Free Adult Day Care Certification Standards Checklist-F-60947 - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F-60947 (Rev. 07/08)

STATE OF WISCONSIN

ADULT DAY CARE CERTIFICATION STANDARDS CHECKLIST
Name ­Adult Day Care Center

Address

Name ­ On Site Manger

Name ­ Certificate Holder

Address ­ Certificate Holder (if different from above)

Capacity

Client Type

Name ­ Person Completing This Form

Date(s) of Certification Visits

Date Form Completed

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COMPLIANCE STANDARD I. PROGRAM I.A. ADMINISTRATION (1) Program Description. The adult day care program shall have a written description of the following: (a) A definition of the program goals; the days and hours of operation; a description of the services provided or made available to participants; and a description of the target population to be served by the program including age groups and specific care needs; (b) A description of any limits the program establishes for providing service to individuals with specific care needs; (c) A fee changing policy which includes: The daily charge; additional fees for specific services, goods, or supplies that are not included in the daily charge, i.e., transportation, baths, personal cares, etc.; and the method for notifying participants or guardians of fee changes; (d) A procedure for informing the participant's guardian, family, or caregiver of any major change in the participant's general functioning or medical condition; (e) A procedure for documenting any incident occurring at the site which would affect the health safety or welfare of a participant. (f) A procedure to implement standard precautions. NOTE: Standard precautions are measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them, as recommended by the U.S. Public Health Services (USPHS) Centers for Disease Control (CDC) and adopted by the U.S. Occupational Safety and Health Administration (OSHA). (g) A statement of how the program will handle situations when a participant arrives at the site with a communicable illness or develops such an illness while at the site; (h) An explanation of how emergency medical situations will be handled at the site, including how participants and guardians are informed of this policy; (i) A policy and procedure to ensure that no staff member, volunteer, visitor, or any other person may be on the premises of the center during hours of operation if the person exhibits: symptoms of illness, communicable disease transmitted by normal contact, or behavior which gives reasonable concern for the safety of the participants; (j) A procedure for following up on any unexplained absences of the participants; Yes No N/A COMMENTS

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COMPLIANCE STANDARD (k) A procedure for obtaining a signed authorization from the participant or guardian, if applicable, allowing the release of any information about the participant to a third party; (l) An explanation of smoking restrictions, if any, on the premises, and the precautions to be taken for non-smoking participants. (m) A description of the criteria for voluntary and involuntary discharge of a participant from the program, and the time frame for notifying the participant or guardian prior to an involuntary discharge; (n) A procedure for investigating and resolving complaints made by a participant, guardian, family member, caregiver, or other interested persons about the services provided by the adult day care program which includes informing such persons of appropriate local, county and/or state agency contacts. (2) The adult day care program shall maintain an organizational chart, which illustrates the lines of authority and communication within the adult day care program. (3) Program staff shall provide a copy of the written statements in (1) and (2), to applicants and other interested persons upon request. (4) Program participants and those designated as their caregivers shall be given at least 30 days notice prior to any changes in the program elements described in (1) above which directly affect the participant. (5) Participant Rights. A written document of the following participant rights shall be posted and/or distributed to participants and adhered to by the program. (a) The right to be treated with respect and dignity; (b) The right to be free from physical or verbal abuse; (c) The right to participate in the development of one's service plan, with support from staff or significant other if needed; (d) The right to refuse to participate in any particular activity; (e) The right to privacy and confidentiality; (f) The right to be fully informed of all the services provided and the charge for each of those services; (g) The right to be informed of the reason for discharge and the procedure for appealing that decision; and (h) The right to initiate a complaint and be informed of the complaint procedure. (6) Written agreements shall be maintained which describe: Yes No N/A COMMENTS

