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[Utah Administrative Code Table of Contents]
[Title R432. Table of Contents]
R432-270-1 Legal Authority.
This rule is adopted pursuant to Title 26, Chapter 21.
R432-270-2 Purpose.
(1) This rule establishes the operational standards for assisted living facilities.
(2) Assisted living as provided in 26-21-2 (3) means:
(a) A Type I assisted living facility is a residential facility that provides assistance with activities of daily living and social care to two or more residents who are capable of achieving mobility sufficient to exit the facility without the assistance of another person;
(b) A Type II assisted living facility is a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services, available 24 hours per day, to residents who have been assessed.
(c) Each resident in a Type I or Type II assisted living facility must have a service plan based on the assessment, which may include:
(i) specified services of intermittent nursing care
(ii) administration of medication; and
(iii) support services promoting residents' independence and self-sufficiency.
(3) Assisted living is intended to enable persons experiencing functional impairments to receive 24-hour personal and health-related services in a place of residence with sufficient structure to meet care needs in a safe manner.
(4) Assisted living services shall be individualized to:
(a) maintain each individual's capabilities and facilitate using those abilities;
(b) create options to enable individuals to exercise control over their lives,
(c) provide supports which validate the self-worth of each individual by showing courtesy and respect for the individual's rights;
(d) maintain areas or spaces which provide privacy; and
(e) recognize each individual's needs and preferences and be flexible in service delivery to respond to those needs and preferences.
(5) Assisted living is intended to allow residents to choose how they will balance risk and quality of life.
(6) Type II assisted living facilities shall provide substantial assistance with activities of daily living, in response to a medical condition, above the level of verbal prompting, supervision, or coordination.
(7) Type II assisted living facilities shall provide each resident with a separate living unit. Two residents may share a unit upon written request of both of the residents.
(8) Type II assisted living is intended to enable residents, to the degree possible, to age in place.
R432-270-3 Definitions.
(1) The terms used in these rules are defined in R432-1-3.
(2) In addition:
(a) "Assistance with the activities of daily living and independent activities of daily living" means prompting and assisting residents with the following:
(i) personal grooming and dressing;
(ii) oral hygiene and denture care;
(iii) toileting and toilet hygiene;
(iv) eating during mealtime;
(v) encouraging and supporting residents to be independent or maintain independence if they use assistive devices (crutches, braces, walkers, wheelchairs) or prosthetic devices (glasses and hearing aids);
(vi) housekeeping;
(vii) self-administration of medication;
(viii) encouraging the resident to maintain his independence and sense of self-direction;
(ix) administering emergency first aid; and
(x) taking and recording oral temperatures.
(b) "Dependent" means a person who meets one or all of the following criteria:
(i) requires inpatient hospital or 24-hour continual nursing care that will last longer than 15 calendar days after the day on which the nursing care begins;
(ii) is unable to evacuate from the facility without the physical assistance of two persons.
(c) "Home-like" as used in statute and this rule means a place of residence which creates an atmosphere supportive of the resident's preferred lifestyle. Home-like is also supported by the use of residential building materials and furnishings.
(d) "Licensed health care professional" means a registered nurse, physician assistant, advanced nurse practitioner, or physician licensed by the Utah Department of Commerce who has education and experience to assess and evaluate the health care needs of the resident.
(e) "Semi-independent" means a person who is:
(i) physically disabled but able to direct his own care; or
(ii) cognitively impaired or physically disabled but able to evacuate from the facility or to a zone or area of safety with the physical assistance of one person.
(f) "Service Plan" means a written plan for services which meets the requirements of R432-270-14.
(g) "Services" means activities which help the residents develop skills to increase or maintain their level of psycho-social and physical functioning, or which assist them in activities of daily living.
(h) "Social care" means:
(i) providing opportunities for social interaction in the facility and in the community; and
(ii) providing services to promote independence and a sense of self-direction.
(i) "Unit" means an individual living space, including living and sleeping space, bathroom, and optional kitchen area.
R432-270-4 Licensure.
(1) Assisted living facilities may be licensed as large, small or limited capacity facilities.
(2) A large assisted living facility houses 17 or more residents.
(3) A small assisted living facility houses six to 16 residents.
(4) A limited capacity assisted living facility houses two to five residents.
R432-270-5 Licensee.
(1) The licensee must:
(a) ensure compliance with all federal, state, and local laws;
(b) assume responsibility for the overall organization, management, operation, and control of the facility;
(c) establish policies and procedures for the welfare of residents, the protection of their rights, and the general operation of the facility;
(d) implement a policy which ensures that the facility does not discriminate on the basis of race, color, sex, religion, ancestry, or national origin in accordance with state and federal law;
(e) secure and update contracts for required services not provided directly by the facility;
(f) respond to requests for reports from the Department; and
(g) appoint, in writing, a qualified administrator who shall assume full responsibility for the day-to-day operation and management of the facility. The licensee and administrator may be the same person.
(2) The licensee shall implement a quality assurance program to include a Quality Assurance Committee. The committee must:
(a) consist of at least the facility administrator and a health care professional, and
(b) meet at least quarterly to identify and act on quality issues.
(3) If the licensee is a corporation or an association, it shall maintain an active and functioning governing body to fulfill licensee duties and to ensure accountability.
R432-270-6 Administrator Qualifications.
(1) The administrator shall have the following qualifications:
(a) be 21 years of age or older;
(b) have knowledge of applicable laws and rules;
(c) have the ability to deliver, or direct the delivery of, appropriate care to residents;
(d) be of good moral character;
(e) complete the background criminal clearance defined in R432-35; and
(f) for all Type II facilities, complete a Department approved national certification program.
