Standards for Licensed Assisted Living Facilities 22 VAC

Standards for Licensed Assisted Living Facilities (22 VAC 40 -73) New Regulation Training 2017 – 2018 Effective date: February 1, 2018 Department of Social Services Division of Licensing Programs – Adult Programs 1

Caveat • The regulatory action we're discussing today repealed 22 VAC 40 -72 and enacted 22 VAC 40 -73. • It is impossible to discuss all the changes or all of the requirements in the new regulation. • Read the regulation, refer to it often, and contact your licensing representative if you have any questions. 2

Part I General Provisions 3

22 VAC 40 -73 -30. Program of Care. Current 22 VAC 40 -72 -40 • Adds that the program of care will: – Meet the resident’s spiritual needs. – Promote the resident’s highest level of functioning, independence, and involvement with appropriate programs based on the resident’s needs and interests. 4

Part II Administration and Administrative Services 5

22 VAC 40 -73 -40. Licensee. Current 22 VAC 40 -72 -50 • Adds: — That the licensee’s agent or relatives of the licensee, facility administrator, and facility staff are prohibited from acting as, seeking to become, or becoming the conservator or guardian of any resident unless appointed by a court. —Licensee must give evidence of financial responsibility and solvency. — Licensee must notify case managers, assessors, and eligibility workers of intended sale, closure, and the date. 6

22 VAC 40 -73 -40. Licensee. Continued Adds (continued): – If sold, licensee must explain to each resident, legal representative, case manager or assessor, and at least 1 designated contact person that resident can choose whether to stay or relocate, unless the new licensee specifies relocation. 7

22 VAC 40 -73 -45. Minimum amount for liability insurance disclosure. • Adds that the minimum amount of liability insurance coverage to be maintained by an ALF for disclosure purposes in the disclosure statement and the resident agreement is: – $500, 000 per occurrence to compensate residents or others for injuries and losses from negligent acts of the ALF, and – $500, 000 aggregate for the same purpose as noted immediately above. • An ALF shall not state that liability insurance is in place unless the insurance provides the minimum amount of coverage established in this section. 8

22 VAC 40 -73 -50. Disclosure. Current 22 VAC 40 -72 -60 • Adds: – That the ALF state whether or not it maintains liability insurance that provides at least the minimum amount of coverage established by the board for disclosure purposes to compensate residents or others for injuries and losses from negligent acts of the facility. The ALF must state in the disclosure statement that the minimum amount of coverage is $500, 000 per occurrence, $500, 000 aggregate. 9

22 VAC 40 -73 -60. Electronic records and signatures. • Adds: – Electronic records or signatures must comply with the Uniform Electronic Transactions Act. – An electronic signature is deemed a signature with the same effect as a written signature on a document when the licensee ensures the following: — Development, implementation, and maintenance of policies and procedures for use of electronic signatures. — Each electronic signature identifies the person signing the document by name and title. 10

22 VAC 40 -73 -60. Electronic records and signatures. Continued Ensures (continued): —The document cannot be altered after the signature has been affixed. —All users have signed statements that they alone have access to and use the key or computer password for their signature and will not share them with others. —There is strong and substantial evidence that would make it difficult for the signer or the receiving party to claim the electronic representation is not valid. • Adds that a back-up and security system must be used for all electronic documents. 11

22 VAC 40 -73 -70. Incident Reports. Current 22 VAC 40 -72 -100 • Changed reporting requirement from “by the next working day” to “within 24 hours. ” • Added to the incident report: Actions to prevent recurrence of the incident, if applicable. 12

22 VAC 40 -73 -100. Infection Control. Current 22 VAC 40 -72 -90 • Adds: – The infection control program shall be consistent with the CDC guidelines and the OSHA blood borne pathogens regulations. – A licensed health care professional shall participate in the development of infection prevention policies and procedures and shall ensure compliance with applicable guidelines and regulations. – Must review infection prevention policies and procedures at least annually. A licensed health care professional must be included in this review. 13

