Part V. Admission, Retention, and Discharge
22VAC40-61-210. Admission policies.
A. The center shall have admission policies, to include admission criteria, that shall be discussed with each person entering the program, his family members, legal representative, or the public, as appropriate. A copy of the admission policies shall be available upon request.
B. Only those persons who meet the admission criteria shall be admitted to the center.
C. All participants shall be 18 years of age or older.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-220. Assessment procedures.
A. A written assessment of a participant shall be secured or conducted prior to or on the date of admission by the director, a staff person who meets the qualifications of the director, or a licensed health care professional employed by the center.
B. The assessment shall be based upon the information presented by the participant, family members, friends, legal representative, the report of the required physical examination, and from other care providers.
C. The assessment shall identify the person's abilities and needs to determine if and how the program can serve the participant.
D. The assessment shall include at minimum a description of the participant's:
1. Medical and functional condition, including:
a. Ambulatory ability;
b. Ability to perform activities of daily living; and
c. Health status to include diagnoses and medications.
2. Mental status, including any intellectual, cognitive, and behavioral impairment and known psychiatric or emotional problems;
3. Social environment, including living arrangements and the availability of family, friends, and other people and organizations in the community to provide services to the participant;
4. Economic conditions;
5. Nutrition needs;
6. Communication limitations;
7. Hobbies and interests; and
8. Personal preferences that would enhance the participant's experience at the center.
E. The assessment shall be reviewed and updated at least every six months.
F. A reassessment shall also be made when there are changes to indicate that a participant's needs may no longer be met by the current plan of care or the center's program of care.
G. The initial assessment and any reassessments shall be in writing and completed, signed, and dated by the staff person identified in subsection A of this section. The assessment or reassessment shall also indicate any other individuals who contributed to the development of the plan with a notation of the date of the contribution.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-230. Participant plan of care.
A. Prior to or on the date of admission, a preliminary multidisciplinary plan of care based upon the assessment shall be developed for each participant. The plan shall be reviewed and updated, if necessary, within 30 days of admission.
B. The plan shall be developed by the director, a staff person who meets the qualifications of the director, or a licensed health care professional employed by the center.
C. The plan shall be developed in conjunction with the participant and, as appropriate, with the participant's family members, legal representative, direct care staff members, case manager, or health care provider.
D. The plan shall be developed to maximize the participant's level of functional ability and to support the principles of individuality, personal dignity, and freedom of choice. Whenever possible, participants shall be given a choice of options regarding the type and delivery of services. The plan shall include:
1. A description of the identified needs and the date identified;
2. The expected outcome or goal to be achieved in meeting those needs;
3. The activities and services that will be provided to meet those outcomes or goals, who will provide them, and when they will be provided;
4. If appropriate, the time by which the outcome or goals should be achieved; and
5. Date outcome or goal achieved.
E. The plan of care shall be reviewed and updated as significant changes occur and at least every six months.
F. The preliminary plan of care and any updated plans shall be in writing and completed, signed, and dated by the staff person identified in subsection B of this section. The participant, family member, or legal representative shall also sign the plan of care. The plan shall indicate any other individual who contributed to the development of the plan, with a notation of the date of contribution.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-240. Participant agreement with the center.
A. At or prior to the time of admission, there shall be a written agreement between the participant and the center. The agreement shall be signed and dated by the participant or legal representative and the center representative.
B. The agreement shall specify the following:
1. Services and care to be provided to the participant by the center. Any additional fees for specific services and care shall be identified.
2. Financial arrangement to include:
a. The amount to be paid, frequency of payments, and rules relating to nonpayment.
b. The amount and purpose of an advance payment or deposit payment and the refund policy for such payment.
c. The policy with respect to increases in charges and the length of time for advance notice of intent to increase charges.
d. The refund policy to apply when transfer of ownership, closing of center, or participant discharge occurs.
e. The fee or notification requirement, if any, associated with participant discharge.
f. The provision of a monthly statement or itemized receipt of the participant's account.
3. Conditions for discharge.
C. A copy of the signed agreement shall be given to the participant or to the legal representative, as appropriate, and a copy shall be kept in the participant's record at the center.
D. The agreement shall be reviewed and updated whenever there is any change in the services or the financial arrangements. The updated agreement shall be signed and dated by the participant or his legal representative and the center representative.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-250. Participant record.
A. The center shall establish policies and procedures for documentation and recordkeeping to ensure that the information in participant records is accurate, clear, and well organized. The record shall contain all information, reports, and documents required by this chapter and other information relevant to the plan of care.
