reglab/statecodes huggingface dataset:
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter III - Licensure and Inspection › § 44–103.06. Inspections

§ 44–103.06. Inspections.
(a) In addition to the inspections required by § 44-103.02(e), the Mayor may inspect an ALR at the Mayor’s discretion to ensure compliance with this chapter.
(b) The Mayor shall at all times ensure that any ALR licensed pursuant to this chapter is able to continually provide appropriate care to its residents. The Mayor shall notify an ALR if, at any time, the Mayor determines that the ALR is unable to provide appropriate care to any of its residents.
(c) Inspection of an ALR, or prospective ALR, for purposes of initial licensure or compliance after license renewal shall be conducted by the Mayor following the procedures set forth in § 44-505 and the requirements of this chapter.
(d) If, upon inspection, the Mayor determines that an ALR, or prospective ALR, is in violation of one or more of the requirements of this chapter, the Mayor shall give written notice of such violation to the ALR, or prospective ALR, within 15 working days of the inspection and may suggest a remedy for each violation.
(e) The violating ALR, or prospective ALR, shall submit a written response to the Mayor within 15 working days of receipt of the Mayor’s notice. The violating ALR, or prospective ALR, may deny the alleged violation, accept the Mayor’s suggested remedy, or propose its own remedy.
(f) If the Mayor accepts the ALR’s, or prospective ALR’s, written response, the Mayor may either issue a license to the ALR, or prospective ALR, if appropriate, or conduct a follow-up inspection to confirm compliance.
(g) If the Mayor and the ALR, or prospective ALR, cannot agree on an acceptable corrective action, or if the ALR, or prospective ALR, fails to respond in writing within 15 working days of receipt of the Mayor’s notice, the Mayor shall determine what action to take, including a penalty in accordance with this chapter and give the ALR, or prospective ALR, notice of his or her determination.
(h) The Mayor may inspect an ALR for the purpose of investigating a complaint.
(June 24, 2000, D.C. Law 13-127, § 306, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter III - Licensure and Inspection › § 44–103.07. Restrictions

§ 44–103.07. Restrictions.
(a) An ALR licensed pursuant to this chapter shall not use in its title the words “hospital,” “sanitorium,” “nursing,” “convalescent,” “rehabilitive,” “subacute,” or “hospice.”
(b) Only a licensed ALR may describe, market, and offer itself as such. No other entity, whether licensed or not by the District government, shall describe, market, or offer itself as an Assisted Living Residence without first obtaining an ALR license. Violation of this requirement shall constitute operation of an ALR without a license and shall be subject to penalties in accordance with this chapter.
(June 24, 2000, D.C. Law 13-127, § 307, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter III - Licensure and Inspection › § 44–103.08. Appeals

§ 44–103.08. Appeals.
Appeals under this subchapter may be taken pursuant to subchapter XII of this chapter.
(June 24, 2000, D.C. Law 13-127, § 308, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IV - Sanctions and Penalties › § 44–104.01. Sanctions

§ 44–104.01. Sanctions.
(a) The sanctions set forth in § 44-509.
(b) On determining that a licensee has violated this chapter, the Mayor, in addition to the sanctions required by subsection (a) of this section, may:
(1) Restrict the number of residents the licensee may admit;
(2) Require the licensee to reduce the number of residents in its care;
(3) Require the licensee and any of its staff to receive remedial instruction or training in a specific area;
(4) Require the licensee to use the services of a management firm approved by the Mayor;
(5) Notify or require the licensee to notify a resident who is affected by the violation and his or her surrogate;
(6) Increase the frequency of monitoring visits during a specified period of time;
(7) Enter into an agreement with the licensee establishing certain conditions for continued operation, including time limits for compliance; and
(8) Petition a court of competent jurisdiction to appoint a receiver as provided in subchapter II of Chapter 10 of this title.
(c) If the Mayor determines that the licensee has violated a condition or requirement of an imposed sanction, the Mayor may suspend or revoke the license.
(d) Appeals under this section may be taken pursuant to subchapter XII of this chapter.
(June 24, 2000, D.C. Law 13-127, § 401, 47 DCR 2647.)
Section References
This section is referenced in § 44-103.04.
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IV - Sanctions and Penalties › § 44–104.02. Civil Penalties

