302 Adult Day Care | Day Health Services | HCBS-5300-MANUAL

The range of services provided for social model programs must include at least the following

The services provided by the program as part of implementing individualized service plans must:

Adult day care core services offered must comply with Department of Community Health Rules Chapter 111-8-1-.12 (see link in MAN 5300 CH 302.27, References).

In addition to the core services provided, adult day health model programs must include the following health-related services:

Nothing in these standards must preclude licensed therapists from providing services to an individual participant in an adult day setting.

Adult day health model services offered must comply with Department of Community Health Rules Chapter 111-8-1-.12 (see link in MAN 5300 CH 302.27, References).

Additional services may be arranged for or provided by the social model adult day care program and may include transportation, health screening, prevention activities, social services, personal care services, assistance with medications, and educational activities. Optional services, and any associated costs, must be explained in the written program description.

Assistance with medications in an adult day social model program implies that the participant can self-administer medications with minimal staff assistance, such as reminders, verbal prompting, checking dosages according to the container label, and assisting a participant with opening or pouring medications. See MAN 5300 CH302.13, Medication Management.

Each facility must establish core hours and days of operation during which day care services are available and that reflect the needs of the communities and client/caregiver populations identified as target groups.

Facilities must offer programming to participants for a minimum of five continuous hours per day (excluding transportation time) when providing day care services. Providers must document their efforts to expand core hours and days of service to meet the needs of the communities in which they provide services, based on customer surveys and market analyses.

Providers may establish separate rates for non-traditional hours or hours beyond the core hours of operation, provided these rates are posted and consumers acknowledge the rates prior to the provision of services. Such rates must be approved by the Area Agency on Aging if used as a payor source.

Each adult day care/adult day health program must have a written description of the following that is available to consumers upon request:

The program must initiate and maintain written agreements that describe:

Personnel records – The facility must keep personnel records in a central location in the facility for six years according to record retention requirements.

Participant attendance records – The facility will maintain a record of daily attendance and transportation to and from the facility, including the time each person began receiving services each day and the time they left the facility’s care. If transportation is provided by the facility, the driver’s transportation records will also document times of arrival and departure. The facility also will document arrival and departure times for participants not using facility-provided transportation.

Transportation records – The facility driver(s) must maintain accurate daily transportation and mileage records, and records of expenses for purchases of gas and oil.

Participant program records – The program must maintain and retain participant records in a secure place according to state records retention requirements for at least six years upon discharge/termination from the program.

Complaints – Staff must date-stamp all written complaints received and maintain accessible records of the complaints and resolution.

All client records will be maintained pursuant to MAN 5600 1060 Technology and Data Management, MAN 5600 1061 Record Retention, and MAN 5600 3012 Area Agency on Aging Records. See also MAN 5300 CH 202.5.

All medication prescribed to clients must be dispensed through a pharmacy or by the client’s treating physician or dentist.

When obtaining a physician’s verbal authorization, follow-up and written documentation must be secured and included in the participant’s records within 30 days to confirm the authorization.

Clients who choose not to or who cannot self-administer their medications must have their medications administered by a person who holds a current license under state law that authorizes the licensee to administer medications.

Physician samples may be given to a client provided the medication has specific dosage instructions for the individual client and is in its original packaging.

Program staff may assist the participant with physician-prescribed medications that are to be self-administered. Assistance is limited to the following:

Each client record must contain physician’s orders for all prescribed medications and treatments directly related to services being delivered.

Each client record must contain a medication profile with current medications, pharmacy name(s), strength, dosages, frequency, directions for use, route of administration, prescription numbers, and dates of issuance by each pharmacy.

The label of such a prescription medication constitutes the pharmacist’s transcription of documentation of the order. Such medications should also be listed on the plan of care.

Each client record must contain documentation of known drug, food and contact allergies and adverse reactions.

Staff who assist with medications must report to the RN/LPN or supervisor any changes in the client’s condition, including those which may be related to medications.

The Supervisor or RN/LPN must immediately communicate any concerns or unusual reactions regarding the client’s medications or treatments to the client’s physician and responsible party.

When the program staff supervises or administers medications, the actual administration of medications must be documented in the participant’s permanent record, including the name of the medication, dosage, method of administration, date and time administered, and the name of the staff member who administered the medication. Staff must keep a written record of occasions when the client does not receive or take medications/treatments as ordered/prescribed.

The facility must provide a locked area for all medications, including over-the-counter drugs. All medications must remain in the original labeled containers.

Each participant’s medication must be stored separately from other clients’ medication within the storage area.

Refrigerators used for medication storage must be in designated and locked storage areas. Medication requiring refrigeration must be stored in a refrigerator used only for medicine storage, or in a separate and locked storage box in a refrigerator.

Poisonous substances and medications labeled “For external use only” must be stored separately from other medications within the locked storage area.

