[35 Pa.B. 2499]
[Continued from previous Web Page] § 2600.42(u). Specific rights
IRRC questioned that in conjunction with proposed §§ 2600.26(a)(1)(viii) and 2600.228, what course may a personal care home pursue if a resident violates rules agreed to in the contract, such as smoking in a nonsmoking facility or violating the civil rights of other residents.
Response
This subsection was amended to include a reference to § 2600.228. In this section, the reasons for discharge were expanded to include documented, repeated noncompliance with the home rules.
§ 2600.42(w). Specific rights
IRRC asked to whom the resident appeals a discharge, if the resident remains in the home while his discharge decision is being appealed and if the Department reviews appeal policies and procedures.
Response
This subsection was amended to clarify the resident right to use both the home's procedures and external procedures, if any, to appeal involuntary discharge. The placement of the resident during an appeal process depends on the individual circumstances and the safety needs of the resident. The Department will review the home's appeal procedures during its annual inspection of the home.
§ 2600.42(x). Specific rights
IRRC questioned the intent and meaning of the term ''mismanaged.''
Response
This subsection was revised to clarify the intent that a resident has the right to a system to safeguard the resident's money or property.
§ 2600.42(y). Specific rights
This section was revised to eliminate the right for the resident to manage his own financial affairs since this is addressed § 2600.20. A new right related to the resident's right to choose his own health care providers was added.
§ 2600.42(z). Specific rights
IRRC requested clarification of the home's role in protecting a resident's right to be free from excessive medication. Commentators noted that the level of medication is either by the resident's choice or under a physician's supervision.
Response
In response to public comment, subsection (z) was deleted. Medication prescription and management is under the purview of the resident's physician and not the home.
§ 2600.44. Complaint procedures (new section)
Several commentators requested clarification of the complaint procedures for a resident or a resident's designated person to file a complaint.
Response
The Department added a section to address notification of the resident and his designated person of their right to file a complaint and the procedure and timelines for filing and responding to a complaint.
STAFFING
§ 2600.51. Resident abuse and criminal history checks (redesignated as Criminal history checks)
Three commentators strongly supported this requirement. Four commentators suggested allowing the hiring of convicted felons who have not had an additional felony conviction in the past 5 years.
Response
This change was not made. The OAPSA governs the criminal history record checks and hiring procedures.
§ 2600.53(a). Staff titles and qualifications for administrators (redesignated as § 2600.53. Qualifications and responsibilities of administrators)
Three commentators strongly supported the proposed administrator qualifications. Some commentators indicated that not all prospective administrators meet the qualifications, yet may do well in that capacity. IRRC and other commentators suggested adding an additional level of qualification for a person who has either graduated from high school or obtained a GED and has a specified amount of direct care experience.
Response
The Department agrees that the enhanced qualifications are critical to assure that administrators are equipped to manage the duties and responsibilities of an administrator as required by this section, as a well as the increasingly complex needs of residents in personal care homes. However, the Department understands that the duties and responsibilities of an administrator in a small personal home (serving eight or fewer residents) are not as burdensome as in a large home. Therefore, the Department has added a new qualification for a small home to permit a qualification option of a GED or high school diploma and 2 years of direct care or administrative experience in the human services field.
§ 2600.53(d). Staff titles and qualifications for administrators (redesignated as § 2600.53. Qualifications and responsibilities of administrators)
Ten commentators suggested allowing the legal entity to assume these administrative and supervisory duties.
Response
This change was not made. The function of managing and supervising the administration of personal care services is the primary job of the administrator.
§ 2600.54. Staff titles and qualifications for direct care staff (redesignated as § 2600.54. Qualifications for direct care staff persons)
Three commentators strongly supported this section as proposed. Forty-three commentators indicated that requiring qualifications is not appropriate. Forty-one commentators suggested replacing requirement for high school diploma or GED with merit based on training or skill. One commentator suggested replacing requirement for good moral character with the criminal background check under the OAPSA Forty-three commentators requested allowing the hiring of direct care staff at 16 and 17 years of age, but prohibiting performance of tasks related to medication management. Eleven commentators suggested setting minimum age at 16 years of age.
Response
The Department appreciates and carefully considered the numerous comments received. The Department included a ''grandfather provision'' in § 2600.55 for staff persons hired or promoted prior to the effective date of the final-form rulemaking. The Department added the option for a certified nurse aide to qualify as a direct care staff person if the minimum age and training requirements are met. The minimum educational standard is critical since staff must be able to read and write in the resident's record and read and follow health and safety procedures. The Department will consider a waiver of the educational requirement, in accordance with § 2600.19, if the home demonstrates the staff person's literacy through a standardized testing method or the home provides an alternate means of assuring resident safety. The requirement to measure character was deleted since this is not measurable.
The amendments permit an individual who is 16 or 17 years of age to be a staff person at a home, but does not permit them to perform tasks related to medication administration. A staff person who is 16 or 17 years of age may perform tasks related to incontinence care, bathing or dressing of residents with supervision.
The Department also clarified the role of volunteers.
