Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 86 - Residential Care Facilities and Assisted Living Facilities › Section 19 CSR 30-86.047 - Administrative, Personnel, and Resident Care Requirements for Assisted Living Facilities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes standards for all
				  assisted living facilities licensed pursuant to sections
				  198.005
				  and
				  198.073,
				  RSMo
(
CCS HCS SCS SB 616, 93rd General Assembly, Second
				  Regular Session (2006)) and required to meet assisted living facility standards
				  pursuant to section 198.073.3, RSMo
(
CCS HCS SCS SB 616, 93rd
				  General Assembly, Second Regular Session (2006)) and section
				  198.076,
				  RSMo 2000.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
AGENCY NOTE: All rules relating to long-term care
				  facilities licensed by the department are followed by a Roman Numeral notation
				  which refers to the class (either Class I, II, or III) of standard as
				  designated in section 198.085.1., RSMo.
(1) Facilities licensed as assisted living
				facilities shall be inspected pursuant to the standards outlined herein
				beginning April 1, 2007. An assisted living facility may request, in writing to
				the department, to comply with these standards prior to April 1, 2007. Upon
				receipt of the request, the department shall conduct an inspection to determine
				compliance with the standards outlined herein prior to issuing a license
				indicating such compliance.
(2)
				Consumer Education Requirements. The facility shall disclose to a prospective
				resident, or legal representative of the resident, information regarding the
				services the facility is able to provide or coordinate, the cost of such
				services to the resident, and the grounds for discharge or transfer as
				permitted or required by the Omnibus Nursing Home Act, Chapter 198, RSMo and
				the department's regulations, including the provisions set forth in section
				(29) of this rule. II
(3) Nothing
				in this rule shall be construed to allow any facility that has not met the
				requirements of 198.073(4) and (6), RSMo, (CCS HCS SCS SB 616, 93rd General
				Assembly, Second Regular Session (2006)) and
				19
				CSR 30-86.045 to care for any individual with a
				physical, cognitive or other impairment that prevents the individual from
				safely evacuating the facility with minimal assistance. I/II
(4) Definitions. For the purpose of this
				rule, the following definitions shall apply:
(A) Appropriately trained and qualified
				individual means an individual who is licensed or registered with the state of
				Missouri in a health care related field or an individual with a degree in a
				health care related field or an individual with a degree in a health care,
				social services, or human services field or an individual licensed under
				Chapter 344, RSMo, and who has received facility orientation training under
				19
				CSR 30-86.042(18), and dementia
				training under section
				660.050,
				RSMo, and twenty-four (24) hours of additional training, approved by the
				department, consisting of definition and assessment of activities of daily
				living, assessment of cognitive ability, service planning, and interview
				skills;
(B) Area of refuge-A space
				located in or immediately adjacent to a path of travel leading to an exit that
				is protected from the effects of fire, either by means of separation from other
				spaces in the same building or its location, permitting a delay in evacuation.
				An area of refuge may be temporarily used as a staging area that provides
				relative safety to its occupants while potential emergencies are assessed,
				decisions are made, and evacuation is begun;
(C) Assisted living facility (ALF)-Is as
				defined in
				19 CSR
				30-83.010;
(D) Chemical restraint-Is as defined in
				19 CSR
				30-83.010;
(E) Community based assessment-Documented
				basic information and analysis provided by appropriately trained and qualified
				individuals describing an individual's abilities and needs in activities of
				daily living, instrumental activities of daily living, vision/hearing,
				nutrition, social participation and support, and cognitive functioning using an
				assessment tool approved by the department, that is designed for community
				based services and that is not the nursing home minimum data set. The
				assessment tool may be one developed by the department or one used by a
				facility which has been approved by the department;
(F) Evacuating the facility-For the purpose
				of this rule, evacuating the facility shall mean moving to an area of refuge or
				from one smoke section to another or exiting the facility;
(G) Home-like-Means a self-contained
				long-term care setting that integrates the psychosocial, organizational and
				environmental qualities that are associated with being at home. Home-like may
				include, but is not limited to the following:
1. A living room and common use areas for
				social interactions and activities;
2. Kitchen and family style eating area for
				use by the residents;
3. Laundry
				area for use by residents;
4. A
				toilet room that contains a toilet, lavatory and bathing unit in each
				resident's room;
5. Resident room
				preferences for residents who wish to share a room, and for residents who wish
				to have private bedrooms;
6.
