22VAC40-72 Standards for Licensed Assisted Living Facilities

REGULATIONS

Vol. 25 Iss. 8 - December 22, 2008

TITLE 22. SOCIAL SERVICES

STATE BOARD OF SOCIAL SERVICES

Chapter 72

Fast-Track Regulation

Title of Regulation: 22VAC40-72. Standards for Licensed Assisted Living Facilities (amending 22VAC40-72-10, 22VAC40-72-50, 22VAC40-72-90, 22VAC40-72-100, 22VAC40-72-150, 22VAC40-72-210, 22VAC40-72-220, 22VAC40-72-230, 22VAC40-72-260, 22VAC40-72-290, 22VAC40-72-340, 22VAC40-72-390, 22VAC40-72-420, 22VAC40-72-430, 22VAC40-72-440, 22VAC40-72-630, 22VAC40-72-660, 22VAC40-72-670, 22VAC40-72-910, 22VAC40-72-920, 22VAC40-72-930, 22VAC40-72-950, 22VAC40-72-960, 22VAC40-72-970, 22VAC40-72-1010, 22VAC40-72-1120; adding 22VAC40-72-191, 22VAC40-72-201; repealing 22VAC40-72-30, 22VAC40-72-190, 22VAC40-72-200).

Statutory Authority: §§ 63.2-217 and 63.2-1732 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comments: Public comments may be submitted until January 21, 2009.

Effective Date: February 5, 2009.

Agency Contact: Judith McGreal, Program Development Consultant, Department of Social Services, Division of Licensing Programs, 7 North 8th Street, Richmond, VA 23219, telephone [phone], FAX (804) 726-7132, TTY [phone], or email [e-mail].

Basis: The following sections of the Code of Virginia are the sources of legal authority to promulgate the regulation: § 63.2-217 (mandatory) states that the board shall adopt regulations as may be necessary or desirable to carry out the purpose of Title 63.2; § 63.2-1732 (mandatory and discretionary) addresses the board’s overall authority to promulgate regulation for assisted living facilities and specifies content areas to be included in the standards; § 63.2-1803 (mandatory and discretionary) relates to licensure of assisted living facility administrators; § 54.1-3041 (mandatory) addresses registration of medication aides by the Board of Nursing; and § 32.1-37 (mandatory) requires licensed facilities to report outbreaks of disease.

Purpose: The amended regulation is needed to coordinate the requirements for the licensure of administrators and the registration of medication aides with regulations promulgated by the Virginia Board of Long-Term Care Administrators and the Virginia Board of Nursing, respectively. This coordination will ensure that the different sets of regulations work together to protect the health, safety, and welfare of residents and to avoid confusing or conflicting requirements.

The amended regulation incorporates recent changes to the Code of Virginia. These amendments keep the regulations up to date and ensure that assisted living facilities do not inadvertently overlook changes to the Code of Virginia.

This regulatory action proposes changes based on other agency regulations, as well as changes for increased clarity and readability of standards. In addition, several technical adjustments are proposed. A well-written regulation promotes compliance, which leads to increased protection for residents of assisted living facilities.

Rationale for Using Fast-Track Process: The fast-track process is being used because this regulatory action is expected to be noncontroversial and there is a sense of urgency regarding the effective date of the proposed changes. The proposed regulation needs to be in effect on January 2, 2009, to coordinate with the dates by which administrators of facilities providing both residential and assisted living care must be licensed (January 2, 2009) and medications aides in all assisted living facilities must be registered (December 31, 2008).

This regulatory action is expected to be noncontroversial because the Assisted Living Facility Advisory Committee was involved in the proposed changes and is expected to agree with the revisions.

Substance: The proposed regulatory action revises the regulation in respect to dedicated hospice facilities, reporting outbreaks of disease, documentation of delegation of resident funds, licensure of administrators, provisions for acting administrators, administrator responsibilities, administrator training, shared administrators for smaller facilities, continuing education for medication aides, tuberculosis risk assessment, bed hold policy information, review and update of individualized service plans, medication reference materials, registration of medication aides, supervision of medication aides, administration of medications, retention of fire inspection reports, and items included in fire and emergency evacuation drill records.

Issues: The following issues were identified:

22VAC40-72-90. There should be more specific requirements for the reporting of outbreaks of disease in assisted living facilities. The proposed language is taken from the Code of Virginia. Procedures for reporting and plans for training staff and providers are being developed in a joint effort by the Department of Social Services (DSS) and the Department of Health and will be available to assisted living facilities as technical assistance.

22VAC40-72-210 and 22VAC40-72-660. Administrators who supervise registered medication aides should complete training required for medication aides, not the much less comprehensive course that is also available. DSS originally proposed that administrators be given the option of either course, but revised the proposed standards to require administrators to complete the more comprehensive registered medication aide training. This change will increase the knowledge base of the administrators who supervise medication aides and, therefore, provide increased protection to residents for whom medication is administered. The course for registered medication aides will take more time to complete than the shorter course and may be more costly, depending upon the circumstances.

22VAC40-72-201. Because licensed administrators are accountable to the Virginia Board of Long-Term Care Administrators, they should not be required to be on the premises of an assisted living facility for a specified number of hours per week. If the Virginia Board of Long-Term Care Administrators determines that a licensed administrator’s performance is inadequate, it can suspend, place on probation, or revoke that person’s license. DSS revised the proposed standards to reflect the same requirements regarding this matter that are specified for licensed nursing home administrators, i.e., licensed administrators will serve as the on-site agent of the licensee and be responsible on a full-time basis for the administration and management of the facility.

The Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The State Board of Social Services (Board) proposes to amend its Standards for Licensed Assisted Living Facilities to incorporate recent changes to Virginia statute and Department of Health Professions (DHP) regulations that affect assisted living facilities. The Board also proposes several amendments to this regulation to conform with recommendations from the Assisted Living Facility Advisory Committee (ALFAC). Among the changes that are ALFAC initiated, the Board proposes to:

• Require facility staff to document when residents delegate management of personal funds to a facility;

• Modify requirements that govern how much time an administrator must spend at any facilities which he administers;

• Change the timing for staff to submit tuberculosis test results from the time of hire to on or within seven days prior to the first day of work; and

• Add qualified mental health professionals to the list of individuals who may be involved in the review and update of individualized service plans.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Persuant to statutory mandate, the Board of Long-Term Care Administrators and the Board of Nursing within DHP have respectively promulgated regulations for licensure of assisted living facility administrators and for registration of medication aides. The State Board of Social Services (Board) proposes to amend sections of their regulation for assisted living facilities so that it conforms with these DHP regulations. For instance, the Board proposes to amend the medication aide requirements in this regulation to explicitly note that medication aides must be registered with the Board of Nursing and that the Board of Nursing requires continuing education for medication aides that must be completed in addition to the continuing education required by this regulation.

The Board also proposes amendments to this regulation that will bring it into conformity with recent changes to the Code of Virginia. For instance, the Board proposes to eliminate provisions in this regulation for dedicated hospice facilities as these are no longer licensed as assisted living facilities. The changes that the Board proposes to conform this regulation to the Code of Virginia and to statute-mandated DHP regulations will likely not cause any new costs for regulated entities. These changes will, however, provide the added benefit of clarity for individuals who would likely, and rightly, be confused by having conflicting standards coming from different sources.

Currently, this regulation has provisions for facilities to manage residents’ private funds if residents choose to delegate this authority. Facility staff is required to keep such funds seperate from any facility money and must keep an accounting of these funds which must be available to affected residents or their legal representatives. There is, however, no current explicit requirement that facilities have documented proof that residents have delegated authority over their funds. The Board proposes to add this requirement. This change is likely to slightly increase bookkeeping costs for facilities but will also benefit both facility staff and residents and their families. Facility staff will be less open to charges of improper keeping of resident funds and residents will be better protected from fund misappropriation.

Current regulation has fairly strict requirements as to how many hours administrators who administer multiple smaller facilities must spend at each of these facilities; current regulation also has different limits on the number of smaller facilities that an administrator may be in charge of depending on how many residents these facilities are licensed for. Currently, administrators must spend at least 10 hours a week in any facilities that are licensed for 10 or fewer residents and may administer up to four of these facilities. Administrators must spend at least 20 hours a week in any facilities that are licensed for 11-19 residents and may only administer two such facilities. Administrators must work a total of at least 40 hours in all their facilities combined. This proposed regulation will require that administrators spend at least 10 hours working in each facility that they administer but must still spend at least 40 hours total working in all facilities combined. Administrators will be allowed to work in up to four facilities so long as these facilities have capacity of 40 or fewer residents total. These regulatory changes will likely not adversely affect patient care but will allow administrators greater flexibility in doing their jobs.

Current regulation requires facility staff to submit the results of a tuberculosis risk assessment upon hire even if they do not start working for some time after that. This proposed regulation will require staff to submit the results of this assessment sometime in a seven day period before they actually start to work (or on their start date). This provision will allow facilities to better protect residents from possible exposure to tuberculosis.

Businesses and Entities Affected. The Department of Social Services (DSS) reports that there are approximately 600 licensed assisted living facilities in the Commonwealth. All of these facilities, and all administrators and medication aides who work in these facilities, will be affected by this proposed regulation.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. This regulatory action will likely have no impact on employment in the Commonwealth.

Effects on the Use and Value of Private Property. This regulatory action will likely have no effect on the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. DSS reports that most, if not all, of the approximately 600 assisted living facilities in the Commonwealth are small businesses. These businesses will likely incur slightly higher bookkeeping costs because of a provision in this proposed regulation that require documentation of residents’ consent for facilities to manage their funds.

Small Businesses: Alternative Method that Minimizes Adverse Impact. There are likely no alternate methods that the board could have employed in writing the requirements of this proposed regulation that would have both accomplished the board’s goals and further minimized any adverse impact on small businesses.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB’s best estimate of these economic impacts.

Agency's Response to the Department of Planning and Budget's Economic Impact Analysis: The Department of Social Services concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

This regulatory action amends the regulation pertaining to licensure of administrators and registration of medication aides in order to coordinate the State Board of Social Services (board) assisted living facility regulation with regulations of the Virginia Board of Long-Term Care Administrators and the Virginia Board of Nursing at the Department of Health Professions. The licensure of administrators and the registration of medication aides are a result of revisions to the Code of Virginia. Other changes made by the regulatory action include adding a requirement for reporting outbreaks of disease and deleting a standard regarding dedicated hospice facilities. These changes are being made to mirror revisions made to the Code of Virginia.

The regulatory action also includes changes to the requirements for safeguarding resident funds, shared administrators for smaller homes, initial tuberculosis risk assessment report, bed hold policy information, individualized service plan update and review, administration of medication, fire safety inspection reports, and fire and emergency evacuation drill records. In addition, revisions were made to several definitions of terms used in the regulations. Changes were also made to improve clarity and readability, and to make technical adjustments.

Part I
General Provisions

22VAC40-72-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Activities of daily living (ADLs)" means bathing, dressing, toileting, transferring, bowel control, bladder control and eating/feeding. A person's degree of independence in performing these activities is a part of determining appropriate level of care and services.

"Administer medication" means to open a container of medicine or to remove the ordered dosage and to give it to the resident for whom it is ordered.

"Administrator" means the licensee or a person designated by the licensee who is responsible for the general administration and management of an assisted living facility and who oversees the day-to-day operation of the facility, including compliance with all regulations for licensed assisted living facilities.

"Advance directive" means, as defined in § 54.1-2982 of the Code of Virginia, (i) a witnessed written document, voluntarily executed by the declarant in accordance with the requirements of § 54.1-2983 of the Code of Virginia or (ii) a witnessed oral statement, made by the declarant subsequent to the time he is diagnosed as suffering from a terminal condition and in accordance with the provisions of § 54.1-2983 of the Code of Virginia. The individual or his legal representative can rescind the document at any time.

"Ambulatory" means the condition of a resident who is physically and mentally capable of self-preservation by evacuating in response to an emergency to a refuge area as defined by 13VAC5-63, the Virginia Uniform Statewide Building Code, without the assistance of another person, or from the structure itself without the assistance of another person if there is no such refuge area within the structure, even if such resident may require the assistance of a wheelchair, walker, cane, prosthetic device, or a single verbal command to evacuate.

"Assisted living care" means a level of service provided by an assisted living facility for adults who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Included in this level of service are individuals who are dependent in behavior pattern (i.e., abusive, aggressive, disruptive) as documented on the uniform assessment instrument.

