Subject 111-8-65 RULES AND REGULATIONS FOR PRIVATE HOME CARE PROVIDERS
These rules are adopted and published pursuant to the
Official Code of Georgia Annotated (O.C.G.A.) § 31-7-300et
seq.
These rules shall be known as the Rules and Regulations for
Private Home Care Providers. The purposes of these rules are to provide for the
licensing and inspection of private home care providers.
In these rules, unless the context otherwise requires, the
words and phrases set forth herein shall mean the following:
| (a) |
"Ambulation and transfer" means the act
of moving or walking about or walking or being moved from place to place with
or without assistance.
In these rules, unless the context otherwise requires, the
words and phrases set forth herein shall mean the following.
|
| (b) |
"Applicant" means:
| 1. |
When the private home care provider is
owned by a sole proprietorship, the individual proprietor shall be the
applicant for the license, complete the statement of responsibility and serve
as the licensee; |
| 2. |
When the
private home care provider is owned by a partnership, the general partners
shall be the applicant for the license, complete the statement of
responsibility and serve as the licensee; |
| 3. |
When the private home care provider is
owned by an association limited liability company (LLC), the governing body of
the association or LLC shall authorize the application for the license and
complete the statement of responsibility and the association shall serve as the
licensee; and |
| 4. |
When the private
home care provider is owned by a corporation, the governing body of the
corporation shall authorize the application for the license and complete the
statement of responsibility and the corporation shall serve as the
licensee. |
|
| (c) |
"Companion
or sitter tasks" means the following tasks which are provided to elderly,
handicapped, or convalescing individuals: transport and escort services; meal
preparation and serving; and household tasks essential to cleanliness and
safety. |
| (d) |
"Criminal history
background check" means a search as required by law of the criminal records
maintained by law enforcement authorities to determine whether the applicant
has a criminal record as defined in these rules. |
| (e) |
"Criminal record" means:
| 1. |
Conviction of a crime; or |
| 2. |
Arrest, charge, and sentencing for a crime
where:
| (i) |
A plea of nolo contendere was
entered to the charge; or |
| (ii) |
First offender treatment without adjudication of guilt pursuant to the charge
was granted; or |
| (iii) |
Adjudication
or sentence was otherwise withheld or not entered on the charge; or |
|
| 3. |
Arrest and being charged for a
crime if the charge is pending, unless the time for prosecuting such crime has
expired pursuant to Chapter 3 of Title 17, O.C.G.A. |
|
| (f) |
"Department" means the Department of
Community Health. |
| (g) |
"Director"
means the chief administrative or executive officer or manager. |
| (h) |
"Home health agency" means a facility
licensed as a home health agency in accordance with the applicable licensing
statutes and associated rules. |
| (i) |
"Home management" means those activities normally performed by a homemaker for
the maintenance of a home's essential services, including but not limited to
activities such as meal planning, shopping, and bill paying; any employee that
is authorized unlimited access to a client's personal funds for home management
shall be bonded through the provider. |
| (j) |
"Housekeeping or housekeeping tasks"
means those activities performed for the upkeep and cleanliness of the home,
including but not limited to such activities as laundry, changing linens, trash
disposal, and cleaning. |
| (k) |
"Inspection" means any examination by the department or its representatives of
a provider, including but not necessarily limited to the premises, and staff,
persons in care, and documents pertinent to initial and continued licensing so
that the department may determine whether a provider is operating in compliance
with licensing requirements or has violated any licensing requirements. The
term inspection includes any survey, monitoring visit, complaint investigation,
or other inquiry conducted for the purposes of making a compliance
determination with respect to licensing requirements. |
| (l) |
"Medically frail or medically compromised
client" means a client whose health status, as determined by appropriate
provider staff in accordance with accepted standards of practice, is likely to
change or has changed because of a disease process, injury, disability or
advanced age and underlying disease process(es). |
| (m) |
"Medically related activities" means
activities such as but not limited to observing and reporting changes in a
client's condition, arranging trips to the doctor, picking up prescription
drugs, accompanying clients on medical appointments, documenting client's food
and/or liquid intake or output, reminding clients to take medication, and
assisting with self-administration of medication; such activities shall not
include professional services that are subject to regulation under professional
practice and licensing statutes and associated rules. |
| (n) |
"Owner" means any individual or any
person affiliated with the corporation, partnership, or association with 10
percent or greater ownership interest in a business or agency licensed as a
private home care provider and who:
| 1. |
Purports to or exercises authority of an owner in the business or
agency; |
| 2. |
Applies to operate or
operates the business or agency; or |
| 3. |
Enters into a contract to acquire
ownership of such a business or agency. |
|
| (o) |
"Personal care home" means a facility
licensed as a personal care home in accordance with the applicable licensing
statutes and associated rules. |
| (p) |
"Personal care tasks" means assistance with bathing, toileting, grooming,
shaving, dental care, dressing, and eating; and may include but are not limited
to proper nutrition, home management, housekeeping tasks, ambulation and
transfer, and medically related activities, including the taking of vital signs
only in conjunction with the above tasks. |
| (q) |
"Private home care provider" means any
person, business entity, corporation, or association, whether operated for
profit or not for profit, that directly provides or makes provision for private
home care services through:
| 1. |
its own
employees who provide nursing services, personal care tasks or companion or
sitter tasks; |
| 2. |
contractual
arrangements with independent contractors who are health care professionals
licensed pursuant to the applicable chapter of Title 43; or |
| 3. |
referral of other persons to render home
care services, when the individual making the referral has ownership or