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COMPLIANCE STANDARD (a) Administrative or participant care services provided for the adult day care program by an outside agency; (b) Collaborative relations with other agencies, which share space or program, staff within a multi-use facility. I.B. PARTICIPANT ENROLLMENT PROCEDURES (1) The applicant and guardian, if applicable, shall be informed of the length of any "trial period" required by the adult day care program to determine its ability to serve the individual, and the individual's desire to participate in the program. (2) The adult day care program shall obtain and document the following information about the participant upon acceptance into the program: (a) The participant's full name, address, telephone number, date of birth and living arrangement; (b) The name, address and telephone number of the participant's primary caregiver(s), or guardian if applicable (c) The name, address and telephone number of at least one family member or significant other designated as the emergency contact, if different from the primary caregiver; (d) The name, address and telephone number of the participant's primary physician; and (e) The name and address of the referring or coordinating agency and case manager, if applicable. (3) A statement shall be signed by the participant, or guardian/responsible party, if applicable, that a written description of the services to be provided, the cost of those services, and a statement of the participant's rights have been received. (4) Health Statement. A statement signed by a licensed physician, physician's assistant, or registered nurse shall be completed within 90 days prior to enrollment or within 30 days after enrollment which includes: (a) An indication that the participant has been screened for any communicable disease that is detrimental to other participants, including tuberculosis; (b) A list of current diseases, chronic conditions, and drug, food or other allergies; (c) A statement of any restrictions in the participant's ability to participate in the program's activities; and Yes No N/A COMMENTS

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COMPLIANCE STANDARD Yes No N/A COMMENTS

(d) The names of all prescribed medications including dosage. (5) All records of current participants must be kept on site. Upon discharge, the records are to be retained for at least three years in a secure, dry space. I.C. ASSESSMENT AND SERVICE PLAN DEVELOPMENT (1) Assessments to get to know the person, and individual service plans to plan the program to meet individual needs, shall be conducted by staff members having the expertise, experience, or training pertinent to the client population served by the program. (2) The service plan to meet the person's identified needs at the program shall be completed and implemented within 30 days of admission and include: (a) A comprehensive written assessment of the participant's functional abilities and disabilities, strengths and weaknesses, personal habits, preferences and interests, likes and dislikes, medical condition and any other information helpful to developing the service plan, such as a life review. (b) A statement of the services and activities the program will provide in order to meet these needs and personal interests. (c) The participant's usual travel arrangements to and from the site, the usual time for arriving and leaving, and any plan for using transportation services. (3) The individualized service plan will be reviewed and updated every six months or more often as warranted by changes in the participant's functioning, health condition, or preferences. Changes shall be documented in the participant's record. (4) Notes shall be maintained at least quarterly documenting how a participant is responding to the service plan. (5) To foster appropriate individualized interaction, the program shall have processes in place which foster communication among staff and with the participant and caregiver about the participant's daily capabilities, interests, general well-being and response to the individualized service plan. I.D. PROGRAM SERVICES (1) The range of services provided or arranged by the program shall be based on the written description of the program under (I.A.), and shall include at least the following: (a) Activity programming which takes into consideration individual differences in health and functioning, lifestyle, ethnicity, religious affiliation, values, experiences, needs, interests, abilities and skills;

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COMPLIANCE STANDARD (b) Nutritional services; (c) Assistance and supervision needed with activities of daily living, i.e., walking, grooming, toileting, eating; and (d) Exercise and rest. (2) The services provided by the program as part of implementing individualized service plans shall: (a) Involve participants in the planning and implementation of the activities; (b) Include individual and group activities that encourage creativity, social interaction, and physical exercise; and (c) Provide opportunities for indoor and outdoor activities, including outings to points of interest and involvement in the general community. NOTE: Additional services may be arranged for or provided by the adult day care program including: transportation, social services, personal cares, medication administration, nursing services, health monitoring, physical therapy, etc. I.E. MEAL REQUIREMENTS (1) The facility shall assure that a meal be provided to each participant attending the program for 5 or more hours. Meals served by the facility shall provide at least 1/3 of an adult's daily nutritional requirements. (2) Documentation shall be maintained of the food served at meals and kept on file for up to six months. (3) Snacks shall be available for those participants who may need them. I.F. ADMINISTRATION OF MEDICATION (1) The adult day care program shall have a written policy for medication management and shall designate which staff are authorized and trained to administer medications in accordance with (3). The policy shall indicate the program's role in the supervision of self-administered medications and/or staff administered medications. (2) Self-administered medications may be supervised by a staff member who may prompt the participant and observe him/her taking the medication. When medications are self-administered (whether supervised or not), the medication list must be reviewed and updated annually by the prescribing practitioner, i.e., physician, physician's assistant, or nurse practitioner. (3) If staff administer participants' medications the following conditions must be met: (a) A written order from the prescribing practitioner must be in the record; Yes No N/A COMMENTS

