e departt rl ornulgated fJy tl ent of and validity of licenses prier law and issued certifications permits by the elder affairs 3le sched fcr latilig upt artntent of de Iowa adminisfrative c de to con espond to administration of clzapier by department of inspections and a peals 407 acts ch 15 G6
criers and
directives
elder affairs under
1 indimgs purpose aaad inteaat 2310 2 T 2310 efanitioms
3 Certi 2310 nof assisted cati
vir programs l g
4 Fire a 2310 ad safety standards 5 Vritter accupancy agreemezat e 2310 uired 6 Iuvalu 2310 transffer atary
7 Complaints 2310 2310 Infornxal review 9 Public diselasnre of di 2310 s a aditianal aperativn 10 Denial suspensian or revocallom eo 2310 11 Notice appeal eauerge 2310 s tflcy provisioa casualties 12 at 2310 tiif a epartme eed I 13 Itetaliatiaffi 2310
Fia purpose and intent gs dan general assembly farads that assisted living 20091awa Code ROM CD 1
is
an
important part
of the
terns long
care
living emphasizes the independence and dignity of the individual ices in acost while previdinb ser effective manner of 2 The purposes establishing an assisted living program include all ofthe following continua in this state Assisted
homelike environment for To encourage the establishment and maintenance of a safe and but who do not individuals of all income levels who require assistance to live independently related care on acontinuoustwenty hour per day basis four require health which b To establish standards for assisted living programs that allow flexibility in design social service focusing an independence individual needs and a
delivery by driven quality of service desires and consumer c To encourage public participation in the development promotes
model of
a
of assisted
programs fox
living
individuals of all income levels a social n7odel for It is the intent of the general assembly that the department promote assisted living programs and a consultative process to assist with compliance by assisted living
3
programs
31 2007 Acts
20x5 Acts ch 60 1 96 Acts ch I I92 I 2003 Acts ch I66 7
ch
215 i60
2 Defanitaous 2310 As used in this
chapter unless the
t contek otherwise
requires
31D defined in section 1 1 Adult day services means adult day services include but are not 2 flssisted Hiring means provision of housing with services which may with instrumental activities of da Iy limited to health related care care and assistance as
ing lit
to
three
personal in a physical
or more tenants
structure which
provides
a
homelike environment
direction and of family involvement tenant self living also zneltxdes encouragement individuality shared tenant participation in decisions that emphasize choice dignity privacy of housing and assistance with risk and independence Assisted living includes the provision f personal care orhealth related care is also included instrumental activities of daily living only i Assisted
Assisted living includes
four twenty
hours per day response staff to meet scheduled and in a manner that promotes maximum dignity and
unpredictable needs provides supervi lion safety and security independence 3 Department means the department of inspections unscheduled
ar
and
and
appeals
or
the
designee 4
ernrnental unit Ga
means
the state
or
any
county
municipality
other
political
other agency of any ofthese entities
subdivision or any department division board or related care means services provided by S Health
registered nurse or a licensed practical provided by other licensed health care
a
part or intermittent basis and services time professionals on apart tine or intermittent basis 6 Instrumental activities of daily living means those activities
nurse
or
s department
on a
that reflect the tenant sability
s needs within the cornsnunity and other tasks necessary to meet the tenant and traveling which may include but are not limited to shopping cooking housekeeping chores to
perform household
2409 Iowa Code ROM CD
within the
community setupr
Ilfedication
7
assistance with various
means
steps
of medication administration to
s autonomy which may include but is not lixz ited to routine prompting cueing support tenant and reminding opening containers or packaging at the direction of the tenant reading a
information or transferring medications from the original container into suitable medication dispensing containers reminder containers ar medication cups 8 occupancy agreement means a written agreement entered into between an assisted living program and a tenant that clearly describes the rights and responsibilities of the assisted living occupancy agreement may program and a tenant and ether information required by rule i n structions or other label
separate signed lease and signed service agreement 9 Personal care means assistance with the essential activities of daily living which may include but are not limited to transferring batl ng personal hygiene dressing grooming and include
a
housekeeping
that
are
essential
to the health and welfare of the tenant
Recognized accrediting entity means a nationally recognized accrediting entity that ng program standards equivalent to department recognizes as having specific assisted li for assisted standards established by the department living programs 10
Tenant
11
assisted
means
an
living
services
through
a
the
certified
living program
Tenant ad ocate
12
individual who receives assisted
the
means
the office of sang term
care
s advocate established in resident
42 section 231 s Tenant
13
legal representative means a person appointed by the court to act
or a person acting pursuant to apower of attorney Acts ch 1192 2 2000 Acts ch 1004 14 22 2003 Acts ch ch 60 3 5 21 2005 Acts ch 179 123 3007 Acts ch 215 161
on
behalf of a
tenant 96
165
19 2003 Sets
ch 366
89
2006 Acts
3 Cer 231C nof assisted living pr aficate Iaas gr murn standards 1 The department shall establish by n11e in accordance with chapter 17A mini
monitoring of assisted living pragrains The department may adopt by reference with amendment nationally recognized standards and rules for assisted living programs The rules shall include specification of recognized accrediting entities and specific programs The standards and rules shall be formulated in entia provisions related to den consultation with affected state agencies and affected industry professional and consumer for certification and or
designed to accomplish
groups shall be limited a
to
rules
without
relating to all
Provisions
of the
to ensure to
treatment
appropriate b Requirements
the purposes of this
application
an
and shall include but
are
not
following
the greatest extent
possible
the health safety and
being well
and
of tenants tha
assisted
living
information necessary to adiniiiister this for
chapter
assisted
living
programs
furnish
chapter
All information related to
program submitted to the
2UD9 Iowa Code ROivt CD 3
the
department
department
with a
specified
provider
shall be considered
a
public c
record pursuant to
Standards for
chapter 22
tenant
evaluation
or
vrith the assessment which may vary in accordance tenant
provided or the status of the criteria teruwaivers for tenants who exceed occupancy d l ravisions for granting short in this state shall be certified by the department If 2 Each assisted living program operating the is voluntarily accredited by a recognized accrediting entity an assisted living program accreditation on the basis of the voluntary department shall certify the assisted living program the department on the basis of voluntary An assisted living program that is certified by fee prescribed iu section shall not be subject to payment of the certilcation
nature of the
services
accreditation
231C but shall i8
be
subject to
an
administrative fee
as
prescribed by
rule An assisted
living
of section 135 63 relating to under this section is exempt from the requirements ed certif program certificate of need requirements the rules assisted living program shall comply with 3 The owner or manager of a certified a A person including governmental adopted by the department for an assisted living program as assisted an living program or to the public unit shall not represent an assisted living program to this unless and until the pragrazn is certified pursuant as a certified assisted living program
chapter 4
staff
certified assisted living program may be provided directly by duals contracting with the assisted living program program by indivi
Services provided by
a
of the assisted
a
living provide services or by individuals employed by the tenant agrees to assume the
relationship
responsibility
to
if the tenant or with whom the tenant contracts
and risk of the
employment
or
the
contractual
under the federal and certified hospice program the assisted living program Medicare program from a Ivledicare itten agreement under which the into a v tlse Medicare certified hospice prograan shall enter responsibility for those sendces hospice program retains professional management of assisted to provide certification and mflnitaring 5 The department may enter into contracts shall 1zving programs The department areas pertaining to all records materials and common a lave fiull access at reasonable times 1 certification monitoring a of services and care to the tenants of program during to the b
and
If
a
tenant is
terminally
provi sian complaint investigations
ill and has elected to receive
of programs
hospice services
seeking certifcafion currently certified
or
alleged
to
he uncertified
sunit b With the consent of the tenant isit the tenant
accreditation for a program provide
providing Require that the recognized accrediting entity to the accreditation monitoring related all materials copies to the department of
and
pFOCSBS
um 17A tuinim
c
6
The
department
may also establish
by
rule in accordance with
chapter
complaint
The riles shall be specific assisted living programs standards for subsidized and dementia and affected industry professional and formulated in consultation unth affected state agencies consumer groups OD9Io Code a ROM Cb 4
7
A department
approve far
not pay of this state ar of any governroentat unit shad gency or offzcer a an actual n for funds any amount to an assisted living progra
payinenf
prospective
from
public
tenant unless the program bolds
a
current certificate issued
by
or or
the department and
requiremeots for certification the conducting or operating of another husiness 8 The department shall adopt rules regarding the assisted living program is distinct part of the physical structure in which in the or activity The rules shall be developed in serves nontenants provided if the business 4r activity and affected industry professional and consumer consultation with affected state agencies
meets all current
groups 9 An assisted
vvith section 1 5033
living program shall comply sessions for personnel responsible for conducting 10 The department shall conduct training of assisted living programs monitoring evaluations and complaint investigations be for two years unless certification is shall 11 Certification of an assisted living program revoked far 46 Acts ch ch 215
162
good
cause
by the department
2603 1192 3
ch 60 6 Acts ch 166 514 2005 Acts
2007 Acts 10 21 2006 Acts ch 1010 72
166
s 4 dire nd saffety staudard 2310 to the in coordination with the department relating The state fire marshal sha11 adopt rules of certified assisted living programs certif cation and monitoring of the fire and safety standards 36 Acts tai
119
97
Acts ch23 21 2003
Acts cb 166
ll2007 Acts ch 215 167
5 rstten ney 2310 eeup agreement required a
in this state unless a written occupancy program shall not operate and is executed between the assisted living program agreement as prescribed in subsection 2 the tenant s occupancy and unless the s legal representative prior to each tenant or the tenant The in accordance with the ternis of the occupancy agreement 1
An assisted
living
assisted living program operates assisted living program shall deliver
to the tenant
ar
s the tenant
legal representati Tea complete
docurneiats and
attachments and shall
agreement and all supporting to the occupancy to arty changes a written copy of changes deliver at least thirty days prior delivered are subsequently made agreement if any changes to the copy originally shall clearly describe the rights and 2 An assisted living program occupancy agreement shall also include but is The occupar cy agreement responsibilities of the tenant and the program or the of the followi T of the agreement in xg information in the bod not limited to inclusion of all copy of the occupancy
supporting
documents and attachments
and basic services covered of all fees charges and rates describing tenancy their related casts and any additional and optional services and structure on third party payments and whether b A statement regarding the impact of the fee are accepted by the assisted living program party payments aad resources third a
A
description
009 a Ia Code
ROM CD 5
of fees
procedure followed for nonpayment for payment d Identification of the party responsible legal representative if any The
c
s of fees and identiflcatian of the tenant
The term of the occupancy agreement s legal tenant shall notify the tenant or the A statement that the assisted living progranl raade in the in writing at least thirty days prior to any change being as
e
f
applicable with the following exceptions occupancy agreement constitutes
representative
s health 1 Whan the tenant safety of the tenant other tenants
status
relocation When
an
emergency
or a
or
ar
behavior
a
substantial threat
others including hen the
to
tenant refuses
scandztion results significant change in the tenant
the health
or
consent
to
to
in tha need for
in the occupancy or level of services included of services that exceed the type provision the assisted livingprogram services cannot be safely provided by to the agreement and the necessary a confidential manner atian shall be maintained in that all tenant inforn statement A b and federal law extent required under state ich ensure a safe wY and transfer criteria and procedures h Occupancy involuntary transfer the
and
orderly transfer
involuntary transfer
appeals process provided relative between the assisted living far addressing grievances j The program s policies and procedures to transfer and occupancy and the tenants including grievances relating program 231 C 13 retaliation as prescribed in section k A statement of the prohibition against Z The emergency response policy anal how staffing will if nurse delegation wi11 be used The staffing policy which specifies rn be adapted to meet changing tenant needs the services acid n 1n dementia specific assisted living to an
i The internal
the life skills programming provided to meet o
The refund policy A statement
regarding milling
and
an
soc
activities of
tenantsof
payment procedures
slegal by each tenant or the tenant in program files from the date be maintained my the assisted living program shall of representative the occupancy aD eement is terminated A copy until three years from the date 3
and related Occupancy agreements
documents executed
of execution
rriost current occupancy agreement and relat request Occupancy agreements and inspection to the department upon request
shall
the
96 Acts chi192
5
2003 Acts ch
trlents shall docu
besmadee available fors site
at reasonable times 215 Acts ch 60 11 21 2007 Acts ch 045 166 5I2
raaasfer b Involuratarl t 231C initiates the involuntary transfer of 1 If an assisted living program not
a
an
result of a monitoring evaluation
or
coruplaint investigation by 2009 Iowa
Code
RON CD b
168
tenant and the action is and if the the a
department
tenant
or
the tenant s
apply a
living
The assisted
carltests the transfer the
legal representative program shad
notify
the tenant
or
iug follov
the tenant s legal
procedure
shall
representative
in
of the need to transfer the reason for the transfer aid accordance vnth the occupancy agreement advocate the contact information of the tenant of the notification the te lant advocate with a copy U The assisted living program shall provide to the tenant
s legal representative notified tenant ar the tenant The tenant advocate shaIl offer the t is not required to accept the The tenara assistance with the program s internal appeals process c
assistance of the tenant advocate the assisted living program upholds the transfer d lf following the internal appeals process authorized by s legal representative may utilize other remedies the tenant or the tenantt
decision law 2
to contest
The
the transfer
department and
professional
in
consultation
consumer
urith affected
state
agencies
and affected
rule in accordance with groups shall establish by
industry
chapter 17Ay
when the transfer of
a
tenant
of an assisted
living
hearing followed including the opportunity the department or complaint investigation conducted by results front a monitoring evaluation ch 2I5 I69 1 i0 2007 Acts ch i66 1 2005 Acts ch b0 12 2I 2000 Acts ch 1222 li I7 20b3 Acts for
to he
procedures
7 oConaplairets 23IC l
Any person with
concerns
regarding
the
operations
or
service
delivery
who files a department The name of the person a complaint ith the program may file or any and any personal identify ng information of the person t complaint with the departxner to discovery confidential and shall not be subject tenant identified in the complaint shall be kept other Haan to a department person 4theT means of legal compulsion for its release
subpoena
ar
employees involved
with the
complaint procedures
shall establish
2 The department accordance with this section 003 Acts ch 166
I4 2007 Acts ch
rmal review 31 Inf l If an assisted living
evaluation
or
complaint
I5
for the
the
received in
complaints
insuff ciencies of
progr contests the regulatory rsz investigation the program shall with the
submit
written
applicable requirement
in support of the
a
or
of the
monitoring
information at
