R501.  Human Services, Administration, Administrative Services, Licensing.
R501-13.  Adult Day Care.
R501-13-1.  Authority.
	Pursuant to 62A-2-101 et seq., the Office of Licensing, hereinafter referred to as Office, shall license adult day care programs according to the following rules.

R501-13-2.  Purpose.
	Adult day care is designed to meet the needs of functionally impaired adults through a comprehensive program that provides a variety of social, recreational and related support services in a protective setting.

R501-13-3.  Definition.
	Pursuant to 62A-2-101(1) adult day care means continuous care and supervision for three or more adults 18 years of age and over for at least four but less than 24 hours a day, that meets the needs of functionally impaired adults through a comprehensive program that provides a variety of health, social, recreational, and related support services in a protective setting.

R501-13-4.  Governance.
	A.  The program shall have a governing body which has responsibility for and authority over the policies, procedures and activities of the program.
	B.  The governing body shall be one of the following:
	1.  a Board of Directors in a nonprofit organization; or
	2.  commissioners or appointed officials of a governmental unit; or
	3.  Board of Directors or individual owners of a for-profit organization.
	C.  The program shall have a list of members of the governing body, indicating name, address and term of membership.
	D.  The program shall have an organization chart which identifies operating units of the program and their interrelationship.  The chart shall define lines of authority and responsibility for all program staff.
	E.  When the governing body is composed of more than one person, the governing body shall establish bylaws, and shall hold formal meetings at least twice a year to evaluate quality assurance.  A written record of meetings including date, attendance, agenda and actions shall be maintained on-site.
	F.  The responsibilities of the governing body shall be as follows:
	1.  to ensure program policy and procedure compliance,
	2.  to ensure continual compliance with relevant local, state and federal requirements,
	3.  to notify the Office within thirty days of changes in program administration or purpose, and
	4.  to ensure that the program is fiscally sound.

R501-13-5.  Statutory Authority.
	A.  A publicly operated program shall document the statutory basis for existence.
	B.  A privately operated program shall document ownership or incorporation.

R501-13-6.  Program Administration.
	A.  A qualified Director shall be designated by the governing body to be responsible for day to day program operation.
	B.  Records as specified shall be maintained on-site.
	C.  Program personnel shall not handle consumer finances.
	D.  There shall be a written statement of purpose to include the following:
	1.  mission statement,
	2.  description of services provided,
	3.  description of services not provided,
	4.  description of population to be served,
	5.  fees to be charged, and
	6.  participation of consumers in activities related to fund raising, publicity, research projects, and work activities that benefit anyone other than the consumer.
	E.  The statement of purpose shall be provided to the consumer and the responsible person and shall be available to the Office, upon request.  Notice of such availability shall be posted.
	F.  There shall be a quality assurance plan to include a description of methods and standards used to assure high quality services.  Implementation of the plan shall be documented and available for review by the Office, the consumer, and the responsible person.
	G.  There shall be written reports of all grievances and their conclusion or disposition.  Grievance reports shall be maintained on-site.
	H.  The program shall have clearly stated guidelines and administrative procedures to ensure the following:
	1.  program management,
	2.  maintenance of complete and accurate accounts, books, and records, and
	3.  maintenance of records in an accessible, standardized order and retained as required by law.
	I.  All program staff, consultants, volunteers, interns and other personnel shall read, understand, and sign the current Department of Human Services, hereinafter referred to as DHS, Provider Code of Conduct.
	J.  The program shall post their license in a conspicuous place on the premises.
	K.  Each program shall comply with State and Federal laws regarding abuse, shall post a copy of State Law 62A-3-301, and provide an informational flyer to each consumer and the responsible person.
	L.  The program shall meet American Disabilities Act,(ADA) guidelines and make reasonable accommodation for consumers and staff.  ADA guidelines and reasonable accommodation shall be determined by the authority having jurisdiction.
	M.  The program shall comply with local building code enforcement for disability accessibility.