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COMPLIANCE STANDARD (b) A listing of current medications with the dosage, frequency, and route of administration must be in the record; (c) Over-the counter and prescription medications shall remain in the original labeled containers and be stored in a locked, safe place; (d) Non-licensed staff must consult with the prescribing practitioner or pharmacist about each medication to be administered; (e) Written information describing side effects and adverse reactions of each medication must be kept in the participant's record; and (f) The administration of medications must be documented in ink in the participant's permanent record (documentation includes the name of the medication, dosage, method of administration, date and time administered, and name of the staff member who administered the medication). I.G. TRANSPORTATION (1) Adult day care programs providing transportation for participants must assure that providers of transportation carry liability insurance and have a valid operator's license. (2) Vehicles used must have safe tires (1/8" tread minimum) and properly functioning headlights, tail lights, directional signals, windshield wipers, brakes, heater, and seat belts (if passenger car). Annual documentation of compliance is required. II. PERSONNEL Definition: "Staff" is defined as any employee or volunteer trained by the adult day care program who performs specific duties as described in a written and signed job description. II.A. STAFF REPORTS (1) The adult day care program shall maintain on site a file on each employee which is available to the certifying agency and includes the employee's name, address, date of birth, education, previous work experience; and the name, address, telephone number of person(s) to be notified in an emergency; and any documentation of training, certification, license, etc. (2) Each employee, including the administrator, shall, before beginning employment, complete the Adult Day Care and Family Adult Day Care Background Character Verification form, F-62603, available from the department's web site at http://dhs.wisconsin.gov/forms/DQAnum.asp . If the person indicates that he or she has been convicted of, or it has been substantiated that he or she was involved in, any of the crimes listed on the form, or has pending charges for any of the crimes listed on the form, the facility shall make a determination on whether the conviction is substantially enough Yes No N/A COMMENTS

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COMPLIANCE STANDARD related to the duties of the position. (3) Before hiring employees with experience working as a nurse assistant, home health aide or hospice aide, (HFS 129), the adult day care program shall document contact with the department's caregiver misconduct registry, to determine if there is a substantiated finding that the person abused or neglected a client or misappropriated the property of a client. If there is a substantiated finding, the person shall not be hired to work in the program. (4) All employees working directly with participants shall have a health examination within 6 months prior to beginning work or within 30 days after beginning work. The report shall certify that the person has been screened for communicable diseases that are detrimental to the participants, including tuberculosis, and shall be signed by a licensed physician, physician assistant, or a registered nurse. II.B. PROGRAM DIRECTOR (1) A person at least 21 years of age shall be designated as program director, responsible for the programmatic activities. (2) The program director shall be knowledgeable about the specific disabilities of the persons being served by the adult day care program, including the physical and psychological aspects of these disabilities; the types of functional deficits which result from these disabilities; and the types of services the program must provide to meet the participants' needs resulting from these disabilities. This knowledge shall be demonstrated by the following or its equivalent: (a) At least two years of course work in a health, social or human services field, or a license or certification in a health or human services profession; or (b) Having worked for at least two years in a program, or related field, which served a population similar to the population at the adult day care program. II.C. STAFFING PATTERNS Definition: "Severely impaired" means any impairment leading to a participant's inability at the program to perform any 3 or more activities of daily living (ADL), e.g., mobility, dressing, eating, toileting, hygiene, etc. The impairment may be physical or cognitive in nature. The severely impaired participant demonstrates an inability to perform these ADLs at the day care unless assistance, supervision or prompting is provided. (1) At least one staff member over the age of 18 years shall be on the premises at all times participants are present. (2) There shall be a minimum of 1 staff person for each 8 non-severely impaired participants at the adult day care site. (3) There shall be a minimum of 1 staff person present for each 4 severely impaired participants at the adult day care site. Yes No N/A COMMENTS

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COMPLIANCE STANDARD (4) The adult day care program will provide sufficient staff time and staff expertise to implement the program as described in I.A.(1) and participant service plans. (5) Daily staffing patterns shall be documented, e.g., time cards, time sheets, or other methods used for payroll purposes. (6) Volunteers who meet the same standards, requirements, and training as employees and who have signed a written job description may be counted as part of the staff/ participant ratio. II.D. STAFF TRAINING (1) The adult day care program shall have and implement a written plan for providing orientation and training to staff members in order to meet the requirements of this subsection. (2) Orientation. All adult day care staff who interact with participants, and volunteers who are included as part of the staff/participant ratio, must complete an orientation within the first 2 weeks of employment which includes: (a) An explanation of participant rights; (b) An explanation of the adult day care program policies; (c) Training in recognizing and responding appropriately to medical and safety emergencies; (d) An explanation of established emergency and evacuation procedures, including the proper use of the fire extinguisher; and (e) An explanation of the program's procedure related to standard precautions as stated in I.A. (1)(f), prior to exposure to potentially infectious material. (3) Training. Within 90 days of employment, all employees who provide care to participants shall have received training on the following topics, if those topics are pertinent to their job responsibilities: (a) Information about the needs and abilities of the participants served; (b) The physical and psychological aspects of each participant's disabilities; (c) The techniques required to provide personal care to participants, i.e., bathing, grooming, walking, and feeding, etc; and (d) The interpersonal communication skills needed to relate to participants including: understanding independent living philosophy; respecting participant rights, needs and uniqueness; respecting age, cultural and ethnic differences; confidentiality; and other relevant topics. Yes No N/A COMMENTS