§ 2600.55(a). Exceptions for staff qualifications
Three commentators strongly supported the proposed section to ''grandfather'' current administrators. Eleven commentators noted that almost all licensed professionals, such as nursing home administrators, doctors and attorneys, retain their credentials as long as continuing education requirements are met. Thirteen commentators suggested allowing the grandfathering of an administrator even with a break in service of more than 1 year. IRRC questioned whether persons 16 or 17 years of age may work as direct care staff and suggested adding ''direct care'' in front of ''staff'' in subsection (c). Nine commentators suggested clarification that persons under 18 years of age may not be the sole direct care staff on duty in the home.
Response
The Department kept the grandfathering provision for current administrators, those administrators who have less than a 1 year break in service and direct care staff persons. The requirement for the age of direct care staff persons in § 2600.54(a) and (b) continue to apply for current and new direct care staff persons.
§ 2600.56. Administrator staffing (new sections added in § 2600.57 (related to direct care staffing); § 2600.58 (related to awake staff persons); § 2600.59 (related to multiple buildings); § 2600.60 (relating to additional staffing based on the needs of the residents); § 2600.61 (relating to substitute personnel); § 2600.62 (relating to list of staff persons) and § 2600.63 (relating to first aid, CPR and obstructed airway training))
Three commentators strongly supported the proposed staffing requirements. One hundred commentators requested retention of current § 2620.74 (relating to staffing), indicating that the change in staff ratio is not appropriate and that the section should specify only that sufficient staff are required to assure that care and services are provided to meet the needs of all residents. IRRC asked whether the Department intends to require an administrator or his designee to be present at the home 24 hours per day. IRRC suggested a further breakdown of proposed subsections (c) and (d). Ten commentators suggested deletion of the requirement to allow the Department to require additional staff if there is objective data demonstrating that resident needs are not being met. IRRC requested clarification of a resident special needs. Eleven commentators suggested that there is no need to arrange for substitute coverage if a home is still meeting staffing requirements.
Response
This section was revised to break out and clarify the requirements for staffing. Specific staffing ratios and requirements are necessary to measure and enforce the minimum staffing requirements for the safe and adequate care of the residents. The enforcement of minimum staffing ratios is absolutely essential to assure that personal care services are provided to residents in a timely and proper manner, that residents are safe and protected from health and safety risks and that all requirements of this chapter are met. The Department clarified the circumstances when an administrator must be present in the home.
In response to IRRC's question about special needs, the Department eliminated the language about a resident's special needs and clarified that the additional staffing hours in § 2600.57(c) are based on the resident's mobility needs.
The Department retained but clarified the requirement for additional staffing based on the needs of the resident as identified in the resident's assessment and support plan in § 2600.60 (relating to additional staffing based on the needs of the residents). This is necessary to address the individual health and safety needs of the residents.
Substitute personnel coverage is essential in the event a staff person calls off sick or cannot make it to work in an emergency. The intent of the requirement for substitute personnel is to ensure staff coverage by qualified individuals at all times, not to require substitute personnel that are not needed.
The Department relocated and revised § 2600.63 (relating to first aid, CPR and obstructed airway training), redesignated from proposed § 2600.57 (final-form § 2600.64) (relating to administrator training and orientation), to require that a staff person trained in first aid, CPR and obstructed airway techniques is present in the home at all times. This is critical so that residents receive proper and immediate emergency treatment in the event of an emergency such as an injury that results in bleeding, a bone fracture, choking or respiratory failure.
§ 2600.57. Administrator training and orientation (redesignated as § 2600.64)
Three commentators strongly supported the proposed section. Forty-two commentators requested retention of the current regulation, stating that additional administrator training is not required. Forty-eight commentators requested requiring that the Department-approved training be provided by an appropriately trained person or agency and deleting the requirement for the 80-hour internship. IRRC asked what constitutes successful completion of the 80 hours of competency-based internship.
Suggestions were received to add additional training components, such as: the requirements of this chapter, ethics, abuse and neglect, accessing health care services, incident reporting and cultural competency.
Nine commentators suggested requiring that certain training be required only if a home serves residents with these needs.
Response
Additional training of administrators is needed to ensure they are trained to manage and supervise staff persons to provide personal care services to address the increasingly complex needs of residents. The requirement for the 80-hour internship was deleted. However, the number of training hours was changed from 60 hours to 100 hours. This is a reduction from 140 combined training hours as proposed to 100 combined training hours. Administrators must take and pass a 100-hour standardized Department-approved administrator training course and competency-based training test. A ''grandfather'' provision was added for administrators hired or promoted prior to the effective date of the final-form rulemaking.
Training in universal precautions, medication effects and side effects, personal care services, gerontology, cultural competency, abuse and neglect prevention and reporting and the requirements of this chapter were added as required administrator training topics to adequately address the needs of residents to protect their health and safety and to properly train an administrator for key duties and responsibilities of his position.
§ 2600.57. Administrator training and orientation (redesignated as § 2600.64)
Thirteen commentators suggested deleting either all or portions of this proposed subsection about the internship.
Response
In response to public comment, the proposed requirement for an internship was deleted.
