Ga. R. & Regs. 111-8-63

Assisted Living Communities

This regulation establishes minimum standards for the licensure and operation of Assisted Living Communities in Georgia, defined as personal care homes serving 25 or more adults who need assistance with activities of daily living but not continuous medical or nursing care. Operators must obtain a permit from the Department of Community Health, maintain a licensed administrator, meet staffing and training requirements, and comply with governance, resident rights, and safety standards. The rules explicitly exclude facilities licensed by the Department of Behavioral Health, Developmental Disabilities and Addictive Diseases.

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Department 111

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Chapter 111-8

» Subject 111-8-63

Subject 111-8-63 RULES AND REGULATIONS FOR ASSISTED LIVING COMMUNITIES

Rule 111-8-63-.01 Authority

The legal authority for this Chapter is found in O.C.G.A. §§ 
31-2-7
 and Chapter 7 of Title
 31.

Rule 111-8-63-.02 Purpose

The purpose of these rules and regulations is to establish
 the minimum standards for the operation of personal care homes to be licensed
 as assisted living communities. Such communities provide assisted living care
 to adults who require varying degrees of assistance with the activities of
 daily living but who do not require continuous medical or nursing
 care.

Rule 111-8-63-.03 Definitions

In these rules, unless the context otherwise requires, the
 words, phrases and symbols set forth herein shall mean the following:

(a)

 "Abuse" means any intentional or grossly
 negligent act or series of acts or intentional or grossly negligent omission to
 act which causes injury to a resident, including but not limited to, assault or
 battery, failure to provide treatment or care, or sexual harassment of the
 resident.

(b)

 "Activities of daily
 living" means bathing, shaving, brushing teeth, combing hair, toileting,
 dressing, eating, laundering, cleaning private living space, managing money,
 writing letters, shopping, using public transportation, making telephone calls,
 grooming, obtaining appointments, engaging in leisure and recreational
 activities, or other similar activities.

(c)

 "Administrator" means the manager
 designated by the Governing Body as responsible for the day-to-day management,
 administration and supervision of the assisted living community, who may also
 serve as the on-site manager and responsible staff person except during periods
 of his or her own absence.

(d)

 "Applicant" means an individual or entity that submits an application for
 licensure pursuant to these rules as described below: 

1.

 When the assisted living community is
 owned by a sole proprietorship, the individual proprietor must be the applicant
 for the license, complete the statement of responsibility and serve as the
 licensee;

2.

 When the assisted
 living community is owned by a partnership, the general partners must be the
 applicant for the license, complete the statement of responsibility and serve
 as the licensee;

3.

 When the
 assisted living community is owned by an association, limited liability company
 (LLC) the governing body of the association or LLC must authorize the
 application for the license, complete the statement of responsibility and serve
 as the licensee; and

4.

 When the
 assisted living community is owned by a corporation, the governing body of the
 corporation must authorize the application for the license, complete the
 statement of responsibility and serve as the licensee.

(e)

 "Assistive device" means a device that
 may restrain movement which has been determined to be required by a licensed
 physician, nurse practitioner or physician's assistant working under a protocol
 or job description respectively and is applied for protection from injury or to
 support or correct the body alignment of the person, for the treatment of a
 person's physical condition, and may only be used as a treatment intervention
 where a specific written plan of care has been developed and the resident
 consents to such use.

(f)

 "Assisted
 living care" means the specialized care and services provided by an assisted
 living community which includes the provision of personal services, the
 administration of medications by a certified medication aide, the provision of
 assisted self-preservation, and the provision of limited nursing
 services.

(g)

 "Assisted living
 community" or "community" means a personal care home serving 25 residents or
 more that is licensed by the department to provide assisted living
 care.

(h)

 "Assisted
 self-preservation" means the capacity of a resident to be evacuated from an
 assisted living community to a designated point of safety and within an
 established period of time as determined by the Office of Fire Safety
 Commissioner. Assisted self-preservation is a function of all of the following:

1.

 the condition of the individual,

2.

 the assistance that is available to be
 provided to the individual by the staff of the assisted living community;
 and

3.

 the construction of the
 building in which the assisted living community is housed, including whether
 such building meets the state fire safety requirements applicable to an
 existing health care occupancy.

(i)

 "Certificate" means a certificate issued
 by the department to operate a memory care center in a licensed assisted living
 community or personal care home.

(j)

 "Chemical Restraint" means a
 psychopharmacologic drug that is used for discipline or convenience and not
 required to treat medical symptoms.

(k)

 "Department" means the Department of
 Community Health of the State of Georgia operating through the Division of
 Healthcare Facility Regulation.

(l)

 "Direct care staff person" means any employee, facility volunteer, or contract
 staff who provides to residents:

(i)

 any
 personal services, including but not limited to, medication administration or
 assistance, assistance with ambulation and transfer, and essential activities
 of daily living such as eating, bathing, grooming, dressing, and toileting;
 or

(ii)

 any other limited nursing
 services.

(m)

 "Director"
 means the chief administrator, executive officer or manager.

(n)

 "Disabled individual" means an individual
 that has a physical or mental impairment that substantially limits one or more
 major life activities and who meets the criteria for a disability under state
 or federal law.

(o)

 "Employee"
 means any person, other than a director, utilized by an assisted living
 community to provide personal services to any resident on behalf of the
 assisted living community or to perform at any facilities of the assisted
 living community any duties which involve personal contact between that person
 and any paying resident of the assisted living community.

(p)

 "Exploitation" means an unjust or
 improper use of another person or the person's property through undue
 influence, coercion, harassment, duress, deception, false representation, false
 pretense, or other similar means for one's own personal advantage.

(q)

 "Governing Body" means the owner, the
 board of trustees or directors, the partnership, the corporation, the
 association, the sole proprietorship or the person or group of persons who
 maintains and controls the assisted living community and who is legally
 responsible for the operation of the community.

(r)

 "Health maintenance activities" means
 those limited activities that, but for a disability, a person could reasonably
 be expected to do for himself or herself. Such activities are typically taught
 by a registered professional nurse, but may be taught by an attending
 physician, advanced practice registered nurse, physician assistant, or directly
 to a patient and are part of ongoing care. Health maintenance activities are
 those activities that do not include complex care such as administration of
 intravenous medications, central line maintenance, and complex wound care; do
 not require complex observations or critical decisions; can be safely performed
 and have reasonably precise, unchanging directions; and have outcomes or
 results that are reasonably predictable. Health maintenance activities
 conducted pursuant to this paragraph shall not be considered the practice of
 nursing.

(s)

 "Health services"
 means the specialized assistance that may be provided by or at the direction of
 either licensed healthcare professionals, such as doctors, nurses, physical
 therapists or through licensed healthcare programs, such as home health
 agencies, hospices and private home care providers to address health needs that
 the assisted living community is not staffed to provide or is not authorized by
 law or regulations to provide.

(t)

 "Injury" as used in the definition of "abuse" means a wrong or harm caused by
 an individual to a resident which is manifested by a physical or behavioral
 reaction or change in the appearance or actions of the resident, such as, but
 not limited to, reddened or bruised skin not related to routine care, crying,
 startling or cowering reaction by the resident and malnutrition or pressure
 ulcers for which the facility has not provided proper care.

(u)

 "Legal Surrogate" means a duly appointed
 person who is authorized to act, within the scope of the authority granted
 under the legal surrogate's appointment, on behalf of a resident who is
 adjudicated incapacitated.

(v)

 "Limited nursing services" means the assessment of the physical, mental, and
 emotional status to determine the appropriate level of care for an individual;
 the performance of health maintenance activities, as defined in division
 (a)(9)(C)(ii) of Code Section
 
43-26-12
; and the provision of any
 nursing care within the direct care staff person's scope of practice that can
 be completed within seven days or intermittently.

(w)

 "Medical alert system" means any device
 or combination of devices used to detect and immediately communicate that an
 individual is experiencing a medical emergency. Such device or combination of
 devices must be approved for their effectiveness by the department in its sole
 discretion.

(x)

 "Medical services"
 means services which may be provided by a person licensed pursuant to Article
 II of Chapter 34 of Title 43 of the Official Code of Georgia
 Annotated.

(y)

 "Memory care
 services" means the additional watchful oversight systems and devices that are
 required for residents who have cognitive deficits which may impact memory,
 language, thinking, reasoning, or impulse control, and which place the
 residents at risk of eloping, i.e. engaging in unsafe wandering activities
 outside the assisted living community.

(z)

 "Memory care center" means the
 freestanding or incorporated specialized unit that either: 

(i)

 holds itself out as providing additional
 or specialized care to persons with diagnoses of probable Alzheimer's or other
 dementias or with cognitive deficits that may place the resident at risk;
 or

(ii)

 charges higher rates for
 care for residents with Alzheimer's or other dementias than for care to other
 residents.

(aa)

 "Non-Family Adult" means a resident 18 years of age or older who is not related
 by blood within the third degree of consanguinity or by marriage to the person
 responsible for the management of the assisted living community or to a member
 of the governing body.

(bb)

 "Nursing services" means those services which may be rendered by a person
 licensed pursuant to Articles I and 2 of Chapter 26 of Title 43 of the Official
 Code of Georgia Annotated.

(cc)

 "On-site manager" means the administrator or person designated by the
 administrator as responsible for carrying out the day-to-day management,
 supervision, and operation of the assisted living community, who may also serve
 as responsible staff person except during periods of his or her own
 absence.

(dd)

 "Owner" means any
 individual or any person affiliated with a corporation, partnership, or
 association with 10 percent or greater ownership interest in the business or
 agency licensed as an assisted living community and who: 

1.

 purports to or exercises authority of the
 owner in a facility;

2.

 applies to
 operate or operates the business or agency;

3.

 maintains an office on the premises of the
 assisted living community;

4.

 resides at the assisted living community;

5.

 has direct access to persons receiving
 care at the assisted living community;

6.

 provides direct personal supervision of
 assisted living community personnel by being immediately available to provide
 assistance and direction during the time such assisted living community
 services are being provided; or 
 
enters into a contract to acquire ownership of such a
 business or agency.

(ee)

 "Permit" or "license" means the
 authorization granted by the Department to the governing body to operate an
 assisted living community.

(ff)

 "Personal care home" means any dwelling, whether operated for profit or not,
 which undertakes through its ownership or management to provide or arrange for
 the provision of housing, food service, and one or more personal services for
 two or more adults who are not related to the owner or administrator by blood
 or marriage.

(gg)

 "Personal
 Services" includes, but is not limited to, individual assistance with or
 supervision of self-administered medication, assistance, essential activities
 of daily living such as eating, bathing, grooming, dressing, toileting,
 ambulation and transfer.

(hh)

 "Physical Restraints" are any manual or physical device, material, or equipment
 attached or adjacent to the resident's body that the individual cannot remove
 easily which restricts freedom or normal access to one's body. Physical
 restraints include, but are not limited to, leg restraints, arm restraints,
 hand mitts, soft ties or vests, and wheelchair safety bars. Also included as
 restraints are assisted living community practices which function as a
 restraint, such as tucking in a sheet so tightly that a bedbound resident
 cannot move, bedrails, or chairs that prevent rising, or placing a wheelchair
 bound resident so close to a wall that the wall prevents the resident from
 rising. Wrist bands or devices on clothing that trigger electronic alarms to
 warn staff that a resident is leaving a room do not, in and of themselves,
 restrict freedom of movement and should not be considered as restraints.

(ii)

 "Physician" means an
 individual who is currently licensed to practice medicine in the State of
 Georgia. For purposes of these rules, it shall be acceptable for any activities
 required to be performed by a physician to be performed by any other licensed
 medical professional (i.e., Nurse Practitioner, Physician Assistant, etc.) who
 is permitted to perform such activities under applicable state scope of
 practice rules and regulations.

(jj)

 "Plan of Correction" means the written
 plan prepared in response to cited rule violations that identifies by date
 certain the specific actions that will be taken by the assisted living
 community to come into compliance with these rules.

(kk)

 "Proxy caregiver" means an unlicensed
 person or a licensed health care facility that has been selected by a disabled
 individual or a person legally authorized to act on behalf of such individual
 to serve as such individual's proxy caregiver and meets the requirements
 contained in the Rules and Regulations for Proxy Caregivers Used in Licensed
 Healthcare Facilities, Chapter 111-8-100.

(ll)

 "Representative" means a person who
 voluntarily, with the resident's written authorization, acts upon resident's
 direction with regard to matters concerning the health and welfare of the
 resident, including being able to access personal and medical records contained
 in the resident's file and receive information and notices pertaining to the
 resident's overall care and condition. This written authorization may take the
 form of an advance directive.

(mm)

 "Resident" means any non-family adult who receives or requires assisted living
 care and resides in the assisted living community.

(nn)

 "Responsible Staff Person" means the
 employee designated by the administrator or on-site manager as responsible for
 supervising the operation of the assisted living community during periods of
 temporary absence of the administrator or on-site manager.

(oo)

 "Self-administration of medications" or
 "self-administered medications" means those prescription or over-the-counter
 drugs that the resident personally chooses to ingest or apply where the
 resident has been assessed and determined to have the cognitive skills
 necessary to articulate the need for the medication and generally knows the
 times, and physical characteristics of medications to be taken.

(pp)

 "Self-preservation" means the ability to
 respond to an emergency condition, whether caused by fire or otherwise, and
 escape the emergency without physical, hands-on assistance from staff. The
 resident may move from place to place by walking, either unaided or aided by
 prosthesis, brace, cane, crutches, walker or hand rails, or by propelling a
 wheelchair.

(qq)

 "Staff" means any
 person who performs duties in the assisted living community on behalf of the
 assisted living community.

Rule 111-8-63-.04 Exemptions

These regulations do not apply to the following
 facilities:

(a)

 boarding homes or
 rooming houses which provide no services other than lodging and
 meals;

(b)

 facilities offering
 temporary emergency shelter, such as those for the homeless and victims of
 family violence;

(c)

 other
 facilities, homes or residences licensed by the department which have not been
 classified as assisted living communities, e.g. community living arrangements,
 personal care homes, hospices, traumatic brain injury facilities;

(d)

 facilities providing residential services
 for federal, state or local correctional institutions under the jurisdiction of
 the criminal justice system;

(e)

 charitable organizations providing shelter and other services without charging
 any fee to the resident or billing any fee on behalf of the
 residents;

(f)

 group residences
 organized by or for persons who choose to live independently or who manage
 their own care and share the cost of services including but not limited to
 attendant care, transportation, rent, utilities and food preparation;

(g)

 facilities licensed by the Department of
 Behavioral Health, Developmental Disabilities and Addictive Diseases;
 or

(h)

 host homes as defined in
 O.C.G.A. § 
37-1-20(18)
.

Rule 111-8-63-.05 Application for Permit

(1)

 The governing body of each assisted
 living community must submit to the Department an application for a permit in
 order to operate.

(2)

 The
 application for a permit must be made on forms made available by the Department
 or in a format acceptable to the Department.

