Adult Day Center 111-8-1 Presentation to: Presented by: Elaine Wright, Director Personal Care Home Program

Mission The Georgia Department of Community Health We will provide access to affordable, quality health care to Georgians through effective planning, purchasing and oversight. We are dedicated to a healthy Georgia.

Purpose of Rules - To provide for licensing and inspection of Adult Day Centers, which provide adult day care services and/or adult day health services to three or more adults. To establish the minimum standards for the operation of adult day centers To promote , safeguard and protect the well-being of adults participating in adult day care

Exemptions A center not receiving compensation as a condition of the participant’s receiving services. Centers who provide services for compensation to only one or two participants Programs who provide day habilitation and treatment services exclusively for the developmentally disabled. Respite care services programs as defined in 111-8-1-.04(hh)

Definitions Respite care services program means a program for aging adults who can function in a group setting and who can feed and toilet themselves with or without the assistance of a personal aide accompanying them and which: Is operated by a non-profit Provides no more than 25 hours per week Managed by a director who has completed an ADC training and orientation program

Respite Definition, cont’d Is staffed primarily by volunteers Has its sole purpose to provide primary caregivers of aging adults with relief from normal caregiving duties and responsibilities. ASSISTANCE MEANS: a) unit or multi-dose packaging b) taking it to resident c) reading label, opening container, removing medication and closing container, in resident’s presence d) placing oral dose in resident’s hand or other container for resident e) applying topical medications f) returning medication to storage unit g) assisting with EPI pen h) staff providing assistance must be proficient in English

Definitions Medical model means a comprehensive program that provides adults with the basic social, rehabilitative, health and personal care services needed to sustain or restore the essential activities of daily living. Social Model means a program that primarily addresses the basic social and recreational activities, but also provides limited personal care assistance, supervision of ADLs based on POC 6

Mobile Adult Day Center ● Designated staff travels from one central location to off-site locations (no more than 5) ●Necessary Staff transported with participant records, supplies and program material to each location ● May be adult day services or adult day health services and are offered 4 days or less at any one location. Verify that CMAs in good standing Skills competency tests if CMA has been certified for more that one year using checklist which meets requirements contained in the standardized clinical skills competency checlist used to certify CMAs. Quarterly Random observations and report to administration.

Nursing Services Performed by licensed personnel and may include therapy May also include observation, promotion and maintenance of health, dressing changes, prevention of illness and disability, management of healthcare during acute and chronic phases of illness, guidance and counseling, administration of medications and referral to physicians, other health care providers, and community resources.

Proxy Caregiver Unlicensed staff Trained by a licensed healthcare professional Performs health maintenance activities (medication administration, catheter/ostomy care) Participant must give informed consent

Application for license A separate application and license required for each adult day center providing services to three or more May not operate prior to obtaining a permit from the Department For those centers operating prior to 1/7/15, the license must be obtained by 4/7/15 Application and rules and regulation available at dch.georgia.gov, select HFRD.

Application Fees Social Model :$250.00 licensing fee and $300.00 application fee, $250.00 annual fee. Medical Model: $350.00 licensing fee and $300.00 application fee, $350.00 annual fee Mobile Adult Day Centers, same as above.

License Requirements Capacity determined by floor space (35 sq.ft) and the occupancy load as determined by the local fire authority having jurisdiction over fire safety License to be displayed in a prominent place on the premises where services are provided Licenses are not transferrable from one governing body to another or one location to another.

Governing Body Designated director available on-site during operating hours Notify Department when director changes Develop written policies and procedures (see checklist) Develop Disaster Preparedness Plan (see checklist) Establish Core Hours and maintain organizational chart

Fire Safety Building kept in good repair Emergency evacuation plan posted Storage items arranged to minimize hazards Outside smoking areas noncombustible ashtrays Hard wired smoke detectors Fire extinguishers checked annually and labeled Portable space heaters prohibited Fire Drills: Quarterly All staff/participants Under variable conditions Documentation maintained 14

Emergency Procedures ▪ File for each resident: Name and # of physician Hospital preference Insurance information Medications and allergies Diagnoses and history Name and # of emergency contacts Advance directive info ▪ Emergency care ▪ Emergency transportation ▪ Notification of law enforcement when participant missing for > 30 minutes 15

Physical Plant Health and Safety Arranged and maintained for health and safety Standard telephone with list of emergency numbers Adequate lighting Adequate ventilation Adequate floor space (35 sq.ft) exclusive of areas not used for participant activities.

Facilities and Furnishings Bathrooms (1 for every 12 residents) accessible Bathing facility for ADHS or if provided Dining areas Kitchen areas Rest areas, as needed Activity areas Private area for first aid , ADL assistance or counseling or as necessary for other services

Core Services Supervision commensurate of the needs Social and leisure activity programming Nutrition (if open more than 4 hours a day) Optional: transportation assistance with medications

Adult Day Health Services Ongoing program of therapeutic activities Nursing Services and health monitoring Medication Administration Physical Therapy Occupational Therapy Speech Therapy

Individual Plan of Care Completed within 3 business days of admission: - Signature of participant or representative - A review of functional abilities, habits, likes/dislikes - A statement of activities and services to be provided - Expected outcomes and frequency of reevaluation - Usual travel arrangements to and from the site - Usual time of arrival and departure (no more than 14 hours)

Plan of Care Cont’d Frequency and intensity of services If ADHS, identification of the therapeutic service provider to provide therapeutic services Reviewed and updated bi-annually and if ADHS should document response to plan quarterly Written agreement with any other agency or other service provider

Staffing Core Requirements Director (Bachelor’s degree or 4 years experience) and/or onsite manager At least one staff who has current CPR at all times Activity Director As many direct care staff as needed to meet the needs of the residents but no less than 1:8 Must be able to promptly evacuate in an emergency, adjusting staff for non-ambulatory residents

Staffing Adult Day Health Center In addition : An RN responsible for the development and supervision of the plan of care Search Board of Nursing website If LPN, must be supervised by an RN and must be available by phone and/or email when not onsite

Personnel Criminal back round checks prior to hire Should not employ persons nor use as volunteers if evidence of abuse neglect or exploitation or if license or certification is restricted Work related training within 90 days of employment At least one staff member with minimum training present in the center at all times.