financial interest in the delivery of those services by those other persons who
would deliver those services. |
|
| (r) |
"Private home care services" means those
items and services provided at a patient's residence that involve direct care
to that patient and includes, without limitation, any or all of the following:
| 1. |
nursing services, provided that such
services can only be provided by a person licensed as a Registered Professional
Nurse or Licensed Practical Nurse in accordance with applicable professional
licensing statutes and associated rules; |
| 2. |
personal care tasks; and |
| 3. |
companion or sitter tasks. |
| 4. |
Private home care services shall not
include physical, speech or occupational therapy; medical nutrition therapy;
medical social services; home health aide services provided by a home health
agency; or proxy caregiver services provided by a proxy caregiver hired by the
patient. |
|
| (s) |
"Records
check application" means two sets of classifiable fingerprints, a records
search fee to be established by the department by rule and regulation, payable
in such form as the department may direct to cover the cost of a fingerprint
records check, and an affidavit by the applicant disclosing the nature and date
of any arrest, charge, or conviction of the applicant for the violation of any
law, except for motor vehicle parking violations, whether or not the violation
occurred in this state, and such additional information as the department may
require. |
| (t) |
"Residence" means the
place where an individual makes that person's permanent or temporary home,
whether that person's own apartment or house, a friend or relative's home, or a
personal care home, but shall not include a hospital, nursing home, hospice, or
other health care facility licensed under O.C.G.A. § 31-7-1 et
seq. |
| (u) |
"Responsible
Party" means any person authorized in writing by the client or appointed by an
appropriate court to act upon the client's behalf; the term shall include a
family member of a physically or mentally impaired client unable to grant the
above authorization. |
| (v) |
"Satisfactory criminal history background check determination" means a written
determination that a person for whom a records check was performed was found to
have no criminal record which includes one of the covered crimes outlined in
O.C.G.A. § 31-2-9, if applicable. |
| (w) |
"Transport and escort services" means
accompanying clients or providing or arranging transportation for clients to
places outside of their residences for purposes such as appointments,
entertainment, exercise, recreation, shopping, or social activities. If the
mode of transportation is not owned by the client and is operated by an
employee of the provider, the provider shall either obtain a signed waiver by
the client of any claims for damages arising out of the operation of the
vehicle or make reasonable efforts to insure that there is current motor
vehicle insurance that will provide medical coverage for the client, in the
event that the vehicle is involved in an accident causing injuries to the
client. |
| (x) |
"Unsatisfactory
criminal history background check determination" means a written determination
that a person for whom a records check was performed has a criminal record
which includes one of the covered crimes outlined in O.C.G.A. § 31-2-9, if applicable. |
Each private home care provider shall have a governing body
empowered and responsible to determine all policies and procedures and to
ensure compliance with these rules.
| (1) |
No private home
care provider shall operate without a license or provisional license issued by
the department.
| (a) |
A license shall be issued
and renewed periodically by the department upon a providers' compliance with
these rules and shall remain in force and effect until the license expires or
is suspended, revoked or limited. |
| (b) |
Prior to the issuance of any new license,
the owner of the business or agency applying for the license shall be required
to submit a records check application so as to permit the department to obtain
a criminal history background check.
| 1. |
An
owner may not be required to submit a records check application if a
determination is made by the Department that the owner does not do any of the
following:
| (i) |
Maintains an office at the
location where services are provided to clients; |
| (ii) |
Resides at a location where services are
provided to clients; |
| (iii) |
Has
direct access to persons receiving care; nor |
| (iv) |
Provides direct personal supervision of
personnel by being immediately available to provide assistance and direction
during the time services are being provided. |
|
| 2. |
In lieu of a records check application,
the owner may submit evidence, satisfactory to the department, that within the
immediately preceding 12 months the owner has received a satisfactory criminal
records check determination. |
|
| (c) |
A private home care provider license
shall not be issued, and any issued license shall be revoked, where it has been
determined that the owner has received an unsatisfactory criminal records check
determination involving any of the following covered crimes, as outlined in
O.C.G.A. 49-2-14.1 et seq.:
| 1. |
A violation of Code Section
16-5-1, relating to murder and
felony murder; |
| 2. |
A violation of
Code Section
16-5-21, relating to aggravated
assault; |
| 3. |
A violation of Code
Section 16-5-70, relating to aggravated
battery; |
| 4. |
A violation of Code
Section 16-5-70 relating to cruelty to
children; |
| 5. |
A violation of Code
Section 16-5-100, relating to cruelty to a
person 65 year of age or older; |
| 6. |
A violation of Code Section
16-6-1, relating to
rape; |
| 7. |
A violation of Code
Section 16-6-2, relating to aggravated
sodomy; |
| 8. |
A violation of Code
Section 16-6-4, relating to child
molestation; |
| 9. |
A violation of Code
Section 16-6-5, relating to enticing a
child for indecent purposes; |
| 10. |
A
violation of Code Section 16-6-5.1, relating to sexual assault against persons
in custody, detained persons, or patients in hospitals or other
institutions; |
| 11. |
A violation of
Code Section 16-6-22.2, relating to aggravated sexual battery; |
| 12. |
A violation of Code Section
16-8-41, relating to armed
robbery; |
| 13. |
A violation of Code
Section 30-5-8, relating to abuse,
neglect, or exploitation of a disabled adult or elder person; or |
| 14. |
Any other offense committed in another
jurisdiction that, if committed in this state, would be deemed to be a crime
listed in this paragraph without regard to its designation elsewhere; |
|
| (d) |
An owner holding a valid
private home care provider license issued on or before June 30, 2007 shall be
required to obtain a fingerprint records check determination no later than
December 31, 2008.
