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

1. 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.

2. 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

3. 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 (hh)

4. 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

5. 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

6. 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

7. 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.

8. 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.

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

10. 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.

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

12. 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.

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

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

20. 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)

21. 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

22. 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

23. 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 when not onsite

24. 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.

25. 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

26. 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

27. 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

28. 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.

29. 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

30. 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

31. 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

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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. 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

39. 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

40. 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

41. 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

42. 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.

43. 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.

44. 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

45. 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.