§ 2600.57(e). Administrator training and orientation (redesignated as § 2600.64(c) and(d))
IRRC asked how the Department determined the 24-hour training requirement and if an administrator must have annual training for each of the subject areas. Sixty-four commentators requested reduction of annual training hours for administrators to 12 hours per year or 24 hours every 2 years. These commentators noted that registered nurses are required to obtain 15 hours of annual training to maintain certification and nursing home administrators are required to obtain 24 hours of continuing education annually.
Response
The requirement for an administrator to have 24 hours of annual training was kept. Annual training may be in any subject area related to the administrator's job duties. This allows the administrator to customize his training to the needs of the residents and to his personal level of experience and education. The Department-approved administrator training specified in § 2600.64(a) fulfills the annual training requirement for the first year. Annual training must be provided by Department-approved training sources listed in the Department's personal care home training resource directory or by an accredited college or university. Annual training is required versus 24-month training to support that training should occur on a regular, ongoing basis and not at the end of a 2-year period.
§ 2600.57(f). Administrator training and orientation (redesignated as 2600.64(e))
Ten commentators suggested requiring the Department to conduct random audits, in addition to regulator licensing inspections, to ensure that annual training requirements are met. Two commentators suggested requiring a home to keep a record of training.
Response
The Department will assure compliance with these requirements through annual inspections and complaint investigations. In response to comment, subsection (f) was added to require a home to keep a record of training including the person trained, date, source, content, length of each course and copies of any certificates received to provide for easy audit and tracking of training internally by the home, as well as by the Department.
§ 2600.57(g). Administrator training and orientation (redesignated as § 2600.64(g))
Fifteen commentators requested clarification that the requirements for a personal care home administrator should not be greater than those for a nursing home administrator.
Response
Because a licensed nursing home administrator must meet the ongoing training requirements by the Department of State, they are exempt from the annual training requirements of this chapter.
§ 2600.58(a). Staff training and orientation (redesignated as § 2600.65(a) and (b). Direct care staff person training and orientation)
Three commentators strongly supported the proposed requirements for direct care staff person training and orientation. Fourteen commentators opposed the training requirements as unnecessary and cost prohibitive.
Commentators suggested that temporary staff, part-time staff and volunteers do not need to complete the training. Fifty-eight commentators suggested that volunteers be trained appropriate to their roles and functions in the home. Thirty-one commentators requested that training of volunteers be the responsibility of the facility director and include job descriptions for volunteers. Commentators recommended revising subsection (a) to ''prior to working with residents unsupervised.'' Two commentators suggested deletion of training in personnel policies and general home operation.
Response
Direct care staff training is essential so that health and safety protections and adequate personal care services are provided to residents. This is especially important given that there are no educational or experience qualifications for direct care staff persons.
Clarification was added that orientation regarding fire safety and emergency preparedness must occur prior to or during the first work day. This initial and immediate orientation training is important for all staff, including volunteers and ancillary staff, so that they can provide emergency assistance.
Subsection (b) clarifies that within 40 scheduled working hours, all staff persons must have an orientation to additional specific training areas such as resident rights, emergency medical treatment, abuse reporting and incident reporting. The areas of orientation were revised to add the critical areas of abuse and incident reporting for all staff persons, including volunteers and ancillary staff. Orientation to general operation of the home was deleted.
§ 2600.58(c). Staff training and orientation (redesignated as § 2600.65(d). Direct care staff person training and orientation)
IRRC suggested adding ''unsupervised'' before ''contact.'' Forty commentators suggested 16 hours of shadowing before providing resident care and a 6-month period to accomplish this training. Three commentators requested deletion of training in safety management and prevention. Four commentators requested deletion of training in medications and purpose and side effects of medications.
Response
This subsection was clarified to require that direct care staff hired after the effective date of the final-form rulemaking may not provide unsupervised ADL services until completion of training that includes a demonstration of job duties, followed by supervised practice and successful completion and passing the Department-approved training course and competency test.
The Department deleted the requirement for training in medication procedures, medical terminology and the use, purpose and side effects of medications since these areas are addressed in §§ 2600.181--2600.191 (relating to medications). Training in safety management and hazard prevention is essential to protect the health and safety of the residents and this training was not deleted.
The Department added the following training components: safe management techniques; IADLs; dementia; mental retardation; the aging-cognitive, psychological and functional abilities of individuals who are older; socialization; community resources; social services; activities in the community; the requirements of this chapter; infection control and, if applicable, care for individuals with mobility needs. These training components are essential to protect the health, safety and well-being of the residents.
§ 2600.58(d). Staff training and orientation (redesignated as § 2600.65. Direct care staff person training and orientation)
Two commentators requested deletion of the requirement for training of ancillary staff.
Response
This subsection was revised and relocated to § 2600.65(c). In response to public comment, the requirement for annual training was deleted. The requirement for orientation was retained.