Healthcare professionals who administer injections, or perform other procedures involving the drawing of blood, must dispose of sharps in appropriate sharps disposal systems or containers, in accordance with O.C.G.A. 31-12-13, and any applicable guidelines issued by the Centers for Disease Control and Prevention, the National Institute of Occupational Safety and Health (NIOSH), the Occupational Safety and Health Act (OSHA), and any other governing rules and regulations (see Sharps Disposal Guidelines in Appendix 302-A).

Medications kept in a central storage area are to be released to discharged clients when the clients or a responsible party have signed a receipt for the medications.

The adult day care program must maintain on site a file on each employee that is available to the Area Agency on Aging staff, DHS DAS staff and any other appropriate state or federal staff who may monitor the program. Programs that are operated from a central office at several branch locations may, with the AAA’s approval, maintain staff files at the central office. However, such files must be made available in a prompt and timely manner for purpose of monitoring or evaluation.

Each file must include at a minimum: the employee’s name, address, and date of birth; educational status; previous work experience and letters of reference; the name, address, telephone number of the person to be notified in an emergency; and any documentation or training, certifications, licensure, etc. At a minimum, emergency contact information for each employee is maintained at each site if primary files are house in a central office.

Letters of Reference – The day care administrator also must obtain three letters of reference or the names of individuals with whom a reference interview can be conducted, including at least one former employer, if any, for each prospective employee. The individuals providing reference information must be knowledgeable of the applicant’s background and qualifications and may not be related by blood or marriage. If the position being recruited is that of the administrator, these requirements accrue to the employing agency

Health Status Check – All employees working directly with participants must have had a health examination within six months prior to beginning work.

The report must certify that the person is in good health, including freedom from communicable disease that are detrimental to the participants, (including tuberculosis), and otherwise fit for employment. The reports must be signed by a licensed physician, physician’s assistant, or registered nurse.

If staff cannot produce evidence of acceptable health status, the administrator may commence, continue, terminate, or reassign employment status, based on an assessment of whether the employee’s work tasks would pose a significant risk to the health of the employee, co-workers, or the public, or whether the employee is unable to perform the normally assigned job duties.

Performance Reviews – The administrator must establish a performance review and evaluation process that will be used by all appropriate supervisory personnel at least annually and following any probationary period.

Position Descriptions – The administrator must assure that for each full time and part time position there is a current, written job description that includes:

It is suggested that the employee sign their position description that indicates understanding of the duties and responsibilities to be performed.

Adult Day/Adult Day Health personnel policy must comply with Department of Community Health Rules Chapter 111-8-1-.14 (see link in MAN 5300 CH 302.27, References).

The administrator must plan for and fill staff positions according to the goals of the program and the manpower needed to develop and direct the activities that meet the program goals.

At least one staff member must be always on the premises participants are present.

In addition to administrative staff there must be a minimum of one direct service staff person for each eight non-severely impaired participants at the day care site.

In addition to administrative staff, there must be a minimum of one direct service staff person present for each four severely impaired participants at the day care site.

The day care program must provide sufficient staff time and staff expertise to implement the program and to develop participant service plans.

The program must document daily staffing patterns through timecards, time sheets, or other appropriate methods used for payroll purposes.

Volunteers who meet the same standards, requirements, and training as employees and who have signed a written job description may be counted as part of the staff-to-client ratio.

Adult Day/Adult Day Health staffing policy must comply with Department of Community Health Rules Chapter 111-8-1-.13 (see link in MAN 5300 CH 302.27, References).

The Program Administrator must have:

Center Director/Program Administrator duties include, but are not limited to:

The Activities Director must have:

Anyone hired prior to July 1, 2015, who has served continuously in the capacity of activities director, may be considered qualified as the activities director.

Activity Director duties include, but are not limited to:

Adult day health programs must always have an RN or LPN present. If the center employs an LPN, the center must ensure that the LPN is supervised by an RN and is available by phone, pager, and/or email when not on site at the center.

A Registered Nurse (RN) must have:

Registered Nurse duties include, but are not limited to:

A Licensed Practical Nurse (LPN) must have:

Licensed Practical Nurse duties include, but are not limited to:

Day Care Assistants must be at least 18 years old, and may also perform the duties of bus drivers, aides, cooks, custodians, porters, housekeepers, and laundry workers.

All assistants who serve as drivers must have a current Georgia operator’s license, which is appropriate for the class of vehicle used to transport clients and must maintain current Adult Cardio-Pulmonary Resuscitation (CPR) certification.

If an assistant prepares or serves food in the facility, they must observe and meet all state and local health requirements for food service sanitation.

