227a
2600.227(a) - A resident requiring personal care services shall have a written support plan developed and implemented within 30 days of admission to the home. The support plan shall be documented on the Department’s support plan form.
Discussion: The Department uses a single document to both assess a resident’s needs and develop a plan to meet those needs. This form is known as the Resident Assessment-Support Plan, or RASP. A copy of the RASP is
available on the Department’s website or by contacting the Operator Support Hotline.
Use of this form is required, unless the home creates a document that captures the same information as the RASP.
For more information about RASP use, please review the instructions that accompany the form and see “The Preadmission Screening, Medical Evaluation, and Assessment-Support Plan: Best Practices” in the “Regulatory Issues and Frequently-Occurring Situations” section.
Inspection Procedures: Inspectors will review resident records, as well as interview the administrator, staff, and/or residents of the home to determine if the home is in compliance with the regulation.
Primary Benefit: Ensures that each resident’s needs are met, and that accountability for meeting those needs is firmly established.
227c 2600.227(c) - The support plan shall be revised within 30 days upon completion of the annual assessment or upon changes in the resident’s needs as indicated on the current assessment.
Discussion: See § 2600.227(a).
Inspection Procedures: Inspectors will review resident records, as well as interview the administrator, staff, and/or residents of the home to determine if the home is in compliance with the regulation.
Primary Benefit: Ensures that each resident’s needs are met as those needs change, and that accountability for meeting those needs is firmly established.
227d
2600.227(d) - Each home shall document in the resident's support plan the medical, dental, vision, hearing, mental health or other behavioral care services that will be made available to the resident, or referrals for the resident to outside services if the resident’s physician, physician's assistant or certified registered nurse practitioner, determine the necessity of these services. This requirement does not require a home to pay for the costs of these medical and behavioral care services.
Discussion: See § 2600.227(a).
Inspection Procedures: Inspectors will review resident records, as well as interview the administrator, staff, and/or residents of the home to determine if the home is in compliance with the regulation.
Primary Benefit: Ensures that each resident’s needs are met as those needs change, and that accountability for meeting those needs is firmly established.
227e 2600.227(e) - The resident’s support plan must document the ability of the resident to self-administer medications or the need for medication reminders or medication administration.
Discussion: See § 2600.227(a).
Inspection Procedures: Inspectors will review resident records, as well as interview the administrator, staff, and/or residents of the home to determine if the home is in compliance with the regulation.
Primary Benefit: Ensures that each resident’s needs are met initially as well as when those needs change, and that accountability for meeting those needs is firmly established.
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227f 2600.227(f) - A resident may participate in the development and implementation of the support plan. A resident may include a designated person in making decisions about services.
Discussion: Self-explanatory.
Inspection Procedures: Inspectors will review the resident records, as well as interview the administrator, staff, and/or residents of the home to determine if a resident and/or the resident’s designated person participated in the development and implementation of his/her support plan.
Primary Benefit: Having a resident and/or designated person participate in the development and implementation of the support plan helps to provide crucial detailed information about the specific resident which can assist the home in developing a specific plan as to how it will meet the needs of the resident identified in the assessment.
227g 2600.227(g) - Individuals who participate in the development of the support plan shall sign and date the support plan.
Discussion: All staff persons (including contractors of the home) who participate in the development of the plan must sign the plan.
Inspection Procedures: Inspectors will review resident records to determine if the home is in compliance with the regulation.
Primary Benefit: Having individuals who participate in the development of the support plan sign and date the support plan provides a record of who participated in the development of the support plan for future reference purposes.
227h 2600.227(h) - If a resident or designated person is unable or chooses not to sign the support plan, a notation of inability or refusal to sign shall be documented.
Discussion: Self-explanatory.
Inspection Procedures: Inspectors will review resident records to determine if the home is in compliance with the regulation.
Primary Benefit: If a resident and/or designated person participates in the development of the support plan and is unable or chooses not to sign and date the support plan, noting this in the record provides a record of who participated in the development of the support plan for future reference purposes (even though the persons did not sign).
227i 2600.227(i) - The support plan shall be accessible by direct care staff persons at all times.
