Ga. R. & Regs. 111-8-62

Personal Care Homes

This regulation establishes minimum standards for the licensing and operation of Personal Care Homes in Georgia, which provide housing, food service, and personal assistance services to adults requiring varying degrees of supervision and care. Operators must obtain a permit from the Georgia Department of Community Health, meet staffing ratios and training requirements, maintain resident rights protections, and comply with governance, administration, and safety standards. Memory care centers operating within a personal care home require a separate certificate. The rules explicitly exclude facilities regulated by the Department of Behavioral Health and Developmental Disabilities, assisted living communities, hospices, and drug abuse treatment facilities.

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Chapter 111-8

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Subject 111-8-62 PERSONAL CARE HOMES

Rule 111-8-62-.01 Authority

The legal authority for this Chapter is the Official Code of
 Georgia Annotated, Chapters 2 and 7 of Title 31.

Rule 111-8-62-.02 Purposes

The purposes of these rules and regulations are to establish
 the minimum standards for the operation of personal care homes which provide
 residential and personal services to adults who require varying degrees of
 supervision and care and to assure safe, humane and comfortable, supportive
 residential settings.

Rule 111-8-62-.03 Definitions

In these rules, unless the context otherwise requires, the
 words, phrases and symbols 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 personal care home, who may also serve as
 the on-site manager and responsible staff person except during periods of his
 or her own absence.

(d)

 "Ambulatory
 Resident" means a resident who has the ability to 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 or scooter; who can respond to an
 emergency condition, whether caused by fire or otherwise, and escape with
 minimal human assistance such as guiding a resident to an exit, using the
 normal means of egress.

(e)

 "Applicant" means any of the following:

1.

 When the personal care home is owned by a sole proprietorship, the individual
 proprietor shall be the applicant for the license, complete the statement of
 responsibility and serve as the licensee.

2.

 When the personal care home is owned by a
 partnership, the general partners shall be the applicant for the license,
 complete the statement of responsibility and serve as the licensee.

3.

 When the personal care home is owned by an
 association or limited liability company (LLC), the governing body of the
 association or LLC shall authorize the application for the license and complete
 the statement of responsibility and the association shall serve as the
 licensee.

4.

 When the personal care
 home is owned by a corporation, the governing body of the corporation shall
 authorize the application for the license and complete the statement of
 responsibility and the corporation shall serve as the licensee.

(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)

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

(h)

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

(i)

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

(j)

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

(k)

 "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.

(l)

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

(m)

 "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.

(n)

 "Governing Body" means the person or
 group of persons as defined in Georgia law who maintain and control the home
 and who are legally responsible for the operation of the home.

(o)

 "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 home is not
 authorized by law or regulations to provide.

(p)

 "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, such as skin breakdowns, for
 which the home has not provided proper care.

(q)

 "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 or certified incapacitated. The legal surrogate may act on a
 resident's behalf where a resident has not been adjudicated as incapacitated
 provided that the action is consistent with the resident's wishes and intent
 and is within the scope of the authority granted. Where such authority is
 exercised pursuant to a Power of Attorney executed by a resident, the facility
 must maintain a copy of this document in the resident's files. The residents
 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. No member of the governing body,
 administration, or staff of the personal care home or affiliated personal care
 homes or their family members may serve as the legal surrogate for a
 resident.

(r)

 "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.

(s)

 "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.

(t)

 "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. or
 appropriately licensed and supervised nurse practitioners and physicians'
 assistants.

(u)

 "Memory care
 services" means the additional watchful oversight systems, program, activities
 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 home.

(v)

 "Memory care center" means the freestanding or incorporated specialized unit
 within a personal care home or assisted living community that either: 

(i)

 holds itself out as providing additional
 or specialized care to persons with diagnoses of probably 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.

(w)

 "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 personal care home or to a member of the
 governing body.

(x)

 "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.

(y)

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

(z)

 "Owner" means any individual or any
 person affiliated with a corporation, partnership, or association with 10
 percent or greater ownership interest in the facility providing care to persons
 under the license of the facility in this state and who: 

1.

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

2.

 applies to
 operate or operates a facility;

3.

 maintains an office on the premises of a facility;

4.

 resides at a facility;

5.

 has direct access to persons receiving
 care at a facility;

6.

 provides
 direct personal supervision of facility personnel by being immediately
 available to provide assistance and direction during the time such facility
 services are being provided; or

7.

 enters into a contract to acquire ownership of a facility.

(aa)

 "Permit" or "Regular Permit" means the
 authorization granted by the Department to the governing body to operate a
 Personal Care Home.

(bb)

 "Personal
 Care Home", "home" or "facility" 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.

(cc)

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

(dd)

 "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 services
 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 provide such services under applicable state scope of practice
 rules and regulations.

(ee)

 "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.

(ff)

 "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 practices employed by the home
 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.

(gg)

 "Plan of
 Correction" means the written plan prepared in response to cited rule
 violations which identify by date certain the specific actions that will be
 taken by the personal care home to come into compliance with applicable
 rules.

(hh)

 "Representative" means
 a person who voluntarily, with the resident's written authorization, may act
 upon resident's direction with regard to matters concerning the health and
 welfare of the resident, including being able to access personal 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.

(ii)

 "Resident" means any non-family adult
 receiving or requiring personal assistance and residing in a personal care
 home.

(jj)

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

(kk)

 "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 medications and generally knows the
 times the medications are to be taken, and physical characteristics of
 medications to be taken.

(ll)

 "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 or scooter.

Rule 111-8-62-.04 Applicability of Rules and Exemptions

(1)

 These rules apply to all personal care
 homes unless the facility is specifically exempted as provided in paragraph (2)
 of this rule.

(2)

 These regulations
 do not apply to the following facilities:

(a)

 Boarding homes or rooming houses which provide no personal 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 personal care homes, e.g. assisted living communities,
 hospices, traumatic brain injury facilities, drug abuse treatment
 facilities.

(d)

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

(e)

 Facilities regulated by the Department of
 Behavioral Health and Developmental Disabilities.

(f)

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

(g)

 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.

(h)

 Charitable organizations providing
 shelter and other services without charging any fee to the resident.

(i)

 Any separate and distinct dwelling which
 is classified by the Department as a community living arrangement subject to
 the Rules and Regulations for Community Living Arrangements, Chapter 290-9-37.
 A facility classified as a Community Living Arrangement cannot be operated on
 the same premises as a personal care home.

(j)

 Medical foster homes regulated by the
 U.S. Department of Veterans Affairs.

Rule 111-8-62-.05 Application for Permit

(1)

 The governing body of each home must
 submit to the Department an application for a permit in the required format in
 order to be eligible to operate if the application is approved.

(2)

 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.

(3)

 The
 application must truthfully and accurately disclose required
 information.

(4)

 Each application
 for a permit must be accompanied by a sketch, plat, photos or simple drawing of
 the home, and grounds with identification of all structures on the premises by
 the applicant. The visual depiction must show the property, windows, doors,
 room measurements, and bed placement for residents, family and/or staff and be
 accompanied by documentation of ownership or lease agreement for the property
 on which the home will be operated.

(5)

 The name of the administrator or on-site
 manager, who will be working in the home, 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
 home shall be fully disclosed in its application for a permit. In the case of
 corporations, partnerships, and other bodies created 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 for a
 permit as well as the registered agent for service of process.

(7)

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

(8)

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

(9)

 For initial application for licensure of
 a home with twenty-five (25) beds or more, the applicant 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.

(10)

 No personal care home
 shall be operated and no residents admitted without such a permit which is
 current under these rules and regulations.

(11)

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

Rule 111-8-62-.06 Permits

(1)

 The governing
 body of each personal care home must obtain a valid permit from the Department
 prior to operating as a personal care home.

(2)

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

(3)

 A licensed personal
 care home must not serve more residents than its approved licensed
 capacity

(4)

 A permit is no longer
 valid and must be returned to the Department when the home ceases to operate,
 is moved to another location, the ownership changes, the governing body is
 significantly changed, or the permit is suspended or revoked.

(5)

 A permit is required for each home
 located on different premises where more than one home is operated under the
 same governing body.

(6)

 No
 personal care home is permitted to provide personal services to individuals
 living in spaces which are not located within the authorized space assigned to
 the licensed personal care home.

(7)

 A home licensed as a personal care home,
 but not specifically licensed as an assisted living community, must not provide
 assisted living care.

