1. A. An administrator shall ensure that a personnel member provides supervision for a participant, except during periods of the day when the participant signs out or is signed out according to policies and procedures.
2. B. An administrator shall ensure that a personnel member provides assistance with activities of daily living and supervision of personal hygiene according to the participant’s care plan and policies and procedures.

3. C. An administrator shall ensure that a personnel member provides a participant with planned therapeutic individual and group activities:

   1. 1. According to the:

      1. a. Participant’s care plan,
      2. b. Policies and procedures, and
      3. c. Monthly calendar of planned activities required in R9-10-1103(D)(2); and

   2. 2. That include:

      1. a. Physical activities,
      2. b. Group discussion,
      3. c. Techniques a participant may use to maintain or improve the participant’s independence in performing activities of daily living,
      4. d. Assessment of deficits in cognitive awareness and reinforcement of remaining cognitive awareness,
      5. e. Activities of daily living,
      6. f. Participants’ council meetings, and
      7. g. Leisure time.

4. D. An administrator shall ensure that a nurse monitors the health status of a participant according to the participant’s care plan and policies and procedures by:

   1. 1. Observing the participant’s mental and physical condition, including monthly monitoring of the participant’s vital signs and nutritional status;
   2. 2. Documenting changes in the participant’s mental and physical condition in the participant’s medical record; and
   3. 3. Reporting any changes to the participant’s representative or medical practitioner.

5. E. If an adult day health care facility administers medication or provides assistance in the self-administration of medication, an administrator shall ensure that policies and procedures for medication administration or assistance in the self-administration of medication:

   1. 1. Include:

      1. a. A process for providing information to a participant about medication prescribed for the participant including:

         1. i. The prescribed medication’s anticipated results,
         2. ii. The prescribed medication’s potential adverse reactions,
         3. iii. The prescribed medication’s potential side effects, and
         4. iv. Potential adverse reactions that could result from not taking the medication as prescribed;

      2. b. Procedures for preventing, responding to, and reporting:

         1. i. A medication error,
         2. ii. An adverse response to a medication, or
         3. iii. A medication overdose; and
      3. c. Procedures for documenting medication services and assistance in the self-administration of medication; and

   2. 2. Specify a process for review through the quality management program of:

      1. a. A medication administration error, and
      2. b. An adverse reaction to a medication.

6. F. An administrator shall ensure that:

   1. 1. Policies and procedures for medication administration:

      1. a. Are reviewed and approved by a pharmacist, medical practitioner, or registered nurse; and
      2. b. Ensure that medication is administered to a participant only as prescribed;
   2. 2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law; and

   3. 3. A medication administered to a participant:

      1. a. Is administered in compliance with an order, and
      2. b. Is documented in the participant’s medical record.

7. G. If an adult day health care facility provides assistance in the self-administration of medication, an administrator shall ensure that:

   1. 1. A participant’s medication is stored by the adult day health care facility;

   2. 2. The following assistance is provided to a participant:

      1. a. A reminder when it is time to take the medication;
      2. b. Opening the medication container for the participant;
      3. c. Observing the participant while the participant removes the medication from the container;

      4. d. Verifying that the medication is taken as ordered by the participant’s medical practitioner by confirming that:

         1. i. The participant taking the medication is the individual stated on the medication container label,
         2. ii. The participant is taking the dosage of the medication stated on the medication container label or according to an order from a medical practitioner dated later than the date on the medication container label, and
         3. iii. The participant is taking the medication at the time stated on the medication container label or according to an order from a medical practitioner dated later than the date on the medication container label; or
      5. e. Observing the participant while the participant takes the medication;
   3. 3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a pharmacist, medical practitioner, or registered nurse;

   4. 4. Training for a personnel member, other than a medical practitioner or registered nurse, in assistance in the self-administration of medication:

      1. a. Is provided by a medical practitioner or registered nurse or an individual trained by a medical practitioner or registered nurse; and

      2. b. Includes:

         1. i. A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medication,
         2. ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and
         3. iii. The process for notifying the appropriate entities when an emergency medical intervention is needed;
   5. 5. A personnel member, other than a medical practitioner or registered nurse, completes the training in subsection (G)(4) before the personnel member provides assistance in the self-administration of medication; and

   6. 6. Assistance in the self-administration of medication provided to a participant:

      1. a. Is in compliance with an order, and
      2. b. Is documented in the participant’s medical record.

8. H. An administrator shall ensure that:

   1. 1. A current drug reference guide is available for use by personnel members, and
   2. 2. A current toxicology reference guide is available for use by personnel members.

9. I. When medication is stored at an adult day health care facility, an administrator shall ensure that:

   1. 1. Medication is stored in a separate locked room, closet, or self-contained unit used only for medication storage;
   2. 2. Medication is stored according to the instructions on the medication container; and

   3. 3. Policies and procedures are established, documented, and implemented to protect the health and safety of a participant for:

      1. a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication, including expired medication; and
      2. b. Storing, inventorying, and dispensing controlled substances.

10. J. A medication error or a participant’s refusal to take a medication is:

    1. 1. Reported to the participant’s representative within 12 hours, and
    2. 2. Documented in the participant’s medical record within 24 hours.

11. K. An adverse reaction is:

    1. 1. Reported to the participant’s representative and medical practitioner within 12 hours, and
    2. 2. Documented in the participant’s medical record within 24 hours.

12. L. An administrator shall:

    1. 1. Immediately notify a participant’s representative and medical practitioner of an injury that may require medical services;
    2. 2. Report an injury to Adult Protective Services according to A.R.S. § 46-454, when applicable;

    3. 3. Prepare a written report on the day of occurrence or when any injury of unknown origin is detected that includes the:

       1. a. Name of the participant;
       2. b. Type of injury;
       3. c. Names of witnesses, if applicable; and
       4. d. Action taken;
    4. 4. Investigate the injury within 24 hours and documenting any corrective action in the report; and
    5. 5. Retain the report for at least 12 months after the date of the injury.

13. M. For a participant whose care plan includes counseling on an individual or group basis, an administrator shall ensure that:

    1. 1. If the counseling needed by the participant is within the adult day health care facility’s scope of services, a personnel member provides the counseling to the participant according to policies and procedures; or
    2. 2. If the counseling needed by the participant is not within the adult day health care facility’s scope of services, a personnel member assists the participant or the participant’s representative to obtain counseling for the participant according to policies and procedures.

Historical Note

Amended effective September 2, 1977 (Supp. 77-5). Repealed effective July 22, 1994 (Supp. 94-3). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Section R9-10-1113 renumbered to Section R9-10-1114; new Section R9-10-1113 renumbered from Section R9-10-1112 and amended by exempt rulemaking at 20 A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13; effective July 1, 2014 (Supp. 14-2).