Part 492 - ADULT-CARE FACILITIES STANDARDS FOR DAY PROGRAMS FOR NONRESIDENTS

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Statutory Authority: 
Social Services Law, Sections 20, 34, 461-k

Section 492.1 - Scope.

Section 492.1 Scope. (a) This Part establishes requirements for the operation of day programs for nonresidents of adult homes, residences for adults and enriched housing programs.

(b) Parts 485, 486, 487, 488 and 490 of this Title apply to this Part except as specifically limited. For the purposes of this Part all applicable references to "resident" in Parts 485, 486, 487, 488 and 490 include residents and participants in day programs.

 

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Section 492.2 - Definitions.

492.2 Definitions. For the purposes of this Part, the following definitions apply:

(a) Day program means an organized program for nonresidents of adult homes, residences for adults and enriched housing programs which include personal care, supervision and such other services which the operator is authorized to provide to residents of such facilities, but which are provided for less than 24 hours during any period of the day or night.

(b) Caregiver means an adult who regularly provides services similar to those provided to participants by the day services for nonresidents program.

(c) Personal care services and supervision services include those services that the operator is required to provide to the residents of the adult home, residence for adults or enriched housing program.

 

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Section 492.3 - General requirements.

492.3 General requirements. (a) No day program for nonresidents of adult homes, residences for adults or enriched housing programs can be operated without prior written approval of the department.

(b) When the department approves an application it will issue a letter of authorization to the operator of an adult home, residence for adults or enriched housing program to provide services to nonresidents of such facilities. The letter of authorization will specifically refer to the ability of the operator to provide day program services to nonresidents of such facilities. Such authorization is subject to periodic review.

(c) When overnight care is provided to nonresidents of adult homes, residences for adults or enriched housing programs, the capacity of such facilities cannot exceed the capacity authorized for such facilities.

(d) At the time of application to operate a day program for nonresidents, the operator must submit to the department a written description of the proposed program including, but not limited to:

(1) a description of the services to be provided to nonresidents and a description of how such services would be coordinated with the services provided to permanent residents;

(2) a description of the physical space to be used including plans for how such space is to be used and coordinated with the space used by the permanent residents;

(3) the number of staff engaged in delivering services to nonresidents, including duties, hours to be worked and staff qualifications and how such staff would be coordinated with existing staff;

(4) the number of participants to be served during the day, evening and night;

(5) a description of how the participants' community-based plan of care, if any, will be used and coordinated with the nonresident services program;

(6) a description of the information and referral services to be provided to participants and the participants' caregivers;

(7) the transportation services, if any, which are available to participants;

(8) the program's financial policies and procedures;

(9) the program's budget;

(10) proposed forms, including any agreements which nonresidents must sign; and

(11) plans to insure that participants, staff and volunteers are included in the provisions for disaster and emergency planning contained in sections 487.12 and 488.12 of this Title.

(e) The facility must provide space, equipment and furnishings equivalent to those required for the facility for each participant in a day program for nonresidents. Space used by participants may be shared with that space required for residents of adult homes and enriched housing programs according to sections 487.11 and 488.11 of this Title provided that such use does not interfere with the care and comfort of such residents. The space set aside for day program services is subject to department approval based upon the program proposal submitted by the operator.

(f) Beds used for nightcare participants must:

(1) be specifically designated for the program; and

(2) must not be situated in a resident's room.

(g) The number of participants accepted for day program services must be limited as specified in the program proposal submitted by the operator and approved by the department.

(h) Space used for day program services must be in an area specifically designated for resident occupancy, or in an area which meets all environmental and fire safety requirements for the facility.

(i) The day program services provided to participants must be provided in a manner which is consistent with the department's regulations concerning the applicable facility, including regulations which set forth the rights of the residents of such facility.

(j) Proposed changes in a day program, including but not limited to substantial changes in the space allocated for day program services and the utilization thereof, the extent and type of services provided, and the number of participants, must be submitted to the department in writing. Such changes must be made only upon the prior written approval of the department.