the time of
contesting
within ten vaorking sha11 review the written information submitted u the deparirnent may 7ie information t the conclusion of the re
department
receipt
modify
of
17I
demonstrating that the program was in compliance the monitoring evaluation ar complaint investigation e department far review s to tl regulatory instzfficienci 2 Tlae
eof findings saii 9 Public dascl 3A0 of a monitoring evaluation
investigation
of an assisted
living
complaint Upon completion this to chapter including the conclusion of informal reviewv program by the department pursuant with to compliance by the assisted living program the department sal findings with respect and or
a readily available form shall be made available to the public i requirements for certification the department to an assisted fining pra ram that is obtained by place Other information relating evaluation or from a
monitoring constitute the department s final findings not be made available to the public shall investigation of the assisted living program under this the denial suspension or revocation of a certificate
which does
complaint
not
except in proceedings involving chapter 2003 Acts ch 166
16 2003 Acts
ch
60
14 2 Z 2007 Acts ch 215
82 4 I73 2008 Acts ch i4
Section amended
al 10 Dea 2310
enslon sns
department may deny suspend
1 The
fznds that there has been to
program
chapter
revmcataon
r
or
comply
a
substantial
with this
chapter
or
or or
l na eondatio perataon c
certificate in any case where the department repeated failure on the part of the assisted living
revoke
a
the rules
following reasons conversion ofthe property
for atiy ofthe
or
minimum standards
this adopted under
living program tenant without the s legal representative consent of the tenant svmtten consent or the written tenant of any illegal act in the assisted living Permitting aiding or abetting the commission a
Appropriation
or
of an assisted
program
attempting to obtain or retain information misrepresentation or by submitting false c
Obtaining
or
a
certificate
by fraudulent
means
drugs by the applicant administrator of the assisted living program executive director manager or supervisor the property of a tenant of an assisted living program by e Securing the devise ar bequest of d
Habitual intoxication
or
addiction to the
usa
of
undue influence
2 as defined in section 235B f Founded dependent adult abuse trustee or desi Iated manager board of directors of the member g In the case of any officer who a 3 s or individual greater than s five percent of the program or any stockholder partner interest in an assisted living or having had an ownership equity interest in the program having home health agency residential care adult day services program elder group home
program
2009 Io a Code RdM Cb 8
of in any state which has been closed due to removal termination from or involuntary ar facility Iicensure ar certification program agency or been found to Dave or Medicare programs having participation in either the rriedical assistance to prevent abuse or neglect failed to provide adequate protection or seruices for tenants who is an ficate applicant or aii existing certified owner or operator h In the case of a ceiti is art officer of the entity other than an individual the person is in a position of control or
facilit
licensed
or
nursing facility
entity
and elagages irs any act or omission proscribed by this chapter v or administrative rule f Far any other reason as provided by la 2 issue
The or
department
continue
a
may
an
as
certificate
reasonable conditions within
alternative
to
suspension or revocation conditionally of performance by the assisted living program
denial
upon the reasonable period oftime
dependent
a
as
set
by
the
department
so as
to
permit
full compliance with
fhe progratu pending the program to commence or continue the operation of does not this chapter If the assisted living program this chapter or the rules adapted pursuant to under the the department may anake diligent efforts to comply with the conditions prescribed An assisted living or revoke the certificate gs prescribed by this chapter suspend praceedir one year on a conditional certificate for more than program shall not be operated 2407 Acts ch 215 17 175 2006 ch ch Acts 1030 34 2405 60 IS 21 Acts 2403 Acts ch 166 X27
aerg provisions e appe fficy X denial suspension or revocation of a certificate shall
olLice 11 I C 23 1
The
be effected
by delivering
to the
by personal service a notice setting or revocation shall become forth the particular reasons for such action Such denial suspension unless the applicant ar certificate effective thirty days after the mailing or service of the notice Thich of the department in v holder within such thirty day period requests a hearing in writing
applicant
case
or
certificate holder
by restricted certified
the notice shall be deemed to lie
mail
or
suspended
ith in accordance u
denial suspension oz revocation of a certificate zaiay be appealed rules adapted by the department in accordance with chapter 17 n to the health or safety of tenants of a 3 Uhen the department finds that an immznent danger ists which requires action on an emergency basis the department may assisted living program e the certificate prior to a direct remosrat of all tenants of an assisted living program and suspend 2
The
hearing 2403 Acts ch 166
1 231C The
18 007 Acts
ch
215
176
ep l easualties tafied rtngeratn
department
shall be notified within
four hours by twenty
expeditious
death and any substantial fire
or available of any accident causing substantial injury or other disaster occurring at or near an assisted living program
2403 Acts ch 166
the most
19 007 Acts ch 215 X177
aCode 2009 iota ROM CD 9
ar
means
natural
ng program r onlsy ssisted 1 lia 3 1Zeta 231C An
assisted living program shall
not
hilaited prc
discriminate
retaliate in any way against a tenant who has initiated or participated in any or
employee of the program violates this section i5 this chapter An assisted living program that authorized by proceeding to be rule in accordance vaith chapter 17A to a penalty as established by administrative subject the state treasury grid credited to the general tnlent paid into assessed and collected by the depa s tenant
family
or
an
fund ofthe state 2003 Acts ch 166 30 2006 Acts
ch I010
73 2007 Acts ch 215
178
14 Civil 231C
penalties far the in accordance with chapter 17A civic penalties The department may establish by rule following violations by an assisted living program a an inuninent dangex or alatory requirements which presents 1 Noncomplial cewith any reg tenant ar ph3Tsical harm to a substantial probability of resultant death failure or refusal to comply Fallowing receipt
2
within
a
prescribed
department continued have with regulatory requirements that
of notice from the
time frame
healt safety or security of program tenants a 3 Preventing or interfering with or attempting
a
direct
relationship
to the
in any way any duly authorized ar of the rules adopted in the lawful enforcement of this chapter of the department representative in this subsection Iawfitl el forcexnerrt includes but is not to this chapter As used
impede
to
pursuant limited
to
of an assisted living program in private at any t any tenar notice reasonable hour and without advance of an assisted living program b Examining any relevant records to this or of the rules adapted pursuant of any violation of this chapter e Preserving evidence a
Contacting
or
interviewing
chapter 2003 Arts ch i 66
2I
2005 Acts ch b0
I6 21 2007 Acts
ch
215
certificate is
180
relied
penalties axad injunctive or operating A person establishing conducting managing of al 15 Cpiffiix Z31C
a
179
ach day guilty of a serious misdemeanor l mail of
a
any assisted
living program without
continuing violation
after conviction
violation shall be considered
a
separate
department by certified or operating an iperson establishing conducting managing offense or chargeable offense f restrained by a be temporarily ar permanently a assisted living program without certificate may ztby the state from such activity in an action brou court of competent jurisdiction 1 1 ch or
notice from the
2003 Acts ch 166
22 2005 Acts y
ch
60
17 21 2007 Acts
Cafe a 009 Iav FOM CD
10
215
a tcatga 6 I 1 31 siing assistant and rnedicatiara ide cs x 3 The allow
department nursing
credit toward 2003
cooperation with
in
assistants
or
sustaining the nursing
s assistant
7Acts ch 215 Acts ch 166 X23 20t
An assisted
living
appropriate agencies
medication aides to claiiu worl thin
16A IVgediicatimn setexp Z31 l
ether
program
or
pracednre living program
shall estahlrsh an
assisted
a
tee as
medication aide s certification
18Z
ad st atian a asta admi rag csf medications for medication setup if requested by may provide
a tenant ar
the
such
request the program s legal representative Ifinedication setup is provided following tenant the tenant shall retain responsibility far shall be responsible for the specific task requested and those tasks not requested to be provided
living program or if the assisted ail of tine foilowin g shall apply living program provides for medication setup s legal is delegated to the program by the tenant or tenant a If administration of medications licensed practical a representative the medications shall be administered by registered nurse in or Iowa or by the licensed registered nurse or advanced registered nurse practitioner administration individual to whom such licensed or registered individuals may pxQperly delegate If medications
are
administered
or
stored
by
an
assisted
of medications
b
IVledications other
than those self administered
by
the
tenant
or
provided through
to persons other than medication setup shall be stored in locked storage that is not accessible or ofmedications employees responsible for administration storage n i maintained compliance with label instructions and state c 3vledications shall be labeled and
and federal law A person other than a person authorized to prescribe prescription federal law shall not alter the prescription of a tenant containers e Med zcations shall be stored in their originally received d
dnzgs
under state and
slegal the program at the request of the tenant or tenant f If medication setup is provided by is delegated to the program by the tenant or representative or if nedicatian administration transfer the redications in the s legal representative appropriate staff of the program may tenant e original prescription container to medication dispensing containers s presence from tl tenant reminder containers
or
medication cups in the
occupancy Program assistance with medication administration asspecified medications of shall not requite the program to provide assistance with the storage g
2005 Acts ch
60 18
agreement
1
care the sang la i o iaaatie f risieans 17 C 231C t teri system transafianal pra B a health care facility licensed pursuant to 1 A hospital licensed pursuant to chapter I3 aCode 2009 Tow R01v1 CD ld
to chapter 2311 rrtay operate services n pragra certified pursuant to this chapter if the assisted living program is certified pursuant an assisted living program as a different type of a licensed that facility 2 This chapter shall not be construed to require the facility is represented to the unless of this chapter facility also comply with the requirements
chapter 13SC
or an
adult
day
s a certified assisted living pragraui public a
that complies with the requirements of this chapter shall 3 A certified assisted living program of facility unless the facilii T is or certified as a different type not be required to be licensed of represented to the public as another type facility 1 may provide limited s defined in section 523D 4 A continuing care retirement community a all of services to its independent laving tenants if care services and emergency response
personal the fallowing conditions are met services does not result care services or emergency response a The provision of such personal needs of all tenants of the continuing care in inadequate staff coverage to meet the service retirement b
community
The staff
providing
the
personal
care ar
services is trained emergency response
such to the extent necessary to provide c
The
pexaanal
continuing
care ar
care
services community retirement
documents the
date time and
qualified
or
nature of the
provided only provided in situations which
emergency response services
constitute an urgent ices xesponse ser due to w fareseen circumstances need for immediate action or assistance tenant of a continuing to prohibit an independent living This subsection shall not be construed with a third party for personal care or emergency care retirement community from contracting d
living program certification and related accreditation s certified by the department on the basis of voluntary assisted living program that i the certification fee but shall not be subject to payment of by a recognized accrediting entity rule Fees collected and retained shall be subject to an administrative fee as prescribed by 1
The
department
shall collect assisted
fund of the state
general deposited pursuant to this section shall shall apply to assisted luring and fees related certification 2 The following seven hundred fifty dollars a Far atwo year initial certification be
in the
programs
one thousand dollars b Far atwo yeaz recertification nine hundred dollars c For a blueprint plan review
f ve hundred dollars For an optional preluninary plan review of accreditation one hundred e For accreditation via anational body ch 60 20 21 2607 Acts ch 215 18 2063 Aets ch tf6 25 2005 Acts d
2iJP9 Iowa Code RUM CB 13
twenty dollars five
9 234Co
t dffi en a l pllc xf I n
iform esidel tial landlord A the u Chapter 6 under s i tl programs chapter 203 acts ch
d tenant rh ar ct shall
166 X36
20U9 Eowa Cade ROM CD 13
apply
to assisted
g Iivir
Inspections
IAC 09 23 9
and
Ch
481J Appeals
67
p 1
CHAPTER 67 GENERAL PROVISIONS FOR ELDER GROUP HOMES ASSISTED LIVING PROGRAMS AND ADULT DAY SERVICES
231E 1 67 481 231D 231C Chapters 68 69 and 481
ns The Definiti
following
definitions
apply
to
this
chapter
and
to
70
care tasks bathing dressing grooming eating ofdaily living means the following self transferring toiletuzg and ambulation ebulation means physically and cognitively able to walk without aid of another Ambulatory or ar Activities
person
Applicable requirements means Iowa Code chapters 135C 231B 231C 231D 235B 235E and 562A this chapter and 481 Chapters 68 69 and 70 as applicable and includes any other applicable administrative rules and provisions of the Iowa Code Applicant or cert cate holder means the owner and operator of a program If a program is under an operating agreement both the owner and the operator are the applicant or certificate operated holder If a program is leased the lessee is the applicant or certificate holder Assistance means aid to a tenant who self directs or participates in a task or activity or who retains the mental or physical ability or both to participate in a task or activity Cueing ofthe tenant regarding a particular task or activity shall be construed to mean the tenant has participated in the task or activity Blueprint means copies of all completed drawings schedules and specifications that have been licensed architect or Iowa licensed engineer of record The certified sealed and signed by an Iowa department may allow electronic transfer of blueprints pursuant to policy Dementia mea3ls an illness characterized by multiple cognitive deficits which represent a decline from previous levels of functioning and includes memory impairment and one or more ofthe following cognitive disturbances aphasia apraxia agnosia and disturbance in executive functioning Department means the department of inspections and appeals Director means the director of the department of inspections and appeals making ability leaves the program without Elope means that a tenant who has impaired decision the knowledge or authorization of staff Global Deterioration Scale or GDS means the seven stage scale for assessment of primary dementia Dr degenerative developed by Barry Reisberg Health care professional means a physician physician assistant registered nurse or advanced registered nurse practitioner licensed in Iowa by the respective licensing board related care means services provided by a registered nurse or a licensed practical nurse Health a on time or intermittent basis and services provided by other licensed health care professionals on part related care ucludes nurse time or intermittent basis Health apart delegated assistance means an Human ser ice professional individual with a bachelor s degree in a human service to human social field including but not limited services gerontology work sociology psychology or family science Two years of experience in a human service field may be substituted for up to two years s degree in a human service field of the required education For example an rndividual with an associate and two years of experience in a human service field is ahuman service professional Impaired decision making ability means a lack of capacity to make safe and prudent decisions s one own routine safety as determined by the program manager or nurse or means having a regarding GDS
score
of four
or
above
Instrumental activities
perform
of daily tivirag
means
those activities that reflect the tenant sability
s needs within the household and other tasks necessary to meet the tenant
may include but are not limited to
Medication setup
means
shopping housekeeping chores
assistance with various
steps
and
to
which
community traveling within the community
of medication administration to
support
a
s autonomy which may include but is not limited to routine prompting cueing and reminding tenant opening containers or packaging at the direction of the tenant reading instructions or other label