(3)

 No application for licensure will be
 acted upon by the Department unless it has been determined to be complete and
 include all required attachments and fees due the Department as specified in
 the Rules and Regulations for General Licensing and Enforcement Requirements,
 Chapter 111-8-25.

(4)

 Each
 application for a permit must be accompanied by an accurate floor plan showing
 windows, doors, common areas, and resident room measurements and digital copies
 in .jpg format of pictures of the assisted living community's exterior, common
 areas and typical resident room.

(5)

 The name of the administrator or on-site
 manager, who will be working in the assisted living community, if known, must
 be included with the application for a permit. If such information is not known
 at the time of application, it must be provided to the Department before a
 permit will be issued.

(6)

 The
 ownership of the assisted living community must be fully disclosed in the
 application for a permit. In the case of corporations, partnerships, and other
 entities recognized by statute, the corporate officers and all other
 individuals or family groups owning ten percent or more of the corporate stock
 or ownership must be disclosed in the application, as well as the registered
 agent for service of process.

(7)

 Each application must include documentation of ownership or lease agreement for
 the property on which the assisted living community will be operated.

(8)

 The filing of an application for
 licensure constitutes a representation that the applicant is or will be in
 complete control of the community as of a specified date.

(9)

 Local zoning and other local requirements
 regarding the proper location and establishment of the assisted living
 community must be addressed by the applicant with the responsible local
 officials.

(10)

 The initial
 application for licensure shall include a financial stability affidavit from a
 certified public accountant affirming the applicant's ability to operate as a
 going concern for the next two years.

Rule 111-8-63-.06 Permits

(1)

 The governing
 body of each assisted living community must obtain a valid permit from the
 Department to provide assisted living care prior to admitting any
 residents.

(2)

 The permit must be
 displayed on the premises in a conspicuous place that is visible to residents
 and visitors.

(3)

 Permits are not
 transferable from one assisted living community or location to
 another.

(4)

 A permit must be
 returned to the Department and is no longer valid when any of the following
 events occurs: 

(a)

 The assisted living
 community is moved to another location which has not been licensed.

(b)

 The ownership of the community
 changes.

(c)

 The permit is
 suspended or revoked.

(5)

 A separate permit is required for each
 assisted living community located on different premises.

(6)

 An assisted living community must not
 serve more residents than its approved licensed capacity, which is listed on
 the face of the permit issued by the Department.

(7)

 An assisted living community must provide
 assisted living care as authorized by law and these rules.

(8)

 An assisted living community must
 disclose its licensure classification as an assisted living community in its
 marketing materials.

(9)

 An
 assisted living community must not operate or allow another business to operate
 on the premises of the assisted living community where the business intrudes on
 the residents' quiet enjoyment and exclusive use of the premises, in any way.

Rule 111-8-63-.07 Owner Governance

(1)

 The assisted living community must have a
 functioning governing body which is responsible for providing the oversight
 necessary to ensure that the community operates in compliance with these rules,
 the Rules for General Licensing and Enforcement, Chapter 111-8-25, the Rules
 for Proxy Caregivers, Chapter 111-8-100, as applicable and other applicable
 state laws and regulations.

(2)

 The
 governing body is responsible for implementing policies, procedures and
 practices in the community that support the core values of dignity, respect,
 choice, independence and privacy of the residents in a safe environment and in
 accordance with these rules. At a minimum, the policies and procedures that are
 developed must provide direction for the staff and residents on the following: 

(a)

 the services available in the assisted
 living community, including, personal services, assisted living care, memory
 care services and any other specialized services such as memory care centers
 and designated proxy caregivers;

(b)

 the staffing plan that the community
 utilizes to ensure that staffing ratios increase proportionally as the number
 of residents who require assisted self-preservation increases;

(c)

 admissions, discharges and immediate
 transfers which ensure that the community does not admit or retain residents
 who need more care that the assisted living community is authorized or capable
 of providing;

(d)

 refunds when a
 resident is transferred or discharged;

(e)

 training and ongoing evaluation of staff,
 including specialized training if designated proxy caregivers are provided or
 memory care is offered;

(f)

 house
 rules and their enforcement;

(g)

 protecting the rights of the residents as set forth in these rules;

(h)

 medication management, procurement, the
 use of certified medication aides and professional oversight provided for such
 services;

(i)

 health and hygiene
 issues for residents and staff relating to infection control, work policies and
 return to work policies, food borne illnesses and reportable
 diseases;

(j)

 the investigation and
 reporting of abuse, neglect, exploitation of residents, residents' wandering
 away from the community, accidents, injuries and changes in residents'
 conditions to required parties;

(k)

 discipline procedures for handling acts committed by staff which are
 inconsistent with the policies of the assisted living community;

(l)

 emergency preparedness, drills and
 evacuation requirements;

(m)

 quality assurance review mechanisms, including resident and family feedback to
 determine opportunities for improving care;

(n)

 the use of volunteers and their
 orientation regarding resident's rights and basic safety precautions;

(o)

 the specific use of proxy caregivers
 allowed within the community and the oversight of proxy caregivers the
 community requires or provides in accordance with Georgia law, these rules and
 the rules for proxy caregivers, Chapter 111-8-100; and

(p)

 the safety and security precautions that
 will be employed by the assisted living community to protect residents from
 harm by other residents, designated proxy caregivers, and other individuals,
 not employed by the community who routinely come into the community.

(3)

 The governing body must
 designate an administrator or on-site manager as responsible for the overall
 management of the assisted living community and for carrying out the rules and
 policies adopted by the governing body.

(4)

 The governing body must ensure that the
 Department has current emergency contact information consisting of name, e-mail
 contact for notifications to the licensed community, physical addresses, and
 phone numbers for the governing body and the administrator or on-site manager
 of the assisted living community.

(5)

 The governing body must take appropriate
 measures within its control, to protect the residents from criminal activity
 occurring in the assisted living community.

(6)

 The governing body must not allow persons
 who are not residents of the assisted living community to live on the premises
 if they are listed on the National Sex Offender Registry.

(7)

 No member of the governing body,
 administration, or staff of the assisted living community or an affiliated
 assisted living community or family members of the governing body or any staff
 may serve as the legal surrogate or representative of a resident.

(8)

 Where the governing body, a member of the
 governing body's family or a staff member of the assisted living community or
 an affiliated assisted living community serves as the representative payee of a
 resident, the individual or entity must be covered by a surety bond.

(9)

 Notification of Emergency
 Relocation
.
 The community must provide timely notification of the
 relocation address to the residents, their family contacts and representatives,
 if any, and the department whenever the community must relocate the residents
 as a result of an emergency situation which disrupts the provision of room and
 board for the residents at the licensed location.

(10)

 Notification of Bankruptcy, Eviction or
 Change of Ownership. The community must provide: 

(a)

 a minimum of sixty (60) days written
 notice to the department and all residents of any impending bankruptcy or
 property eviction that may force discharge or relocation of residents or
 otherwise adversely impact the provision of safe care and oversight;
 and

(b)

 a minimum of thirty (30)
 days written notice to the department and all residents of any impending change
 of ownership. The notice to the department shall be in the form of an
 application which must be approved before the permit is issued to the new
 owner(s).

Rule 111-8-63-.08 Community Leadership

(1)

 Each community must have a full-time
 administrator to provide day-to-day leadership to the community. The
 administrator must be 21 years of age or older and hold a valid license from
 the State Board of Long-Term Care Facility Administrators with an effective
 date no greater than sixty (60) days from the date of hire or July 1, 2021,
 whichever is later.

(2)

 The
 administrator is responsible for ensuring that the policies and procedures are
 effective and enforced to ensure compliance with these rules and community
 policies and procedures.

(3)

 Each
 assisted living community must have a separate administrator or on-site manager
 who works under the supervision of the administrator.

(4)

 The administrator or on-site manager must
 designate qualified staff as responsible staff to act on his or her behalf and
 to carry out his or her duties in the absence of the administrator or on-site
 manager.

(5)

 Residents must not be
 allowed to function or be counted as staff.

(6)

 Staff must be assigned duties consistent
 with their positions, training, experiences, and the requirements of Rule
 .

(7)

 The administrator is responsible for
 ensuring that the assisted living community has an effective quality assurance
 program which includes at least the following: 

(a)

 investigating resident incidents which
 result in injuries or death in order to identify and implement opportunities
 for improvement in care;

(b)

 implementing changes made to support improved care, such as those necessary to
 minimize illness outbreaks and eliminate identified rule violations;

(c)

 monitoring staff performance to ensure
 that care and services are being delivered safely and in accordance with these
 rules and community policies; and

(d)

 obtaining and using feedback from the
 residents and representatives, at least annually, on the quality of services
 provided by the community and opportunities for improvement of
 services.

Rule 111-8-63-.09 Workforce Qualifications, Training and Staffing

(1)

 The on-site manager and responsible staff
 persons must be at least 21 years of age and responsible for supervising the
 provision of care by all other staff. No staff person under the age of 18 is
 permitted to work in the assisted living community unless there is direct
 line-of-sight supervision being provided by the administrator, on-site manager
 or a responsible staff person or the staff member is at least 17 years of age
 and has successfully completed a vocational technical training track as a
 nursing assistant through a Georgia high school.

(2)

 Initial Training for All Staff. The
 administrator or on-site manager must ensure that any person working in the
 assisted living community as staff, receives training within the first 60 days
 of employment on the following: 

(a)

 residents' rights and identification of conduct constituting abuse, neglect or
 exploitation of a resident and reporting requirements to include the employee's
 receipt of a copy of the Long-Term Care Facility Resident Abuse Reporting Act
 as outlined in O.C.G.A. § 
31-8-81
 et seq.;

(b)

 general infection control principles
 including importance of hand hygiene in all settings and attendance policies
 when ill;

(c)

 training necessary to
 carry out assigned job duties; and

(d)

 emergency preparedness.

(3)

 Initial Training for Staff
 Providing Hands-On Personal Services. In addition to the initial training
 required of all staff in paragraph (2) above, the administrator must ensure
 that staff hired to provide hands-on personal services to residents receive
 training within the first 60 days of employment which includes the following: 

(a)

 current certification in emergency first
 aid except where the staff person is a currently licensed health care
 professional;

(b)

 current
 certification in cardiopulmonary resuscitation where the training course
 required return demonstration of competency;

(c)

 medical and social needs and
 characteristics of the resident population, including special needs of
 residents with dementia;

(d)

 residents' rights and the provision of care to residents that is individualized
 and helpful; and

(e)

 training
 specific to assigned job duties, such as, but not limited to, permissible
 assistance with medications, contraindications for medications that must be
 brought to the attention of appropriate individuals, assisting residents in
 transferring, ambulation, proper food preparation, proper performance of health
 maintenance activities if serving as a designated proxy caregiver and
 responding appropriately to dementia-related behaviors.

(4)

 Trained Staff Present. At least two staff
 who have completed the minimum training requirements of Rule
 above must be present in the assisted
 living community at all times any residents are present, with at least one
 staff person on each occupied floor, to provide necessary oversight and
 assistance to staff providing hands-on personal services who have not completed
 the training, to ensure that care and services are delivered safely and in
 accordance with these rules. The staff person posted on the designated floor
 may move about the premises as necessary if the community has implemented a
 medical alert system and each resident has been offered a wearable device that
 connects to such system when activated to alert an administrator or direct care
 staff person of a medical emergency.

(5)

 Training Hours Required During First Year
 of Employment. All staff offering hands-on personal services to the residents,
 including the administrator or on-site manager, must satisfactorily complete a
 total of at least twenty-four (24) hours of continuing education within the
 first year of employment as a direct care worker. The courses offered must be
 relevant to assigned job duties and include such topics as cardiopulmonary
 resuscitation and first aid certifications, utilizing standard precautions in
 working with aging residents, working with residents with Alzheimer's or other
 cognitive impairments, working with persons who have developmental disabilities
 or persons who have mental illness, providing social and recreational
 activities, understanding legal issues, performing necessary physical
 maintenance, fire safety, housekeeping activities, recognizing and reporting
 abuse, neglect and exploitation, preparing and serving food safely, preserving
 the dignity and rights of residents receiving care to make meaningful choices,
 providing and documenting medication assistance, or other topics as determined
 necessary by the Department to support compliance.

(6)

 Ongoing Staff Training. Beginning with
 the second year of employment, staff providing hands-on personal services must
 have a minimum of sixteen (16) hours of job-related continuing education as
 referenced in paragraph
 
 above annually.

(7)

 Training
 Records. The community must maintain documentation reflecting course content,
 instructor qualifications, agenda and attendance rosters for all trainings
 provided.

(8)

 Proxy Caregiver
 Training. An assisted living community employing proxy caregivers must provide
 training to the proxy caregivers in accordance with the Rules and Regulations
 for Use of Proxy Caregivers, Chapter 111-8-100 subject to the limitation that
 only certified medication aides may administer medications on behalf of the
 community.

(9)

 Hospice Training.
 The assisted living community shall ensure that any medication aide(s) who will
 be administering liquid morphine to any hospice patient(s) residing in the
 community receive adequate training from a licensed hospice on the safe and
 proper administration of liquid morphine prior to such administration and on an
 annual basis thereafter. The community shall maintain documentation of all
 training provided.

(10)

 Staff
 Health Examinations and Screenings. The administrator, on-site manager, and
 each employee must have received a tuberculosis screening and a physical
 examination by a licensed physician, nurse practitioner or physician's
 assistant within twelve months prior to providing care to the residents. The
 physical examination must be sufficiently comprehensive to assure that the
 employee is physically qualified to work and free of diseases communicable
 within the scope of employment. Follow-up examinations must be conducted by a
 licensed physician, nurse practitioner or physician's assistant for each
 administrator or staff person to determine readiness to return to work
 following a significant illness or injury. Health information, screenings,
 assessments and medical releases regarding each staff member must be retained
 in a readily retrievable format by the assisted living community and made
 available for review and/or copying by Department representatives upon
 request.

(11)

 Criminal History
 Background Checks for Owners Required. The owner of the business or agency
 applying for the license must comply with the requirements of the Rules and
 Regulations for Criminal Background Checks, Chapter 111-8-12.

(12)

 Criminal History Background Checks for
 Director, Administrator and Onsite Manager Required. Prior to serving as a
 director, administrator or onsite manager of an assisted living community, the
 community must obtain a satisfactory fingerprint records check determination
 for the person to be hired in compliance with the Rules and Regulations for
 Criminal Background Checks, Chapter 111-8-12.

(13)

 Criminal History Background Checks for
 Direct Access Employees Required. Prior to serving as a direct access employee,
 the community must obtain a satisfactory fingerprint records check
 determination for the person to be hired in compliance with the Rules and
 Regulations for Criminal Background Checks, Chapter 111-8-12.

(14)

 The administrator or on-site manager
 must obtain an employment history for each employee and maintain documentation
 in the employee's file. If the potential employee has no prior employment
 history, then the assisted living community must retain documentation of a
 satisfactory personal reference check.

