format, and presentation methods appropriate for effective communication according to the needs and abilities of the resident receiving services; (N) The written informed consent of the resident; (O) Signatures of the resident, participants in the person-centered service planning process, and all people and providers responsible for the implementation of the person-centered service plan as described below in subsection (c) of this section; (P) Self-directed supports; and (Q) Provisions to prevent unnecessary or inappropriate services and supports. (b) When the provider is not required to develop the person-centered service plan but provides services to the resident, the provider must provide relevant information and provide necessary support for the person-centered service plan coordinator or other persons developing the plan to fulfill the characteristics described in these rules; (c) The resident decides on the level of information in the person-centered service plan that is shared with providers. To effectively provide services, providers must have access to the portion of the person-centered service plan that the provider is responsible for implementing; (d) The person-centered service plan is distributed to the resident and other people involved in the person-centered service plan as described in these rules; (e) The person-centered service plan must justify and document any individually-based limitation to be applied as outlined in OAR 309-040-0393 when a resident’s rights under OAR 309-040-0410(2)(b) through (i) may not be met due to threats to the health and safety of the resident or others; (f) The person-centered service plan must be reviewed and revised: (A) At the request of the resident: (B) When the circumstances or needs of the resident change; or (C) Upon reassessment of functional needs as required by 410-173-0025. (15) For crisis respite service providers, the provider is not required to develop a person-centered service plan under these rules during the short period of residency, but the provider must, at a minimum, develop an initial care plan as required by section (7) of these rules to identify service needs, desired outcomes, and service strategies to resolve the crisis or address the resident’s other needs that caused the need for crisis-respite services. In addition, the provider must provide relevant information and provide necessary support for the person-centered service plan coordinator as described in section (11)(b) of this rule. (16) The provider must develop a written resident record for each resident. The provider must keep the resident record current and available on the premises for each resident admitted to the AFH. The provider must maintain an resident record consistent with the following requirements: (a) General Information, Retention, and Release: (A) An easily accessible summary sheet that includes, but is not limited to, the resident’s name and pronouns, previous address, date of admission to the program, gender identity, biological sex, date of birth, marital status, legal status, religious preference, health provider information, mental health diagnoses, medical health diagnosis, medication allergies, food allergies, information specifying whether advance mental health and health directives and burial plan have been executed, the name of residents to contact in case of emergency, (B) The names, addresses, and telephone numbers of the resident’s representative, legal guardian or conservator, parents, next of kin, or other significant persons including, but not limited to; physicians or other medical practitioners; dentist; case manager or therapist; day program, school, or employer; and any governmental or other agency representatives providing services to the resident; (C) Copies of legal documents such as guardianships, power of attorney, advance mental health and medical health directives, PSRB requirements, burial plans, if applicable; (D) Resident records must be immediately available to the Authority upon request as well as available to the resident or the resident’s representative; (E) Original resident records must be kept for a period of three years after discharge or from when an resident no longer resides in the AFH; (F) Resident records must include copies of release authorizations signed by the resident for the CMHP serving the resident, medication prescribers and any other release approved by the resident. Release authorizations must be dated, signed by the resident, and include initials authorizing the disclosure of protected information and indicate how long the authorization is to be in effect. (G) All resident records must be kept confidential in compliance with applicable law and must be stored in a secure location which prohibits access by residents, guests, or other visitors in the home. In all other matters pertaining to confidential records and release of information, providers must comply with ORS 179.505, ORS 192.566, and ORS 441.114. (b) Medical Information: (A) History of physical, emotional, and medical problems, accidents, illnesses or mental status that may be pertinent to current care; (B) Current orders for medications, treatments, therapies, use of restraints, special diets, dietary supplements, and