§ 44–104.02. Civil Penalties.
(a) The Mayor may impose one or more of the civil penalties authorized under § 44-509 against persons who:
(1) Maintain or operate an unlicensed ALR; or
(2) Otherwise violate provisions of this chapter.
(b) Notwithstanding any other provision of law, penalties authorized under § 44-509 shall not be imposed by the Mayor unless a violation, cited during an inspection:
(1) Is within the control of the ALR; and
(2) Poses an immediate or serious and continuing danger to the health, safety, welfare, or rights of residents.
(c) If during a follow-up inspection the Mayor determines that violations within the control of the facility which were cited in an immediately prior inspection have not been corrected or have recurred, the Mayor may impose penalties authorized under § 44-509
(d) Appeals under this section may be taken pursuant to subchapter XII of this chapter.
(June 24, 2000, D.C. Law 13-127, § 402, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IV - Sanctions and Penalties › § 44–104.03. Criminal penalties

§ 44–104.03. Criminal penalties.
The criminal penalties set forth in § 44-509 shall apply to an ALR.
(June 24, 2000, D.C. Law 13-127, § 403, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IV - Sanctions and Penalties › § 44–104.04. Emergency suspension

§ 44–104.04. Emergency suspension.
(a) The Mayor may immediately suspend, as an emergency action, a license on finding that the licensee’s premises are unsafe for human habitation or pose an immediate threat to the health and safety of its residents.
(b) The Mayor shall deliver a written notice to the licensee informing it of the emergency suspension, giving the reasons for the suspension, providing the provisions of law with which the licensee has failed to comply that form the basis for the emergency suspension, and notifying the ALR of its right to request a hearing and to be represented by counsel.
(c) The filing of a hearing request shall not stay the emergency suspension. If the licensee is dissatisfied with the emergency suspension, it may appeal the suspension as provided in § 44-505.
(d) When a license is suspended pursuant to this section, the licensee shall immediately return the license to the Mayor, notify the residents and surrogates of the suspension, and make every effort to assist them in making other assisted living arrangements.
(June 24, 2000, D.C. Law 13-127, § 404, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.01. Standard of care

§ 44–105.01. Standard of care.
(a) An ALR must care for its residents in a manner and in an environment that promotes maintenance and enhancement of the residents’ quality of life and independence.
(b) In order to promote resident independence and aging in place in a residential setting, at a minimum, an ALR shall offer or coordinate for payment 24 hour supervision, assistance with scheduled and unscheduled activities of daily living, and instrumental activities of daily living as needed, as well as provision or coordination of recreational and social activities and health services in a way that promotes optimum dignity and independence for the residents.
(June 24, 2000, D.C. Law 13-127, § 501, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.02. Self-determination, choice, independence, participation, and privacy

§ 44–105.02. Self-determination, choice, independence, participation, and privacy.
(a) A resident shall have the right to be treated at all times as follows:
(1) Courteously;
(2) Respectfully;
(3) With full recognition of personal dignity and individuality; and
(4) With assurance of privacy and the opportunity to act autonomously and share in the responsibility for decisions.
(b) A resident of an ALR shall have the right to live in an environment that:
(1) Maintains and enhances the resident’s dignity, independence, and respect in full recognition of his or her individuality and physical and mental capabilities;
(2) Is creatively designed to counter loneliness, depression, dependence, boredom, and designed to manage difficult behavior;
(3) Provides opportunities for socialization, social interaction, leisure activities, and spiritual and religious activities consistent with the preferences and background of the resident; and
(4) Facilitates participation by arranging for transportation and assisting with communication and social skills and other services.
(June 24, 2000, D.C. Law 13-127, § 502, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.03. Dignity

§ 44–105.03. Dignity.
A resident shall have the right to the following:
(1) A safe, clean, comfortable, stimulating, and homelike environment allowing the resident to use personal belongings to the greatest extent possible;
(2) Control time, space, and lifestyle;
(3) Free access to visitors of his or her choice;
(4) To receive and send correspondence without any restrictions;
(5) To maintain personal possessions to the extent the health, safety, and well being of others is not disturbed;
(6) To remain in his or her living unit unless a change corresponds to the uncoerced preference of the resident or conforms to the obligations set forth in the resident’s contract respecting discharge and is related to the resident’s preference or to transfer conditions stipulated in his or her contract with the ALR;
(7) To approve his or her roommate whenever possible, if the resident is living in a semi-private unit;
(8) To attend or not attend religious services of his or her choice;
(9) To choose activities and schedules consistent with his or her interests, and physical, mental, and psychosocial well-being;
(10) To interact with members of the community inside and outside the facility and make choices about aspects of his or her life in the facility that are significant to the resident;
(11) To be free from mental, verbal, emotional, sexual and physical abuse, neglect, involuntary seclusion, and exploitation; and
(12) To participate in the development, implementation, and review of plans designed to provide services to residents, including the Individualized Service Plan.
(June 24, 2000, D.C. Law 13-127, § 503, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.04. Accommodation of needs

