This Hawaii regulation establishes minimum licensing standards for Adult Residential Care Homes (ARCH) and Expanded ARCHs, which provide 24-hour residential care to adults who need assistance with activities of daily living but do not require skilled nursing or acute care. It covers application and licensing procedures, operational policies, staffing and caregiver qualifications, resident rights, inspection requirements, waivers, and enforcement. Operators must obtain a license from the Hawaii Department of Health, maintain a qualified primary care giver on-site at all times, and comply with ongoing inspection and reporting requirements.
View official sourceDEPARTMENT OF HEALTH
Repeal of Chapter 11-100, "Adult Residential Care Hornes" and
11-101 "Extended Care Adult Residential Care Horne"
and the
Adoption of Chapter 11-100.1, "Adult Residential Care Homes",
Hawaii Administrative Rules
July 24, 2006
Summary
1. Chapter 11-100, Hawaii Administrative Rules, entitled
"Adult Residential Care Homes", is repealed.
2. Chapter 11-101, Hawaii Administrative Rules, entitled
"Extended Care Adult Residential Care Horne", is repealed.
3. Chapter 11-100.1, Hawaii Administrative Rules, entitled
"Adult Residential Care Hornes", is adopted.
,2 7 1 9
HAWAII ADMINISTRATIVE RULES
TITLE 11
DEPARTMENT OF HEALTH
CHAPTER 100.1
ADULT RESIDENTIAL CARE HOMES
Subchapter 1 General Requirements
§11-100.1-1
§11-100.1-2
§11-100.1-3
§11-100.1-4
§11-100.1-5
§11-100.1-6
§11-100.1-7
Purpose
Definitions
Licensing
Waiver
Existing category 3 facilities
Licensing fees
General operational policies
Subchapter 2 Type I ARCH
§11-100.1-8
§11-100.1-9
§11-100.1-10
§11-100.1-11
§11-100.1-12
§11-100.1-13
§11-100.1-14
§11-100.1-15
§11-100.1-16
§11-100.1-17
§11-100.1-18
'§11-100 .1-19
§11-100.1-20
§11-100.1-21
§11-100.1-22
§11-100.1-23
§§11-100.1-24
Primary care giver qualifications
Personnel, staffing and family
requirements
Admission policies
Activities of daily living
Emergency care of residents and disaster
preparedness
Nutrition
Food sanitation
Medications
Personal care services
Records and reports
Recreational, rehabilitative programs,
and social services
Resident accounts
Resident health care standards
Residents' and primary care givers'
rights and responsibilities
Transfer and discharge of residents
Physical environment
to 11-100.1-50 Reserved
Subchapter 3 Type II ARCH
§11-100.1-51
§11-100.1-52
Applicability
Primary care giver requirements
100.1-1
2 7 1 9
§11-100.1-53
§11-100.1-54
§11-100.1-55
§11-100.1-56
§§11-100.1-57
Personnel and staffing requirements
General operating policies
Nutrition and food sanitation
Physical environment
to 11-100.1-77 Reserved
Subchapter 4 Expanded ARCH
§11-100.1-78
§11-100.1-79
§11-100.1-80
§11-100.1-81
§11-100.1-82
§11-100.1-83
§11-100.1-84
§11-100.1-85
§11-100.1-86
§11-100.1-87
§11-100.1-88
§11-100.1-89
§11-100.1-90
Applicability
Purpose
Licensing
Minimum structural requirements
Primary care giver requirements
Personnel and staffing requirements
Admission requirements
Transfer and discharge of expanded ARCH
residents
Fire safety
Personal care services
Case management qualifications and
services
Medications
Expanded ARCH resident's rights
Subchapter 5 Professional Misconduct
§11-100.1-91 Professional misconduct
Subchapter 6 Administrative Enforcement
§11-100.1-92
§11-100.1-93
§11-100.1-94
§11-100.1-95
§11-100.1-96
Enforcement
Emergency procedures
Penalties
Severability
Transition
'Historical Note: Chapter 11-100.1 is based
substantially upon chapters 11-100 and 11-101.
[Eff R SEP 182006 J
100.1-2
2 7 1 9
§11-100.1-1
Subchapter 1
General Requirements
§11-100.1-1 Purpose. This chapter establishes
minimum standards and requirements for the licensure of
adult residential care homes (ARCH) and expanded ARCHs
in order to protect the health, safety, welfare and
civil rights of the residents residing in the ARCH and
expanded ARCH. Services shall be provided in a
cooperative manner with the intent to promote the
dignity and choice of the resident in a home-like
environment. The rules are not intended to intrude on
the privacy or infringe on the desire of individuals to
provide care or services to another in their own home,
but where such services are provided for a fee, the
department reserves the right to ensure compliance with
this chapter. [Eff si:-e lQ?QOn ] (Auth: HRS
§§321-9, 321-10, 321-11, Y21-!5.62) (Imp: HRS §§321-10,
321-11, 321-15.6)
§11-100.1-2 Definitions. As used in this
chapter:
"Abuse" means the willful infliction of injury,
unreasonable confinement, intimidation, or punishment
with resulting physical harm or pain or mental anguish,
or deprivation by an individual, including a caregiver,
of goods or services that are necessary to attain or
maintain physical, mental and psychosocial well-being.
This presumes that instances of abuse of all residents,
even those in a coma, cause physical harm, or pain or
mental anguish.
"Activities of daily living", or "ADL" means basic
services required to be provided by the facility for
benefit of residents in order to obtain and maintain a
·license and shall include, but not be limited to, the
following: personal care, shelter, protection,
supervision, assistance, guidance or training, planned
activities, food service, laundering of personal
clothing, recognition of and provision for changes in
health status, and arrangement for and transportation
to medical and dental offices.
"Adult residential care home", or "ARCH" means any
facility providing twenty four hour living
accommodations, for a fee, to adults unrelated to the
family, who require at least minimal assistance in the
activities of daily living, personal care services,
100.1-3
2 7 1 9
§11-100.1-2
protection, and health care services, but who do not
need the professional health services of an
intermediate, skilled nursing, or acute care facility.
It does not include facilities operated by the federal
government. There shall be two types of ARCHs:
(1) Type I home for five or less residents; and
(2) Type II home for six or more residents.
"Advanced directive" means a written or oral
declaration made by a competent adult, instructing his
or her physician to provide, withhold, or withdraw
life-sustaining procedures under certain conditions
such as a terminal condition or where the resident has
a permanent loss of ability to communicate with others
due to irreversible brain injury or coma. (An advanced
directive is often referred to as a living will.)
"Advanced practice registered nurse", or "APRN"
means a registered nurse who is licensed pursuant to
chapter 457, HRS.
"Ambulatory" means the ability to move on foot
from place to place without human assistance.
"ARCH resident" means a person unrelated to the
primary care giver and licensee who resides in an ARCH.
Individuals residing in an ARCH require minimal
assistance in the activities of daily living, and do
not need assistance from skilled, professional
personnel on a regular long-term basis.
"Assistive devices" means a physical or mechanical
apparatus or equipment required by an individual for
ambulation or mobility.
"Cardiopulmonary resuscitation certification", or
"CPR certification" means verification that an
individual has satisfactorily completed a course
provided by a nationally approved source that contains
instruction and required participation in an emergency
first aid procedure that consists of opening
and maintaining a resident's airway, providing
~rtificial ventilation by means of rescue breathing,
and providing artificial circulation by means of
external cardiac compression.
"Care plan" means a written plan developed by the
resident, resident"s family, legal guardian or
surrogate, case manager, staff of the ARCH or expanded
ARCH, and resident's physician or APRN that articulates
the overall plan of care to be provided to the resident
by the ARCH or expanded ARCH with the purpose of
achieving the optimal level of function of the
resident.
"Case manager" (as it applies to an expanded ARCH)
100.1-4
2 7 1 9
§11-100.1-2
means an individual other than the licensee or staff of
the expanded ARCH who is licensed in the state as a
registered nurse or social worker and possesses the
skills and knowledge required to deal with the long
term care needs of the geriatric population. This
individual shall have the ability to plan, locate,
coordinate, and monitor comprehensive services to meet
the individual resident's needs based on a
comprehensive assessment of the resident.
"Category 3 adult residential care home" means an
ARCH which was established and licensed prior to 1986,
and was providing only room and board services to
individuals that did not require twenty four hour
supervision and personal care services, and whose
licensee does not meet requirements as set forth in
section 11-100.1-8.
"Chemical restraint" means a psychopharmacologic
drug that is used for discipline or convenience and not
required to treat medical symptoms.
"Comprehensive assessment" means an evaluation
which includes, but is not limited to, medically
defined conditions and prior medical history, medical
status measurement, physical and mental functional
status, sensory and physical impairments, nutritional
status and requirements, special treatments or
procedures, mental psychosocial status, discharge
potential, dental condition, activities potential,
cognitive status and drug therapy.
"Convenience" means any action taken by the
licensee or care giver to control resident behavior or
maintain residents with a lesser amount of effort by
the licensee or care giver and not in the resident's
best interest.
"Day care client" means any person who does not
reside in the ARCH or expanded ARCH and requires
temporary supervision during the hours that the
·person's care giver, outside of the ARCH or expanded
ARCH, is unavailable. This person requires minimal
assistance in the activities of daily living and does
not need the professional health services of an
intermediate, skilled nursing, or acute care facility.
This person does not stay overnight in the ARCH or
expanded ARCH but shall be characterized as a resident
for purposes of an ARCH's or expanded ARCH's licensed
capacity.
"Department" means the department of health, State
of Hawaii.
"DHS" means the department of human services,
100.1-5
§11-100.1-2
State of Hawaii.
"Dietitian" means a person who is registered by
the Commission on Dietetics Registration of the
American Dietetic Association or is eligible for such
registration. "Director" means the director of heal th,
State of Hawaii or designee.
"Discipline" means any action taken by the
licensee or care giver for the purpose of punishing or
penalizing residents.
"Emergency" means an event or incident occurring
while an ARCH or expanded ARCH resident is under the
care of a primary care giver or ARCH or expanded ARCH
licensee, whereby a resident experiences physical or
mental changes which necessitate care or services which
cannot be provided by the ARCH or expanded ARCH.
"Expanded ARCH" means any facility providing
twenty four hour living accommodations, for a fee, to
adults unrelated to the family, who require at least
minimal assistance in the activities of daily living,
personal care services, protection, and health care
services, and who may need the professional health
services provided in an intermediate care facility or
skilled nursing facility. There shall be two types of
expanded ARCHs:
(1) Type I home shall consist of five or less
residents with no more than two nursing
facility level residents; provided that more
nursing facility level residents may be
allowed at the discretion of the department;
and
(2) Type II home shall consist of six or more
residents with no more than twenty per cent
of the home's licensed capacity as nursing
facility level residents, provided that more
nursing facility level residents may be
allowed at the discretion of the department;
provided further that the department shall
exercise its discretion for a resident
presently residing in a Type I or Type II
home to allow the resident to remain as an
additional nursing facility resident based
upon the best interest of the resident. The
best interest of the resident shall be
determined by the department after
consultation with the resident, the
resident's family, primary physician, case
manager, primary care giver and home
100.1-6
2 7 1 9
§11-100.1-2
operator.
"Expanded ARCH resident" means a person that meets
the requirements of section 321-15.6l(a).
"Fire Safety Evaluation System rating", or "FSES"
means an assessment conducted by a Life Safety
Consultant to ensure compliance with the prescriptive
code requirements of the National Fire Protection
Association (NFPA) 101 life safety codes.
"First aid certification" means verification that
an individual has successfully completed a course that
provides instruction on basic first aid principles,
including but not limited to rescue breathing
procedures.
"Fully ambulatory" means the ability to move on
foot from place to place without the use of any
mechanical device and/or human assistance.
"Home health agency" means a licensed public or
proprietary agency, a private nonprofit organization,
or a subdivision of such agency or organization which
is primarily engaged in providing direct or indirect
skilled nursing services and other therapeutic services
under a physician's direction to homebound patients on
a part-time or intermittent basis (in a place used as
the individual's home). A homebound patient is a
person who, because of a condition due to illness or
injury, has a restricted ability to leave the place of
residence except with the aid of supportive devices
including but not limited to, crutches, canes,
wheelchairs, walkers, special transportation, or with
the assistance of another person; or a person who has a
condition which is such that leaving home is medically
contraindicated.
"Infection control" means procedures established
for the identification, prevention and control of
infections.
"Interim care plan" means a care plan developed by
·a registered nurse for an expanded ARCH resident within
forty-eight hours of the expanded ARCH resident's
admission to an expanded ARCH. The interim care plan
shall identify the immediate needs of the expanded ARCH
resident and shall be based on information, including
but not limited to physician or APRN progress notes,
the hospital discharge summary, and the emergency room
discharge. The interim care plan shall provide
sufficient information to the licensee or primary care
giver and shall set forth a plan to meet the immediate
needs of the resident until a comprehensive care plan
can be developed within seven days of the expanded ARCH
100.1-7
2 7 1 9
§11-100.1-2
resident's admission to the expanded ARCH.
"Intermediate care facility", or "ICF" means a
facility which provides appropriate care to persons:
(1) Referred by a physician;
(2) Who need twenty four hour a day assistance
with the activities of daily living;
(3) Who need care provided by licensed nursing
and paramedical personnel on a regular, long
term basis; and
(4) Who do not need twenty four hour a day
skilled nursing care.
"Licensee" means the person, group of persons, or
entity that holds the license to operate an ARCH or
expanded ARCH and who is responsible for the
supervision of the ARCH or expanded ARCH and the
residents therein.
"Licensed capacity" means the number of residents
and the type of residents permitted by the director,
pursuant to these rules and chapter 321, HRS, in a
particular ARCH or expanded ARCH, and so stated on the
particular ARCH's or expanded ARCH'S license.
"Licensed nurse" means a person who is either a
licensed practical nurse or a registered professional
nurse.
"Licensed practical nurse", or "LPN" means a
person who is licensed as a practical nurse pursuant to
chapter 457, HRS.
"Life safety consultant" means an individual who
has experience in conducting fire or life safety
inspections of facilities utilizing county and national
fire codes and standards.
·"Minimal assistance in activities of daily living"
means the provision of services including but not
limitetj to, stand-by assistance, set up, verbal cues or
prompting, and visual supervision.
"National Fire Protection Association", or "NFPA"
-means the association that publishes the national fire
codes.
"Neglect" means failure to provide goods and
services necessary to avoid physical harm, mental
anguish or mental illness, with complete disregard for
negative consequences or negative resident outcome
which may arise.
"Nurse aide" means a person who performs a variety
of duties relating to patients and patient care under
the supervision of a nurse, including but not limited
to assisting patients in all activities of daily
living. A nurse aide may also assist a nurse by
100.1-8
2 7 1 9
§11-100.1-2
changing bed linens, delivering messages, and
sterilizing instruments, serving and collecting food
trays, and helping patients get out of bed, bathe, and
dress.
"Nursing facility level of care" means the level
of care provided at skilled nursing facilities or at
intermediate care facilities.
"Occupational therapist" means a person who is
currently registered or eligible for registration by
the American Occupational Therapy Association, and who
meets the qualifications under chapter 457G, HRS.