| 1. |
An owner holding a
valid private home care provider license issued on or before June 30, 2007 who
has received an unsatisfactory criminal records determination which includes
any one of the covered crimes listed in Rule .05(c)(1) -(14) above, shall not
have the license revoked prior to a hearing being held before a hearing officer
pursuant to Chapter 13 of Title 50, the 'Georgia Administrative Procedures
Act'. |
| 2. |
An owner with a valid
private home care provider license who acquires a criminal record for any of
the crimes listed in Rule .14(7)(c)(1) -(14) above subsequent to the effective
date of these rules shall disclose the criminal record to the
department. |
|
| (e) |
If at
any time the department has reason to believe an owner holding a valid license
has been arrested, charged, or convicted of any of the covered crimes listed in
Rule .14(7)(c)(1) -(14) above, the department shall require the owner to submit
a records check application immediately for determination of whether a
revocation action is necessary. |
| (f) |
A provisional license may be issued by the department on a conditional basis
for one of the following reasons:
| 1. |
To allow
a newly established provider a reasonable, but limited, time to demonstrate
that its operational procedures comply with these rules; or |
| 2. |
To allow an existing provider a reasonable
length of time to comply with these rules and regulations, provided that the
provider shall present a plan of improvement acceptable to the
department. |
|
|
| (2) |
Qualifications Requirement. In order to
obtain or retain a license or provisional license, the provider's administrator
and its employees must be qualified, as defined in these rules, to direct or
work in a program. However, the department may require additional reasonable
verification of the qualifications of the administrator and employees either at
the time of application for a license or provisional license or at any time
during the license period whenever the department has reason to believe that an
administrator or employee is not qualified under these rules to direct or work
in a program.
| (a) |
If a governing body
maintains offices as a private home care provider in more than one location,
then each location shall be separately licensed. |
| (b) |
The license shall be prominently and
appropriately displayed at the private home care providers licensed
location. |
| (c) |
No license issued
under these rules is assignable or transferable. Each license or provisional
license shall be returned to the department in cases of changes in name,
location, ownership or governing body or if suspended, revoked, or limited. The
department shall be provided 15 days notice in advance of any providers change
in location. |
|
| (1) |
Initial
applications for a license as a private home care provider must be submitted to
the department on forms provided by the department, and shall include the
submission of an application fee and a license fee established by the Board of
Community Health, and a records check application for the owner. Such
application shall include a description of the private home care provider
services to be offered by the applicant and the geographic area that will be
served. |
| (2) |
Renewal of Licenses.
Licenses shall be renewed by the department periodically from the date of
initial issuance upon submission of a renewal application, and a license
renewal fee established by the Board of Community Health. Such renewal
application shall include a description of the private home care provider
services offered by the licensee and the geographic area served. |
| (3) |
Fees. Fees shall be reasonable and shall
be set so that the total of the fees approximates the total of the direct and
indirect costs to the state of the licensing program. Fees may be refunded for
good cause as determined by the department. |
| (4) |
False or Misleading Information. The
application for any license or renewal must be truthfully and fully completed.
In the event that the department has reason to believe that any application has
not been completed truthfully, the department may require additional reasonable
verification for the facts alleged. The department may refuse to issue or renew
any license where false statements have been made in connection with the
application or any other documents required by the department. |
| (1) |
These rules
shall not apply to private home care services which are provided under the
following conditions:
| (a) |
When those services
are provided directly by an individual, either with or without compensation,
and not by agents or employees of the individual and not through independent
contractors or referral arrangements made by an individual who has ownership or
financial interest in the delivery of those services by others who would
deliver those services. |
| (b) |
When
those services are home infusion therapy services and the intermittent skilled
nursing care is provided only as an integral part of the delivery and infusion
of pharmaceuticals; however, such skilled nursing care, whether hourly or
intermittent, which provides care licensed by these rules beyond the basic
delivery and infusion of pharmaceuticals is not exempt; |
| (c) |
When those services are provided through
the temporary placement of professionals and paraprofessionals to perform those
services in places other than a person's residence; |
| (d) |
When those services are provided by home
health agencies which are licensed under state law; |
| (e) |
When those services are provided in a
personal care home by the staff of the personal care home; and |
| (f) |
When those services are services within
the scope of practice of pharmacy and provided by persons licensed to practice
pharmacy. |
|
| (2) |
A certificate of need issued
pursuant to O.C.G.A. § 31-6-1et seq. is
not required for licensure so long as the provider does not operate as a
licensed home health agency or personal care home. |
| (1) |
Providers shall be inspected by the
department periodically; provided, however, the department may exempt a
provider from such periodic inspections if it is certified or accredited by a
certification or accreditation entity recognized and approved by the
department.