22 VAC 40 -73 -100. Infection Control. Continued • Adds (continued): – A staff person who has been trained in basic infection prevention shall participate in the annual review and serve as point of contact for the program; responsible for on-going monitoring of the program. – Infection control program is applicable to volunteers. – Procedures for the use of personal protective equipment. 14

22 VAC 40 -73 -100. Infection Control. Continued • Adds that the infection control program shall include procedures for other infection prevention measures: – Determination of whether residents have acute infectious disease and use of appropriate measures to prevent disease transmission. – Use of safe injection practices and other procedures where the potential for exposure to blood or body fluids exists. – Blood glucose monitoring practices that are consistent with CDC recommendations; finger stick devices shall not be used for more than one person. 15

22 VAC 40 -73 -100. Infection Control. Continued • Adds that the infection control program include: – Sanitation of rooms, including cleaning and disinfecting procedures, agents, and schedules. – Sanitation of equipment, including medical equipment that may be used on more than one resident. • Adds requirements for: – Readily accessible handwashing equipment and necessary personal protective equipment for staff and volunteers. – Product specific instructions for use of cleaning and disinfecting agents (ex. MSDS sheets). 16

22 VAC 40 -73 -100. Infection Control. Continued • Adds that the facility shall have a staff health program that includes: – Information on recommended vaccinations to facility staff and volunteers who have any potential exposure to residents or to infectious materials. – Assurance that employees with communicable diseases are identified and prevented from work activities that could result in transmission to other personnel or residents. – An exposure control plan for blood borne pathogens. 17

22 VAC 40 -73 -100. Infection Control. Continued • Staff health program includes (continued): – Documentation of screening and immunizations offered to, received by, or declined by employees. – Compliance with requirements of OSHA for reporting workplace injuries or exposure to infection. • Adds that the report of an outbreak of disease shall be made to the licensing representative of DSS in the regional licensing office. 18

Part III Personnel 19

22 VAC 40 -73 -120. Staff orientation and initial training. Current 22 VAC 40 -72 -180 • Changes the time frame for orientation and training to the first 7 working days of employment. • Adds: —All staff shall be oriented to the facility's organizational structure. —Staff orientation and initial training can be counted toward the first year’s annual training hours. 20

22 VAC 40 -73 -130. Reports of abuse, neglect, or exploitation. • Adds: – Requires mandated reporters to report suspected abuse, neglect, or exploitation of residents as required by Code. – Requires the facility to notify the resident’s contact person or legal representative when a report of suspected abuse, neglect, or exploitation is made, without identifying any confidential information. 21

22 VAC 40 -73 -160. Administrator training. Current 22 VAC 40 -72 -210 • Administrators that supervise RMAs, but are not licensed or registered to administer medications themselves, must complete the 68 hour training prior to supervising the RMAs. • Administrators must complete 4 hours of annual medication administration training or complete an annual refresher course provided by a BON approved program. 22

22 VAC 40 -73 -200. Direct care staff qualifications. Current 22 VAC 40 -72 -250 • Qualification requirements now apply to direct care staff working in ALL licensed ALFs. • Adds that: – Successful completion of a nursing education program preparing for RN or LPN licensure is acceptable to meet the standard. – Current enrollment in a nursing education program preparing for RN or LPN licensure and completion of at least 1 clinical course in the nursing program that includes at least 40 hours of direct client care clinical experience is acceptable to meet the standard. 23

22 VAC 40 -73 -210. Direct care staff training. Current 22 VAC 40 -72 -260 • In a facility licensed for residential care only, the annual training hours increase from 8 to 14 hours. • In a facility licensed for both residential and assisted living care, the annual training hours increase from 16 to 18 hours. • In facilities licensed for residential care only, the required hours for topics related to residents’ mental impairments increase from 2 to 4 hours annually. 24