§ 2600.58(e). Staff training and orientation (redesignated as § 2600.65(e). Direct care staff person training and orientation)
Commentators indicated that increasing the continuing education requirements to 24 hours annually is unnecessary, excessive and that direct care staff are trained on the job. IRRC indicated that this requirement is more prescriptive than continuing education requirements for hospital nursing staff in the Department of Health regulation in 28 Pa. Code § 109.52 (relating to orientation and continuing education), which does not set a minimum number of hours for continuing education. IRRC recommended that the Department consider reducing the required number of training hours.
Response
In response to public and IRRC comments, the annual training requirement for direct care staff persons was reduced from 24 to 12 hours. On the job training may count for 6 of the 12 hours annually.
§ 2600.58(f). Staff training and orientation (redesignated as § 2600.65(f). Direct care staff person training and orientation)
Twenty-four commentators suggested keeping all required topics, but requiring only training that pertains to a staff person's specific job duties. Five commentators suggested that training should be completed within a reasonable time following employment. Four commentators suggested adding ''if applicable'' to the requirement for training regarding individuals with mobility needs. Four commentators suggested adding a qualification so that training for personal care services and safe management techniques apply only as it applies to the resident population of the home. Two commentators suggested requiring staff education in managing depression.
Response
The requirements for training for first aid, obstructed airway techniques and cardio-pulmonary resuscitation was revised and relocated to § 2600.63.
The proposed requirement regarding assessment and support plan training was revised to include the medical evaluation as well.
The requested clarification that not all training is required for all staff persons and all resident populations was not made. Since dementia, cognitive impairments and immobility are common in the older adult population, it is important that all direct care staff persons have annual training in these areas. Training in managing depression was not added since this is a clinical function of behavioral health professionals.
§ 2600.58(g). Staff training and orientation (redesignated as § 2600.65(g). Direct care staff person training and orientation)
IRRC asked for clarification as to why volunteers must meet the annual 24-hour training requirement when a volunteer does not perform direct care tasks. Five commentators requested clarification of temporary staff. Three commentators requested a definition of ''fire safety expert.'' Two commentators requested deletion of the requirement for training in personnel policies.
Response
Regularly scheduled volunteers, direct care staff persons, ancillary staff persons and substitute personnel must meet the annual training requirement since these are critical emergency components (such as fire safety, emergency preparedness, resident rights and abuse reporting). In response to comment, the requirement to train temporary staff was removed. Fire safety expert is defined in § 2600.4. In response to comment, the requirement for training in personnel policies was removed.
§ 2600.58(h) and (i).Staff training and orientation (redesignated as § 2600.65(h) and (i). Direct care staff person training and orientation)
IRRC asked for clarification regarding the timeframe for completion of training. Five commentators requested requiring the training at another home to be with in the past year. One commentator requested deletion of subsection (i).
Response
In response to comment, the Department clarified that the transfer of training from one home to another must have occurred within the past year. Subsection (h) was revised to clarify that only the initial direct care staff training may be transferred. In response to comment, subsection (i) was deleted.
§ 2600.59. Staff training plan (redesignated as § 2600.66)
Three commentators strongly supported this section. Fourteen commentators suggested that this section is unnecessary and cost prohibitive. Seventeen commentators suggested retaining current regulation in current § 2620.73(e) (relating to qualifications and training for staff), but adding the training topics from the proposed rulemaking. Forty-eight commentators suggested deleting all the specific requirements of the content of the training plan. The Personal Care Home Advisory Committee Staffing Workgroup and eight commentators recommended deletion of the annual assessment of training needs, the overall plan for addressing needs and the annual evaluation.
Response
In response to comment, the Department deleted the specific training plan process and monitoring requirements and instead developed pared-down requirements for an annual staff-training plan that includes training aimed at improving the knowledge and skills of the home's direct care staff in carrying out their job responsibilities. Documentation requirements for the plan are also added.
§ 2600.60. Individual staff training plan
Three commentators strongly supported this section. Over 50 commentators found this requirement unnecessary, burdensome, cost prohibitive and already covered in the staff training plan and the annual performance reviews. Eight commentators requested deletion of portions of this requirement. Seventeen commentators suggested retaining the current regulation in current § 2620.73(e). IRRC suggested consideration of the time and fiscal impact.
Response
In response to public comment, proposed § 2600.60 was deleted.
§§ 2600.67 and 2600.68. Training institution registration and Instructor approval (new sections)
Two sections were added to address the requirements for the staff training program. This is critical to assure proper monitoring of training institutions and the instructor certification process.
PHYSICAL SITE
§ 2600.81. Physical accommodations and equipment
Twenty-one commentators recommended reference to applicable laws.
Response
Although this requirement will be applied by the Department under the guidance of applicable laws, such as the Americans with Disabilities Act of 1990, this is a licensing requirement of this chapter and will be applied and enforced by the Department under this section. A new requirement regarding the condition of ambulation devices was added.
§ 2600.82(a) and (c). Poisons
Five commentators requested deletion of the requirement to keep poisons in their original container, as long as poisonous materials are properly labeled and stored. Four commentators requested an exemption for housekeeping substances while in use.
