Report Title:

ARCH; Licensing and Staff Requirements; Unannounced Inspections

Description:

Codifies licensing qualifications and personnel, staff, and family requirements for Type I and Type II ARCHs and expanded ARCHs. Allows unannounced inspections of ARCHs during or outside normal business hours.

THE SENATE

S.B. NO.

1061

TWENTY-SECOND LEGISLATURE, 2003

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to adult residential care homes.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Chapter 321, Hawaii Revised Statutes, is amended by adding six new sections to be appropriately designated and to read as follows:

"§321-A Type I adult residential care homes; primary caregiver qualifications. (a) To qualify to receive a Type I adult residential care home license, the applicant, or the individual designated by the applicant to act as the primary caregiver, must:

(1) Be a resident of the State of Hawaii;

(2) Be at least twenty-one years of age;

(3) Be a nurse aide;

(4) Reside in the Type I adult residential care home;

(5) Have completed adult residential care home teaching modules that are approved annually by the department;

(6) Have at least one year experience working full time or its equivalent providing direct nurse aide care as an employee of an intermediate care facility, skilled nursing intermediate care facility, skilled nursing facility, home health agency, or hospital;

(7) Have knowledge of and be able to practice the principles of resident care incorporating the concepts of the social model through family- and community-centered activities and approaches;

(8) Demonstrate to the department sufficient skill in the use of the English language to fully accomplish the objectives of the program and to comply with the requirements of this chapter;

(9) Have achieved acceptable levels of skill and training in first aid, nutrition, cardiopulmonary resuscitation, and appropriate nursing and behavior management as required for care of all residents admitted to the Type I adult residential care home;

(10) Attend and successfully complete a minimum of six hours of training sessions per year, which shall include but not be limited to personal care, infection control, pharmacology, medical and behavioral management of residents, diseases and chronic illnesses, community services, and resources. All in-service training and other educational experiences shall be documented and kept current;

(11) Have knowledge of the availability of community services which may be utilized by the residents, primary caregiver, or licensee; and

(12) If it is deemed necessary by the department, be examined by a physician or mental health professional as a condition for continued licensure. The examination shall be specifically oriented to determine if the primary caregiver is physically or mentally capable of caring for residents.

(b) An applicant for a license for more than one Type I adult residential care home, in addition to the requirements in subsection (a), must:

(1) Establish to the department’s satisfaction that the applicant possesses the skills and abilities to successfully operate multiple facilities;

(2) Maintain an updated, written staffing plan that assures safety and adequate service administration on a twenty-four-hour basis in each facility under all circumstances;

(3) Employ or otherwise engage by contact a qualified primary caregiver in those homes in which the applicant does not reside; and

(4) Have a current history of operating a licensed Type I adult residential care home in compliance with the minimum licensing regulations in the State for one year or more.

§321-B Type I adult residential care homes; personnel, staffing, and family requirements. (a) Each individual who either resides in or provides care or services to residents in a Type I adult residential care home shall have documented evidence that the person has been examined by a physician prior to first contact with residents of a Type I adult residential care home, and thereafter shall be examined by a physician annually. The examination shall be specifically oriented to rule out infectious disease.

(b) Each individual who either resides or provides care or services to residents in a Type I adult residential care home shall have documented evidence of an initial and annual tuberculosis clearance.

(c) Any individual providing services to residents who develops evidence of an infectious disease shall be immediately relieved of any duties relating to food handling or direct resident contact, or both, and shall continue to be relieved of duties until such time as a physician or advanced practice registered nurse certifies it is safe for the individual to resume duties. Undiagnosed skin lesions, respiratory tract symptoms, or diarrhea shall be considered presumptive evidence of having an infectious disease.

(d) The licensee, or individual designated by the licensee to act as the primary caregiver, must be present in the Type I adult residential care home at all times unless either individual has secured a substitute caregiver to provide temporary coverage.

(e) The substitute caregiver who provides coverage for a period of four hours or less shall:

(1) Be at least eighteen years of age;

(2) Have the ability to communicate, and read and write in the English language;

(3) Be currently certified in first aid; and

(4) Be trained by the primary caregiver to make prescribed medications available to residents and properly record administration of medication.

(f) A substitute caregiver who provides coverage for more than four hours, in addition to the requirements specified in subsection (e), shall:

(1) Be currently certified in cardiopulmonary resuscitation;

(2) Be able to provide personal care to residents, including bathing, dressing, transferring, feeding, and transporting residents, and be able to provide care as stipulated in the schedule of activities or care plan;

(3) Have sufficient knowledge and experience in nursing techniques to care for residents, including taking vital signs, observing for medication efficacy and any untoward reactions;

(4) Be able to provide recreational programs as developed; and

(5) Follow planned menus, prepare and serve meals, including special menus and be able to make appropriate substitutions, as required.

(g) The substitute caregiver who provides coverage for longer than one month shall meet the requirements set forth in section 321-A(a).

(h) When the primary caregiver is planning an absence and the licensee is unable to find a substitute caregiver, residents may be temporarily transferred to another facility licensed by the department, including but not limited to an expanded adult residential care home.