22 VAC 40 -73 -220. Private duty personnel. • When private duty personnel from licensed home care organizations provide direct care or companion services to ALF residents, the following applies: — Before services begin, obtain written information on the type, care and frequency of the services to be delivered to the resident. —Services must be identified on the ISP. —Ensure TB requirements are met. —Ensure proper orientation and training of policies and procedures related to their duties. 25

22 VAC 40 -73 -220. Private duty personnel. Continued • Licensed home care organizations (continued): —Ensure that documentation of resident care required by the standards is maintained. —Monitor the delivery of direct care and companion services to the resident by private duty personnel. 26

22 VAC 40 -73 -220. Private duty personnel. Continued • For private duty personnel, who are not employees of a licensed home care organization: —Ensure that private duty personnel are qualified for the types of direct care or companion services they are responsible for providing and maintain documentation of qualifications. —Review original criminal history record report issued by the VDSP for each private duty personnel prior to initiation of services. o The date of the report must be no more than 90 days prior to initiation of services. 27

22 VAC 40 -73 -240. Volunteers. Current 22 VAC 40 -72 -280 • Adds: – ALF must maintain documentation on qualifications, orientation, training, and education required by these standards. – Volunteers must sign and date a statement that they have received and understand the orientation information. • Deletes the word “direct” from the supervision that must be provided to volunteers by a designated staff person when residents are present. 28

22 VAC 40 -73 -260. First Aid and CPR Certification. Current 22 VAC 40 -72 -300 • Adds that: – There shall be at least 1 staff member at all times who has current certification in first aid in each building, rather than on the premises. – There shall be at least 1 staff member at all times who has current certification in CPR in each building, rather than on the premises. 29

Part IV Staffing and Supervision 30

22 VAC 40 -73 -290. Work schedule and posting. • Adds: – A requirement to indicate the person in charge at any given time. – Absences and substitutions shall be noted on the schedule. – Develop and implement a procedure for posting the name of the current on-site person in charge in a place conspicuous to the residents and the public. 31

22 VAC 40 -73 -300. Communication among staff. Current 22 VAC 40 -72 -330 • Adds: – Procedures established for communication among administrators, designated assistant administrators, managers, and designated staff persons in charge, are reviewed with staff. – Written communication that keeps direct care staff informed of significant happenings or problems experienced by residents, shall be included in the records of the involved residents. 32

Part V Admission, Retention, and Discharge of Residents 33

22 VAC 40 -73 -310. Admission and retention of residents. Current 22 VAC 40 -72 -340 • Adds: – Residents shall not be required to relinquish their residents rights as a condition of admission or retention. – If hospice care is provided, there shall be a written agreement between the ALF and any hospice program that provides care in the facility. The agreement shall include: • Policies and procedures to ensure appropriate communication and coordination between the facility and the hospice program. 34

22 VAC 40 -73 -310. Admission and retention of residents. Continued • Agreement (continued): • Specification of the roles, responsibilities, and services between the facility and the hospice program. • Services provided to each resident shall be reflected on the ISP. 35

22 VAC 40 -73 -325. Fall risk rating. • Adds, for residents who meet the criteria for assisted living care: – By the time the comprehensive ISP is completed, a written fall risk rating shall be completed. – The fall risk rating shall be reviewed and updated: • At least annually; • When the condition of the resident changes; and • After a fall. – Should a resident fall, the facility must show documentation of an analysis of the circumstances of the fall and interventions that were initiated to prevent or reduce risk of subsequent falls. 36

22 VAC 40 -73 -330. Mental health screening. Current 22 VAC 40 -72 -360 • Adds an additional exception that states the mental health screening is not required for prospective residents when: – They are under the care of a qualified mental health professional at the time of admission; and – Provided there is documentation of the person's psychosocial and behavioral functioning, as specified in 22 VAC 40 -73 -340 A. 37

22 VAC 40 -73 -340. Psychosocial and behavioral history. Current 22 VAC 40 -72 -365 • Clarifies that when: – Information is relevant to a prospective resident’s psychosocial and behavioral history, the information must be provided prior to admission. – A prospective resident is coming from a private residence, the required information related to his psychosocial and behavioral history can come from family members, friends, or a physician. 38