R501-13-7.  Record Keeping.
	A.  The Director shall maintain the following information on-site at all times:
	1.  organizational chart,
	2.  bylaws of the governing body if applicable,
	3.  minutes of formal meetings,
	4.  daily consumer attendance records,
	5.  all program related leases, contracts and purchase-of-service agreements to which the governing body is a party,
	6.  annual budgets and audit reports,
	7.  annual fire inspection report and any other inspection reports as required by law, and
	8.  copies of all policies and procedures.
	B.  The Director shall have written records onsite for each consumer, to include the following:
	1.  demographic information,
	2.  Medicaid and Medicare number, when appropriate,
	3.  biographical information,
	4.  pertinent background information,
	a.  personal history, including social, emotional, and physical development,
	b.  legal status, including consent forms for dependent consumers, and
	c.  an emergency contact with name, address and telephone number,
	5.  consumer health records including the following,
	a.  record of medication including dosage and administration,
	b.  a current health assessment signed by a physician, and
	c.  signed consent form,
	6.  intake assessment,
	7.  signed consumer agreement, and
	8.  copy of consumers' service plan.
	C.  The Director shall have an employment file on-site for each staff person.
	D.  The Office shall have the authority to review program records at anytime.

R501-13-8.  Direct Service Management.
	A.  The program shall have a written eligibility, admission and discharge policy and procedure to include the following:
	1.  intake process,
	2.  self-admission,
	3.  notification of the responsible person,
	4.  reasons for admission refusal which includes a written, signed statement, and
	5.  reasons for discharge or dismissal.
	B. Intake Assessment
	1.  Before a program admits a consumer, a written assessment shall be completed to evaluate current health and medical history, legal status, social, psychological and, as appropriate, developmental, vocational or educational factors.
	2.  In emergency drop-in care situations which necessitate immediate placement, the assessment shall be completed on the same day of service in all situations.
	3.  All methods used during intake shall consider age, cultural background, dominant language, and mode of communication.
	4.  During intake, the consumer's legal status, according to State Law, shall be determined as it relates to the responsible person who may have legal authority to make decisions on the consumer's behalf.
	C.  Consumer Agreement
	A written agreement, developed with the consumer, the responsible person and the Director or designee, shall be completed, signed by all parties, and kept in the consumer's record.  It shall include the following:
	1.  rules of program,
	2.  consumer and family expectations as appropriate and agreed upon,
	3.  services to be provided and not provided and cost of service, including refunds,
	4.  authorization to serve and to obtain emergency medical care, and
	5.  arrangements regarding absenteeism, visits, vacation, mail, gifts, and telephone calls, as appropriate.
	D.  Individual Consumer Service Plan
	1.  A program staff member in collaboration with the Director, shall be assigned to each consumer and have responsibility and authority for development, implementation, and review of the individual consumer service plan.
	2.  The plan shall include the following:
	a.  findings of the intake assessment and consumer records,
	b.  individualized program plan to enhance consumer well-being,
	c.  specification of daily activities and services,
	d.  methods for evaluation, and
	e.  discharge summary.
	3.  Individual consumer service plans shall be developed within three working days of admission and evaluated within 30 days of admission and every 90 days thereafter or as changes occur.
	4.  All persons working directly with the consumer shall review the individual consumer service plan.
	E.  Incident or Crisis Intervention Reports
	1.  There shall be written reports to document consumer death, injuries, fights, or physical confrontations, situations requiring the use of passive physical restraints, suspected incidents of abuse or neglect, unusual incidents, and other situations or circumstances affecting the health, safety, or well-being of a consumer while in care.
	2.  The report shall include the following:
	a.  summary information,
	b.  date and time of emergency intervention,
	c.  list of referrals if any,
	d.  follow-up information, and
	e.  signature of person preparing report and other witnesses confirming the contents of the report.
	3.  The report shall be completed within 48 hours of each occurrence and maintained in the individual consumer's record.
	4.  When an incident or crisis involves abuse, neglect or death of a consumer, the Director or designee shall document the following:
	a.  a preliminary written report within 24 hours of the incident, and
	b.  immediate notification to the Office, the consumer's legally responsible person, the nearest Human Services office, and as appropriate a law enforcement authority.

R501-13-9.  Direct Service.
	A.  Adult day care activity plans shall be prepared to meet individual consumer and group needs and preferences.  Daily activity plans may include, community living skills, work activity, recreation, nutrition, personal hygiene, social appropriateness, and recreational activities that facilitate physical, social, psychological, and emotional development.
	B.  Activity plans shall be written, staff shall be oriented to their use, and shall be maintained on file at the program.
	C.  There shall be a daily schedule, posted and implemented as designed.
	D.  Each consumer shall have the opportunity to use at least four of the following activity areas each day: general activities, sedentary activities, specialized activities, rest area, self care area, appointed outdoor area, kitchen and nutrition area, and reality orientation area.
	E.  A sufficient amount of equipment and materials shall be provided so that consumers can participate in a variety of activities simultaneously.
	F.  Consumers shall receive direct supervision at all times and be encouraged to participate in activities.
	G.  All consumers shall receive the same standard of care regardless of funding source.