information or transferring medications from the original containers into suitable medication dispensing containers reminder containers or medication cups
Ch 67
Inspections
2 p
and
481 Appeals
IAC 09 23 9
change in physical dimensions or structure except as physical structure of the program sfacility a an site on evaluation of a means program complaint investigation or a ing Monitor the incident investigation parfonned by department to determine compliance with reported program monitor who a A performs monitoring for the department shall be a registered applicable requirements human service or another nurse professional person with program related expertise assistance means delegated Nurse delegation of tasks or activities by a registered nurse or licensed practical nurse The nurse retains accountability for the delegation process and the decision slicense to delegate A licensed practical nurse is allowed to delegate within the scope of the nurse of c with the a nurse supervision registered subrule 655 5 paragraph 2 6 Nurse delegation means the action of a nurse to direct competent individuals to perform selected nursing tasks in selected situations pursuant to subnxle 655 Sparagraph c The decision of a 2 6 nurse to delegate is based on the delegation process including assessment planning implementation supervision and evaluation of the tenant nursing tasks personnel and the situation The nurse retains accountability for the delegation process and the decision to delegate Licensed practical nurses are allowed to delegate within the scope oftheir license with the supervision of a registered nurse means a written contract entered into between or contractual agreement t Occupancy agreerrrer a program and a tenant that clearly describes the rights and responsibilities of the program and the tenant and other information required by applicable requirements An occupancy agreement may include a separate signed lease and signed service agreement time or intermittent care means licensed nursing services and professional therapies that are Part provided no more than 5 days per week or licensed nursing services and professional therapies that are provided 6 or 7 days per week for a temporary period of time with a predictable end within 21 days or licensed nursing services and professional therapies that do not exceed 28 hours per week or for adult delegated assistance with day services 4 hours per day and are provided in combination with nurse medications or activities of daily living means assistance with the essential activities of daily living which may include but Personal care are not limited to transferring bathing personal hygiene dressing and grooming that are essential to means any addition to or customary maintenance of the
catior7 Mod
incidental to the
the health and welfare of
a tenant
means nurse practitioners clinical nurse specialists and physician assistants Physician the evidence means that the evidence considered and compared with the Preponderance of evidence opposed to it produces the belief in a reasonable mind that the allegations are more likely
extender
true than not true
Prograrrz means one or more of the following as applicable an elder group home as defined in 1and 481 Code section 231B Chapter 68 an assisted living program as defined in Iowa Code 1 and and 481 section 231C 1 Chapter 69 or adult day services as defined in Iowa Code section 231D
Iowa
481 70 Chapter ed professional means a facility plant engineer familiar with the type of program being Qual provided or a licensed plumbing heating cooling or electrical contractor who furnishes regular service to such equipment Recognized accrediting entity means a nationally recognized accrediting entity that the department recognizes as having specific program standards equivalent to the program standards established by the department Regulatory insufficiency means a violation of an applicable requirement Remodeling means a modification of any part of an existing building an addition of a new wing or floor to an existing building or a conversion of an existing building Routine means more often than not or on regular customary basis staking personal resporisibihty for all phases of medication administration means a tenant Self the tenant s except for any component assigned to the program under medication setup and may include use of an automatic pill dispenser
IAC 09 23 9
Inspections
iceplain Se of
means
tenant preferences providers Sign cant change a
67 p 3
the document that defines all selvices necessary to meet the needs and
means a
clinical interventions that have
Substantial compliance
causing
Ch
481 Appeals
whether or not the services
normally resolve itselfwithout
identified
and
major decline
or
are
provided by
improvement
the
program
or
other service
in the tenant s status which does not
related by staff or by implementing standard disease s mental physical or functional health status tenant
further interventions an
impact
means
regulatory insufficiency
a
on
the
level of
poses
no
compliance with applicable requirements such that any greater risk to tenant health or safety than the potential for
minimal harm
Tenant means
services tenant
an
indlvidual who receives services
means
a
participant as
defined in
Tenant advocate means the office of
tlu a program ough Chapter 70 481
term long
care
In the context ofadult
day
sadvocate established in Iowa Code resident
section 231 42
legal represe atative means a person appointed by the court to act on behalf of a tenant slegal acting pursuant to a power of attorney In the context of adult day services tenant representative means a participant slegal representative as defined in 481 Chapter 70 Waiver means action taken by the department that suspends in whole or in part the requirements or provisions of a lvle s Tenant
or a
person
ARC8174B
IAB
23 effective 1 9 09 10
231B Program policies 2 67 481 231D 231C
and procedures including those for incident and procedures must meet the minimum standards set program spolicies by applicable requirements The program shall follow the policies and procedures established by a program All programs shall have policies and procedures related to the reporting of incldents including allegations of dependent adult abuse 1 The program 2 67 s policies and procedures on incident reports at a minimum shall include the following a The program shall have available incident report forms for use by program staff b An incident report shall he in detail and shall be provided on an incident report form The person in charge at the time ofthe incident shall prepare and sign the report c d The incident report shall include statements from individuals if any who witnessed the reports
A
incident e
All accidents or unusual
affect tenants shall be
occurrences
within the program s
2 67
The
building
or on
the
premises
that
incidents
reported A copy of the completed incident report f minimum of three years as
spolicies program
and
shall be
kept
on
file on the
spremises program
for
a
procedures on allegations of dependent adult abuse shall be adopted pursuant to that chapter and at a minimum
consistent with Iowa Code chapter 235E and rules shall include a
b
Reporting requirements for staff and employees and Requirements that the victim and alleged abuser be separated
ARC 81748 IAB 9 23109 effective l 10
231C 2 3 67 481 231D 31B Tenant rights All tenants have the following rights 1 To be treated with consideration respect and full recogmtion of personal dignity 3 67
and
autonomy
2 3 67 67 3
To receive care treatment and services which are
adequate
and
appropriate
To receive respect and privacy In the tenant smedical care program Personal and medical records shall be confidential and the written consent of the tenant shall be obtained for the records release to any a
s transfer to individual including family members except as needed m case of the tenant facillty or as required by law or a third parry payment contract 67 To be free from mental and physical abuse 4 3 5 To receive from the manager and staff of the program a reasonable response to all requests 3 67
health care
Ch 67
Inspections
4 p
and
IAC 09 23 9
48I Appeals
and
the
groups of 67 To associate and communicate privately and without restriction with persons 6 3 s initiative or on the initiative of the s choice including the tenant advocate on the tenant tenant
persons
or
groups at any reasonable hour has
been sown financial affairs unless a tenant s legal representative 67 To manage the tenant 7 3 s financial affairs tenant for the the of purpose appointed managing 8 To present grievances and recommend changes in program policies and services personally 3 67 to the or sstaff or person in charge without program through other persons or in combination with others fear of reprisal restraint interference coercion or discrimination 23 effective 7 9 ARC 8174B IAB 09 10 1
n to the department 231C 2 4 67 481 231D 31B Program notificati the next business day by designee shall be notified within 24 hours or
The director the most
or the
s director
expeditious means
available
1 Ofany accident causing major injury For the purposes ofthis rule major 4 67 mean
a
a
injury
shall also
substantial
injury Major injury shall be
1 2 3
Results in death
2 3
Spontaneous fractures
defined as any
injury which
or
for
observation or Requires admission to a higher level of care for treatment other than the of the physician or physician attending physician designee Requires consultation with the extender who determines in writing on a form designated by department that an injury is a major the the accident previous functional ability of the tenant and injury based upon the circumstances of the tenant s prognosis b The following are not reportable accidents the program nor its employees have culpability 1 An ambulatory tenant who falls when neither the tenant a sustains major injury or related to the fall even if or
Hairline fractures
67 When damage to the program is caused by a natural or other disaster 2 4 when a program has knowledge 3 When there is an act that causes major injury to a tenant or 4 67 that results in any physical injury tenant of tenant on another of a pattern acts committed by the same times within a 34 means two or more day period For the purposes of this subrule pattern a 4 When tenant elopes from a program 67 5 When a tenant attempts suicide regardless of injury 4 67 6 When a fire occurs in a program and the fire requires the notification of emergency services 4 67 a tenant requires full or partial evacuation ofthe program or causes physical injury to alarm or fire a failure occurs in the fire sprinkler system for more than 4 7 When defect or 4 67 is in addition to the a hours in 24 hour period This reporting requirement requirement to notify the state fire marshal but not NOTE Additional reporting requirements are created by other rules and statutes including of adult abuse and which to Iowa 235B dependent limited Code chapters 235E require reporting
ARC 8174B IAB 9 09 2 3 effective 1 101
231C 2 5 67 481 231D 31B Medications policy which shall include the following
Each program shall follow its own written medication
administering medications 67 The program shall not prohibit a tenant from self 1 5 administer self medications unless A tenant shall 2 5 67 a The tenant or the tenant slegal representative delegates in the occupancy agreement service b c
or
signed
portion of medication setup to the program plan The tenant delegates medication setup to someone other than the program control of medication setup at the direction of the tenant The The assumes any
program
partial
sregistered nurse deems by the program unless the program plan it appropriate under applicable requirements including those in 655 Chapter 6 governing nurse sregistered nurse must agree to the medication plan delegation The program medication
shall not be implemented
Inspections
23 9 IAC 09
and
Ch 67 p 5
481 Appeals
s s possession unless the tenant or the tenant 67 A tenant shall keep medications in the tenant 3 5 if applicable delegates in the occupaa or service icy agreement signed plan partial legal representative service plan shall include the tenant s choice or complete control ofmedications to the program The
related to storage administration to the program the program a tenant has delegated medication selfmedications the tenant list of the tenant smedications If the tenant administers
67 When 4 5 shall maintain
a
list of medications in the s tenant apartment or to disclose a current list of for the of medications to the program emergency response Ifthe tenant discloses a medication purpose of the to the in case an tenant remains responsible for the accuracy of the list list emergency program is When medication setup 5 67 delegated to the program by the tenant staff via nurse delegation from the transfer medications may original prescription containers or unit dosing into medication may choose to maintain
reminder boxes
or
a
medication cups are administered
traditionally by the program provided by a registered nurse licensed practical nurse nurse or advanced registered practitioner registered in Iowa or by unlicensed assistive personnel in in accordance with requirements Chapter 6 governing nurse delegation 655 be b shall in Medications kept a locked place or container that is not accessible to persons other than employees responsible for the administration or storage of such medications 6 When medications 5 67 a
The administration of medications shall be
c
The program shall maintain
a
list of each tenant s medications and document the medications
administered
67 Narcotics protocol shall be 7 5
determined
by the program sregistered
nurse
9 3109 effective 1 ARC 8X74B IAB 2 lOJ
gram 231C 2 6 67 481 231D 31B Another business or activity located in a pr other than tenants of a program is allowed in a A business or serving 1 6 67 activity persons designated part of the physical structure in which the program is located if the other business or activity meets the requirements of applicable state and federal codes administrative rules and federal regulations 2 A business or activity conducted in the designated part of the physical structure in which the 6 67 with services provided program is located shall not interfere with the use of the program by tenants or to tenants
or
disturb tenants
business or activity conducted in thedesignated part of the physical structure in which the located shall not reduce access space services or staff available to tenants or necessary to is program
3 6 67
A
meet the needs of tenants ARC 8174B IAB 09 23 effective Ul 9 lOJ
aiver of criteria for retention of a tenant in the program 231C 2 7 67 481 231D 31D V4 waiver limited 1 Time 7 67 srequest for aiver of the criteria for Upon receipt of a program waiver of the criteria under applicable requirements retention of a tenant the depar a trnent may grant for atime basis Absent limited extenuating circumstances a waiver of the criteria for retention of a is limited of six months or less to a period tenant aiver petition procedures The following procedures 67 T 2 7 a approval of waiver from criteria for the retention of a tenant a
A program
shall submit the waiver request on a form and m a manner designated by as it becomes apparent that a tenant exceeds retention criteria pursuant to
department as soon evaluation by a health b
The
shall be used to request and to receive
care or
department
shall
human service
respond
in
c
changes
an
professional
writing
to
a
waiver request within 15
working days
required documentation In consultation with the program the department may take 15 working days to report its determination regarding the waiver request
of all
the
an
of
receipt
additional
The program shall provide to the department within 5 working days wntten notification of any in the condition ofthe tenant as described in the approved waiver request
Ch 67
Inspections
6 p
IAC 09 23 9
and Appeals 481
addition to the following factors maybe demonstrative m
3 Factors for corzsideratiora for waiver of criteria for retention of a 7 67 criteria established in Iawa Code subsection
2 9A 17A
In t aa ter
whether the criteria for issuance of a waiver have been met
determining
It is the informed choice of the tenant
a
the
in the program b The program as able to
or
the tenant slegal representative if applicable to remain
provide the staff necessary
s service needs in addition to meet the tenant
to the service needs of the other tenants
The
c
department
shall
only
issue
a
waiver if the waiver will not
jeopardize
the
health safety
welfare of the tenant program staff or other tenants and security The tenant has been diagnosed with a terminal illness and has been admitted to hospice and the d less than six months A tenant exceeds the criteria for retention and admission for a temporary period of or
terminal diagnosis means the tenant is within six months of the end of life 4 Conditional waiver A conditional waiver maybe granted contingent upon the 7 67
receipt
of additional information
a
or
performance
s department
of monitoring
If a waiver has been in effect for six months
a
moiitoring
shall be conducted to determine
whether the tenant meets the criteria to continue on a waiver b
The
department
may seek
additianal information during
the
period
to determine if a
waiver
should be granted 23 effective 1 9 101 ARC 8174B IAB 09
231B All 8 67 481 231D 231C retention of
a
tenant in
a
other waiver
requests Waiver requests relating
be filed in accordance with program shall
Chapter 481
to
topics
other than
6
101 23 effective 1 9 ARC 8174B IAB 09
231C 2 9 67 481 231D 31B Staffing 1 A sufficient number of trained 9 67
staff shall be available at all times
to
fully
meet
tenants
