ࡱ> @ [Cbjbj.. `DD/ 4X(^| DO k ]V$=Rp   ϒ<X-`  Grg\< $ "/{ ] XF{ { { /XRegulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs Part of 10-144 Chapter 113 Effective Date (last amended): August 20, 2008  fb88 Department of Health and Human Services Division of Licensing and Regulatory Services State House Station 11 41 Anthony Ave. Augusta, ME 04333-0011 (207) 287-9300 1-800-791-4080 TDD 1-800-606-0215  HYPERLINK "mailto:dlrs.info@maine.gov" dlrs.info@maine.gov Assisted Living Programs Section 1. Purpose Section 2. Definitions Section 3. Licensing Responsibility for compliance. 1 Unlicensed facilities. 1 Person license issued to.. 1 Application and licensure 1 Application required. 1 Admission and scope of services policy.. 1 Additional licensing requirements 1 Requirement for bond. 1 Limitations on serving as legal representative 1 Issuance of license.. 2 Default licensing 2 Number of licenses required 2 Adult Day Services Programs located in the facility 2 Multilevel facility license 2 Provisional license. 2 Conditional license.. 3 Transfer of licenses 3 Term of license.. 3 Reapplications 3 Posting the license.. 3 Right of entry 3 Filing Plans of Correction 4 Reapplication subsequent to licensing actions. 4 Renewal. 4 Actions requiring prior written approval 4 Waivers. 4 Informal review of waiver denial 4 Rates and contracts.. 4 Rates.. 4 Signing a contract 4 Provisions of contract. 5 Information to consumers 6 Information for Residents of Alzheimers/Dementia Units 6 Refunds .. 7 Use of personal funds by operator.. 7 Tenancy obligation 7 Administrative and resident records. 7 Confidentiality 7 Location of records 7 Inspection of records 7 Record retention.. 7 Storage of records 7 Disaster plan 8 Confidential information 8 Section 4. Enforcement Procedures Inspections required.. 1 Frequency and type of inspections. 1 Licensing records kept by the Department.. 1 Complaints.. 1 Enforcement process. 1 Informal conference 2 Grounds for intermediate sanctions 2 Intermediate sanctions 2 Financial penalties 2 Other sanctions for failure to comply.. 4 Appeal rights 5 Operating without a license 6 Section 5. Consumer Rights Consumer rights 1 Freedom of choice of provider.. 1 Rights regarding transfer and discharge. 1 Transfer or discharge 1 Emergency transfer or discharge 2 Leaves of absence 2 Assistance in finding alternative placement. 2 Right to communicate grievances and recommend changes. 2 Right to manage financial affairs. 3 Right to freedom from abuse, neglect or exploitation. 3 Rights regarding restraints and aversive conditioning 3 Right to confidentiality. 4 Right to refuse to perform services for the facility.. 4 Right to privacy and consideration.. 4 Right to communicate privately with persons of choice. 4 Right to participate in activities of choice 4 Right to personal clothing and possessions.. 4 Couples 4 Right to be informed of services provided by the facility/program 4 Right to refuse treatment or services. 4 Right to be free from discrimination.. 5 Right to information regarding deficiencies. 5 Notification of Residents Rights.. 5 Bill of rights for persons with mental retardation 5 Mandatory report of rights violations 5 Reasonable modifications and accommodations.. 5 Right of action.. 6 Right to appeal an involuntary transfer or discharge. 6 Consumer adjudicated incompetent.. 6 Consumer councils.. 6 Right to a service plan.. 7 Section 6. Alzheimers/Dementia Unit Standards Alzheimers/Dementia Care Units 1 Admission requirements 1 Design standards 1 Physical design 1 Physical environment 2 Physical safety 2 Therapeutic activities for Alzheimers/Dementia Care Units 3 Pre-service training for Alzheimers/Dementia Care Units 3 Section 7. Medications and Treatments Use of safe and acceptable procedures 1 Administration of medications 2 Self administration.. 2 Medications administered by facility.. 2 Unlicensed assistive personnel 3 PRN Psychotropic medications 3 Medication storage 3 Temporary absences 4 Medication labeling.. 4 Improperly labeled medications. 5 Expired and discontinued medications. 5 Medication owned by residents 5 Destroying medications. 5 Schedule II controlled substances 5 Bulk supplies 6 Medication/treatment administration records 6 Medication containers 6 Breathing apparatus 6 Registered Nurse teaching of unlicensed personnel 7 Section 8. Verification of Credentials Licensed staff 1 Employing CNAs and CNA-Ms.. 1 Prohibited Employment 1 Time Limit on Consideration of Prior Criminal Conviction 1 Exception 2 Notification 2 Section 9. Scope of Licenses Change in level of services 1 Section 10. Consumer Records Individual records required. 1 Assessments and reassessments 1 Service plans.. 1 Release of information 1 Progress notes 2 Incident documentation 2 Section 11. Qualifications, Training and Responsibilities Operating standards 1 Minimum age 1 Criteria 1 Training for ALP provider 1 Administrator 1 Administrator training 2 Direct services staff 2 Employee records 2 Section 12. Services and Service Coordination Services 1 Additional responsibilities 1 Section 13. Dietary Services Food safety.. 1 Resident participation in meal planning 1 Meals 1 Registered dietitian. 1 Planned menus. 1 Therapeutic diets 1 Food supplies. 1 Section 14. Physical Plant and Sanitation Applicable standards. 1 Bathrooms. 1 Heat 1 Water temperature.. 1 Lockable door.. 1 Food preparation area 1 Private water supply.. 1 Garbage and rubbish.. 1 Insect and rodent control. 1 Poisonous and toxic materials 1 Section 15. Assisted Living Programs with Nursing Services (Type 2) Licensure required.. 1 Nursing services 1 Statutory authority A Section 1 Purpose These rules establish minimum standards for the licensing of assisted living programs. Assisted living services is the provision by an assisted living program, either directly by the provider or indirectly through contracts with persons, entities or agencies, assistance with activities of daily living and instrumental activities of daily living, personal supervision, protection from environmental hazards, meals, diet care, care management and diversional or motivational activities. Assisted living programs must be consumer oriented and meet professional standards of quality. Section 2 Definitions The following terms have the meanings as specified. 2.1 Abuse means the infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish, sexual abuse or exploitation, or the willful deprivation of essential needs. 2.2 Activities of Daily Living (hereinafter ADLs) means tasks routinely performed by a person to maintain bodily functions, including bed mobility, transfers, locomotion, dressing, eating, toileting, bathing and personal hygiene. 2.3 Adult Day Services means the care and supervision of consumers who attend daytime or nighttime programs but do not live in the building. 2.4 Advance Directives means a document signed by the consumer, guardian or agent under durable power of attorney, giving or withholding consent or approval related to medical or other professional care, counsel, treatment or service for the consumer, in the event that the consumer becomes unable to provide that direction. 2.5 Aging in Place means a program of services that furthers the independence of the consumer and respects their privacy and personal choices, including the choice to continue to reside at home for so long as the assisted living program, as it is fundamentally designed, is able to meet their needs. Assisted living programs provided to consumers must be consumer oriented and meet professional standards of quality. 2.6 Alzheimers/Dementia Care Unit means a unit, building or distinct part of a building that provides care/services in a designated, separated area for consumers with Alzheimers disease or other dementia. The unit, building or distinct part provides specialized programs, services and activities, and is locked, segregated or secured to provide or limit access by consumers inside and outside the designated or separated area. 2.7 Applicant means the person who owns the building and is applying for a license, or the person who is applying for a license pursuant to a valid lease agreement, contract or other agreement with the owner of the building that delineates the roles and duties under these rules. 2.8 Assisted Living Program means a program of assisted living services provided to consumers in private apartments in buildings that include a common dining area, either directly by the provider or indirectly through contracts with persons, entities or agencies. The types of assisted living programs governed by these regulations include: 2.8.1 Type I an assisted living program that provides medication administration directly or indirectly through contracts with persons, entities or agencies. 2.8.2 Type II an assisted living program that provides medication administration and nursing services directly or indirectly through contracts with persons, entities or agencies as follows: 2.8.2.1 Services of a Registered Professional Nurse; and/or 2.8.2.2 Registered Professional Nurse coordination and oversight of consumer services provided by unlicensed health care assistive personnel. 2.9 Assisted Living Services means the provision, either directly by the provider or indirectly through contracts with persons, entities or agencies, of assisted living services defined in any section of 2.9.1 through 2.9.6 plus the addition of 2.9.7 or any section of 2.9.1 through 2.9.6 plus the addition of 2.9.7 and 2.9.8. 2.9.1 Personal supervision, meaning general awareness of a consumers general whereabouts, giving consideration to the nature of the living arrangement; and, observation and assessment of each consumers functioning or behavior to enhance his or her health or safety or the health or safety of others; 2.9.2 Protection from environmental hazards, meaning mitigation of risk in the physical environment to prevent unnecessary injury or accident; 2.9.3 Assistance with Activities of Daily Living and Instrumental Activities of Daily Living; 2.9.4 Diversional, motivational or recreational activities, meaning activities that respond to consumers interests or which stimulate social interaction, both in individual and group settings; 2.9.5 Dietary services, meaning the provision of regular and therapeutic diets that meet each consumers minimum daily food requirements, based on the number of meals served, as defined by the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences; 2.9.6 Care Management Services, meaning a process of working with a consumer to identify his/her needs and strengths, developing a service plan and arranging for and monitoring service delivery; 2.9.7 Administration of medications, meaning services such as reading labels for consumers, observing consumers taking their medications, checking the dosage, removing the prescribed dosage, filling a syringe and administering insulin and bee sting kits (when permitted) and the maintenance of a medication record for each consumer; 2.9.8 Nursing services, meaning services provided by professional nurses licensed pursuant to Title 32, section 2102, subsection 2. It includes coordination and oversight of consumer care services provided by unlicensed health care assistive personnel in assisted living programs. 2.10 Certified Nursing Assistant (CNA) means a person who has successfully completed a training program or course with a curriculum prescribed by the fb88 State Board of Nursing or is deemed to have had comparable training according to regulations established by the fb88 State Board of Nursing, and whose duties are assigned by a registered professional nurse, and who is currently listed on the fb88 Registry of Certified Nursing Assistants. 2.11 Certified Nursing Assistant/Medications (CNA-M) means a Certified Nursing Assistant who has satisfactorily completed the standardized medication course for Certified Nursing Assistants, the curriculum for which is prescribed by the fb88 State Board of Nursing. 2.12 Consumer means any person eighteen (18) years of age or older, who is not related by blood or marriage to the owner or person in charge of the assisted living program or building in which the consumer lives and who receives assisted housing services. Any person seventeen (17) years of age, with written permission from the Department, may be a consumer. The Statutory term resident has the same meaning as consumer. 2.13 Consumers Service Plan means a written service plan developed with a consumer, based upon an assessment of the consumers needs and abilities and including (as appropriate) habilitative or rehabilitative goals and objectives, program goals and objectives and the resources and methods necessary to implement the plan. 2.14 Deficiency means a violation of State licensing regulations. 2.15 Dementia means an acquired loss of intellectual functioning (primarily abstract thinking, memory, and judgment) of sufficient severity to interfere with a persons ability to act independently and perform routine daily activities. Symptoms of dementia can include memory loss and the loss or diminution of other cognitive abilities, such as learning ability, judgment, comprehension, attention and orientation to time and place and to oneself. Dementia is not a disease in and of itself but rather a group of symptoms that accompanies certain diseases and conditions. Dementia can be caused by such diseases as Alzheimers Disease, Picks Disease, Amyotrophic Lateral Sclerosis (ALS), Parkinsons Disease, Huntingtons Disease, Creutzfeldt-Jakob Disease, multi-infarct dementia, etc. 2.16 Department means the fb88 Department of Health and Human Services. 2.17 Directed Plan of Correction means a Plan of Correction issued by the Department which directs how and when to correct cited deficiencies. 2.18 Distinct Part means a physically separate unit that is clearly identifiable from the remainder of the building. Various apartments or beds scattered throughout the building would not comprise a distinct part. The distinct part of a building provides a level of service distinguishable from other levels of care in the building. 2.19 Duly Authorized Licensed Practitioner means an individual currently licensed in the State of fb88 as a physician, physicians assistant or nurse practitioner. 2.20 Emergency means either those events that demonstrate that a consumer has an urgent medical or psychological need that requires immediate acute care treatment or poses imminent danger to other consumers. Emergency also means a natural disaster that damages or interrupts vital services to consumers or the integrity of the physical plant. 2.21 Exploitation means the illegal or improper use of an incapacitated or dependent adult or his/her resources for anothers profit or advantage. 2.22 Failure to Make Timely Correction of Any Deficiency means that a provider has not remedied a deficiency within the time frame established in a Plan of Correction or Directed Plan of Correction, or, if any extension has been granted by the Department, within the time frame of that extension. 2.23 False Information means any written or verbal statement or representation of fact that is not true and that was made intentionally, knowingly or without having taken reasonable steps to ascertain whether or not the information was true. 2.24 Food Preparation Area means an area for storing and preparing food in an individuals apartment. This area must include, as a minimum, six (6) square feet of clear countertop, a small refrigerator, bar-type sink, a cabinet for food storage and either two stovetop burners or a microwave oven. 2.25 Functional Assessment means a comprehensive evaluation of an individuals health, social, environmental, financial and family or community supports, which will determine the strengths and needs of the individual. 2.26 Impede or Interfere with the Enforcement of Regulations means a failure to provide information to the Department that is necessary to determine compliance with licensure regulations or a failure to allow the Department access to an Assisted Housing Program or any part thereof. 2.27 Instrumental Activities of Daily Living (hereinafter IADLs) includes, but is not limited to, preparing or receiving of a main meal, taking medication, using the telephone, handling finances, banking, shopping, routine housework, laundry and getting to appointments. 2.28 Legal Representative means a guardian, conservator, agent under durable power of attorney, representative payee, or other person authorized by law, whose authority extends to the matter under consideration and who has provided the assisted living provider with documentation of their legal authority. 2.29 Licensee means the person to whom a license is issued. 2.30 Licensed Health Care Professional means health care providers, including physicians, registered professional nurses, licensed practical nurses, physician assistants, nurse practitioners, occupational therapists, speech pathologists, physical therapists, dietitians and social workers who have been authorized to practice a health care profession in accordance with fb88 State law. 2.31 Medication Error means the administration of any medication incorrectly, e.g., dosage, selection of drug, selection of consumer, time or method of administration, omission of prescribed medication, error in documentation or the administration of a medication without a valid order. 2.32 Neglect means a threat to an adults health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these threats. 2.33 Person means any individual, owner, corporation, partnership, association, governmental subdivision or any other entity. 2.34 Pharmacist means an individual currently licensed as a registered professional pharmacist in the State of fb88. 