The adult day care program shall provide at least the following services:

1. (1) Activities of daily living.

   1. (A) The adult day care program shall provide assistance with walking, toileting, feeding, grooming, dressing, and other activities of daily living.
   2. (B) Assistance to clients and caregivers with diets.
   3. (C) Counseling with individual clients, as needed, regarding health care.
   4. (D) Minor first aid treatment if needed.
   5. (E) Facilitating specialized services (i.e., speech therapy, physical therapy, counseling, etc.) which may be arranged for or provided through the program as needed by individual clients or as available through community sources;

2. (2) Activities.

   1. (A) A monthly schedule of group activities shall be planned and posted in the facility.
   2. (B) Activities may be conducted individually and in groups.

   3. (C) Activities shall be:

      1. (i) Planned to suit the needs and interests of clients; and

      2. (ii) Designed to:

         1. (a) (a) Stimulate interest;
         2. (b) (b) Rekindle motivation; and
      3. (c) (c) Encourage physical exercise.

   4. (D) Planned activities shall include but not be limited to:

      1. (i) Exercise;
      2. (ii) Recreation; and
      3. (iii) Social activities.

   5. (E) Physical exercise shall be:

      1. (i) Designed in relation to each individual’s needs, impairments, and abilities; and
      2. (ii) Alternated with rest periods or quiet activities;

3. (3) Medications.

   1. (A) Administration.

      1. (i)

         1. (a) (a) Each adult day care must have written policies and procedures to ensure, and facilities shall ensure, that clients receive medications as ordered.
         2. (b) (b) In-service training on facility medications policies and procedures (20 CAR § 408-303(a)) shall be provided at least annually for all facility personnel/staff/employees/volunteers supervising or administering medications.
      2. (ii) Clients must be able to self-administer their own medication.
      3. (iii) Facilities must comply with applicable state laws and rules governing the administering of medications and restrictions applicable to nonlicensed personnel/staff/employees/volunteers.
      4. (iv) The facility shall document in the client’s record whether the client or the facility is responsible for storing the client’s medication.
      5. (v) The facility shall document in the client’s record whether the client will self-administer medication.

      6. (vi)

         1. (a) (a) Clients who self-administer their medications must be familiar with their medications and comprehend administration instructions.
         2. (b) (b) Facility staff shall provide assistance to enable clients to self-administer medications.
      7. (c) (c) For clarification, examples for acceptable practices are listed below:
4. (1) (1) The medication regimen on the container label may be read to the client;

5. (2)

   1. (A) (2)(A) A larger sterile or disposable container may be provided to the client if needed to prevent spillage.
   2. (B) (B) The containers shall not be shared by clients;
6. (3) (3) The client may be reminded of the time to take the medication and be observed to ensure that the client follows the directions on the container; and

7. (4)

   1. (A) (4)(A) Facility staff may assist the client in the self-administration of medication by taking the medication in its container from the area where it is stored and handing the container with the medication in it to the client.
   2. (B) (B) In the presence of the client, facility staff may remove the container cap or loosen the packaging.

   3. (C) (C) If the client is physically impaired but cognitively able (has awareness with perception, reasoning, intuition, and memory), facility staff, upon request by or with the consent of the client, may assist the client in removing oral medication from the container and in taking the medication e.g., if the client is physically unable to place a dose of oral medication in his or her mouth without spilling or dropping it, facility staff may place the dose of medication in another container and place that container to the mouth of the client.

      1. (vii)

         1. (a) (a) Changes in dosage or schedule of the medication shall be made only upon the authorization of the client’s attending physician or advance practice nurse or the client or the client’s responsible party.
         2. (b) (b) Any such authorization shall be documented by the facility in the client’s care plan.

   4. (B) Medication storage.

      1. (i)

         1. (a) (a) Medication stored for clients by the facility must be stored in a locked area in individual compartments or bins labeled with the client’s name.
         2. (b) (b) Drugs or medications kept by the facility for external use shall be kept in a location accessible to clients and staff and that is separate and apart from other medications and drugs.
      2. (c) (c) Provided, however, that if the client administers his or her own medication, the client shall have access to his or her medication.