identified needs and emergency procedures implement the accident fire safety 33a prospective employee of a program shall have 3 Pursuant to Iowa Code section 135C 9 67 abuse check performed before the a criminal history check dependent adult abuse check and child has a criminal history or an abuse history prospective employee begins work Ifa prospective employee the prospective employee shall not be employed by the program unless the department ofhuman services has performed an evaluation and determined that the record does not warrant the employment prohibition Proof ofthe preemployment background check shall be maintained in the program semployee file The 33 and administrative rules adopted must meet all requirements of Iowa Code section 135C All staff shall be able to
2 9 67
program pursuant
Iowa Code section 135C 33
to
and shall maintain documentation 67 The program shall have training and staffing plans on file 4 9 of training received by program staff Iowa Code chapter 152 and 5 Any nursing services shall be provided in accordance with 9 67 Chapter 6 655 fact guardian conservator or in 6 A staff member shall not be designated as attonley 9 67 to the tenant by blood marriage representative payee for a tenant unless the staff member is related or
adoption
ARC 8174B
IA
23 effective 1 9 09 101
231D Monitoring Z31C 231B 17A 10 67 481
plans
of
correction
and
requests
for
reconsideration certified program at least once 67 Frequency of monitoring The department hall monitor a 1 10 scertification period during the program ofthe program deemed 2 Accessibility of records andprobamareas All records and areas 10 67 certification shall be accessible the for with applicable requirements necessary to determine compliance of to the department for purposes monitoring
Ch
Inspections and Appeals 481
IAC 9123109
67 p 7
3 Standard for deter 10 67 zcy exists The department shall g whether a regulatory insufficie ai zi
apreponderance standard when determiiing whether a regulatory insufficiency evidence the of exists evidence standard does not require that the monitor shall have the of Apreponderance personally witnessed the alleged violation 4 aary 10 67 eliTni report When a regulatory insufficiency is found a preliminary report detailing P the insufficiency shall be sent by the department to the program within 20 working days The department shall send the report by certified mail 5 Plait of correction Within 10 working days following receipt of the preliminary report the 10 67 program shall submit a plan of correction to the department a tsof plan The plan of correction shall include elements detailing how the program te Co will correct each regulatory insufficiency what measures will be taken to ensure the problem does not recur how the program plans to monitor performance to ensure compliance and any other required use
information b The
Review
The
ofplan
department
shall review the
working days
revisions to the
may request additional information or suggest of correction has been received the department shall issue
department
plan
of correction within 10
plan
plan Once an acceptable a final report within l0 working days
and shall determine whether any enforcement action related to the
scontinued program
certification is
necessary reconsideration Within
6 Reguest for 10 67 report
10
working days
the program may submit a request for reconsideration in response
Regardless
receiving the preliminary to a regulatory insufficiency
of
ofwhether a request for reconsideration is submitted a plan of correction must be submitted request may include additional information to support the request for reconsideration
a
The
b
The
department
determine whether
to
shall review the request for reconsideration and additional information and
withdraw
or
modify the regulatory insufficiency
shall accept a request for reconsideration if the additional iiformation submitted by the program shows by a preponderance of the evidence that the regulatory insufficiency did not exist at the time ofthe monitonng c
The
d
The
department
sdecision regarding department
report 7 Final report 10 67
The
a
issued
final report
reconsideration have been considered may be
procedures
m
request for reconsideration shall be reflected in the final after
appealed
the plan
of correction
in accordance with the
rule 481 231D The 231C 231B 17A 13 67
department
shall
and
request for sappeal depaiment issue
a
final report
whether or not any
regulatory insufficiency is found The department may conduct a monitoring revisit to ensure that the plan ofcorrection has been implemented and the regulatory insufficiency has been corrected A monitoring revisit by the department shall review the program prospectively from the date of the plan of correction to determine compliance regardmg monitoring 8 Motaitorir 10 67 grevisit a
ARC 81748 IAB 09 23 effective 1 9 101
231D Complaint 231C 2318 11 67 481
and
regorted program
incident
report investigation
procedure 67 Conaplai 1 11 ts The process for filing a complaint is as follows Any person with concerns regarding the operation or service delivery of a program may le a complaint with the Department of Inspections and Appeals Complaints Unit Lucas State Office 0083 by use of the complaint Building Third Floor 321 E 12tH Street Des Moines Iowa 50319 hotline 686 877 by facsimile sent to 515 1 0027 7106 or through the Web site address 281 a
do Home DIA HFD ov iowa hfd dia https b
complaint is outside the department sauthority the department shall to the complainant appropriate investigatory entity c The complainant shall include as much of the following information as possible iii the complaint the complainant sname address and telephone number the complainant srelationship to the program or tenant and the reason for the complaint The coniplamant sname shall be confidential When the
nature
the complaint forward
or
of the
refer the
Ch 67
Inspections
8 p
mformatron and shall not be released by the
and
IAC 09 23 9
481 Appeals
department
The
department
shall act on anonymous
Iarass the program If complaints unless the department determines that the complaint is intended to l the department upon preliminary review determines that the complaint is intended as harassment or is without reasonable basis the department may dismiss the complaint 2 Progrmn 11 67 reported irzcidefat reports When the program is
requirements
to
report
an
incident the program shall
The Web based reporting tool accessible from the
a
required pursuant to applicable the department via iowa hfd dia Internet site https following
make the
report to
DIA HFD gov dounder the Complaints tab Home
sending the complaint to the Department of Inspections and Appeals Complaints Unit 0083 Building Third Floor 321 E 12th Street Des Moines Iowa 50319 c The complaint hotline 686 77or 1 0027 d Facsimile sent to S1S 7106 281 eported incident reports Upon 3 Zime fi 11 67 ames for investigation of complaints or programer made in accordance with this rule the a incident of or reported program report receipt complaint department shall conduct a preliminary review of the complaint or report to determine if a potential regulatory insufficiency has occurred If a potential regulatory insufficiency exists the department shall institute a monitoring of the program within 20 working days unless there is the possibility of immediate danger in which case the department shall institute a monitoring of the program within 2 working days of receipt of the complaint or incident report 4 Standard for determining whether a complaint is substantiated The departrttent shall 11 67 evidence standard in determining whether or not a complaint or the of apply apreponderance reported incident report is substantiated program if 5 Notification ofprogram and complainant The department shall notify the program and 11 67 and The department known the complainant ofthe final report regarding the complaint investigation the program shall follow the procedures outlined in subrules 67 2 through 67 10 7 10 6 Notification of accrediting entity In addition for any credible report of alleged improper 11 67 the department shall notify the or inappropriate conduct or conditions within an accredited program accrediting entity by the most expeditious means possible of any actions taken by the department with b
Mail by
Lucas State Office
respect to certification enforcement 7 Not cation ofcomplainant when complaint not investigated The department shall notify 11 67 The reasons for not the complainant if known if the department does not investigate a complaint
investigating the complaint
shall be included in the notification
23 9 ARC 81748 IAB 09effective 10 I 1
481 Enforcement action In all cases if a regulatory insufficiency has 231D 231C 231S 17A 12 67 been identified the program shall comply with the plan ofcorrection requirements in subrule 67 5 10 In addition the department may take enforcement actions pursuant to this rule as a result of the program s noncompliance with applicable requirements 1 Types of enforcement action The department 12 67 senforcement action may include denial or revocation of a certification issuance of a conditional certification and the placement suspension of conditions upon a certificate such as requiring additional training restriction of the program from accepting additional tenants for a period of tinge or any other action or combination ofactions deemed appropriate by the department 2 Conditional cert 12 67 cation In lieu of denial suspension or revocation of a certificate the a certification for a period of up to one year A conditional certificate issue conditional department may shall be issued only when regulatory insufficiencies pose no greater risk to tenant health or safety than the potential for causing minimal harm a The department shall specify the regulatory insufficiency in the notice ofenforcement action b The department shall notify the tenant advocate when a conditional certificate is issued and when
a
conditional certification is lifted
During the period of a conditional certification the department verify compliance prior to making the final certification decision c
shall conduct
a
monitoring
to
23 9 LAIC 09
d
The
e
Failure
Inspections
and
481 Appeais
Ch
67 p 9
231D 231C 231B 17A 10 67 department shall issue reports pursuant to rule 481 by the program to adhere to the plait of correction may result iii suspension or revocation ofthe conditional certification and may result in further enforcement action as available under applicable requirements A program must be insubstantial compliance with applicable requirements before the removal f of a conditional certificate by the department Once the program is in substantial compliance with applicable requirements the department shall lift the conditional certificate 3 Civil pe 12 67 alties YVliert civilpe a aalties na ay be issued Civil penalties may be issued when the director finds that the has occurred any of following 1 Noncompliance results m imminent danger or substantial probability of resultant death or physical harm A program that is in noncompliance with applicable requirements and the noncompliance results in imminent danger or a substantial probability ofresultant death or physical harm to a tenant may be assessed a civil penalty of not more than 10 000 2 A program has failed to comply and the noncompliance has a direct relationship to the health safety or security of tenants Following receipt of a final report from the department a program which continues to fail or refuses to comply with applicable requirements within prescribed time frames established by the department or approved by the department vz the program s plan of correction and the noncompliance has a direct relationship to the health safety or security of tenants may be assessed a civil 000 penalty of not more than 5 3 The program prevents or interferes with enforcement A program that prevents interferes with or attempts to impede in any way any duly authorized representative of the department in the lawful enforcement of applicable requirements may be assessed a civil penalty of not more than 1 000 b Factors in determin zt g the amou i of a civil penalty The department shall consider the following factors when determining the amount of a civil penalty 1 The frequency and length of time the regulatory insufficiency occurred i e whether the regulatory insufficiency was an isolated or a widespread occurrence practice or condition 2 The past history of the pragram as it relates to the nature of the regulatory insufficiency the department shall not consider more than the current certification period and the immediate previous certification period 3 The culpability ofthe program as it relates to the reasons the regulatory insufficiency occurred 4 The extent of any halm to the tenants or the effect on the health safety or security of the tenants which resulted from the regulatory insufficiency 5 The relationship of the regulatory insufficiency to any other types of regulatory insufficiencies which have occurred in the program The actions of the program after the occurrence of the
6
regulatory insufficiency including
when
corrective measures if any were implemented and whether the program notified the director as required 7 The accuracy and extent of records kept by the program which relate to the regulatory
insufficiency acid the availability of such records to the department 8 The rights of tenants to make informed decisions s specific 9 Whether the program made agood faith effort to address ahigh risktenant
needs and
whether the evidence substantiates this effort Civil
c
department
The program d
penalties
due The department may
within 30
days following may appeal the decision
Automatic reduction
the
assess
s receipt program
a
civil
penalty
which shall be
paid
to the
of the final notice of the enforcement action
in accordance with rule 481 67 13 231D 231C 231B 17A
of civil penalty
aely ifpaid ti
and
hearil is requested or regaeest foY g g earir la penalty does not request a formal hearing rule to pursuant 231Dor has withdrawn the request for a formal hearing 231C 231B 17A 13 67 481 within 30 days of the notice or service and the civil penalty is paid within 30 days of receipt of notice or service the amount of the civil penalty shall be reduced by 35 percent The notice of civil penalty shall is withdrawn If a program has been assessed a civil
include
a
statement to this effect
o
Ch 67 p 10
Inspections
and
23109 IAC 9
481 Appeals
Suspension of civilpenalty pending Jzearirzg Ifthe program appeals the civil penalty the civil accordance with lvle penalty shall be deemed suspended until a final agency decision is reached in 10 231Dand 481 23IC 231B I7A 13 67 481 Chapter f Duplicate penalties prohibited The department shall not impose duplicate civil penalties on a e
program
for the same set of facts and circumstances
4 12 67
bnmediate
suspension of certificate
When the
department
finds that
an
imminent
danger
the safety of tenants of a program exists which requires action on an emergency basis the the certificate or of all tenants from and program suspend require may direct removal
to the health or
department
safety ofthe program stenants prior to a hearing action When the department finds that an imminent 5 bnmediate imposition of erzforce 12 67 zzent the of tenants exists which health or safety requires action on an emergency basis the danger to and accompanying conditions upon the conditional certificate department may immediately impose a removal ofthe tenants from the program of the certificate and program in lieu of immediate suspension and be the that health would still if tenants safety protected The program may request department finds the mzlnediate enforcement action rule on a hearing pursuant to 231D 231C 231B 17A 13 67 481 but the immediate enforcement action remains in effect regardless of the request for hearing additional remedies to
ensure
the ongoing
jARC 8174 LAB 9 23109 effective 1 101
481 Notice hearings and appeals 231D 231C 231B 17A 13 67 1 Effective date and status of enforcement action if a hearing 13 67
requested An enforcement by delivery of a notice of enforcement action setting forth the particular reasons for such action to the applicant or certificate holder by restricted certified mail return receipt requested or by personal service The enforcement the applicant or action shall become effective 30 days after the mailing or service ofthe notice unless certificate holder within such 30 day period gives the department written notice requesting a hearing enforcement action has in which case the notice shall be deemed to be suspended If however an 4 or 67 12 5 the enforcement action 12 been implemented immediately in accordance with subrule 67 action described in rule
is
231D shall be effected 231C 231B 17A 12 67 481
regardless of a request for hearing 2 Final report containing a finding ofa regulatory insufficiency 13 67
remains in effect
to rule
shall be delivered to the
231D 231C 231B 17A 10 67 481
A final
applicant
report issued pursuant
or
certificate holder
service
If a regulatory restricted certified mail return receipt requested or by personal is noted the final report shall include particular reasons for the finding that a regulatory
by insufficiency insufficiency
exists
by the administrative hearings division of the department Chapter I0 pursuant to Iowa Code chapter 17A and 481 time or prior to a hearing the department may rescind or modify the notice At during 4 13 67 any 3Hearings shall 13 67
481 Emergency removal of tenants Ifthe department determines that 231D 231C 17A 15 67 health or safety of tenants is in jeopardy and the tenants need to be removed from the program transfer department shall use the following procedures to ensure a safe and orderly human services the tenant advocate of shall the The 1 15 67 notify department department appropriate area agency on aging and other agencies as necessary and appropriate from a program alternative programs or other appropriate
