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DIR1999-00004 r r „is 16, June 21, 1999 CITY OF TIGAR OREGON Ralston Architects, P.C. Attn: John Ralston 15220 NW Greenbrier Parkway, Suite 340 Beaverton, OR 97006 RE: Assisted Living and Residential Use Types Dear John: This is in response to your letter dated June 3, 1999 in which you requested clarification as to where "Assisted Living" fits into the residential use types. The Director has made an interpretation with respect to residential uses, which clarifies whether the residential density provisions of the Comprehensive Plan applies to certain types of living facilities. I believe the interpretation, a copy of which is enclosed for your reference, also serves to clarify the specific question you raised in your letter. If you have any questions regarding this information, please call me at (503) 639 -4171 x 315. Sincerely Mark J. Roberts Associate Planner is \curpin \mark\letters\ralston asst Ivng.doc enc: Planning Director's Interpretation (dated June 11, 1999) c: 1999 Planning correspondence file 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772 v • DIRECTOR'S INTERPRETATION June 11, 1999 The Development Code Chapter 18.130 classifies land uses. Among those land uses are: 1. Household Living: Living facilities for small groups (households) of people who are related or unrelated, featuring self- contained units including facilities for cooking, eating, sleeping and hygiene. Tenancy is longer than one month. Includes most types of senior housing, e.g., congregate care, assisted living, if residents live in self- contained units. The maximum number of people who may reside in any given dwelling unit shall be determined by the Uniform Building Code. 2. Group Living: Living facilities for groups of unrelated individuals which includes at least one person residing on the site who is responsible for supervising, managing, monitoring and /or providing care, training or treatment of residents. Larger group living facilities may also be characterized by shared facilities for eating, hygiene and /or recreation. Examples include nursing /convalescent homes, residential care /treatment facilities; sororities /fraternities and convents /monasteries. Tenancy is longer than one month. Does not include detention and post- detention facilities (see 18.130.020. E.3., Detention Facilities). The Development Code's density provisions limit the number of household units on a particular piece of property. The code's density provisions do not limit group living facilities. There are various types of living facilities that are a hybrid of the above land use types. One is assisted living with central facilities for 24 RN staff, recreation and a common on -site kitchen with meals prepared for communal dining. Some of these facilities also provide individual units with kitchenettes that contain a sink small refrigerator and microwave. These are sometimes considered "warming kitchens ". The City of Tigard Community Development Director hereby interprets and considers that units with central eating facilities for all meals of the day, recreation and nursing facilities to be among those classed as Group Living under the following circumstances: the facility is consistent with all parts of the Group Living classification and individual units located in the facility shall not have a stove or oven. Full kitchen facilities with an oven and stove would require units to be classed as household living and restricted by density when all other features of self- ontained units .Iso exist (eating, sleeping, and hygiene). -4 /1 /t ( A/V /Community Deve opment I ector i:curpin \dick \dirinter.asl JI,In- 0_>n -99 03 : 25P Ra l st9n Architects 503 617 0312 P _ 01 FAX TRANSMITTAL/COVER SHEET DATE: 6/3/99 *OF PAGES INCLUDING COVER: 3 TO: Mark J. Roberts PROJECT: Tigard Assisted Living Associate Planner, City of Tigard PROJECT NO: 99043 FROM: John L. Ralston FAX NO: 684 -7297 1 ORIGINAL DOCUMENTS WILL FOLLOW El NOT FOLLOW ® VIA REGULAR MAIL ❑ VIA EXPRESS MAIL ❑ OTHER Letter regarding Tigard Community Development Code, 18.130.020 Listing of Use Categories. Wti44- Yc W wt- SAP S 112- ; T M d r \ - p*,+'... f I V -- �� .ITra c••f, +fi �Y1a f1,1 ra(4s �v u fnl .♦rr e d J e` s i 1 P r 7 r Arr. S <.. L� /J na.dtt,..V1Je (.Si) .r r c2 d•r''.Slter) a hre -+ (11S` ae. ; 11) c 1 ! w W -kiIJ C.Pr# , -ta 4' t ;IA ✓r), • r f) w t Pad Siyv 4 to uQ.xr f FILE: Documentl 15220 nw gr parkway • suite 340 beoverton, Oregon 97006 telephone. 503.531.9492 facsimile: 503 617 0312 jralsian teleport.carn Jun -03 -99 03:25P Ralst'n Architects 503.617 0312 P.02 • June 3, 1999 City of Tigard • Mark J. Roberts Associate Planner 13125 SW Hall Blvd. Tigard, OR 97223 RE: Tigard Community Development Code 18.130.020 Listing of Use Categories Dear Mark: Thank you for meeting with us a while back regarding our assisted living project at the Hall and Durham Road intersection. Per our discussion, this letter is to request clarification as to where "Assisted Living" fits into the residential use types. Following is the definition for Household Living per 18.130.020. 1. Household Living: Living facilities for small groups (households) of people who are related or unrelated, featuring self- containing units including facilities for cooking, eating, sleeping and hygiene. Tenancy is longer than one month. Includes most types of senior housing, e.g., congregate care, assisted living, if residents live in self - contained units. The maximum number of people who may reside in any given dwelling unit shall be determined by the Uniform Building Code. Note that Assisted Living is specifically listed. Although the units include a kitchenette, a bathroom, and a bed, it is my suggestion that perhaps this is in error. Following is the definition for Group Living per 18.130.020A: 2. Group Living: Living facilities for groups of unrelated individuals which includes at least one person residing on the site who is responsible for supervising, managing, monitoring and /or characterized by shared facilities for eating, hygiene and/or recreation. Examples include nursing/convalescent homes, residential care/treatment facilities; sororities/fraternities and convents/monasteries. Tenancy is longer than one month. Does not include detention and post- detention facilities (see 18.130.020 E.3., Detention Facilities) The Group Living definition states that it "may be characterized by shared facilities for eating, hygiene and/or recreation ". It mentions an on site manager. No mention is made as to whether the units have or do not have kitchenettes. It is my belief that assisted living falls under the Group Living category. The State of Oregon has set rules and regulations for the operation of an Assisted Living Facility. They are OAR 411 - 056 -0008 and 411 -056 -0085. It is required that each unit have a sleeping area, a bathroom, and a kitchenette. It should be noted that the kitchenette contains a sink, small fridge and a microwave. A stove and oven is not required, therefore only a warming kitchen and not a full independent kitchen is provided. 15720 nw greenhrier parkway • suite 340 beoaertan, Oregon 97006 telephone: 503.531 9492 facsimile: 503.611.0312 jralstan ®lelepart.com Jun -03 -99 03:26P Ralston Architects 503 617 0312 P _ 03 • The State of Oregon also requires 24 -hour RN staffing including a reviewed pharmacy, and common recreation and dining facilities. Meals are prepared by staff in an on -site kitchen. This clearly falls under the "Group Living" category. Assisted Living of the type we will propose is definitely not for small groups (households as described in Household Living.) We will have 50 plus residents. Further, on April 14, 1999, the State rules that a facility may not market itself as an Assisted Living Facility unless the requirements of the OAR are met, as outlined above. A $6,000.00 penalty is established. Therefore, the State basically requires a "Group Living" facility as outlined in your definition for any assisted living facility. Enclosed is a copy of the Oregon Rules on Advertising and Marketing mentioned above, and a description of Assisted Living as defined by the operators of our potential facility. In our meeting you also mentioned that under the Group Living category, density is not defined by square feet of lot area, but rather, it is limited by site constraints such as area, landscape, lot, coverage parking, etc. This is not specifically stated in the Development Code. Please verify that this is true. Mark, thank you for your time and attention. I look forward to hearing from you. • Sincerely, • g&41: John L. Ralston RALSTON ARCHITECTS, P.C, • Jun -ea -99 03:26P Ralson Architects 503 617 0312 P_04 FROM PRIMECaRE PHONE NO. : 503 538 02L May. 16 1999 08:04PP1 P2 nimbi Lit dlea tiseare 3105 VAlgoittood Ct P.O.HoX 3106 tiewb4ag OR 97132 Phone (503)538 -02RO Fay:(503)554-9O 7 Email OREPC OAOLarsu May 16, 1999 City of Tigard Mark. Roberts Associate Planner 13125 SW Mall Blvd Tigard, OR 97223 Dcar Mack Thank you for meeting with us and your assistance in interpreting the Tigard community development code. In our years of working and serving the geriatric population and also our understanding of the definition of assisted living we would like to present ow input on our understanding of the definition of assisted living. The assisted living administrative rules that is effective April 1. 1999 as published by Senior and disabled services division stated: OAR. 411 - 056 - 0005 Definitions: "Assisted living means a program approach, within a pressured physical structure, which provides or coordinates a range of supportive personal and health services, available on a 24 -hour basis, for support of resident independence in a residential setting, Assisted living promotes resident self direction and participation in decisions that emphasize choice dignity, privacy, individuality, independence and home -like surrounding In interpreting these rules we proposed a living condition of unrelated individuals who reside at the particular site longer than one month and who needs some type of assistance in meeting his/her daily activities in the course of a normal day_ snch as: eating/nutrition., dressing/grooming. bathing/personal hygiene, inability, toilette It is a physical structure that promotes meeting all the needs of daily living and provides or coordinates a range of services including health and supportive services on a 24 hour basis while promoting a homelike environment_ The physical structured of an assisted living facility is characterized by shared facilities for eating, hygiene and imitation but also provide a kitchenettes in the resident individual unit. Thank you for reviewing our interpretation of assisted living facility definition. If we can be of any further assistance please do not hesitate to call me at 538 -0280 or cell 504-6814. Sincerd , /J / _ Y / Aida Apple BS, RN • DIRECTOR'S INTERPRETATION June 11, 1999 The Development Code Chapter 18.130 classifies land uses. Among those land uses are: 1. Household Living: Living facilities for small groups (households) of people who are related or unrelated, featuring self- contained units including facilities for cooking, eating, sleeping and hygiene. Tenancy is longer than one month. Includes most types of senior housing, e.g., congregate care, assisted living, if residents live in self- contained units. The maximum • number of people who may reside in any given dwelling unit shall be determined by the Uniform Building Code. 2. Group Living: Living facilities for groups of unrelated individuals which includes at least one person residing on the site who is responsible for supervising, managing, monitoring and /or providing care, training or treatment of residents. Larger group living facilities may also be characterized by shared facilities for eating, hygiene and /or recreation. Examples include nursing /convalescent homes, residential care /treatment facilities; sororities /fraternities and convents /monasteries. Tenancy is longer than one month. Does not include detention and post- detention facilities (see 18.130.020. E.3., Detention Facilities). The Development Code's density provisions limit the number of household units on a particular piece of property. The code's density provisions do not limit group living facilities. There are various types of living facilities that are a hybrid of the above land use types. One is assisted living with central facilities for 24 RN staff, recreation and a common on -site kitchen with meals prepared for communal dining. Some of these facilities also provide individual units with kitchenettes that contain a sink small refrigerator and microwave. These are sometimes considered "warming kitchens ". The City of Tigard Community Development Director hereby interprets and considers that units with central eating facilities for all meals of the day, recreation and nursing facilities to be among those classed as Group Living under the following circumstances: the facility is consistent with all parts of the Group Living classification and individual units located in the facility shall not have a stove or oven. Full kitchen facilities with an oven and stove would require units to be classed as household living and restricted by density when all other features of self -- ontained units -Iso exist (eating, sleeping, and hygiene). /Community l eve opment 11 ector i:curpin \dick \dirinter.asl ,� � Department of Human Resources ' 0 O regon ` Senior and Disabled Services Division -- John A. Kitzhaber, M.D., Governor ummer 500 Summer St. NE S Salem OR 97310 -1015 Voice /TTY (503) 945 -5811 Voice / TTY 1- 800 - 282 -8096 April 14, 1999 FAX (503) 373 -7823 Adult Foster Home Providers Residential Care Facility Administrators Re: New Rule on Advertising and Marketing Dear Providers and Administrators: Senior and Disabled Services Division has completely rewritten the Oregon Administrative Rules for assisted living facilities. These new rules took effect on April 1, 1999. OAR 411- 056 -0008 and 411- 056 -0085 have implications for adult foster homes and residential care facilities. They read as follows: 411 - 056 -0008 License\Contract To operate and be designated as an assisted living facility, the facility must be licensed as an assisted living facility and comply with OAR Chapter 411, Division 056. 411- 056 -0085 Marketing and Advertising (1) A person may not advertise or market its facility as an assisted living facility, or as providing assisted care, or use the term "assisted" in describing the type of care provided unless the person has obtained or can demonstrate intent to obtain an assisted living facility license from the Division. The Division considers the use of the word "assisted" as part of a facility's name to constitute the operating, designating, advertising or marketing of that facility as an assisted living facility. Therefore, use of the word "assisted" by an adult foster home or a residential care facility would be a violation of these rules. Such a violation would be a Class II violation which could result, upon a second finding, in a civil penalty of $5 to $300 per occurrence per day, not to exceed $6,000 in any calendar quarter. Assisting People to Become Independent, Healthy and Safe An Equal Opportunity Employer HRB 10015 (7/98) • 5220 NW GREENBRIER PARKWAY S UITE 340. BEAVERTON, OR 97006 e mail: jralston @teleporl.com a ' © JOHN RALSTON , president 503.531.9492 503.617.0312 fax 503.708.4262 mob PrimeCare P.O.Box 3106 Newberg OR 97132 Fostering Independence and Dignity Aida Apple BS, RN PrimeCare I (503) 538 -4868 PrimeCare II (503) 537 -2657 Pager: (503) 909 -2215 PrimeCare III (503) 537 -9072 Cell phone: (503) 504-6814 Fax (503) 554-9037 PrimeCare IV (503) 554 -1535 3 � el j ..j .. 'r 2 .18 Ac ( ,: ^7300 M � . eg gr �` °� 7200 . x I- ' itt la v I 6900 i 9 oe A.?� 7100 7000 N In ``t «! 04 se - 81" by AVON ° � t5 3Si� 207.7 , I— Y 150 i30 9x4.10 22.50 STREET zoy.m taQ - coil 6500 R•20 1 $ 2 i�40 1600 1 01 . 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J ( , , \ (::� � l� �', -1 ♦ lTc ter t :;';',.'''=5.).''''''''':,,,,' N/ ( ' ,. + l v t n .S 4 c . tt •, r"t : -a- f,J c'. < r } 4 �• 'n > s . l .. CT 't y� ( pe F r b ' '-} 1• 1 f, ti Al � " 3 1 t' - . , • ( h : Jr1 _ .T, :!, ? t 1 '+• ) � yJ -V : A . � ��r•''Y�Y��ppy� _ . '� _ :r . s .: -. o- la. :i� + n- ,,. It r r x�- c . f / r r I : : . ' .. R -'� ' Rr.' ^YR� ��E�� : ,::: �i�i - t: - L. �. Y ! � , C l t `` �r l r 1 I��p r t 4 - / � 7 }. • S )'S °' •• T. � ,-e y � i � I - ..•• i + ` RV al wir �I9 816P [ �. f C 5 J _._ —_ t I .. • i9 ',Iasi_ I. 1 " •C. l. ., • :.:, Str r � +'• •rA l r _ f , f a'• w',? r � . . , > ) / r c . � • �) ,. 1 1 r r :. y : r 1 , +0797 121 bulletin Page 1 of 55 f f .✓: X}g .p c Oregon Bulletin April 1, 1999 Department of Human Resources, Senior and Disabled Services Division Chapter 411 Adm. Order No.: SDSD 1 -1999 Filed with Sec. of State: 3 -1 -99 Certified to be Effective: 3 -1 -99 Notice Publication Date: 2 -1 -99 Rules Amended: 411- 027 -0000 Subject: This rule is amended to (a) clarify flat rate contract program criteria to qualify . for initial approval and renewal, and to specify information reporting requirements; and (b) provide rules for payment of adult day services as part of an overall plan of care for service - eligible clients. Rules Coordinator: Pam Warren- -(503) 945 -6406 411 - 027 -0000 Payment Limitations in Community -Based Care (1) Payment for Services: (a) Division service payments under this rule shall be limited to home and community -based care services provided under Oregon's Title XIX SDSD 1915(c) Waiver. (b) Community -based care services include, but are not limited to: (A) In -Home Care Services (client - employed providers and home care agencies); (B) Residential Care Facility Services; (C) Assisted - Living Facility Services; (D) Adult Foster Home Services; and http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin : _ Page 2 of 55 (E) Specialized Living Services. (2) Payment Basis: (a) Unless otherwise specified, service payment shall be based upon each client's assessed need for care as documented by the Division on the SDS 360. (b) Payments for community -based care services are not intended to replace the resources available to a client from their natural support system of relatives, friends, and neighbors. Payment by the Division may be authorized only when the natural support system is unavailable, insufficient or inadequate to meet the needs of the client. Clients with excess income shall contribute to the cost of care pursuant to OAR 461 -160 -0610 and OAR 461- 160 -0620. (c) Case plans shall be based upon the least costly means of providing adequate care consistent with client choice. (d) SDSD /Type B AAA staff shall monitor the progress of the client. When a change occurs in the client's care needs that may warrant a change in the service payment rate, staff shall update the case plan. (3) Payment Limitations: (a) The total continuing cost of room and board, waivered services and RN professional services contracted for a client in , a community -based care setting shall not exceed the cost of the comparable nursing facility category of payment for that client. The total cost does not include payment for miscellaneous medical services authorized by the Office of Medical Assistance Programs. (b) Notwithstanding section (3), subsection (a) of this rule, SDSD Central Office may authorize service payment, rates that exceed the cost of the comparable nursing facility care when: (A) There is a specific rehabilitation plan approved by the Division, with goals and a definite time frame for delivery, that will improve the client's self - sufficiency; (B) Intensive convalescent care is required for a limited period of time; or (C) Intensive long -term care or special technology is required, but is otherwise available locally only in an acute care facility (hospital). (c) If service payment is authorized under section (3), subsection (b) of this rule: (A) The case plan shall reflect specific provider responsibilities, the time period for the delivery of services and corresponding payment rate adjustments; (B) The Division shall give the provider written authorization for the services provided and the time period for delivery; and (C) SDSD /Type B AAA staff shall monitor the progress of the