(8)

 A
 personal care home must not operate or allow another business to operate on the
 premises of the licensed home where the business intrudes on the residents'
 quiet enjoyment and use of the licensed home.

Rule 111-8-62-.07 Governing Body

(1)

 The governing body is responsible for
 providing the oversight necessary to ensure that the home operates in
 compliance with applicable requirements: Chapter 7 of Title 31 of the Official
 Code of Georgia Annotated, administrative rules and regulations of the
 Department of Community Health, Chapters 111-8-25, 111-8-62 and 111-8-100, and
 all other statutes, rules and regulations.

(2)

 The governing body must ensure that the
 Department has current contact information consisting of name, e-mail address
 for departmental notifications to the home, physical addresses, and phone
 numbers for the governing body and the administrator or on-site manager of the
 home. The governing body must ensure that staff is held accountable for
 delivering any notices provided to the governing body at the listed addresses
 to the governing body.

(3)

 The
 governing body is responsible for implementing policies, procedures and
 practices in the home 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 home,
 including, personal services, memory care services/centers and any other
 specialized services such as designated proxy caregivers.

(b)

 Admissions, discharges and immediate
 transfers which ensure that the home does not admit or retain residents who
 need more care than the home is authorized or capable of providing.

(c)

 Refunds when a resident is transferred or
 discharged.

(d)

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

(e)

 House rules and their
 enforcement.

(f)

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

(g)

 Medication management, procurement and
 the professional oversight provided for such services.

(h)

 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.

(i)

 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.

(j)

 Discipline procedures
 for handling conduct which is inconsistent with the policies of the home
 committed by staff.

(k)

 Emergency
 preparedness, drills and evacuation requirements.

(l)

 Quality assurance and peer review
 mechanisms to determine opportunities for improving care utilizing information
 acquired from reports and investigations of serious incidents, including
 resident and family feedback.

(m)

 The use of volunteers, who have unsupervised access to the residents and their
 orientation regarding resident's rights and basic safety precautions.

(n)

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

(o)

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

(p)

 The staffing plan which
 takes into account the specific needs of the residents and also includes
 arrangements for staffing in the absence of regularly scheduled
 staff.

(4)

 The governing
 body must not permit any person who is a member of the governing body,
 administration or staff to serve as the representative of a resident of the
 home.

(5)

 Where a member of the
 governing body, administration or staff serves as the representative payee of
 the resident, the home must use the funds received for the exclusive use and
 benefit and in the best interest of the resident and maintain necessary records
 to support such use.

(6)

 The
 governing body must ensure that staff accepts certified mail from the
 Department when sent to the licensed home.

Rule 111-8-62-.08 Administration

(1)

 The home must
 have an administrator, who is at least 21 years of age and meets the following
 requirements, as applicable:

(a)

 Administrators of homes licensed for fewer than twenty-five (25) beds must have
 either (i) an Associate's Degree or, (ii) a G.E.D. or a high school diploma and
 2 years of experience working in a licensed personal care home or other
 healthcare-related setting.

(b)

 Administrators of homes licensed for twenty-five (25) or more beds must 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 or on-site manager of
 each personal care home must do the following: 

(a)

 Ensure that the policies and procedures
 are effective and enforced to support the health and safety of the
 residents.

(b)

 Designate qualified
 staff as responsible staff to act on his or her behalf and to carry out his or
 her duties in the administrator or on-site manager's absence. No resident shall
 be designated as staff.

(c)

 Investigate serious incidents involving residents which result in injuries or
 death in order to identify and implement opportunities for improvement in
 care.

(d)

 Monitor and document
 staff performance to ensure that care and services are being delivered safely
 and in accordance with these rules.

(3)

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

(4)

 The facility must comply with the
 requirements of Chapter 111-8-16, Rules and Regulations for Disaster
 Preparedness Plans.

(5)

 Each home
 must have a telephone which is maintained in working order at all times and is
 accessible to the residents.

(6)

Notification of Emergency Relocation
. The home must provide timely
 notification of the relocation address to the residents, their family contacts
 and representatives, if any, and the Department whenever the home 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.

(7)

Notification of
 Bankruptcy, Eviction or Change of Ownership
. The home 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 111-8-62-.09 Workforce Qualifications and Training

(1)

 Age Requirements. The on-site manager and
 all other direct-care supervisory staff working in a personal care home must be
 at least 21 years of age. Non-supervisory staff providing hands-on care to the
 residents must be at least 18 years of age.

(2)

 The administrator or on-site manager must
 be responsible for ensuring that any person working in the home as an employee,
 under contract or otherwise, receives work-related training within the first
 sixty days of employment. Such training must include, at a minimum, the
 following: 

(a)

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

(b)

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

(c)

 Emergency evacuation procedures;

(d)

 Medical and social needs and
 characteristics of the resident population;

(e)

 Residents' rights;

(f)

 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.; and

(g)

 General infection control principles
 including the importance of hand hygiene in all settings and attendance
 policies when ill.

(3)

 At
 least one staff person having completed the minimum training requirements of
 Rule above must be present in the home at all
 times resident(s) are present in the home.

(4)

 All direct care staff, including the
 administrator or on-site manager, must satisfactorily complete continuing
 education each year, in courses, relevant to their job duties, including, but
 not limited to, appropriate medication assistance, working with the elderly,
 working with residents with Alzheimer's or other cognitive impairments, working
 with the mentally ill and developmentally disabled, social and recreational
 activities, legal issues, physical maintenance and fire safety, housekeeping,
 or other topics as needed or as determined by the Department.

(5)

 All direct care staff, including the
 administrator or on-site manager, must have at least sixteen (16) hours of
 training per year.

(6)

 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 assistant within twelve months prior to their
 employment with the home which examination was sufficiently comprehensive to
 assure that the employee is free of diseases communicable within the scope of
 employment and physically qualified to work. Follow-up examinations must be
 conducted by a licensed physician, nurse practitioner or physician assistant of
 each administrator or staff person to determine readiness to return to work
 following a significant illness or injury. Copies of information regarding
 staff member health must be kept in the staff person's file accessible at the
 licensed home or within one hour of the request.

(7)

Criminal History Background Checks
 for Owners Required
. Prior to the issuance of any new license, 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.

(8)

Criminal History Background Checks for Directors, Administrators and
 Onsite Managers Required
. The home must obtain a satisfactory
 fingerprint records check determination for the person being considered for
 employment as a director, administrator or onsite manager. The records check
 determination must be done in compliance with the Rules and Regulations for
 Criminal Background Checks, Chapter 111-8-12.

(9)

Criminal History Background Checks
 for Direct Access Employees Required
. Prior to serving as a direct
 access employee, the home 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.

(10)

 The administrator or on-site manager
 must obtain and verify a five year employment history when possible for each
 employee and maintain documentation in the employee's file. If the potential
 employee has no prior employment history, then the home must retain
 documentation of a satisfactory personal reference check.

(11)

 Personnel file(s) for each employee must
 be maintained either in the home or available for inspection by departmental
 staff within one hour of request or prior to the end of the on-site survey and
 for three years following the employee's departure or discharge. These files
 must include all of the following: 

(a)

 Evidence of a satisfactory fingerprint record check determination, if
 applicable.

(b)

 Report of a
 physical examination completed by a licensed physician, nurse practitioner or
 physician assistant.

(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,
 if previously employed, including 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. personal
 references, 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.

(f)

 Written evidence of satisfactory initial
 and annual work performance reviews, which can take the form of skills
 competency checklists, for unlicensed staff providing hands-on personal care.
 Where the unlicensed staff performs specialized tasks, such as health
 maintenance activities, 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 applicable rules and accepted health and safety
 standards.

(12)

 Where the
 home permits a resident to hire his or her own companion-sitter, proxy
 caregiver to perform health maintenance activities or aide of any sort, the
 home 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.

Rule 111-8-62-.10 Staffing

(1)

 Homes licensed for less than 25 beds must
 maintain a 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 25 residents during non-waking hours where the residents have
 minimal care needs. Homes licensed for 25 or more beds 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. Average monthly minimum
 staffing levels shall be calculated and documented by the home using methods
 and forms specified by the department. Notwithstanding the above requirements,
 all homes 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, or
 private sitters cannot be counted in the staff ratios for the home.