      3. (ii)

         1. (a) (a) Medications may be kept on the client’s person.
         2. (b) (b) Prior to a client being permitted to keep his or her medications, the facility shall:
8. (1) Assess the client to determine the client’s understanding of, and ability to follow, the instructions on the prescription or label, and the understanding of and ability to follow storage requirements or recommendations on the prescription or label, or as made by the pharmacist; and

9. (2)

   1. (A) (2)(A) Document the assessment in the client’s records.

   2. (B) (B) The assessment shall include at a minimum the:

      1. (i) (i) Date of the assessment;
      2. (ii) (ii) Name of person performing the assessment; and
      3. (iii) (iii) Information obtained by the assessment that indicated the client’s ability to understand and follow prescription or label directions and instructions.
      4. (c)
10. (1) (c)(1) After the initial assessment, facilities shall perform reassessments as needed, including changes of conditions of clients, and shall perform the steps outlined in subdivisions (B)(ii)(b)(1) and (2) of this section.
11. (2) (2) Failure to assess or reassess, or to identify clients at risk of harm from medications in unsecured locations or rooms, shall constitute a deficient facility practice.

12. (3) (3) Resulting harm from a failure to assess or reassess, or to identify clients at risk of harm from medications in unsecured locations or rooms, shall constitute a deficient facility practice.

    1. (iii)

       1. (a) (a) Medications must be stored in an environment that is clean, dry, and not exposed to extreme temperature ranges.

          1. (b) (b) Medications requiring cold storage shall be refrigerated.
       2. (c) (c) A locked container placed below food level in a facility’s refrigerator is acceptable storage.
       3. (d) (d) All drugs on the premises of the facility shall be labeled in accordance with accepted professional principles and practices, and shall include the appropriate accessory and cautionary instructions and the expiration date.
       4. (iv) Prescriptive medications must be properly labeled in accordance with current applicable laws and rules pertaining to the practice of pharmacy.
       5. (v) All medications in the control or care of the facility shall have an expiration date that is not expired.

       6. (vi)

          1. (a) (a) Medications must be individually labeled with the client’s name and kept in the original container unless the client or responsible party transfers the medication into individual dosage containers.
          2. (b) (b) Under no circumstances may an owner or personnel/staff/employee of the facility repackage medication.

       7. (vii)

          1. (a) (a) Any medication that is stored by the facility that has been prescribed for but is no longer in use by a client must be destroyed or disposed of in accordance with state law or may be given to the client’s family in accordance with this section.
          2. (b) (b) Schedule II, III, IV, and V drugs dispensed by prescription for a client and no longer needed by the client must be delivered in person or by registered mail to: Drug Control Division, Arkansas Department of Human Services, along with the Department of Human Services’ Form (PHA-DC-1) Report of Drugs surrendered for Disposition According to Law.
       8. (c) (c) When unused portions of controlled drugs go with a client who leaves the facility, the person who assumes responsibility for the client and the person in charge of the medications for the facility shall sign the controlled drug record in the facility.

       9. (d) (d) This shall be done only on the written order of the physician or advance practice nurse and at the time that the client is discharged, transferred, or visits home.

          1. (e) (e) All other medications not taken out of the facility when the client leaves the facility shall be destroyed or returned in accordance with law and applicable rules.
       10. (viii) Under no circumstance will one (1) client’s medication that is under the facility’s control be shared with another client.

       11. (ix)

           1. (a) (a) For all medication that is stored by the facility, the facility must remove from use:
13. (1) (1) Outdated or expired medication or drugs;
14. (2) (2) Drug containers with illegible or missing labels; and

15. (3) (3) Drugs and biologicals discontinued by the physician or advance practice nurse.

    1. (b) (b) All such medications shall be destroyed or returned in accordance with law and applicable rules.

       1. (x)

          1. (a) (a) All controlled drugs or substances stored by the facility shall be stored in a locked, permanently affixed, substantially constructed cabinet within a locked room designed for the storage of drugs.
          2. (b) (b) When mobile medication carts for unit-dose or multiple day card systems are used:
16. (1) (1) The cart must be in a locked room when the cart is not in use and the unit contains controlled drugs; and

17. (2)

    1. (A) (2)(A) The facility shall ensure that the cart remains in the observation of staff utilizing the cart when the cart is in use and that clients are not able to access the cart or obtain medications from the cart.