"Personal care services" means daily personal
attention and care, including but not limited to skin,
nails, hair, teeth, and oral hygiene in addition to any
therapeutic regimen ordered by the resident's physician
or APRN.
"Physical restraint" means any manual method or
physical or mechanical device, material, or equipment
attached or adjacent to the resident's body that the
individual cannot remove easily which restricts freedom
of movement or normal access to one's body.
"Physical therapist" means a person who is
licensed as a physical therapist under chapter 461J,
HRS.
"Physician" means a person who is licensed to
practice medicine or osteopathy under chapters 453 or
460, HRS.
"Plan of correction" means a plan developed by the
licensee to address deficiencies in the operation of an
ARCH or expanded ARCH as detected by the department
pursuant to an inspection and/or complaint
investigation that shall include preventive measures to
ensure compliance with this chapter and chapter 321,
HRS, and the time frame in which these corrections
shall take place.
"Primary care giver" means the licensee or the
,individual designated as the primary care giver by the
licensee pursuant to section 11-100.1-8.
"Provisional licensure" means a temporary license
issued by the department that allows the licensee
additional time to correct deficiencies without putting
the immediate health, welfare and safety of residents
at risk.
"Registered professional nurse" means a person who
is licensed as a registered nurse under chapter 457,
HRS.
"Regular business hours" means the hours between
7:45 a.m and 4:30 p.m., Monday to Friday, inclusive,
100.1-9
2 7 9
§11-100.1-2
except for state holidays.
"Representative payee" means an individual who
meets the requirements of the Social Security
Administration to receive a Social Security payment on
behalf of a resident of an ARCH or expanded ARCH
pursuant to 42 U.S.C. §1605.
"Resident of a category 3 ARCH" means a person
unrelated to the primary care giver who resides in the
category 3 ARCH, for a fee, and requires room and board
which includes a place to sleep, the preparation of
meals and laundering of personal clothing. These
residents do not require assistance with activities of
daily living, and when such care is required, the
resident shall be transferred to an appropriate
facility.
"Responsible agency" means any public or private
agency that has responsibility for the health, welfare,
or financial support of the resident.
"Self preservation" means the ability of an ARCH
or expanded ARCH resident to ambulate without physical
assistance, and the ability of the resident to follow
directions and take appropriate action in exiting an
ARCH or expanded ARCH in the, event of an emergency.
"Skilled nursing" means care and services provided
by a licensed nurse.
"Skilled nursing facility", or "SNF" means a
health facility which provides skilled nursing and
related services to residents who require medical or
nursing care, or rehabilitation services, including but
not limited to physical therapy, occupational therapy
and speech therapy services.
"Social model of care" means the provision of care
that promotes the individuality, dignity, choice,
independence, and privacy of an ARCH or expanded ARCH
resident in a home-like atmosphere and that provides
·for the inclusion of the resident, the resident's
family, and resident's surrogate in the development of
the resident's schedule of activities and/or care plan
and in all decision-making affecting the resident.
"Social worker" means a person licensed as a
social worker pursuant to chapter 467E, HRS.
"Special diet" means a diet ordered by a physician
or APRN that is prescribed as part of the medical
nutrition therapy of an ARCH or expanded ARCH resident.
"Specialized care" means any care that is
identified in the care plan that requires training and
monitoring by a registered nurse.
100.1-10
2 7 1 9
§11-100.1-2
"Staff" means a nurse aide[,] who works in a Type
II ARCH, and performs a variety of duties for residents
under the supervision of a registered nurse.
"Standard precautions" means guidelines developed
by the Center for Disease Control (CDC) which are
designed to reduce the risk of transmission of blood
borne and other pathogens from both recognized and
unrecognized sources of infection, including
recommendations to prevent cross contamination between
residents.
"Substitute care giver" means an adult who is
authorized by the licensee or primary care giver to
temporarily take charge of an ARCH or expanded ARCH
while the licensee or primary care giver is absent and
who possesses the requirements as specified in section
ll-100.l-9(a) through (e) as applicable.
"Surrogate" means an individual, other than an
ARCH or expanded ARCH resident's agent or guardian,
authorized under chapter 327E, HRS, to make a health
care decision for the resident.
"Type I ARCH" means a facility which is licensed
for a capacity not to exceed five residents.
"Type II ARCH" means a facility which is licensed
for a capacity of six or more residents.
"Tuberculosis clearance" means a negative
tuberculin skin test or chest x-ray, which indicates
freedom from any infectious or communicable disease.
"Waiver" means an exemption to a rule.
Whenever the singular is u~ \ng~OO{f chapter it
can include the plural. [Eff ] (Auth:
HRS § § 3 2 1- 9 , 3 2 1-10 , 3 2 1-11 , 3 2 1-13 , 3 21-15 . 6 , 3 2 1-
15.62) (Imp: HRS §§26-13, 321-9, 321-10, 321-11, 321-
15. 6)
§11-100.1-3 Licensing. (a) No person, group of
·persons, or entity shall operate an ARCH or expanded
ARCH without a license previously obtained under and in
compliance with this chapter and chapter 321, HRS.
(1) Any person, group of persons, or entity
desiring to operate an ARCH or expanded ARCH
shall apply to the department for a license
on forms furnished by the department. The
department shall issue a license if the
applicant and home meet the requirements in
this chapter;
100.1-11
§ll-100.1-3
(2) A license, when granted, shall be in force
for one year, or such other interval of time
as may be determined by the department and
shall expire at the end of that time unless
renewed or extended by the department;
(3) Each license shall be issued to a person,
group of persons, or entity by name, for a
specific physical facility; any change in
licensee requires that the department be
notified in order for the department to make
a determination as to whether or not a new
license shall be issued. The license shall
not be transferred under any circumstances.
A separate license must be secured for each
ARCH or expanded ARCH by submitting an
application and obtaining department
approval;
(4) The license issued by the department shall be
posted in a conspicuous place visible to the
public, on the premises of the ARCH or
expanded ARCH;
(S) No more than three day care clients shall be
allowed in an ARCH or expanded ARCH at any
given time as set forth in chapter 17-1424,
Hawaii Administrative Rules;
(6) Each ARCH or expanded ARCH must have a
primary care giver who is present at the ARCH
at all times, unless the primary care giver
has secured a substitute care giver to
temporarily provide care to the ARCH or
expanded ARCH residents;
(7) The primary care giver shall not have
activities outside of the ARCH or expanded
ARCH, or other responsibilities sufficiently
demanding of his/her time and energy that
they would interfere with the proper and
adequate care of the residents; and
(8) In the event that the primary care giver will
be unable to perform his/her duties under
this chapter due to his/her anticipated
departure from the ARCH or expanded ARCH, the
licensee shall ensure that a person qualified
under section 11-100.1-8 assumes the duties
of the primary care giver prior to the
primary care giver's departure from the ARCH
or expanded ARCH. The department shall be
notified of the change in primary care giver
prior to the departure.
100.1-12
27 9
§11-100.1-3
(b) Application.
(1) In order to obtain a license, the applicant
shall apply to the director upon forms
provided by the department and shall provide
any information required by the department to
demonstrate that the applicant and the ARCH
or expanded ARCH have met all of the
requirements of this chapter. The following
shall accompany the application:
(A) Documented compliance with current
county building and zoning codes;
(B) Documented compliance with current fire
code requirements;
(C) Documented clearance by sanitation
branch of the department of health;
(D) Documented clearance by wastewater
branch of the department of health;
(E) Building plans indicating accurate
measurements to scale of the entire
home;
(F) A written approval to operate an ARCH or
expanded ARCH from the owner of the
property if the home is rented, leased
or on leased land;
(G) Disclosure of ownership or control of
the ARCH or expanded ARCH, and a
projected annual budget showing the
ARCH'S or expanded ARCH'S expected
income and expenditures based on an
estimated sixty percent occupancy rate.
The financial resources of the owner
shall be sufficient to operate the ARCH
or expanded ARCH according to standards
set forth in this chapter. The owner
shall provide upon request evidence as
deemed necessary by the licensing agency
to establish that fact;
(H) Current written policies covering the
ARCH'S or expanded ARCH'S proposed
staffing, visiting hours, emergency
plans, access to records, and any other
written policies required by this
chapter for the type of residents
proposed to be admitted;
100.1-13
§11-100.1-3
(I) Documented evidence stating that the
licensee, primary care giver, family
members living in the ARCH or expanded
ARCH that have access to the ARCH or
expanded ARCH, and substitute care
givers have no prior felony or abuse
convictions in a court of law;
(J) Such other information as the department
may reasonably require for the purposes
of this chapter.
(2) Maximum time period for processing of a
complete license application:
(A) The department shall grant or deny an
application and inform the applicant of
its decision within sixty days of
receipt of a complete application.
Applications which do not provide all
requirements specified in section ll-
100.l-3(b)(l) shall be deemed
incomplete and returned to the
applicant;
(B) If the department does not grant a
license or deny an application within
sixty days of receipt of the complete
application, the application for
issuance of a license will be deemed
approved on the sixty first day. After
the expiration of the sixty days, the
department shall issue the license
within a month;
(C) Notwithstanding the requirements of
paragraph (A), the maximum period of
time of sixty days shall be extended
indefinitely in the event of a national
disaster, state emergency, or union
strike, which would prevent the
applicant, the agency, or the department
from fulfilling application or review
requirements in a timely manner;
(c) Denial of licensure. An application for an
ARCH or expanded ARCH license may be denied for reasons
which include but are not limited to the following:
(1) Failure of the applicant to comply with this
chapter or chapter 321, HRS;
(2) Failure of the applicant to provide evidence
of and possess financial capability to
operate the ARCH or expanded ARCH pursuant to
this chapter;
100.1-14
2 7
§11-100.1-3
(3) Fraudulent representation or
misrepresentation of facts by the applicant;
and
(4) Failure of the applicant to provide a
satisfactory work history of patient care
that would include confirmation that the
applicant never abused, neglected or
exploited a resident.
(d) Closure.
(1) The licensee shall notify the department in
writing at least thirty days prior to an
intended closure of an ARCH or expanded ARCH;
(2) The licensee shall notify all residents,
guardians, and other responsible agencies, at
least thirty days prior to an intended
closure of an ARCH or expanded ARCH; and
(3) All residents shall be transferred to
appropriate licensed facilities prior to
closure.
(e) Inspections.
(1) All ARCHs and expanded ARCHs shall be
licensed to ensure the health, safety, and
welfare of the individuals placed therein.
The department shall conduct unannounced
visits, other than the inspection for
relicensing, to every licensed adult
residential care home and expanded adult
residential care home on an annual basis and
at such intervals as determined by the
department to ensure the health, safety, and
welfare of each resident. Unannounced visits
may be conducted during or outside regular
business hours. All inspections relating to
follow-up visits, visits to confirm
correction of deficiencies, or visits to
investigate complaints of suspicion of abuse
or neglect shall be conducted unannounced
during or outside regular business hours.
Inspections for relicensing may be conducted
annually or at intervals determined by the
department during regular business hours.
Inspections for relicensing shall be
conducted with notice, unless otherwise
determined by the department.
100.1-15
2 -, Q
§11-100.1-4
(2) Following an annual inspection, a list of
deficiencies, if any, shall be given to the
licensee or primary care giver of the ARCH or
expanded ARCH. The licensee or primary care
giver of the ARCH or expanded ARCH shall
return a plan of correction for the
deficiencies cited within ten working days.
An acceptable plan for correcting
deficiencies shall include the time frame for
correction and the preventive measures that
will be instituted to ensure compliance with
this chapter; and
(3) The department may refuse to renew a license
if cited deficiencies are not corrected as
per the plan of correction; or a provisional
license may be issued for a specified period
of time at the discretion of the department
for the purpose of giving additional time for
correction of deficiencies. Not more than
two successive provisional licenses shall be
issuecJ,...,.w
1
a
8
~~J;ific ARCH or expanded ARCH.
[Eff :::>tr' LUUO ] (Auth: HRS §91-13.5,
§§321-9, 321-10, 321-11, 321-15.6, 321-15.62,
Act 202, SLH 2003) (Imp: HRS §§91-14, 91-15,
321-4, 321-10, 321-11, 321-15.6)
§11-100.1-4 Waiver. (a) Every request for a
waiver shall be set forth in writing and submitted to
the department for approval. The licensee shall submit
sufficient information as set forth in subsection
(d)(3), to enable the department to make a decision on
the request for a waiver.
(1) The department shall not act upon or consider
any incomplete requests for waivers. A
waiver request shall be deemed complete only
when all required and requested information
including a reason for the waiver and an
alternate plan established to ensure the
health, safety, welfare and civil rights of
the resident, including resident care and
life safety safeguards, is reviewed by the
department;
(2) Every request shall be signed by the licensee
and shall constitute an acknowledgment and
agreement that the licensee will comply with
all terms and conditions of the waiver and
this chapter;
100.1-16
2 7
§11-100.1-4
(3) The department may require the submission of
additional information after the request has
been submitted. If a request is incomplete
or otherwise deficient, processing of the
request shall not be completed until such
time as the licensee has supplied all
required information or otherwise corrected
the deficiency;
(4) All waivers shall not be transferrable;
(5) The failure of the department to act on a
completed request for a waiver within sixty
days of receipt of request, shall be deemed
an approval of the request; provided that the
licensee acts consistently with the request
process; and
(6) A waiver may be granted on a case by case
basis when it does not affect the resident's
health, welfare, and safety.
(b) The request will be reviewed by the
department based on the effect or probable effect the
waiver would have on the health, safety and welfare of
a resident.
(c) Whenever a request is approved by the
department, the department shall issue a waiver
authorizing the operation of an ARCH or expanded ARCH
pursuant to the conditions specified in the request for
the waiver and/or conditions specified by the
department. No waiver shall be granted by the
department unless the request and the supporting
information clearly show that:
(1) Granting the waiver will not endanger the
health, safety, or welfare of an ARCH or
expanded ARCH resident;
(2) The waiver shall not be transferred to
another resident or ARCH or expanded ARCH;
(3) Granting the waiver will not affect the
requirements of licensure provided in section
11-100.1-3; and
(4) Granting the waiver will not affect the
primary care giver requirements provided in
section 11-100.1-8.
(d) Any approved waiver shall be granted within
the requirements of this section, for time periods and
under conditions consistent with this chapter, and with
the following limitations:
(1) The department may issue a waiver for a
period not exceeding one year;
100.1-17
2 7
§11-100.1-4
(2) The department may revoke the waiver at any
time if the waiver creates a threat to the
health, safety, or welfare of an ARCH or
expanded ARCH resident;
(3) For every waiver granted under this section
the department shall require the licensee to
submit to the department information on a
case by case basis such as:
(A) Resident diagnosis with ability for self
preservation, physician or APRN order,
training to be provided to licensee,
primary care giver or substitute care
givers, plan for monitoring, oversight
and evaluation of resident status; or
(B) Conditions under which any structural
changes to the ARCH or expanded ARCH
will be completed, specific time frame
for construction completion, and plan to
ensure the safety of the ARCH or
expanded ARCH residents during
construction; and
(C) Process to be undertaken to ensure the
health, safety and welfare of ARCH or
expanded ARCH residents for staffing
changes or training to meet the
requirements of this chapter.