Response
Removal of poisons from their original containers is never safe. This practice can lead to misidentification of the substance and unsafe storage in a container not equipped to provide the proper insulation of the substance. If a household cleaning product is in use and supervised by a staff person, this meets the requirement in subsection (c) to be inaccessible to residents.
§ 2600.83. Temperature
Several commentators indicated that a constant temperature above 80°F may be too warm for some residents due to their medical conditions or medication regimen. They suggested requiring that air conditioning be required to maintain the temperature at or below 80°F for bedrooms and other living areas. Six commentators suggested that only areas used by the resident need to be at 70°F. IRRC questioned whether the Department should require a maximum indoor temperature.
Response
The Department carefully considered adding a requirement that indoor temperature be kept below 80°F through the use of air conditioning. However, due to the high cost of installing air conditioning in each home, the Department decided that the use of fans to circulate air during the summer months is the most cost-effective alternative.
In response to comments, the Department clarified that the requirement regarding heating applies to areas used by the residents.
§ 2600.85. Sanitation
This proposed section raised many questions from IRRC and others about the presence of pets in homes. Twelve commentators suggested requiring a pest control program on an as-needed basis. Twenty-nine commentators expressed concern that some elderly persons will not be able to work covered containers. Fourteen commentators requested deletion of the requirement for the sewage system approval since this is often a local requirement.
Response
The Department clarified that it did not intend to disallow pets in homes. The requirement for a pest control program was not added since this will not be necessary in most homes.
Covered trash receptacles are an important sanitation protection. There are types of covered trash receptacles that elderly persons are able to operate, such as foot pedal trash receptacle. The staff persons should provide assistance to a resident who needs assistance in opening containers.
Sewage systems are indeed regulated by the local sewage enforcement officer. The Department will look for the required written local approval. This requirement was revised so that it applies only to a large home serving nine or more residents.
§ 2600.86. Ventilation
Nine commentators asked for clarification of sufficient ventilation.
Response
Acceptable types of ventilation are included in subsection (a). The section was clarified that the requirement for ventilation in subsection (a) applies to bathrooms that do not have an operable, outside window.
§ 2600.87. Lighting
Nine commentators asked for clarification of sufficient lighting.
Response
In response to comment, this section was clarified to require that the specified areas be lighted and marked to ensure that residents, including those with vision impairments, can safely move through the home and safely evacuate.
§ 2600.88. Surfaces
Eleven commentators suggested regulation of the use of asbestos and proper remediation activities.
Response
Asbestos is no longer used in home construction or building materials. In some cases, removal of asbestos products from an existing building is more dangerous to residents than covering over the asbestos or keeping it intact. The Department will regulate any unsafe existence or removal of asbestos under § 2600.88 (a) (relating to surfaces). Section 2600.88(b) does not permit the use of asbestos products in renovations or new construction.
§ 2600.89. Water
Eight commentators requested deletion of the requirement for quarterly coliform water tests since this is regulated by the DEP. One commentator suggested adding an option to make provisions for a safe supply of drinking water to subsection (d).
Response
The Department did not eliminate the requirement for water testing for a home that is not connected to a public water system, since this is not regulated by the DEP. The DEP only regulates public water systems.
At the recommendation of the DEP, the Department clarified that the laboratory will report that water is above or below the maximum contaminant level, rather than that water is safe for drinking.
In response to comment and at the suggestion of the DEP, the Department revised subsection (d) to require that an alternate water source be provided during remediation activities.
The new requirement for water safety testing applies only to a home that is not connected to a public water system, but instead has a private water source, such as a well. The quarterly cost for coliform testing at a DEP-certified laboratory is $30 per test. The benefit of assuring that residents have safe drinking water and are not exposed to harmful contaminants outweighs this minimal cost.
§ 2600.90. Communication system
Fifteen commentators requested deletion of the requirement for an internal communication system. IRRC recommended clarifying the language to reflect the Department's intention.
Response
The Department's intent is to ensure that staff persons can immediately communicate with and summon assistance from one another in the event of an emergency. In response to comment, the new requirement for an internal communication system will apply only to a home serving nine or more residents. In a large home, it is critical that staff persons be able to quickly and efficiently contact other staff persons in the event of an emergency or if they need assistance with a resident. The cost of installing a communication system will vary greatly based on the size and lay out of the home. If a home is physically structured so that staff persons can call out for assistance and be heard throughout the home, a system is not required. Many large homes already have internal communication systems in place and will not incur additional costs. Types of communication systems that may be used include walkie-talkies, pagers, cellular phones and intercom systems. The Department estimates that a two-way walkie-talkie system for two staff persons will cost between $20 and $100. The benefit of being able to contact other staff persons in the event of an emergency outweighs this reasonable cost for a large home.
§ 2600.91. Emergency telephone numbers
Twenty-one commentators suggested requiring posting of telephone numbers only for telephones in common areas or for general staff or resident use, not for a resident's personal telephone.
Response
This change was not made. In it important to post emergency telephone numbers by all telephones with an outside line so that anyone, including a resident, may call for emergency assistance. The telephone number for the local emergency management agency has also been added.