22 VAC 40 -73 -350. Sex offender information. Current 22 VAC 40 -72 -367 • Adds that facility must: – Document that each resident or his legal representative has been informed how he can research registered sex offenders, and maintain the documentation in the resident’s record. — Requires that upon request, the facility must • Assist the resident or his legal representative in accessing the information on registered sex offenders, and • Provide printed copies of the information 39

22 VAC 40 -73 -360. Emergency placement. Current 22 VAC 40 -72 -370 • Changes from “seven working days” to “seven days” for a person to remain in the ALF unless all the requirements for admission have been met and the person has been admitted. • Adds that the facility obtain sufficient information to protect the person’s health, safety, and welfare while he remains at the facility. 40

22 VAC 40 -73 -370. Respite care. • Adds: —ISP is to be completed prior to participating in respite care and need not include expected outcome. —Upon return for respite care, the ALF must reevaluate the person’s condition and care needs, and ensure that the UAI, ISP, and medication orders are updated. —If the period of time between respite care stays is 6 months or longer, a new TB screening is only required 1 time per year. The physical examination must be within 30 days prior to the person’s return for respite care. 41

22 VAC 40 -73 -390. Resident agreement with facility. Current 22 VAC 40 -72 -390 • Adds: – For an AG recipient, the agreement contains a list of services included under the AG rate. – AG recipients may not be charged an advance or deposit payment. – All facilities (not only AG) shall inform the resident that he may refuse release of information regarding personal affairs and records to anyone outside the facility. Exceptions: release required by law or transfer to another caregiving facility. 42

22 VAC 40 -73 -390. Resident agreement with facility. Continued • Adds (continued): — Written notification whether the facility maintains liability insurance that provides at least the minimum amount of coverage established by the board for disclosure purposes to compensate residents or other individuals for injuries and losses from negligent acts of the facility. — The notification must state that the minimum amount of coverage is $500, 000 per occurrence, $500, 000 aggregate. The notification must be on the form developed by DSS. 43

22 VAC 40 -73 -420. Acceptance back in facility. Current 22 VAC 40 -72 -410 • Adds: — Obtain written recommendations from a qualified mental health professional regarding supportive services necessary to address the mental health needs of the resident returning to the facility. — Document whether the recommendations can be implemented based on facility or community resources and whether the resident can be retained or would need to be discharged. 44

22 VAC 40 -73 -420. Acceptance back in facility. Continued • Adds (Continued): —Update the resident's ISP. — Ensure that direct care staff receive clear and timely communication regarding their responsibilities for the mental health needs of the resident and behavioral or emotional indicators of possible crisis situations. — For recipients of an AG, the bed hold policy must be consistent with AG program policy and guidance. 45

22 VAC 40 -73 -430. Discharge of residents. Current 22 VAC 40 -72 -420 • Adds: — Resident will be moved within 30 days unless there are extenuating circumstances. — Written notification shall be given to the eligibility worker and assessor for public pay residents during all instances of discharge. — Written notice is required to be given to all parties at least 14 days prior to the date of discharge. — Written notification regarding the death of a public pay resident must be provided to the eligibility worker and assessor within 5 days. 46

Part VI Resident Care and Related Services 47

22 VAC 40 -73 -450. Individualized service plans. Current 22 VAC 40 -73 -440 • Adds: – A preliminary plan of care is to be developed on or within 7 days prior to the day of admission to address the basic needs of the resident to protect the resident’s health, safety and welfare. – A preliminary plan of care is not necessary if a comprehensive ISP is developed on the day of admission. – The department approved ISP training must be provided by a licensed health care professional. – Private pay UAI training must be completed as a prerequisite to ISP training. 48