"Assisted living facility" means, as defined in § 63.2-100 of the Code of Virginia, any congregate residential setting that provides or coordinates personal and health care services, 24-hour supervision, and assistance (scheduled and unscheduled) for the maintenance or care of four or more adults who are aged, infirm or disabled and who are cared for in a primarily residential setting, except (i) a facility or portion of a facility licensed by the State Board of Health or the Department of Mental Health, Mental Retardation and Substance Abuse Services, but including any portion of such facility not so licensed; (ii) the home or residence of an individual who cares for or maintains only persons related to him by blood or marriage; (iii) a facility or portion of a facility serving infirm or disabled persons between the ages of 18 and 21, or 22 if enrolled in an educational program for the handicapped pursuant to § 22.1-214 of the Code of Virginia, when such facility is licensed by the department as a children's residential facility under Chapter 17 (§ 63.2-1700 et seq.) of Title 63.2 of the Code of Virginia, but including any portion of the facility not so licensed; and (iv) any housing project for persons 62 years of age or older or the disabled that provides no more than basic coordination of care services and is funded by the U.S. Department of Housing and Urban Development, by the U.S. Department of Agriculture, or by the Virginia Housing Development Authority. Included in this definition are any two or more places, establishments or institutions owned or operated by a single entity and providing maintenance or care to a combined total of four or more aged, infirm or disabled adults. Maintenance or care means the protection, general supervision and oversight of the physical and mental well-being of an aged, infirm or disabled individual.

Assuming responsibility for the well-being of residents, either directly or through contracted agents, is considered "general supervision and oversight."

"Behavioral health authority" means the organization, appointed by and accountable to the governing body of the city or county that established it, that provides mental health, mental retardation, and substance abuse services through its own staff or through contracts with other organizations and providers.

"Building" means a structure with exterior walls under one roof.

"Cardiopulmonary resuscitation (CPR)" means an emergency procedure consisting of external cardiac massage and artificial respiration; the first treatment for a person who has collapsed and has no pulse and has stopped breathing; and attempts to restore circulation of the blood and prevent death or brain damage due to lack of oxygen.

"Case management" means multiple functions designed to link clients to appropriate services. Case management may include a variety of common components such as initial screening of needs, comprehensive assessment of needs, development and implementation of a plan of care, service monitoring, and client follow-up.

"Case manager" means an employee of a public human services agency who is qualified and designated to develop and coordinate plans of care.

"Chemical restraint" means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the resident's medical symptoms or symptoms from mental illness or mental retardation, that prohibits an individual from reaching his highest level of functioning.

"Commissioner" means the commissioner of the department, his designee or authorized representative.

"Community services board" or "CSB" means a citizens' board established pursuant to § 37.2-501 of the Code of Virginia that provides mental health, mental retardation and substance abuse programs and services within the political subdivision or political subdivisions participating on the board.

"Conservator" means a person appointed by the court who is responsible for managing the estate and financial affairs of an incapacitated person and, where the context plainly indicates, includes a "limited conservator" or a "temporary conservator." The term includes a local or regional program designated by the Department for the Aging as a public conservator pursuant to Article 2 (§ 2.2-711 et seq.) of Chapter 7 of Title 2.2 of the Code of Virginia.

"Continuous licensed nursing care" means around-the-clock observation, assessment, monitoring, supervision, or provision of medical treatments provided by a licensed nurse. Residents requiring continuous licensed nursing care may include:

1. Individuals who have a medical instability due to complexities created by multiple, interrelated medical conditions; or

2. Individuals with a health care condition with a high potential for medical instability.

"Department" means the State Department of Social Services.

"Department's representative" means an employee or designee of the State Department of Social Services, acting as an authorized agent of the Commissioner of Social Services.

"Dietary supplement" means a product intended for ingestion that supplements the diet, is labeled as a dietary supplement, is not represented as a sole item of a meal or diet, and contains a dietary ingredient(s), i.e., vitamins, minerals, amino acid, herbs or other botanicals, dietary substances (such as enzymes), and concentrates, metabolites, constituents, extracts, or combinations of the preceding types of ingredients. Dietary supplements may be found in many forms, such as tablets, capsules, liquids, or bars.

"Direct care staff" means supervisors, assistants, aides, or other employees of a facility who assist residents in the performance of personal care and or daily living activities. Examples are likely to include nursing staff, activity staff, geriatric or personal care assistants, medication aides, and mental health workers but are not likely to include waiters, chauffeurs, cooks, and dedicated housekeeping, maintenance and laundry personnel.

"Discharge" means the movement of a resident out of the assisted living facility.

"Emergency" means, as it applies to restraints, a situation that may require the use of a restraint where the resident's behavior is unmanageable to the degree an immediate and serious danger is presented to the health and safety of the resident or others.

"Emergency placement" means the temporary status of an individual in an assisted living facility when the person's health and safety would be jeopardized by denying entry into the facility until the requirements for admission have been met.

"Good character and reputation" means findings have been established and knowledgeable, reasonable, and objective people agree that the individual (i) maintains business or professional, family, and community relationships that are characterized by honesty, fairness, truthfulness, and dependability; and (ii) has a history and pattern of behavior that demonstrates the individual is suitable and able to administer a program for the care, supervision, and protection of adults. Relatives by blood or marriage and persons who are not knowledgeable of the individual, such as recent acquaintances, may not act as references.

"Guardian" means a person who has been legally invested with the authority and charged with the duty of taking care of the person, managing his property and protecting the rights of the person who has been declared by the circuit court to be incapacitated and incapable of administering his own affairs. The powers and duties of the guardian are defined by the court and are limited to matters within the areas where the person in need of a guardian has been determined to be incapacitated.

"Habilitative service" means activities to advance a normal sequence of motor skills, movement, and self-care abilities or to prevent avoidable additional deformity or dysfunction.

"Health care provider" means a person, corporation, facility or institution licensed by this Commonwealth to provide health care or professional services such as a physician or hospital, dentist, pharmacist, registered or licensed practical nurse, optometrist, podiatrist, chiropractor, physical therapist, physical therapy assistant, clinical psychologist, or health maintenance organization. This list is not all inclusive.

"Household member" means any person domiciled in an assisted living facility other than residents or staff.

"Imminent physical threat or danger" means clear and present risk of sustaining or inflicting serious or life threatening injuries.

"Independent clinical psychologist" means a clinical psychologist who is chosen by the resident of the assisted living facility and who has no financial interest in the assisted living facility, directly or indirectly, as an owner, officer or employee or as an independent contractor with the facility.

"Independent living environment" means one in which the resident or residents perform all activities of daily living and instrumental activities of daily living for themselves without requiring the assistance of another person and take medication without requiring the assistance of another person.

"Independent living status" means that the resident is assessed as capable of performing all activities of daily living and instrumental activities of daily living for himself without requiring the assistance of another person and is assessed as capable of taking medications without the assistance of another person. (If the policy of a facility dictates that medications are administered or distributed centrally without regard for the residents' capacity, this policy shall not be considered in determining independent status.)

"Independent physician" means a physician who is chosen by the resident of the assisted living facility and who has no financial interest in the assisted living facility, directly or indirectly, as an owner, officer, or employee or as an independent contractor with the facility.

"Individualized service plan (ISP)" means the written description of actions to be taken by the licensee, including coordination with other services providers, to meet the assessed needs of the resident.

"Instrumental activities of daily living (IADLs)" means meal preparation, housekeeping, laundry, and managing money. A person's degree of independence in performing these activities is a part of determining appropriate level of care and services.

"Intermittent intravenous therapy" means therapy provided by a licensed health care professional at medically predictable intervals for a limited period of time on a daily or periodic basis.

"Legal representative" means a person legally responsible for representing or standing in the place of the resident for the conduct of his affairs. This may include a guardian, conservator, attorney-in-fact under durable power of attorney, trustee, or other person expressly named by a court of competent jurisdiction or the resident as his agent in a legal document that specifies the scope of the representative's authority to act. A legal representative may only represent or stand in the place of a resident for the function or functions for which he has legal authority to act.

A resident is presumed competent and is responsible for making all health care, personal care, financial, and other personal decisions that affect his life unless a representative with legal authority has been appointed by a court of competent jurisdiction or has been appointed by the resident in a properly executed and signed document. A resident may have different legal representatives for different functions.

For any given standard, the term legal representative applies solely to the legal representative with the authority to act in regard to the function or functions relevant to that particular standard.

"Licensed health care professional" means any health care professional currently licensed by the Commonwealth of Virginia to practice within the scope of his profession, such as a nurse practitioner, registered nurse, licensed practical nurse, (nurses may be licensed or hold multistate licensure pursuant to § 54.1-3000 of the Code of Virginia), clinical social worker, dentist, occupational therapist, pharmacist, physical therapist, physician, physician assistant, psychologist, and speech-language pathologist.

Responsibilities of physicians referenced in this chapter may be implemented by nurse practitioners or physician assistants in accordance with their protocols or practice agreements with their supervising physicians and in accordance with the law.

"Licensee" means any person, association, partnership, corporation, company or public agency to whom the license is issued.

"Manager" means a designated person who serves as a manager pursuant to 22VAC40-72-220 and 22VAC40-72-230.

"Mandated reporter" means the following persons acting in their professional capacity who have reason to suspect abuse, neglect or exploitation of an adult:

1. Any person licensed, certified, or registered by health regulatory boards listed in § 54.1-2503 of the Code of Virginia, with the exception of persons licensed by the Board of Veterinary Medicine;

2. Any mental health services provider as defined in § 54.1-2400.1 of the Code of Virginia;

3. Any emergency medical services personnel certified by the Board of Health pursuant to § 32.1-111.5 of the Code of Virginia;

4. Any guardian or conservator of an adult;

5. Any person employed by or contracted with a public or private agency or facility and working with adults in an administrative, supportive or direct care capacity;

6. Any person providing full, intermittent or occasional care to an adult for compensation, including but not limited to companion, chore, homemaker, and personal care workers; and

7. Any law-enforcement officer.

This is pursuant to § 63.2-1606 of the Code of Virginia.

"Maximum physical assistance" means that an individual has a rating of total dependence in four or more of the seven activities of daily living as documented on the uniform assessment instrument.

An individual who can participate in any way with performance of the activity is not considered to be totally dependent.

"Medication aide" means a staff person who has successfully completed (i) one of the five requirements specified in 22VAC40-72-250 C 1 through 5 (See 22VAC40-72-660 for exception), and (ii) the medication training program developed by the department and approved by the Board of Nursing.

This definition expires one year after the effective date of regulations promulgated by the Board of Nursing for the registration of medication aides. Thereafter, medication aides shall mean those persons who have current registration by with the Virginia Board of Nursing to administer drugs that would otherwise be self-administered to residents in an assisted living facility in accordance with the Regulations Governing the Registration of Medication Aides (18VAC90-60).

"Mental impairment" means a disability that reduces an individual's ability to reason logically, make appropriate decisions, or engage in purposeful behavior.

"Mental illness" means a disorder of thought, mood, emotion, perception, or orientation that significantly impairs judgment, behavior, capacity to recognize reality, or ability to address basic life necessities and requires care and treatment for the health, safety, or recovery of the individual or for the safety of others.

"Mental retardation" means disability, originating before the age of 18 years, characterized concurrently by (i) significantly subaverage intellectual functioning as demonstrated by performance on a standardized measure of intellectual functioning, administered in conformity with accepted professional practice, that is at least two standard deviations below the mean and (ii) significant limitations in adaptive behavior as expressed in conceptual, social, and practical adaptive skills.

"Minimal assistance" means dependency in only one activity of daily living or dependency in one or more of the instrumental activities of daily living as documented on the uniform assessment instrument.

"Moderate assistance" means dependency in two or more of the activities of daily living as documented on the uniform assessment instrument.

"Nonambulatory" means the condition of a resident who by reason of physical or mental impairment is not capable of self-preservation without the assistance of another person.

"Nonemergency" means, as it applies to restraints, circumstances that may require the use of a restraint for the purpose of providing support to a physically weakened resident.

"Outbreak" means a sudden rise in the incidence of a disease or symptoms above expected levels, or the occurrence of a large number of cases of a disease or symptoms in a short period of time. There is not a specific number or percentage that always constitutes an outbreak because the level of risk is dependent upon the severity of the disease or the intensity of the symptoms.

"Physical impairment" means a condition of a bodily or sensory nature that reduces an individual's ability to function or to perform activities.

"Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the resident cannot remove easily, which restricts freedom of movement or access to his body.

"Physician" means an individual licensed to practice medicine or osteopathic medicine in any of the 50 states or the District of Columbia.

"Prescriber" means a practitioner who is authorized pursuant to §§ 54.1-3303 and 54.1-3408 of the Code of Virginia to issue a prescription.

"Private pay" means that a resident of an assisted living facility is not eligible for benefits under the Auxiliary Grants Program.

"Psychopharmacologic drug" means any drug prescribed or administered with the intent of controlling mood, mental status or behavior. Psychopharmacologic drugs include not only the obvious drug classes, such as antipsychotic, antidepressants, and the antianxiety/hypnotic class, but any drug that is prescribed or administered with the intent of controlling mood, mental status, or behavior, regardless of the manner in which it is marketed by the manufacturers and regardless of labeling or other approvals by the United States Food and Drug Administration.