(b)

 At least one administrator, on-site
 manager, or a responsible staff person must be on the premises 24 hours per day
 and available to respond to resident needs, with a minimum of one staff person
 per occupied floor. Homes licensed for 25 beds or more must ensure that at
 least two on-site administrators or on-site direct care staff persons are
 present on the premises at all times with at least one staff person on each
 occupied floor and that person shall be required to remain posted on their
 designated floor at all times; provided, however, that the staff person posted
 on the designated floor may move about the premises as necessary if the
 personal care home 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.

(c)

 Residents must be
 supervised consistent with their needs.

(2)

 All staff, including the administrator or
 on-site manager, who offer direct care to the residents on behalf of the home,
 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.

(3)

 For purposes of these
 regulations, a resident must not be considered a staff person.

(4)

 All homes 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.

(5)

 The home must retain the completed staff
 schedules for a minimum of one year.

(6)

 Sufficient staff time must be provided by
 the home such that each resident:

(a)

 Receives
 treatments, medications and diet as prescribed.

(b)

 Receives proper care to prevent pressure
 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, oral care.

(h)

 Is given assistance with transferring
 when needed.

(7)

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

(8)

 A home licensed to serve more than 24 residents must ensure that staff wear
 employee identification badges which are readily visible.

(9)

 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 111-8-62-.11 Home Accountability and Inspections

(1)

 The home and its records must be
 available for review and examination by properly identified representatives of
 the Department. Inspections may be conducted both on an announced and
 unannounced basis. Unannounced inspections shall be conducted as
 needed.

(2)

 Where the Department
 identifies rule violations, the home will receive a written report of
 inspection. Within 10 days of receipt of the written report of inspection, the
 home must develop a written plan for correcting any rule violations identified.
 The plan of correction must identify the specific actions the home will take
 promptly to come into compliance with each rule for which a deficient practice
 was identified and file the plan with the Department as directed.

(3)

 If the home disagrees with the facts and
 conclusions stated in the inspection report, the home may include with its plan
 of correction a written statement explaining its disagreement and any evidence
 supporting the disagreement to the Department. Where the Department concurs
 with the written statement of disagreement, the Department will issue a revised
 inspection report to the home.

(4)

 A copy of the most recent inspection report and plan of correction must be
 displayed in the home in a location that is routinely used by the home to
 communicate information to residents and visitors. Additionally, if the home
 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 web site for receiving plans of correction electronically
 and notifies the home of the appropriate internet address, the home also must
 file its plan of correction electronically on the Department's web site within
 10 days of receipt of the report of inspection.

(5)

 The home must assess the effectiveness of
 its plan of correction in correcting the deficient practice and modify the plan
 of correction as necessary to ensure compliance with the rules.

(6)

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

(8)

 A personal care home which is not
 licensed as an assisted living community must not use the term "assisted
 living" in its name or marketing materials.

Rule 111-8-62-.12 Home Design Requirements

(1)

 A home must be constructed, arranged, and
 maintained to provide adequately for all of the following: 

(a)

 Health, safety, and well-being of the
 residents.

(b)

 Independence,
 privacy and dignity of the residents.

(c)

 Safe access of all residents with varying
 degrees of functional impairments to living, dining and activity areas within
 the home.

(2)

 A
 currently licensed home which undergoes major structural renovation or one that
 is first licensed after the effective date of these rules must be designed and
 constructed in compliance with applicable state and local building and fire
 codes.

(3)

 Where the home intends
 to make changes to the home which would result in a change to the floor sketch
 from the one that was submitted at the time of initial licensing or certificate
 of need review, the home must have such proposed changes approved by the
 Department.

(4)

 Any renovations to
 the home which put the home out of compliance with these rules may subject the
 home to revocation of its license.

(5)

Common
 Areas
. 
The home must provide common living areas for the
 use of the residents.

(a)

 Separate and
 distinct sleeping and living areas must be provided which allow for necessary
 supervision and assistance by staff and are conveniently located within easy
 walking distance of each resident's private living space (room), available for
 the residents' informal use at any time and do not require any resident to
 leave the building to use.

(b)

 Living rooms must be provided which are large enough to accommodate the
 residents without crowding. The rooms must be comfortably and attractively
 furnished, well heated, well lighted, ventilated and clean.

(c)

 The home must have handrails, grab bars,
 doorways and corridors which accommodate permitted mobility devices, such as
 walkers, motorized scooters, wheel chairs and crutches or canes as the
 residents require for their safety and allow the residents to move about the
 home freely.

(d)

 The home must
 provide an area for use by residents and visitors which affords
 privacy.

(e)

 The home must place at
 least one current calendar and working clock in the common living
 area.

(f)

 The home must provide a
 comfortable dining area which is properly equipped and adequate in size for the
 number of residents being served.

(g)

 The home must provide a means of locked
 storage for any resident's valuables or personal belongings, upon
 request.

(h)

 No living room, dining
 room, hallway, and any other room not ordinarily used for sleeping is permitted
 to be used for sleeping by residents, family, staff or renters.

(i)

 A home must provide laundering facilities
 on the premises for the residents' personal laundry that prevents the
 cross-contamination of clean and dirty laundry.

(6)

Bedrooms or Private
 Living Spaces
. 
The following minimum standards for resident
 bedrooms or private living spaces must be met: 

(a)

 Bedrooms or private living spaces must
 have at least 80 square feet of usable floor space per resident. 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 or private living spaces with a minimum of 70
 square feet of usable floor space per resident which have continuously operated
 since that date may continue to use the minimum 70 square feet standard. Where
 a home 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)

 There shall be no more than four residents per bedroom or private living space
 unless the home is presently permitted to serve more than four residents per
 bedroom or private living space and no change in the ownership, location or
 licensure status of the home occurs.

(c)

 Each bedroom or private living space must
 have at least one window opening through an exterior wall of the home. Bedrooms
 or private living spaces must be well ventilated and maintained at a
 comfortable temperature.

(d)

 If the
 residents specifically choose in writing to share a private bedroom or living
 space with another resident of the home, then the residents must be permitted
 to share the room, subject to the usable square feet requirement and the
 limitation that no more than four residents may share any bedroom or private
 living space.

(e)

 Bedrooms or
 private living spaces for residents must be separated from halls, corridors and
 other rooms by floor to ceiling walls.

(f)

 The floor plan of the home must be such
 that no person other than the residents assigned to a bedroom or private living
 space should pass through that residents' bedroom or private living space in
 order to reach another room.

(g)

 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 administrator or on-site manager must be provided with keys to assure easy
 entry and exit.

(h)

 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 be provided with two useful means of egress. Control of dampness must be
 assured.

(i)

 When a resident is
 discharged, the room and its contents must be thoroughly cleaned.

(7)

Bathroom
 Facilities
.
 The following minimum
 standards apply to bathroom facilities:

(a)

 At
 least one functional toilet and lavatory must be provided for each four
 residents and at least one bathing or showering facility must be provided for
 each eight residents living in a home.

(b)

 At least one toilet and lavatory must be
 provided on each floor having residents' bedrooms.

(c)

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

(d)

 Bathrooms and toilet facilities without
 windows must have forced ventilation to the outside. Bathroom windows used for
 ventilation must open easily.

(e)

 Toilets, bathtubs and showers must provide for individual privacy.

(f)

 All plumbing and bathroom fixtures must
 be maintained in good working order at all times and must present a clean and
 sanitary appearance.

(g)

 A home
 serving a person dependent upon a wheelchair or scooter for mobility
 mus
t
 have at least one bathroom that permits the
 resident to use all bathroom fixtures easily and independently where
 able.

(8)

Interior Design and Construction.
The
 home must be designed and built to provide for the following: 

(a)

 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.

(b)

 Floor covering must be intact and
 securely fastened to the floor. Any hazard that may cause tripping must be
 removed.

(c)

 All areas of the home,
 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.

Rule 111-8-62-.13 Physical Plant Health and Safety Standards

(1)

 Each home must be in compliance with fire
 and safety rules promulgated by the Office of the Safety Fire Commissioner for
 the personal care homes it regulates.

(2)

 Each home must be in compliance with
 applicable local ordinances that specifically address fire safety in homes of
 that size and function. Private quarters must be maintained in such a manner as
 to comply with fire safety codes and not threaten the health or safety of
 residents. In the absence of or in addition to any such local ordinances, the
 following requirements must be met: 

(a)

 Wall
 type electric outlets and lamps or light fixtures must be maintained in a safe
 and operating condition. The home must provide functioning light bulbs for
 light fixtures.

