Health, Family Health and Preparedness, Licensing

Rule R432-270

Assisted Living Facilities

Notice of Proposed Rule

(Amendment)

DAR File No.: 36445
Filed: 07/03/2012 09:00:06 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The change in Section R432-270-12 is to remove an unnecessary requirement so facilities are able to comply with the rule. The change in Section R432-270-16 is to remove a requirement that the facility have a form approved prior to use. The changes in Section R432-270-19 are: at Subsection (2)(c), remove a requirement that the facility is unable to enforce; at Subsection (2)(d)(ii), clarify the requirements so the facilities are able to comply; and at Subsection (2)(5), remove a requirement that is impossible for the facility to comply with and replacing it with a requirement that still ensures resident safety. These amendments were approved by the Health Facilities Committee on 02/08/2012. This committee has representation from a broad cross section of the entities affected by this rule.

Summary of the rule or change:

The change in Section R432-270-12 is to remove the requirement of the facility to require a resident to have a physician prior to admit. The change in Section R432-270-16 is to remove the requirement for a wander risk agreement to be approved by the department prior to use. The changes to Section R432-270-19 are: at Subsection (2)(c), remove part of the rule that regulates who can set up medication when a family member is responsible for the residents medications; at Subsection (2)(d)(ii), change the rule to state that medication are administered according to the order not to the service plan; and at Subsection (2)(5), the change gives the health care professional 72 hours to co-sign on a medication change.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

These rule amendments will have no effect on state budgets since there will be no change in current practice.

local governments:

These rule amendments will have no effect on local government budgets since there will be no change in current practice.

small businesses:

These rule amendments will have no effect on small businesses since there will be no change in current practice.

persons other than small businesses, businesses, or local governmental entities:

These rule amendments will have no effect on persons since there will be no change in current practice.

Compliance costs for affected persons:

These rule amendments will have no effect on persons since there will be no change in current practice.

Comments by the department head on the fiscal impact the rule may have on businesses:

Eliminating unenforceable outdated requirements will be beneficial to business and not compromise the rights or safety of residents.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at jhoffman@utah.gov
• Carmen Richins at the above address, by phone at 801-538-9087, by FAX at 801-538-6024, or by Internet E-mail at carmenrichins@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/31/2012

This rule may become effective on:

09/07/2012

Authorized by:

David Patton, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-270. Assisted Living Facilities.

R432-270-12. Resident Assessment.

[ (1) Each person admitted to an assisted living facility shall have a personal physician or a licensed practitioner prior to admission.

] ( 1[2]) A signed and dated resident assessment shall be completed on each resident prior to admission and at least every six months thereafter.

( 2[3]) In Type I and Type II facilities, the initial and six-month resident assessment must be completed and signed by a licensed health care professional.

( 3[4]) The resident assessment must include a statement signed by the licensed health care professional completing the resident assessment that the resident meets the admission and level of assistance criteria for the facility.

( 4[5]) The facility shall use a resident assessment form that is approved and reviewed by the Department to document the resident assessments.

( 5[6]) The facility shall revise and update each resident's assessment when there is a significant change in the resident's cognitive, medical, physical, or social condition and update the resident's service plan to reflect the change in condition.

 

R432-270-16. Secure Units.

(1) A Type II assisted living facility with approved secure units may admit residents with a diagnosis of Alzheimer's/dementia if the resident is able to exit the facility with limited assistance from one person.

(2) Each resident admitted to a secure unit must have an admission agreement that indicates placement in the secure unit.

(a) The secure unit admission agreement must document that a [Department-approved ]wander risk management agreement has been negotiated with the resident or resident's responsible person.

(b) The secure unit admission agreement must identify discharge criteria that would initiate a transfer of the resident to a higher level of care than the assisted living facility is able to provide.

(3) There shall be at least one staff with documented training in Alzheimer's/dementia care in the secure unit at all times.