"Public pay" means that a resident of an assisted living facility is eligible for benefits under the Auxiliary Grants Program.

"Qualified" means having appropriate training and experience commensurate with assigned responsibilities; or if referring to a professional, possessing an appropriate degree or having documented equivalent education, training or experience. There are specific definitions for "qualified assessor" and "qualified mental health professional" below.

"Qualified assessor" means an individual who is authorized to perform an assessment, reassessment, or change in level of care for an applicant to or resident of an assisted living facility. For public pay individuals, a qualified assessor is an employee of a public human services agency trained in the completion of the uniform assessment instrument (UAI). For private pay individuals, a qualified assessor is an employee of the assisted living facility trained in the completion of the UAI or an independent private physician or a qualified assessor for public pay individuals.

"Qualified mental health professional" means a behavioral health professional who is trained and experienced in providing psychiatric or mental health services to individuals who have a psychiatric diagnosis, including and limited to (i) a physician licensed in Virginia; (ii) a psychologist: an individual with a master's degree in psychology from a college or university accredited by an association recognized by the U.S. Secretary of Education, with at least one year of clinical experience; (iii) a social worker: an individual with at least a master's degree in human services or related field (social work, psychology, psychiatric rehabilitation, sociology, counseling, vocational rehabilitation, or human services counseling) from a college or university accredited by an association recognized by the U.S. Secretary of Education, with at least one year of clinical experience providing direct services to persons with a diagnosis of mental illness; (iv) a Registered Psychiatric Rehabilitation Provider (RPRP) registered with the International Association of Psychosocial Rehabilitation Services (IAPSRS); (v) a clinical nurse specialist or psychiatric nurse practitioner licensed in the Commonwealth of Virginia with at least one year of clinical experience working in a mental health treatment facility or agency; (vi) any other licensed mental health professional; or (viii) any other person deemed by the Department of Mental Health, Mental Retardation and Substance Abuse Services as having qualifications equivalent to those described in this definition. Any unlicensed person who meets the requirements contained in this definition shall either be under the supervision of a licensed mental health professional or employed by an agency or organization licensed by the Department of Mental Health, Mental Retardation and Substance Abuse Services.

"Rehabilitative services" means activities that are ordered by a physician or other qualified health care professional that are provided by a rehabilitative therapist (physical therapist, occupational therapist or speech-language pathologist). These activities may be necessary when a resident has demonstrated a change in his capabilities and are provided to restore or improve his level of functioning.

"Resident" means any adult residing in an assisted living facility for the purpose of receiving maintenance or care.

"Residential living care" means a level of service provided by an assisted living facility for adults who may have physical or mental impairments and require only minimal assistance with the activities of daily living. Included in this level of service are individuals who are dependent in medication administration as documented on the uniform assessment instrument. This definition includes the services provided by the facility to individuals who are assessed as capable of maintaining themselves in an independent living status.

"Respite care" means services provided for maintenance and care of aged, infirm or disabled adults for temporary periods of time, regularly or intermittently. Facilities offering this type of care are subject to this chapter.

"Restorative care" means activities designed to assist the resident in reaching or maintaining his level of potential. These activities are not required to be provided by a rehabilitative therapist and may include activities such as range of motion, assistance with ambulation, positioning, assistance and instruction in the activities of daily living, psychosocial skills training, and reorientation and reality orientation.

"Safe, secure environment" means a self-contained special care unit for individuals with serious cognitive impairments due to a primary psychiatric diagnosis of dementia who cannot recognize danger or protect their own safety and welfare. Means of egress that lead to unprotected areas must be monitored or secured through devices that conform to applicable building and fire safety standards, including but not limited to door alarms, cameras, constant staff oversight, security bracelets that are part of an alarm system, pressure pads at doorways, delayed egress mechanisms, locking devices or perimeter fence gates. There may be one or more self-contained special care units in a facility or the whole facility may be a special care unit. Nothing in this definition limits or contravenes the privacy protections set forth in § 63.2-1808 of the Code of Virginia.

"Sanitizing" means treating in such a way to remove bacteria and viruses through using a disinfectant solution (e.g., bleach solution or commercial chemical disinfectant) or physical agent (e.g., heat).

"Serious cognitive impairment" means severe deficit in mental capability of a chronic, enduring or long-term nature that affects areas such as thought processes, problem-solving, judgment, memory, and comprehension and that interferes with such things as reality orientation, ability to care for self, ability to recognize danger to self or others, and impulse control. Such cognitive impairment is not due to acute or episodic conditions, nor conditions arising from treatable metabolic or chemical imbalances or caused by reactions to medication or toxic substances.

"Significant change" means a change in a resident's condition that is expected to last longer than 30 days. It does not include short-term changes that resolve with or without intervention, a short-term acute illness or episodic event, or a well-established, predictive, cyclic pattern of clinical signs and symptoms associated with a previously diagnosed condition where an appropriate course of treatment is in progress.

"Skilled nursing treatment" means a service ordered by a physician or other prescriber that is provided by and within the scope and practice of a licensed nurse.

"Skills training" means systematic skill building through curriculum-based psychoeducational and cognitive-behavioral interventions. These interventions break down complex objectives for role performance into simpler components, including basic cognitive skills such as attention, to facilitate learning and competency.

"Staff" or "staff person" means personnel working at a facility who are compensated or have a financial interest in the facility, regardless of role, service, age, function or duration of employment at the facility. Staff or staff person also includes those individuals hired through a contract to provide services for the facility.

"Substance abuse" means the use, without compelling medical reason, of alcohol or other legal or illegal drugs that results in psychological or physiological dependency or danger to self or others as a function of continued use in such a manner as to induce mental, emotional or physical impairment and cause socially dysfunctional or socially disordering behavior.

"Systems review" means a physical examination of the body to determine if the person is experiencing problems or distress, including cardiovascular system, respiratory system, gastrointestinal system, urinary system, endocrine system, musculoskeletal system, nervous system, sensory system and the skin.

"Transfer" means movement of a resident to a different assigned living area within the same licensed facility.

"Uniform assessment instrument (UAI)" means the department designated assessment form. There is an alternate version of the form that may be used for private pay residents. Social and financial information that is not relevant because of the resident's payment status is not included on the private pay version of the form.

22VAC40-72-30. Dedicated hospice facilities. (Repealed.)

A. Providers operating an assisted living facility that is a dedicated hospice facility shall maintain compliance with both the department's regulations for the licensure of assisted living facilities and the Department of Health's regulations for the licensure of hospice.

B. When applicable regulations for licensure of assisted living facilities and licensure of hospice are similar, the more stringent regulation shall take precedence.

C. At the time of submission of a renewal application for an assisted living facility license, providers operating a dedicated hospice facility shall include a copy of all inspection reports and plans of correction for the licensed hospice for the previous assisted living facility licensure period. These reports may be taken into consideration in the department's decision to renew an assisted living facility's license.

D. The administration of medications to residents of dedicated hospice facilities shall comply with 12VAC5-391-430 A and B. The use of medication aides is prohibited.

E. The health care oversight stipulated in 22VAC40-72-480 shall be conducted by a registered nurse, licensed physician, or a nurse practitioner or physician's assistant acting as assigned by the supervising physician and within the parameters of professional licensing.

Part II
Administration and Administrative Services

22VAC40-72-50. Licensee.

A. The licensee shall ensure compliance with all regulations for licensed assisted living facilities and terms of the license issued by the department; with relevant federal, state or local laws and other relevant regulations; and with the facility's own policies and procedures.

B. The licensee shall meet the following requirements:

1. The licensee shall give evidence of financial responsibility.

2. The licensee shall be of good character and reputation.

Character and reputation investigation includes, but is not limited to, background checks as required by §§ 63.2-1702 and 63.2-1721 of the Code of Virginia.

3. The licensee shall meet the requirements specified in the Regulation for Background Checks for Assisted Living Facilities and Adult Day Care Centers (22VAC40-90).

4. The licensee shall protect the physical and mental well-being of residents.

5. The licensee shall exercise general supervision over the affairs of the licensed facility and establish policies and procedures concerning its operation in conformance with applicable law, these regulations, and the welfare of the residents.

6. The licensee shall develop and maintain an operating budget, including resident care, dietary, and physical plant maintenance allocations and expenditures. The budget shall be sufficient to ensure adequate funds in all aspects of operation.

7. The licensee shall ensure that the facility keeps such records, makes such reports and maintains such plans, schedules, and other information as required by this chapter for licensed assisted living facilities. The facility shall submit, or make available, to the department's representative, records, reports, plans, schedules, and other information necessary to establish compliance with this chapter and applicable law. Such records, reports, plans, schedules, and other information shall be maintained at the facility and may be inspected at any reasonable time by the department's representative.

8. The licensee shall meet the qualifications of and requirements for the administrator if he serves as the administrator of the facility.

C. An assisted living facility sponsored by a religious organization, a corporation or a voluntary association shall be controlled by a governing board of directors that shall fulfill the duties of the licensee.

D. Upon initial application for an assisted living facility license, any person applying to operate such a facility who has not previously owned or managed or does not currently own or manage a licensed assisted living facility shall be required to undergo training by the commissioner or his designated agents. Such training shall be required of those owners and currently employed administrators of an assisted living facility at the time of initial application for a license.

1. The commissioner may also approve training programs provided by other entities and allow owners or administrators to attend such approved training programs in lieu of training by the department.

2. The commissioner may at his discretion also approve for licensure applicants who meet requisite experience criteria as established by the board.

3. The training programs shall focus on the health and safety regulations and resident rights as they pertain to assisted living facilities and shall be completed by the owner or administrator prior to the granting of an initial license.

4. The commissioner may, at his discretion, issue a license conditioned upon the owner or administrator's completion of the required training.

E. If there are plans for a facility to be voluntarily closed or sold, the licensee shall notify the regional licensing office of intent to close or sell the facility no less than 60 days prior to the closure or sale date. The following shall apply:

1. No less than 60 days prior to the planned closure or sale date, the licensee shall notify the residents, legal representatives, and designated contact persons of the intended closure or sale of the facility and the date for such, and the requirements of 22VAC40-72-420 shall apply.

2. If the facility is to be sold, at the time of notification of residents of such, the licensee shall explain to each resident, legal representative, and at least one designated contact person that unless provided otherwise by the new licensee, the resident has a choice as to whether to stay or to relocate and that if a resident chooses to stay, there must be a new agreement/acknowledgment between the resident and the new licensee that meets the specifications of 22VAC40-72-390.

3. The licensee shall provide updates regarding the closure or sale of the facility to the regional licensing office, as requested.

EXCEPTION: If plans are made at such time that 60-day notice is not possible, the licensee shall notify the regional licensing office, the residents, legal representatives, and designated contact persons as soon as the intent to close or sell the facility is known.

22VAC40-72-90. Infection control program.

A. The assisted living facility shall establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to prevent the development and transmission of disease and infection.

B. The infection control program shall include all staff and services and the entire physical plant and grounds.

C. The infection control program addressing the surveillance, prevention and control of infections shall include:

1. Establishing procedures to isolate the infecting organism;

2. Providing easy access to handwashing equipment for all staff and volunteers;

3. Training for and supervisory monitoring of all staff and volunteers in proper handwashing techniques, according to accepted professional standards, to prevent cross contamination;

4. Training for all staff and volunteers in appropriate implementation of standard precautions;

5. Prohibiting staff and volunteers with communicable diseases or infections from direct contact with residents or their food, if direct contact may transmit disease;

6. Monitoring performance of infection control practices by staff and volunteers;

7. Handling, storing, processing and transporting linens, supplies and equipment in a manner that prevents the spread of infection;

8. Handling, storing, processing and transporting medical waste in accordance with applicable regulations;

9. Maintaining an effective pest control program; and

10. Providing staff and volunteer education regarding infection risk-reduction behavior.

D. The methods utilized for infection control shall be described in a written document that shall be available to all staff.

E. The facility administrator shall immediately make or cause to be made a report of an outbreak of disease as defined by the Virginia Board of Health. Such report shall be made by rapid means to the local health director or to the Commissioner of the Department of Health.

22VAC40-72-100. Incident reports.

A. Each facility shall report to the regional licensing office by the next working day any major incident that has negatively affected or that threatens the life, health, safety or welfare of any resident.

B. The report required in subsection A of this section shall include (i) the name of the facility, (ii) the name(s) of the resident(s) involved in the incident, (iii) the name of the person making the report, (iv) the date of the incident, (v) a description of the incident, and (vi) the actions taken in response to the incident.