| (a) |
A provider seeking exemption
from on-site inspection shall be required to submit to the department
documentation of certification or accreditation, including a copy of its most
recent certification or accreditation report. |
| (b) |
Nothing contained herein shall be
construed to prohibit the department from conducting inspections of any
provider as the department determines necessary. |
|
| (2) |
Consent to Entry and Access. An
application for a license or the issuance and renewal of any license by the
department constitutes consent by the applicant or licensee and the owner of
the premises for the department's representatives to enter the premises for the
purpose of conducting any inspection during regular business hours.
| (a) |
Department representatives shall be
allowed reasonable and meaningful access to the provider's premises, all
records relevant to licensure and all provider staff. Providers shall assist
and cooperate in arranging for department representatives to have meaningful
access to provider's clients who consent to be interviewed by department
representatives in connection with any licensure activity. |
|
| (3) |
Cooperation with Inspection. All provider
staff shall cooperate with any inspection conducted by the department and shall
provide, without unreasonable delay, any documents to which the department is
entitled hereunder. |
| (4) |
If as a
result of the inspection, violations of these licensure regulations are
identified, the provider will be given a written report of the inspection which
identifies the licensure regulations violated. The provider must submit a
written plan of correction (improvement) in response to the inspection report
which states what the provider will do when to correct each of the violations
identified. The provider may offer any explanation or dispute the findings of
violations in the written plan of correction so long as an acceptable plan of
correction is submitted within ten days of the receipt of the written report of
licensure inspection. |
| (1) |
Services Description. A provider shall
establish and implement written policies and procedures that define the scope
of private home care services it offers and the types of clients it serves. No
provider shall provide services that are prohibited by these rules, the
applicable legal authority, or other laws. |
| (2) |
Service Agreements. No provider shall
offer to provide a client any private home care services that it cannot
reasonably expect to deliver in accordance with these rules.
| (a) |
A provider shall establish and implement
policies and procedures for service agreements. All services provided to a
client shall be based on a written service agreement entered into with the
client or the client's responsible party, if applicable. The service agreement
must include the following:
| 1. |
Date that
provider makes initial contact with client for services; |
| 2. |
Date of referral, i.e. the date on which
the provider received a specific request to deliver private home care services
to a particular client; |
| 3. |
Description of services needed as stated by client or responsible party, if
applicable; |
| 4. |
Description of
services to be provided and expected frequency and duration of
services; |
| 5. |
Charges for such
services, and mechanisms for billing and payment of such charges; |
| 6. |
Acknowledgment of receipt of a copy of
client's rights and responsibilities as outlined at rule .12; |
| 7. |
A telephone number of the provider that a
client can call for information, questions, or complaints about services
supplied by the provider; |
| 8. |
The
telephone number of the state licensing authority, i.e. the department, to call
for information or questions about the provider concerning a violation of
licensing requirements that was not resolved to the client's satisfaction by
complaining to the provider; |
| 9. |
Authorization from client or responsible party, if applicable, for access to
client's personal funds when home management services are to be provided and
when those services include assistance with bill paying or any activities, such
as shopping, that involve access to or use of such funds; similarly approved
authorization for use of client's motor vehicle when services to be provided
include transport and escort services and when the client's personal vehicle
will be used; |
| 10. |
Signatures for
the provider's representative and the client or responsible party, if
applicable, and date signed; if a client or responsible party refuses to sign
the agreement, such refusal shall be noted on the agreement with an explanation
from the provider's representative. |
|
| (b) |
For new clients, such initial service
agreements shall be completed not later than the second visit to the client's
residence to provide services if the second visit occurs on a different day
from the first visit or not later than seven calendar days after services are
initially provided in the residence, whichever is earlier.
| 1. |
If the provider is unable to complete the
service agreement for good cause, the provider will document such reason(s) in
the client's file. |
| 2. |
Subsequent
revisions to the initial service agreement may be handled by the provider
noting in the client's record the specific changes in service (e.g. addition or
deletion of service, changes in frequency, or duration, or charge for services,
etc.) that will occur and that the change was discussed with and agreed to by
the client and/or responsible party, as appropriate, who signed the initial
agreement prior to the change in services occurring. |
|
| (c) |
A client has the right to cancel any
service agreement at any time and shall only be charged for services actually
rendered prior to the time that the provider is notified of the cancellation.