§ 2600.93. Handrails and railings
Several commentators, including a 40-bed personal care home, two provider agencies and two advocacy organizations requested deletion of the exemption for outside steps with one or two steps and for a porch with over a 30-inch drop.
Response
In response to public comment, these changes were made. All steps and porches must have a handrail or railing.
§ 2600.94. Landings and stairs
Nine commentators requested deletion of the requirement for nonskid surfaces on walkways. Fourteen commentators suggested adding the requirement for contrast strips for those with vision impairments.
Response
In response to public comment, the change regarding walkways was made. The new requirement for nonskid surfaces on stairs, steps and ramps will be a one time cost for a home that has surfaces that are likely to cause slips, falls and resulting injuries to the residents. Most homes already have acceptable nonskid surface coverings such as carpet, rubber coverings on ramps and textured concrete on outside steps. The estimated average cost per foot for installing a nonskid strip on a stairs or ramp is $4 per yard. The benefit of preventing falls and injuries outweighs the minimal cost.
In response to comment, the requirement relating to contrast strips for residents with a vision impairment was added in § 2600.87 (relating to lighting).
§ 2600.95. Furniture and equipment
Three commentators suggested adding that furniture must be functional, comfortable and home-like.
Response
While the Department supports these concepts, these descriptions are subjective based on the varied individual preferences of the resident and not measurable for purposes of licensing enforcement.
§ 2600.96. First aid supplies (redesignated as First aid kit)
Twenty-one commentators suggested requiring one set of first aid supplies on every floor or wing of each building. IRRC indicated that depending on the size of the building, the response time to reach the other side of the building may not be beneficial to aiding the resident in a timely manner. IRRC recommended that the Department consider requiring that a first aid kit be kept on each floor or for a designated number of rooms.
Response
Many large homes already have multiple first aid kits so that staff persons can respond quickly to an emergency. However, a first aid kit on each floor of the home is not necessary for many small and medium homes. Since a first aid kit is used to treat only minor injuries, the cost to purchase additional first aid kits outweighs the benefit to the residents.
The Department eliminated syrup of ipecac and added tweezers to remove splinters from the contents of the first aid kit. The use of syrup of ipecac is no longer recommended by the American Academy of Toxicology and the United States Food and Drug Administration in response to the ingestion of a poison.
§ 2600.97. Elevators and stair glides
Three commentators suggested requiring completion of repair within 48 hours of the time that the elevator or stair glide was found to be inoperative and development of emergency procedures that will be immediately implemented until the equipment is operable.
Response
The Department added a citation to the Department of Labor and Industry regulation of elevators and stair guides in 34 Pa. Code Chapter 405 (relating to elevators and other lifting devices). In the event of temporary inoperability, the Department will apply § 2600.81(a) (relating to physical accommodations and equipment) that requires the home to provide for the safe movement of the resident within the home. The home will need to provide an alternate means of movement during the temporary period of inoperability.
§ 2600.98. Indoor activity space
Nine commentators suggested that indoor space should be provided according to the needs of the residents. Fifteen commentators suggested applying the current regulation in § 2620.52(q) (relating to living/sleeping quarters).
IRRC recommended relocating the requirements for program activities and activity calendar to § 2600.221 (relating to activities program). Twenty-eight commentators suggested replacing proposed subsections (c)--(e) with a requirement for an activities program designed to promote residents active involvement with other residents, the residents families and the community.
Twelve commentators suggested requiring that the television viewing room be sufficiently large so residents can enjoy watching television in comfort. IRRC recommended deleting the language in subsection (f), since it is written in nonregulatory language.
Response
In response to IRRC and public comment, the program activity and activity calendar requirements were deleted. These areas are addressed sufficiently in § 2600.221. Subsection (f) was deleted, in part based on IRRC's suggestion, as well as because waivers are already addressed in § 2600.19. The other suggested changes were not made since the language is subjective, not measurable and nonregulatory in nature.
§ 2600.99. Recreation space
Seventeen commentators suggested adding that equipment and supplies must be suited for physical, mental, artistic, spiritual and social fulfillment.
Response
This change was not made as it is subjective and not measurable. The section was reworded to give examples of recreational items instead of specifying the recreational items the home must have available.
§ 2600.100. Exterior conditions
Six commentators requested a definition of ''hazard'' in subsection (a). Five commentators suggested modifying subsection (b) to allow a home to restrict access to the recreational areas when snow and ice are present.
Response
The definition of ''hazard'' as found in the dictionary applies. Although no revision to the section was made, a home may temporarily restrict access to exterior recreational areas when extreme weather conditions prevent the prompt removal of snow and ice.
§ 2600.101(a)--(d). Resident bedrooms
Eight commentators supported the flexibility offered by the rulemaking in setting requirements for resident bedrooms. Some commentators indicated that the square footage requirements could hinder their ability to keep some current residents. Twenty-eight commentators requested exempting existing personal care homes from the square footage requirements. IRRC asked for clarification of whether the Department considered grandfathering current facilities.
Response
No substantive changes were made to these four subsections. A ''grandfather provision'' was added in subsection (c) for existing bedrooms serving a resident with mobility needs. The prior allowance for a home licensed as a personal care home before the effective date of this final-form rulemaking to count up to 9 square feet of built-in closet space will be honored.
