Virginia Law

A. Each assisted living facility shall retain a licensed health care professional who has at least two years of experience as a health care professional in an adult residential facility, adult day center, acute care facility, nursing home, or licensed home care or hospice organization, either by direct employment or on a contractual basis, to provide on-site health care oversight.

1. For residents who meet the criteria for residential living care:

a. The licensed health care professional, practicing within the scope of the health care professional's profession, shall provide health care oversight at least every six months, or more often if indicated, based on the health care professional's professional judgment of the seriousness of a resident's needs or the stability of a resident's condition; or

b. If the facility employs a licensed health care professional who is on site on a full-time basis, a licensed health care professional, practicing within the scope of the health care professional's profession, shall provide health care oversight at least annually, or more often if indicated, based on the health care professional's professional judgment of the seriousness of a resident's needs or stability of a resident's condition.

2. For residents who meet the criteria for assisted living care:

a. The licensed health care professional, practicing within the scope of the health care professional's profession, shall provide health care oversight at least every three months, or more often if indicated, based on the health care professional's professional judgment of the seriousness of a resident's needs or stability of a resident's condition; or

b. If the facility employs a licensed health care professional who is on site on a full-time basis, a licensed health care professional, practicing within the scope of the health care professional's profession, shall provide health care oversight at least every six months, or more often if indicated, based on the health care professional's professional judgment of the seriousness of a resident's needs or stability of a resident's condition.

3. All residents shall be included at least annually in health care oversight.

B. While on site, as specified in subsection A of this section, the licensed health care professional shall provide health care oversight of the following and make recommendations for change as needed:

1. Ascertain whether a resident's service plan appropriately addresses the current health care needs of the resident.

2. Monitor direct care staff performance of health-related activities.

3. Evaluate the need for staff training.

4. Provide consultation and technical assistance to staff as needed.

5. Review documentation regarding health care services, including medication and treatment records, to assess whether services are being provided in accordance with physicians' or other prescribers' orders.

6. Monitor conformance to the facility's medication management plan and the maintenance of required medication reference materials.

7. Evaluate the ability of residents who self-administer medications to continue to safely do so.

8. Observe infection control measures and consistency with the infection control program of the facility.

C. For all restrained residents, onsite health care oversight shall be provided by a licensed health care professional at least every three months and include the following:

1. The licensed health care professional shall be, at a minimum, a registered nurse who meets the experience requirements in subdivision A of this section.

2. The licensed health care professional shall review the current condition and the records of restrained residents to assess the appropriateness of the restraint and progress toward its reduction or elimination.

3. The licensed health care professional providing the oversight for this subdivision shall also provide the oversight for subdivisions B 1 through B 8 of this section for restrained residents.

4. The oversight provided shall be a holistic review of the physical, emotional, and mental health of the resident and identification of any unmet needs.

5. The oversight shall include review of physician's orders for restraints to determine whether orders are no older than three months, as required by 22VAC40-73-710 E 2.

6. The oversight shall include an evaluation of whether direct care staff have received the restraint training required by 22VAC40-73-270 and whether the facility is meeting the requirements of 22VAC40-73-710 regarding the use of restraints.

7. The licensed health care professional shall make recommendations for change as needed.

D. The licensed health care professional who provided the health care oversight shall certify that the requirements of subsection B and, if applicable, C of this section were met, including the dates of the health care oversight. The specific residents for whom the oversight was provided must be identified. The administrator shall be advised of the findings of the health care oversight and any recommendations. All of the requirements of this subsection shall be (i) in writing, (ii) signed and dated by the health care professional, (iii) provided to the administrator within 10 days of the completion of the oversight, and (iv) maintained in the facility files for at least two years, with any specific recommendations regarding a particular resident also maintained in the resident's record.

E. Action taken in response to the recommendations noted in subsection D of this section shall be documented in the resident's record if resident specific, and if otherwise, in the facility files.