(k) The operator of an adult home, residence for adults or enriched housing program must not discontinue operation of a day program for nonresidents without written notification to the department and each participant in the program and the participant's caregiver or representative, not less than 60 days prior to the date that services are expected to be discontinued.

 

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Section 492.4 - Program administration and staffing.

492.4 Program administration and staffing. The operator of the adult home, residence for adults or enriched housing program:

(a) is responsible for the overall operation of the program;

(b) is responsible for compliance with all applicable provisions of this Part;

(c) must designate a program director who will:

(1) coordinate the services provided to recipients of day program services with the services provided to the residents of the adult home, residence for adults and enriched housing program; and

(2) be responsible to the operator for the management and administration of the services provided to nonresidents of adult homes, residences for adults or enriched housing programs. Such responsibilities include, but are not limited to:

(i) assigning and supervising activities for all personnel, including volunteers, to assure that participants in the day program receive assistance in accordance with their needs;

(ii) being responsible for the admission and discharge of participants;

(iii) being responsible for the development of individual service plans;

(iv) being responsible for activity programming; and

(v) being responsible for the coordination of transportation services.

(d) The program director must:

(1) be at least 21 years of age; and

(2) be of good moral character as evidenced by at least three letters of recommendation from individuals who have knowledge of the proposed director's background, qualifications and interest in the field of adult care; and

(3) be familiar with the nonresident services program and the operation of facilities in which such program is conducted; and

(4) have a bachelors degree from an accredited college or university in the field of social work or health care plus two years of work experience in programs for the elderly or the mentally or physically handicapped; or

(5) have an associate degree from an accredited college or university with major work in human resources or services delivery, and three years of full-time experience in the provision of services to a dependent adult population; or

(6) have a master's degree in social work or a related field from an accredited college or university, plus one year of experience in a program for the elderly or the mentally or physically handicapped.

(e) If fewer than the equivalent of 15 daily participants are enrolled in a nonresident services program, the following facility staff, approved by the department, may act as program director:

(1) facility administrator;

(2) case manager; or

(3) activities director.

(f) The operator must assure that the personnel requirements of sections 487.9 and 488.9 of this Title are complied with.

(g) The operator must assure that adequate personnel are on duty at all times when the nonresident services program is in operation to assure safe care of the program's participants. Adequate is defined as a ratio of one staff member in addition to those required for residents of the home to each seven full-time participants receiving day and evening care, and one additional staff member for each 15 daily participants receiving night care. This ratio may include the program director, if the program director is not serving in any other capacity on the adult home staff, or if the individual's time as director is in addition to the hours required for adult home or residence duties.

 

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Section 492.5 - Admission and discharge policies.

492.5 Admission and discharge policies. (a) The operator must admit to the program only those persons 18 years of age and older who are not residents of an adult home, residence for adults or enriched housing program who, by reason of social, physical and/or mental dependencies require the services provided by a nonresident services program in order to remain in or return to the community.

(b) The operator must give admission priority to persons who:

(1) require supervision in order to live in the community; or

(2) need assistance with activities of daily living in order to remain in the community; or

(3) are socially isolated or disoriented and need opportunities for social interaction to prevent deterioration that would lead to placement in congregate facilities; or

(4) are in transition from a higher level of care; or

(5) are in danger of being neglected or abused by a caregiver or have needs which the caregiver is unable to meet; or

(6) are receiving services as part of a protective services for adults program.

(c) The operator of an adult home, residence for adults or enriched housing program must not admit or retain in the nonresident services program any person who would be inappropriate for admission to the facility.

(d) Prior to admission, the program director must interview the applicant and the applicant's caregiver or representative, if any. The interview must provide the director with information on the general health characteristics, psychosocial condition, and nutritional habits of the applicant, and his/her home support system and care needs. The interview must acquaint the applicant and caregiver or representative with the services and activities offered by the facility.

(e) At admission, the participant must obtain and provide to the operator a written, dated and signed report from the participant's physician, stating:

(1) that the physician has physically examined the participant within the last 30 days;

(2) a current list of medications and treatments provided to the participant by community providers;

(3) the needs of the participant for assistance with self-administration of medication;

(4) the dietary needs of the participant;

(5) the assistance needed in the activities of daily living;

(6) any contraindications or limitations to the individual's participation in program activities.