    2. (B)

       1. (i) (B)(i) Controlled substances of less than minimal quantity shall be stored in a separately locked compartment within the cart.
       2. (ii) (ii) “Minimal quantity” means a twenty-four-hour or less supply.

       3. (xi)

          1. (a) (a) Medication destruction shall comply with state and federal laws and regulations governing the destruction of drugs.
          2. (b) (b) The record of the destruction shall be recorded in a bound ledger, in ink, with consecutively numbered pages, and retained by the facility as a permanent, retrievable record.

    3. (C) Medication charting.

       1. (i) If a facility stores a client’s medications, the facility shall maintain a list of those medications.

       2. (ii)

          1. (a) (a) If the facility stores and supervises a client’s medication, a notation must be made on the individual record for each client who refuses, either through affirmative act, omission, or silence, or is unable to self-administer his or her medications or refuses to take his or her medication.
          2. (b) (b) The notation shall include the date, time, and dosage of medication that was not taken or administered to or by the client, including a notation that the client’s family or responsible party was notified.
       3. (iii) If medications are prescribed to be taken as needed (PRN) by the client, documentation in the client’s file should list the medication, the date, and the time received by the client and the reason taken.

       4. (iv)

          1. (a) (a) A record shall be maintained in a bound ledger book, in ink, with consecutively numbered pages, of all controlled drugs stored and which are supervised by the facility.
          2. (b) (b) The record shall contain the:
18. (1) (1) Name, strength, and quantity of drug;
19. (2) (2) Date received and date, time, and dosage administered;
20. (3) (3) Name of the client for whom the drug was prescribed, or who received the drug;
21. (4) (4) Name of the prescribing physician or advance practice nurse;
22. (5) (5) Name of the dispensing pharmacy;
23. (6) (6) Quantity of drug remaining after each administered dosage; and

24. (7) (7) Signature of the individual observing the client’s self-administration of the drug.

    1. (v) When a dose of a controlled drug is dropped, broken, or lost, two (2) employees shall record in the record the facts of the event and sign or otherwise identify themselves for the record.

       1. (vi)

          1. (a) (a) For all medications stored by the facility, there shall be a weekly count of all Schedule II, III, IV, and V controlled medications.
          2. (b) (b) The count shall be made by the person responsible for medications in the facility and shall be witnessed by a nonlicensed employee.
       2. (c) (c) The count shall be documented by both employees and shall include the date and time of the event, a statement as to whether the count was correct, and if incorrect, an explanation of the discrepancy.
       3. (d) (d) When the count is incorrect, the facility shall document as required under subdivision (3)(B)(vii) of this section.

       4. (vii)

          1. (a) (a) Medications stored and supervised by the facility shall be recorded in each client's medical record.
          2. (b) (b) The notation shall be in ink, and shall state, at a minimum:
25. (1) (1) The name of the medication;
26. (2) (2) The dosage prescribed and the dosage taken or administered;
27. (3) (3) The method of administration; and

28. (4) (4) The date and time of the administration.

    1. (D) Pharmaceutical services — Responsibility for pharmacy compliance.

       1. (i) The director shall be responsible for full compliance with federal and state laws and regulations governing procurement, control, and administration of all drugs.
       2. (ii) Full compliance is required with the Comprehensive Drug Abuse Prevention and Control Act of 1970, Pub. L. No. 91-513, and all amendments of this set and all regulations and rulings passed down by the United States Drug Enforcement Agency, Arkansas Acts 1971, No. 590 (Title 5, Subtitle 6, Chapter 64 of the Arkansas Code) and all amendments to it and this part; and

29. (4) Dietary — Required facility dietary services.

    1. (A)

       1. (i) Each adult day care facility must make available food for balanced meals and make between-meal snacks available.
       2. (ii) Potable water and other drinking fluids shall be available at all times.
       3. (iii) Meals shall be served at approximately the same time each day.

       4. (iv)

          1. (a) (a) Variations from these stated parameters may be permitted at the written request of the client or his or her responsible party or as directed by the client’s personal physician or advance practice nurse in writing.
          2. (b) (b) The facility shall retain documentation of the request to, and stating the reason for, the variance.