(b)

 Cooking
 appliances must be suitably installed in accordance with approved safety
 practices. Where metal hoods or canopies are provided, they must be equipped
 with filters which must be maintained in an efficient condition and kept clean
 at all times.

(c)

 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
 home.

(d)

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

(e)

 Each home must
 be protected with sufficient 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.

(f)

 Each home must have at least one charged
 5 lb. multipurpose ABC fire extinguisher on each occupied floor and in the
 basement. These extinguishers must be checked annually to assure they remain in
 operable condition.

(g)

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

(h)

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

(3)

 The
 electrical service of the home must be inspected by a licensed electrician or
 local code enforcement official and declared free of hazards within no more
 than six months prior to the date of filing the application for a permit. A
 signed copy of this inspection report must be submitted to the Department as a
 part of the application. 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 home or
 there is a request for a change in capacity or there is reason to believe that
 a risk to residents exists.

(4)

 Where the Department has reason to believe, based on the number of residents
 requiring assistance with ambulation and staffing patterns that the home 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 fire safety
 officials, the Department may either require the home to conduct an immediate
 fire safety drill or make a referral for a new compliance determination to
 responsible fire safety officials. The Department may also require a repeat
 fire safety inspection where substantial renovations or repairs have been made
 to the home.

(5)

 Water and sewage
 systems must meet applicable federal, state, and local standards and/or
 regulations.

(6)

 Floors, walls, and
 ceilings must be kept clean and in good repair.

(7)

 Kitchen and bathroom areas must be kept
 clean and sanitized, at least once daily with disinfectant and more often as
 needed to insure cleanliness and sanitation.

(8)

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

(9)

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

(10)

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

(11)

 Poisons, caustics, and other dangerous
 materials must be stored and safeguarded in areas away from residents, food
 preparation and food storage areas, and medication storage areas.

(12)

 The home must have an adequate hot water
 system that supplies heated water, comfortable to the touch but not exceeding
 120 degrees Fahrenheit (F.) to the residents for their usage.

(13)

 Entrances and exits, sidewalks, yards
 and escape routes must be maintained free of any hazards such as refuse,
 equipment, unsafe furniture, debris or any other impediments. Ice and snow must
 be cleared from the home's entrances, exits and walkways.

(14)

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

(15)

 The exterior of the home must be
 properly maintained to remain safe and in good repair.

(16)

 The following evacuation requirements
 must be met:

(a)

 Residents who need assistance
 with ambulation must be assigned bedrooms which have a ground-level exit to the
 outside or to rooms above ground level which have exits with easily negotiable
 ramps or easily accessible elevators.

(b)

 There must be an established procedure
 and mechanism for alerting and caring for residents in case of emergencies and
 evacuating them to safety. This procedure must include instructions and
 evacuation plans posted on each floor of a home. Each sleeping room must have a
 secondary exit. This secondary exit may be a door or a window usable for
 escape. A plan showing these routes of escape must be posted in the home on
 each floor.

(c)

 A home serving
 person(s) dependent upon wheelchairs or scooters for mobility must provide at
 least two exits from the home, remote from each other, that are accessible to
 these persons.

Rule 111-8-62-.14 Furnishings and Fixtures

(1)

 Furnishings of the home in the living
 room, bedrooms and dining room must be maintained in good condition, intact,
 and functional.

(2)

 Furnishings and
 housekeeping standards must be such that a home presents a clean and orderly
 appearance.

(3)

 Resident bedroom
 furnishings must include all of the following: 

(a)

 An adequate closet or wardrobe.

(b)

 Working lighting fixtures sufficient for
 reading and other resident activities.

(c)

 A bureau or dresser or the equivalent and
 at least one chair with arms per resident in each bedroom or private living
 space.

(d)

 A mirror appropriate for
 grooming unless the resident or resident's representative specifically requests
 to have it removed;

(e)

 An
 individual bed 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 home must provide an extra long mattress upon request. The
 mattress shall be not less than five-inches thick, or four-inches, if of a
 synthetic construction. Couples may request a double bed when available.
 Roll-a-ways, cots, double-decks, stacked bunks, hide-a-beds and studio couches
 are not to be used in lieu of standard beds.

(f)

 Bedding for each resident which includes
 two sheets, a pillow, a pillow case, a minimum of one blanket and bedspread. A
 home must maintain a linen supply for not less than twice the bed capacity
 where the residents do not choose to provide their own linens. Where the
 residents choose to provide their own linens, the home must maintain an
 adequate supply of spare linens on hand to accommodate the needs of the
 residents. A home must change and launder bed linens for each resident at least
 weekly or more often if soiled.

(4)

 Provision must be made for assisting a
 resident to personalize the bedroom by allowing the use of his or her own
 furniture if so desired and mounting or hanging pictures on bedroom
 walls.

Rule 111-8-62-.15 Admission

(1)

 Criteria for
 admission and retention of residents in a home are as follows: 

(a)

 Persons admitted to a personal care home
 must be at least 18 years of age.

(b)

 Except for aging in place exceptions, the
 home is permitted to admit and retain only ambulatory residents who are capable
 of self-preservation with minimal assistance, i.e. staff may assist the
 resident in transferring from a sitting or reclining position and provide
 verbal directions to residents who are able to self-propel to the nearest
 exit.

(c)

 Aging in Place
 Exceptions. The home may allow up to three (3) non-ambulatory residents to
 remain in the home to support an aging in place strategy that is in the best
 interests of the resident, subject to the requirements herein. These aging in
 place exceptions may be revoked by the Department at any time, as part of the
 survey process, if the facility fails to meet any of the following criteria: 

(i)

 The resident has not experienced any
 significant change in a physical or medical condition which would make
 continued placement in the facility inappropriate;

(ii)

 The facility maintains responsibility
 for meeting resident needs for continuing care provided within the scope of
 services the personal care home is licensed to deliver;

(iii)

 The resident remains under hospice
 services (if the resident was under such services at the time of the aging in
 place decision);

(iv)

 The facility
 monitors its performance of fire drills to ensure that it can safely evacuate
 all of the residents at any time in 13 minutes or less;

(v)

 The facility increases the number of
 documented fire drills to a minimum of one fire drill per month, covering all
 shifts, as long as one or more residents in the facility are
 non-ambulatory;

(vi)

 The facility
 notifies the local fire department in writing within two (2) weeks of the
 change in the resident's status to aging in place so that there is local
 awareness of the presence of a non-ambulatory resident at the home;

(vii)

 The facility ensures sufficient staff
 on all shifts to support the safe and timely evacuation of all residents in the
 event of an emergency; and

(viii)

 The facility is in substantial compliance with the department's rules and is
 not subject to any pending enforcement action by the department.

(d)

 The home must not admit, or
 retain persons who require the use of physical or chemical restraints,
 isolation, or confinement for behavioral control.

(e)

 No home is permitted to admit residents
 who either require continuous medical services or continuous nursing care and
 treatment.

(f)

 Medical, nursing,
 health or therapeutic services required on a periodic basis, or for short-term
 illness, must not be provided as services of the home. When such services are
 required, they must be purchased by the resident or the resident's
 representative or legal surrogate, if any, from appropriately licensed
 providers managed independently from the home. The home may assist in
 arrangement for such services, but not provision of those services.

(2)

 No home is permitted to admit
 or retain a resident who needs care beyond which the home is permitted to
 provide.

(3)

 The administrator or
 on-site manager of a home must conduct an interview with the applicant and/or
 representative or legal surrogate, if any, of the applicant to ascertain that
 the home can meet the applicant's needs. The administrator or on-site manager
 must obtain a report of physical examination conducted by a by a licensed
 physician, nurse practitioner or physician's assistant dated within 30 days
 prior to the date of admission using the specific report of physical
 examination form made available by the Department on its website to assess
 whether the home can meet the applicant's needs. Where a home admits a resident
 without the required physical examination pursuant to a specific request for an
 emergency placement made by a governmental agency responsible for adult
 protective service, local law enforcement or a case manager, the home must
 retain documentation of the need for the emergency placement and obtain a copy
 of a physical examination within 14 days following the emergency admission. The
 required report of physical examination form must be completed in its
 entirety.

Rule 111-8-62-.16 Admission Agreement

(1)

 A written admission agreement must be
 entered into between the governing body and the resident. Such agreement must
 contain the following: 

(a)

 A current
 statement of all fees and daily, weekly or monthly charges; any other services
 which are available on an additional fee basis, for which the resident must
 sign; a request acknowledging the additional cost; and the services provided in
 the home for that charge.