a
To alert them to ltle need to transfer tenants
b
To request assistance in
identifying
settings
and
the the
the
ppeals A Inspections and 481
IAC 09 23 9
c
To contact the tenants auld their
others
legal representatives
or
Ch
family members
l 67 p l
if applicable and
health care professionals
as appropriate including 67 The department shall notify the program of the immediate need to transfer tenants and of 2 15 any assistance available in coordination with the appropriate parties under subrule 67 1 15 3 The department in conjunction with other agencies as necessary and appropriate shall 15 67
proceed with
the transfer of tenants 09 2 3 effective 1 IOJ ARC 8174B L4B 9
481 Nursing assistant work credit 231C 16 67 1 A person who is certified as a nursing assistant including a medication aide and who 16 67 is supervised by a registered nurse may submit information to the department to obtain credit toward maintaining certification for working in a program A program may add an employee to the duect care worker registry by calling 515 4077 or by registering through the Health facilities division Web site 281 at
diaHFD l https DIA ov iowa hfd dounder the Documents Home A
tab
67 2 16 program complete department a direct care worker for A registered each certified assistant who works In the program registry application nursung the nurse employed by the program shall The assistant supervise nursing application may the be obtained by telephone at 515 or via health facilities division Web site at 4077 281 the under Documents tab do Home dia HFD s htt DIA ov iowa hfd 3 A program shall complete and submit to the department a direct care worker registry 16 67 quarterly employment report whenever a change in the employment of a certified nursing assistant occurs The report form nay be obtained by telephone at 515 4077 or via the health facilities 281 division Web site
shall
at
and
submit to
the
DIA HFD ov iowa hfd dia hops dounder Home
the Documents tab
ARC 8174 IAB 9 23109 effective 1 lOJ
rmation 481 Public or confidential inf 231D 231C 231B 17 67 1 Public information 17 67 a Public disclosure of findings The program shall post a
stating that copies of department Web site at s doThe program shall post the notice in a prominent location govlpIA HFDJHome iowa hfd dia hops on the premises of the program Copies shall also be available upon request from the Department of Inspections and Appeals Adult Services Bureau Lucas State Office Building 321 E 12th Street Des Moines Iowa 50319 0083 telephone 515 6325 281 b Operz records The following records are open records available for inspection 1 Certification applications certification status and accompalrying materials 2 Final findings of state monitorings Including a monitoring that results from a complaint or reported Incident program 3 Reports from the state fire marshal 4 Plans of coizection submitted by a program S Official notices ofcertification sanctions including enforcement actions the
2 Confidential information Confidential information includes the following 17 67 Information that does not comprise a final report resulting from a monitoring complaint a investigation or program reported incident investigation Information which does not comprise a final be report may made public in a legal proceeding concerning a denial suspension or revocation of certification b
Names ofall
c
Names of tenants of
complainants a program
appointing a legal representative
identifying
medical information
and the address of anyone other than
copies
an owner or
of documentation
operator and
Ch 67
d
Inspections
12 p
Social
security
numbers
or
employer
and
IAC 09 23 9
481 Appeals
identification numbers
EIN
67Redaction of confidential information If a record normally open for inspection contains 3 7 J confidential information the confidential information shall be redacted before the records are provided for inspection ARC 8174B
AB 09 J 23effective 9
10 1
2318 rI 8 1 67 481 231D 231C ainfirag related irreversible derraentia Effective July 1 2010 or Iowa Code section
62whichever is later 231
in administrative rule
to
implement
to
sdisease and sisniiar forards f Alzheimer
when administrative rules
all programs shall
comply
Iowa Code section 231 62 for
are
adopted pursuant
s disease Alzheimer
and
dementia
education ARC 174B IAB 09 23 effective 1 9 10
These rules
are
Filed ARC
implement Iowa Code chapters 231 B 231 C acid 231 D 23 effective 1 9 10 17 IAB 09 6 Notice ARC 7877B IAB 09
intended to 8174B
to
with the requirements set forth
IAC 09 23 9
Inspections
and
Ch
481 Appeals
69 p l
CHAPTER 69 ASSISTED LIVING PROGRAMS
481 2 1 69 310 Definitions In addition 231 C the following definitions apply Accredited
to the definitions in
Chapter 481
67 and Iowa Code chapter
that the program has received accreditation from
means
accreditation entity
an
in subrule
1 14 69 recognized means Iowa Code chapter 2310 this chapter and 481 Chapter 67 and Applicable reguirenzents the Code other administrative rules and of Iowa includes any applicable provisions Assisted living or rograrn means provision ofhousing with services which may include but are not limited tohealth related care personal care and assistance with instrumental activities of daily living to three or more tenants in hich provides a homelike environment Assisted living aphysical structure v also includes encouragement of family involvement tenant self direction and tenant participation in decisions that emphasize choice dignity privacy individuality shared risk and independence Assisted living includes the provision of housing and assistance with instrumental activities of daily living only if related care is also included Assisted living includes 24 hours per day response personal care orhealth staff to meet scheduled and unscheduled or unpredictable needs in a manner that promotes maximum dignity and independence and provides supervision safety and security CARE
means
Cognitive
the Commission on Accreditation ofRehabilitation
disorder
means
a disorder characterized
by cognitive dysfunction presumed
result ofillness that does not meet the criteria for dementia delirium
Dementia assisted living program means speck chapter that 1
Serves fewer than 55 tenants and has 5
and 7 on the Global Deterioration 2 4 and 7
Serves SS on
or more
Scale
or
more
Facilities
an
assisted
or
to be the
armlestic disorder
living program
certified under this
tenants who have dementia between
Stages
4
or
tenants and 10 percent or more of the tenants have dementia between
the Global Deterioration Scale
Stages
or
Holds itself out as providing specialized 3 disease in a dedicated setting
caxe
for persons with
dementia
such
as
s Alzheimer
Dwelling unit means an apartment group of rooms or single room which is occupied as separate living quarters or ifvacant is intended for occupancy as separate living quarters in which a tenant can live and sleep sepazately from any other persons in the building and which has direct access from the outside of the building or through a common hall In the
proximate
area means located within
alassistance with actil Maxi es ofdaily itr
performance
of a minimum of four activities of
a
five minutes
or
less response time
means routine total
Ziving daily living for
dependence
on
staff for the
exceeds 21
that period days Medically unstable means that a tenant has a condition or conditions 1 Indicating physiological frailty as determined by the program s staff in consultation with a physician or physician extender 2 month period Resulting in three or more significant hospitalizations within a consecutive three for more than 3
observation
a
and
Requiring frequent supervision of the tenant for more than 21 days by a registered nurse example a tenant who has a condition such as congestive heart failure which results in three or more significant hospitalizations during a quarter and which requires that the tenant receive frequent supervision may be considered medically unstable Nonaceredited means that the program has been certified under the provisions of this chapter but has not received accreditation from an accreditation entity recognized in subrule 69 14 1 Unmanageable incontinence means a condition that requires staff provision of total care for an incontinent tenant who lacks the ability to assist in bladder or bowel continence care For
Ch
IAC 09 23 9
Inspections and Appealsj481
69 p 2
that persist Unmanageable verbal abuse means repeated verbalizations against tenants or staff verbal abuse includes that the negatively affect program Umnanageable despite all interventions and onented remarks of unwelcome sexually but is not Iim tedto threats frequent use profane language or lOJ ARC 8176B IAB 9123 09 effective 1
6 1 4 2 2 31C 9 Frogram certification A program may obtain certification by meeting all applicable requlrelnents In addition a program maybe voluntarily accredited by a recognized accreditation entity For the purpose of these rules certification is equivalent to licensure the scurrent certificate shall be visibly displayed within 1 Posting requirements A program 2 69 fue marshal designated operation area of the program In addition the latest monitoring report state report and food establishment inspections report issued pursuant made available to the public by the program upon request
to
Iowa Code
chapter
137F shall be
the defuiition of a 2 Dementia 69 speck programs and door alarms If a program meets the program certification two monitorings assisted during sequential specific dementia living program set forth in specific program includuig the requirements requirements for adementia 2 32 d and subrule 69 1 35 rule 481 2 and 69 29 4 paragraph 69 29 231C subrules 69 30 69 which includes the requirements relating to door alarms
shall meet all
ARC 8176B
IAB
9 2 3109 effective 1 IOj
application process 231C Certification of a nonaccredited program 3 69 481 an application packet obtained from the shall department The complete 1 3 69 applicant the health facilities division Web site at materials be obtained from may Application DIA HFD gov iowa hfd dia hops do by mail from the Department of Inspections and Fiome Third Floor 321 E 12th Street Des Appeals Adult Services Bureau Lucas State Office Building 0083 or by telephone at 515 6325 281 Moines Iowa 50319 one copy of the completed application and all supporting The shall submit applicant 2 3 69 documentation to the department at the above address at least 90 calendar days prior to the expected date of beginning
operation
3 The appropriate fee 69
application
and be
payable by
as
check
stated or
18 shall accompany each in Iowa Code section 231C
money order to the
Department of Inspections and Appeals
Fees are nonrefundable
The
4 3 69
shall consider the application when all
department
supporting
documents and fees are
received ARC 8176B
LSB
10 23 effective 1 9 09
application 481 2 4 69 31C Nonaccredited program
content
An
application
for certification
or
recertification of a nonaccredited program shall include the following or 1 A list that includes the names addresses and percentage of stock shares partnership 4 69 and trustees and ofthe designated the of of board of directors interest all members other officers
equity
stockholders partners or any individuals who have greater than a 5 percent equity in the list within ten program The program shall notify the department of any changes
manager as well as interest in the
working days of the change
1 have not been convicted 4 69 A statement winning that the individuals listed in subrule 69 2 4 adult abuse code in any state of a felony or serious misdemeanor or found in violation ofthe dependent subrule 69 1 have or have 4 3 A statement disclosing whether any ofthe individuals listed in 4 69 elder group home had an ownership interest in an assisted living program adult day services program 1or licensed home health agency licensed health care facility as defined in Iowa Code section 135C hospital
as
defined in Iowa Code section 135B 1 or a boarding home as defined in 2009 Iowa Acts be codified as Iowa Code Supplement section 1350 1 which has been
Senate File 484 section 3 closed or
in any
due to
to
state due to removal of program agency or
involuntary termination from
been found to have failed to
neglect
participation
facility licensure certification
in either the Medicaid
provide adequate protection or
services for
or Medicare
participants
or
registration
progx ar have xn to prevent abuse or
Inspections
23 9 IAC 09
and
Ch
481 Appeals
69 p 3
of the evaluatlon tool or 4 The policy and procedure far evaluation of each tenant A copy 69 each shall be included and health status of tenant tools to Ue used to identify the functional cognitive for service plans 5 The policy and procedure 4 69 needs of tenants 6 The policy and procedure for addressing medication 4 69
7 The policy and procedure for accidents and emergency response 4 69 8 The policies and procedures for food service including those relating 4 69 and storage menu planning therapeutic diets and food preparation service
to
staffing nutrition
69 The policy and procedure for activities 9 4 10 The policy and procedure for trarisportation 4 69 llThe policy and procedure for staffing and training 4 69 and 12 The policy and procedure for emergencies including natural disasters The policy 4 69 for and notlfymg legal representatives in procedures procedure shall include an evacuation plan as applicable and upholding tenant autonomy when tenant 69 1 4 3 The policy and procedure for managing risk the tenant or others decision makiig results in poor outcomes for adult abuse as 14 The policy and procedure for reporting incidents including dependent 4 69 required in rule 231C 231B 2 67 481 231D specific 15 The policy and procedure related to life safety requirements for adementia 4 69 as required by subrule b9 2 32 program all attaclunents 16 The tenant occupancy agreement and 4 69 related care services from a certified health 17 If the program contracts for personal care or 4 69 or a licensed health care facility a copy of that entity s current home health agency a mental health center
emergency situations
license
or
certification
18 4 69
A copy of the state license for the
entity that provides food service
whether the
entity
is
combination of bath
the program or an outside entity or a 18 19 The fee set forth in Iowa Code section 231 C 4 69
jARC 8176B
IAB
09 effective 111110 9123
481 2 5 69 31C Ini9aal certification process for a nonaccredited program 1 Upon receipt of all completed documentation including state fire marshal approval and 5 69 structural and evacuation review approval the department shall determine whether or not the proposed program meets
applicable requirements
based upon the review of the complete application including all required supporting for certification a the documents department determines the proposed program meets the requirements be issued to the program to begin operation and accept tenants certification shall provisional Within 180 calendar following issuance of provisional certification the department
2 If 5 69
days scompliance with applicable requirements monitoring to determine the program as a result of the monitoring the process in rule If a is identified insufficiency 4 5 69 regulatory 67 10 481 231D shall be followed 231C 231B 17A 5 The department shall make a final certification decision based on the results of the monitoring 69 and review of an acceptable plan of correction 6 The department shall notify the program of a final certification decision within 10 working 5 69 days following the finalization of the monitoring report or receipt of an acceptable plan of correction whichever is applicable a full two year 7 If the decision is to continue certification the department shall issue 5 69 of the certification from the date effective certification original provisional 3 5 69
shall conduct
a
09 2 3 effective 1 l0 ARC fi176B IAB 9
231C Expiration of the certification of a nonaccredited program 6 69 481 1 Unless conditionally issued suspended or revoked certification of a program 6 69 the end of the time period specified on the certificate
shall
expire at
Ch
Inspections
69 p 4
and
IAC 09 23 9
481 Appeals
69 The department shall send recertification application 2 6 calendar days prior to expiration of the program scertification
materials to each program at least 120
23 effective 1 9 10 ARC 81768 IAB 09
231C Recertificatflon process for 7 69 481 program shall 1 Submit 7 69
one
copy of the
a
nonaccredited program
To obtain
the information
completed application including
recertification
required
a
in rule
listed in Iowa Code section 231 C 4 69 481 least calendar days prior to the in subrule at 90 address stated 69 1 3 18 to the department at the 231C need not submit the certification The policies and procedures that have program s program expiration of and remain The been previously submitted to the department unchanged program shall provide a list of not been submitted and are that being resubmitted have the policies and procedures previously has ofthe documentation that each been inspected by a qualified Submit additional following associated documentation and the recertification fee
2 7 69
as
recommendations with the manufacturer s
professional and found to be maintained in conformance and nationally recognized standards heating system cooling system water heater electrical system ventilation system and if located on site garbage plumbmg sewage system artificial lighting and and machines dryers and elevators disposal kitchen appliances washing IAB
ARC 8176B
23109 effective 1 9 i0 t
for
nonaccredited
