Title of Regulation: 22VAC40-60. Standards and Regulations for Licensed Adult Day Care Centers (amending 22VAC40-60-10, 22VAC40-60-20, 22VAC40-60-30, 22VAC40-60-60, 22VAC40-60-130, 22VAC40-60-200, 22VAC40-60-280, 22VAC40-60-320).

Statutory Authority: §§ 63.2-217 and 63.2-1733 of the Code of Virginia.

Effective Date: April 1, 2012.

Agency Contact: Annette Kelley, Adult Programs Consultant, Department of Social Services, 801 East Main Street, Richmond, VA 23219, telephone (804) 726-7632, FAX (804) 726-7132, or email annette.kelley@dss.virginia.gov.

Summary:

The amendments conform definitions and agency names to the Code of Virginia and update statutory and administrative code citations and regulation titles.

Part I
General Provisions

22VAC40-60-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:

"Administer medication" means to open a container of medicine or to remove the prescribed dosage and to give it to the participant for whom it is prescribed.

Section 54.1-3408 of the Code of Virginia states that only persons authorized by state law may administer drugs. People authorized to administer medication include licensed physicians, registered nurses, licensed practical nurses, physician assistants, and other individuals who meet the requirements of the law. In addition to these persons designated by law, a person may administer medications who has satisfactorily completed a training program for this purpose approved by the Board of Nursing and who administers such drugs in accordance with a physician's instructions pertaining to dosage, frequency, and manner of administration, and in accordance with regulations promulgated by the Board of Pharmacy relating to security and recordkeeping, when the drugs administered would be normally self-administered by a program participant in an adult day care center licensed by the Department of Social Services.

"Adult" means any person 18 years of age or older.

"Adult day care center" means "a any facility, which that is either operated for profit or which that desires licensure and which that provides supplementary care and protection during only a part of the day only to four or more aged, infirm or disabled adults who reside elsewhere except (i) a facility or portion of a facility licensed by the State Board of Health or the State Board Department of Mental Health, Mental Retardation and Substance Abuse Behavioral Health and Developmental Services and (ii) the home or residence of an individual who cares for only persons related to him by blood or marriage." (§ 63.1-194.1 63.2-100 of the Code of Virginia)

"Advance directive" means (i) a witnessed written document, voluntarily executed by the declarant in accordance with the requirements of § 54.2983 54.1-2983 of the Code of Virginia, or (ii) a witnessed oral statement, made by the declarant subsequent to the time he is diagnosed as suffering from a terminal condition and in accordance with the provisions of § 54.1-2983 of the Code of Virginia.

"Ambulatory" means the condition of a participant who is physically and mentally capable of self-preservation by evacuating in response to an emergency to a refuge area as defined by the Uniform Statewide Building Code without the assistance of another person, or from the structure itself without the assistance of another person if there is no such refuge area within the structure, even if such participant may require the assistance of a wheelchair, walker, cane, prosthetic device, or a single verbal command to evacuate.

"Care" means assistance with the activities and tasks of daily living provided to participants.

"Character and reputation" means findings have established that knowledgeable and objective people agree that the subject maintains business and professional, family, and community relationships which are characterized by honesty, fairness, truthfulness, and a concern for the well-being of others to the extent that the subject is considered suitable to be entrusted with the health, safety, and welfare of aged, infirm, or disabled adults.

"Commissioner" means the Commissioner of Social Services, also known as the Director of the Virginia Department of Social Services.

"Communicable disease" means a disease that may be transmitted directly or indirectly from one individual to another.

"Contrast" means a significant difference in diversity of adjacent parts by color, tone, or light.

"Department" means the Virginia Department of Social Services.

"Department's representative" means an employee or designee of the Virginia Department of Social Services who is acting as the authorized agent of the commissioner in carrying out the responsibilities and duties specified in Chapter 9, Title 63.1 of the Code of Virginia Commissioner of Social Services.

"Direct care staff" means the staff in an adult day care center who are actively providing care, guidance, and interaction with participants.

