Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 25 - Division of Provider Services and Quality Assurance › Rule 016.25.19-005 - Rules for Assisted Living Facilities Level II

Current through Register Vol. 49, No. 6, June, 2024
RULES FOR ASSISTED LIVING FACILITIES LEVEL
				II
100
SCOPE
These rules constitute the basis for the licensure of Level I
				assisted living facilities by the Arkansas Department of Human Services,
				Division of Medical Services, Office of Long Term Care. The Office of Long Term
				Care reserves the right, and may at any time, waive any or all of the
				requirements herein in event of emergency or for good cause shown in the sole
				determination of the Office of Long Term Care.
200
PURPOSE
The purpose of these rules is to establish standards for Level
				I assisted living facilities that provide services in a homelike environment
				for elderly and disabled persons. Level I assisted living facilities ensure
				that residents receive supportive health and social services as they are needed
				to enable them to maintain their individuality, privacy, dignity, and
				independence, in the highest degree possible in an apartment-style living unit.
				The assisted living environment actively encourages and supports these values
				through effective methods of service delivery and facility or program
				operation. The environment promotes resident self-direction and personal
				decision-making while protecting resident's health and safety.
300
DEFINITIONS
As used in these rules, the following definitions shall apply
				unless the context clearly states otherwise. Where these rules refer to an
				enactment of the General Assembly, such reference shall include subsequent
				enactment or amendments by the General Assembly on the same subject
				matter.
Abuse
- Shall have the same meaning as
				prescribed by Ark. Code Ann. § 5-28101 and
				42
				CFR §
										488.301. "Abuse" also includes
				sexual abuse as defined in Ark. Code Ann. §
									5-28-101(12).
Activities of Daily Living
- The
				activities of daily living that are performed either independently, with
				supervision, with assistance, or by others. Activities of daily living include,
				but are not limited to, ambulating, transferring, grooming, bathing, dressing,
				eating and toileting.
ADA
- The Americans with Disabilities
				Act.
Administrator
- The person who has
				successfully completed a course of training or instruction certified by the
				Office of Long Term Care as an assisted living facility administrator who is in
				charge of the daily operation of the facility. Until programs have been
				certified by the Office of Long Term Care
,
Residential
				Care Facility Administrators or Nursing Home Administrators may be used.
Advertise
- To make publicly and
				generally known. For purposes of this definition,
advertise
includes, but is not limited to:
1.
			 Signs, billboards, or lettering;
2.
			 Electronic publishing or broadcasting, including the use of the Internet or
			 e-mail; and
3. Printed material.
Alzheimer's Special Care Unit (ASCU)
-
				A separate and distinct unit within an Assisted Living or other Long Term Care
				facility that segregates and provides a special program for residents with a
				diagnosis of probable Alzheimer's disease or related dementia, and that
				advertises, markets or otherwise promotes the facility as providing specialized
				Alzheimer's or related dementia care services.
Assisted Living Facility (ALF)
- Any
				building or buildings, section or distinct part of a building, boarding home,
				home for the aged or other residential facility whether operated for profit or
				not that undertakes through its ownership or management to provide assisted
				living services for a period exceeding twenty-four (24) hours to more than
				three (3) adult residents of the facility who are not relatives of the owner or
				administrator. Assisted living facility means facilities in which assisted
				living services are provided either directly or through contractual
				arrangements or in which contracting in the name of residents is
				facilitated.
Assisted Living Program
- A program of
				assisted living services.
Assisted Living Services
- Housing,
				meals, laundry, social activities, assistance with transportation, direct care
				services, health care services, 24-hour supervision and care, and limited
				nursing services. For purposes of these rules,
assistance with
				transportation
means making arrangements for transportation.
Caregiver
- Shall have the same
				meaning prescribed by Ark. Code Ann. § 5-28101.
Choice
- Viable options available to a
				resident that enables the resident to exercise greater control over his or her
				life. Choice is supported by resident's self-directed care (including methods
				and scheduling) established through the care planning process, and the
				provision of sufficient private and common space within the facility to provide
				opportunities for residents to select when and how to spend time, and when and
				how to receive personal or assisted living services.