(4) For every waiver granted under this
subsection the department shall perform a
thorough review of known and available means
of protecting the health, safety, or welfare
of ARCH or expanded ARCH residents to which
the waiver applies.
(e) Waiver renewal. No waiver renewal shall be
granted except on request therefor. Any such request
shall be submitted to the department at least sixty
days prior to the expiration of the waiver. The
·department shall act on a request for renewal within
sixty days of the receipt of such request. Any waiver
granted pursuant to this section may be renewed on
terms and conditions which would be appropriate on
initial granting of a waiver, for periods not exceeding
one year; provided that:
(1) The request for renewal has met all of the
conditions specified in the immediately
preceding waiver; and
100.1-18
§11-100.1-4
(2) The renewal, and the waiver issued in
pursuance thereof, shall provide for
protection of the health, safety, or welfare
of the ARCH or expanded ARCH resident in a
manner not less than that attained pursuant
to the terms of the immediately preceding
waiver at its expiration.
(f) If the waiver or renewal is not granted, the
department shall, upon request, provide the opportunity
for hearing in accordance with chapter 91, HRS.
(g) No waiver shall be construed to prevent or
limit the application of any emergency provisions and
procedures provided by law. [ E ff. Sr:P 1 8 zoo~ ]
[Auth: §§321-9, 321-10, 321-11, 321-15:1-6, 9t;!.fl.-15.62]
(Imp. HRS 321-15.6, 321.15.62)
§11-100.1-5 Existing category 3 facilities. No
existing category 3 ARCHs shall admit any new
residents. Any resident in the category 3 ARCH who
develops the need for nurse aide care shall be
transferred to an appropriate facility.
[Eff SEP 18 2006 ] (Auth: HRS §§321-9, 321-10,
3 2 1-11 , 3 2 1-15 . 6 ) ( Imp: HRS § 3 2 1- 15 . 6 )
§11-100.1-6 Licensing fees. Appropriate fees, if
any, as determined by the director, shall be charged by
the department for obtaining an initial license or
obtaining a license renewal. Prior notice of the
amount of the fee shall be provided to the licensee.
[Eff ~ ► P 1 8200R ] (Auth: HRS §§321-9, 321-10) (Imp:
HRS §§ffl-t0, J~l-11)
§11-100.1-7 General operational policies. (a)
·General operational policies of an ARCH or expanded
ARCH shall be submitted by the applicant in writing to
the department prior to licensure and shall include,
but shall not be limited to:
(1) Admission policies as specified in
section 11-100.1-10;
(2) Types of services to be provided to residents
which at a minimum shall include activities
of daily living;
100.1-19
§11-100.1-7
(3) A clear definition of the responsibility of
the ARCH or expanded ARCH to the ARCH or
expanded ARCH resident and the ARCH or
expanded ARCH resident's family, legal
guardian, surrogate or responsible agency;
(4) Visiting hours;
(5) Emergency measures;
(6) Responsibilities of the primary and
substitute care givers, and ARCH or expanded
ARCH residents;
(7) Appropriate action to be taken in the event
of allegations of mistreatment, neglect,
misappropriation of funds or property,
procedure for notification of appropriate
agencies pursuant to state law;
(8) Infection control procedures;
(9) Written evaluation of any incidents occurring
which result in resident injury or illness,
review of circumstances leading to the event,
and a written plan to prevent a similar
situation from recurring; and
(10) Transfer and discharge policies as specified
in section 11-100.1-22.
(b) The general operational policies approved by
the department shall be explained to the ARCH or
expanded ARCH resident and the ARCH or expanded ARCH
resident's family, legal guardian, surrogate or
responsible agency prior to the ARCH or expanded ARCH
resident's admission. A copy of these general
operational policies shall be provided to all parties.
(c) A written agreement shall be completed at the
time of admission between the licensee or primary care
giver of the ARCH or expanded ARCH and the ARCH or
expanded ARCH resident and the ARCH or expanded ARCH
resident's family, legal guardian, surrogate or
responsible agency that sets forth that resident's
'rights, the licensee or primary care giver of the ARCH
or expanded ARCH responsibilities to that resident, the
services which will be provided by the licensee or
primary care giver of the ARCH or expanded ARCH
according to that resident's schedule of activities or
care plan, and that resident's responsibilities to the
licensee or p~a~y ~R.re giver of the ARCH or expanded
ARCH. [Eff :)tr' 18 LU06 ) (Auth: HRS §§321-9, 321-10,
3 2 1-11 , 3 21-15. 6, 3 21-15. 61 and 3 21-15. 6 2) (Imp: HRS
§§321-10,321-11, 321-15.6, 321-15.61 and 321-15.62)
100.1-20
2 7 9
§11-100.1-8
Subchapter 2
Type I ARCH
§11-100.1-8 Primary care giver qualifications.
(a) The licensee of a Type I ARCH acting as a primary
care giver or the individual that the licensee has
designated as the primary care giver shall:
(1) Be a resident of the State of Hawaii;
(2) Be at least twenty-one years of age;
(3) Be at least a nurse aide;
(4) Reside in the Type I ARCH, or employ or
otherwise engage by contract a qualified
primary care giver in those homes in which
the licensee does not reside;
(5) Have completed ARCH teaching modules that are
approved annually by the department;
(6) Have at least one year experience working
full time or its equivalent providing direct
nurse aide care as an employee of a state
licensed and approved intermediate care
facility, skilled nursing facility, home
health agency, or hospital or demonstrate
competency equivalence through completion of
a program approved by the department;
(7) Have knowledge of and be able to practice the
principles of resident care incorporating the
concepts of the social model through family
and community centered activities and
approaches;
(8) Demonstrate to the department sufficient
skill in the use of the English language to
fully accomplish the objectives of the
program and to comply with the requirements
of this chapter;
(9) Have achieved acceptable levels of skill and
training in first aid, nutrition,
cardiopulmonary resuscitation, and
appropriate nursing and behavior management
as required for care of all residents
admitted to the Type I ARCH;
(10) Attend and successfully complete a minimum of
six hours of training sessions per year which
shall include but not be limited to any
combination of the following areas: personal
care, infection control, pharmacology,
medical and behavioral management of
residents, diseases and chronic illnesses,
100.1-21
2 7 iJ
( 11 )
( 12 )
( b)
addition
( 1)
( 2 )
( 3 )
§11-100.1-9
community services and resources. All
inservice training and other educational
experiences shall be documented and kept
current;
Have knowledge of the availability of
community services which may be utilized by
the residents, primary care giver, or
licensee; and
If it is deemed necessary by the department,
be examined by a physician and/or mental
health professional as a condition for
continued licensure. The examination shall
be specifically oriented to determine if the
primary care giver is physically and/or
mentally capable of caring for the residents;
The applicant of more than one Type I ARCH, in
to the requirements in subsection (a), shall:
Establish to the department's satisfaction
that the applicant possesses the skills and
abilities to successfully operate multiple
facilities;
Maintain an updated, written staffing plan
that assures safety and adequate service
administration on a twenty four hour basis in
each facility under all circumstances; and
Have a current history of operating a
licensed Type I ARCH in compliance with the
minimum licensing regulations in the State
for one year or more. [Eff SEP l 8?nnR J
(Auth: HRS §§321-9, 321-10, 321-11, JTf-15.6,
346-224) (Imp: HRS §§321-10, 321-11, 321-
15.6, 346-224)
§11-100.1-9 Personnel, staffing and family
requirements. (a) All individuals who either reside
'or provide care or services to residents in the Type I
ARCH, shall have documented evidence that they have
been examined by a physician prior to their first
contact with the residents of the Type I ARCH, and
thereafter shall be examined by a physician annually,
to certify that they are free of infectious diseases.
(b) All individuals who either reside or provide
care or services to residents in the Type I ARCH shall
have documented evidence of an initial and annual
tuberculosis clearance.
(c) Any individual providing services to the
residents who develops evidence of an infectious
100.1-22
2 7
§11-100.1-9
disease shall be immediately relieved of any duties
relating to food handling or direct resident contact,
or both, and shall continue to be relieved of those
duties until such time as a physician or APRN certifies
it is safe for the individual to resume the duties.
Undiagnosed skin lesions, respiratory tract symptoms or
diarrhea shall be considered presumptive evidence of an
infectious disease.
(d) The primary caregiver or licensee acting as
the primary caregiver must be present in the Type I
ARCH at all times unless the primary caregiver or
licensee acting as the primary caregiver has secured a
substitute caregiver to provide temporary coverage for
the primary caregiver or licensee acting as the primary
caregiver.
(e) The substitute care giver who provides
coverage for a period less than four hours shall:
(1) Be at least eighteen years of age;
(2) Have the ability to communicate, read and
write in the English language;
(3) Be currently certified in first aid; and
(4) Be trained by the primary care giver to make
prescribed medications available to residents
and properly record such action.
(f) The substitute care giver who provides
coverage for a period greater than four hours in
addition to the requirements specified in subsection
(e) shall:
(1) Be currently certified in cardiopulmonary
resuscitation;
(2) Be able to provide personal care to the
residents, including bathing, dressing,
transferring, feeding, and transporting
residents, and be able to provide care as
stipulated in the schedule of activities or
care plan;
(3) Have sufficient knowledge and experience in
nursing techniques to care for the
residents, including taking vital signs,
observing for medication efficacy and any
untoward reactions;
(4) Be able to provide recreational programs as
developed; and
(5) Follow planned menus, prepare and serve
meals, including special menus and be able to
make appropriate substitutions, as required.
100.1-23
§11-100.1-10
(g) The substitute care giver who provides
coverage for a period greater than one month, shall
meet the requirements as set forth in section 11-100.1-
B(a).
(h) When the primary care giver is planning an
absence and the licensee is unable to find a substitute
care giver, residents may be temporarily transferred to
another appropriate facility licensed by the
department, including but not limited to an ARCH or
expanded ARCH.
(i) The primary care giver shall give advance
notice to residents and the resident's families, legal
guardians, or surrogates or responsible agencies if the
primary care giver plans to be absent for more than
three days. Such advance notice shall be not less than
one week except during emergencies. The primary care
giver shall have a written plan, approved by the
department, for providing resident care during any
absence of the primary care giver from the Type I ARCH.
This written plan shall also identify the duties and
responsibilities of the substitute care giver. This
rule does not apply to the primary care giver's short
absences for shopping, errands, or other appointments
unless the resident's condition requires full-time
supervision and is addressed in the resident's schedule
of activities or care plan. [Eff S ]
(Auth: HRS §§321-9, 321-10, 321-11, ffi:iJ.-8iOQ& (Imp: HRS
§§321-10, 321-11, 321-15.6)
§11-100.1-10 Admission policies. (a) Type I
ARCHs shall admit residents requiring care as stated in
section 11-100.1-2. The level of care needed by the
resident shall be determined and documented by that
resident's physician or APRN prior to admission.
Information as to each resident's level of care shall
'be obtained prior to a resident's admission to a Type I
ARCH and shall be made available for review by the
department, the resident, the resident's legal
guardian, the resident's responsible placement agency,
and others authorized by the resident to review it.
(b) All licensed Type I ARCHs shall admit
residents without regard to age, disability, race,
color, national origin (including language), sexual
orientation, religion or gender.
(c) The licensee has the right to refuse a person
for admission if the licensee has made a determination
that the Type I ARCH lacks the capability for providing
100.1-24
2 / I
§11-100.1-10
appropriate care.
(d) The Type I ARCH shall only admit residents at
appropriate levels of care. The capacity of the Type I
ARCH shall also be limited by this chapter, chapter
321, HRS, and as determined by the department.
(e) Persons requiring an increased level of care
may be permitted in a Type I or Type II ARCH if the
primary care giver is deemed capable by the department
of providing the necessary interim care while awaiting
transfer to an appropriate facility.
(f) The resident and the resident's family, legal
guardian, surrogate or representative shall be informed
at the time of admission of all facility policies and
procedures.
(g) An inventory of all personal items brought
into the Type I ARCH by the resident shall be
maintained.
(h) Residents requiring emergency admission to an
ARCH or expanded ARCH, due to removal from their
current placement by the department or other state
agency and who lack immediate access to a physician or
emergency room, and who are unable to provide a report
of tuberculosis clearance within one year of admission,
may be admitted to the ARCH or expanded ARCH if the
resident obtains a chest x-ray indicating freedom from
communicable tuberculosis within twenty-four hours
after admission. The resident shall obtain a
tuberculin skin test within three days after admission,
as per departmental procedure. The resident shall also
submit to a physical examination within one week after
admission unless he or she has don~ so within three
months prior to admission. [Eff ::,;£p 18 2006 ] (Auth:
HRS §§321-9, 321-10, 321-11, 321-15.6) (Imp: HRS §§321-
10 , 3 2 1-11 , 3 2 1-15 . 6 , 4 2 USC § 2 0 0 0 a)
§ll-100.1-11 Activities of daily living. The
licensee shall provide personal care, shelter,
protection, supervision, assistance, guidance or
training, planned activities, food service, laundering
of personal clothing, recognition of and provision for
changes in health status, and arrangement for
tran~t.a;t;.i.frl~'to medical and dental offices.
[Eff ~tr' l l:s LUUO ] (Auth: HRS §§321-9, 321-10, 321-11,
321-15.6) (Imp: HRS §§321-10, 321-11, 321-15.6)
100.1-25
§11-100.1-13
§11-100.1-12 Emergency care of residents and
disaster preparedness. (a) The licensee shall
maintain written procedures to follow in an emergency
which shall include provisions for the following:
(1) Arranging for immediate transfer or
evaluation by a physician for any resident
who becomes acutely ill, injured, or dies;
(2) Arranging for transfer or placement of a
resident at an emergency shelter or crisis
response unit, as appropriate; and
(3) Response to disasters which would include
evacuation, emergency shelters, and food
supply, and as directed by the Civil Defense.
(b) The licensee shall maintain a first aid kit
for emergency use for each Type I ARCH.
(c) The licensee shall conduct regular quarterly
rehearsals of emergency evacuation plans for staff and
residents to follow in case of fire, explosion, or
other civil emergency occurring in or within the
environs of the facility.
(d) Records of disaster evacuation and safety
drills shall be av~ilable for inspection by the
department. [ Ef f ~£P 1 8 2006 ] ( Auth: HRS §§321-9,
3 2 1-10 , 3 2 1-11 , 3 2 1-15 . 6 , 15 . 61 , 15 . 6 2 ) ( Imp: HRS
§§321-10, 321-11, 321-15.6)
§ll-100.1-13 Nutrition. (a) The Type I ARCH
shall provide each resident with an appetizing,
nourishing, well-balanced diet that meets the daily
nutritional needs and diet order prescribed by state
and national dietary guidelines. To promote a social
environment, residents, primary care givers and the
primary care giver's family members residing in the
Type I ARCH shall be encouraged to sit together at meal
times. The same quality of foods provided to the
'primary care givers and their family members shall be
made available to the residents unless contraindicated
by the resident's physician or APRN, resident's
preference or resident's family.