The provider may assess a reasonable charge for travel and staff time if notice
of the cancellation of the service agreement is not provided in time to cancel
the service prior to the provider's staff member arriving at the client's house
to perform the service. |
|
| (3) |
Administrator. The governing body shall
appoint an administrator who shall have full authority and responsibility for
the operation of the private home care provider.
| (a) |
Any administrator employed after the
effective date of these rules must meet the following minimum qualifications:
| 1. |
Never have been shown by credible evidence
(e.g. a court or jury, a department investigation, or other reliable evidence)
to have abused, neglected, sexually assaulted, exploited, or deprived any
person or to have subjected any person to serious injury as a result of
intentional or grossly negligent misconduct as evidenced by an oral or written
statement to this effect obtained at the time of application; |
| 2. |
Participate in the orientation and
training required by these rules; |
| 3. |
Not have made any material false
statements concerning qualifications requirements either to the department or
the provider. |
|
|
| (4) |
Record keeping.
| (a) |
Client Records. A provider shall maintain
a separate file containing all written records pertaining to the services
provided for each client that it serves and the file shall contain the
following:
| 1. |
Identifying information
including name, address, telephone number, and responsible party, if
any; |
| 2. |
Current service agreement
as described at rule .09(2); |
| 3. |
Current service plan as described at rule .11; |
| 4. |
Clinical and/or progress notes if the
client is receiving nursing services that have been signed and dated by the
staff providing the direct care; |
| 5. |
Documentation of personal care tasks and companion or sitter tasks actually
performed for the client; |
| 6. |
Documentation of findings of home supervisory visits by the supervisor unless
entered in service plan; |
| 7. |
Any
material reports from or about the client that relate to the care being
provided to the client including items such as progress notes and problems
reported by employees of the provider, communications with personal physicians
or other health care providers, communications with family members or
responsible parties, or similar items; |
| 8. |
The names, addresses, and telephone
numbers of the client's personal physicians, if any; and |
| 9. |
Date and source of referral. |
|
| (b) |
Retention and Confidentiality
of Client Records. Written policies and procedures shall be established and
implemented for the maintenance and security of client records specifying who
shall supervise the maintenance of records, who shall have custody of records,
to whom records may be released and for what purposes and how long the records
will be retained.
| 1. |
At a minimum, all client
records shall be retained for five years from the date of last service
provided. The provider shall maintain the confidentiality of client
records. |
| 2. |
Employees of the
provider shall not disclose or knowingly permit the disclosure of any
information in a client record except to appropriate provider staff, the
client, responsible party (if applicable), the client's physician or other
health care provider, the department, other individuals authorized by the
client in writing or by subpoena. |
|
| (c) |
Personnel Records. A provider shall
maintain separate written records for each employee and the records shall
include the following:
| 1. |
Identifying
information such as name, address, telephone number, and emergency contact
person(s); |
| 2. |
A five year
employment history or a complete employment history if the person has not been
employed five years; |
| 3. |
Records of
qualifications; |
| 4. |
Documentation of
a satisfactory TB screening test upon employment and annually
thereafter; |
| 6. |
The person's job
description or statements of the person's duties and
responsibilities; |
| 7. |
Documentation
of orientation and training required by these rules; |
| 8. |
Documentation of at least an annual
performance evaluation; |
| 9. |
Documentation of bonding if the employee performs home management services
which permit unlimited access to the client's personal funds. (If bonding is
provided through a universal coverage bond, evidence of bonding need not be
maintained separately in each personnel folder.) |
|
| (d) |
Reports of Complaints and Incidents. The
provider shall maintain files of all documentation of complaints submitted
pursuant to rule .12(2). A provider shall also maintain on file for a minimum
of five years all incident reports or reports of unusual occurrences (e.g.
falls, accidents, significant medication errors, etc.) that affect the health,
safety, and welfare of its clients. Documentation required to be maintained
shall include what actions, if any, the provider took to resolve clients'
complaints and to address any incident reports or unusual occurrences required
to be retained. |
|
| (5) |
Staffing. The provider shall have sufficient numbers of qualified staff as
required by these rules to provide the services specified in the service
agreements with its clients. In the event that the provider becomes aware that
it is unable to deliver the specified services to the client because of an
unexpected staff shortage, the provider shall advise the client and refer the
client to another provider if the client so desires.
| (a) |
All staff employed by a provider shall
have included in their personnel records or files maintained by the particular
provider a written evaluation that was performed within one year before or
after the effective date of these rules. The written evaluation must reflect
that the employee's performance of required job tasks was observed personally
by a supervisor either by demonstration or observation and such performance was
determined to be competent for all job tasks required to be performed. All
staff hired after the effective date of these rules must meet the following
minimum qualifications:
| 1. |
Never have been
shown by credible evidence (e.g. a court or jury, a department investigation,
or other reliable evidence) to have abused, neglected, sexually assaulted,
exploited, or deprived any person or to have subjected any person to serious
injury as a result of intentional or grossly negligent misconduct as evidenced
by an oral or written statement to this effect obtained at the time of
application; |
| 2. |
Participate in the
orientation and training required by these rules; |
| 3. |
Not have made any material false
statements concerning qualifications requirements either to the department or
the provider. |
|
| (b) |
Nursing Personnel. Any persons employed by the provider to provide nursing
services shall be licensed in Georgia in accordance with professional licensing
laws and associated rules. Such persons may also provide any other types of
private home care services offered by the provider. |
| (c) |
Personal Care Assistant (PCA). The
provider may have PCAs perform personal care tasks for clients. Such persons
may also perform companion or sitter tasks for clients, but shall not provide
nursing services unless qualified as stated in rule .09(5)(b) above.