program 481 2 8 69 310 Notification ofrecertification the application and associated documentation and fees Ifthe shall review The 1 8 69 department to the additional information application is ilmcomplete the department shall contact the program request shall After all finalized documentation is received including state fire marshal approval the department determine the program scompliance with applicable requirements 60 and 90 days prior to The 2 8 69 department shall conduct a monitoring ofthe program between
expiration
ofthe
3 If a 8 69
program certification s regulatory insufficiency
i5 identified
481shall be 231D 231C 231B 17A 10 67
a
as
a
result of the
monitoring
the process in rule
followed
the monitoring the department shall regulatory insufficiency is identified as a result of 4 8 69 issue a report ofthe findings with the final recertification decision the program atwo year certification 5 IftYie decision is to recertify the department shall issue 8 69 effective from the date of the expiration of the previous certification shall issue a notice ofdenial and 6 If the decision is to deny recertification the department 8 69 231D 231C 231B 17A 13 67 provide the program the opportunity for a hearing pursuant to rule 481 the no fault of the program 7 If the department is unable to recertify a program through 8 69 than one of certification of no limited extension atime longer department shall issue to the program
Ifno
year
ARC 8176B
It1B
23109 effective 1 9 10
an application program 48i 2 9 69 310 Certification or recertification of a program accredited by a recognized recertification 1 An applicant for certification or 9 69 accredituZg entity shall materials Submit a completed application packet obtained from the department Application a of
may be obtained from
doby Home at
Building 6325 281 515 b
the health facilities division Web site at
mail from time
State Office
accredited
Department
of
Inspections
and
DlA HFD 6ov iowa hfd dia https
Appeals
Adult Services Bureau Lucas
0083 Third Floor 32LE 12th Street Des Moines Iowa 50319
or
by telephone
Submit a copy of the current accreditation outcome from the recognized accrediting entity verification of for certification or recertification within 90 calendar days following
c Apply to this chapter compliance with life safety requirements pursuant with life Maintain compliance safety requirements pursuant d e
process
Submit
the
appropriate
to this
chapter
18 fees asset forth in Iowa Code section 2310
not consider an
69 The department shall 2 9
supporting
Ch
Inspections and Appeals 481
IAC 09 23 9
documentation and the
appropriate
application
69 p 5
until it is complete and includes all
fees
23 effective 1 9 ARC 8176B IAB 09 lOJ i
231C Certification 10 69 481 cozntemt An
application
or
recertification
for certification
or
of
accredited
am
recertification of an
application programm
accredited program shall include the
following of stock shares partnership or 1 A List that includes the names addresses and percentage 10 69 the of and trustees and of the designated board other equity interest ofall officers members of directors who have greater than a 5 percent equity manager as well as stockholders partners or any individuals the of any changes in the list within ten interest in the program The program shall notify department working days of the change 1 have not been convicted 10 2 A statement affirming that the individualslisted in subrule 69 10 69 of a felony or serious misdemeanor or found in violation of the dependent adult abuse code in any state the individuals listed in sulirule 69 0 have or 1 3 A statement disclosing whether any of 10 69 have had
an
ownership
elder group home home health program adult day services program under Iowa 135C or licensed hospital as Code section 1 facility as defined
interest in
a
agency licensed health care 1 or a boarding home as defined in 2009 Iowa defined under Iowa Code section 135B
484 section
3
to
be codified as Iowa Code
Supplement
any state due to removal of program agency or
section
facility licensure
1 1350 or
certification
Medicare program
om participation ui either the Medicaid or termination fi failed to provide adequate protection or services for tenants to prevent abuse A copy ofthe current accreditation outcome from the 8176B TAB 9 23109 effective 1 10J
4 10 69 AttC
Acts
Senate File
osed in which has been c
or
or
due
to
involuntary
have been found to have
neglect recognized accrediting entity ar
231C Initial certification process for an accredited programm 11 69 481 1 Within 20 working days of receiving all finalized documentation including state fire 11 69 marshal approval the department shall determine and notify the accredited program whether or not the be issued accredited program meets applicable requirements and whether or not certification will ofthe accreditation certification shall be issued the term Ifthe decision is to a for certify 2 11 69 not to exceed three years unless the certification is conditionally issued suspended or revoked by either the department or the recognized accrediting entity 3 If the decision is to deny certification the department shall provide the applicant an 11 69 231D 231C 231B 17A 13 67 opportunity for hearing in accordance with rule 481 4 Unless conditionally issued suspended or revoked certification for a program shall expire 11 69 at the end of the time period specified on the certificate 09 2 3 effective 1 lOJ ARC 8176B IAB 9
481 Recertification process for an accredited program 231C 12 69 120 1 The department shall send recertification application materials to each program at least 12 69 calendar days prior to expiration of the program scertification To obtain an accredited program shall submit one copy of the completed recertification 2 12 69 231 C 18 application associated documentation and the administrative fee as stated in Iowa Code section to the to the department at the address stated zu subrule 69 expiration 1 at least 90 calendar days prior 9 scertification program 20 working days of receiving all finalized documentation including state fire marshal approval the department shall determine the program s compliance with applicable requirements and make a recertification decision 4 The department shall notify the accredited program within 10 working days of the final 12 69 of the
3 Within 6912
recertification decision a
Ifthe decision
is
to
recertify
department
or
the
full certification shall be issued for the tern of the accreditation
certification is conditionally issued suspended or revoked by recognized accrediting entity
not to exceed three years unless the the
a
either
Inspections and
Ch 69 p 6
b
If the decision
is
to
IAC 09 23 9
481 Appeals
the department l deny recertificatio
shall
provide
the
applicant
an
231D 231C 231B 17A 13 67 opportunity for hearing in accordance with rule 481 of the program the 5 If the department is unable to recertify a program through no fault 12 69 limited extension of certification of no longer than one atime department shall issue to the program year
23 effective 1 9 10 ARC 8176B IAB 09
231C Listing 13 69 481
department shall maintain a list of all do Home under the die HFD s DIA gov iowa htthfd
of all certified programs
certified programs which is available online at Entities Book tab 23 effective 1 9 10 ARC 8176B TAB 09
The
231C Recognized accrediting entity 14 69 481 1 The department designates CARF as a recognized accrediting entity for programs 14 69 2To apply for designation by the department as a recognized accrediting entity for programs 14 69 an
accrediting entity shall submit
a
the letter of request and its standards shall at minimum meet
applicable requirements for programs continue to as long as the accreditation standards 3 The designation shall remain in effect for 14 69 for programs meet at minimum the applicable requirements edition 4 An accrediting entity shall provide annually to the department at no cost a current 14 69 within 120 and thereon training of the applicable standards manual and survey preparation guide working days
after the
publications
are
released
23 effective 1 9 10 ARC 8176B TAB 09 that is
Each accredited
program 481 Requirements for an accredited program 231C 15 69 the shall certified by department 1 Provide the department a copy of all survey reports including outcomes quality 15 69 or received as applicable improvement plans and annual conformance to quality reports generated the of ten of within receipt reports working days of 2 Notify the department by the most expeditious means possible of all credible reports 15 69 taken the the program and any actions by alleged improper or inappropriate conduct or conditions within
accrediting entity with respect thereto revocation 3 Notify the department mzmediately of the expiration suspension 15 69
or
other loss
of the program saccreditation
10 9 3109 effective 1 ARC 8176B JAB 2
481 Maintenance of program accreditation 231C 16 69 for certification by the department 1 An accredited program shall continue to be recognized 16 b9 if both of the following requirements are met 231 C 15 69 a The program complies with the requirements outlined in rule 481
limited time The program maintains its voluntary accreditation status for the duration of the certification period status must become certified 2 A program that does not maintain its voluntary accreditation 16 69 by the department prior to any lapse in accreditation status and is not certified by 3 A program that does not maintain its voluntary accreditation 16 69 shall cease operation as a program the to any involuntary accreditation b
department prior
lapse
23 9 ARC 8176B TAB 09effective I0 1
481 Transfer of certification 231C 17 69 1 Certification unless conditionally issued suspended 17 69 new
owner of a program
must receive
approval
revoked
may be transferable to a
program certification has been conditionally issued s department prior to transfer of the certification
If the
from the
or
the
new owner
IAC 9123109
to
Inspections
and
Ch
481 Appeals
69
7 p
69 The new owner is required to notify the department ui venting within 30 calendar days prior 2 17 change in ownership The notice shall include assurance that the new owner meets all applicable
the
requirements for programs 3 The department may conduct a monitoring within 90 days following a change in the 17 69 sownership or management corporation to ensure that the program complies with applicable program requirements If a regulatory insufficiency is found the department shall take any necessary enforcement action authorized by applicable requirements 10 ARC 8176B LAB 09 23 effective 1 9
481 Structural and life safety reviews of a huilding for a new program 2310 18 69 1 Before a building is constructed or remodeled for use in a new program the department 18 69 shall review the blueprints for compliance with requirements pursuant to this chapter Construction or remodeling includes new construction remodeling of any part of an existing building addition of a new wing or floor to an existing building or conversion of an existing building sealed by an 2A program applicant shall submit to the department blueprints wet 18 69 licensed architect or Iowa Iowa licensed engineer and the blueprint plan review fee as stated in Iowa Code section 2310 18 to the Department of Public Safety State Fire Marshal Division 215 E 7th Street Thud Floor Des Moines Iowa 50319 3 Failure to submit the blueprint plan 18 69
review fee with the blueprints shall result in delay of blueprint plan review until the fee is received licensed architect or 4 The department shall review the blueprints and notify the Iowa 18 69 licensed engineer ill writing regarding the status of compliance with requirements Iowa licensed engineer shall respond to the department to licensed architect or Iowa 5 The Iowa 18 69 state how any noncompliance will be resolved 6 Upon final notification by the department that the blueprints meet structural and life safety 18 69 requirements construction or remodeling of the building may commence site visit of the building site with the contractor or 7 The department shall schedule an on 18 69 licensed engineer during the construction or remodeling process to licensed architect or Iowa Iowa ensure compliance with the approved blueprints Any noncompliance must be resolved prior to approval the
for certification ARC 8176B
LAB
23 effective Ill 9 09 lOj
2310 19 69 481
Structural and life safety review prior to the remodeling of
certified program 1 Before 19 69
blueprints
for
a
building
compliance
with
for
conversion of an
building
for a
department shall review the 231 C Remodeling includes 35 69 481 of a new wing or floor to an existing building
certified program is remodeled the
a
requirements
set
forth in rule
modification of any part of an existing building addition or
a
existing building
A certified program shall submit to the licensed architect or Iowa Iowa licensed engineer and the
2 19 69
Code section 2310 18 to the
Department
of Public
Street Third Floor Des Moines Iowa 50319 3 Failure to submit the blueprint plan 14 69 the
blueprint plan
review until the fee
69 The department 4 19
shall
rs
sealed by an department blueprints wet review fee as stated m Iowa blueprint plan State Fire Marshal Division 215 E 7th Safety
review
fee with the blueprints shall
result in delay of
received
review the
the Iowa licensed architect
blueprints within 20 working days of receipt and licensed engineer in writing regarding the status Iowa
immediately notify of compliance with requirements licensed engineer shall respond to the department rn licensed architect or Iowa 5 The Iowa 19 69 20 working days to state how any noncompliance will be resolved 6 Upon final notification by the department that the blueprints meet structural and life safety 19 69 requirements remodeling of the builduig may commence site visit of the building with the contractor or 7 The department shall schedule an on 19 69 licensed architect or Iowa Iowa licensed engineer during the remodeling process to ensure compliance or
Ch
Inspections
69 p 8
with the
and
approved blueprints Any noncompliance
certification
IAC 9 23109
481 Appeals
must be resolved
prior
to
approval
for continued
recertification of the program
or
09 2 3 effective 1 10 i jARC S176B IAB 9
481 Cessation of program operation 231C 20 69 which includes seeking decertification at any 1 If a certified program ceases operation 20 69 the certificate to the time prior to expiration of the program scertification the program shall submit in advance of cessation which includes department The program shall provide at least 90 days notification to the department written seeking decertification unless there is some type of emergency which includes seeking will cease operation and the tenant advocate ofthe date on which the program decertification If a certified program the time the program scertification
2 20 69
plans to expires
cease
operation
which includes
seeking decertification
at
written notice ofthis fact to the
provide expiration of the certification to cease operation which includes seeking decertification 3 At the time a program decides 20 69 the safe and orderly transfer the program shall submit a plan to the department and make arrangements for subrule 2 20 69 or transition of all tenants within the 90 day period specified by of the 90 day period to ensure the safety 4 The department may conduct a monitoring during 20 69 department
the program
and the tenant advocate at least 90
days prior
shall to
during the transfer process or transition process sitevisit to verify that the program has ceased operation 69 The department may conduct an on 5 20 the program as a certified program in accordance with the notice provided by includes seeking decertification tenant advocates 6 When a program ceases operation which 20 69 to with tenants provide education and service options shall be allowed by the program to privately meet tenants
23 effective 1 9 10 ARC 8I76B LAB 09
231C Occupancy agreement 21 69 481
point type or larger shall be written in plain 69 The occupancy agreement shall be in 12 1 21 the tenant or the tenant s legal language using commonly understood terms and shall be easy for
representative to 2 21 69
understand
In addition to the
requirements
of lowa Code section 5 231C the written occupancy following information in the body of the agreement
agreement shall include but not be limited to the or in the supporting documents and attachments
telephone number for filing a complaint with the department telephone number for the office of the tenant advocate The telephone number for reporting dependent adult abuse A copy of the program sstatement on tenants rights A statement that the tenant landlord law applies to assisted living programs A statement that the program will notify the tenant at least 90 days in advance
a
The
b
The
c
d e
f
of any
planned
includes voluntary decertification except in cases of emergency program cessation which and updated as necessary to reflect any change The 3 21 69 occupancy agreement shall be reviewed in services
or
financial arrangements
s Legal tenant agreement shall be provided to the tenant or the 69 4 21 the program representative if any and a copy shall be kept by A most current agreement shall be made available to the general of the occupancy copy 5 21 69 statement that a copy ofthe occupancy public upon request The basic marketing material shall include a A copy of the occupancy
to all persons upon lOJ 09 2 9 3 effective 1
agreement is available IARC 8176B
IAB
231C Evaluation 22 69 481
request
of tenant s tenant to occupancy A program shall evaluate each prospective Evaluation prior 1 22 69 and takvig the ssignuig occupancy agreement functional cognitive and health status prior to the tenant for the including s tenant program the eligibility occupancy of a dwelling unit in order to determine whether the services needed are available The cognitive evaluation shall utilize a scored objective
tool
When the score from the
evaluatton indicates moderate
cognitive
69 p 9
cognitive decline and risk applicable If the tenant