§ 2600.101(e)--(g). Resident bedrooms
Four commentators suggested changing the ceiling height to 8 feet. Four commentators suggested requiring that a window must be able to be opened from inside with normal ease. Two commentators suggested ''grandfathering'' existing homes in subsection (g).
Response
Ceiling height for resident bedrooms in homes licensed after the effective date of this final-form rulemaking was changed to an average of 7 feet, to permit the use of bedrooms with irregular or sloped ceilings or dormer windows. Eight foot ceilings are not required, because the Commonwealth's new Uniform Construction Code requires ceiling height in new buildings to be a minimum of 7 1/2 feet in occupied spaces and corridors and a minimum of 7 feet in bathrooms, toilet rooms, kitchens and storage rooms. Many homes in this Commonwealth do not have 8-foot ceilings.
Clarification was added that windows do not need to be operable to permit the use of buildings that have controlled ventilation systems. Windows are required for the purpose of providing direct lighting and visual exposure and stimulation.
The Department did not grandfather existing homes in subsection (g). The requirement for a resident's bedroom to be used only as a bedroom and not as a common area is critical to assure privacy and dignity, as well as to assure the safety and health of residents. This does not preclude the sharing of bedrooms by more than one resident.
§ 2600.101(i) and (j). Resident bedrooms
Thirteen commentators recommended requiring curtains or partitions to insure the resident's privacy. Three commentators suggested deletion of subsection (j) and indicated that resident access to bedrooms cannot be guaranteed at all times.
Response
The requirement for privacy within a bedroom was deleted as it was not the Department's intent to require that partitions or curtains be installed in all shared bedrooms. Subsection (j) was not changed, but this requirement will be applied with reason to afford flexibility to assure the privacy of a roommate while the roommate is dressing or completed other private personal hygiene activities.
§ 2600.101(k). Resident bedrooms (redesignated as § 2600.101(j))
Forty-six commentators requested deletion of the requirements for a fire retardant and plastic covered mattress, stating that type of mattress should be determined by needs of resident served. IRRC requested the Department's consideration of costs of replacing current mattresses with fire retardant mattresses. IRRC asked if it is necessary for every resident to use a plastic-covered mattress if they are not incontinent. Two commentators suggested adding the requirement for an operable lamp.
Response
In response to public and IRRC comment, and based on the cost of replacing mattresses, the requirement for a plastic covered mattress was removed. Existing homes will be exempt from the requirement for a fire-retardant mattress. In response to comment, an addition was made to require each bedroom to have an operable lamp or other source of lighting that can be turned on at bedside. The Department also added the requirement for a bedside table and mirror since these are reasonable and basic bedroom furnishings. The Department clarified that many of the bedroom furnishings may be shared with another resident.
§ 2600.101(r). Resident bedrooms (redesignated as § 2600.101(q))
Commentators noted that requiring homes to purchase any chair that the resident deems comfortable will be costly. IRRC questioned who is responsible for determining what is comfortable and who is responsible for supplying the chair.
Response
This requirement was revised to require a chair that meets the resident's needs. It was relocated to subsection (j)(2). In response to comment, the Department added a requirement fort storage space for personal property.
§ 2600.101(t). Resident bedrooms (redesignated as § 2600.101(r))
Two commentators suggested deleting this requirement indicating that window treatments that cover the entire window may be unnecessary or not desirable for very tall windows, skylights or other similar windows.
Response
The Department's intent is to assure the resident's privacy. In the unusual cases mentioned by the two commentators, a home may request a waiver of this requirement in accordance with § 2600.19.
§ 2600.102(a)--(c). Bathrooms
Fifty commentators suggested clarification to count only residents or other household members when determining the ratios. Twelve commentators suggested increasing the shower/bathtub ratio from 15 to 6. IRRC requested the Department's rationale for increasing the shower/bathtub ratio from the current 8 to 15.
Response
In response to comment, the Department clarified that only the residents, staff persons and other household members who use the bathroom facilities will be counted. This is necessary to assure there are enough toilets for the residents if staff persons and other individuals living in the home also use the toilet. Visitors will not be counted in determining the ratios. The current ratio for showers/bathtubs is one for every 15 or less users in § 2620.52(l)(3). In response to public comment and based on research of other states licensing regulations, the Department increased the number of showers/bathtubs required to one for every ten users. Existing homes are permanently grandfathered from the new shower/bathtub ratio.
§ 2600.102(d). Bathrooms.
The Department clarified that in addition to slip-resistant surfaces, toilet and bath areas must have grab bars.
§ 2600.102(e). Bathrooms
Three commentators suggested allowing curtains for privacy at toilets and showers/bathtubs.
Response
This change was not made. Curtains do not provide privacy.
§ 2600.102(f) and (g) Bathrooms
Thirty-three commentators suggested clarifying that the home may charge the resident for these items, unless the resident is on SSI.