C. The facility shall submit a written report of each incident specified in subsection A of this section to the regional licensing office within seven days after the incident took place. The report shall be signed and dated by the administrator and include the following information:

1. Name and address of the facility;

2. Name of the resident(s) involved in the incident;

3. Date and time of the incident;

4. Name, title, and signature of the person making the report;

5. Date of completion of the report;

6. Type of incident;

7. Description of the incident, the circumstances under which it happened, and when applicable, extent of injury or damage;

8. Location of the incident;

9. Actions taken in response to the incident;

10. Outcome resolution of the incident, and if applicable follow-up actions or care;

11. Name of staff person in charge at the time of the incident;

12. Names, telephone numbers and addresses of witnesses to the incident, if any.

D. The facility shall submit to the regional licensing office amendments to the written report when circumstances require, such as when substantial additional actions are taken, significant new information becomes available, or there is resolution of the incident after submission of the report.

E. A copy of the written report of each incident shall be maintained by the facility for at least two years.

22VAC40-72-150. Safeguarding residents' funds.

A. If the resident delegates the management of personal funds to the facility, the following standards apply:

1. Documentation of this delegation, signed and dated by the resident and the administrator, shall be maintained in the resident's record.

1. 2. Residents' funds shall be held separately from any other moneys of the facility. Residents' funds shall not be borrowed, used as assets of the facility, or used for purposes of personal interest by the licensee/operator, administrator, or facility staff.

2. 3. If the facility's accumulated residents' funds are maintained in a single interest-bearing account, each resident shall receive interest proportionate to his average monthly account balance. The facility may deduct a reasonable cost for administration of the account.

3. 4. If any personal funds are held by the facility for safekeeping on behalf of the resident, a written accounting of money received and disbursed, showing a current balance, shall be maintained. Residents' funds and the accounting of the funds shall be made available to the resident or the legal representative or both upon request.

B. No facility administrator or staff person shall act as either attorney-in-fact or trustee unless the resident has no other preferred designee and the resident himself expressly requests such service by or through facility personnel. Any facility administrator or staff person so named shall be accountable at all times in the proper discharge of such fiduciary responsibility as provided under Virginia law, shall provide a quarterly accounting to the resident, and, upon termination of the power of attorney or trust for any reason, shall return all funds and assets, with full accounting, to the resident or to his legal representative or to another responsible party expressly designated by the resident. See also 22VAC40-72-120 regarding conservators or guardians appointed by a court of competent jurisdiction.

22VAC40-72-190. Administrator provisions and responsibilities. (Repealed.)

A. Each facility shall have an administrator of record. This does not prohibit the administrator from serving as the administrator of record for more than one facility.

B. The licensee shall notify the licensing office in writing within 10 working days of a change in a facility's administrator including, but not limited to, the resignation of an administrator, appointment of an acting administrator, and appointment of a new administrator.

C. When an administrator terminates employment, the licensee shall hire a new administrator within 90 days from the date of termination. Unless a new administrator is employed immediately, a qualified acting administrator shall be appointed when the administrator terminates employment.

D. The administrator shall be responsible for the general administration of the facility and shall oversee the day-to-day operation of the facility. This shall include, but shall not be limited to, responsibility for:

1. Developing and implementing all policies and services as required by this chapter;

2. Ensuring staff and volunteers comply with residents' rights;

3. Maintaining buildings and grounds;

4. Recruiting, hiring, training, and supervising staff; and

5. Ensuring the development, implementation, and monitoring of an individualized service plan for each resident, except that a plan is not required for a resident with independent living status.

E. Either the administrator or a designated assistant who meets the qualifications of the administrator shall be awake and on duty on the premises at least 40 hours per week with no fewer than 24 of those hours being during the day shift on week days.

EXCEPTIONS:

1. 22VAC40-72-220 allows a shared administrator for smaller facilities.

2. In facilities licensed for both residential and assisted living care, if the designated assistant is performing as an administrator for fewer than 15 of the 40 hours or for fewer than four weeks due to the vacation or illness of the administrator, the requirements of 22VAC40-72-200 D shall be acceptable.

F. The facility shall maintain a written schedule of the on-site presence of the administrator and, if applicable, the designated assistant or, as provided for in 22VAC40-72-220 and 22VAC40-72-230, the manager.

1. Any changes shall be noted on the schedule.

2. The facility shall maintain a copy of the schedule for two years.

22VAC40-72-191. Administrator qualifications.

A. The administrator shall be at least 21 years of age.

B. The administrator shall be able to read and write, and understand this chapter.

C. The administrator shall be able to perform the duties and carry out the responsibilities required by this chapter.

D. For facilities licensed for residential living care only, the administrator shall:

1. Be a high school graduate or shall have a General Education Development (GED) Certificate,

2. (i) Have successfully completed at least 30 credit hours of postsecondary education from a college or university accredited by an association recognized by the U.S. Secretary of Education or (ii) have successfully completed a department-approved course specific to the administration of an assisted living facility, and

3. Have at least one year of administrative or supervisory experience in caring for adults in a group care facility.

EXCEPTIONS:

1. A nursing home administrator or an assisted living facility administrator licensed by the Virginia Board of Long-Term Care Administrators,

2. A licensed nurse who meets the experience requirements in subdivision 3 of this subsection, or

3. An administrator of an assisted living facility employed prior to December 28, 2006, who met the requirements in effect when employed and who has been continuously employed as an assisted living facility administrator.

E. For facilities licensed for both residential and assisted living care, the administrator shall be licensed as an assisted living facility administrator or nursing home administrator by the Virginia Board of Long-Term Care Administrators pursuant to Chapter 31 (§ 54.1-3100 et seq.) of Title 54.1 of the Code of Virginia and in conformance with 18VAC95-20 or 18VAC95-30 respectively.

22VAC40-72-200. Administrator qualifications. (Repealed.)

A. The administrator shall be at least 21 years of age.

B. The administrator shall be able to read and write, and understand this chapter.

C. The administrator shall be able to perform the duties and carry out the responsibilities required by this chapter.

D. For facilities licensed for residential living care only, the administrator shall:

1. Be a high school graduate or shall have a General Education Development (GED) Certificate;

2. (i) Have successfully completed at least 30 credit hours of postsecondary education from a college or university accredited by an association recognized by the U.S. Secretary of Education or (ii) have successfully completed a department-approved course specific to the administration of an assisted living facility; and

3. Have at least one year of administrative or supervisory experience in caring for adults in a group care facility.

EXCEPTIONS:

1. A licensed nursing home administrator who meets the qualifications under § 54.1-3103 of the Code of Virginia;

2. A licensed nurse who meets the experience requirements in subdivision 3 of this subsection;

3. An administrator of an assisted living facility employed prior to December 28, 2006, who met the requirements in effect when employed and who has been continuously employed as an assisted living facility administrator.

E. Until the provisions of this subsection expire as specified in subsection F of this section, for facilities licensed for both residential and assisted living care, the administrator shall:

1. Be a graduate of a four-year college or university accredited by an association recognized by the U.S. Secretary of Education; or

2. Have successfully completed at least 60 credit hours of courses in human services or group care administration, from a college or university accredited by an association recognized by the U.S. Secretary of Education; or

EXCEPTION: Ten or fewer of the 60 credit hours may be in business courses.

3. Have successfully completed at least 30 credit hours of courses in human services or group care administration from a college or university accredited by an association recognized by the U.S. Secretary of Education and have successfully completed a department-approved course specific to the administration of an assisted living facility; and

4. Have completed at least one year of administrative or supervisory experience in caring for adults in a group care facility.

EXCEPTIONS:

1. A licensed nursing home administrator who meets the qualifications under § 54.1-3103 of the Code of Virginia;

2. A licensed registered nurse who meets the experience requirements in subdivision 4 of this subsection;

3. An administrator of an assisted living facility employed prior to December 28, 2006, who met the requirements in effect when employed and who has been continuously employed as an assisted living facility administrator.

EXCEPTION: An administrator employed prior to February 1, 1996, who met the exception to the standards effective February 1, 1996, shall successfully complete within one year a department-approved course specific to the administration of an assisted living facility.

F. The provisions of subsection E of this section expire one year after the effective date of regulations promulgated by the Board of Long-Term Care Administrators for the licensure of assisted living facility administrators. Thereafter, assisted living administrators for facilities licensed for both residential and assisted living care shall meet the qualifications for licensure and be licensed by the Board of Long-Term Care Administrators within the Virginia Department of Health Professions.

G. The administrator, designated assistant administrator, or acting administrator shall not be a resident of the facility.

22VAC40-72-201. Administrator provisions and responsibilities.

A. Each facility shall have an administrator of record.

B. When an administrator terminates employment, the licensee shall hire a new administrator within 90 days from the date of termination. If a new administrator is not employed immediately when the administrator terminates employment, a qualified acting administrator, who is not required to be licensed, shall be appointed so that no lapse in administrator coverage occurs.

1. The licensee shall notify the department's regional licensing office in writing within 10 working days of a change in a facility's administrator including, but not limited to, the resignation of an administrator, appointment of an acting administrator, and appointment of a new administrator.

2. For facilities licensed for both residential and assisted living care, if the facility is operating without an administrator licensed by the Virginia Board of Long-Term Care Administrators, the acting administrator shall immediately notify the Virginia Board of Long-Term Care Administrators and the department's regional licensing office of this fact.

EXCEPTION: An acting administrator who is awaiting the final licensing decision of the Virginia Board of Long-Term Care Administrators may be granted one extension of up to 60 days in addition to the 90 allowed days if a written request to the regional licensing office of the Virginia Department of Social Services provides documentation of such.

C. The administrator shall be responsible for the general administration and management of the facility and shall oversee the day-to-day operation of the facility. This shall include, but shall not be limited to, responsibility for:

1. Maintaining compliance with applicable laws and regulations;

2. Developing and implementing all policies, procedures and services as required by this chapter;

3. Ensuring staff and volunteers comply with residents' rights;

4. Maintaining buildings and grounds;

5. Recruiting, hiring, training, and supervising staff; and

6. Ensuring the development, implementation, and monitoring of an individualized service plan for each resident, except that a plan is not required for a resident with independent living status.

D. For facilities licensed for residential living care only, either the administrator or a designated assistant who meets the qualifications of the administrator shall be awake and on duty on the premises at least 40 hours per week with no fewer than 24 of those hours being during the day shift on week days.

EXCEPTIONS:

1. 22VAC40-72-220 allows a shared administrator for smaller facilities.

2. If the administrator is licensed as an assisted living facility administrator or nursing home administrator by the Board of Long-Term Care Administrators, the provisions regarding the administrator in subsection E of this section apply. When such is the case, there is no requirement for a designated assistant.

E. For facilities licensed for both residential and assisted living care, an administrator licensed by the Virginia Board of Long-Term Care Administrators, as specified in 22VAC40-72-191 E, shall serve as the on-site agent of the licensee and shall be responsible on a full-time basis for the day-to-day administration and management of the facility, except as provided in 22VAC40-72-220.

F. The administrator, acting administrator or, as allowed in subsection D of this section, designated assistant administrator shall not be a resident of the facility.

G. The facility shall maintain a written work schedule of the on-site presence of the administrator and, if applicable, the designated assistant or, as provided for in 22VAC40-72-220 and 22VAC40-72-230, the manager.

1. Any changes shall be noted on the schedule.

2. The facility shall maintain a copy of the schedule for two years.

22VAC40-72-210. Administrator training.

A. The For facilities licensed for residential living care only, the administrator shall attend at least 20 hours of training related to management or operation of a residential facility for adults or relevant to the population in care within 12 months from the date of employment and annually thereafter from that date. When adults with mental impairments reside in the facility, at least five of the required 20 hours of training shall focus on topics related to residents' mental impairments. Documentation of attendance shall be retained at the facility and shall include title of course, name of the entity that provided the training, date and number of hours.

EXCEPTION: If the administrator is licensed as an assisted living facility administrator or nursing home administrator by the Virginia Board of Long-Term Care Administrators, subsection B of this section applies rather than subsection A of this section.

B. For facilities licensed for both residential and assisted living care, the administrator shall meet the continuing education requirements for licensure as an assisted living facility or nursing home administrator, whichever is applicable.

C. Any administrator who has not previously undergone the training specified in 22VAC40-72-50 D shall be required to complete that training within two months of employment as administrator of the facility. The training may be counted toward the annual training requirement for the first year, except that for licensed administrators, whether the training counts toward continuing education and for what period of time depends upon the administrator licensure requirements.

EXCEPTION: Administrators employed prior to December 28, 2006, are not required to complete this training.

C. Administrators shall be required to complete training on standards when they are revised, unless the department determines that such training is not necessary.