§ 44–105.04. Accommodation of needs.
A resident shall have the right to the following:
(1) To receive adequate and appropriate services and treatment with reasonable accommodation of individual needs and preferences consistent with their health and physical and mental capabilities and the health or safety of other residents;
(2) To have access to appropriate health and social services, including social work, home health, nursing, rehabilitative, hospice, medical, dental, dietary, counseling, and psychiatric services in order to attain or maintain the highest practicable physical, mental and psychosocial well-being;
(3) To remain in the current setting, forgoing a recommended transfer to obtain additional services as contracted for by the resident or secure additional services in a manner acceptable to the ALR;
(4) To engage in a shared responsibility agreement with the ALR which is acceptable to the resident and the ALR and does not violate any applicable law;
(5) To refuse to participate in any service once the potential consequences of such participation have been explained and a shared responsibility agreement has been reached, if necessary, between the resident, the surrogate, and the ALR;
(6) To be free of physical restraints at all times; and
(7) To be free of chemical restraints.
(June 24, 2000, D.C. Law 13-127, § 504, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.05. Representation and resolution of grievances and complaints

§ 44–105.05. Representation and resolution of grievances and complaints.
(a) A resident shall have the right to the following:
(1) To designate a person as his or her surrogate or to have their guardian, or advance directives or surrogate health decision maker, act for them if for any reason the resident cannot act for him or herself;
(2) To uncoerced consent;
(3) To present grievances and complaints without fear of threat of retaliation and have them acknowledged and acted upon promptly with due respect to the provisions of this chapter;
(4) To have access to an internal grievance and complaint procedure for any denial of services or rights provided for under this chapter and to an external review process by an independent person or entity;
(5) To address grievances and complaints to representatives of the Office of the Long-Term Care Ombudsman of the District of Columbia pursuant to Chapter 7 of Title 7 or other representative;
(6) To appoint a specially designated person or attorney to represent the resident in any grievance or complaint, procedure, or appeal process who shall have access to all necessary and relevant books and records of the ALR; and
(7) To organize and participate in and hold meetings of resident groups in the ALR and invite staff or visitors to the meetings and have a designated staff person to assist and respond to written requests resulting from the meetings.
(b) The ALR shall maintain complete written records of the filing and disposition of all grievances, complaints, and appeals.
(c) Appeals under this section may be taken pursuant to subchapter XII of this chapter.
(June 24, 2000, D.C. Law 13-127, § 505, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.06. Privacy and confidentiality

§ 44–105.06. Privacy and confidentiality.
(a) A resident shall have the right to the following:
(1) To access their ALA and healthcare records on demand;
(2) To have their records kept confidential and released only in accordance with their informed uncoerced consent in accordance with District and federal law;
(3) To have their records maintained during their residency;
(4) To have their records maintained for up to 3 years after discharge or death; and
(5) To have any case discussion, consultation, examination, or treatment of the resident be kept confidential.
(b) If, for any reason, a resident cannot act for him or herself, their consent shall be given on their behalf by their designated surrogate which consent shall also be uncoerced and informed.
(June 24, 2000, D.C. Law 13-127, § 506, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.07. Full disclosure

§ 44–105.07. Full disclosure.
A resident shall have the right to full disclosure of contract terms and billing practices that are fair and reasonable.
(June 24, 2000, D.C. Law 13-127, § 507, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.08. Notice of resident’s rights

§ 44–105.08. Notice of resident’s rights.
An ALR shall place a copy of a document delineating the resident’s rights, as set forth in this chapter, in a conspicuous location, plainly visible and easily read by residents, staff, and visitors and provide a copy to each resident and resident’s surrogate upon admission and at the time of any change to the resident’s status, level of care, or services available to the resident.
(June 24, 2000, D.C. Law 13-127, § 508, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter V - Resident’s Rights and Quality of Life › § 44–105.09. Abuse, neglect, and exploitation

