Authenticated PDF VersionStatutory Authority: 29 Delaware Code, Section 7971(d)(1) (29 Del.C. §7971(d)(1))
16 DE Admin. Code 3315
The Department of Health and Social Services ("Department") / Division of Long Term Care Residents Protection (DLTCRP) initiated proceedings to establish Regulation 3315 Family Care Homes. The Department's proceedings to establish the regulation was initiated pursuant to 16 Del.C. §1119C and its authority as prescribed by 29 Delaware Code §7971.
The Department published its notice of proposed regulation changes pursuant to 29 Del.C. §10115 in the October 2014 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by October 31, 2014 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Comment 1: Consider amending §3.1.2.1 by adding, "Violation of any of these provisions of these rules and regulations or 16 Del.C. Ch 11."
Response: §5.4.6.2 was amended as follows: "A ramp must be compliant with the standards outlined in Americans with Disabilities Act (ADA)."
Response: §5.6 was amended as follows: "A licensee must ensure that the facility's or program's premises and equipment accessible to or used by residents are free from any danger to their health, safety and well-being."
Response: To lower the occupancy rate to four (4) would substantially decrease the number of family care homes available. §5.12.4 is amended as follows:" There shall be one (1) bathtub or shower for every six (6) occupants."
Response: A minimum water temperature of 110º (F) is required in these homes. None of the regulations governing long term care facilities require the separation of laundry by individual resident.
Response: The definition of Level of Care has been amended to read, ""Level of Care means a written determination by a Licensed Independent Practitioner…"
“Level of Care" means a written determination of the amount of assistance a resident requires in the areas of, activities of daily living, medication, treatments and therapies, mobility, behavior management and supervision. [The document will also contain the amount of time a resident can be left unsupervised while the FCH provider is out of the residence.]
4.11 The family care provider may not leave the FCH when residents are present without delegating care duties to a responsible adult [unless the resident's Level of Care documentation contains an amount of time that the resident can be left unsupervised. In any case, the maximum amount of time the provider can be away is 12 hours.]
The Department finds that the proposed changes as set forth in the October 2014 Register of Regulations, with the amendments listed herein, should be adopted.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend Title 16 of the Delaware Administrative Code is adopted and shall be final effective January 12, 2015.
“Activities of Daily Living” getting out of bed, bathing, dressing, eating and ambulation.
“Affiliated Social Agency/Program” an agency which has entered into an agreement with the Department of Health and Social Services to determine that agreed social requirements are met.
“Care Provider” a person who is responsible for giving and providing direct supervision and care for residents. The care provider is to offer the residents who need and desire the support, protection, and security of family living, an opportunity to continue or to resume living within a family unit where they can function as an individual with both rights and obligations.
“Case Manager” an agency staff person. from an Affiliated Social Agency/Program who works with the residents, the care provider, the medical units and/or social, agencies, etc. to assist the individuals in adjusting to and maintaining oneself in the community. This includes planning, organizing, coordinating and/or advocating so that effective services are provided.
“Continuous” available at all times without cessation, break, or interruption.
“Direction” authoritative policy or procedural guidance for the accomplishment of a function or activity.
“Home(s)” the site, physical structure and equipment necessary to provide the required service.
“Licensee/Sponsor” a person who receives payment for giving and providing supervision and care for residents. Licensee may be the care provider.
“Living Space” any enclosed eating, sleeping, or recreational area available and 'utilized by the occupants
“Occupant” any person living in a home on a twenty-four (24) hour continuing basis, in excess of forty‑eight (48) hours in continuity, or more than thirty (30) days per year. Included are: residents, care provider and care provider family members.
“Personal Care Services” those services that include general supervision of, and direct assistance to, individuals in their activities of daily living to insure their safety, comfort, nutritional needs and well‑being.
“Physician” a physician licensed to practice in the State of Delaware.
“Resident” an individual who for payment of a fee is residing in a home which provides shelter, housekeeping services, food, personal care or direction in the activities of daily living.
“Resident Beds” accommodations with supportive services such as: meals, laundry and housekeeping for persons who generally stay in excess of twenty-four (24) hours.
“Sanitize” the process of destruction of disease causing pathogenic microorganisms by chemical or physical means directly applies to a clean surface (Example: Immerse for two (2) minutes in a solution of one (1) tablespoon of household bleach per gallon of water).