Discussion: The support plan must be accessible to the direct care staff identified as the “responsible person” on the RASP. For homes using support plans in an electronic format, it is recommended but not required that the home have a copy of the support plan in hard copy format so that staff persons have easy access to the plan.
Inspection Procedures: Inspectors will verify that there is a system in place to grant access to the RASP to the staff persons responsible for carrying it out.
Primary Benefit: Ensures that the staff responsible for meeting a resident’s needs is aware of the plan to meet those needs.
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227j 2600.227(j) - The home shall give a copy of the support plan to the resident and the resident’s designated person upon request.
Discussion: Self-explanatory.
Inspection Procedures: Inspectors will review the resident records, as well as interview the administrator, staff, and/or residents of the home to determine if the home provided a copy of the support plan to the resident and the resident’s designated person upon request.
Primary Benefit: Giving a copy of the support plan to the resident and the resident’s designated person makes the persons aware of the plan showing how the home will meet the needs of the resident identified in the
assessment.
Notice of Termination
228a 2600.228(a) - At the resident’s request, the home shall provide assistance in relocating to the resident’s own home or to another residence that meets the needs of the resident.
Discussion: It is strongly recommended that homes specify what type of assistance will be provided in both the resident-home contract (see § 2600.25(c)(9)) and in the home’s written criteria for admission and discharge (see § 2600.223(a)). In the absence of a written description of the degree of assistance a home will provide, the
Department encourages the following, at a minimum:
• Contacting local human services agencies, if applicable
• Identifying and contacting three other personal care homes or other appropriate residential settings of the resident’s choosing and inquiring about vacancies for the resident
• Transportation to the prospective homes at no cost to the resident.
Inspection Procedures: Inspectors will obtain and review the home’s written description of what assistance is provided, if one exists. Inspectors will review the record of at least one resident that has requested and received assistance in relocating to verify that the home acted in accordance with its procedures or, in the absence of written procedures, with the requirements above.
Primary Benefit: Providing relocation assistance to a resident helps to ensure that the resident’s needs will be met in a safe and appropriate environment, especially if the resident is unable to advocate for him/herself or incapable of finding a new home.
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228b
2600.228(b) - If the home initiates a discharge or transfer of a resident, or if the legal entity chooses to close the home, the home shall provide a 30-day advance written notice to the resident, the resident's designated person and the referral agent citing the reasons for the discharge or transfer. This shall be stipulated in the resident-home contract. A 30-day advance written notice is not required if a delay in discharge or transfer would jeopardize the health, safety or well-being of the resident or others in the home, as certified by a physician or the Department. This may occur when the resident needs psychiatric or long-term care or is abused in the home, or the Department initiates closure of the home.
Discussion: The physician’s certification that a delay in discharge or transfer would jeopardize the health, safety or well-being of the resident or others in the home must be in writing and must be retained in the resident’s record (see § 2600.228(e) and § 2600.252(21)).
To request the Department’s certification that a delay in discharge or transfer would jeopardize the health, safety, or well-being of the resident or others in the home, please contact the Operator Support Hotline.
It is recommended that voluntarily closing homes provide the residents with a 60-day advance written notice. See
§ 2600.228(c).
Inspection Procedures: Inspectors will review a sample of discharged residents’ records to verify that 30-day notices were provided and referenced a reason for discharge permitted by § 2600.228(h).
Primary Benefit: Issuing a 30-day notice allows a resident time to identify and relocate to a new home. It also allows the home sufficient time to render relocation assistance as required by § 2600.228(a). The ability to discharge a resident without a 30-day notice under specific circumstances protects other residents from harm.
228c 2600.228(c) - A home shall give the Department written notice of its intent to close the home, at least 60 days prior to the anticipated date of closing.
Discussion: Notice of intent to close a home should initially be provided by telephone. Homes should contact the regional office in which the home is located, inform the region of their intent to close, and obtain a copy of the Department’s voluntary closure form if desired. Written notice must be provided, either by mail, facsimile, or email.