(2) In addition to R432-270-6(1) the administrator of a Type I facility shall have an associate degree or two years experience in a health care facility.
(3) In addition to R432-270-6(1) the administrator of a Type II small or limited-capacity assisted living facility shall have one or more of the following:
(a) an associate degree in a health care field;
(b) two years or more management experience in a health care field; or
(c) one year's experience in a health care field as a licensed health care professional.
(4) In addition to R432-270-6(1) the administrator of a Type II large assisted living facility must have one or more of the following:
(a) a State of Utah health facility administrator license;
(b) a bachelor's degree in a health care field, to include management training or one or more years of management experience;
(c) a bachelor's degree in any field, to include management training or one or more years of management experience and one year or more experience in a health care field; or
(d) an associates degree and four years or more management experience in a health care field.
R432-270-7 Administrator Duties.
(1) The administrator must:
(a) be on the premises a sufficient number of hours in the business day, and at other times as necessary, to manage and administer the facility;
(b) designate, in writing, a competent employee, 21 years of age or older, to act as administrator when the administrator is unavailable for immediate contact. It is not the intent of this subsection to permit a de facto administrator to replace the designated administrator.
(2) The administrator is responsible for the following:
(a) recruit, employ, and train the number of licensed and unlicensed staff needed to provide services;
(b) verify all required licenses and permits of staff and consultants at the time of hire or the effective date of contract;
(c) maintain facility staffing records for the preceding 12 months;
(d) admit and retain only those residents who meet admissions criteria and whose needs can be met by the facility;
(e) review at least quarterly every injury, accident, and incident to a resident or employee and document appropriate corrective action;
(f) maintain a log indicating any significant change in a resident's condition and the facility's action or response;
(g) complete an investigation whenever there is reason to believe that a resident has been subject to abuse, neglect, or exploitation;
(h) report all suspected abuse, neglect, or exploitation in accordance with Section 62A-3-302 , and document appropriate action if the alleged violation is verified.
(i) notify the resident's responsible person and physician of significant changes or deterioration of the resident's health, and ensure the resident's transfer to an appropriate health care facility if the resident requires services beyond the scope of the facility's license;
(j) conduct and document regular inspections of the facility to ensure it is safe from potential hazards;
(k) complete, submit, and file all records and reports required by the Department;
(l) participate in a quality assurance program; and
(m) secure and update contracts for required professional and other services not provided directly by the facility.
(5) The administrator's responsibilities shall be included in a written and signed job description on file in the facility.
R432-270-8 Personnel.
(1) Qualified competent direct-care personnel shall be on the premises 24 hours a day to meet residents needs as determined by the residents' assessment and service plans. Additional staff shall be employed as necessary to perform office work, cooking, housekeeping, laundering and general maintenance.
(2) The services provided or arranged by the facility shall be provided by qualified persons in accordance with the resident's written service plan.
(3) All personnel who provide personal care to residents in a Type I facility shall be at least 18 years of age and shall have related experience in the job assigned or receive on the job training.
(4) Personnel who provide personal care to residents in a Type II facility shall be certified nurse aides or complete a state certified nurse aide program after four months of the date of hire.
(5) Personnel shall be licensed, certified, or registered in accordance with applicable state laws.
(6) The administrator shall maintain written job descriptions for each position, including job title, job responsibilities, qualifications or required skills.
(7) Facility policies and procedures must be available to personnel at all times.
(8) All personnel must receive documented orientation to the facility and the job for which they are hired. Orientation shall include the following:
(a) job description;
(b) ethics, confidentiality, and residents' rights;
(c) fire and disaster plan;
(d) policy and procedures; and
(e) reporting responsibility for abuse, neglect and exploitation.
(9) Each employee shall receive documented in-service training. The training shall be tailored to include all of the following subjects that are relevant to the employee's job responsibilities:
(a) principles of good nutrition, menu planning, food preparation, and storage;
(b) principles of good housekeeping and sanitation;
(c) principles of providing personal and social care;
(d) proper procedures in assisting residents with medications;
(e) recognizing early signs of illness and determining when there is a need for professional help;
(f) accident prevention, including safe bath and shower water temperatures;
(g) communication skills which enhance resident dignity;
(h) first aid;
(i) resident's rights and reporting requirements of Section 62A-3-201 to 312; and
(j) special needs of the Dementia/Alzheimer's resident.
(10) An employee who reports suspected abuse, neglect, or exploitation shall not be subject to retaliation, disciplinary action, or termination by the facility for that reason alone. (11) The facility shall establish a personnel health program through written personnel health policies and procedures which protect the health and safety of personnel, residents and the public.
(12) The facility must complete an employee placement health evaluation to include at least a health inventory when an employee is hired. Facilities may use their own evaluation or a Department approved form.
(a) A health inventory shall obtain at least the employee's history of the following:
(i) conditions that may predispose the employee to acquiring or transmitting infectious diseases; and
(ii) conditions that may prevent the employee from performing certain assigned duties satisfactorily.
(b) The facility shall develop employee health screening and immunization components of the personnel health program.
(c) Employee skin testing by the Mantoux Method and follow up for tuberculosis shall be done in accordance with R388-804, Tuberculosis Control Rule.
(i) Skin testing must be conducted on each employee within two weeks of hire and after suspected exposure to a resident with active tuberculosis.
(ii) All employees with known positive reaction to skin tests are exempt from skin testing.