2.35 Physician means an individual currently licensed to practice medicine or osteopathy in the State of fb88. 2.36 Plan of Correction (hereinafter POC) means a section of the Statement of Deficiencies completed by the provider, detailing the plan to correct deficiencies and the completion dates. 2.37 Private Apartment means a private dwelling unit with an individual bathroom, bedroom and a food preparation area. 2.38 Provider means the licensee. 2.39 Psychotropic Medications means antipsychotic agents, major tranquilizers, antidepressant agents, anxiolytic agents and hypnotic agents. 2.40 Qualified Consultant Dietitian means an individual who is currently licensed to practice dietetics in the State of fb88. 2.41 Qualified Interpreter means an interpreter who is able to interpret effectively, accurately and impartially, both receptively and expressively, using any necessary specialized vocabulary. 2.42 Registered Nurse or Registered Professional Nurse (hereinafter RN) means an individual who is currently licensed by the fb88 State Board of Nursing to practice professional nursing. 2.43 Related by Blood or Marriage means spouses, parents, children, grandparents, grandchildren, great-grandparents, great-grandchildren, brothers, sisters, aunts, uncles, nephews, nieces, and step-relations. 2.44 Repeated Deficiency means a violation of a rule more than once in a two (2) year period. 2.45 Resident means any person eighteen (18) years of age or older, who is not related by blood or marriage to the owner or person in charge of the assisted living program or building in which the resident lives and who receives assisted housing services. Any person seventeen (17) years of age, with written permission from the Department, may be a resident. The Statutory term resident has the same meaning as consumer. 2.46 Consumer Rights means those rights enumerated in Title 22 M.R.S.A. 7921 et seq., 22 M.R.S.A. 7853(6), which apply to assisted housing programs, and Section 5 of these regulations. 2.47 Restraints means any device or other means, except mechanical supports used in normative situations to achieve proper body position and balance: 2.47.1 Which is intended to restrict freedom of movement or access to ones body; or 2.47.2 Any medication which alters cognition or behavior and which is used for discipline or convenience and is not required to treat medical symptoms. 2.48 Self-Administration of Medication means a consumer takes his/her own medication(s) independent of a staff person preparing the medication for the individual. 2.49 Shared Staffing as defined in 22 M.R.S.A. 7860 means the use of licensed and unlicensed personnel who are employed, directly or under contract, by a long term care facility in more than one level of care provided by a single entity on the same premises. 2.50 Statement of Deficiencies (hereinafter SOD) means a document issued by the Department which describes deficiencies in complying with these regulations. 2.51 Submit means to deposit in the US mail, hand deliver, fax submission and electronic submission to the Department. 2.52 Tenancy Obligation means a house rule that does not conflict with these regulations, which is established by the licensee and included in the contract, that all consumers must adhere to in order to continue their residence. 2.53 Unlicensed Health Care Assistive Personnel means individuals employed to provide hands-on assistance with activities of daily living to individuals in homes, assisted living programs, residential care facilities, private non-medical institutions, hospitals and other health care settings. Unlicensed assistive personnel does not include certified nursing assistants employed in their capacity as certified nursing assistants. Unlicensed Health Care Assistive Personnel are also referred to as Unlicensed Assistive Personnel. 2.54 Working Days means weekdays. Legal holidays (when state offices are closed), Saturdays and Sundays are not working days. Section 3 Licensing 3.1 Responsibility for compliance. The applicant/licensee shall comply with these regulations. 3.2 Unlicensed assisted living program. No person, firm, partnership, association, corporation or other entity shall manage or operate an assisted living program without a license. 3.3 Person license issued to. The license is only valid for the named licensee(s). 3.4 Application and licensure. 3.4.1 Application required. The applicant is required to submit a written application for a license on a form approved by the department. A license must be issued prior to the commencement of operation, or the applicant may be subject to sanctions. Incomplete applications, on which no action has been taken by the applicant after sixty (60) calendar days, shall be void. 3.4.2 A non-refundable licensing fee of $200 shall be submitted with the application for each assisted living program. The check shall be made payable to the Treasurer, State of fb88. 3.4.3 Annually thereafter a licensee fee of $200 is required. 3.4.4 Admission and scope of services policy. Assisted Living Programs are required to provide the department with a written admission policy at the time of application for a license. The policy shall describe who may be admitted and scope of services provided, including scope of Nursing Services, consistent with applicable state and federal law. 3.4.5 Additional licensing requirements. Prior to the issuance of a license and prior to re-licensure, the assisted living program shall: 3.4.5.1 Be certified to be in compliance with the National Fire Protection Association (NFPA) Life Safety Code. Assisted living programs must be inspected using the section of the Life Safety Code that applies to new apartment buildings and must be protected throughout by a supervised, automatic sprinkler system approved by the Commissioner of Public Safety. 3.4.5.2 Comply with all applicable laws and regulations promulgated there under, relating to fire safety, plumbing, water supply, sewage disposal and maintenance of sanitary conditions (Class I, II, III). 3.4.5.3 Comply with all other applicable laws and regulations pertaining to licensing. 3.5 Requirement for bond. The applicant shall furnish evidence of a bond covering the applicant and any employee or agent of the applicant who manages, holds or otherwise is entrusted with consumer funds in an amount sufficient to replace those funds in the event of loss. 3.6 Limitations on serving as legal representative. No licensee, owner, proprietor, administrator, employee or a person with a substantial financial interest in the assisted living program may serve as guardian, conservator or power of attorney of any consumer, but may be a representative payee or manager of personal funds. 3.7 Issuance of license. A new applicant will be notified by the department within two (2) weeks of filing an application whether the application is complete. The department and the department of Public Safety are required to provide a new applicant necessary services and inspections within ninety (90) days of the filing of the completed application and the date the building is ready for inspection. The license shall specify the name of the applicant, the name of the program, the type of program, the name of the administrator, the address of the premises where the program is located, the maximum number of units, the type of license, and the expiration date of the license. 3.8 Default licensing. If a new applicant has filed a completed application and has a building ready for inspection, has not been provided the necessary notifications, inspections or services from the department and the department of Public Safety, and a period of more than ninety (90) days has elapsed since notification that the application is complete, a provisional license will be issued. All required application materials must be submitted for the application to be considered complete. The department shall notify a new applicant within two (2) weeks of filing of the application on whether the application is complete. If initial services and inspections are completed within the ninety (90) day time period, an initial license will be issued and no default licensing will occur. 3.9 Number of licenses required. When more than one type of facility or program is provided, the department may consider the following criteria in determining the number of licenses required: 3.9.1 The physical location; 3.9.2 The structure or management and ownership; 3.9.3 If providing more than one licensed level of care, the physically distinct part of the building designated for the assisted living program; and 3.9.4 The administrative and regulatory burdens and benefits of granting a given number of licenses. The department will specify the number of apartments, as appropriate, for each level of care. The provider shall not exceed licensed capacity. 3.10 Adult day services programs. When an adult day services program is physically located in an assisted living program, separate licenses shall not be required. The adult day services programs shall comply with the Regulations Governing the Licensing and Functioning of Adult Day Services Programs and licensed capacity will be reflected on the license. 3.11 Multilevel facility license. For multilevel facilities, a single license will be issued by the department, identifying each level of service. Multilevel facilities are assisted living programs that are located on the same contiguous grounds with licensed nursing facilities; adult day services programs or home health agencies. Multilevel facilities, when subject to licensing action or other sanctions, may have one or more of its levels sanctioned, and the department will specify the particular levels in writing. 3.12 Provisional license. The department shall issue a provisional license, for a minimum period of three (3) months or longer as deemed necessary by the department but not to exceed twelve (12) consecutive months, to an applicant who: 3.12.1 Has not previously operated the program for which the application is made or is licensed and has not operated the program during the term of that license; 3.12.2 Complies with all applicable laws and regulations, except those which can only be complied with once consumers are served by the applicant; and 3.12.3 Demonstrates the ability to comply with all applicable laws and regulations by the end of the Provisional license term; or 3.12.4 Meets the criteria for default licensing. 3.13 Conditional license. The department may issue a conditional license when the licensee fails to comply with applicable laws and regulations and, in the judgment of the Commissioner of the department of Health and Human Services, the best interest of the public would be so served by issuing a conditional license. The conditional license shall specify when and what corrections must be made during the term of the conditional license. A conditional license may be issued for up to a twelve (12) month period. 3.14 Transfer of licenses. No license may be transferred or applicable to any location or persons other than those specified on the license. When an assisted living program is sold or otherwise transferred to another provider, the new provider must apply for and obtain a license and pay a licensing fee prior to operating the program. 3.15 Term of license. A license may be valid for two (2) years, as long as the department has determined the assisted living program is in substantial compliance with licensing rules and has no history of health or safety violations. Prior to the expiration of the license, the department shall inspect for continued compliance with applicable laws and regulations as often as deemed necessary by the department. In facilities/programs licensed for more than one level of care, the term of the license will be the term permitted for the highest level of care. For purposes of this section, the following terms have the following meanings: 3.15.1 Substantial compliance means there were no Class I or II violations that would threaten the health or safety of consumers. 3.15.2 No history of health or safety violations means that within the preceding two (2) years, the applicant was in substantial compliance with the rules. 3.16 Reapplications. Whenever a licensee has made timely and sufficient application for renewal of a license, the existing license shall not expire until the application has been finally determined by the department. 3.17 Posting the license. The licensee shall post the license where it can be seen and reviewed by the public. 3.18 Right of entry. The departments authorized representatives, authorized representatives of the fb88 Attorney Generals Office and authorized representatives of the Long Term Care Ombudsman Program shall have the right to enter upon and into any licensed facility/program at any time, in order to determine the state of compliance with applicable laws and regulations contained herein. To inspect the premises of an assisted living program, that the department knows or believes, is being operated without a license, the department may enter only with the permission of the owner or the person in charge or with an administrative inspection warrant issued pursuant to the fb88 Rules of Civil Procedure, Rule 80E by the District Court authorizing entry and inspection. An application for an assisted living program license shall constitute permission for entry and inspection to verify compliance with applicable law and rules. 3.19 Filing Plans of Correction. Whenever the department issues an SOD, the applicant/licensee shall submit a specific POC within ten (10) working days of the date the applicant/licensee received the SOD. 3.20 Reapplication subsequent to licensing actions. Subsequent to any of the following actions, a full annual or biennial license will not be issued until the deficiencies identified by the department have been corrected: 3.20.1 Issuance of a conditional license; 3.20.2 Refusal to issue or renew a license; 3.20.3 Revocation or suspension of a license; or 3.20.4 Refusal to issue a provisional license. 3.21 Renewal. A renewal application must be received by the department thirty (30) days prior to the license expiration date. Regardless of the term of the license, the licensee must pay a license fee annually. Prior to acting on the application for renewal the department may: 3.21.1 Verify any information in the renewal application and conduct an inspection of the program; 3.21.2 Issue an SOD, as appropriate. If cited deficiencies are not corrected within the established time frame, the department may deny the renewal application, impose a fine, issue a Directed POC, and/or impose a conditional license. 3.22 Actions requiring prior written approval. When an alteration of the common dining room and public bathrooms are proposed, consumers may not use these areas until the department has determined that the changes comply with these regulations and issues a written approval to proceed. 3.23 Waivers. The department may waive or modify any provision(s) of these regulations as long as the provision is not mandated by state or federal law and does not violate consumer rights described in Section 5 of these regulations. The applicant/licensee shall indicate, in writing, what alternative method will comply with the intent of the regulation for which the waiver is sought. If approved, the waiver may be time limited. 3.24 Informal review of waiver denial. The applicant/licensee may appeal a decision of the department to deny a waiver request by submitting a written request for an informal review by the department, or its designee, within ten (10) working days of the date of receipt of the denial. The applicant/licensee shall state in the written request, the grounds for the appeal. Should the applicant/licensee disagree with the informal review decision, an administrative hearing (pursuant to the fb88 Administrative Procedure Act) may be requested within ten (10) working days of the date of notice or receipt of the informal review decision by writing to the department. See also Section 4.10 of these regulations. 3.25 Rates and contracts. 3.25.1 Rates. Assisted living programs shall list all standard charges and make them available to the public. 3.25.2 Signing a contract. Each provider and each consumer or someone authorized to act on the consumers behalf, shall sign a standard contract issued by the department, attached as Appendix A, at the time of any modification of an existing contract and with all new admissions. The consumer and/or consumers legal representative shall be given an original of the signed contract and the provider shall keep a duplicate in the consumers file. No one other than the consumer shall incur any responsibility for the consumers obligations by signing the contract for admission of the consumer. Financial responsibility for the consumers expenses can only be assumed according to Section 3.25.3.7. 3.25.3 Provisions of contract. The contract shall contain provisions regarding services and accommodations to be provided and the rates and charges for such and any other related charges not covered by the programs basic rate. The contract may contain additional provisions, as addenda, that do not conflict with these regulations. The provider may supplement but not replace the standard provisions, as long as they are consistent with the applicable assisted living program rules. Each contract is subject to the following requirements: 3.25.3.1 No contract may contain a provision for the discharge of a consumer which is inconsistent with state law or rule. 3.25.3.2 No contract may contain a provision that may require or imply a lesser standard of care or responsibility than is required by law or rule. 3.25.3.3 Each contract shall provide for at least thirty (30) calendar days notice prior to any changes in rates, responsibilities, services to be provided or any other items included in the contract. The thirty (30) day notice will not be required if it is the resident, or the residents legal representative, who requests additional services not included in the existing contract. 