(b) Menus shall be written at least one week in
advance, revised periodically, dated, and followed. If
cycle menus are used, there shall be a minimum of four
weekly menus.
(c) Menus shall accommodate residents' food
preferences, cultural and ethnic backgrounds and habits
as much as possible, provided nutritional quality is
maintained.
100.1-26
§11-100.1-13
(d) Current menus shall be posted in the kitchen
and in a conspicuous place in the dining area for the
residents and department to review.
(e) Substitutes offered to residents who refuse
food served shall be of similar nutritive value and
documented.
(f) A minimum of three meals shall be provided at
regular intervals in each twenty four hour period.
There shall be no more than fourteen hours between a
substantial evening meal and breakfast.
(g) There shall be on the premises a minimum of
three days' food supply, adequate to serve the number
of individuals who reside at the ARCH or expanded ARCH.
(h) The kitchen and food supply shall be
accessible to residents who may desire snacks between
meals, as appropriate.
(i) Each resident shall have a documented diet
order on admission and readmission to the Type I ARCH
and shall have the documented diet annually signed by
the resident's physician or APRN. Verbal orders for
diets shall be recorded on the physician order sheet
and written confirmation by the attending physician or
APRN shall be obtained dµring the next office visit.
(j) Each resident shall be provided with
sufficient fluids to ensure adequate hydration.
(k) Physician or APRN orders for nutritional
supplements including vitamins, minerals, formula meals
and thickening agents shall be updated annually or
sooner as specified.
(1) Special diets shall be provided for residents
only as ordered by their physician or APRN. Only those
Type I ARCHs licensed to provide special diets may
admit residents requiring such diets.
(m) A business entity operating more than one
Type I ARCH, shall utilize a registered dietitian to
assist in the planning of menus and provide special
'diet consultation, as needed. The consultant shall
provide special diet training to food preparation staff
to ensure competency. [Eff S£P 182006 ] (Auth: HRS
§§321-9, 321-10, 321-11, 321-15.6) (Imp: HRS §§321-10,
321-11, 321-15.6)
11-100.1-14 Food sanitation. (a) All food shall
be procured, stored, prepared and served under sanitary
conditions.
(b) All foods shall be stored in covered
containers.
100.1-27
§11-100.1-15
(c) Refrigerators shall be equipped with an
appropriate thermometer and temperature shall be
maintained at 45°F or lower.
(d) Potentially hazardous food shall meet proper
temperature requirements during storage, preparation,
display, service, and transportation.
(e) A metal stem thermometer shall be available
for checking cold and hot food temperatures.
(f) Toxic chemicals and cleaning agents, such as
insecticides, fertilizers, bleaches and all other
poisons, shall be properly labeled and securely stored
apart from any food supplies.
(g) Rooms used for the stored food and supplies
shall be well ventilated.
(h) All persons who prepare food shall wash their
hands with soap and water prior to food preparation and
cooking.
(i) A kitchen sink with hot and cold running
water and soap shall be available for washing dishes,
equipment, and utensils.
(j) Potable water from
be provided to all fixtures.
(Auth: HRS §§321-10, 321-11,
§§321-10, 321-11, 321-15.6)
an approved source shall
[ E ff SEP I 8 2008' l
321-15.6) (Imp: HRS
§11-100.1-15 Medications. (a) All medicines
prescribed by physicians and dispensed by pharmacists
shall be deemed properly labeled so long as no changes
to the label have been made by the licensee, primary
care giver or any ARCH/Expanded ARCH staff, and
pills/medications are not removed from the original
labeled container, other than for administration of
medications. The storage shall be in a staff controlled
work cabinet-counter apart from either resident's
bathrooms or bedrooms.
(b) Drugs shall be stored under proper conditions
of sanitation, temperature, light, moisture,
ventilation, segregation, and security. Medications
that require storage in a refrigerator shall be
properly labeled and kept in a separate locked
container.
(c) Separate compartments shall be provided for
each resident's medication and they shall be segregated
according to external or internal use.
(d) Appropriate liquid medicine measuring devices
shall be available and in use when liquid medicine is
made available.
100.1-28
§11-100.1-15
(e) All medications and supplements, such as
vitamins, minerals, and formulas, shall be made
available as ordered by a physician or APRN.
(f) Medications made available to residents shall
be recorded on a flowsheet. The flowsheet shall
contain the resident's name, name of the medication,
frequency, time, date and by whom the medication was
made available to the resident.
(g) All medication orders shall be reevaluated
and signed by the physician or APRN every four months
or as ordered by the physician or APRN, not to exceed
one year.
(h) All telephone and verbal orders for
medication shall be recorded immediately on the
physician's order sheet and written confirmation shall
be obtained at the next physicians visit and not later
than four months from the date of the verbal order for
the medication.
(i) Only trained staff shall be allowed to make
prescribed medications available to residents.
(j) Medication shall be offered only to the
resident for whom it is ordered.
(k) Medication errors and drug reactions shall be
reported immediately to the physician or APRN
responsible for the medical care of the client and
shall document observations and action taken in the
resident's record.
(1) There shall be an acceptable procedure to
separately secure medication or dispose of discontinued
medications.
(m) All medications and supplements, such as
vitamins, minerals, and formulas, when taken by the
resident, shall be recorded on the resident's
medication record, with date, time, name of drug, and
dosage initialed by the care giver.
(n) Self administration of medication shall be
'permitted when it is determined to be a safe practice
by the resident, family, legal guardian, surrogate or
case manager and primary care giver and authorized by
the physician or APRN. Written procedures shall be
availasep fcg:z~rage, monitoring and documentation.
[Eff UUO ] (Auth: HRS §§321-9, 321-10,
321-11, 321-15.6) (Imp: HRS §§321-10, 321-11, 321-15.6)
100.1-29
§11-100.1-16
§ll-100.1-16 Personal care services. (a) Each
resident shall be given proper daily personal attention
and care including but not limited to skin, nails,
hair, teeth, and oral hygiene in addition to any
therapeutic regimen ordered by the resident's physician
or APRN.
(b) Residents shall be taught and encouraged to
perform health, hygiene, and grooming practices,
including bathing, brushing teeth, shampooing, combing
and brushing hair, shaving and caring for toenails and
fingernails as independently as possible and be
assisted as necessary.
(c) Primary care givers shall be responsible for
proper care of and encourage the use of dentures, eye
glasses, hearing aids, braces and prostheses and
ambulatory equipment. The resident, family, legal
guardian or responsible agency, shall be responsible
for any costs involved with purchase and maintenance of
the above.
(d) When ordered by a physician, APRN, or
psychologist, primary care givers shall provide an
appropriate training program for every resident who has
problems with elimination. Progress shall be
documented for each resident receiving such training.
(e) Residents who are incontinent shall be bathed
or cleaned promptly upon voiding and soiling. All
soiled items shall be segregated and appropriately
stored until they can be properly cleaned.
(f) Residents shall be allowed to select and be
dressed appropriately in clean and comfortable clothing
at all times.
(g) Residents, and the residents' family members,
legal guardians, surrogates and case managers shall be
given the opportunity to participate in the planning of
resident care and activities.
(h) A schedule of activities shall be developed
and implemented by the primary care giver for each
resident which includes personal services to be
provided, activities and any special care needs
identified. The plan of care shall be reviewed and
updated as needed.
(i) The primary care giver shall provide the
opportunity for each resident to have pneumococcal and
influenza vaccines and all necessary immunizations
following the recommendations of the Advisory Committee
on Immunization Practices (ACIP) or resident's
physician or APRN.
100.1-30
§11-100.1-16
(j) Resident(s) manifesting behaviors that may
cause injury to self or others shall be assessed by a
physician or APRN to determine least restrictive
alternatives to physical restraint use, which may be
used only in an emergency when necessary to protect the
resident from injury to self or to others. If
restraint use is determined to be required and ordered
by the resident's physician or APRN, the resident and
the resident's family, guardian or surrogate, and case
manager shall be notified and a written consent
obtained. The licensee shall maintain a written policy
for restraint use outlining resident assessment
processes, indications for use, monitoring and
evaluation and training of licensee and substitute care
givers. Renewal orders for restraint use shall be
obtained on a weekly basis from the resident's
physician or APRN based on the assessment, monitoring
and evaluation data presented by the primary care
giver. [Eff SEP 18 70Qfl ) (Auth: HRS §§321-9,
3 2 1-10, 3 2 1-11, 3 2 1- 1; . b) (Imp. HRS § § 3 2 1-10, 3 21-11,
321-15.6)
§11-100.1-17 Records and reports. (a) The
licensee or primary care giver shall maintain
individual records for each resident. On admission,
readmission, or transfer of a resident there shall be
made available by the licensee or primary care giver
for the department's review:
(1) Documentation of primary care giver's
assessment of resident upon admission;
(2) Recording of identifying information such as
resident's name, social security number,
racial extraction, marital status, date of
birth, sex, and minister or religious
denomination, and information about medical
plan or coverage;
(3) Documentation of date of referral and
admission, referral agency with address and
telephone number, place or source from which
admitted, physician, APRN, dentist,
ophthalmologist, optometrist, psychiatrist,
and all other medical or social service
professionals who are currently treating the
resident, next of kin, legal guardian,
surrogate or other legally responsible
agency;
100.1-31
§11-100.1-17
(4) A report of a recent medical examination and
current diagnosis taken within the preceding
twelve months and report of an examination
for tuberculosis. The examination for
tube-rculosis shall follow current
departmental policies;
(5) Copy of advanced directive, as available;
(6) Physician or APRN signed orders for diet,
medications, and treatments;
(7) Height and weight measurements taken; and
(8) A current inventory of money and valuables.
(b) During residence, records shall include:
(1) Annual physical examination and other
periodic examinations, pertinent
immunizations, evaluations, progress notes,
relevant laboratory reports, and a
report of annual re-evaluation for
tuberculosis;
(2) A copy of advanced directives, as available;
(3) Progress notes that shall be written on a
monthly basis, or more often as appropriate,
shall include observations of the resident's
response to medication, treatments, diet,
care plan, any changes in condition,
indications of illness or injury, behavior
patterns including the date, time, and any
and all action taken. Documentation shall be
completed immediately when any incident
occurs;
(4) Entries describing treatments and services
rendered;
(5) Entries detailing all medications
administered or made available;
(6) All recordings of temperature, pulse,
respiration as ordered by a physician, APRN
or as may appear to be needed. Physician or
APRN shall be advised of any changes in
physical or mental status promptly;
(7) Recording of resident's weight at least once
a month, and more often when requested by a
physician, APRN or responsible agency;
(8) Notation of visits and consultations made to
resident by other professional personnel as
requested by the resident or the resident's
physician or APRN; and
(9) Correspondence pertaining to the resident's
physical and mental status.
100.1-32
§11-100.1-17
(c) Unusual incidents shall be noted in the
resident's progress notes. An incident report of any
bodily injury or other unusual circumstances affecting
a resident which occurs within the home, on the
premises, or elsewhere shall be made and retained by
the licensee or primary care giver under separate
cover, and shall be made available to the department
and other authorized personnel. The resident's
physician or APRN shall be called immediately if
medical care may be necessary.
(d) When a resident is transferred,
transfer summary shall be prepared, and a
promptly to the receiving facility, which
include:
a written
copy given
shall
( 1 )
( 2 )
The reason for the transfer;
Evidence of prior notice or the written
consent of the resident's family, legal
guardian, surrogate or representative;
(3) Current physical and mental status of
resident; and
(4) Current diet, medication, and activity orders
signed by a physician or APRN.
(e) In the event of an emergency, an oral summary
of the resident's condition shall be provided to the
receiving facility, followed by a written transfer
summary.
( f)
( 1 )
( 2 )
General rules regarding records:
All entries in the resident's record shall be
written in black ink, or typewritten, shall
be legible, dated, and signed by the
individual making the entry;
Symbols and abbreviations may be used in
recording entries only if a legend is
provided to explain them;
(3) An area shall be provided for safe and secure
storage of resident's records which must be
retained in the ARCH for periods prescribed
by state law; and
(4) All records shall be complete, accurate,
current, and readily available for review by
the department or responsible placement
agency.
(g) All information contained in the resident's
record shall be confidential. Written consent of the
resident, or resident's guardian or surrogate, shall be
required for the release of information to persons not
otherwise authorized to receive it. Records shall be
secured against loss, destruction, defacement,
100.1-33
2 7 '
§ll-100.1-18
tampering, or use by unauthorized persons. There shall
be written policies governing access to, duplication
of, and release of any information from the resident's
record. Records shall be readily accessible and
available to authorized department personnel for the
purpose of determining compliance with the provisions
of this chapter.
(h) Miscellaneous records:
(1) A permanent general register shall be
maintained to record all admissions and
discharges of residents;
(2) When requested, statistical information shall
be provided to the department;
(3) When day care clients are permitted in a Type
I ARCH, records shall be maintained and
include:
(A) Current physical examination and
tuberculosis clearance;
(B) Medication and diet or supplement
( C)
( D)
orders;
Emergency information; and
Progress notes, as appropriate.
[Eff SEP 18 2006 ] (Auth: HRS §§321-9,
3 2 1-10 , 3 21-11 , 3 2 1-15 . 6 ) ( Imp: HRS
§§321-10, 321-11, 321-15.6, 622-5(7),
622-5(8))
§ll-100.1-18 Recreational, rehabilitative
programs, and social services. (a) Residents shall be
up and out of bed and appropriately dressed daily,
unless physician or APRN orders indicate otherwise.
(b) The primary care giver shall provide social
and recreational activities for residents on a regular
basis and shall encourage participation in activities
according to the resident's interests, needs, and
'capabilities.
(c) Residents shall be encouraged to participate
in work, educational, recreational, social, and health
activities provided by community agencies.
(d) The primary care giver shall recognize the
need for and provide a warm, emotionally accepting
atmosphere to residents. Residents shall be included,
as much as possible, in all aspects of family and
community life to help foster a greater sense of
belonging, as relating to the social model.
(e) Visits with relatives and friends shall be
encouraged.
100.1-34
2 7
§11-100.1-18
(f) The primary care giver shall provide the
resident with access to a radio, television and
telephone.
(g) The primary care giver shall arrange and
provide for appropriate social services through
private, public or community resources.
(h) The primary care giver shall arrange or
provide means of transportation for residents for:
(1) Visits to physician, APRN and other medical
providers;
(2) Transfer to another facility; and
(3) Participation in activities outside the Type
I ARCH. [ Eff SEf 1 A ?QnR 1 (Auth: HRS
§§321-10, 321-1 , 3'2t-'1'5.6) (Imp: HRS
§§321-10, 321-11, 321-15.6)
§11-100.1-19 Resident accounts. (a) The
conditions under which the primary care giver agrees to
be responsible for the resident's funds or property
shall be explained to the resident and the resident's
family, legal guardian, surrogate or representative and
documented in the resident's file. All single
transfers with a value in excess of one hundred dollars
shall be supported by an agreement signed by the
primary care giver and the resident and the resident's
family, legal guardian, surrogate or representative.
(b) Individuals associated with the ownership or
operation of a Type I ARCH, the licensee, and the
primary care giver shall not serve as guardian, power
of attorney, or trustee of the resident or resident's
estate.
