6 Colo. Code Regs. § 1011-1 Chapter 07, pt. 9

Current through Register Vol. 47, No. 20, October 25, 2024

Part 9 - POLICIES AND PROCEDURES

9.1 The assisted living residence shall develop and at least annually review, all policies and procedures. At a minimum, the assisted living residence shall have policies and procedures that address the following items:

(A) Admission and discharge criteria in accordance with Parts 11 and 25, if applicable, including, but not limited to criteria for involuntary discharge as listed in Parts 11.11 through 11.12;

(B) Resident rights;

(C) Grievance procedure and complaint resolution, including a grievance procedure for involuntary discharge in accordance with Part 9.3;

(D) Investigation of abuse, neglect, and exploitation allegations;

(E) Investigation of injuries of known or unknown source/origin;

(F) House rules;

(G) Emergency preparedness;

(H) Fall management;

(I) Provision of lift assistance, first aid, obstructed airway technique, and cardiopulmonary resuscitation;

(J) Unanticipated illness, injury, significant change of status from baseline, or death of resident;

(K) Infection control;

(L) Practitioner assessment;

(M) Health information management;

(N) Personnel policies as required in both Part 6 and Part 7 of these rules;

(O) Staff Training;

(P) Environmental pest control;

(Q) Medication errors and medication destruction and disposal;

(R) Management of resident funds, if applicable;

(S) Policies and procedures related to secure environment, if applicable;

(T) Provision of palliative care in accordance with 6 CCR 1011-1, Chapter 2, Part 4.3, if applicable; and

(U) Visitation in accordance with Part 9.2.

9.2 The assisted living residence shall havewritten policies and procedures regarding the visitation rights detailed in Section 25-3-125(3)(a), C.R.S. Such policies and procedures shall:

(A) Set forth the visitation rights of the resident, consistent with 42 CFR 482.13(h); 42 U.S.C. 1396r(c)(3)(C); 42 U.S.C. 1395i(c)(3)(C); 42 CFR 483.10(a), (b), and (f); and Section 25-27-104, C.R.S., as applicable to the facility type;

(B) Describe any restriction or limitation necessary to ensure the health and safety of residents, staff, or visitors and the reasons for such restriction or limitation;

(C) Be available for inspection at the request of the Department;

(D) Be provided to residents and/or family members upon request; and

(E) Include the right of each resident of an assisted living residence to have at least one visitor of the resident's choosing during their stay at the residence, unless restrictions or limitations under federal law or regulation, other state statute, or state or local public health order apply. This visitation right shall be exercised in accordance with the following:

(1) A visitor to provide a compassionate care visit to alleviate the resident's physical or mental distress.

(2) For a resident with a disability:

(a) A visitor or support person, designated by the resident, orally or in writing, to support the resident during the course of their residency. The support person may visit the resident and may exercise the resident's visitation rights even when the resident is incapacitated or otherwise unable to communicate.

(b) When the resident has not otherwise designated a support person and the resident is incapacitated or otherwise unable to communicate their wishes, an individual may provide an advance medical directive designating the individual as the resident's support person or another term indicating that the individual is authorized to exercise visitation rights on behalf of the resident.

Pursuant to Section 15-18.7-102(2), C.R.S., "(2) 'Advance medical directive' means a written instruction concerning medical treatment decisions to be made on behalf of the adult who provided the instruction in the event that he or she becomes incapacitated. An advance medical directive includes, but need not be limited to:

(a) A medical durable power of attorney executed pursuant to Section 15-14-506;

(b) A declaration executed pursuant to the "Colorado Medical Treatment Decision Act", article 18 of this title;

(c) A power of attorney granting medical treatment authority executed prior to July 1, 1992, pursuant to Section 15-14-501, as it existed prior to that date; or

(d) A CPR directive or declaration executed pursuant to article 18.6 of this title."

(3) For a resident who is under eighteen years of age, the parent, legal guardian, or person standing in loco parentis to the resident is allowed to exercise these visitation rights pursuant to any limitations described in Parts 9.2(F) and (G).

(F) The policies and procedures may impose limitations on visitation rights. During a period when the risk of transmission of a communicable disease is heightened, an assisted living residence may:

(1) Require visitors to enter the residence through a single, designated entrance;

(2) Deny entrance to a visitor who has known symptoms of the communicable disease;

(3) Require visitors to use medical masks, face-coverings, or other personal protective equipment while on the assisted living residence premises or in specific areas of the residence;

(4) Require visitors to sign a document acknowledging:

(a) The risks of entering the residence while the risk of transmission of a communicable disease is heightened; and

(b) That menacing and physical assaults on health-care workers and other employees of the residence will not be tolerated;

(5) Require all visitors, before entering the residence, to be screened for symptoms of the communicable disease and deny entrance to any visitor who has symptoms of the communicable disease;

(6) Require all visitors to the residence to be tested for the communicable disease and deny entry for those who have a positive test result; and

(7) Restrict the movement of visitors within the residence, including restricting access to where immunocompromised or otherwise vulnerable populations are at greater risk of being harmed by a communicable disease.