§ 44–105.09. Abuse, neglect, and exploitation.
(a) An ALR shall develop and implement policies and procedures prohibiting abuse, neglect, and exploitation of residents.
(b)(1) An ALR, employee of an ALR, or other person who believes that a resident has been subjected to abuse, neglect, or exploitation shall report the alleged abuse, neglect, or exploitation immediately to the assisted living administrator who shall take appropriate action to protect the resident. The ALR shall report any allegation of abuse, neglect, or exploitation brought to its attention to the Mayor and the Adult Protective Services Program, administered by the Family Services Administration of the Department of Human Development.
(2) An ALR or employee of an ALR may be subject to a penalty imposed by the Mayor for failure to report an alleged incident of abuse, neglect, or exploitation pursuant to Chapter 19 of Title 7.
(3) An ALR shall thoroughly investigate any allegation of abuse, neglect, or exploitation and shall take appropriate action to prevent further incidents. The ALR shall report the results of its investigation and actions taken, if any, to the Mayor.
(c) An ALR shall post signs that set forth the reporting requirement of this section conspicuously in the employee and public areas of the ALR.
(June 24, 2000, D.C. Law 13-127, § 509, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.01. Admissions

§ 44–106.01. Admissions.
(a) An ALR shall accept as residents only individuals for whom the ALR can provide appropriate services unless the ALR arranges for third party services or the resident does so with the agreement of the ALR.
(b) Prior to admission of a resident, the ALA or designee shall determine that the resident is appropriate for admission to the ALR and that the resident’s needs can be met in addition to the needs of the other residents.
(c) An ALR may only admit individuals who are at least 18 years of age.
(d) No individual may be admitted who at the time of initial admission, and as established by the initial assessment:
(1) Is dangerous to him or herself or others or exhibits behavior that significantly and negatively impacts the lives of others, where the ALR would be unable to eliminate such danger or behavior through the use of appropriate treatment modalities; or
(2) Is at high risk for health or safety complications which cannot be adequately managed by the ALR and requires more than 35 hours per week of skilled nursing and home health aide services combined, provided on less than a daily basis, according to section 2113.1 of HCFA Pub. 75 and 42 CFR, sections 409.32, 409.33, and 409.44.
(e) An ALR shall not admit individuals who require the following:
(1) More than intermittent skilled nursing care;
(2) Treatment of stage 3 or 4 skin ulcers;
(3) Ventilator services; or
(4) Treatment for an active, infectious, and reportable disease or a disease or condition that requires more than contact isolation.
(f) The ALR shall maintain records of all denials of admission.
(g) Nothing in this section shall automatically exclude persons with primary or secondary mental health issues from admission.
(June 24, 2000, D.C. Law 13-127, § 601, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.02. Resident agreements

§ 44–106.02. Resident agreements.
(a) A written contract must be provided to the resident prior to admission and signed by the resident or surrogate, if necessary, and a representative of the ALR. The nonfinancial portions of the contract shall include the following:
(1) The ALR’s organizational affiliations (including parent or subsidiary organizations, religious or charitable affiliation, and management company);
(2) The specific nature of any special care that it holds itself out to provide, such as specialty in Alzheimer’s disease or Parkinson’s disease;
(3) An identification of services to be included and excluded, part of which is the ISP;
(4) A list of resident rights including grievance procedures;
(5) Unit assignment and procedures if changes occur;
(6) Admission and discharge policies which include clear and specific criteria for admission, transfer, and discharge;
(7) A description of responsibility for provision or coordination of healthcare, if any;
(8) An arrangement for notification in case of the resident’s death; and
(9) A disposition of the resident’s property upon discharge, transfer, or death of the resident.
(June 24, 2000, D.C. Law 13-127, § 602, 47 DCR 2647.)
Section References
This section is referenced in § 44-106.03.
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.03. Financial agreements

§ 44–106.03. Financial agreements.
(a) The written resident agreement required by § 44-106.02 shall include financial provisions which indicate the following:
(1) The obligations of the ALR, the resident, or the resident’s surrogate as to performance of the following:
(A) The handling of the finances of the resident;
(B) The purchasing or renting of essential or desired equipment and supplies;
(C) The coordinating and contracting for services not covered by the resident agreement; and
(D) The purchasing of medications and durable medical equipment;
(2) Separate and accurate records of all funds and personal property deposited with or managed by the ALR for the benefit of a resident which include a receipt stating the date, amount, and purpose of any transaction and the current balance;
(3) Rate structure and payment provisions covering all rates to be charged to the resident, including the following:
(A) Service packages;
(B) Fee for service rates; and
(C) Any other nonservice related charges;
(4) Payment arrangements and fees, if known, for third-party services not covered by the resident agreement, but arranged for by either the resident, the resident’s surrogate, or the ALR;
(5) Identification of the persons responsible for payment of all fees and charges and a clear indication of whether the person’s responsibility is or is not limited to the extent of the resident’s funds;
(6) A provision which provides at least 45 days notice of any rate increase except if necessitated by a change in the resident’s medical condition;
(7) The procedures the ALR will follow in the event the resident or surrogate can no longer pay for services provided for in the resident agreement or for additional services or care needed by the resident; and
(8) The terms governing the refund of any pre-paid fees or charges in the event of a resident’s discharge from the ALR or termination of the resident agreement.
(b) The ALR shall establish billing, payment, and credit practices that are fair and reasonable.
(June 24, 2000, D.C. Law 13-127, § 603, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.04. Individualized Service Plans