(d) All infections and communicable diseases reportable by law shall be reported to the local health department in accordance with R386-702-2.
(e) The facility shall comply with the Occupational Safety and Health Administration's Bloodborne Pathogen Standard.
R432-270-9 Volunteers.
(1) Volunteers may be used in the daily activities of the facility, but may not be included in the facility's employee staffing plan.
(2) Volunteers must be supervised by facility staff.
(3) Volunteers must be familiar with the facility's policies and procedures and with residents' rights.
R432-270-10 Residents' Rights.
(1) Assisted living facilities shall develop a written resident's rights statement based on this section.
(2) The administrator or designee shall give the resident a written description of the resident's legal rights upon admission, including the following:
(a) a description of the manner of protecting personal funds, in accordance with Section R432-270-20; and
(b) a statement that the resident may file a complaint with the state long term care ombudsman and any other advocacy group concerning resident abuse, neglect, or misappropriation of resident property in the facility.
(3) The administrator or designee shall notify the resident or the resident's responsible person at the time of admission, in writing and in a language and manner that the resident or the resident's responsible person understands, of the resident's rights and of all rules governing resident conduct and responsibilities during the stay in the facility.
(4) The administrator or designee must promptly notify in writing the resident or the resident's responsible person when there is a change in resident rights under state law.
(5) Resident rights include the following:
(a) the right to be treated with respect, consideration, fairness, and full recognition of personal dignity and individuality;
(b) the right to be transferred, discharged, or evicted by the facility only in accordance with the terms of the signed admission agreement;
(c) the right to be free of mental and physical abuse, and chemical and physical restraints;
(d) the right to refuse to perform work for the facility;
(e) the right to perform work for the facility if the facility consents and if:
(i) the facility has documented the resident's need or desire for work in the service plan,
(ii) the resident agrees to the work arrangement described in the service plan,
(iii) the service plan specifies the nature of the work performed and whether the services are voluntary or paid, and
(iv) compensation for paid services is at or above the prevailing rate for similar work in the surrounding community;
(f) the right to privacy during visits with family, friends, clergy, social workers, ombudsmen, resident groups, and advocacy representatives;
(g) the right to share a unit with a spouse if both spouses consent, and if both spouses are facility residents;
(h) the right to privacy when receiving personal care or services;
(i) the right to keep personal possessions and clothing as space permits;
(j) the right to participate in religious and social activities of the resident's choice;
(k) the right to interact with members of the community both inside and outside the facility;
(l) the right to send and receive mail unopened;
(m) the right to have access to telephones to make and receive private calls;
(n) the right to arrange for medical and personal care;
(o) the right to have a family member or responsible person informed by the facility of significant changes in the resident's cognitive, medical, physical, or social condition or needs;
(p) the right to leave the facility at any time and not be locked into any room, building, or on the facility premises during the day or night. This right does not prohibit the establishment of house rules such as locking doors at night for the protection of residents;
(q) the right to be informed of complaint or grievance procedures and to voice grievances and recommend changes in policies and services to facility staff or outside representatives without restraint, discrimination, or reprisal;
(r) the right to be encouraged and assisted throughout the period of a stay to exercise these rights as a resident and as a citizen;
(s) the right to manage and control personal funds, or to be given an accounting of personal funds entrusted to the facility, as provided in R432-270-20 concerning management of resident funds;
(t) the right, upon oral or written request, to access within 24 hours all records pertaining to the resident, including clinical records;
(u) the right, two working days after the day of the resident's oral or written request, to purchase at a cost not to exceed the community standard photocopies of the resident's records or any portion thereof;
(v) the right to personal privacy and confidentiality of personal and clinical records;
(w) the right to be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being; and
(x) the right to be fully informed in a language and in a manner the resident understands of the resident's health status and health rights, including the following:
(i) medical condition;
(ii) the right to refuse treatment;
(iii) the right to formulate an advance directive in accordance with UCA Section 75-2-1101 ; and
(iv) the right to refuse to participate in experimental research.
(6) The following items must be posted in a public area of the facility that is easily accessible by residents the following:
(a) the long term care ombudsmen's notification poster;
(b) information on Utah protection and advocacy systems; and
(c) a copy of the resident's rights.
(7) The facility shall have available in a public area of the facility the results of the current survey of the facility and any plans of correction.
(8) A resident may organize and participate in resident groups in the facility, and a resident's family may meet in the facility with the families of other residents.
(a) The facility shall provide private space for resident groups or family groups.
(b) Facility personnel or visitors may attend resident group or family group meetings only at the group's invitation.
(c) The administrator shall designate an employee to provide assistance and to respond to written requests that result from group meetings.
R432-270-11 Admissions.
(1) The facility shall have written admission, retention, and transfer policies that are available to the public upon request.
(2) Before accepting a resident, the facility must obtain sufficient information about the person's ability to function in the facility through the following:
(a) an interview with the resident and the resident's responsible person; and
(b) the completion of the resident assessment.
(3) If the Department determines during inspection or interview that the facility knowingly and willfully admits or retains residents who do not meet license criteria, then the Department may, for a time period specified, require that resident assessments be conducted by an individual who is independent from the facility.
(4) The facility shall accept and retain only residents who meet the following criteria:
(a) Residents admitted to a Type I facility shall meet the following criteria before being admitted:
(i) be ambulatory or mobile and be capable of taking life saving action in an emergency;
(ii) have stable health;
(iii) require no assistance or only limited assistance from facility staff in the activities of daily living; and
(iv) require and receive regular or intermittent care or treatment in the facility from a licensed health professional either through contract or by the facility, if permitted by facility policy.