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COMPLIANCE STANDARD Yes No N/A COMMENTS

Note: A variance may be requested for staff who have training or demonstrated competence in (b)-(d). See Section VII. (4) Continuing education. After the first year of employment, all employees who have responsibility for direct care or program activities, including the program director, shall receive 10 hours of continuing education annually. Educational topics should be pertinent to the general job responsibilities of the staff member. These hours of continuing education may include training for staff at the program site, at outside workshops, lectures, or training provided through audio or video materials. The training shall be provided by someone who has demonstrated expertise in the topic being presented including a staff member. (5) A written record shall be kept of the training in (2)-(4) above provided to each staff member including the dates and topics of training. (6) The adult day care program shall provide orientation, training and supervision to volunteers. III. Environment III.A. Sanitation (1) Individuals who prepare or serve meals shall wear clean clothing and wash their hands before and after each handling of food, and after using the toilet. (2) Day care participants who assist in preparing food shall be directly supervised by staff. (3) All kitchen utensils and food contact surfaces used in preparation, storage and food services shall be thoroughly cleaned and sanitized after each use. (4) Single-service utensils may not be reused. (5) All utensils and dishes shall be scraped and prewashed under running water. (6) For manual washing of dishes and utensils, the following 3-step procedure shall be used.* (a) Wash in water of at least 110 degrees F. (43 degrees C.); (b) Rinse by immersing dishes and utensils in clean, hot water to remove soap or detergent; and *Note: Alternative methods of washing and sanitizing are allowed if in compliance with HFS 196, Wisconsin Administrative Code, regulating restaurants. (c) Sanitize by immersing dishes and utensils for at least 2 minutes in a solution of sanitizer approved by the department. (7) For mechanical washing of dishes and utensils in home type dishwashers with a temperature setting of at least 110 degrees F. (43 degrees C.), the following shall apply:*

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COMPLIANCE STANDARD (a) Wash and rinse dishes and utensils in the dishwater; and (b) Remove from dishwater and sanitize by submerging dishes and utensils for at least 2 minutes in a solution of a sanitizer approved by the department. (8) For mechanical washing of dishes and utensils using a commercial dishwasher, the following shall apply:* (a) Wash in water of at least 130 degrees F. (54 degrees C.) for at least 20 seconds, using an effective cleaning agent; (b) Rinse and sanitize at 180 degrees F. (82 degrees C.) for 10 seconds or more, using automatic rinse injector; and (c) Have readily-visible temperature gauges in the wash compartment of all mechanical dishwashers and in the rinse tank of an immersion-type dishwasher. *Note: Alternative methods of washing and sanitizing are allowed if in compliance with HFS 196, Wisconsin Administrative Code, regulating restaurants. (9) All dishes and utensils shall be air-dried in racks or baskets or on drain boards, unless a dishwasher, which performs this function, is used. (10) Food storage. (a) All food and drink shall be stored in a safe and sanitary manner. No food or drink shall be stored on the floor. (b) All readily perishable foods shall be covered and refrigerated at or below 40 degrees F. (4 degrees C.), and stored in a sanitary manner. (c) Freezing units shall be maintained at or below 0 degrees F. (-18 degrees C.). Foods to be stored in a freezer shall be wrapped and identified. (d) Each refrigerator and freezer shall have an accurate thermometer inside the unit. (11) The premises and furnishings shall be free from litter, clean, safe and in good repair. (12) Toilet rooms and fixtures shall function properly and shall be maintained in a sanitary and odor free condition. III.B. SAFETY (1) The center shall have a telephone on the premises, which is immediately accessible during hours of operation. A list of emergency telephone numbers shall be posted at each telephone. (2) Stairs, walks, ramps, and porches shall be maintained in a safe condition. (3) Animals kept on the premises shall be tolerant of persons on the premises and Yes No N/A COMMENTS