| 1. |
Any PCA hired after the effective date of
these rules shall have the following training and/or experience:
| (i) |
successful completion of a nurse aide
training and competency evaluation program pursuant to the requirements of 42
CFR Part 483, Subpart D, as revised or recodified, if applicable; or |
| (ii) |
successful completion of a competency
examination for nurse aides recognized by the department; or |
| (iii) |
successful completion of a health care
or personal care credentialing program recognized and approved by the
department; or |
| (iv) |
successful
completion or progress in the completion of a 40 hour training program provided
by a private home care provider, which addresses at least the following areas:
| (I) |
Ambulation and transfer of clients,
including positioning; |
| (II) |
Assistance with bathing, toileting, grooming, shaving, dental care, dressing,
and eating; |
| (III) |
Basic first aide
and CPR; |
| (IV) |
Caring for clients
with special conditions and needs so long as the services are within the scope
of the tasks authorized to be performed by demonstration; |
| (VI) |
Home safety and sanitation; |
| (VII) |
Infection control in the
home; |
| (VIII) |
Medically related
activities to include the taking of vital signs; and |
|
|
| 2. |
A training program described in
rule .09(5)(c)1.(iv) must be conducted under the direction of a licensed
registered professional nurse, or a health care professional with commensurate
education and experience. Twenty hours of the program must be completed by the
employee prior to serving clients and the additional twenty hours must be
completed within six months of the date the training initially began. No PCA
shall be assigned to perform a task for which training has not been completed
and competency has not been determined. No PCA shall be assigned to care for a
client with special conditions unless the PCA has received training and has
demonstrated competency in performing such services related to such special
conditions. |
|
| (d) |
Companions or Sitters. The provider may have companions or sitters perform
companion or sitter tasks for clients.
| 1. |
Such
persons may not provide other private home care services to clients unless
qualified as stated in rules .09(5)(b) and (c). |
| 2. |
Any companion or sitter hired after the
effective date of these rules must meet the following minimal requirements:
| (i) |
Be able to read and write, follow verbal
and written instructions, and complete written reports and documents; |
| (ii) |
Successfully complete training or
demonstrate understanding and practical competency in the following areas:
understanding the needs and characteristics of elderly, handicapped, or
convalescing individuals; meal preparation and serving; transportation and
escort services; housekeeping to include sanitation; home safety; handling
medical emergencies in the home; and infection control. |
|
|
|
| (6) |
Staff Training.
Prior to working with clients, all employees hired or used on or after the
effective date of these rules and who provide services to clients shall be
oriented in accordance with these rules and shall thereafter receive additional
training in accordance with these rules.
| (a) |
Orientation shall include instruction in:
| 1. |
The provider's written policies and procedures regarding its scope of services
and the types of clients it serves (rule .09(1) and clients rights and
responsibilities and complaints (rule .12 ), as well as other policies that are
relevant to the employee's range of duties and responsibilities; |
| 2. |
The employee's assigned duties and
responsibilities; |
| 3. |
Reporting
client progress and problems to supervisory personnel and procedures for
handling medical emergencies or other incidents that affect the delivery of
services in accordance with the client's services plan; |
| 4. |
The employee's obligation to report known
exposure to tuberculosis and hepatitis to the employer. |
|
| (b) |
Additional training consisting of a
minimum of eight clock hours of training or instruction shall be provided
annually for each employee after the first year of employment. Employees hired
prior to the effective date of these rules are also required to receive eight
clock hours of training or instruction annually beginning with the effective
date of these rules. Such training or instruction shall be in subjects that
relate to the employee's assigned duties and responsibilities. |
|
| (7) |
Contracted Services. If a
provider arranges with independent contractors, individuals, or agents for them
to provide any authorized private home care services on behalf of the provider
in any way, such arrangements shall be set forth in writing detailing the
services to be provided. The provider must assure that the independent
contractor, individual, or agent supplying the services follow the provisions
of these rules and are qualified to provide the services. The services must be
supervised, as outlined in rule .10(2) (Supervision of Services), by a
supervisor of the licensed provider. |
| (1) |
A provider may provide three categories
of home care services as defined in these rules.
| (a) |
Nursing Services. If a provider provides
nursing services, such services shall be provided by a licensed registered
professional nurse or a licensed practical nurse under the direction of a
supervisor as required by these rules. Such services shall be provided in
accordance with the scope of nursing practice laws and associated rules, and
the client's service plan.
| 1. |
Nursing services
shall include the following: ...
| (i) |
Regularly assess the nursing needs of the client; |
| (ii) |
Participate in the establishment and
implementation of the client's service plan; |
| (iii) |
Provide nursing services as needed and
in accordance with the client's service plan; |
| (iv) |
Report problems and progress of client
to supervisory personnel or the client's personal physician. |
|
|
| (b) |
Personal Care
Tasks. If a provider provides personal care tasks, such tasks, at a minimum,
shall be performed by a qualified PCA under the direction of a supervisor as
required by these rules, and in accordance with the client's service plan. In
addition to following the service plan, a PCA must report on the personal care
needs of the client, on changes in the client's condition, and on any observed
problems that affect the client. Licensed nurses are also authorized to perform
personal care tasks. |
| (c) |
Companion
or Sitter Tasks. If a provider provides companion or sitter tasks, such tasks,
at a minimum, shall be performed by a qualified companion or sitter under the
direction of a qualified supervisor as required by these rules, and in
accordance with the client's service plan. In addition to following the service
plan, a companion or sitter must report on the needs of the client, on changes
in the client's condition, and on any observed problems that affect the
client. |
|
| (2) |
Supervision
of Services. Services shall be supervised by qualified staff of the provider.
