Division of Public Health

Office of Health Facilities Licensing and Certification

Statutory Authority: 16 Delaware Code,Section 122(3)s1 (16 Del.C. 122(3)s1)


Nature of the Proceedings

Adult Day Care Facilities Regulations

Notice of Public Hearing


Page numbers will be inserted after any final revisions.


PART II Regulations



Title 16 - Health and Safety

Part I, Chapter 1, Subchapter II, Section 122.(3).s.1.

Powers and Duties of the Department of Health and Social Services




68.101 Accessible - an environment which allows an individual using a wheelchair or support appliance to enter, exit and move about freely with no assistance from another person.

68.102 Activities of Daily Living - the tasks for self-care which are performed either independently or with supervision or assistance. Activities of daily living include ambulating, transferring, grooming, bathing, dressing, eating, and toileting.

68.103 Adult - any person 18 years of age or older.

68.104 Aide/Assistant/Technician - an individual who provides care that does not require the judgment and skills of a licensed nurse. The care may include but is not limited to the following: bathing, dressing, grooming, toileting, ambulating, transferring and feeding, observing and reporting the general well-being for the person(s) to whom they are providing care.

68.105 Department - the Delaware Department of Health and Social Services.

68.106 Dietitian - a person currently registered by the Commission on Dietetic Registration of the American Dietetic Association and/or a Certified Dietitian/Nutritionist in the State of Delaware.

68.107 Functionally Impaired Adult - An adult who requires supervision due to cognitive or physical impairment or who cannot independently perform one or more Activities of Daily Living.

68.108 Nursing Services - those procedures commonly employed in providing for the physical, emotional and rehabilitation needs of functionally impaired adults which require technical skills and knowledge beyond that which the untrained person possesses, including, but not limited to, such procedures as: irrigations; catheterization; application of dressings; supervision of special diets; objective observation of changes in participant condition as a means of determining required nursing care and the need for further medical diagnosis and treatment; special procedures contributing to rehabilitation; administration of medication and carrying out treatments prescribed by a physician or an Advanced Practice Nurse in accordance with the Rules and Regulations related to the law Regulating the Practice of Nursing in Delaware which involve a like level of complexity and skill in administration.

68.109 Participant - an individual receiving services in an adult day care facility.

68.110 Representative - a person acting on behalf of the participant under Delaware law.


68.201 No person shall establish, conduct or maintain in this State any adult day care facility without first obtaining a license from the Department of Health and Social Services.

68.202 Separate Licenses

68.203 Inspection

68.204 Application Process


68.301 The adult day care provider shall neither knowingly admit, nor continue to care for, participants whose needs cannot be met by the program.

68.302 All records maintained by the adult day care facility shall at all times be open to inspection by the authorized representatives of the Department.

68.303 No policies shall be adopted by the adult day care facility which are in conflict with these regulations.

68.304 The adult day care facility shall establish written policies regarding the rights and responsibilities of participants, and these policies and procedures shall be made available to authorized representatives of the Department.

68.305 The adult day care facility shall establish policies and procedures that address the handling and documentation of incidents, accidents, medical emergencies and the prevention of wandering away from safe areas by cognitively impaired participants. Reports of these events shall be kept on file at the facility.

68.306 Emergency telephone numbers for each participant shall be available to staff at all times.

68.307 A procedure, approved by the Department, shall be established to enable participants and their families or representatives, if any, to have their concerns addressed without fear of reprisal.

68.308 The adult day care facility shall advise the Department in writing within fifteen (15) days following any change in the designation of the director/administrator of the facility.


68.401 Construction

68.402 Site Provisions

68.403 The adult day care facility shall comply with all local and state building codes and ordinances as pertain to this occupancy.

68.404 Building

68.405 Water Supply and Sewage Disposal

68.406 Heating, Ventilation and Air Conditioning

68.407 Lighting

68.408 Safety Equipment

68.409 Bathrooms and Hand Washing Facilities

68.410 Program Area

68.411 Furnishings

68.412 Emergency Equipment and Supplies

68.413 Sanitation and Housekeeping

68.414 Existing Facilities

68.415 Waiver of Requirements


68.501 Fire safety in adult day care facilities shall comply with the adopted rules and regulations of the State Fire Prevention Commission. Enforcement of Fire Regulations is the responsibility of the State Fire Prevention Commission. All applications for a license or renewal of a license must include, with the application, a letter certifying compliance by the Fire Marshal having jurisdiction. Notification of noncompliance with the Rules and Regulations of the State Fire Prevention Commission shall be grounds for revocation of a license.