(f) Every six months, beginning on the date of admission to the program, the participant must obtain and provide to the operator a written, dated and signed statement from the participant's physician indicating changes in the participant's needs for assistance with self-administration of medication. If there are no changes in such needs, the statement required by this subdivision must so indicate.

(g) The operator must enter into a written agreement with the participant. The agreement must specify the basic services to be provided to the individual by the operator, the charges for these services, and the obligations of the participant, the participant's representative and the caregiver. The agreement must also contain a statement of the operator's refund policies.

(h) The participant and caregiver or representative must receive a copy of the written agreement.

(i) When a participant is involuntarily discharged from the program, the operator must provide at least 72 hours prior written notification to the participant and caregiver or representative. The notification must state the date of the notice, the date of discharge and the reason(s) for discharge.

(j) The notice required by subdivision (i) of this section may be disregarded when a participant develops a serious physical or mental dysfunction which constitutes an immediate and present danger to himself/herself or others.

 

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Section 492.6 - Program planning and implementation.

492.6 Program planning and implementation. (a) The operator must assure that each participant in a nonresident services program has an individualized written plan for services prepared by the program director.

(b) In developing the plan, the program director must involve the participant, caregiver, other professionals and the local department of social services, as appropriate. The service plan must describe:

(1) the needs of the participant;

(2) the service goals for the participant while in the nonresident services program and the manner in which they will integrate with other care being rendered by other service providers;

(3) the services to be provided;

(4) the name of the staff member responsible for implementing the service plan; and

(5) the time limit for the plan, with provision for review and renewal.

(c) The operator must have a program plan which meets the following criteria:

(1) Overall planning of services and activities must reflect the individual service plans.

(2) The primary program mode must be group activities with provision for individual activities and services.

(3) Staff will encourage participants to engage in the planning and operation of the program.

(4) Staff will encourage participants and residents to attend meals and activities together.

(5) Staff will explore and utilize other available community resources as a regular part of the program activities.

(6) The operator will supply adequate and appropriate equipment and supplies.

(7) Physical activity will be encouraged within the participant's limitations, as determined by information furnished by the participant's physician.

(8) Activities designed to improve the capacity of the participants for selfcare and personal hygiene will be provided.

(9) Participants will be afforded the opportunity to rest; there will be a sufficient number of lounge chairs available for participants' needs.

(10) Participants may refuse to participate in any activity of the nonresident services program.

(d) A schedule of activities must be prepared and must:

(1) be in writing;

(2) be planned for a two-week period, one week in advance of its implementation;

(3) specify each activity to be provided, the days of the week each activity will be conducted, and the approximate duration of each activity; and

(4) be posted in a conspicuous place in the area where the nonresident services program will be conducted.

(e) If activities for participants and residents are jointly planned and conducted, one schedule of activities provided in accordance with applicable provisions of section 487.7 of this Title may be used.

(f) There will be a minimum of four hours of planned activities for each program day.

(g) Personal care services will be provided in accordance with applicable provisions of sections 487.7 and 488.7 of this Title.

(h) Supervision services will be provided in accordance with applicable provisions of sections 487.7 and 488.7 of this Title.

(i) The program director will encourage caregivers to transport the participants to and from the facility.

(j) The program director will coordinate the utilization of volunteers and other resources in the community for the purpose of transporting participants to the facility.

(k) The operator may transport participants to and from the program.

(l) If a participant wants or needs to leave the program before the scheduled departure time, the participant's caregiver must be notified before the participant leaves the facility. Such notification must be documented in the participant's case record.

(m) If a participant does not arrive as scheduled and the facility has not been contacted about the delay, the program director will immediately attempt to contact the participant, caregiver or representative to determine the reason for the absence.

(n) Any abrupt or progressive changes in a participant's behavior or appearance which suggests the need for additional help or services will be reported as follows:

(1) A report will be made immediately to the participant's caregiver and local department of social services caseworker if the participant is a social services client.