Common Areas (for Alzheimer's Special Care
				Units)
- Portions of the Alzheimer's Special Care Unit, exclusive
				of residents' rooms and bathrooms. Common areas include any facility grounds
				accessible to residents of the Alzheimer's Special Care Unit.
Compliance Agreement
- If needed, the
				written formal plan developed in consideration of shared responsibility, choice
				and assisted living values and negotiated between the resident or his or her
				responsible party and the assisted living facility to avoid or reduce the risk
				of adverse outcomes that may occur in an assisted living environment.
Continuous
- Available at all times
				without cessation, break or interruption.
Deficiency
- A facility's failure to
				meet program participation requirements as defined in these and other
				applicable rules and laws.
Dementia
- A loss or decrease in
				intellectual ability that is of sufficient severity to interfere with social or
				occupational functioning; it describes a set of symptoms such as memory loss,
				personality change, poor reasoning or judgment, and language
				difficulties.
Department
- The Department of Human
				Services and its divisions and offices.
Direct Care Services
- Services that
				directly help a resident with certain activities of daily living such as
				assistance with mobility and transfers; assistance to resident to consume a
				meal, grooming, shaving, trimming or shaping fingernails and toenails, bathing,
				dressing, personal hygiene, bladder and bowel requirements, including
				incontinence, or assistance with medication, only to the extent permitted by
				the state Nurse Practice Act and interpretations thereto by the Arkansas State
				Board of Nursing.
Direct Care Service Plan
- A written
				plan for direct care services that is developed to meet the needs and
				preferences of the resident or his or her responsible party through a
				negotiated process that becomes a part of the resident's occupancy admission
				agreement.
Direct Care Staff
- Any licensed or
				certified staff acting on behalf of, employed by, or contracted by the
				facility, to provide services and who provides direct care services or
				assistance to residents, including activities of daily living and tasks related
				to medication administration or assistance.
Direct Care Staff (Alzheimer's Special Care
				Unit)
- An individual who is an employee of the facility, or an
				individual who is an employee of a temporary or employment agency assigned to
				work in the facility, who has received or will receive, in accordance with
				these rules, specialized training regarding Alzheimer's or related dementia,
				and who is responsible for providing direct, hands-on care or cuing services to
				residents of the ASCU.
Direct Contact
- The ability or
				opportunity of employees of the facility, or individuals with whom the facility
				contracts, to physically interact with or be in the presence of
				residents.
Direct Threat
- A significant risk to
				the health or safety of self or others that cannot be eliminated by reasonable
				accommodation. This term as used in these rules is designed to ensure
				conformity with the Americans with Disabilities Act (ADA) in determining
				whether a person with a disability poses a "direct (health or safety)
				threat".
Directed Plan of Correction
- A plan
				developed by the Office of Long Term Care that describes the actions the
				facility will take to correct deficiencies and specifies the date by which
				those deficiencies will be corrected.
Discharge
- When a resident leaves the
				facility, and it is not anticipated that the resident will return. A discharge
				occurs when a return to the facility by the resident requires that admission
				procedures set forth in these rules be followed.
Disclosure Statement (Alzheimer's Special Care
				Unit)
- A written statement prepared by the facility and provided
				to individuals or their responsible parties, and to individual's families,
				prior to admission to the ASCU, disclosing the form of care, treatment, and
				related services especially applicable to, or suitable for residents of, the
				ASCU.
Elopement
- Circumstances where a
				resident, who has been identified as being cognitively impaired, has left a
				facility without staff knowledge. Facilities must comply with all reporting
				requirements of any special programs in which they participate.
Emergency Measures
- Those measures
				necessary to respond to a serious situation that threatens the health and
				safety of residents.
Endangered Adult
- Shall have the same
				meaning as prescribed by Ark. Code Ann. §
										5-28-101 and as
				amended.
Exploitation
- Shall have the same
				meaning as prescribed by Ark. Code Ann. § 528-101.
First Aid Measures
- Temporary
				interventions necessary to treat trauma or injury.
Health Care Service Plan
- A written
				plan for health care services that is developed to meet the needs and
				preferences of the resident or his or her responsible party through a
				negotiated process that becomes a part of the resident's occupancy admission
				agreement.