(c) The primary care giver shall be permitted to
become a representative payee under conditions
prescribed by the Social Security Administration.
(d) An accurate writt~n accounting of resident's
'money and disbursements shall be kept on an ongoing
basis, including receipts for expenditures, and a
current inventory of resident's possessions.
(e) The resident's personal property kept by the
primary care giver for safekeeping shall be released,
upon request, to the resident, or if the resident is
incompetent, to the duly appointed legal guardian,
surrogate or responsible agency. This transaction
shall be documented in writing. [Eff SEP 1 Q 2on~ ]
(Auth: HRS §§321-9, 321-10, 321-11, 321-ls'°".~) t~mp: HRS
§§321-10, 321-11, 321-15.6)
100.1-35
2 7
§11-100.1-21
§11-100.1-20 Resident health care standards. (a)
The primary and substitute care giver shall provide
health care within the realm of the primary or
substitute care giver's capabilities for the resident
as prescribed by a physician or APRN.
(b) The primary and substitute care giver shall
utilize standard precautions in the provision of
personal care to the residents.
(c) The primary and substitute care giver shall
be able to recognize, record, and report to the
resident's physician or APRN significant changes in the
resident's health status including, but not limited to,
convulsions, fever, sudden weakness, persistent or
recurring headaches, voice changes, coughing, shortness
of breath, changes in behavior, swelling limbs,
abnormal bleeding, or persistent or recurring pain.
(d) When the resident has experienced a
significant change in mental or physical well-being, a
prompt report shall be made and provided to the
resident's physician or APRN, by the primary or
substitute caregiver. Any change in physician or APRN
orders shall be promptly carried out.
(e) Arrangements shall be made by the primary
care giver for annual dental examinations.
Arrangements shall be made by the primary or substitute
care giver for emergency dental examinations.
(f) Residents shall be accompanied by an adult to
emergency rooms and other medical care facilities with
all available resident records.
(g) Payment for all medical and dental treatment
shall be the responsibilitY, pt the resident or
responsible agency. [Eff StP 182006 ) (Auth: HRS
§§321-9, 321-10, 321-11, 321-15.6, 457) (Imp: HRS
§§321-10, 321-11, 321-15.6, 457)
§11-100.1-21 Residents' and primary care givers'
rights and responsibilities. (a) Residents' rights and
responsibilities:
(1) Written policies regarding the rights and
responsibilities of residents during the stay
in the Type I ARCH shall be established and a
copy shall be provided to the resident and
the resident's family, legal guardian,
surrogate, sponsoring agency or
representative payee, and to the public upon
request. The Type I ARCH policies and
procedures shall provide that each individual
100.1-36
q
,/
§11-100.1-21
( 2 )
admitted shall:
(A) Be fully informed orally or in writing,
prior to or at the time of admission, of
these rights and of al~ rules governing
resident conduct. There shall be
documentation signed by the resident
( B)
( C)
( D)
that this procedure has been carried
out;
Be fully informed that interpreter
services including but not limited to
translation, sign language or visual
services will be provided if the
resident requires such services. Should
the resident require the assistance of
an interpreter, the licensee or primary
care giver shall attempt to facilitate
reasonable accommodations for
interpreter services including but not
limited to translation, sign language or
visual services. The cost for
interpreter services shall not be the
responsibility of the licensee or
primary care giver.
Be fully informed orally and in writing,
prior to or at the time of admission,
and during stay, of services available
in or through the Type I ARCH and of
related charges, including any charges
for services not covered by the Type I
ARCH's basic per diem rate; and
Be given advance written notice, of not
less than thirty days, of involuntary
transfer or discharges, except in an
emergency.
Each resident shall:
(A)
( B)
Be encouraged and assisted to exercise
the resident's rights to vote, voice
grievances, recommend changes in
policies and services to care givers or
outside representatives of the
resident's choice, be free from
interference, coercion, discrimination,
or reprisal;
Be informed of the conditions under
which the Type I ARCH may manage the
resident's personal financial affairs as
detailed in section 11-100.1-18;
100.1-37
2 l t '}
§11-100.1-21
(C) Be free from chemical and physical
restraints and not be humiliated,
harassed, or threatened.
(D) Physical restraints may only be used in
an emergency when necessary to protect
the resident from injury to self or to
others. In such a situation the
resident's physician or APRN shall be
notified immediately to obtain an
assessment for least restrictive
alternatives to restraint use. If
restraint use is determined to be
necessary, written orders shall be
obtained from the resident's physician
or APRN indicating the form of restraint
to be used, the length of time restraint
shall be applied, the frequency of use
and the alternative care that can be
provided to the resident. If a less
restrictive alternative to restraint
exists, it must be used in lieu of the
restraint. The resident's family, legal
guardian, surrogate or representative,
and case manager shall be notified if no
alternative to restraint exists and a
written consent shall be obtained for
restraint use. The restraint use shall
be in compliance with the Type I ARCH's
written policy, as approved by the
department;
(E) Be treated with understanding, respect,
and full consideration of the resident's
dignity and individuality, including
privacy in treatment and in care of the
resident's personal needs;
(F) Have the right to be free from ill
treatment, physical punishment,
exploitation, neglect, physical or
psychological abuse and shall be
protected from further potential abuse
while an investigation is in progress;
(G) Have the right to an environment free of
weapons, illicit drugs or other
conditions that may cause the residentto
feel unsafe in a Type I ARCH;
(H) Perform services for the Type I ARCH or
the primary and substitute care givers
only when agreed to by the resident,
100.1-38
~ r C,
§11-100.1-21
resident's family, resident's legal
guardian, surrogate or representative,
and shall be documented;
(I) Have the right to associate and
communicate privately with persons of
the resident's choice, and to send and
receive the resident's personal mail
unopened;
(J) Have the right to refuse visitors;
(K) Have the right to meet with and
participate in social, religious, health
and community group activities at the
resident's discretion, unless medically
contra-indicated;
(L) Have the right to refuse to participate
in social, religious, or health and
community group activities;
(M) Make contacts with the community and to
achieve the highest level of
independence, autonomy, and interaction
with the community of which the resident
is capable;
(N) Manage his or her financial affairs, or
be given at least a quarterly accounting
of financial transactions made on his or
her behalf by the Type I ARCH should the
Type I ARCH accept his or her written
delegation of this responsibility to the
Type I ARCH for any period of time in
conformance with state law;
(0) Participate in the planning of his or
her schedule of activities, and/or care
plan and medical treatment;
(P) Retain and use personal clothing and
possessions as space permits, unless
doing so:
(i) Would infringe upon the rights of
other residents; or
(ii) Is specifically forbidden by
written orders of the resident's
physician or APRN;
(Q) If married, be assured of privacy for
visits by the spouse and, if both are
residents in the home, be permitted to
share a room if agreeable to both;
(R) Have flexible daily visiting hours and
provisions for privacy established;
100.1-39
2 7
§ll-100.1-21
(S) Have the right to reject living in a
particular facility;
(T) Provide the primary care giver with a
fourteen day notice when wishing to
transfer to another facility;
(U) Have the right to request food
preferences and not have dietary
restrictions as punishment;
(V) Have the right to locked storage space;
(W) Have their personal and medical records
kept confidential and subject to release
only as provided in section 11-100.1-
1 7 ( g) ; and
(X) Have access to a telephone providing
privacy.
(b) Primary care givers' rights and
responsibilities:
(1) Written policies regarding primary care
givers' rights and responsibilities shall be
established and a copy shall be provided to
the resident and the resident's family, any
guardian, next of kin, surrogate, sponsoring
agency or representative payee and to the
public upon request;
(2) The primary care giver has the right to:
(A) Be shown consideration and respect that
recognizes the dignity and individuality
of the primary care giver and the Type I
ARCH;
(B) Terminate a resident's agreement for
just cause after a written 30 day
notice;
(C) Terminate an agreement immediately,
after notice to the resident, family
member or surrogate, case manager and
physician, if the primary care giver
finds that a resident creates a serious
or immediate threat to the health,
safety or welfare of other residents of
the Type I ARCH;
(D) Present grievances, file complaints, or
provide information to state agencies or
other persons;
(E) Refuse to perform services for the
resident or the resident's surrogate
other than those agreed upon by the
resident and the care giver;
100.1-40
§11-100.1-21
(F) Contract with community resources to
achieve the highest level of
independence, autonomy, interaction and
services for residents;
(G) Be able to gain access to resident
information, as per the referring
agency's policy and procedures, for each
resident referred to the Type I ARCH.
All information shall be kept
confidential;
(H) Refuse to accept a resident if the
referral is inappropriate;
(I) Information relating to a resident's
problems, including self-abuse, violent
behavior, alcoholism, or drug abuse; and
(3) The primary care giver or licensee shall be
responsible for maintaining an environment
safe from weapons or illicit drugs.
(4) The primary care giver or licensee shall be
responsible for ensuring the health, safety,
welfare and civil rights of all residents
under their care. [ E ff SFP 1 ~ 2nrn~ ]
(Auth: HRS §§321-9, 321-11, .:f2'1-l'S".6) (Imp:
HRS § § 3 2 1-10 , 3 21-11 , 3 2 1-15 . 6, 6 2 2- 5 7 )
§11-100.1-22 Transfer and discharge of residents.
(a) Except as provided in subchapter 6 of this chapter,
written notice of a resident's transfer to an
appropriate facility or discharge to another living
arrangement or transfer within the Type I ARCH shall be
given no less than thirty days prior to transfer or
discharge except in case of an emergency, to the
resident, the resident's family, the resident's legal
guardian, surrogate or representative, and the case
manager when:
(1) Ordered by the resident's physician or APRN;
(2) Physical or mental changes of the resident
necessitates services which cannot be
provided in the existing Type I ARCH;
(3) Physical or mental changes of the primary
care giver resulting in the inability of the
primary care giver to provide the service;
(4) Resident wishes to transfer; or
(5) Primary care giver wishes to transfer the
resident for just cause.
100.1-41
2 7
§11-100.1-23
(b) The licensee or primary care giver of the
Type I ARCH shall provide assistance to the resident,
resident's family, legal guardian, representative,
surrogate or case manager with the transfer.
[ E ff SEP 1 8 2006 ] ( Au th: HRS § § 3 2 1-9, 3 2 1-10 , 3 21-
11, 321-15.6) (Imp: HRS §§321-10, 321-11, 321-15.6)
§11-100.1-23 Physical environment. (a) For all
ARCHs, suitability of site, quietness, sanitary
features of the immediate environment, accessibility,
and proximity to the community to be served shall be
considered in licensing a facility.
(b) The Type I ARCH shall be free of excessive
noise, dust, or odors and shall have good drainage;
(c) The Type I ARCH shall be provided with
adequate means of sewage, garbage, and other refuse
disposal, approved potable water supply, and
electricity;
(d) The Type I ARCH shall be accessible by
emergency medical services and be near a means of
public transportation;
(e) Resident living areas shall be designed and
equipped for the safety, comfort, and privacy of the
resident; and
(f) Any person regularly utilizing the portions
of the home designated for residents including but not
limited to day care residents, relatives, and visitors
shall be considered as residents for purposes of
calculating the space requirements of section 11-100.1-
23(1)(2) and section ll-100.l-23(m)(3).
(g) Fire prevention protection.
(1) All Type I ARCHs licensed under this chapter
shall initially comply, and shall be
inspected at least annually by appropriate
fire authorities for compliance, with state
and county codes, ordinances, and laws;
(2) Fees for fire inspections shall be the
responsibility of the licensee;
(3) Type I ARCHs shall be in compliance with, but
not limited to, the following provisions:
(A) Fire escapes, stairways and other exit
equipment shall be maintained
operational and in good repair and free
of obstruction;
(B) There shall be a clear and unobstructed
access to a safe area of refuge;
100.1-42
2 7
§11-100.1-23
(C) Each Type I ARCH shall have a written
plan for the safe care and evacuation of
residents to areas of refuge in case of
emergency. This plan shall be reviewed,
and updated as necessary, whenever there
is a significant change in the physical
or mental condition of a resident or
whenever a new resident enters the
facility. All personnel shall be
instructed in their respective duties in
carrying out this plan. The written
plan with directional diagrams shall be
posted in a conspicuous location within
the facility;
(D) A drill shall be held to provide
training for residents and personnel at
various times of the day or night at
least four times a year and at least
three months from the previous drill,
and the record shall contain the date,
hour, personnel participating and
description of drill, and the time taken
to safely evacuate residents from the
building. A copy of the fire drill
procedure and results shall be submitted
to the fire inspector or department upon
request;
(E) There shall be an adequate system of
communication to summon help in case of
fire or other emergency. This shall
include telephone service. Inside
stairways shall be provided for
communication between floors within the
Type I ARCH. All rooms utilized by the
Type I ARCH, under the same roof, shall
be connected by interior doors. The
communication system shall assure prompt
contact with care givers;
(F) Smoking shall be permitted only in
approved areas where proper equipment
and supervision is provided;
(G) Smoke detectors shall be provided in
accordance with the most current edition
of the National Fire Protection
Association (NFPA) Standard 101 Life
Safety Code, One and Two Family
100.1-43
§11-100.1-23
Dwellings. Existing Type I ARCHs may
continue to use battery operated
individual smoke detector units,
however, upon transfer of ownership or
primary care giver, such units shall be
replaced with an automatic hard wiring
UL approved smoke detector system;
(H) Fire extinguishers shall be installed in
accordance with NFPA 101 Life Safety
Code and have a minimum fire
extinguisher classification rating as
required by the county fire code;
(I) Each resident of a Type I home must be
certified by a physician that the
resident is ambulatory and capable of
following directions and taking
appropriate action for self-preservation
under emergency conditions, except that
a maximum of two residents, not so
certified, may reside in the Type I home
provided that either:
(i) For each such non-certified
resident there must be a
responsible adult on the premises
of the home at all times that the
non-certified resident is present
in the home, and there must never
be a stairway which must be
negotiated for emergency exit by
such non-certified resident; or
(ii) Type I homes having residents not
so certified shall have a sprinkler
system installed throughout in
accordance with the National Fire
Protection Association (NFPA)
Standard 13-D, Sprinkler Systems,
One and Two Family Dwellings.
(h) The Type I ARCH shall maintain the entire
facility and equipment in a safe and comfortable manner
to minimize hazards to residents and care givers.
(1) Housekeeping:
(A) A plan including but not limited to
sweeping, dusting, mopping, vacuuming,
waxing, sanitizing, removal of odors and
cleaning of windows and screens shall be
made and implemented for routine
periodic cleaning of the entire Type I
100.1-44
2 7 ~
§11-100.1-23
ARCH and premises;
(B) After discharge of any resident, the
bed, bed furnishings, bedside furniture
and equipment shall be thoroughly
cleansed prior to subsequent resident
admission;
(C) Floors in resident areas shall be
cleaned at least once daily;
(D} All walls, ceilings, windows and
fixtures shall be kept clean; and
toilets and lavatories shall be cleaned
and deodorized daily.