(b)

 A
 statement that residents and their representatives or legal surrogates must 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 resident's authorization and consent
 to release medical information to the home as needed.

(d)

 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.

(e)

 Provision
 for transportation of residents for shopping, recreation, rehabilitation and
 medical services, which must be available either as a basic service or on a
 reimbursement basis. Provision must also be made for access to emergency
 transportation at all times.

(f)

 A
 statement of the home's refund policy including but not limited to when a
 resident decides not to move into the home, dies, is transferred or
 discharged.

(g)

 A statement that a
 resident may not perform services for the home.

(h)

 A copy of the house rules, which must be
 in writing and also posted in the home. 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, 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)

 For residents first admitted after the
 effective date of these rules, a statement disclosing whether the home permits
 the resident to hire independent proxy caregivers, sitters, or requires the
 purchase of such services from the home or approved providers.

(j)

 For residents first admitted after the
 effective date of these rules, the admission agreement must disclose how and by
 what level of staff medications are handled in the home. The agreement must
 also specify who is responsible for initial acquisition, refilling of
 prescribed medications and whether unit or multi-dose packaging of medications
 is required.

(k)

 An explanation of
 how and when residents must be discharged or transferred from the
 home.

(l)

 For residents first
 admitted after the effective date of these rules, an explanation of how social
 media, photos of residents and other media involving residents are
 handled.

(m)

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

(2)

 Each
 resident, and representative, where applicable, prior to the execution of the
 admissions agreement, must have an opportunity to read the agreement. In the
 event that a resident is unable to read the agreement, the administrator or
 on-site manager must take special steps to assure communication of its contents
 to the resident.

(3)

 The resident
 and representative or legal surrogate, if any, must each be given a signed copy
 of the agreement and 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 home.

Rule 111-8-62-.17 Services

(1)

 Personal
 assistance must be given to those residents who are unable to keep themselves
 neat and clean.

(2)

 Each home must
 provide sufficient activities to promote the physical, mental and social
 well-being of each resident.

(3)

 Each home must provide books, newspapers, and games for leisure time
 activities. Each home must encourage and offer assistance to residents who wish
 to participate in hobbies, music, arts and crafts, religion, games, sports,
 social, recreational and cultural activities available in the home and in the
 community.

(4)

 Each home must have
 at least one operable, non-pay telephone which is accessible at all times for
 emergency use by staff. Residents must have access to an operable, non-pay
 telephone in a private location, both to make and receive personal calls. The
 same telephone may meet all the requirements of this section.

(5)

 The daily living routine of the home must
 be such that a resident may spend the majority of his or her non-sleeping hours
 out of the resident's bedroom, if he or she so chooses.

(6)

 A home must not restrict a resident's
 free access to the common areas of the home unless the resident is living in a
 specialized memory care center. If the resident is residing in a specialized
 memory care center, unrestricted access to the common areas contained within
 the memory care center must be provided to the resident.

(7)

 A home must not lock the resident into or
 out of the resident's bedroom or private living space.

(8)

Resident Needs Assessment
.
 The home must complete an assessment of the resident at the time of admission
 and update as changes occur 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.

(9)

Written Care Plan
. Utilizing
 the information acquired during the admission process and the move-in
 adjustment period, a home which provides proxy caregivers or memory care 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 resident and family involvement in the development of the plan when
 appropriate.

(g)

 Evidence of the
 care plan being updated at least annually and more frequently where the needs
 of the resident change substantially.

Rule 111-8-62-.18 Precautions for Residents at Risk of Elopement

(1)

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

(a)

 Develop, train and enforce policies and
 procedures for staff to deal with residents who may elope from the home
 including what actions, as specified in rule
 are to be taken if a
 resident wanders away (elopes) from the home.

(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 locks used on exit doors, as approved by the fire
 marshal having jurisdiction over the home, 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 home 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 operation must be posted
 on the outside of the door to allow individuals' access to the memory care
 center. However, if the center is a whole home, then directions for the
 operation of the locks need not be posted on the outside of the door. The
 center 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)

 A home serving residents who are at risk
 of eloping from the premises must retain on file at the home current pictures
 of residents who are at risk of eloping.

Rule 111-8-62-.19 Additional Requirements for Certified Memory Care Centers

(1)

 A home must meet the additional
 requirements contained in rule
 where the home serves
 persons with probable diagnoses of Alzheimer's Disease or other dementia and
 does any of the following:

(a)

 Holds itself
 out as providing additional or specialized care to such residents; or

(b)

 Charges rates in excess of that charged
 other residents for the provision of additional or specialized care.

(2)

 Written Description. The home
 must develop an accurate written description of the memory care center that
 includes the following:

(a)

 A statement of
 philosophy and mission.

(b)

 How the
 services of the memory care center are different from services provided in the
 rest of the personal care home.

(c)

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

(d)

 Admission procedures, including screening
 criteria.

(e)

 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.

(f)

 Staffing patterns,
 maintained within the center, including the ratio of direct care staff to
 resident for a 24-hour cycle.

(g)

 A
 description of the physical environment including safety and security
 features.

(h)

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

(i)

 The
 program's fee or fee structure for all services provided by the
 center.

(j)

 Discharge criteria and
 procedures;

(k)

 The procedures that
 will be utilized for handling emergency situations.

(l)

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

(3)

 Disclosure of Description. A personal
 care home with a memory care center must disclose the written description of
 the center to:

(a)

 Any person upon
 request.

(b)

 The family or
 resident's representative before admission of the resident to the
 center.

(4)

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

(a)

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

(b)

 Secured outdoor spaces and walkways which are wheel chair accessible and allow
 residents to ambulate safely but prevent undetected egress.

(c)

 High visual contrasts 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.

(d)

 Adequate and even lighting which
 minimizes glare and shadows.

(e)

 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 four residents.

(f)

 Individually identified entrances to residents' rooms to assist residents in
 readily identifying their own personal spaces.

(g)

 An effective automated device or system
 to alert staff to individuals entering or leaving the building in an
 unauthorized manner. A home 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
 home. If the exit door is not always staffed, then the home must have a system
 that activates an automated alert when the door is not attended;

(h)

 A 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

(i)

 A center or home 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 home.

(5)

 Staffing Requirements. The home must
 ensure that the center is staffed at all times with sufficient specially
 trained staff to meet the unique needs of the residents in the center. At a
 minimum, the home must provide the following staffing: 

(a)

 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 nonwaking hours based on a monthly average;
 provided, however, that such ratio is adequate to meet the needs of the
 residents;

(b)

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

(c)

 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

(d)

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

(i)

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

(ii)

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

(iii)

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

(iv)

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

(6)

 Staff Training Requirements. The home
 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.
 Effective July 1, 2021, the memory care center shall meet the following
 training requirements:

(a)

 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: 

(i)

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

(ii)

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

(iii)

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

(iv)

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

(b)

 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: 

(i)

 General training, to include: 

(A)

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

(B)

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

(C)

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

(D)

 General infection
 control principles;

(E)

 Emergency
 preparedness training;

(F)

 Emergency first aid; and

(G)

 Cardiopulmonary resuscitation.

(ii)

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

(A)

 The nature of
 Alzheimer's and other dementias;

(B)

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

(C)

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

(D)

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

(E)

 Positive therapeutic interventions and
 activities;

(F)

 Skills for
 maintaining the safety of the resident; and

(G)

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

(iii)

 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 .

(c)

 Ongoing Training. Direct care staff shall
 complete a minimum of eight (8) hours of specialized competency-based training
 in dementia care on an annual basis using forms specified by the
 department.

(d)

 Hospice Training
 for Certified Medication Aides Administering Morphine. The memory care center
 shall ensure that any medication aide(s) who will be administering liquid
 morphine to any hospice patient(s) residing in the center 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 memory care center shall maintain documentation of all training
 provided.

(e)

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

(7)

 Special Admission Requirements for Memory
 Care Center Placement. Residents must have a Report of Physical Examination
 completed by a licensed physician, nurse practitioner or physician's assistant
 within 30 days prior to admission to the center on forms provided 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 the center as a companion to
 a resident with a probable diagnosis of Alzheimer's Disease or other dementia
 with which the resident has a close personal relationship. In addition, the
 physical examination report must establish that each potential resident of the
 center does not require 24-hour skilled nursing care.