(b) Residents admitted to a Type II facility may be independent and semi-independent, but shall not be dependent.
(5) Type I and Type II assisted living facilities shall not admit or retain a person who:
(a) manifests behavior that is suicidal, sexually or socially inappropriate, assaultive, or poses a danger to self or others; or
(b) has active tuberculosis or other chronic communicable diseases that cannot be treated in the facility or on an outpatient basis; or may be transmitted to other residents or guests through the normal course of activities; or
(c) requires inpatient hospital or long-term nursing care;
(6) In addition to the conditions outlined in R432-270-11(5), a Type I facility shall not accept or retain a person who:
(a) requires significant assistance during night sleeping hours;
(b) is unable to take life saving action in an emergency without the assistance of another person; or
(c) requires close supervision and a controlled environment.
(7) The prospective resident or the prospective resident's responsible person must sign a written admission agreement prior to admission. The admission agreement shall be kept on file by the facility and shall specify at least the following:
(a) room and board charges and charges for basic and optional services;
(b) provision for a 30-day notice prior to any change in established charges;
(c) admission, retention, transfer, discharge, and eviction policies;
(d) conditions under which the agreement may be terminated;
(e) the name of the responsible party;
(f) notice that the Department has the authority to examine resident records to determine compliance with licensing requirements; and
(g) refund provisions that address the following:
(i) thirty-day notices for transfer or discharge given by the facility or by the resident,
(ii) emergency transfers or discharges,
(iii) transfers or discharges without notice, and
(iv) death of a resident.
R432-270-12 Transfer or Discharge Requirements.
(1) A resident may be discharged, transferred, or evicted for one or more of the following reasons:
(a) The facility is no longer able to meet the resident's needs.
(b) The resident fails to pay for services as required by the admission agreement.
(c) The resident fails to comply with written policies or rules of the facility.
(d) The resident wishes to transfer.
(e) The facility ceases to operate.
(2) Prior to transferring or discharging a resident, the facility shall serve a transfer or discharge notice upon the resident and the resident's responsible person.
(a) The notice shall be either hand-delivered or sent by certified mail.
(b) The notice shall be made at least 30 days before the day on which the facility plans to transfer or discharge the resident, except that the notice may be made as soon as practicable before transfer or discharge if:
(i) the safety or health of persons in the facility is endangered; or
(ii) an immediate transfer or discharge is required by the resident's urgent medical needs.
(3) The notice of transfer or discharge shall:
(a) be in writing with a copy placed in the resident file;
(b) be phrased in a manner and in a language the resident can understand;
(c) detail the reasons for transfer or discharge;
(d) state the effective date of transfer or discharge;
(e) state the location to which the resident will be transferred or discharged;
(f) state that the resident may request a conference to discuss the transfer or discharge; and
(g) contain the following information:
(i) for facility residents who are 60 years of age or older, the name, mailing address, and telephone number of the State Long Term Care Ombudsman;
(ii) for facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under part C of the Developmental Disabilities Assistance and Bill of Rights Act; and
(iii) for facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act.
(4) The facility shall provide sufficient preparation and orientation to a resident to ensure a safe and orderly transfer or discharge from the facility.
(5) The resident or the resident's responsible person may contest a transfer or discharge. If the transfer or discharge is contested, the facility shall provide an informal conference, except where undue delay might jeopardize the health, safety, or well-being of the resident or others.
(a) The resident or the resident's responsible person must request the conference within five calendar days of the day of receipt of notice of discharge to determine if a satisfactory resolution can be reached.
(b) Participants in the conference shall include the facility representatives, the resident or the resident's responsible person, and any others requested by the resident or the resident's responsible person.
R432-270-13 Resident Assessment.
(1) Each person admitted to an assisted living facility shall have a personal physician or a licensed practitioner prior to admission.
(2) A signed and dated resident assessment shall be completed on each resident prior to admission and at least annually thereafter.
(3) In a Type I facility, the resident assessment shall be completed and signed by a physician, an advanced practice registered nurse, physician assistant, or a registered nurse.
(4) In a Type II facility, the resident assessment shall be completed and signed by the facility's registered nurse.
(5) The resident assessment shall include a signed statement, by the health professional completing the resident assessment, that the resident is able to function in either a Type I or Type II assisted living facility.
(6) The resident assessment shall document the resident's cognitive, physical, medical, and social conditions.
(7) The facility shall use a resident assessment form that is approved and reviewed by the Department to document the resident assessments.
(8) The facility shall revise and update each resident's assessment when there is a significant change in the resident's cognitive, medical, physical, or social condition.
(9) A Type I facility shall conduct a semi annual resident review in each 12-month period.
(a) The semi-annual review shall document the assistance required by the resident in the activities of daily living.
(b) The semi annual resident review may be completed and signed by facility staff other than a licensed health care professional.
(10) A Type II facility shall conduct a semi-annual resident assessment review.
(a) The semi-annual resident assessment review shall document changes in a resident's cognitive, medical, physical, and social conditions.
(b) A registered nurse must complete and sign the resident assessment.
R432-270-14 Service Plan.
(1) Each resident must have an individualized service plan that is consistent with the resident's unique cognitive, medical, physical, and social needs, and is developed within seven calendar days of the day the facility admits the resident. The facility shall periodically revise the service plan as needed.
(2) The facility shall use the resident assessment to develop, review, and revise the service plan for each resident.