(2) Temperature control:
(A) Temperature and humidity shall be
maintained within a practical comfort
range by heating, air conditioning, or
other means in accordance with
residents' needs and desires; and
(B) Any heating apparatus or appliances, or
open flame in stoves, water heaters and
fireplaces shall conform to UL standards
as they existed on the date of adoption
of this chapter.
(3) All Type I ARCHs shall comply with applicable
state laws and rules relating to sanitation,
health, infection control and environmental
safety;
(4) Water supply. Hot and cold water shall be
readily available to residents for personal
washing purposes. Temperature of hot water
at plumbing fixtures used by residents shall
be regulated and maintained within the range
of l00°-120°F.
(i) All construction or alterations shall comply
with current county building, land use and fire codes
and ordinances in the state. The Type I ARCH licensed
'for wheelchair residents shall be accessible to and
functional for the residents at the time of licensure.
(1) Windows:
(A) A habitable room shall have an aggregate
window area of not less than one-tenth
of the gross floor area;
(B) In bedrooms occupied by residents in
wheelchairs, window sills may not be
higher than forty four inches, or as
stipulated by the current county
building codes; and
100.1-45
2 7
§11-100.1-23
(C) Windows in residents' rooms shall have
adequate means of insuring privacy.
(2) Windows shall have screens having no less
than sixteen meshes per inch.
(3) Doors:
(A) Two exit doors shall be included which
are remote from each other and shall be
provided for each floor or separate
building where residents reside. For
residents with assistive devices,
doorways shall be wide enough to allow
passage and access;
(B) When multiple locking devices are used
on exits, a maximum of two locking
mechanisms for egress shall be allowed;
(C) Sliding doors and folding doors shall
not be used as exit doors, but where
used in service areas not utilized by
residents, shall be of light material
and easy to handle;
(D) Provision for the free passage of
handicapped residents, including
wheelchair residents, to rooms, toilets,
corridors, and exits shall be maintained
at all times; and
(E) Each occupied room shall have access to
required exits.
(4) Lighting:
(A) Appropriate lighting fixtures adequate
in number shall be provided for the
comfort of residents and care givers;
and
(B) Residents' rooms shall have artificial
light adequate for reading at bedside.
This lighting shall be at least thirty
foot candles at normal reading height;
(5) In multi-level homes there shall be an inside
enclosed stairway. Ramps shall not exceed a
slope of more than one inch per foot and
shall be provided with non-slip material.
Elevators, stairways and ramps and handrails
shall comply with current county building
codes;
(6) In Type I ARCHs, bedrooms, hallways, and
corridors shall be large enough to allow
passage, access and be comfortable for
residents with assistive devices. Type I
ARCHs shall establish a performance criteria
100.1-46
§11-100.1-23
for safe evacuation and exit from the
facility meeting the standards and
requirements as set forth by the Uniform
Building Code (UBC) and NFPA 101 (with
utilization of the FSES rating).
(7) At least one toilet, lavatory and bathtub or
shower shall be conveniently located and
provided for each floor occupied by residents
for sleeping;
(8) Toilets, bathtubs and showers shall have
provisions for individual privacy;
(9) Bathrooms shall have non-slip surfaces in
tubs and showers;
(10) For Type I ARCHs with wheelchair residents,
walk-in showers flush with the floor shall be
provided. Showers shall have a minimum floor
area of sixteen square feet arranged and
located to accommodate both the resident and
the care giver providing personal care. The
shower entrance shall be at least thirty two
inches wide. Adjacent floor areas shall be
protected from the water which could
constitute an unsafe area;
(11) Handrails and grab bars shall be at a height
of thirty two to thirty four inches from the
floor for residents' use in the hallways and
bathrooms.
(12) Floors shall be nonabrasive, slip resistant,
flush at doorways and be of material which do
not retain odors.
(j) Waste disposal:
(1) Every Type I ARCH shall provide a sufficient
number of watertight receptacles, acceptable
to the department for rubbish, garbage,
refuse, and other matter. These receptacles
shall be kept closed by tight fitting covers;
and
(2) Disposal of infectious waste shall be in
compliance with Hawaii Administrative Rules
chapter 104, Management and Disposal of
Infectious Waste.
(k) Storage space for resident's luggage and
other bulky items and equipment shall be provided and
located in a safe and convenient place.
(1) An enclosed dining area within the Type I
ARCH shall be provided for residents which shall be
apart from sleeping quarters but may be in continuity
to the living room area. The following shall prevail:
100.1-47
2
( 1 )
( 2 )
( 3)
( 4 )
( m)
( 1 )
( 2 )
( 3)
( n)
shall be
( 0)
( 1)
§11-100.1-23
At least one table with twenty nine inches
clearance between floor and lower edge shall
be provided to allow for those residents
using wheelchairs;
Dining space allotment shall not be less than
twenty square feet per resident capacity;
Residents shall be served meals in dining
rooms unless they are temporarily confined to
their bedrooms; and
Safe supportive chairs shall be provided in
accord with each resident's need;
Family or living room:
Provisions shall be made for at least one
conveniently located enclosed area for
recreational, social and activity needs of
the residents within or contiguous to the
facility;
The family room shall be equipped with
reading lamps, tables, chairs and other
appropriate furnishings for the use and
comfort of the residents but shall not
include beds; and
The living room space allotment shall not be
less than thirty square feet per resident.
Outdoor areas accessible to the residents
made safe for use by the resident.
Bedrooms:
General conditions:
(A) Bedrooms shall be at or above grade
level;
(B) There shall be an adequate number of
rooms provided for immediate family
members as well as residents;
(C) Family members shall not sleep in
residents' bedrooms;
(D) Bedrooms shall not be used for
recreation, cooking, dining, storage,
bathrooms, laundries, foyers, corridors,
lanais, and libraries;
(E) Access from each bedroom to a bathroom,
toilet, corridor, central utility, or
other area shall be arranged to avoid
passing through another bedroom;
(F) Bedrooms shall be conveniently located
near adequate toilet and bathing
facilities appropriate in number, size,
and design to meet the needs of the
residents;
100.1-48
2 '
§11-100.1-23
(G) All occupants of any bedroom shall be of
the same sex except for designated semi
private rooms which may be occupied by a
mixed sex couple if the primary care
giver and both residents agree to the
living arrangements; and
(H) Type I ARCH licensed for a person in a
wheelchair shall provide an accessible
route to and into all sleeping rooms,
bathrooms, common areas and exits.
(2) Floor space:
(A) Minimum usable floor space allowable
shall be seventy square feet per bed in
a multiple resident bedroom and eighty
square feet per bed in a single resident
bedroom, excluding toilet, closets,
lockers, alcoves, and vestibules. The
number of residents shall be limited to
a maximum of two;
(B) Beds shall be placed at least three feet
apart in multiple occupant bedrooms;
(C) In all Type I ARCHs and those undergoing
construction or renovation, closet space
for residents shall be provided within
the bedroom, allowing a minimum of
thirty inches in width, twenty inches in
depth, and five feet in height per
person exclusive of bedroom space; and
(D) Hanging clothes rods and shelves shall
be adjusted as necessary.
(3) Bedroom furnishings:
(A) Each resident shall be provided for
their individual use, a clean bed
including spring with mattress, at least
thirty six inches wide, of sufficient
length and proper height for the
resident and to permit an individual in
a wheelchair to get in and out of bed
unassisted;
(B) Each bed shall be supplied with a
comfortable mattress cover, a pillow,
pliable plastic pillow protector, pillow
case, and an upper and lower sheet. A
sheet blanket may be substituted for the
top sheet when requested by the
resident; and
(C) A suitable bedspread shall be used on
each resident's bed.
100.1-49
2 -!
§11-100.1-23
(p) Miscellaneous:
(1) Conveniently located space for personal care
items and for equipment, such as crutches and
wheelchairs, shall be provided;
(2) Walkers, wheelchairs, canes, crutches and
bedside rails shall be provided by the
resident;
(3) Equipment for bedside care shall be stored in
resident's bedside stand or other adjacent
enclosed space;
(4) There shall be adequate provision for privacy
when caring for resident or when requested by
the resident and an individual bath sheet
blanket shall be used when bed baths are
given; and
(5) Signaling devices approved by the department
shall be provided for resident's use at the
bedside, in bathrooms, toilet rooms, and
other areas where residents may be left
alone. In Type I ARCHs where the primary
care giver and residents do not reside on the
same level or when other signaling mechanisms
are deemed inadequate, there shall be an
electronic signaling system.
(q) All construction, additions, alterations:
(1) Drawings and specifications for all new
construction or additions, alterations or
repairs to existing buildings shall be
submitted to the department for review prior
to construction;
(2) While final authority to approve the
construction and fire safety features of such
building rests with county agencies and fire
marshals, if construction drawings and
specifications are submitted to the
department, the department shall promptly
review such submittals and make every effort
to advise the applicant of features which
appear nonconforming; and
(3) Minor alterations which do not affect
structural integrity, fire, safety, or which
do not change functional operation, or
increase beds or services over that for which
the ARCH is licensed may be submitted by
freehand drawings or sketches.
100.1-50
§11-100.1-23
(r) Facilities shall be maintained in accordance
with provisions of state and local zoning, building,
fire safety and health codes. [Eff SEP 1 8 ?()rJFf ]
(Auth: HRS §§321-9, 321-10, 321-11, 321-15.t>) (Imp: HRS
§§321-10, 321-11, 321-15.6)
§§11-100.1-24 to 11-100.1-50 (Reserved).
Subchapter 3
Type II ARCH
§11-100-1-51 Applicability. In addition to the
requirements in Subchapter 1 Type I ARCH, the following
requirements shall apply to Type II ARCHs.
[Eff SEP 1 ~ ?Qnf.': ] (Auth: HRS §§321-9, 321-10,
321-11, 32f-1~.'°tr) (Imp: HRS §§321-10, 321-11, 321-15.6)
§11-100.1-52 Primary care giver requirements.
The licensee of a Type II ARCH facility acting as the
administrator or the individual that the licensee has
designated as the administrator, in addition to the
requirements in section 11-100.1-S(a), shall:
(1) Have at least two years experience, in a
management capacity, in the areas of housing,
health care and personal care services or any
combination thereof;
(2) Have knowledge of generally acceptable
accounting principles;
(3) Have training or experience in supervisory
management;
(4) Have knowledge of purchasing of large volumes
of food and meal preparation, as appropriate;
(5) Have knowledge of infection control
procedures in relation to resident care,
personnel and handling of large volume of
laundry, as appropriate; and
(6) Be accountable for providing training for all
facility personnel in the provision of
resident care in conjunction with the
princi~les of the social model.
[Eff StP J 87DnFf ] (Auth: HRS §§321-9, 321-
10, 321-11, JL1-15.6)(Imp: HRS §§321-9, 321-
10, 321-11, 321-15.6)
100.1-51
§11-100.1-54
§ll-100.1-53 Personnel and staffing
requirements. (a) Personnel policies shall be
developed and maintained indicating staff orientation
and in service training, job descriptions, staff
qualifications, job requirements for each class of
employees, code of conduct and other pertinent
personnel information.
(b) All Type II ARCHs shall have available an
administrator to provide direct overall management and
oversight of staff and residents.
(c) All Type II ARCHs shall have available a
registered nurse to provide direct management and
oversight of residents and direct care staff. The
registered nurse shall provide assessments of residents
with appropriate training and oversight of staff to
ensure that resident needs are met.
(d) An adequate number of qualified staff, as
determined by the department, shall be on duty twenty
four hours a day.
(e) At least one staff member of each shift shall
be a nurse aide.
(f) There shall be a designated and properly
trained person to make prescribed medications available
and to perform treatments under the general supervision
or direction of a licensed nurse or who meets the
requirements as set forth in section 11-100.1-B(a).
(g) No staff shall work more than two consecutive
eight hour shifts within a twenty four hour period.
(h) The administrator, primary care giver and
substitute care givers shall attend and successfully
complete a minimum of six hours of training sessions
per year which shall include but not be limited to
personal care, infection control, pharmacology, medical
and behavioral management of residents, diseases and
chronic illnesses, community services and resources.
All inservice training and other educational
experiences shall be documented and kept current.
(i) All in service training and other educational
experiences for employees and primary and substitute
care givers shall be documented and kept current.
[Eff SEP 182006 ] (Auth: HRS §§321-9, 321-10,
3 2 1- 11 , 3 2 1-15 . 6 ) ( Imp: HRS § § 3 2 1-10, 3 2 1-11, 3 2 1-15. 6 )
§11-100.1-54 General operational policies. In
addition to the requirements in section 11-100.1-7, the
Type II ARCH shall have general operational policies on
the following topics:
100.1-52
2 7
§11-100.1-54
( 1 )
( 2 )
( 3 )
( 4 )
( 5 )
( 6 )
( 7 )
( 8)
( 9 )
( 10 )
Nursing services, delegation and staffing
pattern/ratio;
Medication administration;
Drug storage, disposal, safety and quality
control;
Medical emergencies, outlining situations or
circumstances which would warrant contacting
a registered nurse, physician or emergency
medical personnel;
Use of restraints, outlining assessment
processes, indications for use, monitoring
and evaluation;
Resident rights, including system for
administering resident funds and covered and
non-covered items;
Meal planning, food purchase, meal
preparation and service, and referral and use
of consultant registered dietitian;
Abuse, neglect, and exploitation of
residents, process for reporting and
investigation;
Resident assessment indicating assessment
process, care plan development, evaluation
and prevention of negative outcomes.
Procedures will also identify process for
referral and follow-up when changes in
resident status occur; and
Storage and disposal of h~zardous and
infectious waste. [Eff ~£P 18 2006 ]
(Auth: HRS §§321-9, 321-10, 321-11, 321-15.6)
(Imp: HRS §§321-10, 321-11, 321-15.6)
§11-100.1-55 Nutrition and food sanitation. In
addition to the requirements in section 11-100.1-13 the
following
' ( 1 )
( 2 )
shall apply to all Type II ARCHs:
A registered dietitian shall be utilized to
assist in the planning of menus, and provide
nutritional assessments for those residents
identified to be at nutritional risk or on
special diets. All consultations shall be
documented;
All consultant dietitians shall provide
special diet training for food preparation
staff and ensure staff competency; and
100.1-53
§11-100.1-56
(3) All Type II ARCHs shall be in compliance with
Hawaii Administrative Rules Chapter 11-12.
[Eff ~FP 182006 ] (Auth: HRS §§321-9, 321-
10, 32°'1-lf, 321-15.6) (Imp: HRS §§321-10,
321-11, 321-15.6)
§11-100.1-56 Physical environment. (a) In
addition to the requirements in section 11-100.1-23 ,
all Type II ARCH shall satisfy the requirements of this
section.
(b) Type II ARCH that was licensed prior to 1986
and cannot fully comply with the current county
building and fire codes shall continue to be licensed
as long as all residents are ambulatory and the
ownership remains the same unless the director
determines that failing to meet the requirements of
these rules would jeopardize the health and safety of
the residents in the Type II ARCH.