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COMPLIANCE STANDARD vaccinated against rabies if indicated. (4) A supply of safe drinking water shall be readily available to participants at all times. Note: If well water is used, wells shall be approved by the State Department of Natural Resources and water samples shall be tested annually at a state approved lab. Documentation is to be kept on file at the center. (5) Each adult day care program shall have a written plan for responding to fires, tornadoes, missing participants, injuries and other emergencies which includes: (a) Posting an evacuation plan; (b) Informing all staff members of their duties during an emergency; and (c) Practicing and recording quarterly fire and annual tornado drills. III.C. FIRE PROTECTION (1) The adult day care program shall maintain written reports of fire safety inspections as well as any other inspection reports required by local authorities. (2) The adult day care facility shall have at least one 2A, 10-B-C fire extinguisher per 1,500 square feet of space. If only one extinguisher is necessary in the building, it is to be located near the cooking area. Fire extinguishers shall be operable at all times, inspected once a year by a qualified person, and shall bear a label indicating its condition and date of the last inspection. (3) All staff members shall be instructed in the use of the fire extinguisher. (4) Unless the fire department indicates otherwise in writing, the facility shall have a fire alarm system or working smoke detectors in each activity room and hallway which shall be tested monthly. III.D. BUILDING AND FURNISHINGS (1) If required by the Department of Commerce or local municipality, the adult day care program shall have on file an inspection report signed by an authorized agent demonstrating that its facility, including remodeling, has met applicable building codes. (2) The facility shall be designed in such a way that it is accessible and functional in meeting the identified needs of the adult population it serves. (3) The adult day care program shall provide the certifying agency with a detailed floor plan of its facility. (4) The adult day care program shall provide at least 50 square feet of usable floor space for each participant exclusive of passageways, bathrooms, lockers, office, storage areas, staff room, furnace rooms, and parts of rooms occupied by stationary equipment. Yes No N/A COMMENTS

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COMPLIANCE STANDARD (5) The facility shall provide sufficient furniture and equipment for use by participants that provides comfort and safety, and is appropriate for an adult population with physical disabilities, visual and mobility limitations, and cognitive impairments. (6) Heat shall be maintained at not less than 70 degrees F. IV. ADDITIONAL STANDARDS FOR ADULT DAY CARE PROGRAMS LOCATED IN A MULTI-USE FACILITY To assure that adult day care programs are community based, the following goal and standards have been developed for programs which are part of multi-use facilities. GOAL: The adult day care setting is typical of or strongly resembles the locations where adults in that community customarily congregate for social, recreational or association activities (e.g., clubs, church halls, private homes, lodges, restaurants). The building is consistent with the environment in terms of size, architectural style and type (urban vs. rural) and would be attractive and inviting to members of that community. The setting, programs and physical environment will enhance the dignity and individual respect of participants. IV.A. ADULT DAY CARE PROGRAM, IN A MULTI-USE FACILITY WHICH IS NOT IN OR CONNECTED TO A NURSING HOME, e.g., A CBRF, HOSPITAL. (1) Staff from other parts of the multi-use facility may be utilized in the adult day care program and counted in the staff/participant ratio if the following conditions are met: (a) As much as possible, the same multi-use facility staff members work in the adult day care program in order to maintain consistency in the relationships and services provided; (b) The multi-use facility staff members assigned to the adult day care program have only the adult day care participants as their responsibility during the hours of the assignment; (c) The sharing of staff is included in the adult day care program statement; and (d) Shared staff meet personnel requirements as stated in Section II. (2) If there are joint activities, they shall be on a planned basis and be described in the adult day care program statement. (3) Adult day care program space shall be separate from living areas, shall be in addition to space required for the other program, and shall meet the requirements of III.D. (4) and (5). (4) The program shall have a separate door to the outside so that participants and staff are not walking through or otherwise infringing upon the living area of others. IV.B. ADULT DAY CARE PROGRAM IN OR CONNECTED TO A NURSING HOME (INCLUDES AREAS WITHIN A HOSPITAL WHERE "SWING BEDS" Yes No N/A COMMENTS