(15)

 Personnel files must be maintained in
 the assisted living community for each employee and for three years following
 the employee's departure or discharge. These files must be available for
 inspection by departmental staff but must be maintained to protect the
 confidentiality of the information contained in them from improper disclosure.
 The files must include the following:

(a)

 evidence of a satisfactory fingerprint record check determination, if
 applicable;

(b)

 report of physical
 examination completed by a licensed physician, nurse practitioner or
 physician's assistant, and a TB screening completed within the 12 months
 preceding the date of hire;

(c)

 evidence of trainings, skills competency determinations and recertifications as
 required by these rules and, if applicable, the Rules for Proxy Caregivers,
 Chapter 111-8-100;

(d)

 employment
 history, including previous places of work, employers and telephone contacts
 with previous employers;

(e)

 supporting documentation reflecting that the employee has the basic
 qualifications as represented, e.g. documentation of good standing by nursing
 board, no findings of abuse, neglect or exploitation entered against the
 individual in the nurse aide registry, satisfactory report of motor vehicle
 driving record where the employee may be transporting residents; and

(f)

 written evidence of satisfactory initial
 and annual work performance reviews for unlicensed staff providing hands-on
 personal care. Where the unlicensed staff perform specialized tasks, such as
 health maintenance activities, assistance with medications or medication
 administration, such performance reviews must include the satisfactory
 completion of skills competency checklists as specified in applicable rules.
 Such reviews must be conducted by staff or contractors qualified by education,
 training and experience to assess that the assigned duties are being performed
 in accordance with these rules and accepted health and safety
 standards.

(16)

 Where the
 assisted living community permits a resident to hire his or her own
 companion-sitter, proxy caregiver to perform health maintenance activities or
 aide of any sort, the assisted living community must require assurance that the
 companion-sitter, proxy caregiver or aide so hired is familiar with emergency
 evacuation routes and has documentation reflecting compliance with the
 provisions of the Rules for Proxy Caregivers, Chapter 111-8-100, as
 applicable.

(17)

 The administrator,
 on-site manager, and staff persons must not be under the influence of alcohol
 or other controlled substances while engaged in any work-related activity on
 behalf of the assisted living community.

(18)

 The community must maintain an average
 monthly minimum on-site staff to resident ratio of one awake direct care staff
 person per 15 residents during waking hours and one awake direct care staff
 person per 20 residents during non-waking hours where the residents have
 minimal care needs. Average monthly minimum staffing levels shall be calculated
 and documented by the community using methods and forms specified by the
 department. However, the assisted living community must staff above these
 minimum on-site staff ratios to meet the specific residents' ongoing health,
 safety and care needs.

(a)

 Staff, such as
 cooks and maintenance staff, who do not receive on-going direct care training
 and whose job duties do not routinely involve the oversight or delivery of
 direct personal care to the residents, must not be counted towards these
 minimum staffing ratios. Personnel who work for another entity, such as a
 private home care provider, hospice, etc. or private sitters cannot be counted
 in the staff ratios for the assisted living community.

(b)

 At least two on-site direct care staff
 persons must be on the premises 24 hours per day providing supervision whenever
 residents are present, with at least one staff person on each occupied
 floor.

(c)

 A registered
 professional nurse or licensed practical nurse must be on-site to support care
 and oversight of the residents, as follows: 

(i)

 For communities with one to 30 residents,
 a minimum of 8 hours per week;

(ii)

 For communities with 31 to 60 residents, a minimum of 16 hours per
 week;

(iii)

 For communities with 61
 to 90 residents, a minimum of 24 hours per week;

(iv)

 For communities with more than 90
 residents, a minimum of 40 hours per week;

(d)

 Residents must be supervised consistent
 with their needs.

(19)

 Sufficient staff time must be provided by the assisted living community such
 that each resident:

(a)

 receives services,
 treatments, medications and diet as prescribed;

(b)

 receives proper care to prevent decubitus
 ulcers and contractures;

(c)

 is
 kept comfortable and clean;

(d)

 is
 treated with dignity, kindness, and consideration and respect;

(e)

 is protected from avoidable injury and
 infection;

(f)

 is given prompt,
 unhurried assistance if she or he requires help with eating;

(g)

 is given assistance, if needed, with
 daily hygiene, including baths and oral care; and

(h)

 is given assistance in transferring and
 assisted self-preservation when needed.

(20)

 All persons, including the administrator
 or on-site manager, who offer direct care to the residents on behalf of the
 assisted living community, must maintain an awareness of each resident's normal
 appearance and must intervene, as appropriate, if a resident's state of health
 appears to be in jeopardy.

(21)

 All
 assisted living communities must develop and maintain accurate staffing plans
 that take into account the specific needs of the residents and monthly work
 schedules for all employees, including relief workers, showing planned and
 actual coverage for each day and night. The assisted living community must
 retain the completed staff schedules for a minimum of one year.

(22)

 Staff must wear employee identification
 badges which are readily visible with abbreviations for professional/special
 credentials displayed on the badges, if any.

(23)

 Medical Alert Systems. Homes utilizing
 medical alert systems to allow on-site staff to move about as specified in Rule
 
 must meet the following requirements: 

(a)

 The
 medical alert system must include a wearable sensor device that enables the
 resident to request help when needed.

(b)

 The home may encourage, but not require,
 residents to wear the sensor device and must ensure that residents who do not
 consistently wear the sensor device receive appropriate monitoring from
 staff.

(c)

 The wearable sensor
 device must be programmed to immediately notify appropriate staff, and to
 identify the specific resident or location from which the alert signal has been
 made, by:

(i)

 activating a portable electronic
 device worn by the administrator and/or a direct care staff person with an
 audible tone or vibration; or

(ii)

 sending a signal to a stationary electronic device located in a designated area
 monitored by staff.

(d)

 The home must establish policies and procedures which address the following
 requirements and must maintain documentation to demonstrate compliance with
 such policies and procedures:

(i)

 routine
 testing and maintenance of the medical alert system;

(ii)

 initial training for residents and staff
 on use of the system and additional training as needed;

(iii)

 procedures for electrical outages or
 severe weather events that include making more frequent rounds to check on
 residents if the system is not working, as well as testing the system following
 such events to ensure operability; and

(iv)

 a process for reviewing any
 documentation produced by the system for opportunities to enhance
 individualized care and service.

(e)

 The department may prohibit a home from
 using or relying on a medical alert system if the above requirements are not
 met.

Rule 111-8-63-.10 Community Accountability

(1)

 The records required by these rules and
 other records maintained in the normal course of the business of the community
 must be available for inspection and review by properly identified
 representatives of the Department.

(2)

 Where the Department identifies rule
 violations, the assisted living community will receive a written report of
 inspection. If the assisted living community disagrees with the facts and
 conclusions stated in the inspection report, it must submit its written
 statement explaining its disagreement and any evidence supporting the
 disagreement to the Department within 10 days of the receipt of the written
 inspection report. Where the Department concurs with the written statement of
 the assisted living community, it will issue a revised inspection report to the
 assisted living community.

(3)

 Within 10 days of receipt of the written report of inspection, the assisted
 living community must develop a written plan for correcting any rule violations
 identified. The plan of correction must identify the specific actions that the
 assisted living community will take by date certain to come into compliance
 with each rule for which a deficient practice was identified.

(4)

 A copy of the most recent inspection
 report and plan of correction must be displayed in the assisted living
 community in a location that is routinely used by the community to communicate
 information to residents and visitors. Additionally, if the community maintains
 a website, it shall post a web link in a prominent location on the main page of
 the website that provides access to copies of all inspection reports and plans
 of correction from the previous 18 months. When the Department develops a
 website for receiving plans of correction electronically and notifies the
 community of the appropriate internet address, the community also must file its
 plan of correction electronically on the Department's website within 10 days of
 receipt of the report of inspection.

(5)

 The assisted living community must take
 the corrective actions necessary to achieve compliance with the
 rules.

(6)

 The assisted living
 community must complete and maintain an accurate and current licensed
 residential care profile on file with the Department when the Department makes
 available a system for the submission and collection of such information
 electronically.

(7)

 The assisted
 living community must provide services that are consistent with the information
 reported on its licensed residential care profile, its license and these
 rules.

(8)

 The assisted living
 community's marketing materials must be consistent with its licensure
 classification as an assisted living community, the information reported on its
 licensed residential care profile, and these rules.

(9)

 Only an assisted living community
 licensed pursuant to these rules may hold itself out as offering assisted
 living care.

(10)

 No memory care
 center shall be operated and no residents admitted without a certificate which
 is current under these rules and regulations.

Rule 111-8-63-.11 Community Design and Use Requirements

(1)

 An assisted living community shall be
 designed, constructed, arranged, and maintained so as to provide for all of the
 following:

(a)

 health, safety, and well-being
 of the residents;

(b)

 independence,
 privacy and dignity of the residents; and

(c)

 safe access of all residents with varying
 degrees of functional impairments to living, dining and activity areas within
 the assisted living community.

(2)

 An assisted living community which
 undergoes major structural renovation or is first constructed after the
 effective date of these rules must be designed and constructed in compliance
 with applicable state and local building and fire codes.

(3)

 The assisted living community must have
 handrails, doorways and corridors which accommodate mobility devices, such as
 walkers, wheel chairs and crutches or canes as the residents may require for
 their safety.

(4)

 Assisted living
 communities serving persons dependent upon wheelchairs for mobility must
 provide at least two (2) exits from the community which are remote from each
 other and wheelchair accessible.

(5)

Common Areas.
 The assisted
 living community must have common areas which meet the following requirements: 

(a)

 The assisted living community must have
 separate and distinct living room(s) which are conveniently located within easy
 walking distance of each resident's private living space, available for the
 residents' informal use at any time and not requiring any resident to leave the
 building to use.

(b)

 The assisted
 living community must have living rooms large enough to accommodate the
 residents without crowding. The rooms must be comfortably and attractively
 furnished.

(c)

 The assisted living
 community must have areas in the community for use by residents and visitors
 which afford them privacy.

(d)

 The
 assisted living community must have a kitchen and a comfortable dining area
 which are properly equipped and adequate in size for the number of residents
 being served.

(e)

 All stairways and
 ramps must have sturdy and securely fastened handrails, not less than 30 inches
 nor more than 34 inches above the center of the tread. Exterior stairways,
 decks and porches must have handrails on the open sides.

(f)

 Floor coverings must be intact and
 securely fastened to the floor and free of hazards that might cause
 tripping.

(g)

 All areas of the
 assisted living community, including hallways and stairs must provide
 sufficient ambient lighting such that the residents may move about safely and
 objects may be easily observed by the residents. In addition, appropriate task
 lighting necessary for more visually demanding activities such as reading,
 knitting or preparing food must also be provided for resident use.

(h)

 The assisted living community must
 provide laundering facilities on the premises for residents' personal
 laundry.

(i)

 An assisted living
 community which provides laundry services for the residents must have a storage
 area that is used for clean laundry that is separate from the dirty
 laundry.

(j)

 Common areas, such as
 living, dining, activity, laundry or other multi-purpose rooms, or hallways
 must not be used as sleeping accommodations for residents, family or
 staff.

(6)

 Bedrooms or Private Living Spaces.
 The assisted living community must
 have bedrooms or private living spaces for the residents which meet the
 following requirements: 

(a)

 Bedrooms or
 private living spaces assigned to individual residents must have at least 80
 square feet of usable floor space per resident with no more than two residents
 sharing the private living space. Usable floor space is defined as that floor
 space under a ceiling at least seven feet in height. However, licensed personal
 care homes approved prior to or on February 6, 1981 to operate with bedrooms
 with a minimum of 70 square feet of usable floor space per resident which have
 continuously operated since that date seeking licensure as assisted living
 communities, may continue to use the minimum 70 square feet standard. Where an
 assisted living community operating under this exception has its permit
 revoked, changes ownership, changes location, or undergoes extensive
 renovations, or for any other reason surrenders its permit, this exception
 regarding the minimum square footage is no longer available.

(b)

 The resident's private living space must
 be self-contained and separated from halls, corridors and other rooms by floor
 to ceiling walls and must not be used as a passageway or corridor by others to
 access other parts of the assisted living community.

(c)

 The resident's private living space must
 have at least one window opening through an exterior wall of the assisted
 living community.

(d)

 Each sleeping
 room must have a secondary exit. This secondary exit may be a door or a window
 usable for escape.

(e)

 A room must
 not be used as a bedroom or private living space where more than one-half the
 room height is below ground level. Bedrooms or private living spaces which are
 partially below ground level must have adequate natural light and ventilation
 and have two useful means of egress. Control of dampness must be
 assured.

(f)

 Doorways of bedrooms
 or private living spaces occupied by residents must be equipped with
 side-hinged permanently mounted doors equipped with positively latching
 hardware which will insure opening of the door by a single motion, such as
 turning a knob or by pressing with normal strength on a latch. For bedrooms or
 private living spaces which have locks on doors, both the occupant and staff
 must be provided with keys to assure easy entry and exit.

(7)

Bathing and Toileting
 Facilities.
 The assisted living community must provide bathing and
 toileting facilities that meet the accessibility needs of the residents and the
 following requirements:

(a)

 At least one
 toilet and lavatory must be provided for each four residents' use based on the
 licensed capacity of the assisted living community.

(b)

 At least one bathing or showering
 facility must be provided for each eight residents based on the licensed
 capacity of the assisted living community. Assisted living communities serving
 residents who are dependent on wheel chairs or walkers, for mobility must have
 fully accessible bathrooms available for these residents.

(c)

 There must be at least one toilet and
 lavatory provided on each floor where residents have bedrooms.

(d)

 There must be a separate toilet and
 lavatory for the staff's use that is not counted in the minimum ratio of
 toilets and lavatories required for residents.

(e)

 Grab bars and nonskid surfacing or strips
 must be properly installed in all showers and bath areas.

(f)

 Bathrooms and toilet facilities must have
 working exhaust fans vented to the outside or windows that are screened and
 open to the outside easily.

(g)

 Toilets, bathtubs and showers must provide for individual privacy.

(8)

Electrical
 Inspection.
 An applicant to operate an assisted living community must
 submit evidence of a satisfactory inspection of the electrical service of the
 assisted living community by a qualified electrician within no more than six
 months prior to the date of filing the application for a permit However, where
 the applicant holds a personal care home permit for the premises at the time of
 the application to become an assisted living community, no new electrical
 inspection is required unless renovation or repair work has been done since the
 last electrical inspection. Electrical service must be maintained in a safe
 condition at all times. The Department may require a re-inspection of the
 electrical service at any time renovation or repair work is done in the
 assisted living community or there is a request for a change in capacity or
 there is reason to believe that a risk to residents exists.

(9)

Fire Safety.
 The assisted
 living community must have an effective fire safety program for the benefit of
 the residents which takes into account the unique needs of the residents being
 served.

(a)

 The assisted living community must
 comply with applicable fire and safety rules published by the Office of the
 Safety Fire Commissioner.

(b)

 The
 assisted living community must comply with applicable local ordinances that
 specifically address fire safety.