22 VAC 40 -73 -450. Individualized service plans. Continued • Adds (continued) —The date a need is identified and the date an outcome is achieved to the ISP. —A requirement for all those that contribute to the development of the ISP to be documented with the date and title or relationship. —A current copy of the ISP must be provided to the resident. 49

22 VAC 40 -73 -470. Health care services. Current 22 VAC 40 -72 -460 • Adds: – Written policy for resident allergies, allergic reactions, life-threatening conditions, and actions that staff may need to take. – Gastric tubes - the following criteria shall be met: • Prior to GT care being provided, the facility shall obtain a signed informed consent that includes an acknowledgment of how GT care will be provided. 50

22 VAC 40 -730 -470. Health care services. Continued • Adds (continued): – Only those direct care staff with written approval from the delegating RN may provide the tube care and feedings. – The delegating RN shall be employed by or under contract with the ALF and shall have supervisory authority over the direct care staff providing GT care. – The delegating RN shall schedule supervisory oversight of GT care. 51

22 VAC 40 -73 -490. Health care oversight. Current 22 - VAC 40 -72 -480 • Adds: – Residential Living Care Residents: If the facility employs a licensed health care professional, who is on site on a full-time basis, health care oversight shall be provided at least annually. – Assisted Living Care Residents: If the facility employs a licensed health care professional, who is on site on a full-time basis, health care oversight shall be provided at least every 6 months. 52

22 VAC 40 -73 -490. Health care oversight. Continued • Restrained Residents: – On-site health care oversight shall be provided by a licensed health care professional at least every 3 months and include the following: • Be at a minimum a registered nurse. • Review the current condition and records of restrained residents to assess the appropriateness of the restraint and progress toward its reduction or elimination. • Be a holistic review of the physical, emotional, and mental health of the resident and identify any unmet needs. 53

22 VAC 40 -73 -490. Health care oversight. Continued – Oversight (continued): • Include review of physician's orders for restraints to determine whether orders are no older than 3 months. • Include an evaluation of whether direct care staff have received required restraint training and whether the facility is meeting the requirements for the use of restraints. 54

22 VAC 40 -73 -510. Mental health services coordination and support. Current 22 VAC 40 -72 -500 • Adds the requirement: — For written procedures to ensure communication and coordination between the ALF and the mental health service provider. — Facility shall assist in ensuring that prescribed interventions are implemented, monitored, and evaluated for their effectiveness in addressing the resident's mental health needs. 55

22 VAC 40 -73 -540. Visiting in the facility. Current 22 VAC 40 -72 -540 • Adds: – Visiting hours shall not be restricted, unless it is the resident’s choice. – Facility may establish a policy so that visiting is not disruptive to other residents and facility security is not compromised. 56

22 VAC 40 -73 -550. Resident rights. Current 22 VAC 40 -72 -550 • Adds: – Rights and responsibilities must be printed in at least 14 -point type. – For a resident unable to understand exercise rights and responsibilities, a responsible individual must be made aware of the rights and responsibilities on their behalf. – The responsible individual shall not be the facility licensee, administrator, staff person or their family members. 57

22 VAC 40 -73 -560. Resident records. Current 22 VAC 40 -72 -560 • Adds: – That a legal representative shall have access to the resident’s record. – A requirement for retaining resident records after the resident leaves the facility: • For at least first year, the record shall be retained at the facility. • After first year, the record may be retained off site in a safe, secure area that will allow for the record to be available within 48 hours. 58

22 VAC 40 -73 -580. Food service and nutrition. Current 22 VAC 40 -72 -580 • Changes the minimum amount of time allowed for each resident to complete a meal from 30 to 45 minutes. 59

22 VAC 40 -73 -590. Number of meals and availability of snacks. Current 22 VAC 40 -72 -610 • Changes that snacks must be made available at all times, rather than bedtime and between meals, for all residents or in accordance with physician’s or other prescriber’s orders. 60