(8)

 Post-Admission Assessment. The home must
 assess 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.

(9)

 Individual Service Plans. The
 post-admission assessment must be used to develop the resident's individual
 service plan within 14 days of admission. The service plan must be developed by
 a team with at least one member of the direct care staff participating and
 input from each shift of direct care staff that provides care to the resident.
 All team members participating must sign the service plan and the service plan
 must be shared with the direct care staff providing care to the resident and
 serve as a guide for the delivery of services to the resident. The service 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 expressed preferences
 regarding care, activities and interests.

(c)

 Specific behaviors to be addressed with
 interventions to be used.

(d)

 Names
 of staff primarily responsible for implementing the service plan.

(e)

 Evidence of family involvement in the
 development of the plan, if possible, with incorporation of family and personal
 history to support a person-centered approach to care.

(f)

 Evidence of the service plan being
 updated at least quarterly or more frequently if the needs of resident change
 substantially.

(10)

 Therapeutic Activities. The center must provide therapeutic activities
 appropriate to the needs of the individual residents and adapt the activities,
 as necessary, to encourage the participation of the residents. The following
 kinds of therapeutic activities must be provided at least weekly with at least
 some therapeutic activities occurring daily: 

(a)

 Gross motor activities; e.g. exercise,
 dancing, gardening, cooking, other outdoor activities.

(b)

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

(c)

 Social activities; e.g. games, music, crafts.

(d)

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

(11)

 No
 licensed personal care home may provide or 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 residents with cognitive
 deficits that place the residents at risk of engaging in unsafe wandering
 activities (eloping) unless it meets the additional requirements specified in
 Rule .

Rule 111-8-62-.20 Medications

(1)

Self-Administration of Medications
. Residents who have the
 capacity to self-administer 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
. A resident who is not capable of independent
 self-administration of medication may be assisted and supervised in
 self-administration by staff to the following extent; 

(a)

 Staff providing such assistance or
 supervision may perform the following:

1.

 Take
 the medication, in its previously dispensed, properly labeled container, from
 where it is stored, and bring the medication to the resident.

2.

 Read the label, open the container, remove
 a prescribed amount of medication from the container, and close the container,
 in the presence of the resident.

3.

 Place an oral dosage in the resident's hand or in another container where the
 resident requests assistance.

4.

 Apply topical medications.

5.

 Assist with self-administration of drops, inhalers, nasal sprays and
 patches.

6.

 Return the medication
 container to proper secured storage.

7.

 Assist 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)

Basic Medication Training for Staff
 Assisting with Self-Administration
. The home must provide and document
 medication training for the unlicensed staff that 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 home'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.

(i)

 Proper
 documentation and record keeping using the Medication Assistance
 Record.

(4)

Medication Skills Competency Determinations
. Unlicensed staff in
 homes providing assistance with or supervision of self-administered medications
 must demonstrate to a qualified supervisor when hired and at least, annually
 thereafter, the necessary skills to perform the medication tasks assigned
 competently.

(5)

Memory Care
 Medication Administration.
 Medications for residents living in the
 memory care center must be provided to the residents by a proxy caregiver
 trained in accordance with the requirements of Chapter 111-8-100; a licensed
 registered nurse; a licensed practical nurse working under the supervision of a
 physician or registered nurse; or a certified medication aide subject to the
 requirements set forth below.

(6)

Certified Medication Aide Requirements.
 A home using certified
 medication aides must meet the requirements below. CMAs working in the memory
 care center may also assist non-memory care residents in the same building. 

(a)

 Check the Registry. The home must check
 to ensure that the medication aides employed in the home 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. The
 home must administer skills competency checks to 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 residents in care. The home 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. The home must 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 home's administration for resolution.

(d)

 Quarterly Drug Regimen Reviews. The home
 must secure the services of a licensed pharmacist to perform all of the
 following duties: 

(i)

 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;

(ii)

 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;

(iii)

 establish or review
 policies and procedures for safe and effective drug therapy, distribution, use
 and control; and

(iv)

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

(e)

 Authorized
 Tasks for Certified Medication Aides. A home 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: 

(i)

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

(ii)

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

(iii)

 Administer
 medications via a metered dose inhaler;

(iv)

 Conduct finger stick blood glucose
 testing following established protocol;

(v)

 Administer a commercially prepared
 disposable enema ordered by a physician;

(vi)

 Assist residents in the supervision of
 self-administration of medications; and

(vii)

 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: 

(i)

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

(ii)

 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

(iii)

 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.

(7)

 Homes
 Conducting Certified Medication Aide Training. A home 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; and

(g)

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

(8)

Maintaining Records on Medication
 Assistance and Administration
. Where the home either provides assistance
 with, or supervision of self-administered medications, or administers
 medications to residents, the home must maintain a daily Medication Assistance
 Record (MAR) for each resident receiving such service. 

(a)

 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 a summary of severe 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).

(b)

 The staff providing the assistance or
 administration of medications must update the MAR each time the medication is
 offered or taken.

(c)

 The home 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.

(d)

 Staff 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.

(e)

 Refills of
 prescribed medications must be obtained timely so that there is no interruption
 in the routine dosing. Where the home 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, advance
 practice registered nurse or physician assistant indicates that the medication
 change must be made immediately. In homes, where unit or multi-dose packaging
 is not available for immediate changes in medications, unit or multi-dose
 packaging of the medication must be obtained when the prescription is
 refilled.

(f)

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

(i)

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

(ii)

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

(iii)

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

(iv)

 the training
 provided by the licensed hospice; and

(v)

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

(9)

Orders Required for All Medications
. A home must not allow its
 staff to assist with, provide supervision of self-administered medications,
 including over-the-counter medications, unless there is a physician, advance
 practice registered nurse or physician assistant's order or individualized
 prescription bottle, specifying clear instructions for its use on file for the
 resident.

(10)

Timely
 Management of Medication Procurement
. The home 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 home must notify the physician of the unavailability of the
 prescription and request direction.

(11)

Storage of Medications
. 

(a)

 The home is accountable for having an
 effective system to manage the medications it receives including storing
 medications under lock and key, or other secure system to prevent unauthorized
 access, at all times, whether kept by a resident or kept by the home for the
 resident, except when required to be kept by a resident on his or her person
 due to need for frequent or emergency use, as determined by the resident's
 physician, advance practice registered nurse or physician assistant, or when
 closely attended by a staff member. 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 home to account for all
 inventory.

(b)

 Medication kept by a
 resident may be stored in the resident's bedroom, in a locked cabinet or other
 locked storage container. Single occupancy bedrooms which are kept locked at
 all times are acceptable. Duplicate keys for the resident's locked storage
 container and room must be available to the resident and the administrator,
 on-site manager or designated staff.

(c)

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

(d)

 A home may stock over-the-counter
 medications such as aspirin or acetaminophen for the convenience of residents
 who have PRN (as needed) orders for the specific medication and dosage.
 However, where the resident takes an over-the-counter medication daily as
 prescribed in a written order by a licensed physician, nurse practitioner or
 physicians assistant, such as vitamins or low-dose aspirins, the resident must
 have an individual bottle of the prescribed medication that is kept for the
 resident's individual usage.

(e)

 Unused or expired medications must be properly disposed of using the current
 U.S. Food and Drug Administration or U.S. Environmental Protection Agency
 guidelines for the specific medications.

(f)

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

Rule 111-8-62-.21 Nutrition

(1)

 A minimum of
 three regularly scheduled, well-balanced, meals must be provided seven days a
 week. There must be no more than 14 hours elapsing between the scheduled
 evening and morning meals. Meals must meet the general requirements for
 nutrition currently found in the Recommended Daily Diet Allowances, Food and
 Nutrition Board, National Academy of Sciences Meals must be of sufficient
 quantity, proper form, consistency and temperature. Food for at least one
 nutritious snack shall be available and offered each mid-afternoon and
 evening.

(2)

 Food received or used
 in a personal care home must be from satisfactory sources and must be clean,
 wholesome, free from spoilage, adulteration, and misbranding, and safe for
 human consumption.

(3)

 Properly Furnished Food Areas. 
A home must have a properly equipped
 kitchen with appropriate cabinets, drawers, holders and shelves or racks for
 storage of necessary equipment and utensils to prepare meals safely unless the
 home has arranged for meals to be obtained from a permitted food service
 establishment. The kitchen 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.