Training Orientation to ADC rules and regulations Current CPR with return demonstration Standard Precautions Identification of participants who may be victim of elder abuse or self-neglect Participants’ rights Confidentiality of information and records Nature of influenza and role of vaccinations Diversity and cultural sensitivity Alzheimer’s disease and dementia

Training cont’d Medication training for unlicensed staff who provide assistance or supervision of medications Volunteers at a minimum should received training in abuse, neglect and exploitation and reporting requirements and participants’ rights

Staff Records Personnel records maintained for each employee and volunteer who provides direct care to the participants- employee shall have access to his/her record which should contain: Application for employment or volunteer services References, oral or written Current license or certificate, as applicable Training records Criminal background check Comprehensive physical, negative TB or x-ray

Admission In-person interview to assess needs Contraindications or limitations to participation Negative TB/x-ray within 12 months of admission Signed admission agreement Sex Offender Registry search and any safety plan needed for staff, other participants or visitors If providing assistance with medications, documentation of all medications including over the counter medications.

Admission Adult Day Health Centers Medical examination report within 6 months of admission MD orders for therapies, when applicable Copy of the Centers policies and procedures Participant’s rights information

Participant Agreement Description of services Statement of fees and charges Days and hours of attendance (14 hrs or less) Arrangements for payment Admission and discharge criteria Refund policy Any non-financial obligations Holiday closures Procedures for unexpected closings

Participant Records Identifying information Two emergency contacts information Primary healthcare provider identifying information Signed agreement Any POA/guardianship orders Individual POC Authorizations to receive and provide confidential information and for receipt of emergency care Physical within 6 months or 30 days after updated annually Receipt of policies Activity participation

Participant Record cont’d Medication Assistance Records Record of accidents, incidents or emergencies All records for ADCs to be retained for 3 years

Participant Records ADHS In addition ADHS centers shall maintain: Evaluation of participant’s progress Activities schedules Monthly fees collected and to be collected Daily record of attendance by name

Nutrition Nutritious meal to be provided if open more than 4 hours or operating during regularly scheduled mealtimes Snacks and fluids available mid-morning and mid-afternoon at a minimum Meals planned to keep sugar, salt and cholesterol intake to a minimum Food permit for 24 or more participants

Nutrition ADHS A therapeutic diet provided when prescribed Menus shall be approved by a dietitian or RN Dietitian or RN shall provide written techniques to staff on nutritional needs and food handling Training in planning and preparing therapeutic diets, if prepared by center staff

Nutrition For less than 24 participants: Properly equipped kitchen Food stored, prepared, distributed and served with generally accepted food service standards Must orginiate from a reputable source Pershables shall be stored to protect against spoilage Protected against contamination and safe for human consumption

Nutriition All foods to be cooked, maintained, stored and served at appropriate temperatures Refrigerator temperatures to be maintained at or below 41 degrees F and freezers 0 Degrees F Non-disposable dishes, glasses and silverware shall be properly cleaned by pre-rinsing an scraping, washing sanitizing and drying.

Medications All medications required by a participant that does not employ an RN, LPN or proxy caregiver shall be self-administered by the participant a. staff may remind of the time b. staff may check the dosage c. staff may physically assist in opening or pouring the medication

Medications Centers that employ RN, LPN or proxy caregiver: May administer medications Must maintain an MAR which includes the name, dosage, date, time and signature of staff for all medications that are supervised by the staff Medications stored securely and in original containers

Nurse Responsibilities Monitor medication regime Evaluates health status of participant Make recommendations to family or physician Follow up on previous recommendations Count all controlled substances and sign the controlled substances book and report discrepancies to the Director

Transportation If center provides: Vehicle should comply with all state and federal regulations for driver and vehicle Each person should have a seat Seatbelts required and must be used First aid kit with fire extinguisher and safety triangles Driver to be trained in seizure care, CPR and 1st aid Medical and emergency info available in vehicle Two-way communication device Trip roster addresses and emergency information

Discharge 14 days written notice Participant agreement contains discharge procedures Can be readjusted based on the participant’s circumstances Emergency discharges authorized if health safety and welfare of the participant or other participants are at risk.

Reporting Death while at the center – LE notified, family and the Department within 24 hours Rape Serious injury that requires medical attenition other than basic 1st aid Suspected abuse, neglect or exploitation Any time a participant can’t be located and has been missing for more than 30 minutes.

Reporting cont’d External disaster which caused a disruption of services Interruption of services vital to the continued safe operation of an adult day center, such as telephone, or utility services. Reporting required no later than the next business day

Inspections by Department Staff Prior to licensure and periodically thereafter Complaint investigations Application for licensure or issuance of a license constitutes consent by the applicant for the Department’s representative to enter the premises to determine compliance with these rules.