22 VAC 40 -73 -620. Oversight of special diets. • Changes oversight of diets from quarterly to every 6 months. • Adds: – A written report must be submitted to the facility administrator within 10 days of completion of the oversight. – The administrator, dietitian, or nutritionist shall report the recommendations of the oversight to the resident's physician. 61

22 VAC 40 -73 -640. Medication management plan and reference materials. Current 22 VAC 40 -72 -630 • Adds to the medication management plan: – Facility must also implement the plan. – Standard operating procedures, including standard dosing schedules, and restrictions specific to facility. – Verification of accurate transcription of medication orders to the MAR within 24 hours of receipt of a new order or change in an order. – Methods to ensure that MARs are maintained as part of the resident’s record. 62

22 VAC 40 -73 -640. Medication management plan and reference materials. Continued • Plan (continued): – Methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes. – Supervision of staff responsible for medication administration includes periodic direct observation of medication administration. – Methods to ensure that staff who are responsible for administering medications are trained on the facility's plan. – Procedures for internal monitoring of the facility’s conformance to the plan. 63

22 VAC 40 -73 -650. Physician’s or other prescriber’s order. Current 22 VAC 40 -72 -640 • Adds: – Medication aides may not transmit an oral order to a pharmacy. – Orders shall be organized chronologically in the resident’s records. – Facility must document contact with the physician regarding any new orders upon a resident’s return from the hospital. 64

22 VAC 40 -73 -660. Storage of medications. Current 22 VAC 40 -72 -650 • Adds: – Single-use and dedicated medical supplies and equipment shall be appropriately labeled and stored. – Medical equipment suitable for multi-use shall be stored to prevent cross-contamination. 65

22 VAC 40 -73 -680. Administration of medications and related provisions. Current 22 VAC 40 -72 -670 • Adds: – Medical procedures and treatments must be provided according to the orders/instructions from the physician or other prescriber. – A master list confirming identity of all staff administering medication may be used in lieu of the name, signature and initials on each individual MAR. – The hospice comfort kit must meet the requirements for PRN medication use and each medication must have a prescription label attached by the pharmacy. 66

22 VAC 40 -73 -690. Medication review. Current 22 VAC 40 -72 -680 • Adds that the review: – May include a staff interview. – Include a consideration of a gradual dose reduction of antipsychotic medications for those residents with a diagnosis of dementia and no diagnoses of a primary psychiatric disorder. – Include that the health care professional will provide documentation whenever the attending physician is notified of any concerns or problems. 67

22 VAC 40 -73 -690. Medication review. Continued • Adds: – The licensed health care professional to provide the administrator with signed and dated report of findings within 10 days. – The report maintained in the facility files for at least 2 years. – The recommendations regarding a particular resident also maintained in the resident's record. 68

22 VAC 40 -73 -700. Oxygen therapy. Current 22 VAC 40 -73 -690 • When oxygen therapy is provided, adds the following to the disaster preparedness checklist : — Whethere are on-site emergency generators to safely operate oxygen concentrators efficiently. — Whethere agreements with vendors for emergency generators that can support oxygen concentrators. — Where the facility maintains emergency back-up plans for each resident’s oxygen equipment and supplies. — How equipment and supplies will be transported in an evacuation. 69

22 VAC 40 -73 -710. Restraints. Current 22 VAC 40 -72 -700 • Adds: – Use of prone or supine restraints is prohibited. – Prohibits any restraint or restraint technique that restricts a resident's breathing, interferes with the ability to communicate, or applies pressure on the torso. – Physician orders for non-emergency restraint use must be reviewed at least every 3 months and renewed if warranted. 70

22 VAC 40 -73 -710. Restraints. Current 22 VAC 40 -72 -700 • Adds (continued): – Restraints may only be used as an emergency intervention of last resort to prevent imminent threat of death or serious physical injury to the resident or others. – Facility shall review the resident’s ISP within 1 week of the application of an emergency restraint, and document additional interventions to prevent the future use of emergency restraints. 71