(2) The report will be made to the caregiver or representative if the participant is not a social services client.

(3) The report will be made to the local department of social services if the participant has no caregiver or representative.

(4) Any action taken by the operator or program director as a result of changes in the participant's behavior or appearance will be noted in the participant's case record.

(o) The operator will offer referral services to participants and caregivers when such persons are in need of services not otherwise provided by the facility.

 

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Section 492.7 - Nutrition services.

492.7 Nutrition services. (a) A meal must be provided to each participant in attendance at the program during the time meals are served in the facility. The meal must provide at least one third of an adult's daily nutritional requirement as recommended by the U.S. Department of Agriculture.

(b) A nutritious mid-morning, mid-afternoon, and evening snack must be offered daily to each participant in attendance.

(c) A modified diet must be provided for a participant, if prescribed in writing by a physician, and if such diets are regularly available to residents of the facility.

(d) If the operator does not provide or cannot arrange for the provision of a modified diet to a participant who needs such a diet, the participant cannot be accepted or retained in the program.

(e) Space permitting, participants and residents must dine together.

(f) Nutrition education must be provided to participants in need of such instruction, as determined by the individual service plans.

(g) The operator must assure that the quality and quantity of food provided to participants complies with the provisions of sections 487.8 and 488.7 of this Title.

(h) Food service records for the nonresident program must be maintained in accordance with sections 487.8 and 488.8 of this Title.

 

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Section 492.8 - Support services.

492.8 Support services. (a) Participants must be observed throughout the time spent in the nonresident services program for symptoms of illness or injury.

(b) The operator must make advance arrangements for the care of participants who become ill or are injured while receiving nonresident services. Such arrangements must include:

(1) immediate notification of the participant's caregiver or representative;

(2) provision for emergency medical care or first aid; and

(3) notification of the participant's physician.

(c) Specific instructions obtained from a physician for the care of persons with special medical problems or needs must be written on their records and followed.

(d) Participants must be permitted to retain and self-administer their own medications provided their physicians have certified, in writing, that they are capable of doing so.

(e) Self-administration of medication means that the person for whom a medication is prescribed is able to:

(1) correctly read the label on the medication container;

(2) correctly interpret the label;

(3) correctly ingest, inject or apply the medication, whichever is appropriate;

(4) correctly follow instructions as to the time and/or frequency of taking the medications; and

(5) obtain the medication.

(f) For participants who require, by order of their physicians, assistance with self-administration of medication, the operator may:

(1) remind the participant when it is time to take the medication;

(2) read the label to the participant;

(3) help the participant to open the container;

(4) observe the participant to see that the correct dosage is being taken, according to the prescription. Neither the operator nor staff of a nonresident services program can administer medication to a participant in the program.

(g) If a participant is assisted in the administration of medications, a record must be kept for each participant in accordance with applicable provisions of sections 487.7 and 488.7 of this Title.

(h) Medication kept by a facility for a participant must be stored in accordance with applicable provisions of sections 487.7 and 488.7 of this Title.

(i) Medication kept by the facility must be returned to the participant, caregiver or sponsor:

(1) when the participant leaves the program on a permanent basis;

(2) when a physician changes a medication order;

(3) upon the occurrence of the expiration date; or

(4) when the container is empty.

 

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Section 492.9 - Records and reports.

492.9 Records and reports. (a) The operator must maintain records for each participant in the nonresident services program which contain a copy of:

(1) the written agreement;

(2) a medical evaluation and semiannual update;

(3) a preadmission interview;

(4) a written plan for services; and

(5) such other information relating to the physical, mental and social status of the participant.

(b) The following records must be maintained for the nonresident services program:

(1) a chronological admission and discharge register (DSS-3026) or a substitute approved by the department;

(2) a daily attendance record; and

(3) an incident report (DSS-2903).

(c) The operator must assure that program and participant records are maintained and retained according to applicable provisions of sections 487.10 and 488.10 of this Title.

 

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