D. If medication is administered to residents by medication aides as allowed in 22VAC40-72-660 1 b, the administrator shall successfully complete a medication training program approved by the Virginia Board of Nursing for the registration of medication aides. The training program for administrators who supervise medication aides, but are not registered medication aides themselves, must include a minimum of 68 hours of student instruction and training, but need not include the prerequisite for the program or the written examination for registration. The training shall be completed within four months of employment as an administrator and may be counted toward the annual training requirement for the first year, except that for licensed administrators, whether the training counts toward continuing education and for what period of time depends upon the administrator licensure requirements. Administrators employed prior to December 28, 2006, have six months from December 28, 2006, to successfully complete the medication training program. The following exceptions apply:

1. The administrator is licensed by the Commonwealth of Virginia to administer medications;, or

2. Medication aides are supervised by an individual employed full time at the facility who is licensed by the Commonwealth of Virginia to administer medications.

22VAC40-72-220. Shared administrator for smaller facilities.

The A. For facilities licensed for residential living care only, the administrator may be awake and on duty on the premises of a facility for fewer than the minimum 40 hours per week, without a designated assistant, under the following conditions:

1. In facilities licensed for 10 or fewer residents:

a. The administrator shall be awake and on duty on the premises of each facility for at least 10 hours a week; and

b. The administrator shall serve no more than four facilities.

2. In facilities licensed for 11-19 residents:

a. The administrator shall be awake and on duty on the premises of each facility for at least 20 hours a week; and

b. The administrator shall serve no more than two facilities.

3. In facilities licensed for 10 or fewer residents as specified in subdivision 1 of this section and in facilities licensed for 11-19 residents as specified in subdivision 2 of this section:

a. The administrator shall serve as a full time administrator, i.e., shall be awake and on duty on the premises of more than one assisted living facility for at least 40 hours a week;

1. The administrator shall serve no more than four facilities.

2. The combined total licensed capacity of the facilities served by the administrator shall be 40 or fewer residents.

3. The administrator shall be awake and on duty on the premises of each facility served for at least 10 hours a week.

4. The administrator shall serve as a full-time administrator, i.e., shall be awake and on duty on the premises of all facilities served for a combined total of at least 40 hours a week.

b. 5. Each of the facilities served shall be within a 30-minute average one way travel time of the other facilities;.

c. 6. When not present at a facility, the administrator shall be on call to that facility during the hours he is working as an administrator and shall maintain such accessibility through suitable communication devices;.

d. 7. A designated assistant may act in place of the administrator during the required minimum of 40 hours only if the administrator is ill or on vacation and for a period of time that shall not exceed four consecutive weeks. The designated assistant shall meet the qualifications of the administrator;.

e. There shall be a designated person who shall serve as manager and who 8. Each of the facilities served shall have a manager, designated and supervised by the administrator. The manager shall be awake and on duty on the premises of each the facility for the remaining part of the 40 required hours per week when the administrator or designated assistant as permitted in subdivision 7 of this subsection is not present at the facility and who shall be supervised by the administrator. The manager shall meet the following minimum qualifications and requirements:

(1) a. The manager shall be at least 21 years of age.

(2) b. The manager shall be able to read and write, and understand this chapter.

(3) c. The manager shall be able to perform the duties and to carry out the responsibilities of his position.

(4) d. The manager shall:

(a) (1) Be a high school graduate or shall have a General Education Development (GED) Certificate;,

(b) (2) Have successfully completed (i) at least 30 credit hours of postsecondary education from a college or university accredited by an association recognized by the U.S. Secretary of Education or (ii) a department-approved course of 40 or fewer hours specific to the management of an assisted living facility;, and

(c) (3) Have at least one year of administrative or supervisory experience in caring for adults in a group care facility.

EXCEPTION: A licensed nurse who meets the experience requirements in subdivision (c) (3) of this subdivision (4) d.

(5) e. The manager shall not be a resident of the facility;.

f. 9. The manager shall complete the training specified in 22VAC40-72-50 D within two months of employment as manager. The training may be counted toward the annual training requirement for the first year;.

g. Managers shall be required to complete training on standards when they are revised, unless the department determines that such training is not necessary;

h. 10. The manager shall attend at least 16 hours of training related to management or operation of a residential facility for adults or relevant to the population in care within each 12-month period. When adults with mental impairments reside in the facility, at least four of the required 16 hours of training shall focus on topics related to residents' mental impairments. Documentation of attendance shall be retained at the facility and shall include title of course, name of the entity that provided the training, date and number of hours;.

i. 11. There shall be a written management plan for each facility that includes written policies and procedures that describe how the administrator shall oversee the care and supervision of the residents and the day-to-day operation of the facility;.

j. 12. The minimum of 40 hours per week required for the administrator or manager to be awake and on duty on the premises of a facility shall include at least 24 hours during the day shift on week days.

4. This section shall not apply to an administrator who serves both an assisted living facility and a nursing home, as provided for in 22VAC40-72-230.

EXCEPTION: If the administrator is licensed as an assisted living facility administrator or nursing home administrator by the Board of Long-Term Care Administrators, the provisions in subsection B of this section apply rather than subsection A of this section.

B. For facilities licensed for both residential and assisted living care, the administrator, as the on-site agent of the licensee or licensees, may be responsible for the day-to-day administration and management of multiple facilities under the following conditions:

1. The administrator shall serve no more than four facilities.

2. The combined total licensed capacity of the facilities served by the administrator shall be 40 or fewer residents.

3. The administrator shall serve on a full-time basis, proportioning his time among all the facilities served in order to ensure that he provides sufficient administrative and management functions to each facility.

4. Each of the facilities served shall be within a 30-minute average one way travel time of the other facilities.

5. When not present at a facility, the administrator shall be on call to that facility during the hours he is working as an administrator and shall maintain such accessibility through suitable communication devices.

6. Each of the facilities served shall have a manager, designated and supervised by the administrator, to assist the administrator in overseeing the care and supervision of the residents and the day-to-day operation of the facility. The majority of the time, the administrator and the manager shall be present at a facility at different times to ensure appropriate oversight of the facility. The manager shall meet the qualifications and requirements specified in subdivisions A 8 through 11 of this section.

7. There shall be a written management plan for each facility that includes written policies and procedures that describe how the administrator shall oversee the care and supervision of the residents and the day-to-day operation of the facility.

C. This section shall not apply to an administrator who serves both an assisted living facility and a nursing home as provided for in 22VAC40-72-230.

22VAC40-72-230. Administrator of both assisted living facility and nursing home.

A. Any person meeting the qualifications for a licensed nursing home administrator pursuant to § 54.1-3103 of the Code of Virginia may serve as the administrator of both an assisted living facility and a licensed nursing home, provided the assisted living facility and licensed nursing home are part of the same building and the requirements of subsections B and C of this section are met.

B. Whenever an assisted living facility and a licensed nursing home have a single administrator, there shall be a written management plan that addresses the care and supervision of the assisted living facility residents. The management plan shall include, but not be limited to, the following:

1. Written policies and procedures that describe how the administrator will oversee the care and supervision of the residents and the day-to-day operation of the facility;

2. If the administrator does not provide the direct management of the assisted living facility or only provides a portion thereof, the plan shall specify a designated individual who shall serve as manager and who shall be supervised by the administrator.

C. The manager referred to in subdivision B 2 of this section shall be on-site and meet the following minimum qualifications and requirements: of 22VAC40-72-220 A 8 through 11.

1. The manager shall be at least 21 years of age.

2. The manager shall be able to read and write, and understand this chapter.

3. The manager shall be able to perform the duties and carry out the responsibilities of his position.

4. The manager shall:

a. Be a high school graduate or shall have a General Education Development (GED) Certificate;

b. (i) Have successfully completed at least 30 credit hours of postsecondary education from a college or university accredited by an association recognized by the U.S. Secretary of Education or (ii) have successfully completed a department-approved course of 40 or fewer hours specific to the management of an assisted living facility; and

c. Have at least one year of administrative or supervisory experience in caring for adults in a group care facility.

EXCEPTIONS:

1. A licensed nurse who meets the experience requirements in subdivision c of this subdivision 4;

2. EXCEPTION: A manager employed prior to December 28, 2006, who met the requirements in effect when employed and who has been continuously employed as a manager is excepted from 22VAC40-72-220 A 8 a, 8 d, and 9.

5. The manager shall not be a resident of the facility.

6. The manager shall complete the training specified in 22VAC40-72-50 D within two months of employment as manager. The training may be counted toward the annual training requirement for the first year.

EXCEPTION: Managers employed prior to December 28, 2006, are not required to complete this training.

7. Managers shall be required to complete training on standards when they are revised, unless the department determines that such training is not necessary.

8. The manager shall attend at least 16 hours of training related to management or operation of a residential facility for adults or relevant to the population in care within each 12-month period. When adults with mental impairments reside in the facility, at least four of the required 16 hours of training shall focus on residents who are mentally impaired. Documentation of attendance shall be retained at the facility and shall include title of course, name of the entity that provided the training, date and number of hours.

22VAC40-72-260. Direct care staff training.

A. In facilities licensed for residential living care only, all direct care staff shall attend at least eight hours of training annually (in addition to (i) required first aid training; and (ii) CPR training) training, if taken; and (iii) for medication aides, continuing education required by the Virginia Board of Nursing). Training for the first year shall commence no later than 60 days after employment.

1. The training shall be relevant to the population in care and shall be provided by a qualified individual through in-service training programs or institutes, workshops, classes, or conferences.

2. When adults with mental impairments reside in the facility, at least two of the required eight hours of training shall focus on the resident who is mentally impaired.

3. Documentation of the type of training received, the entity that provided the training, number of hours of training, and dates of the training shall be kept by the facility in a manner that allows for identification by individual staff person and is considered part of the staff member's record.

B. In facilities licensed for both residential and assisted living care, all direct care staff shall attend at least 16 hours of training annually (in addition to (i) required first aid and training; (ii) CPR training) training, if taken; and (iii) for medication aides, continuing education required by the Virginia Board of Nursing). Training for the first year shall commence no later than 60 days after employment.

1. The training shall be relevant to the population in care and shall be provided by a qualified individual through in-service training programs or institutes, workshops, classes, or conferences.

2. When adults with mental impairments reside in the facility, at least four of the required 16 hours of training shall focus on the resident who is mentally impaired.

3. Documentation of the type of training received, the entity that provided the training, number of hours of training, and dates of the training shall be kept by the facility in a manner that allows for identification by individual staff person and is considered part of the staff person's record.

EXCEPTION: Direct care staff who are licensed health care professionals or certified nurse aides shall attend at least 12 hours of annual training.

22VAC40-72-290. Staff records and health requirements.

A. A record shall be established for each staff person. It shall not be destroyed until at least two years after employment is terminated.

B. All staff records shall be retained at the facility, treated confidentially, kept in a locked area, and made available for inspection by the department's representative upon request.

EXCEPTION: Emergency contact information required by subdivision C 14 of this section shall also be kept in an easily accessible place.

C. Personal and social data to be maintained on staff and included in the staff record are as follows:

1. Name;

2. Birthdate;

3. Current address and telephone number;

4. Social security number;

5. Position title, job description and date employed;

6. Verification that the staff person has received a copy of his job description and the organizational chart;

7. Most recent previous employment;

8. For persons employed after November 9, 1975, copies of at least two references or notations of verbal references, obtained prior to employment, reflecting the date of the reference, the source and the content;

9. An original criminal record report and a sworn disclosure statement;

10. Previous experience or training or both;

11. Verification of current professional license, certification, registration, or completion of a required approved training course;

12. Annual staff performance evaluations;

13. Any disciplinary action taken;

14. Name and telephone number of person to contact in an emergency;

15. Documentation of formal training received following employment, including orientation, in-services and workshops; and

16. Date and reason for termination of employment, when applicable.

D. Health information required by these standards shall be maintained at the facility and be included in the staff record for the administrator and each staff person, and also shall be maintained at the facility for each household member who comes in contact with residents.

1. Initial tuberculosis examination and report.

a. Each staff person at the time of hire on or within seven days prior to the first day of work at the facility and each household member prior to coming in contact with residents shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. The risk assessment shall be no older than 30 days.

b. An evaluation shall not be required for a staff person who (i) has separated from employment with a facility licensed or certified by the Commonwealth of Virginia, (ii) has a break in service of six months or less, and (iii) submits a copy of the original statement of tuberculosis screening to his new employer.

2. Subsequent tuberculosis evaluations and reports.

a. Any staff person or household member required to be evaluated who comes in contact with a known case of infectious tuberculosis shall be screened as determined appropriate based on consultation with the local health department.

b. Any staff person or household member required to be evaluated who develops chronic respiratory symptoms of three weeks duration shall be evaluated immediately for the presence of infectious tuberculosis.

c. Each staff person or household member required to be evaluated shall annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it.

3. Any individual suspected to have infectious tuberculosis shall not be allowed to return to work or have any contact with the residents and personnel of the facility until a physician has determined that the individual is free of infectious tuberculosis.

4. The facility shall report any active case of tuberculosis developed by a staff person or household member required to be evaluated to the local health department.