22 VAC 40 -73 -720. Do Not Resuscitate (DNR) Orders. Current 22 VAC 40 -72 -710 • Adds that if the facility will not honor DNR orders it shall have a policy so stating and, prior to admission, the resident or his legal guardian will: – Be notified of the policy – Sign an acknowledgment of notification 72

22 VAC 40 -73 -730. Advance directives. • Adds: – If a resident has advance directives - a living will or a durable power of attorney for health care - the facility shall obtain copies or document its efforts to do so. – Information about advance directives shall be readily available to authorized persons, such as EMTs. – A resident requesting assistance with advance directives shall be referred to his primary health care provider or attorney. 73

Part VII Resident Accommodations and Related Provisions 74

22 VAC 40 -73 -740. Personal possessions. Current 22 VAC 40 -72 -720 • Adds that when a resident’s clothing or other personal possessions are reported missing, the results of the investigation shall be reported in writing to the resident. 75

22 VAC 40 -73 -750. Resident rooms. Current 22 VAC 40 -72 -730 • Adds: – A resident may specify in writing that he does not wish to have a required item in his bedroom. – The written specification is to be maintained in the resident’s record. 76

22 VAC 40 -73 -780. Laundry and linens. Current 22 VAC 40 -72 -760 • Adds that when the facility provides laundry service for residents’ clothing or personal linens, the clean items must be sorted according to individual resident by facility staff. 77

22 VAC 40 -73 -830. Resident councils. Current 22 VAC 40 -72 -810 • Adds that the facility shall provide a written response to any recommendations to resolve problems or concerns made by the council prior to the next meeting. 78

22 VAC 40 -73 -850. Pets visiting the assisted living facility. Current 22 VAC 40 -72 -830 • Adds a requirement that if the facility allows pets to visit, it shall have a written policy about pets. 79

Part VIII Buildings and Grounds 80

22 VAC 40 -73 -860. General requirements. Current 22 VAC 40 -72 -840 • Adds: – Documentation completed and signed by the building official shall be obtained as evidence of compliance with the Uniform Statewide Building Code. – Any window that may be opened must be screened. – Resident may be permitted to keep cleaning supplies or other hazardous materials in an out-of-sight place in his room if he does not have a serious cognitive impairment. – Out-of-sight and inaccessible safeguard may not apply if no residents have serious cognitive impairments. 81

22 VAC 40 -73 -870. Maintenance of buildings and grounds. Current 22 VAC 40 -72 -850. • Adds: — Fixtures must be kept clean and in good repair and condition. — Furnishings and equipment owned by a resident must, at a minimum, be in safe condition and not soiled in a manner to present a health hazard. 82

22 VAC 40 -73 -880. Heating, ventilation, and cooling. Current 22 VAC 40 -72 -860 • Changes the requirement so all areas used by residents must be at least 72°F when they are normally awake. • Adds: – Facility may allow the temperature in a bedroom where only 1 resident resides to be controlled by the resident if the room has a thermostat, and the resident’s health, safety, or welfare is not endangered. – Facility must have a plan to protect residents in the event of loss of air conditioning or heat. 83

22 VAC 40 -73 -900. Sleeping areas. Current 22 VAC 40 -72 -880 • Adds that when there is a new facility licensee, there shall be no more than 2 residents residing in a bedroom. 84

22 VAC 40 -73 -925. Toilet, face/hand washing, and bathing supplies. Current 22 VAC 40 -72 -900 • Adds: – Soap must be accessible to each bathtub or shower. – Residents may not share bar soap. – Facility may not charge an additional amount for toilet paper, soap, paper towels, or use of an air dryer at common sinks and commodes. 85

22 VAC 40 -73 -930. Provisions for signaling and call systems. Current 22 VAC 40 -72 -910 • In buildings licensed to care for 19 or fewer residents under one roof: — Allows for rounds to be made on a different frequency if requested by the resident and the facility agrees. — The agreement must be in writing, specify the frequency, be signed and dated by the resident and the facility, and retained in the resident’s record. — The log used on rounds must indicate the name of the resident. —If there is a change in the resident’s condition or care needs, the agreement must be reviewed, adjusted if necessary, and retained in the resident’s record. 86