client. When a change occurs in the client's care needs that may warrant a change in the service payment rate, staff shall update the case plan and recommend an adjustment in the service payment rate to SDSD Central Office. (4) All service payments shall be prior authorized by the SDSD /Type B AAA local unit or by SDSD Central Office. http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 3 of 55 (5) The Division shall publish the established provider payment rate schedule. When the Division has established a rate schedule, SDSD /Type B AAA case managers may prior authorize service payments according to the payment rate for the client's living situation and based on the client's assessed need for care documented by the Division on the SDS 360. (6) The Division shall not make payment to a spouse for providing community -based care services except for In -Home Care Services as provided in OAR Chapter 411, Division 030 (state funded spousal pay program). (7) Flat Rate Contracts: (a) Flat Rate Contracts: The Division may authorize a service payment rate not included in the established rate schedule for residential care facilities, assisted - living facilities and adult foster homes providing special services to a targeted population, pursuant to a written contract with the Division. To qualify, the facility must demonstrate to the Division that: (A) There is a documented need for specialized services to the target population; (B) The administrative and care staffs have sufficient program knowledge and skills to achieve program goals and provide the special services; (C) The facility provides substantial additional services beyond those covered under the established rate schedule; (D) There is a comprehensive ongoing staff training program targeted to the population's needs; (E) The facility has made any modifications necessary to provide the special services; (F) The Medicaid clients served in the facility must on average, by assessment using the CAPS 360, demonstrate at least levels 4 and 5 of impairment as defined by the administrative rules appropriate to the facility's Medicaid service payment; and (G) The facility has provided the special service for at least six months prior to the date on which the flat rate contract will take effect. (i) Notwithstanding section (7), subsection (a), paragraph (G) of this rule, the Central Office may approve flat rate contracts to be effective prior to the date on which the facility will have provided the special service for six months based on: (I) Central Office knowledge of provider ability to provide the special service; or (II) The recommendation of the SDSD /Type B AAA local office staff; or (III) Unmet community need for the specialized services to be offered under the contract. (b) The facility must identify, at the time of application for the flat rate contract, the additional costs that the facility will incur to deliver the special services. The facility shall include, at a minimum, the additional staffing and training costs it will incur as a result of delivery of the special services. (c) The Division will evaluate the information submitted by the facility, and may authorize a service payment rate in excess of the established rate schedule. The Division shall not authorize a payment rate in excess of the Level 5 service payment rate being paid to assisted - living facilities at the date http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 1.21 bulletin Page 4 of 55 that the flat rate contract becomes effective. (d) A contract may be renewed at an appropriate payment rate on an annual basis for a facility that continues to meet the criteria stated in section (7), subsection (a) of this rule. (A) At the time of the request for renewal, or at any other time the Division requests, the facility shall provide the Division with information on actual costs incurred in delivery of the special services. Information provided by the facility shall include the costs of staffing the special services and of training for direct care staff. (B) The Division will evaluate the information submitted by the facility,, and may authorize a service payment rate in excess of the established rate schedule. The Division shall not authorize a payment rate in excess of the Level 5 service payment rate for assisted - living facilities clients at the date that the flat rate contract renewal becomes effective. (e) Payments made to residential care facilities under this section shall receive service payment rate increases in the same way and at the same time as other residential care facilities. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate for assisted - living facilities. (f) Payments made to adult foster homes under this section shall receive service payment rate increases in the same way and at the same time as other adult foster homes. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate for assisted - living facilities. (g) Payments made to assisted - living facilities under this section shall receive service payment rate increases in the same way and at the same time as other assisted - living facilities. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate. (h) Contracts executed prior to March 1, 1999 will be honored for the duration of the contract. After expiration, the facility must meet the criteria listed in section (7), subsections (a) and (b) of this rule for the Division to consider granting a flat rate contract under section (7), subsection (a) of this rule. (8) Exceptions: (a) SDSD /Type B AAA local units may authorize individual exception payments greater than the established rate schedule as stated in OAR 411 - 027 -0050 for service provided on or after March 1, 1998. (A) If a facility provides care under a flat rate contract, individual payment exceptions to that rate must be pre- authorized by the SDSD Central Office. (9) Payments for Adult Day Services: (a) Local SDSD /Type B AAA local units may authorize payments to any Medicaid - contracted adult day services program as defined in OAR 411 -66 -0000 through 411 -66 -0020. (b) Adult day services may be authorized as part of an overall plan of care for service - eligible clients and may be used in combination with other community -based services if day services is the appropriate resource to meet a special need. (c) Adult day services may be authorized for payment as a single service or in combination with other community -based care services. Adult day services shall not be authorized nor paid for if another http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 5 of 55 provider has been authorized payment for the same service. Payments authorized for adult day services shall be included in computing the total cost of care. (d) The Division will pay for a half day of program services when less than four hours are provided, and will pay for a full day of program services when more than four, but less than twenty -four, hours are provided. Stat. Auth.: ORS 410.070 Stats. Implemented: ORS 410.070 Hist.: SSD 9- 1984(Temp), f. & ef. 11 -1 -84; SSD 3 -1985, f. & ef. 4 -1 -85; SSD 10 -1985, f. & ef. 8 -1- 85; SSD 12- 1985(Temp), f. & ef. 9- 19 -85; SSD 16 -1985, f. 12- 31 -85, ef. 1 -1 -86; SSD 4 -1987 (Temp), f. & ef. 7 -1 -87; SSD 13 -1987, f. 12- 31 -87, cert. ef. 1 -1 -88; SSD 6 -1988, f. & cert. ef. 7 -1 -88; SSD 9- 1989, f. 6- 30 -89, cert. ef. 7 -1 -89; SSD 2 -1993, f. 3- 19 -93, cert. ef. 4 -1 -93; SSD 9 -1993, f. & cert. ef. 12 -1 -93; SDSD 3 -1998, f. 2- 27 -98, cert. ef. 3 -1 -98; SDSD 1 -1999, f. & cert. ef. 3 -1 -99 Adm. Order No.: SDSD 2 -1999 Filed with Sec. of State: 3 -1 -99 Certified to be Effective: 4 -1 -99 Notice Publication Date: 2 -1 -99 Rules Amended: 411- 027 -0000 Subject: This rule is amended to add language for payments to Assisted Living Facilities and furthers the division's efforts to remove payment language from its facility licensing rules. Rules Coordinator: Pam Warren- -(503) 945 -6406 411 - 027 -0000 Payment Limitations in Community -Based Care (1) Payment for Services: (a) Division service payments under this rule shall be limited to home and community -based care services provided under Oregon's Title XIX SDSD 1915(c) Waiver. (b) Community -based care services include, but are not limited to: (A) In -Home Care Services (client - employed providers and home care agencies); (B) Residential Care Facility Services; (C) Assisted - Living Facility Services; http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411 5/3/99 0797 121 bulletin Page 6 of 55 (D) Adult Foster Home Services; and (E) Specialized Living Services. (2) Payment Basis: (a) Unless otherwise specified, service payment shall be based upon each client's assessed need for care as documented by the Division on the SDS 360. (b) Payments for community -based care services are not intended to replace the resources available to a client from their natural support system of relatives, friends, and neighbors. Payment by the Division may be authorized only when the natural support system is unavailable, insufficient or inadequate to meet the needs of the client. Clients with excess income shall contribute to the cost of care pursuant to OAR 461 -160 -0610 and OAR 461 -160 -0620. (c) Case plans shall be based upon the least costly means of providing adequate care consistent with client choice. (d) SDSD /Type B AAA staff shall monitor the progress of the client. When a change occurs in the client's care needs that may warrant a change in the service payment rate, staff shall update the case plan. (3) Payment Limitations: (a) The total continuing cost of room and board, waivered services and RN professional services contracted for a client in a community -based care setting shall not exceed the cost of the comparable nursing facility category of payment for that client. The total cost does not include payment for miscellaneous medical services authorized by the Office of Medical Assistance Programs. (b) Notwithstanding section (3), subsection (a) of this rule, SDSD Central Office may authorize service payment rates that exceed the cost of the comparable nursing facility care when: (A) There is a specific rehabilitation plan approved by the Division, with goals and a definite time frame for delivery, that will improve the client's self - sufficiency; (B) Intensive convalescent care is required for a limited period of time; or (C) Intensive long -term care or special technology is required, but is otherwise available locally only in an acute care facility (hospital). (c) If service payment is authorized under section (3), subsection (b) of this rule: (A) The case plan shall reflect specific provider responsibilities, the time period for the delivery of services and corresponding payment rate adjustments; (B) The Division shall give the provider written authorization for the services provided and the time period for delivery; and (C) SDSD /Type B AAA staff shall monitor the progress of the client. When a change occurs in the client's care needs that may warrant a change in the service payment rate, staff shall update the case plan and recommend an adjustment in the service payment rate to SDSD Central Office. http: / /arcweb.sos.state.or.us /rules /0499 Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 7 of 55 (4) All service payments shall be prior authorized by the SDSD /Type B AAA local unit or by SDSD Central Office. (5) The Division shall publish the established provider payment rate schedule. When the Division has established a rate schedule, SDSD /Type B AAA case managers may prior authorize service payments according to the payment rate for the client's living situation and based on the client's assessed need for care documented by the Division on the SDS 360. (6) The Division shall not make payment to a spouse for providing community -based care services except for In -Home Care Services as provided in OAR Chapter 411, Division 30 (state funded spousal pay program). (7) Flat Rate Contracts: (a) Flat Rate Contracts: The Division may authorize a service payment rate not included in the established rate schedule for residential care facilities, assisted - living facilities and adult foster homes providing special services to a targeted population, pursuant to a written contract with the Division. To qualify, the facility must demonstrate to the Division that: (A) There is a documented need for specialized services to the target population; (B) The administrative and care staffs have sufficient program knowledge and skills to achieve program goals and provide the special services; (C) The facility provides substantial additional services beyond those covered under the established rate schedule; (D) There is a comprehensive ongoing staff training program targeted to the population's needs; (E) The facility has made any modifications necessary to provide the special services; (F) The Medicaid clients served in the facility must on average, by assessment using the CAPS 360, demonstrate at least levels 4 and 5 of impairment as defined by the administrative rules appropriate to the facility's Medicaid service payment; and (G) The facility has provided the special service for at least six months prior to the date on which the flat rate contract will take effect. (i) Notwithstanding section (7), subsection (a), paragraph (G) of this rule, the Central Office may approve flat rate contracts to be effective prior to the date on which the facility will have provided the special service for six months based on: (I) Central Office knowledge of provider ability to provide the special service; or (II) The recommendation of the SDSD /Type B AAA local office staff; or (III) Unmet community need for the specialized services to be offered under the contract. (b) The facility must identify, at the time of application for the flat rate contract, the additional costs that the facility will incur to deliver the special services. The facility shall include, at a minimum, the additional staffing and training costs it will incur as a result of delivery of the special services. http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 8 of 55 (c) The Division will evaluate the information submitted by the facility, and may authorize a service payment rate in excess of the established rate schedule. The Division shall not authorize a payment rate in excess of the Level 5 service payment rate being paid to assisted - living facilities at the date that the flat rate contract becomes effective. (d) A contract may be renewed at an appropriate payment rate on an annual basis for a facility that continues to meet the criteria stated in section (7), subsection (a) of this rule. (A) At the time of the request for renewal, or at any other time the Division requests, the facility shall provide the Division with information on actual costs incurred in delivery of the special services. Information provided by the facility shall include the costs of staffing the special services and of training for direct care staff. (B) The Division will evaluate the information submitted by the facility, and may authorize a service payment rate in excess of the established rate schedule. The Division shall not authorize a payment rate in excess of the Level 5 service payment rate for assisted - living facilities clients at the date that the flat rate contract renewal becomes effective. (e) Payments made to residential care facilities under this section shall receive service payment rate increases in the same way and at the same time as other residential care facilities. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate for assisted - living facilities. (f) Payments made to adult foster homes under this section shall receive service payment rate increases in the same way and at the same time as . other adult foster homes. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate for assisted - living facilities. (g) Payments made to assisted - living facilities under this section shall receive service payment rate increases in the same way and at the same time as other assisted - living facilities. However, no payment increase will cause the maximum payment rate under this section of rule to exceed the Level 5 service payment rate. (h) Contracts executed prior to March 1, 1999 will be honored for the duration of the contract. After expiration the facility must meet the criteria listed in section (7), subsections (a) and (b) of this rule for the Division to consider granting a flat rate contract under section (7), subsection (a) of this rule. (8) Exceptions: (a) SDSD /Type B AAA local units may authorize individual exception payments greater than the established rate schedule as stated in OAR 411- 027 -0050 for service provided on or after March 1, 1998. (A) If a facility provides care under a flat rate contract, individual payment exceptions to that rate must be pre- authorized by the SDSD Central Office. (9) Payments for Adult Day Services: (a) Local SDSD /Type B AAA local units may authorize payments to any Medicaid - contracted adult • day services program as defined in OAR 411 -66 -0000 through 411 -66 -0020. (b) Adult day services may be authorized as part of an overall plan of care for service - eligible clients and may be used in combination with other community -based services if day services are the http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 bulletin Page 9 of 55 appropriate resource to meet a special need. (c) Adult day services may be authorized for payment as a single service or in combination with other community -based care services. Adult day services shall not be authorized nor paid for if another provider has been authorized payment for the same service. Payments authorized for adult day services shall be included in computing the total cost of care. (d) The Division will pay for a half day of program services when less than four hours are provided, and will pay for a full day of program services when more than four, but less than twenty -four, hours are provided. • (10) Payments to Assisted - Living Facilities (ALF's): (a) Local SDSD /Type B AAA local units may authorize payments to any Medicaid - contracted Assisted- Living Facility as defined in OAR 411- 056 -0005. (b) In all instances, placement in ALFs is contingent upon the client meeting the payment levels described in section (10), subsection (c), paragraph (C) of this rule. (c) Monthly Service Payment Determination: (A) Monthly service payment for Division clients is based on degree of impairment in each of the six Activities of Daily Living (ADL) as determined by the Division's assessment document and the payment levels described in section (10), subsection (c), paragraph (C) of this rule. The initial service plan shall be developed prior to admission and shall be revised if needed within 30 days. The service plan shall be reviewed and updated at least quarterly or more often as needed, as per OAR 411 -056- 0015 (2)(g). (B) Activities of Daily Living (ADL) are weighted for purposes of determining the monthly service payment as follows: (i) Critical activities of daily living (ADL): toileting, eating and behavior; (ii) Less critical ADLs: mobility, bathing /personal hygiene and dressing /grooming; (iii) Essential factors: Other essential factors considered are medical problems, structured living, medical management and other needs. (C) Payment (Impairment) Levels: (i) Level 5 - Client is dependent in three to six ADLs; OR dependent in behavior AND one or two other ADLs; (ii) Level 4 - Client is dependent in one or two ADLs; OR requires assistance in four to six ADLs plus assistance in behavior; (iii) Level 3 - Client requires assistance in four to six ADLs; OR requires assistance in toileting, eating and behavior; (iv) Level 2 - Client requires assistance in toileting, eating and behavior; OR requires assistance in behavior AND eating or toileting; (v) Level 1 - Client requires assistance in two or more of the critical ADLs; OR requires assistance in http ://arcweb. so s. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797_121 bulletin Page 10 of 55 any three ADLs; OR requires assistance in toileting, eating or behavior and assistance in at least one other essential factor; OR requires assistance in one critical ADL and one other ADL. (D) The reimbursement rate for Division clients shall not be more than the rates charged private paying clients receiving the same type and quality of care. Stat. Auth.: ORS 410.070 Stats. Implemented: ORS 410.070 Hist.: SSD 9- 1984(Temp), f. & of. 11 -1 -84; SSD 3 -1985, f. & ef. 4 -1 -85; SSD 10 -1985, f & ef. 8 -1- 85; SSD 12- 1985(Temp), f & of. 9- 19 -85; SSD 16 -1985, f. 12- 31 -85, ef. 1 -1 -86; SSD 4 -1987 (Temp), f. & of. 7 -1 -87; SSD 13 -1987, f. 12- 31 -87, cert. ef. 1 -1 -88; SSD 6 -1988, f. & cert. ef. 7 -1 -88; SSD 9 -1989, f. 6- 30 -89, cert. ef. 7 -1 -89; SSD 2 -1993, f. 3- 19 -93, cert. ef. 4 -1 -93; SSD 9 -1993, f. & cert. ef. 12 -1 -93; SDSD 3 -1998, f. 2- 27 -98, cert. ef. 3 -1 -98; SDSD 1 -1999, f. & cert. ef. 3 -1 -99; SDSD 2 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 Adm. Order No.: SDSD 3 -1999 Filed with Sec. of State: 3 -1 -99 Certified to be Effective: 4 -1 -99 Notice Publication Date: 2 -1 -99 Rules Adopted: 411 - 056 -0018, 411- 056 -0035, 411- 056 -0045, 411 - 056 -0075, 411- 056 -0085 Rules Amended: 411 - 056 -0000, 411- 056 -0005, 411- 056 -0010, 411- 056 -0015, 411 - 056 -0020, 411- 056 -0030, 411- 056 -0040, 411- 056 -0060, 411 - 056 -0070, 411- 056 -0090, 411 - 056 -0095 Rules Repealed: 411 - 056 -0065 Rules Ren. & Amend: 411 - 056 -0050 to 411- 056 -0008, 411 - 056 -0080 to 411 - 056 -0055 Subject: Chapter 411, Division 56 is amended to revise and adopt standards for Assisted Living Facilities. OAR 411- 056 -0065, Payment, is repealed from this Division and incorporated, under separate Certificate, into OAR 411 - 027 -0000, Payment Limitations in Community -Based Care. Rules Coordinator: Pam Warren- -(503) 945 -6406 S` 411 - 056 -0000 Purpose (1) The purpose of these rules is to establish standards for assisted - living facilities. The support the concept of aging in place and promote the availability of appropriate service and disabled persons in a home -like environment which enhances the dignity, independe____, individuality, privacy, choice and decision making ability of the resident. http: / /arcweb.sos. state. or .us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_121 bulletin Page 11 of 55 (2) Assisted living requires the facility to address standards in the delivery of services to residents and design the physical environment to support dignity, independence, individuality, privacy, choice, and decision making abilities of individual residents. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3- 1999,.f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0005 Definitions For the purpose of these rules, authorized under ORS 443.400 - 443.460 and 443.991, the following definitions apply: (1) "AAA" means a Type B Area Agency on Aging (AAA) which is an established public agency within a planning and service area designated under Section 305 of the Older Americans Act which has responsibility for local administration of Division programs. For the purpose of these rules, the AAAs contract with the Division to perform specific activities in relation to licensing assisted - living facilities including: Conducting inspections and investigations regarding protective service, abuse monitoring, and making recommendations to the Division regarding assisted living license approval, denial, revocation, suspension, non - renewal and civil penalties. (2) "Abuse" means: (a) Any physical injury to a resident caused by other than an accident. Physical injuries include injuries that a reasonable and prudent person would be able to prevent such as hitting, pinching or striking, or injury resulting from rough handling; (b) Neglect, which results in physical harm or discomfort or loss of human dignity. Neglect includes failure to provide agreed upon care or services to a resident, failure to make a reasonable effort to assess what care is necessary for the well -being of the resident, or failure to provide a safe and sanitary environment; (c) Sexual contact, including fondling of a resident by an employee, agent or other resident by force, threat, duress or coercion, or sexual contact with a resident who has no ability to consent; (d) Financial exploitation which includes illegal or improper use of a resident's resources or personal property for the personal profit or gain of another person; borrowing resident funds; spending resident funds without the resident or their designee's consent or if the resident is not capable of consenting; spending resident funds for items or services from which the resident cannot benefit or appreciate; or spending resident funds to acquire items for use in common areas when such purchase is not authorized by the resident; (e) Verbal abuse, including the use of oral, written or gestured communication to a resident, or to a visitor or staff about a resident within that resident's presence, that describes the resident in disparaging or derogatory terms; http: / /arcweb.sos.state.or.us/rules/0499_Bulletin/0499_ch411_bull etin.html 5/3/99 0797_121 bulletin Page 12 of 55 (f) Mental abuse including humiliation, harassment, threats of punishment or deprivation directed toward the resident; (g) Corporal punishment; (h) Involuntary seclusion of a resident for convenience of staff, or discipline; or (i) Using restraints, except when a resident approves or requests the use of the restraint as a supportive or enabling devise to increase independence; or when a resident's actions present an imminent danger to self or others and only until appropriate action is taken by medical, emergency, or police personnel. (3) "Activities of Daily Living (ADL)" are tasks usually performed in the course of a normal day in an individual's life which include: Eating /nutrition, dressing /grooming, bathing /personal hygiene, mobility, toileting, and behavior management. (a) "Independent" means the resident can perform an the ADL task without assistance of another person or needs minimal reminding. (b) "Assistance" means the resident can perform some portions of a task independently but requires assistance or supervision with other portions of the task. Assistance ranges from supervision to physical performance of one or more portions of a task. (c) "Dependent" means the resident is dependent on another person to perform all portions of a task. The person does not perform any part of the ADL even with mechanical aids; or the person would perform the ADL task, but has been ordered not to by a physician. (4) "Aging in Place" refers to a philosophical approach to care and services which advocates for a person to remain in his/her living environment (home) despite the physical and /or mental decline that may occur with the aging process. For aging in place to occur, needed services are added, increased or adjusted to compensate for the physical and /or mental decline of the individual. (5) "Applicant" means the person who completes an application for a license and is the owner of the business. (6) "Assisted Living " means a program approach, within a prescribed physical structure, which provides or coordinates a range of supportive personal and health services, available on a 24 -hour basis, for support of resident independence in a residential setting. Assisted living promotes resident self direction and participation in decisions that emphasize choice, dignity, privacy, individuality, independence, and home -like surroundings. (7) "Choice" means a resident has viable options which enable the resident to exercise greater control over his/her life. Choice is supported by the provision of sufficient private and common space within the facility to provide opportunities for residents to select where and how to spend time and receive personal assistance. (8) "Department" means the Department of Human Resources. (9) "Dignity" means providing support in such a way as to validate the self -worth of the individual. Dignity is supported by designing a structure which allows personal assistance to be provided in privacy and delivering services in a manner that shows courtesy and respect. (10) "Direct Care Staff' means an employee who provides service and assistance to residents http: / /arcweb.sos. state. or. us /rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_121 bulletin Page 13 of 55 including activities of daily living and medication tasks. (11) "Disclosure" means the written information prepared by the facility which must be provided to prospective residents and if requested to their family, prior to signing a move -in agreement and at any time after admission if the facility makes any changes in the information. (12) "Division" means the Senior and Disabled Services Division of the Department of Human Resources. (13) "Exception" means a written variance from a regulation or provision of these rules. (14) "Facility" means the licensed physical structure, the licensed owner of the assisted - living facility and each entity with which the business owner leases the business directly or indirectly, or contracts directly or indirectly, to manage overall operation of the assisted - living facility. (15) "First Payor" means policy of insurance, or benefits from Veterans Administration, Medicare, Medicaid, long -term Care insurance or other payor source. (16) "Home" means a living environment which creates an atmosphere supportive of the resident's preferred lifestyle. Home is also supported by the use of residential building materials and furnishings. (17) "Independence" means supporting resident capabilities and facilitating use of those abilities. Independence is supported by creating barrier -free structures and careful design of assistive devices. (18) "Individuality" means recognizing variability in residents' needs and preferences and having flexibility to organize services in response to those needs and preferences. (19) "Licensee" means the individual, firm or partnership, association, or corporation who applied for, and was issued a license and whose name is designated as owner on the license. (20) "Managed Risk" means a process by which a resident's high -risk behavior or choices are reviewed with the resident. Alternatives to and consequences of the behavior or choices are explained to the resident and the resident's decision to modify behavior or accept the consequences is documented. (21) "Modified Special Diet" means a diet ordered by a physician or other licensed health care professional that may be required to treat medical conditions (i.e., heart disease or diabetes). These diets include small frequent meals, no added salt, reduced or no added sugar and simple textural modifications. Medically complex diets are not included. (22) "Nursing Care" means the practice of nursing as governed by ORS Chapter 678 and Administrative Rules adopted by the Oregon State Board of Nursing in OAR Chapter 851, Division 047. (23) "Personal Incidental Funds (PIF)" means the monthly amount allowed each Medicaid and General Assistance resident for personal incidental needs. For the purpose of these rules, personal incidental funds include monthly payments, as allowed, and previously accumulated resident savings. (24) "Privacy" means a specific area and /or time over which the resident maintains a large degree of control. Privacy is supported by designing living space which is not shared with others, except by personal choice, and by services that are delivered with respect for the resident's civil rights. (25) "Psychoactive Medications" means medications used to alter mood, level of anxiety, behavior or http ://arcweb.sos. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797 121 bulletin Page 14 of 55 cognitive processes. This term includes antidepressants, antipsychotic, sedatives, hypnotics, and antianxiety medications. (26) "Resident" means any individual residing in a unit within an assisted - living facility. (27) "Restraint" means any physical device that the resident cannot manipulate which is used to restrict movement or normal access to the resident's body. (28) "Service Plan" means a written plan for services developed by a service planning team and the resident, or the resident's legal representative, which reflects the resident's capabilities, choices and if applicable, measurable goals and managed risk issues. The plan defines the division of responsibility in the implementation of the services. (29) "Service Planning Team" means two or more individuals who assist the resident in determining what services /care are needed, preferred, and will be provided to the resident. (30) "Services" means supervision or assistance provided in support of a resident's needs, preferences and comfort, including health care and activities of daily living, that help develop, increase, maintain, or maximize the resident's level of independent, psycho - social and physical functioning. (31) "SDSD" means the Senior and Disabled Services Division of the Department of Human Resources. (32) "Unit" means an individual living space constructed as a completely private apartment, including living and sleeping space, kitchen area, bathroom and adequate storage areas. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.400 & ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411- 056 -0008 License \Contract To operate and be designated as an assisted - living facility, the facility must be licensed as an assisted- living facility and comply with OAR Chapter 411, Division 056. (1) Licensing Requirement (a) No person or governmental unit acting individually or jointly with any other person or governmental unit shall establish, maintain, conduct, manage or operate an assisted - living facility without being duly licensed. (b) The Administrator of the Senior and Disabled Services Division or his /her designee shall determine whether an assisted - living facility license is required in cases where the definition of a facility's services is in dispute. (2) Application Process http: / /arcweb.sos.state.or.us /rules /0499_Bulletin/0499_ch411 bulletin.html 5/3/99 0797_121 bulletin Page 15 of 55 Application for a license accompanied by the required fee shall be made to Senior and Disabled Services Division upon forms provided by the Division and.shall include full and complete information as to the: (a) Identity of: (A) Each officer and director of the corporation if organized as a corporation; (B) Each general partner if organized as a partnership or limited liability partnership; and (C) The governing body if the facility is a government owned facility. (b) Name of the administrator of the facility; (c) Physical location (address), mailing address, and telephone number of the facility; (d) Maximum number of residents at any one time; (e) Maximum number of units; (f) Policies and procedures consistent with the assisted - living philosophy and a written statement of the administrator's understanding of the philosophy; and (g) Name of the management company. (3) Identification. Every facility shall have distinct identification or name and shall notify the Division prior to changing such identification. (4) Descriptive Titles. An assisted - living facility licensed by the Division shall neither assume a descriptive title nor be held under any descriptive title other than that which is permitted within the scope of its license. (5) Reporting of Changes. Each assisted - living facility shall promptly report to the Division, changes which would affect the current accuracy of Section (2) of this rule. (6) Submission of Plans (a) One set of building plans and specifications shall be submitted to the Oregon Health Division, Licensing Plans Review Program, for approval: (A) Prior to construction of any new building; (B) Prior to construction of any addition to an existing building; (C) Prior to any remodeling, modification, or conversion of an existing building; or (D) In support of any application for an initial license of a facility not previously licensed under this rule. (b) Plans shall comply with the current edition of the State Fire and Life Safety Code. http: / /arcweb.sos. state. or. us /rules /0499_Bulletin/0499_ch411 bulletin.html 5/3/99 • 0797_121 bulletin Page 16 of 55 (c) Plans shall be drawn to a scale of one -fourth inch or one - eighth inch to the foot and shall specify the date upon which construction,, modification, or conversion is expected to be completed. (d) Construction containing 4,000 square feet or more shall be prepared and bear the stamp of an Oregon licensed architect or engineer. (7) Required Fees (a) Each application for an assisted - living facility license shall be accompanied by a the required nonrefundable fee. (b) No fee shall be required of a government owned facility. (8) License Issued (a) Upon receipt of an application and fee, the Division shall cause an investigation to be made. Initial action by the Division on the application shall begin within 30 days of receipt of application. (b) The Division shall issue a license to an applicant found to be in compliance with these rules. The license shall be in effect for two years from the date issued unless revoked or suspended. (c) No assisted - living facility license is transferable or applicable to any location, facility, management agent or ownership other than that indicated on the application and license. (d) No assisted - living facility shall be operated or maintained in combination with a nursing facility, hospital, residential care, congregate care or other type of retirement facility unless licensed, maintained and operated as a separate and distinct part. (e) The license shall be posted in public view in the facility and available for inspection at all times. (f) Each license shall be considered void immediately on suspension or revocation of the license, or if the operation is discontinued by voluntary action of the license holder, or if there is a, change of ownership. The voided license shall be returned to the Division immediately. (9) Renewal of License (a) A license is renewable upon submission of an application to the Division and the payment of the required nonrefundable fee, except that no fee shall be required of a governmental owned facility. (b) Filing of an application for renewal before the date of expiration extends the effective date of expiration until the Division takes action upon such application. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.410, ORS 443.425 & ORS 443.440 Hist.: SSD 14- 1989, f. & cert. ef. 9 -1 -89; SSD 15 -1991, f. & cert. ef. 7 -1 -91; SDSD 3- 1999, f. 3 -1- 99, cert. ef. 4 -1 -99 [Renumbered from 411- 056 -0050] 411 -056 -0010 http: / /arcweb.sos. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797_ 121_ bulletin Page 17 of 55 Responsibilities of Administration (1) The facility shall develop and conduct an ongoing quality improvement program that evaluates services, resident outcomes and resident satisfaction. (2) The facility shall develop and implement written policies and procedures approved by the Division that promote high quality services, health and safety for residents and incorporate the assisted - living principles of individuality, independence, dignity, privacy, choice, and a home -like environment. (3) The facility shall ensure that all employees and residents have a tuberculin test in compliance with Health Division Administrative Rules, Chapter 333, Division 19. Documentation of results shall be available for review by the Division. (4) The facility shall evaluate prospective employees consistent with OAR Chapter 411, Division 009, Criminal History Clearance. (5) Abuse and Reporting: (a) The facility shall not inflict, or tolerate to be inflicted, abuse of residents. (b) All employees who have reasonable cause to believe a resident has suffered abuse are responsible for reporting to appropriate facility personnel, SDSD, or the State Long -Term Care Ombudsman Office. Upon receipt of an allegation of abuse the facility shall immediately conduct an investigation. The facility administrator shall notify the local SDSD /AAA office of the incident unless the facility investigation reasonably concludes that abuse did not occur. (A) A person who, in good faith, reports abuse shall have immunity from any civil or criminal liability with respect to the making, or content of a report. Immunity under this subsection does not protect a self - reporting facility from liability for the underlying conduct, if any, that is described in the report. (B) No complainant, witness, resident or employee of a facility shall be subject to any retaliation. If the employee is the complainant, he or she shall not be dismissed or harassed for making a good faith report, or being interviewed about a complaint, or being a witness. (6) The facility shall identify methods of preventing and responding to incidents such as injury, loss of property and abuse. (7) The facility shall exercise reasonable precautions against any condition which could threaten the health, safety or welfare of residents. (8) The facility is responsible for the supervision, training and overall conduct of staff when acting within the scope of their employment duties. (9) The facility shall develop and implement effective methods of resolving resident complaints. (10) Resident Bill of Rights. The facility shall implement a residents' Bill of Rights. Each resident or resident's designated representative shall be given a copy of their rights and responsibilities. The Bill of Rights shall state that residents have the right: (a) To be treated with dignity and respect; http: / /arcweb.sos. state. or .us /rules/ 0499_ Bulletin /0499_ch411 5/3/99 0797 121 bulletin Page 18 of 55 (b) To be given informed choice and opportunity to select or refuse service and to accept responsibility for the consequences; (c) To exercise individual rights that do not infringe upon the rights or safety of others; (d) To be free from neglect, financial exploitation, verbal, mental, physical or sexual abuse; (e) To receive services in a manner that protects privacy and dignity; (f) To have access to his /her records; (g) To have medical and other records kept confidential except as otherwise provided by law; (h) To interact freely with others within their assisted - living home and in the community; (i) To be free from physical restraints and inappropriate use of psychoactive medications; (j) To manage personal financial affairs unless legally restricted; (k) To have access to and participate in social activities; (1) To be encouraged and assisted to exercise rights as a citizen; (m) To voice grievances, be informed of grievance procedures, and suggest changes in policies and services to either staff or outside representatives without fear of retaliation; (n) To have a safe and home -like environment; (o) To be free of discrimination in regard to race, color, national origin, gender, sexual orientation or religion; and (p) To have proper notification if requested to move out of the facility, and to be required to move out only for reasons stated in OAR 411 - 056 -0020, Involuntary Move -out Criteria, and have the opportunity for an informal conference and hearing. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411- 056 -0015 Range of Services (1) Initial Screening (a) The facility shall determine whether a potential resident meets the facility's admission requirements. http ://arcweb. sos. state.or.us/rules/0499_Bulletin/0499_ch411_bulletin.html 5/3/99 0797_121 bulletin Page 19 of 55 (b) Prior to the resident moving in, an appropriate staff person shall conduct an initial screening to determine the prospective resident's service needs and preferences. The screening shall determine the ability of the facility to meet those needs and preferences considering the needs of the other residents and the facility's overall service capability. (c) Based on the initial screening, an initial service plan shall be developed before the resident moves into the assisted-living facility. The initial service plan shall be reviewed within 30 days of move-in to ensure the plan accurately reflects the resident's needs and preferences. (2) Service Plan and Assessment (a) A service plan shall be developed and followed for each resident consistent with that person's unique physical, psycho-social, and health care needs with recognition of his/her capabilities and preferences. (b) The plan shall include a written description of. Who will provide the services, what, when, how, if applicable, the desired outcome. Each resident and how often the services will be provided, and p shall actively participate in the development of the service plan to the extent of his/her ability to do so. The resident or legal representative shall be offered a copy of the agreed upon service plan. (c) The plan shall reflect assessed needs and resident decisions (including resident's level of involvement), support principles of dignity,privacy, choice, individuality, independence, and a home-like environment; and identify others who will participate in the delivery of services. (d) A service plan shall be developed by a service planning team. The service planning team shall consist of the resident or legal representative and two or more of the following persons: (A) SDSD/AAA case manager, if applicable; (B) Facility administrator or designee; and C A licensed nurse if the resident will be or is receiving nursing services. ( ) g g (e) In addition, the service planning team may include any or all of the following persons as appropriate, or as requested by the resident or his/her legal representative: (A) Facility personnel such as direct care givers, activity director, food preparer; etc. (B) Resident's physician or other health practitioner; and (C) Other persons as requested by the resident or his/her legal representative. (f) The service planning team, shall: A Conduct an assessment of the resident's needs; (B)Plan responsive services; (C) Implement services; and (D) Periodically evaluate results of the plan. http://arcweb.sos.state.or.us/rules/0499_Bulletin/0499_ch4lI bulletin.html 5/3/99 0797_121 bulletin Page 20 of 55 (g) The service plan shall be reviewed and updated quarterly by the service planning team and the resident, or more often, if the resident's needs change requiring service plan modification. The service plan shall be updated based on a current assessment of the resident. (h) The service plan shall be readily available and followed by all staff. (i) Managed risk. The service plan shall include agreed upon actions if a managed risk plan is developed. 0) The facility shall identify the need for and develop a managed risk plan following the facility's established guidelines and procedures. A managed risk plan shall include: (A) An explanation of the cause(s) of concern; (B) The possible negative consequences to the resident and/or others; (C)A description of resident preference(s); (D) Possible alternatives/interventions to minimize the potential risks associated with the resident's current preference/action; E A description of the services the facility will provide to accommodate the resident's choice or ( ) p Y minimize the potential risk; and (F) The final agreement, if any, reached by all involved parties. (k) The facility shall involve the resident,the resident's designated representative and others as indicated, to develop, implement and review the managed risk plan. The resident's preferences shall take precedence over those of a family member(s). A managed risk plan shall not be entered into or continued with or on behalf of a resident who is unable to recognize the consequences of his/her behavior or choices. (1) The managed risk plan shall be reviewed at least quarterly. (3) Services (a) The assisted-living facility shall provide the following: ee nutritional meals daily with snacks available seven ys a week, in accordance with the recommended dietary allowances found in ide Pyramid, including seasonal fresh a es; (B) Modified Special diets which are appropriate to residents' needs and choices; (C) Menus prepared at least one week in advance, and made available to all residents. Meal substitutions may be made in compliance with this subsection. The facility shall encourage residents' involvement in developing menus. (D) Personal and other laundry services; (E)A program of social and recreational activities that is based upon individual and group interests / and creates opportunities for active participation in the community at large; http://arcweb.sos.state.or.us/rules/0499_Bulletin/0499_ch4l 1_bulletin.html 5/3/99 0797_121 bulletin Page 21 of 55 (F) Services to assist the resident in performing all activities of daily living, on a 24 -hour basis, including: (i) Assistance with mobility, including one - person transfers; (ii) Assistance with bathing /personal hygiene; (iii) Assistance with dressing /grooming; (iv) Assistance with eating; (v) Assistance with bowel and bladder management, including incontinency management; (vi) Intermittent cuing, redirecting and environmental cues for cognitively impaired residents; (vii) Services for residents who exhibit behavioral symptoms that may benefit from intermittent intervention, supervision, and staff support. (G) Household services essential for the health and comfort of the resident that are based upon the resident's needs and preferences (e.g., floor cleaning, dusting, bed making, etc.); (b) The assisted - living facility shall provide or arrange for the following: (A) Transportation for medical and social purposes; (B) Ancillary services for medically related care (e.g. physician, pharmacist, therapy, podiatry), barber/beauty services, social /recreational opportunities, hospice, home health, and other services necessary to support the resident; (C) Maintenance of a personal fund account for residents that documents deposits and withdrawals. (c) The facility shall provide health services which include: (A) Accessing first payor benefits to provide health care for residents who are eligible for those benefits. When benefits are no longer available or if the resident is not eligible for benefits, the facility shall provide or coordinate the required services for residents whose health status is stable and predictable. (B) An Oregon - licensed registered nurse, either on staff or on contract who provides: (i) Health care assessment and periodic monitoring of residents as appropriate; (ii) Assignment of basic tasks of nursing and delegation of special tasks of nursing in accordance with the Oregon State Board of Nursing Administrative Rules, Chapter 851, Division 47. (C) Providing intermittent nursing services for a resident whose medical needs are stable and predictable. The facility shall assist in the coordination of nursing care such as home health, when a resident's medical condition is complex, unstable, or unpredictable, and such care can be managed in the facility. (D) Oversight and monitoring of resident's health status. http://arcweb.sos.state.or.us/rules/0499_Bulletin/0499 ch411 _bulletin.html 5/3/99 0797_ 121_ bulletin Page 22 of 55 (E) Health care teaching and counseling. (F) Interaction with other health care professionals on behalf of the resident as needed. (G) Coordinating the provision of health services with outside service providers such as hospice, home health, physicians' offices, etc. (H) Systems which respond to the health and medical care needs of residents on a 24 -hour basis. (I) Immediate notification to medical, emergency, or police personnel when a restraint is applied because a resident's actions present an imminent danger to self or others. (4) Medications and Treatments (a) Medication/Treatment Administration: (A) The facility shall have safe medication and treatment administration systems in place that are approved by a pharmacist consultant, registered nurse, or physician. The administrator is responsible for ensuring adequate professional oversight of the medication and treatment administration system. (B) Written, signed physician or other legally recognized practitioner orders shall be documented in the resident's facility record for all medications and treatments which the facility is responsible to administer. Medication or treatment changes shall not be made without a physician's or other legally recognized practitioner's order. (C) All medications administered by the facility to a resident shall be reviewed at least every ninety days by the prescriber, registered pharmacist, or registered nurse. (D) Medication and treatment orders shall be carried out as prescribed. The resident or the person legally authorized to make health care decisions for the resident has the right to consent to, or refuse medications and treatments. The physician/practitioner shall be notified if a resident refuses consent to an order. Subsequent refusals to consent to an order shall be reported as required by the physician/practitioner. (E) An accurate medication record for each resident shall be kept of all medications, including over - the- counter medications, administered by the facility to that resident. The record shall include: (i) Name of medication, reason for use, dosage, route and date /time given; (ii) Name of the primary care or prescribing physician/nurse practitioner and telephone number; (iii) Current month, day and year; (iv) Allergies and sensitivities, if any; (v) Resident specific parameters and instructions for p.r.n. (as needed) medications; (vi) Documentation of treatments with resident specific parameters; (vii) Initials of the person administering the medication and treatment at the time of administration; and http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_121 bulletin • Page 23 of 55 (viii) Review date and name of reviewer. (F) The facility shall maintain legible signatures of staff who administer medications and treatments, either on the medication administration record or on a separate signature page. (G) Residents may keep and use over-the-counter medications in their unit without a written order unless otherwise contraindicated by a physician or other legally recognized practitioner's written orders. (H) If the facility administers or assists a resident with his/her medication, all medication obtained through a pharmacy shall be clearly labeled with the pharmacist's label in the original container in accordance with the facility's established medication delivery system. (I) Over-the-counter medication or samples of medications shall have the original manufacturer's label(s) if the facility administers or assists a resident with his/her medication. (J) The facility shall not require residents to purchase prescriptions from a pharmacy which contracts with the facility. The facility shall comply with ORS 443.437, Residential Facilities and Homes, regarding prescription and non-prescription medications and supplies. (K) The facility shall have a system approved by a pharmacist consultant, registered nurse, or physician, for tracking controlled substances and for disposal of all unused, outdated or discontinued medications administered by the facility. (L)All medications administered by the facility shall be stored in a locked container(s) in a secured environment such as a medication room or medication cart. (M) The facility shall obtain and place a written signed order in the resident's record for any medications administered b the facility. Order changes obtained by telephone must be followed-up Y tY with written, signed orders. (b) Psychoactive Medication (A) The facility shall not request psychoactive medication to treat a resident's behavioral symptoms without a consultation from a physician, nurse practitioner, registered nurse or mental health professional. Facility administered psychoactive medication(s) shall be used only when required to treat a resident's medical symptoms or to maximize a resident's functioning. (B) Prior to administering any psychoactive medication(s)to treat a resident's behavior, all caregivers providing care for the resident shall know the specific reasons for the use of the psychoactive medication for that resident, the common side effects and when to contact a health professional regarding side effects. P.R.N. medications that are given to treat a resident's behavior shall have written, specific parameters. These medication(s) may be used only after documented, non- pharmacological interventions have been tried with ineffective results. All caregivers shall have knowledge of non-pharmacological interventions. (C) Psychoactive medications shall not be given to discipline a resident, or for the convenience of the facility. Psychoactive medications may be used only pursuant to a prescription that specifies the circumstances, dosage and duration of use. (c) Self-Medication (A) Residents must have a physician's or other legally recognized practitioner's written order of http://arcweb.sos.state.or.us/rules/0499—Bulletin/0499—ch4l 1bulletin.html 5/3/99 0797_121 bulletin Page 24 of 55 approval for self-administration of prescription medications. The resident shall be encouraged to have his/her medications reviewed by the prescriber, nurse practitioner, registered nurse or pharmacist at least every 90 days. (B)Residents able to administer their own medication regimen may keep prescription medications in their unit; and (C) If more than one resident resides in the unit, an assessment will be made of each person and his/her ability to safely have medications in the unit. If safety is a factor, the medications shall be kept in a locked container in the unit. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.437, ORS 443.445 & ORS 443.450 Hist.: SSD 14-1989, f. & cert. ef. 9-1-89; SSD 15-1991, f. & cert. ef. 7-1-91; SDSD 3-1999, f. 3-1- 99, cert. ef. 4-1-99 411-056-0018 Direct Care Staff guns e facility shall have qualified staff sufficient in number,to meet the 24-hour scheduled and eduled needs of each resident, and respond in emergency situations. (2) Staff or volunteers under 18 years of age shall not assist with medication administration or delegated nursing tasks. Staff or volunteers under the age of 18 must be supervised when providing bathing,toileting or transferring services. (3) A staff member on each shift shall be trained in the use of the Heimlich Maneuver, CPR and First Aid. (4) Staff shall have sufficient communication and language skills to enable them to perform their duties and interact effectively with residents and other staff. (5) Prior to providing care, staff shall receive documented orientation and training as approved by the Division. Training topics shall include: (a) Principles of assisted living; (b) Changes associated with aging processes including dementia; (c) Resident's rights, including confidentiality; (d) How to perform direct ADL care; (e) Location of resident service plans and how to implement; (f) Fire safety/emergency procedures; (g) Responding to behavior issues; http://arcweb.sos.state.or.us/rules/0499_Bulletin/0499_ch4l 1_bulletin.html 5/3/99 1 0797 121 bulletin Page 25 of 55 (h) Standard precautions for infection control; (i) Food preparation, service and storage, if applicable; and (j) Observation/reporting skills. (6) Staff shall comply with OAR Chapter 411, Division 9, Criminal History Clearance and OAR Chapter 333, Division 19, Health Division, Tuberculosis testing. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0020 Involuntary Move -Out Criteria The Division encourages facilities to support a resident's choice to remain in his or her living environment while recognizing that some residents may no longer be appropriate for the assisted - living setting due to safety and medical limitations. (1) A resident may, but is not required to be, asked to leave under the following circumstances: (a) Residents shall be given 30 days written notice when they are requested to move out for the following reasons: (A) The resident's needs exceed the level of ADL services the facility provides. There shall be documentation of the facility's efforts to provide or arrange for the required services. The minimum required services identified in OAR 411- 056- 0015(3) shall be provided before a resident can be asked to move out for this reason; (B) The resident exhibits behavior or actions that repeatedly and substantially interferes with the rights or well being of other residents and the facility has tried prudent and reasonable interventions. There shall be documentation of the interventions attempted; (C) The resident, due to severe cognitive decline, is not able to respond to verbal instructions, recognize danger, make basic care decisions, express need or summon assistance; (D) The resident has a medical condition that is complex, unstable or unpredictable and treatment cannot be appropriately developed and implemented in the assisted - living environment. There shall be documentation of the facility's efforts to obtain appropriate care for the resident; or (E) Non - payment of charges. (b) The resident may be asked to move out with less than 30 days, but not less than 14 days written notice for the following reasons: (A) The resident exhibits behavior that is an immediate danger to self or others; http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_121 bulletin Page 26 of 55 (B) The resident has had a sudden change in condition that requires medical or psychiatric treatment outside the facility and at the time the resident is to be discharged from that setting to move back into the facility, appropriate facility staff have re- evaluated the resident's needs and have determined the resident's needs exceed the facility's level of service. If the resident appeals the notification to move out , the facility shall not rent the resident's unit pending completion of the appeals process; (C) The facility is unable to accomplish resident evacuation in accordance with OAR 411 - 056 -0035; or (D) The resident requires 24 -hour, seven - day -a -week nursing supervision. (c) A resident or his /her legal representative may be given less than 14 days notice with written consent from the Division. All appeal rights shall remain intact. (d) A resident or his /her legal representative shall be given at least 30 days notice if a facility has had its license revoked, not renewed, or voluntarily surrendered. (e) A resident or his /her legal representative may terminate residency of a resident without notice due to abuse or conditions of imminent danger to life, health or safety, as substantiated by an SDSD /AAA office, or the Division. (2) The written move -out notice shall be completed on a Division approved form. The form shall be filled out in its entirety and a copy of the notice shall be sent by certified mail or delivered in person to the resident, the resident's legal representative, or any person designated by the resident, guardian, or conservator and if applicable, the case manager. Where a person lacks capacity and there is no legal representative, a copy of the notice to move out shall be faxed or sent next -day delivery to the State Long -Term Care Ombudsman, who may request an informal conference for the resident. (3) Residents who are given 14 day or less, notification to move out and who object to the requirement to move shall be given the opportunity of an informal conference if requested within five working days after receiving the notification. If notification is given under Section (1), Subsection (a) of this rule, the resident has ten days to object after receiving notification. When a resident or designee requests an informal conference, the Division shall be notified by the facility. (4) The Division shall hold an informal conference as promptly as possible, but no later than seven working days after the request is received. Participants shall include the resident and others as requested by the resident. The purpose of the informal conference is to resolve the matter without a formal hearing. If a resolution is reached at the informal conference, no formal hearing will be held. If a resolution is not reached at the informal conference, the resident or resident's representative may request a formal hearing. The administrative hearing will be held within seven days from the request if the requirement to move has been given for the protection and welfare of the resident or other residents. (5) The resident shall have the right to a formal administrative hearing prior to an involuntary move - out. (6) Temporary absence for medical treatment is not considered a move -out. (7) Intra - facility move policy shall be included in the facility's disclosure statement. In the case of a facility requested move, the facility shall pay all associated costs with the move. Residents shall not be relocated from one unit to another for the convenience of the facility. Stat. Auth.: ORS 410 & ORS 443 http: / /arcweb. so s. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797 121 bulletin Page 27 of 55 Stats. Implemented: ORS 443.450 Hist.: SSD 14- 1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0030 Organization of Business (1) Administrative Standards (a) The licensee shall be responsible for the operation of the facility. (b) Each licensed assisted - living facility shall employ a full -time administrator. (c) The administrator is designated by the licensee as the person responsible for the daily operation of the facility and for the daily care provided in the facility. (d) The administrator shall appoint a staff member as designee to oversee the operation of the facility in the administrator's absence. The administrator or designee shall be in charge on site, at all times and shall ensure there are sufficient, qualified staff and the care, health and safety needs of the residents are met at all times. (e) The administrator shall maintain and post in public view the facility staffing plan and the name of the administrator or designee in charge shall be posted by shift. (2) Administrator Qualifications (a) Facility administrators hired, or transferred between facilities, on or after April 1, 1999, shall meet the following requirements: (A) Be at least 21 years of age; (B) Possess a high school diploma or equivalent; (C) Have two years' successful experience providing care to persons in a community -based or long- term care setting or have a minimum of two years' education in a health- related field, or a combination thereof; (D) Complete 40 hours of Division - approved training prior to operating an assisted - living facility; (E) Have 20 hours of documented Division - approved continuing education credits each year. The 40- hour, Division - approved training fulfills the 20 -hour continuing education requirement for the first year; and (F) Comply with OAR Chapter 411, Division 9, Criminal History Clearance and OAR Chapter 333, Division 19, Health Division, Tuberculosis testing. (b) The Division shall be notified within five days of an administrator's departure or employment. A new administrator shall receive or be enrolled in a 40 -hour, Division - approved Administrator Training Course prior to assuming the responsibilities of administrator. An administrator enrolled in http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 • 0797 121 bulletin Page 28 of 55 an approved training course shall complete the course within 60 days of hire. Until training has successfully been completed, a qualified person who has completed the 40 -hour course shall provide on -site supervision. (3) Administrator Training Course Standards (a) The Division shall approve, in writing, the training curriculum for the 40 -hour Administrator Training. The curriculum shall be re- evaluated by the Division at periodic intervals. (b) Individuals, companies or organizations providing the Administrator Training Course shall be approved by the Division. The Division may withdraw approval under the following conditions; (A) Failure to follow the Division - approved curriculum; (B) The trainer demonstrates lack of competency in training; (C) There is insufficient frequency of training to meet the need; or (D) Facilities owned or operated by the training entity have a pattern of substantial non - compliance with these rules. (c) Approved training shall be open and available to all applicants and shall not be used to orient trainees to.a specific company's management or operating procedures. (4) Financial Management The assisted - living facility shall have written policies, procedures, and accounting records for handling residents' personal incidental funds, which are managed in the resident's own best interest. (a) The resident may manage his /her personal financial resources, or may authorize another person or the assisted - living facility to manage personal incidental funds. . (b) Records shall include a statement as to whether or not the facility will handle the resident's money, if requested by the resident . (c) Records shall include the Resident Account Record (SDS 713) or other comparable expenditure form if the facility manages or handles a resident's money. The resident account record shall show in detail with supporting documentation all monies received on behalf of the resident and the disposition of all funds received. Persons shopping for residents shall provide a list showing description and price of items purchased, along with payment receipts for these items. (d) Funds containing more than $150, shall be maintained in the resident's own interest - bearing account or in an interest - bearing account with a system that credits the appropriate interest specifically to each resident. (e) Upon the death of a Medicaid resident, with no surviving spouse, any personal incidental funds held by the facility for the resident shall be forwarded to SDSD, Estate Administration Unit, P.O. Box 14021, Salem, OR 97309. (5) Disclosure - Residency Agreement (a) Prior to a resident moving in, the facility shall provide a residency agreement and disclosure statement to each potential resident or his /her designated representative. The residency agreement and http ://arcweb. so s. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797_121 bulletin Page 29 of 55 disclosure statement must be approved by the Division prior to distribution and shall include the following: (A) Terms of occupancy; (B) Payment provisions, including the following: (i) Basic rental rate, and what it includes; (ii) Additional services costs; (iii) Billing method, payment system and due dates; (iv) Deposits /fees, if applicable; (C) Policy for rate changes including: (i) Thirty days prior written notice of any facility -wide increases, additions or changes; (ii) Immediate written notice at the time the facility determines a resident's service rates will increase due to increased service provision as negotiated in a service plan; (D) Refund /proration conditions; (E) A description of the scope of services available according to OAR 411- 056 -0015; (F) A description of the service planning process and the relationship between the service plan and cost of services; (G) Additional available services; (H) The philosophy of how health care and ADL services are provided to the resident; (I) Resident rights and responsibilities; (J) The facility system for packaging medications and the resident's right to choose a pharmacy; (K) Criteria, actions, circumstances or conditions which may result in a move -out notification or • intra- facility move and resident's rights pertaining to notification of move -out; (L) Notice that the Division has the authority to examine resident's records as part of the evaluation of the facility; and (M) Staffing plan. (b) The facility shall not include any provision in a residency agreement or disclosure statement that is in conflict with these rules and shall not ask or require a resident to waive any of the resident's rights or the facility's liability for negligence. (c) The facility shall retain a copy of the signed and dated residency agreement and provide copies to the resident or to their designated representative; and http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 .0797 121 bulletin Page 30 of 55 (d) The facility shall give 30 days prior written notice of any additions or changes to the residency agreement. [ED. NOTE: Copies of the Forms referenced in this rule are available from the agency.] Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.420 & ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SSD 15 -1991, f. & cert. ef. 7 -1 -91; SDSD 3 -1999, f. 3 -1- 99, cert. ef. 4 -1 -99 411 - 056 -0035 Fire and Life Safety (1) Building and Fire Codes. Each assisted - living facility shall meet the requirements of the Oregon Structural Specialty Code (OSSC), and the Oregon Uniform Fire Code (OUFC) in effect at the time of original licensure and as required by building and fire code agencies having jurisdiction. When a change in use and building code occupancy classification occurs, licensure approval shall be contingent on meeting the OSSC and minimum standards of ADA in effect at the time of such change. (2) Emergency Procedure and Disaster Plan. A written emergency procedure and disaster plan for meeting all emergencies and disasters shall be approved by the State Fire Marshal or authorized representative. The plan shall be immediately available to the administrator and employees. The plan shall include: (a) Emergency instructions for employees in the event of fire, explosion, missing person, accident, or other emergency; (b) The telephone numbers of the local fire departments, police departments, the administrator, the administrator's designee, and other persons to be contacted in emergencies; and (c) Instructions for the evacuation of residents and employees in the event of a fire, explosion, or other emergency. (3) Combustible and Hazardous Materials. Flammable and combustible liquids or hazardous materials shall be safely and properly stored in original, properly labeled containers in areas inaccessible to residents in accordance with the OUFC. (4) Safety Evacuation Capability (a) The evacuation capability of the residents and staff is a function of both the ability of the residents to evacuate and the assistance provided by the staff. Facilities classified as impractical or slow shall meet one of the following evacuation levels: (A) SR -1 Impractical. A group, even with staff assistance, that cannot reliably move to a point of safety in a timely manner, and evacuation drill times are in excess of 13 minutes; http ://arcweb. sos. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 .0797 121 bulletin Page 31 of 55 (B) SR -2 Slow. A group that can move to a point of safety in a timely manner with some assistance and have evacuation drill times over three minutes, but not in excess of 13 minutes. (b) All two - story, assisted - living facilities with approved plans or constructed on or after April 1, 1999, shall be constructed to meet SR -1 standards, or if an SR -2 classification is used, shall include a minimum of one 2 -hour area separation wall, constructed to standards as defined in the OSSC. (c) All existing facilities shall be subject to review and may be reclassified into one of these two classification groups. Waivers shall be given only with the approval of the Fire Marshal Agency having jurisdiction. (5) Approved Documentation of Evacuation Capability. The assisted - living facility shall document, on State Fire Marshal forms, the evacuation capability of the residents as specified in the OUFC. (6) Fire Drills. A minimum of one unannounced fire drill shall be conducted and recorded every other month. Each month a fire drill is conducted, the time (day, evening and night shifts) and location of the drill shall vary. Fire and life safety instruction to staff will be provided on alternate months. The facility or local Fire Marshal may develop alternative fire drill plans in consultation with the State Fire Marshal or his designee. Any such plan shall be submitted to the Division for approval. (7) Evacuation Assistance. Staff shall provide fire evacuation assistance to residents from the building to a designated meeting area outside the building through a horizontal exit (2 -hour minimum fire wall) or other points of safety approved by the State Fire Marshal or his designee. (8) Inability to Evacuate. When the facility is unable to meet the applicable evacuation level, the facility shall make an immediate effort to make changes to ensure the evacuation standard is met. Changes shall include, but are not limited to, increasing staff levels, changing staff assignments, requesting intra - facility move of resident(s) and arranging for special equipment. The facility shall document efforts to accomplish evacuation. If the facility cannot meet the applicable evacuation level, the facility shall prepare to move out the resident(s) in accordance with OAR 411 - 056 -0020. (9) Alternative Exit Routes. Alternate exit routes shall be used during fire drills to react to varying potential fire origin points. (10) Fire Alarms or Smoke Detectors. Fire alarms, smoke detectors, or other approved signal devices shall be set off during each fire drill. Fire detection and protection equipment, including visual signals with alarms for hearing- impaired residents, shall be inspected and maintained in accordance with the requirements of the State Fire Marshal or authorized representative. (11) Fire Drill Records. A written fire drill record shall be kept to include the date and time of day, location of simulated fire origin, the escape route used, comments relating to residents who refused or were unable to participate in the drills, whether the alarm system was operative at the time of the drill and evacuation time period needed. Records shall be maintained for a minimum of 24 months. (12) Safety Program. A safety program shall be developed and implemented to avoid hazards to residents such as dangerous substances, sharp objects, unprotected electrical outlets, slippery floors or stairs, exposed heating devices, broken glass, water temperatures and fire prevention. (13) Training for Residents. Residents shall be instructed about the facility's safety procedures. (a) Each resident shall be instructed within 24 hours of admission and reinstructed annually in general safety procedures, evacuation methods, responsibility during fire drills, designated meeting places outside the building or within the fire safe area in the event of an actual fire, and smoking safety • http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 °0797 121 bulletin Page 32 of 55 procedures if residents smoke in the building. This requirement does not apply to a resident whose mental capability does not allow for following such instructions. (b) A written record of fire safety training, including content of the training sessions and the residents attending, shall be kept. (c) All residents shall be encouraged to actively participate in the bi- monthly fire drills. All participating residents shall evacuate in accordance with subsection (7) of this rule. (14) Unobstructed Egress. Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. (15) Smoking. A resident's ability to smoke safely shall be evaluated and addressed in the service plan. (a) An assisted - living facility can designate itself as non - smoking; (b) If a facility designates itself non - smoking, this information shall be disclosed in the residency agreement; (c) The rights of non - smoking residents shall be given priority in settling smoking disputes between residents; (d) If there is a designated smoking area within the facility common areas, it shall be designed to keep other common areas smoke free; and (e) The facility shall provide 30 -days written notice to all residents if a facility adopts a non - smoking policy and shall include accommodations for residents who smoked prior to the change. (16) First -Aid Supplies. First -aid supplies shall be provided, properly labeled and readily accessible. (17) Fire extinguisher(s). The provider shall provide and maintain one or more 2A10B fire extinguishers on each floor in accordance with the OUFC. [Publications: Copies of the publications referenced in this rule are available from the agency.] Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.435, ORS 443.450 & ORS 443.500 Hist.: SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0040 Facility Standards Facilities which have building plans approved, on or after April 1, 1999, must comply with the Oregon Structural Specialty Code (OSSC), Oregon Uniform Fire Code (OUFC), Title III of the Americans with Disabilities Act (ADA), and Fair Housing Act, Fair Housing Design Guidelines (FHA) where applicable, and the facility standards set forth in these rules. Facilities which are licensed or have had their construction plans approved by the Division are exempt from any new http: / /arcweb.sos.state.or.us /rules /0499 Bulletin /0499_ch411_bulletin.html 5/3/99 0797_ 121_ bulletin Page 33 of 55 physical plan requirements before the effective date of these rules. All remodeling or modifications made to a facility on or after April 1, 1999 shall be subject to requirements in place at that time. (1) Physical Environment Generally (a) All facilities shall meet adaptable and accessible requirements of the OSSC, ADA, and FHA, where applicable, in effect at the time of plan approval. (b) All interior and exterior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows, and furniture) and all equipment necessary for the health, safety and comfort of the resident shall be kept clean and in good repair. (c) Measures shall be taken to prevent the entry of rodents, flies, mosquitoes and other insects. (d) The facility grounds shall be kept orderly and free of litter and refuse. (e) All exterior pathways and /or accesses to the facility's common use areas and entrance /exit ways shall be of hard, smooth material, accessible, and be maintained in good repair. (f) An accessible outdoorr recreation area is required which shall be available to all residents and have lighting equal to a minimum of five foot candles. (2) Storage. The facility shall include sufficient storage for the following: (a) Locked storage for all poisons, chemicals, rodenticide, and other toxic materials. All materials shall be properly labeled; (b) Locked storage for any flammable and combustible materials. Materials shall be properly labeled and stored in their original containers; (c) All maintenance equipment used and stored at the facility, including yard maintenance tools; and (d) Garbage stored in covered refuse containers. (3) General Building Interior (a) Elevators. Facilities with residents on more than one floor, with approved building plans on or after April 1, 1999, shall provide at least one elevator that shall meet Oregon Elevator Specialty Code (OESC) requirements. (b) Corridors. Facilities with building plans approved, on or after April 1, 1999 must comply with the corridor standards set forth in these rules. (A) Resident -use areas and units shall be accessible through temperature controlled common corridors with a minimum width of 48 inches. Resident -use corridors exceeding 20 feet in length to an exit or common area, shall have a minimum width of 72 inches. (B) Corridors shall not exceed 150 feet in length from any resident unit to a seating or other common area. (C) Handrails shall be installed at one or both sides of resident use corridors. (c) Floors http ://arcweb. sos. state.or.us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797 121 bulletin a Page 34 of 55 (A) Hard surface floors and base shall be free from cracks and breaks. (B) Carpeting and other floor materials shall be constructed and installed to minimize resistance for passage of wheelchairs and other ambulation aids. Thresholds and floor junctures shall also be designed and installed for passage of wheelchairs and to prevent a tripping hazard. (d) Finishes. Walls and ceilings shall be washable in kitchen, laundry and bathing areas in facilities with building plans approved on or after April 1, 1999. Kitchen walls shall be finished smooth per Oregon Health Division Food Sanitation Rules, OAR 333 - 156 -0080. (e) Doors (A) In facilities with building plans approved on or after April 1, 1999, all doors to resident units, bathrooms and other common use areas shall provide a minimum clear opening of 32 inches (36 -inch doors recommended); (B) Lever -type or other OSSC /ADA approved hardware shall be provided on all doors used by residents; and (C) Exit doors shall not include locks which prevent evacuation except as approved by the Fire Marshal and building codes agencies having jurisdiction. Such locks shall not be installed except for purposes of resident safety and with written approval by the Division. (f) The interior of the facility shall be free from unpleasant odors. [Publications: Copies of the publications referenced in this rule are available from the agency.] Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SSD 15 -1991, f. & cert. ef. 7 -1 -91; SDSD 3 -1999, f. 3 -1- 99, cert. ef. 4 -1 -99 411 - 056 -0045 Resident Units and Common Use Areas (1) All resident units shall be comprised of individual adaptable and accessible apartments with a lockable door, private bathroom and kitchenette facilities conforming to the requirement of the OSSC, FHA and the facility standards set forth in these rules. Designers shall emphasize a residential appearance while retaining the features required of such a facility to support special resident needs as outlined in this rule. (2) Unit Dimensions. New construction units shall have a minimum of 220 net square feet not including the bathroom.Units in pre- existing structures being remodeled shall have a minimum of 160 square feet not including the bathroom. Each unit shall have a bathroom as required in section (5), subsection (a) through (d) of this rule. (3) Windows http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 '0797 121 bulletin Page 35 of 55 (a) All units shall have an escape window that opens directly onto a public street, public alley, yard or exit court. This window section shall be operable from the inside to provide a full clear opening without the use of separate tools and shall have a minimum net clear open area of 5.7 square feet, a minimum net clear opening height of 24 inches, a minimum net clear open width dimension of 20 inches and shall not be below grade. (b) Each resident's living room and bedroom shall have exterior windows which have an area at least one -tenth of the floor area of the room. One window shall be at least 3' -6" x 5' -0" in size and have a maximum sill height of 36 ". Operable units shall be designed to prevent accidental fall when sill heights are lower than 36 ". (c) Bedroom windows shall be equipped with curtains or blinds for privacy and control of sunlight. (4) Doors (a) Each unit shall have an entry door which is self - closing, does not swing into the exit corridor, and is equipped with lever handles. A locking device shall be included which is released with action of the inside lever. The lock for the entry door shall be individually keyed, master keyed, and a key supplied to the resident. (b) The unit exit door shall open to an indoor, temperature controlled, common area or common orridor. P a ) Bathroom The unit bathroom shall be a separate room with a toilet, sink, roll -in shower, have at least one towel bar (36" in height), one toilet paper holder, one accessible mirror and storage for toiletry items. The door to the bathroom shall open outward or slide into the wall. (b) The unit bathroom shall have unobstructed floor space of sufficient size to inscribe a circle with a diameter of not less than 60 inches or a "T" turn conforming to the requirements of the OSSC and ADA, for maneuverability by residents using wheelchairs or other mobility aids. The "circle" or "T" may infringe in the space of the roll -in shower stall by a maximum of 12 inches. (c) Wall construction shall have proper and appropriately placed blocking near toilets and in showers to allow installation of grab bars. (d) Roll -in shower stalls shall meet OSSC and ADA requirements except as noted in this subsection. The minimum number of resident unit bathroom showers required by OSSC shall have a clear inside dimension of 36 inches deep by 60 inches long. All other resident unit showers shall have a minimum nominal dimension of 36 inches deep by 48 inches long. A folding seat is not required. Showers shall have non -slip floor surfaces in front of roll -in showers, a hand -held shower head, cleanable shower curtains, and appropriate grab bar. In facilities with plans approved on or after April 1, 1999, ramps shall not be allowed in front of roll -in showers. (e) Water closets and lavatories shall meet OSSC and ADA requirements to be fully accessible unless otherwise noted in this subsection. Water closets shall meet the minimum number required to be accessible by the OSSC unless otherwise noted in this subsection. The lavatory may have readily removable cabinets underneath or be readily adaptable to meet the OSSC and ADA requirements for a forward approach by a wheelchair. Grab bars for the water closet may be omitted provided all structural reinforcements for grab bar installation are provided in the appropriate locations in adjoining walls. http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 .0797 121 bulletin Page 36 of 55 (6) Kitchens. Each unit shall have a kitchen area equipped with a sink, refrigerator, a cooking appliance that can be removed or disconnected, adequate space for food preparation, and storage space for utensils and supplies. In facilities with plans approved on or after April 1, 1999, counter heights shall be 34 inches; and the sink, refrigerator and cooking appliance shall meet OSSC and the ADA reach and clear floor space requirements for wheelchairs. The sink may have readily removable cabinets underneath or be readily adaptable to meet the OSSC and ADA requirements for a forward approach by a wheelchair. Fifty percent of the shelving shall be within the reach ranges per the OSCC and ADA. (7) Resident Storage Space. Each unit shall provide usable space totaling at least 100 cubic feet for resident clothing and belongings and include one clothes closet with a minimum of 4 linear feet of hanging space. The rod shall be adjustable for height or fixed at no higher than 48 inches and no lower than 36 inches for accessibility. In calculating usable space, closet height shall not exceed 8 feet and a depth of 2 feet. Kitchen cabinets shall not be included. (8) Common Use Areas (a) Bathing Room (A) There shall be a special bathing room with a tub with whirlpool action, accessible by side transfer, without the use of mechanical aids and designed for staff assistance. (B) The room shall have individual heat control and be equipped with an exhaust to the outside. (C) There shall be direct access to a toilet and sink in the same room or in an adjacent room. (D) There shall be a non -slip floor surface required in facilities with plans approved on or after April 1, 1999. (b) Public Restrooms (A) There shall be accessible public restrooms for visitor, staff and resident use, convenient to dining and recreation areas. (B) The room shall contain a toilet, sink, waste containers, and a hand drying means that cannot be reused. (c) Dining Room (A) The building shall have a dining area with the capacity to seat 100% of the residents. (B) The dining room(s) shall provide 22 sq. ft. per resident for seating, exclusive of service carts and other equipment or items that take up space in the dining room. This rule is exclusive of any separate private dining room(s). (d) Reception Area. A reception area shall be visible and accessible to residents and visitors when entering the doors of the main entrance to the facility. (e) Social /Recreation Areas. The building shall have common areas for social - recreational use totaling at least 15 sq. ft. per resident. (f) Stove(s). If a stove is provided in the activities /common area available for resident use, a keyed or http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 •0797 bulletin Page 37 of 55 remote switch or other safety device shall be provided to insure staff supervision. (g) Resident Laundry Facilities. Laundry facilities shall be operable at no additional cost with at least one washer and dryer accessible by residents using wheelchairs. (h) Smoking Area. If there is a designated smoking area, it shall be separate from other common areas, be indoors, and provided with mechanical exhaust. (i) Mailbox. Each resident /unit shall be provided a mailbox which meets OSSC and ADA reach and clear floor space requirements for wheelchairs. It shall also meet US Postal Service requirements. (9) Support Service Areas (a) Medication Storage. The facility shall provide a secured space for medication storage with access to a sink and cold storage in the same area. Space for necessary medical supplies and equipment shall be provided. (b) Housekeeping /Sanitation. The building shall have a secured janitor closet for storing supplies and equipment, with a floor or service sink. (c) Laundry and Soiled Linen Storage. For the purpose of this rule "soiled linens or soiled clothing" means linens or clothing soiled due to a resident's incontinence. (A) Laundry facilities may be located to allow for both resident and staff use when a time schedule for resident use is provided and equipment is of residential type. Laundry facilities shall be separate from food preparation and other resident use areas. When the primary laundry is not in the building or suitable for resident use, separate resident laundry facilities shall be provided. (B) On -site laundry facilities, used by staff for facility and resident laundry, shall have capacity for locked storage of chemicals and equipment. (C) There shall be a separate area or room and closed containers which ensure the separate storage and handling of soiled linens. Arrangement shall provide a one -way flow of linens from the soiled area to the clean area and preclude potential for contamination of clean linens and clothing. Soiled linen and clothing shall be stored and processed separately from other linen and clothing. (D) The soiled linen room, or area, shall include a flushing rim clinical sink with rinsing device and a handwash sink or lavatory. (E) There shall be adequate space and equipment to handle laundry processing needs. When washing soiled linens, washers shall have a minimum rinse temperature of 140 degrees Fahrenheit (160 degrees recommended), unless a chemical disinfectant is used. (F) Covered or enclosed clean linen storage shall be provided which may be on shelves or carts. Clean linens may be stored in closets outside the laundry area. (d) Kitchen and Food Storage (A) Food Sanitation. assisted - living facilities shall comply with Oregon Health Division Food Sanitation Rules Chapter 333, Divisions 150 through 175, for food handling and primary meal preparation areas. (B) Public toilet facilities required in this rule may also serve kitchen staff when conveniently http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797121 bulletin Page 38 of 55 available. (C) Dry storage space, not subject to freezing, shall store a minimum one week supply of staple foods. (D) There shall be refrigeration and freezer space at proper temperature to store a minimum two clays supply of perishable foods. (E) Storage for all dishware and utensils used by residents shall meet Oregon Health Division Food Sanitation Rules. (F) Storage in the food preparation area for garbage shall be enclosed and separate from food storage. (G) Storage shall be available for cookbooks, diet planning information and records. (10) Mechanical & Electrical Systems (a) Heating and Ventilation Systems. Heating and Ventilation systems shall conform to the Oregon Mechanical Specialty Code in effect at the time of facility construction. (A) Temperature. For all areas occupied by residents, design temperature for construction shall be 75 degrees Fahrenheit. All existing facilities shall include heating systems capable of maintaining 68 degrees Fahrenheit in resident areas. Required minimum temperatures are no less than 68 degrees Fahrenheit during the day and 60 degrees Fahrenheit during sleeping hours. During times of extreme summer heat, at the request of the resident, individual fans shall be provided or arranged for, when air conditioning is not provided. (B) Temperature Controls. Each unit shall have individual thermostatic heating controls. (C) Exhaust Systems. All toilet, shower and smoking rooms shall be equipped with a mechanical exhaust fan or central exhaust system which discharges to the outside. (D) Ventilation. Ventilation in each unit shall occur via an open window to the outside, or with a mechanical venting system capable of providing two air changes per hour with one -fifth of the air supply taken from the outside. (b) Plumbing Systems. Plumbing systems shall conform to the Oregon Plumbing Specialty Code in effect at the time of facility construction. (A) Plumbing. Hot water temperature in residents' units shall be maintained within a range of 110 - 120 degrees Fahrenheit. (B) Hot water and laundry temperatures serving dietary areas shall equal 140 degrees Fahrenheit minimum and temperatures at dishwashers shall meet Oregon Health Division Food Sanitation Rules. (C) Sprinkler System. Assisted- living facilities with building plans approved on or after April 1, 1999, shall have a sprinkler system installed in accordance with the Oregon Uniform Fire Code; (D) In facilities with building plans approved on or after April 1, 1999, an area drain and hot and cold water hose bibs shall be provided for sanitizing laundry carts, food carts and garbage cans. (c) Electrical Systems http: / /arcweb. sos.state.or.us / rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 •0797 121 bulletin Page 39 of 55 (A) Wiring Systems. All wiring systems shall meet the Oregon Electrical Specialty Code in effect at the date of installation and devices shall be properly wired and in good repair. When not fully grounded, circuits in resident areas may be protected by GFCI type receptacles or circuit breakers as an acceptable alternative. (B) All electrical circuits shall be protected by circuit breakers or type S fuses and fuse holders of proper capacity. Electrical loads on circuits shall be limited in accordance with proper circuit capacity. (C) Sufficient electrical outlets shall be provided to meet resident and staff needs without the use of extension cords or other special taps. (d) Lighting (A) Each unit shall have general illumination in the bath, kitchen, living space and sleeping area. The general lighting intensity in the unit for way finding shall be at least 20 foot - candles measured from the floor. (B) Lighting in the unit bathroom shall be at least 50 -foot candles measured from the height of the basin. (C) Task lighting at the unit food preparation/cooking area shall be at least 50 -foot candles measured from counter height. (D) In facilities with building plans approved on or after April 1, 1999, corridor lighting shall equal a minimum of 20 -foot candles measured from the floor. (E) In facilities with building plans approved on or after April 1, 1999, task lighting in the dining room shall equal a minimum 25 foot - candles without light from windows measured from table height. (e) Call System (A) A two -way voice interactive call system shall be provided, capable of being turned off by the resident, connecting resident units to the care staff center and /or staff pagers. (B) A manually operated emergency call system shall be provided at each resident bathroom and central bathing rooms. (C) An exit door alarm or other acceptable system shall be provided for security purposes. It may be combined with the call system. (f) Telephones. (A) Resident Phones. Each unit shall have at least one telephone jack to allow for individual phone service. (B) Public Telephone. There shall be an accessible local access public telephone in a private area that allows a resident or another individual to conduct a private conversation. (g) Television Antenna or Cable System. In facilities with building plans approved on or after April 1, 1999, a television antenna or cable system with an outlet in each resident unit shall be provided. http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 ,0797 121 bulletin Page 40 of 55 (h) Smoke Detectors. An interconnected smoke detection system is required, including an annunciator panel, meeting requirements of the Oregon Structural and Fire and Life Safety Code and Oregon Electrical Specialty Code. [Publications: Copies of the publications referenced in this rule are available from the agency.] Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 -056 -0055 Exception and Variance (1) The Division may grant exceptions to OAR Chapter 411, Division 56. Exceptions shall not be granted which are judged to be detrimental to the residents. The facility seeking an exception shall submit to the Division, in writing, reasons for the exception request. (2) No exception shall be granted from a regulation or provision of these rules pertaining to the monitoring of the facility, resident rights, and inspection of the public files. Exceptions shall not be granted by the Division without prior consultation with agencies involved. (3) Exceptions granted by the Division shall be in writing and be reviewed periodically. (4) An individual exception shall be required for each resident who chooses to share a unit with someone other than his/her spouse to assure personal choice. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SSD 15 -1991, f. & cert. ef. 7 -1 -91; SDSD 3 -1999, f. 3 -1- 99, cert. ef. 4 -1 -99 [Renumbered from 411- 056 -0080] 411- 056 -0060 Monitoring, Inspections and Investigations (1) The facility shall cooperate with Division personnel in surveys, monitoring, inspections, complaint investigations, planning for resident care, application procedures and other necessary activities. (2) Staff of the Division or its designee may visit, inspect and monitor assisted - living facilities at any time, but no less often than once every two years, to determine whether it is maintained and operated in accordance with these rules. (3) Facilities not in compliance with these rules may be required to submit a plan of correction that satisfies the Division within the time frames specified. The Division may impose sanctions for failure 5/3/99 http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 0797 121 bulletin Page 41 of 55 to comply with these licensing rules. (4) Division staff shall have full access and authority to examine and copy facility and resident records. Division personnel may conduct private interviews with residents, staff and other witnesses. (5) Representatives from the State Long -Term Care Ombudsman office and each designee shall have the right of entry and access to records pursuant to ORS 441.117, 441.109 and OARs 114- 005 -0000, 114- 005 -0010 and 114 - 005 -0030. (6) The State Fire Marshal or his /her authorized representative(s) shall be permitted access to the facility and records pertinent to resident evacuation and fire safety. (7) A copy of the most current inspection survey shall be made available for the public by the facility. A sign shall be posted in public view, stating the survey is available upon request. (8) Standards shall be followed for investigations. (a) The Division shall cause an investigation to begin: (A) Within two hours if a complainant alleges a resident has been injured due to abuse, any resident's health or safety is in imminent danger, or a resident has died or been hospitalized due to abuse; (B) By the end of the next working day if circumstances exist which could result in the injury /abuse of a resident. (C) Investigations for all other complaints shall be commenced within five days. (b) An unannounced on -site visit will be conducted. (c) All available witnesses identified by any sources as having personal knowledge relevant to the complaint shall be interviewed. Interviews shall be confidential and conducted in private unless otherwise requested by the witness. The investigator shall interview the administrator and shall advise the administrator of the nature of the complaint and give the administrator an opportunity to submit relevant information to the investigator. (d) All evidence and physical circumstances that are relevant and material to the complaint shall be observed. (e) Immediate protection shall be provided. The administrator shall correct any substantiated problem immediately. (f) The investigation shall be completed and the report shall be written within 60 days of receipt of a complaint which includes the investigator's personal observations, a review of documents and records, a summary of all witness(es) statement(s), and a conclusion. (g) Reports indicating the need for a sanction by the Division shall be referred to the appropriate office for corrective action immediately upon completion of the investigation. (h) The Division, through its local offices, will mail a copy of the investigation report to the following people within seven days of the completion of the investigation. (A) The complainant (unless the complainant requests anonymity); http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 ,0797 121 bulletin Page 42 of 55 (B) The resident(s) involved and any person(s) designated by the resident(s) to receive the information; (C) The facility; and (D) The State Long -Term Care Ombudsman. (i) The report shall treat as confidential the identity of the resident, the complainant, and any witnesses. (j) The AAA/SDSD office shall provide written notification informing such persons of the right to give additional information about the report to the Division's local office within seven days of receipt. (k) The SDSD /AAA office shall review the responses and reopen the investigation if additional evidence of a violation is received. A copy of the entire report shall be sent to the Division upon completion of the investigation report whether or not the investigation report concludes the complaint is substantiated. (1) Investigation reports, including copies of responses (with confidential information deleted), shall be available to the public at the local SDSD /AAA office. (m) At any time after receipt of a notice of violation or an inspection report, the licensee or the Division may request a conference. The conference shall be scheduled within 10 days of a request by either party. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.435 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0070 Conditions on License (1) Conditions which may be imposed on a licensee include: (a) Restricting the total number of residents; (b) Requiring additional staff or staff qualifications; (c) Requiring additional training of administrator /staff; (d) Requiring additional documentation; (e) Restriction of admissions; or (f) Other conditions at the determination of the Division. http ://arcweb. sos. state.or.us /rules/ 0499_ Bulletin /0499_ch411 _bulletin.html 5/3/99 0797_ 121_ bulletin Page 43 of 55 (2) Conditions may be attached to a license upon a finding that: (a) Information on the application or initial inspection requires a condition to protect the health and safety of prospective residents; (b) There exists a threat to the health, safety, and welfare of residents; (c) There is reliable evidence of abuse, or exploitation; or (d) The facility is not being operated in compliance with these rules. (3) The Division shall notify the facility by certified mail when a decision is made to place conditions on the facility license. The condition(s) shall take effect immediately upon receipt of notice or on a date specified in the notice. (4) Written notification of impositions of conditions shall be posted with the facility's license in public view near the main entrance of the facility. The notification shall state the reason for the conditions and the facility will be given an opportunity to request a hearing under ORS 183.310 to 183.550. (5) If a request for review is made, the Division will review all material relating to the allegation of resident abuse or health or safety violations and to the license condition. The Division shall determine, based on review of the material, whether or not to sustain the condition and shall notify the facility of the decision within 20 days of receiving the request for review. (6) If the Division determines not to sustain the decision, the condition shall be lifted immediately. Otherwise, the condition will remain in effect until the Division determines that the conditions leading to the abuse or health or safety violations have been corrected. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.450 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0075 Non - Renewal, Denial, Suspension or Revocation of License (1) The Division shall deny, suspend or revoke a license when it finds there has been substantial failure to comply with these rules. (2) The Division shall deny, suspend or revoke a license if the licensee fails to comply with a final order of the Division imposing an administrative sanction, including the imposition of a Civil Penalty. (3) In cases where an imminent danger to the health or safety of residents exists or if the facility is not in substantial compliance with these rules, a license may be suspended immediately. (4) The Division shall not renew a license if the facility is not in compliance with these rules. http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 44 of 55 (5) Such revocation, suspension, denial or non - renewal shall be done in accordance with rules of the Division and ORS Chapter 183. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.410, ORS 443.415, ORS 443.420, ORS 443.425 & ORS 443.440 Hist.: SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 411 - 056 -0085 Marketing and Advertising (1) A person may not advertise or market its facility as an assisted - living facility, or as providing assisted care, or use the term "assisted" in describing the type of care provided unless the person has obtained or can demonstrate intent to obtain an assisted - living facility license from the Division. (2) All advertisements shall be consistent with facility policies, these rules, and the Federal Trade Commission in the representation of license status, services, staffing and amenities. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.410 & ORS 443.450 Hist.: SDSD 3 -1999, f. 3 -1 -99, cert. e£ 4 -1 -99 411 - 056 -0090 Civil Penalties (1) For purposes of imposing civil penalties, assisted - living facilities licensed under ORS 443.400 to 443.455 and subsection (2) of ORS 443.991 are considered to be long -term care facilities subject to ORS 441.705 to 441.745. (2) For purposes of this rule, the following definitions apply: (a) "Person" means a licensee under ORS 443.420 or a person who the Senior and Disabled Services Division Administrator or his /her designee finds should be so licensed but is not, but does not include any employee of such licensee or person; (b) "Direct patient care or feeding" means any care provided to or for any resident related to that resident's physical, medical, and dietary wellbeing as defined by rules of the Oregon Health Division; and (c) "Resident rights" means those rights identified in OAR 411 - 056 -0010. (3) The Division shall exercise its' authority under ORS 441.705 to 441.745, and thereby issues the following schedule of penalties applicable to assisted - living facilities: http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_ 121_ bulletin Page 45 of 55 (a) A Class I violation exists when there is noncompliance involving direct resident care or feeding, adequate staff, sanitation involving direct resident care or resident rights. A Class I violation may result in imposition of a fine for first and subsequent violations of no less than $5 and no more than $500 per occurrence per day not to exceed $6,000 in any calendar quarter. (b) A Class II violation exists when there is noncompliance with the license requirements relating to a license required, the license requirements relating to administrative management, personal services (care) and activities. Class II violations may result in imposition of a fine for violations found on two consecutive monitoring of the assisted - living facility. The fine may be no less than $5 and no more than $300 per occurrence per day, not to exceed $6,000 in any calendar quarter. (c) A Class III violation exists when there is noncompliance with the license requirements relating to building requirements, resident furnishings, and move -out criteria. Class III violations may result in imposition of a fine for violations found on two consecutive monitoring of the assisted - living facility. The fine may be no less than $5 and no more than $150 per occurrence per day not to exceed $6,000 in any calendar quarter. (4) In imposing a penalty pursuant to the schedule published in this rule, the Administrator for the Senior and Disabled Services Division or a designee shall consider the following factors: (a) The past history of the person incurring a penalty in taking all feasible steps or procedures necessary or appropriate to correct any violation; (b) Any prior violations of statutes or rules pertaining to assisted - living facilities; (c) The economic and financial conditions of the person incurring the penalty; and (d) The immediacy and extent to which the violation threatens the health, safety, and wellbeing of residents. (5) Any civil penalty imposed under ORS 443.455 and 441.710 shall become due and payable when the person incurring the penalty receives a notice in writing from the Administrator of the Senior and Disabled Services Division or a designee. The notice referred to in this section shall be sent by registered or certified mail and shall include: (a) A reference to the particular sections of the statute, rule, standard, or order involved; (b) A short and plain statement of the matters asserted or charged; (c) A statement of the amount of the penalty or penalties imposed; and (d) A statement of the party's right to request a hearing. (6) The person to whom the notice is addressed shall have 10 days from the date of mailing the notice in which to make written application for a hearing before the Division. (7) All hearings shall be conducted pursuant to the applicable provisions of ORS Chapter 183. (8) If the person notified fails to request a hearing within the time specified in ORS 441.712, an order may be entered by the Division assessing a civil penalty. (9) If, after a hearing, the person is found to be in violation of a license, rule, or order listed in ORS http: / /arcweb.sos.state.or.us /rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 : 0797 _ 121 _ bulletin Page 46 of 55 441.710(1), an order may be entered by the Division assessing a civil penalty. (10) A civil penalty imposed under ORS 443.455 or 441.710 may be remitted or reduced upon such terms and conditions as the Administrator of the Senior and Disabled Services Division considers proper and consistent with the public health and safety. (11) If the order is not appealed, the amount of the penalty is payable within 10 days after the order is entered. If the order is appealed and is sustained, the amount of the penalty is payable within 10 days after the court decision. The order, if not appealed or sustained on appeal, shall constitute a judgment and may be filed in accordance with the provisions of ORS 18.320 to 18.370. Execution may be issued upon the order in the same manner as execution upon a judgment of a court of record. (12) A violation of any general order or final order pertaining to an assisted - living facility issued by the Administrator of the Senior and Disabled Services Division is subject to a civil penalty in the amount of not less than $5 and not more than $500 for each and every violation. (13) Judicial review of civil penalties imposed under ORS 441.710 shall be as provided under ORS 183.480, except the court may, in its discretion, reduce the amount of the penalty. (14) All penalties recovered under ORS 443.455 and 441.710 to 441.740 shall be paid into the State Treasury and credited to the General Fund. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.991 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SSD 15 -1991, f. & cert. ef. 7 -1 -91; SDSD 3- 1999, f. 3 -1- 99, cert. ef. 4 -1 -99 411- 056 -0095 Criminal Penalties (1) Violation of any provision of ORS 443.400 to 443.455 is a Class B misdemeanor. (2) In addition, the Division may commence a suit in equity to enjoin operation of an assisted - living facility: (a) When an assisted - living facility is operated without a valid license; or (b) After notice of revocation has been given and a reasonable time has been allowed for placement of individuals in other facilities. Stat. Auth.: ORS 410 & ORS 443 Stats. Implemented: ORS 443.991 Hist.: SSD 14 -1989, f. & cert. ef. 9 -1 -89; SDSD 3 -1999, f. 3 -1 -99, cert. ef. 4 -1 -99 http: / /arcweb.sos. state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_121 bulletin Page 47 of 55 Adm. Order No.: SDSD 4 -1999 Filed with Sec. of State: 3 -15 -99 Certified to be Effective: 3 -15 -99 Notice Publication Date: 1 -1 -99 Rules Amended: 411- 066 -0000, 411- 066 -0005, 411- 066 -0010, 411- 066 -0020 Subject: Adoption of these amendments will clarify and implement changes to standards of the National Association of Adult Day Care Systems and improve readability of the rules. Rules Coordinator: Pam Warren- -(503) 945 -6406 411 - 066 -0000 Statement of Purpose The purpose of these rules is to develop a registry of all adult day services programs and to establish standards of operation by which each registered adult day services program can voluntarily meet. Adult day services are community -based group programs designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non - residential programs provide a variety of health, social, and related support services in a protective setting. Adult day services enable participants to live in the community by providing support to families and caregivers. An adult day services provider assesses the needs of the participant and offers services to meet those needs. Participants served attend on a planned basis. Stat. Auth.: ORS 410.485, ORS 410.490 & ORS 410.495 Stats. Implemented: ORS 410.495 Hist.: SSD 12- 1992, f. & cert. ef. 12 -1 -92; SDSD 4 -1999, f. & cert. ef. 3 -15 -99 411 - 066 -0005 Definitions (1) "Activities of Daily Living (ADLs)" are tasks usually performed in the course of a normal day in an individual's life which include: Eating /nutrition, dressing /grooming, bathing /personal hygiene, mobility, toileting and behavior management. (2) "Adult Day Services" as used in these rules means a community -based group program designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non - residential programs provide health, social and related support services in a protective setting during part of a day but for less than 24 hours. (3) "Division" means Senior and Disabled Services Division of the Department of Human Resources. http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_ 121_ bulletin Page 48 of 55 (4) "Group" as used in these rules, means a program with ten (10) or more enrolled participants. Group also includes programs just beginning, with plans to enroll ten (10) or more participants. (5) "Long -Term Care Facilities" as used in these rules, are nursing facilities, residential care facilities, assisted - living facilities, and adult foster homes. (6) "Programs" as used in these rules, means adult day services programs. Stat. Auth.: ORS 410.485, ORS 410.490 & ORS 410.495 Stats. Implemented: ORS 410.490 & ORS 410.495 Hist.: SSD 12 -1992, f. & cert. ef. 12 -1 -92; SDSD 4 -1999, f. & cert. ef. 3 -15 -99 411 - 066 -0010 Registration (1) All adult day services programs shall register with the Division on forms provided by the Division. The form for registration shall include, but not be limited to: (a) The name and address of the program; and (b) A checklist to determine the extent each program is voluntarily complying with the standards set forth in these rules. (2) Licensed long -term care facilities providing adult day services programs are not required to register. Stat. Auth.: ORS 410.485, ORS 410.490 & ORS 410.495 Stats. Implemented: ORS 410.495 Hist.: SSD 12 -1992, f. & cert. ef. 12 -1 -92; SDSD 4 -1999, f. & cert. ef. 3 -15 -99 411- 066 -0020 Standards for Adult Day Services Programs The following standards are substantially consistent with the standards developed by the Oregon Association of Adult Day Care Services, as required under ORS 410.495. Compliance with these standards by adult day services programs is voluntary. (1) PROGRAM COMPONENTS: (a) Individual Plan of Care. For each participant, the program shall have an individual plan of care based on services needed and available. The individual plan of care shall include the following: http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 49 of 55 (A) Intake Screening. The intake screening shall be completed in order to determine the appropriateness of the program for the individual and determine that the participants' needs are within the scope of the program. The screening shall include information regarding safety and emergency needs of the participant, general health and financial status (i.e., insurance coverage, Medicaid status and OPI). (B) Enrollment. An enrollment agreement shall be completed and include: Identification of services to be provided; a disclosure statement that describes the center's range of care and services; admission, discharge and /or transfer criteria; fees and arrangements for reimbursement and payment; and identification of and authorization for third -party payers (i.e., insurance coverage, Medicaid status and OPI). (C) Assessment. An assessment shall be conducted to determine the individual's health and psychosocial status, needs in activities of daily living and ability to live independently, nutritional status, as well as the individual's history and interests. (D) Individual Plan of Care. The written plan of care shall reflect the participant's strengths, needs, and abilities. It shall include realistic objectives that are both long -term and short-term. It shall also identify the services to be provided and the responsible staff. The participant, family /caregiver, and other service providers shall have the opportunity to contribute to the development, implementation, and evaluation of the plan of care. (E) Coordination of Care. The need for coordination of care shall be considered for each participant. If coordination of care is needed and the participant is a client of another agency or resides in a long- term care facility, a care plan shall be developed in conjunction with the services provided by that agency or facility. (F) Service Documentation and Reassessment. Progress notes on each participant shall be written at least quarterly and shall reflect a review of the plan of care and the participant's status in regard to the services. Reassessing the participant's needs and reevaluating the appropriateness of the plan of care shall be done when needed, but at least semiannually. (b) Participants' Records. All programs shall: (A) Keep a permanent registry of all participants with dates of admission and discharge. (B) Keep application and enrollment forms, medical history and functional assessments, nutritional status assessment, plans of care, ancillary reports, correspondence, attendance and service records, log of medication provision and treatments, transportation plans, results of physical examinations, physician's orders, if any, progress notes, current photograph of participant, emergency records, signed authorizations, advance health care directive form, and a Physician's Order for Life Sustaining Treatment (POLST) or a statement that none has been signed. (c) Services. All programs shall make services available relative to the needs of the participants. All adult day services programs shall make the following services available: (A) ADL Assistance. This includes assistance and supervision with activities of daily living. (B) Social Services. Social services shall be provided to participants and their families to help them with personal, family, and adjustment problems that interfere with the effectiveness of the plan of care. Programs shall make the following social services available: (i) Counseling; http ://arcweb.sos. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 0797 121 bulletin Page 50 of 55 (ii) Arranging for other community services; (iii) Advocacy for the participant's human and civil rights; (iv) Assessing for indicators of mental illness or dementia and make referrals for diagnosis; (v) Provide discharge planning and assist in the transition and followup; and (vi) Provide information and referral for persons not appropriate for adult day service. (C) Nutrition Services. Programs shall screen and assess participants for nutrition needs and shall provide nutrition intervention as appropriate. (D) Food Services. Adult day services programs shall provide participants with a minimum of one meal per day. The meal shall meet the adult daily nutritional requirement as established by state and federal regulations. (E) Therapeutic Activities. Programming shall take into consideration individual differences in age, health status, sensory deficits, needs, interests, abilities, and skills by providing opportunities for a variety of types and levels of involvement. The activity plan shall be an integral part of the total plan of care for the individual based on the interests, needs, and abilities of the participant. The activities may include social, intellectual, cultural, economic, emotional, physical and spiritual activities. (F) Health - related Services. The adult day services program shall provide health care coordination, prevention and education. Services, as appropriate to the participant, may include a health assessment, nursing oversight, and restorative therapy. (G) Transportation. The adult day services program shall provide, arrange, or contract for transportation to enable persons, including persons with disabilities, to attend the center and to participate in center - sponsored outings. (H) Emergency Care for Participants. The center shall have a written procedure for handling medical emergencies. This document shall include procedures for notification, transportation arrangements and provision for an escort, if necessary. (I) Education. Education shall be made available to the families /caregivers and participants to improve the well -being and functional level of the participants and /or caregiver. (2) PHYSICAL DESIGN, ENVIRONMENT AND SAFETY. The facility housing the adult day services program shall comply with applicable state and local building regulations, zoning, fire and health codes or ordinances and: (a) The facility shall be accessible to participants. Adult day services centers shall comply with the Americans with Disabilities Act's standards for accessibility. (b) There shall be an evacuation plan for relocation of participants in an emergency. (c) The facility shall have one toilet per ten participants in an accessible bathroom. Each bathroom shall be equipped with a sink, grab bars and call bells. (d) There shall be a minimum of 60 square feet of floor space available per adult day services participant. (The square footage excludes hallways, offices, restrooms, and storage spaces.) Programs http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 • 0797 121 bulletin - Page 51 of 55 serving participants, of which 25% or more are cognitively impaired or require the use of adaptive equipment, shall provide at least 80 square feet per participant. (e) The physical building, premises, and equipment shall be maintained in a clean and sanitary condition, free of hazards and in good repair. (f) Outside space that is used for outdoor activities shall be safe, accessible to indoor areas, and accessible to those with a disability. (g) Heating, ventilation, and lighting shall be adequate to protect the health of the participants and staff. (h) Illumination shall be adequate in all areas and glare should be avoided. (i) Flooring shall be easily cleaned and made of a nonskid material. Stairs must be covered with nonskid material and handrails provided. (j) There shall be sufficient private space for the provision of nursing services and therapy services, if provided, and staff consultation. (k) There shall be one room with one bed available per ten participants for participants to rest. (1) There shall be a telephone available for participants use. (m) Storage space shall be provided for files, records, recreational and cleaning supplies. (n) Sufficient furniture for the entire participant population shall be of sturdy construction that will not easily tip over or move when used for seating or support while walking. The furniture shall be safe and comfortable. (o) Each bathroom shall contain an adequate supply of liquid hand soap, toilet tissue, and paper hand towels with dispenser. Common towels are not allowed. Disposable paper cups, individual drinking cups, or inclined jet type drinking fountains shall be provided. (p) Programs that store medications shall designate a secured area away from participant activity area for storing labeled medications. (q) Provide a Safe and Sanitary Environment. This includes food services, general maintenance and cleaning, sewage disposal, and standard precautions : (A) Food Services. In order to assure the provision of safe food, the Food Sanitation Rules of Oregon's Health Division shall be the minimum requirements for all facilities serving 16 or more persons. Facilities serving 15 or fewer persons or a facility which purchases meals from an outside meal source shall be required to meet the minimum requirements of the Food Sanitation Rules of Oregon's Health Division relating to the preparation, storage, and serving of food. Facilities serving 15 or fewer individuals are not required to use commercial equipment. (B) Garbage and Refuse. Garbage and refuse containers shall be insectproof, rodentproof, leakproof, and nonabsorbent. Garbage and refuse shall be removed at least once a week from the premises or more often if needed to prevent odors and attraction of insects, rodents, and other animals. Items being recycled shall be clean, and pending removal, stored in a manner that does not present rodent harborage or insect breeding. Recycled items shall be stored separately from food supplies and food preparation equipment. http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797 121 bulletin Page 52 of 55 (C) Cleaning and Maintenance. The facility shall be kept clean and in good repair. In facilities serving 16 or more persons, a utility sink shall be provided. (D) Sewage Disposal. If a community disposal system is available it shall be utilized by the facility. If a private sewage disposal system is utilized it shall be properly operating and meet code requirements. (E) Infection Control. Local health department standards shall be met regarding communicable diseases. (F) If smoking is permitted, it shall be in an adequately ventilated and supervised, designated area away from the main program. (G) Standard Precautions. Procedures for safely handling soiled items and minimizing the potential for the spread of communicable diseases shall be established. Such procedures shall include: Soiled item disposal /storage, hand washing, sanitizing of contaminated surfaces, and preventing contamination. The participants' privacy and comfort shall be considered in developing the procedure for their incontinent care. (r) Emergency Standards: (A) A program emergency plan shall be posted, providing the locations of fire extinguishers and exit routes. (B) Staff shall be instructed and drilled in the evacuation procedures and relocation site on their first day of employment. (C) Records for fire and evacuation drills shall be kept as a part of the program's plan. Fire and evacuation drills shall be held at least once every six months. (D) A fire warning system, which includes at least smoke detectors, but may include a sprinkler system or other alarm system, shall be installed in all adult day services care facilities to insure the safety of the participants and the staff (E) At least one fire extinguisher classed as 2A -10BC shall be visible and readily accessible. (F) A written policy for dealing with sick or injured participants shall be developed and given to participants upon admission. (G) Emergency first aid kits shall be visible and accessible to staff. Personnel trained in first aid and CPR shall be on duty whenever participants are present. (H) At least two well - identified exits shall be available. (3) STAFFING REQUIREMENTS. Staff shall be adequate in number and skills to provide the services described in subsection (1)(c) of this rule. (a) Basic Staff Requirements: (A) Each staff person shall be competent, ethical and qualified for the position held. Qualified means education or experience dealing with the adult day services population. Each staff member must test negative for tuberculosis per local health department requirements prior to work. Staff shall hold http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_ 121_ bulletin Page 53 of 55 rt _ personal information about participants and their families in confidence, treating all participants with respect and dignity. (B) The staff /participants ratio shall be a minimum of one staff person to six participants (1 to 6). As the number and/or impairment level of participants increase, the staff /participant ratio will be adjusted accordingly. Programs serving a high percentage of participants who are severely impaired shall have a staff /participant ratio of one to four (1 to 4). (C) Each program that is located with another program in the same facility, such as a hospital, senior center or church, shall designate staff and staff hours committed to the adult day services program. (D) To insure adequate care and safety of participants, there shall be provisions for qualified substitute staff (E) There shall be at least one staff person on duty at all times who shall be familiar with the fire, safety, and disaster plan; infection control; CPR and first aid; body mechanics /transfer techniques; mandatory reporting laws of abuse /neglect; behavior management and the needs of the participants. Staff shall have sufficient knowledge to provide essential services to the participants. (F) Volunteers can be included in the staff ratio only when they conform to the same standards and requirements as paid staff, meet the job qualifications and have designated responsibilities. (G) There shall be general orientation and continued in- service training for both paid staff and volunteers including, but not limited to: (i) Program mission/philosophy; (ii) Mandatory reporting laws of abuse /neglect and indicators of abuse; (iii) Behavioral intervention/behavior acceptance /accommodations; (iv) Standard precautions; (v) Participant rights; (vi) Fire, safety, disaster plan, and emergency procedures; and (vii) Body mechanics /transfer techniques /assistance with ADLs. (4) ADMINISTRATION. (a) Plan of Operation. Each adult day services program shall develop and implement a plan of operation. The plan of operation shall be reviewed and, if necessary, revised annually. The plan shall include: (A) A definition of the target population including number, age and needs of participants; (B) Geographical definition of the service area; (C) Description of basic services and any optional services; (D) Hours and days of operation; http: / /arcweb. so s. state. or. us /rules /0499_Bulletin/0499_ch411 _bulletin.html 5/3/99 • 0797_ 121_ bulletin Page 54 of 55 (E) Admission and discharge policies and procedures; (F) Staffing; (G) Statement of participants' rights and grievance procedure; (H) Rates; (I) Procedures for reporting suspected abuse; and (J) A written policy for dealing with lost or wandering participants shall be developed and some type of identification for participants who wander shall be provided. (b) Advisory Committee. An adult day services program shall have a body that serves as an advisory committee. Members of the advisory committee shall be representative of the community and shall include family members of current or past participants and non - voting staff representatives. The advisory committee shall meet at least twice a year and shall have an opportunity, at least annually, to review and make recommendations on program policies such as: (A) The scope and quality of services and activities provided; (B) Admission and discharge criteria; (C) Service records; (D) Quality assurance or quality improvement activities, findings, and plan of corrective action; (E) Program evaluation; and (F) Rates. (c) Discharge Policy. (A) The center shall develop a discharge policy that includes at a minimum: (i) Time frame for termination; (ii) Criteria for discharge; (iii) Notification procedures; and (iv) Follow -up plan. (B) The discharge criteria shall include reasons for discharge and a discharge summary. Each participant and family /caregiver shall receive a minimum of two weeks' notice if the participant is to be discharged from the program, except in matters of an urgent nature. (d) Program Evaluation. All programs shall have and implement a quality assurance or quality improvement plan for the evaluation of its operation and services. Each center shall develop policies and procedures for monitoring continuous quality improvement and determining further action. http: / /arcweb.sos.state.or.us/ rules / 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 0797_ 121_ bulletin Page 55 of 55 (e) Personnel Policies and Practices. Every program shall have written personnel policies for both staff and volunteers. (f) General Records Policies. The programs shall have a records policy for administrative records and participants' records. (A) The programs shall maintain administrative records which include personnel records, fiscal records, statistical reports, government- related records, contracts, organizational records, quality improvement plans or quality assurance plans, advisory committee minutes, certificates of annual fire and health inspections as required by local ordinances, and incident reports. (B) The programs shall develop a written policy on confidentiality and the protection of participants' records. The policy shall define procedures for the use and removal of participants' records; conditions for the release of information; and conditions that require authorization in writing by the participant or his /her legally responsible person, for the release of information, not otherwise authorized by law. Stat. Auth.: ORS 410.485, ORS 410.490 & ORS 410.495 Stats. Implemented: ORS 410.495 Hist.: SSD 12 -1992, f. & cert. ef. 12 -1 -92; SDSD 4 -1999, f. & cert. ef. 3 -15 -99 This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is the printed copy. Discrepancies, if any, between the two versions are satisfied in favor of the printed version. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 13, 1998. Copyright 1999 Oregon Secretary of State: Terms and Conditions of Use Alphabetical Index of Agencies (1999 OAR Compilation) Numerical Index of Agencies by OAR Chapter (1999 OAR Compilation) Search the Text of the OAR and Oregon Bulletin Questions about Administrative Rules? Return to Oregon State Archives Home Page http: / /arcweb.sos.state.or.us /rules/ 0499_ Bulletin /0499_ch411_bulletin.html 5/3/99 DATE: 6/11/1999 CODE SECTIONS: 18.130 c_ �� - ` " 7 ,TOPIC: Use Classifications: Household Living and Group Living INTERPRETATION: The Development Code Chapter 18.130 classifies land uses. Among those land uses are: Household Living: Living facilities for small groups (households) of people who are related or unrelated, featuring self- contained units including facilities for cooking, eating, sleeping and hygiene. Tenancy is longer than one month. Includes most types of senior housing, e.g., congregate care, assisted living, if residents live in self- contained units. The maximum number of people who may reside in any given dwelling unit shall be determined by the Uniform Building Code. Group Living: Living facilities for groups of unrelated individuals which includes at least one person residing on the site who is responsible for supervising, managing, monitoring and /or providing care, training or treatment of residents. Larger group living facilities may also be characterized by shared facilities for eating, hygiene and /or recreation. Examples include nursing /convalescent homes, residential care /treatment facilities; sororities /fraternities and convents /monasteries. Tenancy is longer than one month. Does not include detention and post- detention facilities (see 18.130.020. E.3., Detention Facilities). The Development Code's density provisions limit the number of household units on a particular piece of property. The code's density provisions do not limit group living facilities. There are various types of living facilities that are a hybrid of the above land use types. One is assisted living with central facilities for 24 RN staff, recreation and a common on -site kitchen with meals prepared for communal dining. Some of these facilities also provide individual units with kitchenettes that contain a sink small refrigerator and microwave. These are sometimes considered "warming kitchens ". The City of Tigard Community Development Director hereby interprets and considers that units with central eating facilities for all meals of the day, recreation and nursing facilities to be among those classed as Group Living under the following circumstances: the facility is consistent with all parts of the Group Living classification and individual units located in the facility shall not have a stove or oven. Full kitchen facilities with an oven and stove would require units to be classed as household living and restricted by density when all other features of self- contained units also exist (eating, sleeping, and hygiene).