(4) Each secure unit must have an emergency evacuation plan that addresses the ability of the secure unit staff to evacuate the residents in case of emergency.

 

R432-270-19. Medication Administration.

(1) A licensed health care professional must assess each resident to determine what level and type of assistance is required for medication administration. The level and type of assistance provided shall be documented on each resident's assessment.

(2) Each resident's medication program must be administered by means of one of the methods described in (a) through (d) in this section:

(a) The resident is able to self-administer medications.

(i) Residents who have been assessed to be able to self- administer medications may keep prescription medications in their rooms.

(ii) If more than one resident resides in a unit, the facility must assess each person's ability to safely have medications in the unit. If safety is a factor, a resident shall keep his medication in a locked container in the unit.

(b) The resident is able to self-direct medication administration. Facility staff may assist residents who self-direct medication administration by:

(i) reminding the resident to take the medication;

(ii) opening medication containers; and

(iii) reminding the resident or the resident's responsible person when the prescription needs to be refilled.

(c) Family members or a designated responsible person may administer medications[from a package set up by a licensed practitioner or licensed pharmacist which identifies the medication and time to administer]. If a family member or designated responsible person assists with medication administration, they shall sign a waiver indicating that they agree to assume the responsibility to fill prescriptions, administer medication, and document that the medication has been administered. Facility staff may not serve as the designated responsible person.

(d) For residents who are unable to self-administer or self-direct medications, facility staff may administer medications only after delegation by a licensed health care professional under the scope of their practice.

(i) If a licensed health care professional delegates the task of medication administration to unlicensed assistive personnel, the delegation shall be in accordance with the Nurse Practice Act and R156-31B-701.

(ii) The medications must be administered according to the prescribing order[service plan].

(iii) The delegating authority must provide and document supervision, evaluation, and training of unlicensed assistive personnel assisting with medication administration.

(iv) The delegating authority or another registered nurse shall be readily available either in person or by telecommunication.

(3) The facility must have a licensed health care professional or licensed pharmacist review all resident medications at least every six months.

(4) Medication records shall include the following:

(a) the resident's name;

(b) the name of the prescribing practitioner;

(c) medication name including prescribed dosage;

(d) the time, dose and dates administered;

(e) the method of administration;

(f) signatures of personnel administering the medication; and

(g) the review date.

(5) The licensed health care professional or licensed pharmacist should document any change in the dosage or schedule of medication in the medication record. When changes in the medication are documented by the facility staff the licensed health care professional must co-sign within 72 hours. The licensed health care professional must notify all unlicensed assistive personnel who administer medications of the medication change.[Each facility must have a licensed health care professional or licensed pharmacist document any change in the dosage or schedule of medication in the medication record. The delegating authority must notify all unlicensed assistive personnel who administer medications of the medication change.]

(6) Each resident's medication record must contain a list of possible reactions and precautions for prescribed medications.

(7) The facility must notify the licensed health care professional when medication errors occur.

(8) Medication error incident reports shall be completed when a medication error occurs or is identified.

(9) Medication errors must be incorporated into the facility quality improvement process.

(10) Medications shall be stored in a locked central storage area to prevent unauthorized access.

(a) If medication is stored in a central location, the resident shall have timely access to the medication.

(b) Medications that require refrigeration shall be stored separately from food items and at temperatures between 36 - 46 degrees Fahrenheit.

(c) The facility must develop and implement policies for the security and disposal of narcotics. Any disposal of controlled substances by a licensee or facility staff shall be consistent with the provisions of 21 CFR 1307.21.

(11) The facility shall develop and implement a policy for disposing of unused, outdated, or recalled medications.

(a) The facility shall return a resident's medication to the resident or to the resident's responsible person upon discharge.

(b) The administrator shall document the return to the resident or the resident's responsible person of medication stored in a central storage.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [February 8, 2011]2012

Notice of Continuation: December 16, 2009

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-1