Assisted Living Residence Licensing

1 HS 2095 5/18 55 Pa. Code Chapter 2800 March 1, 2015 Edition Bureau of Human Services Licensing Adult Residential Licensing REGULATORY COMPLIANCE GA Tool for AssistedLiving Residence Regulators, Operators,and StakeholdersUIDE2 Introduction What is Assisted Living ? Chapter 2800 identifies Assisted Living residences as a significant long-term care alternative to allow individuals to age in place, and goes on to read that residents of Assisted Living residences will receive the assistance they need to age in place and develop and maintain maximum independence, exercise decision-making and personal choice. This begs the question, alternative to what? A private Residence , a personal care home, a skilled nursing facility, or all three, or something else entirely?

2 Assisted Living is not meant to be an alternative to care in any one particular location. It is an alternative to the primary method of providing care to older adults. It is not uncommon for older adults to receive care in a variety of settings; such settings may include their own homes, personal care homes, domiciliary care homes, acute care hospitals, rehabilitation facilities, and skilled nursing facilities. Importantly, residency in such settings is not always linear. Older adults do not move from home to personal care to skilled nursing in a direct path. Older adults are frequently moved back-and-forth from setting to setting for short-term and long-term lengths of stay depending on their immediate care needs. Not only does this prohibit a consistent sense of home at any one location, it all but eliminates a person s right to choose his or her own manner of Living .

3 Assisted Living residences are meant to reduce the need for residents to leave the community in order to receive care for chronic or acute conditions. This is made possible by allowing Assisted Living residences to directly provide health and medical services that other non-skilled community settings may not provide directly. Additionally, many elements of Chapter 2800 address residents rights to self-determination and choice in the manner in which such care is provided. To be clear: Chapter 2800 is not meant to supplant care in a person s private home, a personal care home, or any other out-of-home residential care setting. Many people live in such settings for the duration of their adult lives, and consider them to be home, and nothing prohibits non- Assisted Living residential settings from arranging the type of care needed to permit aging in place.

4 In short, Assisted Living is exactly what Chapter 2800 says it is: an alternative. 3 How to Use the Regulatory Compliance Guide This guide has been developed to provide clearer explanations of the regulatory requirements of 55 Pa. Code Chapter 2800 to help Assisted Living Residence operators provide safe environments and effective services to residents through regulatory compliance, and to help regulators protect residents by conducting consistent and comprehensive inspections. It provides a detailed explanation of each regulatory requirement, including expectations for compliance, guidelines for measuring compliance, and the primary benefit of the requirement. Each regulation that can be measured during an inspection is included in the RCG and is accompanied by clarifying information.

5 The illustration below shows how regulations are presented and how inspectors and residences can effectively use the RCG. 16f (f) - The Residence shall keep a copy of the report of the reportable incident or condition. Discussion: Copies of all reports must be retained. Retention of the incidents in residents records is in accordance with (10), but remember that reportable incidents must be reviewed in aggregate as part of the Residence s quality management process pursuant to (b)(1). Inspection Procedures: Inspectors will verify that copies are retained. If necessary, inspectors will compare the Residence s record of reports with those received by the regional office. Primary Benefit: Permits residences to review reports to identify and address patterns of incidents and conditions that may otherwise be a source of harm to residents.

6 This area lists the regulation exactly as it appears in Chapter 2800. The Discussion section provides information about applying the regulation, including referencing other regulations and applicable narratives. The Inspection Procedures section describes how inspectors may measure compliance with the regulation. The Primary Benefit section explains how the regulation protects residents health, safety, and well-being. 4 Residence The RCG uses the word Residence and community interchangeably to aid in readability. For example, the resident- Residence contract is referred to as the Residence -community contract. Recommended Throughout the RCG, you will repeatedly see the words recommended or strongly recommended.

7 These words indicate that what you are reading is a suggestion based on best practices, not a regulatory requirement. Failure to follow a recommendation will not result in a regulatory violation. Admission Date Versus Move-In Date Multiple regulations (including but not limited to regulations relating to resident-community contracts, medical evaluations, assessments, and support plans) require certain events to occur before, after, or on the date of admission. Residences occasionally use the term admission to refer to the date a contract is signed, the date an admission fee is paid, or the date a resident moves personal items such as furniture into the Residence . The Department interprets admission date to mean the first day the resident resides in the Residence .

8 As such, the date the resident begins to live at the Residence is the date from which regulatory timeframes relating to admission should be met. Grace Periods Annually as used throughout this guide means at least once every 12 months. A 15-day flex or grace period is allowed for any item that has a time requirement of one year or more. This includes, but is not limited to: Medical evaluations ( ) Fire-safety inspections and supervised fire drills ( (b)) Documentation of evacuation times and fire-safe areas ( (d)) Completion of ANNUAL Resident Assessments ( (a)(1)) Unless there is a specific grace period or timeline specified in the applicable section, a 5-day flex or grace period is allowed for any item that has a time line of less than one year.

9 This does not apply to the following: Inspecting fire extinguishers ( (f)) Conducting fire drills ( (a)) (a) (h) (a) (c) 5 Inspection Procedures Please note that the inspection procedures are guidelines, and the specific means of measuring compliance with a regulation may differ depending on circumstances specific to the Residence and the nature of the regulatory violation. Repeated Violations A repeated violation is noncompliance with the same regulation number (to the most finite letter or number) on the violation report (VR) from at least the prior 12 months of VRs, to include the last renewal inspection and all VRs issued since the last renewal inspection. Source of Inspection Compliance with regulations can be measured through three methods: Site Direct observation during an on-site inspection.

10 This includes direct observation using all 5 senses. Site observations include the physical inspection of staff offices and private Living quarters of staff persons or others Living in the Residence to assure compliance with building-wide requirements such as the prohibition of portable space heaters and other unsafe practices that may be in violation of the regulations. Records Inspection of written documents. This includes the inspection of written materials, electronic transmissions, photographs and other paper or verbal materials. Interview Asking questions of residents, staff persons, families and others to determine compliance. This includes unsolicited information provided orally, informal conversations and formal questioning.