3.25.3.4 No contract or agreement will require a deposit or other prepayment, except one months rent in an assisted living program which may be used as a security deposit. The contract must state the explicit return policy of the program with regard to the security deposit. 3.25.3.5 No contract may contain a provision which provides for the payment of attorney fees or any other cost of collecting payments from the consumer. 3.25.3.6 The following shall be appended to the contract and made a part thereof: 3.25.3.6.1 Grievance procedure; 3.25.3.6.2 Tenancy obligations, if they exist; 3.25.3.6.3 Consumer rights; and 3.25.3.6.4 Copy of the admissions policy. 3.25.3.7 The contract signed for admission of the consumer may not require or encourage anyone other than the consumer to obligate himself/herself for the payment of the consumers expenses. If anyone other than the consumer informs the assisted living program that he/she wishes to guarantee payment of the consumers expenses, he/she can do so only in a separate written agreement. No provision in the separate written agreement can conflict with these rules. This separate agreement must be provided to the guarantor of payment and must plainly state the following: 3.25.3.7.1 Do not sign this agreement unless you voluntarily agree to be financially liable for paying the consumers expenses with your own money. 3.25.3.7.2 You may change your mind within forty-eight (48) hours of signing this agreement by notifying the assisted living program that you wish to revoke this agreement. 3.25.3.7.3 You may call the Long Term Care Ombudsman Program for an explanation of your rights. 3.26 Information to consumers. The licensee must provide an information packet that includes the following information to the consumer and/or consumers legal representative at the time of admission or within sixty (60) calendar days of the effective date of these regulations for all current consumers who have not already been given this information: 3.26.1 Advance Directives information; 3.26.2 Information regarding the type of assisted living program and the licensing status; 3.26.3 The fb88 Long Term Care Ombudsman Program brochure; 3.26.4 The departments toll-free telephone numbers for the Office of Advocacy, Adult Protective Services, and the Division of Licensing and Regulatory Services, Community Services Programs; 3.26.5 The process and criteria for placement in, or transfer or discharge from, the assisted living program; and 3.26.6 The assisted living programs staff qualifications. 3.27 Information for residents of Alzheimers/dementia units. When a provider operates a unit meeting the requirements of a Designated Alzheimers/Dementia Care Unit as all or part of its program, consumers and family members, or any other authorized representative must be provided the following information: 3.27.1 A written statement of philosophy; 3.27.2 The process used for consumer assessment and establishment of a consumer services plan and its implementation; 3.27.3 Those physical environment and design features that support the functioning of adults with cognitive impairments; 3.27.4 The frequency and types of group and individual activities provided by the program; 3.27.5 A description of family involvement and the availability of family support programs; 3.27.6 A description of security measures provided; 3.27.7 A description of in-service training provided for staff; and 3.27.8 Policies with criteria and procedures for admission and discharge of consumers to and from the program/unit. 3.28 Refunds. Refunds are to be managed as follows: 3.28.1 If a consumer dies or is discharged, the provider shall issue a refund to the consumer, the consumers legal representative or the consumers estate for any advance payments on a pro-rated basis. The refund will be calculated from the time the unit is surrendered to the licensee or 15 days from the date of written notice (in a non-emergency situation), whichever is later. 3.28.2 Refunds shall be made within thirty (30) calendar days of date of discharge or death. 3.28.3 If a consumer is determined to be retroactively eligible for third party payment, upon payment from a third party payer, the provider must repay the family or other payer any payments made for the period covered by third party payment. 3.29 Use of personal funds by operator. Under no circumstances shall any operator or agent of an assisted living program use the personal funds of any consumer for the operating costs of the assisted living program or for items that are part of the contractual payment. The personal funds of any consumer shall not be commingled with the business funds of the assisted living program or with the personal funds or accounts of the owner, any member of the owners family or any employee of the assisted living program. No operator or agent of the assisted living program shall borrow money from any consumer. (Class IV) 3.30 Tenancy obligation. Tenancy obligations, if they exist in the assisted living program, must not conflict with these regulations and are subject to Section 5.26 of these regulations. 3.31 Administrative and consumer records. Confidentiality. All administrative and consumer records shall be stored in such a manner that unauthorized persons cannot gain access to them. 3.31.2 Location of records. All consumer records, consumer finances, admission/discharge records and census logs shall be readily accessible to the department even in the event of a change of ownership or administration, unless this is done pursuant to a court order or to Section 5.12 of these regulations. Other administrative records, including personnel records, shall be made available with reasonable notice by the department. All records shall be maintained in a format that is readily accessible and available to all appropriate staff. 3.31.3 Inspection of records. All reports and records shall be made available for inspection upon request by the department, the Long Term Care Ombudsman Program or the fb88 Attorney Generals Office without the consent of the consumer or his/her legal representative. 3.31.4 Record retention. All administrative and consumer records shall be maintained in an accessible format for at least seven (7) years after the date of death or last discharge of the consumer. 3.31.5 Storage of records. Provisions shall be made for the safe storage of all records required by these regulations. 3.31.6 Disaster plan. Each assisted living program shall develop a comprehensive disaster plan. This plan shall include the following: 3.31.6.1 Contingencies for loss of power, heat, lights, water and/or sewage disposal; 3.31.6.2 Contingencies for short term and long term emergencies; and 3.31.6.3 If an assisted living program has no back up power source that can be used to continue operation of heat, lights, water and sewage disposal, the plan shall include contingencies for evacuation that include contractual arrangements with other agencies or facilities for temporary living accommodations. Confidential information. Pursuant to 22 M.R.S.A. 7703, confidential information may not be released without a court order or a written release from the person about whom the confidential information has been requested, except as provided by law. Section 4 Enforcement Procedures 4.1 Inspections required. The provider shall submit to regular and unannounced inspection surveys and complaint investigations in order to receive and/or maintain a license. The provider shall give access to all records required by these regulations. The department has the right to interview consumers and employees in private. [Class I] 4.2 Frequency and type of inspections. An inspection may occur: 4.2.1 Prior to the issuance of a license; 4.2.2 Prior to renewal of a license; 4.2.3 Upon complaint that there has been an alleged violation of licensing regulations; 4.2.4 When there has been a change or proposed change in administrator, physical plant or services; 4.2.5 When necessary to determine compliance with a Directed Plan of Correction, conditions placed on a license or that cited deficiencies have been corrected; 4.2.6 For routine monitoring of services; or 4.2.7 Any time the department has probable cause to believe that an assisted living program has violated a provision of these regulations or is operating without a license. 4.3 Licensing records kept by the department. The department will maintain a complete record of all licensing activities related to the assisted living program. Those sections of the files not made confidential by law are available for public inspection at any time during normal business hours. 4.4 Complaints. The department will accept complaints from any person about alleged violation(s) of licensing regulations. The provider shall not retaliate against any consumer or his/her representative for filing a complaint. Complainants have immunity from civil or criminal liability when the complaint is made in good faith. Any licensing violations noted as a result of a complaint investigation will be provided to the assisted living program in writing. 4.5 Enforcement process. 4.5.1 After inspection, an SOD will be sent to the licensee if the inspection identifies any failure to comply with licensing regulations. An SOD may be accompanied by a Directed POC. 4.5.2 The licensee shall complete a POC for each deficiency, sign the plan and submit it to the department within ten (10) working days of receipt of any SOD. 4.5.3 Failure to correct any deficiency (ies) or to file an acceptable POC with the department may lead to the imposition of sanctions or penalties as described in Sections 4.7 and 4.8 of these regulations. 4.5.4 Informal conference. If a licensee disagrees with the imposition or amount of any penalty assessed by the department, the licensee must submit a written notification to the department stating the nature of the disagreement, within ten (10) working days of receipt of an Assessment of Penalties. Upon receipt of this request, the Assistant Director of the Division of Licensing and Regulatory Services, Community Services Programs or his/her designee shall schedule an informal conference for the purpose of trying to resolve the dispute. The Director or his/her designee shall inform the licensee of the results of the informal conference in writing. If a provider desires to appeal the result of an affirmed or modified assessment of penalties following an informal conference, a written request for an administrative hearing, pursuant to Section 4.10, must be made. The department will stay the collection of any fiscal penalties until final action is taken on an appeal. Penalties shall accrue with interest for each day until final resolution and implementation. 4.6 Grounds for intermediate sanctions. The following circumstances shall be grounds for the imposition of intermediate sanctions: 4.6.1 Operation of an assisted living program without a license; 4.6.2 Operation of an assisted living program over licensed capacity; 4.6.3 Impeding or interfering with the enforcement of laws or regulations governing the licensing of assisted living programs, or giving false information in connection with the enforcement of such laws and regulations; 4.6.4 Failure to submit a POC within ten (10) working days after receipt of an SOD; 4.6.5 Failure to take timely corrective action in accordance with a POC, a Directed POC or Conditional License; 4.6.6 Failure to comply with state licensing laws or regulations that have been classified as Class I, II, III or IV pursuant to Sections 4.8.2 & 4.8.3. 4.7 Intermediate sanctions. The department is authorized to impose one or more of the following intermediate sanctions when any of the circumstances listed in Section 4.6 are present and the department determines that a sanction is necessary and appropriate to ensure compliance with State licensing regulations to protect the consumers of an assisted living program or the general public: 4.7.1 The assisted living program may be directed to stop all new admissions, regardless of payment source, or to admit only those consumers the department approves, until such time as it determines that corrective action has been taken. 4.7.2 The department may issue a Directed POC or Conditional License. 4.7.3 The department may impose a financial penalty. 4.8 Financial penalties. 4.8.1 Certain provisions of these regulations have been classified as noted below. Financial penalties may be imposed only when these regulations are violated. 4.8.2 Certain provisions of the regulations have a single classification. Such regulations are followed by a notation (i.e., Class I). Classifications have been established according to the following standards: 4.8.2.1 Class I. - Any failure to comply with a regulation where that failure poses an immediate threat of death to a consumer(s). 4.8.2.2 Class II. - Any failure to comply with a regulation where that failure poses a substantial probability of serious mental or physical harm to a consumer(s). 4.8.2.3 Class III. - The occurrence of a repeated deficiency that poses a substantial risk to the health or safety of a consumer(s). 4.8.2.4 Class IV. - The occurrence of a repeated deficiency that infringes upon consumer rights. 4.8.3 Certain regulations have been given alternative classifications. Such regulations are followed by an alternative notation (i.e., Class I/II or Class II/III). When these regulations are not complied with, the department will determine which classification is appropriate, on a case-by-case basis, by reference to the standards set forth in Section 4.8.2. 4.8.4 If the department assesses financial penalties, an Assessment of Penalties will be issued. The Assessment shall describe the classification of each violation found to have been committed by the assisted living program, the regulation or law that has been violated and the scheduled amount of time corresponding to that violation. If the provider does not contest the imposition or amount of the penalty, the provider must pay within thirty (30) calendar days of receipt of the Assessment of Penalties. If the provider disagrees with the imposition or amount of the penalty, the provider must notify the department, in writing, stating the nature of the disagreement, within ten (10) working days of receipt of the Assessment of Penalties. The department will schedule an informal conference to resolve the dispute and a written decision based upon this conference will be provided. If the provider is still dissatisfied with the written decision, an administrative hearing may be requested in accordance with Section 4.10. 4.8.5 The amount of any penalty to be imposed shall be calculated according to the following classification system: 4.8.5.1 Any failure to comply with regulations classified as Class I, $6.00 per pursuant to Section 4.8.2.1; consumer per occurrence Operation of an assisted living program or residential care per day facility over licensed capacity, or Impeding, interfering or giving false information in connection with the enforcement of laws or regulations governing licensure. 4.8.5.2 Any failure to comply with regulations classified as $5.00 per Class II, pursuant to Section 4.8.2.2; consumer per occurrence Failure to submit a POC within ten (10) working days per day after receipt of an SOD; or Failure to take timely corrective action in accordance with a POC, Directed POC or conditional license. 4.8.5.3 The occurrence of a repeated deficiency in complying $4.00 per with regulations classified as Class III, pursuant to consumer per Section 4.8.2.3; occurrence per day The occurrence of a repeated deficiency in complying with regulations classified as Class IV, pursuant to Section 4.8.2.4. 4.8.6 The department may impose a financial penalty on a licensee of an assisted living program for a violation of these rules. Each day of violation constitutes a separate offense. A penalty or a combination of penalties imposed on a licensee of an assisted living program may not be greater than a sum equal to $10 times the total number of consumers served by the assisted living program per violation, up to a maximum of $10,000 for each instance in which the department issues a statement of deficiency to a licensee of an assisted living program. 4.8.7 Any provider unable to immediately pay penalties may within thirty (30) calendar days from receipt of notification of penalty assessment apply to the department for a delay in payment or installment payments or, in certain circumstances, to have the penalty reduced. 4.8.7.1 In order to have the payment delayed or paid in installments, a provider must supply sufficient information to the department to demonstrate that immediate full payment of the total amount due would result in the interruption of the provision of necessary services to consumers. 4.8.7.2 In order to have a fine reduced, a provider must supply sufficient information to the department to demonstrate that payment in full would result in a permanent interruption in the provision of necessary services to consumers. 4.8.7.3 The department has the authority to determine whether the provider has supplied sufficient information. 4.9 Other sanctions for failure to comply. 4.9.1 When an applicant fails to comply with applicable laws and regulations, the department may refuse to issue or renew a license to operate an assisted living program. 