E. At the request of the administrator of the facility or the department, a report of examination by a licensed physician shall be obtained when there are indications that the safety of residents in care may be jeopardized by the physical or mental health of a staff person or household member.

F. Any staff person or household member who, upon examination or as a result of tests, shows indication of a physical or mental condition that may jeopardize the safety of residents in care or that would prevent performance of duties:

1. Shall be removed immediately from contact with residents;, and

2. Shall not be allowed contact with residents until the condition is cleared to the satisfaction of the examining physician as evidenced by a signed statement from the physician.

Part V
Admission, Retention and Discharge of Residents

22VAC40-72-340. Admission and retention of residents.

A. No resident shall be admitted or retained:

1. For whom the facility cannot provide or secure appropriate care;,

2. Who requires a level of care or service or type of service for which the facility is not licensed or which the facility does not provide;, or

3. If the facility does not have staff appropriate in numbers and with appropriate skill to provide the care and services needed by the resident.

B. Assisted living facilities shall not admit an individual before a determination has been made that the facility can meet the needs of the resident. The facility shall make the determination based upon the following information at a minimum:

1. The completed UAI;.

2. The physical examination report;.

3. A documented interview between the administrator or a designee responsible for admission and retention decisions, the resident and his legal representative, if any. In some cases, medical conditions may create special circumstances that make it necessary to hold the interview on the date of admission.

4. A screening of psychological, behavioral, and emotional functioning, conducted by a qualified mental health professional, if recommended by the UAI assessor, a health care professional, or the administrator or designee responsible for the admission and retention decision. This includes meeting the requirements of 22VAC40-72-360.

C. An assisted living facility shall only admit or retain residents as permitted by its use and occupancy classification and certificate of occupancy. The ambulatory/nonambulatory status of an individual is based upon:

1. Information contained in the physical examination report;, and

2. Information contained in the most recent UAI.

D. Upon receiving the UAI prior to admission of a resident, the assisted living facility administrator shall provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. Copies of the written assurance shall be given to the legal representative and case manager, if any, and a copy signed by the resident or his legal representative shall be kept in the resident's record.

E. All residents shall be 18 years of age or older.

F. No person shall be admitted without his consent and agreement, or that of his legal representative with demonstrated legal authority to give such consent on his behalf.

G. Assisted living facilities shall not admit or retain individuals with any of the following conditions or care needs:

1. Ventilator dependency;

2. Dermal ulcers III and IV except those stage III ulcers that are determined by an independent physician to be healing, as permitted in subsection H of this section;

3. Intravenous therapy or injections directly into the vein, except for intermittent intravenous therapy managed by a health care professional licensed in Virginia as permitted in subsection I of this section or except as permitted in subsection J of this section;

4. Airborne infectious disease in a communicable state that requires isolation of the individual or requires special precautions by the caretaker to prevent transmission of the disease, including diseases such as tuberculosis and excluding infections such as the common cold;

5. Psychotropic medications without appropriate diagnosis and treatment plans;

6. Nasogastric tubes;

7. Gastric tubes except when the individual is capable of independently feeding himself and caring for the tube or as permitted in subsection J of this section;

8. Individuals presenting an imminent physical threat or danger to self or others;

9. Individuals requiring continuous licensed nursing care;

10. Individuals whose physician certifies that placement is no longer appropriate;

11. Unless the individual's independent physician determines otherwise, individuals who require maximum physical assistance as documented by the UAI and meet Medicaid nursing facility level of care criteria as defined in the State Plan for Medical Assistance (12VAC30-10); or

12. Individuals whose physical or mental health care needs cannot be met in the specific assisted living facility as determined by the facility.

H. When a resident has a stage III dermal ulcer that has been determined by an independent physician to be healing, periodic observation and any necessary dressing changes shall be performed by a licensed health care professional under a physician's or other prescriber's treatment plan.

I. Intermittent intravenous therapy may be provided to a resident for a limited period of time on a daily or periodic basis by a licensed health care professional under a physician's or other prescriber's treatment plan. When a course of treatment is expected to be ongoing and extends beyond a two-week period, evaluation is required at two-week intervals by the licensed health care professional.

J. At the request of the resident in an assisted living facility and when his independent physician determines that it is appropriate, (i) care for the conditions or care needs specified in subdivisions G 3 and 7 of this section may be provided to the resident by a physician licensed in Virginia, a nurse licensed in Virginia or a nurse holding a multistate licensure privilege under a physician's or other prescriber's treatment plan, or a home care organization licensed in Virginia or (ii) care for the conditions or care needs specified in subdivision G 7 of this section may also be provided to the resident by unlicensed direct care facility staff if the care is delivered in accordance with the regulations of the Board of Nursing for delegation by a registered nurse, 18VAC90-20-420 through 18VAC90-20-460 and 22VAC40-72-460 D.

This standard does not apply to recipients of auxiliary grants.

K. When care for a resident's special medical needs is provided by licensed staff of a home care agency, the assisted living facility direct care staff may receive training from the home care agency staff in appropriate treatment monitoring techniques regarding safety precautions and actions to take in case of emergency.

L. Notwithstanding § 63.2-1805 of the Code of Virginia, at the request of the resident, hospice care may be provided in an assisted living facility under the same requirements for hospice programs provided in Article 7 (§ 32.1-162.1 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, if the hospice program determines that such program is appropriate for the resident.

22VAC40-72-390. Resident agreement with facility.

A. At or prior to the time of admission, there shall be a written agreement/acknowledgment of notification dated and signed by the resident/applicant for admission or the appropriate legal representative, and by the licensee or administrator. This document shall include the following:

1. Financial arrangement for accommodations, services and care that specifies:

a. Listing of specific charges for accommodations, services, and care to be made to the individual resident signing the agreement, the frequency of payment, and any rules relating to nonpayment;

b. Description of all accommodations, services, and care that the facility offers and any related charges;

c. The amount and purpose of an advance payment or deposit payment and the refund policy for such payment;

d. The policy with respect to increases in charges and length of time for advance notice of intent to increase charges;

e. If the ownership of any personal property, real estate, money or financial investments is to be transferred to the facility at the time of admission or at some future date, it shall be stipulated in the agreement; and

f. The refund policy to apply when transfer of ownership, closing of facility, or resident transfer or discharge occurs.

2. Requirements or rules to be imposed regarding resident conduct and other restrictions or special conditions and signed acknowledgment that they have been reviewed by the resident or his legal representative.

3. Acknowledgment that the resident or his legal representative has been informed of the policy regarding the amount of notice required when a resident wishes to move from the facility.

4. Acknowledgment that the resident has been informed of the policy required by 22VAC40-72-840 J regarding weapons.

5. Those actions, circumstances, or conditions that would result or might result in the resident's discharge from the facility.

6. Acknowledgment that the resident or his legal representative or responsible individual as stipulated in 22VAC40-72-550 G has reviewed a copy of § 63.2-1808 of the Code of Virginia, Rights and Responsibilities of Residents of Assisted Living Facilities, and that the provisions of this statute have been explained to him.

7. Acknowledgment that the resident or his legal representative or responsible individual as stipulated in 22VAC40-72-550 G has reviewed and had explained to him the facility's policies and procedures for implementing § 63.2-1808 of the Code of Virginia, including the grievance policy and the transfer/discharge policy.

8. Acknowledgment that the resident has been informed that interested residents may establish and maintain a resident council, that the facility is responsible for providing assistance with the formation and maintenance of the council, whether or not such a council currently exists in the facility, and the general purpose of a resident council. (See 22VAC40-72-810.)

9. Acknowledgment that the resident has been informed of the bed hold policy in case of temporary transfer or movement from the facility, if the facility has such a policy.

10. Acknowledgment that the resident has been informed of the rules and restrictions regarding smoking on the premises of the facility, including but not limited to that which is required by 22VAC40-72-800.

11. Acknowledgment that the resident has been informed of the policy regarding the administration and storage of medications and dietary supplements.

12. Acknowledgment that the resident has received written assurance that the facility has the appropriate license to meet his care needs at the time of admission, as required by 22VAC40-72-340 D.

B. Copies of the signed agreement/acknowledgment of notification shall be provided to the resident and as appropriate, his legal representative and shall be retained in the resident's record.

C. The original agreement shall be updated whenever there are changes in financial arrangements, accommodations, services, care provided by the facility, or requirements governing the resident's conduct, and signed by the licensee or administrator and the resident or his legal representative. If the original agreement provides for specific changes in financial arrangements, services, or requirements any of these items, this standard does not apply to those changes.

22VAC40-72-420. Discharge of residents.

A. When actions, circumstances, conditions, or care needs occur that will result in the discharge of a resident, discharge planning shall begin immediately, and there shall be documentation of such, including the beginning date of discharge planning. The resident shall be moved within 30 days, except that if persistent efforts have been made and the time frame is not met, the facility shall document the reason and the efforts that have been made.

B. As soon as discharge planning begins, the assisted living facility shall notify the resident and the resident's legal representatives and designated contact person if any, of the planned discharge, the reason for the discharge, and that the resident will be moved within 30 days unless there are extenuating circumstances as referenced in subsection A of this section. Written notification of the actual discharge date shall be given to the resident and the resident's legal representatives and contact person if any, at least 14 calendar days prior to the date that the resident will be discharged.

C. The assisted living facility shall adopt and conform to a written policy regarding the number of calendar days notice that is required when a resident wishes to move from the facility. Any required notice of intent to move shall not exceed 30 days.

D. The facility shall assist the resident and his legal representative, if any, in the discharge or transfer process. The facility shall help the resident prepare for relocation, including discussing the resident's destination. Primary responsibility for transporting the resident and his possessions rests with the resident or his legal representative.

E. When a resident's condition presents an immediate and serious risk to the health, safety or welfare of the resident or others and emergency discharge is necessary, 14-day notification of planned discharge does not apply, although the reason for the relocation shall be discussed with the resident and, when possible, his legal representative prior to the move.

F. Under emergency conditions, the resident's legal representative, designated contact person, the family, caseworker, social worker or other agency personnel, as appropriate, shall be informed as rapidly as possible, but by the close of the business day following discharge, of the reasons for the move.

G. If the resident's uniform assessment instrument has been completed by a public human services agency assessor, the assisted living facility shall notify such assessor of the date and place of discharge to which the resident moved, as well as when a resident dies, within 10 days of the resident's discharge or death.

H. Discharge statement.

1. At the time of discharge, except as noted in subdivision 2 of this subsection, the assisted living facility shall provide to the resident and, as appropriate, his legal representative and designated contact person a dated statement signed by the licensee or administrator that contains the following information:

a. The date on which the resident, his legal representative or designated contact person was notified of the planned discharge and the name of the legal representative or designated contact person who was notified;

b. The reason or reasons for the discharge;

c. The actions taken by the facility to assist the resident in the discharge and relocation process; and

d. The date of the actual discharge from the facility and the resident's destination.

2. When the termination of care is due to emergency conditions, the dated statement shall contain the above information as appropriate and shall be provided or mailed to the resident, his legal representative, or designated contact person as soon as practicable and within 48 hours from the time of the decision to discharge.

3. A copy of the written statement shall be retained in the resident's record.

I. When the resident is discharged and moves to another caregiving facility, the assisted living facility shall provide to the receiving facility such information related to the resident as is necessary to ensure continuity of care and services. Original information pertaining to the resident shall be maintained by the assisted living facility from which the resident was discharged. The assisted living facility shall maintain a listing of all information shared with the receiving facility.

J. Within 60 days of the date of discharge, each resident or his legal representative shall be given a final statement of account, any refunds due, and return of any money, property or things of value held in trust or custody by the facility.

Part VI
Resident Care and Related Services

22VAC40-72-430. Uniform assessment instrument (UAI).

A. All residents of and applicants to assisted living facilities shall be assessed face-to-face using the uniform assessment instrument pursuant to the requirements in Assessment in Adult Care Residences Assisted Living Facilities (22VAC40-745). Assessments shall be completed prior to admission, annually, and whenever there is a significant change in the resident's condition.

1. For private pay individuals, the UAI shall be completed by one of the following qualified assessors:

a. An assisted living facility staff person who has successfully completed state-approved training on the uniform assessment instrument and level of care criteria for either public or private pay assessments, provided the administrator or the administrator's designated representative approves and then signs the completed UAI, and the facility maintains documentation of the completed training;

EXCEPTION: An assisted living facility staff person who began employment at the facility prior to December 28, 2006, and who had documented training that was not state-approved state approved in the completion of the UAI and application of level of care criteria shall meet the requirements for state approved state-approved training within one year from December 28, 2006;

b. An independent physician; or

c. A qualified public human services agency assessor.

2. For public pay individuals, the UAI shall be completed by a case manager or qualified assessor as specified in 22VAC40-745.