any known food or medication allergies; (C) Completed medication administration records for the last 12 months or from the date of admission, whichever is less; (D) Name and claim number of medical insurance and any pertinent medical information such as hospitalizations, accidents, immunization records including previous TB tests, incidents or injuries affecting the health, safety, or emotional well-being of any resident. (E) Documentation of current prescriber order for self-administration of medication, if applicable. (F) Documentation the resident has been trained for self-administering of prescribed medication or treatment, who provided the training and when it was provided or documentation that the prescriber has determined that the training for the resident is unnecessary, if applicable; (G) A description of how the resident manages his or her own medication regimen, or how the provider supports the resident’s medication management, and how the medications will be stored in an area that is inaccessible to others and locked when not on the resident’s person; (H) Documentation of self-administration retraining when there is a change in dosage, medication, and time of delivery or documentation that the prescriber has determined that the training continues to be unnecessary; and (I) The Residential Care plan must include a list of medications that can be self-administered by the resident and what services and supports the provider is required to provide to support the self-administration. (c) Individual account record: (A) Resident’s income sources; (B) The resident or the resident’s representative must agree to specific costs for room and board and services within the pre-set limits of the state contract. A copy must be given to the individual, the individual's representative, and the original in the resident’s resident record; (C) Resident’s record of discretionary funds including detailed receipts of all deposits and expenditures. (d) If an individual maintains custody and control of his or her discretionary funds, then no accounting record is required; (e) If a designee of the AFH maintains custody and control of an resident ‘s discretionary fund, the provider and resident must have a written agreement describing where funds will be maintained and how funds will be distributed. The agreement will include the resident’s right nullify the agreement at any time. The provider will maintain a signed and dated account and balance sheet that will accurately document the current balance and distribution of funds with initials indicating what staff distributed the funds and a signature of the resident receiving the funds. (f) The provider must maintain a copy of the written house rules with documentation the provider discussed the house rules with the resident; (g) Written incident reports of any unusual incidents relating to the resident including but not limited to resident care needs, safety concerns, conflicts with staff, or significant changes in the AFH environment. The incident report must include how and when the incident occurred, who was involved, what action was taken by staff, and the outcome to the resident. In compliance with HIPAA rules, only the resident’s name may be used in the incident report. Separate reports must be written for each resident involved in an incident. A copy of the incident report must be submitted to the CMHP within five working days of the incident. The original must be placed in the resident’s record; (h) Any other information or correspondence pertaining to the resident; (i) The provider or staff must document all services performed for the resident in the resident’s record, including all services for which Medicaid payment is being requested. Documentation must be compliant with OAR 410-120-1360, 410-172-0620 and 410-173-0045, and must include the service performed, the frequency the service was provided, the length of time each service is performed, and be initialed by the caregiver providing the service. (j) General progress notes must be documented at least weekly and must be documented immediately as significant events or changes in behavior are identified. All entries must be signed and dated by the author. (k) The provider must explain and document in the resident’s file that a copy of the Residents’ Bill of Rights was given to each resident at admission. (17) The licensee must ensure qualified staff are available to provide direct services to residents to assure resident safety and resident’s attain or maintain the highest practical physical, mental and psychosocial well-being of each resident as determined by the resident assessments and person-centered service plans and considering the number, acuity and diagnoses of the resident population. (18) The provider, resident manager and all substitute caregivers must provide care, services, and supports necessary to ensure the health, safety, and quality of life for each resident including activities of daily living, instrumental activities of daily living, services, and skills training. (19) The provider must: (a) Prominently post the State license and Abuse and Complaint poster where it can be seen by residents; (b) Cooperate with Division personnel, Oregon Department of Human Services (ODHS), or their designee in complaint investigation procedures, abuse investigations, and protective services, planning for resident care, application procedures, and other necessary activities, and allow access of Division and ODHS personnel, or their designee to the AFH, its residents, and all records; (c) Document all resident complaints, written or verbal and maintain a record of the complaint in both facility records and the resident’s personal records. The provider must document the date and time of the complaint, how they responded, how the complaint was resolved and whether the complaint was filed with another agency. The Provider may not retaliate in any manner when a complaint is filed. (d) Provide care and services, as appropriate to the age and condition of the resident and as identified on the RCP. The provider must ensure that physicians' orders and those of other medical professionals are followed and that the resident’s physicians and other medical professionals are informed of changes in health status or if the resident refuses care. Additional staff may be required to safely evacuate the residents and all occupants from the AFH; (e) Make available at least six hours of activities each week which are of interest to the residents, not including television or movies. (f) Be directly involved with residents on a daily basis. (g) Document their efforts to assist each resident to engage in activities of social, religious and community groups. (h) Develop House Rules: (A) The provider must develop reasonable written house rules that will be included in or attached to the residency agreement. House rules will address guidelines for visitors;, the use of cannabis and tobacco, and, mealtimes; guidelines for sharing the community telephones and kitchen appliances. No house rules shall restrict resident consumption of alcohol; (B) The provider must discuss house rules with the resident and families at the time of arrival. and be posted in a conspicuous place in the facility. (C) The provider must maintain written documentation in the resident record that the provider discussed the house rules with the resident along with a copy of the house rules; (D) House rules are subject to review and approval by the Division and must not violate resident’s rights as stated in ORS 430.210 and ORS 443.739; and (E) House rules must not restrict or limit the resident rights under OAR 309-040-0410(2). (i) Ensure a qualified caregiver (the provider, a resident manager or a substitute caregiver) is present in the home at all times residents are present; (j) Notify the CMHP of the name of the substitute caregiver for the provider or resident manager for absences greater than 72 consecutive hours; (k) Allow and encourage residents to exercise all civil and human rights accorded to other citizens; (l) Not allow or tolerate physical, sexual, or emotional abuse or punishment, or exploitation, or neglect of residents; (m) Provide care and services as agreed to in the RCP; (n) Keep information related to residents confidential as required under ORS 179.050; (o) Ensure that the number of residents requiring nursing care does not exceed the provider's capability as determined by the Division or CMHP; (p) Not admit residents who are clients of Aging and People with Disabilities without the express permission of the Division or its designee; (q) Exercise reasonable precautions against any conditions that threatens the health, safety, or welfare of residents; (r) Immediately notify the appropriate RCP Team members (in particular the CMHP representative and family or guardian) if: (A) The resident has a significant change in medical status; (B) The resident has an unexplained or unanticipated absence from the AFH; (C) The provider becomes aware of alleged or actual abuse of the resident; (D) The resident has a major behavioral incident, accident, illness, hospitalization; (E) The resident contacts or is contacted by the police; or (F) The resident dies, and follow-up with an incident report. (20) The provider must write an incident report for any unusual incident and forward a copy of the incident report to the CMHP within five working days of the incident. Any incident that is the result of, or suspected of being abuse, must be reported to the Office of Training, Investigations, and Safety within 24 hours of occurrence. (21) The provider must send critical incident reports to the Division within 48 hours of the incident occurring. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 443.705 - 443.825 History: BHS 5-2025, amend filed 02/28/2025, effective 03/01/2025 BHS 14-2024, amend filed 06/24/2024, effective 07/01/2024 BHS 2-2024, temporary amend filed 01/09/2024, effective 01/10/2024 through 07/07/2024 BHS 6-2018, amend filed 03/21/2018, effective 03/30/2018 MHS 9-2017, f. 6-29-17, cert. ef. 7-1-17 MHS 3-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17 MHS 14-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17 MHD 3-2005, f. & cert. ef. 4-1-05, Renumbered from 309-040-0052 MHD 4-2002, f. 2-26-02, cert. ef. 2-27-02 MHD 7-2001(Temp), f. 8-30-01, cert. ef. 9-1-01 thru 2-27-02 MHD 6-1999, f. 8-24-99, cert. ef. 8-26-99 MHD 1-1992, f. & cert. ef. 1-7-92, Renumbered from 309-040-0050(8)-(10)