(3) The service plan must be prepared by a service coordinator who is an employee of the assisted living facility. The resident or the resident's responsible person shall actively participate with the service coordinator in developing the service plan.
(4) The service plan shall include a written description of the following:
(a) what services are provided;
(b) who will provide the services, including the resident's significant others who may participate in the delivery of services;
(c) how the services are provided;
(d) the frequency of services; and
(e) changes in services and reasons for those changes.
R432-270-15 Nursing Services.
(1) The facility must develop written policies and procedures defining the level of nursing services provided by the facility.
(a) A Type II assisted living facility shall employ or contract with a registered nurse to provide or supervise nursing services to include:
(i) a nursing assessment on each resident;
(ii) general health monitoring on each resident; and
(iii) routine nursing tasks, including those that may be delegated to unlicensed assistive personnel in accordance with the Utah Nurse Practice Act R156-31-603.
(b) A Type I assisted living facility may provide nursing care according to facility policy. If a Type I assisted living facility chooses to provide nursing services, the nursing services must be provided in accordance with R432-270-15(1)(a)(i) thru (iii).
(2) Type I and Type II assisted living facilities shall not provide skilled nursing care, but must assist the resident in obtaining required services.
(3) To determine whether a nursing service is skilled, the following criteria shall apply:
(a) The complexity or specialized nature of the prescribed services can be safely or effectively performed only by, or under the close supervision of licensed health care professional personnel.
(b) Care is needed to prevent, to the extent possible, deterioration of a condition or to sustain current capacities of a resident.
R432-270-16 Arrangements for Medical or Dental Care.
(1) The facility shall assist residents in arranging access for ancillary services for medically related care including physician, dentist, pharmacist, therapy, podiatry, hospice, home health, and other services necessary to support the resident.
(2) The facility shall arrange for care through one or more of the following methods:
(a) notifying the resident's responsible person;
(b) arranging for transportation to and from the practitioner's office; or
(c) arrange for a home visit by a health care professional.
(3) The facility must notify a physician or other health care professional when the resident requires immediate medical attention.
R432-270-17 Activity Program.
(1) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in activity and recreational programs.
(2) The facility shall provide opportunities for the following:
(a) socialization activities;
(b) independent living activities to foster and maintain independent functioning;
(c) physical activities; and
(d) community activities to promote resident participation in activities away from the facility.
(3) The administrator shall designate an activity coordinator to direct the facility's activity program. The activity coordinator's duties include the following:
(a) coordinate all recreational activities, including volunteer and auxiliary activities;
(b) plan, organize, and conduct the residents' activity program with resident participation; and
(c) develop and post monthly activity calendars, including information on community activities, based on residents' needs and interests.
(3) The facility shall provide sufficient equipment, supplies, and indoor and outdoor space to meet the recreational needs and interests of residents.
(4) The facility shall provide storage for recreational equipment and supplies. Locked storage must be provided for potentially dangerous items such as scissors, knives, and toxic materials.
R432-270-18 Medication Administration.
(1) A licensed health care professional must assess each resident to determine what level and type of assistance is required for medication administration. The level and type of assistance provided shall be documented on the resident's service plan.
(2) The resident's medication program shall include one or all of the following:
(a) The resident is able to self-administer medications.
(i) Residents who have been assessed to be able to self- administer medications may keep prescription medications in their rooms.
(ii) If more than one resident resides in a unit, the facility must assess each person's ability to safely have medications in the unit. If safety is a factor, a resident shall keep his medication in a locked container in the unit.
(b) Facility staff may assist residents who self-medicate by:
(i) reminding the resident to take the medication;
(ii) opening medication containers;
(iii) reading the instructions on container labels;
(iv) checking the dosage against the label of the container;
(v) reassuring the resident that the dosage is correct;
(vi) observing a resident take the medication; and
(vii) reminding the resident or the resident's responsible person when the prescription needs to be refilled.
(c) Family members or a significant other may set up medications in a package which identifies the medication and time to administer. If a family member or significant other assists with medication administration, they shall sign a waiver indicating that they agree to assume the responsibility to fill prescriptions, administer medication, and document that the medication has been administered. The facility staff may assist the resident to self medicate by:
(i) reminding residents to take medications; and
(ii) opening the container at the resident's request.
(d) Unlicensed assistive personnel may assist with medication administration under the supervision of the facility's registered nurse.
(i) The facility's registered nurse may delegate the task of assisting with medication administration to unlicensed assistive personnel in accordance with the Nurse Practice Act R156-31-603.
(ii) The registered nurse who delegates the assisting with medication administration must verify and evaluate the practitioner's orders, perform a nursing assessment, and determine whether unlicensed assistive personnel can safely perform the assisting with administration of medications.
(iii) The medications must be administered according to a plan of care developed by the registered nurse.
(iv) The registered nurse shall provide and document supervision, evaluation, and training of unlicensed assistive personnel assisting with medication administration.
(v) The delegating nurse or another registered nurse shall be readily available either in person or by telecommunication.
(e) The resident may have the facility's licensed nurse administer medications.
(i) The service plan shall document instructions for medication administration.
(ii) All medications shall be prescribed in writing for the resident by the resident's licensed practitioner.
(3) The facility must review all resident medications at least every six months unless the resident has been assessed to safely self-administer medications.
(a) Medication records shall include the following:
(i) the resident's name;
(ii) the name of the prescribing practitioner;
(iii) the name of the medication, including prescribed dosage;
(iv) the times and dates administered;
(v) the method of administration;
(vi) signatures of personnel administering the medication; and
(vii) the review date.