(c)

 The assisted living community is required
 to obtain a repeat fire safety inspection if at any time the physical plant
 undergoes substantial repair, renovation or additions.

(d)

 Where the Department has reason to
 believe, based on the number of residents requiring assisted self-preservation
 and staffing patterns that an assisted living community may not be able to
 evacuate all of the residents to a designated point of safety within an
 established period of time as determined by the Office of the Safety Fire
 Commissioner, the Department may either require the assisted living community
 to conduct an immediate fire safety drill or make a referral for a new
 compliance determination to the Office of the State Fire
 Commissioner.

(10)

Water and Sewage.
 The assisted living community's water and sewage
 systems must meet applicable federal, state, and local regulations.

(11)

Outdoor Spaces.
 Assisted
 living communities must provide or have conveniently located access to outdoor
 spaces for the use of the residents and access to parking spaces for the use of
 residents and visitors. Such outdoor spaces may include solaria, porches,
 balconies, roof decks, gardens or patios.

Rule 111-8-63-.12 Community Furnishings

(1)

 The assisted living community must
 provide furnishings throughout the assisted living community for the use of the
 residents that are maintained in good condition, intact, and
 functional.

(2)

 The assisted living
 community must provide a name plate, or other identification, outside the
 resident's bedroom or personal living space that marks the area as the personal
 living space of the particular resident(s), unless the resident specifically
 requests no identification markers to be used.

(3)

 Each resident's bedroom or private living
 space must have an adequate closet or wardrobe.

(4)

 Each resident's bedroom or private living
 space must have working lighting fixtures sufficient for reading and other
 resident activities.

(5)

 If the
 community provides the furnishings, each resident's bedroom or private living
 space must have a bureau or dresser or the equivalent and at least one
 comfortable chair per resident in each bedroom or private living
 space.

(6)

 Each resident bedroom
 must have a mirror appropriate for grooming unless the resident or resident's
 representative explicitly requests to have the mirror removed.

(7)

 Each resident's bedroom or private living
 space must have a waste basket unless the resident or resident's representative
 specifically requests to have it removed.

(8)

 The assisted living community must allow
 the resident to personalize the bedroom or private living space as the resident
 chooses by permitting the resident to use personal furniture so long as such
 furnishings do not pose a threat to the health or safety of the other
 residents. The assisted living community must provide the resident with
 assistance in mounting or hanging pictures on bedroom walls.

(9)

 Each resident must have an individual bed
 which is at least 36-inches wide and 72-inches long with comfortable springs
 and mattress, clean and in good condition. Where a particular resident is very
 tall, the assisted living community must provide an extra-long mattress. The
 mattress must not be less than five-inches thick, or four-inches, if of a
 synthetic construction. Roll-a-ways, cots, double-decks, stacked bunks,
 hide-a-beds and studio couches are not to be provided by the assisted living
 community in lieu of standard beds. However, residents who prefer to furnish
 their own living units may choose to use different-sized beds in lieu of
 standard twin-size beds.

(10)

 The
 assisted living community must make available for each resident who requires
 linen service an adequate supply of clean linens which includes, at a minimum,
 two sheets, pillow, pillowcase, blanket, bedspread, towels and wash cloth. If
 the resident requires more blankets for comfort, the assisted living community
 must provide them.

(11)

 The
 assisted living community must change and launder linens for each resident at
 least weekly or more often unless the resident specifically declines the linen
 service. Whether or not the resident declines linen services, the assisted
 living community must maintain an adequate supply of spare linens on hand to
 accommodate the needs of the residents.

(12)

 At least one current calendar and
 working clock must be placed in the common living area of each assisted living
 community.

Rule 111-8-63-.13 Community Safety Precautions

(1)

 The interior and exterior of the assisted
 living community must be kept clean, in good repair and maintained free of
 unsanitary or unsafe conditions which might pose a health or safety risk to the
 residents and staff.

(2)

 Where the
 assisted living community includes private living space for persons who are not
 receiving services as residents of the assisted living community, the
 maintenance of the private living space must comply with fire safety codes and
 not threaten the health or safety of the residents.

(3)

 The assisted living community must
 maintain wall-type electric outlets and working lamps or light fixtures
 throughout the assisted living community in good working order and which are
 safe for the intended use. The assisted living community must provide necessary
 light bulbs.

(4)

 Refrigeration and
 cooking appliances must be properly installed, maintained in accordance with
 manufacturer's recommendations and kept clean. Where metal hoods or canopies
 are provided, they must be equipped with filters which are maintained in an
 efficient condition and kept clean at all times.

(5)

 Space heaters must not be used, except
 during an emergency situation after obtaining specific written approval of the
 fire safety authority having jurisdiction over the assisted living
 community.

(6)

 Fire screens and
 protective devices must be used with fireplaces, stoves and heaters.

(7)

 Each assisted living community must be
 protected with sufficient functioning smoke detectors, powered by house
 electrical service with battery back-up, which when activated, must initiate an
 alarm which is audible in the sleeping rooms.

(8)

 Each assisted living community must have
 charged 5 lb. or more multipurpose ABC fire extinguishers available for use
 throughout the community as required by state or local fire codes, whichever is
 more stringent. These fire extinguishers shall be checked and tagged annually
 by a licensed fire extinguisher company to assure the extinguishers remain in
 operable condition.

(9)

 Each
 assisted living community must have a working doorbell or doorknocker which is
 audible to staff inside at all times.

(10)

 Exterior doors must be equipped with
 locks which do not require keys to open them from the inside.

(11)

 Entrances and exits, sidewalks, and
 escape routes must be maintained free of any hazards such as refuse, equipment,
 furniture, ice, snow, debris or any other impediments to ensure complete and
 immediate entry and exit in the case of fire or other emergency.

(12)

 The assisted living community must have
 its name and house number displayed so as to be easily visible from the
 street.

(13)

 The assisted living
 community must store and safeguard poisons, caustics, and other dangerous
 materials in safe areas and separate from food preparation and storage areas,
 and medication storage areas.

(14)

 Heated water must be made available by the assisted living community to the
 residents for their usage and must be comfortable to the touch but must not
 exceed 120 degrees Fahrenheit (F.).

(15)

 Where the assisted living community
 provides transportation to the residents, the assisted living community must
 maintain on the vehicle: basic emergency contact information on the residents
 being transported.

Rule 111-8-63-.14 Emergency Preparedness

(1)

 An assisted living community must comply
 with the requirements of Chapter 111-8-16, Rules and Regulations for Disaster
 Preparedness Plans.

(2)

 Building
 evacuation maps with routes of escape clearly marked must be posted
 conspicuously on each floor of the assisted living community. Assisted living
 communities must have a clearly accessible route for emergencies throughout the
 common areas of the assisted living community.

(3)

 The disaster preparedness plan must be
 readily accessible to staff, residents and their families at the assisted
 living community and identify the staff position(s) responsible for
 implementing the plan, obtaining necessary emergency medical attention or
 intervention for residents.

(4)

 The
 assisted living community must provide timely notification of the relocation
 address to the residents, their family contacts and representatives, if any,
 and the Department whenever the assisted living community must relocate the
 residents as a result of an emergency situation which disrupts the provision of
 room and board for the residents at the licensed location.

Rule 111-8-63-.15 Admission and Resident Retention

(1)

Resident Profile for
 Admission.
 The assisted living community must determine that the
 potential residentmustmeet all of the following criteria at the time of
 admission: 

(a)

 The resident must be an adult
 who is at least 18 years of age.

(b)

 The resident must not have active
 tuberculosis, or require continuous medical or nursing care and treatment or
 require physical or chemical restraints, isolation or confinement for
 behavioral control.

(c)

 The
 resident's physical condition must be such that the resident is capable of
 actively participating in transferring from place to place.

(d)

 The resident must be able to participate
 in the social and leisure activities provided in the assisted living
 community.

(2)

 Evaluation of Applicants for Admission.
 In determining whether the
 assisted living community will be able to meet the needs of the applicant for
 admission to the assisted living community, the administrator or on-site
 manager of an assisted living community must consider and maintain
 documentation of the following: 

(a)

 the
 information provided in an interview with the applicant and/or representative
 or legal surrogate, if any, regarding the applicant's care and social needs and
 behavioral issues that may require more watchful oversight;

(b)

 a physical examination conducted by a
 licensed physician, nurse practitioner or physician's assistant dated within 30
 days prior to the date of admission which reflects that the resident does not
 require continuous medical or nursing care and services and is free of active
 tuberculosis. The report of the physical examination must be completed on forms
 made available by the Department;

(c)

 either the results of an inquiry of the
 National Sex Offender Registry website coordinated by the Federal Bureau of
 Investigation or a fingerprint records check;

(d)

 where the applicant for admission is a
 registered sex offender or has committed another violent crime, the assisted
 living community must document the additional safety measures that the assisted
 living community will employ to ensure the safety of all residents, such as
 additional monitoring, room and roommate selection and in-servicing of staff;
 and

(e)

 whether the applicant for
 admission has retained the services of a designated proxy caregiver which
 complies with the requirements of the Rules and Regulations for Proxy
 Caregivers Used In Licensed Healthcare Facilities, Chapter 111-8-100.

(3)

Emergency
 Placement.
 Where the applicant for admission is being evaluated for
 admission pursuant to an emergency placement made at the request of the Adult
 Protective Services Section of the Division of Aging Services, Department of
 Human Services or another licensed facility that is requesting the placement
 pursuant to activation of its emergency preparedness plan for relocation of
 residents, the complete physical examination required by Rule
 
 may be deferred for up to 14 days after the emergency admission if no record of
 a qualifying physical examination or a copy of a current clinical record is
 available at the time of admission.

(4)

Community Admission
 Decisions.
 The assisted living community must not admit residents who
 either do not meet the admission profile or who meet the profile but whose care
 needs cannot be met by staff available to provide assistance. The assisted
 living community's decision to admit a resident must reflect that it has taken
 into account the condition of the resident to be admitted, the needs of
 currently admitted residents, the assistance with self-preservation current
 residents require, and the construction of the building including whether such
 building meets the state fire safety requirements applicable to an existing
 health care occupancy.

(5)

 Community Retention Decisions.
 The assisted living community must
 require a resident to move out when any one of the following occurs: 

(a)

 The resident requires continuous medical
 or nursing care.

(b)

 The resident's
 specific care needs cannot be met by available staff in the community, e.g.,
 the resident is not ambulatory and not capable of assisted
 self-preservation.

(c)

 The
 community is not able to evacuate all of the current residents to a point of
 safety within established fire safety standards.

(6)

Change in Condition Requiring
 Reevaluation.
 In the event a resident develops a significant change in
 physical or mental condition, the assisted living community must obtain medical
 information necessary to determine that the resident continues to meet the
 retention requirements and the assisted living community is capable of meeting
 the resident's needs. Where the Department has reason to believe either that
 the assisted living community cannot meet needs of the resident or the resident
 no longer meets the retention criteria for living in the licensed assisted
 living community, the governing body must provide to the Department, upon
 request, a current physical examination for the resident from a physician,
 advanced practice registered nurse or physician's assistant as properly
 authorized.

Rule 111-8-63-.16 Admission Agreements

(1)

 Contents of the Written Admission
 Agreement. The assisted living community must ensure that the admission
 agreement is written in plain and understandable language and is consistent
 with the information contained on the licensed residential care profile.

(a)

 The admission agreement must include a
 current statement of all fees and daily, weekly or monthly charges; the
 services covered by those basic fees and any other services which the assisted
 living community provides on an additional fee basis.

(b)

 The admission agreement must contain a
 statement that residents and their representatives or legal surrogates shall be
 informed, in writing, at least 30 days prior to any increase in established
 charges related to the provision of personal services and at least 60 days
 prior to any increase in charges for room and board.

(c)

 The admission agreement must contain
 provisions for the administrator or on-site manager's continuous assessment of
 the resident's needs, referral for appropriate services as may be required if
 the resident's condition changes and referral for transfer or discharge if
 required due to a change in the resident's condition.

(d)

 The admission agreement must contain a
 description of how the community responds to formal complaints received from
 residents and their representatives and how to file a complaint within the
 community.

(e)

 The admission
 agreement must contain provisions for transportation of residents for shopping,
 recreation, rehabilitation, medical services. Such transportation service may
 be provided by the assisted living community as either a basic service or on a
 reimbursement basis; with transportation for emergency use available at all
 times.

(f)

 The admission agreement
 must include the assisted living community's refund policy when a resident
 dies, is transferred or discharged.

(g)

 The admission agreement must include a
 statement that a resident may not be required to perform services for the
 assisted living community.

(h)

 The
 admission agreement must include a copy of the house rules, which must be in
 writing and also posted in the assisted living community and explain how
 violations of the house rules will be addressed by the community. House rules
 must be consistent with residents' rights. House rules must include, but not be
 limited to policies regarding the use of tobacco and alcohol, the times and
 frequency of use of the telephone, visitors elopement from the community, hours
 and volume for viewing and listening to television, radio and other audiovisual
 equipment, whether residents' personal pets or household pets are permitted and
 the use of personal property.

(i)

 The admission agreement must disclose how and by what level of staff
 medications are handled in the community. The agreement must also specify who
 is responsible for initial acquisition and refilling of prescribed medications
 utilizing unit or multidose packaging for the resident. Either this
 responsibility will remain with the resident, representative or legal
 surrogate, if any, or be assigned to the assisted living community operating
 through the administrator or on-site manager.

(j)

 The admission agreement must disclose
 whether the community permits the resident to employ independent proxy
 caregivers, sitters, etc. or requires the purchase of such services from
 approved providers.

(k)

 For
 residents first admitted after July 1, 2025, the admission agreement must
 include information on the medical alert system, if applicable, including a
 statement explaining that use of the system is optional for
 residents.

(2)

 The
 assisted living community must provide each resident, representative, legal
 surrogate with an opportunity to read the complete agreement prior to the
 execution of the admissions agreement. In the event that a resident,
 representative or legal surrogate is unable to read the agreement, the
 administrator or on-site manager must take steps to assure communication of the
 contents of the admission agreement to be signed.

(3)

 The assisted living community must
 provide the resident and representative or legal surrogate, if any, with a
 signed copy of the agreement. A copy signed by both parties (resident and
 administrator or on-site manager) must be retained in the resident's file and
 maintained by the administrator or on-site manager of the assisted living
 community.

(4)

 The assisted living
 community must not use a written admission agreement or any other written
 agreement signed by the resident or the resident's legal representative which
 waives or attempts to waive any of the resident's rights these rules
 protect.

Rule 111-8-63-.17 Services in the Community

(1)

 The assisted living community must
 provide assisted living, including protective care and watchful oversight,
 which meets the needs of the residents it admits and retains.

(2)

Resident Needs Assessment
.
 The assisted living community must complete an assessment of the resident that
 addresses the resident's care needs taking into account the resident's family
 supports, the resident's functional capacity relative to the activities of
 daily living, physical care needs, medical information provided, cognitive and
 behavioral impairments, if any, and personal preferences relative to care
 needs.

