Report Title:

Adult Residential Care Homes; Caregiver Qualifications; Inspections

Description:

Codifies licensing qualifications and personnel, staff, and family requirements for Type I and Type II adult residential care homes (ARCHs)and expanded ARCHs. Strengthens primary caregiver qualifications. Allows unannounced inspections of ARCHs during or outside normal business hours. (SD1)

THE SENATE

S.B. NO.

1061

TWENTY-SECOND LEGISLATURE, 2003

S.D. 1

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, shall:

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

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

(3) Be at least 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 of health;

(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 may include 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 available community services which may be utilized by residents, the primary caregiver, or the 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), shall:

(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 contract 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.

Each individual over eighteen years of age who either resides in or provides care or services to residents in a Type I adult residential care home shall have documented evidence of an initial criminal background check, which shall be submitted to the department with the application for licensure. Anyone moving into the home after the license has been granted shall submit documentation of an initial criminal background check to the department prior to moving in. The department shall determine if an individual's past criminal conviction places the residents at risk, and if so, licensure may be denied or revoked. In making this determination, the department shall consider:

(1) The type of conviction;

(2) The age of the perpetrator at the time of conviction;

(3) The length of time since the conviction; and

(4) Evidence of rehabilitation.

(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, shall be present in the Type I adult residential care home at all times unless the licensee or designated primary caregiver 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, 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 residents' care plans;

(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 of section 321-A(a). The name and qualifications of the substitute caregiver shall be provided to the department before the substitute caregiver begins to provide care.

(h) The primary caregiver shall give advance notice of at least one week, except during emergencies, to residents, the residents' families, legal guardians, surrogates, or responsible persons, and 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. The 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 a resident's condition requires full-time supervision and is addressed in the resident's schedule of activities or care plan.

(i) 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. The primary caregiver shall notify the department of the unavailability of a substitute caregiver prior to the planned absence.

§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, shall:

(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. In addition to the requirements of sections 321-B(a), (b), and (c), an applicant for license to operate a Type II adult residential care home shall comply with the following:

(1) 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;

(2) 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 or fewer residents shall have available an administrator that meets the requirements of sections 321-A(a) and 321-C;

(3) All Type II adult residential care homes with a licensed capacity of more than eight residents shall have a registered nurse on duty twenty-four hours a day to provide nursing management and oversight. Type II adult residential care homes with a licensed capacity of eight or fewer residents shall have a registered nurse available to provide nursing management and oversight;

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

(5) At least one staff member of each shift shall be a nurse aide;

(6) 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); provided that the department shall study whether certified nurse aides are the appropriate persons to make prescribed medications and perform treatments, or whether these services should only be done by a registered nurse;

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

(8) The administrator, primary caregiver, and substitute caregivers shall attend and successfully complete a minimum of six hours of training per year, which may include 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; and

(9) The administrator shall provide to the department, residents, the residents' families, legal guardians, surrogates, or responsible persons, and agencies, a minimum of thirty days written notice in the event of a forthcoming closure so there is sufficient time to transfer residents to another facility.

§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 for Type I expanded adult residential care homes, or section 321-C for Type II expanded adult residential care homes, the applicant for a license shall:

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

(2) Provide sufficient trained staff on duty twenty-four hours a day to meet the needs of expanded adult residential care home residents and to provide care in accordance with the expanded adult residential care home residents' care plans;

(3) Submit a plan 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 to the department 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 shall train and monitor primary and substitute caregivers in providing daily personal and specialized care to residents as needed to implement their care plans; provided that a registered nurse serving as a case manager shall not also be a licensee;

(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 licensed nurse;

(3) The licensee of a Type II expanded adult residential care home shall provide primary caregivers who shall be licensed nurses;

(4) A substitute caregiver who is trained by the primary caregiver with the assistance of a registered nurse or case manager and who meets the requirements in sections 321-B(e), (f), and (g), shall take charge of an expanded adult residential care home during the primary caregiver's absence or inability to perform regular duties; provided that the department shall be notified before the substitute caregiver begins to provide care; and

(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. The department shall conduct unannounced inspections of every licensed adult residential care home and expanded adult residential care home on an annual basis and 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, and the annual inspection 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.