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COMPLIANCE STANDARD ARE LOCATED). THERE ARE NO EXCEPTIONS TO THE FOLLOWING CRITERIA. (1) External Setting (a) Names, location, signage and promotional materials connote a communitybased program rather than a health care facility or institution; (b) Access to the nursing home and access to the day care program must be distinct, that is, have separate entrances (this would not preclude a shared lobby as long as neither nursing home residents nor day care participants infringe on others' program/living areas); and (c) Adult day care participants do not share outdoor space at the same time as nursing home residents are using the space. (2) Interior Setting (a) Decor and furnishings reflect non-institutional settings, home-like or club-like (such as a senior center or community center) or a hospitality service (resort or lodge); (b) Decor and activities are age appropriate; (c) Staff wear street clothes, not uniforms, unless performing medical procedures (as is common practice in facilities, not connected to a nursing home); (d) Adult day care program space shall be separate from living areas, shall be in addition to space required for other programs, and shall meet the requirements of III.D.(4) and (5); and (e) Spaces designated for program activities, toileting and exercise / ambulation are distinctly part of the adult day care area and limited to use by the adult day care participants. Adult day care participants may be provided personal care (bathing, grooming, other hands-on assistance) or therapy in space also used by nursing home residents provided that the adult day care services are scheduled at different times from nursing home residents. (3) Integrity of the Adult Day Care Program (a) Day care participants have separate dining facilities from the nursing home residents; (b) Activities are unique to the adult day care program and are not part of the calendar of events and activities planned for the nursing facility; (c) Transportation for adult day care participants is provided separately from that provided to nursing home residents (unless the transportation is contacted through another entity); Yes No N/A COMMENTS

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COMPLIANCE STANDARD (d) The sharing of staff is included in the adult day care program statement; (e) On a routine basis, separate staff are maintained both by the day care program and nursing facility. No staff member may be concurrently assigned to the program and nursing facility (day care staff have only day care participants as their responsibility during their hours of day care assignment). Nursing home staff assigned to the day care program meet requirements in II. and have been trained and oriented in accordance with II.D; (f) Staff are permanently assigned to adult day care to allow development and continuity of relationships and are not rotated on a routine basis to service in the nursing home; (g) Staff are trained in and the program is directed towards promotion of participant independence. Adaptive equipment is used to enable individuals to function as independently as possible; (h) The adult day care program is responsive to the family/caregiver needs including such things as information, referrals, assistance with home care or respite arrangements, hours of service to meet caregiver need, etc.; and (i) The program staff are directed to work cooperatively with community care managers, including: responding to needs identified in the assessment and care plan, communicating information with care manager, responding to consumer satisfaction feedback, adjusting individualized day care services to be responsive to a comprehensive care package. (4) Community Interaction. This section provides examples to further explain the intent of Program Services (I.D.). (a) Participants join in community activities outside of the day care center on at least a bi-monthly basis; in addition to any "special" community activities; (b) Community residents are involved in day care center activities, at least bimonthly, e.g., intergenerational activities, hosting local group meetings; (c) Activities available provide ample opportunity to express an individual's personality and interests (see I.C. and I.D.); and Yes No N/A COMMENTS

(d) Opportunities are provided to sustain or reclaim community involvement identified in the individualized assessment and designated in the service plan (e.g., banking, hair care, health, laundry care, shopping, dining out) as being important to the individual.

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COMPLIANCE STANDARD Yes V. PROGRAM EVALUATION (1) Adult day care programs shall develop and implement an annual plan to evaluate and improve the effectiveness of the program's operation and services to ensure continuous improvement in service delivery. (2) The evaluation process shall include: a review of the existing program; survey results from participants, families, and referral sources; program modification that responded to changing needs of participants; and proposed program and administrative improvements. A written report which summarizes the evaluation findings, improvement goals and implementation plan shall remain on file at the site. VI. LAWS AND CODES (1) Non-compliance with any federal, state, and local laws/codes that govern the operation of the facility, including, but not limited to, space, heating, plumbing, ventilation and lighting systems, fire safety, sanitation and wage and hour requirements may result in revocation of certification. (2) The adult day care programs should also comply with the requirements set by the Federal 1991 Americans with Disabilities Act, and by the Federal Occupation, Safety and Health Administration. (3) Non-compliance with these standards may result in revocation of certification and ineligibility for Medicaid Waiver funds. VII. EXCEPTIONS/VARIANCES TO THE STANDARDS The department may grant an exception or variance to a standard (except IV.B.) when it is assured that the health, safety, and welfare of the participants being served will not be jeopardized. A request for an exception or variance shall be in writing, shall be sent to the Department of Health Services and shall include justifications for the requested action and a description of any provisions planned to meet the intent of the standard. No N/A COMMENTS