(3)

Written Care
 Plan
. Utilizing the information acquired during the admission process
 and the move-in adjustment period, the assisted living community must develop
 the resident's individual written care plan within 14 days of admission and
 require staff to use the care plan as a guide for the delivery of care and
 services to the resident. The care plan must include the following: 

(a)

 a description of the resident's care and
 social needs and the services to be provided, including frequency to address
 care and social needs;

(b)

 resident's particular preferences regarding care, activities and
 interests;

(c)

 specific behaviors
 to be addressed with interventions to be used;

(d)

 any physician order or order of a nurse
 practitioner or physician assistant working under protocol or job description,
 respectively for assistive devices;

(e)

 staff primarily responsible for
 implementing the care plan;

(f)

 evidence of family involvement in the development of the plan when appropriate;
 and

(g)

 evidence of the care plan
 being updated at least annually and more frequently where the needs of the
 resident change substantially or the resident is assigned to a memory care
 center.

(4)

Social
 Activities
. Each assisted living community must provide social
 activities on a daily basis that promote the physical, mental and social
 well-being of each resident and take into account the personal preferences of
 the residents.

(5)

Activity
 Resources
. The assisted living community must provide, books, current
 newspapers or magazines, and games for leisure time activities. The assisted
 living community must offer assistance to residents who wish to participate in
 hobbies, music, arts and crafts, religion, games, and sports, social,
 recreational and cultural activities available in the assisted living community
 and in the community.

(6)

Available Telephone
. The assisted living community must have at
 least one operable, non-pay telephone which is accessible at all times for
 emergency use by staff on the premises. Residents must also have access to an
 operable, non-pay telephone in a private location, both to make and receive
 personal calls. The same telephone may be used for staff and resident
 access.

(7)

 The assisted living
 community must not restrict a resident's free access to the common areas of the
 assisted living community or the memory care center or lock the resident into
 or out of the resident's bedroom.

(8)

Proxy Caregiver Services
.
 Where the assisted living community chooses to allow proxy caregivers to
 function in the community to perform certain health maintenance activities that
 are not covered in the basic assisted living care the community is required to
 provide, the assisted living community must do either of the following: 

(a)

 Provide employees who are available for
 designation by a resident to serve as proxy caregivers to perform certain
 health maintenance activities; or

(b)

 Permit the resident or a person legally
 authorized to act on behalf of the resident to employ designated proxy
 caregivers to provide health maintenance activities.

(9)

Proxy Caregiver Records
. The
 community must maintain documentation on all proxy caregivers performing health
 maintenance activities which complies with the Rules and Regulations for Proxy
 Caregivers, Chapter 111-8-100.

(10)

Prohibited Proxy Caregiver Services
. Where the assisted living
 community employs proxy caregivers, the community must not permit proxy
 caregivers to provide assistance with or administer medications.

(11)

 Medical, nursing (other than developing
 and updating care plans, training, medication administration and skills
 competency determinations) health services required on a periodic basis, or for
 short-term illness, must not be provided as services of the assisted living
 community. When such services are required, they shall be purchased by the
 resident or the resident's representative or legal surrogate, if any, from
 appropriately licensed providers which are managed independently and not owned
 or operated by the assisted living community. The assisted living community may
 assist in arrangement for such services, but not in the provision of those
 services.

Rule 111-8-63-.18 Precautions for Residents at Risk of Elopement

(1)

 An assisted living community which serves
 residents with cognitive deficits which place the residents at risk of eloping,
 i.e. engaging in unsafe wandering activities outside the assisted living
 community must do the following: 

(a)

 Develop,
 train and enforce policies and procedures for staff to deal with residents who
 may wander away from the assisted living community including what actions, are
 to be taken if a resident wanders away (elopes) from the assisted living
 community.

(b)

 Utilize appropriate
 effective safety devices, which do not impede the residents' rights to mobility
 and activity choice or violate fire safety standards, to protect the residents
 who are at risk of eloping from the premises. 

1.

 If the safety devices include magnetic
 locks used on exit doors, as approved by the fire marshal having jurisdiction
 over the assisted living community, then the locking device shall be electronic
 and release whenever the following occurs: activation of the fire alarm or
 sprinkler system, power failure to the assisted living community or by-pass for
 routine use by the public and staff for service using a key button/key pad
 located at the exit or continuous pressure for thirty (30) seconds or
 less.

2.

 If the safety devices
 include the use of keypads to lock and unlock exits, then directions for their
 operations shall be posted on the outside of the door to allow individuals'
 access to the unit. However, if the unit is a whole assisted living community,
 then directions for the operation of the locks need not be posted on the
 outside of the door. The units must not have entrance and exit doors that are
 closed with non-electronic keyed locks nor shall a door with a keyed lock be
 placed between a resident and the exit.

(2)

 An assisted living community serving
 residents who are at risk of eloping from the premises must retain on file at
 the assisted living community current pictures of any such residents.

Rule 111-8-63-.19 Additional Requirements for Certified Memory Care Centers

(1)

 In addition to all other requirements
 contained in this Chapter, where an assisted living community holds itself out
 as providing additional or specialized care to persons with probable diagnoses
 of Alzheimer's Disease or other dementia, or charges rates in excess of that
 charged other residents for the provision of additional or specialized care,
 the assisted living community must meet the following requirements: 

(a)

 Written Description. The assisted living
 community must include in its licensed residential care profile an accurate
 written description of the memory care center that includes the following: 

1.

 a statement of philosophy and
 mission;

2.

 how the services and
 activities of the memory care center are different from those provided in the
 rest of the assisted living community;

3.

 staffing including job titles of staff who
 work in the center, staff training and continuing education
 requirements;

4.

 admission
 procedures, including screening criteria;

5.

 assessment and service planning protocol,
 including criteria to be used that would trigger a reassessment of the
 resident's status before the customary quarterly review;

6.

 staffing patterns, including the ratio of
 direct care staff to resident for a 24-hour cycle, and a description of how the
 staffing pattern differs from that of the rest of the program;

7.

 a description of the physical environment
 including safety and security features;

8.

 a description of activities, including
 frequency and type, and how the activities meet the needs of residents with
 dementia,

9.

 the program's fee or
 fee structure for all services provided by the center or assisted living
 community;

10.

 the discharge
 criteria and procedures;

11.

 the
 procedures that will be utilized for handling emergency situations;
 and

12.

 the involvement of the
 center with families and family support programs.

(b)

 Physical Design, Environment, and Safety.
 The memory care center must be designed to accommodate residents with severe
 dementia or Alzheimer's Disease in an assisted living community-like
 environment which includes the following:

1.

 multipurpose room(s) for dining, group and individual activities which are
 appropriately furnished to accommodate the activities taking place;

2.

 secured outdoor spaces and walkways which
 are wheelchair accessible and allow residents to ambulate safely but prevent
 undetected egress;

3.

 high visual
 contrast between floors and walls and doorways and walls in resident use
 areas-except for fire exits, door and access ways which may be designed to
 minimize contrast to conceal areas where the residents should not
 enter;

4.

 adequate and even
 lighting which minimizes glare and shadows;

5.

 the free movement of the resident, as the
 resident chooses, between the common space and the resident's own personal
 space in a bedroom that accommodates no more than two (2) residents;

6.

 individually identified entrances to
 residents' rooms to assist residents in readily identifying their own personal
 spaces;

7.

 an effective automated
 device or system to alert staff to individuals entering or leaving the center
 in an unauthorized manner. An assisted living community need not use an
 automated alert for an exit door when the particular exit is always staffed by
 a receptionist or other staff member who views and maintains a log of
 individuals entering and leaving the assisted living community. If the exit
 door is not always staffed, then the assisted living community must activate an
 automated alert when the door is not attended;

8.

 communication system(s) which permit staff
 in the center to communicate with other staff outside the center and with
 emergency services personnel as needed; and

9.

 a center providing specialized memory care
 services which undergoes major renovation or is first constructed after
 December 9, 2009, must be designed and constructed in compliance with
 applicable state and local building and fire codes relevant to the center and
 the assisted living community.

(c)

 Staffing Requirements. The assisted
 living community must ensure that the memory care center is staffed with
 sufficient specially trained staff to meet the unique needs of the residents in
 the center. At a minimum, the memory care center must provide the following
 staffing:

(i)

 One dementia trained direct care
 staff person for every 12 residents on-site during all waking hours and for
 every 15 residents on-site during all non-waking hours based on a monthly
 average; provided, however, that such ratio is adequate to meet the needs of
 the residents;

(ii)

 One registered
 professional nurse, licensed practical nurse, or certified medication aide
 on-site or available in the building at all times;

(iii)

 Two direct care staff persons on-site
 at all times, which may include one licensed registered professional nurse,
 licensed practical nurse, or certified medication aide, if they remain on-site
 in the memory care center; and

(iv)

 One registered professional nurse or licensed practical nurse on-site or
 available in the building at all times as follows: 

(A)

 For memory care centers with one to 12
 residents, a minimum of 8 hours per week;

(B)

 For memory care centers with 13 to 30
 residents, a minimum of 16 hours per week;

(C)

 For memory care centers with 31 to 40
 residents, a minimum of 24 hours per week; or

(D)

 For memory care centers with more than 40
 residents, a minimum of 40 hours per week.

(d)

 Staff Training Requirements. The
 community shall ensure that all staff are properly trained initially and on an
 annual basis to provide safe, quality care to residents in the memory care
 center. The memory care center shall meet the following training requirements: 

(i)

 General Orientation. All staff,
 regardless of role, shall receive at least four (4) hours of dementia-specific
 orientation within the first thirty (30) days of working in the center. Such
 orientation shall include:

(A)

 Basic
 information about the nature, progression, and management of Alzheimer's and
 other dementias;

(B)

 Techniques for
 creating an environment that minimizes challenging behavior from residents with
 Alzheimer's and other dementias;

(C)

 Methods of identifying and minimizing
 safety risks to residents with Alzheimer's and other dementias; and

(D)

 Techniques for successful communication
 with individuals with Alzheimer's and other dementias.

(ii)

 Direct Care Orientation. All direct care
 staff shall receive initial orientation training within the first thirty (30)
 days of caring for residents independently that, at a minimum, includes: 

(A)

 General training, to include: 

(I)

 Development, updating, and implementation
 of comprehensive and individual service plans;

(II)

 Skills for recognizing physical or
 cognitive changes in the resident that warrant seeking medical
 attention;

(III)

 Residents' rights
 and identification of conduct constituting abuse, neglect, or
 exploitation;

(IV)

 General
 infection control principles;

(V)

 Emergency preparedness training;

(VI)

 Emergency first aid;

(VII)

 Cardiopulmonary
 resuscitation.

(B)

 A
 minimum of sixteen (16) hours of specialized, competency-based training using
 forms specified by the department, to include, at a minimum: 

(I)

 The nature of Alzheimer's and other
 dementias;

(II)

 The center's
 philosophy related to the care of residents with Alzheimer's and other
 dementias;

(III)

 The center's
 policies and procedures related to care of residents with Alzheimer's and other
 dementias;

(IV)

 Common behavior
 problems characteristic of residents with Alzheimer's and other
 dementias;

(V)

 Positive therapeutic
 interventions and activities;

(VI)

 Skills for maintaining the safety of the resident; and

(VII)

 The role of the family in caring for
 residents with Alzheimer's and other dementias.

(C)

 Staff members who have passed a memory
 care specialist competency exam established by the department, as documented by
 the home, may satisfy the training requirements of Rule
 
 by completing a minimum of four (4) hours of training on the topics specified
 in Rule .

(iii)

 Ongoing Training. Direct care staff
 shall complete a minimum of eight (8) hours of specialized training in dementia
 care on an annual basis.

(iv)

 Training Documentation. The memory care center shall maintain documentation
 reflecting course content, instructor qualifications, agenda, and attendance
 rosters for all training sessions provided.

(e)

 Special Admission Requirements for Memory
 Center Placement. Residents must have a physician's report of physical
 examination completed within 30 days prior to admission to the center on forms
 made available by Department. The physical examination must clearly reflect
 that the resident has a diagnosis of probable Alzheimer's Disease or other
 dementia and has symptoms which demonstrate a need for placement in the center.
 However, the center may also care for a resident who does not have a probable
 diagnosis of Alzheimer's Disease or other dementia, but desires to live in this
 center and waives his or her right to live in a less restrictive environment.
 In addition, the physical examination report must establish that the potential
 resident of the center does not require 24-hour skilled nursing care.

(f)

 Post-Admission Assessment. If the
 resident is admitted directly into the specialized memory care center, the
 center must obtain an assessment of each resident's care needs to include the
 following components: resident's family supports, level of activities of daily
 living functioning, physical care needs and level of behavior
 impairment.

(g)

 Individual Written
 Care Plan and Reviews. The resident's written care plan will be developed or
 updated by staff with at least one member of the specialized memory care staff
 providing direct care participating. Input from each shift of direct care staff
 that provides care to the resident will be requested. All team members
 participating shall sign the written care plan and the plan will be shared with
 the direct care staff providing care to the resident and serve as a guide for
 the delivery of care to the resident. The resident's family shall participate
 in the development of the plan, if possible, with incorporation of family and
 personal history to support a person-centered approach to care. The written
 care plan must be reviewed at least quarterly and modified as changes in the
 resident's needs occur.

(h)

 Therapeutic Activities. The unit shall provide activities appropriate to the
 needs of the individual residents and adapt the activities, as necessary, to
 encourage participation of the residents in the following at least weekly with
 at least some therapeutic activities occurring daily: 

1.

 gross motor activities; e.g. exercise,
 dancing, gardening, cooking, etc;

2.

 self-care activities; e.g. dressing,
 personal hygiene/grooming;

3.

 social activities; e.g. games, music;

4.

 sensory enhancement activities, e.g.
 distinguishing pictures and picture books, reminiscing and scent and tactile
 stimulation; and

5.

 outdoor
 activities; e.g. walking outdoors and field trips.

(2)

 No licensed assisted living
 community is permitted to hold itself out as providing specialized care for
 residents with probable Alzheimer's disease or other dementia or charge a
 differential rate for care of such residents unless it meets the additional
 requirements specified in Rule
 
 and its subparagraphs (a) through (h) above.

Rule 111-8-63-.20 Medications

(1)

Self-Administration of Medications.
 Residents who have the
 cognitive and functional capacities to engage in the self-administration of
 medications safely and independently without staff assistance or supervision
 must be allowed to store their own medications securely and self-administer
 medications if they so desire.

(2)

Assistance with Self-Administration.
 An assisted living community
 must provide assistance with or supervision of self-administered medications to
 those residents who have the cognitive capacity to engage in the
 self-administration of medications, but require or request staff assistance
 with or supervision of the self-administration of medications for safety or
 convenience. 