4.9.2 If, at the expiration of a full or Provisional license, or during the term of a full license, the provider fails to comply with applicable laws and regulations, and, in the judgment of the Commissioner, the best interest of the public would be served, the department may issue a Conditional license, or change a full license to a Conditional license. Failure by the licensee to meet the conditions specified by the department shall permit the department to void the Conditional license or refuse to issue a full license. The conditional license shall be void when the department has delivered in hand or by certified mail a written notice to the licensee, or, if the licensee cannot be reached for service in hand or by certified mail, has left written notice thereof at the agency or facility. For the purposes of this subsection the term licensee means the person, firm, or corporation or association to whom a conditional license has been issued. 4.9.3 Upon investigation, whenever conditions are found which, in the opinion of the department, immediately endanger the health or safety of the persons living in or attending the assisted living program, the department may request that the District Court suspend the license on an emergency basis, pursuant to Title 4 M.R.S.A. 184, subsection 6. 4.9.4 Any license may be suspended or revoked for violation of applicable laws or regulations, committing, permitting, aiding or abetting any illegal practices in the operation of the assisted living program, or conduct or practices detrimental to the welfare of persons living in or attending the assisted living program. When the department believes a license should be suspended or revoked, it shall file a complaint with the District Court as provided in the fb88 Administrative Procedure Act, Title 5 M.R.S.A. Chapter 375 10051. 4.9.5 Pursuant to Title 22 M.R.S.A. Chapter 1666-A 7931 et seq., the department may petition the Superior Court to appoint a receiver to operate the assisted living program in the following circumstances: 4.9.5.1 When the assisted living program intends to close, but has not arranged for the orderly transfer of its consumers at least thirty (30) calendar days prior to closure; 4.9.5.2 When an emergency exists which threatens the health, security or welfare of consumers or 4.9.5.3 When the assisted living program is in substantial or habitual violation of the standards of health, safety or consumer care established under State or Federal laws and regulations, to the detriment of the welfare of the consumers. 4.10 Appeal rights. Any assisted living program aggrieved by the departments decision to take any of the following actions, or to impose any of the following sanctions, may request an administrative hearing to refute the basis of the departments decision, as provided by the fb88 Administrative Procedure Act, Title 5 M.R.S.A. 9051 et seq. Administrative hearings will be held in conformity with the departments Administrative Hearing Regulations. A request for a hearing must be made, in writing, to the Assistant Director of the Division of Licensing and Regulatory Services, Community Services Programs, and must specify the reason for the appeal. Any request must be submitted within ten (10) working days from receipt of the departments decision to: 4.10.1 Issue a conditional license; 4.10.2 Amend or modify a license; 4.10.3 Void a conditional license; 4.10.4 Refuse to issue or renew a full license; 4.10.5 Refuse to issue a provisional license; 4.10.6 Stop or limit admissions; 4.10.7 Issue a directed POC; 4.10.8 Affirm or modify an Assessment of Penalties after an informal review; 4.10.9 Deny an application to reduce the amount or delay the payment of a penalty; or 4.10.10 Deny a request for a waiver of a rule. 4.11 Operating without a license 4.11.1 License required. A person, firm, partnership, association, corporation or other entity may not, without first obtaining a license, manage or operate an assisted living program. 4.11.2 Civil penalty for operating without a license. A person, firm, partnership, association, corporation or other entity who operates an assisted living program without a license commits a civil violation and is subject to a civil penalty of not less than $500 nor more than $10,000 per day. Each day of violation constitutes a separate offense. 4.11.3 Injunctive relief. Notwithstanding any other remedies provided by law, the Office of the Attorney General may seek an injunction to require compliance with the provisions of section 4.11. 4.11.4 Enforcement. The Office of the Attorney General may file a complaint with the District Court seeking civil penalties or injunctive relief or both for violations of section 4.11. 4.11.5 Jurisdiction. The District Court has jurisdiction pursuant to 4 M.R.S.A. 152 for violations of section 4.11. 4.11.6 Burden of proof. The burden is on the department to prove, by a preponderance of the evidence, that the alleged violations of section 4.11 occurred. 4.11.7 Right of entry. To inspect the premises of an assisted living program that the department knows or believes is being operated without a license, the department may enter only with the permission of the owner or the person in charge or with an administrative inspection warrant issued pursuant to the fb88 Rules of Civil Procedure, Rule 80E by the District Court, authorizing entry and inspection. 4.11.8 Administrative inspection warrant. The department and a duly designated officer or employee of the department have the right to enter upon and into the premises of an unlicensed assisted living program with an administrative inspection warrant issued pursuant to the fb88 Rules of Civil Procedure, Rule 80E by the District Court at a reasonable time and, upon demand, have the right to inspect and copy any books, accounts, papers, records and other documents in order to determine compliance with section 4.11. Pursuant to the fb88 Rules of Civil Procedure, Rule 80E the department's right of entry and inspection may extend to any premises and documents of a person, firm, partnership, association, corporation or other entity that the department has reason to believe is operating without a license. 4.11.9 Noninterference. An owner or person in charge of an unlicensed assisted living program may not interfere with or prohibit the interviewing by the department of residents or consumers of services. 4.11.10 Violation of injunction. A person, firm, partnership, association, corporation or other entity that violates the terms of an injunction issued under section 4.11 shall pay to the State a fine of not less than $500 nor more than $10,000 for each violation. Each day of violation constitutes a separate offense. 4.11.10.1 In an action brought by the Office of the Attorney General against a person, firm, partnership, association, corporation or other entity for violating the terms of an injunction under section 4.11, the District Court may make the necessary orders or judgments regarding violation of the terms of the injunction. 4.11.10.2 In an action under section 4.11, when a permanent injunction has been issued, the District Court may order the person, firm, partnership, association, corporation or other entity against which the permanent injunction is issued to pay to the General Fund the costs of the investigation of that person, firm, partnership, association, corporation or other entity by the Office of the Attorney General and the costs of suit, including attorney's fees. Section 5 Consumer Rights 5.1 Consumer rights. The assisted living program shall promote and encourage consumers to exercise their rights, to age in place and make informed choices. [Class IV] 5.2 Freedom of choice of provider. For services and supplies not provided by the licensee, each consumer has the right to select the provider of his/her choice. [Class IV] 5.3 Rights regarding transfer and discharge. Each consumer has the right to continued residence whenever a valid contract for services is in force. The assisted living program must show documented evidence of strategies used to prevent involuntary transfers or discharges. A consumer shall not be transferred or discharged involuntarily, except for the following reasons: 5.3.1 When there is documented evidence that a consumer has violated the admission contract obligations, despite reasonable attempts at problem resolution; [Class IV] 5.3.2 A consumers continued tenancy constitutes a direct threat to the health or safety of others; [Class IV] 5.3.3 A consumers intentional behavior has resulted in substantial physical damage to the property of the assisted living program or others residing in or working there; [Class IV] 5.3.4 A consumer has not paid for his/her services in accordance with the contract between the assisted living program and the consumer; [Class IV] 5.3.5 When there is documented evidence that the assisted living program cannot meet the needs of the consumer as the program is fundamentally designed; [Class IV] or 5.3.6 The license has been revoked, not renewed, or voluntarily surrendered. [Class IV] 5.4 Transfer or discharge. When a consumer is transferred or discharged in a non-emergency situation, the consumer or his/her guardian shall be provided with at least fifteen (15) days advance written notice to ensure adequate time to find an alternative placement that is safe and appropriate. The provider has an affirmative responsibility to assist in the transfer or discharge process and to produce a safe and orderly discharge plan. If no discharge plan is possible, then no involuntary non-emergency discharge shall occur until a safe discharge plan is in place. Appropriate information, including copies of pertinent records, shall be transferred with a consumer to a new placement. [Class IV] Each notice must be written and include the following: 5.4.1 The reason for the transfer or discharge, including events which are the basis for such action; [Class IV] 5.4.2 The effective date of the transfer or discharge; [Class IV] 5.4.3 Notice of the consumers right to appeal the transfer or discharge as set forth in Section 5.28; [Class IV] 5.4.4 The mailing address and toll-free telephone number of the Long Term Care Ombudsman Program; [Class IV] 5.4.5 In the case of consumers with developmental disabilities or mental illness, the mailing address and telephone number of the Office of Advocacy, Department of Heath and Human Services (formerly known as the Department of Behavioral and Developmental Services (BDS)); [Class IV] 5.4.6 The consumers right to be represented by himself/herself or by legal counsel, a relative, friend, or other spokesperson. [Class IV] 5.5 Emergency transfer or discharge. When an emergency situation exists, no written notice is required, but such notice as is practical under the circumstance shall be given to the consumer and/or consumers representative. The assisted living program shall assist the consumer and authorized representatives in locating an appropriate placement. Transfer to an acute hospital is not considered a placement and the obligation in regard to such assistance does not necessarily terminate. [Class IV] 5.6 Leaves of absence. When a consumer is away, and continues to pay for services in accordance with the contract, the consumer shall be permitted to return unless any of the reasons set forth in Section 5.3 are present and the consumer or consumers legal representative has been given notice as may be required in these regulations. [Class IV] 5.7 Assistance in finding alternative placement. Consumers who choose to relocate shall be offered assistance in doing so. 5.7.1 Assisted living programs may require up to a fifteen (15) calendar day notice for consumers choosing to relocate in order to obtain a refund. For those consumers who relocate for emergency medical treatment no advance notice is required to obtain a refund. 5.7.2 The assisted living program shall offer information to the consumer, as appropriate, regarding potential risks that may be inherent in the discharge plan and information that will support the consumers adjustment to his/her next setting. [Class IV] 5.8 Right to communicate grievances and recommend changes. The assisted living program shall assist and encourage consumers to exercise their rights as consumers and citizens. Consumers may freely communicate grievances and recommend changes in policies and services to the assisted living program and to outside representatives of their choice, without restraint, interference, coercion, discrimination or reprisal. All grievances shall be documented. The consumer has the right to be assisted throughout the grievance by a representative of his/her choice. Section 5.25 of these regulations list advocacy services which may be available to consumers. Assisted living programs shall establish and implement a procedure for the timely review and disposition of grievances, and shall notify consumers upon admission of their right to file a grievance and information about how to do so. The procedure shall include a written response to the grievant describing disposition of the complaint. These documents shall be maintained and available for review upon request by the Department. [Class IV] 5.8.1 Consumers who are class members under the AMHI consent decree may also file grievances alleging a violation of the terms of the AMHI settlement agreement. The grievances may be brought by or on behalf of individuals or groups of class members. If the grievances include allegations of employee misconduct, no disciplinary action may be taken nor facts found with regard to the alleged misconduct except in accordance with the providers personnel policies and with any employment contract provisions. A class member who files a grievance is entitled to a hearing conducted by an impartial hearing officer, who may be employed by the provider but who must not have been directly involved in the incident. The hearing officer must hold a hearing, either in person or by telephone; must accept evidence from both parties, including testimony of witnesses; and must make a decision in writing promptly after the hearing. The hearing must be recorded verbatim. The hearing must be expedited if the consumer can establish that an emergency will exist if the grievance is not resolved very soon. 5.9 Right to manage financial affairs. Consumers shall manage their own financial affairs, unless there is a representative payee, other legal representative appointed or other person designated by the consumer. [Class IV] 5.10 Right to freedom from abuse, neglect or exploitation. Consumers shall be free from mental, verbal, physical and/or sexual abuse, neglect and exploitation. [Class I, II, III, IV] 5.11 Rights regarding restraints and aversive conditioning. There shall be no use of physical, chemical, psychological or mechanical restraints or aversive conditioning, except in accordance with this section. [Class I, II, III, IV] 5.11.1 Full-length bedrails on both sides of the bed are considered restraints and shall not be attached to the bed. Half-length bedrails attached to the top half of the bed are permissible. One full-length bed rail and one half-length bed rail may be used if the full-length rail is on the side against the wall. [Class I, II, III, IV] 5.11.2 In the case of a person with mental retardation, the provider must comply with the requirements of the Regulations Governing the Use of Behavioral Procedures in fb88 Programs Serving Persons with Mental Retardation and the Regulations Governing the Use of Restraints in Community Settings. These regulations are promulgated and enforced by the Department of Health and Human Services (formerly known as Department of Behavioral and Developmental Services) [Class I, II, III, IV] 5.11.3 For any consumer who is a client of the Department of Health and Human Services Adult Mental Health Program (formerly known as Behavioral and Development Services) due to his/her mental illness, the assisted living program shall comply with the Rights of Recipients of Mental Health Services, promulgated and enforced by the Department of Health and Human Services (formerly knows as Department of Behavioral and Developmental Services) [Class I, II, III, IV] 5.12 Right to confidentiality. Consumers records and information pertaining to their personal, medical and mental health status is confidential. Consumers and their legal representatives shall have access to all records pertaining to the consumer at reasonable times, in the presence of the provider or his/her representative, within one (1) business day of the request. Consumers and their legal representatives are entitled to have copies made of their record within one (1) business day of the request. The licensee and employees shall have access to confidential information about each consumer only to the extent needed to carry out the requirements of the licensing regulations or as authorized by any other applicable state or federal law. The written consent of the consumer or his/her legal representative shall be required for release of information to any other person except authorized representatives of the Department or the Long Term Care Ombudsman Program. The Department shall have access to these records for determining compliance with these regulations. Records shall not be removed from the assisted living program, except as may be necessary to carry out these regulations. Upon admission, each consumer shall sign and date a written consent which lists individuals, groups, or categories of individuals with whom the program may share information (e.g., sons, daughters, children, family members or duly authorized licensed practitioners, etc.). A written consent to release of information shall be renewed and time dated every thirty (30) months, pursuant to 22 M.R.S.A. 1711-C (4). Consent may be withdrawn at any time. [Class IV] 5.13 Right