(c) Except as provided in subsection (a), Type II
ARCHs shall be in compliance with the requirements for
Group I occupancies as defined in the Uniform Building
Code and as detailed in applicable chapters of the NFPA
101 Life Safety Code adopted by reference by the state
fire code and respective county fire codes. Compliance
shall include but are not limited to the following:
(1) All exits in Type II ARCHs shall be lighted
from sunset to sunrise and under other
conditions required by applicable provisions
of the state and county fire codes;
(2) Night lighting shall be provided in hallways
and bathrooms; and
(3) An approved secondary source of power
(generator or battery operated) for emergency
lighting of exits shall be operational at all
times.
(d) The number of occupants in bedrooms shall be
limited to a maximum of four.
(e) There shall be:
(1) One toilet for each eight occupants;
(2) One bathtub or shower for each fourteen
occupants; and
(3) One lavatory for each ten occupants.
(f) A utility area shall be provided to wash and
clean garbage containers and for storing garbage,
trash, and solid waste.
(g) Storage space shall be provided for janitor's
supplies and equipment.
100.1-54
§11-100.1-56
(h) If bedpans are used, suitable bedpan flushing
attachments to existing toilets must be available and
used.
(i) A preventive maintenanc~~qg.r~m shall be
developed and documented. [Eff ~tr 1 ~LU06 ] (Auth:
HRS § § 3 2 1- 9 , 3 2 1- 1 0 , 3 2 1- 11 , 3 2 1- 1 5 . 6 ) ( Imp : HRS § § 3 2 1-
10, 321-11, 321-15.6)
§§11-100.1-57 to 11-100.1-77 (Reserved).
Subchapter 4
Expanded ARCH
§ll-100.1-78 Applicability. In addition to the
requirements in Subchapter 1 Type I ARCH and Subchapter
2 Type II ARCH, the fol~~g
8
~~~irements will apply
to expanded ARCHs. [Eff ~tP l LUUO ](Auth: HRS
§§321-9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
3 2 1-15 . 6 2 ) ( Imp: § § 3 2 1- 9 , 3 2 1-10 , 3 2 1- 11 , 3 2 1-15 . 1 ,
321-15.6, 321-15.61, 321-15.62)
§11-100.1-79 Purpose. The purpose of this
subchapter is to establish a category of ARCHs
quali~ f'S zrnj8we nursing facility level residents.
[Eff O ] (Auth: HRS §§321-1, 321-9,
321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
321-15.62) (Imp: HRS §§321-1, 321-9, 321-10, 321-11,
321-15.1, 321-15.6, 321-15.61, 321-15.62)
§ll-100.1-80 Licensing. (a) In addition to the
requirements in section ll-100.l-3(a), every applicant
for an expanded ARCH license shall be licensed as an
ARCH and shall have been operating satisfactorily for a
minimum of six months prior to applying for expanded
ARCH licensure.
(b) Each expanded ARCH shall be inspected prior
to licensure to determine its capability for
accommodating residents who are not capable of self
preservation.
(c) Prior to determining eligibility of an
applicant, all existing waivers in the ARCH shall be
subject to review by the department.
100.1-55
§11-100.1-81
(d) Policies and procedures shall be developed by
the licensee to meet the provisions of this chapter.
(e) At no time shall the total bed capacity of the
expanded ARCH exceed the liceRsed capacity under the
original ARCH license. [Eff ~EP 182001' ] (Auth:
HRS §§321-1, 321-9, 321-10, 321-11, 32I-15.l, 321-15.6,
3 21-15. 61, 3 21-15 . 6 2 ) ( Imp: HRS § § 3 21-1, 3 21-9 , 3 21-10 ,
321-11, 321-15.1, 321-15.6, 321-15.61, 321-15.62)
§ll-100.1-81 Minimum structural requirements.
(a) In addition to the requirements in section 11-
100.1-23 and section 11-100.1-56, the expanded ARCH
shall satisfy the requirements of this section.
(b) All signaling devices shall be approved by
the department and installed at bedside, in bathrooms,
toilet rooms, and other areas where expanded ARCH
residents may be left alone. All such signaling
devices shall be approved by the department. In
expanded ARCHs where the primary care giver and
expanded ARCH residents do not reside on the same floor
or when other signaling mechanisms are deemed
inadequate, electronic signaling systems shall be
installed.
(c) Every interior door, when locked, shall
permit opening from the outside with the use of a
common tool or implement.
(d) Door locks or other devices shall not be
installed to restrict the free movement or use of exits
by the expanded ARCH residents.
(e) There shall be interior stairways in a multi
story structure.
(f) If swimming pools are located on expanded
ARCH property, there shall be a solid pool cover with a
key lock approved by the department or a fence six feet
in height which completely encloses the pool. The pool
cover shall be locked onto the pool or the gate to the
pool shall be locked at all times unless the pool is
being used, in which case, proper supervision of
expanded ARCH residents shall be provided to assure
resident safety. [Eff SEP 18 2006 ] (Auth: HRS
§§321-1, 321-9, 321-10, 321-11, 321-15.1, 321-15.6,
§ll-100.1-83,321-15.61, 321-15.62) (Imp: HRS §§321-1,
321-9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
321-15.62)
100.1-56
§11-100.1-82
§11-100.1-82 Primary care giver requirements.
(a) In addition to requirements in section
ll-100.l-8(a) this section shall apply.
(b) The primary care giver shall be approved by
the department to provide special diets.
(c) The licensee shall provide staff on duty
twenty four hours of each day sufficient and trained to
meet the needs of expanded ARCH residents and to carry
out the responsibilities based on the expanded ARCH
resident's care plan.
(d) The licensee shall submit a plan, which must
be approved by the department detailing the process by
which the expanded ARCH will arrange for the services
of a registered nurse and case manager, the role and
responsibilities of the registered nurse, case manager,
and care givers and how training of the primary and
substitute care givers will be ensured.
(e) Licensees shall submit the name of the
trained substitute care givers at the time of
application and as changes occur.
[ E ff srr, 1 Q ?11nR ] ( Au th: HRS § § 3 21-1 , 3 21-9,
3 2 1 - 1 0 , 3 2 1 't. 1 , Y.24'.!./l:r_ 5 . 1 , 3 2 1 - 1 5 . 6 , 3 2 1 - 1 5 . 6 1 , 3 2 1 -
15. 62) (Imp: HRS §§321-1, 321-9, 321-10, 321-11, 321-
15. l, 321-15.6, 321-15.61, 321-15.62)
§11-100.1-83 Personnel and staffing requirements.
In addition to the requirements in subchapter 2 and 3:
(1) A registered nurse other than the licensee or
primary care giver shall train and monitor
primary care givers and substitutes in
providing daily personal and specialized care
to residents as needed to implement their
care plan;
(2) The licensee of a Type I expanded ARCH shall
provide a primary care giver who shall:
(A) Reside in the expanded ARCH or employ or
otherwise engage by contract a qualified
primary care giver in those homes in
which the licensee does not reside; and
(B) Be a nurse aide or licensed nurse.
(3) The licensee of a Type II expanded ARCH shall
provide primary care givers who shall be at
least a nurse aide or licensed nurse who may
reside in the expanded ARCH;
(4) A substitute care giver who is trained by the
primary care giver with the assistance of the
registered nurse or case manager and meets
100.1-57
§11-100.1-84
the requirements as set forth in section 11-
100.1-9, shall take charge of an expanded
ARCH during an expanded ARCH primary care
giver's absence or inability to perform
regular duties; and
(5) Primary and substitute care givers shall have
documented evidence of successful completion
of twelve hours of continuing education
courses per year on subjects pertinent to the
management of an expanded ARCH and care of
expans~p t~nJ.esidents.
[Eff OLWO ] (Auth: HRS §§321-1,
321-9, 321-10, 321-11, 321-15.1, 321-15.6,
3 2 1-15 . 6 1, 3 2 1- 15 . 6 2 ) ( Imp: HRS § § 3 2 1-1 ,
321-9, 321-10, 321-11, 321-15.1, 321-15.6,
321-15.61, 321-15.62)
§11-100.1-84 Admission requirements. (a)
Licensees of an expanded ARCH shall admit nursing
facility level residents as determined and certified by
the resident's physician or APRN.
(1) A Type I expanded ARCH shall provide services
to no more than two nursing facility level
residents at any one time provided that more
nursing facility level residents may be
allowed at the discretion of the department;
and
(2) A Type II expanded ARCH shall provide
services to nursing facility level residents
not to exceed twenty percent of the licensed
capacity, provided that more nursing facility
residents may be allowed at the discretion of
the department;
provided further that the department shall exercise its
discretion for a resident presently residing in a Type
I or Type II home to allow the resident to remain as an
additional nursing facility resident based upon the
best interest of the resident. The best interest of
the resident shall be determined by the department
after consultation with the resident, the resident
family, primary physician, case manager, primary care
giver and home operator.
(b) Upon admission of a resident, the expanded
ARCH licensee shall have the following information:
(1) A current physician's report on the expanded
ARCH resident's physical examination and
diagnosis, including mental, functional, and
100.1-58
§11-100.1-84
behavioral status;
(2) Orders for diet, medication, specialized
care, or activities signed by the physician;
(3) Evidence of compliance with the department's
uniform tuberculosis policy;
(4) Evidence of current immunizations for
pneumococcal and influenza as recommended by
the ACIP; and a written care plan addressing
resident problems and needs. [ Ef f SEP 1 8 2006
] (Auth: HRS §§321-1, 321-9, 321-10, 321-11,
321-15.1, 321-15.6, 321-15.61, 321-15.62)
(Imp: HRS §§321-1, 321-9, 321-10, 321-11,
321-15.1,321-15.6, 321-15.61, 321-15.62)
§11-100.1-85 Transfer and discharge of expanded
ARCH residents. (a) All transfers and discharges of
expanded ARCH residents shall be coordinated with the
resident, resident's family or surrogate, resident's
case manager, primary care giver or licensee and
resident's physician or APRN. The licensee or primary
care giver shall assist with the transfer or discharge.
(b) If the licensee requests transfer of the
expanded ARCH resident, a written request stating the
reason for the transfer shall first be made to the
resident, resident's family or surrogate, resident's
case manager and physician or APRN no less than thirty
days prior to the desired date of transfer.
(c) Thirty days written notice shall not be
required for emergency transfers, discharges, or if
mutually agreed upon by resident, licensee, and case
manager.
(d) If the resident, resident's family or
surrogate wishes to have the resident transferred,
notice of no less than fourteen days shall be provided
to the primary care giver. [Eff ~EP 1 g ?OQ6 ]
{Auth: HRS §§321-1, 321-9, 321-1~, 3tI-i~, 321-15.1,
321-15.6, 321-15.61, 321-15.62) (Imp: HRS §§321-1,
321-9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
321-15.62)
§11-100.1-86 Fire safety. (a) A Type I expanded
ARCH shall be in compliance with existing fire safety
standards for a Type I ARCH, as provided in
section ll-100.l-23(b), and the following:
100.1-59
§11-100.1-87
(1) Locking devices for room doors shall be
readily opened by the occupant from inside
the room without the use of a key or special
knowledge. Push button locks shall
automatically pop open upon turning of the
doorknob;
(2) Resident's sleeping room doors shall be self
closing;
(3) Fire drills shall be conducted and documented
at least monthly under varied conditions and
times of day;
(4) Hard wired smoke detectors shall be approved
by a nationally recognized testing laboratory
and all shall be tested at least monthly to
assure working order;
(5) In the residents' area, a hard wired smoke
detector shall be located in the hallway
outside of the resident sleeping rooms and
also in the living/activity room. Hard wired
or battery operated smoke detectors, or both,
shall also be located in all resident
s-leeping rooms;
(6) In a one-story structure, a hard wired smoke
detector shall separate the expanded ARCH
resident area from the care giver's living
area; and
(7) In a multi-story home, a hard wired smoke
detector shall be in the care giver's living
area or hallway outside the sleeping rooms
and at the top of the interior stairway
landing.
(b) Type II expanded ARCHs shall be in compliance
with the requirements for Group I occupancies as
defined in the Uniform Building Code and as detailed in
applicable chapters of the NFPA 101 Life Safety Code
adopted by reference by the state fire code and
respective county fire codes. [ E ff ~r:e 1 ~ 2nnR ]
(Auth: HRS §§321-1, 321-9, 321-10, ~~1-~r, v321-15.l,
321-15.6, 321-15.61, 321-15.62) (Imp: HRS §§321-1,
321-9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
321-15.62)
§11-100.1-87 Personal care services. (a) The
primary care giver shall provide daily personal care
and specialized care to an expanded ARCH resident as
indicated in the care plan. The care plan shall be
developed as stipulated in section 11-100.1-2 and
100.1-60
2 7
§11-100.1-87
updated as changes occur in the expanded ARCH
resident's care needs and required services or
interventions.
(b) The expanded ARCH shall provide an ongoing
program of recreational and social activities designed
to meet, in accordance with the comprehensive
assessment, the interests and the physical, mental,
psycho-social well being of each resident, and shall be
documented in the care plan.
(c) The primary care giver shall, in coordination
with the case manager, make arrangements for each
expanded ARCH resident to have:
(1) Annual physical and dental examinations;
(2) Pneumococcal and influenza vaccines and any
necessary immunizations following the
recommendations of the Advisory Committee of
Immunization Practices (ACIP); and
(3) Visits to the physician every four months or
more frequently to ensure adequate medical
supervision.
(d) The primary care giver shall have twenty four
hour access to a physician or APRN and case manager.
Except for an emergency, whenever the primary care
giver observes a significant change in the health
status of the expanded ARCH resident, the primary care
giver shall promptly notify the resident's physician or
APRN and case manager. The primary care giver shall
record this action in the expanded ARCH resident's
progress notes.
(e) The primary care giver with the assistance of
the case manager shall provide training to all
substitute care givers and ensure that all services and
interventions indicated in the expanded ARCH resident's
care plan are provided to expande~,hRCH residents by
the substitute care giver. [ Ef f ~tP 1 8 2008 ]
(Auth: HRS §§321-1, 321-9, 321-10, 321-11, 321-15.1,
321-15.6, 321-15.61, 321-15.62) (Imp: HRS §§321-1, 321-
9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.61,
321.15.62)
§11-100.1-88 Case management qualifications and
services. (a) Case management services shall be
provided for each expanded ARCH resident to plan,
locate, coordinate and monitor comprehensive services
to meet the individual resident's needs based on a
comprehensive assessment. ,Case management services
shall be provided by a registered nurse who:
100.1-61
§11-100.1-88
(1) Possesses a bachelor's degree in nursing and
current license to practice in the State of
Hawaii; and
(2) Has at least two years experience with client
care coordination responsibilities and
possesses knowledge and skills pertaining to
the long term care needs of the geriatric
population. The department may allow
substitution of two additional years of
client care coordination experience for a
bachelor's degree.
(b) When the care plan goal cannot be met by the
registered nurse, a social worker shall be available to
the resident and primary care giver for areas that
include, but are not limited to, counseling, access to
community services, financial matters, and behavior
management. These services shall be provided by a
social worker who:
(1) Possesses a master's degree in social work
and current license to practice in the State
of Hawaii; and
(2) Has at least two years experience with client
care coordination responsibilities and
possesses knowledge and skills pertaining to
the long term care needs of the geriatric
population. The department may allow
substitution of two additional years of
client care coordination experience for a
master's degree.