(a)

 Such staff assistance with
 or supervision of self-administered medications may only be provided for unit
 or multi-dose packaged medications prescribed for the particular resident and
 may include only the following tasks:

1.

 taking the medication, in its previously dispensed, properly labeled container,
 from where it is stored, and bringing the medication to the resident;

2.

 reading the label, opening the container,
 removing a prescribed amount of medication from the container, and closing the
 container, in the presence of the resident;

3.

 placing an oral dosage in the resident's
 hand or placing the dosage in another container where the resident requests
 assistance;

4.

 applying topical
 medications;

5.

 returning the
 medication container to proper secured storage; and

6.

 assisting the resident's use of an EPI pen
 where the resident has known severe allergies for which an EPI pen has been
 prescribed on condition that there is an established written protocol detailing
 how it is to be used and when. The protocol must include immediately calling
 Emergency Services, 911, after any use of the EPI pen.

(b)

 Staff assisting with or supervising
 self-administration of medications must be proficient in English and able to
 read, write and follow written instructions in English.

(3)

Community Administration of
 Medications.
 Where the residents either are not capable of
 self-administration of medications or choose not to self-administer medications
 with assistance or supervision, the assisted living community must provide
 medication administration services to the residents in accordance with
 physicians' orders, the needs of the residents and these rules.

(4)

Specialized Staffing for Medication
 Administration.
 The assisted living community offering medication
 administration services must employ certified medication aides, at a minimum,
 to administer medications.

(5)

Certified Medication Aide Requirements.
 An assisted living
 community using certified medication aides to administer specific medications
 must do all of the following:

(a)

Check
 the Registry.
 Ensure that the medication aides employed in the community
 are listed in good standing on the Georgia Certified Medication Aide Registry
 and have no record of being terminated for cause relating to the performance of
 medication aide tasks before permitting the aides to administer
 medications.

(b)

Administer
 Skills Competency Checks.
 Determine and document that the medication
 aides who have been certified for more than one year upon hiring, continue to
 have the knowledge and skills necessary to administer medications properly for
 the particular community. The community must use a skills competency checklist
 which meets the requirements contained in the standardized clinical skills
 competency checklist used to certify medication aides.

(c)

Quarterly Observations.
 Use
 a licensed registered professional nurse or a pharmacist to conduct quarterly
 random medication administration observations to determine that the aides are
 administering medications correctly and in compliance with these rules and
 report any issues to the assisted living community administration for
 resolution.

(d)

Quarterly
 Drug Regimen Reviews.
 Secure the services of a licensed pharmacist to
 perform all of the following duties:

1.

 Conduct quarterly reviews of the drug regimen for each resident of the assisted
 living community and report any irregularities to the assisted living community
 administration.

2.

 Remove for
 proper disposal any drugs that are expired, discontinued or in a deteriorated
 condition or where the resident for whom such drugs were ordered is no longer a
 resident.

3.

 Establish or review
 policies and procedures for safe and effective drug therapy, distribution, use
 and control.

4.

 Monitor compliance
 with established policies and procedures for medication handling and
 storage.

(e)

Authorized Tasks for Certified Medication Aides.
 An assisted
 living community may allow a certified medication aide to do only the following
 tasks related the administration of medications utilizing only unit or
 multidose packaging of medications:

1.

 Administer physician ordered oral, via a feeding tube, ophthalmic, topical,
 otic, nasal, vaginal and rectal medications.

2.

 Administer insulin, epinephrine, and B12
 pursuant to physician direction and protocol.

3.

 Administer medications via a metered dose
 inhaler.

4.

 Conduct finger stick
 blood glucose testing following established protocol.

5.

 Administer a commercially prepared
 disposable enema ordered by a physician.

6.

 Assist residents in the supervision of
 self-administration of medications.

7.

 Administer liquid morphine to a resident
 of the community who is the patient of a licensed hospice, pursuant to a
 hospice physician's written order that contains specific instructions for
 indication, dosage, frequency and route of administration.

(f)

Annual Competency Reviews.

 Complete comprehensive clinical skills competency reviews for each certified
 medication aide utilizing the skills competency checklist at least, annually
 after hiring to determine that the aides continue to have the necessary skills
 to perform the medication tasks assigned competently. Such skills competency
 checklists must be administered by Georgia-licensed registered nurses,
 pharmacists or physicians, who indicate in writing that the tasks observed are
 being performed competently.

(g)

Proper Notice of Separation for Cause.
 Ensure that where a
 medication aide is terminated for cause relating to the performance of
 medication aide tasks, the aide is provided with the following: 

1.

 a separation notice that clearly describes
 the facts that support the termination for cause;

2.

 written notice that being terminated for
 cause related to the administration of medications, if not successfully
 appealed through a hearing on right to unemployment benefits will result in the
 loss of good standing on the Georgia Certified Medication Aide Registry;
 and

3.

 the loss of good standing on
 the Certified Medication Aide Registry will make the aide ineligible for hiring
 as a certified medication aide by another assisted living community.

(h)

Registry
 Notification.
 Submit to the Georgia Certified Medication Aide Registry a
 copy of the Separation Notice for the certified medication aide only if the
 separation related specifically to the performance of medication aide tasks and
 the termination for cause has either been finally upheld by the Department of
 Labor or the time for appealing the Separation Notice has expired.

(6)

Communities Conducting
 Certified Medication Aide Training.
 A community choosing to provide a
 certified medication aide training program must do all of the following: 

(a)

 Utilize the state-approved medication
 aide training program ensuring that the training is administered by a
 Georgia-licensed registered nurse, pharmacist, or physician.

(b)

 Require the aide to demonstrate the
 requisite clinical skills to serve as a medication aide before a
 Georgia-licensed registered nurse, pharmacist or physician utilizing the
 standardized medication administration checklist developed by the
 Department.

(c)

 Prepare the aide to
 take the written competency examination to become a certified medication
 aide.

(d)

 Verify that the aide is
 in good standing on the Georgia certified nurse aide registry.

(e)

 Provide information to the aide on the
 registration and locations for taking the written competency
 examination.

(f)

 Provide the
 documentation to the Georgia Certified Medication Aide Registry that is
 necessary to complete the application for placement of the aide's name on the
 Georgia Certified Medication Aide Registry.

(g)

 Not permit the aide to administer
 medications independently unless the aide is listed on the Georgia certified
 medication aide registry in good standing.

(7)

Basic Medication Training for Staff
 Assisting with Self-Administration.
 The assisted living community must
 provide and document medication training for the unlicensed staff who are not
 certified medication aides but who are providing assistance with or supervision
 of self-administration of medications to capable residents. The medication
 training must be conducted with an appropriate curriculum for providing
 medication assistance and include at least the following topics: 

(a)

 the assisted living community's
 medication policy and procedures, including actions to take if concerns
 regarding resident's capacity to self-administer medications are
 identified;

(b)

 how to read
 prescription labels including common abbreviations;

(c)

 providing the right medication to the
 right resident at the right time in the right amount and the right way
 including how to measure various medications;

(d)

 actions to take when concerns regarding
 medications are identified;

(e)

 infection control procedures relative to providing assistance with
 medications;

(f)

 proper medication
 storage and disposal;

(g)

 recognition of side effects and adverse reactions for the specific
 medications;

(h)

 understanding the
 common classifications of medications, typical side effects and adverse
 reactions and medications for which unlicensed staff may never provide
 assistance with or supervision of self-administration; and

(i)

 proper documentation and record keeping
 using the Medication Assistance Record.

(8)

Medication Skills Competency
 Determinations.
 Unlicensed staff who are not certified as medication
 aides providing assistance with or supervision of self-administered medications
 must demonstrate when hired and at least, annually thereafter, the necessary
 skills to perform the medication tasks assigned competently by completing
 skills competency checklists before appropriately trained community
 staff.

(9)

Maintaining
 Records on Medication Assistance and Administration.
 Where the assisted
 living community either provides assistance with, or supervision of
 self-administered medications or administers medications to residents, the
 community must maintain a daily Medication Assistance Record (MAR) for each
 resident who receives assistance or administration. The MAR must include the
 name of the specific resident, any known allergies, the name and telephone
 number of the resident's health care provider, the name, strength and specific
 directions including key side effects and adverse reactions for use of each
 medication and a chart for staff who provide assistance or administration to
 record initials, time and date when medications are taken, refused or a
 medication error is identified (e.g. missed dosage). The staff providing the
 assistance or administration of medications must update the MAR each time the
 medication is offered or taken.

(a)

 The
 assisted living community must make medication information concerning the
 descriptions of medication, dosing, side effects, adverse reactions and
 contraindications for each medication being administered to the residents
 immediately available for reference by staff providing medication assistance or
 administration.

(b)

 Staff of the
 assisted living community providing assistance with or administration of
 medications must document in the resident's record any unusual reactions to the
 medications and provide such information to the resident, the resident's
 representative and the health care provider as appropriate.

(c)

 For any administration of liquid morphine
 by a certified medication aide, staff shall observe and document the following
 in the resident's record: 

1.

 the resident's
 need for PRN liquid morphine, including but not limited to verbalizations of
 pain, groaning, grimacing or restlessness;

2.

 the date, time and location of the initial
 dose administered by a licensed hospice health care professional;

3.

 the dosage, time and route of
 administration for the morphine administered in the community;

4.

 the training provided by the licensed
 hospice; and

5.

 information
 regarding the special circumstances under which the hospice was unavailable to
 administer the medication.

(10)

Orders Required for All
 Medications.
 An assisted living community must not allow its staff to
 assist with, provide supervision of self-administered medications or administer
 any medications, including over-the-counter medications, unless there is a
 physician's order specifying clear instructions for its use on file for the
 resident.

(11)

Timely
 Management of Medication Procurement.
 Where the assisted living
 community procures medications on behalf of the residents, the community must
 obtain new prescriptions within 48 hours of receipt of notice of the
 prescription or sooner if the prescribing physician indicates that a medication
 change must be made immediately. If the pharmacy does not have the medication
 needed for the immediate change, available and has not obtained further
 directions from the physician, the community must notify the physician of the
 unavailability of the prescription and request direction. Refills of prescribed
 medications must be obtained timely so that there is no interruption in the
 routine dosing. Where the assisted living community is provided with a new
 medication for the resident, the MAR must be modified to reflect the addition
 of the new medication within 48 hours or sooner if the prescribing physician
 indicates that the medication change must be made immediately.

(12)

Storage and Disposal of
 Medications.
 Medications must be stored securely and inventoried
 appropriately to prevent loss and unauthorized use. Medications must be stored
 under lock and key at all times whether kept by a resident or kept by the
 assisted living community for the resident, unless the medication is required
 to be kept by the resident on his or her person or staff member in close
 attendance due to the need for physician-prescribed frequent or emergency use.
 Additionally, for controlled substances, the secure storage must be a locked
 cabinet or box of substantial construction and a log must be maintained and
 updated daily by the community to account for all inventory. 

(a)

 Duplicate keys for all medication storage
 containers must be available on site for appropriate use.

(b)

 Medications must be kept in original
 containers with original labels intact.

(c)

 Medications must be properly labeled in
 separate unit or multi-unit dose packaging and handled in accordance with
 physician's instructions, and laws and regulations applicable to the
 medications.

(d)

 The assisted
 living community must ensure that it properly disposes of unused medications
 using the current U.S. Food and Drug Administration or U.S. Environmental
 Protection Agency guidelines for the specific medications.

(e)

 The supply of liquid morphine on site
 shall be limited to 50 ml for each hospice patient in the community for which
 there is a physician's order for such medication.

Rule 111-8-63-.21 Nutrition and Food Preparation

(1)

 Regularly Scheduled Meals.

 The assisted living community must provide a minimum of three regularly
 scheduled well-balanced meals per day seven days a week which meet the
 nutritional needs of residents, and must provide therapeutic diets as ordered
 by the residents' healthcare providers for residents that require special
 diets. There must be no more than fourteen hours elapsing between the scheduled
 evening and morning meals.

(2)

Nutritious Meals.
 Meals must meet the general requirements for
 nutrition adjusted for age, sex and activity, currently found in the
 Recommended Daily Diet Allowances, Food and Nutrition Board, National Academy
 of Sciences.

(3)

Snacks.
 Food for at least one nutritious snack must be available
 and offered each day in addition to the regularly scheduled meals. Snacks are
 not considered to be meals for the purposes of calculating the time between
 meals.

(4)

Wholesome
 Food.
 Food received or used in an assisted living community must be
 clean, wholesome, free from spoilage, adulteration, and misbranding, and safe
 for human consumption.

(5)

Proper Handling of Food.
 All foods while being stored, prepared
 and served must be protected from spoilage and contamination and be safe for
 human consumption. At a minimum to protect from spoilage and contamination, the
 assisted living community must do all of the following: 

(a)

 Store perishable foods, such as but not
 limited to meat, fish, eggs, dairy products, juices at temperatures that will
 minimize spoilage, i.e. at or below 41 degrees F.

(b)

 Thaw frozen foods properly, i.e. in the
 refrigerator or under cold running water with an unplugged sink.

(c)

 Provide hot and cold running water and
 sanitizing agents and ensure that they are used appropriately in the kitchen to
 clean and sanitize food, hands and utensils as required for safe food
 preparation.

(d)

 Prevent
 cross-contamination of foods via hands, cutting boards or utensils during
 preparation.

(e)

 Ensure that hot
 foods leave the kitchen (pot, steam table, etc.) for serving at or above 140
 degrees F. and that cold foods leave the kitchen for serving at or below 41
 degrees F.

(6)

Duties of Food Service Manager.
 The person designated by the
 assisted living community as being responsible for managing the preparation of
 meals for the residents must enforce safe food handling practices which address
 basic food safety, hygiene, cross contamination, time and temperature
 requirements and sanitation with staff and residents.

(7)

 Emergency Food Supply.
 A
 3-day supply of non-perishable dry or canned foods and water, must be on hand
 at all times in the assisted living community for emergency use. The quantity
 of food required to be stored must be based on the usual resident census. The
 food must be kept in sealed containers which are labeled and dated. The food
 must be rotated in accordance with shelf life to ensure safety and
 palatability. Water sufficient for drinking and food preparation must also be
 stored.

(8)

Properly
 Furnished Food Areas.
 Kitchen and dining areas must be properly equipped
 with appropriate cabinets, drawers, holders and shelves or racks for storage of
 necessary equipment and utensils. These rooms must be kept clean and
 disinfected at least daily unless more frequent sanitization is required to
 prevent the spread of infection or food borne illnesses.

(9)

Food Service Permit Required.
 
An assisted living community must either possess a valid food service
 permit issued through the authority of the Department of Public Health pursuant
 to Chapter 290-5-14 or a copy of the valid food service permit of the caterer'
 who provides meals to the community.

(10)

Menu Requirements.
 Menus to
 be served in assisted living residences must be dated and planned at least one
 week in advance for both regular and therapeutic diets. Residents must be
 encouraged to participate in menu planning. Planned menus must be conspicuously
 posted or easily available to residents. Regular and therapeutic menus as
 served, with substitutions noted before the meal is served, must be kept on
 file in the assisted living community for 30 days.

(11)

Food Safety Reports
. The
 assisted living community must retain copies of food safety inspection reports
 required by law which were issued during the year preceding the most recent
 inspection. The most recent food service inspection report must be posted in
 the assisted living community.