B. The UAI shall be completed within 90 days prior to the date of admission to the assisted living facility except that if there has been a change in the resident's condition since the completion of the UAI that would affect the admission, a new UAI shall be completed.

C. When a resident moves to an assisted living facility from another assisted living facility or other long-term care setting that uses the UAI, if there is a completed UAI on record, another UAI does not have to be completed except that a new UAI shall be completed whenever:

1. There is a significant change in the resident's condition;, or

2. The previous assessment is more than 12 months old.

D. The assessor is responsible for being knowledgeable of the criteria for level of care and authorizing the individual for the appropriate level of care for admission to and for continued stay in an assisted living facility based on the information in the UAI.

E. Annual reassessments and reassessments due to a significant change in the resident's condition, using the UAI, shall be utilized to determine whether a resident's needs can continue to be met by the facility and whether continued placement in the facility is in the best interest of the resident.

F. For private pay individuals, the assisted living facility shall ensure that the uniform assessment instrument is completed as required by 22VAC40-745.

G. For a private pay resident, if the UAI is completed by an independent physican or a qualified human services agency assessor, the assisted living facility shall be responsible for coordinating with the physician or the agency assessor to ensure that the UAI is completed as required.

H. The assisted living facility shall be in compliance with all requirements set forth in 22VAC40-745.

I. The facility shall maintain the completed UAI in the resident's record.

J. At the request of the assisted living facility, the resident, the resident's legal representative, the resident's physician, the department, or the local department of social services, an independent assessment using the UAI shall be completed to determine whether the resident's care needs are being met in the assisted living facility. The assisted living facility shall assist the resident in obtaining the independent assessment as requested.

An independent assessment is one that is completed by a qualified entity other than the original assessor.

K. During an inspection or review, staff from the department, the Department of Medical Assistance Services, or the local department of social services may initiate a change in level of care for any assisted living facility resident for whom it is determined that the resident's UAI is not reflective of the resident's current status.

L. The facility shall ensure that facility staff and independent physicians who are qualified assessors advise orally and in writing all applicants to and residents of assisted living facilities of the right to appeal the outcome of the assessment, the annual reassessment, or determination of level of care.

22VAC40-72-440. Individualized service plans.

A. The licensee/administrator who has completed an individualized service plan (ISP) training program approved by the department or his designee who has completed such a program shall develop an individualized service plan to meet the resident's service needs. The licensee/administrator or designee shall develop the ISP in conjunction with the resident, and as appropriate, with the resident's family, legal representative, direct care staff members, case manager, health care providers, qualified mental health professionals, or other persons. The plan shall be designed to maximize the resident's level of functional ability.

An individualized service plan is not required for those residents who are assessed as capable of maintaining themselves in an independent living status.

B. The service plan to address the immediate needs of the resident shall be completed within 72 hours of admission. The comprehensive plan shall be completed within 30 days after admission and shall include the following:

1. Description of identified needs based upon the (i) UAI; (ii) admission physical examination; (iii) interview with resident; (iv) assessment of psychological, behavioral and emotional functioning, if appropriate; and (v) other sources;

2. A written description of what services will be provided and who will provide them;

3. When and where the services will be provided;

4. The expected outcome and date of expected outcome; and

5. If a resident lives in a building housing 19 or fewer residents, a statement that specifies whether the person does need or does not need to have a staff member awake and on duty at night.

C. The individualized service plan shall reflect the resident's assessed needs and support the principles of individuality, personal dignity, freedom of choice and home-like environment and shall include other formal and informal supports that may participate in the delivery of services. Whenever possible, residents shall be given a choice of options regarding the type and delivery of services.

D. When hospice care is provided to a resident, the assisted living facility and the licensed hospice organization shall communicate, establish and agree upon a coordinated plan of care for the resident. The services provided by each shall be included on the individualized service plan.

E. The individualized service plan shall be signed and dated by the licensee/administrator or his designee, i.e., the person who has developed the plan, and by the resident or his legal representative. The plan shall also be signed and dated by any other individuals who contributed to the development of the plan. Each person signing the plan shall note his title or relationship to the resident next to his signature. These requirements shall also apply to reviews and updates of the plan.

EXCEPTION: The signature of an individual who contributed to the plan without being present at the facility shall not be required, although his name, date of participation, and title or relationship shall be indicated on the plan.

F. The master service plan shall be filed in the resident's record. A current copy shall be maintained in a location accessible at all times to direct care staff, but that protects the confidentiality of the contents of the service plan. Extracts from the plan may be filed in locations specifically identified for their retention, e.g., dietary plan in kitchen.

G. The facility shall ensure that the care and services specified in the individualized service plan are provided to each resident.

EXCEPTION: There may be a deviation from the plan when mutually agreed upon between the facility and the resident or the resident's legal representative at the time the care or services are scheduled or when there is an emergency that prevents the care or services from being provided. Deviation from the plan shall be documented in writing, including a description of the circumstances, the date it occurred, and the signatures of the parties involved, and the documentation shall be retained in the resident's record.

The facility may not start, change or discontinue medications, dietary supplements, diets, medical procedures or treatments without an order from a physician or other prescriber.

H. Outcomes shall be noted on the individualized plan or on a separate document as outcomes are achieved, and progress toward reaching expected outcomes shall be noted on the service plan or other document at least annually. Personnel making such notes shall sign and date them.

I. Individualized service plans shall be reviewed and updated at least once every 12 months and as needed as the condition of the resident changes. The review and update shall be performed by a staff person who has completed an ISP training program approved by the department, in conjunction with the resident, and as appropriate, with the resident's family, legal representative, direct care staff, case manager, health care providers, qualified mental health professionals or other persons.

22VAC40-72-630. Medication management plan and reference materials.

A. The facility shall have, and keep current, a written plan for medication management. The facility's medication plan shall address procedures for administering medication and shall include:

1. Methods to ensure an understanding of the responsibilities associated with medication management;

2. Standard operating procedures and any general restrictions specific to the facility;

3. Methods to prevent the use of outdated, damaged or contaminated medications;

4. Methods to ensure that each resident's prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages;

5. Methods for verifying that medication orders have been accurately transcribed to Medication Administration Records (MARs);

6. Methods for monitoring medication administration and the effective use of the MARs for documentation;

7. Methods to ensure that staff who are responsible for administering medications meet the qualification and training requirements of 22VAC40-72-660;

8. Methods to ensure that staff who are responsible for administering medications are adequately supervised;

9. A plan for proper disposal of medication;

10. Methods to ensure that residents do not receive medications or dietary supplements to which they have known allergies; and

11. Identification of the medication aide or the person licensed to administer drugs responsible for routinely communicating issues or observations related to medication administration to the prescribing physician or other prescriber.

B. The facility's written medication management plan and any subsequent changes shall be approved by the department.

C. The plan and subsequent changes shall be reviewed as part of the department's regular inspection process.

D. In addition to the facility's written medication management plan, the facility shall maintain, as reference materials for medication aides, a current copy of "A Resource Guide for Medication Management for Persons Authorized Under the Drug Control Act," approved by the Virginia Board of Nursing until such time as registration of medication aides is enforced, and at least one pharmacy reference book, drug guide or medication handbook for nurses that is no more than two years old.

22VAC40-72-660. Qualifications, training, and supervision of staff administering medications.

When staff administers medications to residents, the following standards shall apply:

1. Each staff person who administers medication shall be authorized by § 54.1-3408 of the Virginia Drug Control Act. All staff responsible for medication administration shall:

a. Be licensed by the Commonwealth of Virginia to administer medications;. or

b. (i) Have successfully completed one of the five requirements specified in 22VAC40-72-250 C 1 through 5 and (ii) have successfully completed the medication training program developed by the department and approved by the Board of Nursing Be registered with the Virginia Board of Nursing as a medication aide.

EXCEPTION: Staff responsible for medication administration prior to December 28, 2006, who would otherwise be subject to completion of one of the five requirements specified in 22VAC40-72-250 C 1 through 5 do not have to meet any of the requirements listed in 22VAC40-72-250 C 1 through 5 in order to administer medication.

2. All staff who have met the requirements of subdivision 1 b of this section shall be listed in the department's database for medication aides.

3. All staff who have successfully completed the medication training program approved by the Board of Nursing shall also successfully complete:

a. Annual in-service training provided by a licensed health care professional, acting within the scope of the requirements of his profession, on side effects of the medications prescribed to the residents in care and on recognizing and reporting adverse medication reactions.

b. The most current refresher course developed by the department that is based on the curriculum approved by the Board of Nursing. The refresher course shall be completed every three years.

4. 2. Medication aides shall be supervised by:

a. A licensed health care professional, acting within the scope of the requirements of his profession An individual employed full time at the facility who is licensed by the Commonwealth of Virginia to administer medications;

b. The administrator who is licensed by the Commonwealth of Virginia to administer medications or who has successfully completed the medication a training program approved by the Virginia Board of Nursing for the registration of medication aides. The training program for administrators who supervise medication aides, but are not registered medication aides themselves, must include a minimum of 68 hours of student instruction and training, but need not include the prerequisite for the program or the written examination for registration; or

c. The For facilities licensed for residential living care only, the designated assistant administrator, who meets the qualifications of the administrator as specified in 22VAC40-72-201 D, who is licensed by the Commonwealth of Virginia to administer medications or who has successfully completed the medication a training program approved by the Virginia Board of Nursing for the registration of medication aides. The training program for designated assistant administrators who supervise medication aides, but are not registered medication aides themselves, must include a minimum of 68 hours of student instruction and training, but need not include the prerequisite for the program or the written examination for registration.

22VAC40-72-670. Administration of medications and related provisions.

A. Drugs shall be administered Staff who are licensed or registered as specified in 22VAC40-72-660 shall administer drugs to those residents who are dependent in medication administration as documented on the UAI.

B. All medications shall be removed from the pharmacy container by an authorized a staff person licensed or registered as specified in 22VAC40-72-660 and administered by the same authorized staff person not earlier than one hour before and not later than one hour after the facility's standard dosing schedules, except those drugs that are ordered for specific times, such as before, after or with meals. Pre-pouring for later administration is not permitted.

C. All medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing.

D. All medications shall remain in the pharmacy issued container, with the legible prescription label or direction label attached, until administered.

E. Sample medications shall remain in the original packaging, labeled by a physician or other prescriber or pharmacist with the resident's name, the name of the medication, the strength, dosage, route and frequency of administration, until administered.

F. Over-the-counter medication shall remain in the original container, labeled with the resident's name, or in a pharmacy-issued container, until administered.

G. In the event of an adverse drug reaction or a medication error:

1. First aid shall be administered as directed by a physician, pharmacist or the Virginia Poison Control Center.

2. The resident's physician of record shall be notified as soon as possible.

3. The direct care staff person shall document actions taken in the resident's record.

H. The facility shall document on a medication administration record (MAR) all medications administered to residents, including over-the-counter medications, and dietary supplements. The MAR shall include:

1. Name of the resident;

2. Date prescribed;

3. Drug product name;

4. Strength of the drug;

5. Dosage;

6. Diagnosis, condition, or specific indications for administering the drug or supplement;

7. Route (for example, by mouth);

8. How often medication is to be taken;

9. Date and time given and initials of direct care staff administering the medication;

10. Dates the medication is discontinued or changed;

11. Any medication errors or omissions;

12. Description of significant adverse effects suffered by the resident;

13. For PRN medications:

a. Symptoms for which medication was given;

b. Exact dosage given; and

c. Effectiveness; and

14. The name, signature and initials of all staff administering medications.

I. The performance of all medical procedures and treatments ordered by a physician or other prescriber shall be documented and the documentation shall be retained in the resident's record.

J. The use of PRN (as needed) medications is prohibited, unless one or more of the following conditions exist:

1. The resident is capable of determining when the medication is needed;

2. Licensed health care professionals are responsible for medication administration and management; or

3. The facility has obtained from the resident's physician or other prescriber detailed written instructions or a staff person as allowed in 22VAC40-72-640 D has telephoned the physician or other prescriber prior to administering the medication, explained the symptoms and received a documented oral order to assist the resident in self-administration. The physician's or other prescriber's instructions shall include symptoms that might indicate the use of the medication, exact dosage, the exact timeframes time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist.

K. Medications ordered for PRN administration shall be available, properly labeled for the specific resident and properly stored at the facility.

L. Stat-drug boxes may only be used when the following conditions are met:

1. There is an order from the prescriber for any drug removed from the stat-drug box; and

2. The drug is removed from the stat-drug box and administered by a nurse, pharmacist or prescriber licensed to administer medications.

A stat-drug box may be prepared by a pharmacy prior to the receipt of ordered drugs from the pharmacy. Stat-drug boxes are subject to the conditions specified in 18VAC110-20-550 of the Virginia Board of Pharmacy.

22VAC40-72-910. Provisions for signaling/call systems.