Health Care Services
- The provision
				of services in an assisted living facility that assists the resident in
				achieving and maintaining well-being (e.g., psychological, social, physical,
				and spiritual) and functional status. This may include nursing assessments and
				the monitoring and delegation of nursing tasks by registered nurses pursuant to
				the Nurse Practice Act and interpretations thereto by the Arkansas State Board
				of Nursing, care management, records management and coordinating basic health
				care and social services in such settings. Health care services may not be
				provided in a Level I Assisted Living Facility except as provided in Section
				702 of these rules.
Home Health Services
- Home health
				aide services, medical supplies suitable for use in the resident's assisted
				living facility apartment, and nursing services as defined in the state Nurse
				Practice Act and interpretations thereto by the Arkansas State Board of
				Nursing.
IDR
- The informal dispute resolution
				process as described in these rules.
Imminent Danger to Health and Safety
-
				Shall have the same meaning as prescribed by Ark. Code Ann. §
										5-28-101.
Impaired Adult
- Shall have the same
				meaning as prescribed by Ark. Code Ann. §
										5-28-101.
Independence
- The maintenance and
				promotion of resident capabilities to enhance the resident's preferences and
				choices within a barrier-free environment.
Individual Assessment Team (IAT)
- A
				group of individuals possessing the knowledge and skills to identify the
				medical, behavioral, and social needs of residents of the Alzheimer's Special
				Care Unit (ASCU), and to develop services designed to meet those needs.
Individual Support Plan
- A written
				plan developed by an Individual Assessment Team (IAT) that identifies services
				to a resident of the Alzheimer's Special Care Unit (ASCU).
Limited Nursing Services
- Acts that
				may be performed by licensed personnel while carrying out their professional
				duties, but limited to those acts that the department specifies by rule. Acts
				that may be specified by rule as allowable limited nursing services shall be
				for persons who meet the admission criteria established by the Department for
				facilities offering assisted living services, shall not be complex enough to
				require twenty-four (24) hour nursing supervision and may include such services
				as application and care of routine dressings, and care of casts, braces, and
				splints.
Long Term Care Facility License
- A
				time-limited, non-transferable, permit required by Ark. Code Ann. §
										20-10-224
				and issued for a maximum period of twelve (12) months to a licensee who
				complies with Office of Long Term Care rules. This document must list the
				maximum number of beds for the facility.
Medication Assistance and Monitoring
-
				Services provided by the facility, either directly or through contract, in
				accordance with the Nurse Practices Act and interpretations thereto by the
				Arkansas State Board of Nursing, designed to ensure that residents receive
				necessary or prescribed medication, and to prevent wastage of
				medication.
Mental Abuse
- Verbal, written, or
				gestured communication, to a resident, or to a visitor or staff, about a
				resident within the resident's presence, or in a public forum, that a
				reasonable person finds to be a material endangerment to the mental health of a
				resident.
Neglect
- Shall have the same meaning
				as prescribed by Ark. Code Ann. § 5-28101 and
				42
				C.F.R. §
											488.301.
New Admission
- An individual who is
				being admitted to the facility for the first time, or who is returning after a
				formal discharge.
Non-Compliance
- Any violation of
				these rules, or of applicable law or rules.
Nurse Practice Act
- As used in these
				rules, the term
Nurse Practice Act
refers to Ark. Code Ann.
				§
										17-87-101
et seq.
and interpretations thereto by the Arkansas State
				Board of Nursing.
Operator
- The individual or entity
				that conducts the business of the facility. The individual or individuals
				executing the licensure application form shall be deemed an operator.
OLTC
- The Office of Long Term
				Care.
Office of Long Term Care
- The Office
				in the Division of Medical Services of the Department of Human Services that
				has responsibility for the licensure, certification, and rules, of long term
				care facilities, herein referred to as the Office or OLTC.
Person
- An individual, partnership,
				association, corporation, or other entity.
Personnel/Staff/Employee
- Any person
				who, under the direction, control, or supervision of facility administration,
				provides services as defined in these rules for compensation, or who provides
				services voluntarily, and may include the owner, operator, professional,
				management and persons, firms, or entities providing services pursuant to a
				contract or agreement.