(4)

 Handling of Food. 
All foods
 while being stored, prepared and served must be protected from spoilage and
 contamination and be safe for human consumption. The home must ensure that
 staff does the following: 

(a)

 Store
 perishable foods properly, 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
 (e.g. pot, steam table) for serving at or above 140 degrees F. and that cold
 foods leave the kitchen for serving at or below 41 degrees F.

(5)

 A home serving 25 or more
 residents must possess a valid food service permit issued through the authority
 of the Department of Public Health or a copy of the valid food service permit
 of the caterer who provides meals to the residents.

(6)

 Catered Food Service. 
When
 the a home uses a catered food service (food service establishment), the home
 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.

(7)

 A home
 must maintain a three day supply of non-perishable food and water for emergency
 needs. 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)

 Menus must
 be written and posted 24 hours prior to serving the meal. Any change or
 substitution must be noted and considered as a part of the original menu.
 Alternatives to the food offered on the menu must be available to accommodate
 individual resident preferences.

(9)

 Homes must maintain records of all menus
 as served for 30 days after use.

(10)

 The person designated by the home 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.

(11)

 A home
 must arrange for special therapeutic diets as prescribed by the resident's
 physician, advance practice registered nurse of physicians assistant.

Rule 111-8-62-.22 Temperature Conditions

(1)

 The temperature throughout the home must
 be maintained by an adequate heating and cooling systems 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 home must not fall
 below 68 degrees during waking hours and 62 degrees F during sleeping hours.
 Mechanical cooling devices must be made available for use in those areas of the
 building used by residents when inside temperatures exceed 80 degrees F. No
 resident must be in any residence area that exceeds 85 degrees F.

(3)

 Where a power outage or mechanical
 failure impacting the ability of the home to maintain appropriate temperature
 ranges occurs, the home 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 home's emergency
 preparedness plan.

Rule 111-8-62-.23 Infection Control, Sanitation and Supplies

(1)

 The home 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.

(2)

 A home must provide hand-sanitizing
 agents or soap and water at the sinks, clean towels and toilet tissue at each
 commode.

(3)

 Hand washing
 facilities provided in both kitchen and bathroom areas must include hot and
 cold running water, soap, and clean towels.

(4)

 The home must have an effective infection
 control program which includes, at least 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.

(f)

 Providing notices as recommended by
 public health regarding outbreaks and infestation issues to residents, staff
 and any visitors. Homes licensed for twenty-five (25) or more beds must meet
 the notification requirements of the Rules and Regulations for Disaster
 Preparedness Plans, Chapter 111-8-16.

(5)

 The home 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,
 properly stored to prevent accidental ingestion but available for and properly
 used in the home to minimize the spread of infections.

(6)

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

(7)

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

(8)

 Homes licensed for twenty-five (25) or
 more beds must follow 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.

Rule 111-8-62-.24 Resident Files

(1)

 An individual resident file must be
 maintained by the administrator or on-site manager for each resident in the
 home. 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 copy to the Department, the resident or the resident's representative or
 legal surrogate, if any, upon request.

(2)

 Each resident file must include the
 following information:

(a)

 Identifying
 information including name, social security number, veteran status and number,
 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, (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.

(e)

 Date of discharge,
 facility or residence discharged to and telephone number.

(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 valuables entrusted to the home for safekeeping; a receipt for
 same shall be provided to the resident or representative or legal surrogate, if
 any, at the time of admission and at anytime thereafter when the resident
 acquires additional property and wishes to entrust such property to the home
 for safekeeping.

(i)

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

(j)

 An inventory of all personal items
 brought to the home by the resident to be updated at anytime after admission if
 a resident or representative or legal surrogate, if any, submits to the home 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 health care if executed prior to 2007 or a copy of the
 Georgia advance directive for health care and a physician's order for
 life-sustaining treatment, if any. At least the advance directive for health
 care form must be made available at the time of admission and shall remain
 available to the resident.

(o)

 A
 copy of the resident's written waiver of the personal needs allowance charge
 pursuant to the provisions of Rule

(p)

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

(q)

 All
 individual written care plans required by these rules and the rules for proxy
 caregivers, Chapter 111-8-100 if applicable. 

(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 home or not, the performance
 of identified health maintenance activities.

(s)

 A copy of the search results obtained
 from the National Sex Offender Registry website maintained through the
 Department of Justice and any resulting safety plan for residents, staff and
 visitors.

(3)

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

(a)

 Spiritual preference
 e.g., church membership, name and telephone number of minister, priest, rabbi,
 or imam.

(b)

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

(4)

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

Rule 111-8-62-.25 Supporting Residents' Rights

(1)

 The home 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)

 Each resident must receive care, and
 services which must be adequate, appropriate, and in compliance with applicable
 federal and state law and regulations.

(b)

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

(c)

 Each
 resident must have the right to: 

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 home and to participate fully in the life of the
 community.

4.

 Make choices about
 aspects of his or her life in the home that are significant to the
 resident.

(d)

 Each
 resident must have the right to enjoy privacy in his or her room; home
 personnel 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)

 Each
 resident must be treated with dignity, kindness, consideration and respect and
 be given privacy in the provision of personal care. Each resident must be
 accorded privacy and freedom for the use of bathrooms at all hours.

(g)

 No religious or spiritual belief or
 practice may 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.

(h)

 Each resident has the right to be free
 from mental, verbal, sexual and physical abuse, neglect and exploitation. 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 and interference with the daily functions of living, such as
 eating or sleeping.

(i)

 Each
 resident has 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 has the right to reasonable safeguards
 for the protection and security of his or her personal property and possessions
 brought into the home.

(j)

 Each
 resident's mail must be delivered unopened to the resident on the day it is
 delivered to the home. Each resident's outgoing correspondence may not be
 opened or tampered with prior to being mailed or otherwise delivered.

(k)

 Each resident must have access to a
 telephone 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.

(l)

 Each home 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 has the right to refuse to see visitors or terminate
 any visit.

(m)

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

(n)

 Each
 resident has 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 home
 unless waived by the resident. 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 home ordinarily supplies, and must in no way relieve the
 home of the obligation to insure that such necessary goods are available to the
 resident.

(o)

 Each
 resident has the right to receive or reject medical care, dental care, or other
 services except as required by law or regulations.

(p)

 Each resident has the right to choose and
 retain the services of a personal physician and any other health care
 professional or service. No home 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, has the
 right to be fully informed about care and of any changes in that care and the
 right of access to all information in medical records retained in the
 home.

(q)

 Each resident has the
 right to fully participate in the planning of his or her care. Case discussion,
 consultation and examination shall 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.

(r)

 Each resident has
 the right to inspect his or her records on request. Each resident has the right
 to make a copy of all records pertaining to the resident. Each resident has the
 right to confidential treatment of personal information in the resident
 file.

(s)

 Each resident who has not
 been committed to the home 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 notification to
 the home in conformance with the home's policies and procedures.

(t)

 Each resident has 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 must be
 posted in a common area of the home.

(u)

 Residents have the right to form a
 Resident Council and have meetings in the home outside the presence of owners,
 management or staff members of the home.

(v)

 Each resident has the right to file a
 complaint with the Department concerning care being provided in the home that
 violates these rules. The home must post the name of the Department and the
 address and telephone number where licensing complaints are received in the
 common area of the home.

(2)

 Each resident must be provided, at the
 time of admission to the home, with a copy of the Resident's Bill of Rights, as
 provided in Rule
 which 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 special steps to assure communication of its contents to the
 resident.

(3)

 A personal care home
 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.

Rule 111-8-62-.26 Procedures for Change in Resident Condition

(1)

 In case of an accident or sudden adverse
 change in a resident's physical condition or emotional adjustment, a home must
 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 home must retain a record of all such accidents or sudden adverse
 changes and the home's response in the resident's files.

(2)

 Where the sudden change in the resident's
 condition causes the resident to experience cardiac or respiratory arrest, the
 home 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 home must contact the
 hospice for directions regarding the care to be provided. If the hospice staff
 is not available to provide direction, then home must immediately contact the
 duly-appointed health care agent for direction. If no health care agent has
 been appointed or is not available and if no Do Not Resuscitate (DNR) order has
 been written, then the home must initiate cardiopulmonary resuscitation
 immediately and must contact emergency medical services immediately to arrange
 for emergency transport.