    2. (B)

       1. (i) In the event that a client is unable or unwilling to consume regular meals served to him or her for more than two (2) consecutive days, the facility shall immediately notify the client’s family or responsible party.
       2. (ii) If a client chooses not to consume regular meals, this must be documented in the care plan.

    3. (C)

       1. (i) For those facilities that prepare food on site, a supply of food shall be maintained on the premises at all times.
       2. (ii) This shall include at least a twenty-four-hour supply of perishable food and a three-day supply of nonperishable food.
       3. (iii) The food supply shall come from a source approved by the Department of Health.

       4. (iv)

          1. (a) (a) Adult day care facilities attached to other licensed long-term care facilities may utilize the kitchen facilities of the attached long-term care facility.
          2. (b) (b) However, the adult day care shall ensure that the kitchen facilities so utilized are adequate to meet the needs of the clients of the adult day care.
    4. (D) Dietary personnel/staff/employees shall wear clean clothing and hair coverings.
    5. (E) Each facility shall comply with all applicable regulations relating to food service for sanitation, safety, and health as set forth by state, county, and local health departments.
    6. (F) Food service personnel/staff/employees shall ensure that all food is prepared, cooked, served, and stored in such a manner that protects against contamination and spoilage.
    7. (G) The kitchen and dining area must be cleaned after each meal.

    8. (H)

       1. (i) An adequate supply of eating utensils (e.g., cups, saucers, plates, glasses, bowls, and flatware) will be maintained in the facility’s kitchen to meet the needs of the communal dining program.
       2. (ii) An adequate number of pots and pans shall be provided for preparing meals.
       3. (iii) Eating utensils shall be free of chips or cracks.

    9. (I)

       1. (i) Each adult day care facility shall have adequate refrigeration and storage space.
       2. (ii) An adequately sized storage room shall be provided with adequate shelving.

       3. (iii)

          1. (a) (a) The storage room shall be constructed to prevent the invasion of:
30. (1) (1) Rodents;
31. (2) (2) Insects;
32. (3) (3) Sewage;
33. (4) (4) Water leakage; or

34. (5) (5) Any other contamination.

    1. (b) (b) The bottom shelf shall be of sufficient height from the floor to allow cleaning of the area underneath the bottom shelf.

    2. (J)

       1. (i) Refrigerator temperature shall be maintained at forty-one degrees Fahrenheit (41˚ F) or below, and freezer temperatures shall be maintained at zero degrees Fahrenheit (0˚ F) or below.
       2. (ii) Thermometers will be placed in each refrigerator and freezer.

    3. (K)

       1. (i) Raw meat and eggs shall be separated from cooked foods and other foods when refrigerated.
       2. (ii) Raw meat is to be stored in such a way that juices do not drip on other foods.
    4. (L) Fresh whole eggs shall not be cracked more than two (2) hours before use.
    5. (M) Hot foods should leave the kitchen (or steam table) above one hundred forty degrees Fahrenheit (140˚ F) and cold foods at or below forty-one degrees Fahrenheit (41˚ F).

    6. (N)

       1. (i) Containers of food shall not be stored on the floor of a walk-in refrigerator, freezer, or storage rooms.
       2. (ii) Containers shall be seamless with tight-fitting lids and shall be clearly labeled as to content.

    7. (O)

       1. (i) In facilities that have a home-style type kitchen, a five-pound ABC fire extinguisher is required in the kitchen.
       2. (ii) In facilities that have commercial kitchens with automatic extinguishers in the range hood, the portable five–pound fire extinguisher must be compatible with the chemicals used in the range hood extinguisher.
       3. (iii) The manufacturer recommendations shall be followed.

    8. (P)

       1. (i) Food scraps shall be placed in garbage cans with airtight fitting lids and bag liners.
       2. (ii) Garbage cans shall be emptied as necessary, but no less than daily.
    9. (Q) Leftover foods placed in the refrigerator and freezer shall be sealed, dated, and used or disposed of within forty-eight (48) hours.
    10. (R) Personnel/staff/employees shall not use tobacco, in any form, while engaged in food preparation or service, nor while in areas used for equipment or utensil washing or for food preparation.

    11. (S)

        1. (i) Menus shall be posted on a weekly basis.
        2. (ii) The facility shall retain a copy of the last month’s menus.
    12. (T) The adult day care facility shall arrange for clients’ special diets and other diet modifications.