to refuse to perform services for the assisted living program. Consumers may refuse to perform services for the assisted living program. [Class IV] 5.14 Right to privacy and consideration. Consumers shall be treated with respect. Residents shall also be treated with respect and consideration with regard to their individual need for privacy when receiving personal care or treatment, preferred mode of language and communication. [Class IV] 5.15 Right to communicate privately with persons of choice. Consumers may associate and communicate privately with persons of their choice at any time, unless to do so would infringe on the rights of others. They may receive personal mail, unopened, and shall be assisted when necessary with writing and mailing letters and making phone calls. Consumers shall have privacy when having telephone conversations. [Class IV] 5.16 Right to participate in activities of choice. Consumers may participate in social, political, religious and community activities, unless to do so would infringe on the rights of others. [Class IV] 5.17 Right to personal clothing and possessions. Consumers may retain and use their personal clothing and possessions as space permits, unless to do so would infringe upon the rights of other consumers or impair the providers ability to meet the purpose of these rules. [Class IV] 5.18 Couples. A couple residing in an assisted living program has the right to share a unit. [Class IV] 5.19 Right to be informed of services provided by the facility/program. Consumers shall be fully informed of items or services which are included in the rate they pay. This rate shall include the cost of repair or replacement of items damaged by normal wear and tear. [Class IV] 5.20 Right to refuse treatment or services. Consumers may choose to refuse medications, treatments or services. If the consumer refuses necessary care or treatment, the provider shall make reasonable efforts to consult the consumers duly authorized licensed practitioner, caseworker or other appropriate individuals in order to encourage consumers to receive necessary services. No person without legal authority to do so shall order treatment which has not been consented to by a competent consumer. [Class IV] 5.21 Right to be free from discrimination. A consumer shall be provided services without regard to race, age, national origin, religion, disability, gender or sexual orientation. [Class IV] 5.22 Right to information regarding deficiencies. Consumers have the right to be fully informed of findings of the most recent survey conducted by the Department. The provider shall inform consumers or their legal representatives that the survey results are public information and are available in a common area of the building. Consumers and their legal representatives shall be notified by the provider of any actions proposed or taken against the license of the assisted living program by the Department, including but not limited to, Directed Plans of Correction, decisions to issue a Conditional license, refusal to renew a license, appointment of a receiver or decisions to impose fines or other sanctions. This notification shall take place within fifteen (15) working days from receipt of notice of action. [Class IV] 5.23 Notification of Residents Rights. The provider shall inform each consumer and legal representative of these rights prior to or at admission and shall provide them with a copy of these rights. In addition, the provider shall inform each consumer and legal representative, within thirty (30) calendar days of any changes to Section 5 and shall provide them with a copy of the change . The provider must accommodate for any communication barriers that may exist, to ensure that each consumer is fully informed of his/her rights. [Class IV] 5.24 Bill of rights for persons with mental retardation. Programs serving persons with mental retardation shall post and comply with the Bill of Rights for Persons with Mental Retardation, Title 34-B M.R.S.A. 5601 et seq. [Class IV] 5.25 Mandatory report of rights violations. Any person or professional who provides health care, social services or mental health services or who administers a long term care facility or program who has reasonable cause to suspect that the regulations pertaining to consumers rights or the conduct of consumer are have been violated, shall immediately report the alleged violation to the Department of Health and Human Services (800-383-2441) and to one or more of the following: Disability Rights Center (DRC), pursuant to Title 5 M.R.S.A. 19501 through 19508 for incidents involving persons with mental illness; the Long Term Care Ombudsman Program, pursuant to Title 22 M.R.S.A. 5107-A for incidents involving elderly persons; the Office of Advocacy, pursuant to Title 34-B M.R.S.A. 1205 for incidents involving persons with mental retardation; or Adult Protective Services, pursuant to Title 22 M.R.S.A. 3470 through 3487. Reporting suspected abuse, neglect and exploitation is mandatory in all cases. Documentation shall be maintained at the assisted living program that a report has been made. Mandated reporters shall contact the Department of Health and Human Services (800-383-2441) immediately after receiving and/or obtaining information about any rights violations. [Class IV] 5.26 Reasonable modifications and accommodations. To afford individuals with disabilities the opportunity to reside in an assisted living program, the licensee shall: 5.26.1 Permit directly, or through an agreement with the property owner, if the property owner is a separate entity, reasonable modification of the existing premises, at the expense of the disabled individual or other willing payer. Where it is reasonable to do so, the provider may require the disabled individual to return the premises to the condition that existed before the modification, upon discharge of that individual. Neither the provider nor the property owner, if a separate entity, is required to make the modification at his/her own expense, if it imposes a financial burden. [Class IV] 5.26.2 Make reasonable accommodation in regulations, policies, practices or services, including permitting reasonable supplementary services to be brought into the building. The provider is not required to make the accommodation, if it imposes an undue financial burden or results in a fundamental change in the program. [Class IV] 5.27 Right of action. In addition to any remedies contained herein, any consumer whose rights have been violated may commence a civil action in Superior Court for injunctive and declaratory relief pursuant to Title 22 M.R.S.A. 7948 et seq. [Class IV] 5.28 Right to appeal an involuntary transfer or discharge. The consumer has the right to an expedited administrative hearing to appeal an involuntary transfer or discharge. A consumer may not appeal a discharge due to the impending closure of the program unless he/she believes the transfer or discharge is not safe or appropriate. To file an appeal regarding an involuntary transfer or discharge, the consumer must submit the appeal within five (5) calendar days of receipt of a written notice. If the consumer has already been discharged on an emergency basis, the provider shall hold a space available for the consumer pending receipt of an administrative decision. Requests for appeals shall be submitted to the Assistant Director of the Division of Licensing and Certification, Community Services Programs for submission to the Office of Administrative Hearings, 11 State House Station, Augusta, fb88 04333-0011. The provider is responsible for defending its decision to transfer or discharge the consumer at the administrative hearing. [Class IV] 5.29 Consumer adjudicated incompetent. In the case of a consumer adjudicated incompetent, the rights of the consumer are exercised by the consumers legal representative, as defined in Section 2.28 of these Regulations. [Class IV] 5.30 Consumer councils 5.30.1 Consumers have the right to establish a consumer council, pursuant to Title 22 M.R.S.A. 7923. Consumers and their families shall be notified of this right, orally and in writing, within the first month after admission, in a manner understood by each consumer and by a notice of the right to form a council being posted prominently in a public area. 5.30.2 If a majority of the consumers choose not to establish a council, they shall be given the opportunity to choose otherwise at least once each year thereafter. 5.30.3 The council has the following rights: 5.30.3.1 To be provided with a copy of the programs policies and procedures relating to consumer rights and to make recommendations to the administrator on how they may be improved; [Class IV] 5.30.3.2 To establish procedures that will ensure that all consumers are informed about and understand their rights; [Class IV] 5.30.3.3 To elicit and disseminate information regarding programs and to make recommendations for improvement; [Class IV] 5.30.3.4 To help identify consumer problems and recommend ways to ensure early resolution; [Class IV] 5.30.3.5 To inform the administrator of the opinions and concerns of the consumers; [Class IV] 5.30.3.6 To find ways of involving the families and consumers of the assisted living program; [Class IV] 5.30.3.7 To notify the Department and The Long Term Care Ombudsman Program when the council is constituted; and [Class IV] 5.30.3.8 To disseminate records of council meetings and decisions to the consumers and the administrator and to make these records available to family members or their designated representatives and the Department, upon request. [Class IV] 5.31 Right to a service plan. The provider shall assist consumers to implement any reasonable plan of service developed with community or state agencies. [Class IV] Section 6 Alzheimers/Dementia Unit Standards 6.1 Alzheimers/Dementia Care Units. A building or unit may be designated as an Alzheimers/Dementia Care Unit if the following regulations are met and the assisted living program has received written designation from the Department. 6.2 Admission requirements. 6.2.1 At the time of admission to an Alzheimers/Dementia unit, the consumers individual record must contain: 6.2.1.1 Documentation of the legal representatives authority for placement, including but not limited to, the order, instrument or other documentation upon which the legal representative or assisted living program relies upon for authority, the name, address and telephone number of the individual(s) consenting to placement, and all other documentation required by State and Federal law for valid authority. 6.2.1.2 Documentation of a physicians diagnosis of Alzheimers disease or dementia within 30 days of admission to the unit. 6.3 Design standards. The unit shall be designed to accommodate consumers with dementia, enhance their quality of life, and promote their safety. 6.3.1 Physical design. In addition to any physical plant standards required for the licensure, an Alzheimers/dementia care unit shall have; 6.3.1.1 Adequate space for dining, group and individual activities and family visits; 6.3.1.2 Secured outdoor space and walkways, which allow consumers to ambulate but prevent undetected egress; 6.3.1.3 High visual contrasts between floors and walls and doorways and walls in consumer use areas. Other doors used as fire exits and access ways may be designed to minimize contrast to obscure or conceal areas the consumer should not enter; 6.3.1.4 Non-reflective floors, walls and ceilings; 6.3.1.5 Adequate and even lighting which minimizes glare and shadows; and 6.3.1.6 A staff work area for charting and storage of consumer records, and a communication system such as a telephone or two-way voice actuated call system. 6.3.2 Physical environment. The designated Alzheimers/dementia care unit shall: 6.3.2.1 Provide freedom of movement for the consumers between common areas and his/her room; 6.3.2.2 Provide assistive equipment that maximizes the independence of individual consumers; 6.3.2.3 Label or inventory all consumer possessions; 6.3.2.4 Provide comfortable, non-institutional seating in the common use areas; 6.3.2.5 Encourage consumers to decorate and furnish their units with personal items and furnishings, as appropriate; 6.3.2.6 Individually identify consumers units as appropriate; and 6.3.2.7 Only use a public address system in the unit (if one exists) for emergencies. 6.3.3 Physical Safety. 6.3.3.1 The designated Alzheimers/dementia care unit shall have policies and procedures regarding consumers who may wander. The procedures shall include actions to be taken in case a consumer elopes. 6.3.3.2 If locking devices are used on doors that exit the unit, as approved by the building codes agency and the Office of the State Fire Marshal having jurisdiction over the assisted living program, then the locking device shall be electronic and will automatically release when the following occurs: 6.3.3.2.1 Upon activation of the fire alarm or sprinkler system; 6.3.3.2.2 Power failure; or 6.3.3.2.3 Bypassing a key button/key pad located at exits for routine use by staff for service. 6.3.3.3 If the unit uses keypads to lock and unlock doors exiting from the unit, then directions for access to the unit shall be posted on the outside of the door. 6.3.3.4 The units shall not have entrance and exit doors that are closed with non-electric keyed locks, nor shall a door with a keyed lock be placed between a consumer and the exit. 6.4 Therapeutic activities for Alzheimers/Dementia Care Units. All facilities with Alzheimers/Dementia Care Units shall offer the following types of individual or group activities at least weekly: 6.4.1 Gross motor activities (e.g., exercise, dancing, gardening, cooking, etc.); 6.4.2 Self-care activities (e.g., dressing, personal hygiene/grooming, etc.); 6.4.3 Social activities (e.g., games, music, reminiscing, etc.); 6.4.4 Crafts (e.g., decorations, pictures, etc.); 6.4.5 Sensory enhancement activities (e.g., auditory, visual, olfactory and tactile stimulations, etc.); 6.4.6 Outdoor activities (e.g., walking outdoors, field trips, etc.); and 6.4.7 Spiritual activities. 6.5 Pre-service training for Alzheimers/Dementia Care Units. For pre-service training, all facilities with Alzheimers/Dementia Care Units must provide a minimum of eight (8) hours classroom orientation and eight (8) hours of clinical orientation to all new employees assigned to the unit. The trainer(s) shall be qualified with experience and knowledge in the care of individuals with Alzheimers disease and other dementias. In addition to the usual assisted living program orientation, which shall cover such topics as consumer rights, confidentiality, emergency procedures, infection control, assisted living program philosophy related to Alzheimers Disease/dementia care, and wandering/egress control, the eight (8) hours of classroom orientation shall include the following topics: 6.5.1 A general overview of Alzheimers Disease and related dementias; 6.5.2 Communication basics; 6.5.3 Creating a therapeutic environment; 6.5.4 Activity focused care; 6.5.5 Dealing with difficult behaviors; and 6.5.6 Family issues. Section 7 Medications and Treatments 7.1 Use of safe and acceptable procedures. The administrator shall ensure that all persons administering medications and treatments (except consumers who self-administer) use safe and acceptable methods and procedures for ordering, receiving, storing, administering, documentation, packaging, discontinuing, returning for credit and/or destroying of medications and biologicals. All employees must practice proper hand washing and aseptic techniques. A hand-washing sink shall be available for staff administering medications. [Classes I/II/III] 7.1.1 Consumers shall receive only the medications ordered by his/her duly authorized licensed practitioner in the correct dose, at the correct time, and by the correct route of administration consistent with pharmaceutical standards. [Classes I/II/III] 7.1.2 No injectable medications may be administered by an unlicensed person, with the exception of bee sting kits and insulin. 7.1.3 Before using a bee sting kit, unlicensed persons must be trained by a registered professional nurse in regard to safe and proper use. Documentation of training shall be included in the employee record. 7.1.4 Unlicensed assistive personnel must be trained by a registered professional nurse in regard to the management of persons with diabetes. The registered professional nurse must provide in-service training and documentation to include: [Class III]. 7.1.4.1 Dietary requirements; 7.1.4.2 Anti-Diabetic Oral Medications inclusive of adverse reactions and interventions, hyper and hypo glycemic reactions; 7.1.4.3 Insulin mixing including insulin action; 7.1.4.4 Insulin storage; 7.1.4.5 Injection techniques and site rotation including signs/symptoms; 7.1.4.6 Treatment and prevention of insulin reaction; 7.1.4.7 Foot care; 7.1.4.8 Lab testing, urine testing and blood glucose monitoring; and 7.1.4.9 Standard Precautions. Documentation of training shall be included in the employee record 7.1.5 Urine testing shall not be done around medication or areas where food is stored or prepared. Proper Standard Precautions relative to body fluids shall be implemented. Toilets shall be used for the disposal of urine and test sample waste. Toxic urine testing chemicals (tablets, solutions) shall be stored in a locked area totally apart from oral medications. 