“Supervision” direct overseeing of a function or activity by a responsible person who is not a resident.
4.2 A statement of level of care of the resident will be issued prior to placement and at least yearly thereafter. Determination of level of care will be done by a nursing representative of the Division of Public Health.
4.4 The term "Rest (Family Care) Home" shall not be used as a part of the name of any institution in this State unless it has been so classified by the Division of Public Health.
4.11 Each licensed home shall cooperate fully with the state protection and advocacy agency, as defined in 16 Del.C. §1102(7), in fulfilling functions authorized by Title 16, Chapter 11.
4.12 A care provider that provides direct healthcare services to persons diagnosed as having Alzheimer’s disease or other forms of dementia shall receive annual dementia specific training that includes: communicating with persons diagnosed as having Alzheimer’s disease or other forms of dementia; the psychological, social, and physical needs of those persons; and safety measures which need to be taken with those persons.
5.0 Plant, Equipment and Physical Environment
5.2.1 The water supply and the sewage disposal system shall be approved by the Division of Public Health and the Department of Natural Resources and Environmental Control, respectively.
5.3.5 New and existing facilities accommodating residents who regularly require wheelchairs ‑shall be equipped with ramps‑ located at primary and secondary means of egress. A ramp shall not exceed one (1) foot of rise in twelve (12) feet of run.
5.6 Lighting. Each room shall be suitably lighted at all times for maximum safety, comfort, sanitation and efficiency of operation. A minimum of thirty (30) foot candles of light shall be provided for all working and reading surfaces and a minimum of ten (10)" foot candles of light on all other areas. This includes hallways, stairways, storerooms and bathrooms.
5.7.4 Low windows, open porches, changes in floor levels and areas on the grounds shall not present safety hazards.
5.11.1 Each kitchen shall have:
5.12.6 If the washing machine is in the kitchen, soiled laundry shall not be taken into the kitchen until it is ready to be washed.
Written notification to the State Board of Health by the State Fire Marshal of the existence of a fire hazard may be grounds for revocation of a license.
7.1.2 If the medications prescribed for residents are kept by the care provider, they shall: be kept locked in a cabinet set aside for that exclusive purpose. Medications requiring refrigeration shall be kept. locked in a separate box within the refrigerator.
7.3.3 The care provider shall assume responsibility for seeing that necessary precautions are taken and that all rules and regulations of the Division of Public Health are followed so that there is a, minimum of danger of transmission of a communicable disease. This responsibility includes all occupants of the home.
7.3.4 Each occupant shall have a screening test for tuberculosis. A P.P.D. skin test with an induration of less than 10mm is considered insignificant (negative). Chest x‑ray showing no evidence of active tuberculosis taken within a twelve (12) month period on a symptomatic individual shall satisfy this requirement. Report 'of skin test or chest x-ray shall be on file.
7.3.5 The admission or occurrence of patient with a reportable disease within a Rest (Family Care) Home shall be reported to the Director of the Division of' Public Health so as to determine the potential health hazard involved as currently required by the State Board of Health. (See Appendix A)
7.3.6 All homes shall have on file evidence of an annual vaccination, against influenza for all residents as recommended by the Immunization Practice Advisory Committee of the Center for Disease Control unless medically contraindicated
7.5.1 The interest and well‑being of every resident in a Rest (Family Care) Home is protected by the Patient's Bill of Rights as defined by law under Title 16 Del.C. 1121. All homes and care‑providers are to treat their residents in accordance with these provisions.
Any person who neglects or fails to comply with these regulations shall be subject to penalty as provided in 16 Del.C. 107.
17. Hansen's Disease (Leprosy)
This regulations are adopted by the Director, Division of Long Term Care Residents Protection pursuant to 16 Del.C., Chapter 11, Subchapter II, Rights of Patients.
C. After admission, each facility shall submit to the resident or legal representative on a monthly basis, a written, itemized statement of the charges and expenses the resident incurred during the previous month. The group home shall make reasonable efforts to communicate the contents of the individual written statement to persons who it has reason to believe cannot read the statement.