Each staff member providing services to a client shall be evaluated in writing
by his or her supervisor, at least annually, either through direct observation
or demonstration, on the job tasks the staff member is required to perform. No
supervisor shall knowingly permit an employee who has been exposed to
tuberculosis or hepatitis or diagnosed with the same to provide services to
clients until it is determined that the employee is not contagious.
| (a) |
Supervision of Nursing Services. If a
provider provides nursing services, it shall employ fully licensed Georgia
registered professional nurse to supervise the provision of such services and
the employees who provide the services. Such supervisor may perform other
duties provided he or she is able to fulfill the supervisory responsibilities
described in these rules. A supervisor shall complete the client's service plan
in accordance with rule .11 and in coordination with the appropriate staff who
will be providing the client's services. |
| (b) |
Supervision of Personal Care Tasks. If a
provider offers personal care task services, the provider shall employ
supervisor(s) that have been determined to be qualified by education, training
and experience to supervise the provision of such tasks in accordance with
accepted standards of care. A licensed registered professional or practical
nurse shall supervise the provision of personal care tasks for clients
determined to be medically frail or medically compromised. If such supervision
is provided by a licensed practical nurse, the licensed practical nurse shall
report to a licensed registered professional nurse who will continue to be
responsible for the development and management of the service plan. Such
supervisor may perform other duties provided he or she is able to fulfill the
supervisory responsibilities described in these rules.
| 1. |
The appropriate supervisor as specified in
these rules shall complete the client's service plan in accordance with rule
.11 and in coordination with the appropriate staff who will be providing the
client's services. For clients who are determined to be medically frail or
compromised, a licensed registered professional nurse shall complete the
initial service plan. Subsequent revisions to the service plan may be made by a
licensed practical nurse who is supervising the provision of personal care
tasks services to the client. Revisions made by the licensed practical nurse
will be reviewed in a timely manner by the provider's licensed registered
professional nurse ultimately responsible for the management of the client's
care. |
| 2. |
The appropriate supervisor
shall make a supervisory home visit to each client's residence at least every
92 days, starting from date of initial service in a residence or as the level
of care requires to ensure that the client's needs are met. The visit shall
include an assessment of the client's general condition, vital signs, a review
of the progress being made, the problems encountered by the client and the
client's satisfaction with the services being delivered by the provider's
staff. Such supervision shall also include observations about the
appropriateness of the level of services being offered. Routine quarterly
supervisory visits shall be made in the client's residence and shall be
documented in the client's file or service plan. |
|
| (c) |
Supervision of Companion or Sitter Tasks.
If a provider provides companion or sitter tasks, supervision of such tasks
shall be provided by a qualified supervisor (e.g. registered professional
nurse, licensed practical nurse, the administrator, or any other staff member
assigned responsibility for supervision of the delivery of care.)
| 1. |
The appropriate supervisor, as specified
in these rules, shall complete the client's service plan in accordance with
rule .11 and in coordination with the appropriate staff who will be providing
the client's services. |
| 2. |
The
appropriate supervisor shall make a supervisory home visit to each client's
residence at least every 122 days starting from date of initial service in the
residence or when the provider receives a complaint concerning services and the
complaint raises a serious question concerning the services being delivered.
The visit shall include an assessment of the client's general condition, a
review of the progress being made, the problems encountered by the client and
the client's satisfaction with the services being delivered by the provider's
staff. Such supervision shall also include observations about the
appropriateness of the level of services being offered. Routine supervisory
visits shall be made in the client's residence. All supervisory visits shall be
documented in the client's file or service plan. |
|
| (d) |
When employees or subcontractors are
performing personal care tasks for clients who are medically frail or medically
compromised in the clients' residences, the provider shall have a
representative on call and accessible who shall be able to contact a nurse
supervisor by telephone or other means to provide appropriate consultation to
the employees or subcontractors concerning responding to the clients' medical
needs. |
|
| (3) |
Documentation
of Home Care Services Provided. A provider shall establish and implement
written policies and procedures for documenting the services actually performed
for its clients each day. Such documentation shall be incorporated into the
client's file in accordance with rule .09(4)(a). |
| (4) |
Quality Improvement Program. The provider
must have and maintain documentation reflecting that there is an effective
quality improvement program that continuously monitors the performance of the
program itself and client outcomes to ensure that the care provided to the
clients meets acceptable standards of care and complies with the minimum
requirements set forth in these rules. At a minimum, the quality improvement
program must document the receipt and resolution (if possible) of client
complaints, problems with care identified and corrective actions
taken. |
| (1) |
Service Plan Content. A provider shall
establish and implement written policies and procedures for service planning. A
written plan of service shall be established in collaboration with the client
and the responsible party, if applicable, and the client's personal physician
if the services to be provided are nursing services and the client has a
personal physician.
| (a) |
The service plan
shall include the functional limitations of the client, types of service
required, the expected times and frequency of service delivery in the client's
residence, the expected duration of services that will be provided, the stated
goals and objectives of the services, and discharge plans. |
| (b) |
When applicable to the condition of the
client and the services to be provided, the [service] plan shall also include
pertinent diagnoses, medications and treatments, equipment needs, and diet and
nutritional needs. |
|
| (2) |
Service plans shall be completed by the service supervisor within seven working
days after services are initially provided in the residence. Service plans for
nursing services shall be reviewed and updated at least every sixty-two days.