§ 44–106.04. Individualized Service Plans.
(a)(1) An ISP shall be developed for each resident prior to admission.
(2) An ISP shall be developed following the completion of the “post move-in” assessment.
(3) The ISP shall be written by a healthcare practitioner using information from the assessment.
(4) The ISP shall be developed with the resident, or surrogate, as a full partner.
(5) The ISP shall be signed by the resident, or surrogate, and a representative of the ALR.
(6) The ISP shall include a shared responsibility agreement when necessary.
(7) The ISP shall be based on such factors as:
(A) The medical, rehabilitation, and psychosocial assessment of the resident;
(B) The functional assessment of the resident; and
(C) The reasonable accommodation of resident and, if necessary, surrogate preferences.
(b) The ISP shall include the services to be provided, when and how often the services will be provided, and how and by whom all services will be provided and accessed.
(c) During the ISP development process, the ALR shall confer with the prospective resident and, if necessary, the surrogate to arrive at a mutual agreement as to the responsibilities of each party in accessing care and achieving related outcomes.
(d) The ISP shall be reviewed 30 days after admission and at least every 6 months thereafter. The ISP shall be updated more frequently if there is a significant change in the resident’s condition. The resident and, if necessary, the surrogate shall be invited to participate in each reassessment. The review shall be conducted by an interdisciplinary team that includes the resident’s healthcare practitioner, the resident, the resident’s surrogate, if necessary, and the ALR.
(e) An ALR shall facilitate aging in place to the best of its ability with the understanding that there may be a point reached where adequate and appropriate services can not be marshalled to support the resident safely, making transfer to another setting necessary.
(June 24, 2000, D.C. Law 13-127, § 604, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.05. Shared responsibility agreements

§ 44–106.05. Shared responsibility agreements.
(a) Whenever disagreements arise as to lifestyle, personal behavior, safety, and service plans the ALR staff, resident or surrogate, and other relevant service providers shall attempt to develop a shared responsibility agreement.
(b) A shared responsibility agreements represents a tool for ALRs to recognize an individual resident’s right to autonomy by respecting his or her right to make individual decisions regarding lifestyle, personal behavior, and ISPs. In some cases, a resident’s decision may involve increased risk of personal harm and therefore potentially increase the risk of liability by the ALR absent an agreement between the resident and ALR concerning such decisions or actions. In such instances the ALR shall:
(1) Explain to the resident, or surrogate, why the decision or action may pose risks and suggest alternatives to the resident; and
(2) Discuss with the resident, or surrogate, how the ALR might mitigate potential risks.
(c) If, after consultation with the ALR as required by subsection (b) of this section, a resident decides to pursue a course of action, such as refusal of services, that may involve increased risk of personal harm and conflict with the ALR’s usual responsibilities, the ALR shall:
(1) Describe to the resident the action or range of actions subject to negotiation; and
(2) Negotiate a shared responsibility agreement, with the resident as a full partner, acceptable to the resident and the ALR that meets all reasonable requirements implicated. The shared responsibility agreement shall be signed by the resident or surrogate and the ALR.
(June 24, 2000, D.C. Law 13-127, § 605, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.06. Resident records

§ 44–106.06. Resident records.
A record shall be maintained for every resident and include the following:
(1) The resident agreement required by this subchapter, including the “Resident’s Rights” statement and any additional agreements;
(2) The functional assessment of ADLs;
(3) A physician’s statement, including medical orders and rehabilitation plans;
(4) The ISP and any revisions thereto;
(5) All shared responsibility agreements; and
(6) Any note and comments added to the record by the ALR.
(June 24, 2000, D.C. Law 13-127, § 606, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.07. Services to be provided