"Director" means the person who has been delegated responsibility for the programmatic and administrative functions of the adult day care program.

"Disabled" means the inability to perform some or all of the activities and tasks of daily living due to physical or mental impairments or injuries.

"Infirm" means the inability to perform some or all of the activities and tasks of daily living because of weakness or illness.

"Legal guardian" means an individual who has legal control and management of the person, or the property, or of both the person and the property of the participant. A legal guardian is appointed by a court. A legal guardian of the person is appointed to see that the participant has proper care and supervision in keeping with his needs. A legal guardian of the property is appointed to manage the financial affairs in the best interest of the participant.

"Licensee" means any person, association, partnership, corporation or governmental unit to whom the license is issued.

"Licensed health care professional" means any health care professional currently licensed by the Commonwealth of Virginia to practice within the scope of his profession, such as a clinical social worker, dentist, licensed practical nurse, nurse practitioner, pharmacist, physical therapist, physician, physician assistant, psychologist, registered nurse, and speech-language pathologist.

"Licensed practical nurse" means any individual who holds a current, valid, license from the Commonwealth of Virginia as an L.P.N.

"Nonambulatory" means the condition of a participant of an adult day care center who by reason of physical or mental impairment is not capable of self-preservation by evacuating in response to an emergency to a refuge area as defined by the Uniform Statewide Building Code without the assistance of another person, or from the structure itself without the assistance of another person if there is no such safe refuge area within the structure.

"Nurse" means any individual who holds a current, valid license from the Commonwealth of Virginia as a licensed practical nurse or as a registered nurse.

"Participant" means an aged, infirm or disabled adult who takes part in the program of care and receives services from the center.

"Personal representative" means the person representing or standing in the place of the resident for the conduct of his affairs. This may include a guardian, committee, attorney-in-fact under the durable power of attorney, next of kin, descendant, trustee, or other person expressly named by the participant as his agent.

"Physician" means any individual licensed to practice medicine in any of the 50 states or the District of Columbia.

"Program director" means the person responsible for programmatic functions and supervision of all staff who work directly with participants.

"Protection" means the intent to prevent harm and to provide oversight of the participant.

"Registered nurse" means any individual who holds a current, valid license from the Commonwealth of Virginia as an R.N.

"Respite care" means temporary care given to a person to relieve family members or other caregivers. These standards apply only if respite care is provided during part of the day. If 24-hour respite care is planned or provided for four or more people, the Standards and Regulations for Licensed Adult Care Residences Assisted Living Facilities (22VAC40-71-10 et seq. (22VAC40-72) shall apply.

"Snack" means a light meal or nutritious meal supplement.

"Sponsor" means an individual, partnership, association, or corporation responsible for the operation of an adult day care center subject to licensure.

"Staff or staff person" means compensated administrative, program, and service personnel including the licensee when the licensee is an individual.

"Standard precautions" means an approach to infection control. According to the concept of standard precautions, all human blood and certain human body fluids are treated as if known to be infectious for human immunodeficiency virus (HIV), hepatitis B virus, and other blood borne pathogens.

"Supplementary care" means a part of the total care that is required by participants. Supplementary care augments the care that the family or other persons provide. Care provided by an adult day care center is supplementary care.

"Supervision" means the general oversight of the physical and mental well-being of participants.

"These standards" means the requirements in this chapter, 22VAC40-60-10 et seq. 22VAC40-60, Standards and Regulations for Licensed Adult Day Care Centers.

"Volunteer" means a person who works at the center and:

1. Is not compensated; and

2. Is supervised by a staff member when working with participants.

22VAC40-60-20. Legal base.

Article 3 (§ 63.1-194.1 et seq.) of Chapter 9 17 of Title 63.1 63.2 of the Code of Virginia describes the responsibility of the Department of Social Services for the regulation of adult day care centers.

22VAC40-60-30. Board authority.