A. All assisted living facilities shall have a signaling device that is easily accessible to the resident in his bedroom or in a connecting bathroom that alerts the direct care staff that the resident needs assistance.

B. In facilities buildings licensed to care for 20 or more residents under one roof, there shall be a signaling device that terminates at a central location that is continuously staffed and permits staff to determine the origin of the signal or is audible and visible in a manner that permits staff to determine the origin of the signal.

C. In facilities buildings licensed to care for 19 or fewer residents under one roof, if the signaling device does not permit staff to determine the origin of the signal as specified in subsection B of this section, direct care staff shall make rounds at least once each hour to monitor for emergencies or other unanticipated resident needs. These rounds shall begin when the majority of the residents have gone to bed each evening and shall terminate when the majority of the residents have arisen each morning, and shall be documented as follows:

1. A written log shall be maintained showing the date and time rounds were made and the signature of the direct care staff member who made rounds.

2. Logs for the past two years shall be retained.

22VAC40-72-920. Fire safety: compliance with state regulations and local fire ordinances.

A. An assisted living facility shall comply with the Virginia Statewide Fire Prevention Code (13VAC5-51) as determined by at least an annual inspection by the appropriate fire official. Reports of the annual inspections shall be retained at the facility for at least two years.

B. An assisted living facility shall comply with any local fire ordinance.

Part IX
Emergency Preparedness

22VAC40-72-930. Emergency preparedness and response plan.

A. The facility shall develop a written emergency preparedness and response plan that shall address:

1. Documentation of contact with the local emergency coordinator to determine (i) local disaster risks, (ii) communitywide plans to address different disasters and emergency situations, and (iii) assistance, if any, that the local emergency management office will provide to the facility in an emergency.

2. Analysis of the facility's potential hazards, including severe weather, fire, loss of utilities, flooding, work place violence or terrorism, severe injuries, or other emergencies that would disrupt normal operation of the facility.

3. Written emergency management policies outlining specific responsibilities for provision of:

a. Administrative direction and management of response activities;

b. Coordination of logistics during the emergency;

c. Communications;

d. Life safety of residents, staff, volunteers, and visitors;

e. Property protection;

f. Continued provision of services to residents;

g. Community resource accessibility; and

h. Recovery and restoration.

4. Written emergency response procedures for assessing the situation; protecting residents, staff, volunteers, visitors, equipment, medications, and vital records; and restoring services. Emergency procedures shall address:

a. Alerting emergency personnel and facility staff;

b. Warning and notification of residents, including sounding of alarms when appropriate;

c. Providing emergency access to secure areas and opening locked doors;

d. Conducting evacuations and sheltering in place, as appropriate, and accounting for all residents;

e. Locating and shutting off utilities when necessary;

f. Maintaining and operating emergency equipment effectively and safely;

g. Communicating with staff and community emergency responders during the emergency; and

h. Conducting relocations to emergency shelters or alternative sites when necessary and accounting for all residents.

5. Supporting documents that would be needed in an emergency, including emergency call lists, building and site maps necessary to shut off utilities, memoranda of understanding with relocation sites, and list of major resources such as suppliers of emergency equipment.

B. Staff and volunteers shall be knowledgeable in and prepared to implement the emergency preparedness plan in the event of an emergency.

C. The facility shall develop and implement an orientation and quarterly review on the emergency preparedness and response plan for all staff, residents, and volunteers. The orientation and review shall cover responsibilities for:

1. Alerting emergency personnel and sounding alarms;

2. Implementing evacuation, shelter in place, and relocation procedures;

3. Using, maintaining, and operating emergency equipment;

4. Accessing emergency medical information, equipment, and medications for residents;

5. Locating and shutting off utilities; and

6. Utilizing community support services.

D. The facility shall review the emergency preparedness plan annually or more often as needed and make necessary revisions. Such revisions shall be communicated to staff, residents, and volunteers and incorporated into the orientation and quarterly review for staff, residents, and volunteers.

E. In the event of a disaster, fire, emergency or any other condition that may jeopardize the health, safety and welfare of residents, the facility shall take appropriate action to protect the health, safety and welfare of the residents and take appropriate actions to remedy the conditions as soon as possible.

F. After the disaster/emergency is stabilized, the facility shall:

1. Notify family members and legal representatives;, and

2. Report the disaster/emergency to the regional licensing office by the next working day as specified in 22VAC40-72-100.

22VAC40-72-950. Fire and emergency evacuation drills.

A. Fire and emergency evacuation drill frequency and participation shall be in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter shall not be conducted in the same month.

B. Additional fire and emergency evacuation drills may be held at the discretion of the administrator or licensing inspector and must be held when there is any reason to question whether the requirements of the approved fire and emergency evacuation plan can be met.

C. Each required fire and emergency evacuation drill shall be unannounced.

D. Immediately following each required fire and emergency evacuation drill, there shall be an evaluation of the drill by the staff in order to determine the effectiveness of the drill. The licensee or administrator shall immediately correct any problems identified in the evaluation.

E. A record of the required fire and emergency evacuation drills shall be kept in the facility for two years. Such record shall include:

1. Identity of the person conducting the drill;

1. 2. The date and time of the drill;

3. The method used for notification of the drill;

2. 4. The number of staff participating;

3. 5. The number of residents participating;

6. Any special conditions simulated;

4. 7. The time it took to complete the drill;

5. 8. Weather conditions; and

6. 9. Problems encountered, if any.

22VAC40-72-960. Emergency equipment and supplies.

A. A complete first aid kit shall be on hand at the facility, located in a designated place that is easily accessible to staff but not to residents. Items with expiration dates must not have dates that have already passed. The kit shall include, but not be limited to, the following items:

1. Activated charcoal (use only if instructed by physician or Poison Control Center);

2. Adhesive tape;

3. Antiseptic ointment;

4. Band-aids (assorted sizes);

5. Blankets (disposable or other);

6. Disposable single use breathing barriers/shields for use with rescue breathing or CPR (CPR mask or other type);

7. Cold pack;

8. Disposable single use waterproof gloves;

9. Gauze pads and roller gauze (assorted sizes);

10. Hand cleaner (e.g., waterless hand sanitizer or antiseptic towelettes);

11. Plastic bags;

12. Scissors;

13. Small flashlight and extra batteries;

14. Syrup of ipecac (use only if instructed by physician or Poison Control Center);

15. 14. Thermometer;

16. 15. Triangular bandages;

17. 16. Tweezers; and

18. 17. The first aid instructional manual.

Items with expiration dates must not have dates that have already passed.

B. In facilities that have a motor vehicle that is used to transport residents and in a motor vehicle used for a field trip, there shall be a first aid kit on the vehicle, located in a designated place that is accessible to staff but not residents, that includes items as specified in subsection A of this section.

C. First aid kits shall be checked at least monthly to assure that all items are present and items with expiration dates are not past their expiration date.

D. Each facility with six or more residents shall be able to connect by July 1, 2007, to a temporary emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply. The installation of a connection for temporary electric power shall be in compliance with the Virginia Uniform Statewide Building Code, 13VAC5-63.

E. The following emergency lighting shall be available:

1. Flashlights or battery lanterns for general use.

2. One flashlight or battery lantern for each employee directly responsible for resident care who is on duty between 5 p.m. and 7 a.m.

3. One flashlight or battery lantern for each bedroom used by residents and for the living and dining area unless there is a provision for emergency lighting in the adjoining hallways.

4. The use of open flame lighting is prohibited.

F. There shall be an alternative form of communication in addition to the telephone such as a cell phone, two-way radio, or ham radio.

G. The facility shall ensure the availability of a 96-hour supply of emergency food and drinking water, and oxygen for residents using oxygen.

22VAC40-72-970. Plan for resident emergencies and practice exercise.

A. Assisted living facilities shall have a written plan for resident emergencies that includes:

1. Procedures for handling medical emergencies including identifying the staff person responsible for (i) calling the rescue squad, ambulance service, resident's physician, or Poison Control Center, and (ii) providing first aid and CPR, when indicated.

2. Procedures for handling mental health emergencies such as, but not limited to, catastrophic reaction or the need for a temporary detention order.

3. Procedures for making pertinent medical information and history available to the rescue squad and hospital, including but not limited to information on medications and any advance directives.

4. Procedures to be followed in the event that a resident is missing, including but not limited to (i) involvement of facility staff, appropriate law-enforcement agency, and others as needed; (ii) areas to be searched; (iii) expectations upon locating the resident; and (iv) documentation of the event.

5. Procedures for notifying the resident's family, legal representative, designated contact person, and any responsible social agency.

6. Procedures for notifying the regional licensing office as specified in 22VAC40-72-100.

B. At least once every six months, all staff on each shift shall participate in an exercise in which the procedures for resident emergencies are practiced. Documentation of each exercise shall be maintained in the facility for at least two years.

C. The plan for resident emergencies shall be readily available to all staff.

22VAC40-72-1010. Staff training.

A. Commencing immediately upon employment and within three months, the administrator shall attend 12 hours of training in cognitive impairment that meets the requirements of subsection C of this section. This training is counted toward the annual training requirement for the first year, except that for licensed administrators, whether the training counts toward continuing education and for what period of time depends upon the administrator licensure requirements. Previous training that meets the requirements of subsection C of this section and was completed in the year prior to employment is transferable if there is documentation of the training. The documented previous training is counted toward the required 12 hours but not toward the annual training requirement, except as noted earlier in this subsection.

B. Commencing immediately upon employment and within four months, direct care staff shall attend four hours of training in cognitive impairment that meets the requirements of subsection C of this section. This training is counted toward meeting the annual training requirement for the first year. Previous training that meets the requirements of subsection C of this section and was completed in the year prior to employment is transferable if there is documentation of the training. The documented previous training is counted toward the required four hours but not toward the annual training requirement.

C. Curriculum for the training in cognitive impairment for direct care staff and administrators shall be developed by a qualified health professional or by a licensed social worker, shall be relevant to the population in care and shall include, but need not be limited to:

1. Explanation of cognitive impairments;

2. Resident care techniques;

3. Behavior management;

4. Communication skills;

5. Activity planning; and

6. Safety considerations.

D. Within the first month of employment, staff other than the administrator and direct care staff shall complete one hour of training on the nature and needs of residents with cognitive impairments relevant to the population in care.

22VAC40-72-1120. Staff training.

A. Commencing immediately upon employment and within two months, the administrator and direct care staff shall attend at least four hours of training in cognitive impairments due to dementia. This training is counted toward meeting the annual training requirement for the first year, except that for licensed administrators, whether the training counts toward continuing education and for what period of time depends upon the administrator licensure requirements. The training shall cover the following topics:

1. Information about the cognitive impairment, including areas such as cause, progression, behaviors, management of the condition;

2. Communicating with the resident;

3. Managing dysfunctional behavior; and

4. Identifying and alleviating safety risks to residents with cognitive impairment.

Previous training that meets the requirements of this subsection and subsections C and D of this section that was completed in the year prior to employment is transferable if there is documentation of the training. The documented previous training is counted toward the required four hours but not toward the annual training requirement, except as noted earlier in this subsection. In this subsection, for direct care staff, employment means employment in the safe, secure environment.

B. Within the first year of employment, the administrator and direct care staff shall attend at least six more hours of training, in addition to that required in subsection A of this section, in caring for residents with cognitive impairments due to dementia. The training is counted toward meeting the annual training requirement for the first year, except that for licensed administrators, whether the training counts toward continuing education and for what period of time depends upon the administrator licensure requirements. The training shall cover the following topics:

1. Assessing resident needs and capabilities and understanding and implementing service plans;

2. Resident care techniques for persons with physical, cognitive, behavioral and social disabilities;

3. Creating a therapeutic environment;

4. Promoting resident dignity, independence, individuality, privacy and choice;

5. Communicating with families and other persons interested in the resident;

6. Planning and facilitating activities appropriate for each resident; and

7. Common behavioral problems and behavior management techniques.

Previous training that meets the requirements of this subsection and subsections C and D of this section that was completed in the year prior to employment is transferable if there is documentation of the training. The documented previous training is counted toward the required six hours but not toward the annual training requirement, except as noted earlier in this subsection. In this subsection, for direct care staff, employment means employment in the safe, secure environment.

C. The training required in subsections A and B of this section shall be developed by:

1. A licensed health care professional acting within the scope of the requirements of his profession who has at least 12 hours of training in the care of individuals with cognitive impairments due to dementia; or

2. A person who has been approved by the department to develop the training.

D. The training required in subsections A and B of this section shall be provided by a person qualified under subdivision C 1 of this section or a person who has been approved by the department to provide the training.

E. Within the first month of employment, staff, other than the administrator and direct care staff, who will have contact with residents in the special care unit shall complete one hour of training on the nature and needs of residents with cognitive impairments due to dementia.

VA.R. Doc. No. R09-1523; Filed December 3, 2008, 10:54 a.m.