7.1.6 For those residents for whom the facility is responsible for assistance with medication administration, no medications, including those brought into the assisted living program by the consumer, family or friends, shall be administered or discontinued without a written order signed by a duly authorized licensed practitioner or other person licensed to prescribe medications. [Class III] 7.1.7 Orders for medications and associated treatments shall be in writing, signed and dated by a duly authorized licensed practitioner and shall be in effect for the time specified by the duly authorized licensed practitioner, but in no case to exceed twelve (12) months, unless there is a written reorder. Orders for psychotropic medications shall be reissued every three (3) months, unless otherwise indicated by the duly authorized licensed practitioner. Standing orders for individual consumers are acceptable when signed and dated by the duly authorized licensed practitioner. 7.1.7.1 Upon admission to another facility, all existing orders are no longer in effect. Upon return to the facility, all orders must be reviewed and approved by the residents duly authorized licensed practitioner within 72 hours. During that timeframe, orders that are signed and dated by the discharging duly authorized licensed practitioner are the current acceptable orders. Prior to admission to another facility all medications must be removed from service and placed in a locked area in accordance with Section 7.7. Administration of medications. Self-administration. Upon admission, each individuals ability to self-administer medications will be determined by an assessment of his/her ability or need for assistance, unless the consumer/legal representative elects (in writing) to have the assisted living program administer his/her medications. A final decision will be reached between the consumer, his/her legal representative, his/her duly authorized licensed practitioner, and a facility representative. Medications administered by assisted living program. For those medications for which the assisted living program is responsible, the following apply: 7.2.2.1 Telephone orders shall be accepted only by a registered or licensed nurse or pharmacist. Written dated orders for telephone orders must be signed by the duly authorized licensed practitioner within five (5) working days. [Class III] 7.2.2.2 Facsimile orders are acceptable legal orders as long as they are in compliance with the Commission on Pharmacy regulations. 7.2.3 Unlicensed assistive personnel. Unlicensed assistive personnel administering medications and/or treatments must successfully complete training approved by the Department. There shall be evidence available in the assisted living program that such training has been successfully completed. Whenever the standards or guidelines of the medication administration course are substantially revised, unlicensed personnel must be re-certified within one (1) year of the revision, by a method approved by the Department. An additional exception will be made on a case-by-case basis for persons who only administer dietary supplements and/or minor medicated treatments, shampoos, lotions and creams that could be obtained over the counter without a physicians order. A person qualified to administer medications must be on site at the assisted living program whenever a resident(s) have medications prescribed as needed (PRN) if this medication is not self-administered. All unlicensed assistive personnel administering medications and/or treatments must complete a Department-approved eight (8) hour refresher course biennially for re-certification within two (2) years of the original certification. [Class III] 7.2.4 PRN Medications 7.2.4.1 PRN Psychotropic medications. Psychotropic medications ordered as needed by the duly authorized licensed practitioner, shall not be administered unless the duly authorized licensed practitioner has provided detailed behavior-specific written instructions, including symptoms that might require use of medication, exact dosage, exact time frames between dosages and the maximum dosage to be given in a twenty-four (24) hour period. Assisted living program staff shall notify the duly authorized licensed practitioner within twenty-four (24) hours when such a medication has been administered, unless otherwise instructed in writing by the duly authorized licensed practitioner. 7.2.4.2 A person qualified to administer medications must be on site at the assisted living program whenever a resident(s) have medications prescribed as needed (PRN) if this medication is not self-administered. In no event, however, shall antipsychotic-type psychotropic medications be prescribed on a PRN basis only, having no routinely scheduled and administered doses. 7.3 Medication storage. 7.3.1 Consumers who self-administer medications and who handle their own medical regime may keep medications in their own apartment. [Class III] 7.3.2 Medications administered by the assisted living program shall be kept in their original containers in a locked storage cabinet. The cabinet shall be equipped with separate cubicles, plainly labeled, or with other physical separation for the storage of each consumers medications. It shall be locked when not in use and the key carried by the person on duty in charge of medication administration. [Class III] 7.3.3 Medications/treatments administered by the assisted living program for external use only shall be kept separate from any medications to be taken internally. [Class III] 7.3.4 Medications administered by the assisted living program which require refrigeration shall be kept safely stored and separate from food by placement in a special tray or container, except vaccines, which must be stored in a separate refrigeration unit that is not used to store food. Refrigeration shall not exceed forty-one (41) degrees Fahrenheit. A thermometer shall be used to ensure proper refrigeration. [Class III] 7.4 Temporary absences. When a temporary absence from the assisted living program is expected to be greater than seventy-two (72) hours, medications leaving the assisted living program (except those by consumers who self-administer) must be in a form packaged and labeled by a pharmacist. For medications leaving the assisted living program for seventy-two (72) hours or less, the medication shall be packaged in such a way as to facilitate self-administration or administration by a responsible party of the correct medication at the appropriate time. Properly certified or licensed staff will use acceptable methods and procedures for preparing medications for leaving the assisted living program. Staff will follow the same policies used in the assisted living program for administering medications. The name of the consumer and the name and strength of each drug, as well as the directions from the original prescription package, should be conveyed to the consumer or their responsible party along with all cautionary information in writing, either directly on an envelope containing the appropriate dose or on a separate instruction sheet. If the medication is sent in original containers, pills must be counted and documented upon leaving and returning to the assisted living program. [Class III] 7.5 Medication labeling. For medications administered by the assisted living program, each prescription dispensed by a pharmacy shall be clearly labeled in compliance with requirements of the Commission on Pharmacy and shall include at least the following: 7.5.1 Prescription number; 7.5.2 Consumers full name; 7.5.3 Name, strength and dosage of the drug; 7.5.4 Directions for use; 7.5.5 Name of prescribing duly authorized licensed practitioner; 7.5.6 Name and address of issuing pharmacy; 7.5.7 Date of issue of latest refill; 7.5.8 Expiration date; and 7.5.9 Appropriate accessory and cautionary instructions. 7.6 Improperly labeled medications. For medications administered by the assisted living program, all pharmaceutical containers having soiled, damaged, incomplete, incorrect, illegible or makeshift labels shall be returned to the original dispensing pharmacy for re-labeling within two (2) working days or shall be disposed of in accordance with the requirements contained in Section 7.9. [Class III] 7.7 Expired and discontinued medications. For medications administered by the assisted living program, medications shall be removed from use and properly destroyed after the expiration date and when discontinued according to procedures contained in Section 7.9. They shall be taken out of service and locked separately from other medications until reordered or destroyed. [III] 7.8 Medication owned by consumers. Prescribed medicines are the property of the consumer and shall not be given to or taken by other consumers or any other person. 7.9 Destroying medications. For medications administered by the assisted living program, all discontinued medications, expired medications or medications prescribed for a deceased consumer, except controlled substances and individual doses, shall be destroyed by the administrator or the administrators designee and witnessed by one (1) competent person who is not a consumer. The destruction shall be conducted so that no person can use, administer, sell or give away the medication. Individual unit doses may be returned to the pharmacist and a credit or rebate made to the person(s) who originally paid for the medication. Amounts destroyed or returned shall be recorded on the consumers record, with the signature of the administrator or the administrators designee and witness(es). Destruction or return to the pharmacy shall take place within thirty (30) calendar days of expiration or discontinuation of a medication or following the death of the consumer. 7.10 Schedule II controlled substances. All Schedule II controlled substances administered by the assisted living program, listed in the Comprehensive Drug Abuse Act of 1970, Public Law 91-513, Section 202 and as amended pursuant to Section 202 are subject to the following standards. [Class II] 7.10.1 For all Schedule II controlled substances, there shall be an individual record in which shall be recorded the name of the consumer, prescription number, the date, drug name, dosage, frequency and method of administration, the signature of the person administering it and verification of the balance on hand. [Class II] 7.10.2 There shall be a recorded and signed count of all Schedule II controlled substances at least once a day, if such substances have been used in the assisted living program that day. [Class II] 7.10.3 All Schedule II controlled substances on hand shall be counted at least weekly and records kept of the inventory in a bound book with numbered pages, from which no pages shall be removed. [Class II] 7.10.4 All Schedule II controlled substances shall be stored under double lock in a separate locked box or cabinet within the medication cabinet or in an approved double-locked cabinet attached to the wall. [Class II] 7.10.5 All excess and undesired Schedule II controlled substances in the possession of a licensed assisted living program that are no longer required for a consumer, shall be disposed of in the following manner. The Administrator or a licensed or registered nurse shall list all such unused substances and keep the same in a securely locked area apart from all other drugs. Disposal shall be in the form of incineration or flushing into the sewage system only in the presence of an authorized representative of the Department, a licensed pharmacist, a member of the Commission on Pharmacy or an authorized representative of the Drug Enforcement Agency. At least one (1) of the persons must be a person who did not dispense the drug or who was the last person to inventory the drug. Documentation of such destruction shall be made on the consumers record and in the inventory record required in Section 7.10.3, signed by the individual authorized to dispose of the drug. [Class II] 7.11 Bulk supplies. Assisted Living Programs may, but are not required to, stock in bulk supply those items regularly available without prescription at a pharmacy. 7.12 Medication/treatment administration records for medications administered by the assisted living program, 7.12.1 Individual medication/treatment administration records shall be maintained for each consumer and shall include all treatments and medications ordered by the duly authorized licensed practitioner. The name of the medication, dosage, route and time to be given shall be recorded in the medication/treatment administration record. Documentation of treatments ordered and time to be done shall be maintained in the same manner. These rules apply only to treatments ordered by licensed health care professionals. [Class III] 7.12.2 Whenever a medication or treatment is started, given, refused or discontinued, including those ordered to be administered as needed (PRN), the medication or treatment shall be documented on the medication/treatment administration record. It shall be initialed by the administering individual, with the full signature of the individual written somewhere on such record. A medication or treatment shall not be discontinued without evidence of a stop order signed and dated by the duly authorized licensed practitioner. [Class III] 7.12.3 Medication errors and reactions shall be recorded in an incident report in the consumers record. Medication errors include errors of omission, as well as errors of commission. Errors in documentation or charting are errors of omission. [Class II] 7.12.4 Administration of medications ordered as needed (PRN) shall be documented and shall include date, time given, medication and dosage, route, reason given, results or response and initials or signature of administering individual. Treatments ordered PRN shall be documented in the same manner. 7.13 Medication containers. Graduated medicine containers, for the accurate measurement of liquid medications, shall be used. If not disposable, medicine containers shall be returned to the dishwashing unit for sanitization after each use. Only sterile disposable syringes and needles shall be used for insulin injection. Disposable medicine containers shall not be reused. [Class III]] 7.14 Breathing apparatus. When the assisted living program assists a consumer with a hand-held bronchodilator, metered dose nebulizers, intermittent positive pressure breathing machine or oxygen machine, there shall be documentation of the following: 7.14.1 The names of staff who are qualified or trained to use the equipment and/or to mix medications, the nature of their training, the date and who provided it; 7.14.2 The name of the distributing agency and the frequency and specific directions for cleaning the equipment; and 7.14.3 The consumers record shall contain a copy of the duly authorized licensed practitioners order, possible side effects to be monitored, specific instructions as to when the duly authorized licensed practitioner must be notified regarding side effects and instructions to the consumer on the use of the breathing apparatus. 7.15 Whenever a Registered Nurse teaches or provides in-service training to unlicensed personnel on medical issues, treatments and/or use of medical equipment not specifically outlined in these regulations there must be documentation for the employee file. Section 8 Verification of Credentials 8.1 Licensed Staff. Prior to employing licensed staff, the assisted living program must verify that the person has a valid and current license. Employing CNAs and CNA-Ms. Prior to employing a CNA or CNA-M (in the capacity of a CNA or CNA-M), the assisted living program must contact the CNA Registry and determine that the CNA or CNA-M is on the Registry and has not been annotated. If the CNA or CNA-M is not on the Registry, or if the CNA or CNA-M has been annotated for abuse, neglect or misappropriation of patient/client/consumer funds in a health care setting, or if the CNA or CNA-M has been the subject of a substantiated complaint involving abuse, neglect or misappropriation of patient/client/resident funds in a health care setting by the Department, the individual cannot be employed to function as a CNA or CNA-M. Prohibited Employment. The facility may not hire as unlicensed assistive personnel as defined in section 2.53 an individual who is prohibited from employment as a certified nursing assistant as outlined below and in section 8.4: An individual may not be employed in a hospital, nursing facility, home health agency or assisted housing program as a certified nursing assistant if that individual has been convicted in a court of law of a crime involving abuse, neglect or misappropriation of property in a health care setting; and An individual may not be employed in a hospital, nursing facility, home health agency or assisted housing program as a certified nursing assistant if that individual: Has been the subject of a complaint involving abuse or neglect that was substantiated by the department pursuant to its responsibility to license hospitals, nursing facilities, home health agencies and assisted housing programs and that was entered on the fb88 Registry of Certified Nursing Assistants; or Has been the subject of a complaint involving the misappropriation of property in a health care setting that was substantiated by the department and entered on the fb88 Registry of Certified Nursing Assistants. Time Limit on Consideration of Prior Criminal Conviction: Except as otherwise provided in this section, an individual may not be employed in a hospital, nursing facility, home health agency or assisted housing program as a certified nursing assistant if that individual has a prior criminal conviction within the last 10 years of: A crime for which incarceration of 3 years or more may be imposed under the laws of the state in which the conviction occurred; A crime for which incarceration of less than 3 years may be imposed under the laws of the state in which the conviction occurred involving sexual misconduct or involving abuse, neglect or exploitation in a setting other than a health care setting. Exception: The restrictions on employment under sections 8.3.1 and 8.3.2 do not apply to an individual listed and active on the fb88 Registry of Certified Nursing Assistants prior to the effective date of Title 22 M.R.S.A. 1812G(8) as long as the individual meets other state and federal requirements for certified nursing assistants and continues to maintain an active status by timely re-registration as required by the rules. Notification: A nursing assistant training program must notify applicants to that program of the restrictions under 8.3.1 and 8.3.2 prior to the acceptance of any applicant. Section 9 Scope of Licenses 9.1 Change in level of services. No Assisted Living Program may provide services in excess of those permitted by its license. When a licensed Type 1 Assisted Living Program applies to be licensed as a Type 2 program that provides nursing services, a modified application process is used. The provider must contact the Department in writing and provide such additional information as may be requested in order to assess the providers capacity to deliver nursing services under a Type 2 license. Section 10 Consumer Records 10.1 Individual records required. For each consumer receiving assisted living services, the program must develop and maintain individual records that include, but are not limited to, the following: 10.1.1 Name, address, mailing address (if different) and telephone number; 10.1.2 Name, address and telephone number of a person to contact in an emergency; 10.1.3 A functional assessment and reassessments; 10.1.4 A service plan; 10.1.5 A dated release of information authorization; and 10.1.6 Documented proof of legal representation. 