(c) Case management services for each expanded
ARCH resident shall be chosen by the resident,
resident's family or surrogate in collaboration with
the primary care giver and physician or APRN. The case
manager shall:
(1) Conduct a comprehensive assessment of the
expanded ARCH resident prior to placement in
an expanded ARCH, which shall include, but
not be limited to, physical, mental,
psychological, social and spiritual aspects;
(2) Develop an interim care plan for the expanded
ARCH resident within forty eight hours of
admission to the expanded ARCH and a care
plan within seven days of admission. The
care plan shall be based on a comprehensive
assessment of the expanded ARCH resident's
needs and shall address the medical, nursing,
social, mental, behavioral, recreational,
dental, emergency care, nutritional,
100.1-62
§11-100.1-88
spiritual, rehabilitative needs of the
resident and any other specific need of the
resident. This plan shall identify all
services to be provided to the expanded ARCH
resident and shall include, but not be
limited to, treatment and medication orders
of the expanded ARCH resident's physician or
APRN, measurable goals and outcomes for the
expanded ARCH resident; specific procedures
for intervention or services required to meet
the expanded ARCH resident's needs; and the
names of persons required to perform
interventions or services required by the
expanded ARCH resident;
(3) Review the care plan monthly, or sooner as
appropriate;
(4) Update the care plan as changes occur in the
expanded ARCH resident care needs, services
and/or interventions;
(5) Promote continuity of care and appropriate
integration and utilization of services
necessary to implement the care plan;
(6) Coordinate care giver training, hospital
discharge, respite, home transfers and other
services as appropriate. Facilitate,
advocate and mediate for expanded ARCH
residents, care givers and service providers
to ensure linkages and provision of quality
care for the optimal function of the expanded
ARCH resident;
(7) Arrange and participate in the expanded ARCH
resident's case conferences. Ensure that the
expanded ARCH resident, resident's family or
surrogate, expanded ARCH resident's physician
and the primary care giver are represented at
the case conferences;
(8) Have face-to-face contacts with the expanded
ARCH resident at least once every thirty
days, with more frequent contacts based on
the resident's needs and the care giver's
capabilities;
(9) Provide ongoing evaluation and monitoring of
the expanded ARCH resident's status, care
giver's skills, competency and quality of
services being provided;
(10) Conduct comprehensive reassessments of the
expanded ARCH resident every six months or
sooner as appropriate;
100.1-63
§11-100.1-89
(11) Make arrangements with a case manager and/or
registered nurse who meets the requirements
of this subchapter (a) to provide coverage in
the event that the case manager takes leave
or is unable to provide services as required
in this chapter; and
(12) Inform the department of any change in
quality of services being provided to the
expanded ARCH resident.
Case management services shall be subject to all
applicable state regulations.
(d) The department in collaboration with the
expanded ARCH resident family or surrogate may require
a change in case management services when it has been
determined through review of resident records, care
plans and interventions that the case manager is unable
to provide adequate services as outlined in this
subchapter.
(e) When a change in case management services
occurs, the new case manager shall perform a
comprehensive reassessment of the expanded ARCH
resident, review the care plan and make necessary
amendments. The expanded ARCH resident, resident's
family or surrogate, physician or APRN and primary care
giver shall be notified if a change in case management
~:~v~~;~ 1~~, c~~1~;~
1
;~~~io, [~~i-1 fEP3J1~?qJJ.Si, 12 i~~~~ ~,
3 2 1- 1 5 . 6 1 , 3 2 1- 15 . 6 2 ) ( Imp : HRS § § 3 2 1- 1 , 3 2 1- 9 , 3 2 1-1 0 ,
321-11, 321-15.1, 321-15.6, 321-15.61, 321-15.62)
§ll-100.1-89 Medications. In addition to the
requirements in subchapter 2 and subchapter 3, the
following shall apply to an expanded ARCH:
(1) Injectable medications shall be administered
by a licensed nurse, unless physician orders
permit an expanded ARCH resident to self
inject. The registered nurse case manager
may delegate this task according to rules
established by the Board of Nursing. The
licensee or primary care giver shall maintain
written policies and procedures outlining
this responsibility; and
(2) The primary care giver shall obtain training,
relevant information, and regular monitoring
from the expanded ARCH resident's physician,
a home health agency, or a registered nurse
100.1-64
§11-100.1-89
case manager for any and all specific
medications that the expanded ARCH resident
requires. [Eff SEP J 8 ?nm; 1 (Auth: HRS
§ § 3 2 1 - 1 , 3 2 1- 9 , 3 2 1 - 1 , J11 - 11 , 3 2 1- 1 5 . 1 ,
3 2 1- 15 . 6 , 3 2 1- 15 . 6 1 , 3 2 1- 15 . 6 2 ) ( Imp : HRS
§§321-1, 321-9, 321-10, 321-11, 321-15.1,
321-15.6, 321-15.61, 321-15.62)
§11-100.1-90 Expanded ARCH resident's rights. In
addition to the resident's rights in section 11-100.1-
21, the expanded ARCH resident shall have the right to:
(1) Be fully informed, orally and in writing,
prior to or at the time of admission, of
individual rights and responsibilities and of
all rules governing expanded ARCH resident
conduct. There shall be documentation that a
copy of this document has been received,
acknowledged, and signed by the expanded ARCH
resident, expanded ARCH resident's family,
legal guardian, surrogate or representative.
Should the resident require the assistance of
an interpreter~ the licensee shall ensure
that interpreter services including but not
limited to translation, sign language or
visual services are provided;
(2) Immediate transfer effected through the case
manager, when the expanded ARCH resident's
health and safety is threatened, which shall
trigger a waiver of the thirty day minimum
notice requirement for transfers or
discharges;
(3) Immediate transfer effected through the case
manager, when the expanded ARCH resident's
health and safety is threatened, which shall
trigger a waiver of the fourteen day minimum
notice requirement for transfers, requested
by the resident, the resident's family or
surrogate;
(4) Choose a primary physician or APRN and case
manager; and
(5) Be afforded privacy curtains or screens when
required to share a room with another
resident. [Eff crp 1 8 znnR ] (Auth: HRS
§ § 3 2 1 - 1 , 3 2 1 - 9 , 3-2--1! - l'0 , ~'t"L - 1 1 , 3 2 1 - 1 5 . 1 ,
3 2 1- 1 5 . 6 , 3 2 1- 1 5 . 6 1 , 3 2 1- 1 5 . 6 2 ) ( Imp : HRS
§§321-1, 321-9, 321-10, 321-11, 321-15.1,
321-15.6, 321-15.61, 321-15.62)
100.1-65
Subchapter 5
Professional Misconduct
§11-100.1-91
§11-100.1-91 Professional misconduct. (a) The
department shall take action, as specified in
subchapter 6, against any licensee, primary care giver
or substitute care giver who is guilty of misconduct or
employs or houses any persons guilty of misconduct that
has been brought to the department's attention.
(b) Misconduct includes, but is not limited to,
the following:
(1) Procurement of license by fraud or
misrepresentation;
(2) Gross negligence;
(3) Repeated negligent acts;
(4) Mental or clinical incompetence;
(5) Any conduct that has endangered or is likely
to endanger the health, safety, or welfare of
the residents;
(6) Habitual intemperance in the use of alcohol
or drugs;
(7) Conviction of a crime which is substantially
related to the qualifications, functions, or
duties of an individual providing care to
residents;
(8) The conviction of a felony or misdemeanor, or
petty misdemeanor involving moral turpitude,
dishonesty, or corruption, whether or not the
act is committed in the course of the
individual's activities as one providing care
to residents. The department may order a
license to be suspended, limited or revoked,
or may decline to issue a
license when the time for appeal has elapsed,
or when the judgment of conviction has been
confirmed on appeal;
(9) Violation of any law regulating the
dispensing or administration of narcotics,
dangerous drugs, or controlled substances;
(10) Violating or attempting to violate, directly
or indirectly, or assisting in, or abetting
in, the violation of, or conspiring to
violate any provision or term of chapter 321,
HRS, this chapter, or any lawful order of the
department;
(11) Making or giving false statement of
information in connection with an application
for issuance of a license;
100.1-66
§11-100.1-91
( 12 )
( 13 )
Aiding or abetting an unlicensed person to
operate an ARCH or expanded ARCH as defined
by chapter 321, HRS, and this chapter; and
Conduct or character likely$~~ deceive or
defraud the public. [Eff tt> 18 20Ufi ]
(Auth: HRS §§321-9, 321-10, 321-11, 321-15.6,
321-15.61, 321-15.62) (Imp: HRS §§321-9, 321-
10, 321-11, 321-15.6, 321-15.61, 321-15.62)
Subchapter 6
Administrative Enforcement
§11-100.1-92 Enforcement. (a) If the department
determines that any person has violated any provision
of this chapter, any provision of chapter 321, HRS, or
any term or condition of a license issued pursuant to
this chapter, the department shall do one or more of
the following:
(1) Issue an order assessing an administrative
penalty for any past or current violation; or
(2) Require compliance immediately or within a
specific time.
(b) Any order issued pursuant to this section may
include a suspension, modification, or revocation of
any license issued pursuant to this chapter and any
administrative penalty assessed in accordance with
section 321-20, HRS. The order shall state with
reasonable specificity the nature of the violation, the
legal bases for the findings of violation, and the
right to request an administrative hearing and retain
legal counsel. The order shall be provided to the
alleged violator by certified mail.
(c) Any order issued under this chapter shall
become final, unless not later than twenty days after
receipt of the notice of order by certified mail, the
alleged violator requests in writing a hearing before
the director. Any penalty imposed under this chapter
shall become due and payable twenty days after receipt
of the notice of order by certified mail unless the
alleged violator requests in writing a hearing before
the director. Whenever a hearing is requested on any
penalty imposed under this chapter, the penalty shall
become due and payable only upon completion of all
review proceedings and the issuance of a final order
confirming the penalty in whole or in part. Upon
100.1-67
§11-100.1-93
request for a hearing, the director or director's
designee shall require that the alleged violator appear
before the director for a hearing at a time and place
specified in a notice of hearing and answer the charges
complained of.
(d) Any hearing conducted under this section
shall be conducted as a contested case hearing under
chapter 91, HRS. If after a hearing held pursuant to
this section, the director or the director's designee
finds that the violation or violations have occurred,
the director or the director"s designee shall affirm or
modify any penalties imposed or shall modify or affirm
the order previously issued or issue an appropriate
order or orders. If, after the hearing on an order or
penalty contained in a notice, the director or the
director"s designee finds that no violation has
occurred or is occurring, the director or the
director"s designee shall rescind the order or penalty
or both.
(e) Nothing in this section shall be construed to
limit other penalties provided elsewhere.
[Eff SEP 182MA ] (Auth: HRS §§321-9, 321-10, 321-
11 , 3 2 1 - 1 5 . 6 , '"'j"J 1 - 1 5 . 7 , 3 2 1- 1 5 . 6 1 , 3 2 1 - 1 5 . 6 2 , 3 2 1- 2 0 )
(Imp: HRS §§321-9, 321-10, 321-11, 321-15.6, 321-15.7,
321-15.61, 321-15.62, 321-20)
§11-100.1-93 Emergency procedures. (a) If the
department determines that the licensee, primary care
giver, staff or other household member has subjected a
resident to abuse, neglect, or financial exploitation,
the department at its discretion may order the
immediate discontinuance of the ARCH or expanded ARCH
and revoke the license issued pursuant to this chapter.
The order shall be immediately effective and shall
designate the date for the discontinuance of the ARCH
6r expanded ARCH. The department shall provide written
notice of the order to the licensee by certified mail
prior to the date of discontinuance. The department
may assist in the coordination and arrangement for
orderly transfer and discharge of residents.
(b) The department shall provide an opportunity
for a hearing within twenty four hours after service of
the order. If a hearing is not provided as requested,
a stay in the department's decision will be provided
until a hearing can be conducted.
100.1-68
§11-100.1-93
(c) Any hearing conducted under this section
shall be conducted as a contested case hearing under
chapter 91, HRS. If after a hearing held pursuant to
this section, the director finds that the violation or
violations have occurred, the director shall affirm or
modify any penalties imposed or shall modify or affirm
the order previously issued or issue an appropriate
order or orders as may be appropriate. If, after the
hearing on an order or penalty contained in a notice,
the director finds that no violation has occurred or is
occurring, the director ~lJ.nr~~ind the order or
penalty or both. [Eff ~t~ loLUUO ] (Auth: HRS
§§321-9, 321-10, 321-11, 321-15.6, 321-15.7, 321-15.61,
321-15.62) (Imp: HRS §§321-9, 321-10, 321-11, 321-15.6,
321-15.7, 321-15.61, 321-15.62)
§11-100.1-94 Penalties. In addition to any other
action to enforce these rules, the director may
initiate procedures for invoking penalties as provided
in chapter 321, HRS. [Eff ~EP J ~7flllR ] (Auth: HRS
§§321-9, 321-10, 321-11, 32r-15.b,~311-15.7, 321-15.61,
321-15.62, 321-18) (Imp: HRS §§321-9, 321-10, 321-11,
321-15.6, 321-15.7, 321-15.61, 321-15.62, 321-18)
§11-100.1-95 Severability. If any provision of
this chapter or the application thereof to any person
or circumstance is held invalid, the remainder of this
chapter, or the application of the provision to other
persons or circu,mstance~~shall not be affected
thereby. [Eff ~EP l 8wuo ] (Auth: HRS §§321-1,
321-9, 321-10, 321-11, 321-15.1, 321-15.6, 321-15.7,
321-15.61, 321-15.62) (Imp: HRS §§321-1, 321-9, 321-10,
321-11, 321-15.1, 321-15.6, 321-15.7, 321-15.61,
321-15.62)
§11-100.-96 Transition. Adult residential care
homes licensed at the time of adoption of these rules
shall have a period of nine months to institute
required changes or requirements as set forth in this
chapter.
100.1-69
2 7
DEPARTMENT OF HEALTH
The repeal of chapter 11-100 and chapter 101, and
the adoption of chapter 11-100.1 Hawaii Administrative
Rules, on the Summary Page dated ~JL 2 't 2006 ,
following public hearings held on April 15, 2003 via
video conferencing at (1) Kakuhihewa State Office
Building, Kapolei, Hawaii; (2) Keoni Ana Building,
Honolulu, Hawaii; (3) Hilo State Office Building, Hilo,
Hawaii; (4) Lihue State Office Building, Lihue, Hawaii;
and (5) Wailuku Judiciary Building, Wailuku, Hawaii,
after a public notice was published on March 12
and 14, 2003 in the West Hawaii Today, Hawaii Tribune,
Maui News, Garden Island and Honolulu Advertiser.
The repeal of chapters 11-100 and 11-101, Hawaii
Administrative Rules, and the adoption of chapter 11-
100.1, Hawaii Administrative Rules, shall take effect
ten days after filing with the Office of the Lieutenant
Governor.
M.D.
of Health
APPROVED:
LIND~
Governor
State of Hawaii
Date: SEP - ti 2006
APPROVED AS TO FORM:
~;t~ D ~ttorneyGeral
Filed:
100.1-70
r