22 VAC 40 -73 -930. Provisions for signaling and call systems. Continued • For residents unable to use the signaling device: —Inability must be included on the ISP. —ISP must specify a minimum frequency of daily rounds to be made by direct care staff. —Unless requirement for rounds at least once each hour is applicable, once the resident has gone to bed each evening until the resident has arisen each morning, direct care staff must make rounds no less than every 2 hours. 87

22 VAC 40 -73 -930. Provisions for signaling and call systems. Continued Unable to use signaling device (continued): —Resident and facility may enter into an agreement for rounds to be made on a different frequency. — Facility must document that the rounds were made, the name of the resident, date and time of the rounds, direct care staff member who made the rounds, and retain the documentation for 2 years. 88

Part IX Emergency Preparedness 89

22 VAC 40 -73 -950. Emergency preparedness and response plan. Current 22 VAC 40 -72 -930 • Clarifies that contact with the local emergency coordinator occurs initially when developing the EP&R plan and annually thereafter. • Changes the plan review from quarterly to semiannually. • Adds: – Biohazard events to the analysis of the facility’s potential hazards. – Documenting the annual review by signing and dating the EP&R plan. 90

22 VAC 40 -73 -980. Emergency equipment and supplies. Current 22 VAC 40 -72 -960 • Adds: – There must be a first aid kit in each building. – Temporary emergency electrical power source must be capable of providing power to required circuits when connected and sufficient to implement the EP&R plan. – Of the 96 hour supply of emergency food and drinking water, at least 48 hours of the supply must be on site at any time. The facility’s rotating stock may be used to fulfill this requirement. 91

22 VAC 40 -73 -990. Plan for resident emergencies and practice exercise. Current 22 VAC 40 -72 -970 • Adds: – The plan must be reviewed every 6 months with all staff. Documentation of the review shall be signed and dated by each staff person. – The exercise of the plan shall be conducted with all staff on duty on each shift. – The plan shall be readily available to residents’ families and legal representatives. 92

Part X Additional Requirements for Facilities that Care for Adults with Serious Cognitive Impairments 93

22 VAC 40 -73 -1030. Staff training. Current 22 VAC 40 -72 -1010 • Changes: — Administrator to complete training within 3 months of employment. — Direct care staff to complete training within 4 months of employment. • Required hours of training from 4 to 6. 94

22 VAC 40 -73 -1050. Outdoor access. Current 22 VAC 40 -72 -1030 • Adds the requirement that residents with serious cognitive impairments be reminded of the opportunity to be outside on a daily basis, weather permitting. 95

22 VAC 40 -73 -1120. Activities. Current 22 VAC 40 -72 -1100 • Increases the required hours of weekly activities from 16 to 21, for no less than 2 hours each day. 96

22 VAC 40 -73 -1130. Staffing. Current 22 VAC 40 -72 -1110 • Changes the staffing requirement for safe secure environment: – When 20 or fewer residents are present, there shall be at least 2 direct care staff members awake and on duty at all times in each safe and secure unit, who shall be responsible for the care and supervision of the residents. – For every additional 10 residents, or portion thereof, there shall be at least 1 more direct care staff member awake and on duty in the unit. 97

22 VAC 40 -73 -1140. Staff training. Current 22 VAC 40 -72 -1120 • Changes: — Administrator to complete at least 12 hours of training within 3 months of employment in the safe, secure environment. — Direct care staff to complete at least 10 hours of training within 4 months of employment in the safe, secure environment. 98

Reminder • It would have been impossible to discuss all of the changes and new requirements in the regulation today. • You are strongly encouraged to read the regulation thoroughly and refer to it often to ensure compliance. 99

Questions • You may also email questions about the new ALF regulation at: ALFREGS@dss. virginia. gov 100