B. The following personal information shall be kept current for each participant:
1. Full name of participant, address, and telephone number;
2. Date of admission;
3. Birth date;
4. Marital status;
5. Names, addresses, and telephone numbers of at least two family members, friends, or other designated people to be contacted in the event of illness or an emergency;
6. Names, addresses, and telephone numbers of the participant's local primary care provider, personal physician, any other health or social service provider, and the name of the preferred hospital in the event of an emergency;
7. Name, address, and telephone number of any legal representative and documentation regarding the scope of their representation;
8. Known allergies, if any;
9. Information regarding an advance directive or Do Not Resuscitate Order, if applicable;
10. Mental health, substance abuse, or behavioral concerns; and
11. A current photograph or narrative physical description of the participant, which shall be updated annually.
C. Participant records shall be retained at the center and kept in a locked area.
D. The center shall assure that all records are kept confidential and that information shall be made available only when needed for care of the participant and in accordance with applicable federal and state laws. All records shall be made available for inspection by the department's representative.
E. If the participant or legal representative consents in writing, records shall be shared with other centers or agencies for a specific purpose such as care coordination, referral for other services, or upon discharge.
F. Participants shall be allowed access to their own records. A legal representative of a participant shall be provided access to the participant's record or part of the record only as allowed within the scope of his legal authority.
G. The complete participant record shall be retained for at least two years after the participant leaves the center.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-260. Physical examinations and report.
A. Within the 30 days preceding admission, a participant shall have a physical examination by a licensed physician.
B. The report of the required physical examination shall be on file at the center and shall include:
1. The person's name, date of birth, address, and telephone number.
2. The date of the physical examination.
3. Height, weight, and blood pressure.
4. Significant medical history.
5. General physical condition, including a systems review as is medically indicated.
6. All diagnoses and significant medical problems.
7. Any known allergies and description of the person's reactions.
8. Any recommendations for care, including:
a. A list of all medications, including dosages, route, and frequency of administration;
b. Any special diet or any food intolerances;
c. Any therapy, treatments, or procedures the individual is undergoing or should receive and by whom; and
d. Any restrictions or limitations on physical activities or program participation.
9. The participant shall obtain an evaluation by a qualified licensed practitioner who completes an assessment for tuberculosis (TB) in a communicable form no earlier than 30 days before admission. The evaluation for tuberculosis shall be consistent with the TB risk assessment as published by the Virginia Department of Health, with additional testing, singly or in combination, as deemed necessary. Documentation of the TB evaluation is required, which includes the information contained on the form "Report of Tuberculosis Screening" recommended by the Virginia Department of Health. The form shall be signed by the qualified licensed practitioner who performs the evaluation.
10. A statement that specifies whether the individual is considered to be ambulatory or nonambulatory.
11. A statement that specifies whether the individual is or is not capable of self-administering medication.
12. The signature of the examining physician or the physician's designee.
C. Subsequent medical evaluations.
1. Each participant shall annually submit a report of physical examination by a physician, including the information required in subdivisions B 1 through B 8 and B 10, B 11, and B 12 of this section.
2. At the request of the licensee or director of the center or the Department of Social Services, a report of examination by a physician shall be obtained when there are indications that the center can no longer provide appropriate or safe care because of changes in the participant's physical or mental health. The written report of the physical examination shall be:
a. Dated;
b. Signed by a physician or the physician's designee; and
c. Used in evaluating the participant's continued suitability for adult day services.
D. Subsequent evaluations for tuberculosis.
1. Any participant who comes in contact with a known case of infectious tuberculosis shall be screened as deemed appropriate in consultation with the local health department.
2. Any participant who develops respiratory symptoms of three or more weeks' duration shall be evaluated immediately for the presence of infectious tuberculosis. Any such participant shall not be allowed to return to the program until a physician has determined that the individual is free of infectious tuberculosis.
3. If a participant develops an active case of tuberculosis, the center shall report this information to the local health department.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-270. Discharge of participants.
A. When actions, circumstances, conditions, or care needs occur that will result in the discharge of a participant, discharge planning shall begin immediately.
B. A written discharge notice shall identify the reasons for discharge and outline the services needed by the participant upon discharge. The discharge notice shall be provided to and discussed with the participant and family members or legal representative.
C. The center shall notify the participant and family members or legal representative at least 30 calendar days prior to the actual discharge date.
D. The center shall develop a policy regarding the number of days notice that is required when a participant wishes to leave the center. Any required notice of intent to leave shall not exceed 30 calendar days.
E. When a participant's condition presents an immediate and serious risk to the health, safety, or welfare of the participant or others and immediate discharge is necessary, the 30-day notification of planned discharge does not apply.
F. The center shall assist the participant, his family members, or legal representative, if any, in the discharge or transfer process. The center shall prepare a transfer report for the new program, if requested.
G. The center shall have a process by which participants, family members, or legal representatives can appeal a center-initiated discharge.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.