(i) The primary caregiver shall give advance notice of at least one week, except during emergencies, to residents and the residents' families, legal guardians, or surrogates, or responsible agencies if the primary caregiver plans to be absent for more than three days. The primary caregiver shall have a written plan, approved by the department, for providing resident care during any absence of the primary caregiver from the Type I adult residential care home. This written plan shall also identify the duties and responsibilities of the substitute caregiver. This subsection shall not apply to the primary caregiver’s short absences for shopping, errands, or other appointments unless the resident's condition requires full-time supervision and is addressed in the resident's schedule of activities or care plan.

§321-C Type II adult residential care homes; primary caregiver qualifications. To qualify to receive a Type II adult residential care home license, the applicant, or the individual designated by the applicant to act as the primary caregiver, in addition to the requirements in section 321-A(a), must:

(1) Have at least two years experience in a management capacity in the areas of housing, health care, and personal care services, or any combination thereof;

(2) Have knowledge of generally acceptable accounting principles;

(3) Have training or experience in supervisory management;

(4) Have knowledge of purchasing of large volumes of food and meal preparation, as appropriate;

(5) Have knowledge of infection control procedures in relation to resident care, personnel, and handling of large volumes of laundry, as appropriate; and

(6) Be accountable for providing training for all facility personnel in the provision of resident care in conjunction with the principles of the social model.

§321-D Type II adult residential care homes; personnel, staffing, and family requirements. (a) Personnel policies shall be developed and maintained providing for staff orientation and in-service training, job descriptions, staff qualifications, job requirements for each class of employees, code of conduct, and other pertinent personnel information.

(b) All Type II adult residential care homes with a licensed capacity of more than eight residents shall have a full-time administrator that meets the requirements of sections 321-A(a) and 321-C. Type II adult residential care homes with a licensed capacity of eight and fewer residents shall have available an administrator that meets the requirements of sections 321-A(a) and 321-C.

(c) All Type II adult residential care homes with a licensed capacity of more than eight residents shall have a full-time registered nurse to provide nursing management and oversight. Type II adult residential care homes with a licensed capacity of eight and fewer residents shall have a registered nurse available to provide nursing management and oversight.

(d) An adequate number of qualified staff, as determined by the department, shall be on duty twenty-four-hours a day.

(e) At least one staff member of each shift shall be a nurse aide.

(f) There shall be available a designated and properly trained person to make prescribed medications and to perform treatments under the general supervision or direction of a licensed nurse or who meets the requirements as set forth in section 321-A(a).

(g) No staff member shall work more than two consecutive eight-hour shifts within a twenty-four-hour period.

(h) The administrator, primary caregiver, and substitute caregivers shall attend and successfully complete a minimum of six hours of training per year which shall include but not be limited to personal care, infection control, pharmacology, medical and behavioral management of residents, diseases and chronic illnesses, community services, and resources. All in-service training and other education experiences shall be documented and kept current.

(i) All in-service training and other educational experiences for employees and primary and substitute caregivers shall be documented and kept current.

§321-E Expanded adult residential care homes; primary caregiver qualifications. To qualify to receive an expanded adult residential care home license, in addition to the requirements in section 321-A(a), the applicant for a license must:

(1) Acting as the primary caregiver, be approved by the department to provide special diets;

(2) Provide staff on duty twenty-four hours of each day sufficient and trained to meet the needs of expanded adult residential care home residents and to carry out the responsibilities based on the expanded adult residential care home resident's care plan;

(3) Submit a plan, which must be approved by the department detailing the process by which the expanded adult residential care home will arrange for the services of a registered nurse and case manager, the role and responsibilities of the registered nurse, case manager, and caregivers, and how training of the primary and substitute caregivers will be ensured;

(4) Submit the name of trained substitute caregivers at the time of application and as changes occur; and

(5) Not be a substitute caregiver for another adult residential care home or expanded adult residential care home.

§321-F Expanded adult residential care homes; personnel and staffing requirements. In addition to the requirements in sections 321-A, 321-B, 321-C, 321-D, and 321-E:

(1) A registered nurse other than the licensee or the individual designated by the licensee to act as the primary caregiver, shall train and monitor primary caregivers and substitutes in providing daily personal and specialized care to residents as needed to implement their care plan;

(2) The licensee of a Type I expanded adult residential care home shall provide a primary caregiver who shall:

(A) Reside in the expanded adult residential care home; and

(B) Be a nurse aide or licensed nurse;

(3) The licensee of a Type II expanded adult residential care home shall provide primary caregivers who shall be nurse aides or licensed nurses but who shall not reside in the expanded adult residential care home;

(4) A substitute caregiver who is trained by the primary caregiver with the assistance of a registered nurse or case manager and meets the requirements in section 321-B, shall take charge of an expanded adult residential care home during an expanded adult residential care home primary caregiver's absence or inability to perform regular duties;

(5) Primary and substitute caregivers shall have documented evidence of successful completion of twelve hours of continuing education courses per year on subjects pertinent to the management of an expanded adult residential care home and care of expanded adult residential care home residents."

SECTION 2. Section 321-15.6, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) All adult residential care homes shall be licensed to ensure the health, safety, and welfare of the individuals placed therein. Every licensed adult residential care home or expanded adult residential care home shall be inspected by the department on an annual basis or at such intervals as determined by the department to determine compliance with licensing requirements. All inspections relating to licensing, including follow-up visits, visits to confirm correction of deficiencies, visits to investigate complaints or suspicion of abuse or neglect, may be conducted unannounced during or outside regular business hours."

SECTION 3. In codifying the new sections added by section 1 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 4. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:

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