(12)

Catered Food Service.
 When the assisted living community uses a
 catered food service (food service establishment), the assisted living
 community must ensure that the service is properly licensed, provides meals in
 accordance with these rules, has a satisfactory record of compliance with food
 safety requirements and properly transports and stores food at time of delivery
 to maintain food safety.

(13)

Catering Records.
 An assisted living community utilizing a catered
 food service must maintain copies of the current contract between the assisted
 living community and the food service establishment agreeing to provide food
 service in the assisted living community, the certificate or license
 authorizing the operation of the food service establishment issued by the
 county health agency and the most recent food safety inspection
 reports.

Rule 111-8-63-.22 Temperature Control

(1)

 The temperature throughout the assisted
 living community must be maintained by an adequate central heating and cooling
 system or its equivalent at ranges which are consistent with individual health
 needs of residents and provides a comfortable environment for the
 residents.

(2)

 Temperatures in the
 assisted living community must not fall below 62 degrees F during sleeping
 hours or above 85 degrees F during the day. Mechanical cooling devices shall be
 made available for use in those areas of the building used by residents when
 inside temperatures exceed 80 degrees F.

(3)

 Where a power outage or mechanical
 failure impacting the ability of the assisted living community to maintain
 these temperature ranges occurs, the assisted living community must take
 immediate action to provide for the health and safety of the residents,
 including but not limited to, arranging immediately for a service call,
 providing additional blankets or fans or utilizing an emergency power generator
 in accordance with the assisted living community's emergency preparedness
 plan.

Rule 111-8-63-.23 Infection Control, Sanitation and Supplies

(1)

 The assisted living community must have
 an effective infection control program which includes, at a minimum, the
 following: 

(a)

 training provided to staff on
 effective measures for minimizing the spread of infections and food borne
 illnesses;

(b)

 responding to
 disease outbreaks appropriately and participating in infection control
 investigations;

(c)

 staff
 demonstrating their understanding and use of proper infection control practices
 in their delivery of care to the residents;

(d)

 enforcing work and return to work
 policies to minimize the spread of infection and illnesses; and

(e)

 implementing the additional infection
 control requirements set forth in the Rules and Regulations for Disaster
 Preparedness Plans, Chapter 111-8-16, regarding pandemic plans, supplies and
 policies and procedures.

(2)

 The assisted living community must have
 an adequate supply of sanitizing and cleaning agents, e.g.. effective hand
 hygiene products, hand soap, laundry soap, household disinfectants and other
 cleaning materials, available and used in the assisted living community to
 minimize the spread of infections.

(3)

 Toilet tissue, soap, hot and cold running
 water and clean towels must be available for use wherever commodes are
 located.

(4)

 The assisted living
 community must have a supply of first-aid materials available for use. This
 supply must include, at a minimum, gloves, band aids, thermometer, tape, gauze,
 and an antiseptic.

(5)

 The storage
 and disposal of bio-medical and hazardous wastes must comply with applicable
 federal, state, and local rules and/or standards.

(6)

 Solid waste which is not disposed of by
 mechanical means must be stored in vermin-proof, leak-proof, nonabsorbent
 containers with close-fitting covers until removed. Waste must be removed from
 the kitchen at least daily and from the premises at least weekly.

(7)

 An insect, rodent or pest control program
 must be maintained and conducted in a manner which continually protects the
 health of residents.

(8)

 Residents'
 private living spaces or bedrooms must be thoroughly cleaned and sanitized
 after residents move out of the rooms.

(9)

 The assisted living community must clean
 the residents' private living spaces periodically and as needed to ensure that
 the space does not pose a health hazard.

(10)

 The assisted living community must
 notify residents of infectious disease outbreaks or incidents as specified in
 the Rules and Regulations for Disaster Preparedness Plans, Chapter
 111-8-16.

Rule 111-8-63-.24 Residents' Files

(1)

 An individual resident file must be
 maintained by the administrator or on-site manager for each resident in the
 assisted living community. Personal information must be treated as confidential
 and must not be disclosed except to the resident and his or her representative
 or legal surrogate, if any, an authorized agent of the Department, and others
 to whom written authorization is given by the resident or his representative or
 legal surrogate, if any. The resident file must be made available for
 inspection and/or copying to the resident or the resident's representative or
 legal surrogate, if any, and Department representatives, upon
 request.

(2)

 Each resident's file
 must include the following information: 

(a)

 identifying information including name, social security number, veteran status,
 age, sex and previous address;

(b)

 name, address and telephone number of next of kin, legal guardian and/ or
 representative or legal surrogate, if any, or representative payee and any
 court order or written document designating the resident's representative or
 legal surrogate, if any;

(c)

 name,
 address and telephone number of any person or agency providing additional
 services to the resident. This information must include the name of the agency
 personnel primarily responsible where provided to the community by the person
 or agency, (i.e., the caseworker, case manager, or therapist);

(d)

 an admission and discharge log to include
 the date of admission, prior residence of resident, referral source, agency
 contact and telephone number of referral source date of discharge, facility or
 residence discharged to and telephone number;

(e)

 all individual written care plans
 required by the serules and the rules for proxy caregivers, Chapter 111-8-100
 if applicable;

(f)

 the name,
 address and telephone number of a physician, hospital and pharmacy of the
 resident's choice;

(g)

 a record of
 all monetary transactions conducted on behalf of the resident with itemized
 receipts of all disbursements and deposits;

(h)

 a record of all monies and other valuable
 sentrusted to the assisted living community for safe keeping; a receipt for
 same shall be provided to the resident or representative or legal surrogate, if
 any, at the time of admission and at any time there after when the resident
 acquires additional property and wishes to entrust such property to the
 assisted living community for safe keeping;

(i)

 health information including all health
 appraisals, diagnoses, prescribed diets, medications, and physician's
 instructions;

(j)

 an inventory of
 valuable personal items brought to the assisted living community for use by the
 resident to be updated at anytime after admission if a resident or
 representative or legal surrogate, if any, submits to the assisted living
 community a new inventory of the resident's personal items;

(k)

 a signed copy of the Resident's Rights
 form;

(l)

 a signed copy of the
 admission agreement;

(m)

 any power
 of attorney or document issued by a court or by the Social Security
 Administration or any other governmental authority which designates another
 person as responsible for management of the resident's finances;

(n)

 a copy of a living will and/or durable
 power of attorney for healthcare if executed prior to 2007 or a copy of an
 executed Georgia advance directive for healthcare, if any, the forms for which
 must be made available at the time of admission and remain available to the
 resident upon request;

(o)

 any
 signed medical or ders impacting end of life care, e.g. do not resuscitate,
 physician's orders for life sustaining treatment, etc.

(p)

 a copy of the resident's written waiver,
 if any, of the personal needs allowance charge pursuant to the provisions of
 Rule ;

(q)

 a copy of any findings from a search of
 the National Sex Offender Registry maintained through the Department of
 Justice, etc.; and

(r)

 any informed
 written consents signed by the resident or resident's representative,
 designating and delegating to any trained proxy caregiver, whether employed by
 the assisted living community or not, the performance of identified health
 maintenance activities.

(s)

 evidence the resident has received educational information on influenza disease
 no later than September 1 of each year. Such information shall include, but is
 not limited to, the risks associated with influenza disease; the availability,
 effectiveness, and known contraindications of the influenza immunization;
 causes and symptoms of influenza; and the means in which it is spread.
 Provision of the appropriate and current Vaccine Information Statement as
 provided by the Centers for Disease Control and Prevention shall be deemed to
 comply with this regulation.

(3)

 The following information may be given
 voluntarily by the resident, guardian, or representative or legal surrogate, if
 any, but may not be required of the resident: 

(a)

 religious preference, church membership,
 name and telephone number of minister, priest or rabbi, if applicable;
 and

(b)

 information about insurance
 policies and prearranged funeral and burial provisions, if any.

(4)

 Resident files must be
 maintained by the assisted living community for a period of three years after a
 resident's discharge.

Rule 111-8-63-.25 Supporting Residents Rights and Obtaining Feedback

(1)

 The assisted living community must
 operate in a manner that respects the personal dignity of the residents and the
 human rights of the residents which rights cannot be waived, except as provided
 in these rules by the resident or the resident's representative or legal
 surrogate. 

(a)

 The assisted living community
 must provide to each resident care and services which are adequate,
 appropriate, and in compliance with state law and regulations.

(b)

 The assisted living community, its agents
 or employees must not punish or harass a resident because of the resident's
 efforts to enforce his or her rights.

(c)

 The assisted living community must
 operate in a manner that protects each resident's rights to do all of the
 following: 

1.

 exercise the constitutional
 rights guaranteed to citizens of this state and this country including, but not
 limited to, the right to vote;

2.

 choose activities and schedules consistent with the resident's interests, and
 assessments;

3.

 interact with
 members of the community both inside and outside the assisted living community
 and to participate fully in the life of the community; and

4.

 make choices about aspects of his or her
 life in the assisted living community that are significant to the
 resident.

(d)

 Each
 resident must have the right to enjoy privacy in his or her room. Assisted
 living community staff and others must respect this right by knocking on the
 door before entering the resident's room.

(e)

 Each resident must have the right to
 associate and communicate freely and privately with persons and groups of the
 resident's choice without being censored by staff.

(f)

 If a resident is married and the spouse
 is also a resident in the assisted living community, the residents must be
 permitted to share a room unless they request otherwise, subject to the
 limitation that no more than two residents may share a bedroom or private
 living space.

(g)

 Each resident
 must be treated with dignity, kindness, consideration and respect and be given
 privacy in the provision of assisted living care. Each resident must be
 accorded privacy and freedom to use the bathroom(s) at all hours.

(h)

 No religious belief or practice must be
 imposed upon any resident. Residents must be free to practice their religious
 beliefs as they choose. Each resident must have the right to participate in
 social, religious, and community activities that do not interfere with the
 rights of other residents.

(i)

 Each
 resident must have the right to be free from mental, verbal, sexual and
 physical abuse, neglect and exploitation.

(j)

 Each resident has the right to be free
 from actual or threatened physical or chemical restraints and the right to be
 free from isolation, corporal, or unusual punishment including interference
 with the daily functions of living, such as eating or sleeping.

(k)

 Each resident must have the right to use,
 keep and control his or her own personal property and possessions in the
 immediate living quarters, except to the extent a resident's use of his or her
 property would interfere with the safety or health of other residents. Each
 resident must have the right to reasonable safeguards for the protection and
 security of his personal property and possessions brought into the assisted
 living community.

(l)

 Each
 resident's mail must be delivered unopened to the resident on the day it is
 delivered to the assisted living community. The assisted living community must
 not permit any resident's outgoing correspondence to be opened or tampered with
 prior to being mailed or otherwise delivered.

(m)

 Each resident must have access to a
 telephone made available by the assisted living community and the right to have
 a private telephone, at the resident's own expense. Telephones must be placed
 in areas to insure privacy without denying accessibility.

(n)

 Each assisted living community must
 permit immediate access to residents by others who are visiting with the
 consent of the resident. Residents have the right to have visitors at mutually
 agreed upon hours. Once the hours are agreed upon, no prior notice is
 necessary. Each resident also has the right to refuse to see visitors or
 terminate any visit.

(o)

 Each
 resident must have the right to manage his own financial affairs, including the
 right to keep and spend his own money unless that resident has been adjudicated
 incompetent by a court of competent jurisdiction. Each resident must have the
 right to be free from coercion to assign or transfer to the assisted living
 community money, valuables, benefits, property or anything of value other than
 payment for services rendered by the assisted living community.

(p)

 Each resident must have the right to a
 personal needs allowance for the free use of the resident in the amount of
 twenty dollars per week to be distributed by the administrator, on-site
 manager, or a responsible staff person in the assisted living community. The
 following conditions must be met regarding the personal needs allowance: 

1.

 The personal needs allowance must be
 included as a charge for services to each resident's account which a resident
 or a resident's representative or legal surrogate, if any, may waive by signing
 a written waiver upon admission or anytime thereafter. No allowance charge may
 be assessed where a resident or a resident's representative or legal surrogate,
 if any, has signed a written waiver of the personal needs allowance. Such a
 waiver must be kept in a resident's file.

2.

 Where no waiver has been signed, the
 personal needs allowance must be tendered to each resident, in cash, on the
 same day each week.

3.

 The personal
 needs allowance must not be intended or needed for purchasing necessary goods
 such as toilet paper and light bulbs which the assisted living community
 ordinarily supplies, and shall in no way relieve the assisted living community
 of the obligation to insure that such necessary goods are available to the
 resident.

(q)

 Each
 resident must have the right to receive or reject medical care, dental care, or
 other services by those authorized and/or licensed to provide such medical care
 except as required by law or regulations. 

(r)

 Each resident must have the right to
 choose and retain the services of a personal physician and any other health
 care professional or service. No assisted living community is permitted to
 interfere with the resident's right to receive from the resident's attending
 physician complete and current information concerning the resident's diagnosis,
 treatment and prognosis. Each resident and his or her representative or legal
 surrogate, if any, must have the right to be fully informed about care provided
 in the community and of any changes in that care and the right of access to all
 information in medical records retained by the community.

(s)

 Each resident must have the right to
 fully participate in the planning of his or her care and to question the need
 for changes in the plan of care. Case discussion, consultation and examination
 must be confidential and conducted discreetly. A person who is not directly
 involved in the resident's care may be present when care is being rendered only
 if he or she has the resident's permission. The resident's duly appointed legal
 surrogate(s) shall have the authority to act on the resident's behalf as
 established by written applicable federal and state of Georgia law, and shall
 be entitled to receive information relevant to the exercise of his or her
 authority.

(t)

 Each resident,
 representative or legal surrogate must have the right to inspect his or her
 records on request. Each resident must have the right to make a copy of all
 records pertaining to the resident on the premises or obtain a copy from the
 community. The community may charge a fee for providing photocopies of the
 records, but such charge may not exceed what is charged by the local library
 for photocopies. Each resident has the right to confidential treatment of
 personal information in the resident file.

(u)

 Each resident who has not been committed
 to the assisted living community by court order or who does not have a
 representative or legal surrogate with specific written authority to admit,
 transfer or discharge, may discharge or transfer himself or herself upon 30
 days written notification to the assisted living community in conformance with
 the assisted living community's policies and procedures.

(v)

 Each resident must have the right to
 access to the State Long-Term Care Ombudsman Program O.C.G.A. § 
31-8-50
et seq.
 
and the name, address, and telephone number of the ombudsman assigned
 to the assisted living community must be posted in a common area of the
 assisted living community.

(w)

 Residents must have the right to form a Resident Council and have meetings in
 the assisted living community outside the presence of owners, management or
 staff members of the assisted living community and the assisted living
 community must provide assistance in coordinating the meetings of the Resident
 Council.