68.502 The adult day care facility shall have a minimum of two (2) exits remote from each other which shall be clearly marked.

68.503 Staff and participants shall be trained in executing the evacuation plan. A written record of fire safety training, including content of the training and persons attending shall be maintained.

68.504 Evacuation fire drills shall be held and documented at least quarterly for all staff and participants.


68.601 The adult day care facility shall have written admission policies which describe admission and discharge criteria.

68.602 The admission policies shall be discussed with each participant entering the program, and their representative, if any.

68.603 The adult day care facility shall only admit those individuals whose needs can be met by the facility.

68.604 All participants shall be 18 years of age or older and functionally impaired as defined at Section 68.107.

68.605 There shall be a written agreement between the participant and the adult day care program. The agreement shall:

68.606 Assessment

68.607 Discharge


68.701 Prior to admission, a preliminary written plan of care, based upon the initial assessment shall be developed for each participant.

68.702 A written individual plan of care shall be developed within thirty (30) calendar days of the participant’s first day in the program. The plan shall be based on a functional assessment and information obtained from the participant, participant’s family, physician, and the referring agency (if appropriate).

68.703 The plan shall be developed to improve or maintain the functional capabilities of the participant. The plan shall include:

68.704 The written plan of care and personal information shall be revised as frequently as warranted by the participant’s condition, but shall be reviewed at least every six (6) months with the participant and representative, if any, and updated on an annual basis. All revisions to the plan of care shall be in writing.


68.801 Aide/Assistant/Technician as defined at Section 68.104 or licensed nurses shall provide supervision and assistance in activities of daily living, such as feeding and toileting, to participants who require those services. Facilities that have been in operation before the adoption of these regulations shall comply with this requirement within 12 months of the adoption date of the regulations.

68.802 Rehabilitation services, including occupational therapy, physical therapy, and speech therapy, if provided, shall be ordered by the participant’s physician and be performed by qualified therapists or therapy aides under supervision of a qualified therapist.

68.803 Medication Management

68.804 Transportation Services

68.805 Nutrition and Food Services

68.806 Nursing Services


68.901 Each facility licensed under these regulations shall provide appropriate programming for each participant. Programming shall take into consideration individual differences in age, health status, sensory deficits, lifestyle, ethnicity, religious affiliation, values, experiences, needs, interests, abilities, and skills by providing opportunities for a variety of types and levels of involvement.

68.902 Activities shall be planned to support the plans of care for the participants, and shall be consistent with the program statement and the admission policies.

68.903 Activities shall be planned and shall include:

68.904 Activity Schedule

68.905 Activities Coordinator

68.906 Equipment and Supplies


68.10.1 Each participant shall be treated as an adult, with respect and dignity.

68.10.2 Each participant shall have the right to participate in a program of services and activities which promotes positive attitudes regarding one’s usefulness and capabilities.

68.10.3 Each participant shall have the right to participate in a program of services designed to encourage learning, growth and awareness of constructive ways to develop one’s interests and talents.

68.10.4 Each participant shall have the right to be encouraged and supported in maintaining one’s independence to the extent that conditions and circumstances permit, and to be involved in a program of services designed to promote personal independence.

68.10.5 Each participant shall have the right to self-determination within the adult day care setting, including the opportunity to:

68.10.6 Each participant shall have the right to privacy and confidentiality.

68.10.7 Each participant shall have the right to be protected from abuse, neglect, solicitation and harassment.

68.10.8 Each participant shall have the right to voice grievances without discrimination or reprisal.

68.10.9 Each participant shall have the right to be free from physical restraints.

68.10.10 Each participant shall have the right to be fully informed, as evidenced by the participant’s written acknowledgment of these rights, and of all rules and regulations regarding participant conduct and responsibilities.

68.10.11 Each participant shall have the right to be fully informed, at the time of acceptance into the program, of services and activities available and related charges.