intervals if
shall be used at all
subsequent the cognitively Impaired state the program may discontinue be health care tool The evaluation shall conducted a by cognitive screening
the Global Deterioration Scale
returns to the tenant smildly
subsequently
GDS and revert to
professional
Ch
1 4 Inspections and Appeals
IAC 09 23 9
or
a scored
human service
professional
shall
cant change A program 2 Evaluation witlaira 34 days of occupancy and with sigra 22 69 and within 30 days of occupancy A program each s tenant health status evaluate functional cognitive and health also s tenant status as needed with significant change shall evaluate each functional cognitive scontinued eligibility for the program and to determine but not less than annually to determine the tenant The to services needed evaluation shall be conducted by a health care professional or human any
changes professional
service
A licensed practical
the tenant has not exhibited a significant 23 effective X 9 10 1 ARC 8176B IAB 09
nurse
may
a
b c
a
the evaluation via nurse
retention of tenants or
ed A program shall not retaiJ
f g
admit or
knowingly
tenant who Is
bed or bound Requires routine person two assistance with standing transfer or evacuation or Is dangerous to self or other tenants or staff including but not limited to a tenant who Despite intervention chronically elopes is sexually or physically aggressive or abusive
1 displays unmanageable verbal abuse or aggression or 2 Displays behavior that places another tenant at risk or d Is in an acute stage of alcoholism drug addiction or uncontrolled e
delegation when
change
481 Criteria for admission and 2310 23 69 1 Persons wl2o niay not be adnutted 23 69 retain
complete
mental illness
or
or
Is under the age of 18 or related care or time or intermittent health Requires more than part Has
unmanageable incontinence on
a
routine basis
despite
an
toileting
individualized
program
or
medically unstable or Requires maximal assistance with activities of daily living 2 Disclosure of additional occupancy and transfer criteria 23 69 h
Is
i
occupancy
or
transfer criteria if the criteria
are
disclosed
In
A program Inay have additional the written occupancy agreement prior to the
s occupancy tenant
69 Assistance 3 23
with
transfer from
flee program A program shall
provide
assistance to
a
tenant
s legal representative if applicable to ensure a safe and orderly transfer from the program and the tenant when the tenant exceeds the program scriteria for admission and retention 23effective 1 9 101 ARC 8176B IAB 09
481 Involuntary transfer from the program 2310 24 69 1 Program initiation of transfer If a program initiates the involuntary transfer of a tenant 24 69 and the action is not the result of a monitoring including a complaint Investigation orprogram reported slegal representative contests the incident investigation by the department and if the tenant or tenant transfer the following procedures shall apply a The program shall notify the tenant or tenant slegal representative in accordance with the the tenant and ofthe occupancy agreement ofthe need to transfer the advocate the contact information for tenant
reason
for the transfer and shall include
The program shall immediately provide to the tenant advocate notification and notify the tenant streating physician if any b
c
Pursuant to
representative representative
not
certified
statute the tenant advocate shall offer the notified
assistance with the is
by
required
sinternal appeal program
process The to accept the assistance of the tenant advocate
copy
of the
s tenant
legal legal
mail
tenant tenant
or or
a
s tenant
If following the internal appeal process the program upholds the transfer decision the tenant s legal representative may utilize other remedies authorized by law to contest the transfer or tenant d
Inspections
Ch 69 p 10
and
LAC 09 23 9
481 Appeals
t eported incideJa t 69 Transfer pursuant to results of monitoring or complaint or program 2 24 one or more tenants are identified as exceeding the admission acid the If investigation by department retention criteria for tenants and need to be transferred as a result of a monitoring or a complaint or the department the following procedures shall reported incident investigation conducted by program
apply working days of the monitoring or complaint or of the department shall notify the program iri writing reported incident investigation program identification of any tenant who exceeds admission and retention criteria the tenant s Legal representative if applicable b Notification of others Each identified tenant be notified of their opportunity to provide responses of services to the tenant shall and other providers and documentation directly addressing any written information comment including specific input the department All with the identification responses shall be provided to agreement or disagreement a
Notfication of
the prrogram Within 20 the
within ZO days of receipt of the notice s c s finding Ifthe program agrees with the department Program agreement with the department the internal appeal process transfer s program proceedings finding and the program begins involuntary shall be utilized for in subrule 69 appeals 1 24 d sfinding If the program does not agree with the Program disagreement with the department collect and that the tenant exceeds admission and retention criteria the program may
sfinding department
the program s submit all responses to the department including those from other interested parties In from others and note the list the known the shall the tenant responses program identify response The program or disagreement with the responses from others sresponse shall
sagreement program be submitted to the department
a working days of the receipt of the notice Submission of submission of a plan of correction response does not eliminate the applicable requirements including also submit information Other directly to the department subrule 481 may under persons 5 10 67 of receipt of the program Within 10 sresponse for Consideration of working days response 1 final finding regarding the each identified tenant the department shall consider the response and make a
within 10
continued retention of a tenant
sdetermination is to amend the 2 Amending the regulatory insufficiency If the department the report of findings regulatory insufficiency based on the response the department shall modify retains the regulatory insufficiency the If the department 3 Retaining regulatory insufficiency in accordance with this chapter and 48I Chapter 67 department shall review the plan of correction relate The department shall notify the program of the opportunity to appeal the report findings as they the to the tenant or to the admission and retention decision In addition the department shall provide A of the final report copy slegal representative the contact information for the tenant advocate tenant shall also be sent to the tenant advocate
appeal is filed the tenant who exceeds admission and all administrative appeals have retention criteria shall be allowed to continue living at the program until sexceeding adlnissian and retention criteria shall been exhausted Appeals filed that relate to the tenant s needs shall be provided be heard within 30 days of receipt and appropriate services to meet the tenant 4
during
5
Effect of the
filing of an appeal
period of time Request for waiver of criteria
If an
that
for retention of a tenant in a program To allow a tenant to remain to lisle of criteria for retention of a tenant
in the program the program may request a waiver 231B from the department within 10 7 67 481 231D 231C 23 effecrive 1 9 lOj ARG8176B IAB 09
pursuant
working days of the receipt
of the report
481 Tenant documents 231C 25 69 shall include 1 Documentation for each tenant shall be maintained by the program and 25 69 home identification and address s tenant birth An occupancy record including the name date a numbers date ofoccupancy and names addresses and
name address and
telephone
contact in the event of illness or an
b
Application forms
telephone
number ofhealth
numbers of family members friends emergency
or
s diagnosis professional other
designated people
to
c
The initial evaluations and
d
A nutritional assessment
e
The initial individual
media information
as
Ch
481 Appeals
69 l pl
updates
as
necessary
service
Signed authorizations for
f
and
Inspections
IAC 09 23 9
plan
and
updates to
permission
release medical
information photographs
or
other
necessary
signed authorization for the tenant to receive emergency medical care necessary if any A signed managed risk policy and signed managed risk consensus agreements the to medical information care is the related i When any personal or health delegated program those for such as treatment therapy and sheet documentation of health professionals orders medication anal nurses notes written by exception g h
j
as
A
subrule 67 4 5 Medication lists which shall be maintained in confozmance with 481 Advance health
k
care
directives
as
applicable
s occupancy agreement including any updates complete copy of the tenant s legal representative if applicable nz A written acknowledgment that the tenant or the tenant s tenant been fully informed of the rights Z
A
r
durable power of attorney for health care power of attorney or other documentation of a legal representative the tenant including but not limited to those related to medication
A copy of
conservatorship
or
guardianship
Incident reports involving errors accidents falls and elopements o
included in the tenant smedical p
has
such reports record
shall be maintained
by the program but need
not be
A copy ofwaivers of admission or retention criteria if any sown behalf or the tenant has When the tenant is unable to advocate on the tenant
multiple the completion ofroutine providers including hospice care providers accurate documentation of ordered the tasks shall be related care is required on task sheets Iftasks are doctor personal or health and part of the medication administration records MARs q
service
Authorizations for the release of information if any The program records relating to after the transfer or death ofthe tenant
2 25 69 3 25 69
a
tenant shall be retained for
All records shall be protected from loss
damage
a
minimum of three years
and unauthorized
use
23 effective T 9 10 1 ARC 8176B TAB 09
481 Service plans 2310 26 69 1 A service plan shall be developed for 26 69 accordance with subrules 6922 2and 22 1and 69 of the individual tenant The service
shall
each tenant based shall be
on
to
designed subsequently be updated
the
evaluations conducted in
meet the at least
specific service needs annually and whenever
plan changes are needed ssigning the occupancy agreement and taking occupancy of a dwelling 2 Prior to the tenant 26 69 service unit a preliminary plan shall be developed by a health care professional or human service s request with other individuals identified in with the tenant and at the tenant consultation professional with the s tenant the if tenant and legal representative All persons who develop the by applicable and the the s tenant tenant or legal representative shall sign the plan plan related care the service plan shall be updated When a tenant needs personal care or health 3 26 69 s occupancy and as needed with significant change but not less than annually within 30 days ofthe tenant a If a significant change triggers the review and update of the service plan the updated service signed and dated by all parties significant change does not exist the program may after nurse review add minor discretionary changes to the service plan without a comprehensive evaluation and without obtaining signatures on the service plan If a significant change relates to a recurring or chronic condition a previous evaluation and c service plan of the recurring condition may be utilized without new signatures being obtained For is adequate to institute the example with chronic exacerbation of a urinary tract infection nurse review previously written evaluation and service plan plan
shall be
b
If
a
Inspections
Ch 69 p 12
4 26 69
The service
plan shall be
and
23 9 IAC 09
1 4 Appeals
individualized and shall indicate
at a
minimum
preferences for assistance b Any services and care to be provided pursuant to the occupancy agreement but not united to providers of c The service provider sif other than the program including hospice care home health care occupational therapy and physical therapy d For tenants who are unable to plan their own activities including tenants with dementia planned sabilities and personal interests and and spontaneous activities based on the tenant slegal representative for nursing facility care if e Preferences if any of the tenant or the tenant the need for nursing facility care presents itself durngthe assisted living program occupancy The tenant sidentified needs and
a
10 1 ARC 8176B IAB 09 23 effective I 9
related care but an health 231C Nurse review If a tenant does not receive personal or 27 b9 481 a nurse shall be conducted If a s tenant condition review occurs observed significant change in the tenant receives
personal
or
related care the program shall health
licensed practical nurse via nurse delegation 27 To monitor at least every 90 days 69
provide
fora
registered
nurse or
a
s condition significant change in the tenant for adverse reactions to the medications any tenant who receives program administered prescription the prescription that and to ensure interventions or referrals medications and to make appropriate
medication orders
are
current and that the
such orders and 2 To ensure that health 27 69 care
directed professional
care
or
after
prescription
professionals
a
medications
orders
are
are
administered consistent with
current for tenants who receive
health
care from the program and
health status of each tenant to make recommendations and at least every 90 and to monitor referrals progress relating to previous recommendations appropriate and in s tenant whenever the health status there are changes days and under the serviceplan 4 To provide the program with written documentation of the activities 27 69 the and date tune signature as set forth in rule 481 231 C showing 26 b9 69 To 3 27
assess
and document the
as
NOTE Refer to Table A at the end of this health care to a tenant related 10 23 effective 1 9 ARC 8176B IAB 09
nurse
chapter If the program required
does not
provide personal
or
review is not
231C Food service 28 69 481 other community providers to provide a hot 1 The program shall provide or coordinate with 28 69 for the availability of meals or other appropriate meal s at least once a day or shall make arrangements site shall be obtained from 2 Meals and snacks provided by the program but not prepared on 28 69 laws and ordinances concerning of state and local health or provided by an entity that meets the standards the preparation and serving of food the following percentage of the daily recommended 3 Menus shall be planned to provide 28 69 ofthe National Research Council of dietary allowances as established by the Food and Nutrition Board based on the number ofmeals provided by the program A minimum of33 3percent if the program provides one meal per day A minimum of66 3percent if the program provides two meals per day and One hundred percent if the program provides three meals per day
the National a
b c
Academy
of Sciences
Iftherapeutic diets are provided they 69 Therapeutic diets may be provided by a program 4 28 advanced registered nurse practitioner A shall be prescribed by a physician physician assistant or Iowa Dietetic Association shall the current copy of the Iowa Simplified Diet Manual published by A licensed dietitian shall be diets be available and used in the planning and serving of therapeutic the and for reviewing procedures for food therapeutic menu responsible for writing and approving preparation and service for therapeutic diets and who are responsible far 5 Personnel who are employed by or contract with the program 28 69 food
preparation or service
or
and safe food handling prior to
both food
handling
preparation and service shall have
food and shall have
an
orientation
service training annual in
on
on
food
sanitation
protection
Inspections
IAC 09 23 9
and
Ch
481 Appeals
69 p 13
food requirements above a mmiznum of one person directly responsible for food by protection program completed astate approved preparation Obtaining certification as a dietary manager ar food protection professional or 2 Obtaining certification as a for a food protection program a 3 Successfully completing course meeting the requirements be included in the Food Code adopted pursuant to Iowa Code chapter 137F Another course may substituted if the course scurriculum includes substantially similar competencies to acourse that meets a statement the requirements ofthe Food Code and the provider of the course files with the department a
In addition to the
shall have successfully
indicating that food handling
the course
provides substantially
similar instruction
as
it relates to sanitation and safe
If the person is in the process of completing a course or certification listed in paragraph a approved food protection program shall be considered requirement relating to completion of astate b
the to
have been met
6 Programs engaged in the preparation and service 28 69 standards of state and local health laws and ordinances pertaining and shall be licensed pursuant to Iowa Code chapter 137F
69 Programs may 7 28 through other methods
have
an
site dietitian on
of meals and snacks shall meet the to the preparation and service of food
Programs
may secure menus and a dietitian
09 2 3 effective 1 ARC 8176B IAB 9 O
231C Staffing In addition to the general staffing requirements 29 69 481 231B the following requirements apply to staffing in programs 9 67 231D 231C