Section 63.1-194.2 63.2-1733 of the Code of Virginia requires the State Board of Social Services to prescribe standards for certain activities, services, and facilities for adult day care centers.

22VAC40-60-60. Facilities not covered.

The following types of facilities are not subject to licensure as an adult day care center:

1. A facility or portion of a facility licensed by the State Board of Health;

2. A facility or portion of a facility licensed by the State Board of Mental Health and Mental Retardation Behavioral Health and Developmental Services;

3. A home or residence of an individual who provides care only for persons related to him by blood or marriage;

4. A facility or a portion of a facility that is licensed by the Department of Mental Health, Mental Retardation and Substance Abuse Behavioral Health and Developmental Services, and that conducts a mental health program where treatment is provided for adults who are experiencing varying degrees of mental health related problems;

5. A facility or a portion of a facility licensed by the Department of Mental Health, Mental Retardation and Substance Abuse Behavioral Health and Developmental Services that conducts a mental retardation program where treatment is provided for mentally retarded or developmentally disabled adults;

6. A facility or a portion of a facility that conducts programs whose primary purpose is training or employment for physically or mentally impaired adults (e.g., sheltered workshops, etc.); and

7. A facility or a portion of a facility that conducts a socialization or recreation activity program for adults who do not receive assistance with the activities or tasks of daily living or protective oversight and supervision (e.g., senior centers, etc.).

22VAC40-60-130. Financial responsibilities.

With an initial application for licensure, the applicant shall provide the department with the following evidence of financial responsibility:

1. A projected budget detailing income and expenses of the proposed center for the first year of operation;

2. A complete balance sheet showing separately the current assets committed to and current liabilities charged against the proposed center; and

3. Documentation of funds or credit available for the first 90 days of operation.

NOTE: Financial records may be requested pursuant to § 63.1-194.7 63.2-1706 of the Code of Virginia.

Part III
Personnel

22VAC40-60-200. General qualifications.

A. All staff members, including the administrator, shall:

1. Be of good character and reputation;

2. Be competent, qualified and capable of carrying out assigned responsibilities;

3. Be willing and able to accept training and supervision;

4. Be considerate, understanding and respectful of aged and disabled persons;

5. Be clean and well groomed; and

6. Meet the requirements specified in the Regulation for Criminal Record Checks for Homes for Adults Background Checks for Assisted Living Facilities and Adult Day Care Centers (22VAC40-90-10 et seq.) (22VAC40-90).

B. All staff members shall be able to communicate in English effectively both orally and in writing as applicable to their job responsibilities.

C. All staff members shall be able to understand and apply these standards as they relate to their respective responsibilities.

D. All staff persons who work directly with participants and who are counted in the staff-to-participant ratio shall be at least 18 years of age.

22VAC40-60-280. Orientation and staff training.

A. Prior to working directly with participants, all staff shall receive training in:

1. Their individual responsibilities in the event of fire, including the location and operation of any fire extinguishers and fire alarm boxes and approved exits;

2. Their individual responsibilities in the event of illness or injuries, including the location and use of the first aid and emergency supplies;

3. Their individual responsibilities in the event of emergencies, such as a lost or missing participant, severe weather, and loss of utilities;

4. Standard precautions; and

5. Participant rights.

B. Staff who work with participants shall receive at least 24 hours of training no later than three weeks after starting employment; part-time staff shall receive the training no later than six weeks after employment.

C. A supervisor or designated trained staff shall closely oversee the individual's work with participants until training is complete.