Response
The Department clarified that the home may charge a resident, who is not an SSI recipient, for individual toiletry items. These charges must be indicated in the resident-home contract. If the resident is a recipient of SSI, toiletry items must be provided in accordance with § 2600.27(d)(1).
§ 2600.102(h)--(j). Bathrooms
Three commentators suggested revising subsection (h) to require paper towels and toilet paper for all public toilets in the home. Fifteen commentators suggested rewording subsection (i) to require a soap dispenser in all public or shared bathrooms. Nine commentators suggested revising subsection (j) to require that toiletries and linens shall be made available on request or accessible to the resident.
Response
The suggestion to require the stocking of public bathrooms was not added. The purpose of the final-form rulemaking is to protect the health, safety and well-being of the residents and to regulate the resident areas, not the public areas. Subsection (i) was revised to require that the soap dispenser be within reach of each sink. In addition, the Department added clarification that unmarked bar soap is allowed if a resident has a private bathroom. Subsection (j) was amended to allow for towels and washcloths to be stored in a space other then the resident's living space as long as the resident has access to the home's linen supply. The Department clarified that use of a common towel is not allowed. The Department added that shelves or hooks for the resident's towel and clothing must be provided.
§ 2600.103(b) and (c). Kitchen areas (redesignated as Food service)
Four commentators stated that it is costly to sanitize a kitchen after every meal. Three commentators suggested deleting the term ''transported'' in subsection (c), stating that food is carried a few feet from stove to table.
Response
Sanitization is important to reduce the spread of disease. This does not have to be a costly expense to the home. Thoroughly washing the area with soap and water or some other type of kitchen cleaner is acceptable. In subsection (c), the term ''transported'' is intended to mean transported form outside the home such as from another building on the premises or if the kitchen and dining areas are not in close proximity to each other.
Clarification was added to permit the use of a service kitchen in another building on the grounds, as long as there is a kitchen area for storage and preparation of beverages and snacks in each home.
§ 2600.103(d)--(f). Kitchen areas (redesignated as Food service)
Five commentators stated that high quality food storage bins designed to sit on the floor should not be excluded in subsection (d). Nineteen commentators suggested deletion of the requirement to date, rotate and inventory foods.
Response
In response to public comments, the Department clarified that food must be stored off the floor. The use of quality, tightly sealed, plastic food bins is acceptable. Also in response to comment, the Department deleted the requirement for dating, rotating and inventorying food items. The Department relocated the requirement from proposed § 2600.162(b) to this section.
§ 2600.103(h)--(j).Kitchen areas (redesignated as Food service)
Seven commentators suggested deletion of the requirements for holding temperatures and dishwashing, stating that these are nursing home requirements.
Response
The requirement for holding temperatures was deleted in response to comment. The dishwashing requirement was retained to assure proper protections during dishwashing. The Department relocated a portion of the requirement from proposed § 2600.162(d) to this section.
§ 2600.103(k) and (l). Kitchen areas (redesignated as Food service)
Two commentators requested deletion of subsection (k). Ten commentators suggested deleting subsection (l), stating that personal care homes are residential environments that may include pets.
Response
These subsections were deleted in response to public comment. Trash is appropriately regulated in § 2600.85. Pets are permitted in the kitchen and food service areas of the home.
§ 2600.104(a)--(c). Dining room
Four commentators suggested replacing ''maximum'' in subsection (a) with ''seating.'' Seven commentators requested modification of subsection (b) to allow use of nondisposable plastic glasses. Nine commentators suggested deleting ''at the dining table'' in subsection (c).
Response
Subsection (b) was clarified to permit the use of plastic and paper plates, utensils and cups on an irregular basis. The dining room must accommodate all residents.
The requirement to place condiments at the dining table is reasonable.
§ 2600.104(d)--(g). Dining room
Nine commentators suggested requiring special provisions, if necessary, to assist residents in eating at the table. Nine commentators suggested permitting pets, stating that a pet can be very important to residents.
Response
These changes were made in response to comment.
§ 2600.105(a) and (b). Laundry
Twenty-one commentators requested deletion of the second sentence in subsection (a), stating that this is addressed in subsections (b)--(e).
Response
This change was made in response to comment.
§ 2600.105(d), (f) and (g). Laundry
Three commentators suggested revising subsection (d) to require that clean linens and towels be offered to the resident at least once every week. Three commentators requested clarifying subsection (f) to require that resident clothing is not lost or misplaced in the process of laundering. Thirty-four commentators requested deletion of subsection (g) regarding the cleaning of lint traps and drums. IRRC asked for clarification of subsection (g).
Response
The change to subsection (d) was not made. It is important for health and sanitation purposes that linens and towels actually be replaced with clean linens and towels every week and not just offered or available. In fact, due to the needs of many residents, the Department clarified that linens and towels must be changed more often that once a week as needed to maintain sanitary conditions.
A change to subsection (f) was made in response to the concern about resident clothing being lost or misplaced in the process of laundering.
The intent of subsection (g) is that lint be removed not only the lint trap and drum of the clothes dryer after each use, but also from vent duct and ductwork according to the manufacturer's instructions. This is necessary to prevent a fire hazard. This subsection was clarified.
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