(b) Any change in the dosage or schedule of medication administration shall be made by the resident's licensed practitioner and be documented in the medication record. All personnel shall be notified of the medication change.
(c) The facility shall keep on file a list of possible reactions and precautions to any medications that facility staff assist the resident to administer.
(6) The licensed practitioner shall be notified when medications errors occur.
(7) Medications shall be stored in a locked central storage area to prevent unauthorized access.
(a) If medication is stored in a central location, the resident shall have timely access to the medication.
(b) Medications that require refrigeration shall be stored separately from food items and at temperatures between 36 - 46 degrees F.
(c) The administration, storage, and handling of oxygen must comply with the requirements of NFPA 99 which is adopted and incorporated by reference.
(8) The facility shall develop and implement a policy for disposing of unused, outdated, or recalled medications.
(a) The facility shall return a resident's medication to the resident or to the resident's responsible person upon discharge.
(b) The administrator shall document the return to the resident or the resident's responsible person of medication stored in a central storage.
R432-270-19 Management of Resident Funds.
(1) Residents have the right to manage and control their financial affairs. The facility may not require residents to deposit their personal funds or valuables with the facility.
(2) The facility need not handle residents' cash resources or valuables. However, upon written authorization by the resident or the resident's responsible person, the facility may hold, safeguard, manage, and account for the resident's personal funds or valuables deposited with the facility, in accordance with the following:
(a) The licensee shall establish and maintain on the residents' behalf a system that assures a full, complete, and separate accounting according to generally accepted accounting principles of each resident's personal funds entrusted to the facility. The system shall:
(i) preclude any commingling of resident funds with facility funds or with the funds of any person other than another resident, and preclude facility personnel from using residents' monies or valuables as their own;
(ii) separate residents' monies and valuables intact and free from any liability that the licensee incurs in the use of its own or the facility's funds and valuables;
(iii) maintain a separate account for resident funds for each facility and not commingle such funds with resident funds from another facility;
(iv) for records of residents' monies which are maintained as a drawing account, include a control account for all receipts and expenditures and an account for each resident and supporting receipts filed in chronological order;
(v) keep each account with columns for debits, credits, and balance; and
(vi) include a copy of the receipt that it furnished to the residents for funds received and other valuables entrusted to the licensee for safekeeping.
(b) The facility shall make individual financial records available on request through quarterly statements to the resident or the resident's legal representative.
(c) The facility shall purchase a surety bond or otherwise provide assurance satisfactory to the Department that all resident personal funds deposited with the facility are secure.
(d) The facility shall deposit, within five days of receipt, all resident monies that are in excess of $150 in an interest-bearing bank account, that is separate from any of the facility's operating accounts, in a local financial institution.
(i) Interest earned on a resident's bank account shall be credited to the resident's account.
(ii) In pooled accounts, there shall be a separate accounting for each resident's share, including interest.
(e) The facility shall maintain a resident's personal funds that do not exceed $150 in a non-interest-bearing account, interest-bearing account, or petty cash fund.
(f) Upon discharge of a resident with funds or valuables deposited with the facility, the facility shall that day convey the resident's funds, and a final accounting of those funds, to the resident or the resident's legal representative. Funds and valuables kept in an interest-bearing account shall be accounted for and made available within three working days.
(g) Within 30 days following the death of a resident, except in a medical examiner case, the facility shall convey the resident's valuables and funds entrusted to the facility, and a final accounting of those funds, to the individual administering the resident's estate.
R432-270-20 Facility Records.
(1) The facility must maintain accurate and complete records. Records shall be filed, stored safely, and be easily accessible to staff and the Department.
(2) Records shall be protected against access by unauthorized individuals.
(3) The facility shall maintain personnel records for each employee and shall retain such records for at least three years following termination of employment. Personnel records must include the following:
(a) employee application;
(b) date of employment;
(c) termination date;
(d) reason for leaving;
(e) documentation of CPR and first aid training;
(f) health inventory;
(g) food handlers permits;
(h) TB skin test documentation; and
(i) documentation of criminal background check.
(4) The facility must maintain in the facility a separate record for each resident that includes the following:
(a) the resident's name, date of birth, and last address;
(b) the name, address, and telephone number of the person who administers and obtains medications, if this person is not facility staff;
(c) the name, address, and telephone number of the individual to be notified in case of accident or death;
(d) the name, address, and telephone number of a physician and dentist to be called in an emergency;
(e) the admission agreement;
(f) the resident assessment; and
(g) the resident service plan.
(5) Resident records must be retained for at least three years following discharge.
R432-270-21 Food Services.
(1) Facilities must have the capability to provide three meals a day, seven days a week, to all residents, plus snacks.
(a) The facility shall maintain onsite a one-week supply of nonperishable food and a three day supply of perishable food as required to prepare the planned menus.
(b) There shall be no more than a 14 hour interval between the evening meal and breakfast, unless a nutritious snack is available in the evening.
(c) The facility food service must comply with the following:
(i) All food shall be of good quality and shall be prepared by methods that conserve nutritive value, flavor, and appearance.
(ii) The facility shall ensure food is palatable, attractively served, and delivered to the resident at the appropriate temperature.
(iii) Powdered milk may only be used as a beverage, upon the resident's request, but may be used in cooking and baking.
(2) The facility shall provide adaptive eating equipment and utensils for residents as needed.
(3) A different menu shall be planned and followed for each day of the week.
(a) All menus must be approved and signed by a certified dietitian.