Day care assistant duties include, but are not limited to:

The facility may engage the services of additional professional staff provided that associated requirements and responsibilities/duties are documented. Examples include:

All adult day care staff who interact with participants, and volunteers who are included as part of the staff-to-participant ratio, must complete an orientation within the first two weeks of employment. Content must include, but not be limited to:

Within 60 days of employment, all employees who provide care to participants must have received a minimum of 18 hours of training in the following areas, if the areas are relevant to their job responsibilities:

After the first year of employment, all employees who have direct care or program activity responsibilities, including the program administrator, must complete three hours of continuing education quarterly or 12 hours in total annually.

Educational topics must be pertinent to the general job responsibilities of each staff member.

Hours of continuing education may include in-service training, outside workshops, lectures, or training provided through audio/video, or Internet interactive technology.

The trainers must be persons known to have expertise in the topics presented and may include staff members.

The program administrator must assure that appropriate staff maintains current Adult CPR and Basic First Aid certifications.

The grounds, building, and furnishings must be free from litter, clean, and safe, and in good repair.

Waste, trash, and garbage must be removed from the premises at regular intervals, in accordance with state/local practices.

All outside refuse containers must have tight fitting lids which are left in closed position.

Containers must be maintained in clean and serviceable condition.

Floors must be constructed of materials appropriate for the intended use of each room or activity area, maintained in good condition and cleaned regularly. Materials used for flooring and floor coverings must be slip-proof and secured to prevent falls.

Walls and Ceilings must be structurally sound and maintained, clean, repaired, and/or painted when needed.

The rooms and fixtures must be accessible, must function properly, and must be maintained in a sanitary and odor free condition.

At least of one toilet is available for every 15 participants or fraction thereof. If separate toilets for staff and volunteers are not provided, they are included in the count. If urinals are provided, they are counted as one-half toilet.

There must be a minimum of one lavatory for every two toilets, or fraction thereof.

The floor area of each toilet room must measure a minimum of 15 square feet per installed toilet. For each additional plumbing fixture, there will be an additional eight square feet.

Multiple toilet rooms must have individual stalls with doors that can be closed.

All toilets must be equipped with grab bars.

Lavatories must provide hot and cold water, soap, and either warm air dryers or a sanitary source of individual paper towels. Each toilet room must be equipped with waste receptacles which are emptied and cleaned regularly, but not less than weekly.

Exposed lavatory pipes must be covered with an appropriate form and amount of insulating material.

Doors to all toilet rooms must be equipped with locks which can be opened from the outside, in case a participant has trouble and needs staff assistance.

A minimum of one bathing unit must be provided in facilities which aid with personal care and bathing.

The bathing unit must not interfere with the use of restrooms by other participants.

Each tub or shower must be in an individual room or enclosure which provides for the private use of the fixture, for bathing, drying, and dressing.

Tubs/showers for participants use must have non-slip bottoms or floor surfaces, either installed or applied to the surface.

All bathrooms, toilet rooms, and other odor producing rooms, or areas where soiled materials are handled, must be mechanically ventilated to the exterior. Windows may not be the sole source of ventilation.

The facility must make every effort to guard against insects, rodents, and any other condition that would affect a sanitary environment.

A pest control program must be provided by qualified center staff or by contract with a licensed pest control company, using the least toxic and flammable chemicals available.

The facility must maintain documentation of routine pest control work performed.

Each program must develop and maintain a current, written emergency response plan (for each site where services are provided), with procedures for responding to fires; tornadoes and other weather-related emergencies; missing participants; injuries; and other emergencies. The site must:

Fire safety is to be always observed.

The building must have electrical and mechanical systems which are safe and in working order, as evidenced by a fire marshal, city or county building official having jurisdiction, or a report from a registered professional engineer.

The program must maintain written documentation of annual fire safety inspections, as well as any other inspection reports required by local authorities.

The building must be kept in good repair.

Electrical, heating, and cooling systems must be maintained in a safe manner.

Electrical appliances must be used in a manner that prevents overload circuits.

Extension cords more than six feet in length must be secured to prevent falls.

All facilities will comply with all applicable local and state building codes, ordinances, and health department requirements, as well as all federal and state laws, licensure requirements and regulations, to provide a safe environment for clients and staff (see Manual 5300 202 Program Guidelines and Requirements).

Existing buildings – The building must meet all local requirements pertaining to the use of the building as an adult day care facility.

Each program facility must be designed and constructed in such a way that is accessible and functional in meeting the identified needs of the adult population it serves.

Space per participant – Each program must comply with licensure and/or other occupancy requirements based on the number of participants and square footage in the facility.

Furnishings – The facility must provide sufficient furniture and equipment for use by participants, which provide comfort and safety and are appropriate for an adult population with physical limitations, visual and mobility limitations, and cognitive impairments.

Furnishings and equipment are arranged in a manner that does not obstruct exits and movement within the facility.

Lighting – Facilities must be planned and constructed to provide as much natural lighting from windows are possible, using shades, blinds, or draperies to control/prevent glare.