D. The following areas or topics shall be covered in the staff training:

1. The purpose and goals of the adult day care center;

2. The policies of the center as they relate to the staff member's responsibilities and to the responsibilities of other staff members;

3. Procedures for detecting and reporting suspected abuse, neglect, or exploitation of participants to the appropriate local department of social services (§ 63.1-55.3 63.2-1606 of the Code of Virginia);

4. Confidential treatment of personal information about participants and their families;

5. This chapter as it relates to the employee's responsibilities;

6. Needs of the center's target population (for example, those with dementia, developmental disability, depression);

7. Individual capabilities and special needs of the elderly, the cognitively impaired adult, or the handicapped;

8. The specific needs of participants in care, including diagnoses, plans of care, and adjustment issues;

9. The schedule of activities;

10. Behavioral interventions, behavior acceptance and accommodation, and behavior management techniques;

11. Interdisciplinary team approach;

12. Communication skills;

13. Review of basic terminology;

14. Advance directive policies;

15. How to safely and appropriately help participants perform activities of daily living (ADLs), including good body mechanics;

16. Risk management; and

17. The needs of participants' family members or care givers.

E. The required 24 hours of training can be accomplished through a variety of methods including, but not limited to, formal lecture, observation, self-study of material provided by the center, supervised practice, and audio-visual training.

22VAC40-60-320. Director.

A. There shall be one person responsible for the center's program who is present at least 51% of the center's weekly hours of operation and whose responsibilities shall include, but not be limited to, the following areas:

1. The content of the program offered to the participants in care;

2. Programmatic functions, including orientation, training, and scheduling of all staff who directly supervise participants, whether or not the director personally performs these functions;

3. Management of the supervision provided to all staff who directly supervise participants, whether or not the director individually supervises such staff;

4. Assignment of a sufficient number of qualified staff to meet the participants' needs for:

a. Adequate nutrition;

b. Health supervision and maintenance;

c. Personal care;

d. Socialization, recreation, activities and stimulation;

e. Supervision and protection;

f. Safety; and

5. The duties and responsibilities required by this chapter.

B. The director shall meet the following qualifications.

1. The director shall be at least 21 years of age.

2. The director shall have completed at least a bachelor's degree from an accredited college or university and two years of experience working with older adults or persons with disabilities. This may be paid full-time employment or its equivalent in part-time employment, volunteer work, or internship. The following qualifications may be substituted for a bachelor's degree:

a. Current licensure as a nursing home administrator from the Board of Nursing Home Long-Term Care Administrators; or

b. Current licensure in Virginia as a registered nurse who meets the experience requirements in subdivision 2 of this subsection.

EXCEPTION: Any person employed in an adult day care center licensed prior to July 1, 2000, as either a director or assistant director shall have completed at least 48 semester hours or 72 quarter hours of post-secondary education from an accredited college or institution and shall have completed at least two years experience working with older adults or persons with disabilities. This may be paid full-time employment or its equivalent in part-time employment or in volunteer work.

3. The director shall demonstrate knowledge, skills and abilities in the administration and management of the adult day care program including: (i) knowledge and understanding of impaired elderly or disabled individuals, (ii) supervisory and interpersonal skills, (iii) ability to plan and implement the program, and (iv) knowledge of financial management sufficient to ensure program development and continuity.

4. The director shall demonstrate knowledge of supervisory and motivational techniques sufficient to: (i) accomplish day-to-day work; (ii) train, support and develop staff; (iii) plan responsibilities for auxiliary staff to ensure that services are provided to participants.

5. The director shall complete 24 hours of continuing education annually to maintain and develop skills. This training shall be in addition to first aid, CPR, or orientation training.

FORMS (22VAC40-60)

Initial Application for a State License to Operate an Adult Day Care Center, 032-05-316/4 (rev. 8/02).

Renewal Application for a State License to Operate an Adult Day Care Center, 032-05-317/3 (rev. 8/02).

Report of Tuberculosis Screening Evaluation (eff. 7/00).

Meal Pattern for Adults (eff. 7/00).

Initial Application for a State License to Operate an Adult Day Care Center, 032-05-0316-05-eng (rev. 8/07).

Renewal Application for a State License to Operate an Adult Day Care Center, 032-05-0317-04-eng (rev. 8/07).

Report of Tuberculosis Screening, 032-05-0420-00-eng (rev. 02/12).

Report of TB Screening, 032-05-0077-01-eng (rev. 02/12).