10.2 Assessments and reassessments. 10.2.1 A functional assessment must be completed within thirty (30) calendar days for a consumer receiving assisted living services. The assessment must include a review of the consumers need for assistance with ADLs, IADLs, medication administration and nursing service. The document shall contain the date of the assessment and the signature of the assessor. 10.2.2 Reassessments shall be done at least every six (6) months thereafter, indicating the date of the reassessment and the signature of the assessor. 10.3 Service plans. A service plan shall be signed by the consumer or his/her legal representative. The plan authorizes the program to arrange for or to provide services. The service plan must be reviewed and revised as appropriate, but at least every six (6) months, unless changes occur. The plan must describe: 10.3.1 What services will be provided; 10.3.2 The desired outcome; 10.3.3 Who will provide the services; 10.3.4 When and how often assistance will be provided; and 10.3.5 When the service will begin. 10.4 Release of information. A dated release of information authorization shall be on a form approved by the Department, and signed by the consumer. The release of information authorization must: 10.4.1 Be in language the consumer can understand; 10.4.2. State whether or not the consumer gives permission for information to be disclosed and if permission is given, the authorization must contain: 10.4.2.1 Names of the agencies or people who are authorized to disclose information; 10.4.2.2 A description of the type of information that may be disclosed; 10.4.2.3 Names of the people or agencies to whom information may be disclosed; 10.4.2.4 The date the authorization will expire; and 10.4.2.5 A statement that the consumer can revoke or change the release at any time. 10.5 Progress notes. Signed and dated progress notes shall be completed at least monthly on implementation of the service plan and/or any significant changes in the consumers functioning. 10.6 Incident documentation. For any consumer who has sustained an injury, who has a medication reaction or when an error is made in the documentation or administration of medication, a report shall be completed. The report shall describe the incident and indicate the extent of the injury or reaction and necessary treatment. It shall be filed in the consumers record. Section 11 Qualifications, Training and Responsibilities 11.1 Operating standards. The licensee shall operate in compliance with all applicable laws and regulations, consistent with the standard of conduct that a reasonable and prudent person would observe in the same situation. 11.2 Minimum age. The chief executive officer of the licensee shall be at least twenty-one (21) years of age. 11.3 Criteria. The licensee and administrator shall demonstrate their willingness and ability to operate and manage the assisted living program with regard for the best interests of consumers. In making this determination, the Department shall consider each of the following factors to the extent that they are relevant to the proposed program, ownership interest and/or employment: 11.3.1 Record and reputation for honest and lawful conduct in business and personal situations. The provider shall, as part of the license application and renewal process, authorize the Department to review the records of professional licensing boards or registers and any criminal record, child protective record or adult protective record necessary to determine compliance with these rules. 11.3.2 Financial viability, including but not limited to, a history of timely payment of employee federal withholding taxes, a good credit rating from an appropriate agency and/or financial institution, capability of obtaining financing for working capital. 11.4 Training for Assisted Living Provider. The licensee shall attend any training sessions that the Department determines are necessary to meet licensing standards. 11.5 Administrator. There shall be an administrator who holds a current professional license related to residential care, assisted living programs or health care, or have a combination of five (5) years of education or experience in the health care field, including financial management and staff supervision. In addition, the administrator must meet the following qualifications: 11.5.1 The administrator shall be at least twenty-one (21) years of age. 11.5.2 The administrator shall have management and supervisory experience, including the capacity to manage the financial operations and staff of the assisted living program for which the license is sought. 11.5.3 The administrator shall have experience in the field of health care, social services or areas related to the provision of assisted living services. 11.5.4 The administrator shall demonstrate conduct which shows an understanding of, and compliance with, consumers rights. 11.5.5 The administrator shall provide information which relates to the ability and willingness to comply with all applicable laws and regulations. 11.5.6 The administrator shall provide any information reasonably related to the ability to provide safe and appropriate services at the level of care for which the license is sought. 11.6 Administrator training. The Administrator shall attend any training sessions which the Department determines to be mandatory. 11.7 Direct Services staff. No person under the age of eighteen (18) shall provide direct services except for CNAs sixteen (16) or older who are acting in the capacity of a CNA. 11.8 Employee records. Individual employee records are required, and must contain the initial date of employment, date of birth, home address and telephone number, experience and qualifications, social security number, copy of current occupational license (if applicable), references and reference check information, job description, record of participation in in-service, orientation or other training programs, results of annual personnel evaluations, disciplinary actions, illness and injury records and date of and reason for termination. Records may be computerized. Section 12 Services and Service Coordination 12.1 Services. The following services must be offered: 12.1.1 Service coordination to identify a consumers need and desire for services and to coordinate the appropriate types and amounts of services, as identified in the service plan. This activity is to be carried out with the involvement of the consumer, the service provider and other persons of the consumers choice, as applicable. Service coordination includes: 12.1.1.1 Completing the functional assessment and reassessments; 12.1.1.2 Coordinating and participating in a health professionals assessment or reassessment as necessary; 12.1.1.3 Reviewing, with the consumer, the findings of the functional assessments, the options available to address the consumers needs and the development of a service plan; 12.1.1.4 Implementation of a service plan; 12.1.1.5 Monitoring of the consumers needs and services furnished, as often as necessary; 12.1.1.6 Advocating on behalf of the consumer; and 12.1.1.7 Maintaining complete and accurate consumer records. 12.1.2 Housekeeping services to assist consumers with IADLs; Assistance with ADLs; 12.1.4 At least one nutritious meal a day; 12.1.5 Chore services to assist with heavy cleaning; and 12.1.6 Other goods and services identified in the service plan. 12.2 Additional responsibilities. The provider must assure that: 12.2.1 Administrators meet the requirements of Section 10.5 of these regulations; 12.2.2 Written agreements with service providers and, if applicable, the building owner, are current and comply with the applicable laws and regulations; 12.2.3 The names, addresses, telephone numbers for and descriptions of the services available from advocacy and legal assistance programs and the Long Term Care Ombudsman Program are posted conspicuously; 12.2.4 The requirements of the fb88 Human Rights Act, Title 5 M.R.S.A. 4551 et seq., are observed; 12.2.5 Written admission criteria, discharge policies, complaint resolution procedures and consumer fee requirements are given to consumers at the time of application for service; 12.2.6 Consumer and program records are complete, current and available for Department review; 12.2.7 The site meets applicable state and/or federal regulations for handicapped accessibility; 12.2.8 Licensure requirements for food safety are met; and 12.2.9 Licensure requirements for building safety are met. Section 13 Dietary Services 13.1 Food Safety. An Assisted Living Program site with a community kitchen must have a valid license from the Department of Health and Human Services, Division of Health Engineering. Meals prepared off-site must be prepared by an appropriately licensed provider. 13.2 Consumer participation in meal planning. Consumers shall be encouraged to participate in food planning. 13.3 Meals. Food shall be served at the proper temperatures. 13.4 Registered dietitian. A registered dietitian shall be required to sign off annually on menus and menu cycles. 13.5 Planned menus. Menus shall be planned in accordance with consumers needs and preferences. 13.6 Therapeutic diets. Therapeutic diets are considered treatments and shall be ordered, in writing, by a duly authorized licensed practitioner. Menus for medically prescribed therapeutic diets shall be planned, in writing, and approved by a registered dietitian. 13.7 Food supplies. For Assisted Living Programs that prepare meals on-site, supplies of perishable foods for a forty-eight (48) hour period and supplies of non-perishable foods for a three (3) day period shall be on hand to meet the requirements of the planned menus. Section 14 Physical Plant and Sanitation 14.1 Applicable standards. Buildings containing an Assisted Living Program must comply with all applicable local, state and federal rules and regulations regarding building safety, fire safety, handicapped accessibility and fair housing practices. When codes conflict, the higher standard shall apply. 14.2 Bathrooms. Public bathrooms must be safe and sanitary. 14.3 Heat. Heat needs to be available and individually controlled in each apartment. 14.4 Water temperature. The hot water temperature for consumer use must be between 105F. and 120F. and in adequate supply. 14.5 Lockable door. Each apartment must have a lockable door to common areas. 14.6 Food preparation area. Each apartment must have an area for the purpose of storing and preparing food. This area must include, as a minimum, six (6) square feet of clear countertop, a small refrigerator, bar-type sink, a cabinet for food storage and either a two-burner stovetop or a microwave oven. 14.7 Private water supply. A private water supply shall be tested annually and a satisfactory result obtained. 14.8 Garbage and rubbish. Pending removal, all refuse collected in common areas or from consumer apartments shall be stored in cleanable, rodent-proof, covered containers. 14.9 Insect and rodent control. There shall be no evidence of rodent or insect infestation. All reasonable precautions will be taken in maintaining a safe, sanitary and comfortable living environment in regards to controlling insects and rodents. 14.10 Poisonous and toxic materials. When not in use, poisonous and toxic materials such as cleaning solutions, compounds and other non-food supplies, shall be stored in compartments which are used for no other purpose. They shall be separated from the food storage and preparation areas, clean equipment, utensil storage rooms and medication storage areas. Bactericides and cleaning compounds shall not be stored in the same cabinet or area of the room with insecticides, rodenticides or other poisonous materials. All containers must be properly labeled for identification. This section does not apply to materials belonging to consumers and stored in their apartments. Section 15 Assisted Living Programs with Nursing Services (Type 2) 15.1 License required. Before an assisted living program can provide nursing services directly or indirectly, it must demonstrate to the Departments satisfaction the capacity to provide nursing services and receive a Type 2 Assisted Living Program license. 15.2 Nursing services. The assisted living program shall disclose whether it provides nursing services, directly or indirectly, as follows: 15.2.1 Services of a Registered Professional Nurse; and/or 15.2.2 Registered Professional Nurse coordination and oversight of consumer care services provided by unlicensed health care assistive personnel. Statutory Authority Public Law 2007, Chapter 324 (5) (6) (7) (11). [routine technical rule] 22 M.R.S.A. Chapters 1663 and 1664 22-A M.R.S.A. 205(2) Regulatory History AMENDED June 1, 2006 [major substantive rulemaking process] AMENDED August 20, 2008 - Sections 3 and 4 [routine technical rules pursuant to Public Law 2007, Chapter 324 (5) (6) (7) (11)], filing 2008-352. Also moved from umbrella-unit number 10-149 to 10-144 at the request of the agency. Appendix A Licensed Assisted Housing Program Standard Contract This contract is entered into between _________________________________ (hereinafter the Provider) and you, ___________________________________. This contract describes your financial obligations, as well as other responsibilities and rights. It also describes the rights and obligations that apply to the Provider in the course of providing services to you. This contract is a standard contract required for use in the State of fb88. Providers may add additional provisions to the standard contract in a customized addendum but these additional provisions may not conflict with or replace the use of the standard contract. The intent of having a standard contract in fb88 is to permit you to compare costs and services among providers. Providers are required to disclose their contracts and rates. In consideration of the payment and promises made in this contract, you and the Provider agree as follows: I STANDARDS The Provider will help to further your independence and respect your privacy and personal choices, including your choice to continue to reside here for as long as the Provider and program, as it is fundamentally designed, is able to meet your needs. The Providers programs will be consumer oriented and meet professional standards of quality at all times. This means that if your needs exceed the Providers ability to provide services, the Provider will assist you in making other arrangements including moving somewhere else, if necessary. II PROVIDER LICENSE The Provider is licensed in conformity with the requirements of the State of fb88. The type of provider is stated on the license issued by the fb88 Department of Human Services and posted for public inspection in the ____________. This Provider is licensed as follows (check one):  FORMCHECKBOX  Level I Residential Care Facility  FORMCHECKBOX  Level II Residential Care Facility  FORMCHECKBOX  Level III Residential Care Facility  FORMCHECKBOX  Level IV Residential Care Facility  FORMCHECKBOX  Level I PNMI Residential Care Facility  FORMCHECKBOX  Level II PNMI Residential Care Facility  FORMCHECKBOX  Level III PNMI Residential Care Facility  FORMCHECKBOX  Level IV PNMI Residential Care Facility  FORMCHECKBOX  Type I Assisted Living Program  FORMCHECKBOX  Type II Assisted Living Program  FORMCHECKBOX  This box will be checked if you rent your unit from a separate entity (referred to in this contract as the Landlord) that is not the Provider. The Landlord is responsible for enforcing the terms and conditions of the lease. The Provider is responsible for assuring that the terms and conditions of your lease agreement with the Landlord do not conflict with this contract. The State of fb88 has reviewed the separate lease agreement and has determined that it complies with all laws and regulations related to the provision of assisted living services. A copy of this lease is attached for reference as Appendix F to this contract. Even though you have a lease with separate landlord, you have the same rights as you would have if the landlord and provider were one and the same. III APPENDICES The following Appendices are attached and made a part of this contract:  FORMCHECKBOX  Appendix A: Admissions Policy  FORMCHECKBOX  Appendix B: Your Rights  FORMCHECKBOX  Appendix C: Grievance Policy  FORMCHECKBOX  Appendix D: Tenancy Obligations (check if this applies)  FORMCHECKBOX  Appendix E: Additional terms in Customized Addendum (check if this applies)  FORMCHECKBOX  Appendix F: Applies only if you rent your unit from an entity (the Landlord) that is not the Provider IV ADMISSION POLICY There is an Admission Policy that meets the requirements of the State of fb88 that describes who can be admitted and the types of services provided. A copy of this policy is attached as AppendixA. V SERVICES PROVIDED DIRECTLY OR INDIRECTLY BY PROVIDER INCLUDED IN THE DAILY/MONTHLY RATE A. You agree to purchase:  FORMCHECKBOX  Housing and Services.  