C. A physician from the Division of Public Health not employed by any of the hospitals' it operates.
State Board of Health Regulations adopted pursuant to 16 Del.C. 1109 July 1, 1956. Amended March 13, 1962. December 18, 1969, November 24, 1971, February 17, 1972, December 27, 1972, May 23, 1973, August ‑21, 1975, August 8, 1977, January 25, 1978, September 19, 1978, October 17, 1978, October 14,1980, April 14, 1981, March 3, 1983, to be effective April 1,1983, February 1, 1989, and March 3, 1993, to be effective March 4, 1993.
"Activities of Daily Living" (ADL) means the tasks for self-care which are performed either independently, with supervision, or with assistance. Activities of daily living include but are not limited to ambulating, transferring, grooming, bathing, dressing, eating and toileting.
"Affiliated Social Agency/Program" means an agency which has entered into an agreement with the Department of Health and Social Services to ensure that the health and welfare needs of the resident are met.
"Case Manager" means an individual from an affiliated social agency/program who works with the residents, the family care provider and others to assist the residents in adjusting to and maintaining themselves in the community. This includes planning, organizing, coordinating and/or advocating so that effective services are provided.
"Department" means the Delaware Department of Health and Social Services.
"Family Care Home" (FCH) means a home (physical structure and necessary equipment) that provides beds and personal care services for 2 or 3 residents who cannot live independently and who need or could benefit from a family living situation. The home provides shelter, housekeeping services, food/meals and personal care for residents.
"Family Care Provider" means a person, the holder of the license, who is responsible for providing direct supervision and care for residents. The family care provider is to provide consumer-driven services which maximize independence through individual choice, enable individuals to continue living active and productive lives and protect those who are vulnerable and at risk.
"Level of Care" means a written determination of the amount of assistance a resident requires in the areas of, activities of daily living, medication, treatments and therapies, mobility, behavior management and supervision. [The document will also contain the amount of time a resident can be left unsupervised while the FCH provider is out of the residence.]
"Licensed Independent Practitioner" means a physician; a physician's assistant; or a nurse practitioner licensed under 24 Del.C. Chs. 17 or 19.
"Occupant" means any person living in a home on a 24 hour continuing basis, in excess of 48 hours per week, or more than 30 days per year. Included are: residents, family care provider and family care provider family members.
"Resident" means an individual residing in a family care home.
"Supervision" means direct oversight of a function or activity by a responsible person who is not a resident.
3.1.2.3 The holder of the license may, within such 10-day period, give written notice of her/his desire to have a hearing. Proceedings in regard to such hearing shall be conducted in accordance with provisions for case decisions as set forth in 29 Del.C. Ch. 101 and in accordance with applicable rules and regulations of the Department.
4.4 The affiliated social agency/program or a licensed independent practitioner with the placement agency will establish a level of care. The level of care [determination shall be made in consultation with the resident’s personal primary care licensed independent practitioner if any, and] will include an assessment of the physical and mental status of the resident prior to [placement in admission to] the FCH and annually thereafter.
4.11 The family care provider may not leave the FCH when residents are present without delegating care duties to a responsible adult [unless the resident’s Level of Care documentation contains an amount of time that the resident can be left unsupervised. In any case, the maximum amount of time the provider can be away is 12 hours].
4.13 Each FCH shall cooperate fully with the state protection and advocacy agency, as defined in 16 Del.C. §1102(7), in fulfilling functions authorized by 16 Del.C. Ch. 11.
5.4.6.2 A ramp [shall not exceed one (1) foot of rise in 12 feet of run must be compliant with the standards outlined in Americans with Disabilities Act (ADA)].
5.6 [The HVAC systems for all areas shall be adequate, safe, protected, and easily controlled. It shall be capable of maintaining the temperature in each room used by residents between 70ºF and 80ºF. Portable heating or cooling devices shall not be used. A licensee must ensure that the facility’s or program’s premises and equipment accessible to or used by residents are free from any danger to their health, safety and well-being.]
5.9.6 [Camera's Cameras] or monitoring devices are not permitted in resident bedrooms or bathrooms unless written permission by resident(s), resident guardian(s) is on file.
5.10.4.3 Have the beds spaced at least three (3) feet apart. [Bunk beds are prohibited.]
5.11.3.2 [If a resident chooses they may bring their own mattress that may only be used by that resident. A resident may choose to provide an individual mattress to be used only by that resident.]
7.1.4 The family care provider shall maintain a list of each resident's [physician(s) or licensed independent practitioner(s)], the [physician(s)] contact information [for each] and all medications taken by the resident.