Other service plans shall be reviewed and updated at the time of each
supervisory visit. Parts of the plans must be revised whenever there are
changes in the items listed in rules .11(l)(a) and (b), above. |
| (1) |
A provider
shall establish and implement written policies and procedures regarding the
rights and responsibilities of clients, and the handling and resolution of
complaints. |
| (2) |
Such policies and
procedures shall include a written notice of rights and responsibilities which
shall be provided to each client or responsible party, if applicable, when the
service agreement described in rule .09(2) is completed. The required notice
shall include the following items:
| (a) |
Right
to be informed about plan of service and to participate in the
planning; |
| (b) |
Right to be promptly
and fully informed of any changes in the plan of service; |
| (c) |
Right to accept or refuse
services; |
| (d) |
Right to be fully
informed of the charges for services; |
| (e) |
Right to be informed of the name,
business telephone number and business address of the person supervising the
services and how to contact that person; |
| (f) |
Right to be informed of the complaint
procedures and the right to submit complaints without fear of discrimination or
retaliation and to have them investigated by the provider within a reasonable
period of time. The complaint procedure provided shall include the name,
business address and telephone number of the person designated by the provider
to handle complaints and questions; |
| (g) |
Right of confidentiality of client
record; |
| (h) |
Right to have property
and residence treated with respect; |
| (i) |
Right to receive a written notice of the
address and telephone number of the state licensing authority, i.e. the
department, which further explains that the department is charged with the
responsibility of licensing the provider and investigating client complaints
which appear to violate licensing regulations; |
| (j) |
Right to obtain a copy of the provider's
most recent completed report of licensure inspection from the provider upon
written request. The provider is not required to release the report of
licensure inspection until the provider has had an opportunity to file a
written plan of correction for the violations, if any, identified. The facility
may charge the client reasonable photocopying charges; |
| (k) |
Right to be advised that the client and
the responsible party, if applicable, must advise the provider of any changes
in the client's condition or any events that affect the client's service
needs. |
|
| (3) |
Such policies
shall also include procedures for clients and others to present complaints,
either orally or in writing, about services and to have their complaints
addressed and resolved as appropriate by the provider in a timely
manner. |
| (4) |
A provider shall supply
all clients and responsible parties, if applicable, with the specific telephone
number of the provider for information, questions or complaints about services
being delivered by the provider. |
| (1) |
Enforcement of these rules and
regulations shall be conducted in accordance with Rules and Regulations for
Enforcement of Licensing Requirements, |
| (2) |
If the department finds that an applicant
for a license has violated any provisions of these rules or other laws, rules,
regulations, or formal orders related to initial or continued licensing, it
may, subject to notice and an opportunity for hearing, refuse to grant any
license or limit or restrict any license. |
| (3) |
If the department finds that a provider
has violated any provision of these rules or other laws, rules, regulations, or
formal orders related to initial or continued registration, it may, subject to
notice and an opportunity for hearing, take any of the following actions:
administer a public reprimand; limit or restrict a license; suspend a license;
impose a fine; refuse to renew a license; or revoke a license. |
| (1) |
The department may, in its discretion,
grant waivers and variances of specific rules upon application or petition
being filed on forms provided by the department. The department may establish
conditions which must be met by the provider in order to operate under the
waiver or variance granted. Waivers and variances may be granted in accordance
with the following conditions: |
| (2) |
Variance. A variance may be granted by the department upon a showing by the
applicant or petitioner that the particular rule or regulation that is the
subject of the variance request should not be applied as written because strict
application of the rule would cause undue hardship. The applicant or petitioner
must also show that adequate standards affording protection for the health,
safety and care of persons in care exist and will be met in lieu of the exact
requirements of the rule or regulation in question. |
| (3) |
Waiver. The department may dispense
entirely with the enforcement of a rule or regulation by granting a waiver upon
a showing by the applicant or petitioner that the purpose of the rule or
regulation is met through equivalent standards affording equivalent protection
for the health, safety and care of persons in care. |
| (4) |
Experimental Variance or Waiver. The
department may grant waivers and variances to allow experimentation and
demonstration of new and innovative approaches to delivery of services upon a
showing by the applicant or petitioner that the intended protections afforded
by the rule or regulation which is the subject of the request are met and that
the innovative approach has the potential to improve service
delivery. |
| (1) |
In the event
that any rule, sentence, clause or phrase of any of these rules and regulations
may be construed by any court of competent jurisdiction to be invalid, illegal,
unconstitutional, or otherwise unenforceable, such determination or
adjudication shall in no manner affect the remaining rules or portions
thereof. |
| (2) |
The remaining rules or
portions thereof shall remain in full force and effect, as if such rule or
portions thereof so determined, declared, or adjudged invalid or
unconstitutional were not originally a part of these rules. |