(2)

 Each
 resident must be provided, at the time of admission to the assisted living
 community, with a copy of the Resident's Bill of Rights, as provided in Rule
 
111-8-63.25
. The Bill of Rights
 must include provisions for protecting the personal and civil rights of each
 resident. In the event that a resident is unable to read the Resident's Bill of
 Rights the manager must take steps to assure communication of its contents to
 the resident.

(3)

 An assisted
 living community must comply with the provisions of the "Remedies for Residents
 of Personal Care Homes Act" as outlined in O.C.G.A. § 
31-8-131
et
 seq.

(4)

 The assisted
 living community must ensure that residents and their representatives, where
 applicable, are given opportunities to provide feedback in writing and
 otherwise on their satisfaction with the services being provided by the
 assisted living community with respect to at least the following areas: quality
 of care, food, activities, cleanliness of the assisted living community and
 helpfulness of the staff.

(5)

 The
 assisted living community must retain a copy of the resident's record for two
 years following the date of discharge.

(6)

 The assisted living community must
 maintain documentation of the feedback it receives and its response to the
 feedback.

Rule 111-8-63-.26 Procedures for Change in Resident's Condition

(1)

 In case of an accident or sudden adverse
 change in a resident's condition or adjustment, an assisted living community
 must immediately take the actions appropriate to the specific circumstances to
 address the needs of the resident, including notifying the representative or
 legal surrogate, if any. The assisted living community must retain a record of
 all such adverse changes and the assisted living community's response in the
 resident's files.

(2)

 Where the
 sudden change in the resident's condition causes the resident to become
 unresponsive, the assisted living community must immediately take one of the
 following actions: 

(a)

 If the resident is
 enrolled in a licensed hospice and has a specific hospice plan of care, the
 assisted living community must contact the hospice for directions regarding the
 care to be provided. If the hospice staff is not available to provide
 direction, then the assisted living community must immediately contact the
 duly-appointed health care agent for direction. If no health care agent has
 been appointed or is not available, then the assisted living community must
 immediately contact emergency medical services to arrange for emergency
 transport and must initiate cardiopulmonary resuscitation if no DNR order has
 been written.

(b)

 If the resident
 has a valid Do Not Resuscitate (DNR) order readily available, the caregiver may
 effectuate the DNR order if done in good faith.

(c)

 If the resident has appointed a health
 care agent in a living will, durable power of attorney for health care or an
 advance directive for health care which complies with the requirements of
 O.C.G.A. § 
31-32-1
et
 seq.
,then the assisted living community must immediately contact the
 health care agent for directions regarding the care to be provided. Where the
 health care agent is not immediately available and there is no valid DNR order
 for the resident, the assisted living community must immediately contact
 emergency medical services to arrange for emergency transport and must initiate
 cardiopulmonary resuscitation.

(d)

 If the resident is not enrolled in hospice, and does not have either a DNR or
 an advance directive, then the staff of the assisted living community must
 immediately contact emergency medical services to arrange for emergency
 transport and must initiate cardiopulmonary resuscitation where it is not
 obvious from physical observation of the resident's body (e.g. body is stiff,
 cool to the touch, blue or grayish in color, etc.) that such efforts would be
 futile and there is not a physician, or authorized registered nurse or
 physician's assistant on site to assess and provide other direction.

(2)

 The staff must have ready
 access to phone numbers for emergency medical personnel and the resident's file
 or appropriate emergency medical and contact information for each resident,
 both at the assisted living community and when residents are being transported
 by the assisted living community for any reason.

(3)

 Immediate investigation of the cause of
 an accident, injury or death involving a resident must be initiated by the
 administrator or on-site manager of the assisted living community and a report
 made to the representative or legal surrogate, if any, with a copy of the
 report maintained in the resident's file and in a central file for quality
 assurance review.

Rule 111-8-63-.27 Death of a Resident

(1)

 Should a resident die while in the
 assisted living community, the administrator, on-site manager or designated
 staff must immediately notify the resident's physician, the next of kin, and
 the representative or legal surrogate, if any, and appropriate law enforcement
 authorities where the law so requires, such as in the case of a sudden or
 unexpected death.

(2)

 Upon death of
 the resident, the assisted living community must refund to the representative
 or legal surrogate, if any, any security deposit made to the assisted living
 community by or on behalf of the resident in compliance with O.C.G.A. § 
44-7-30
et
 seq.

Rule 111-8-63-.28 Immediate Transfers of Residents

(1)

 The administrator or on-site manager of
 the assisted living community must initiate an immediate transfer to an
 appropriate setting if the resident develops a physical or mental condition
 requiring continuous medical care or nursing care.

(2)

 Where immediate transfer is required to
 be made, the administrator or on-site manager shall make arrangements for
 transfer in accordance with the admission agreement and must transfer the
 resident to an appropriate setting where the resident's needs can be met. Prior
 to making such transfer, the administrator or on-site manager shall: 

(a)

 inform the resident and representative or
 legal surrogate, if any, of the reason for the immediate transfer;

(b)

 inquire as to any preference of the
 resident and representative or legal surrogate, if any, regarding the
 appropriate setting to which the resident is to be transferred;

(c)

 inform the representative or legal
 surrogate, if any, of the resident's choice regarding such transfer;

(d)

 inform the resident and the
 representative or legal surrogate, if any, of the place to which the resident
 is to be discharged;

(e)

 provide a
 copy of the resident file to the receiving setting within 24 hours of transfer;
 and

(f)

 document in the resident's
 file the following: 

1.

 the reason for the
 immediate transfer;

2.

 the fact
 that the resident and the representative or legal surrogate, if anywhere
 informed pursuant to this paragraph; and

3.

 appropriate location and contact
 information regarding the place to which the resident is to be transferred or
 discharged.

(3)

 Upon immediate transfer of the resident,
 the assisted living community must refund to the resident or representative or
 legal surrogate, if any, any security deposit made to the assisted living
 community by or on behalf of the resident in compliance with O.C.G.A. § 
44-7-30
et seq.

Rule 111-8-63-.29 Discharge or Transfer of Residents

(1)

 Each admission agreement shall include a
 written procedure for handling the discharge and transfer of the resident. The
 administrator or on-site manager must contact the representative or legal
 surrogate, if any, when there is need to discharge or transfer of a resident.
 The community must provide 30 days' written notice of its intent to discharge
 or transfer the resident unless an immediate transfer is required. The written
 notice must be issued to both the resident and the representative or legal
 surrogate, if any.

(2)

 In all cases
 except those requiring immediate transfer pursuant to Rule
 , residents whose needs
 cannot be met by the assisted living community or who no longer choose to live
 in the assisted living community must be discharged or transferred to an
 appropriate facility or other appropriate setting in accordance with the
 resident's, representative or legal surrogate's wishes based on discharge and
 transfer procedures entered into at the time of admission. Where there is no
 representative or legal surrogate or the representative or legal surrogate is
 unwilling to act to consent to the discharge or transfer, the administrator or
 on-site manager must petition the probate court in the county where the
 assisted living community is located for an order authorizing the discharge or
 transfer. The transferring assisted living community must provide a copy of the
 resident file to the receiving facility prior to or at the time of
 transfer.

(3)

 Where the Department
 has reason to believe that a resident is receiving or requires continuous
 medical or nursing care, other than as permitted by a certified medication
 aide, the Department may require the assisted living community to discharge the
 resident. However, the provision of medical, nursing or health services
 required by the resident on a periodic basis or for a short-term illness, where
 such services are not provided by the assisted living community is
 permissible.

(4)

 Upon discharge or
 transfer of the resident, the assisted living community must refund to the
 resident or representative or legal surrogate, if any, any security deposit
 made to the assisted living community by or on behalf of the resident in
 compliance with O.C.G.A. § 
44-7-30
et
 seq.

Rule 111-8-63-.30 Reports to the Department

(1)

 The staff of the assisted living
 community must call the local police department to report the elopement of any
 resident from the assisted living community within 30 minutes of the staff
 receiving actual knowledge that such person is missing from the assisted living
 community in accordance with the Mattie's Call Act and the requirements set
 forth in O.C.G.A. § 
35-3-170
et seq.

 The assisted living community shall also report the initiation and
 discontinuation of a Mattie's call to the Department within thirty (30) minutes
 of communications with local law enforcement authorities having
 occurred.

(2)

 Whenever a serious
 incident involving a resident occurs, the assisted living community must report
 in a format acceptable to the Department either within 24 hours after the
 incident has occurred, or the assisted living community has reasonable cause to
 believe that a reportable incident involving a resident has occurred. The
 serious incidents that must be reported to the Department include the
 following: 

(a)

 any accidental or
 unanticipated death not directly related to the natural course of the
 resident's underlying medical condition;

(b)

 any serious injury to a resident that
 requires medical attention;

(c)

 any
 rape, assault, any battery on a resident, or any abuse, neglect, or
 exploitation of a Resident in accordance with the Long Term Care Resident Abuse
 Reporting Act O.C.G.A. § 
31-8-80
et
 seq.;

(d)

 an external
 disaster or other emergency situation that affects the continued safe operation
 of the residence; and

(e)

 when an
 owner, director or employee acquires a criminal record as defined in these
 rules.

(3)

 The incident
 report required by these rules must be filed with the Department, in confidence
 and must include at least:

(a)

 the name of the
 assisted living community and the name of the administrator or site
 manager;

(b)

 the date of the
 incident and the date the assisted living community became aware of the
 incident;

(c)

 the type of incident
 suspected, with a brief description of the incident; and

(d)

 any immediate corrective or preventative
 action taken by the assisted living community to ensure against the replication
 of the incident.

(4)

 Where the Department determines that a rule violation related to the incident
 has occurred, the Department will initiate a separate complaint investigation
 of the incident. The complaint investigation report and the report of any rule
 violation compiled by the Department arising either from the initial report
 received from the assisted living community or an independent source is subject
 to disclosure in accordance with applicable laws.

Rule 111-8-63-.31 Deemed Status

The Department may accept the certification or accreditation
 of an assisted living community by an accreditation body or certifying
 authority recognized and approved by the Department provided that certification
 or accreditation constitutes compliance with standards that are substantially
 equivalent to these rules. Nothing herein shall prohibit any departmental
 inspection to determine compliance with licensure rules.

Rule 111-8-63-.32 Variances and Waivers

(1)

 The Department may, in its discretion,
 grant variances and waivers of specific rules upon application or petition
 filed on forms made available by the Department. The Department may establish
 conditions which must be met by the assisted living community in order to
 operate under the variance or waiver granted. 

(a)

Variance.
 A variance may be
 granted by the Department upon a showing by the applicant or petitioner that
 the particular rule or regulation that is the subject of the variance request
 should not be applied as written because strict application of the rule would
 cause undue hardship. The applicant or petitioner must also show that adequate
 standards affording protection for the health, safety, and care of the
 residents exist and will be met in lieu of the exact requirements of the rule
 or regulations in question. The Department may require additional documentation
 by the assisted living community to support its application for a variance or
 waiver.

(b)

Waiver.

 The Department may dispense entirely with the enforcement of a rule or
 regulation by granting a waiver upon a showing by the applicant or petitioner
 that the purpose of the rule or regulation is met through equivalent standards
 affording equivalent protection for the health, safety, care, and rights of the
 residents.

(c)

Experimental
 Variance or Waiver.
 The Department may grant variances and waivers to
 allow experimentation and demonstration of new and innovative approaches to
 delivery of services upon a showing by the applicant or petitioner that the
 intended protections afforded by the rule or regulation which is the subject of
 the request are met and that the innovative approach has the potential to
 improve service delivery without compromising health, safety, residents'
 rights, or other relevant standards.

(2)

 The decision of the Department regarding
 either granting or denying the application of the governing body of the
 assisted living community for a waiver or variance is not subject to further
 administrative review. The governing body may file a petition for judicial
 review in the appropriate superior court.

(3)

 Where the Department has denied the
 application for a waiver or variance in writing, the Department will not
 consider a subsequent application for the same waiver or variance as a new
 application unless the applicant includes new evidence of a substantial change
 in the circumstances which formed the basis for the initial request.

Rule 111-8-63-.33 Enforcement of Licensing Requirements

An assisted living community that fails to comply with
 licensing requirements contained in these rules, the Rules and Regulations for
 the Use of Proxy Caregivers, Chapter 111-8-100 and the Rules and Regulations
 for General Licensing and Enforcement Requirements, Chapter 111-8-25, is
 subject to civil and administrative actions brought by the Department to
 enforce licensing requirements as provided by law and rules. Such actions will
 be initiated in compliance with the Georgia Administrative Procedures Act,
 O.C.G.A. § 
50-13-1
et seq.
,
 O.C.G.A. § 
31-2-11
 and the Rules and
 Regulations for General Licensing and Enforcement Requirements, Chapter
 111-8-25.

Rule 111-8-63-.34 Severability

In the event that any rule, sentence, clause or phrase of any
 of the rules and regulations may be construed by any court of competent
 jurisdiction to be invalid, illegal, unconstitutional, or otherwise
 unenforceable, such determination or adjudication shall in no manner affect the
 remaining rules or portions thereof. The remaining rules or portions thereof
 shall remain in full force and effect as if such rule or portions thereof so
 determined, declared or adjudicated invalid or unconstitutional were not
 originally part of these rules.

Rule 111-8-63-.01 Authority
Rule 111-8-63-.02 Purpose
Rule 111-8-63-.03 Definitions
Rule 111-8-63-.04 Exemptions
Rule 111-8-63-.05 Application for Permit
Rule 111-8-63-.06 Permits
Rule 111-8-63-.07 Owner Governance
Rule 111-8-63-.08 Community Leadership
Rule 111-8-63-.09 Workforce Qualifications, Training and Staffing
Rule 111-8-63-.10 Community Accountability
Rule 111-8-63-.11 Community Design and Use Requirements
Rule 111-8-63-.12 Community Furnishings
Rule 111-8-63-.13 Community Safety Precautions
Rule 111-8-63-.14 Emergency Preparedness
Rule 111-8-63-.15 Admission and Resident Retention
Rule 111-8-63-.16 Admission Agreements
Rule 111-8-63-.17 Services in the Community
Rule 111-8-63-.18 Precautions for Residents at Risk of Elopement
Rule 111-8-63-.19 Additional Requirements for Certified Memory Care Centers
Rule 111-8-63-.20 Medications
Rule 111-8-63-.21 Nutrition and Food Preparation
Rule 111-8-63-.22 Temperature Control
Rule 111-8-63-.23 Infection Control, Sanitation and Supplies
Rule 111-8-63-.24 Residents' Files
Rule 111-8-63-.25 Supporting Residents Rights and Obtaining Feedback
Rule 111-8-63-.26 Procedures for Change in Resident's Condition
Rule 111-8-63-.27 Death of a Resident
Rule 111-8-63-.28 Immediate Transfers of Residents
Rule 111-8-63-.29 Discharge or Transfer of Residents
Rule 111-8-63-.30 Reports to the Department
Rule 111-8-63-.31 Deemed Status
Rule 111-8-63-.32 Variances and Waivers
Rule 111-8-63-.33 Enforcement of Licensing Requirements
Rule 111-8-63-.34 Severability

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