R501-13-10.  Behavior Management.
	A.  There shall be a written policy and procedure for methods of behavior management to include the following:
	1.  definition of appropriate and inappropriate consumer behaviors, and
	2.  acceptable staff responses to inappropriate behaviors.
	B.  The policy shall be provided to all staff prior to working with consumers and staff shall receive annual training relative to behavior management.
	C.  No staff member shall use, nor permit the use of physical restraint, humiliating or frightening methods of punishment on consumers at anytime.
	D.  Passive physical restraint shall be used only in behavioral related situations as a temporary means of physical containment to protect the consumer, other persons, or property from harm.  Passive physical restraint shall not be associated with punishment in any way.

R501-13-11.  Rights of Consumers.
	A.  The program shall have a written statement of consumers' rights to include the following:
	1.  privacy of information and privacy for both current and closed consumers' records,
	2.  reasons for involuntary termination and criteria for readmission to the program,
	3.  potential harm or acts of violence to consumers or others,
	4.  consumers' responsibilities including household tasks, privileges, and rules of conduct,
	5.  service fees and other costs,
	6.  grievance and complaint procedures,
	7.  freedom from discrimination,
	8.  the right to be treated with dignity, and
	9.  the right to communicate with family, attorney, physician clergyman, and others.
	B.  The consumer and the responsible person shall be informed of the consumer rights statement to his or her understanding verbally and in writing.

R501-13-12.  Personnel Administration.
	A.  There shall be written policies and procedures to include the following:
	1.  staff grievances,
	2.  lines of authority,
	3.  orientation and ongoing training,
	4.  performance appraisals, and
	5.  rules of conduct.
	B.  Individual staff and the Director shall review policy together.
	C.  The program shall have a Director, appointed by the governing body, who shall be responsible for day to day program and facility management.
	D.  The Director or designee shall be on-site at all times during program operating hours.
	E.  The program shall employ a sufficient number of trained, licensed, and qualified staff in order to meet the needs of the consumers, implement the service plan, and comply with licensing rules.
	F.  The program shall have a written job description for each position, to include a specific statement of duties and responsibilities and the minimum required level of education, training and work experience.
	G.  The governing body shall ensure that all staff are certified or licensed as legally required and appropriate to their assignment.
	H.  The program shall have access to a physician licensed to practice medicine in the State of Utah.
	I.  The Director shall have a file on-site for each staff person to include the following:
	1.  application for employment, including record of previous employment with references,
	2.  applicable credentials and certifications,
	3.  initial health evaluation including medical history,
	4.  Tuberculin test,
	5.  food handler permit as required,
	6.  training record, including first aid and CPR,
	7.  performance evaluations, and
	8.  signed copy of Code of Conduct.
	J.  Provisions of R501-14 and R501-18 shall be met.
	K.  Staff shall have access to his or her staff file and shall be allowed to add written statements to the file.
	L.  Staff files shall be retained for a minimum of two years after termination of employment.
	M.  A program using volunteers, student interns or other personnel, shall have a written policy to include the following:
	1.  direct supervision by a paid staff member,
	2.  orientation and training in the philosophy of the program, the needs of consumers, and methods of meeting those needs,
	3.  character reference checks, and
	4.  all personnel shall complete an employment application and shall read and sign the current Provider Code of Conduct.  The application shall be maintained on-site for two years.
	N.  Staff Training:
	1.  Staff members shall be trained in all program policies and procedures.
	2.  Staff shall have Food Handler permits as required to fulfill their job description.  The program shall have a staff person trained, by a certified instructor, in first aid and CPR on duty with the consumers at all times.
	3.  DHS may require further specific training, which will be defined in applicable State contracts.
	4.  Training shall be documented and maintained in individual staff files.