				Outdoor area for outdoor activities and recreation; and
7. A place where residents can give and
				receive affection, explore their interests, exercise control over their
				environment, engage in interactions with others and have privacy, security,
				familiarity and a sense of belonging;
(H) Individualized service plan (ISP)- Shall
				mean the planning document prepared by an assisted living facility, which
				outlines a resident's needs and preferences, services to be provided, and the
				goals expected by the resident or the resident's legal representative in
				partnership with the facility;
(I)
				Keeping residents in place-Means maintaining residents in place during a fire
				in lieu of evacuation where a building's occupants are not capable of
				evacuation, where evacuation has a low likelihood of success, or where it is
				recommended in writing by local fire officials as having a better likelihood of
				success and/or a lower risk of injury;
(J) Minimal assistance-
1. Is the criterion which determines whether
				or not staff must develop and include an individualized evacuation plan as part
				of the resident's service plan;
2.
				Minimal assistance may be the verbal intervention that staff must provide for a
				resident to initiate evacuating the facility;
3. Minimal assistance may be the physical
				intervention that staff must provide, such as turning a resident in the correct
				direction, for a resident to initiate evacuating the facility;
4. A resident needing minimal assistance is
				one who is able to prepare to leave and then evacuate the facility within five
				(5) minutes of being alerted of the need to evacuate and requires no more than
				one (1) physical intervention and no more than three (3) verbal interventions
				of staff to complete evacuation from the facility;
5. The following actions required of staff
				are considered to be more than minimal assistance:
A. Assistance to traverse down stairways
				;
B. Assistance to open a door;
				and
C. Assistance to propel a
				wheelchair;
(K) Physical restraint-Any manual method or
				physical or mechanical device, material, or equipment attached to or adjacent
				to the resident's body that the individual cannot remove easily which restricts
				freedom of movement or normal access to one's body. Physical restraints
				include, but are not limited to, leg restraints, arm restraints, hand mitts,
				soft ties or vests, lap cushions, and lap trays the resident cannot remove
				easily. Physical restraints also include facility practices that meet the
				definition of a restraint, such as the following:
1. Using side rails that keep a resident from
				voluntarily getting out of bed;
2.
				Tucking in or using Velcro to hold a sheet, fabric, or clothing tightly so that
				a resident's movement is restricted;
3. Using devices in conjunction with a chair,
				such as trays, tables, bars, or belts, that the resident cannot remove easily,
				that prevent the resident from rising;
4. Placing the resident in a chair that
				prevents a resident from rising; and
5. Placing a chair or bed so close to a wall
				that the wall prevents the resident from rising out of the chair or voluntarily
				getting out of bed;
(L)
				Significant change-means any change in the resident's physical, emotional or
				psychosocial condition or behavior that will not normally resolve itself
				without further intervention by staff or by implementing standard
				disease-related clinical interventions, that has an impact on more than one (1)
				area of the resident's health status, and requires interdisciplinary review or
				revision of the individualized service plan, or both;
(M) Skilled nursing facility-Means any
				premises, other than a residential care facility, assisted living facility or
				an intermediate care facility, which is utilized by its owner, operator or
				manager to provide for twenty-four (24) hour accommodation, board and skilled
				nursing care and treatment services to at least three (3) residents who are not
				related within the fourth degree of consanguinity or affinity to the owner,
				operator or manager of the facility. Skilled nursing care and treatment
				services are those services commonly performed by or under the supervision of a
				registered professional nurse for individuals requiring twenty-four
				(24)-hours-a-day care by licensed nursing personnel including acts of
				observation, care and counsel of the aged, ill, injured or infirm, the
				administration of medications and treatments as prescribed by a licensed
				physician or dentist, and other nursing functions requiring substantial
				specialized judgment and skill;
(N)
				Skilled nursing placement-Means placement in a skilled nursing facility as
				defined in subsection (4)(M) of this rule; and
(O) Social model of care-Means long-term care
				services based on the abilities, desires, and functional needs of the
				individual delivered in a setting that is more homelike than institutional,
				that promote the digni-t y, individuality, privacy, independence and autonomy
				of the individual, that respects residents' differences and promotes residents'
				choices.