§ 44–106.07. Services to be provided.
(a) An ALR shall provide or ensure the provision of the following:
(1) Twenty-four hour supervision and oversight to ensure the well-being and safety of its residents;
(2) Three nutritious and attractive meals and additional snacks, modified to individual dietary needs as necessary, on a daily basis;
(3) A variety of fresh and seasonal foods, adapted to the food habits, preferences, and physical abilities of the residents;
(4) At minimum, some assistance with ADLs and IADLs to meet the scheduled and unscheduled service needs of the residents; and
(5) Laundry and housekeeping service not provided by the resident or surrogate.
(b) An ALR shall facilitate access for a resident to appropriate health and social services, including social work, home health agencies, nursing, rehabilitative, hospice, medical, dental, dietary, counseling, and psychiatric services.
(c) An ALR shall provide or coordinate scheduled transportation to community-based services.
(June 24, 2000, D.C. Law 13-127, § 607, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VI - Admissions; Residential Agreements; Quality of Care; Discharge; Transfer › § 44–106.08. Discharge and transfer

§ 44–106.08. Discharge and transfer.
(a) When a resident wishes to be discharged from an ALR, the resident or surrogate shall give 30 days written notice to the ALR.
(b) When a sudden, unexpected, and life-threatening medical emergency arises necessitating the immediate transfer of the resident to an acute care facility, the ALR shall immediately notify the surrogate and the resident’s healthcare provider of the transfer. The ALR shall provide the surrogate and healthcare provider with information concerning cause of the transfer and the name and location of the acute care facility.
(c) After a resident is transferred pursuant to subsection (b) of this section, his or her return to the ALR shall be determined by the renegotiation of the ISP with the resident or surrogate, the resident’s healthcare provider, and the ALR. If, in renegotiating the ISP, the interested parties determine that the resident can no longer safely reside at the ALR, discharge planning shall take place in consultation with the resident or surrogate, the resident’s healthcare provider, and the ALR. Under these circumstances the ALR shall waive the 30 day notice requirement.
(d) Before a resident may be discharged on an involuntary basis, the ALR shall provide 30 days written notice to the resident and surrogate of the planned discharge, and make arrangements for the discharge in consultation with the resident, the surrogate, and the healthcare provider. Any involuntary discharge shall conform to the notice and process established in subchapter III of Chapter 10 of this title.
(e) Although an ALR shall make every effort to avoid discharge, grounds for involuntary discharge may include the following:
(1) Failure to pay all fees and costs as specified in the contract; and
(2) Inability of the ALR to meet the care needs of the resident as provided in the ISP.
(f) An involuntary discharge shall be canceled upon the occurrence of one of the following:
(1) The payment of all monies owed at any time prior to discharge; or
(2) The negotiation of a new ISP.
(June 24, 2000, D.C. Law 13-127, § 608, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VIII - Resident Assessment › § 44–108.01. General

§ 44–108.01. General.
A resident assessment required by this subchapter shall form the basis for the development of the resident’s service plan, and shall be completed for all routine admissions to the ALR.
(June 24, 2000, D.C. Law 13-127, § 801, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VIII - Resident Assessment › § 44–108.02. Medical, rehabilitation, and psychosocial assessment

§ 44–108.02. Medical, rehabilitation, and psychosocial assessment.
(a) A medical, rehabilitation, and psychosocial assessment of the resident shall be completed within 30 days prior to admission.
(b) The ALR shall maintain resident information obtained from a standardized physician’s statement approved by the Mayor. The information shall include a description of the applicant’s current physical condition and medical status relevant to defining care needs, and the applicant’s psychological and cognitive status, if so indicated during the medical assessment.
(c) The assessment shall be based on an examination by the prospective resident’s primary, licensed healthcare practitioner within 30 days prior to admission. The information obtained from the examination shall include at least the following:
(1) The individual’s medical history with a recent evaluation;
(2) Any significant medical conditions affecting function, including the individual’s ability for self-care, cognition, behavior, and psychosocial activities;
(3) Presence of allergies;
(4) Confirmation that the applicant is free from communicable TB and from other active, infectious, and reportable communicable diseases;
(5) Current medication profile and projected and other needed medications, treatments and service; review of nonprescription drugs and review of possible adverse interactions;
(6) Current dietary needs and restrictions;
(7) Medically necessary limitations or precautions; and
(8) Monitoring or tests that may need to be performed or followed up after admission.
(June 24, 2000, D.C. Law 13-127, § 802, 47 DCR 2647.)
Section References
This section is referenced in § 44-102.01.
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VIII - Resident Assessment › § 44–108.03. Functional assessment