R501-13-13.  Staffing.
	A.  Adult Day Care Staffing Ratios
	1.  When eight or fewer consumers are present, one staff person shall provide direct supervision at all times with a second staff person meeting minimum staff requirements immediately available.
	2.  When nine to 16 consumers are present, two staff shall provide direct supervision at all times.  The ratio of one staff person per eight consumers will continue progressively.
	3.  In all programs where one-half or more of the consumers are diagnosed by a physician's assessment with Alzheimer, or related dementia, the ratio shall be one staff for each six consumers.
	4.  Staff supervision shall be provided continually throughout staff training periods.
	5.  For programs with nine or more consumers, administrative and maintenance staff shall not be included in staff to consumer ratio.
	B.  The Director shall meet one of the following credentials:
	1.  a licensed nurse,
	2.  a licensed social worker,
	3.  a licensed psychologist,
	4.  a recreational, or physical therapist, properly licensed or certified,
	5.  other licensed professionals in related fields who have demonstrated competence in working with functionally impaired adults, or
	6.  a person that has received verifiable training to work with functionally impaired adults, and is in consultation on an ongoing basis with a licensed or certified professional with Director credentials.
	C.  Directors shall obtain 10 hours of related training on an annual basis.
	D.  Minimum Staff Requirements
	1.  Staff shall be 18 years of age or older and demonstrate competency in working with functionally impaired adults.
	2.  Staff shall receive eight hours of initial orientation training designed by the Director to meet the needs of the program, plus 10 hours of work related training on a yearly basis.

R501-13-14.  Physical Facility.
	A.  The governing body shall provide written documentation of compliance with the following:
	1.  local zoning,
	2.  local business license,
	3.  local building codes,
	4.  local fire safety regulations, and
	5.  local health codes, as applicable, including but not limited to Utah Food Service and Sanitation Act.
	B.  In the event of ownership change, structural remodeling or a change in category of service, the Office and other regulatory agencies shall be immediately notified.
	C.  Building and Grounds
	1.  The program shall ensure that the appearance and cleanliness of the building and grounds are maintained.
	2.  The program shall take reasonable measures to ensure a safe physical environment for its consumers and staff.

R501-13-15.  Physical Environment.
	A.  There shall be a minimum of fifty square feet of indoor floor space per consumer designated specifically for adult day care during program operational hours.  Hallways, office, storage, kitchens, and bathrooms shall not be included in computation.
	B.  Outdoor recreational space on or off site and compatible recreational equipment shall be available to facilitate activity plans.
	C.  All indoor and outdoor areas shall be maintained in a clean, secure and safe condition.
	D.  Areas determined to be unsafe, including steep grades, cliffs, open pits, swimming pools, high voltage boosters, or high speed roads, shall be fenced off.
	E.  Space shall be used exclusively for adult day care during designated hours of operation.
	F.  Bathrooms
	1.  There shall be at least one bathroom exclusively for consumers use during business hours.  For facilities serving more than ten consumers there shall be separate male and female bathrooms exclusively for consumer use.
	2.  Adult day care programs shall provide the following:

	TABLE 1

                Toilets                       Sinks

                Male    1:15               Female 1:15
                Female  1:15               Male   1:15
	
	3.  Bathrooms shall accommodate physically disabled consumers.
	4.  Each bathroom shall be properly supplied with toilet paper, individual disposable hand towels or air dryers, soap dispensers, and other items required for personal hygiene. Consumers' personal items shall be labeled and stored separately for each consumer.
	5.  Toilet rooms shall be ventilated by mechanical means or equipped with a screened window that opens.  Toilet rooms shall be maintained in good operating order and in a clean and safe condition.
	6.  Each toilet shall be individually stalled with closing doors for privacy.
	G.  Safety
	1.  All furniture and equipment shall be maintained in a clean and safe condition.  Equipment shall be operated and maintained as specified by manufacturer instructions.
	2.  Grade level entrance, approved ramps, handrails and other safety features shall be provided as determined by local, state and federal regulations and fire authorities in order to facilitate safe movement.
	3.  Provisions of the Utah Clean Air Act shall be followed if smoking is allowed in the building.
	4.  Use of restrictive barriers shall be approved by fire authorities.
	5.  Use of throw rugs is prohibited.
	6.  Hot water accessible to consumers shall be maintained at a temperature that does not exceed 110 Fahrenheit.
	7.  A secured storage area, inaccessible to consumers, shall be used for volatile and toxic substances.
	8.  Heating, ventilation, and lighting shall be adequate to protect the health of the consumers.  Indoor temperature shall be maintained at a minimum of 70 Fahrenheit.
	H.  Food Service
	1.  Meals provided by program:
	a.  Kitchens used for meal preparation shall be provided with the necessary equipment for the preparation, storage, serving and clean up of all meals.  All equipment shall be maintained in working order.  Food preparation areas shall be maintained in a clean and safe condition.
	b.  One person shall be responsible for food service.
	c.  The person responsible for food service shall maintain a current list of consumers with special nutritional needs or allergies.  Records of consumer special nutritional needs shall be kept in the consumer's service records.  Food shall be prepared and served in accordance with special nutritional needs.
	2.  Food activities in which consumers participate shall be directly supervised by staff with a food handlers permit.
	3.  Catered foods and beverages provided from outside sources shall have adequate on-site storage and refrigeration as well as a method to maintain adequate temperature control.
	4.  Dining space shall be designated and maintained in a clean and safe condition.
	5.  Menus shall be approved by a registered dietitian unless the program is participating in the Federal Adult and Child Nutrition program administrated through the State Office of Education.
	6.  Consumers shall receive meals or snacks according to the following:

	TABLE 2

Hours in Care            Meals/Snacks That Shall Be Served

8 or more hours          1 meal and 2 snacks or
                         2 meals and 1 snack

4 hours but less
  than 8 hours           1 meal and 2 snacks

4 hours or less          1 snack
	
	7.  Sufficient food shall be available for second servings.
	8.  There shall be no more than three hours between snack or meal service.
	9.  Powdered milk shall be used for cooking only.
	I.  Medication
	1.  All prescribed and over the counter medication shall be provided by the consumer, the responsible person or by special arrangement with a licensed pharmacy.
	2.  All medications shall be clearly labeled.  Medication shall be stored in a locked storage area.  Refrigeration shall be provided as needed with medication stored in a separate container.
	3.  There shall be written policy and procedure to include self administered medication, medication administered by persons with legal authority to do so and the storage, control, release, and disposal of medication in accordance with federal and state law.
	4.  Any assisted administration of medication shall be documented daily by the Director or designee.

R501-13-16.  Infectious Disease and Illness.
	A.  The program shall have policies and procedures designed to prevent or control infectious and communicable diseases in the facility.
	B.  If a consumer shows signs of illness after arrival, staff shall contact the family or the responsible person immediately.  The consumer shall be isolated.
	C.  No consumer shall be admitted for care or allowed to remain at the program if there are signs of vomiting, diarrhea, fever or unexplained skin rash.
	D.  Staff shall follow Department of Health rules in the event of suspected communicable and infectious disease.

R501-13-17.  Emergency Plans and General Safety.
	A.  Each program shall have a written plan of action for disaster developed in coordination with local emergency planning services and agencies.
	B.  Consumers and staff shall receive instructions on how to respond to fire warnings and other instructions for life safety.
	C.  The program shall have a written plan which staff follow in medical emergencies and in arrangements for medical care, including notification of consumers' physician and the responsible person.
	D.  Fire drills shall be conducted at least monthly at different times during hours of operation, and documented.  Notation of inadequate response shall be documented.
	E.  The program shall have immediate access to 24 hour telephone service.  Telephone numbers for emergency assistance shall be posted by the telephone.
	F.  The program shall have an adequately supplied first aid kit on-site, appropriate to program size.

R501-13-18.  Transportation.
	A.  There shall be written policy and procedures for transporting consumers.
	B.  A list of all occupants or consumers, and the name, address and phone number of the program shall be maintained in each vehicle.
	C.  There shall be a means of transportation in case of emergency.
	D.  Vehicle drivers shall have a drivers license valid in the State of Utah and follow safety requirements of State Motor Vehicles and Public Safety.  Drivers shall have certified first aid and CPR training.
	E.  Each vehicle shall be equipped with an adequately supplied first aid kit.
	F.  A belt cutter shall be kept in all vehicles used to transport consumers.  The belt cutter shall be located in an easily accessible, safe place.
	G.  Loose items shall be secured within the vehicle to reduce the danger of flying objects in an emergency.

KEY:  human services, licensing
Date of Enactment or Last Substantive Amendment:  April 15, 2000
Notice of Continuation:  October 4, 2017
Authorizing, and Implemented or Interpreted Law:  62A-2-101 et seq.; 62A-4