Plan of Correction (P-o-C)
- A plan
				developed by the facility and approved by OLTC that describes the actions the
				facility will take to correct deficiencies, and which specifies the date by
				which those deficiencies will be corrected.
PRN
- A medication or treatment
				prescribed by a medical professional to a person, allowing the medication or
				ointment to be given "as needed".
Program Requirements
- The
				requirements for participation and licensure under these and other applicable
				rules and laws as an assisted living facility.
Proprietor/Licensee
- Any person,
				firm, corporation, governmental agency or other legal entity, issued an
				assisted living facility license, and who is responsible for maintaining
				approved standards.
Protective Services
- Shall have the
				same meaning as prescribed by Ark. Code Ann. §
										5-28-101.
Provisional Licensure
is a temporary
				grant of authority to the purchaser to operate an existing long-term care
				facility upon application for licensure to the Office of Long Term Care.
Provisional Placement
- Placement in
				an assisted living facility made for the purposes of assessment to determine
				appropriateness of admission or emergency, such as placement by law enforcement
				or Adult Protective Services. A provisional placement shall be permitted for no
				longer than thirty (30) days, at which time the resident must either be
				discharged or admitted to the facility in conformity with theses rules. A
				provisional placement shall not be an admission pursuant to these rules, and
				any individual in an assisted living facility pursuant to a provisional
				placement shall not be deemed a resident of the facility.
Responsible Party
- An individual,
				who, at the request of the applicant or resident, or by appointment by a court
				of competent jurisdiction, agrees to act on behalf of a resident or applicant
				for the purposes of making decisions regarding the needs and welfare of the
				resident or applicant. These rules, and this definition, does not grant or
				permit, and should not be construed as granting or permitting, any individual
				authority or permission to act for or on behalf of a resident or applicant in
				excess of any authority or permission granted by law. A competent resident may
				select a responsible party or may choose not to select a responsible party. In
				no event may an individual act for, or on behalf of, a resident or applicant
				when the resident or applicant has a legal guardian, attorneyin-fact, or other
				legal representative. For purposes of these rules only, responsible party will
				also refer to the terms
legal representative, legal guardian, power of
				attorney
or similar phrase
.
Separate Premises
- Buildings housing
				Assisted Living Facility operations that are located on non-contiguous
				land.
Significant Change
- Any improvement
				or decline in a resident's medical, physiological, psychological, or social
				condition, in which:
a. The decline
			 cannot be reasonably expected to resolve itself; or,
b. In which the decline may cause a worsening
			 of another or pre-existing medical, physiological, psychological, or social
			 condition.
Substandard Quality of Care
- One or
				more deficiencies related to participation requirements, as set forth in these
				or other applicable rules or laws, that constitute either immediate jeopardy to
				resident health or safety; a pattern of, or widespread actual harm, that is not
				immediate jeopardy; or a widespread potential for more than minimal harm, but
				less than immediate jeopardy, with no actual harm.
Survey
- The process of inspection,
				interviews, or record reviews, conducted by the Office of Long Term
				Care.
Standard Survey
- A comprehensive
				survey conducted by the Office of Long Term Care on an average of every 18
				months for each facility.
Transfer
- The temporary or permanent
				relocation of a resident from one living unit within the facility to another
				living unit within the facility, or the temporary relocation of a resident to a
				location outside the facility.
Twenty-Four (24) Hour Nursing
-
				Services that are ordered by a physician or advance practice nurse for a
				resident whose condition requires the supervision of a physician or advance
				practice nurse and continued monitoring of vital signs and physical status and
				whose condition is medically complex enough to require on site nursing
				supervision on a twenty-four (24) hour per day basis.
Visually and Functionally Distinct
				Area
- A space that can be distinguished from other areas within
				the apartment by sight. A visually and functionally distinct area need not be a
				separate room. To create a visually distinct area, one or more of the following
				methods must be employed: change in ceiling height, separation by ceiling
				soffit(s) or wall returns, change in flooring color, partial height partitions
				or counters, use of alcoves, use of permanent screening devices such as columns
				or fixed screens. In the case of an "L" shaped studio apartment or unit,
				kitchenettes and living areas may be combined and bedroom areas may be in a leg
				of an "L" shaped plan and qualify without additional separation
				methods.