§ 44–108.03. Functional assessment.
Within 30 days prior to admission, the facility shall collect, on a standardized form approved by the Mayor, the following information regarding each applicant:
(1) Level of functioning in activities of daily living including bathing, dressing, grooming, eating, toileting, and mobility;
(2) Level of support and intervention, including any special equipment and supplies, required to compensate for the individual’s deficits in activities of daily living;
(3) Current physical or psychological symptoms of the individual requiring monitoring, support, or other intervention by the ALR;
(4) Capacity of the individual for making personal and healthcare related decisions;
(5) Presence of disruptive behavior or behavior which presents a risk to the physical or emotional health and safety of self or others;
(6) Social factors, including:
(A) Significant problems with family circumstances and personal relationships;
(B) Spiritual status and needs; and
(C) Ability to participate in structured and group activities and the resident’s current involvement in such activities.
(June 24, 2000, D.C. Law 13-127, § 803, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VIII - Resident Assessment › § 44–108.04. Short-term residential care

§ 44–108.04. Short-term residential care.
For individuals who will stay in the ALR no longer than 30 days, only the following information is required for admission to the ALR:
(1) An analysis of the individual’s current physical condition, medical status, and functional assessment as set out in this subchapter; and
(2) A resident agreement in accordance with this chapter.
(June 24, 2000, D.C. Law 13-127, § 804, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter VIII - Resident Assessment › § 44–108.05. Emergency placement

§ 44–108.05. Emergency placement.
A resident admitted as an emergency placement, not to exceed 14 days, must comply with admission, physical examination, and assessment requirements of this chapter.
(June 24, 2000, D.C. Law 13-127, § 805, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.01. Responsibilities of the ALR personnel in medication management

§ 44–109.01. Responsibilities of the ALR personnel in medication management.
An ALA shall ensure that an initial assessment identifies whether a resident:
(1) Is capable of self-administering his or her own medications;
(2) Is capable of self-administering his or her own medication, but requires a reminder to take medications or requires physical assistance with opening and removing medications from the container, or both; or
(3) Requires that medications be administered by a TME or a licensed nurse.
(June 24, 2000, D.C. Law 13-127, § 901, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.02. Pre-admission medication management assessment

§ 44–109.02. Pre-admission medication management assessment.
Within 30 days prior to admission, the ALR shall consult with the prospective resident’s healthcare practitioner regarding:
(1) The prospective resident’s current medication profile, including a review of nonprescription drugs;
(2) Possible adverse interactions;
(3) Common expected or unexpected side effects; and
(4) The potential that such medications have to act as chemical restraints.
(June 24, 2000, D.C. Law 13-127, § 902, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.03. On-site medication review

§ 44–109.03. On-site medication review.
The ALR shall arrange for an on-site review by a registered nurse every 45 days to:
(1) Supervise the administration of medications by Trained Medication Employees;
(2) Assess the resident’s response to medication; and
(3) Assess the resident’s ability to continue to self-administer his or her medications.
(June 24, 2000, D.C. Law 13-127, § 903, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.04. Medication storage

§ 44–109.04. Medication storage.
(a) The ALA shall provide a secured space for medication storage with access to a sink and cold storage in the same area. Space for necessary medical supplies and equipment shall be provided.
(b) The storage area shall be kept locked when not in use.
(c) The storage area shall be used only for storage of medications and medical supplies.
(d) The key to the storage area shall be kept on the person of the employee on duty who is responsible for administering the medications.
(e)(1) All medications shall be kept in their original packaging and shall be properly labeled and identified.
(2) The label of each resident’s prescription medication container shall be permanently affixed and contain the resident’s full name, healthcare practitioner’s name, prescription number, name and strength of drug, lot number, quantity, date of issue, expiration date, manufacturer’s name, if generic, directions for use, and cautionary or accessory information. Required information appearing on individually packaged drugs or within an alternate medication delivery system need not be repeated on the label.
(3) All over-the-counter (OTC) medications repackaged by the pharmacy shall be labeled with an expiration date, name and strength of the drug, lot number, date of issue, manufacturer’s name if generic, and cautionary or accessory labels, in accordance with U.S.P. regulations. Original manufacturer’s containers shall be labeled with at least the resident’s name. The name label shall not obstruct any of the aforementioned information.
(4) In the “unit of use” distribution system, each dose of medication shall be individually packaged in a hermetically sealed, tamper-proof container, and shall carry full manufacturer’s disclosure information on each discrete dose. Disclosure information shall include product name, strength, lot number, expiration date, and the manufacturer’s distributor’s name.
(5) Single use and disposable items shall not be reused.
(6) No stock supply of prescription medications shall be maintained, unless prior approval is obtained from the Mayor.
(7) Discontinued or expired medications shall be destroyed within 30 days in the ALR, or, if unopened and properly labeled, returned to the pharmacy. All medication destroyed in the ALR shall be witnessed and documented by two persons, one of whom shall be the ALA or the ALA designee.
(8) Residents who self-administer may keep and use prescription and nonprescription medications in their units as long as they keep them secured from other residents.
(June 24, 2000, D.C. Law 13-127, § 904, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.05. Medication administration