68.11.1 There shall be at least two adult day care facility staff on duty at all times when participants are present. If separate sections are established within each facility, each separate section shall independently comply with the staffing requirements of this section. The minimum staffing requirements shall not include volunteers or employees who have not yet completed the required orientation program.

68.11.2 For facilities with more than sixteen (16) participants there shall be a minimum of one adult staff person on duty for each eight participants (1:8). Facilities may not use rounding in determining staffing requirements, i.e., for 17-24 participants at least 3 staff members would be required, for 25-32 participants at least 4 staff members, etc.

68.11.3 Programs serving mainly participants who are severely cognitively or severely physically impaired shall have a staff-participant ratio of at least one to four (1:4) for all severely impaired participants.

68.11.4 There shall be at least one RN or LPN on the premises at all times, when participants are present, for those facilities serving participants requiring nursing services as defined at 68.108.

68.11.5 There shall be at least one employee on the premises at all times, when participants are present, who is certified in cardiovascular pulmonary resuscitation (CPR).

68.11.6 The individual (director/administrator/etc.) or designee responsible for the management of the adult day care program shall be present and in charge during all hours that participants are on the premises.


68.12.1 Adult day care providers must comply with the special employment practices relating to health care and child care facilities (DE Code, Title 19, Part I, Chapter 7, §708 and DE Code, Title 11, Part V, Chapter 85, Subchapter V, §8563) and adult abuse registry check (DE Code, Title 11, Part V, Chapter 85, Subchapter V, §8564) and the regulations promulgated by the Department of Labor regarding same.

68.12.2 No employee shall be less than 18 years of age and no person shall be employed who has been convicted of a crime where the victim was a person regardless of whether the crime was a felony or a misdemeanor.

68.12.3 The facility shall have written personnel policies and procedures that adequately support sound care and services to participants.

68.12.4 Personnel records of each employee shall be kept current and available upon request by the Department’s representatives and shall contain sufficient information to support placement in the positions to which assigned.

68.12.5 Minimum requirements for pre-employment and annual tuberculosis (TB) testing are those currently recommended by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.

68.12.6 All new employees shall be required to have a pre-employment physical examination. A copy of the pre-employment physical examination shall be maintained in individual personnel files.

68.12.7 Any individual who cannot adequately perform her/his duties or who may jeopardize the health or safety of the participants shall be relieved of his duties and removed from the center until such time as the condition is resolved. This includes infections of a temporary nature.

68.12.8 The adult day care provider shall provide for systematic performance review to communicate expectations and responsibilities, recognize achievement, and identify areas for skill development and work performance improvement. Performance reviews shall be completed annually and shall be maintained in the employee personnel record.

68.12.9 The director/administrator shall be responsible for complying with the regulations herein contained. In the absence of the director, a qualified substitute shall be authorized, in writing, to be in charge.

68.12.10 The director’s/administrator’s responsibilities shall include, but not be limited to, the following areas:

68.12.11 The director shall have a Bachelor’s Degree in health or social services or a related field, with one year supervisory experience (full-time or equivalent) in a social or health service setting; have comparable technical and human service training with demonstrated competence and experience managing in a health or human service setting.

68.12.12 Volunteers

68.12.13 Aides/Assistants/Technicians

68.12.14 Staff Training and Development

68.12.15 Aide Orientation and Training

68.12.16 The adult day care program must maintain sufficient documentation to demonstrate that all requirements of this section have been met.


68.13.1 Each adult day care facility shall develop and implement a documented ongoing quality improvement program. The program shall include at a minimum:


68.14.1 There shall be a separate record maintained at the adult day care facility for each participant which shall contain:

68.14.2 All participants’ medical records shall be maintained in accordance with professional standards.

68.14.3 All program records shall be available for review by authorized representatives of the Department and to legally authorized persons; otherwise such records shall be held confidential. The consent of the participant or her/his representative if the participant is incapable of making decisions shall be obtained before any personal information is released from her/his records as authorized by these regulations or Delaware law.

68.14.4 The adult day care facility records shall be retained for a minimum of five (5) years before being destroyed.

68.14.5 Records shall be protected from loss, damage, and unauthorized use.


68.15.1 In the event any particular clause or section of these Regulations should be declared invalid or unconstitutional by any court of competent jurisdiction, the remaining portions shall remain in full force and effect.

5 DE Reg. 1879 (04/01/02) (Prop.)