Inspection Procedures: Inspectors will review the home’s written notice and verify that the scheduled closure date is at least 60 days into the future.
Primary Benefit: The Department is required to offer relocation assistance to the residents of a home that is closing. Advance notice of closure allows the Department to contact local human services agencies and plan for a safe, orderly relocation.
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228d
2600.228(d) - A home may not require a resident to leave the home prior to 30 days following the resident's receipt of a written notice from the home regarding the intended closure of the home, except when the Department determines that removal of the resident at an earlier time is necessary for the protection of the health, safety and well-being of the resident.
Discussion: The Department will determine that a resident must be moved before the 30-day notice period expires only in exceptional circumstances. To request the Department’s assistance in determining whether a resident must relocate prior to the expiration of the 30-day notice period, please contact the Operator Support Hotline.
Inspection Procedures: Inspectors will review a sample of discharged residents’ records to verify that residents who left the home prior to the expiration of the 30-day notice period did so of their own choosing/agreement or at the determination of the Department.
Primary Benefit: Issuing a 30-day notice allows a resident time to identify and relocate to a new home.
Requiring a resident to leave the home prior to the expiration of the 30-day period limits the amount of time that residents have to make an informed choice.
228e 2600.228(e) - The date and reason for the discharge or transfer, and the destination of the resident, if known, shall be recorded in the resident record.
Discussion: Self-explanatory.
Inspection Procedures: Inspectors will review a sample of discharged residents’ records and verify that the required information is present.
Primary Benefit: It is occasionally necessary for a home, the Department, another regulatory oversight agency, or law enforcement personnel to locate residents who have been discharged or transferred.
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228h
2600.228(h) - The only grounds for discharge or transfer of a resident from a home are for the following conditions:
(1) If a resident is a danger to himself or others.
(2) If the legal entity chooses to voluntarily close the home, or a portion of the home.
(3) If a home determines that a resident’s functional level has advanced or declined so that the resident's needs cannot be met in the home. If a resident or the resident’s designated person disagrees with the home’s decision to discharge or transfer, consultation with an appropriate assessment agency or the resident’s physician shall be made to determine if the resident needs a higher level of care. A plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident and the resident’s designated person, if any. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/mental retardation program or drug and alcohol program, for assistance. The administrator shall also contact the Department’s personal care home regional office.
(4) If meeting the resident's needs would require a fundamental alteration in the home’s program or building site, or would create an undue financial or programmatic burden on the home.
(5) If the resident has failed to pay after reasonable documented efforts by the home to obtain payment.
(6) If closure of the home is initiated by the Department.
(7) Documented, repeated violation of the home rules.
Discussion: Residents may only be discharged for one or more of the reasons listed above. Discharge for any other reason is a regulatory violation, and the home will likely be required to readmit a resident who was discharged on unacceptable grounds.
(1) If the resident is a danger to him/herself or others such that the home cannot care for him/her for the 30-day notice period, written certification by a physician or the Department that a delay in discharge or transfer would jeopardize the health, safety or well-being of the resident or others in the home is required in accordance with § 2600.228(b).
(2) It is recommended that residents receive 60 days’ notice in the event of voluntary closure.
(3) If a resident’s functional level has advanced or declined such that the home cannot care for him/her for the 30-day notice period, written certification by a physician or the Department that a delay in
discharge or transfer would jeopardize the health, safety, or well-being of the resident or others in the home is required in accordance with § 2600.228(b).
(4) Self-explanatory.
(5) “Reasonable documented efforts by the home to obtain payment” means no less than two attempts to obtain payment in full.
(6) Self-explanatory.
(7) “Documented, repeated violation” means no less than two documented violations.
Inspection Procedures: Inspectors will review a sample of discharged residents’ records to verify that 30-day notices were provided and referenced a reason for discharge permitted by this regulation.
Primary Benefit: Limiting the allowable grounds for discharge protects residents from retaliatory discharge as well as their right to remain in the home (see § 2600.42(u)). Building flexibility into the allowable grounds for discharge allows homes to discharge residents who pose a threat to other residents, whose needs cannot be met by the home, or who do not pay for services.