(b) Cycle menus shall cover a minimum of three weeks.
(c) The current week's menu shall be posted for residents' viewing.
(d) Substitutions to the menu that are actually served to the residents shall be recorded and retained for three months for review by the Department.
(4) Meals shall be served in a designated dining area suitable for that purpose or in resident rooms upon request by the resident.
(5) Residents shall be encouraged to eat their meals in the dining room with other residents.
(6) Inspection reports by the local health department shall be maintained at the facility for review by the Department.
(7) If the facility admits residents requiring therapeutic or special diets, the facility shall have an approved dietary manual for reference when preparing meals. Dietitian consultation shall be provided at least quarterly and documented for residents requiring therapeutic diets.
(8) The facility shall employ food service personnel to meet the needs of residents.
(a) While on duty in food service, the cook and other kitchen staff shall not be assigned concurrent duties outside the food service area.
(b) All personnel who prepare or serve food shall have a current Food Handler's Permit.
(c) Dietary staff must receive a minimum of six hours of documented in-service training each year.
(9) Food service shall comply with the Utah Department of Health Food Service Sanitation Regulations, R392-100.
R432-270-22 Housekeeping Services.
(1) The facility shall employ housekeeping staff to maintain both the exterior and interior of the facility.
(2) The facility shall designate a person to direct housekeeping services. This person shall:
(a) post routine laundry, maintenance, and cleaning schedules for housekeeping staff.
(b) ensure all furniture, bedding, linens, and equipment are clean before use by another resident.
(3) The facility shall control odors by maintaining cleanliness.
(4) There shall be a trash container in every occupied room.
(5) All cleaning agents, bleaches, insecticides, or poisonous, dangerous, or flammable materials shall be stored in a locked area to prevent unauthorized access.
(6) Housekeeping personnel shall be trained in preparing and using cleaning solutions, cleaning procedures, proper use of equipment, proper handling of clean and soiled linen, and procedures for disposal of solid waste.
(7) Bathtubs, shower stalls, or lavatories shall not be used as storage places.
(8) Throw or scatter rugs that present a tripping hazard to residents are not permitted.
R432-270-23 Laundry Services.
(1) The facility shall provide laundry services to meet the needs of the residents, including sufficient linen supply to permit a change in bed linens at least twice a week.
(2) The facility shall inform the resident or the resident's responsible person in writing of the facility's laundry policy for residents' personal clothing.
(3) Food may not be stored, prepared, or served in any laundry area.
(4) The facility shall make available for resident use, the following:
(a) at least one washing machine and one clothes dryer; and
(b) at least one iron and ironing board.
R432-270-24 Maintenance Services.
(1) The facility shall conduct maintenance, including preventive maintenance, according to a written schedule to ensure that the facility equipment, buildings, fixtures, spaces, and grounds are safe, clean, operable, and in good repair.
(2) Entrances, exits, steps, and outside walkways shall be maintained in a safe condition, free of ice, snow, and other hazards.
(3) Electrical systems, including appliances, cords, equipment call lights, and switches shall be maintained to guarantee safe functioning and compliance with the National Electric Code, NFPA 70.
(4) The facility shall inspect and clean or replace air filters installed in heating, air conditioning, and ventilation systems according to manufacturers specifications.
(5) A pest control program shall be conducted in the facility buildings and on the grounds by a licensed pest control contractor or a qualified employee, certified by the State, to ensure the absence of vermin and rodents. Documentation of the pest control program shall be maintained for Department review.
(6) The facility shall document maintenance work performed.
(7) Lighting levels shall meet or exceed the minimum standards as outlined in "Lighting for Health Care Facilities", Illuminating Engineering Society of North America, 1995 edition.
(8) Hot water temperature controls shall automatically regulate temperatures of hot water delivered to plumbing fixtures used by residents. The facility shall maintain hot water delivered to public and resident care areas at temperatures between 105 - 120 degrees F.
R432-270-25 Disaster and Emergency Preparedness.
(1) The facility is responsible for the safety and well-being of residents in the event of an emergency or disaster.
(2) The licensee and the administrator are responsible to develop and coordinate plans with state and local emergency disaster authorities to respond to potential emergencies and disasters. The plan shall outline the protection or evacuation of all residents, and include arrangements for staff response or provisions of additional staff to ensure the safety of any resident with physical or mental limitations.
(a) Emergencies and disasters include fire, severe weather, missing residents, death of a resident, interruption of public utilities, explosion, bomb threat, earthquake, flood, windstorm, epidemic, or mass casualty.
(b) The emergency and disaster response plan shall be in writing and distributed or made available to all facility staff and residents to assure prompt and efficient implementation.
(c) The licensee and the administrator must review and update the plan as necessary to conform with local emergency plans. The plan shall be available for review by the Department.
(3) The facility's emergency and disaster response plan must address the following:
(a) the names of the person in charge and persons with decision-making authority;
(b) the names of persons who shall be notified in an emergency in order of priority;
(c) the names and telephone numbers of emergency medical personnel, fire department, paramedics, ambulance service, police, and other appropriate agencies;
(d) instructions on how to contain a fire and how to use the facility alarm systems;
(e) assignment of personnel to specific tasks during an emergency;
(f) the procedure to evacuate and transport residents and staff to a safe place within the facility or to other prearranged locations;
(g) instructions on how to recruit additional help, supplies, and equipment to meet the residents' needs after an emergency or disaster;
(h) delivery of essential care and services to facility occupants by alternate means;
(i) delivery of essential care and services when additional persons are housed in the facility during an emergency; and
(j) delivery of essential care and services to facility occupants when personnel are reduced by an emergency.