FORMCHECKBOX  Housing Only. B. You agree to pay the following current rate to the Provider:  FORMCHECKBOX  Daily rate of $________  FORMCHECKBOX  Monthly rate of $________  FORMCHECKBOX  The amount you pay will be determined by the fb88Care Program. C. If you rent your unit from a landlord that is a different entity from the Provider, you understand that: The landlord is________________________________________. The amount of your current monthly rent is ___________. D. Certain basic services must be provided in all licensed assisted housing programs. If you have decided to purchase assisted living services, these basic services are provided under the daily/monthly rate you pay for your care. This means the Provider must act in accordance with the regulations to: Observe and assess how you function and/or your individual behaviors for the purpose of enhancing your health and safety or the health and safety of others; Protect you from environmental hazards by mitigating risk in the physical environment to prevent unnecessary injury or accident; and Identify your needs and strengths, develop a service plan and arrange for and monitor service delivery. E. There is a wide range of services available. Those services and their costs are listed in Appendix E. What you actually receive for services will be based on whether you are purchasing assisted living services, and on your individual assessment and service plan. If checked below, the service is offered by the Provider as part of your current daily/monthly rate and there is no additional charge to you if it becomes part of your service plan: 1. Personal Supervision.  FORMCHECKBOX  Even though you may travel independently in the community, the Provider will keep track of your general whereabouts  FORMCHECKBOX  Staff will accompany you to medical appointments  FORMCHECKBOX  The Provider provides an escort for regular travel  FORMCHECKBOX  The Provider has qualified staff in the building 24-hours/day  FORMCHECKBOX  Other____________________________________________  FORMCHECKBOX  Additional provisions: See Appendix E 2. Assistance with activities of daily living. (These are tasks that you may routinely need assistance with in order to maintain your best level of physical function.)  FORMCHECKBOX  Walking  FORMCHECKBOX  Changing position in bed  FORMCHECKBOX  Transferring from place to place  FORMCHECKBOX  Dressing  FORMCHECKBOX  Eating  FORMCHECKBOX  Using the bathroom  FORMCHECKBOX  Bathing  FORMCHECKBOX  Personal hygiene, such as help washing your hair  FORMCHECKBOX  Other ____________________________________________  FORMCHECKBOX  Additional Provisions: See Appendix E 3. Incidental activities of daily living.  FORMCHECKBOX  Using the telephone  FORMCHECKBOX  Handling your finances  FORMCHECKBOX  Banking  FORMCHECKBOX  Shopping  FORMCHECKBOX  Light housekeeping  FORMCHECKBOX  Heavy housekeeping  FORMCHECKBOX  Getting to appointments  FORMCHECKBOX  Barber/beautician services  FORMCHECKBOX  Other ____________________________________________  FORMCHECKBOX  Additional Provisions: See Appendix E 4. Medication assistance.  FORMCHECKBOX  Obtaining medications from the Pharmacy of your choice:________________________________.  FORMCHECKBOX  Ordered by Provider  FORMCHECKBOX  Delivered by the Pharmacy  FORMCHECKBOX  Ordered by you/family member  FORMCHECKBOX  Picked up by Provider  FORMCHECKBOX  Picked up by you/family member  FORMCHECKBOX  Provide qualified staff to help you take your medications (such as reading the container labels, watching while you take a medication, checking the correct dosage, removing the dosage from the container, administering prescribed dosage, filling a syringe, administering any medication as allowed by applicable licensing regulations)  FORMCHECKBOX  Maintaining an individual medication administration record for you that will include all the medications and treatments that your physician orders for you, and a record that includes, for example, information that they have been administered at the right time and in the right dose  FORMCHECKBOX  Other ___________________________________________  FORMCHECKBOX  Additional Provisions: See Appendix E 5. Food Service.  FORMCHECKBOX  Meal preparation (including the cost of food) _____ times each day  FORMCHECKBOX  Meal preparation (food purchased separately by you) _________ times each day  FORMCHECKBOX  Nutritious between-meal snacks __________ times each day  FORMCHECKBOX  Special diets ordered by your physician as follows: _____________________________________  FORMCHECKBOX  Shopping for groceries you purchase  FORMCHECKBOX  Meal planning  FORMCHECKBOX  Other ___________________________________________  FORMCHECKBOX  Additional Provisions: See Appendix E 6. Transportation services.  FORMCHECKBOX  Arranging transportation (cost of transportation included) ________miles roundtrip  FORMCHECKBOX  Arranging transportation (cost of transportation not included)  FORMCHECKBOX  Transportation without escort to medical appointments within ________ miles roundtrip  FORMCHECKBOX  Transportation with escort to medical appointments within ________ miles roundtrip  FORMCHECKBOX  Other _________________________________________ 7. Nursing services. Some providers provide the services of a registered professional nurse. Others use registered professional nurses to coordinate the services and oversee staff who are not nurses. The following nursing services are part of your daily/monthly rate:  FORMCHECKBOX  None  FORMCHECKBOX  Skilled nursing services provided by a registered professional nurse.  FORMCHECKBOX  Registered professional nurse who oversees staff and coordinates your health care needs. 8. Housing Costs. These costs include those associated with your housing instead of your services, and may include things such as heat, lights, cable TV, telephone, your unit and other costs. Check all that apply:  FORMCHECKBOX  All housing costs (there will be no extra charges)  FORMCHECKBOX  All housing costs except: ______________________________________________________ ______________________________________________________ ______________________________________________________  FORMCHECKBOX  Semi-private room  FORMCHECKBOX  Shared bathroom  FORMCHECKBOX  Private room  FORMCHECKBOX  Private bathroom  FORMCHECKBOX  Efficiency apartment  FORMCHECKBOX  One Bedroom Apartment  FORMCHECKBOX  Two Bedroom Apartment  FORMCHECKBOX  Other  FORMCHECKBOX  Additional Provisions: See Appendix E  FORMCHECKBOX  You have a lease agreement with a landlord other than the Provider: See Appendix F 9. Equipment and supplies. The Provider will supply the following equipment and supplies, as needed, as part of the daily cost that you pay:  FORMCHECKBOX  None  FORMCHECKBOX  Non-prescription analgesics and antacids  FORMCHECKBOX  Bedroom furnishings: ___________________________________ ____________________________________________________  FORMCHECKBOX  Pillows, sheets, linens, towels  FORMCHECKBOX  Laundry supplies and equipment  FORMCHECKBOX  Laxatives  FORMCHECKBOX  Thermometers  FORMCHECKBOX  Non-prescription skin creams/lubricants  FORMCHECKBOX  Mouthwash  FORMCHECKBOX  Toothpaste  FORMCHECKBOX  Other non-prescription ointments:_______________________  FORMCHECKBOX  Shampoo  FORMCHECKBOX  Soap  FORMCHECKBOX  Facial tissue  FORMCHECKBOX  Toilet tissue  FORMCHECKBOX  Paper towels  FORMCHECKBOX  Incontinence supplies  FORMCHECKBOX  Other:______________________________________________ 10. Additional Services  FORMCHECKBOX  See Appendix E VI. SERVICES NOT INCLUDED IN THE DAILY RATE. In some instances you may wish to purchase services beyond those included in your daily rate at an additional charge.  FORMCHECKBOX  See Appendix E for listing of items that are available at an additional charge. VII. BILLING AND PAYMENT A. Payment for services covered by the daily/monthly rate. The Provider requires you to pay for your care under the terms of this contract within the following time frame: __________________________________. If there is a separate lease agreement, payment must also be made in accordance with that agreement. You should be aware that failure to pay for your services in accordance with this contract may result in your discharge from the Providers facility or program. The Provider may not hold you responsible for the payment of attorneys fees or any other cost of collecting payment. B. Source of payment for services covered by the daily/monthly rate:  FORMCHECKBOX  Self-pay  FORMCHECKBOX  Self-pay and billing to a third party:_____________ C. Payment for services not covered by the daily/monthly rate. You agree to be responsible for payment for any services or convenience items not specifically included by this contract in the daily/monthly rate. Those that are provided by the Provider will be billed directly to you at the end of each month in addition to the daily/monthly rate. D. Source of payment for services not covered by the daily/monthly rate:  FORMCHECKBOX  Self-pay  FORMCHECKBOX  Other________________ E. Holding your unit. If you are away temporarily, you are still responsible for paying for your unit and you may return as long as you continue to pay and this contract is in force. F. Security deposit. A security deposit may be charged only for apartment units in an assisted living program.  FORMCHECKBOX  There is a security deposit. This security deposit will not exceed one months rent (currently $____________), and will be refunded to you within thirty (30) days from date of discharge/death.  FORMCHECKBOX  The following costs may be deducted from the security deposit: _____________________________________________________________ _____________________________________________________________  FORMCHECKBOX  Security deposits are part of your separate lease with the Landlord. G. Calculation of refund. You are entitled to a refund for any advance payments you make on a prorated basis when you are discharged. This will include a refund for the day in which you are discharged.  FORMCHECKBOX  In residential care facilities, the refund is calculated by multiplying the amount you paid per day times the remaining number of days in the month, including the date of discharge.  FORMCHECKBOX  In assisted living programs, your refund is calculated from the date your apartment unit is vacated or from the last day of any required notice period, whichever is later. The refund is calculated by multiplying the amount you paid per day times the remaining number of days in the month, including the date your unit is vacated or the last day of any required notice period, whichever is later. VIII. RIGHTS REGARDING TRANSFER AND DISCHARGE You have certain rights under law and regulations regarding transfer and discharge. A copy of a document explaining your rights is attached as Appendix B. IX. MODIFICATION OF CONTRACT TERMS At least thirty (30) days written notice is required for any modifications of contract terms including, but not limited to, rate and charge changes, responsibilities, services to be provided or any other items included in this contract. The thirty (30) days notice will not be required if you are the one requesting additional services not already included in the rate you pay pursuant to this contract. X. NOTICE PROVISION Any notice required by this contract shall be in writing. The notice shall be considered delivered on the date of its receipt, if hand delivered. If the notice is deposited with the U.S. Postal Service, it shall be considered delivered three (3) days from the date of deposit in the mail. Notice to the Agent shall be by delivering it to him/her at the address provided at the end of this contract. XI. ACKNOWLEDGEMENT A. You acknowledge that your rights, attached as Appendix B and included as part of this contract, have been explained to you and you have signed that attachment. B. You acknowledge that you have been given a copy of the Providers admission policy, grievance policy and any tenancy obligations (See Appendix A, C and D). C. You have made arrangement for the management of your affairs, either personal and/or financial, as follows:  FORMCHECKBOX  Manage own affairs  FORMCHECKBOX  Durable Financial Power of Attorney  FORMCHECKBOX  Health Care Power of Attorney  FORMCHECKBOX  Representative Payee  FORMCHECKBOX  Guardian  FORMCHECKBOX  Conservator  FORMCHECKBOX  Trustee  FORMCHECKBOX  Advance Directive/Living will  FORMCHECKBOX  Other You agree to supply copies of all relevant information about those individuals who are responsible for your affairs as they relate to your care under this contract. XII. CHANGES IN LAW Any provision of this contract that is found to be invalid or unenforceable as a result of a change in Federal or State law or regulation will not invalidate the remaining provisions of this contract and it is agreed that, to the extent possible, you and the Provider will continue to fulfill your respective obligations under this contract consistent with law. XIII. SIGNATURES This contract may not require or encourage any person other than yourself to obligate himself/herself for the payment of your expenses. If any person informs the Provider that he/she wishes to guarantee payment of your expenses, he/she can do so only in a separate written agreement. The separate written agreement allows for the guarantor of payment to change his/her mind within forty-eight (48) hours of signing this separate written agreement. If someone else who you authorize (hereinafter your Agent) signs this contract in his/her capacity as Agent, the individual may or may not be able to make health care or other decisions on your behalf. The extent of the Agents authority depends on the nature of that legal relationship. Seen and agreed by: Date: ____________________ ___________________________________ Signature of Provider Representative _______________________________ Name of Provider _______________________________ Address __________________________________ Your Name __________________________________ Your Signature or Signature of Your Agent __________________________________ Address __________________________________ Telephone Number  APPENDIX F This Appendix applies only if you rent your unit from an entity (the Landlord) that is not the Provider. Your Landlord is: _____________________________. Your current monthly rent is:____________________. Among other things, your lease provides that you will receive the following (check all that applies):  FORMCHECKBOX  All housing costs (there will be no extra charges)  FORMCHECKBOX  All housing costs except: ______________________________________________________ ______________________________________________________ ______________________________________________________  FORMCHECKBOX  Semi-private room  FORMCHECKBOX  Shared bathroom  FORMCHECKBOX  Private room  FORMCHECKBOX  Private bathroom  FORMCHECKBOX  Efficiency apartment  FORMCHECKBOX  One Bedroom Apartment  FORMCHECKBOX  Two Bedroom Apartment  FORMCHECKBOX  Other D. Your lease is attached here for reference.     10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Table of Contents  PAGE iv 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 1: Purpose  PAGE 1 of  SECTIONPAGES \* MERGEFORMAT 1 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 2: Definitions  PAGE 1 of  SECTIONPAGES \* MERGEFORMAT 1 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 3: Licensing 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 4: Enforcement Procedures 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 5: Consumer Rights 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 6: Alzheimers/Dementia Unit Standards 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 7: Medications and Treatments 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 8: Verification of Credentials 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 9: Scope of License 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 10: Consumer Records 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 11: Qualifications, Training and Responsibilities 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 12: Services and Service Coordination 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 13: Dietary Services 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 14: Physical Plant and Sanitation 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Section 15: Assisted Living Programs with Nursing Services (Type 2) PAGE  PAGE 2 10-144 Chapter 113: Regulations Governing the Licensing and Functioning of Assisted Housing Programs: Assisted Living Programs, Appendix A: Standard Contract $Rm{   . / U V d e ռwneneneneWnF j++h[-5CJUaJjh[-5CJUaJhS5CJaJh[-5CJaJh[-5:B*CJaJphh[-5:B*CJ!aJ!phjhWhEB*UphhWhEB*CJ(phh[-B*CJ(phhWh[-B*CJ(phh[-5B*CJ(phhWhE5B*CJ(phhWhE5:B*CJ0phhWhEB*ph$(47RSlm / ? 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