(8) If an assisted living residence requires that a visitor use a medical mask, face covering, or other personal protective equipment or to take a test for a communicable disease in order to visit a resident at the assisted living residence, nothing in these regulations:

(a) Requires the residence allow a visitor to enter, if the required equipment or test is not available due to lack of supply;

(b) Requires the residence to supply the required equipment or test to the visitor, or bear the cost of the equipment for the visitor; or

(c) Precludes the health-care residence from supplying the required equipment or test to the visitor.

(G) The policies and procedures may impose additional limitations for the visitors of a resident with a communicable disease who is isolated. In this case, the residence may impose additional restrictions including:

(1) Limiting visitation to essential caregivers who are helping to provide care to the resident;

(2) Limiting visitation to one caregiver at a time per resident with a communicable disease;

(3) Scheduling visitors to allow for adequate time for screening, education, and training of visitors and to comply with any limits on the number of visitors permitted in the isolated area at the time; and

(4) Prohibiting the presence of visitors during aerosol-generating procedures or during collection of respiratory specimens.

(H) Any limitations imposed shall be consistent with applicable federal law and regulation and other state statute.

9.3 The assisted living residence shall have an involuntary discharge grievance policy that complies with Section 25-27-104.3, C.R.S., and includes, at a minimum:

(A) The individual designated by the assisted living residence to receive involuntary discharge grievances.

(B) The ability for any of the persons the assisted living residence is required to notify in accordance with Part 11.16 to file a grievance challenging the involuntary discharge and/or reasons for the discharge with the individual designated in subpart (A), above, within 14 calendar days after written notice of the involuntary discharge is provided by the assisted living residence.

(C) The ability for the resident, or other person allowed to file a grievance to receive assistance in preparing and filing a grievance without interference from the assisted living residence.

(D) A requirement that grievances related to involuntary discharge be submitted to the individual designated by the facility in accordance with subpart (A) as follows:

(1) In writing, or

(2) Orally submitted to the individual designated in accordance with subpart (A), above. In the case of an oral submission, the assisted living residence shall ensure the individual submitting the grievance retains proof of the oral submission through a witness or other evidence.

(a) If the grievance is orally submitted and witnessed, the assisted living residence shall ensure that the resident or other person filing the grievance has the witness's name and contact information, and shall keep that information as part of the grievance documentation.

(E) A requirement that no later than 5 business days after the submission of a grievance in accordance with subpart (D), above, the individual designated by the assisted living residence to receive involuntary discharge grievances shall provide a response to the grievance as follows:

(1) A written response shall be provided to the individuals required to receive notice in Part 11.16, the state long-term care ombudsman, and the designated local ombudsman.

(2) An oral explanation of the written response shall be provided to the resident and/or person filing the grievance, as appropriate.

(3) The written response shall include the following statement regarding the filing of an appeal:

"If the resident, or other person that submitted this grievance is dissatisfied with this response, they may file an appeal to the executive director of the Colorado Department of Public Health and Environment within 5 business days after receiving this written response. The appeal must include the original grievance, the original notice of involuntary discharge and supporting documentation given to the resident as part of that notification, and any additional information or documentation."

(F) Acknowledgement that if the resident, the individual filing the grievance, or the assisted living residence is dissatisfied with the findings and recommendations of the Department related to an appeal, they may request a hearing conducted by the Department pursuant to Section 24-4-105, C.R.S.

(G) A requirement that the assisted living residence not take any punitive or retaliatory action against a resident due to the resident filing a grievance or appeal pursuant to this Part.

(H) A requirement that the assisted living residence continue to assist with planning a discharge or transfer of the resident while the grievance or appeal to the Department is pending.

(I) A requirement that the resident be allowed to return to the assisted living residence if all of the following apply:

(1) The stated reason for the involuntary discharge in the notice of involuntary discharge provided in accordance with Part 11.17 is nonpayment of monthly services or room and board,

(2) The assisted living residence discharged the resident on or after the 31st day after the written notice of involuntary discharge was provided to the resident, and

(3) The resident substantially complied with payments due to the residence, as determined through the grievance and appeal process.

6 CCR 1011-1 Chapter 07, pt. 9

46 CR 24, December 25, 2023, effective 11/15/2023, exp. 3/14/2024 (Emergency)

46 CR 24, December 25, 2023, effective 1/14/2024