(b)

 If the
 resident has a valid DNR order, 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 home 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
 home must initiate cardiopulmonary resuscitation immediately and contact
 emergency medical services to arrange for emergency transport.

(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 home must immediately 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) that such efforts would be
 futile and there is not a physician, or authorized registered nurse or
 physician assistant on site to assess and provide other direction and contact
 emergency medical services immediately to arrange for emergency
 transport.

(3)

 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 home and when residents are being transported by the
 home for any reason.

(4)

 An
 immediate investigation of the circumstances associated with an accident or
 injury involving a resident must be initiated by the administrator or on-site
 manager of the home. Additionally, a report of the occurrence of the accident
 or injury must be made to the representative or legal surrogate, if any, with a
 copy of the notification report maintained in the resident's file. The complete
 investigative review concerning the circumstances, cause of the incident and
 opportunities identified to improve care, must be retained in a central file
 for quality assurance/peer review.

(5)

 In the event a resident develops a
 significant change in physical or mental condition, the governing body must
 provide to the Department, upon request, a current physical examination report
 from a physician, nurse practitioner or physician assistant, indicating the
 resident's continued ability to meet the resident retention requirements in
 these rules.

Rule 111-8-62-.27 Death of a Resident

(1)

 Should a resident die while in the home,
 the administrator, on-site manager or responsible staff person must immediately
 notify the resident's physician, the next of kin, and the representative or
 legal surrogate, as applicable. Statutes applicable to the reporting of sudden
 or unexpected death and reports which must accompany the deceased must be
 followed.

(2)

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

Rule 111-8-62-.28 Immediate Transfer of Residents

(1)

 The administrator or on-site manager of
 the home must initiate immediate transfer if the resident develops a physical
 or mental condition requiring continuous medical care or nursing care or if a
 resident's continuing behavior or condition directly and substantially
 threatens the health, safety and welfare of the resident or any other
 resident.

(2)

 In the event such
 immediate transfer is required, the administrator or on-site manager of the
 home must advise both the resident and the resident's representative or legal
 surrogate and case manager, if any, and immediate arrangements must be made
 based on the written admission agreement to transfer such resident to an
 appropriate facility. The administrator or on-site manager must document in the
 resident's file the reasons for the transfer.

(3)

 Where immediate transfer is to be made
 pursuant to paragraphs (1) and (2), the administrator or on-site manager must
 make arrangements for transfer in accordance with the admission agreement and
 shall transfer the resident to an appropriate facility where the resident's
 needs can be met. Prior to making such transfer, the administrator or on-site
 manager must: 

(a)

 Inform the resident and
 representative or legal surrogate and case manager, 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 facility 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 transferred.

(e)

 Provide a copy of the resident file to
 the receiving facility within 24 hours of transfer.

(f)

 Document in the resident's file the
 following:

1.

 The reason for the immediate
 transfer.

2.

 The manner in which
 the resident and the representative or legal surrogate, if any, were informed
 pursuant to this paragraph.

3.

 The
 name, address, and telephone number of the place to which the resident is to be
 transferred or discharged.

(4)

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

Rule 111-8-62-.29 Discharge or Transfer of Residents

(1)

 The administrator or on-site manager must
 contact the representative or legal surrogate, if any, when there is need for
 discharge or transfer of a resident. The home 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 home or who no longer choose to live in the home must be
 discharged or transferred to an appropriate facility based on discharge and
 transfer procedures entered into at the time of admission. Where the resident
 is incapable of making informed decisions and there is no representative or
 legal surrogate or the representative or legal surrogate is unwilling to act,
 the administrator or on-site manager must petition the probate court in the
 county where the home is located for an order authorizing the discharge or
 transfer. The transferring home must provide a copy of the resident's 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, the Department may require the home 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 home is permissible.

(4)

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

Rule 111-8-62-.30 Reporting

(1)

 The staff of
 the personal care home must call the local police department to report the
 elopement of any resident from the home within 30 minutes of the staff
 receiving actual knowledge that such person is missing from the home in
 accordance with the Mattie's Call Act and the requirements set forth in
 O.C.G.A. § 
35-3-170
et seq.
 
The home must also report the initiation and discontinuation of a
 Mattie's call to the Department utilizing the complaint intake system within 30
 minutes of communications with local law enforcement authorities having
 occurred.

(2)

 The personal care
 home must report a serious incident using the complaint intake system and
 location designated by the Department within 24 hours following the occurrence
 of a serious incident or the home's learning that a serious incident involving
 a resident may have occurred. The serious incidents that must be reported to
 the Department include the following:

(a)

 Any
 accidental or unanticipated death of a resident not directly related to the
 natural course of the resident's underlying medical condition.

(b)

 Any serious injury to a resident that
 requires medical treatment.

(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.

(e)

 Any
 circumstances where a member of the governing body, administration, staff
 associated with or affiliated with the personal care home, or family member of
 staff becomes associated with an account at a financial institution, will,
 trust, benefit of substantial value or life insurance policy of a resident or
 former resident to verify that such gift is knowingly and voluntarily made and
 not the result of any coercion.

(f)

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

(3)

 The
 incident report, submitted through the home's peer review process will be
 received by the Department in confidence and must include at least: 

(a)

 The name of the personal care home and
 the name of the administrator or site manager.

(b)

 The date of the incident and the date the
 personal care home became aware of the incident.

(c)

 The type of incident suspected, with a
 brief description of the incident.

(d)

 Any subsequent remedial and quality
 measures determined through peer review to be taken by the personal care home
 to make such injury or harm arising from the particular incident less likely to
 recur.

(4)

 Where the
 Department determines that a rule violation related to the reported 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 personal care home or an independent source is subject to
 disclosure in accordance with applicable laws.

Rule 111-8-62-.31 Deemed Status

The Department may accept the certification or accreditation
 of a home 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 111-8-62-.32 Variance and Waiver

(1)

 The Department may, in its discretion,
 grant variances and waivers of specific rules upon application or petition
 filed on forms provided by the Department. The Department may establish
 conditions which must be met by the home 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 home to support its application for a variance or
 waiver.

(b)

Waiver.
 
The Department, in its discretion, 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 home may request a final review of
 the initial waiver or variance decision made by program staff to the chief of
 the division by filing a written request for review of the initial decision and
 providing any additional written information which supports the request for
 review. The chief of the division will issue a final decision on behalf of the
 Department. Where the governing body believes that the Department has abused
 its discretion in acting upon the waiver or variance request, it may seek
 appropriate relief.

(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 111-8-62-.33 Enforcement and Penalties

A home 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 as applicable 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 111-8-62-.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 111-8-62-.01 Authority
Rule 111-8-62-.02 Purposes
Rule 111-8-62-.03 Definitions
Rule 111-8-62-.04 Applicability of Rules and Exemptions
Rule 111-8-62-.05 Application for Permit
Rule 111-8-62-.06 Permits
Rule 111-8-62-.07 Governing Body
Rule 111-8-62-.08 Administration
Rule 111-8-62-.09 Workforce Qualifications and Training
Rule 111-8-62-.10 Staffing
Rule 111-8-62-.11 Home Accountability and Inspections
Rule 111-8-62-.12 Home Design Requirements
Rule 111-8-62-.13 Physical Plant Health and Safety Standards
Rule 111-8-62-.14 Furnishings and Fixtures
Rule 111-8-62-.15 Admission
Rule 111-8-62-.16 Admission Agreement
Rule 111-8-62-.17 Services
Rule 111-8-62-.18 Precautions for Residents at Risk of Elopement
Rule 111-8-62-.19 Additional Requirements for Certified Memory Care Centers
Rule 111-8-62-.20 Medications
Rule 111-8-62-.21 Nutrition
Rule 111-8-62-.22 Temperature Conditions
Rule 111-8-62-.23 Infection Control, Sanitation and Supplies
Rule 111-8-62-.24 Resident Files
Rule 111-8-62-.25 Supporting Residents' Rights
Rule 111-8-62-.26 Procedures for Change in Resident Condition
Rule 111-8-62-.27 Death of a Resident
Rule 111-8-62-.28 Immediate Transfer of Residents
Rule 111-8-62-.29 Discharge or Transfer of Residents
Rule 111-8-62-.30 Reporting
Rule 111-8-62-.31 Deemed Status
Rule 111-8-62-.32 Variance and Waiver
Rule 111-8-62-.33 Enforcement and Penalties
Rule 111-8-62-.34 Severability

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