1 29 69
Each tenant shall have
access to
automatically identifies the tenant in distress and
2 29 69
In hen of providing
access to a
a
in
rule
481
hour personal emergency response system that 24
can
be activated with
one
touch
system a program serving dementiashall follow a system program or written staff
personal
emergency response
with cognitive disorder or s that address how the program will respond to the emergency needs ofthe tenant The owner or management corporation ofthe program is responsible for ensuring that all
one ormore tenants
procedures 3 29 69 tasks to personnel employed by or contracting with the program receive training appropriate assigned and target population who specific assisted living program shall have one or more staff persons 4 Adementia 29 69 awake be and on s service plan The staff shall duty 24 monitor tenants as indicated in each tenant the tenants The on tenants as indicated in staff shall check hours a day on site and in the proximate area service plans 5 All programs employing a new program manager after January 1 2010 shall require the 29 69 whose curriculum manager within six months of hire to complete an assisted living management class on assisted to and laws Iowa rules includes at least six hours of training specifically related living who have completed a similar training prior to January 1 2010 shall not be Managers programs required to complete additional training to meet this requirement 6 All programs employing a new delegating nurse after January 1 2010 shall require the 29 69 delegating nurse within six months of hire to complete an assisted living manager class or assisted living to Iowa rules nursing class whose curriculum includes at least six hours of training specifically related each A of nurse from must and laws on assisted living minimum one delegating program complete the and one nurse delegating completes the training only training If there are multiple delegating nurses train the other nurses in the Iowa rules the delegating nurse who completes the training shall delegating shall have a minimum of one delegating and laws on assisted living As of January 1 2011 all programs nurse who has completed the training described in this subrule 23 effective 1 9 ARC 8176B TAB 09 10
481 Dernentia 231C 30 69 specific education for progrann personnel All specific program shall receive a 1 30 69 personnel employed by or contracting with adementia hours education and of minimum specific ofdementia training within 30 days ofeither employment eight date the of as or the beginning contract applicable
Ch
IAC 09 23 9
Inspections and Appeals 481I
69 p 14
2 The dementia 30 69 specific education
or
training
shall include
at
a
minimum
the
following
of Alzheimer s disease and related
disorders explanation dementia care philosophy and program b The program specialized s c Skills for communicating with persons with dementia Skills for communicating with family and friends of persons with dementia d and Ions guilt relunquishmg s An explanation of family issues such as role reversal grief giving role and family dynamics care The importance of planned and spontaneous activities f Skills in providing assistance with instrumental activities of daily living g h The importance of the service plan and social history information i Skills in working with challenging tenants for simplifying cueing and redirecting Techniques j AIn
a
k
Staff support and stress reduction and
1
Medication management and
the
interventions
nonpharmacological
specific program shall receive contracting with adementia education contact persorunel a minimum of two hours of dementia annually Direct specific continuing education annually shall receive a minimum of eight hours ofdementia specific continuing of a dementia 4 An employee or contractor who provides documentation of completion 30 69 3 All personnel employed by 30 69
or
from the education
specific education or training program within the past 12 months shall be exempt and training requirement of subrule 69 1 34 on trainuig and may include any of 5 Dementia 30 69 specific training shall uiclude hands the program and based training case studies of tenants in following classroom instruction Web ARC 1765
IAB
the
23 effective 1 9 09 10
The program shall policy and managed risk consensus agreements be to the tenant risk along with the shall provided have policy managed managed risk policy the shall include following The risk policy managed occupancy agreement and meeting the needs of 1 An acknowledgment of the shared responsibility for identifying 31 69 the tenant and the process for managing risk and for upholding tenant autonomy when tenant decision
231C li9 31 69 481 anaged
risk
The
a
making results
in poor outcomes for the tenant
or
others
and
2Aconsensus 31 69 basedprocess to address specific risk situations Program staff and the tenant based process may be a managed risk The result of the consensus in the shall
participate
process the signature of the tenant agreement The managed risk consensus agreement shall include risk consensus agreement and the signatures of all others who participated in the process The managed file be included in the s tenant shall 10 2 23109 effective 1 ARC 176B TAB 9 consensus
emergency policies 231C Life safety 32 69 481
and
procedures
and
structural
requirements
safety
1 The program shall submit to the department and follow written emergency policies 32 69 procedures which shall include the following a
is
plan
b c
d e
f g
h z
j
plan which shall include procedures for natural located for easy reference Fire safety procedures Other general or personal emergency procedures Provisions for amending or revising the emergency plan Provisions for periodic training ofall employees An emergency
Procedures for fire drills
Regulations regarding smoking control systems Monitoring and testing of smoke Tenant evacuation procedures and Procedures for reporting and documentation
disasters
identify
and
where the
23 9 IAC 09
Inspections
An
2 32 69
alaixri system shall be
operating
program A program seining
specific dementia
and
a
persons
Clr 69
481 Appeals
coiulected
to
each exrt door in
with cognitive disorder
or
a
15 p
specific dementia
dementia whether
in
a
general or
setting shall have
s procedures regarding alarm systems and appropriate staff response when a tenant a risk of elopement or a tenant exhibits wandering behavior plan Written procedures regarding appropriate staff response if a tenant with cognitive disorder ar b dementia is missing 3 The program 32 69 sstlucture and procedures and the facility in which a program is located shall meet the requirements adopted for assisted living programs in administrative rules promulgated by the state fire marshal Approval of the state fire marshal indicating that the building is in compliance with these requirements is necessary for certification of a program 4 The program shall have the means to control the maximum temperature of water at sources 32 69 accessible by a tenant to prevent scalding and shall control the maximum water temperature for tenants s request with cognitive impairment or dementia or at a tenant a
Written
service
indicates
ARC 8176B
IAB
09 2 9 3 effective 1 10
2310 rI 33 69 481 ansportation When transportation
services
are
provided directly
or
under
contract with the program to the tenants who use it with consideration impairments 2 Evely tenant transported shall have a seat iii the vehicle except for a tenant who remains 33 69 in a wheelchair during transport 3 Vehicles shall have adequate seat belts aild securing devices for ambulatory and 33 69 using passengers wheelchair 4 Wheelchairs shall be secured when the vehicle is in motion 33 69 5 During loading and unloading of a tenant the driver shall be in the proximate area of the 33 69
1 The vehicle shall be accessible and appropriate 33 69
for any physical disabilities and
tenants in a vehicle s slicense or commercial driver appropriate Iowa driver being utilized for transport Ifthe driver is licensed in another driver state the license shall be valid and appropriate for the vehicle being utilized for transport The for the vehicle operated shall meet any state or federal requirements for licensure or certification aid kit fire extinguisher safety triangles and a device for 7Each vehicle shall have afirst 33 69
6 The driver 33 69
license
as
shall have a valid and
required by law
for the vehicle
way communication two ARC 8176B IAB 09 23 effective 1 4 10
2310 34 69 481
Activities
ect 69 The program shall provide appropriate activities for each tenant Activities s17a11 re 1 34 and in ethnic cultural individual differences beliefs religious age health status sensory deficits lifestyle beliefs values experiences needs interests abilities and skills by providing opportunities for a variety of
types and levels of involvement 2 Activities shall be planned 34 69
to support the tenait s service plan and shall be consistent with the program statement and occupancy policies 3 A written schedule of activities shall be developed at least monthly and made available to 34 69
tenants and their legal
4 34 69
representatives
Tenants shall be given the opportunity to choose their levels ofparticipation in all activities
offered in the program 23 effective 1 9 10 ARCS176B IAB 09
481 Strclcttdral requirelneants 2310 35 69 1 Gener 35 69 a1equz ents en u
The structure ofthe program shall be
b
The
c
and
designed and operated
to meet the needs of the tenants
shall be well maintained clean safe and
buildings grounds Programs shall have private dwelling units
with
sanitary action lockable entrance asingle
door
Inspections
Ch b9 p 16
and
IAC 09 23 9
481 Appeals
whether in
general dementia persons with cognitive impairment door and specific setting shall have the means to disable or remove the lock on an entrance dementia and the to the health of tenant safety shall disable or remove the lock if its presence presents a danger of at a minimum Type V 111 e The structure in which a program is housed shall be built to 2 6 of NFPA 1 3 and Sections 6 1A 2 101 Life Safety construction as in Section 22 d
A program
or
serving
a
or
provided
Code 2003 edition published by the National Fire Protection Association 1 Batterymarch Park Quincy Massachusetts 02169 7471 or as required in administrative rules promulgated by the state fire marshal Programs may have individual cooking facilities within the private dwelling units f a general or Any program serving persons with cognitive impairment or dementia whether in
specific setting shall dementia or
have the
to disable or
means
easily
remove
appliances
and shall disable
and safety of the tenant or others remove them if their presence presents a danger to the health Facilities for programs certified prior to July 4 prior to July q 2001 2 Prrog 35 69 ams certified
2001 shall floor
area
following requirements dwelling unit shall have at least one room
meet the
Each
a
Other habitable
b
Each
c
A
that shall have not less than 120 square feet of
than 70 square feet rooms shall have an area of not less
unit shall have not less than 190 square feet of floor area excluding bathrooms unit used for double occupancy shall have not less than 290 square feet of floor
dwelling
dwelling
area excluding bathrooms d The program shall have
minimum of 15 square feet of common area per tenant 35 Neiv construction built on or after July 4 2001 Programs operated iu new construction 69 3
built on
or
after
July 4 2001
a
following requirements
shall meet the
that shall have not less than 120 square feet of less than 70 square feet of not floor area Other habitable rooms shall have used shall have a total square footage of not less than fox single occupancy b Each dwelling unit
Each dwelling unit shall have at least
a
one room
an
area
240 square feet offloor area excluding vathrooms and door swing A dwelling unit used for double occupancy shall have a total square c
footage of not Less than
bathrooms and door
swing and including but not limited to a toilet sink a whether in or A with dementia cognitive impairment bathing facilities program serving persons to disable or remove the sink or bathing facility shall have the means general or dementia specific setting to the health water control and shall disable or remove the water control if its presence presents a danger 340 square feet offloor area
d
excluding
Each dwelling unit shall contain
and safety ofthe tenant The program shall have e
a
bathroom
of25 square feet of common space per tenant required for individual dwelling units whether in a
a minimum
general or f closing Self the authority with jurisdiction determines that the level of hazard has unless specific setting dementia a stove range or increased to require the installation of closure hardware for example presence of doors are not
oven A a ana on or after July 4 2001 69 Structure being converted to or remodeledfor use by prog 4 35 converted or remodeled for use for a program on or after July in a structure that was program operating 4 2001 shall meet the following requirements 120 square feet of floor a Each dwelling unit shall have at least one room that has not less than area
Other habitable
rooms
shall have
of not less than 70 square feet of not less than occupancy shall have a total square footage
an area
b single 190 square feet of floor area excluding bathrooms and door swing less than c A dwelling unit used for double occupancy shall have a total square footage of not 290 square feet of floor area excluding bathrooms and door swing 15 square feet of common d The program shall have dedicated for use by tenants a minimum of Each dwelling unit used for
area
per e
facility
tenant
Each dwelling unitshall have
a
bathroom including but not limited to
a
toilet sink
and
bathing
IAC 9123 49
Inspections
and
Ch 69
481 Appeals
7 square feet sleepiltg room shall have a minimum of 5 the fire state marshal or designee this requirement may be granted by
f
Each
of
operable
7 1 p
dozv Waiver of wil
101 ARC S176B IAB 9123 09 effective 1
specific programs are specific programs Dementia 481 Dwelling units in dementia 231C 36 69 as from the in subrules to follows 2 35 69 4 35 69 requirements exempt 1 Far a program built in a family or neighborhood design 36 69 a Each dwelling unit used for single occupancy shall have a total square footage of not less than 150 square feet offloor area excluding a bathroom and b Each dwelling unit used for double occupancy shall have a total square footage of not less than 250 square feet of floor area excluding a bathroom 2 Dementia 36 69 specific programs may choose not to provide bathing facilities in the dwelling units 09 2 3 effective I 101 1 ARC 81765 IAB 9
231C 37 69 481
Landlord and
landlord and tenant Act shall
apply
tenant Act Iowa Code to programs under
chapter 562A
the uniform residential
this chapter
23 effective 1 9 10 ARC 8176B IAB 09 s benefit elagil 481Identification of veteran SF203 83GA 38 69 ility s tenant admission to an assisted living program that receives 1 Within 34 days of a 38 69 reimbursement through the medical assistance program under Iowa Code chapter 249A the program
personal representative whether the tenant is a veteran dependent of a veteran and shall document the response
s shall ask the tenant or the tenant tenant is the spouse
2 If the 38 69
widow
or
or
whether the
veteran or the spouse widow or the s tenant name along with the name of the veteran
program determines that the tenant
may be
a
dependent of a veteran the program shall report if applicable as well as the name of the contact person for this information to the Iowa department of veterans affairs When appropriate the program may also report such information to the Iowa department of human services S Department of Veterans Affairs or other 3 Ifa tenant is eligible for benefits through the U 38 69 shall seek reimbursement from the identified payor source before party payor the program first third medical assistance program established w lder Iowa Code chapter 249A 23109 effective 1 11101 ARC 8176B IAB 9 These rules are intended to implement Iowa Code chapter 231C
seeking reimbursement from the
there
a
significant thange in
ar ciagriidon atth
function
If both answers are
co
do c
a
Any change in 8nt c4nditiO tef n 1
Start
Isthere
an
intrease ar
decrease intame
needs or
servites3
that rei ufres
a
snote nwrse
00
rn
tr O
r
consider rri ditatian or treatmenE or additiiins changes Iab orders hospitaE stays ar physician visits
If eifiher answer Fs
if the evaluation dc es warrant
n
service
a
a
plan updat s
cryy
If any an wet is Yes
7 C
es Y
Nurse Review
231C 27 69 A81
service Plan
0 Evaluation
00
1
Update sections triggered by evaluation tyy adding ordeleting services 2 Date and sign all parties the updated service plan if no change or condition is resolved then nurse to note same date and sign
rn
0
Q
N w
0
1 Reoccurrence of a chronic condition rimy permit useof previous the evaluations and service plan intervenkians after a second significank occurrence fn athree periadif month notated on current service plan with nurse to date arid sigri 2 ImpiemenYatian of chronic condition protocol does not require new signatures except ttie s nursa
Any addittana raqui d services far s ADI
1
2 3
f e fform comprehensive evaluation of Freaittt cognition and function areas only on health triggered Update and function a foil cognitive evaluation ompiete with everysignlficant change 4 The nurse to date and sign the uPdat2 5 AevFew and notate no change for triggered areas tnitiai and date non
service plan update
Q
7
R
S
Haveservice changed needs s orders ar medication result bf iioztur as
a
changes 5
CD
w
tion warrant further evaluation
t
If the evaluator dges not a warrant
the doctor be cantacted7 Should Does the s tenant cognition or condi
w G
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