(4) The facility must maintain safe ambient air temperatures within the facility.
(a) Emergency heating must have the approval of the local fire department.
(b) Ambient air temperatures of 58 degrees F. or below may constitute an imminent danger to the health and safety of the residents in the facility. The person in charge shall take immediate action in the best interests of the residents.
(c) The facility shall have, and be capable of implementing, contingency plans regarding excessively high ambient air temperatures within the facility that may exacerbate the medical condition of residents.
(5) Personnel and residents shall receive instruction and training in accordance with the plans to respond appropriately in an emergency. The facility shall:
(a) annually review the procedures with existing staff and residents and carry out unannounced drills using those procedures;
(b) hold simulated disaster drills semi-annually;
(c) hold simulated fire drills quarterly on each shift for staff and residents in accordance with Rule R710-3; and
(d) document all drills, including date, participants, problems encountered, and the ability of each resident to evacuate.
(6) The administrator shall be in charge during an emergency. If not on the premises, the administrator shall make every effort to report to the facility, relieve subordinates and take charge.
(7) The facility shall provide in-house all equipment and supplies required in an emergency including emergency lighting, heating equipment, food, potable water, extra blankets, first aid kit, and radio.
(8) The following information shall be posted in prominent locations throughout the facility:
(a) The name of the person in charge and names and telephone numbers of emergency medical personnel, agencies, and appropriate communication and emergency transport systems; and
(b) evacuation routes, location of fire alarm boxes, and fire extinguishers.
R432-270-26 First Aid.
(1) There shall be one staff person on duty at all times who has training in basic first aid, the Heimlich maneuver, certification in cardiopulmonary resuscitation and emergency procedures to ensure that each resident receives prompt first aid as needed.
(2) First aid training refers to any basic first aid course approved by the American Red Cross or Utah Emergency Medical Training Council.
(3) The facility must have a first aid kit available at a specified location in the facility.
(4) The facility shall have a current edition of a basic first aid manual approved by the American Red Cross, the American Medical Association, or a state or federal health agency.
(5) The facility must have a clean up kit for blood borne pathogens.
R432-270-27 Pets.
(1) The facility may allow residents to keep household pets such as dogs, cats, birds, fish, and hamsters if permitted by local ordinance and by facility policy.
(2) Pets must be kept clean and disease-free.
(3) The pets' environment shall be kept clean.
(4) Small pets such as birds and hamsters shall be kept in appropriate enclosures.
(5) Pets that display aggressive behavior are not permitted in the facility.
(6) Pets that are kept at the facility or are frequent visitors must have current vaccinations
(7) Upon approval of the administrator, family members may bring residents' pets to visit.
(8) Each facility with birds shall have procedures which prevent the transmission of psittacosis. Procedures shall ensure the minimum handling and placing of droppings into a closed plastic bag for disposal.
(9) Pets are not permitted in central food preparation, storage, or dining areas or in any area where their presence would create a significant health or safety risk to others.
R432-270-28 Respite Services.
(1) Assisted Living facilities may offer respite services and are not required to obtain a respite license from the Utah Department of Health.
(2) The purpose of respite is to provide intermittent, time limited care to give primary caretakers relief from the demands of caring for a person.
(3) Respite services may be provided at an hourly rate or daily rate, but shall not exceed 14-days for any single respite stay. Stays which exceed 14 days shall be considered a non-respite assisted living facility admission, subject to the requirements of R432-270.
(4) The facility shall coordinate the delivery of respite services with the recipient of services, case manager, if one exists, and the family member or primary caretaker.
(5) The facility shall document the person's response to the respite placement and coordinate with all provider agencies to ensure an uninterrupted service delivery program.
(6) The facility must complete a service agreement to serve as the plan of care. The service agreement shall identify the prescribed medications, physician treatment orders, need for assistance for activities of daily living and diet orders.
(7) The facility shall have written policies and procedures approved by the Department prior to providing respite care.
(8) Policies and procedures must be available to staff regarding the respite care clients which include:
(a) medication administration;
(b) notification of a responsible party in the case of an emergency;
(c) service agreement and admission criteria;
(d) behavior management interventions;
(e) philosophy of respite services;
(f) post-service summary;
(g) training and in-service requirement for employees; and
(h) handling personal funds.
(8) Persons receiving respite services shall be provided a copy of the Resident Rights documents upon admission.
(9) The facility shall maintain a record for each person receiving respite services which includes:
(a) a service agreement;
(b) demographic information and resident identification data;
(c) nursing notes;
(d) physician treatment orders;
(e) records made by staff regarding daily care of the person in service;
(f) accident and injury reports; and
(g) a post-service summary.
(10) Retention and storage of respite records shall comply with R432-270-21(1)-(2).
(11) If a person has an advanced directive, a copy shall be filed in the respite record and staff shall be informed of the advanced directive.
R432-270-29 Penalties.
Any person who violates any provision of this rule may be subject to the penalties enumerated in 26-21-11 and R432-3-6 or be assessed a penalty not to exceed the sum of $5,000 or be punished for violation of a class B misdemeanor for the first violation and for any subsequent similar violation within two years for violation of a class A misdemeanor as provided in Section 26-23-6.
[Indexing]
KEY: health facilities
January 29, 1999
[Editor's note: Below are references
to the Utah Code that are listed by the
agency making this rule as authority
for the rule.]
26-21-5
26-21-1
Notice of Continuation February 9, 2000