§ 44–109.05. Medication administration.
(a) Licensed nurses, physicians, physician assistants, and TMEs may administer medications to residents or assist residents with taking their medications.
(b)(1) Each resident shall be identified prior to drug administration.
(2) Drugs prescribed for one resident shall not be administered to another resident.
(3) The TME shall report drug errors to the healthcare practitioner or licensed nurse and shall document the incident in the resident’s record.
(June 24, 2000, D.C. Law 13-127, § 905, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.06. Medication management training program

§ 44–109.06. Medication management training program.
(a) The Mayor shall develop medication management training courses which shall be approved by the Board of Nursing. The medication administration training program shall include instruction in the following areas:
(1) Cuing, coaching, and monitoring residents who self-administer medications with or without assistance;
(2) Pharmacology;
(3) Terminology related to medication;
(4) Procedures and precautions in administering medication;
(5) Types of medication;
(6) Actions, interactions, and effects of medication;
(7) Administration of medication in emergency or life-threatening circumstances;
(8) Recordkeeping, storage, handling, and disposal requirements for medications;
(9) Rights of residents;
(10) Monitoring of vital signs;
(11) Federal and District of Columbia laws governing medication; and
(12) Reference sources related to medication.
(b) The Mayor shall maintain a list of approved medication administration courses for the training of persons to be certified by the District of Columbia as TMEs.
(c) In order to maintain certification, every 2 years a TME shall successfully complete a clinical update or refresher course approved by the Mayor.
(d) The ALA shall document completion of the medication training course in TME’s personnel file.
(June 24, 2000, D.C. Law 13-127, § 906, 47 DCR 2647.)
Section References
This section is referenced in § 44-102.01.
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter IX - Medication Management › § 44–109.07. Medication control

§ 44–109.07. Medication control.
(a) Each resident shall be identified prior to drug administration.
(b) Drugs prescribed for one resident shall not be administered to another resident.
(c) Staff shall report drug errors and adverse drug reactions immediately to the ALA or ALA designee who shall report, as appropriate, to the doctor, prescriber, pharmacist, resident, and resident’s surrogate and shall document the incident in the resident’s record.
(d) A unit drug compliance package (blister or bubble or unit dose package) shall be developed and implemented where feasible.
(e) Medications shall be refrigerated separately from lab specimens and food.
(June 24, 2000, D.C. Law 13-127, § 907, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter X - Facility Regulations › § 44–110.01. General conditions

§ 44–110.01. General conditions.
(a) An ALR shall meet applicable zoning, building, housing, sewer, water, fire prevention codes, rules, and regulations of the District of Columbia.
(b) An ALR shall maintain all structures, installed equipment, grounds, and individual living units in good repair and operable.
(c) An ALR may be classified as a residential occupancy and may be located in a single or multi-family dwelling.
(June 24, 2000, D.C. Law 13-127, § 1001, 47 DCR 2647.)
2023 District of Columbia Code › Title 44 - Charitable and Curative Institutions › Chapter 1 - Assisted Living Residence Regulation › Subchapter X - Facility Regulations › § 44–110.02. Fire safety

§ 44–110.02. Fire safety.
An ALR shall comply with the Life Safety Code of the National Fire Protection Association, NFPA 101, 1997 edition as follows:
(1) An ALR shall be in compliance with Chapter 22, New Residential Board and Care Occupancies, Life Safety Code of the National Fire Protection Association; and
(2) An existing community residence facility that is converting to an ALR shall be in compliance with Chapter 23, Existing Residential Board and Care Occupancies, of the Life Safety Code of the National Fire Protection Association.
(June 24, 2000, D.C. Law 13-127, § 1002, 47 DCR 2647.)